HomeMy Public PortalAbout5016 WILLMONTE AVE_Building__ 76A888A CB#808 10-88 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER. ADDREss
BUILDING AND SAFETY DIVISION 'LOCALITY `
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D'.GRIFFIN,SUPT OF BUILDING CROSS ST.
i DISTRICT NO. GROUP TYpE
FOR APPLICANT TO FILL IN I CON ,39
STATISTICAL CLASSIFICATION SEWER MAP
BUILDING 1 / - A? CLASS.IVO WELL.UNIT&./._l
K G
ADDRESS Q J /// .
�( �
` aa''b )) t MAP STATE
LOT NO.N �% 6 � ,�j(y-f111 LO YES '
NUMBER HWY. "
TRACT USE ZONE SPECIAL
OF.BLDGS ` CONDiT10N8
{ SIZE OF LOT i(•'_• ON LOT (/
USE OF
EXISTING BLDG. BUILDING YARD HWY ETRE 'NAME EXIST.
SETBACK WIDTH `s
OWNER Al o e B-5i U&L) FRONT
MAIL �/ J�f i
ADDRESS D '/ f\( J ? /y 'SIDE
CITY a /'�. NO. •j'&, P.L. -
ARCH ITECT OR T6L.
I/, • INSPECTION RECORD
ENGINEER . I 5 NO. r/') c. /� ' -
1
ADDRESS 1 zi Z e .S - 1�� vi. J� /�''�s r p'Cl.t F� ��_tJ s���•�.�
TEL.
CONTRACTOR Jobe.) 'e NO.
ADDRESS DESCRIPTION OF WORK C3 Ncc-a�'� G�tl /r'�&4.P
Yd-N r ✓Vey•r v
NEW' ADDS J ALTER REPAIR DEMOLISH
�
SQ.
T '�f I TORIES FA•O
S IES
USE OF e 'f ,Z?��� Y G'..1.' e.er •r2�ti;t
STRUCTURE 7 C' ki
SIGNATURE OF
APPLICANT — APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION:LOCATION
ADDRESS �. FORMS;MATERIALS
VALUATION s _ FRAME:.FIRE STOPS.
Nj. �, BRACING.'BOLTS - pz-Y�
P.C. OO I PMT. �� I FURNACE:LOCATION.,
FEE S •� FEE $ GAS VENT,DUCTS' 'Z~ 'b O
1 HIEREAY ACKNOWLEDGE THAT I HAVE READ THIS AP- ,r m
PLICATION AND STATE THAT THE ABOVE 1S CORRECT AND LATH.INT. g
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND r `�
TATE LAW_S--RqGULAT7 BYAPING OlNarRUrrTION. LATH.EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTE ' I RECT AND POSTED 5tr• r— ..•,
ADDRES I FINAL L\ y
CLYDE N.DIRL`AM.PRINCIPAL ST A CT RAL ENGINEER
PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION VM.O. CASH
Aro8 1 6 9s NOV2 7 2 3 A 24,00 ,; L
Or
-J�0 8 3 9 7 1 DEC 2 1 A 48-00 1
WORKERS'COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING P E RM I T
insure, or a certificate of Workers'Compensation Insurance, I
or a certified copy thereof-(Sec. 3800, Lab. C.) { COUNTY OF LOS ANGELES ) BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRE &P
Certified copy is filed with the county building inspec- BUILDING ��
tion department. ADDRESS .7 A6 /V: (ll LOCALITY
NEAREST
Date Applicant CITY ZIP 1IV CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one USE ZONE MAP
hundred dollars($100)or less.) TRACT BLOCK LOT NO. I NO. O l
TEL. 9 j/"J� ` SPECIAL
I certify that in the performance of the work for which this OWNER NO. r`I CONDITIONS �.
permit is issued,I shall not employ an arson in an manner DISTRICT .GROUP TYPE FIRE PR �BY O
so as to become subject to the Wy�rko p09
erson
sat on Laws. ADDRESS S� �A�D ���� �0 �/ C ZONE
CITY ( D/ ZIP a4,�, :: a 0
Date Appliccn STATISTICAL CLASSIFICATION APT. CONDO. V
ARCHITECT OR TEL.
NOTICE TO APPLICANT: If, afterIng this Certificate of CLASS NO. v2 DWELL.UNITS
Exemption, -you should become subject to the Workers' ENGINEER NO. IL
Compensation.provisions of the Labor Code, you must forth- ADDRESS SEWER MAP �
with comply with such provisions or this permit shall. be �J v
deemed revoked. CONTRACTOR NO. BK. /� PGVALIDATION
LICENSED CONTRACTORS DECLARATION LIC,
I hereby'affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION
(dommencing with Section 7000)of Division 3 of the Business and LIC• n O.
Professions Code,and my license is in full force and effect. CITY CLASS
SQ. FT. NO.OF NO.OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
Contractor Date / DESCRIPTION OF WORK NEW $I
A D u
I am exempt under Sec. Y
, ALTER C] FINA�v,���/) ,
B.BP.C. for this reason REPAIR
DATE
Date: DEMOL (C
USE OF FINAL
f
• EXISTING BLDG. ,. Bir •
Signature APPLICANT TEL.
OWNER-BUILDER DECLARATION PRINT NO. 01 6 Gla
I hereby affirm that I am exempt from the Contractor's License o o'0 0 0
Law for the following reason (Section 7031.5, Business and ADDRESS
Professions Code): PRESENT j
BUILDING o o �; ;� -4
I, as owner of the property, or'.my employees,with ADDRESS
wages as their sole compensation,will do the work and c r C �'
.the structure is not intended or offered for sale(Section LOG4LITY
7044, Business and Professions Code). MOVING TEL. ;±.0 2—8 4
I,as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT
the performande of the work for which this permit is issued P.L. .
tSec. 3097, Civ. C.). SIDE
ii P.L.
o Lender's Name
3 P.C.Fee$ Permit Fee se,
Lender's Address
' I certify that I have read this application and state that the Issuance Fee
above information is correct. I agree to comply with,all County Investigation Fee
ordinances and State-laws relating to building construction, Total Fee
and hereby authorize representatives of this County to enter I
up nth above- rationed property for inspection purposes.
/r/rte{/�/ SEE REVERSE FOR EXPLANATORY LANGUAGE
/ '\Signature of Applicant or Agent Date I
iy