The URL can be used to link to this page

Home My Public Portal About6235 LOMA AVE_Building__ 7uA636A DBS-3 12.54 ' APPLICATION FOR. BUILDING PERMIT 1 DIVISION OF'BUILDING AND SAFETY BUILDING Department of County Engineer ADDRESS County of Los Angeles LOCALITY 1 WM. J. FOX, COUNTY ENGINEER NEAREST J /� �y� /1 I'f CASSATT D. GRIFFIN,Sup•7 of BUILDING CROSS ST. ! �" /(i a v/� DISTRICTNO. GROUP SEWER -MAP FOR APPLICANT TO FILL IN "4— I I TYPE BK PG BUILDING. CONST. ADDRESS MAP cj �.O t•Z STATE HWY `r NUMBER ./` (J +7 LOT NO. BLOCK USE ZONE SPECIAL - CONDITIONS TRACT .. - 9 NO. OF BLDGS. SIZE OF LOT GL z�� _. .I NOW ON LOT 7c— BUILDING DING YARD HWY STREET NAME EXIST. USE OF SETBACK WIDTH EXISTING BLDG. FRONT OWNER SIDE P. L. MAIL ADDRESS TEL. I D.WZLL. I UNIT 5 INDUSTRIAL CITY , N . _ - - - - 2 DUPLEX—UNIT- 6 PUBLIC BLDG. ARCHITECT - TEL. - - ENGINEER NO. ------ ^ 3 APT. UNITS 7- ADDN.,A�LT.,ETC.._ - - ADDRESS - - 4 COMMERCIAL - 8 MISCEL}`�4L` TEL. CONTRACTOR NO. INSPEC'T'ION RECORD ADDRESS DESCRIPTION OF.WORK NEW y ADD ALTER REPAIR .DEMOLISH SO. FT. NO. OF NO. OF SIZE STORIES FAMILIES - - USEO STRU SIG ATURE OF - APPLICANT APPROVALS ADDRESS DATE INSPECTOR'S SIGNATURE FOUNDATION:.LOCATION P.C.-S FORMS, MATERIALS FEE FRAME: FIRE STOPS. /V v it VALUATION E BRACING, BOLTS FEE IF a FURNACE: LOCATION. , GAS VENT, DUCTS - 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT - AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH, EXT. SIGNATURE OF _ 1 HOUSE NUMBER COR PERMITTEE - _RECT AND POSTED - ADDRESS— FINAL' ,�7' �`� �''�PL•��✓ 1 - . VVM. J: FOX, Cou rT,r Er"t+alNEr>A ATIOIoT BY - BY /� /'� DEPUYY�,(� .1 L i.�C�s t+nn 14 1 1 .00 R) DEPUTY . BY .. j(� By ® DEPUTY DEPUTY I • APPLICATION FOR ,BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY I WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILG ADDRESS I I hereby affirm that I have a certificate of consent to self insure, GUILE C I ��i� �3� �✓Zn/ �� . ( or a certificate of Workers' Compensation Insurance,or a certified 1 copy thereof (Sec.3800,Lab.C.) �Y 0 .�' C-rry ZI 7?(:) LOCALITY Policy No. Company SIZE OF LOT - NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ell ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOUSE department. - `� USE ZONE MAP NO. Date Applicant ASSES O AP OK PAGE 9 1 PARCEL CE SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER. N COMPENSATION INSURANCE VA,00(L rc-oris O WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) I certify that in the performance of the work for which this permit CITY I T1 1 Z is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become s bj t to the Workers'Compensation Laws. s� STATISTICAL CLASSIFICATION APT CONDO Date Applicant ��-rLS5 �if/� O 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' CONTCTOR S L NO,�� ` SET BACK YARD HWY PROP LINE WIDTH — Compensation Compensation provisions of the Labor Code, you must forthwith !G� S 7/ FRONT comply with such provisions or this permit shall be deemed revoked. ADD ES LIC.NO. PL 7y LICENSED CONTRACTORS DECLARATION S��YS�� yLI ZZ SIDE CITY ` , LIC. LASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 / u � ' 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 an�effect. �� NEW ❑ BK PG , D- Cl gyp DESCRIPTION OF WORK VALUATION License Nu ber Lic.Class ADD 0 Contractor VA,1J L+ Date ALTER ❑ $ cc 12,o9fl-10 W,-- OSc/&, REPAIR El El am exempt under Sec. $ V BAP.C.for this reason (/ �(pZ p DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ Signature APPCANT PRINT) T L LDMA Perm# r-` Z El 1, as owner of the property, or my employees with wages as c�-�`�u� � 7/7 � their sole compensation, will do the work and the structure is A KESS r not intended or offered for sale (Section 7044, Business and �� S I1��/Y !/�! CrL,l�r/ /I FIN ATE Q .::�I. :J:=,• .`_I Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL j OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE s El I, a5 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, ves El NO[I :t•1 =.a Business and Professions Code.) _ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING Y-1M OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ---- CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. s 1 S`?Fp I hereby affirm that there is a construction lending agency for YES❑ NO❑ N the performance of the work for which this permit is issued(Sec. f_E { � O I 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, „�33 ##� TITLE 2,CHAPTER 2.20 SECTIONS 2,20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS C H-1 :•K s_ Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. o Lender's Address A� 3,r- - EL '•t IS'is9i',L OWNER OR AGENT O 0 1 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.FEEj�, PERMIT FEE C� sem....j , with all county ordinances and State laws relating to building rL) [,lII_�l _ construction, and hereby authorize representatives of this County ISSUANCE FEE �� .f, y_. to r upon a�b e- ne property for ins ti pu oses. 0 r`f= f -a AN a ^`/hep INVESTIGATION FEE TOTAL FEE n ✓ W //2, A” s�re�� t i SEE REVERSE FOR EXPLANATORY LANGUAGE