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HomeMy Public PortalAbout9433 BLACKLEY ST_Building__ 7GA638A CE 9803 2-63 APPLI CATI ON FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ADDRESS 3 DEPARTMENT OF COUNTY.ENGINEER BUILDING AND SAFETY DIVISION LOCALITY 7. JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. (2/p / DISTRICT N G 'P I TYPE •� P BY FOR APPLICANT TO FILL IN � 0 CONST. � BUILDING KL STATISTICAL CLASSIFICATION SE ER MAP ADDRESS CLASS. NO. U DWELL. UNITS LOT NO it �� �(�Uj AC4Qjk BLOCK WATER NOT REQUIRED1:1RECEIVED ❑ CERTIFICATE: TRACT 7�. 0 & 3a3: Fr MAP HIGHWAY, STATE MAJOR SECOND, OCAL NO:OF BLDGS. NO. J (CIRCLE) SIZE OF LOT/01.4 NOW ON LOT O� USE ZONE SPPECIAL USE OF 4�/tom-./'' CONDITIONS i EXISTING BLDG. DCI (r R-it I E OWNER FL'�l�Y TIE BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS '43FRONT y� �1 ARCHITECT OR - TEL. P. L. (./ ! ENGINEER NO. - SIDE ' L. } ADDRESS rr TELA qq�� 2 CONTRALTOel? -77 I� \ ADDRESSAt �1 /1`i � S p�S16A,3 f U l S 1 ;J A,4-1 , O DESCRIPTION OF WORKu W NEW ADD ..ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE STORIES I FAMILIES USE OF STRUCTURE V 0 f �� "B �i�•. �, �:r� €�.e�'., �> r �""ALA SIGNATUR Ems.: rT,� PPLICA 01. VALUATION $ VVGG// APPROVALS DATE INSPECTORS SIGNATURE P.C. PMT FOUNDATION: LOCATION _j, FIRE FEE $ n� FEE $� FORMS."MATERIALS t - -. +�"`LaaS.^ �_ FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTSI. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. ,,, �j{/'7 '44T WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS �..✓ BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH, INT. TION OF THE LABOR CODE OF THE STA OF CALIFORNIA RELAT- ING TO WORK 'S CO ENSATI S NCE. (\'}��J LATH, EXT. p SIGNATUR \1� S HOUSE NUMBER COR PERMITTE b RECT AND POSTED 'A/��•'� � :" �'m'`-�'i"i�. - ADDRESS FINAL ( 6{' JOHN F. LEW", P INCI,PAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH LAA` .3,6 6 7 DEC 18 2 3 02 8.5-"A Limo 4 1 2 4JAN 1 D 5 7,00- �~ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES -" r BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN -BUILD nos I hereby affirm that I have a certificate of consent to self insure, BUI G A DRE$ „ or a certificate of Workers' Compensation Insurance,or a certified ^��dS copy thereof (Sec.3800,Lab.C.) Vi—�11�� � ZIP LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ' ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ BLOCK LOT NO. Certified copy is filed with the county building inspection TRACT department. USE ZONE MAP NO. ASSESSOR MAP BOOK�S�O PAGE 999 PARCEL Date Applicant SPECIAL CONDITIONS r CERTIFICATE OF EXEMPTION FROM WORKERS' ow TEL NO. ES COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDR J �� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) I certify that in the performance of the work for which this permit a-- Z q 1 VW DA is issued, f shall not employ any per on in any manner so as to become Sub" al to the Workers'C ensation awAM ARCHITECT OR ENGINEER TEL NO. - STATISTICAL CLASSIFICATION APT CONDO Date 14 Applicant ADDRESS CLASS NO. � DWELL UNITS NOTICE YTO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' C gClgp T L 0. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions Of the Labor Code, you must forthwith N A FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS G. + ��/) n� LI .NOJ� / P L 10 G. W"�. OVA DA° � .J � SIDE LICENSED CONTRACTORS DECLARATION CITA, ��/� CLASS P L I hereby affirm that I am licensed underprovisio.ns of Chapter 9 I— /`� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE I NO.OF TORIES NO.OF F MILIES Professionsima l force and fect. NEW ❑ BK PG a DESC ION OF O ADD ❑ VALUATION O License NuClass ��1 'A 9%5 V Contractor 9%5 Contractor ALTER d0�'©� ❑. cc I am exempt under Sec. REPAIR El $. 0, BAP.C.for this reason DEMOL ❑ LDMA P/C# W Date: USE-OF.EXISTING BLDG. URM ❑ fir;i a Signature APPLICANT(PRINT) TEL NO. LDMA Perm# --- _ Z ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is ADDRESS 1 FINAL DATE f-Mi u not intended or offered for sale (Section 7044, Business and Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ` — -`i l ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ Y. Y 9 AMOUNTS SPECIFIE ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY t !J illi n ' W. licensed contractors to construct the project (Section 7044, YES❑ NO Business and Professions Code.) "•L4••.i:-E WILL THE INTENDED USE OF THE 13UJDLJNG BY THE APPLICANT OR FUTURE BUILDING t-'�tI'4E �•- cI_�'_ 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. «•• a a• . I hereby affirm that there is a construction lending agency for VES❑permit a the performance Of the Work for which this permIS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ; t0 4 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address O - OWNER OR AGENT , o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct. I agree to Comply P.C.FEE PERMIT FEE 7 N with all county ordinances and State laws relating to building m constr n, and hereby aut rize repre§entatives of this County ISSUANCE FEE to e e Ove t" n d prop �[ for in ec q p p Se Z Q (/ � � �T INVESTIGATION FEE TOTAL�E e ��. ature of Applicant I Agent C~� SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY `f# 05118 BUILDING PERMIT DEPARTMENT-OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT- TEMPLE CITY CA BL 0508 9706100043 PHONE: (818) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 9433 BLACKLEY ST STRUCTURE: 0 VN TEMP CA 917803141 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ENCINITA 8590-003-039 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RFS 1D USE ZONE: R-I ISSUED ON: _-7—R-0Z ESSED BY; 0 : EXIST OCC GRP: 06/10/97 TC 06/10/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DAk FINAL BY: CODE: BURT ROBIN J (818) 286-2952- 1 3,000 9433 BLACKLEY ST TEMP 917803141 FEES PAID DESCRIPTION F WORK T/0 HOUSE & GllAGE INSTALL CLASS "A" COMP. GAF-25 YR. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. .NO: CHAMPION ROOFS (800) 260-5443- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 3000.00 VAL 0.50 SPECIAL CONDITIONS. D2 PERMIT W/O EN_-HC ;3000.00 VAL 99.15 ' TOTAL FEES 127.40 � J CONTRACTOR: TEL. N0: APPROVALS DATE INS ECTQR SIGNATURE CHAMPION ROOFS, INC. (818) 796-3925- i —2 3257 VERDUGO ROAD LIC. NO V�� LOCATION AND SETBACKS LOS ANGELES CA 90065 429481/C39 �•a`���i �, -� ' ��`�� �";� SOILS ENGINEER APPROVAL RCHI ECT OR ENGINEER: TEL. NO: FO NDATION/TRENC FORMS LIC. NO: SLAB/UNDER FLOOR AISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ONE: CMP: 147H265 3 01 UNDERFLOOR INSULATION FLOOR SHEATHING 0. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS i NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS C SHEAR PANELS AIR QUALITY:. .1000 FEET _ MATERIALS= NO N0 N0, �r ; FRAME INSPECTION . REQUIRED TOTAL SETBACK FROM EXIST (/'%' C>�' FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL r/� ��!% INSULATION/WEATHER STRIP SIDE PL INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR CEIL ASSEM. RATED WALL SSEMBLIES RATED SHA /OPENING T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508