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HomeMy Public PortalAbout6403 LOMA AVE_Building__ _ � F t8A888A CE}t808.9-6c1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILRDING �� DEPARTMENT OF COUNTY ENGINEER ADOESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE• COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT G O TY R S BY FOR APPLICANT TO FILL INCID o CO ST, � BUILDING /' �' / ��� � STATISTICALCLASSIFICATION SE ER MAP. ADDRESS Cy L 0 I K' ©PG CLASS. NO. ``'l� DWELL,L. UNITS LOT NO: .� BLOCK MAP . STAT NUMBER V Q ✓ HWYE YES NO . TRACT USEZONE SPECIAL NO.OF BLDGS. ' CONDITIONS SIZE OF LOT I NOW ON LOT USE OF EXISTING BLDG. BUILDING EXIST. YARD HWY STREET NAME - TEL. SETBACK WIDTH OWNER � /� 1. �/Q'(,.6 NO. FRONT / /I / P, L. ADDRESS �/G N• Lasmo`\ SIDE it /� / �y ARCHITECT O TEL. P. L. (O G° ENGINEER ./.� �/� , �O L_4- / .i�NO. INSPECTION REC RD 'ADDRESS / ? i '• f° .r d a TEL. L I .fi{�'•P 1!'+" �.�1s,;.`'^ '-i!n .^fV_>As �4� O CONTRACTOR 4f ?� $i A4_ /-00 t-NO. U ADDRESS �S�(J�f /L7� ieo, a791 /'J-� 0 O DESCRIPTION OF WORK U�. W a ' NEW K'ADD ALTER REPAIR DEMOLISH h SQ.FT. a /' NO.OF NO.OF SIZE STORIES FAMILIESUSE OF , STIR UT URE -S,4,//-I, �`oco 4.- fix 3-y� SIGNATURE OF APPLICANT- VALUATION PPLICANT VALUATION$ —3 �y� FOUNAPPROVALS DATE INSPECTOR'S SIGNATURE FP C.EE FEE $ / �'Q DATION: LOCATIONS al FORMS, MATERIAL ..-. 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 BUILDING CONSTRUCT ION. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR. WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH, INT. EMPLOY ANY PERON IN ANYMANNERSO AS TO BECOME SUBUECT TO THE WORKMEN'S COMPENSATION AWS F CALIFORNIA. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE 0 RECT AND POSTED �f ADDRESS FINAL `d CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGIN ER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH ._I8 0 7 2 iU?152 -7D 6.0 0 - �``: / 76A 638A CE#803 9-67 p ' .APPLFCA�1"lON FOR BUILDI . G PERMI/J- COUNTY OF:LOS ANGELES BUILDING Azn DEPARTMENT OF. COUNTY ENGINEER ADDRESS LTJ BUILDING AND SAFETY DIVISION LocA41TY JOHN A. LAMBIE, COUNTY. ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. �i DISTRICT N ROUP F'E E -B FOR APPLICANT TO FILL IN �'�1 - CONS (Print or type only) BUILDING /�,/ STATISTICAL"C AS IFICATION SEWER MAP ADDRESS 3 ©�-l.� CLASS NO. DWELL.UNITS B PG LOT NO. BLOCK USE ZONE MAP NO. TRACT SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT NOW ON�LOT USE OF /� EXISTING BLDG; .. l,r IQ BLDG.SETBACK FROM //''jj TEL. - FRONT PROP.LI NE OF (STREET). OWNER! (2 , (j�� NO. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESSHWAY WIDTH FROM C.L. } CITY pL/S A1,0 /ii A1, ARCHITECT OR TEL. SI KFROM (STREET) SDE PROP.LI F ENGINEER NO. .TYPE OF EXISTING SETS HIGHWAY } YARD .= TOTAL ADDRESS -/ HIGHWAY WIDTH FROM C.L. CONTRACTORtZ/,0 OL O z S�. ADDRES65ololC�/v s NO CORNER CUTOFF YES ❑ U CITY AI G6e-L A- k1 CLIC* SEE REVERSE SIDE FOR SPECIAL APPROVAL DESCRIPTION OF WORK NEW ADD> ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF P SIZE - STORIES FAMILIES USE OF Q STRUCTURE G RIO v 'D D SIGNATURE OF APPLICANT VALUATION $ r " APPROVALS DATE INSPECTOR'S SIGNATURE P.C. V � PMT. FOUNDATION: LOCATION FEE$ - FEE $ FORMS, MATERIALS 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 BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. LATH�/INT. ING TO WORKMEN'S COM ENSATION INSUR CE. � LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE- - RECT AND POSTED ADDRESS `v �_ 21 1 rG FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH, _ PERMIT VALIDATION CK. M.O. CASH U� y7 2a JN 7 1 D 0:^ WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION FOR • BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified'copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING // ❑ CertifiecJ copy is hereby furnished. FOR APPLICANT�TO FILL IN ADDRESS Ca 4 3 ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS (� �/G,j /'✓ �LOh'1 vep CITY y ZIP p LOCALITY �. Date Applicant NO. OF BLDGS. t NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 'SIZE OF'LOT O X O NOW ON LOT" / CROSS ST. } COMPENSATION INSURANCE ASSESSOR (This section need not be'completed if the.permit is for one TRACT' BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) ✓ TEL O> d cv USE ZONE' rN P OWNER �eCu(C aAW ,J OeL NO.�® /-04 k .I certify that in the'performance of the work for which this. / CIALpermit is issued, I shall not employ any person in any manner ADDRESS p X7( d�f/� �VPi NDITIONS d so as To become subject to the ers'Compe ation Laws. /' 1 � O S/I�C �O� CITY �e�' � l: %T ZIP �, Date Applicant ARCHITECT OR TEL DISTRIC GROUP- TYPE FIRE PROCESSED BY NOTICE TO APPLICANT:'If, aft .making this Certificate of ENGINEER NO. / CONST. ZONE Exempption, you should be a.subject. to The Workers' • j r LU Com ensgtion provisions of The Labor Code, you mush forth- ADDRESS v ) W with comply with such.provisions.or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. 1 CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with.Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,.and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number' Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ ❑I am exempt under Sec. CA/Py" !�L 1?cp a%2 ADD ❑ ► ALTER ❑ B.&P.C. for this reason Ove 'l� a e REPAIR E Date:. . USE OF / 75' 00 EXISTING BLDG. DEMOL ❑ Signature, APPLICANT TEL FINAL /° OWNER-BUILDER DECLARATION (PRINT). NO.' _ DATE ' I hereby affirm That I am exempt from the Contractor's License Law for The following_reason (Section 7031.5, Business and ADDRESS FINAL 1 Professions-Code): PRESENT ByBU LDING 1 ❑ I, as owner of the property, or my employees with ADDRESS AULT wages as their sole compensation,will do the work and .-+ O the structure is not intended or offered for sale(Section LOCALITY , I�7I 7044, Business and Professions Code.) MOVING- TEL. ! T LEJ I, as owner of the property, CONTRACTOR NO. I I`� / p p y, am exclusively contracting T qAi with licensed contractors-to construct the project (Sec- ADDRESS 'f ° f) int 28 50 tion 7044, Business and Professions Code:) REQUIRED CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL ROP SETBACK FRO" EXIST. z, �� Ve�U I hereby affirm that There is a construction lending agency for FRONT HAKE .00 the performance of the work_for which this'permit is-issued P.LF (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name. t3_'tW,_1JM1 5/f6!8 � LDMA Ref: # P. Fee$ Permit Fee Lender's Address 3 1 PM12:00 I certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating To building construction, Total Fee LDMA Perm. # a and hereby authorize-representatives of this County to-enter up a above-me ' ned property/ r inspection p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date