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Home My Public Portal About5705 LOMA AVE_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR' BUILDING -PERMIT insure, or a certificate of-Workers'Compensation Insurance, or a certified copy thereof'(Sec. 3800, Lab. C.) �- COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. . Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 0 •.Certified copy is filed with the county building inspec- BUILDING _tion department. ADDRESS y LOCALITY NEARESTt Date Applicant CITY IP r� CROSS ST, a �I 5 CERTIFICATE OF EXEMPTION FROM WORKERS' NOAF BLDGS. 'ASSESSOR COMPENSATION INSURANCE SIZE OF LOT ! NOW ON LOT MAP BOOK PAGE PARCEL (This section need not.be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less:) TRACT BLOCK LOT NO. NO. /� ��j TEL / SPECIAL I certify that in the performance of.the work-for which.this - OWNER 4 s rV NO -� r, CONDITIONS 9. permit is issued; 1 shall not employ a person in any manner :DISTRICT GROUP TYPE J FIRE PROCESSED BY so as to become subject to the Wor s'Cc pensation Laws. ADDRESS CONST. . / ZO E IX [/// aY Date Applican CI OZE aI ZIP ATISTI L CLASSIFI ION APT. ]CONDO. NOTICE TO APPLI ANT: If, after' making this Certificate of ARCHITECT OR TEL. ENGINEER NO: CLASS NO. DWELL: UNITS LU 'Exemption, you should become subject to the Workers' ®. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP r) with comply with such provisions-or this.permit shall be z deemed revoked. TEL• BK. PG, 'VALIDATION CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. V LUATION DO (commencing with Section 7000)of Division 3 of the Business and LIC. / Professions Code, and my license is in full force and effect. CITY CLASS $ / 1,0O SQ. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE $ Contractor Date DESCRIPTION OF WORK- NEW ' ADD I am exempt under Sec. dQ F FINAL ALTER B.&P.C. for this reason - REPAIR DATE ✓�� " • , Date: USE OF DEMOL FINA EXISTING BLDG. By !rill I i / /,'�/ Signature APPLICANT TEL. ( N j[ 7 OWNER-BUILDER DECLARATION, (POINT) NO. r I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 01 Professions Code): PRESENT �-y BUILDING 17Ct�' I, as owner of the property, or my employees with ADDRESS c 3 7 6 7A wages as their sole compensation,will do the work and the structure:is not intended or offered for sale(Section _ :LOCALITY _ 7044, Business and Professions Code). MOVING TEL. o 0 0 0 0 CONTRACTOR NO. 20{0.4 9r8.+8 �. I,.as owner of the-property, am.exclusively contracting r with licensed contractors to construct the project (Sec- ADDRESS o ro o 49881 'tion 7044, Business and Professions Code). _ REQUIRED TOTAL SETBACK FROM EXIST. /� CONSTRUCTION LENDING,AGENCY SET BACK YARD HWY PROP. LINE WIDTH �. .2`+—84 I hereby affirm that there is a construction lending agency for FRONT a+ the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name Lender's Address P.C..Fee$ ' Permit Fee certify that I have read this application and state that the Issuance Fee ' above information is correct. I agree to comply with.all County Investigation Fee $ ordinances and State laws relating to building construction, Total Fee u and hereby authorize representatives of this County.to enter m u n the above-mentioned property for inspection purposes. ---_J�! � SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Signature of Applicant or Agent Date �_- yI TEMPLECUTT 76A638A CE h8032-63' %- PPLICATIC, N" FO RBUILDING PEERMIT . COUNTY OF LOS ANGELES" BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY z2 � JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRT NO. TYPE P OCESSED Y FOR APPLICANT TO FILL IN .a Q CONST.` BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS r BK P CLASS. NO. DW ELL..UNITS LOT NO. JY, BLOCK WATER NOT REQUIRED RECEIVED ❑ CERTIFICATE: TRACT MAP HIGHWAY STATE MAJOR SECOND, OCAL e NO. OF BLDGS. . NO. (CIRCLEI SIZE OF LOT. (J NOW ON LOT USE ZONE SPECIAL USE OF - CONDITIONS EXISTING BLDG. f R. J TEL I OWNER y��d. F�aG�w NO. - U I L D I NG YARD HWY `ET NAME EXIST. SETBACK WIDTH ADDRESS " QS� FRONT ARCHITECT OR L. P. L. ENGINEER "• NO. SJ.DE d .,P./L. ADDRESS- r" 4 1 O TEL. / CONTRACTOR NO. ADDRESS ESCRIPTION OF WORK �- ,:..-G:;X,,v..4s 1 �,�t1�}*`�}„% �"•� dry.""-�� ' Z NEW ALTS REPAIR DEMOLISH d f I SO. FT. A D NO. OF NO. OF �.1. adt9 •.rsF= ,fid. Iii 6•(� .✓fit %.sk( .I.6� SIZE STORIES FAMILIES USE OF /P9GvvJ'_ s..'+-•el.' .r"FT' �'✓)!-2 STRUCTURE144 SIGNATURE OF \ /•�/ �vP Com .-.%�rw?` e`'le�1a' �'4• a ' �- APPLICANT , ' J9 VALUATION APPROVALS DATE . .INSPFCT,OR'S SIGNATURE P.C. PMT. FOUNDATION: OION FEE $ 'r--` FEE $ !� •-� _FORMS, MATERIALSfj `•'�i 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. WITHALL 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. 1�/��' '"j TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- INGTO WORKMEN'S COAPENSATION INSURANCE. LATH. EXT. SIGNATURF. HOUSE.NUMBER COR- L" �I' ° t, L ,✓ PERMITTEE 111..777 ��/ �' RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CK, M.O. CASH _ PERMIT VALIDATION CK.' M.O. cnsH 0 2.3 0 8G NOV 6 1 D 15.00- APPL,ICATI®N FOR. BUILDING PERMIT ]. DIVISION,OF BUILD,I,NG AND SAFETY BUILDING ��-- w�. Department of County Engineer ADDRESS %�>� .• :r, County of Los Angeles LOCALITY � ..<.�../rsta✓ WM.J. FOXY.COUNTY ENGINEER NEAREST' • CASSATT D. GRIFFIN, SUPT OF BUILDING' CROSS ST. :C-a...-6 if ..4.o...v•�4.�>G�� " DISTRICT NO. GROUP. SEWER. MAP FOR APPLICANT TO FILL"IN �.- I' YPE . � BK. PG= BUILDING - - 'M/ _ ., •}`� CONST. ADDRESS` MAP cif c STATE �, ✓ 7�_ ,n/ NUMBER o• - gyp. HWY J LOT NO, ( � �BIjdck US ZONE SPECIAL y CONDITIONS TRACT 2 `/+Si p/'y / NO. OF SLOGS. ` _ SIZE OF LOT ,�� x M-Iq I -NOW ON LOT BUILDING - EXIST. i SETBACK 'YARD HWY STREET.NAME - WIDTH USE OF - � - EXISTING BLDG. FRONT r ' OWNERSIDE. MAIL - - ADDRESS Y i,/ / �/ Awe•-�..• &-4L-e, P. L. w `'TEL. L _ DWELL. 1 UNIT �J INDUSTRIAL CITY �;,,( S f�(f"yR: -„ ( NO. C� 2 DUPLEX- UNIT 6 PUBLIC BLDG. ARCHITECTIORTEL. ENGINEERd /LNO. - 3 APT. UNITS 7. ADDN.,ALT., ETC. ADDRESS - q COMMERCIAL 8 MISCEL. CONTRACTOR (7 �A?s1a ,/ No' �/� _ INSPECTION RECORD ADDRESS &I.b .< l )_ndu£�(`$+ , /n�'7� G.�2.P_- A..1 C DESCRIPTION OF WORK / NEW ADD ALTER REPAIR. DEMOLISH �� pl`y` A v,M�e TN c-I- �, Il �Q,�1 SQ. FT. / L� STORIES NO. OF / '�•.��- a SIZE ,� FAMILIES / - 1�i 1,PD LA Q Ou! i-1 USE OF STRUCTURE SIGNATURE OF APPLICANT `/%�JJ� � ,G.�f�� - I. \ «:.s'-° 'KL• �6 �. C't,�Qk�� .-�. ADDRESS��,R• (/ DATE INSPECTOR'S SIGNATURE �r ".�' _ FOUNDATION: LOCATION. C. $i :G'> FORMS, MATERIALS Z1 SS .Qw.- �� ! it g f1 G1 - FEE FRAME: FIRE-STOPS. ,I ---_--;- x BRACING, BOLTS , � I �� R�•LrCOQ.I:.�. - _.:r VALUATION 00 i' -�' FEE 2U FURNACE: LOCATION, GAS VENT, DUCTS A 1 HEREBY ACKNOWLEDGE THAT I HAVE READ'.THIS APPLICATION AND STATE THAT THECORRECT AND AGREE TO .COMPLY WITH ALL COUNTY TY OR GRDINANCES LATH, INT. r 41t--�-- AND STATE LAWS! REGULATING BUILDING CONSTRUC- L� TION. LATH, EXT. �^ SIGNATURE OFA � v �. HAUSE NUMBER-COR- _L,/l+11 kp�' �.. PERMITTEE- RECT AND POSTED �� '�-R•S5 �lL]�. f�Y -GTs•l+! ADDRESS - FINAL %41M.'J. FOX, COUNTY ENGINkEn VALIDATION. BY3..�- ,6. 50Y1...,4 -- .. pp-. . .-- DEPUTY_ - - »_• -DEPUTY-/. BY - - - _.BY .. .. .V � DEPUTY ". .. D '!