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HomeMy Public PortalAbout9405 BLACKLEY ST_Building__ ©s 76A6-'),8A 1. CE#803(REV 11!78) 9*f APPLICATIBUILRM IT COUNTY OF LOS ANGELES BUILDING AND SAFETY FLDING OR APPLICANT TO FILL IN ADIDRESS LDING fADDRESS .J �•� LOCALITYQ NEARESTY ZIP f 1J� O CROSSST -� NO OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE I PARCEL DISTRICT GROUP• TYPE FIRE O D BY TRACT BLOCK LOT NO ICON /� TEL OWNER/� NO f,, STATISTICAL CLAS ICATION SEWER MAP ADDRESS � �� LCLASS NO J DWELL UNITS BK PG CITY e ' ZIP ARCHITECT OR TEL VALUATION $ ENGINEER NO - v ADDRESS BLDG SETBACK FROM FRONT PROP LINE (STREET) ? CONTRACTOR NO TOTAL SETBACK F TYPE OF EXISTING C HIGHWAY + YARD = FRONT PROP L HIGHWAY WIDTH ADDRESS NO _ LIC + CITY CLASS BLDG SETBACK FROM CONSTRUCTION LENDER SIDE PROP LINE OF (STREET) NAME AND BRANCH � _ HIGHWAYS + YARD = TOTAL SEJBACK FROM TYPE,OF EXISTING � d ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH 0 V SO FT NO OF NO OF CHECK + _ ag SIZE STORIES NO 4 ONE 0 USE ZONE MAP ClO/ DESCRIPTION OF WORK - NEW NO ADD �i/ SPECIAL d " ONDITIONS y� / /� t Z / ICOo ALTER ❑ DATE L REPAIR ❑ t USE OF DEMOL EXISTING BLDG P ❑ Z APPLICANT [�'� � 2 (PRINT) e? ' • '' NO�f�do�J 3 BY(SIGNATURE) F4/J �G( L��l�( 4 ;20965A I HEREBY ACKTHIS APPLICATION AND STATE x THAT THE ABOVENSO CORRECT WLEDGE TAND HAT (AGREE TOHAVEAACOMPLY WITH ALL ORDINANCES Ju o 0 0 0 0 l 1 , _ AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE UWOK AUTHORIZED HEREBY I , IN VIOLATION THE LA OR CODE OF THE STATE OF CALIIFORNIAWILL NOTOIN ELATING TANYOO WORKMEN 5 COMF z 2 o o16 1,00 PENSATION INSURANCE ` '00061,00 SIGNATURE O Z'b-8 0 PERMITTEE ADDRESS 2 TEL C CITY NO PC Fee$ Permit Fee / > Issuance Fee :E - W • 6 Total Fee i _ 76,06 SPA CEr #803 1/71 1 -Ar,*LICATION FOR BUILDIN PERMIT ' COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL w BUILDING AND SAFETY DIVISION BUILDING Q ADDRESS / COLEMAN W. JENKINS, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print ort only) CROSS ST DISTRICT GROUP TYPE P O S BY BUILDNG ADDREISS O Jam_ CONST 9 S� �GAGNL� S%, ......Y��/// z- rr STATISTICAL CLASSIFICATION SEWER MAP LOT NO CD� — LOCK ' CLASS NO�_DWELL UNITS -$FCPG TRACT �y y ) j USE ZONE MAP SIZE OF LOT a z/ /� /Z�/ NOWOON LOTS / /'�' SPECIALL (J USE OF ` , 1 CONDITIONS EXISTING BLDG OWNER JOEL x,(J'�12�-� NOL� 71.3Z-S BLDG SETBACK FROM ADDRESS 9pS' «�/�(,�Y S/ FRONT PROP LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY T'��^yf�[I`L G/T j' HIGHWAY WIDTH FROM C L ARCHITECT ORTEL } _ ENGINEER d�re2 B�/�D�►- NO � BLDG SETBACK F ADDRESS SIDEPROP LINEOF (STREET) TEL TYPE OF EXISTING SETBACK HI Y } YARD = TOTAL O CONTRACTOR NO HIGHWAY WIDTH FROM C L V ADDRESS LIC +NO - CD LIC CITY CLASS CORNER CUTOFF YES ❑ NO ❑ W CONSTRUCTION LENDER c� N NAME AND BRANCH / SEE REVERSE SIDE FOR SPECIAL APPROVALS Z ADDRESS - SQ FT NO OF NO OF / NEW SIZEjT,4pIES FAMILIES O USE OF ADD ALTER �- E PAIR❑ SIGNATURE a-It APPLICANTO F7 DEMOL ❑ rr VALUATION / APPROVALS DATE NSATOR'SnfIGNATURE P C PMT FOUNDATION LOCATION FEE S FEES 770 1 FORMS MATERIALS U z— FRAME FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION, 7 WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT DUCTS ` STRUCTIONI CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE LATH, EXT SIGNATURE OFHOUSE NUMBER COR- ✓✓'' PERMITTEE n r/^ RECT AND POSTED ADDRESS OSf!�L6f-C Z S� / c C FINAL 1 JOHN F LEWIS PRINCIPAL STRU RAL ENGINEER PLAN CHECK VALIDATION CK M o CASH _ PERMIT VALIDATION CK o CASH 5 3'N SEP Z 3 1 0 ' 4 8.7 5- c DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ��` � � DISTRICT NO PLANCK NO / PERMIT NO BUILDING c I /P// /r33 O ADDRESS —ram , (/+ _ l�`•'•'� LOCALITY v1 � RECEIVED BY DATE OF APPL DATE ISSUED , C NEAREST CROSS ST BUILDING OWNER \ /^ RNAC ' DDRESS /� MAIL S D r- Y IMc LOCALITY f / 0 ADORES NEAREST TEL CROSS ST. CITY NO FIRE NO OF TYPE GROUP/ ARCHITECTTEL ZONE PLANS '�" ENGINEER OR _ � BLDG �C 9 /O RSD NO SETBACK LINE ADDRESS �jut� `t`TEL {I'�" A L BY DATE�`r/ DATE CONTRACTOR LYTHER G P �IAU�1pNO A l 4 0 ca `` USE ��� APPROVED S ADDRES So kAvFF'�/��'�`� G ZONE BY DATE LEGAL1,{,QaCORRECTIONS DESCRIPTION OT NO / 1 BLOCK TRACT NO OF BLDGS'./ , SIZE OF LOT I NOW ON LOT�y�/�� USE I OF I NO OF EXISTING FANG BLDG FgMI LIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION — O A REPAIR 4°�MOVING NO OF \ DEMOLISH SQ SIZE T #/ ROOMS J STORIES / _ D WALL ROOF yrs T r COVER I NG�� �u/1r.-,�j:' I COVERING USE OF NEW � „ BUILDING c 1 V (; P0" RIf.CT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ,THI1J APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORREC* FOUNDATIONI. LOCATIONINSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE& FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION \ - FRAME FIRE STOPS, // '� � SIGNATURE OF ► BRACI ND,BOLTS 8'�1� PERMITTE — LATH, INT AUTHORIZED AGT 1 LATH, EXT TJ'✓" 5�/�/ 76A638A s-aB11 DBS-3 SOM SETS � P C $ PLASTER, INT JFEE PLASTER,EXT. VALUATION • FEE $� / 1� FINAL APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN eul G DDRESS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure, 9405 Blackley St. or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec 3800,Lab C) LOCALITW 7 1 Policy No 1330196 State Comp. Temple Cit 91780 Company SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnished NEAREST CROSS ® Certified copy Is filed with the count building Inspection TRACT BLOCK LOT NO USE ZONE MAP NO department Date 4/6/95 Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO YES / COMPENSATION INSURANCE Debbie Franklin 286-0208 WITHIN 1000 FT OF SCHOOL? NO ADDRESS (This section need not be completed If the permit is for one hundred 9554 Blackley S t. DISTRICT GROUP CONST FIRE ZONE PROCESSED BY dollars($100)or less) CITY ZIP I certify that In the performance of the work for which this permit Temple City 91780 Is Issued, I shall not employ any person In any manner,so as to ARCHITECT OR ENGINEER TEL NO become subject to the Workers'Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate OfCONTRACTOR TEL NO REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith United Roofin5z Co. Inc. 213/223-4081 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL 1821, Daly St. 137650 SIDE d LICENSED CONTRACTORS DECLARATION CITY LIC CLASS P L CD Los Angeles C-39 1 hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP SQ FT SIZE NO OF STORES NO OF FAMILIES (commencing with Section 7000)of in full force 3 of the Business and 29 1 SFD NEW ❑ BK PG ® � Professions Code,and my license is in full force and effect v License Number 137650 Llc Class C-39 DESCRIPTION OF WORK ADD ❑ VALUATION c- ContrsctorUnited RoofingDic 10/31/96 Remove existingroof. Install ALTER ❑ Z $5,531.00 3 tab composition shingles. { ❑ I am exempt under Sec Smoke decectOLS requrred. REPAIR "' B&PC for this reason USE OF EXISTING BLDG DEMOL ❑ LOMA PIC M "=r: - - Date URM ❑ )_ {ij_ ar a 65 Signature APPLICANT(PRINT) TEL NO LDMA Perm N = t 1-(`t 11 - c= ❑ 1, as owner of the property, United Roofing Co. Inc. 213/223-4081 p party, or my employees with wages as O , , � ,.,- their sole compensation,will do the work and the structure Is ADDRESSI-�1 not Intended or offered for sale (Section 7044, Business and 1821 Daly St. , LA CA 90031 FINAL DATE a Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 1 licensed contractors to construct the project (Section 7044, YES❑ No ,- Business and Professions Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there Is a construction lending agency for YES❑ NO the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,Civ C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE TITLE CHAPT 220 SEC NS2 20 100THROUGH 22014000NGERNING 3 Lender's Name HAZARDOUS MAT Ls RE ppp ING SE OBTAINING A PERMIT FROM THE SCAOMD Lender's Address—OR AGENT 0 1 certify that I have read this application and state that the above PC FEE PERMIT FEE Information Is correct I agree to comply with all county / ordinances and State laws relating to building construction,and hereby authorize repr_Qsentatives of this County to enter upon ISSUANCE FEE � / the above-mention ro for inspection purposes &7 4/6/95 INVESTIGATION FEE TOTAL FEE ' Sguwrt d�ppkrn« Deb SEE REVERSE FOR EXPLANATORY LANGUAGE