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HomeMy Public PortalAbout9342 BLACKLEY ST_Building__ 76A6HSA CE#6086_,8 APPLICATION FOR. BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDIN DEPARTMENT OF COUNTY ENGINEER A°DREss BUILDING AND SAFETY DIVISIONLOCALITY / JOHN A.LAMBIE•COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT GROUP TYPE PR�O ESS�Y FOR APPLICANT TO FILL IN I CONST. BUILDINGn_;- } STATISTICAL CLASSIFICATION SEWER MAP 'ADDRESS dam' / J j C CLASS. NO.�DWELL. UNITS LOT NO. BLOCK MAP - - STATE YES O NUMBER ,-1(' �� HWY. TRACT • USEZONE SPECIALNO.OF l ,,.� ��y� NOW ON LOTS CONDITIONS..i-,i/,.yg.�, SIZE OF LOT , � USE OF ry EXISTING BLDG -1 BUILDING. _ EXIST. J YARD HWY' ' - STREET NAME SETBACK WIDTH OWNER FRONT / MAIL -,I- .�1-�} P.L. - 1 L ,,�� ' ADDRESS S37iZ-- ;..�'/- t-s Ll SIDE jag T r T� TEL .�./ P.L. - - fCJCA cI�L—�'_yYr lrs L .`� NO.�'I E 4$Z„ Q SECT ON RECOR D„q'G;L ARCHITECT OR( TEL. - __ LZ ENGINEER .S Gi 0P - NO. 4�-- ¢-- ` .1 �" +• �. ..� ADDRESS 1 C°, 5 A )nn � TEL. CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK Ag-s EW ADD ALTER REPAIR DEMOLISH • o NO.OF NO.OF SIZE STORIES FAMILIES USE O STRUC UREA SIGNATURE OF APPROVALS APPLICANT DATE INSpECT0RS81GNATURE ADDRESS FOUNDATION: LOCATION - 115141 FORMS.MATERIALS �.! ` JL L�-0 0 t`� P.C. $ ( ) FRAME: FIRE=STOPS. / `� J FEE BRACING, BOLTS VALUATION $ [) FURNACE: LOCATION. FEE / GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. LATH,INT. /f PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, EXT. STATE LAWS- GULATIN LDIN C STRUCTION. SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL \ CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION c .O. CASH PERMIT VALIDATION CK. M.O. CASH' •--LA'C01 $ .5, 5 � JAN 1 5 2 3 A 2. 4.a© A -- ;p2'.1 71 Fr 4 1 A 4 8.0 i 76AGSBACE#80345-88 ''APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING c = ADDRESS DEPARTMENT OF COUNTY ENGINEER V� BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT N:Oj GRajiPTypE PROCESSED BY - FOR.APPLICANT TO FILL IN �(' , I CONST. BUILDING t STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 3 U C L I BK PG CLASS.NO. SOWELL. UNITS LOT NO. BLOCK MAP ^� STATE YES NO NUMBER 7� �-� HW 3Kgo NO.OF BLDG .TRACT. UXNE SPECIAL r� ! I NOW ON LOTS CONDITIONS SIZE OF LOT USE OF EXISTING BLDG. BUILDINGEXIST. SETBACK YARD HWY STREET NAME VVI DTH OWNER A 140- FRONT MAILP.L. 'C ADDRESS•" i' 0 Ms Ail SIDE EL. ` CITY TTE . ARCHITECT OR TEL. INSPECTION RECORD AN-e-Z(Z �, ENGINEER NO. ADDRESS TEL. CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SO.FT. ,/'� NO.OF NO.OF SIZE ( J RIES FAMILIES USE OF STRUCTURE L SIGNATURE OF APPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS.MATERIALS $ P, C. $ �� _ FRAME: FIRE STOPS. �® FEE BRACING, BOLTS VALUATION $ FURNACE: LOCATION, FEE o �{j GAS VENT,DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE 0 STATE' LAWS EATING BU DINGO NSTRUC 1 N. LATH.EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RE CT AND POSTED ADDRESS AL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL E PLAN CHECK VALIDATION. CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH Ia O764C JUll1 A .UQ K APPLICATION FOR BUILDING PERMIT �1 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, BUIING ADDRESS, or a certificate of Workers'Compensation Insurance,or a certified ZIP copy thereof(Sec.3800,Lab.CJ ' 6,?n LOCALI 71111114 Policy No. Company SIZE OF LO NO.OF BLDON LOT t — P/ GS: OW ❑ Certified copy is hereby furnished. � � NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT No. USE ZONE MAP NO. department. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant SPECIAL CONDITIONS O ER _ TEL.NO. e/;::] CERTIFICATE OF EXEMPTION FROM WORKERS' �' YES NO COMPENSATION INSURANCE vm./ r �� Z -S'. / WITHIN 1000 FT.OF SCHOOL? AD ESS. (This section need not be completed if the permit is for one hundred I7 ����� ✓ zS�� DISTRICT GROUP TYPE CONST.' FIRE ZONE OCESS BY dollars($100)or less.) C ZIP ,Q �� I certify that in the performance of the work for which this permit T FO is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.�N/O. d U 7 1 _ 7 STATISTICAL CLASSIFICATION APTLf C DO become subject to the Workers'Compensation Laws. /, Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST NO. Exemption, you should become subject to the Workers' CONTRACTOR TEL. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 60C FRONT comply with such provisions or this permit shall be deemed revokeJ. ADDRESS LIC.NO. P L SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL c U I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP SQ.Fr.SIZE NO.OF STORES NO.OFAFAMILIES 1 " +�(commencing with Section 7000)of Division 3 of the Business and � NEW ❑ BK PG Fr ` i ° „0Professions Code,and my license is in full force and effect. b — . it11 —* DESCFIIpTION OF WORK ADDVALUATIONf ,License Number Lic.Class II���� i f7��Contractor Date ALTER ❑ � i 1TEI3=qsveeREPAIR ❑ $ I.TAL 469 - 3 El am exempt under Sec. ���A f •c ❑ •i , B.BP.C.for this reason �' DEMOL LDMA P/C# CH. • . 1 USE OF EXISTING BLDG. p Date: URM ❑ /� t,`dIat 11 ,. nature APP ANqT/fPRINT) i TEL.NO. LDMA Perm# $y`°i.-j} as owner of the property, or my employees with wages as E V 1N ' '�/` O �, � E { their sole compensation,will do the work and the structure is ADD9aSS 8 4r not intended or offered for sale Section 7044, Business and �4:.L L Sr �� CI FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL V ❑ 1, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q 5,T f -•!� s r4 Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Fn r � f.: — °C 34 E r :-54 licensed contractors to construct the project. Section 7044, L. .4`' Business and Professions Code.) p ) ( ves❑ No❑ - - 1 .�i t�J WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING -- - A}�) 57 -1 CE OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH -33;-i r1L. -_.8 .�•• '�—" CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. 3r 'itS,TL -g° 01 I hereby affirm that there is a construction lending agency for YES 1:1NO❑ r the performance of the work for which this permit is issued(Sec. A •, _:L ° I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE LL) (� 1 � 51 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 1 m. COUNTYCODE,TITLE2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING Lenders Name :HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. aLenders Address owr+eaoaADFr+r o 1 certify that I have read this application and state that the above Q information is Correct. I agree to comply with all County P.C.FEE / �� PERMIT FEE a=� 2IG ordinances an State laws relating t building construction,and /(.•- �V.1J 59,00 ¢. hereby But ize repro tativ f this County to enter upon ISSUANCE FEE (2 o 6 the ab mention ro or' spection purposes. 'J eS':p e— U INVESTIGATION FEE TOTAL FEE ­fAPPH °r Aq Dan 4 SEE REVERSE FOR EXPLANATORY LANGUAGE