HomeMy Public PortalAbout9435 BLACKLEY ST_Building__ 76A638A CE#8032-63 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
UIL IIN
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY ,1
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF-BUILDING CROSS ST r
DISTRICTNO GR P TYPE R ES BY
FOR APPLICANT TO FILL.IN �r �) CONST -c,
BUILDISS f �. C /f L L T� STATISTICAL CLASSIFICATION SEWER MAP
DDRENG
/ CLASS NO 0 DWELL UNITS --
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fl-LOT NO N% S)b VjE((J Acs BLOCK WATER
CERTIFICATE NOT REQUIRED ❑ RECEIVED
W 76.60 r
TRACT MAP IR
NO
P A5 (CIRCLE)STATE MAJOR SECOND LOCAL
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SIZE OF LOT A� NOW OF BLDGS ON LOT USE ZONE TPECIAL
USE OF I / CONDITIONS
EXISTING BLDG ��JL[�1 ,
OWNER E E SN NO /7 BUILDING - EXIST
SETBACK YARD HWY STREET NAME WIPTH
ADDRESS I FRONT
ARCHITECT OR TEL P L670
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ENGINEER NO SIDE s
P L �.
ADDRESS d
CONTRACTOR W� IVC, NE % ',3 O
ADDRESS 0/ /5 '
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DESCRIPTION OF WORK ` °`� �� //� u
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NEW ADD _ ALTER REPAIR DEMOLISH .1 In g aA 1+y enoie o N
SQ FT ��/ NO OF IA OF 6f !'1 aR' Hl
SIZE / STORIES FAMILIES �!^�4 9
USE'OF C g
STRUCTURE S 1 00 ry � g � �d�" �yp 4 [a'7,y/1
S I G N A E O Fjlj� I X!`3PK+K•r� ,�1L`a+rvT�ID ..$l;o� m L,+r9� 11'�Y'b{��1' I
APPLICANT
VALUATION $ oxv
7� APPROVALS DATE IINS ECTOR S SIGNATURE
PC PMT
$ tFEE $> OO FOUNDATION LOCATION
FEE FORMS MATERIALS
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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
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 WUR:'
MEN 34 OMPENSAT ON SURA NCE -
LATH EXT d -�
SIGNAT LL HOUSE NUMBER COR-
PERMIT V RECT.AND POSTED -
ADDRES FINAL
JOHN F LEWIS PRINCIPALS TRU TURAL ENGIVEER
PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK M- CASH
3. 6 6 8 1 DEC 18 2 3 D 2 8.5 0A
Ao 4 1 2 5 JAN 6 1 D 5 7.0 0- .,
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~' WOR'r:ERS' COMPENSATION DECLARATION
{Y
•1 hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compenshon Insurance, or APPLICATION FOR BUILDING PERMIT
a certified';opy thereof (Sec 3800, Lab C ) - COUNTY OF LOS ANGrLES BUILDING AND SAFETY
Policy No Company
A��. I I
❑ Certified copy is hereby furnishedFOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building inspec- BUILDING
tion department' ADDRESS LOCALITY 1
Date Applicant CITY / C/ % ZIP l T CROSS NEARESTT ` RG
CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE ' I SIZE OF LOT NOW ON LOT MAP BOOK _ PAGE PARCEL
(This section need not be completed if the permit is for one USE ZONE MAP /
hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO
TEL / SPECIAL
I certify that in the performance of the work for which this OWNER d e / C�/f NO CONDITIONS O
permit is issued, I shall not employ any person in any manner — DISTRICT GROUP TYPE F PR E Y 11.)so as to become subject to the Workers'Compensation Laws ADDRESS C Lh CO .
CITY `, ^ '{� ZIP IL�
! H
Date Applicant STATISTICAL CLASON APT CONDO (J
NOTIC TO APPLICANT If, after making thi ertificate of ARCHITECT OR TELLU
Exemption, you should become subject to the Workers' ENGINEER NO CLASS NO / DWELL UNITS H
'Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER P
with-comply with such provisions or this permit shall be 7 9/^/
deemed revoked CONTRACTOR- Q NO �"/� BK PG C v VALIDATION
LICENSED CONTRACTORS DECLARATION LIC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO d VALUATI IN ,
(commencing with Section 7000)of Division 3 of the Business and LIC
Professions Code, and my license is in full force and effect CITY 1 CLASS '� $
SQ FT' NO OF NO OF CHECK
License Number�7 7J /' Lic Classes SIZE STORIES FAMILIES ONE 41�—Ov
Contractor kl,005 0 A//0 A// Date
0 DESCRIPTION OF WORK V O NEWEl
❑ f / AD
re entasD
I am exempt from the licensing requiI am a
licensed architect or a registered professional engineer ALTER
acting in my professional capacity (Section 7051, DATE DATE
D
REPAIR
Business and Professions Code) USE OF
FINAL
EXISTING BLDG DEMOL
By
Lic or Reg No Date APPLICANT TEL
"OWNER-BUILDER DECLARATION (PRINT) - 'NO - 1
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031 5, Business and ADDRESS
Professions Code) PRESENT
El
BUILDING r _ - -
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and
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
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code) -
REQUIRED TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 2 1 6 0.2 A
I hereby affirm that there is a construction lending agency for FRONT � t
the performance of the work for which this permit is issued P L
(Sec 3097, Civ C ) SIDE # s o 0 0*0
P` 2'- 70. 00
Lender's Name _ _ _ - _ ;� _ _
' Lender's Address P C Fee$ Permit Fee o 0 --7
W I certify that I have read this application and state that the V Issuance Fee `�" 0 8, 0 7—8 0
aabove information is correct I agree to comply with all County Investigation Fee - - --
$ ordinances-and State laws-relating to building construction, IT.
Fee
and hereby authorize representatives of this County to enter
m
Vhe above-me ion pro erty for inspection pu ose %
a SEE REVERSE FOR EXPLANATORY LANGUAGE
0
Signature of Applicant or Agent Dat ' a
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0703160041
PHONE (626) 285-0488 EXT
(LEGAL ID 1, NO OF CONST BUILDING ADDRESS 1
ON FILE 1 SQ FT STORIES TYPE 1 9435 BLACKLEY ST
I (STRUCTURE VN 1 TEMP CA 917803141 1
(ASSESSOR INFORMATION NUMBER 1 NEAREST CROSS STREET 1
18590-003-038 1 1 t THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl
1TENANT (EXIST BLDG USE RESID USE ZONE R-1 IISSU.D ON PROCESSED BY EXPIRES ON 1
(EXIST OCC GRP 103/113/07 JK 03/10/08
I
(OWNER TEL NO 1BLDGS NOW ON LOT VALUATION IFINAL11A.1 F N BY CODE 1
1MARCUS JACK H,KARAKLAJICH SHARON (626) 285-7233- 5,250 1
19435 BLACKLEY ST I 1
(TEMP 917803141 I FEES PAID 1EPSCRIPTIOlq OF WORK 1
I 1PROVIDE & INSTALL 9 WINDOWS & 3 DOORS ALL LIKE FOR LIKE 1
I FEE DESCRIPTION QUANTITY UOM AMOUNT 1WINDOWS TO BE DUAL PANE WITH LOW GLASS I
1APPLICANT TEL NO I _ I
BRITTANY RANGEL (714) 996-1807- lAA BLDG PERMIT ISSUANCE 27 75 1-
11315-D N BLUE GUM IAC STRONG MOTION RESID 5250 00 VAL 0 53 1SPECIAL CONDITIONS 1
1ANAHEIM, CA 92806 1D2 PERMIT W/O EN-HC 5250 00 VAL 149 40 1
TOTAL FEES 177 68
I
CONTRACTOR TEL NO 1 _ IAPPR3VALS DATE INSPECTOR SIGNATURE
1HARDY WINDOW COMPANY (714) 996-1807- 1 1 It I
11315-D BLUE GUM ST LIC NO 1 1LOCAIION AND SETBACKS I I I
1ANAHEIM, CA 92806 503323 C17 1 I I
I I 1SOIL? ENGINEER APPROVAL I I
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(ARCHITECT OR ENGINEER TEL NO I (FOUNDATION/TRENCH FORMS I I I
I LIC NO 1SLAB/UNDER FLOOR I I
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I I 1RAI�D FLOOR FRAMING I I
uta 1
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMF I (UNDERFLOOR INSULATION I I I
1147H265 3 Oil 1 1-1 I
I I IFLOCR SHEATHING I II t
1NO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I I 'Le -1-1 I
I NO 21 1 IROOFj SHEATHING I I I
I
I SCHOOL WITHIN HAZARDOUS 1 SHEAR PANELS I I
(AIR QUALITY 1000 FEET MATERIALS 1 I
NO NO NO FRA1,E INSPECTION
1REQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS I
ISET BACK YARD HWY PROP LINE WIDTH I
(FRONT PL- 1 (INSULATION/WEATHER STRIPI I I
SIDE PL- i -
_I 11NTERIOR LATH/DRYWALL I I
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I I (EXTERIOR LATH I I I
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I 1RATLD FLOOR/CEIL ASSEM I I 1
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1 IRATFD WALL ASSEMBLIES
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I I 1RATFD SHAFTS/OPENINGS 1
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I IT-BPA CEILINGS I I I
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(REPORT ID DPR261 ROUTE TO BS0508 I
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