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HomeMy Public PortalAbout4979 LOMA AVE_Building__ 76A638A CE 03Y5-65 APPLICATION- FOR .BUILD G PERVr kvv 14COUTITY OF LOS ANGELES BUILDING 1. DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST 411, COLEMAN W JENKINS,SUP T OF BUILDING CROSS ST ., DISTRICT O G TYPE _ P S Ell, Y FOR APPLICANT T0,FILL IN x CONST. BUILDING - TATIISTICAL C SIFICATION � SEWER MAP ADDRESS L.L6 O _ DWELL UNITS 6K PG LOOT NO CK USEONE MAP - f �}n✓ NO C/ 1RACT A d SPECIAL , NO OF BLDG CONDITIONS SIZE OF LOT NOW ON LOT E IS ING BLDG , BLDG SETBACK FROM / EL // FRONT PROP LINE OF (STREET) 6' NER f&j_ O 4 TYPE OF EXISTING SETBAC HIGHWAY + YARD - NOTAL ADDRESS - HIGHWAY WIDTH FROM •//''�� yy��yy CITY � � - - + 20 l.1 ARCHITECT OR EL „ - BLDG SETBACK FROM ENGINEER NO ' '��� SIDE PROP LINE OF (STREET) TYPE OF E41STI NG SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L CONTRACTOR -(,!, TEL + = 3 NO O LIC ADDRESS NO- CORNER CUTOFF YES E] NO Q, V ' " w FNEW LIC CLASS SEE REVERSE SIDE`FOR SPECIAL APPROYVpALS O DESCRIPTION OF WORK ///if�4 G 1' n�pPti7 a ADD ALTER REPAIR DEMOLISNO OF N C O-STORIES FAMILIF_S ieS'. uam` •� Id f� ./�Lc:fdu-r ��/.�d�k'J � v � SIGNATURE OF u APPLICANT VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATdR P C PMT ` FOUNDA•TION, LOCATION ' �. FEE$ _ FEE$ FORMS, MATERIALS - � FRAME, FIRE STOPS, _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE.;LOCATION WITH ALL C OUNTY_ORDINANCES AND STATE LAWS REGULATING GAS VENT .DU'CTS - 9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK - AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH 'INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT .l SIGNATURE OF HOUSE NUMBER COR- _ - PERMITTEE f RECT AND POSTED ADDRESS JL FINAL /` Z2 w e ' PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRINCIPAL ST URAL ENGINEER PERMIT-VALIDATION CK M o CASH ' Li�Lo,B .g.� a�� 3 1 D 1 8.5-0 N DEPARTMENT OF BUILDING AND SAFETY 'APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. ERMIT NO. BUILDING ADDRESS LOCALITY RECE E BY DATE OF APPL. DATE ISSUED NEAREST 0 0 CROSS ST. " ' �[J 1/ BUILDING ADDRESS OWNER MAIL ��- 1 LOCALITY ADDRESS; NEAREST �� 1 v lh ' TEL. CROSS 3T. /�- K /�/(� yf� CITY , ��t �Q- NO. � ZFIREONE J I PNO. OF LANS TYPE / GROUP i ARCHITECT OR TEL. V ✓ ENGINEER - NO. f BLDG. ORD. NO. SETBACK LINE �'E•� LECr i9/ l�,E•I'C✓i d6L'a ADDRESS APPROVED - TEL. USE DATE CONTRACTOR_ (/{� /{�L'— NO. USE APPROVED ' ZONE BY DATE ADDRESS _ HOUSE NUMBERING LEGAL LOT NO. P /C7 BLOCK MAP NUMBER_ 2-6!• F FIELD CHECK BY— TRACT-DESCRIPTION TRACT �rs NO. ASSIGNED BY .DATE NO. OF SLOGS. CORRECTIONS' SIZE OF LOT NOW ON LOTAAL �A C'_�P j� USEOF - I NO OF ' J�E'I' - JEXISTINIILDG' . FAMIueS DESCRIPTION OF WORE THic NEW I I ALTERATION I I ADDITION I '77 - F /-p 7- A R6U S61g 4.vMAP0 REPAIR "I DEMOLITION--j I I - - - -• A SO. FT. NO. OF n — SIZE - ROOMS STORIES / Z EXT WALLROOF,,{/ � �c,1y FdR Ale• La MA hiiE r COVERING ;V ��/�'r � I COVERING �� ,p �- USE OF STRUCTURE ROVALS PECTO •S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIi- 70ASSaA, UNDATION• LOCATION PLICATION AND STATE- THAT THE INFORMATION GIVORMS, MATERIALS CORRECT. 1 AGREE TO COMPLY WITH THE CORRECTIONS LAME: FIRE STOPS, j HEREON AND WITH ALL COUNTY ORDINANCES AND RACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. ;=L•OCATION,� SIGNATURE OF L11 . / AS'-/ENT;DUC'P'S ��l PERMITTE11 • �J Z.Lt'! ��/VYI��.L/ TH, INT. CST�o :.lG ADDRESS TH, EXT. AUTHORIZED AGT. PLASTER, INT. DBS3 10-50 $ P. C. © o FEE I PLASTER, EXT. / VALUATION , ' FEE $ / O FINAL ��Jj-� �, J 1a/�t WORKERS' COMPENSATION DECLARATION I hereby affirm that'[ have a certificate of consent to self Q p p Q D 0 y p p insure tri a certificate of Workers' Compensation Insurance,• - Qppd C�Q� O ] OQ f�or„a certified copy thereof (Sec 3800, L`ab C ) t COUNTY-OF LOS ANGELES 8, !LDING AND SAFETY s � 'Policy No Company . y�iR' BUILDING ❑ Certified,copy_is•hereby furnished. _ .- ' ' FOR APPLICANT TO FILL IN" ADDRESS ❑- Certified co is filed with the county building inspec- CBUILDING tion department ADDRESS�''pq V��� D Date Applicant ZIP LOCALITY I NO OF B,LDG ` CERTIFICATE OF EXEMPTION FROM-WORKERS' ' SIZE OF LOT Z 090 S NOW ON LOTS NEAREST - •� CROSS`ST • `COMPENSATION INSURANCE ASSESSOR • (This section need not be completed if the permit is for one TRACT BLOCK LOT NO / MAP BOOK PAG PARCEL hundred dollars ($100)•or less,) TEL : - USE ZONE.' MAP y / OWNER e - P NO ZSSS NO �� 0c �o I certify that in the performance of th work for which this permit is issued, I shall not employ a person in any manner. ADDRESS G®f�(`j /y-(�Q� =� SPECIAL- ». •. " d so as to become subject to The War r Compe Laws. �' CONDITIONS O [^ ^�A CITY ZIP , 90 T Date C pplicant ARCHITECT OR TEL , t DISTRICT;.•, GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT If, after mak g this Certificate.of ENGINEER f/j `I.e"Z NO ,�S���S CONST ZONE F Exemption, ,you.should become subject to the Workers' Z,C� [,OS �/' QS S7L-d/!_ `�� /J� �, LU Compensation provisions of the Labor Code, you must forth- ADDRESS �T �1 rjJl r(� 0- a with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO- N deemed revoked r CONTRACTOR NO Z LICENSED CONTRACTORS'DECLARATION LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ' ADDRESS NO (commencing with,Section 7000)of Division 3 of the Business UC SEWER MAP and Professions Code,and my license is in full force and effect CITY" CLASS BS=& PG VALIDATION SQ FT NO OF FN-0-0 F. CHECK License Number Lic Class SIZE �� STORIES FAMILIES ONE VALUATION t DESCRIPTION OF WORK /. / NEW ❑ Contractor Date s �S ^� _ .• - ❑I am exempt under Sec- ADD ALTER ❑ - - B&P C for this reasonREPAIR ❑ $ Date - USE OF _ EXISTING BLDG DEMOL ❑ Signature APPLICANT TEL ��7 pp FINAL OWNER-BUILDER DECLARATION (PRINT/' NO GL7S �� DATE 6-22--ft I hereby affirm that I am exempt from the Contractor's License c� 7 _ Law forthe following reason.(Section 7031 5, Business and ADDRESS ! << FINAL Profe ons Code) PRESENT BYBU LDING ` 1, as owner of the property, or my employees with ADDRESS 'g wages as their sole compensation,will do the work and 21- the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code ) MOVING TEL _ ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO 1 i i Li E with licensed contractors to construct the project-(Sec- ADDRESS ,!, _: ;E`.f riL m a`, tion 7044; Business and Professions Code ) ay ,� r - ,;. REQUIRED TOTAL SETBACK FROM EXIST_ T. :7— ..0 `CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I hereby'affirm that there is a construction lending agency for FRONT' F •t iii= ,i fl i the performance of the work-for which this permit is issued P L (Sec 3097, Civ C ) SIDE PL Lender's Name _. lLii lti-3![!i�i 51 �= LDMA Ref # PC Fee$^ Permit Fee _^Z., t--,i I-+ Lender's Address _, Hi, I certify that I have read this application and state that the Issuance Fee �� LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee L �¢ �� ordinances,a State laws relating To building construction, Total Fee 'T J LDMA Perm # a and here harrze re entatives of this County to enter • upon th b ve-m ri n pr perry for inspection pur po se s SEE REVERSE FOR EXPLANATORY'LANGUAGE / Signat a of App scant or nt Date /J