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HomeMy Public PortalAbout9241 BLACKLEY ST_Building__ C I 78A838A CE#803 8.83 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING �� — DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A JENSEN, SUP T OF BUILDING CROSS ST DISTRICT N I GROUP I TYPED BY FOR APPLICANT TO FILL IN CONS BUILDING STATISTICAL CLASSIFICATION SIEWER MAP ADDRESSBK PG CLASS NO DWELL UNITS _ � / LOT�NO ,fid BLOCKWATER NOT REQUIRED ❑ RECEIVED ❑ /y CERTIFICATE TRACT ��7' MAP HIGHWAY STATE MAJOR SECOND OC L NO OF BLDGS NO ' (CIRCLE) SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG TEL OWNER Ronald D. Tomlin NO BUIL ING EXIST SETBACK YARD HWY STREET NAME WIDTH ADDRESS 9241 E. Blackley, Tem le City_ FRONT ARCHITECT OR TEL P L ENGINEER NO SIDE P L � ADDRESS O TEL 1 V CONTRACTOR NO Virgin Roof 09 ADDRE -AlSanGal I iel DESCRIPTION OF 0 WORK 3 W CL NEW ADD ALTER EPAIR Vf DEMOLISH Z SQ FT NO O NO OF SIZE STORIES FAMILIES USE OF STRUCTURE 235# compo. shingles Job #2459 SIGNATURE OF APPLICANT VALUATION $ 398.00j APPROVALS D♦ATE\ INSPECTORS SIGNATURE P C PMT FOUNDATION LOCATION I \ FEE $ FEE $ FORMS MATERIALS /' ! 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 / r BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT ( f� TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ) ! ING TO WORKMEN S COMPENSATION INSURANCE y LATH EXT j SIGNATURE OF HOUSE NUMBER COR- {� PERMITTEE RECT AND POSTED ADDRESS Marcia Madden, Sect y. FINAL Gabrel PLAN CHECK VALIDATION •cK Mo Blvd. JOHN F LEWIS PRINCIPAL ST RAL*ENGIfJ ER PERMIT VALIDATION CK ' M O CASH LALL o 7 9 4,7� DEC 9 1 D 6.00- V APPLICATION FOR, BUILDING PERMIT , FQR APPLICANT TO FILL IN (Print or type only) a BUILDING pp COUNTY OF LOS ANGELES ADDRESS / Al DEPARTMENT OF COUNTY ENGINEER /� CITY �!4 �"ZIP Q BUILDING AND SAFETY DIVISION !�J l .i+T ��, NO OF BLDGS BUILDING SIZE OF LOT �X �j�. NOW ON LOT ADDRESS TRACT BLOCK LOT NO / LOCALITY TEL `��( NEAREST y OWNER NO (a CROSS ST ASSESSOR ADDRESS C J J MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PR(9CESSED BY CITY %tA "��_ P ei t /� �CONST/j ZONE ARCHITECT OR TEL • �v� �_ _ I J Q� ENGINEER NO STATISTICAL CLASSIFICATION SEWER ADDRESS TEL CLASS NO DWELL UNITS 4 B U PG " CONTRACTOR NO ONE NOP U/ LIC (`/// ADDRESS NO y �� SPECIAL LIC - ^ CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION CENDER NAME AND BRANCH BLDG SETBACK FROM FROW PROP LINE OF (STREET) ADDRESS CITY __ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD SQ FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH SIZE ` OD STORIES FAMILIES ONE ' DESCRIPTION OF WORKRJA NEW + CL Ov ADD ❑ BLDG SETBA (STREET) Cie O Q SIDE PROP LINE OF ALTER ❑ TOTAL SETBACK FROM OF EXISTING w ❑ HIGHWAY + YARD = SIDE PROP LINE HIGH WIDTH N USE OF REPAIR Z EXISTING BLDG DEMOL ❑ + APPLICAN TEL a�G 6l3S CORNER CUTOFF YES ❑ NO ❑ (PRINT( � O a - IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATUR f� �� _ V IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION $ � I( � U U IHEREBY ACKNOWLEDGE THAT I'HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM PENSATION INSURANCE SIGNATURE ( PERMITTEE A.X! ` ADDRESS ��'� /` (� TEL ea CITY tM `J d f1 NO �I 1 J DATE L ^� MAKE CHECKS PA ABLE TO FEE E FT $ HARVEY BRANDT,COUNTY ENGINE ER L�f— L�]� PLAN CHECK VALIDATION CK M o CASH m PERMIT VALIDATION �K ? M o CASH 5 4 1[APR 27 1 U 2 8.5 0 Os 76A63BA CE#803 3 75 p ©5 h6A638A" t � CE 1803(REV$,*78) APPLICATION OR, B DING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING FOR APPLICANT TO FILL IN ADDRESS 9r-z Al BUILDING ADDRESS LOCALITY NEAREST CITY ZIP CROSS ST O BLDGS ASSESSOR SIZE OF LOT NO LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE CESSED BY TRACT BL K LOT NO CONST ZONE ` TEL OWNE ' R NO STATISTICAL CLASSIF CATION SEWER M ADDRESS CLASS NO DWELL UNITS 1 BK G CITY ZIP ARCHITECT OR TELa VALUATION /3 ENGINEER NO ADDRESS BLDG SETBACK FROM / /�,, / FRONT PROP LINE OF (STREET) CONTRACTO -7 `IVl�lf//�.�NO TOTAL SETBACK FROM TYPE OF EXISTING LIC ` HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH ADDRESSJJ Z2/�! NO &7� LIC + CITY CLASS BLDG SETBACK FROM CONSTRUCTION LENDER SIDE PROP LINE OF (STREET) NAME AND BRANCH HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP LINE E HIGHWAY WIDTH V SO FT NO OF NO OF CHECK + _ SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ PC Fee$ Permit Fee _ 0 O ADD Issuance Fee #A ALTER ` ' Z REPAIR ❑ Total Fee //d{'^� USE TI ` DEMOL El G EXISTING BLDG .f APPLICANT TEL (PRINT) NO •}T67o W`�o��7 90 77 G BY(SIGNATURE) 7 4 ��` HEREBY AC LEDGE HAVE READ THIS APPLICATION AND STATE Y 94,,l 1,4A THAT THE ABO IS CORK ECT ND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS RE EATING BUILDING CONSTRUCTION CERTIFY THAT IN DOING THE _ # O O O O'O 1 1 WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM Z PENSATION INSURANCE s g 2 ° 1 3 3.00 SIGNATURE OF �O 1 3 3 0 0 6 PERMITTEE ADDRESS Z 0 5 0 '1 I— 19 - O CITY C� TEL r NO � USE ZONE MAP NO C, > . ( SPECIAL ►' CONDITIONS cc Lu FINAL G/ / / BYCL DATE ti,J ' ,:P, 1 DEP! R T OF BUILDING AND SAFET;Xi OV b APPLICATION FOR PERMT ' •�`"��TY OF LOS ANGELES - ,w �,�q I L I `�68 �� WM J. FOX, CHIEF BNGINEER �" FOR APPLICANT TO FILL IN ` FOR OFFICE USE ONLY DISTRICT NO PLANCK NO PERMIT NO BUILDING67 �s c LOCALITY ��PL �/T RECEIVED BY DATE OF APPL DAT ISSUED NEAREST 6Al CROSS ST 62,9 7 Ae I 11 BUILDING _ SC - ADDRESS OWNER Qa ! LOCALITY MAIL / ADDRESQ 109 L,C oST '` CNEAREST ROSS 9Te12 CIT`Y /" //- TEL J- R�D� TEL �I sFIRE NO bF D ZONE PLANS�j I TY E I GROUP ARCHITECT� ,-_� ENGINEER NO BLDG ORD NO SETBACK LINE / L.LL1 Z1 ADDRESS APPROVED r osCIH¢ Aeevs TEL �9p1EDATE CONTRACTOR NO USE APPROVED /^► ZONE / BY DATE ADDRESS ��/�� / I7t�J8�/� HOUSE NUMBERING LEGAL / DESCRIPTION hLOT NO BLOCK MAP NUMBER FIELD CHECK BY TRACT NO ASSIGNED BY �� M DATF NO OF SLDGS CORRECTIONS SIZE OF LOTT' I NOW ON LOT / USE OF NO OF S� EXISTING BLDG, FAMILIES r illn 19 a7 DESCRIPTION OF WORK ►) / `X, O A %A_e NEW I '\ I ALTERATION I I ADDITION I �I � I +✓1�tl•��uS4�1�14 C�n�^so�/D�cs�/ O REPAIR DEMOLITION SQ FT �OO NO OF SIZE ROOMS STORIES I EXT WALL CROOF OVERING A� Ab A� / USE OF STRUCTURE �w e�7 ^ a CAPPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- O DATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN 19 MS, MATERIALSu/ CORRECT I AGREETO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOPS, v� HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING UI DINGY CONSTRUCTION FURNACE LOCATION, SIGNATu- ✓/S%y' GAS VENT, DUCTS URE OF v PERMITTE / D✓ , LATH, INT ADDRESS n ,w� (z, LATH, EXT AUTHORIZED AGT i PLASTER, INT 76AGOEA DB87 10-00 $ P C $ r f FEE r� T'-"" PLASTER, EXT VALUATION i FEE $�Z S" FINAL 1-�4tz"k90-t-1 3T � i v WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self q p p j CAT I O N' i5 R'. BUILDING PERMIT. insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec 3800, Lab C )` 1 - »_ - - - -„ - �'- - —"_- ' V,� ---- Tx _ I u ;3,t COUNTY OF LOS ANGELES , BUILDING AND SAFETY }. Policy No Company - - - - - - - - - ❑ Certified copy is hereby furnished ` ,t FOR APPLICANT TO FILLJN BUILDING ADDRESS ❑ Certified copy is filed with'the county building mspec BUILDING f i tion deportment ` i pql ADDRESS + Date Applicant " ' Y CITY t ZIP LOCALITY -CERTIFICATE OF EXEMPTION`FROM WORKERS''i' - -' NO OF BLDGS- ----- NEAREST.- COMPENSATION INSURANCE t*' " F i' SIZE OF LOT NOW ON LOT r CROSS ST (This section need not be completed if the perm,t'is for one _- _ _ _ _ �_ __ ASSESSOR hundred dollars ($100)or less ) TRACT BLOCK LOT NO MAP BOOK "i, PAGE PARCEL I r 'TEL USE NE MAP t ' I certify that m the performance of the work for which this OWNER NOcsZ NO permit is issued, I shall not employ any person in'any manner - =I SPECIAL t - O so as to become subject to the Worke Compensaho Laws ADDRESS Q �-- CONDITIONS >nia ,,� - t ti U Date' Applicant CITY _ZIP NOTIC TO/APPLICANT If, after,making this Certificate ARCHITECT G9 TEL DISTRICT _ GROUP TYPE . t FIRE _ y CESSED,BY _ 11 0 ENGINEER NO CONST ZONE rj Exemption, you should become` subject to the Worke r\^, w Kul Compensation provisions of the Labor Code,•you must.forth- ADDRESS with comply with%such provisions for this permit shall be deemed revoked . TEL STATISTICAL CLASSIFICATION APT CONDO z CONTRACTOR NO LICENSED CONTRACTORS DECLARATION s - - - - -- LIC-" - - - CLASS N-O � I 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 ivr061l force and'effect CITY CLASS BK' - 'VALIDATION PG SQ_FT NO OF NO OF_ CHECK SIZE - STORIES FAMILIES 1 ONE- T License4Number t' Lic Class , Q VALUATION ORK _ "' DESCRIPTION OF W � NEW --Q Co JsnJ , ntractor i r„ Date ADD ❑ $ ❑ I am exempt under Sec T ALTER X B 8P C for this reason0 = $ - - '- -- -- �- REPAIR-� _ USE OF Date EXISTING BLDG Q DEMOL ❑ _ _ - f APPLICANT TEL • Signature `_ '� _ �- - = FINAL OWNER-BUILDER DECLARATION PRINT 51-9.6 Ay- -1 hereby affirm that I am exempt-from the Contractor's License I Law for the followm'g reason=(Section 7031 5, Business and ADDRESS J y IF 1 0 0 0 e o ) Piafessions Code) PRESENT # _ ,-"� -, - BUILDING - - _ - Q V- - - - ,- • ; r�t�::� I, as owner of the property, or my employees with ADDRESS t'4<9.,8.8 wages as their'sole compensation,will do the work and / the structure is not intended or offered for sale(Section LOCALITY �(/ ! o e,o 4,9.8'8 c'i 7044,-Business and Professions Code)^ "" "' MOVING -TEL �o'' ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR- ^ NO M y ^0 ,06-86 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code) ADDRESS REQUIRED _TOTAL SETBACK 1 f CONSTRUCTION LENDING AGENCY _ SET BACK YARD HWY PROP LINE WIDTH' 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 m 2 LDMA Ref # y i - PC Fee$ r -- - Permit Feet - Lende'r's Address -1 certifyd this application h _ _ _ _ _ __ .. that I have reais a PPication anstate that the - - Issuance Fee-- �V - r LDMA P/C# a above information is correct I agree to comply with all County _ Investigation Fee Q a z "r ordinances and State jaws relating to buTotal`Fee- t LDMA Perm ilding construction, 7 0 and hereby authorize representatives of this County to enter - '# upon a above-mention d property for nspection p rpos s 4 'a M1 O - v SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or I APPLICATION FOR BUILDING PERMIT ` COUNTY OF LOS ANGELES BUILDING AND SAFETY • WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN ADDRE S I hereby affirm that I have a certificate of consent to self Insure, BUILDINGA KESS or,a certificate of Workers Compensation Insurance,or a certified 9QVES! copy thereof( 3800,Lab C) n� CI�y� zIP / EO i Policy,No a q Company / rkbLOCALITY SIZE OF LO 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 'T 1• ` USE ZONE MAP NO Date_ Applicant J.W ASSESSOR MAP BOOK PAGE PARCEL ' SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO COMPENSATION INSURANCE WITHIN 1000 FT of SCHOOL? YES No (This section need not be completed If the permit is for one hundred RE S DISTRICT GROUP TYPE CONST FIRE ZONE PROCESS dollars ($100) or less) VQ 64Le CITY ZIP ^/ -o6 J/ I certify that In the performance of the work for which this permit (� d (/,w- � Is Issued, I shall not employ any person In any manner so as to p� become subject to the Workers Compensation Laws ARCHITECT O ENGINEER TEL NO STATISTICAL CLASSIFICATION APT CON O Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If,'after making t6 Certificate Of t� p REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject 'to the Workers C=RACT R TEL NOJ O �� 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 ADDRESS _ LIC N�-20 P� PL LICENSED CONTRACTORS DECLARATION C SIDE Y g- , /� %,,.�.'� LIC LASS PL I hereby affirm that I am licensed underprov[s[ons of Chapter 9 !t.{��^R�l SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES Professions Code,and y�y license Is in full force and effect NEW ❑ BK PG License Number v �O02 Llc Class C-- 3 DESCRIPTION OF WORK _ ADD ❑ VAL(U�ATTIIO/NN/, , Q Contractor r DateV. w ALTER p❑ $ /v'�v� 0 ElI am exempt under Sec REPAIR $ _B&PC for this reason DEMOL ❑/ LDMA P/C# W I Date 'USE OF EXISTING BLDG URM ❑ C- J. fn Signature APPLICANT(PRINT) TEL NO LDMA Perm# A z El as owner of the property,,or my employees with wages as' Z At C T.a their sole compensation, will do the work and the structure is ADDRESS O 1*3. , not Intended Or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code) WILL THE APPLCANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL -J 1 ITEMS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ElI as owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 4 TOTAL /` licensed contractors to construct the project (Section 7044 3 . 63 Business and Professions Code) YES El No 1:1 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHECK 140.6 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH lo�� w _ a CONSTRUCTION LENDING AGENCY COAST AIR OUADTV MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR .,cj 1\�i�fes LJ/��GE ( GUIDELINES a v t.Cll'Tr'17C tJ(I I hereby affirm that there is a construction lending agency for YES❑ No❑ a 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 I�� �I ��I �i ��� 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 7591 i 1 AM �:C` CL Lender's Address �. I1 OMJER OR AGENT o I certify that I have read this application and state under penalty _ 0 of perjury that the above information[S correct I agree to comply PC FEE PERMIT FEE o with all county ordinances and State laws relating to building < construction, and hereby authorize representatives of this County ISSUANCE FEF„ ter to enpon the a e- t[o ed property for inspectio�nlpurpose L INVESTIGATION FEE TOTAL FEE co 3' we p4—a ,� o 1. SEE REVERSE FOR EXPLANATORY LANGUAGE