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HomeMy Public PortalAbout5614 LOMA AVE_Building__ FOR COUNTY OF LOS:ANGELES,<- DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY:DIVISION v. BUILDING � FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS r(y LOCALITY NEAR EST CITY );PZ:,r J'. ZIP 7 �' CROSS ST. NO.OF BLDGS. ASSESSOR . SIZE OFLOT NOW ON LOT MAP BOOK PAGE PARCEL ' DISTRICT GROUP TYPE FIRE CE D BY TRACT t I BLOCK LOT NO.p [r A,Q CONST / ZO TEL OWNER Y�/p�L jQ NO d STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �. CLASS NO. DWELL.UNITS BK(��2G. CITY_ �r G C ZIP �O USE ZONE MAP' ARCHITECT OR `T L.. NO::. ENGINEEPr" NO. SPECIAL _ DITIONS ADDRESS' ix *t ROAD DEPARTMENT APPROVAL REQUIRED YES ❑": NO''❑ r.. TEL. f�q CONTRACTOR /(j' C('1'11,4NO. 0' BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET).. ADDRESS D d a NO. .- TOTAL SETBACK FROM. E OF EXISTING HIGHWAY + YARD• FRONT PROP.L HIGHWAY WIDTH LIC. CITY L CLASS CONST UCTION LENDER + t. - cl NAME AND BRANCH ti BLDG.SETBACK FROM ADDRES QCITY U SIDE PROP E LINOF (STREET( O SQ.FT. NO.OF NO.OF CHECK' HIGHWAY + YARD m_ TALSETBACKFROM TYPEOF _EXISTING SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH . - w + Z. DESCRIPTION OF WORK L J�C ( ip NEW ; — ADD ❑ CORNER CUT YES ❑ NO,VA L� �y,e ALTER ❑ IN OPEN SPACE YES ❑ NO Q USE OF /(O�Sf cZ�.. REPAIR ❑ IN COASTALPERMIJ_ZONE YES'.' ❑ NO EXISTING BLDG. DEMOC -❑ APPLICANT TEL. (PRINT) -NO. BY.(SIGNATURE) 'I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE" - THAT THE ABOVE IS,CORRECT SAND AGREE TO COMPLY WITH ALL ORDINANCES - - - - AND LAWS REGULATING BUILDING CONSTRUCTION.i CERTIFY THAT IN DOING THEWORK AUTHORIZED HEREBY.I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION OM PENSATION INSURANCE. - j,�/'f///'/q - SIGNATURE OF'• FINAL BY PERMITTEE - PATE,DATE, r 4A TEL.1" (Q✓7 P.C: Fee$ Permit Fee ' CITY .NO. Issuance Fee VALUATION Total'Fee `.:PLAN`CHECK VALIDATION cK: ''nn.o. -CASH PF,RMIT VALIDATION CK. m.o." CASH 0 ` L 51 =1 ©5 76A638A CE N803A 8/77 COUNTY.OF LOS-ANGELES APPLICATION F,®R DEPARTMENT OF COUNTY ENGINEER, a' I N IVI IT �.; ' I amu® E'FZ BUILDINIG AND SAFETY;DIVISION 7 BUILDING y .FOR APPLICANT TO`FILL'IN ADDRESS BUILDING ADDRESS-..' LOCALITY Q • = NEAREST CIT ZIP.9rI ;7G 'Q CROSS ST NO.OF.BLDGS' ASSESSOR SIZE OF LOT :-NOW ON LOT''- MAP-BOOK GE _-, PARCEL' DISTRICTI-'GRCUP.. YPE FIRE OC SED Y: TRAC/�/:9 BLOCK, LOT-NO LONST:' ZON TEL OWNER ` NO.�c ✓S STATISTICAL CLASS FICATION W ER MAP ADDRESS CLASS NO , " DWELL UNITS CI Y ZIP JJ ZONE MAP C.CSG ,�✓ ARCHITECT R. {TEL[. J NOr 6 ENGINEER - -NO. SP.ECIAL.. �� CONDITIONS`' ADDRESS ROAD DEPARTMENT.-APPROVAL REQUIRED YES NO TE �_ L. p CONTRACTOR' GC N06 D BLDG.SETBACK FROM Y LIC. FRONT PROP LINE OF (STREET)' n ADDRESS y 6�. L' L'.NO. TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY ++: .YARD = FRONT PROP LINE HIGHWAY WIDTH 1 G LIC.. CITY.. 61-9 CLASS - CONSTRUCTION LENDER } °- NAME AND BRANCH. BLDG.SETBACK FROM O, SIDE PROP LINE OF (STREET(-', ADDRESS CITY O SOrFT. NO.OF NO..OF - :L,• CHECK, HIGHWAY: } =YARD = TOTAL SETBACK FROM'', TYPE OF EXISTING U SIZE STORIES FAMILIES, ONE -. SIDE-PROP,.,LINE HIGHWAY. WIDTH_, �. DESCRIPTION OF WORK ��'Cl EW - / CORNER-CUTOFF: YES .� NO r GL��/1/G.�' .� DD - `; 101 ALTER: IN OPEN SPACE_ YES ,Q NO ❑ REPAIR O USE OF .IN COASTAL•,PERMIT ZONE YES O NO Q EXISTING BLDG, DEMOL- APPLICANT •` TEL (PRINT( NO. ` BY(SIGNATURE) IHEREBY ACKNOWLEDGE THAT I'HAVEREAD'THIS APPLICATION AND STATE THAT.THE ABOVE IS'CORRECT-AND^AGREE TO COMPLY'WITH ALL.ORDINANCES ' _ • �I AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THA INDOINGTHE WORK AUTHORIZED HEREBY`I'WILL NOT EMPLOY:ANY PERSON IN VIOLATION OF _ ': -• - l THE'LABOWCODE OF.THE'STATE OF,CALI FORNIA IN.RELAFING TO WORKMEN S COM- PENSATION OM- - PENSATIONINSURANCE� • ' _. - '•�, SIGNATURE OF FINAL �i) BY ./ PERMITTEE'_ DATE ADDRESS r y y TEL. Perm11 Fee / P C Fee. CITY, Q Issuance Fee r VALUATION Total Fee, PLAN.CHECK°VALIDATION cK. ` M o: "CASH PERMITVA IDATIORI r CK. M:O. CASH , 3 8'"AUG 1 3 '.0•,f '.a ©5 76A638A.CE N803A 8/77. DEPARTMENT OF BUILDING AND SAFETY ��`'` COUNTY OF LOS ANGELES M. J. FOX, CHIEF ENGINEER APPLICATION FOR APPLI ANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. OR REC.No: PERMIT NO. BUILDING ADDRESS 2 ' REQ VED BY DATE OF APPL D TE ISSUED LOCALITY ` NEAREST CROSS 6T. .LiG.Ci BUILDING - - ADDRESS' OWNER MAIL �(// LOCALITY �. ADDRESS(O SSG NEAREST' - �s TELJ CROSS ST. /® ' CITY NO 7 �. FIRE NO.OF GROUP ARCHITECTOR TEL ZONE - I PLANS ENGINEER NO. BL DG. 6- ._.I Y••- _� SETBACK LINE ADDRESS - USE '�1`. / APPROVED TEL ZONEr! BY DATE CONTRACTOR NO. �Q-0 HOUSE NUMBERING '®rj ADDRESS MAP NUMBER ® NO. ASSIGNED BY_ ' LEGAL : CORRECTIONS DESCRIPTION LOT NO. •� BLOCK _ w TRACTNO. OF BLDGS. �-. --•_ 912E OF LOT �1 Z/�t y I NOW ON LOT USE OF I NO. OF - EXISTIN BLDG. FAMILIES + DESCRIPTION OF WORK ; ° r - QM V�0 / .h �, o. NEW ALTERATION ADDITION REPAIR DEMOLITION SQ.FT. .)D L NO. OF ~ SIZE [ V ROOMS STORIES EXT.WALL ROOF COVERING, COVERINGjj)e {.�� USED STRUCTURE IS ��o e �o o INSPECTION FOR APPROVALS OCCUPANCYAS ' INSPECTOR'S SIGNATURE yDATE - rOI FORMS, MATERIALS ION -.r^'� "".C�'✓ 4�/ CoA 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS, CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. �GAS VENT, DUCTS SIGNATURE OF % � /LATH, INT. PERMITTEE LATH, EXT. ADDRESS _ � / PLASTER, INT. AUTHORIZED AOT. PLASTER, EXT. �b p�® P. C. J-0J// FEE eo.- HOUSE NUMBER COR- RECT AND POSTED VALUATION FEE �' FINAL �clGa .-� ✓�'� ` ��-°' 7GA636A DB5 3 7-51 WORKERS'-COMPENSATION DECLARATION ; 1'hereby affirm tt eifj I` have'.a certificate 'f consent to'self 'msure,'or a certificate of Workers Compensatjon.jnsurance ,-: ::. : aP. LI Tl N F - �:I:J DI•� 1OTERM1T _ or ci`certified copy thereof (Sec.3800, Lab C ) ' s .,000NTY'OF LOS.aANGELES BUILDING AND SAFETY Policy No 1046140_C,o �y Stater Fund BUILDING. ❑ Certified co s:herebyfurnrshed. FOR.APPLIC'ANT;TO FI LL.IN ADDRESS-AD .� ' PY:., y 9'.,p. BUILDING ` Certifiedico" is.-file with_the count buildin ins ec- .;tion.department. 614 ADDRESS 5 N. 'Lorna l l 1=90 Randol =Roofln' :_ Locaury • Date Applicant g CITY, ZIP o= " o NO:OF,BLDGS.,. ce w 3 -CERTIFICATE OF EXEMPTION"IF WORKERS' SIZE OF LOTr " NOW:ON LOT ' COMPENSATION'INSURANCE r NEAREST• CROSS ST " ASSESSOR (This section need nofbe completed if,ihe peimiT.is for-one TRACT, BLOCK:' "` LOT NO., ,?' MAP BOOK PAGE. PARCEL hundred dollars.($1'00) or less ) " TEL. — OWNER " NO. ' ,'I`certify thaf in the'performance°of the:work;for'-which flits � E �•NO:, USE Z N 'permit is issued; l shall,riot employ many,persorn'in•ony manner` a ADDRESS'S614 N. `Loma CONDITIONS p}; so,as to becoe subject To the Workersw -:Compensation•Las., _. CITY..', -Tem le CYt ,ZIP917.80 , Date Applicant ARCHITECT OR TEL.- DIS RICT.--' OUP. TYPE FIRE, P OGESSE \ Y NOTICE::TO.•APPLICANT:. If;; after making this Certificate.'of ENGINEER- NO. CONST Z NE ExernpiioQ, -y6u'should become=subject to+the 'Workers w r Comp'en'sation•provisons of'the Labor.Code, youmust forth ADDRESS - a- wA comply:with such provisions or this permit shall 6e, TEL STATISTICAL CLASSIFICATION APT. C O deemed revokedr ,',. L„ ,, OR Ra do,l .R fl NO.' — _ CONTRACT _ "` LIC. .,CLASS NO`' DWELL.-UNITS � � � �. >- LICENSED CONTRACTORS DECLARATION, _ — Z , I.hereby affirm that lam li'ensed'under. rovisions,of Cha ter,9 ADDRESS NO. P P,. - _,. LIC SEWER MAP (cornmencing'with'Section;7000)'of Divi'sjon 3 of Business, San Gabriel CLASS G-3.9, - ! and Professions Code,'ond my. -e i^ ln''full force and effect gK pG (i).}�ji/F( IL�f TION I. , , ., CITY S . FT NO. OF NO. OF HECK € O K License Number` 4.5193 7: Lic:•Class C-39 SIZE , STORIES FAMILIES' ONE VALUATION` Ul, FI { DESCRIPTION OF WORK NEW :❑ Contractor Randol Roofin>; Date 1 31=91 — S .1,492.00 t am.exeffi`t under sec garage erglaS El ADD- with Genstar 'fib ❑ P for'this reason " S�llrileS.... RAIR USE-OF ALTER . ❑ Date SFD EXISTING BLDG? Signature APPLICANT a dOl'.ROO f lri 2 — :,FINAL • DEMOL ❑•' (PRINT). R ri , g NO: 88.,4'040 R' -„OWNER-BUILDER DECLARATION . 4 DATE, ' or s License , • ' ADDRESs -''529' E. Valle' Bl' 'Sari Gati"riel FINAL Lawfor the lrfollowmarrrea on Seci onh7031'.5,`Business and i Y P 9w ( ::.Professions Code) PRESENT :,: By; ACCT ti•_i air ❑ ' 'f, as,ow or.'my' ADDRESS _ 1 wages as their sole compensation„will do'the work,and �1€J1 a' thest�ucture is not inte'nded.or offefed for sale(Section _,>-_.5 LOCALITY :--` } '.T . T��• MOVING TEL:. s s i E 7044,.-Business an'd•Professions Code.-) ��.” I, as owner.of The'propert am,exclusivel contracting CONTRACTOR NO. --a P P. Y; Y 9 5.6®03 'With licensed.contractors,to construct'the-project (Sec .:- ADDRESS _. ,.• �• _ 'til€HL ,tion,7044,,Business and P.rofessons Code::) .' .• � X •± `•.=+a0 REQUIRED ,; TOTAL SETBACK,FROM = EXIST.'; CONSTRUCTION LENDING,AGENCY"y 'SETBACK YARD HWY PROP. LINE' WIDTH1s1i� I hereby affirmahat there is a:construetion-lending agency for FRONT the^"per formance of the"work for"which:this permit js,issued ''.° P:L. (Sec:,3097, Civ, C ) SIDE 00 Z. 0000' IN 44 tt- := a Lenders Name _ , ' ' Lender's Address' - 5s �6� >� s - P C Fee$ Permrt�Fee I certify that l :have read.this applicat on and'stdte that the A , u '. - Issuance Fee 1DMA.P/C#' o - 'yabove information;is correcT. I4agree to,comply with all County Investigation-Feb, 0 ordinances.and.STate jaws,relating to;building,construction Total fee LDMA Perm. # Q and.hereby authorize.re' rese `tatives of.this County to enter_' upon t e enti,Ze0cperty for'_inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Applica 1^oi•Agent' : Date =, WORKERS COMPENSATION'DECLARATION i I hereby affirm that I 'have a certificdte of consent'to self APPLICATION:,, � ® FOR .�U I L D Q = E'MIT insure,.or,a-certificate of Workers Compensation Insurance " - - Cs or a certified copy thereof (Sec:,3800 Lob C) COUNTY OF LOS -ANGELES BUILDING .AND<SAFETY Polity No Company , ❑ .,, w BUILDING,FOR,APPLICANCertified copy is T TOFILL"IN ADDRESS �41 ❑,: Certified copy is filed with the county;building tnspec- BUILDING ADDRESS tion•department;: CITY:` /'�. � 'ZIP Date" Applicant:_F r'"' „ LOCALITY NO. OF BLDGS. a NEAREST - CERTIFICATE OF.;EXENIPTION FROM WORKERS SIZE'OF'LOT " 4 NOw'ON LOT' `- " COMPENSATION INSURANCE CR SS 5 . ,�.. ASSESSOR ;+ (This section nee`d:`not.be completed if--`the permE-is for one TRACT, BLOCK LOT NO. g'pq .,, ,.hundred dollars $100 ar less ( ) )..: r TEL: K " MAP BOO � PAGE RCEL�L/ ' I certify ihaT m'ihe: erformance of the°.work.foY"whicH.•This USE ZONE' MAP, OWNER' / Y P NO. " ,.Permit isziss'ued,l•sF alhnoT employ any person many manner, ADDRESS•� � � �_ �—� n} `, so•,as to.become subject,to-the:Wor rs' Corr ensat'on taws: ;_ O ". CITY:'r /�.. .�.. ZIP %�O Q SPECIAL CONDITIONS „IJCSxeApplicant ARCHITECT,,O •. :. - TEL ' - y" ' DISTRICT GROUP TYPE FIRE, ._...,PROCESSED B,Y- N0 CE TO APPLICANT -If, after. making this--Certi icate.of:' -- ENGINEER yr ... NO.. "Y R 9 Y' CONST ZO E �O ' �Ezemption you> should become,sul5ject to the: Worker's" " U Compensation•provisions,of•thelLaborCode,:you.must;forth ADDRESS..' CL "With;_comply;with such' 6r'cions or this Zr permit shall.:be : '. " , TEL. ST �§. APT: CONDO ` tA' ' STATI/TICAL CLASSIFICAT deemed revoked CONTRACTOR' %�-- "NO. — DECLARATION LIC ' , CLASS NO DWELL ,UNITS 110ENSED,CONTRACTORS DECL ADDRESS � : � - ' NO:-. '• „- hereby affimn that I am license)under provisions of Chapter,9 SE MAP .(commencingwith Section 7000 of Division 3•of the'Business , LIC SEWER and Professions Code,.and:my license is in full force and effectVALIDATION SOFT NO:OF NO: OF CLASS* CHECK f , LicenseNumber Lic. Cldss -. SIZE `'. 'STORIES FAMILIES` / ONE BK. PG.Liz L • --' VA DATION Contractor Date _ DESCRIPTION OF WORK NEW El �, d ❑I_am.exempt under Sec.' C. , r O� I� - -ADD ' ALTER ❑ B:BP,.C. for this reason $ te: - USE'OF REPAIR EXISTING.BLDG. DEMOL Da Signature, • TEL FINAL: OWNER-BUILDER DECLARATION:-. APPLICANT, r' (PRINT)' < O �� 6 I hereby affirm that I am exempt'fromahe,Contract6r's License DATE > `� /, Law for the following reason.(Sectton 7031.5, Business.and ADDRESS �7 �G c_ ��: - FINAL Prof ssians Code): PRESENT ,By .� •; BUILDING.,v r- I' as owner'of, the ro ert or m em 'lo ees withADDRESS, L C = P P Y Y P. Y a as their sole compensation;will do'the'work'and wages LOCALITY - s. ,. "the structure is not intended or.offered for'sale(Section � .. 7044 Business and Professions Code ) MOVING -,: TEL::. r �. . ❑' 1;as owner of,ihepro periy,-am exclusivelyconteacting CONTRACTOR NO; r with'licensed contractors o construct the'proiect,(Sec ADDRESS I^7 `• tion 71 f 044', Business and.Profession`s.Code.) t` REQUIRED' YARD TOTAL SETBACK FROM L., EXIST..' { CONSTRUCTION`LENDING-AGENCY SETBACK PROP. LINE WIDTH HWY;, 1 I hereby affirm that there is,a constructio"n lending-age6cyfor FRONT } " the performance of,the"work for 'which this permit'is issued P.L: " " " " ti 'L s '(Sec-3097, Civ. C ) -SIDE : 'Lender s Name, r LDMA Ref #,- P C.,Fee$ \ Permit-Feer i " J .. Lenders Address "- A. I certify that I have read Th is.applicahon and state,ihat the lssuanceFee, LDMA P/C# 1 a /Fy above information is correct.]agree To comply with'all County .. Investigation Fee S 0 ordina es and State laws relating to,building'"construction, Total Fee' a CJ LDMA Perm. # d- and ,eby a onze,re resentatives.of this County to enter 4D up" h en ne operty,for inspecnon'pur ores. < / (. 9C� SEE REVERSE FOR EXPLANATORY LANGUAGE S7 I ignature of'App li nP r A'enh - `-. - -