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HomeMy Public PortalAbout5664 LOMA AVE_Building__ M, CI TY CITYOF [''1ftIIII 76A688A CE}x803,1-61 LJ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST 2 / WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. (r. DISTRI T NO. GROUP TYPE PR ESSED BY FOR APPLICANT TO FILL IN - _ CONST. -� - r4-- BUILDING STATISTICAL CLASSIFICATION SE ER MAP ADDRESS 5664 Loma e52-- �� I K PG CLASS. NO. DWELL. UNITS LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED ❑ _/ 4�� ,/ CERTIFICATE: TRACT !'� MAP - 'j HIGHWAY , NO.OF BLDGS. NO. (/ (CIRCLE) STATE MAJOR SECOND, OL SIZS OF LOT. I NOW ON LOT USE ZONE SPECIAL USE OF Re-roof HoUSe & Garage CONDITIONS EXISTING BLDG. .1. OWNER Florence - Smi t�h NO. BUILDING YARD HWY ST ET NAME EXIST. ,},. ADDRESS 5664 Loma, Temple Ct4Y SETBACK WIDTHFRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE F.L. ADDRESS d pf'+ INSPECTION RECORD 0 CONTRACTOR Virgin Roo CosN iI' 7050 � ADDRESS 600 S.San Gabriel B1.3an p DESCRIPTION OF WORK W a N NEW ADD ALTER =REPAIR/ DEMOLISH SQ. T. NO. NO.OF IZE STORIES FAMILIES USE OF STRUCTURE /7L F�C� SIGNATURE OF APPLICANT VALUATION$438.00 APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION FEE $ �� FEE $ 6 00 _FORMS,MATERIALS FRAME: FIRE STOPS, I 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. TYON OF THE LABOR CODE OF�T�HEE OF CALIFORNIA RELAT- ING TO WORKMEN' PE NSCE. �, LATH, EXT. SIGNATURE O� i HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS 600 S. San Gabriel Blv FINAL San Gie l CLYDE N. DIRLAM, P INCIPAL STRU;CTURAL'ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VAIMATION CK. M.O. CASH I E DEPARTMENT OF BUILDInJ _AND. SAFETY q APPLICATION FOR PERbaT �'. _ COUNTY OF LOS ANGELES ` -WM:-J. FOX, CHIEF ENGINEER u � L I N "" FOR OFFICE USE ONLY FOR 'APPLICANT TO FILL IN 'y/ �'�Jy DISTRICT NO_ � PLANCK. NO. PERMIT NO. BUILDING �wJ+ ',f ! tai -�r -•.�y'1rA,-�.�^• Frvc-moi.... .J 4? 7-4 c:�z3 . ADDRESS "LOCALITY `- �' , RECEIVED BY; DATE OF APPL DATE ISSUED NEAREST ! ��/q• CROSS ST. , BUILDING / ADDRESS OWNER .i .. ,s.P,a.el�n.r�..�_P. � i �. MAIL /yt"- !'� /''� - LOCALITYNEAREST C-/ ADDRESS / D L�~G `- ' 8�S �, CROSS ST. CITY TEL TEL. I? - FIRE- NO.-OF TYPE GROUP^ ARCHITECT OR �- ZONE I PLANS � ENGINEER NO. BLDG. ORD. NO. SETBACK LINE -'-Iil y�y1i►�+'+-'�- i ADDRESS ! - APPROVED , ` ,TEL. _ BY DATE CONTRACTOR 6/..d�+•�a.R- „d NO. :USE 'APPROVED ZONE BY - DATE ADDRESS - •HOUSE-NUMBERING LEGAL I DESCRIPTIOLOT NO b BLOCK MAP NUMBER �""a � —FIELD CHECK BY — TRACT / ~ TRACT -/ �j /,� , NO. ASSIGNED BY •� �`'� �ATF SIZE OF LOT �� Al X J 4 I NO.OF BLDGB. - CORRECTIONS NOW ON LOT 4 USE OF - INO. OF _ EXISTING BLDG. FAMILIES ` DESCRIPTION OF WORK NEW I x I ALTERATION ( I ADDITION I . •- A.� REPAIR .,I. p"[DEMOLITION D SIZE J.%: ROOMS STORIES ' - •Z D EXT. WALL �j 4,� � ROOFp� � � � 3 - r COVERING d" - x s��'i COVERING.14 � °,Ii ' USE OF STRUCTURE I f tl APPROVALS INSPECT•R'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP FOUNDATION:'LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS `� p �-,_�, ,� '"W COI AGREE TO COMPLY- WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS. / HEREON AND WITH. ALL COUNTY ORDINANCES AND STATE '. BRACING, BOLTS / - LAWS-REGULATING BUILDING CONSTRUCTION. • 'FURNACE: LOCATION, SIGNATURE OFA GAS VENT, DUCTS - PERMITTEE ADDRESS ' �.b , Sl�./�•.r!-� .s „�--•+� �! !..,�, LATH, INT. LATH, EXT. AUTHORIZED AGT.' \•' PLASTER, INT. - 76A088A• 0888 10-30 �^ P. © ��'/ - FEE PLASTER, EXT. FINAL i �� ✓ . FEE , . -AP-'L`ICATION FOR BUILDINGS PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING � - ,�� jr � � �,, COUNTY OF LOS ANGELES AbORESS _ _ DEPARTMENT OF COUNTY ENGINEER clrY ! '��y i' �� ' %' .I Z P BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOTwl '� NOW ON LOT ADDRESS TRACT ✓ BLOCK LOT NO. LOCALITY •'�%' �- TEL.-) i/ NEAREST OWNER �✓,�L1/{e- NO. T•• 1C' CROSS ST. ASSESSOR ADDRESS �6�,(;1 �y•, �3. MAP BOOK PAGE PARCEL rte, _ / DISTRICT GROUP TYPE FIRE PROCESSED BY CITY elif 26.E L i ZIP �1/ 96 .r -_7./' CONST. ZONE ARCHITECT OR TEL. 0 " �_ 6 ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO.-,a2 __DWELL.UNITS BK PG J iI TEL. CONTRACTOR NO USE ZONE MAP LIC. NO. ADDRESS NO. SPECIA L LIC. CONDITIONS CITY CLASS R AD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) d ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING O� SQ. FT. NO. OF NO. OF CHECK HI WAY + YARD - FRONT PROP. LINE HIGHWAY WIDTH SIZE NO. FAMILIES ONE o DESCRIPTION OF WORK NEW ❑ _ + IU �� ` •�j ADD BLDG.SE HACK FROM GO SIDEPRO LINEOF (STREET) Z ALTER ❑ HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING REPAIR❑ S. SIDE PROP. LINE HIGHWAY WIDTH USE EXISTING BLDG, Lj( �:��(,/ „T.• �` DEMOL ❑ + L 1 �f ? 7/(; '"� /f/p CORNER CUT F YES ❑ NO ❑ AP PRI NT)N OR,6,1 L J ,(!,91/ 7 !"OL 7&1t&1t D BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ (F��) � � � /� IN COASTAL ZONE YES NO ❑ VALUATION Q•V `eo CATEGORICAL EXEMPTION S❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE ���JJJ LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TOAc� WORKMEN'S �iP�� AA may- �C �- WORKMEN'S CO MPE NS TION INSURANCE. 1(�j;� 9 /�Ed �,` j SIGNATURE OF ���� ,, •%l��a.��/c� PERMITTEE ADDRESS ��`',`� TEL. [FIN7AL0 } 7K BYCITY NO. . PMT.11,1KL CfiECKS PAYAHLE '1U: E FEE HARVEY T. BRANDT, COUNTY ENGINEER �4` PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH 76A638A CE 9803 12/72 1 4 IT2 a 24 1. V -+- 2+0 0 76A638A CE*803 8-63 APPLICATION FO BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING . DEPARTMENT OF COUNTY ENGINEER . AooREss LLZ! BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT of BUILDING - CROSS ST. �- DISTRICT NO. GR - TYPE -IF CE D.BY FOR APPLICANT TO FILL IN CONST' BUILDING j" '" STATISTICAL CL LFICATION SE ER MAP -ADDRESS t �. - CLASS. NO.. DWELL. UNITS LOT NO. - BLOCK WATER ��yy - CERTIFICATE: NOT REQUIRED .,RECEIVED TRACT 0, � - MAP _ HIGHWAY NO.OF BLDGS. NO. y�a (CIRCLE) STATE MAJOR SECO . LOCA SIZE OF LOT T NOW ON LOT, USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. EL OWNER Ax,- NO. (f '�wa BUILDING ✓+B EXIST. YARD HWY ST REET AME y7 SETBACK WIDTH ADDRESS , cam` FRONT ARCHITECT OR TEL. P. L. ENGINEER / NO. SIDE P. L. ADDRESS e' ,/_ ) IL TEL. ,13--� ��d"T s=l 7.-Ps .•�� t�./.�C- � .1S,E?�. - D' 0 CONTRACTOR( I NO. ADDRESS' w, Im . DESCRIPTION OF WORK" �� '- - U Lu 14EW (ALTER REPAIR DEMOLISH - !/ 9y + ,r.'� y SCI. FT. N O..O F - N O. O F il.�/_f.,r d.fiR ✓y - A`..-,c�.`Y'"."�' ..t8�" -�'�t _ Z SIZE STORIES FAMILIES USE OF -..+fes .. 65%'-i4+,ai�`p '�*• dam+�?t 'rf6J; " uY �✓ STRUCTURE-tell SIGNA URE OF y_ 5'1r +^�I,e l d l� . 47 �dgUJ C/w'I . APPLICANT VALUATION ,;,i v �• ✓ APPROVALS DATE INSP SIGNATURE' P.C. Q FOUNDATION: LOCATION /� ! 9 ' FEE $ - FEE PMT.$ y. FORMS, MATERIALS. (/gip F RAME:•FIRE STOPS. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACW.G. BpLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNA OCAyTIOFf WITH ALL COUNTYORDINANCES AND STATE- .LAWS REGULATING GAS V T CT BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK E n /•� �/� 1 AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. ice"!/ /Zd? • TION OF THLABOR CODE OF THE STATE OF CALIFORNIA*RELAT- ING TO WORKMEN'S COMPENSATI N�I`NSyUURR}AANNJCE. LATH. EXT. 14`�� �� f''•Yi/ � SIGNATURE OF ' W_/ - HOUSE NUMBER COR- 4k Y ' PERMITTEE �° RECT AND POSTED. '•ADDRESS , FINAL - - JOHN F. LEWIS. PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION, CK. M:O. CASH PERMIT VALIDATION CK. M.O. CASH I wbkERS' COMPENSATION DECLARATION - ! §y ��>r � I havecertificate of consent to self L' AT ®N FOR ®' �. RM' or a certificate cf Workers' Compensation Insurance, w, or'a certified�'py thereof►(Sec.'i38db, Lab. C.)' "' ' P ly �F COUNTY OF LOS ANGELES t, - BUILDING AND SAF TY PolicyNo., Com an r Certified copy-'is hereby furnished. FOR APPLICANT TO FILL IN BUILDING � ! ADDRESS (/^ 7-0 Certified'copy-is filed with`the-county b-iIding i'nspec- BUILDING 70 Tion.d dr ent:'- • �'• ' S` ADDRESS r D"ate` O Applica CITY ZIP LOCALITY -CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BCDGS. NEAREST -COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is.for.one — ASSESSOR, , _ hundred dollars ($100)or less.) TRACT BLOCK ' LOT NO. /- MAP BOOK PAG PARCEL ti.. EL. �. USE ZO E MAP i OWNER NO I certify that,in the performance of the work for which this i NO. permit iaissued,1 shall not employ any person in any manner SPECIAL — 0. so.as to become subject to the Workers'Compensation Laws. ADDRESSinaCONDITIONS O. CITY --ZIP. IM Date t' ` Applicant ARCHITECT OR EL O NOTICE'TO APPLICANT:' If, after making:this Certificate of ENGINEER. .. NO. ST C DI RI T- G OUP .T.YPE FIRE PRO SSED BY Exemption you'' shbuld become sobje`ct to`the Workers' {� 2 CONST,' ZONE V. Com ensation rovisions:of the Labor Code, you must.forth-' U J P P Y ADDRESS I�♦Y W with comply .with.-such. provisions ,ori this permit shall be -•-. - deemed-revoked.•.. .- },; TEL. STATISTICAL CLASSIFICATION APT. NDO.` CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION -_ , LIC. CLASS NO. DWELL. UNITS I hereby affirm that'I am licensed under provisions of Chapter 9 ADDRESS l NO. SEWER MAP (commencing with.Section7006)of Division 3 of'the�Business and LIC.- Professions Code, and my license is m full force and effect. CITY CLASS - gK. PG.b.L. VALIDATION- SQ. FT. NO.OF_. - NO. OF CHECK_ -� License Number Lic;Class .r - SIZE STORIES. FAMILIES ONE - VALUATION DESCRIPTION OF"WORK NEW Contractor ate -� $ O� r ADD I am exempt under Sec ALTER Q oil, rr B.BP.C: for this reason REPAIR- � $ _. _ Date . .. USE OF —i EXISTING BLDG. DEMOL Q Signature _- APPLICANT EL. FINAL OWNER-BUILDER DECLARATION PRINT NO: n DATErr• # o o'o'0 2 I'hereby affirm that I am exempt from the Contractor's License _ j l °.7J 6 4 C Law for the following-reason,(Section 7031.5, Business and ADDRESS v • FINAL'�� VA' - Professions Code): " PRESENT BY '1.� I, as owner.of the ro erT or m employees �fl r BUILDING ❑..�_ .. P P Y, Y _ . , with .._._ ADDRESS ;.t � wages as their sole compensation,will Io the work and The structure is not intended or offered for sale(Section LOCALITY ® 7044, Business and Professions Code)' MOVING TEL. CONTRACTOR NO. _. �_. y I, as owner of The property, am exclusively:-contracting _ with licensed contractors to construct the'project (Sec- ADDRESS - 1 tion 7044, Business and Professions Code). t I �4 9 7,' f _REQUIRED - _ TOTAL SETBACK-FROM EXIST. � 1 CONSTRUCTION LENDING AGENCY .4 - SET BACK YARD"' HWY PROP. LINE WIDTH f # 0.0 o, o, o 1 I hereby,offirm'that there is a construction lending agency for FRONT the-performance of the work'for which•this permit is-issued — P.L: - ` (Sec. 3097,-Civ. C.). SIDE - - ( ° 43 8.7-5 - n . ._ P.L. Lender's Name ° 7 J�cL� 387 o' 7 LDMA Ref. # P:C'. Fee$..__ y' Permit'Fee. ig� g� - - Lender's Address I-certif that-1 have read this•a lication and state-that the 0 08 86 Y- PP - - Issuance Fee - - � PLDMA P/C# - „r. above information is correct..I agree to comply with-all County Investigation Fee ordinances and,State,laws-relating io,building construction, Total Fee - - CDMA Perm. # u 'an y authorize.representatives of this County to enter - _ - y- - Pon th above-me d propert f r inspection pu.po es. _ _ SEE REVERSE F.OR EXPLANATORY LANGUAGE 1 ' ' ' .Signature of Applicant.'or Agent r•- --- te: