The URL can be used to link to this page

Home My Public Portal About5936 LOMA AVE_Building__ 76A636A CE #803 1/71 - / .Y 0 - APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER , MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS' COLEMAN W. JENKINS, .SUP'T OF,BUILDING 1 CL ..I .... - - .LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or tyoe only) CROSS ST. BUILDING - - - - DIS ICT NO. OUP TYPE- _ RO ADDRESS c Q� . ] _T_ ICONST.// STATISTICAL CLASSIFICATION —�' SEWER MAP. LOT NO. BLOCK CLASS NO.—n—DWELL.UNITS BKE PG 9' TRACT. B USE ZONE MAP NO.OF BLOGS: •• r� NO. SIZE OF LOT NOWON LOT SPECIAL USE OF - CONDITIONS ' EXISTING BLDG. - - - TEL... OWNER ''W. E. LEHMAN NO. `BLDG.SETBACK,FROM, ADDRESS 5936 NORTH LOM FRONT PROP.LI NE OF ' _ (STREET) TYPE OF EXISTING SETBACK GHWAY. + YARD, . = TOTAL CITY HIGHWAY WIDTH FROM C ARCHITECT OR - TEL. } — ENGINEER NO. - BLOG•SETB K FROM - - ADDRESS SIDE PRO INEOF (STREET) TEL: p TYPE O XISTING 'SETBACK- HIGHWAY, + YARD = TOTAL d. CONTRACTOR VIRGIN ROOF CO. NO." ZS —Q Q .HIGH Y WIDTH, FROM C.L. - CD U ADDRESS 600 S. SAN BABRIELNO. 160650 + o CITY' ' SAN GABRIEL-. c ASS C-39 CORNER CUTOFF YES ❑ NO ❑ w CONSTRUCTION LENDER n- NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS z ADDRESS - SQ. FT. ' NO.'OF 1 NO. OF NEW ❑ SIZE STORIES FAMILIES L.. - ❑ - USE OFD D - STRUCTURE ' L ALTER ❑ SIGNATURE OF REPAIR'- APPLICANT DEMOL ❑ VALUATION $ 1.430.00 _ APPROVALS - DATE INSPECTOR'S SIGNATURE P.C. PMT. - FOUNDATION:'LOCATION FEE $. FEES 21 � FORMS, MATERIALS ' FRAME: FIRE STOPS, - 1 HEREBY ACKNOWLEDGE THATA HAVE READ THIS APPLICATION.. BRACING, BOLTS ' 'AND 'STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, - WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE I WORK AUTHORIZED - HEREBY 1, WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. - - LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPE.NSATIO INSURANCE. - LATH, EXT.; SIGNATURE OF 'HOUSE-NUMBER COR- - - PERMLTTEE RECT AND POSTED ADDRESS FINAL . . .JOHN F. LEWIS. PRINCIPAL STRUCTURAL-ENGINEER PLAN CHECK VALIDATION CK., M.D. CASH PERMIT VALIDATION I M.O. CASH U A I AT1 N IL IN • PERIOIIIT 1 PPL C ® ® U G COUNTY OF LOS ANGELES .. BUILDING AND SAFETY .WORKER'S COMPENSATION_ DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS' BUILDING ADDRESS I hereby affirm.that I have.a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof c 38 b.C.) �$ LOCALITY Policy NO.—Mi Company ✓�� SIZE OF L T NO.OF BLDGS.NOW ON LOT YECertified copy is hereby furnished. NEAREST CROSS St. ❑ Certe5 0 ified CO is filed with th ount buil ins action TRACT BLOCK LOT NO. y y P US ZONE PIANdepart e14�t.Date DApplicant J/ ' ASSESSOR MAP BOOK PAGE PARCEL ." NDITIONS OWNER // �� CERTIF LATE OF EXEMPTION FROM WORKERS' 11/V YES No COMPENSATION INSURANCE C WITHIN iaoo FT.of scr+oo�� ADDRESS - ' (This section need not be Completed if the permit is for one hundred DISTRICT - GROUP TYPE CONST.' FIRE ZONE OCESS BY dollars($100)or less.) Cm ZIP • _ ot I certify that in the performance of the k for whi Is permit IS issued, I shall.not employ any pars imian�YYn er so as to .ARCHITECT OR EN INEER - TEL.NO. becomes bje to the Workers'Comp SatiO S. STATISTICAL CLASSIFICATION APT CONDO Date J7 �� Applicant wsv yJ ADDRESS CLASS NO. DWELL UNITS NOTI E O APPLICANT. If; after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST - Exemption, OU Should CONT ACTOR T L.NO.become subject t0 the Workers' � � SET BACK YARD HWY PROP LINE WIDTH_ Compensation provisions of the Labor Code, you must forthwith I �� h�''�G �,1)_ �`�b FRONT comply with such provisions or this permit shall be deemed'revoked. ADDRE S F LIC.NO PL � 6� SIDE d LICENSED CONTRACTORS DECLARATION CI / LIC.CJ,AsS PL CL I hereby affirm that I am licensed under provisions of Chapter 9 .� f( SEN/ER MAP S NO.OF STORES NO.OF FAMILIES (commencing with Section 7000)of Division 3 of the Business and y/ NEW ❑ BK � PGCD Professions Code,.and.m license's in full force and effect. V ' ('' DESCRIPTION OF WORKADD ❑ VALUATION pop. �. License Number �' Lic.Class L./� Contractor A' d Date ' 7-1 Fa ALTER ❑ Z ❑ I am exempt under Sec. REPAIR ❑ BARO'.for this reason DEMOL LDMA PIC# USE OF EXISTING BLDG. Date: URM. Signature A LICANT(PR \T) TEL.NO. ,A LDMA Perm# Z ``s�j ❑ I, as owner of.the property, or my employees with wages as r►w C n�� i4 L O y their sole compensation,will do the work and the structure is ESS, 1 not intended or offered for sale (Section 7044, Business and �' Si >?t ' �C^d FINAL DATE O, Q AX P Professions Code.) G Ham•'•-1 °g WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE AHAZARDOUS MATERIAL" J ❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B .1c licensed contractors to construct the project.(Section 7044, YES❑ NO❑ 'ic i 'Business and Professions Code.) - ' WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING ff _ 'OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH FOR GUIDELINES. 00 / g�I 1 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST 1J1\ t ;HL • l..I E " I hereby affirm that there is a construction lending agency for YES❑ NO❑ y�i 2FC-K the performance of the work for which this permit Is issued(Sec. I HAVE READ THE HAZARDOUS,T.IUNDERSTANRIA Y INFORMATIONREQUIREMENT GUIDE AND THE ANGELES' [I�(�NGE .00 3097,CIV.C.). � - _ PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES' � - �. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTINGAND FOR OBTAININGA PERMIT FROM THE SCAOMD.. '. . .._._.:....... Lender's Address t 'I'00-0001 —.119n OWNER OR AGENT ...- J J7b:i o' I certify that I have read this application and state that the above - information is correct. I agree to comply with all. county P.C.FEE, PERMIT FEE.. D 96'22 1 H4;1�iQy; ordinan an State I relating to building construction,and here Uthorize rep ntatives of this County to a ter upon ISSUANCE FEE the ove-men' n erty for inspection purpos 1310 111 L v INVESTIGATION FEE TOTAL FEE s�r6 re of Auwmdn w Mmf- l SEE REVERSE FOR EXPLANATORY LANGUAGE: WORKERS' COMPENSATION,DECLARATION - • �I hereby offirm'Ahat Ir have a'certificdte of consent"to self • :nsuie, or a certificate,,of Workers Compensotion;Jnsurance; ' .- APPLICATION' F O.R. BUILDING:-.. PERMIT br a certified copy thereof (Sec: 3800, Lab C. COUNTY'OF LOS ANGELES BUILDING AND SAFETY Policy No. ' Company BUILDING ❑ Certified copy.is*hereby,furniihecl... FOR APPLICANT"TO FILL,IN ADDREss. 011 16 , ❑ Certified co is filed with the count buildin ins ec BUILDING �j. �p)'t� PY y g P ADDRESS: tion department. Date Applicant CITY'. wVf' L C'G• ,iP NO. OF'BLDGSNEAREST :; i _ LOCALITY CERTIFICATE OF EXEMPTION'FROM WORKERS' , . SIZE OF.L'OT -*/.Gi '4 � ., '';7NOW ON LOT p �, 1. CROSSST. L COMPENSATION'INSU RANCE' ASSESSOR ' (This section need not be completed if the permit'is for one.'. TRACT BLOCK'• } " LOT NO. !' MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) f- /_.TEL y1 . ?[ ,� OWNER CSS"4 tCi �J"®/tf(I Np ZfJ.:: i i/.✓QS USE ONE OP I certify that in,the performance rof-the work for which this // Permit is Issued; I shallnot employ any person in any manner ADDRESS v L ,I '� SPECIAL. , CONDITIONS' so as to become subject to the Workers'Compensation Laws. CITY } ZIP ; Date Applicant_ ARCHITECT OR' TEL p ` ENGINEER I(� �y6f�� r✓f ✓�- yt1 Vq_I S DISTRICT GROUP TYPE FIRE PROCESSED BY' NOTICE TO APPLICANT: ,If, after-making.this Certificate of �� N 1_ / CONST. ZONE Exemption„ you.should become: subject.to the Workers' f ,Compensation provisions of the Labor Code,.you must.forth- ADDRESS 2 r� L�tti)!v / � �� `3 Y a with,comply•with such provisions or. this permit .-shall 'be - n r��' TEL. r STATISTICAL CLASSIFICATION AP CONDO. N deemed revoked. CONTRACTOR 19, 2W12 6- NO. -- / Z ' LICENSED,CONTRACTORS DECLARATION" LIC. CLASS NO. . " DWELL. UNITS I hereby affirm that I am licensed under proVisioris,of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC.. SEWER,MAP. ,,{,.i _ 6E b�0 and Professions Code,and my license is in full force and-effect. CITY CLASS BK. PG. OT}VALIDATION License Number `[ 'Lic. Class' ORIIEES' F MILLIIES ONEK , SQ. FT.' NO c _ 33017, SIZE 3. Contractor Date DESCRIP I DF W ^ NEW o VALUATI0 ❑I am exempt under Sec.' LRC` �J p ADD ❑ E<- B:&P.C. for this reason REPAIR l DD`s,.v `�iJ-f j,:�. " Date: USE 01`.: q7 EXISTING BLDG. 'DEMOL,❑ I t EM.-�. APPLICANT-•� TEL. �i I Si nature PRINT ��C y /��i/•//(Jl NO: d"�t� O•'•1 j FINAL _/ ��j 3 � g OWNER-BUILDER DECLARATION (PRINT), l DATE ;�lTf I hereby affirm that I am exempt from the Contractors License _ �. ;1CHE K G?,'"�. Law for the following reason (Section 7031.5; Business and ADDRESS �'t 6J ff�ZC.n 50/J �i M_ FINAL/ t1 3 Professions Code): PRESENT. �. By '.HANG LIQ!! BUILDI� ❑ I, as owner of.=the property, or my employees with ADDRESS wages as their sole compensation,will do the work-and, t }. LOCALITY f uL the structure is not intended or"offered for sale(Section" s .. !ljl �l-WJ�l1 �; 7044, Business and Professions Code.) - MOVING ti TEL: `1{{ i AM _ Z" CONTRACTOR NO. , S ? F t 1. . ; l 6640 1. A I 9 p 33 I, as ownerof the',property,.am exclusively contracting 1 " with,licensed contractors,to construct-the project- ADDRESS tion 7044, Business and Professions Code_) REQUIRED' YARD+' HWY TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY... SET BACK. PROP. LINE WIDTH •"_ I hereby affirm that there is a construction lending agency for .FRONT j � ;j;,1�/ 161 the performance of the.work for'which.thjs permit'is'issued P:1:. (Sec. 3097, Civ. C.).. T SIDE: .rt ` �,,_� ti�a $ +,tl '1ITEMS _ Lender's Name. /VO�G - in r J 't t �,1 i t iOIii 1 6 �•®9:2 P.L: iF LD �} m k•PEL f S° P.C. $ s Permit Fee �' ,, 3 .• Lender's Address i� ,� I certif that I.have read this a lication and state that the fi `''�0, Issuance Fee 3. 0 (e,/ ~ LDMA P/C q above nformation.is correct. I agree to comply with-all County nvesHgatiori Fee $ nn ordinances and'State laws relating to building construction, Total�Fee a LDMA Perm. q a and hereby authorize representatives ofthis County:to enter �y r { r = upon the Bove-mentio d property for inspection pur oyes. F 7 Y;•3' r-! 19`-lLt -o! l�11 . �1j 'Ej'` !'I a t rat CS7 ,_�,t �t�.� ° SEE REVERSE FOR EXPLANATORY LANGUAGE °O ° '�� f Mlii 7°-k%° .':a ,—, r , r t r.. Signature of App i ant or AdAt , Date