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Home My Public Portal About9217 BLACKLEY ST_Building__ 76A638A CE$803.10.56 APPLICATION FOR R EUIL®ING PERMIT 1' BUILDING AND SAFETY DIVISION BUILDING a DDREss 9-2147 Department of County Engineer County of Los Angeles LOCALITY. JOHN A. LAMBIE, COUNTY ENGINEER NEAREST ° CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. DISTRICT ROUP - .TYPE SEWER MAP. FOR APPLICANT TO FILL IN orvsT e��f P eL�l%t�Cd/U BUILDING � P7 E. �� - ADDRESS i (,"7 4 STATISTICAL ASSIFICATION LOT NO. / LO CLASS. NO. DWELL. UNITS-1 - - �7 Mqp STATE YES O ' TRACT I �/ NUMBER - !� - HWY // �� p�// ^'�� USE ZONE SPECIAL SIZE OF LOT (fQ K 14-54- 1-5 4- I NOW ON LOTS CONDITIONS USE OF EXISTING BLDG. BUILDINGEXIST. SETBACK WARD .HWY STREET NAME WIDTH OWNER Cie-eirc2e. FRONT 7 /, MAILP. L. ADDRESS C?l4�1 .SIDE TEL � . P.L. 6-t4CITY N INSPECTION RECORD ARCHIT CT OR TEL. ENGINEER NO. ADDRESS - TEL. CO T NO. AD DESCRIPTIOO OF WORK NEW 4510> ALTER REPAIR DEMOLISH . SQ. FT. NO. OF NO.OF SIZE - STORIES FAMILIES - USE OF STRUCTURE ® t �� APPROVALS - SIGNATURE OF. - APPLICANT 1 DATE INSPECTORS SIGNATURE J ADDRESS FOUNDATION:LOCATION FORMS. MATERIALS _ p P. C. S FRAME: FIRE STOPS, - FEE BRACING. BOLTS VALUATION / $ v FURNACE: LOCATION, - - FEE 'GAS VENT, DUCTS ,AIP I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,-INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, EXT. STATE LAWS RE,ULATING BUILDIN CONS UCTION. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE Z L_ 0. RECT AND POSTED ? A ADDRESS FINAL JOHN A. LAMBIE, COUNTY GINEER, CLYDE N, DIRLAM, PRINCIPAL STRU URAL E GMhEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK M.O. CASH rWo3 4. $` SEP 3 0 1 A 2.0`0 �® of ' WORKER S'COMPENSATION DECLARATION hereby affirm ifI have certificate of consent to self APPLICATION' FOR BUILDING P E RM I T 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 ❑ Certified copy is hereby furnished. FOR APPLICANT T FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS _V:_ Date Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT Y NOW'ON LOT CROSS,ST. , (This section need not be completed if the permit is for one J ASSESSOR, - hundred dollars ($100)or less.) TRACTll �l BLOCK I LOT N�>L //7t MAp BOOK PAG/E^� PARCEL I certify that'in the performance of the work for which this OWN?R M1 P h eI 1 NO. -�lD/ USE ZONE NO. L 7�/ L permit is issued, I�shall not employ any person in any manner - SPECIAL IL so as to become subject to the Workers'Compensation LawsA6 . ADDRESS CONDITIONS O Date "'2b�X APPlicanak� CITY. _ZIP cc NOTI TO 9 PLICANT: If, after''�inaking 'this Certificate of ARCHITECT OR TEL. O DISTRICT GROUP TYPE.. FIRE PRO SSED BY P_ ENGINEER NO. CONST. ZONE -� Exemption, you' should become subject to the .,Worker., Q U Compensation provisions of the Labor Code, you must forth- ADDRESS �Qv - 9L with comply with such provisions or this permit shall be deemed revoked. TEL. CONTRACTOR N0. STATISTICAL CLASSIFICATION APT. CONDO. • 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 and LIC SEWER MAP Professions Code, and my license is in full'foice and effect. CITY CLASS BIS PG ' VALIDATION SQ. FT. _ NO.OF FNO. OF CHECK 6c'.License Number c'.Class SIZE STORIES IFAMILIES ONE Contractor Date DESCRIPTION OF-WORK .4 - NEW-- 0 VALUATION ; ADD ❑ $ plop❑ I am exempt under Sec. —' n ALTER B.&P.C. for this reason ( REPAIR. ❑ $ Date: USE OF DEMOL EXISTING BLDG. ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. _ DATE le _607(1111 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Prof ssions Code): PRESENT B / BUILDING 9 5 2 9, 9 A I, as owner of the property, or my employees with _ADDRESS � • wages as their sole.compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ' # 0'0'0 001 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. I a o49, 88 with licensed contractors to construct the project (Sec- ' tion 7044, Business and Professions Code). ADDRESS - 49,886 -REQUIRED. TOTAL SETBACK FROM. ' CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH. a I hereby affirm that there is a construction lending agency for FRONT 0 Q 2 5 8 6. the performance of the work for which this permit is issued PAL - - (Sec. 3097, Civ. C.). SIDE M P.L., Lender's Name o' 2 f!' LDMA Ref: # � P:C.'Fee$ - -- Permit Fee- - VO . Lender's Address x 1 certify that I have read this application and state that the .-.. . Issuance fee 0.1-5 0 -•LDMA P/C# a above information is correct. I agree to comply with all County. Investigation Fee ordinances and State laws relating to building construction, _ v and hereby authorize representatives of this County to enter Total fee -Q LDMA Perm. # upo the above-mentioned prop�rty for inspection purposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date APPLICATION FOR BUILDING PERMIT r _ COUNTY OF LOS ANGELES BUILDING AND SAFETY ` 4 WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, or a certificate a Workers'Compensation Insurance,or a certified CITY` UTY ZIP •� �j copy thereof(Sec.3800,Lab.C.) lft LOCALITY ) _ Policy No. Company SIZE OF LOT ' NO.OF BLDGS.NOW ON LOT / �-�� /'' NEAREST CROSS ST. ❑ Certified copy is hereby furnished. j( �9 ❑ Certified copy is filed with the county building inspection TRACT 6LOCK LOT NO. department. I I USE ZONE MAP NO. _ Date Applicant ASSESSOR MAP BOOK PAGE PARCEL /) � �O goo SPECIAL CONDITIONS- CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER-TTEL.NO. _ �� COMPENSATION INSURANCE ADDRESS �v � ' � �0 WITHIN 1000 FT.OF SCHOOL? YES No /^ (This section need not be completed if the permit is for one hundred GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit fp ':3 ✓ G �t.� � is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER T .NO become subject to the Workers'Compensation Laws. �(�,dw1 '5 1 ypSr STATISTICAL CLASSIFI ATION APT CONDO Date Applicant ADDRESS I f CLASS NO. DWELL UNITS NOTICE TO APPLICANT. if, after makingthis Certificate of 'c " AC CONT ACTOR REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' ' SETBACK 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. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P�E o I hereby affirm that I am licensed under provisions of Chapter 9SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and S SIZE tNO. F STORE NO. FAMILIES Professions Code,and my license is in full force and effect. w _ NEW C3 BK PG DESCRIPTION OF WORK VALUATION Poo.. License Number Lic.Class �s� �. `�,) ADD VV /� Contractor Date ^ ALTER 1:1 ❑ 1 am exempt under Sec. REPAIR ❑H f� $ B.&P.C.for this reason /r'T 2� DEMOL ❑ i-s',.•'•_•! 1 USE OF EXISTIN B LDMA P/C# - Date: URM. ❑ 73730 7' � 0•. r t5_` Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# Z j T`,"-H. ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is ADDRESS y;i I f; 656 ® =s not intended or offered for sale (Section 7044, Business and FINAL DATE l a Professions Code.) _ _ / € -'r`• �= WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q •{' A Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BJL 3 •HAI I E a 00 licensed contractors to construct the project (Section 7044, YES 'NO ElBusiness and Professions Code.) 1:1 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CONSTRUCTION LENDING AGENCY OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTr,/,o / ij{ 1 3Jj = rS COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST �f 'FOR GUIDELINES.hereb affirm that there is a construction lendin a enc for z �,3Y 9 9 Y YES❑ NO❑ � D7 't Fi {!'the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD3097,CIV.C.). PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES -9Q COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING fo Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CLLender's Address e�cJ OOWNEROR AGENT o _ I certify that I have read this application and state that the above g information is correct. I agree to comply with all county P.C.FEE �&R. 0 PERMIT FEE a ordinances and State laws relating to building construction,and 7 a hereb)f q6thorize r presentatives o this County to enter upon ISSUANCE FEE �� A the a-men o ropertyforction purposes. INVESTIGATION FEE TOTAL FEE 50T sg�W.of APP11-M o Agem Dn q> SEE REVERSE FOR EXPLANATORY LANGUAGE