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HomeMy Public PortalAbout10781 BLACKLEY ST_Building__ 76AG38A DOS-3 12.54 - - APPLICATION FOR% BUIL DING PERMIT - ,:,0- ERIVI.I -, `DIVISION OF BUILDING AND SAFETY BUILDING ADDRESS V •� / / F DC7 L�/1/ �/j L,� y Department--of County Engineer County of Los Angeles LOCALITY a- - WM.J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN; SUPT OF BUILDING NEAREST CROSS ST. DISTRICT NO. TYPE OUP SEWER MAP FOR APPLICANT TO FILL 'IN -� , - - I CONST. y {:= BUILDING T7 ADDRESS / ,MAP )) ��yy ,�-/'� STATE NUMBER /i, �+_� e - HWY LOT NO. B OCK USE ZONE SPECIAL - /��/� CONDITIONS ,TRACT . • - of NO.OF BLDGS. SIZE OF LOT 10 Ifo I NOW ON LOT BUILDING YARD HWY STREET NAME - EXIST. USE OF r SETBACK WIDTH EXISTING BLDG. ,&S/V PNS • FRONT !t J - �• P. L. .e7 �' a FI OWNER / L(�/� - SIDE - - MAIL ADDRESS - TEL. V DWELL. I UNIT 5 INDUSTRIAL CITY NO. ' - 1;1. - 2 DUPLEX_UNIT 6 PUBLIC BLDG'- ARCHIT CT OR IF - TEL. _ ENGINEER No. 3 APT. UNITS ADDN.,ALT., ETC. ADDRESS - 4 COMMERCIAL 8 - MISCEL. ' CONTRACTOR CJ/,�/���� TEL n 749 No. 0— ADDRESS / INSPECON RECORD � �{��� TI�� DESCRIPTION-OF WORK NEW ALTER REPAIR DEMOLISH so,'FT. /Q NO OF / NO. OF _ SIZE pts S- STORIES -1 'FAMILIES - - USE OF STRU U ;]/A/ SIGNATURE OF APPROVALS APPLICANT c ADDRESS pI /..lj"fi J. DATE - INSPECTOR'S SIGNATURE FOUNDATION: LOCATION'' 00 P. C. S FORMS, MATERIALS INJGd i FRAME: FIRE STOPS, FEE $ •BRACING, BOLTS _0Z� )M/�Alw VALUATION �l e _ FEE- '" y FURNACE: LOCATION, �,.. GAS VENT, DUCTS - • 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THISLI APPLICATION AND STATE THAT THE ABOVE IS CORRECT -AND AGREE TO COMPLY WITH -ALL COUNTY ORDINANCES LATH, INT.AND TION.STATE LAWS REGULATING BUILDING CO TRUC- LATH, EXT. lope, "` "` SIGNATURE OF HOUSE NUMBER COR-, PERMITTEE RECT AND POSTED ' ADDRESS FINAL WM. J. FOX. COUNTY ENGINEER VALIDATION - - -BY CO 7, 6 3 C• SEP 7 1 4.00 L� • DEPUTY, I •- DEPUTY BY BY © _ DEPUTY - - .DEPUTY APPLICATION FOR BUILDING PERMIT COUNTY OF'LOS-ANGELES BUILDING AND SAFETY WORKER-S COMPENSATION DECLARATION FOR APPLICANT TP FILL IN BUILDINGKE AD SS (y4 I hereby affirm that I have a certificate of consent to self insure, BUIL NIV - p 7�� �— or a certificate of Workers' Compensation Insurance,or a certified C /� ZIP copy thereof (Sec 3800,Lab C) /`/ LOCA TTY ' Policy No. Company STZE OF T NO OF BLDGS NOW ON LOT ❑ Certified'copy Is hereby furnished NEAREST CROSS SIr ❑ Certified copy Is filed with the county my building Inspection TRACT BLOCK LOT NO department USE ZONE MAP NO ASSESSOR MAP BOOK PAGE PARCEL Date Applicant . SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' QW E COMPENSATION INSURANCE �v w Y d'1 T WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed If the permit Is for one hundred ADDR SS DISTRICT GROUP TYPOST ST FIRE ZONE PROCESSED BY dollars ($100) or less) I certify that In the performance of the work for which this permit CITY ZIP IS Issued, I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL NO' become subject to the Workers'Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant- ADDRESS CLASS NO ---21 DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate Of I REQUIRED TOTAL SETBACK FROM * EXIST � Exemption, you Should become subject to the Workers' Aon ^ T )� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be.deemed revoked ADD ES P IL LICENSED CONTRACTORS DECLARATION / S SIDE GI lJ� LIC S� PL I hereby, affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of'the Business and SQ NO OF-SjORIES NO rMILIES Professions Code,and my license Is In full force and effect A NEW ❑ BK PG , a License Number Llc.Class DESCR JJQN O � ADD ❑ VALUATION � Q Contractor DateJP7 J? El (J' ALTER $ ❑ I am exempt under SEC REPAIR $ 0 BAP.C.for this reason DEMOL ❑ LDMA P/C# W Date USE OF EXISTING BLD URM ❑ CO Signature A T(PRI T) _ TEL NO LDMA Perm# _ 1 " Z _ n M ❑ 1, as owner of the property, or my employees with wages as A ESS d' N O ACCT JI sole compensation,'will do the work and the structure is �^�•I not Intended or offered for sale (Section 7044, Business and FINAL D TE Q 3M 158.$ PfOfeSSIOr1S Code) WILL,THE APPUCANT,OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ' ❑ I, as owner of the property, am exclusively contracting with AMOUNTS B SPECT IED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FIN ycyM licensed contractors to construct the project (Section 7044, Business and Professions Code) VES EJ No WILL THE INTE DED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there Is a construction lending agency for YES❑ tRAND N the performance of_the work for which this permit Is Issued(Sec IHAVE READUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097, CIV C) CHECKLIST MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, N TITLE 2,CHCTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS - Lender's Name MATERIALS FOR OBTAINING A PERMIT FROM THE SCAQMD o Lender's Address t 0 OWNER OR A NT , _ o I certify that I have read this application and state under penalty ` 0 of perjury that the lbove Information Is correct I agree to comply PC FEE PERMIT FEE j�✓ N' with all county Inances and State laws relating to building construction, an reby authorize representatives of thI C_ y ISSUANCE FEE '30 ID to enter upon the ve ntioned property for Inspec r INVESTIGATION FEE TOTAL FEE/" D O� - I Sgnature of Apphoo •r A n Date SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT - COUNTY OF LOS ANGELES BUILDING AND SAFETY- WORKER'S COMPENSATION DECLARATION FOR,APPLICANT'TO FILL IN BUILDING AnDDRESScyp I hereby affirm that I.have a certificate of consent to self Insure, BUILDINGb ADDRES A C 2V 7,a '' or a certificate of Workers' Compensation Insurance, o a certified 7! copy•thereof Sec Lab CITY ZIP LOCALITY �/� 'CI Policy No Company W SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certifled'bopy i8 hereby furnished NEAREST CROSSST ❑ Certified copy,is filed with the county building Inspection TRACT BLOCK LOT NO department' USE ZONE _MAP NO ASSESSOR MAP BOOK PAGE PARCEL Date Applicant - SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O�WNE �?Cc TEL NO YES NO # COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for orie hundred ADDRESS 'a 7 S/ �'� �c p DISTRICT GROUP TYY�PENST FIRE ZONE PROCESSED BY dollars ($100) or less) C . CITY ZIP 1 certify that in the performance of"the work for which this permit �� Is Issued, I Shall not employ any person In any manner so as t0 !JsAR HITECT R ENGINEER TEL NO become subject to the Workers'Compensation Laws %STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO o 2 DWELL UNITS NOTICE TO' APPLICANT. - If, after making -this Certificate of REQUIRED TOTAL SETBACK FROM EXIST ; Exemption, you should become subject to the Workers' CONTRACTOEL NO p - SET BACK ,YARD HWY - PROP LINE WIDTH Compensation-provisions of the Labor Code, you must forthwith �vt �p D�w �e 1 J FRONT comply with such provisions or this permit shall be deemed revoked ADDRE S ,�// L yQ� ` P L LICENSED CONTRACTORS DECLARATION 1 S3 l/A p L r�1 PILE 5 a CIT � � %� LIC�ASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 ' ~ SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZI I NO OF STORIES NO OF FAMILIES Professions Code,and my license Is In full force and effect VV 6AJ i(/ NEW 1:1 BK PG a License Number J 6 Ic Class DESC IPTI .11OF WO K i DD . VALUATION , - O Contractor ate g�2 �i9X o eS�- ALTER ❑ $ 9, V ❑ I-am exempt under Sec d REPAIR El $ 0 B&PC for this reason DEMOL ❑ U LDMA P/C# W Date. USE OF EXISTING BLDG URM O 1 a- co Signature APPLICANT(PRINT) TEL NO LDMA Perm# - - "' Z El 1, ACCT.*'I, as owner of the property, or my employees with wages as' - their sole compensation, will do the work and the structure Is ADDRESS 00 3 209.25 not Intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 'L - J 1' ITEMS . ❑ 1, as Owner of the property, am exclusive) contracting With ORA MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE TOTAL 209_25 y, Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES 'FINAL BY ,7 licensed contractors t0 construct the project (Section 7044, YES❑ NO❑ Business and Professions Code.) CHECK 20p7 a25 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �/� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR• CHA14Gf °OO GUIDELINES 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. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097, CIV C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, WOO-0001 8/24/95 ' N 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 SCAOMD 1992_ 1 AM5 Y 10: o Lender's Address 177E I71f J 0 OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above Information is correct I agree to comply PC FEE PERMIT FEE with all county ordinances and State laws relating to building construction, and hereb authorize representatives of this County - ISSUANCE FEE O to enter upon th bo mentlo d pr pe t`y f pection purposes Q \ P .. ' t 4#-zg 9 INVESTIGATION FEE • TOTAL FEE 1 4—J-1 APPI—.,Agent Dace (/ / SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUIL ING. ✓" /1 d or a certificate of Workers' Compensation Insurance, or a certified ' ������ ZIP copy thereof (Sec.3800,Lab. C.) ,/' /� �` LOCALITY Policy No. Company SIZE OF r0T NO.OF BLDGS.NOW ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the County building inspection TRACT BLOCK LOT NO. department. I I USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' o / / TE N . COMPENSATION INSURANCE ?✓ !� `� �' , WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDR SS �,, ` dollars ($100) or less.) a to y DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY CITY ZIP I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become to the Workers' Compensation Laws. ARCHITECT OR ENGINEER TEL NO. ecome subject- STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.- If, after making this Certificate of I REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the Workers' RAGTOft `.! SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith j f�� �j ,> FRONT comply with such provisions or this permit shall be deemed revoked. ADDRE� Ll`Gf�J_0. P L LICENSED CONTRACTORS DECLARATION CJ( LIC --LASSSIDE a I hereby affirm that I am licensed underprovisions of Chapter 9 `- '? O. I NO.OF DRIES NO.OF AMILIES SEWER MAP Q S (commencing with Section 7000)of Division 3 of the Business and ? y� 0 Professions Code,and my license is in full force and effect. f NEW ❑ BK PG DESC P ION O RK - VALUATION , J License Number Lic.Class ADD ❑ Contractor Date F� i!o.. ALTER ❑ } ❑ I am exempt under Sec. J ,+, REPAIR D Q B.&P.C.for this reason j i<� /?[. DEMOL ❑ LDMA P/C# Q Date: USE OF EXISTING BLDdr URM ❑ n- Signature APPLICANT(PRINT) TEL NO. LDMA Perm# WJ' --r h El 1, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is 70—CRESS 0 AGQ„I, not intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL MATERIAL EQUAL El 1, as owner of the property, am exclusively contracting with AAMOUNTSTURE S EC)FIIEDTNG ONI THE HAZARDOUSSMATERALS NFORMATTIIONRGUIDE?ER THAN THE FINAL BY 7 licensed contractors to construct the project (Section 7044, YES❑ NCI Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ N4-R b N the performance of the work for which this permit is issued(Sec. 3097,CIV.C. (HAVE READDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING N ) CHECKLISTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. TITLE 2,CHSECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALSAND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address 0 OWNER ORA ENT o I certify that I have read this application and state under penalty of perjury that the bbove information is correct.I agree to comply P.C.FEE PERMIT FEE with all county;V,Jinances and State laws relating to building <coconstruction, an� reby authorize representatives of thi Cou ty % ISSUANCE FEE co to enter upon the' ove-mentioned property for inspection urpo es. (0 m i INVESTIGATION FEE TOTAL FEE �. r sl9oew.e of Aapr or Age oe�� GE SEE REVERSE FOR EXPLANATORY LANGUA WORKERS' COMPENSATION DECLARATION snsure k< afirm ce of catte o�Wark'e scertificate'Pensat on Insuran ent to lf A'P P_L I CAT I Q N sF Q R IJ I L D I:N G PERM I T or a certified cdpy'thereofc. 3800, Lab C ) > ,•• g --COUNTY OF.LOS ANGELES BUILDING;AND SAFETY, PohcyNo ompany:fQ/�/�1�{ El , Certified copy is hereby furnished. FOR"APPLICANT TO FILL IN BUILDING O �� ADDRESS �� Certified copy is filed'wrth-th4`courity building inspec- BUILDING F�-" `'hon'departmeent. ADDRESS jd ��1G K oa'f �f Date '`/6: _r_Jf Applicant' CITY Ilim e C! y ZIP ��7�D LOCALITY ILAi CERTIFICATE OF EXEMPTION FROM WORKERS''` o NO OF BLDGS -� NEAREST_ COMPENSATION`INSU RANCE"' SIZE OF LOT 9c 9.L NOW ON LOT CROSS ST. _ I&C (This'section need not be`completed if-the permit is for one TRACT �!_�.... _ _ __ . _ _ _ ASSESSOR, hundred dollars ($1.00)or less.) BLOCK LOT NO MAP BOOK PAGE' PARCEL . / L TEL. USE ONE MAP { , OWNER JU�LG7G. CIRC/lC � NO `J 76-49/S NO. I certify that in the.performance of the work for which this permit is issued, I ifiall not'employ any person m I " anner ADDRESS lO7l�I ����^/e --- � '-' SPECIAL - -- --- --. - - d so'as to become"sublect-to the Workers'Compensation-Laws. �a /� CONDITIONSi. ( O CITY ZIP-_-- �� Dote ;.a.•. •, .; .. Applicant.> . ; NOTICE'-TO APPLICANT:'If,;afte'r' making`this Certificate of ARCHITECT OR Al Sf� �Y� TEL. DISTRICT GROUP TYPE FIRE PRO ESSED BY-_ ENGINEER �C NO CONST. t •.ZONE . V Exemptiori,•`'tyou• should become'subject to the"Workers' /�Q W Compensation-provisions•of.the Labor=Code, you,must forth- ADDRESS e VV �• Ir--- •- -•�J d with comply,_with such provisions or this-permit.shall be " ,�j[ TEL. STATISTICAL CLASSIFICATION, APT ONDO, ' Z deemed.revoked'. CONTRACTOR lyf eQQ� «�T • NO i 'A'0 LICENSED CONTRACTORS DECLARATION1;,.• - ` - lCCLASS NO. �' _DWELL UNITS I hereby affirm that I am licensed under provisions of'Chapter 9 ADDRESS 13:?3b �'}'I Ni O '4 1117 / SEWER MAP (commenarig with Section 7000)of Division 3 of-the Business and /� / r �" LIC - r ` Prof es'sions'Code,.and my license is.in full-force and effect. CITY I�7-G le tv .9 Q Ie�C CLASS ��f VALIDATION ' 'd'j 3 SQ FT )) NO OF NO OF f CHECK BK. PG License Number h'? 2 ` Lic.Class `'B '� - SIZE r t� STORIES FAMILIES I ONE .tr' , „ '• ' , :,; +. VALUATION 3l� dOD f'i /� / �Flate? O-S�d �I DESCRIPTION OF WORK CVs% NEW- "O Contractor,�p(iSfi' V D'CIL / _Z S 9306,0k j - t -- .• _ -iJ q� [ ADD # E 3 ' '� I am exempt under Sec. / - - , ' 0 2 8 8 3 ALTER ,a e i B.&P.C. for this reason 0 $ --• _ _ - USE OF REPAIR :o ­286885: y Date:-' DEMOL EXISTING BLDG. - -- t APPLICANT TEL. y ' Signatur`e _" -- ---. -. _.-- - -- •- • FINAL '/ ( 0,03-85 OWNER-BUILDER DECLARATION ' (PRINT) NO DAT {` - -1-herebyaffirm that-I am exempt from the.Contractor's License ' Law,for the followirig`reasori (Section 7031.5, Business and ADDRESSFI ; t , �Profe"ssions'Code)i' "' """ ""' ' PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their so le'compensation,will do the worVand t`1•"ti;�,l�-• - �a -t the-structure is not intended or offered•for sale(Section LOCALITY ' j') sit.• _ ;( '7044,-Business-and Professions Code).' MOVING' "" " ` TEL , =�• -- - - I, as owner of the property, am exclusively contracting CONTRACTOR NO. }'•;• 'r•. } �^ with licensed-contractors to construct the-prolect (Sec= S 6 A tion 7044, Business and Professions Code) ADDRESS' REQUIRED ,_ TOTAL.SETBQCK FROM_ - T, •, - ._ :'�-#0 0.0 e e " CONSTRUCTION'LENDING AGENCY'" SETBACK YARD' HWY' PROP LINE WIDTH- I hereby affirm that there is a construction lending agency for FRONT _; • 3'4 0-0 the performance•-of;the-work-for-which this permit-is issued - - - PL - - (Sec. 3097, Civ..C ). \ o,0.3 + r = ,. 4 a,o,io SIDE P.L. - t.'. z• _. ,. Lender's Name \` 3 1 _8,5 LDMA Ref # - ,- ( 0. 8, Permit-Fee (f - =•i -- '- - - - - Lender's Address P C Fee•$ Perm •� _ _• , I certify that I,have_read this application and.state that the _ Issuance Fee - ( e Q -LDMA'.P/C# - a above inform n is correct. I agree to.comply with all County Investigation Fee Y �: in Ni m ordinances nd State_laws_relating'to building construction, _ _ _-•,�_ •_ : ' a .- Total,Fee- '•► -CDMA Perm•# d. and here y a horize representatives of this County to enter m upon t ove-mente property fol in3ptction purposes. _ a SEE REVERSE FOR EXPLANATORY LANGUAGE a n, Signature of-Applicant or Agent •• ,- - Date - - -•-_. - ,. .. ._ _ - _ __. .