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Home My Public Portal About5749 LOMA AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR•APPLLICANT'TO FILL IN (Print or type only) Bui LDI NG - COUNTY OF LOS.ANGELES ADDRESS -5749'No.-LomaDEPARTMENT OF COUNTY ENGINEER CITY Temple e City ZIP 91780 BUILDING AND SAFETY DIVISION �;��,7 NO.OF BLOGS. _ BUILDING 57 ry SIZE OF LOTS✓"D-IL3' NOW ON LOT ADDRESS J / .L. • R TRACT/242BLOCK7 LOT.NO. - r] LOCALITYTE - •OWNER e NOL 28 _7062 NEAREST CROSS.ST. - - - -• - - ASSESSOR - - - ADDRESS 571.9 .MAP BOOK _ PAGE PARCEL —Gma �7Q DISTRICT GROUP TYPE FIRE SSED BY •CITY ie Cit ZIP 91.780 CONST. ZONE - ARCHITECT OR - TEL .ENGINEER NO. _ STATISTICAL CLASSIFICATION SEWER MAP - ADDRESS - ;CLASS NO.- OWELL•UNITS� BK PG -..TEL... _ CONTRACTOR _ NO _1p USE ZONE MAP - LIC. �i� NO. 0�� - ADDRESS p IIa.1:en o-- •• NO. `2 16 - �i1> SPECIAL LIC. CONDITIONS CITY .1 hamb ra, Calif CLASSoOfin ROAD DEPARTMENT APPROVAL REQUIRED YES'[] NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG. TBACK FROM FRONTip ROR.LiNEOF (STREET) y ADDRESS - CITY- C- WA } YARD HIGHTOTAL SETBACK FROM TYPE OF EXISTING CD SQ. FT.- - NO.'OF NO. OF CHECK -_-. FRONT-RROP. LINE HIGHWAY WIDTH U SIZE - STORIES FAMILIES ONE - .. . - - - O DES'C RIPTION OF WORK�e� 0� .C� t N W ❑ - - V euj r D ❑ BLDG.SETBAC 0- ar - - SIDE PROP. LINE.0F (STREET) Z eCLIJ SIA ma ALTER HIGHWAY YARD OTA.L E BACK FROM TYP F EXISTING } = -- - - - SIDE PROP. LINE- HIGHW WIDTH REPAIR. USE DEMOL ❑ + - .EXISTING BLDG. - � •- - - - - APPLICANT - TEL CORNER CUTOFF -.YES ❑,, - NO.,❑ APR NT) - NO. BY (SIGNATURE) - IN OPEN SPACE _ .. YES ❑ NO ❑ �{ - IN COASTAL ZONE YES..❑ NO ❑ VALUATION "".JO�/V �-�® _ .. - - .._- .. :. CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT-THE ABOVE IS CORRELT�AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATIONSIGNED (DATE) WITH ALL 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 - - LABOR CODE OF THE.:STATE OF -CALIFORNIA IN RELATING. TO WORKMEN'S CO MPE NSATION.INSURANCE.,• - SIGNATURE OF PERMITTEE. �1 ADDRESS 12 o-. Maren �o lvee �y, y, _ n _�'Q_ FINAL BY. CITY . .. Alhambra- 'C� o NOL 2 82..1 8 DATE-3 f,I. 71A Kl---.CHLCKS. P,1 A1.3LE .CO: C.,FEE $ FEE 60oo. . HARVEY. T.•BRANDT, COUNTY ENGINEER PLAN CHECK VALIDATION- cK. M.o. CASH PERMIT VALIDATION. cK. M.O. CASH v 5.0 G 76A638A CE#803 12/72 DEPARTMENT OF BUILDING AND SAFETY __ ��r icATioN ruts rt.stmi� , COUNTY OF LOS ANGELES • It U 1 WM. J. FOX, CHIEF ENGINEER 'l FOR-OFFICE USE ONLY FOR APPLICANT TO FILL IPT BUILDING DISTRICT NO. PLAN CK.NO. PERMIT NO. ADDRESS /11.111 L l -Qq ^ LOCALITY�Q/�^n Ail V�/[ J(/V/ RE EIVED BY DATE OF APP/L (DDA/TE iBs ED NEAREST ` CROSS ST. ./�/� ,AAABUILDING A,,,( e/ O1 tl\PAI 1� {Y �i/l}iCiCIII YYft!�f�.OU,l��U:� ADDRESS ��J � �'�"``�'��'t`�• . -OWNER 1MAIL ADDRESS c3 "'T V'�.�^'� LOCALITY �•'/, NEAREST N\ NOV CITY 0 AAA� 1 TEL CROSS ST. �6-1 FIREI -NO.OF TYPE, GROUP 'ARCHITECT OR �I. TEL. ZONE PLANS ENGINEER NO. NO. I ,C�- BLDG. I SG�✓�/ ADDRESS - SETBACKLINE APPROVED TEL BY DATE CONTRACTOR �NO/. rUSE ADDRESS I Lf �. �l (�� V6 �/V`l! ZONES/ BY DATE DATE LEGAL R — DESCRIPTION I LOTNO. 1_7q D I BLOCK CORRECTIONS TRACT SIZE OF LOTJ 5 XNOW ON LOT II I :NO.OF SLOGS USE OFpp -, Ir+ f EXISTING BLDG. rtJ�� FAOM'ILOIE9 A ROOMS ✓ , DESCRIPTION OF WORK NEW ALTERATION ADDITION /\• O A REPAIR MOVING DEMOLISH - Q Sq.FT. NO.OF _ SIZE . ROOMS STORIES -� _vp1 > WALLCROOF OVERING )L�/I/l.e..� i COVERING r USE OF NEW BUILDING � J I HEREBY ACKNOWLEDGE THAT, I� HAVE READ'THIS - .. APPROVALS APPLICATION AND-STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS z55 AND STATE LAWS REGULATING BUILDING CONSTRUCTION. /- FRAME: FIRE STOPS, �� > SIGNATURE OF BRACING,BOLTS • OWNER Y(/�/fI)l1!/ �!1 LATH,INT.: AUTHORIZED AGT.k_ , I R`_ JA \\.ey ` LATH,EXT.: DBS-3 25M �sETs 1-47 $ P C PLASTER. INT. FEE PLASTER, EXT. VALUATION /`110 FEE FINAL ' WORKERS'COMPENSATION DECL"ARATION ®®22 B W •� insure boraatcertif cirm ate of Work'ersrtCompensaf on ificate.of. ensuran elf �. �! �'��'®�a��®�.;. V U;I ®' �• ��' " ora;ce�tif,ed'copy thereof (Sec. 380 0, Lab.'C ) :,BUILDING ' ., COUNTY•OF LOS ANGELES BUILDING AND SAFETY,, Policy No WOOD714.6Company Bea Vel' If15U1'6 l1Ce.._ - ! Certified copy_:is hereby furnished,a, FOR APPLICANT TQ FILL IN ADDRESS {" ADDRESS Certt ie copy is filed with the county 6uilding'irispec- BUILDING ionidepartment. r; :.y,. .. 1 ADDRESS 574 N Loma' x„. 1 .. Date 7-�1SIApplicant. U•I I'�sl'.fl. COH'] Roof . CITY ZIP `^9178n LOCALITY, { r._ .-. __ _ NO: NEAREST. ,CER TIFICATE'OF'EXEMPTION FROM WORKERS' ' GOMPENSATION'INSURANCE SIZE OF LOT NOW ON LOT CROSS.ST: . (This section'need not be`completed.if the,permit is for'•one {�,, ° - TRACT BLOCK LOT NO. MAP BOOK PAGE' PARCEL ; hundrecl,dollors ($100)or-less.), TELMAP - - - 'OWNER-'- - :NO.'4 ._^.. 51 4 _-. ... I certify that m the performance'of the work for which this ? permit is wsued J shalLnot employ any person in any manner - CIAL- -- t USE tJE� lS�- ADDRESS::' _ _ so'as to become subiecf to-the-Workers"Compensation Lawn. 'N" Loma "'” '" CONDITIONS ®- K. }•. s +U „ - _, CITY. Tem l e_:C i't _ZIP ,l 80L �� _. Date Applicant;. . NOTICE"TO"APPLICANT i If; after''making this Certificate of ARCHITECT OR TEL." _ O tENGINEER NO: DIST$,CT, G OUP ONS ZO - PR ESSED BY Exemption, you'should become sobjecC-to'the.:Workers' ✓ ;/ } - Compensation'provisions-of the Labor Cod'e;'.you must forth- ADDRESS ---- - I - .:� F Y with comply,with such-provisions or this permit shall be - -- _ -_ -_ ;- -- - TEL ion deemed,reyoked. CONTRACTOR U 1'C 1'f1 ROOF CO NO. 28 -O O STATISTICAL'CLASSIFICATION ' APT. CO O LICENSED CONTRACTORS DECLARATION + - - - - - LIC: CLASS t50._ ' 2� DWELL,-UNITS I hereby affirm that I am licensed under provisions of.Chapter 9 ADDRESS P Q NO. (commencing w,th'•Section 7000)of Division 3 of the Business and LIC. _ ._ W MAP- Lit Professions Code,.anid my license is'in full force'and�effect. CITY , San Gabriel 1 e CLASS C' "' VALIDATION SEWER MA :. .BK. � PG. x S _ _ •_ _ NO'OF _ _ NOS OF _ _HECK Q. FL C License Number 160650 Lic.'Class` ' -C39 SIZE - STORIES * FAMILIES V ONE :-•+_ c:, „ VALUATION _ % U I C J f1 4ROOf°`CO i'Date 7715 8] __.W__ •DESCRIPTION`OF`WORK'-- _ NEW: $2258.00 ;1 - Contractor ❑ _ ❑ I am exempt under Sec: ADD ❑ a ALTER :❑ $ B.&P.C. for this-reason •` REPAIR.:.❑ DEMOL`. ❑ USE OF EXISTING BLDG _ I _ Signature' _. . , . .;' ._. _, FINAL �; , ••- - APPLICANT : TEL. ' t• OWNER-BUILDER DECLARATION__ PRINT) 4 +„ -+^ a7 NO - DAT t fr m,the Contractor's,License 1-hereby affirm•that I am.exem o •- - - �•� Law for the following treason(Section 7031:5, Business and ADDRESS 17 . - "Professions Code):' PRESENTBUILD -- - PRESE NG i .5 U 2 A y { I, as-owner of-the_ property, or my employees with,. ADDRESS i ® o o-a.6 { wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY �_ I'° 0'4 9'8 8 7044, Business and Profess ions'Code): MOVING TEL. -` -_ = o.o o = 988 �❑ I, as owner of the property,:am,exclusively contracting _ - _ 8 m 8 CONTRACTOR NO. with licensed contractors to'construct the project (Sec- '` ""` " ''"- - - ` 072 7 tion 7044, Business.and Professions,Code). ADDRESS i ' REQUIRED,_ TOTAL.SETBACK.FROM -- ""CONSTRUCTION LENDING AGENCY' SET BACK YARD->-,HWY ' .. PROP:LINE WIDTH, I'hereby affirm that there is a construction lending agency for FRONT_ s the performance of the'work for which-this permit•is-issued - - (Sec. 3097, Civ: C.). SIDE 0 P.L., Lender's Name r o LDMA Ref. # s - P.C. Fee$ _ - _ Permit•Fee _, ! Lender's Address + t t I L.certify'that-1.have.read this.application.„and,state_that..the _ Issuance Fee.'-- -Q- LDMA P/C#•- -- - Y ` Q above information is correct. I agree to comply with all County Investigation Fee ° ` ` ` ? g ,ordiricinces and State- laws relating to building_const'ryction; _9 _._. Total-Fee: - ;+ '`:CDMA Pe w ; . 4 _.88 d 'an hecebyauthorize representatives of this-County to enter ` upon the above-m rationed property for inspection purposes. f 7�1 SIH7 REVERE R 1 SEE 5 FOR EXPLANATORY LANGUAGE Si lure of Applicant•orAgent- . ._ -Date - - ....._. _ ... _ ,.- _.. . _..