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HomeMy Public PortalAbout5649 LOMA AVE_Building__ i DEPART�ENT"OF BUILDING AND SAFETY APPLICATION FOR PERMIT. COUNTY OF LOS ANGELES LsuLo-WM. J. FOX, CHIEF ENGINEER - FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT 0. '. PLAN(;K. NO. _ �PERMIT)NO. BUILD . ADD EISS S`G.��. I'7 / f�I� 6S LOCALITY RE EIVED BY DATE OF APPL. 'DATE ISSUED NEAREST If 9 � CROSS ST. � � BUILDING / / //' �y�� , ,f�Jv ADDRESS OWNER MAIL ( ! / 'v " ADDRESS ,Q,,� NEAREST a TEL. / CROSS ST. •o.c-.�r..�'' / CITY NO. d! 4/ FIRE ZONE �I.PLANS n kap-- I �( ARCHITECT OR TEL. - \ - ENGINEER 'Y' `NO.' BLDG. e SETBACK LINE ADDRESS (a , APPROVED TEL. V BY DATE CONTRACTOR n NO. '� USEAPPROVED ZONE/ BY DATE _ ADDRESS - HOUSE.NUMBERING LEGAL DESCRIPTION Ir•� I 1K_J LOT NO. BLOCK MAP NUMBER '' -FIELD CHECK BY TRACT '41 NO. ASSIGNED BY C, � -t Alm SIZE OF LOT �S`D 6 I NO. OF BLDGS. CORRECTIONS NOW ON LOT USEOF .., .,t. . NO. OF EXISTING'BLDG. I FAMILIES - DESCRIPTION OF WORE d NEW I /1 I ALTERATION I. I ADDITION ' I 77r5ZZ^•, ,�e�i>� REPAIR I .I DEMOLITION I I I - /r //v - - A SQ. FT. NO. OF SIZE ROOMS �� STORIES. /� Z EXT. WALL ROOF D r COVERING..417 C.0 ( COVERING USE OF STRUCTURE ]V-ENIS � � e .-APPROVAL S INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVEREAD TFOUNDATION:.LOCATION �p `PLICATION AND STATE THAT THE INFORMATION GIFORMS, MATERIALSCORRECT.I AGREE TO COMPLY WITH THE CORRECTIONS FRAME: FIRE STOPS,- v HEREON AND ,WITH ALL' COUNTY ORDINANCES ANDBRACING, BOLTSLAWS REGULATING UILDING CON TRUCTION. FURNACE: LOCATION, - iy , SIGNATURE OF , GAS VENT, DUCTS PERMITTEE���/// ` LATH, INT. _ ADDRESS J 6 4 0.S/Ld`+C44Cn ti1 ►1 �1 �i� 4 .. LATH, EXT. "3 AUTHORIZED AGT: PLASTER, INT. 7ews38A. Desi to-so $ P. C. $ �® ©43 .'r FEE me-• PLASTER, EXT. / VALUATION � - _ FEE $' ; FINAL • APPLICATIONTOR BUILDING 'PEAMIT COUNTY OF LOS ANGELES"' �' BUILDING AND SAFETY C WORKER'S COMPENSATION DECLARATION' ` > FOR APPLICANT TO`FILL IN' BUILDING DDRESs I hereby affirm that I have a certificate of consent.to self insure, BUILDING' DRE S - .�`•-'' '- - or a certificate of Workers' Compensation Insurance,ora certified fA copy thereof (Sec.3800,.Lab.C.) CJ4Y ZIP-� LOCALITY Ftla Policy.No. Company SIZE O�LOT• 1 NO.OF BLDGS.NOW ON LOT „ NEAREST CROSS ST. 0 Certified copy is hereby furnished. x ,a+ TRACT BLOCK. LOT NO. QCertified copy is filed with the cou ty building inspection 2 USE ZONE MAP N . depar merit: ASSESSOR MAP BOOK '.• PAGE PARCEL -`: - � .� Qa ^ L Date Applicant 1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWINER TEL N COMPENSATION INSURANCEY&R WITHIN 1000 FT.OF SCHOOL? YES NO ADDRESS (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 is issued, I shall not employ any person in any manner so as to �J'v" /` —� ✓ �G� become subject to the Work s'Compensation Laws. • ARCHITECT -- - _ EL NO I 2�[ p �f 4. STATISTICAL CLATION, APTJCONDO Dab Ap"plic0t— ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after king this Certifi e of �P0 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should "become -subject to the eA Orkers' CO RA TOR _ TEL NO. SET BACK YARD HWY• PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith r�71rlPI) FRONT comply with such provisions or this permit shall be deemed revoked. ADDD ESSQ�� �� LIC:NO. 2 P L p cow J SIDE LICENSED CONTRACTORS DECLARATION cIT LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 '� /5 SEWER MAP (commencing with Section.7000)of Division 3 of the Business a`n�d'. SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. ;,.) 4AS NEW' ❑ BK PG d License Numbe 6!273a Lic.Class— DESCRIPTION OF WORK .. ADD I� VALUATION Contractor Date ALTER w❑` $ t� U ❑ 1 am exempt under Sec. REPAIR ❑ $ 0 BAP.C.for this reason 49-4-1'C LeP DEMOL ❑ LDMA P/C# V _ UJ Date: - USE OF EXISTING BLDG.' U � URM ❑ - i (CL n Signature; AP LICANT PRINT) L N0. 'LDMA Perm# - " ' •+•. a - Z .. . ' .- _V �( /� Z " �I 1, as owner of the property, or my.employees with wages as '"W - v t - r• O - =r their sole compensation, will do the work-and the structure is ADDRESS hot intended'or offered for sale (Section 7044, Business and PA7 w FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT•HANDLE A HAZARDOUS MATERIAL ,t J ❑ I, as owner Of the property, am- exclusive) contracting WIYh OR A MIXTURE CONTAINING HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE P y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY Au.-1 licensed_contractors to construct the project (Section'7044, YES❑ NO❑ Business and Professions Code.) ' _ _ {_a__ _ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE.BUILDING - .- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH -COAST AIR QUALITY MANAGEMENT.DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR :,(C• S CONSTRUCTION LENDING AGENCY GUIDELINES. - t_tin thereby affirm that there is a construction lending agency for YES F-1 Nor❑ 8-• 1 • - --'- :s _ �'}•�� w the performance of the work for which this permit Is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING - - - ° 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY RHOUIREMENTS UNDER,THE LOS ANGELES COUNTY CODE, I'1 �`• f I '_ - - TITLE 2,CHAPTER2.20 SECTIONS,2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS - •-.- .� 'Lender.S Name, MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address ' OWNER OR AGENT o I certify that I have read this application and state under penalty _` o "P.C.'FEE �-" PERMIT FEE / �� _ - j if i ;�_--ft 1r; s T �� ; of perjury that the above information is correct.I agree to comply d N with all county ordinances and State laws relating to building < construction;and hereby authorize representatives of this County ISSUANCE FEE - -��-f•7 `" l •�r ' ' "' to.enter upon the above-mentioned property for inspec�n p rposis. ��-u !L7 INVESTIGATION FEE TOTAL FEE Q' n i alure o1.Applica r,Agenl are ' - D� �• � /�(� SEE REVERSE FOR EXPLANATORY LANGUAGE - , LIC . BUILDING PERMIT . COUNTY OF LOS ANGELES _ BUILDING°AND SAFETY: WORKER'S-COMPENSATION DECLARATION FOR APPLICANT TO FILL IN •' -BUILDING°ADDRESS .� _, " 1 - •_; BU NC,� S ( HADD E - I hereby affirm that I have a certificate of consent to self Insure, or,a certificate of Workers'Compensation Insurance, or a certified' CITY -._ ZIP - 5 - copy thereof (Sec.3800,Lab �') - LOCALITY Policy No. Company - , - -SIZE OF LOT- ff NO.OFrBLDGS.NOW ON LOT Certifiedcopy is hereby furnished'"' ' •'"- NEAREST-CROSS ST.' xcbrtifled•copy Is fded',with the cou ty building•inspection. T N0. ;TRACT-- BLOCK .LO depaLLrttment... NO Datd'22 A'plican _ O USE ZONE. :MAP " P _ - SPECIAL CONDITIONS _ ASSESSOR MAP BOOK PAGE PARCEL ' • ,. ES CERTIFICATE OF EXEMPTION FROM WO ERS' ow R /� /^/ TEL/,NO. COMPENSATION INSURANCE/ Y! C/„ �� 7J��bD� WITHIN 1000 FT.OF SCHOOL? Y NO (This section need not beJcompleted if the'permit is for one hundred": ADDRESS " "- P ,', DISTRICT°• GROUP ' TY CONST. FIRE ZONE 'PROCESSED ''BY dollars($100)or less)' _ I certify that in the performance.of the work•for which this permit , ., CITY - . . - ,ZIP • ' �j np Is Issued,�l shall not.employ any person In any manner`so-as to'. C7 O" ARCHITECT OR ENGINEER^. • TEL NO.: - bed ome"subject-to the Workers CompensatlOn'LaWS;. STATISTICAL CLASSIFICATION - ' APT' CONDO Date Applicant ADDRESS" I _ CLASS N0: DWELL UNITS ' NOTICE' TO' APPLICANT.•- If, after making this Certificate, of REQUIRED ;TOTAL SETBACK FROM EXIST , Exemption,p you'" should..'become, subject to the Workers' CONT TOR i, - TEL-NO. / SETBACK. YARD - HWY PROP LINE WIDTH Compensation provisions of the Labor-Code, you must forthwith �/(J/�+ yY$�sO7D FRONT r' _ ed;revoked:' ADDRESS LIC.NO. _ - .: p L F . com I LICENSED CONTRACTORS DECLARATION P y, P P, .�� SIDE - N ` CITY LIC.CLA I hereby.affirm-that•1.am licensed underprovisions of Chapter 9' E i4 - SEWER MAP (Commencing with Section 7000)of'Division 3 Of the Business and SQ FT.SIZ NO OF TORIES NO.OF FAMILIES Professions Code,and my license is;in'full force and effect.' NEW BK PG. a Sf f 7/� °' , DESCRIPTION OF WORK - ApD ❑, VALUAT-ON Q- 'License Number Lic Class. rL �OTI�Q Contractor RrJGr��' : Date' ' Z s--9 • ALTER. ❑ $ O ❑-I'am exempt under Sec. J. AIR- ❑ REP ,$ BAP.C.for this reason t/ /(,lsfl�y �Flyyi i• DEMOL: ❑ V Date: Us ExISTI 8 .- URM ❑. :_ - f a. LDMA P/C# - • s - _ - - Signature - APP' NT(PRINT) ,,;- TEL NO. 'LDMA.Perm# - ,- ''�``-4 j•=y AZ Z ❑ I,'as owner of the property:or my employees with wages as' d -/IJJ �7`l-0 I—Y� .t their sole compensation, will do the•work,and the.structure is. ADDRESS - not intended'or offered for sale (Section 7044, Business anda�lo• ST / C- FINAL DATE Professions Code:) / j� _ - - WILL THE APPLICANT OR FUTURE-BUILDING OCCUPANT HANDLE'A HAZARDOUS MATERIAL a f ',(/J�jj ❑ I, as owner of the r0 eft am eXCIUSIVeI OR A'MIXTURE CONTAINING A'HAZARDOUS MATERIAL EQUAL••TO OR,GREATER THAN THE Q f it �a y p p, y, y,contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? a licensed contractors to .construct the project (Section 7044, ,"' to.construct NO .. - - t,•- E r�L i FINAL BY Business and Professions Code.) F • WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING LL - - - - OCCUPANT REQUIRE A PERMIT FOR.CONSTRUCTION OR MODIFICATION FROM THE-,SOUTH - �,.g°'f!^3t'•,,,`' - -- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY,MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR ; _ GUIDELINES. I:hereby affirm that there,is a construction.lending agency for YES❑ No❑ N the-performance Of.the work for which.thls permit IS ISSUed(Sec. (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING - '' 1110. { i e 3097,Civ.C. - ' CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS'ANGELES COUNTY CODE F TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 220:140 CONCERNING HAZARDOUS - L:+�45 _ Lender's Name• MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD o Lender's'Address s .C) ..:OWNER OR.AGENT --_ - o' I certify hat have'read this application and state under penalty of:pequr thatahe.above informationis correct.I:agree'to comply �P.CrFEEr PERMIT FEE ' �o - N -with all oLmty ordinances and. State laws relating to building oo constru ion, and hereby aut rite representatives of"this County' ISSUANCE,FEE, �. . to ante upon the a - e onedproperty for inspection rpos •: /f 'INVESTIGATION FEE- --`TOTAL FEE• /0 ' n afore of Ae01'c5nf or.A - - Da _ ..• •. f - -., _ - SEE REVERSE FOR EXPLANATORY LANGUAGE `" '