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Home My Public Portal About6417 LOMA AVE_Building__ 76A638,4 CE#803 9-68 _ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING I/ DEPARTMENT OF COUNTY ENGINEER ADDRESS CO7 BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUP T of BUILDING CROSS ST FOR APPLICANT TO FILL IN DISTRICT N GROUP YPE PROCESSED BY CONST (Print ort pe only) .� (' ,_� BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ` CLASS NO. DWELL UNITSto L BK PG LOT NO - BLOCK USE ZONEMAP _ NO TRACT �O _ / SPECIAL NO.OF BLDGS �\ CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. tqtAi,&-ZZ e 0 eL BLDG.SETBACK FROM - /� \ TE FRONT PROP LINE OF (STREET) OWNER )o /V c(3p3 NO '-/ TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL - HIGHWAY ADDRESS A CITY. , � L 7 7 + •�-v ARCHITECT OR / TELBLDG SETBACK FROM - (STREET) ENGINEER L NO 'SIDE PROP.LINE OF - TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS HIGHWAY WIDTH FROM C L 136 CONTRACTOR' /; N T NOL3 8 + C„• CLIC. CORNER CUTOFF YES ❑ NO C ADDRESS -�' SO, Q NO. L CITY CLASS C SEE REVERSE SIDE FOR SPECIAL APPROVALS u CONSTRUCTION LENDER CL NAME AND BRANCH 0 ? ADDRESS SQ FT NO OF NO. OF NEW t ❑ SIZE -B STORIES FAMILIES-/ •USE OF ADD STRUCTURE e2 ALTER ❑ C'a V,,M� S?D -PAIR F] SIGNATURE OF APPLICANT EMOL ❑ ' VALUATIOryN�$`7•qL Q APPROVALS DATE INSPECTOR'S SIGNATURE P.CFEE $ �• !�/ PMT FOUNDATION: LOCATION FEE$ 9-0 FORMS, MATERIALS FRAME: FIRE-STOPS, ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS'APPLICAT ION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE' LOCATION, _ WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STR UC TION_ I CERTIFY THAT IN DOING THE ORK AUTHORIZED - HEREBY I WILL NOT EMPLOY ANY PERSON IN LATION OF THE LATH, INT. LABOR CODE OF THE STATE OF CALIF NIRELATING TO WORKMEN'S COMPENSATION INSURANCE LATH, EXT SIGNATUREOF HOUSE NUMBER.COR- PERMITTE RECT AND POSTED ADDRESS ` 0 FINAL D(p �7 JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER pT�C �10I �T2 M o 2►al Q"?`oz" PERMIT VALIDATION (::cK m. CASH 6-2;5Z, AUG2'7 1 D 9.0 Q" � jw • . CITY OF TEMPLE CITY ' _ 76A638A CE 4803 2-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 61-117 Z 0A4,4 BUILDING AND SAFETY DIVISION LOCALITY TEMPLE CITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST / WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DIST CT ��OUP TYPE Ur O SE BY FOR APPLICANT TO FILL IN o CON BUILDINGA STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �!4yy � --] ArP CLASS. NO.�L_DWELL. UNITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED ❑ CERTIFICATE: TRACT /Z"� T MAP HIGHWAY NO.OF BLDGS. �7 NO. d a (CIRCLE) STATE MAJOR SECON , LOCAL SIZE OF LOT NOW ON LOT L USE ZONE SPECIAL USE EXISTING NG BLDG. ,�,� CONDITIONS j ]'EL. OWNER �f�®e,. BUILDING EXIST. 7 / SETBACK YARD HWY S EET NAME WIDTH ADDRESS 6Y/7 [„rf Z4 FRONT tARCy ENGI EC TAX FERRELL SIP.DE ENGINEER 12i SIDE P. L. efp ADDRESS GjC t L/qS �L,ci1'1GL4� - p CONTRALTO ,CALIF. POOLS AT- f 0 ADDRESPOUD i-AZjN O DESCRIPTION OF WORK u Lu D_ NEW ADD ALTER REPAIR DEMOLISH z Z SQ. FT. ee,� NO. OF NO. OF "- SIZE a! O S FAMILIES USE OF STRUCTURE STANDARD PTA19 SIGNATURE OF APPLICANT $13,300APPROVALSAPPROVALS DATE INSPECTOR'S GNATURE P.C. PMT. o FOUNDATION: LOCATION _ I s FEE $ e FEE $ FORMS, MATERIALS � -- Z ( 6? , '�,�' ,.• 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- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORK N'S COMPEN A-ION INSU ANCE. LATH. EXT. SIGNATURE HOUSE NUMBER COR- PERMITTEEC _ RECT AND POSTED _ ADDRESS FINAL 1? ? JOHN F. LEWIS. P INCIPAL STRUCTURAL ENGINEER PLAN H CK VALIDATION CK M.O. CASH _ PERMIT VALIDATION 0, M.O. CASH U , _ Ffr��y7 rtp"�p''Fqq� el��J�\ 12� .f , � ��•�{t�p�/Jp(�7�� - ALI fJ t��Cd�1MON'll COIR BU�LD�.NG COUNTY OF COS ANGELES BUILDING AND SAFETY IIL..JJJ WORKER'S COMPENSATION DECLARATION `- ' FOR APPLICANT TO FILL IN:, BUILDING DDRESS ve,a certlflcate of,consent to self Insure„ BUILDING DR SS I hereby affirm that I ha ora certificate of Worker's' Compensation Insurance, ora certified copy thereof(Sec 9800,'Lab C) ' "? CITY .. '/•t -ZIP LOCALITY , E Policy Nom'?a`q`�(, t, ICompany y SIZE OF LOT NO OF BLDGS NOW ON°LOT 14 'rifled copy Is hereby furnished - _' - NEAREST CROSS ST - - -• - ' i ' ❑ Certified copy is flTRACT BLOCK' LOT NOed,with the,county building inspection USE•ZONE MAP NO' Date-77 Appllcant. ASSESSOR MAP BOOK- -• -PAGE— - '=- PARCELdepartment , 'SPECIAL'CONDITIONS CERTIFICATE OF EXEMPTION FROM WOOL S;1 OWNER- TEL NO COMPENSATION INSURANCE WITHIN'1000 FT OF SCHOOL? YES NO' ADDRES (This section need'ot be completed If the permit is for one hundred DISTRICT GROUP TY CONST FIRE ZONE PRO CESSED'BY dollars ($1'00)or less a - ., . , CITY - -... -- -- ZIP / I certify tKat In.the perfo mance of the-work,for vdhich this permit �1 Is,Issued I shall not em oy a y'person m any manner'so as to J s ARCHITECT OR ENGINEER .•'.- TSL NO -• - become subject to the W k`rs'Cbmpensation Laws _ STATISTICAL CLASSIFICATION - APT CONDO ` Date Appllca t ADDRESS -- CLASS NO a, - DWELL UNITS ) NOTICE. TO. APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM ]'EXISTExemption, 'you should become Subject ' to the` Workers'. CONTRA TOR• TEL NO SET BACK YARD HWY. PROP LINE DTHCompensation provisions of,the Labor,Code, you must,forthwith %77 FRONTcomply-with such,provisions or this permit shall be deemed revoked ADDRE IC N P LLICENSED CONTRACTORS DECLARATION � SIDE1. CITY� r LI LA /�` P L , I hereby affirm that I am licensed underprovisions of Chapter 9, l (commencing with Section 7000)of,Division.3 of the Business and SO FT SIZE NO OF STORIES _ NO OF FAMILIES SEWER MAP I Professions Code,and my Iicense`Is In full force and effect NEW ❑ 'BK PG - j d License Number LIc Class - DE TION OF WOR -ADD E] VALUA O •7C - Q Contractor Date, ALTER ❑ $ ❑ I am exempt under Sec EPAIR $ 0 B&PC for this reason' "' DEMOL' 'E] U LDMA P/C# Date US OF E STING BLDG - - URM ❑ - L - '( CL Signature APP ICA ( TEL_,NO LDMA Per #x _ g+� _ {}tQ�6 Z ❑ I, as owner'of the property, or'my employees,with wages-as OZ A �E' t e their sole_compensatlon,.w111'd'o the,work and the structure is ADDRESS_ _ ' not Intended or offered for sale (Section 7044, Business and V FINAL DATE Q r Professions Code)• {WILL THE APPLICANT OR FUTURE BUILDING^OCCUPANT HANDLE A.HA_ZARDOUS MATERIAL ✓ O (T(�(y�� MUM OR A MIXTURE COMAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J 11U1J IIIYIiVY�Ty ❑ I, as owner of the property, am exclusively contractrng with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY licensed contractors to construct,the project (Section 7044, ves 1:1 No -•3 V Business and Professions Code) WILL THE I NDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE'BUILDING I OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY ENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES � I hereby affirm that there Is a construction lending agency for YES ❑ N the performance of the work for which,this permit IS Issued(Sec, HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2 20 SECT^S 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS - Lender's Name ALS EP TING AND OOBTAINING A PERMrr FROM THE SCAOMD o Lender's Address" v`� _ OMER OR AGENT o I certify'that I have read this application and state under penalty oPC FEE - -PERMIT FEE - of perjury that the above Information Is correct I agree to comply o with all county ordinances and State lavis relating to building ,I <, construction, and hereby authorize representatives of this County - - ISSUANCE FEE o enter upon the above-mentioned property for inspection purposes � INVESTIGATION FEE TOTAL FEE r _ SQna of APOi,c or Agent ace ' • " SEE REVERSE FOR EXPLANATORY LANGUAGE