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Home My Public Portal About9428 BLACKLEY ST_Building__ 76A638A CE4803 3-68 APPLICATION FOR BUILDI G PERM COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS a BUILDING AND SAFETY DIVISION LOCALITY- JOHN A LAMBIE, COUNTY ENGINEER NEAREST_ COLEMAN W. JENKINS, SUP T OF(BUILDING CROSS ST TYPE FOR APPLICANT TO FILL IN DISTRICT NO GROU CONST V PRO D B Print or type only) ' g V BUILDING STATISTICAL CL FICA TION SEWER MAP ADDRESS 9428 E. Blackley St. CLASS NO' DWELL UNITS BK PG_ LOT NO BLOCK USE ZONE MAP /!` NO TRACT `/Vr z SPECIAL IT ONS NO OF BLDGS COND ` SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG P,e s i de-face BLDG SETBACK FROM 77,, T TEL ^ FRONT PROP LI NE OF (STREET) OWNER 1� a L en NO At7-5041 ,TYPE OF EXISTING SETBACK HIGHWAY + YARD = r TOTAL HIGHWAY WIDTH FROM C L ADDRESS FBlackley, St - ^ CITY Temple C1 ty BLDG SETBACK FROM ARCHITECT OR TEL SIDE PROP LINEOF (STREET) ENGINEER _ NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L TEL" d— i + d CONTRACTOR�7 p o i. ADDRESS 710 S . Garf le" C39-6676 CORNER CUTOFF YES ❑ NO ❑ v CITY IiA.m CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS o DESCRIPTION OF WORK a rn z NEW ADD ALTER' a Aei� DEMOLISH SQ FT NO OF NO OF SIZE 12100 STORIES FAMILIES USE OF STRUCTURE 'P SIGNATURE OF, u APPLICANT ' t ' VALUATION $340.00 _ ' 340 CO APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT ONON FEE $ FEE $ q.00, FOUNDATFORMS'MATERIAALS `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 BUILDING CONSTRUCT*WIN THAT IN DOING THE WORK I AUTHORIZED HER Y LOY ANY PERSON IN VIOLA LATH, INT `TION OF LADD TATE OF CALIFORNIA RELATING TO RKM S CRANCE LATH, EXT SIGNATURE HOUSE NUMBER COR-' PERMITTEE RECT AND POSTED ADDRESS o FINAL JOHN F LEWIS PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK MO 51 CASH' +� PERMIT VALIDATION CK M O CASH L7� _ 3 . 9 9.00- APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES , BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILD A DREG$ I hereby affirm that,l have a certificate,of consent to self Insure, BUILDI D aY or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) CITY 1. ZIP r— _ ` � LOCALITY POIICy NO Company SIZE OF LCT NO OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished NEAREST CROSS ST ❑ Certified copy IS filed with the co ty b ding a tion TRACT BLOCK LOT NO USE ZONE MAP NO de�r ant Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION IF OM WORKERS' owNE TEL NO COMPENSATION INSURANCE C WITHIN 1000 FT OF SCHOOLS yrs No his section need not be com leted if the permit Is for one hundred ADDR (Tp � DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars ($100)or less) ((( CITY ZIP I certify that In the performance of the work for which this permit is Issued I shall not employ any person In any manner so as to ARC141TECT OR ENGINEER TEL NO become subject to the Workers'Compensation Laws STATISTICAL CLAS� �IFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers CO C TE SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith O FRONT comply with such provisions or this permit shall be deemed revoked AD R �✓ LIC NO P L LICENSED CONTRACTORS DECLARATION !tgt SIDE CIT LIC CJA S,y P L I hereby affirm that I am licensed,underprovisions Of Chapter 9 1 SEWER MAP >- (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES d Professions Code n m license Is In full force a d ct NEW BK PG , Q License Num r Lic Class — DE TION w Knn ADD ❑ VALu V Contractor ^ to a� _ ALTER 1:1 $ N22 0 ❑ I am exempt under Sec REPAIR E] $ U B&PC for this reason DEMOL ❑ LDMA P/C# W CL Date USE OF EXISTING BLDG U ❑ N 1 ? Signature APPLICANT(PRINT) TEL NO LDMA Perm# Cl 1, as owner of the property, or my employees with wages as ZO T ii'_C i ,Y their sole compensation will do-the work and the structure Is ADDRESS _ not Intended or offered for sale (Section 7044 Business and FINAL DATE Professions Code) " WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �1 Q i }TC 1! ❑ I, as owner Of the property am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE S 1 1 C�i P P Y Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE1 FINAL BY licensed contractors to construct the project (Section 7044 i ITAL 12 1 m 35 Business and Professions Code) vas 1:1 No❑ j WILL THE INTENDED USE OF THE BUIDLING BY THE APPUCANT OR FUTURE BUILDING OCCUPANT i-I�(.(., 1� , OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 1, t - CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)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 IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV C) _ CHECKLIST I UNDERSTAND My REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE -- N TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUSi.!!U"U�FJ Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD o Lenders Address �t-� 1''-' OWNER OR AGENT O o I certify that I have read this appllc ion and state under penalty 0 of perjury that the above informa IS correct I agree to comply PC FEE PERMIT FEE with all county ordin ce a ate laws relating to building construction d he by a t rl representatives of this County ISSUANCE FEEco r$40/,.. co to a ve- o d property for Insp n purposes �J a INVESTIGATION FEE TOTAL FEE ' n ve o1 a Agem Dale SEE REVERSE FOR EXPLANATORY LANGUAGE