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Home My Public Portal About8616 WORTHINGTON DR - Building - 1960-04-01 A ROAD DEPT. PC,:r1r,;T IS RK.'"'„,D , Plan 3 FOR ANY MA i E;IAL °i;JRr^.; RK DONE IN ME ROAD RlUr,f OF WAY. . ;6Al79A Cfi M9Ce 6_sa APPLICATION FOR BUILDING- PE.RMIT • 1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT-OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY 1 JOHN A. LAMBIM COUNTY ENGINEER NEAREST ` CASSATT D. GRIFFIN.SUPT OF BUILDING CROSS ST. - DISTRICT NO. GROUP TYPE P GESSED BY FOR APPLICANT TO FILL IN �� CONST. = BUILDIN STATISTICAL CLASSIFICATION SEWER MAP ADDRESS SK PG CLASS.NO.�DWELL•.UNIT LOT NO. 7 BLOCK NUMBER ps��Cy HWY.' YES NO TRACT , USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS �) SIZE OF LOT 82 x I”NOW ON LOT U` J USE OF •' ' EXISTING BLDG. BUILDING ' EXIST. YT SETBACK YARD HW� STREE AME WIDTH OWNER FRONT MAIL P.L. of) -- le Eileen ADDRESS SIDE P.L. CITY NO' 1.38273 A'INSPECTION RECORD ARCENGIiNEER ITECT OR NO. / ADDRESS �� / Jack Kil®en TEI�q 1 .�..�•r i.r,�-a-, :ter * CONTRACTOR Np0 38273 �• ADDRESS ' s DESCRIPTION OF WORK NEW X ADD 'ALTER REPAIR DEMOLISH NO- SIZE' '1270 STORIES 1 FAMIO LIES 1 USE OF STRUCTURE ResicLence an . Or QC , are SIGNATURE OF APPLICA APPROVALS DATE INSPECTOR'S SIGNATURE " ADD SS FFORMSrMATERIALS ION VALS ION $ ✓�� ]FRAM E:FIRE STOPS, RACING.BOLTS RNACE:LOCATION. /• 13•-'P /Yl �yf�'�,L/L vs P"gC.E ,fQ� PMT. Jl Q AS VENT,DUCTS �J FEE $ 7 FEE $�J 1 HEREBY ACKNOWL'ED E THAT 1 HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE•TO COMPLY WITH A COUNTY ORD NCES AND LATH,EXT. STATE LAWS REG TI BUILDIN TRUCTION. HOUSE-NUMBER COR- SIGNATURy t� PERMITTE E OF y RECTANDPOSTED I G� %/� //% p ADDR04C--'00FINAL i ' [-p CLYDE N. DIRLAM, PRINCIPAL ST C RAL ENGINEER PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION CK, M.O. 'CASH ; Uiif,07 5 1 2 53 43A11 9 2 3 A 2 4.0 0 A VIR J"E.0 8 6 3 7` ASR 1 1 A .. 48-00 . • 76A638A CE 0803 4/72 APPLICATION FOR BUILDING PERMIT f] COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP•BOOK PAGE s PARCEL 13 BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO: ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY _J� Gry6C� FOR APPLICANT TO FILL IN NEAREST ��AA Print or tvDe onl CROSS ST. BUILDING DISTRICT NO. G UP PE PRO ESSE BY ADDRESS �� i�lZ /C�L// -j � ONS LOT NO. 7 BLOCK STATISTICAL CLASSIFICATION SEWER MAP CLASS NO.3_DWELL,UNITS BKy PGE// TRACT ZONE MAP _�7 O NO.OF SLOGS. NO. Ot 40, SIZE OF LOT NOW ON LOT �, SPECIAL USE OF CONDITIONS EXISTING BLDG. OWNER f O Q.Lp NO. BLDG,SETBACK FROM ADDRESS FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY �/�!✓ �jjCf�j�/ ( IGHWAY WIDTH FROM C.L. ARCHITECT TEL. + ENGINEER ///` lL. /O/�/TV`J NO. Z/ BLDG.S KFROM }a ADDRESS 17119 SIDE PROP.LI (STREET) C TEL. TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL C. CONTRACTOR (J �' ®O NO. HIGHWAY WIDTH FROM C.L. C LIC. _ ADDRESS Q � //L hJ NO. Z� + - LL LIC. CL CITY CLASS GUS CORNER CUTOFF YES ❑ NO a CONST UCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROV LS ADDRESS SQ, FT. NO. OF NO. OF NEW ❑ SIZE STQRIES FAMI ❑ USE OF ADD STRU URE ALTER ❑ REPAIR❑ SIGNATURE OF APPLICANT DEMOL Cl VALUATIONS pm o APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION FEES 6-, 0 FEES 199 �� FORMS, MATERIALS, 20-�l3 FRAME: FIRE STOPS! I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES 2ANREGULAT NGBUILDING CON- GAS VENT, DUCTS STRUCTION. 1 CERTIFY ING TH WORK AUTHORIZED HEREBY 1 WILL NOT EMRSO N VIOLA .ION OF THELATH, INT.LABOR CODEOFTH ACI RNIA I ELATING TOWORKMEN'S COMPE NSA E I LATH, EXT, SIGNATURE OF C HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M:O. CA H I i 11L0 0 6 0 ? Alvi 2 3 2 5.7.0 n WORKERS' COMPENSATION DECLARATION hereby affirm that I have r certificate of consent To self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or/a i copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY f' . . o+cy No. �'L0�a�Company S U�(�/�rdt/` + ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING U ' ADDRESS U ertified copy is filed with the my building insp:C__ ADDRESS�j' r� / tion department. ADDRESS (p _110V Date ppll CI �C 1?t� ZIP r 7U LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FRO KERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSU NCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK I PAGE I PARCEL hundred dollars ($100)or less.) // TEL. OWNER (dC A /� USE Z EMO. AP N I certify that in the performance of the work for which this /S �' SPECIAL a permit is issued, I shall not employ any person in any manner ADDRESS Sep CONDITIONS so as to become subject to the Workers'Compensation Laws. O CITY ZIP U Date Applicant ARCHITECT OR TELW NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY O CONST. ZONE L) Exemption, you should become subject to the Workers' U / ?� nw. Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall beC TEL.�+ -7� STATISTICAL CLASSIA TION APT, O. Z deemed revoked. CONTRACT R — c 6 NO./ 3< _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 4 � NO. LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business CITY CLASS and Professions Code,and my license is in full force and effecctt. BK PG VALIDATION License Numbe�� ( SIZES STORIES FAMILOIES ONEK Lic. Class C / �G /24'D ESCRIPTION OF WOR bt7 !�� NEW ❑ VALIJ TION�q Contrac gDate S ��L/� ❑I am exempt under Sec. ? c- /'-^— le 9,9 �— ADD ❑ �v% ► ^� p ALTER ❑ B.&P.C. for this reason J l Z-� s �� REPAIR ❑ $ Date: USE OF EXISTING BLDG--C?L / DEMOL ❑ Signature APPLICANT (PRINT) ,, aL7 5••� NL �� rj' FINAL OWNER-BUILDER DECLARATION •/ DATE I hereby affirm that I am exempt from the Contractor's License ('� Law for the following reason (Section 7031.5, Business and ADDRE O� Z'� Ok 1��> FINAL / Professions Code): PRESENT By i BUILDING I, as owner of the property, or my employees with ADDRESS rACC-14 a wages as their sole compensation,will do the work and LOCALITY , r'- "(� the structure is not intended or offered for sale(Section 3307 87.158 7044, Business and Professions Code.) MOVING TEL. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. j i T EMS with licensed contractors to construct the project (Sec- ADDRESS TOTAL 87 o ,� tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. ��S CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 'Hut-CK I hereby affirm that there is a construction lending agency for FRONT CHANGE .00 the performance of the work for which this permit is issued P.L. YI (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name 0000-0001 ir`12189 B �� LDMA Ref. # � Lender's Address P.C. Fee$ Permit Fee r 0388 1 HM1 j;x.11. 1 certify that I have read this application and state that the Issuance Fee f S� LDMA P/C# 3 above information is correct. I agree to comply with all County Investigation Fee �( i ordinances d State laws relating to b Ing construction, Total Fee �5 u LDMA Perm. # and her y uthorize entative is County to enter g upon t -m ntioned op . rriinspectioonn purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Pricant or Agent Date i WORKERS'COMPENSATION DECLARATION t hereby affirm that I have a certificate,of consent to self APPLICATION FOR BUILDING PERMIT insure, ora certificate of Workers'Compenstion Insurance,or t o�ertified copy thereof (Sec. 3800, La Li. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company I BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ` Certified copy is filed with the county building inspec- BUILDING r / ♦°cam /► /� ° I tion department. ADDRESS !J/v �� L!i LOCALITY � ��w-i �� r✓�•� Oh! NEAREST � ' Date Applicant CIT ZIP / / CROSS ST. l9/� 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 PNE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. >' TEL. y` SPECIAL I certify that in the performance of the work for which this OWNER i NO. CONDITIONS O permit is issued, I shall not employ any person in any manner / .� n DI TRIC7 GROUP TYPE FIRE PROCESSED BY U ADDRESS (9 @y• A//�( ,n CONST ZE � so as to become subject to the Work s' �om,r�p ensati n Laws. Date /y2 Appl icant � �� CITY ZIP / ✓ STATISTICAL CLASSIFICATION 09 APT. ONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. �� Im _xempfion, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL.UNITS Zompensation provisions of the Labor Code, you must forth- ADDRESS' SEWER MAP with comply with such provisions or this permit shall be TEL, � VALIDATION jeemed revoked. CONTRACTOR NO. BK. PG, �� LICENSED CONTRACTORS DECLARATION LIC. hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION 19&, [commencing with Section 7000)of Division 3 of the Business and LIC. `'- � � professions Code, and my license is in full force and effect. CITY CLASS $ f I SQ. FT.0 NO.OF ) NO.OF ® CHECK .1cense Number Lic.Class SIZE STORIES / FAMILIES ONE contractor Date DESCRIPTION OF WORK NEW $ I am exempt from the licensing requirements as I am a 116�;3— �`.� �n ADD licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, c tT REPAIR DATE Business and Professions Code). USE OF DEMOL FINAL EXISTING BLDG. By .ic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. hereby affirm that I am exempt from the Contractor's License .aw for the following reason (Section 7031.5, Business and ADDRESS professions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ;2 30.5 5 A 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusive) contracting CONTRACTOR NO. P P Y� Y 9 00000 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 2 0'- 7 9 0 0 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT I o o o79. 0 0 P! he performance of the work for which this permit is issued P L ;Sec. 3097, Civ. C.). SIDE 0 2 2 4--8 2 P.L. .ender's Name .ender's Address ,t P.C. Fee$ Permit Fee certify that I have read this application and state that the Issuance Fee tbove information is correct. I agree to comply with all County Investigation Fee trdinances and State laws relating to building construction, Total Fee tnd hereby authorize representatives of this.County to enter tppt'i the abov -menf�d property fo Inspection p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ®s