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Home My Public Portal About9422 BLACKLEY ST_Building__ ' APPLICATION''1"0 � COUNTY OF LOS ANGELES PARTMENT OF COUNTY U ILD I N G PE FSM IT" '` D BUILDING AND,SAF TY DIVISION ENGINEER. UIL•. - FOR APPLICANT TO FILL IN 'DDRE G // ADDRESS ADIDRESS J Z ,Z L,J GK L� LOCALITY NEAREST CITY CITY �E/i/�L CJ `/r ZIP CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT" 1?1 yl- /3 s- NOW ON LOT MAP BOOK PAGE PARCEL l/ DISTRICT GROUP, TYPE FIRE PROWED ED BY TRACT/ /55,-7' LOCK LOT NO "7` ) '_ - CONST' / ZONE OWNER .��vt C l� _ 7_ k .TID / ��S O8 e / a v STATISTICAL CLASSIFICATION SEWER MAP ADDRESS /f Z2, C� mac'/J 6 L CLASS NO _�DWELL,UNI/TS_ �y BK / ,�< CITY -TF/_1 L� c� %'� IP_ / �+(� USE ZONE NO U �.V� ARCHITECT OR ° TEL �� ENGINEER NO PKIAL _ 7Z ONDITIONS f ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED - YES,❑ NO ❑ TEL CONTRACTOR NO BLDG SETBACK FROM' LIC -FRONT PROP LINE OF (STREET) - ADDRESS - NO TOTAL SETBACK FROM TYPE OF EXISTING LIC HIGHWAY + YARD - FRONT PROP LINE HIG Y WIDTH CITY- CLASS CONSTRUCT( LENDER + - a NAME AND BRANCH BLDG SETBACK FROMU ADDRESS CITY SIDE PROP LINE OF (STREET) O SQ FT _ NO OF NO OF CHECK HIGHWAY + YARD AL SETBACK FROM TYPE OF EXISTING U SIZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH - 1:1 + = 3l Z DESCRIPTION OF WORK NEW — DID ® CORNER CUTOFF YES ❑ NO ❑ ALTER ' IN OPEN SPACE YES ❑ NO ❑ REPAIR ElUSE OF <4— / IN COASTAL PERMIT"ZONE a YES ❑ NO ❑ EXISTING BLDG S DEMOL ® - - APPLICANT TEL //u� ,(PRINT) � _ NO '` "$ f /Z i ,�vy7 BY(SIGNATURE) IHEREBY ACKNOWLEDGE THAT I HAVEIREAD THIS`APPLICATION AND STATE r ' THAT THE ABOVE IS CORRECT AND,AGREE TO COMPLY WITH ALL ORDINANCES , i 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 _ .I PENSATION INSURANCE SIGNATURE OF FINAL BY t PERMITTEE DATE ADDRESS - d TEL PC Fee$ Permit Fee S Q CITY- - - NO 14 } Q C_ _ Issuance Fee $ > " VALUATION Total Fee 9,. PLAN CHECK VALIDATION CK M o CASH _ + PERMIT VA D TION CK M O CASH , 3 9.0 r�_-AUG -24 0 , 1,U 9.5 0 ,&-,46 �f 76A638A CE#803A 6/76 1`r 76AB38A CE#803 8-63 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 DIR� tieTYPE E D B FOR APPLICANT TO FILL IN - conlsT ADDREISS � ,�lG c�!�e STATISTICAL CLASSY ICATION EBWK R MAP f CLASS NO DWELL UNITS ` — /11 , L7 LOT NO BLOCK WATER CERTIFICATE NOT REQUIRED ❑ RECEIVED ❑� TRACT j� P SIZE OF LOT (p R /� ' NNO OF OW ON LOTS a NO / HC(CIRCLE) STATE MAJOR SECOND LOCAL WLD SPECIAL USE OF CON'D ITION S. EXISTING BLDGEL �(X t OWNER �LQ T. �C`�LLC NO 161) 1 [ YARDHWY STREET NAME EXIST SETBACK WIDTH A DDRESS FRONT n /ti ARCHITECT OR ELS P L p!i(/ 0 ENGINEER NO SIDE P L � ADDRESS xx pyi�pp� L�,ic� ,(� /� rl TEL tl �/1 . X- .0-fA"Nr L .�r�/ • r 0, CONTRACTOR 6Vq Yj e,r NO ADDRESS DESCRIPTION OF WORK fgr1'a 9W i fA NEW ADD ALTER REPAIR DEMOLISH � � ) V4 s ,✓f�,S / � SQ FT �-• h NO OF NO OF /� .l2 .aI1 777 i SIZE d O �c30 STORIE A ILIES USUOCTURE ly SIGNATURE F Off /?PGS -"'.4R .,• J' T Al �r9'oJ:.I�Ar i d A PPLICAN VALUATION $ �� Ov oa 1Y �F APPROVALS i ODATE INSPECTOR S SIGNATURE PC PMT FOUNDATION LOCATION T �f } FEE $ FEE FORMS MATERIAtra � +�- .+r' • FRAME FIRE STOP I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT$ RC- 1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION" v WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COM ENSATION INSUI E �JJ LATH EXT J SIGNATURE OF HOUSE NUMBER COR PERMITTEE JJ �.• RECT AND POSTED ADDRESS FINAL �4 JOHN F LEWIS PRINCIPAL ST URAL ENG! EER PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK MO CASH UAC,'o 0 7 7 5 ZZ JM 2 1 0 1 8.5 0, 14, WORKERS' COMPENSATION'DECLARATION insureboraafcerhficatte of Worke shave a rtComtpensatton Insuran elf APPLICATION F O R; B U I L D I N G' PERMIT T �' or'a certified copy Thereof (Sec'3800, Lab C ) - L- - COUNTY-OF LOS ANGELES BUILDING AND SAFETY Policy No Company I- - -` BUILDING Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS L' } Certified'copy is filed with the county building inspec- BUILDING hon departmenLt ADDRESS x' , / Date Applicant CITY / ZIP D LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' °' ' - + O OF BLDGS - NEAREST_ £ t - COMPENSATION INSURANCE SIZE OF LOT �J , NOW ON LOT CROSS ST (This'section need not be completed if-the permit is for one - ASSESSOR w ' 71 hundred dollars ($100)or less ) TRACT �r '7 BLOCK �a , LOT NwOt ) MAP'BOOK`' PAGE PARCEL < OWNER14 (;- 1 . L D to NOTEL I,�(D n ' USE ZONE NO I certify that,in the performance of the work for which this _ ut emit`is issued, I shall not employ a person-in an manner jj - ' -/��-/QUI SPECIAL i so as�o become subject to the WorkersPCompensat on Laws ADDRESS "L= I,J � - _ - /Z�/V CONDITIONS r- 0 _ ._ _ _ _ _ -.. V CITY — L _ _ZIP g _ OC Date' Applicant O ARCHITECT OR TEL DISTRICT _ GROUP :TYPE FIRE PROCE ED BY NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO CONST r ZONE Exemption, you should become subject to the Workers' /J W Compensation provisions of the Labor Code, you must forth- ADDRESS with comply-with 'such provisions or,,this permit,shall be - TEL STATISTICAL CLASSIC TION APT CONDO Z deemed revoked`, CONTRACTORto NO LICENSED CONTRACTORS DECLARATION< - -- - - - LIC-11CLASS NO DWELL UNITS I hereby affirm that I am licensed,under provisions of Chapter 9• ADDRESS NO (commencing with Section 7000)`of Division 3 oLIC f the Business and _ SEWER MAP - -- - Professions Code, and my license is in full force and'effect CITY CLASS BKVALIDATION - _ SQ FT NO OF NO OF_ _ _CHECK PG LicenseNumberLic`Cldss SIZE ISTORIES FAMILIES ONE - VALUATION '+ r • '- ' ` DESCRIPTION OF WORK- - -" - NEW-• 1` O " Contractor Date ADD El $ ! , I am exempt under Sec C= - 5 L U C, ALTER B 8P C for this reason I� �y� REPAIR $ Dote USE OFEXISTING BLDG `\ L—� '�' 1 DE _ ___ -21 5 7.7 n, Signature '' ^ APPLICANT TEL FINAL n OWNER-BUILDER DECLARATION PRINT u NO _ �' DATE ---p e o 91 I hereby affirm that I am exempt from the Contractor's License -' - ( o o'(�Q,5 0 Law for the following^reason (Section 7031 5, Business and ADDRESS FINAL Professions Code)" ' -1� ' - "' PRE BY o 0 o"b Q 5 0,� �( BUILDING - IJt I- ly as owner of the property, or my employees with - ADDRESS _ _ _ w O 2 2 G-85 wage`s as their sole compensation,will do the work and i the structure is not,intended or offered for sale(Section LOCALITY 7044, Business and Professions Code)-- - - "` MOVING - - TEL I, as owner of the property, am exclusively contracting - CONTRACTOR _ NO - t with licensed contractors to'construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) REQUIREi ' CONSTRUCTION LENDING AGENCY EXIST SETT BACKD YARD HWY TOTAPREOTP LINE WIDTH WIDTH t I hereby affirm that there is a construction lending agency for FRONT 1 ' the performance of the work for which this permit is issued P L - - - - (Sec 3097, Civ C ) SIDE m _ _ PL Q Lender's Name y- �j� - - P C- Fee$ - - Permit Feev LDMA Ref # Y - Lender's Address Y VSOI certify that I have read-this application and state that the _ _. Issuance Fee LDMA P/C#--_+-- - - above information is correct I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, �. Total Fee- - 6d.15-6 1-LDMA Perm # - - - - u and hereby authorize representatives of•this County to enter upon the above-mentioned propertfor insp hon purpos7es7 a T T [ Ai^L^ SEE REVERSE FOR EXPLANATORY LANGUAGE f ' Signature of Applicant or Agent - - - - Date-