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Home My Public Portal About9222 BLACKLEY ST_Building__ DIVISION OF BUMDING AND SAFETY Depax ent of CountyEag9neer APR191BUILDING County of Los Angeles WM J FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN ADDRESS -BUILDING ADDRESS dY �( LOCALITY NEAREST LOCALITY /,►'Q:.. ,pry► CROSS ST DISTRICT NO PLAN CK OR REC No PERMIT NO NEAREST CR089 ST LJ OWNER /*" �s � � RECEIVE BY DAT"F APPL DATE ISSUED AMAILDDRESS ] � 6.�' o�t�'�'�d'/+9r��lr� _ / `5 �� ,q/� //'� USE ZONEI O OF PE P .FIRE ZONE CITY aje` 6Vf 4_ 0011 r TEL NO PLAN1� ARCHITECT OR TEL ZONING ATE ENGINEER NO (/l/(/ APPROVED BY BUILDING ADDRESS SETBACK LINE // J / CONTRACTeOR A!///�'j �I �� /NCO /e.r 46 BYPROVED y� /� ADDRESS iCC �"�� J j (� J6J6100/49-/ /HOUB NUMBERING ///��/JJ �T LEGAL MAP NUMBER 14119 NO ASSIGNED B'Y DESCRIPTION I LOT NO I BLOCK �+♦-��i+�+ Av f� DATE CORRECTIONS I INSPF�'TOR TRACT I I I NO OF BLDGS SIZE OF LOT / I NOW ON LOTUSE NO ( . EXISTOING BLDG I FAMIOLFES - i4 7C� p DESCRIPTION OF WORE _ a NEW ��DEMOLITION ADDITION 3�� !� /�QyT-�// Atl♦,,,. /-p,y !/3Aey-f r, REPAIR 5`�ill .SAM / `OrlC..� _ ALaIGI ZESQ A NO OF S ROOMS STOEXT WALL ROOF RIES COVERING �C I COVERING I L USE OF STRUCTURE es 77 � �� APPROVAJS INSPECTOR,'ff SIGNATURE DATE FOUNDATION LOCATION FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT t HAVE READ THIS AP- FRAME FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS f CORRECT BRACING, BOLTS IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION, GAS:VENT, DUCTS SIGNATURli TTEF'OF fi�� //gyp 60e/f, LATH,` INT �✓ �/�!� Y —� ��?CA '! A�e .f LATH, EXT ADDRESS v� V �/J/� yr✓�> �J ED ear �P/ • ��s/�L�i@ PLASTER, INT AUTHORIZED PLASTER, EXT $ HOUSE NUMBER COR- FEE /J RECT AND POSTED //, .• p VALUATION d .. FEE 2(p O� FINAL - / 76A686A DBS 3 z-ea + - APPLICATION FOR BUILDING PERMIT F(XisAPPLICANT TO FILL IN (Print or type only) [TRACT 0ILDING COUNTY OF LOS ANGELES DDRESS �."�). L_R-c.K S,'"'- DEPARTMENT OF COUNTY ENGINEER ITY ZIP BUILDING AND SAFETY DIVISION rr ,1 NO OF BLDGS BUILDING G IZE OF LOT V o '7J�aJ NOW ON LOT Z. ADDRESS j1� � BLOCK LOT NO LOCALITY TEL CROSS ST I~ h NEAREST OWNER �(,t G. Q 1- NO -`� ��'1 ��` ASSESSOR ADDRESS �L �„/' ;.� MAP BOOK PAGE RCEL DISTRICT GRO P TYPE FIRE PRO ESSED BY CITY 'may i s a ZIP :�hw7 CONS ZONE ARCHITECT OR TEL " 0 ENGINEER NO STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO DWELL UNITS BK PG TEL P // CONTRACTOR j N ZONE MA 1 LIC v NO -ADDRESS - NO - SPECIAL LIC CONDITIONS CITY CLASS - ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM �.. FRONT PROP LINE OF (STREET) CD ADDRESS CITY HIGHW } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING V SO FT NO OF NO OF CHECK - FRONT PROP LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE O _ = U DESCRIPTION OF WORK NEW d BLDG SETBACK FR (STREET) Z ADD SIDE PROP LINE OF ALTER ❑ TOTAL TBACK FROM TYPE OF EXISTING ^� HIGHWAY } YARD = SIDE PR LINE HIGHWAY WIDTH REPAIR❑ USE OF EXISTING BLDG DEMOL 1:1 } APPLICANT TEL CORNER CUTOFF YES ❑ NO (PRINT) _ NO _ IN OPEN SPACE YES ❑ - NO, BY (SIGNATURE) ❑ �j IN COASTAL ZONE YES ❑ NO ❑ VALUATION G d�A�Q J J'C �C� CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED - (DATE) WITH ALL ORDINANCES AND LAWS:PG ULAT GULAT ING BUILDING CON- STRUCTION CERTIFY DE OF THE �STAT' T IN D NG THE RK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMAN PERSOpNpIN OLA TION OF THE LABOR WORKMEN'S COM PE NSA S URANC ELtJA IN RELATING TO /SIGNATURE O ` ACl_ , g� PERMITTEE ADDRESS ,f' w (I FINAL ° ' BY / V � - T L DATE CITY NO /l IRE ( 11L-( hS P I)IA131-L- 10 FEE $ ' FElj$ /► HARVEY T BRANDT, COUNTY ENGINEER V L� PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O CASH 3 5 3 873 OCT 11 1 D 6.0 0 e 76A638A CE 9803 12/72 vt WORKERS'COMPENSATION DECLARATION.3 A Aubfirm nself acertifcae of Workes'Compensatia certificate of on Insurance, P P L I CATION FOR BUILDING PERMIT rr certified copy the of (Sec 3800 Lab C ) BUILDING- cy o �� P COUNTY OF LOS ANGELES BUILDING AND SAFETY ] ertified copy is hereby furrYynished ~ FOR APPLICANT TO FILL IN ADDRESS y Certified copy is filed with the county building inspec- BUILDINIt tioC4 Lriment ADDRESS LOCALITY NEAREST , )ate Applcant TY ZIP CROSS ST ERTIFI TE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LO NOW ON LOT MAP BOOK PAGE PARCEL This section need not be completed if the permit is for one USE ZONE MAP /J tundred dollars ($100)or less ) TRACT BLOCK LOT NO NO t ! fd o TEL,/� SPECIAL } " certify that in the performance of the work for which this OWNS NOG d CONDITIONS _ d. )ermit is issued, I shall not employ any person in any manner DISTRICT GROUP CONST ZONE TYPE FIRE PROCESSED BY 0 ;o as to become subject to the Workers'Compensation Laws ADDRESS OL )ate Applicant CITY ZIP` S ATISTICAL CLASSIFICATION PT CONDO O- gOTICE TO APPLICANT If, after making this Certificate of ARCHITECT O TEL ENGINEER NO CLASS NO DWELL UNITS W :xemption, you should become subject to the Workers' II1L :ompensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP rn ovith comply-with such provisions or this permit shall be Teemed revoked CONTRALTO NO —TEL BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION C hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS VALUATION 'commencing with Section 7000)of Division 3 of the Business and LIC 'rofessions Code, and my license is in full force and effect CITY CLASS $ 6 000 oil. O NO OF CHECK M.icense Number Li Class STORIES FAMILIES ONE EW ❑ $ :ontracto r1 DESCRIPTION OF WORKJIL O� ADO59 m 1 am exempt under Sec ❑ FINAL I/-2 b b'7,o a B 8P C for this reason - R DATE ` USE ❑ FINAL # ° o • e 23 Date EXISTING BLDG OL ❑ BY �_ Signature APPLICAN PRINT TEL 2 ° o 5 6,4 0 OWNER-BUILDER DECLARATION c /� y i I hereby affirm that I aexempt from the Contractor's License ADDRESS 2 , G 1�j( O �J � �i o ° 0 5�t 4 Q 0 m Law for the,following reason (Section 7031 5, Business and Professions Code) TRESENT 005'-82 BUILDING } ' I, as owner of the property, or my employees with ADDRESS b 6 7, 1 a wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY # 0 0 0 0 0 7044, Business and Professions Code) MOVING TEL CONTRACTOR I, as owner of the property, am exclusively contracting NO 2'0 0 7'9, 00 ADDRESS o with licensed contractors to construct the project (Sec- eo 79.00 tion 7044, Business and Professions Code) ~ REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH , 1 O,O Sr 82+ I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE PL Lender's Name Lender's Address P C Fee$ _ c-- Permit Fee I certify that I have read this application and state that the Issuance Fee above information is correct I agree,to comply with all County Investigation Fee , ordinances and State laws relating to building construction, Total Fee, and hereby authonze,representatrves of this County to enter on th ove-mentioned propert for inspection purposes ` '� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applcant or Agent j�a - es- J 1