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HomeMy Public PortalAbout6002 LOMA AVE_Building__ APPL_ICA`I"ION FOR* BUILDING PERMI"1 FOR AP�PL'ICANT TO FILL IN (Print ortype only) - BUIL ING ,r _ COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER . arr t zip'. ` BUILDING:AND SAFETY DIVISION!-` Q AC' �l 7 �/�c5 e9 O.OF.BLDGS. y BUILDING SIZE OF LOT K'./� F NOW ON t0T'. ADDRESS' 00 TRACT BLOCK _ LO.T NC>. <;_ LOCALITY TEL. REST r .' OWNER e� , .� �, �t�`,CY ...N4aa���-°s�t,F� CROSS;SP ASSESSOR ADDRESS C✓C MAP BOOK PAGE:;' -- PARCEL =CITY; ' ZIP . ''.� � 'DISTRICT GROUP TYPE -FIRE• PROCESSED BY-- ARCHITECT OR TEL .•� i � ,,�� CONS�,�7+• ZONE ENGINEER - G�cy� NCv([� 'C7 J - Y "'' STATISTICAL CLASSIFICATION SEW R MAP' ADDRESS; C`.C� '` �I, 1Cr iiv a ' ,CLASS NO.-� DWELL,UNITS` TEL:. � _ CONTRACTOR•„ NO: USE, ZONE MAP �J LIC. NO. - ADDRESS NO. q� a SPECIAL r. '. "L'IC. .�' CON DITIONSZ' CX�J�. CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES 'Q'. NO CONSTRUCTION,LENDER NAME AND BRANCH - =' ADDRESS CITY' BLDG. �/� 9� FRONT PROP LINE OF (STREET) HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING SQ.FS NO:OF NO:OF CHECK'. FRONT PROP LINE .• HIGHWAY WIDTH SIZE- �t� STORIES FAMILIES ONE w r > DESCRIPTION OF WORK NEW - O fj ` Gl 0 �. r • _ + e �^/ BLDG.SETBACK FR6M ;ffe ADD SIDE PROP.LINE OF. (STREET) O CJS . (J r ALTER- TOTAL SETBACK FROM TYPE OF EXISTING 'w. a�p ;,, , HIGHWAY YARD, z- !� + SIDE PROP.LINE HIGHWAY WIDTH N REPAIR 13 z USE EXISTING BLDG.1DAv,51-"eD•"r �'`✓ DEMOL APPLICANT TEL CORNER CUTOFF. YES NO (P,RINT) IN OPEN SPACE . YES'E) NO 0 BY(SIGNATURE , . . - IN COASTAL PERMIT ZONE YES �. NO VALUATION O O•® o ,! 6 . I HEREBY'ACKNOWLEDGE'THAT-I HAVE READ:THIS•APPLICATION AND STATE THAT THE'ABOVE-IS'CORRECT AND AGREE;TO COMPLY WITH ALL ORDINANCES ANDzLAWS REGULATING'BUILDING CONSTRUCTION:}I;CERTIFY THAT IN`DOING THE "WORK AUTHORIZED'HEREBY I WILL NOT-EMPLOY ANY PERSON-IN VIOLATION OF - •. THELABOR CODE OF THE STATE OF-CALIFORNIA-IN'RELATING"TO WORKMEN'S'COM- PENSATION INSURANCE.�'; •• - y%. ' -- - - - SIGNATUREOF PERMITTEE` T ; ADDRESS FINATEL'. DATE L, / fy/ BY CITY = NO:' MAKE,CHECKS PAYABLE TO"'' t P C $ - PMT . HARVEY T.BRANDT,COUNTY ENGINEER FEE -L�`, FEE PLAN CHECK VALIDATION K M O GASH o PERM`IT� TION CK. M.O. =CASH ®s 76463&A CfIBQ6 70 - ,AP F�'L=1 C;d4T ➢®�-' COUNTY OF LOS ANGELES ` s s F DEPARTMENT OF COUNTY ENGINEER'' ��`� �yr UILDING AND SAFETY'DIVISION s fi � B -BUILDING - FOR;A00L.ICANT TQ.'FILL IN': „`:r,,.lR,. ADDRESS BUILDING ADDRESS •, {,i " t v' ! 'Ci, LOCAMY NEARESTr CITY' �.i •; C Q _, , ZIP, ,i 4,C7_.� CROSSST; r ' " NO'OF BLDGS x i -4} e ASSESSOR SIZE'OF LOT. `.' •O 4,x 1 NOW ON LOT ':� -MAP BOOK PAGE PARCEL . pr^ t Pik T x yx /LL p DISTRICT GROUP 'TYPE FIRE ROC ED BY TRACT J �? BLOCK ;u A CONST l t 7E TEL ' s OWNER 61 m � p r ,NO 6 Jam' j STATISTICAL CLASSIFICATION, SEWER MAP. /✓ 4tiD '/� a ADDRESS :@ D �} r CLASS NO � DWELL LNITS �BK CITY' a ZZIP C b USE ZONE NOAB` O s ARCHITECT OR: STEL.• j ENGINEER NO.' �:/' SPECIAL o t.• k CONDITION y r ADDRESS. . - :,'t. ROAD,DEPARTMENTAPPR6VAL REQUIRED YES O NO Q TEC""' 'F CONTRACTOR, fi NO BLDG.SET ACK'FR M L G B O p• LIC " FRONT PROP LINE OF ISTREET) ADDRESS ANO`- TOTAL SETBACK FROM: TYPE OF EXISTING LL LIC.`. H H FRONTPROP LINE HIG AY WIDTH WAY + YARD 'CLASS .y + _ ^;z ,t �. CONSTRUC.TION LENDER•;' NAME AND BRANCH W BLDG'SETBACK-FROM x , SIDE PROP LINE OF (STREET). ADDRESS CITY. OF SOFT NO_'OF, NOOF CHECK, HIGHWAY+ + YARD = WAv E OTAL SETBACK FROM." TYPE.' XISTING SIZE' 77.,V,( STORIES •.'FAMILIES. '•f ONE b. _= SIDE PROP LINE HIGH WIDTH,-, Z.DESCRIPTION OF WORK ,. o - NEW C,•" �Q ADD ;❑ CORNER CUTOFF YES Q NO Q <`. ALTER ` b IN OPEN SPACE YlES Q NO Q REPAIR - , US6;OF_ s + ° DE/v10C O IN COASTAL PERM) NE YES D NO Q EXISTING BLDG APPLICANT TEL- PRINT) NO. RE). S 'I'•HEREBYy AC KNOWLEDGE THAT I HAVE READ•THIS APPLICATION"AND STATE THAT,THE=ABOVE IS-CORRECT AND:AGREE,TO COMPLY WITH ALL ORDINANCES - AND'LAWSREGULATING"BUILDING CONSTRUCTION.,I CERTIFY;THAT-INIDOING THE ::; y;•: _ WORKvA UTHORI Z ED'HEREBY!I',WILL'NOT IEMP,LOY;ANYPERSON IN VIOL"ATION,OF'': THEL'ABOR CODE OF THE STATE OF CALIFORNIA IN.RELAfING'•TO WORKMEN'S COM - PENS ATION INSURANCE r j SIGNATURE O FINAL <i �� BY PERMITTEE = ADDRESS rt 19j r4.C__ °t e TEL � x.J.GT-` P C..Fee$ " Permit Fee �' J y n _ITYl: �� NO., r iii b, aT Issuance Fee; Totcll Fee 4PLAM CHECK VALIDATION K c ` M o cns R IT VALIDATION; cK M O: CASH F , J 32.0 "-22 ©576A638A CE N803A 64.76