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HomeMy Public PortalAbout5643 LOMA AVE_Building__ .I 5 A ' RO°� C FT �Fl.hrliT IS: FLQUf�Sr� 5. .' FO22 'I)FK DONE IN I I L RbAL f<', l' GF ;GVgY 78A898A`CE '80E e.E9 APPLICATION - Mk,,"'.Im BU ILD] P;EF�'MIl' .: .. .. f. =;COUNTY OF LOS°ANGELES BUILDING { ADDRESS DEPARTMENT OF COUNTY,ENGINEER BUILDING''AND,.SAFETY DIVISION:-- ieCAury <JOHN'A: LAME31E', GOUNTY'ENGINEER NEAREST „ r ""-CASSATT D: GRIFFIN, SuP•T OF BUICDIN'G' _ CROSS S7T. - •• DISTRICT NO: GROUP -PRO TYPE , FOR APPLICANT 'TO FILL•IN _I coNST i BUILDING STATISTICAL C SIFICATION SEWER'MAP ADDRESS'. <U �� �•,:/Vo /Of�J/r �� I .. -., - B ` .: _ ✓� - .; - . , ,... SS.NO:"DWELL UNITS— MAP, • I , -LOT NO BLOCKSTATE J NUMBER (� HWY yES O TRACT: s/.. �-- ° - USE,ZONE �=` SPECIAL ` NO OF.BLDGS. CONDITIONS SIZEOF. UX �TS I;NOW ON LOT ' USE OF / Q EXISTING BLDG. l'YBvS rl��'��T 6w; . . BUILDING- SETBACK -*� �..? SETBACK •tYARD - STREET NAME. WIDTH OWNER •J?,oit��I?T // FRONT - ` ,�^ .MAIL /� ,gyp > >'; .t� .. ADDRESS w �'V�. ILO/ _ SIDE - ;.TEL. P L. CITY �/'7�/. e'%`/ NO. P23 INSPECTION RECORD'. ARCHITECT OR - TEL. ENGINEER NO.. - } . ADDRESS tr h"- 0 TEL. v`y�.`P.r�-.PJ CONTRACT OR�I�.U,S�'�,��/�I NO. U,�'�• s'"� a,- • _ ` ! ' ..,/� DES/C/RIPTION OF WORK .. 'H*A14 NEW HADD I ALTER REPAIR DEMOLISH _ ' • � ` / SQ. FT.'' - ".. 'STORIES"/-""NO. OF ..:.'_NO' OF., '.. - �. -'; '�C-'7.P'r- •%3 -T�/`�i✓/ i .FI', /�/'CL'JCa•� SIZE �Z '+. . . STORIES FAMILIES / .USE OF STRUCTURE 9 .vo - 1 , c, SIGNATURE OF 3 �'. <T'i/.:c7'rS'1. ''<..1 ,�? b t :,/�/, 1'•��'Ak' -�, APPLICANT e�-r`"�. "C�`c.."7 � ? 6/ - ,�ppct •' APPROVALS: ;.DATE,.'- ANSPECTOR'SSIGNATURE ADDRESS."',. T/`C� '' •�Lt.�+*'. L FOUNDAT.ION:-LOCATION . FORMS,,;MATERIALS .. VAL'UATION'$. ��' I FRAME:'FIRESTOPS,;'� ... IOD.. . ; 'BRACING, BOLTS' •Cd "i�''Z/L7 v;., FURNACE:LOCATION,,, PMT. / - GAS`VENT,.DU CTS FEE $ I'FEE.' $/. ' I HEREBYACKNOWLEDGE THAT I`HAVE,READ=THIS AP ' - ,• �; PLICATION AND•STATE-THAT THE ASOVE_ IS.CORRECT AND U v . rrr w wv r AGREE'TO-COMPLY. WITH ALL COUNTY ORDINANCES AND STATE .LAWS E'G�ll ING BUIL�,�LIIl.�-NC^�'�C' STRUCTION. 'LATH, EXT ERMITTEF OFLi1:++ / ROUSE NUMBER•COR-. .�. .: . OUSE AND POSTED - ,.. ,.�1-1917 �� /] I ADDRESS- rlrer� FINAL U Grp C.+O(l�Jni�GG(� ��� //N r / CLYDE N. DIRL`P.M, PRINCIPAL`ST.R CT,RAL.ENGINEER PLAN CHECK VALIDATION �K• M.o..: SASH : ;PERNIIT VALIDATIONK M o '`CA9H ;: DEPARTMENT.-OK BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES l L %.VNM.aj. FOX, CHIEF ENGINEER iFOR APPLICANT TO FILL -IN FOR OFFICE,USE ONLY. BUILDIN / a. DISTRIG�NO.' PLANCK. NO. PERMIT NO. ADDRES •� - 4�6.1�3!� j. . d LOCALITY RE EIVED BY DATE OF APPL. DATE ISSUED NEAREST 2, CROSS ST �•` BUILDING - �.q - }o - ADDRESS C� '�' ,46 /; . OWNER MAILQ;J� /.: . �� LOCALITY ADDRESS f0 NEAREST TEL � � /. .` � CROSS ST. CITY NO. �/ FIRE NO. OF., 'I TYPE' GR CITY ARCHITECT_OR :TEL. ZONE /'� I PLANS ± s.' �'[_• w;.•' ENGINEER p�,�.�rv�n....�,a •N0. x" BLDG. ` - - SETBACK LINE 1jL`y Gf ADDRESS - APPROVED - � •i TEL. BY DATE CONTRACTOR NO. ' : USE APPROVED. -' ZONE ��'�BY DATE ' ADDRESS - - HOUSE NUMBERING e LEGAL DESCRIPTION, I LOT NO.. ., BLOCK MAP NUMBER FIELD CHECK BY - TRACT. rpl y NO. ASSIGNED BY 964-"—�—DATE t NO. OF BLDGS. ®• CORRECTIONS SIZE OF LOT'.y_D /CD ¢� I NOW ON LOY USE OF NO. OF P, EXISTING BLDG.' - I FAMILIES I D jQpW , DESCRIPTION OF WORN 'so Lia• /�Lcc�� �676+�E�N T,Ga.L JD'S4�' NEW I ' ALTERATION I I ADDITION I - _7ovetLc' -<!r-.00,c�2 ,e.���Is®' 4� ,�/�i.F'o .a✓.c%'1''.c' p REPAIR • I ( DEMOLITION I .I I -• - -- - - A SQ. FT. NO. OF SIZE f 6. ROOMS_ STORIES ( Z EXT. WALL ROOF � y♦ - r COVERING jO I COVERING i(//Y USE OF STRUCTURE poop APPROV S INSPECT R'S SIGNATURE - DATE . 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-. FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS ' FORMS, MATERIALS ) �i � :5Z CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND. WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING AAAUILDINIG CONSTRUCTION.' - y FURNACE: LOCATION, .04 SIGNATURE OF '" - GAS VENT, DUCTS ../`Z7� 3 PERMITTEE LATH, INT. - ADDR6S8� �O�.J 6_ �. 71�, � w LATH, EXT. AUTHORIZED AGT. + - ,� PLASTER, INT. 7CA6i8A Diggs P. C. $ '�l� / © M� FEE / PLASTER, EXT. - VALUATION FEE $ _ //5 FEE p�'(� FINAL / �. meq, S°`' WORKERS'COMPENSATION DECLARATION y 1.hereby affirm that'I'i have a certificate of,.consent to self . insure,.oi o-certificate•`of Workers'Corripensotiarn.lnsurance, Y" P`�I�E"V `� ' ,F ,' UIL®I �„�c �� or a certified.copy_tFiereof (Sec. 3800 Lab'C.). - COUPITY OFxLOS'ANGELES BUILD11�9G°APID'SAFETY Policy N''c A16-347-8.aompany'. a Fi nd . • Certified copy is herebyfuinished; FOR`APPLICANT TO:FILL IN;: ADDRESS. 5643 N..'LOma `St. -Certified copy is filed„with the'county.building nspec. BUILDING x, tion department. DDRESs•-5643 N:}``Lort�a S, T ae Cit 917801; A - ' LOCALITY,- ;' NEAREST Las.,Tunas Date 1 LS$•'.= •Applicant'CeC�aY._R[Y�fS C'ri.- CITY Te Ile''(Ti ZIP ] CROSS ST. ,. CERTIFICATE OF EXEMPTION FROM:WORKERS' NO;OF BLDGS: ASSESSOR; ' - ".r `. COMPENSATION•INSURANCE SIZE OF LOT NOW ON LOT MAP.BOOK PAGE PARCEL Y (This,section`need not.be'completedJf the permit,isfor.one MAP a s hundred doll ars.($100),or less )`,'. TRACT BLOCK_`.,' 'TEL.'NO Ol SPECIAL"',” O.0 US ` IAL � OWNER Bonnle':'Leak NO. 28&-502_3 CONDITIONS' I certify,jhat in:the.performance of the:work for'which this DISTRI G UP TYPE'; FIRE PROCESSED BY permit.is issued,,l shall.not.employ any,person.in-any'manner ZONE : - ADDRESS.s so as,to become sublect`to the Workers Compensation Laws: a 5643 78 n : - CITY' .� le Ci ZIP 91. 0 Date Applicant' . NOTICE TO.AP.PLICANT: If, .after-"making' this'Certificate:of ARCHITECT OR: TEL:. STATISTICAL CLASSIFICATION' APT CO 0. g ENGINEER NO. •CLASS NO. DWELL..UNITS` `_`�: Exemption,.:you should become subject to .the Workers'z.r Com�.ensatioh rovisi,ons'of the Labor Code'i ou;must'forth- P p Y - ADDRESS "SEWER MAP with comply with".such provisions or this:permit.shall.be deemed revoked, CONTRACTOR NO: BK. PG, - .-� ...,, VALIDATION LICENSED'CONTRACTORS•DECL'ARATION I hereby affirm that I:am licensed under provisions of"Chapter 9 ADDRESS ". NO: VALUATION:- (commencingwith Section 7000)of:Drvision,3.of the'Business and LIC:'m Professions Code,and,my:license i" in"full:force.and effect- CITY Alt] 1Tlbra 91802 CLASS 'C- $ SQ: FT. NO.OF NO. OF GH�ECK _ SIZE STORIES FAMILIES ONE License Numbers S7H13 Li¢:,Class��� NEW ❑ $ Contractor Date y1 Q�QQ DESCRIPTION OF WORK'- y e7 ❑,.f am exempt under Sec FINAL sting using #340,. G,,: instal ADD ❑ ALTER ; new.valley metal B.BP:C. for this reason REPAIR USE'OF Date: DEAAOL'. ❑ DATE • r FIN .. _ EXISTING BLDG. eS d e• „ TEL ` APPLICANT : ,. _ r Signature" '.' PRINT Cedar. RoOfS Co. ,NO284- 1 2 9 6 37 A B OWNER-BUILDER DECLARATION - I hereby affirm that I'am exempt from the Contractor s License.'y :AP„ T. Law for the following'reason (Section 7031.5;:Business and ADDRESS •D,rBOX.s87 '..Alhambra 91802 #", ® o 0 0 Professions Code) " PRE ENT property,,. - y P BUILDING Ig as owner oth'eor my em loyees with, ADDRESS'— f.- " (?o 0.4 9..8 8 1 awages as their:'sle:compensation,:will do'the work'and •the,structure,is.not:intended or offered for'sale(Section LOCALITY 7044,Business_'and Professions,Cpde)" MOVING ? TEL .ye yo 0 0 4 9.,'S ❑ I, as.owner of'the`property,,am exclusively-c"ontracting.`. - • `CONTRACTOR .` NO. wit0icensed contractors'to construct the'project';($ec tion 7044,.•Business and,Professions Code). ADDRESS., REQUIRED,: TOTAL SETBACK.'FROM EXIST. CONSTRUCTION LENDING AGENCY` SET BACK YARD HWY r PROP:LINE WIDTH hereby affirm that there is a construction lending agency for FRONT 4!, the',performance of the work'for-which this:permit;is'issued P.L" - (Sec; 3097 Civ. C:). 4 SIDE z _ , , Lender's Name' !�� .- ,. .... _ P' P C Fee PermitrFe $ , • Lender's Address ' I certify.that I have read this application and state that the oc •. � �- lssuance!Fee �, 10 50 ' above information,is correct,l agree to comply with al l County Investigation;Fee $ ordinances'and State laws relating to building construction :I" Total Fee :: : •`� 8 �` u', and hereb 'auth'orize re resentatives.of:this.Count to enter L E,. k t _ a n,uporrihe y ove;mentioned ropert ,for,inspectibn;.purposes `� r �^ m 1 x a p ��/ �Q ,'° SEEX E REVERSE FOR PLANATORY LANGUAGE 'r 'Signature of Applicantor_Agenf 'Date'