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HomeMy Public PortalAbout6032 LOMA AVE_Building__ DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles i WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO., PLAN CK. OR REc.No. PERMIT NO. DDRESS RECEIVED BY DATE�OFAPPL. DATEISSUED LOCALITY NEAREST . CROSS ST.. -F` BUILDING ADDRESS ZovvlOWNERIZ,A, A 11-Z"t,4 llsOW-;-X— MAIL -; LOCALITY ` d_! ADORESNEAREST TFL CROSS BT. CI r NO. FIRE PL S TY I O ARCHITECT OR �j/ ' TEL. ZONE PLANS ROMB ENGINEER / / NO. ,� BLDG. K yy �"'" / d��Y eJ SETBACK LINE �/r•V f `3•' ADDRESS n USE APPROVED TEL ZONE SY' DATE CONTRACTOR NO. HOUSE NUMBERING ADDRE88 MAP NUMBER NO. ASSIGNED BV60PJ 4e DESCRIPTION LOT NO.��� BLOCK LEBAL CORRECTIONS TRACT\tf®llNo. Or BLD13B. SIZE OF LOT (,,®, [j tl� NOW ON LOT - USE OF NO.OF �yf� EXISTINGBLDG.g i I FAM.ILIEB DESCRIPTION OF WORK °� 0 NEW ALTERATION ADDITION Z _ D REPAIR DEMOLITION _ r N 3F S ZE 1Y ROOMB STORIES EXT.WALL I ROOF � CQVERJNO COVERING .,,p /� USE OF STRU URE / L INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION /U ( _ 7 I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FORMS. MATERIALS AA - - PLICATION AND STATE THAT THE INFORMATION GIVEN. IS FRAME: FIRE STOPS, CORRECT. BRACING, BOLTS 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. - GAS VENT,DUCTS SIGNATURE OF :6 LATH, INT. PERMITTEcs/j►� ADDRESS K�i° fd'li't,. fMPs� "`, LATH, EXT. PLASTER, INT. AUTHORIZED AOT. PLASTER, EXT.. COOFEE HOUSE NUMBER COR-RECT AND POSTED VALUATION FEEFINALFINAL 76AS38A DBS 3 1-52 DEPARTMENT OF BUILDING AND SAFETY ' APPLICATION FOR_ PERMIT COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER ^� BIJI L DING FOR APPLICANT TO FILL IN FOR OFFICE USE ,ONLY BUILDING r DISTRICCT.,NO. PLAN{CK. yNO. PERMIT NO.. ADDRESS LOCALITY /�� _�����a� RE EIV D BY. DATE OF APPL. DATE ISSUED ��T ��?`L 9�f' .NEAREST - U � - CROSS ST..I } li BUILDING l, y - OWNfi� '/�G' � /�C.?! I_•�' ADDRESS !t 3L G M A- MAIL / ��� - LOCALITYrl� O ' ADDRESS �j�Lj/ y�.�2'C NEAREST ' TEL. CROSSST. CITY N/ NO. ! •- CV FIRE NO. OF TYPE GROUP ARCHITECT OR TEL ZONE I PLANS �Ij/ I �. ENGINEER f�yi'e> ia•� �z/�',[/C. ONOi�1 91�'�-`/� 7 SBLDG.ETBACK LINE_. Q'��/ d'� ORD. NO. ADDRESS APPROVEDTE CONTRACTORf�,P NO. ®"' :G(J/ BY DATE USE APPROVED ADDRESS �Da3.L� ZONE BY. DATE �J/l�r11 HOUS NUMBERING LEGAL DESCRIPTION. I,LOTNO.N . I BLOCK `.MAP NUMBERDo IELD CHECK BY - TRACT NO. ,ASSIGNED BY DATE i �� y� I SIO. OF BLDGS. CORRECTIONS SIZE OF LOT /1 _ NOW ON LOT - USE OF - NO. OF - EXISTING BLDG. I FAMJLlg'S � DESCRIPTCON OF WORE 6f NEW I I ALTERATION I I ADDITION IL 4- > s-z. /'. - /�t/ ! ./l Ale, O REPAIR `I I DEMOLITION I I I - _ /�`- N A S0. FT. �Q NO. OF /l� . /r F [� I✓F /X /�.PNCEf D SIZE �a ROOMS STORIFSr, / r/�Q _M �/7G�.�/�.r 7!� C����J��> EXT. WALL ROOF COVERING G+ GU I COVERING ����,�" USE OF STRUCTURE Q •,/, APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-` FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS .CORRECT.. .. _ 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS 6 LAWS REGULATING BUILDING CONSTRUCTION. - - - .FURNACE: LOCATION, SIGNATURE OF, /}��/��'�"��J /��y „� �', GAS VENT, DUCTS - PERMITTEF"'"`�j'�" .%+�- mac-+v���/'-%'''%u' ,J�✓��' Ad , LATH, INT. DDR988 AUTHORIZED AGT. LATH, EXT. .i w - PLASTER, INT. / 7CA638A, 0092 to-so //f,�"� P. C. $ �° © UU -FEE ®--�"- PLASTER, EXT. VALUATION - $ ' FEE FINAL 76A6�38A SCE #803 12!69 a APPLICATION FOR BUILDIN PERMI "COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ,f /°� Gj JOHN A. LAMBI E, COUNTY ENGINEER ADDRESS (Q(� e /CJ COLEMAN W. JENKINS, SUPT OF BUILDING !�� LOCALITY $L FOR APPLICANT TO FILL IN NEAREST Print or type onl CROSS ST, DISTRICT NO. I GR ZUP TYPE ROC SED BY BUILDINGc .0 7^ CONST ADDRESS r -� 31L— STATISTICAL CLASSIFICATION SEWER MAP- LOT NO. A BLOCK CLASS NO. Z/ DWELL,UNITS TRACT C)/V USE ZONE MAP �} NO.OF BLDGS. NO. SIZE OF LOT ��/� NOW ON LOT y J SPECIAL USE OF / CONDITIONS EXISTING BLDG. TEL. OWNER 1 NO, BLDG.SETBACK FROM ADDRESS FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH FROM C.L. ARCHITECT OR. TEL. + _ ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CONTRACTOR NO, HIGHWAY WIDTH FROM C,L. _ ADDRESS LIC. +NO. ' LIC. C CITY CLASS CORNER CUTOFF YES NO CONSTRUCTION LENDER i NAME AND BRANCH ' ,� Q. SEE'REVERSE SIDE FOR SP CI AP ROVALS LL ADDRESS SQ. FT, NO. OF NO. OF Z 76 SIZE STORIES FAMILIES NEW ❑ USE OF ADD STRUCTURE ALTER ❑ REPAIR[] SIGNATURE OF APPLICANT //�� DEMOL ❑ VALUATION $ ,00 OU APPROVALS DATF, INsPE,�roR's IG ATURE P.C. PMT. ZS FOUNDATION; LOCATION 0 FEES G�j 2; 5 FEE$ K FORMS, MATERIALS FRAME. FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION` BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE' LOCATION, WITH ALLORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION, i CERTIFY THAT IN DOING THE WORK AUTHORIZED , HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE _ LATH, INT. O 7(p LABOR CODE OF THE STATE OF 'CALIFORNIA IN RELATING TO WORKMEN'S COMP A ION INSURA E. /E� _ LATH, EXT. SIGNATURE OF(/ HOUSE NUMBER COR- o -PERMITTEE RECT AND,POSTED �y,, 7 ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION -..K. M.O. CASH 6 ;6:1 9'R:. SEP 4-,2 3 D 2 2.9 5 A, ' a . !' 6.:6,.4.6:R SEP . 8 1 D 3 8.2 5— Q WORKERS COMPENSATION DECLARATION I hereby affirm that I have a Certificate of consent to'self - APPLIC ,insure, or a certificate of Workers' Compensation Insurance, ATION FO ..•BIJILDII\IG, PERMIT Pr a c No.'-Cb,ed copy thereof (Sec. 3800, Lab.;C.)'. NG`AN E ympany aCOUNTY OF O A • NGELES � : BUILDING � D SAFETY ❑ 'Certified copv.is hereby furnishBUILDING- ed. FOR APPLICANT TO FILLIN •ADDRES Certified copy is filed with,the county building inspec- BUILDING �/ _ =^3ion department. ADDRESS..b /yp �.1/�': LOCALITY NEAREST Date A licant CITY r&�"I//U C a i ZIP - CROSS ST. pp • ' L CERTIFICATE.OF EXEMRTION'FROM WORKERS' ' i NO.:OF BLDGS. ASSESSOR COMPENSATION INSURANCE MAP h,s secT,on;need notbe cam feted if the permit'is for one SIZE OF LOT BLOCK _ NOW ON L OT NO. UEP O OK' PAGE PARCEL'hundred dollars`($100).or less ) TRACT �.'I,certify'that ,n-the performance of.the work for.wh,chthis OWEl. SPECIAL, NERNO. �- R­�i- T CONDITIONS fRI.0YP C► "permit is issued, I shall not employ any persomin any manner _ e' . /,.MP� AVE-; DIS so as t'o become'subject to the.Workers'Compensation Laws. ADDRES a yL/ /�/ a . CONST. �PED�1• -,� _ ZIP C► CITY G..//, ti. Date Applicant C STATISTICAL LA IFI TION APT CONDO.= NOTICE TO. APPLICANT: 1f,•after=making this Certificate of ARCHITECT OR TEL.. -,Z-- Exemption,,.you ,should become subject to'the .Workers'' ENGINEER NO. CLASS NO. DWELL. UNITS ' C Compensation provisions of the,Labor Code you must forth ADDRESS SEWER MAP with .comply'with such provisions,or this permit shall be, TEL � ''� deemed revoked. CONTRACTOR NO BK PG, / / VALIDATION 'LICENSED CONTRACTORS DECLARATION' - LIC I hereby affirm that Lam licensed underpro vision's-of Chapter 9.. ADDRESS NO. V LUATION (commencing with Section 7000)'of Division 3,of the Bus,ness'and UC. =Prafessibns Code, and:my.license,is ,n full force and effect',. CITY - - -CLASS - SQ.•FI NO. OF NO.OF `CHECK License Number' Lic.Class SIZE 2 STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK �' NEW ADD. D. .❑ �� 1 am eliempt under,Sec ALTER FINALr�t` /_ B.&P.C. for this reason ��A !�' REPAIR ❑ DATE „ . USE OF Date EXISTING BLDG.. DEMOL ❑ APPLICANT U TEL. FINAL Signature PRINT OWNER-BU ILDER°DECLARATION .- •, cA a) I hereby affirm that I am exempt.from the Contractors License Law.for The following,reason•'(Section 7031.5, Business;and, ADDRE Professions Code): PRESENT . BUILDING I, as owner of the property, or.my•employees with ADDRESS wages as their,sole com,pensaTion;w,ll'do the work and - :• • ,. LOCALITY J the structure isnot_intended or offered for sale(Section 7044, Business and Professions Code) MOVING /�- TEL.. ❑ '1, as owner of the,property, am,exclus,velycontracting CONTRACTOR,. NO. with licensed contractoes'to construct The project (Sec- tion 7044, Business and Professions'Code): _ (� •� 0:(�A ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY --SET PROP.'LINE WIDTH o'® l YARD HWY I hereby affirm that thereis a construction;lending'agency for' FRONT $' 010 0 The performance of:the work for whjch'.`thjs permit is issued P.L. (( '•Sec, 3097 Civ:.C.:. SIDE c ) X9,88 Pac: 04 0,0 4 9,8 8 Name o Lendera. + { P C Fee$ Permit Fee _ �,y�'� Lender's Address R I certify,that I have read this application and state that the Issuance fee above information is correct.'I agree to comply with,all County Investigat,onrFee g ordinances and Stare 1aws,reI ting To.buiId' g construction, Total Fee `.u' and hereby authorize representatives'of,thi ounty'to enter upon th boye-mentioned pr cgpn purposes a h SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date