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Home My Public Portal About9451 BLACKLEY ST_Building__ APPLICATION FOR COUNTY OF LOS ANGELES t a T OF COUNTY ENGINEER BUILDING PERMIT DEPARTM BUILDING AND SAFETY/DIVISION BUILDING q LA (i FOR APPLICANT TO FILL IN ADDRESS v' `. rC BUILDING gy ADDRESS r L P LOCALITY-rP-,pi e Cl-T NEAREST CITY _Ze (� ZIP CROSS ST NO OF SLOGS ASSESSOR SIZE OF LOT✓�J ^ 13V NOW ON LO MAP BOOK PAGE PARCEL M C�� DISTRICT L20 YPE FIRE PR ED BY TRACJr In L'� BVOCK N (� N T OWNER/�/ /� ,// pNOL�a STATISOT L CLAS IFICATION EWER M P ADDRESS57/ - `� �/C l.G CLASS NOSDWELL UNITS==,=j BK(?O-G CITY m ` ZI sa93 E ZONE MAP oe_) NO ARCH TECT I'=�J `/n TE NO� n/` �p SPECIAL ENGINEER �_ / N V CONDITIONS ADDRESS V 0 Q/ 0d' JIV ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONTRACT R TE • L p/ BLDG ETBACK FROM IC//�� NO 0 FRON PROP LINEOF (STREET) ADDRESS (J /"7C/2dlO NIGHW Y + YARD = TOT SETBACK FROM TYPE OF EXISTING CITY /li//7 LIC FRONT PROP LINE HIGHWAY WIDTH l/V� CLAS CONSTRUCTION LENDER S7 NAME AND BRANCH _ " BLDG SETBACK FR a' ADDRESS CITY SIDEPROP LINEOF (STREET) Ej SQ FT NO OF NO OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM T E OF EXISTING I= SIZE STORIES FAMILIES ONE SIDE PROP LINE HIG AV WIDTH DESCRIPTION OF WORK NEW + CC0 -7 ,J ADD CORNER CUTOFF YES ❑ NO ❑ Z ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ D EPAIR❑ USE OF IN COASTAL PER ZONE YES ❑ NO ❑ EXISTING BLDG EMOL ❑ APPLICAN TEL 9 (PRINT) t� NO �-r�� BY (SIGNATURE) IL/ I�L� GJ f�diUTlt ON COWA I HEREBY ACKNOWLEDGE THAT I HAVE RE D THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- ST RUC TION 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 COMPEN7rT_lbtI IN ANCE r� SIGNATURE OF ti/ I� FINAL �-77 BY PERMITTE DATE ADDRESS 0 V(,��J TEL��J� P C Fee$ Z d Permit Fee 2� CITY V NO $A" ,� ,yam Issuance Fee VALUATION /w,t/�►/v�."—�� Total Fee Z� PLAN CHECK VALIDATION M O CASH _ PERMIT VALIDATION cK M O CASH 7 2 9 0--'jiW 30 1 8 42.() () A�,6 T2 8g2-JUN 30 2"1 0 1 2.6 0 - - - 76A838A CE0803B 12/78 •- _ t \ l APPLICATION FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER-- fl ~ , 1BU I L D I'N G PERMIT BUILDING,AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS I r ICL LOCALITY NEAREST CIT P O CROSS ST -- NO 6F BLDGS ASSESSOR " SIZE OF LOT , ( NOW ON LOT MAP BOOK PAGE PARCEL TOAI l� p� DISTRICT JGROUPJTYPE „i FIRE ESSED BY 1.Z-I-[/ BLOCK L T-NtD CONS ' � _ _ 3 X10 8 - OWNER STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NOI_�W DWELL UNITS BK PG U ZONE MAP CITY _ ZIP _� NO ' ARCHITECT OR TEL SPECIAL ' ENGINEER n NO 2uJ CONDITIONS ' ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONTRACTOR IT R pw' TEL BLDG SETBACK FROM NO FRO T PROP LINE OF I (STREET) ¢ .q _ LI ADDRESS O 3 y �t//IP� C O't NO 4,L NIGHWY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING IC FRONT PROP LINE HIGHWAY WIDTH. CITY �j_ caiLASS _ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM - a' ADDRESS CITY SIDE PROP LINE OF (STREET) SQ FT NO OF NO OF CHECK HIGHWAY + YARD = TOTAL SETBACK FRO YPE OF EXISTING O SIZE STORIES FAMILIES ONE' t SIDE PROP LINE H HWAY WIDTH + DESCRIPTION OF WORK NEW ❑ Cn ADD ❑ - CORNER CUTOFF YES ❑ NO ❑ Z ALTER ❑ REPAIR-El IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG DEMOL ❑ APPLICANT TEL �� (PRINT) g / BY (SIGNATURE) a I HEREBY ACK NOWL E THAT-I HAVE EA T A PLICATION AND STATE THAT THE BOVE IS CORRECT AND AGR 0 COMPLY ' WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- S T R UC TION -I CERTIFY THAT IN DOING THE WORK AUTHORIZED - - HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO 'WORKMEN'S COMP ATION INSURANCE - SIGNATUREO - FINAL •� •� BY PERMITTEE - DATE / !J ADDRESS11 L% _ TIE / PC Fee$ Permit Fee r-:�2� CITY NO r Issuance Fee VALUATION$ - (� P" Total Fee PLAN CHECK VALIDATION CK M O CASH PERMIT 'VALIDATION-( -K mo CASH 9l9'-bEl-0SEP 1- --1- 1 _2:,1.'7 .5- Azl3 76AG38A CE#8038 1Z/75 - \ l0/2 /-p V�ORKERS' COMPENSATION�i�ARATP?J I- hereby affirm t ca I leave r certificate of tion Ins to self APPLICATION FOR BUILDING PERMIT , insure; or a certificate of Workers' Compensation Insurance,. � - or a certified copy thereof (Sec 3800, Lab C ) �ic Aft7�p COUNTY OF_LOS ANGELES � BUILDING AND SAFETY PolNo I��G 9=Company � �:I BUILDING, Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDREss ❑ Certified copy is filed with the county building inspec- BUILDING /� I -_ tion department �/�1 ( ADDRESS T C `p/ q 10 QQ ) c Date AppliconT tvw CITY 11� t - ZIP V^ 11_0CALITY' LG NO OF BLDGS ' I NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT Z NOW ON LOT l CROSS S7 D COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK 0(, PAGE 00q PARCEL - hundred dollars''($100) or less ) " �p r TEL Q/ Q MAP OWNER NONO ' - s L' Z U 7 �V USEZONE, I certify that in the performance of'the work for which this Q SPECIAL permit is issued, I shall not employ any person in any manner - ADDRESS C l - CONDITIONS CL so as to become subject to the Workers'Com en anon Lo s Hoe O 1 p CITY ,"t mP�e - ZIP I I o e - V .Date X_eApplicant ARCHITECT OR 'J TEL f' / 0 NOTICE T NT If, after making this Certificate of ENGINEER r l L) 10NO ��-f.� > O DISTRICT_ GROUP OPE ZONE PROCESSED BY 0 Exemption, you. should become subject to the Workers' } ✓ ! W Compensation provisions of the Labor Code, you must forth- ADDRESS Z �✓h 1 e 1',gdr4 �/r _�{f� 0- with comply with such provisions or this permit shall be �) TEL !U STATISTICAL C SSIFICATION APT CONDO N deemed revoked CONTRACTOR WI 01014 NO 1 Da� Z LICENSED CONTRACTORS DECLARATION J UC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Z L r" Q NO �J�4 0*- (commencing with Section 7000)of Division 3,ofihe Business7 LIC � SEWER MAP ( ! a and Professions Code,and my license is in full force and effect CITY AvC,4 CLASS IJ BK PGCAI ��',VALIDATION T71e t i_ SQ FT c, NO OF NO OF CHECK License Number-i 3 Lic Class SIZE O STORIES FAMILIES ONE VALUATI�33, i r E 0 DESCRIPTION OF WORK A P b^ OKI NEW ❑ j 1 ITEM: Contractor Date 01 y s �7 � TOTAL ' 37 -1 ® O� ❑I am exempt under Sec [7 l (7 `)�V� �^�pn ADD ► ��Et =(� I); Q / ,�' p y p ALTER ///�� /� - B&P C for this reason —G BQ ►1 l7pl/`' "I f> $ V Q CHANGE ,CO REPAIR ❑ USE OF �; ° 1 Date EXISTING BLDG J}r�;I Ar 7(�Gr / r L^�`f DEM ❑ 1 0000-131,101 Signature APPLICANT ) r` 11/V �rl fid Vl NO S L`f DOSS FINAL ti O 12/29,29 OWNER-BUILDER DECLARATION DATE 1 hereby affirm that I am exempt from the Contractor's License1a✓ _ ] It �� ti:tt° Law for the following reason (Section 7031 5, Business and ADDRESS z '1�1 FINAL , Professions Code) PRESENT By. ❑ I, as owner of the property, or my employees with ADDRESS r L rtT,IL o wages as their sole compensation,will do the work andthe structure is not intended or offered for sale(Section LOCALITY Poo. t __k�] 1, i 7044, Business and Professions Code ) MOVING TEL _ ❑ ,I, as owner of the property, am exclusively contracting CONTRACTOR NO ITEM= - with licensed contractors to construct the project (Sec- ADDRESS " i tion 7044, Business and Professions Code ) J 1 t i ;l1I,IHL 6 1 - 20 ' REQUIRED TOTAL SETBACK FROM - EXIST ° _ _ ..4 '9 i1��. - a+.:I CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH - I hereby affirm that there is a construction lending agency for FFRONT the performance of the work for which this permit is issued H�tFwE(Sec 3097, Civ C ) E •u ,w° ° rT i _ iLender's Name i t— < rFee$ ✓ Permit Fee LDMA Ref`# �� '',ts��ll I-�lut �' F '�I Lender's Address m A ► Li 3 i `, }� i of 0 I certify that I have read This application and state that the Issuance Fee LDMA /C 8 above information is correct I agree to comply with all County Investig tion Fee / o R ordinances and State jaws relating to building construction, Total Fee 1 / LDMA Wrn # a and hereby authorize representatives of this County to enter upon the above-mentioned pr ert for inspection purposes ` L SEE REVERSE FOR EXPLANATORY LANGUAGE., cy i �4-1 ty r1 gat a c4 pl nt or Agent IDate APPLICATION FOR BUILDING PERMIT �1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION BUILDING DDRE FOR APPLICANT TO FILL IN BUILDING DDRE I hereby affirm that I have a certificate of consent to self Insure, 'Cl G l or a certificate of Workers'Compensation Insurance,or a certified CITY 1 ZIP copy thereof(Sec 3800,Lab C) 11 ( I f, LOCALITY Policy No Company SIZE OF LOT t NO OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished fir( NEARES ElCertified copy Is filed with the county building Inspection TRACT BLOCK LOT NO UFO MAP NO department ASSESSOR MAP BOOK PAGE PARCEL Data Applicant OWNER tSPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' I l TEL NO YES NO COMPENSATION INSURANCE � l WITHIN 1000 FT OF SCHOOL? ADDRESS (This section need not be completed If the permit is for one hundredct#owf DISTRICT GROUP TYPE NST' FIRE ZONE ROCESSED B 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 ARCHITECT OR ENGINEER TEL NO become subject to the Workers'Compensation Laws ATISTICA LA IFICATION APT Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK Fb6m EXIST Exemption, you should become subject to the Wofkers' CONTRACTOR O C TELO 2 { SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ) (� FRONT comply with such provisions dr thmpermit shall be deemed revoked ADDRESS LIC NO PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC CLASS PL °p- I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP 8 (commencing with Section 7000)of Division 3 of the Business and SQ SIZ NO OF STORES NO OF FAMILIES O Professions Code,and my license Is in full force and effect NEW ❑ BK License Number Lic Class DESWTION 9F WORK ADD ❑ LUATION w Contractor Date ( / ALTER ❑ $ ti 0 ❑ 1 am exempt under Sec REPAIR ❑ $ - B&P C for this reason DEMOL ❑ LOMA P/C# Date USE OF EXISTING BLDG URM ❑ 1 Signature APPLICANT( INT) TFL NO LDMA Perm# s �/ O Y rt`. I .a 13I, as owner of the property, or my employees with wages as u" ('t 26� O their sole compensation,will do the work and the structure is ADDRESS ,Z q d< Ild r( FlNAL TE Q `507 . not intended or offered for sale (Section 7044, Business and ;r4 1 TEhS Professions Code) J 1 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIA ❑ I, 8S owner of the property, OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I Q —n.Q. p p rty, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL TI I j T kL 70 ® ,�'v licensed contractors to construct the project (Section 7044, YES❑ NO❑ Business and Professions Code) / C HEC" 70.1-1 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST ��i 77 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 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,Civ C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ;,,,I�N��i g� COUNTY CODE TITLE CHAPTER 220 SECTIONS 2 20 100 THROUGH 220140 CONCERNING IJP rt33 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD 4 1 j 271 I;,)� o 13 Lender's AddressOWN�� s i o I certify that 1 have read this application and state that the above PC FEE PERMIT FEE ' Information Is correct I agree to comply with all county ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE he ve-menJodtioned roperty for Spec pu ses a INVESTIGATION FEE TOTAL FEE sy,mn, o.r SEE REVERSE FOR EXPLANATORY LANGUAGE