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Home My Public Portal About9440 BLACKLEY ST_Building__ '78A838A CE#803 I1-E7 APPLICATION FOR BUILDING -PERMIT 1' COUNTY OF LOS ANGELESBUILDING DEPARTMENT OF COUNTY ENGINEERADDRESS �7 f L J' /' l9� 1 �h 6= `✓ G BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE.COUNTY ENGINEER NEAREST CASSATT D GRIFFIN,SUP T OF BUILDING CROSS ST [J/'e/F {e ! 7 4., 0 Y e DISTRICT NO I GRQUP TYPE SEWER MAP FOR APPLICANT TO FILL INBK PG BUILDING J n J 2- CONST ADDRESS �(�7�F-C�,K c� STATISTICAL C SIFICATION CLASS NO DWELL UNITS LOT NO I BLOCK MAP STATE A 1 r n NUMBER HWY YES O TRACT y l.F ) L�. /jUSNE SPECIAL NO OF SIZE OF LOT €r� �'�\ u�`� NOW ON LOTS CONDITIONS USEOF EXISTING BLDG 0'fN jY7 Y_ BUILDING EXIST / SETBACK YARD HWY STREET AME WIDTH OWNER P91+.A �/ .s'a/ c�191-�� FRONT MAILADDRESS q'z 4Q. 1J L YC k1Z, P L SIDE TEL P L CITY T, Cl NO INSPECTION RECOREr ARCHITECT OR TEL ENGINEER NO r ADDRESS '/ r /�q q 9 y� ` CONTRACTOR �tV �l RA,111�y NO #Il �/ ADDRESS l I Z ..7, 7A/Y A- 7-C.> DESCRIPTION OF WORK ' NEW ADD X ALTER REPAIR DEMOLISH _j�i - u r SQ FTI y NO OF n NO OF f %56 • !�y � SIZE ,'/ I% 0 STORIES FAMILIES/' USE OF STRUCTURE �� SIGNATURE OF y ��, ,, APPLICANT` ' Lv I f C �i r _ DATE INSPECTORS SIGNATURE ADDRESS D yj! FOUNDATION LOCATION FORMS MATERIALS P C $ ,ice FRAME FIRE STOPS CJS V V FEE BRACING BOLTS CJ VALUATION $ FURNACE LOCATION FEE GAS VENT DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILD ING,r/CONSTRUCTION LATH EXT SIGNATURE OF -i� �,/r' HOUSE NUMBER COR- PERMITTEE OR- PERMITTE ` l'"� RECT AND POSTED ADDRESS r �F - �� FINAL CLYDE N DIRLAM PRINCIPAL STR TURALlENGINEER PIAN CHECK VALIDATION CK mo CASH PERMIT VALIDATION 6K M o CASH LlAr 5 0 4 9UN SEP2 2 1 A 13.50 �� 76A630A CE#8032-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY /SLE G T JOHN A LAMBIE COUNTY ENGINEER NEAREST (� / ' WILLIAM A JENSEN SUP T OF BUILDING CROSS ST C G„ /__ DIS $ICT NO GROUP TYPE I PROCESSED BY FOR APPLICANT TO FILL IN ,Lr,D coNsr BUILDING T.C./� - STATISTICAL CL SSIFICATION SE ER MAP ADDRESS 9440 Blackley 1.C• G BK PG C?C CLASS NO DWELL UNITS 1 LOT NO BLOCK WATER CERTIFICATE NOT REQUIRED ® RECEIVED ❑ ^ TRACT 5 MAP HIGHWAY STATE MAJOR SECON LOCAL NO OF BLDGS NO O (CIRCLE) _ SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF _ CONDITIONS `EXISTING ELDGReMA Ldence OWNER T. . Gooch NO BUILDING EXIST- SETBACK YARD HWY' STREET NAME WIDTH ' ADDRESS- 9440 Blackley1r77.Vry. FRONT O� / ��/ M ARCHITECT OR TEL P L h G ( V ENGINEER NO SIDE - P L ADDRESS 0- 0 O CONTRACTOR Vi r i n Roof C orri O A T70507 EL Ixu ADDRESS 600 S. San .Gabriel Blvd. - O DESCRIPTION OF WORK San Gab W CL V) NEW ADD ALTER REPAIR DEMOLISH Z SO FT NO OF NO OF SIZE STORIES FAMILIES USE OF STRUCTURE Re-roof house & att. garage. SIGNATURE OF APPLICANT- VALUATION 3 VALUATION $ .00 APPROVALS D AT E'--"NI N SPECTOR S SIGNATURE FPC PMT EE $ 7 FEE $ 6.00 FOUNDATION LOCATION FORMS MATERIALS J t ¢ 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 CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABO C DC OF TH TAT OF CALIFORNIA RELAT ING To WORKMEN 5 MPEN$ATI IN CE LATH EXT SIGNATURE OF HOUSE NUMBER COR PERMITTEE RECT AND POSTED ADDRESS FINAL �� ,PLAN CHEC VA ATION l CK M o cnsH JOHN F LEWIS PRINCYIPAL STr.)K URAL ENGI ER PERMIT VALIDATION M D CASH �lili 4 2 6 9 1.0 SEP 2 8 1 D 6.00- I WORKERS'COMPENSATION DECLARATION v hereby affirm that I havecertificate of consent to self APPLICATION F PERMIT insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof (Sec 3800, Lab C ) Policy Nd1IP84-44676 Company Fremont Indemnity COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING 41 ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS /� i �2 ® Certified copy is filed with the county buildmg'tnspec- BUILDING tion department ADDRESS 9440 Blackley LOCALITY Date 7/14/83 Applicant Virgin Roof Coo CITY Temple Ci NEAREST City ZIP CROSS ST ti CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK GE 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 / f NO TEL �/ SPECIAL 1. I certifythat in the performance of the work for which this OWNER Mrs. Paul Gooch NO CONDITIONS d P DISTRICT GROUP TYPE FIRE PR SSED B� O permit is issued, I shall not employ any person in any manner ADDRESS 9440 Blackle CONST ZONE V so as to become subject to the Workers'Compensation Laws d Date' Applicant AIRCHITECT OR TY t-y ZIP TEL STATISTICAL CLASSIFICATION PT CONDO 11 NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO CLASS NO ! DWELL UNITS W Exemption, you should become subject to the Workers' CL H Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with,comply with such provisions or this permit shall be TEL �y Z deemed revoked CONTRACTOR Vir iII RAOf CO• NO 2870507 BK`' �- n VALIDATION LICENSED CONTRACTORS DECLARATION LIC j hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P. 0. BOX J NO 160650 VALUATION (commencing with Section 7000)of Division 3 of the,Business and LIC $ 16 36.00 Professions Code, and my license is in full force and effect CITY San Gabriel 1778 CLASS 3 , SQ FT NO OF NO OF CHECK License Number 160650 L.c Class C39 SIZE STORIES FAMILIES ONE $ Contract orVirgin Roof CO. Date 7/14/83 DESCRIPTION OF WORK - -roof hOUSe & NEW ❑ ADD arae with 220# Fiberglass El I am exempt under Sec ALTER ❑ FINAL B 8P C for this reason composition shin les• REPAIR ❑ DATE G�3 JP3 7 8 7 A USE OF ❑ FINAL DEMOL �� --�, -k # 0 0 0 0 0 1 Date EXISTING BLDG By .a-v__,�� Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRINT NO I hereby affirm that I am exempt from the Contractor's License ADDRESS ® 0 0 49.88 Law for the following reason (Section 7031 5, Business,and Professions Code) PRE - o a o 4 9,8 8 6 ❑ BUILDING v j, as owner of the property, or my employees with ADDRESS 7, 1 9-8,3 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 ❑ j, 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 ETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PRSOP LIN WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P L k , (Sec 3097, Civ C ) SIDE m _ P'L Lender's Name Lender's Address :PC Fee$ Permit Fee ' 39.38 I certify that I have read this application and state that the Issuance Fee 10.50 above information is correct I agree to comply with all Courity Investigation Fee ordinances and State laws relating to building construction, Total Fee 49.88 13 and reby authorize representatives of this County to enter upon he above-mentioned p arty fo.tri action purposes 0 _E SEE REVERSE FOR EXPLANATORY LANGUAGE Si tune of Applicant or Agent Date ®s