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HomeMy Public PortalAbout5452 LOMA AVE_Building__ BUIL ln tT�i'I":J ,L � 0 U n `i:�.11 I .LOCA TY � ADDRESS APPLICATION - LOCALITY � ,1 NEAREST DIVISION OF BUILDING AND SAFETY' CROSS ST. Department of County Engineer DISTRICT NO. RECEIPT NO. PERMIT NO. County of Los Angeles WM. J. FOX, COUNTY ENGINEER f GROUP DATE RECEIVED 'DATE ISSUED CASSATT D. GRIFFIN, SUPT OF BUILDING I'"7 FOR APPLICANT TO FILL IN/ 1 TYPE CONST. RECEIVED BY I UED 9 OWNER �+r Q,E p� �A/ O MAP3�•••///`"' /� STATE YESMAIL NO = ADDRESS �'J �o�I� �' I NUMBER vC�6 HWY USE ZONE SPECIAL TEL. /;r 17 I / CONDITIONS CITY T NO.� , ARCHITECT OR TEL- -ENGINEER ELENGINEER NO. M {, BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS {� V W TEL. P {� FRONT P. l , CONTRACTOR NO. , P� J C� AI , SIDE - - - - ADDRESSd�, y lAA A V�D .F +I P. L. . BUILDING ..n DATE CORRECTIONS _ INSPECTOR- ADDRESS /S �. v1))h 19JE LOT NO. 4fCV, /D ( `l // BLOCK 'S TRACT 7 7 Q/ `"' NO. OF 91ZE OF LOT ) 8s I NOW ON LOTS. USE OF FXIRTING BLDG. S DESCRIPTION OF WORK t a NEW - ADD ALTER REPAIR DEMOLISH;{ Z NO. OF NO.OF ;I D p�{�''' Q d /S�TORIES��//yy►► 11�� FAMILIES r USE OF 9T9-1-0 Ib i O w: NO.OF EMPLOYEES --I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-'4- P LI CATION P14- PLICATION AND STATE THAT THE INFORMATION GIVEN 19' APPROVALS INSPECTOR'S SIGNATURE DATE CORRECT. IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES] FOUNDATION: LOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION., FORMS, MATERIALS I y�q ' FRAME: FIRE STOPS, �n7 SIGNATURE OF/'�/�S_. BRACING,BOLTS dXQ,..i Lm I�I S� rPERMITTE v4QlJ FURNACE: LOCATION, J S 1 ���p� GAS VENT,DUCTS ADDRESS Ow (6. G: LATH, INT. AUTHORIZED AOT. IE LATH, EXT. P. C. $ If HOUSE NUMBER COR- FEE 4 RECT AND POSTED VALUATION FEE FINAL _ ��i�Y�!oQ►1r t© ��►�'�`� _ 76A638A DBS 3(9b 5-54 ! G-��,��Q�O®IBJ G�O�t ���[�®��� G°��G��i]�`1� _:_ • ��' COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD BUILDING AD Lo/!� ^ I hereby affirm that I have a certificate of consent to self insure, `//.l. °• • or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab C,) CITYt E m n ,* ZIP /� �y�d /+ 1 l� `� LOCALI� v,.ol E CL Policy No Company `• SIZE OF LOT NO OF BLDGS NOW O LOT i ❑ Certified copy Is hereby furnished NEAREST,gSS ST �� .❑•Certified copy is filed with-the county building inspection TRACT BLOCK LOT NO US ONE MAP NO department - ESSO MAP BO K PAGE P "CEy00 1 - ,�1 Date Applicant t, �/., SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER E TEL NO� �� vEs No COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL4 AD RESS (This section need not be completed If the permit is for one hundred DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less) CITY zIP (/� I certify that In the performance of.the work for which this permit (j © Is issued, I shall not employ any person In any manner.so as t0 ARCHITECT OR ENGINEER TEL NO become subject to the Workers'Compensation Laws . • STATISTICAL CLASSIFICATION APT CONDO Date Applicant' IADDRESS* _ CLASS NO.17/ DWELL UNITS - NOTICE TO APPLICANT If, after making,this'Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRAC OR TEL NO SETBACK YARD HWY - PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith W E L FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P U LICENSED CONTRACTORS DECLARATION " CITY LIC'CLASS SPL IDE 0- I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZE NO OF STORES NO OF FAMILIES Professions Code,and my license is In full force and effect Jc • NEW ❑ BK -PG v'D � License Number Lic Class 1 - DESCRIPTION OF WORK � ADD VALUATION Iy ED P-00 M g�f rL rn Contractor Date i ALTER ❑ Z ❑ I am exempt under Sec REPAIR El B.&PC for this reason DEMOL ❑ LDMA P/C# ` Date. USE OF EXISTING BLDG URM ❑ —1\ Signature APPLICANT(PRINT L _�� LDMA Penn# 1 I, as owner of the property, or my employees with wages as - p their sole compensation,will do the work and the structure is ADDR FINAL DATE ACCT, not intended or offered for sale (Section 7044, Business ar Z L-DA J�/`� I� L ` i� Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL _ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN i TTEM;Li ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY - > } t I licensed contractors to construct the project (Section•7044, YES❑ NO❑ //��`, (J TOTAL 1 � P .. l� Business and Professions Code) t} , WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r ,( r;}i 3,116.�� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST ' - - FOR GUIDELINES a - I hereby affirm that there is a construction lending agency for FOR ❑ No❑, CHANGE the performance of the work for which this permit is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES _ ry _ COUNTY CODE•TITLEZ CHAPTER220SECTIONS22010DTHR000H22014000NCERNING i JI{_3 if!`11 tr('s/19/91_i Lender s Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD l(• L JL 1 t I l(LLender's OMERORAGEW � _Q9 1 AN v=tee 0 1 certify that I have read this application and state that the above PC FEE PERMIT FEE information is correct-I agree to comply with all county ' ordinances and State laws relating to building construction,and hereby authorize representatives of this County,to enter upon ISSUANCE FEE the bove-mentioned ro for Inspection purposes � .1q ` O INVESTIGATION FEE TOTAL FEE m - / App9uM or Aqr , D. i SEE REVERSE FOR EXPLANATORY LANGUAGE, f