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Home My Public Portal About9247 BLACKLEY ST_Building__ 7OA630A CL:0032/60 ,APPLICATION FORBUILDING PERMIT- COUNTY OF LOS ANGELES ADDRE1SS oZ ! DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY -JOHN,A LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUPT OF BUILDING [CROSS ST DISTRICT O GROUP �.pE PR ESSED BY FOR APPLICANT,TO FILL IN `{,-6 CONST ING STATISTICAL CLASSIFICATION __ SEWER MAP- BUILD1 , ADDRESS BK`-' - PG CLASS NO DWELL UNITS O LOT NO TZ-6----eaBLOCK MAP // / STATE O 04 NUMBER o�� v HWY YES TRACT USEZONE SPECIAL " y NO OF BLDGS -f CONDITIONS ' SIZE OF LOT , NOW ON LOT USE OF EXISTING BLDG BUILDING YARD ,HWY "STREET NAME' EXIST / SETBACKWIDTH OWNERS FRONT P LXo ADDRESSPDE f0 -�31 ARCHITECT OR TEL V ENGINEER NO INSPECTION RECORD ADDRESS - - TE a CONTRACT NO O O ADDRESS V DESCRIPtION OF WORIKa 5 - O NEW ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF SIZE STORIES FAMILIES - y USE OF STRUCTURE SIGNATURE O APPLICANT?--!I" -VALUATION APPROVALS DATE -I SPECTORSSIGNATURE PC PMT FOUNDATION LOCATION FEE FEE $ 1G>�� FORMS MATERIALS FRAME FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- BRACING BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS u _ STATE LAWS REGULATING BUILDING `CONSTRUCTION �/ I CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH,INT I-CAM" WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE _ WORKMEN S CON^NSATIONLA W F IFORNIA LATH,EXT = 7 SIGNATURE'OF t' HOUSE NUMBERCOR- PERMITTE RECT AND POSTED ADDRESS da4FINAL CLYDE N DIRLAM, PRINCIPAL S CTU L ENGINEER PLAN CHECS �v2fA TION' C& M o. CASH PERMIT VALIDATION CK., o CASH ,(� ftp J 2, 1 AUG 17 .�.i'1 ®: I T DING AND SAFETYAPPLICATION FOR PERMT COUN F LOS ANGELES �>�C , 1951 ® � WM J.'FOX, CHIEF ENGINEER -- FOR APPLICANT TO FILL IN FOR OFFICE USE,ONLY rDISTRICT NO PLAN CK.NO PERMIT NO ADDBUDINg RES 3 L+ R EI Y I DATE OF APPL , DATE ISSUED LOCALITY,NEAREST j� CROSS ST oc'q 1 5 p yBUILDING r - - ADDRESS, �j r/r �G OWNER` LOCALI ADD �.�L r ADDRESS I � �/ NEAREEfT t v S 1 TEL 3C - f� gltl, CROSS ST / T CITY S&P - NO fG FIRE NO OF T1�P1P' I OU ARCHITECT OR I s TEL ZONE PLANS ENGINEER NO BLDG SETBACK LINE . / r' L ADDRESS r it, CdAPPROVED CRY" TE sA�'18 BY DATE CONTRACTOR C USE APPROVED ' ADDRESS J A'P'ic- ZONE BY DATE HOUSE NUMBERING LEGALGol DESCRIPTIONQ I LOT NO 0 Ir13 I BLOCK MAP NUMBEI2_ C FIELD CHECK BY TRACT ` f / NO ASSIGNED rBYATE O OF BLDGS `' - CORRECTIONS SIZE OF LOT o� A� i6, NOW ON LOT /�� USE OF I NO OF _ EXISTING BLDG r FAMILIES DESCRIPTION OF WORK J NEW I I ALTERATION I I ADDITION O REPAIR I I DEMOLITION SO FT NO OF SIZE ROOMS �jS�T�OORIESt_n�� r�� D EXT WALL 4ryV&OSipjft(t-COOVERINGIiO•/�� Nfi !- MT Ti'�} 1-�.-f•*�l r COVERING % + l c- USE OF STRUCTURE ES- 4 i9r r �q L. GNEGKiJ "1 oil-k- l= APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT I AGREE TO COMPLY, WITH TH C ECTIONS LISTED FRAME FIRE STOPS, HEREON AND WITH CO RD CES AND STATE BRACING, BOLTS LAWS REGULATIN IDI - ST ION FURNACE LOCATION, " GAS VENT, DUCTS SIGNATURE OF { PERMITTE LATH, INT ADDRESS /,o -,7 / IL J LATH, EXT r,A AUTHORIZED AGT PLASTER, INT 76A638A OBS9 to-80 P C $ FEE ��" PLASTER, EXT VALUATION /7//d1 FEE $ 'Y` FINAL #900168 SB WORKERS' COMPENSATION DECLARATION hereby affirm that I have cert of consent to self APPLICATION FOR B U I L D I N G PERMIT insure, or a certificate of Workers' Compkers' Compensation Insurance,' _ or a certified copy thereof (Sec 3800, L'ab CCOUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No PC997500 Company Republic Indemnity 4 ❑ .{_ BUILDING _Certified copy is hereby furnished FOR APPLICANT TO FILL IN-, ADDRESS BUILDING: t V% 1 % ° Certified copy is filed witFi the county building mspec- ADDRESS ,` 924N7 B'l�ackle `,` " �, - tion department '' Date 7-1-90 A licanr Virgin Roof Co. CITY 'Temple Cit ZIP 91780- LOCALITY f L Ci PP , `NO OF BLDGS,'_ _ _. NEAREST - CERTIFICATE'OF'EXEMPTION FROM WORKERS' SIZE OF LOT „ ��' NOW ON LOT CROSS ST } COMPENSATION INSURANCE 7, ASSESSOR (This section need not be completed if-the permit is for one TRACT BLOCK.- LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100)or'less )' _%{ TEL OWNER Ann & Tullio Gobber NO USE ZONE MAP I certify that in the performance of the-work for which this _ NO permit is issued, I shall not-employ an person in an manner ADDRESS 9247-Blackley', - SPECIAL P P Y Y P Y "' CONDITIONS O so as to become subject to the Workers' Compensation,Laws _ U CITY Temple Cit ZIP 91780_ Date A hcant ARCHITECT OR TEL 0 PP DISTRICT GROUP' TYPE FIRE' PROCES D BY O NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO - CONS ZONE � Exemption, you should become subject to the, Workers' U Compensation provisions of The Labor Code, you must forth- ADDRESS �d�� N with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO Z deemed revoked ' I CONTRACTOR Virgin Roof Co. No 287-0507 _ LICENSED CONTRACTORS DECLARATIONLIC CLASS NO DWELL UNITS- I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P.O. BOX .J NO 160650 SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC and Professions Code,and my license is in full force and effect CITY San Gabriel CLASS C39 BK' PG VALIDATION C39 SIZE FT NO 23 s S IEES 1 F OFCHECK ONE ORIMIL "License Number 160650 Lic Class _ ` - - -6-30-91 VALUATION DESCRIPTION OF WORK House & Garage: NEW Virgin Roof Co. Date ❑ $ 3682.00 � Apply Class "A" Fiber la ADD ❑ Poo. { El am exempt under Sec ❑ . __ - ALTER , B&P C for this reason- Shlri les over eXlstln Com REPAIR El $ , Date _ USE OF EXISTING BLDG Dwelling DEMOL F-1 Signature APPLICANT TEL FINA = OWNER-BUILDER DECLARATION (PRINT) Vir iri Roof Co. NO 287-0507" DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS P.O. BOX J 'San Gabriel 917 78- FINAL 1 Law for the following,reason (Section 7031 5, Business andA Professions Code) PRESENT - BY �� e4 _ ❑ 1, as owner of the property, or my employees with ADDRESS _ 3 �'j 3 17 ° wages as their sole compensation,will do the work and r the structure is not intended'or offered for sale(Section LOCALITY ► I ITEM"--' 7044, Business and Professions Code ) MOVING TEL - TM� P,` t TOTAL 93 ®6— ❑ CONTRACTOR NO 1 . I, as owner of the property, am exclusively contracting �cF with licensed contractors to construct the project (Sec- ADDRESS CHEC Vi "O�` tion 70", Business and Professions Code ) °!fel +REQUIRED TOTAL SETBACK FROM EXIST CHANGE- 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 `.f?9/oil (Sec 3097, Civ C ) SIDE P L. �11 i t Il t 'e�� Lender's Name LDMA Ref # P C Fee$ Permit Fee 80.3 Lender's Address Poo.1 certify that'I have'read this application and state that the Issuance Fee 1S.00, LDMA P/C# 8 above information is correct I agree to comply with all-County Investigation Fee R ordinances and State laws relating to building construction, Total Fee $93.63 LDMA Perm # a and hereby authorize representatives of this County to'enter _ upon the above- endo ed property for inspection purposes 5=25-90 SEE REVERSE FOR EXPLANATORY LANGUAGE 4 ature of Applicant or Agent Date , r