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Home My Public Portal About4967 LOMA AVE_Building__ D&ARTNIENT O iRJMDING AND SAFEjy SAFEAPPLICATION FOR PERMIT f e� ,dOUNTY OF LOS ANGELES N 10 1 � I L®I G W.M. J." FOX, CHIEF ENGINEER - `�' FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING 7 /1/ 1 o� R l/ illE ADDRE68 y { , , 7 ' BY DATF OF APPL. DATE ISSUED LOCALITY ` /`91D� l TqNEAREST • CROSS ST. �-> ' !' '` BUILDING `_ /] _ ADDRISP OWNER40/-VAP//,0 � 61t)/d E ICaaNDT1�!�f� LOCALITY ' Vl ! �fj /��/ MAIL /v �n. O //�, l/E ADDRESS ✓ NEAREST CITYA� �, NO. CROSS ST. i 1 FIRE ' NO. OF-1/ TY I GRO ARCHITECT OR TEL. ZONE PLANS 7 .ENGINEER NO. BLDG. `O SETBACK LINE ADDRESS APPROVED ' TEL. BY DATE CONTRACTOR r LF NO. USE APPROVED i ZONE BY DATE ADDRESS HOUSE NUMBERING, LEGAL �}( Eek DESCRIPTION,- LO NO. 17 1 BLOCK MAP NUMBE W, -FIELD CHECK BY TRACT NO. ASSIGNED BY ATE NO OF BLDGS. / CORRECTIONS SIZE OF LOT(�/�Q,7t I NOW ON LOTQSV I- USEOF NO OF EXISTING BLDG, FAMILIES DESCRIPTION OF WORK NEW ISI ALTERATION I I ADDITION I ' REPAIR I . ,I DEMOLITION I NO. OF SQ. FT. �1= f SIZE ROOMS • 3 STORIES EXT. WALL ROOF COVERING COVERING USE OF STRUCTURE 1,46��Q�J APPROVALS Q ✓ INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION- LOCATION BB PLICATION AND STATE THAT THE- INFORMATION GIVEN IS FORMS, MATERIALS !'',v..•. CORRECT. 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, n � HEREON AND WITH ALL COUNTY /fORD,IgANCES AND STATE BRACING, BOLTS LAWS REGULA�� BUILDING CONSTRUCTION. UCTION. FURNACE. LOCATION, S16NATURE OF y GAS VENT, DUCTS/ ---��--- T7'�6a' •i 0^-O 1^ 27/� ADDRESS LATH, INT. _/ ' 0l LATH, EXT. AUTHORIZED ACiT. s PLASTER, INT. 76AG28A• DBaa ID-BD $ P. C. $ ® � FEE 0 PLASTER, EXT. �_ VALUATION 7 Op $ FEE FINAL I WORKERS' COMPENSATION DECLARATION -ins ure I'hereboraa certif cafe of Workersffirm'that I have a rlComtpensahon ensuran ent to lf u Cu UTION O o, M 0 d DD 0.[ ] p C�G°3 vfi�i or a certified copy thereof:(Sec 3800, lab C ) ;. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company /` L� E] Certifiedcopy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS %� ❑ 'Certified copy is filed with the county building inspec- BUILDING { L-ia,�y� Tion department. e c ADDRESS #V //-�- AVE CITY ! ZIP �O + LOCALITY Date Applca`nt- "' NO OF BLDGS _ CERTIFICATE OF EXEMPTION^FROM WORKERS' SIZE OF LOT fi NOW ON LOT NEAREST ' CROSS ST _ COMPENSATION INSURANCEASSESSOR '(This section need not be completed if'the permit is for one TRACT' BLOCK LOT NO MAP BOOK PAGE OV21 PARCEL Q� hundred dollars ($100) or,less )-'• - - " TEL ' ' ' ' ' - OWNER W FA J' 1 A NO USE ZONEMAP L,certify that in thetperformance of the work for which this , • . NO permit is issued, I shall not employ any person in any manner ADDRESS - SPECIAL a CONDITIONS sofas to become subject to the Workers' O Compensation Laws U n CITY ZIP' ' Date Applicant ARCHITECT OR TEL Cz NOTICE TO APPLICANT -If,-after, making' this Certificate of ENGINEER N0= DISTRICT GROUP TYPE ' - FIRE PROCESSED BY r CONST ZONE O Exemption, you,-should become subject to the.Workers' p Com pensation,provisions,of the Labor Code, you must forth- ADDRESS �Q c3 Z �Y� ..' N with ,comply with such provisions"or this permit shall be //�J r I''E'L!1 STATISTICAL CLASSIFICATION APT CONDO Z deeme`d'revoked _ CONTRACTOR, �/!/ Z'GGc t .K�ilJ _ _ — LICENSED CONTRACTORS DECLARATION T UC CLASS NO DWELL UNITS — LICENSED hereby affirm that I am licensed under provisions of Chapter 9 . ADDRESS NO ' LIC SEWER MAP -(commenting with,Section 7000)of Division 3 of the Business - , and Professions Code,and my•I'e se is'In full force,an"d effect CITY CLASS BK PG VALIDATION, SQ FT-,/ NO OF NO OF CHECK " Lcense'Number " LL ic Class SIZE (lp-2 I STORIES FAMILIES ONE s VALUATION t' + DNEW DESCRIPTION OF WORK _ Contractor Date ADD S '26 d' - ❑ ❑I-am exempt under Sec. ' 7 0 ALTER .❑ „ B&P C for this reason REPAIR ❑ s Date- USE OF _ EXISTING BLDG DEMOL ❑ Signature " _ APPLICANT- TEL '-• FINAL OWNER-BUILDER DECLARATION , (PRINT) NO rDATE ,, I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS FINAL 1 Professions Code) PRESENT By - . + BUILDING ACCT.Ir I, as owner of-the property„ or my employees with ADDRESS + -+ wages as their`scale compensation,will do the work and 3307 83 °6*7 the structure is not intended or offered for'sale(Section LOCALITY i 7044, Business and Professions Code ) MOVING TEL 1 1T'E tS - ❑ j, as owner of the ro ert am exclusive) contractin CONTRACTOR NOTOTAL 83. 63 with licensed contractors to construct the project (Sec- ' ADDRESS �. ; tion 7044, Business and Professions Code ) �� 3 .613 REQUIRED SETBACK-FROM+- TOTAL SETBACK-FM 'EXIST SET BACK PROP LINE WIDTH CONSTRUCTION LENDING AGENCY YARD HWY CHA%E' ,0I - ' I hereby affirm that tHere is a"construction lending agency for FRONT the performance of the work for which this permit'is issued PL " (Sec 3097, Civ C ) SIDE, ��{��'yy ��}}��•yyii { ' PL �UUV�W iV l vl�ll � Lender's Name �x -CDMA Ref-# 5134 1 q AM 7°° PC Fee$ Permit Fee ��v t1!1 4�I Lender's Address �7�/ o I certify that I have read this appli a'ion and state that the Issuance Fee O I /' CDMA P/C# Sabove information is correct I agre t comp] all County Investigation Fee ordinances and State jaws ielat g o i construction, - Total Fee U 4--70 LDMA Perm # a and hereby authonze epr en 0f�tftis County to enter •, upon the above-me' ion Oar inspection p rl es a • 2" SEE REVERSE FOR EXPLANATORY LANGUAGE + Si re pplicant or Ag nt Da ! i WORKERS' COMPENSATION DECLARATION 't. I Ner ' affirm that I haveL/��PP'a certificate of consent to self APP O 1p7 -_Ue ra•certficate of Workers' Compensation Insurance, LACA•YJ'�� ®� ®� %:v u �� or,'a.cert,f ed 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 .) BUILDING ,,aa � ADDRESS DCertified copy is filed with the county buildirig inspec- BUILDING '/, !` ; ` O q� jL -,tion department ADDRESS_ �7 O 'L'//1 Date Applicant CITY, C" _T D r/� �/r LOCALITY CERTIFICATE OF EXEMPTION FROM-WORKERS' ' ` NO OF LDGS "NEAREST COMPENSATION INSURANCE SIZE OF LOT V �C Z S` NOW ON LOT r CROSS ST (This section need not be completed'if"the permit is for oneASSESSOR , hundred dollars ($100)or less,) TRACT : BLOCK LOT NO MAP BOOK PAGE PARCEL TEL I certify that in the performance of the work for which this OWNER /�/� j / NO 7 �' Gn` �� JUNE OP permit is issued, I shall not-employ any person in any mo ner SPECIAL' so as to become subject to the Workers'Compensation d s ADDRESS 'J /4s`G/1 I CONDITIONS � Date — / 5 Applicant' CITY A �v - C,•' ZIP 4<11)- '��77 11 NOTICE TO APPLICANT If, after ertific te' of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER' NO ` �_ / (� CONSTE Exemption, you should become su ject to the W rkeri N Qv C_/r, J Z Compensation provisions of the Labor Code, you mu forth- ADDRESS ✓ with comply with such provisions or this permit s all be ,TEL _ STATISTICAL CLAS�l ON APT NDO deemed revoked; CONTRACTOR NO LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 `ADDRESS NO• SEWER"gyp (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and_my license•is,in full force'and effect CITY• CLASS BK 'PG _ VALIDATION d SQ FT NO OFNO OF`, ' CHECK License Number Lic Class SIZE STORIES - FAMILIES ONE a ' VALUATION ACCT°$ Contractor Date DESCRIPTION OF WORK " NEW D 11h, �! ( rr J°V•?� 7YY t�1{ i�J'r;riz.� I am exempt under Sec ® ld IZ0,- ALTER (� i ITE�l I� W B 8P C for this reason f a0 J _V 01 90VM REPAIR $ O L �a D e' -USE OF STDRAG,E RnaH DEMOL ❑ +_{r(i( m —aN EXISTING BLDG 400.t,]i_F— Signature ✓ `� APPLICANT TEL FINAL / V 2' R DECLAR ION PRIN95 T O 7� —?p DATE �. (-��!{�i� i° I hereby affirm that I am exempt,from t e Contractor's License ; Law for the following reason (Sectio 7031 5, Business and ADDRESS FINAL Professions Code)' - BY '1l1C;—I�( i�j t,`1,9 Professions BUILDING I,.as owner of the property, or my employees with ADDRESS -aI1 °¢ (� e �1 wages as their sole compensation,will do the work and 17 25°_- the structure is not'mdLOCALITY _!tened or offered for sole(Section t w,� ( 7044, Business and Professions'Code) MOVING, TEL aCONTRACTOR NO I. 0i 1, as owner of the property, am exclusively contracting �ti with licensed contractors'to construct the project (Sec- ADDRESS i i i i i f =a = —a tion 7044, Business and Professions Code) REQUIREDTOTAL SETBACK1 11 °moi� CONSTRUCTION LENDING AGENCY SET BACK YARD HWY pROP LINE WIDTH tl -` .I hereby affirm that there is a construction lending agency for FRONTLi the',performance of the work for which this permit is issued P L _ �� (Sec 3097, Civ C ) SIDE P 1_11 Lender's Name ,- - m LDMA,Ret f_t1-t: i—ii•�titit i i'I Ci eS � PerfCee PC Fe4faLender's Address 0 1'certify that I have read this application and state that the Issuance Fee LDMA P/C fl 9 above information is correct I agrn e comply with all County Investigation Feed �� r 0 ordinances and State laws'relati to building construction, Total Fee 5• ZS OLDMA Perm M and hereby authonze represent v of this County to enter - upon the obove- enti ned pr for inspection purposes ` SEE REVERSE FOR EXPLANATORY LANGUAGE r_rt 16 �o ure of Applicant or nt Date q' <� �' r.t jq H•�