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HomeMy Public PortalAbout5426 LOMA AVE_Building__ 76A 638A�46E#403..0-67 APPLICATION FOk BUILDING PEI �r COUNTY OF LOS ANGELES BUILDING -4 7 / �(� DEPARTMENT OF COUNTY ENGINEER ADDRESS '5 T G (p / V� BUILDING AND SAFETY DIVISION LOCALITY 7.0- �.� JOHN A. LAMBI E, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUP T OF BUILDING CROSS ST F11 OR APPLICANT TO FILL IN DISTRICT NO GROUP TYPEV PROC S ED BY CONST (Print or type only) [, ) BUILDING � ,rte L STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �(A u ST, l 'rL LASS NO._j__DWELL UNITS BK lyf PG r LOT NO 17 BLOCK USE ZONEMAP NO �d/ TRACT ., -/ SPECIAL NO OF BLDGS CONDITIONS SIZE OF LOT;-ZP1 Yi(--q-Iq NOW ON LOT USE OF EXISTING BLDGJX fti INCi BLDG SETBACK FROM TEL. FRONT PROP LINE OF (STREET) OWNER [� NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS 13A!t-� �� W . �! HIGHWAY WIDTH FROM C L CAP( s'S �O + CITY - BLDG SETBACK FROM ARCHITECT OR TEL SIDE PROP.LINEOF (STREET) ENGINEER NO TYPE OF 1EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY1 WIDTH FROM C.L. TE + = a CONTRACTOR Vj 1- NOL. O LIC CORNER CUTOFF YES NO G7 ADDRESS%j �C..7, l,,O C" ,a ANO 22 .�Z E] I CITY _ CI ASS SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK z NEW (A DID ALTER REPAIR DEMOLISH �p� SQ FT NO OF NO. OF �"+� g BiQ � BI�/ AWfSIZ ��, USE OF j STORIES FAMILIES �J1 v USE OF (A� CC.. '` Y�IA STRUCTURE SIGNATURE OF yT t o i APPLICANT / ilri7�I J d VALUATION$ a'� s APPROVALS DATE INSPECT R'S SIGNATURE FE' PMT / �Jf� FOUNDATION: LOCATION FEE$ FEE $ / FORMS, MATERIALS FRAME: FIRE STOPS, N I HEREBY ACKOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, V WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH, INT A w TION OF THELABOR CODE OF THE STATE OF CALIFORNIA RELAT (Iq V,4JA A ING TO WORKMEN S COMPENSATION INSURANCE L� j✓W 0 Wbw, J s 4 LATH, EXT 11 SIGNATURE OF T !�/ { � HOUSE NUMBER COR - PERMITTE ` tfv �f - RECT AND POSTED ADDRESS �� S- Ldr'f nO ���� L =+, FINAL r I JOHN F LEWIS PRINCIPALS URAL ENGINEER PLAN CHECK VALIDATION CK M o CASH _ PERMIT VALIDATION CK -0 CASH 0,2-7 53"S J"23 D 2 ! .7 J~ l 76A638A CE x`+803 6-62 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS ? ►1 BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. DISTRICT NO G P TYPE P BY FOR APPLICANT TO FILL IN ' t°I CONST. /J BUILDING STATISTICAL CLASSIFICATION StWER MAP ADDRESS J ' CLASS. NO. DWELL. UNITS / BK-'f�! LOT NO. BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATEMAP : 1-1 TRACT (9 NO. / HQR AY WE) NO.OF BLDGS. STATE MAJOR SECOND]LOCAL SIZE OF LOT 2 NOW ON LOT USE 701`4E SPECIAL I _ USE OF CONDITIONS EXISTING BLDG. Au , I TEL , J OWNER NO. .3 C' BUILDINGEXIST. YAR HWY STREET NAME SETBACK WIDTH ADDRESS,S FRONT \�+ ARCHITECT OR TEL, P. L. ENGINEER NO. SIDE P. L. �- ADDRESS O' TEL. / 7 0 CONTRACTOR p s NO. rC•J 3 S� ADDRESS _ DESCRIPTION OF WORK V t w (N:EW 1 ADD ALTER REPAIR DEMOLISH - N SO. FT. NO. OF NO. OF SIZE STORIES FAMILIES --- USE OF ---- STRUCTURE SIGNATURE OF APPLICANT VALUATION $ f 3 �� � APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. .s�: FOUNDATION: LOCATION FEE $ < _� FEE $.`�,. _FC•RMS, MATERIALS FRAME: FIRE STOPS, 1 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR COD C OF THE STATE OF CALIFORNIA Jl- ING TO WORKMEN'S COMPENSATION INSURANCE. ' LATH, EXT. SIGNATURE O /��' /�� / HOUSE NUMBER COR- PERMITTEE ( L_15L�-LLQ _ RECT AND POSTED / r ADDRESS .7 -?lam ��,' �' T FINAL b JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION cK. M.o. CASH _ PERMIT VALIDATION cK. M.O. CASH �3 4 2 3 D 2:� 6.75ri �,'tl�o 1 0 0 u`1'0` FEB 1 5 1 D JG- 5.� WORKERS' COMPENSATION DECLARATION M nn I hereby affirm that I have a certificate of consent to self /U /U\ O IJ V F O� D U�L D�U V(G F E R U U E U insure, or a certificate of Workers'Compenstion Insurance, or [r u u-u a certified copy thereof (Sec 3800, Lab C ) I - •COUNTY OF, LOS ANGELES BUILDING AND SAFETY Policy No -5501 Company State Compensation 4 Certified copy is hereby furnished Insurance Fund FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department t ADDRESS 5426 Loma Avenue LOCALITY , '11-1-80 ' Howard L.Randol Co. j NEAREST Date Applicant CITY le City. ZIP .91780 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 TRACT G BLOCK - LOT NO NO hundred dollars ($100)or less ) _ � � Ted Tsunakai I TEL-285-3696 SPECIAL o. OWNER NO CONDITIONS I certify that in the performance of the work for which this I V permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PR ESSED BY ADDRESS 5426 Loma.Avenue $ CONST ZONE so as to become subject to the Workers'Compensation Laws QC 9-10=81 , Howard L.Randol Co. CITY Temple City ZIP 91780 ,D /�'3 3 p Date Applicant ARCHITECT OR_- TEL STATISTICAL CLASSIFICATION PT CONDO V NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO CLASS NO DWELL UNITS p. LU Exemption, you should become subject to the Workers' - - N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP ' with comply with such provisions or this permit shall be Z deemed revoked f CONTRACTOR ai dol Coao288-4040 BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC e I hereby affirm that I am licensed under provisions of Chapter 9 _ ADDRESS-5.2.9 E.Vally 41v-d,. N NO186086- - EVALUIATION (commencing with Section 7000)of Division 3 of the Business and _ LIC Y Professions Code,, and my license is in full force and effect CITY San Gabriel CLASS ,C-39- 17.00 SQ FT NO OF NO OF CHECK License Number 1196096 .Lic Class C-39 SIZE STORIES FAMILIES ONE ConrracrorHnwa rd T. Randol Cn,se 9-10-81 DESCRIPTION OF WORK Re-roof house NEW $ _ __ _ - I am exempt from the licensing requirements as I _am a and garage Wiyth 12X18 COM— ADD licensed architect or a registered professional engineer _ ALTER Q FINAL //may 7 acting in my professional capacity (Section 7051, position shin .les.ClaSS C "DATE /'L! ZG 8( REPAIR Business and Professions Code) USE OF EXISTING BLDG DEMOL- Q FINAL Lic or Reg No Dare APPLICANT TEL ByCS OWNER-BUILDER DECLARATION (PRINT)HOward L.- Randol C- NO 288-4040 / �f I hereby affirm that I am exempt from the Contractor's License ADDRESS 529 E. Valley Bl. -San Gabriel Law for the following reason (Section 7031 5, Business and Professions Code) PRESENT BUILDING- 1, as owner of the,property, or my employees with ADDRESS wages as their sole compensation,will do the work and 1 2 2 6 a the structure is not intended or offered for sale(Section- LOCALITY -- 7044, Business and Professions Code) MOVING TEL #,0 0 0 0 0 1 D1, as owner of the property, am exclusively contracting' CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS 2 ° ° 3 0 tion'7044, Business and Professions-Code) _ REQUIRED TOTAL SETBACK FROM EXIST o 0 0 3[( Q Q CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH �; v 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P L -0 9 1Y7—81 (Sec '3097, Civ C ) SIDE - - PL Lender's Name 5 . Lender's Address P C Fee$ ' Permd Fee 27.00 w I certify that I have read this application and state that the Issuance Fee 7.00 above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, and hereby authorize representatives of thi County to enter Total Fee 34.00 U upon thea e- d proper for pection purposes i SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of Applimnt or Agert Date ©s