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HomeMy Public PortalAbout6224 LOMA AVE_Building__ /per (/,�®Tp\� yp�( ^q r 76A638A CE#803 2-63 /-\PPLI•C 1 ■ IOC V` OO, `, ✓UI L:DI NG PERMIT ' COUNTY OF• LOS ANGELES BUILDING DEPARTMENT OF .COUNTY'ENGINEER ADDRESS BUILDING-AND:SAFETY..DIVISION` LOCALITY JOHN A: LAMB[E,,gOUNTY ENGINEER' NEAREST / ? WILLIAM A JENSEN, SUPT OF BUILDING + CROSS ST' �j--T" _ _ �j)/r✓ c - DISTR�T NO •GROUP TYPE PROC_ B FOR APPLICANT TO FILL IN CON �/(///� BUlILDI NG `��z - - STATI ICAL CLASSIFICATION. ., SEWER MAP-1 • ':'' '•ADDRESS "'Z -�QQ' �- --�' _ K P ,CLASS NO, DWELL UNITS '' LOT NO _ �j f° " BLOCK WATER `• CERTIFICATE '•^.NOT REQUIRED p RECEIVED ❑a TRACT ,�/ _ F '�' MAP' HIGHWAY STATE MAJOR SECOND, CAL , " NO OF BLDGS , NO _ (CIRCL'E)- - . SIZE OF,LOT • NOW ON LOT USE ZONE SPECIAL, w , USE OF _ _ - - CONDITIONS _ 'EXISTING•BLDG > OWNERir,- ' — 77 TEL e ,NO' _ BUILDINGEXIST •� _ ,{ SETBACK 'YARD HWY ST EET NAME WIDTH ADDRESS �'y' L�®YNh`..: ;.0• n FRONT ARCH,ITECT•OR EL ..`,., P L 1- ENGINEER - Y- -NO - SIDE - ADDRESS:- r• r , •,9 O CONTRACTOR e, •ems-• A• NO _ i r A1DOR ESS _ — �•, •� C•l O,` ' DESCRIPTION OF, WO K. w CL, .NEW, ,'DD ALTER': 'REPAIR DEMOLISH r, , +'IT _ •` • Z SQ. FT _ - - ..NO OF 'NO OF 4- - •'�`' SIZE K STORIESv_ FAMI-LIES .USE OF• - - _ +STRUCTURE ' APPLICANT' VALUATION $ n . '`-'Y", �. . • - -t,= '-' APPROVALS DATE INSPECTOR'S SIGNATURE PC / r MT• FOUNDATION,LOCATION ' FE ••l _ EE FORMS, MATERIALS - c FRAME FIRE STOPS, ,• �,> -' _ '� 'I HEREBY ACKNOWLEDGE THA_T''I HAVE,READ THIS'APPLICATION '+ BRACING, BOLTS •I AND;STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY`, RNACE LOCATION WITH ALL COUNTY ORDINANCES AND, STATE LAWS REGULATING '.'G AS,VENT DUCTS 'BUILDING CONSTRUCTION 11 CERTIFY THAT IN•DOING THE,WORK- - - - - , C AUTHORIZED HEREBY (:.WILL NOT•EMPLOY ANY PERSON I VIOLA= ' - TION OFlTHE'LABOR'CODE OF'THE STATE OF CALI OF; -RELAT= LATH,-INT ING TO,WORK MENS COMPE TI SURA _ -• _I ,;LATH, EXT 'SIGNATURE OF HOUSE NUMBER COR- _ •' - -PERMITTEE �•• ,RECT:4ND'POSTED_ ADDRESS �"`— �'�~ FINAL' JOHN F LEWIS PRINCIPAL ST URAL ENGINEER' PLAN CHECK VALIDATION CK M O SASH' _sPERMIT VALIDATION CK M O CASH 4;•-.�,C' fah i'+ I :�' r V� �'3 .0 1O'er ` GEC 21 D y TEMPLE CITY 7/AG98A CQ#Bos 1- 1 APP Lk,-�kTtl V N R BUILDING PERMIT RM � '~• ' COUNTY OF LOS ANGELES B U I EISNsADO "2_ MA CS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY 7 ,C JOHN A. LAMBIE, COUNTY ENGINEER NEAREST j O WILLIAM A. JENSEN 8UP'T OF BUILDING CROSS ST. L 'V DISTRICT N GROUP TYPE P CE BY .FOR APPLICANT TO FILL IN � 9+ CONST. BUILDING yyq )� STATISTICAL CLASSIFICATION, - ` SEWER�M7P ADDRESS Z^� A�I -FILL'" �' CLASS NO DWELL UNITS / BK / ' LOT NO:TCt4 ' e' +_� OJJ ,BLOCK WATER ' NOT REQUIRED 'RECEIVED I►.. CERTIFICATElw ' IGHWAY TRACT D _ _ NO (Do I(CIRCLE) STATE MAJOR SECOND, LOCAL NO OF BLDGS. �ceC/� SIZE OF LOT ©/V FI L C NOW ON LOT USE ZONE SPECIAL USE OF 0 CONDITIONS EXISTING BLDG -------- TEL OWNER ® S/ t�G' NO. BUILDING EXIST "• ADDRESS �? ZO VK i/"� �� i SETBACK YARD HWY STREET NAME WIDTH FRONT 1-G MA Ch ARCHITECT OR TEL P L /`� l/ ENGINEER NO SIDE P L >- ADDRESS TEL. INSPECTION RECORD - O CONTRACTOREF ^C _NO - U gm ADDRESS 57q 1q 2&'-,7-c !/ >�" O DESCRIPTION OF WO ' W d NEW ADD ALTER REPAIR DEMOLISH H ? T. 7 NO OF NO OF ` IZE STORIES FAMILIES ' USE OF o STRUCTURE !�rT e eQ1 SIGNATURE OF APPLICANT VALUATION$ '`f - APPROVALS DATE INSPECTOOS SIGNATURE _ Q r PMT. FOUNDATION LOCATION /,,, FEE $�-vf+`� FEE FORMS,MATERIALS % �(t! FRAME FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS APPLICATION BRACING BOLTS _ ,/ I 0 AND STATE THAT THE ABOVE IS CORRECT AND AGREF-TO COMPLY FURNACE- LOCATION, � WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS //'' ll BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- TION OF THE LABOR CODE F THE STATE OF CALIFO NIA ELAT- LATH, INT. INC TO WORKMEN'S CO NSATI ORAN-ELATH,EXT.SIGNATURE OF /`f� HOUSE NUMBER COR-PERMITTE (� RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL S IURAL ENGINEER, PLAN CHECK VALIDATION cK . M.C. CASH PE dVlIT VALIDATION cK M.C. CASH :8 6^'7'4to' AUG 9. 2 3 D 2 8J-50'a jy9:r3{8;-ate_ ,f7_ _ - - - 0 COUNTY OF LOS ANGELES\ BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION > —FOR APPLICANT TO FILL IN BUILDIN ADDRESS ���o 'I Hereby affirm that I have a certificate of consent'to self Insure, BUILDI G_ DR SSS. +� „ �,r _. �'vy`C•. or acertificate of Workers' Compensation Insurance,or.a'certified copy thereof(Sec 3800,Lab C) CITY ✓- zip,, _ . LOCALITY POhcy NO Company [SIZE OF OT O OF B S NOW ON LOT ❑ NEAREST CROSS ST Certified copy Is hereby furnished ❑•Certified copy Is filed with the county building Inspection TRACT BLOCK LOT NO department' • USE ZONE MAP NO Date ,Applicant ASSESSOR MAP BOOK PAGE PARCEL • • - SPECIAL CONDITIONS, OD YES NO CERTIFICATE OF EXEMPTION FROM WORKERS'-- WNE - COMPENSATION INSURANCE - WITHIN I000 FT of scHooL� (This section need not be completed If the permit Is for one hundred ADDRESS DISTRICT GROUP TY CONST FIRE ZONE PROCESSED BY dollars($400)or less) _ - CITY - ZIP I certify that in the performance of the work for which this permit 91 O 5 !pdr- - 3 Is Issued, I'shall not employ any person In any manner so as to become subtect to the Workers'Compensation Law's ARCHI E OR NGINEER ' TEL NO STATISTICAL CLASSIFICATION 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 t0 the Workers' CONT TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provislons,or this permit shall be,deemed revoked ADDR S LIC-NO P L LICENSED CONTRACTORS DECLARATIONSIDE CITY UC CLASS PL I hereby affirm that I am licensed underprovlsions of Chapter 9 SEWER MAP a (commencing with Section 7000)of Division 3 of the Business and SQ F NO OF DRIES NO OF F MILIES pp Professions Code,and my license Is,in full force and effect NEW BK PG c7 License Number Llc Class DES RIPTION. F.WORK 1 ADD ❑ VALUATION n y{/ v�� (1 � o Contractor Date ALTER ❑ $ `� v W ❑ I am exempt under Sec / REPAIR ❑ $ z B&PC for this reason DEMOL ❑ LDMA P/C# Date - USE OF EXISTIN BLDG , URM .`❑ .. Signature, 1 APPLICANT(PRINT) _ TEL NO LDMA Perm# W � I,as owner of the property, or my employees with wages as Z 1°-'_ I their sole compensation, will do the work and the structure Is ADDRESS A 0 t37 L - not Intended or offered for sale (Section 7044, Business and FINAL DATE a -- '' L­ not Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT-HANDLE A HAZARDOUS MATERIALfJ V L!Z `. ,J _ El I, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY F 'L s 5' licensed contractors to construct the project (Section 7044, °t j; L -- -e—' —¢'^' Business and Professions Code) YES 1:1 NO WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING `-„k l :i' '•''•' °-'� _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR �YIeY ,( - :Yi6�t•f-W GUIDELINES "v?�- J 3 f r I hereby affirm that there Is a construction lending agency for YES ElNOIV - N the performance Of the work for WI11Ch this permit IS ISSUed(See IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,Civ G) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY-CODE, _f�t TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS •+ ^ _ Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD �•; i 'Tf _n_I t o Lender's Address O OWNER OR AGENT oI certify that I have read this application and state under penalty o PC FEE PERMIT FEE d of perjury that the above Information Is correct I agree to comply C� N with all county ordinances and State laws relating to budding m construction, a hereby authorize represent twes of thisnty ISSUANCE FEE to upon above-mentioned propert ellen roses INVESTIGATION FEE , TOTAL FEE ' ^ AppI a.or Ap,t Dere SEE REVERSE FOR EXPLANATORY LANGUAGE