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Home My Public Portal About6436 LOMA AVE_Building__ i APPLICATION FOR BUILDING PERMIT FOR'AaPAICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES ADDRESS 4_4/3,L , M A DEPARTMENT OF COUNTY ENGINEER CITY L- t ! ZIP BUILDING AND SAFETY DIVISION jN0.OFBLDGS. BUILDING SIZE OF LOT 7/v/"® ,% NOW ON LOT ? ADDRESS (df TRACT 3 BLOCK LOT NO. (36 LOCALITY \ OWNER Mt2a}�111�� x/217 I'L NO. b 7_3'CLb CROSS ST. i ASSESSOR ADDRESS LL K A- MAP BOOK PA E PARCEL CITY ?tC �L� ZIP DISTRICT p GROUP CONTY EST ZONEFIRE ESSED BY ARCHITECT OR TEL. CJ�J �- ENGINEER NO. STATISTICAL CLASSIFIC��JAAJTT1/ION` SEWER AP ADDRESS p� p CLASS NO. DWELL.UNITS BK PG CONTRACTOR /(� / li NOD 7 `P>� USE ZONE MAP / LIC NO. ADDRESS b Q 2 co �L NO3 SPECIAL CONDITIONS LIC. CITY (�W CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTfON LENDER NAME AND BRANCH BLDG.SETBACK FROM. FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SO.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRIPTION OF WORKR�q�t NEW ❑ + .� O ` U• I ADD ❑ SETBACK FROM SIDE PP.LINE OFF (STREET) O ALTER TOTAL SETBACK FROM TYPE OF EXISTING w d - ►M90 HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH USE OF REPAIR ❑ Z EXISTING BLDG. DEMOL ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE( i .. IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALU YI_ N I HEREY ACKNOWLEDGE THAT I HAVE READ THI APPLICATION AND STATE ,V THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCT( I CERTIFY THAT IN DOING THE _ �. _� WORK AUTHORIZED HEREBY I WILL NOT NY PERSON IN VIOLATION OFA. THE LABOR CODE OF THE STATE CALI I I ELATING TO WORKMEN'S COM- f PENSATION INSURANCE. SIGNATURE OF PERMITTEE ADDRESS 'psco `-' L TEL.�j / FINAL B CITY* LV NO �l0 DATE cs MAKE CHECKS PAYABLE TO: FEE $ FET $ --�--L HARVEY T.BRANDT,COUNTY ENGINEER �� PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION C GKS� M.O. CASH 3 ?"_JUL 7 1 D - 5 5.5 0 ��J ®f 76A63BA CE#803 3-75 7BA638A CE#80311-57 APPL.I-CATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING /l ADDRESS (p V*L G� 14 VIC DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST y CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRI T NO. IGROUP .TYPE SEWER MAP FOR APPLICANT TO FILL IN B PG �( . CONST.BUILDING A/ ADDRESS !C�43!c� LomA' A is STATISTICAL,CLASSIFICAT[ON CLASS.NO-6—DWELL. UNITS III LOT NO. BLOCK - MAP STATE YES O TRACT t 6f'3�� NUMBER 2d a HWY. ,q USE ZONE SPECIAL - SIZE OF LOT &4C" X I NO.OF BLDGS. �� CONDITIONS NOW ON LOT ��oo _ USE OF Qhs NIIEKG� �. UF+TC.i�D I:AR. u.B0U EXISTING BLDG. BUILDING EXIST. SETBACK E. L WIDTH a YARD HWY STREET NAME OWNER �o. &ep A• E yL' FRONT / AMAILDDRESS `►� �1--A/AA F `•i P.L: 2� Cfy,, PC SIDE TEL. P.L. CITY rEa'1P ��T NoiDT ® INSPECTION RECORD ARCHITECT OR TEL. ENGINEER" NO. ADDRESS' TEL. ' CONTRACTOR C✓ ry � NO. /.- ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH L. " SO. FT. cc P NO.OF NO.OF i r - 2P6P�Mjr? .XU%�'xez'-! SIZE �G "� STORIES FAMILIES 1 �/ U OF STRUCTURE / d .� 0%01 Yo SIGNATURE O APPROVALS, APPLICANT ` Cy� 6, DATE INSPECTOR'S SIGNATURE ADDRESS 6 G FOUNDATION: LOCATION - _FORMS,MATERIALS $ P.C. $ FRAME: FIRE STOPS. 2- p' /� f / . L/ FEE BRACING.BOLTS `� -S p /. �"hy�/j,�.7"ti,,, vALUATIOIV $ FURNACE: LOCATION. /- -61 /�7 `vaL( �/� 1 FEE �� GAS VENT.DUCTS l J ( �j -f/ 1 LATH,INT. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- /2/J 3t& ark- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND pry STATE LAWS REG LAYING BUILDI G CON R CTION. LATH.EXT. � `llt f F,T.�-;.i.f t✓e.-y:��. SIGNA URE OF HOUSE NUMBER COR- P RECT AND POSTED ADDR S FINAL i CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. AS PERMIT VALIDATION CK. M.O. CASH LACo51 7 '1 °; SEP 24. 1 A . 13.50 � ®' 1 7 1 78A898A DOS-3 APPLICATION FOR -BUILDING PER-MIT 11.55. DIVISION OF BUILDING AND SAFETY Bu1LDING // J� ADDRESS C!J :J",- Z' Ad,c,, Department of County Engineer County. of Los Angeles- LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN. SUPT OF BUILDING CROSS ST. DISTRICT NO. OUP SEWER MAP TYPE_ FADDRESS OR APPLICANT TO FILL IN CONST �K PG MAP : STATE YES O' ft , HWY ls' — NUMBER �j i BLOCK U EZONE SPECIAL jj CONDITIONS / _ NO.OF BLDGS. BUILDING EXISTT - I NOW ON LOT YARD HWY STREET NAME SETBACK - WIDTH USE OF EXISTING BLDG. FP. L. OWNER 4 SIDE MAIL /,��• ADDRESS(O 101YIR O TRACT DWELL. 1 UNIT /% TEL 5 INDUSTRIAL / CITY X / / NO. 1 DWELL. 1 UNIT 6 PUBLIC BLDG. ARCHITECT OR - TEL. 2 DUPLEX 2 UNITS ENGINEER NO. 7 ADDN.,ALT.. ETC. 3 APT. UNITS 8 MISCEL. ADDRESS 4 COMMERCIAL, may! /.��• E`• INSPECTION RECORD .CONTRACTOR • r. & NO. ADDRESS- v - DESCRIPTION OF WORK NEW ADD ALTER .REPAIR DEMOLISH SQ. FT. NO. OF NO. OF. SIZE oO STORIES FAMILIES USE OF STRUCTU /,.0 � s SIGNATURE OF APPLICANT APPROVALS ADDRESS- DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION d $ pS � [FEE .C. $ FORMS. MATERIALS ! ` ,) FRAME: FIRE STOPS. VALUATION $ L'TZBRACING• BOLTS EE � — FURNACE: LOCATION, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS - GAS VENT. DUCTS APPLICATION AND STATE THAT T BOVE IS CORRECT -AND AGREE TO COMPLY W HAL C UNTY ORDINANCES LATH, INT. AND STATE LAWS IN ILDIN�a CONSTRUC- TION. LATH. EXT: SIGNATURE OF HOUSE NUMBER COR- - PERMITTEE RECT AND POSTEDj OVA ,( ADDRESS FINAL Z` 3, ` 'Z07Md ,11 JOHN A.LAMBIE. COUNTY ENGINEER VALIDATWA CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR CK MO CASH 2 9'7 8*'°. DEC. 4 1 2.0:0 P WORKERS' COMPENSATION DECLARATION. .hereby affirm That I have a certificate of consent to self AFPLICATIO* N F Q R BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certifi&d o t r sec. 3800, La C. p I WC;N 9�y °�d7 ��}' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company (P !! BUILDING ❑y/ Certified copy is he furnished. FOR-APPLICANT/Tp FILL IN ADDRESS � � �• L7 Certified copy is filed with the,cou building i spec- BUILDING do dep riment. ADDRESS (p Y OC 7,074 17k «(!�+-�-- CITY Q s'►1 �� ` 6 ZIP �'� LOCALITY C l N Date �y y A licant �� PF NO. OF BLDGS. NEAREST CE IFICATE OF EXEMP N.FROM WORKERS' SIZE OF LOT / ' NOW ON LOT CROSS ST. COMPENSAT INSURANCE { � ( � ASSESSOR (This section need,not be ompleted if the permit is for one TRACT I--I u!a BLOCK OTS MAP'BOOK PAGE( PARCEL V� hundred dollars ($100) or less.) t EL: ' OWNER ,9 e,- Iew J /L USE ZONE. MAP 1 certify that in.the performance of the work'for.which this NO. SPECIAL > permit is issued, I shall not employ any person in anymanner ADDRESS " �y1 CONDITIONS CL 0 so as to become subject to the Workers=.Compensation Laws. U CITY IF Date Applicant ARCHITECT OR TEL W PP . DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE.TO APPLICANT: If, after making this Certificate of ENGINEER .�r c� /tiL� a�aNO. CONST: ZONE Exemption, you should become subject to :.the Workers' L-��% w Compensation provisions of the Labor Code, you must forth- ADDRESS d Lrs2-z�- N with comply with such provisions or this permit shall be TEL!l,%1 YJ STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR c c�N S !`C' 10'LNO. yy�'7,2'1 — LICENSED CONTRACTORS DECLARATION r G LIC. p CLASS NO:oV� DWELL. UNITS I hereby affirm that l am licensed under'provisi0ns of Chapter 9 ADDRESS dl ! /�S � /7 NO. 7(OY�3�' SEWER MAP (commencing with.Section 7000)of Division 3 of the Business LIC and Professions Code,and my license is in full force effect. CITY /,-(,R ldr— CLASS BK PG. VALIDATION SQ..FT NO. OF NO:OF ' CHECK License Number Lic. Class SIZE' STORIES FAMILIES / ONE i/ VALUATION �;,C` y` bate DESCRIPTIO WORK NEW ❑ / �y 0 Contractor cis VG !vc f ' p S-' � $ 1�I Q ADD ►❑I am exempt under Sec. f _ t ALTER ❑ , B.&P.C. for This reason; REPAIR ❑ a USE OF. ate: EXISTING BLDG. 151L4 f V1 DEMOL - L APPLICANT TEL. Signature s FINAL (PRINT). 0 e/�10 NO. `iS��'7z NER-BUILDER DECLARATION DATE I hereby of that I am exempt from the Contractor's License "' 41° Law for following reason (Section 7031.5, Business and ADDRESS ve rani .d FINAL Professi ns Code): PRESENT BY ❑ .of the ro ert BUILDING i..t E I, as owner p ji y,.,or my employees with ADDRESS �'''�'° °� wages as their sole compensation,will do the work and s j 3( PP' ii' the structure is not intended or offered for sale(Section LOCALITY °..: 7044, Business and Professions Code.) MOVING. TEL. t T �- CONTRACTOR NO. - = # -` ❑ I, as owner of the property, am exclusively.contracting I 083 with licensed contractors to construct:the project,(Sec- E i FL 'fi- 3+ ice, ADDRESS tion 7044, Business and Professions Code.) -.- REQUIRED TOTAL SETBACK FROM EXIST. f.. -K 74 e CONSTRUCTION LENDING AGENCY SETBACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FIRON' CHANGE ;he performance of the work for which this permit is issued L. `(Sec. 3097, Civ. C.). DE L. _ Lender's Name E ti 100 LDMA Ref. # Lender's Address Fee$ Permit Fee L 1:' t 1 certify that I have read this application and state that the Issuance Fee J LDMA PSC#. Pilo 8 above information is correct.)agree to comply.with all County Investigation Fee P d ordinances State laws relating to building construction; Total Fee (p/ D c/ LDMA Perm. # a and here b uthorize rept sentatives of this County to enter up - en ion d property for inspectiorn rpos �' +G "^\ : 1! Gr/L! / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent