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HomeMy Public PortalAbout6111 LOMA AVE_Building__ ' PI ©s 76A638A CE'{803(REV.6/78) rt APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS UtAnLOCALITY NEAREST CITY �� �` ZIP CROSS ST. ,,// .�/. NO. F BLDGS. ASSESSOR SIZE OF LOT X.0 2J,NO ON LOT MAP BOOK PAGE I PARCEL s DISTRICT G TYP FIRE ROCES ED BY TRACTS BLOCK'. L BL ZS 7 C ST.. ZONE TEL (/ OWNER NO. `d STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO—3/ DWELL.UNITS.--] BK CITY �. ZIP ARCHIT17CT OR TEL. VALUATION $� ENGINEER NO. �Ltt)(\� I - i ADDRESS BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) CONTRACTO 1 NO. O HIGHWAY + YARD, = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. LIC. + CITY 1 CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER SIDE PROP.LINE OF (STREET) NAME AND BRANCH HIGHWAY + YARD = TOTAL SETBACK FROM' TYPE OF EXISTING t ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SO.FTLJ SNO T6 OF NO.OF CHECK + = u SIZE STORIES FAMILIES ONE cc a DESCRIPTION OF WORK NEW P.C. Fee$ J• J A6 Permit Fee c- ADD ❑ Issuance Fee g ALTER REPAIR ❑ Total Fee USE OF EXISTING BLDG. DEMOL ❑ -C� Z APPLICANT TEL 2 3'33 S 5 A (PRINT) NO. 5 zl--7,k # o-o o o 21 BY(SIGNATURE) / Q IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ]L 2 O O 45,3 6 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES 4 S 3 6 U AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE O V O O WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF - THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z PENSATIONI SU RANCE. g o 3,2 1 / 9 SIGNATURE F C 3 3 S 6 A PERMITTEE A # o 0 0 0 0 ADDRESS TEL. 0 2 o-o 8800 CITY NO, Q USE ZONE NOP �cCJa�' 03288.79 / J SPECIAL / CONDITIONS By of DATE,r/,2�5/� ,77 / J f ' DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS*ANGELES B U ' L 1 WM. J. FOX. CHIEF ENGINEER I FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. y PERM IT/NO. I ADDRESS" / CY 1 / *Z,7 / LOCALITY RECEIVED BY DATE OF APPL. �yDATE 19tfAlUiDD C"EA EST Ross BT. f4'.1=/ L A,& I BUILDING OWNER �. -¢-'�..(y[�.l' IL61P/t.. �i�.• /s+�lr/" ADDRESSMAIL ADDRESS D J /L.(/ 1�.. /'�.-G( G+'fitLOCALITYNEAREA �e TEL1 C'ROSS9T - CITY -�F'a' [�C�`• NO.' � ��s-��� CR0898T. OR" FIRE NO.OF TYPE GROUP ARCHITECT OR - TEL. ZONE-!5'0 PLANS, ENGINEER NO. �� ORD. ,pdd��9NO. 14 ADDRESS SETBACK LINE APPROVED CONTRACTOR TEL. BY DATE USE APPROVED ADDRESS ZONE /0/ BY DATE LEGAL CORRECTIONS i ���Q�. CORRECTIONS DESCRIPTION LOT NO. BtOC.K_ ,/ cam✓ / �^ TRACT �® +I-' t" "� ",;/" W/3. --/ / / ;e -NO.OF SLOG SIZE OF LOT 4 '� '. �� ♦ �I NOW ON LOTS USE OF NO.OF - NO.OF EXISTING BLDG. .Q FAMILIES ROOMS DESCRIPTION OF WORK _ -2-o NEW ALTERATION ADDITION /{�/ �'•t� ////o///,,,fid} ,-g O _ REPAIR �y MOVING DEMOLISH 1/130) _ A6_lldnloo_ SIZE T. ®C./ R OMS STORIES f-�/ .�ND 13F r �_ D - �� r WALL ROOF COVERING I C 0 V E R I N G j-/' OtiL USE OF ,,/�,��.—•'� ,�/ ,ice ' /r .,� /,yew BUILDING /4,.,��-'cam (Y- yV' A���1 r�6� �"' �® a y y94 luf �iErty I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS. APPROVALS L APPLICATION AND STATE THAT THE ABOVE IS CORRECTINSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOFUORMSTMATER NDA ALS LOCATION �� W 3 AND STATE LAWS REGULATING BUILDING CONSTRUCTION. / FRAME: FIRE STOPS. 6._ ,ro ln„ SIGNATURE OF / �. Q/f_ V BRACING,BOLTS "tel PERMITTEE / I -�"_t G IA�C�('•J,'d'`� f/ LATH, INT. {! AUTHORIZED AST ` LATH, EXT. 76A639A-3 7-49 $ P.C.$ �fA PLASTER, INT. FEE, ® CFaP° PLASTER,EXT. VALUATIONL/•�®, Ld -2- 1 6 D FINAL 3 4v ✓�t.fc FEE , r APPLICATION FOR COUNcTY OF kS ANGELES DEPARTMENT OF COUNTY ENGINEER. BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING &/) ) � Z-oni v� FOR APPLICANT TO FILL IN ADDRESS BUILDINGE LOCALITY G(�- C17 NEAREST ADDRESS �Q (� CITY ZIP 1' CROSS ST. A �8 4-AD • NO.OF BLOGS. ASSESSOR •- ,SIZE OF LOT NOW ON LOT MAP BOOK PAGE P L - o DISTRICT GROUP TYPE FIRE O SS O BY A f CONST ZONE TRACT BL�CR —� LOT NO. TEL. '" OWNER NO. STATISTICAL CLASSIFICATION WER MAP ADDRESS CLASS NO DWELL,UNITS L�BK7-12pG USE ZONE MAP �v CITY ZIP ,,,,g NO. ARCHITECT O TEL. /yA'lJ� SPECIAL ENGINEER NO. „�F - CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED- YES❑ NOpq CONTRACTOR VIV� t ESA LNEOL -5�. BLDG.SETBACK FROM - QQ��''`` LIC. FRONT PROP.LINE OF (STREET) ADDRES C /a"JOVE NO. _ TOTAL SETBACK FROM TYPE OF -EXISTING HIGHWAY } YARD - LIC. FRONT PRO LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER + 9 a NAME AND BRANCH A16AIIE' BLDG.SETBACK FROM ADDRESS CITY SI DE PROP.LINE OF (STREET) SQ. FT. NO. OF NO. OF CHECK HIGHWAY } YARD - OTAL SET CK FROM TYPE OF EXISTING d-' SIZE STORIES FAMILIES ONE SIDE OP. LINE HIGHWAY WIDTH f�+�' DESCRIPTION OF WORK VE- NEW., ❑ } H y , j�9 r ADD ❑ CORNER CUTOFF YES ❑ NO ❑ N W 1�. � ALTER ' � LL6a'��� ',. REPAIR❑ IN OPEN SPACE YES ❑ NO ❑ EUSE OF XISTING BLD�� DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ APPLICANT TEL {�/ (PRINT) NO. d � LOIN 1.�, BY (SIGNATURE) = ',. ? t, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �V WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. 1 CERTIFY THATIN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE v LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO 1 WORKMEN'S COMPENSATION INSURANC IY SIGNATURE OF a rry �QJ FINAL � �, X BY PERMITTEE `` ,/wa��� DATE I (/ ADDRESS , D J / UE TE CITY e /w,-a l.(T)� NOL�a"'�33 1 P•C. Fee$ Permit Fee Issuance Fee VALUATION$ T I Total Fee PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. CASH 7 6 4 t-FEB 22 1 D 1 2..0 0 c u 76A638A C9*8038 12/75 / J . .. 1 LJ 76A638A CE0803 B-64 APPLICATION FOR BU ILDI G PERMI COUNTY OF LOS ANGELES . .BUILDING ` u� DEPARTMENT OF COUNTY ENGINEER ADOREss BUILDING AND SAFETY DIVISION L 0 C A L I T r JOHN A. LAMBIE. COUNTY EN GINGER NEAREST i f COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. DISTRICT NO� G TYPE FOR APPLICANT TO FILL IN CONS . BUILDINGp�/,. STATISTICAL SSIFICATION SEWER MAP . ADDRESS ^' f I �® y V' i CLASS NO. DWELL UNITSO . BK PG -' LOT NO. p( /Q�' USE ZON MAP -2 TRACT �� SPECIAL l �/ NO. OF BLDOS. CONDITIONS SIZE OF LOT /2.J g/( 43 NOW ON LOT USE OF W 1__ 1 7 �p, _ EXISTING BLDG. ,�, (G*,/�L-L�..--T /�! BLDG. SETBACK FROM , O R� S�s I� i LL JJ7 C:NOL FRONT PROP. LINE OF (STREET) / TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS / // ,i 4 o �+ �. GHWAY WIDTH 'F_ROM C.L. CITY L-- 1..i I �.7 ® + �V O /f - - ARCHITECT OR EL. BLDG. SETBACK FROM /C ENGINEER NO. SIDE PROP. LINE OF .(STREET) _ TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS r HIGHWAY WIDTH FROM C.L. a CONTRACTOR 0viAiE�Z NOL. + - O ADDRESSS ,wE A5 BoY{LNO CORNER CUTOFF YES NO 0 CITY CLASSSEE REVERSE SIDE FOR SPECIAL APPROVALS u W DESCRIPTION OF WORK CL NEW ADD /� ALTER REPAIR DEMOLISH - SQ.FT. �"1 J NO. OF % NO. OF 44 SIZE ro / STORIES l FAMILIES USE OF-- I STRUCTURE 1•� Gr- SIGNATURE OF APPLICANT' ./''V✓vW' /� V ALUATAON� C 3e2� • APPROVALS DATE INSPECTOR'S SIGNATURE P.C. S� P,MT. pZJ FOUNDATION, LOCATION r��— FEE FEE$� ! FORMS, MATERIALS $ i 6T '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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9U ILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK 1 AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. /"/� •-� X19 r�-'�' TION OF THE LABOR CODC OF THE Sf). OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATJON INNCE. LATH. EXT. ell USIGNATRE OFHOUSE NUMBER CO.R- PE,RMITTEE RE.CT AND POSTED ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL STRUCTURAL E jA PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. C Lnuo 9 7. 8 5� FEB 18 2 3 D 1 4..;,CASH,._ � Lh�u. 7 8' 6`� FEB 18 1 D 2 9.0 0- a .1 _. APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUIL/DING A DRESS or a certificate of Workers' Compensation Insurance,or a certified 4 I PL �' L o M vE- copy thereof(Sec.3800,Lab.C.) CITY MP�+�• �� ZIP / LOCALITY - Policy No. - Company SIZE OF LOT / NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. X J Z� I/Z NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT �,.•� BLOCK LOT N.Q.' department.. /1PWR .2-57 USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL - SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. _ COMPENSATION INSURANCE C ) CSS 2�G� 5 35 7 WITHIN 1000 FT OF SCHOOL? Y No (This section need not be completed if the permit is for one hundred ADDR S A \f dollars($100) or less.) DISTRICT GROUP T CO FIR E PROCESSED BY ZIP CITY s I certify that in the performance of the work for which this permit is issued, I shall not employ any person in.any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CL SIF ATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor. Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS.DECLARATION SIDE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 17 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. . NEW BK PG , a DESCRI TION OF WORK ADD ❑ VALUATION Q License Number Lia.Class E /2 Or QUS� �O� p-ri V Contractor Date _ n ALTER ❑ � /5 S URRCS �V.�tSc 1� REPAIR ❑ 0 ❑ I am exempt.under Sec. a l _ _ $ V BAP.C.for this reason �p SHAW L 1-006 D ,.SW1106 LE DEMOL ❑ ILDMA P/C# W Date: USE OF EXISTING BLDG/1 URM ❑ y Signature APPLICANT(PRINT) TEL NO. LDMA Perm# z I, as owner of the property, or m employees with wages as fi /.� Y. Y 9 p fiL•L•s a a heir sole compensation, will do the work and the structure is ADDRESS i-- not intended or offered for sale (Section 7044, Business and FINAL DATE Q _i?^ i•sk:,Li_t Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 1_� J TT OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct.the project (Section 7044, r'` 3 Business and Professions Code.) YES El NO❑ i:t i^1r 0., 3 - 05 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING nl L� 3.05{'p OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH c"'V �j"� vi{ •'•. L CONSTRUCTION LENDING AGENCY COAST AIR QUAJTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR /// GUIDELINES. f_ ANG'... I hereby affirm that there is a construction lending agency for YES❑ NO❑ / a the performance of the work for which this permit is issued(Sec. rn (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) 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 HAZARDOUSi X 7 'r Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. `I _II � ;�0 oi ;�r0 Lender's Address f••>> t -It �'tu' � OWNER OR AGENT • oI certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE with all. county ordinances and State laws relating to building m const tion, and here authorize representatives of this County ISSUANCE FEE i o � t o r pun the abo entio property for inspectio purp9ses. (p ` y u�,w I JJ j 3/ INVESTIGATION FEETOTAL FEE ,Siamre of Aoph—t o.Age o- SEE REVERSE FOR EXPLANATORY LANGUAGE