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Home My Public Portal About9457 BLACKLEY ST_Building__ 1 APPLICATION pp p� p p p APPL.ICATION FOR BUILDING PERMIT a440 1 u.as DkVISIQT OF BUILDING AND SAFETY BUI R ING ADDRESS Deportment of County Engineer A County of LOS Angeles LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUP'T OF BUILDING CROSS ST FOR APPLICANT TO FILL IN DISTRI T NO GROUP SEWER MAP TYPE 1 J5 BK PG CONST BUILDING i- MAP STATE ' ADDRESS NUM ERHWY YES O ' LOT NO BLOCK USE ZONE /SPECIAL �'� _ CONDITIONS TRACT TRACT i�flGGBG LI.L!tl.ct-s i /� /I I 1( 4 NO OF BLDGS SIZE OF LOT _/ NOW ON LOT BUILDING EXIST SETBACK YARD HWY STREET lA E WIDTH USE OF EXISTING BLDG FRONT - P L !'L/ OWNER SIDE MAIL ADDRESS O TRACT DWELL 1 UNIT TEL //yy 5 INDUSTRIAL CITY NO p(- DWELLr 1 UNIT 6 PUBLIC BLDG ARCHITECT OR TEL 2 DUPLEX 2 UNITS ENGINEER NO 3 APT. UNITS 7 ADDN.ALT, ETC 8 MISCEL. ADDRESS 41 COMMERCIAL J TEL CONTRALTO NO INSPECTION RECORD �/ ADDRESS DESCRIPTION OF WORK _ E ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF SIZE STORIES FAM114ES ' USE OF STRUCTUR c SIGNATURE APPLICANT APPROVALS r ADDRESS D TE INSP CTOR'S SIGNATURE FOUNDATION LOCATION / P C $ �G FORMS MATERIALS FEE FRAME FIRE STOPS. cC VALUATION $ l BRACING BOLTS t7- /� 4-1t FEE FURNACE LOCATION, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS V. APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT I II ryv LA AND STATE LAWS REGULATING BUILDING CONSTRUC, TION �' LATH, EXT 4 SIGNATURE OFX0 HOUSE NUMBER COR- PERMITTEE' RECT AND POSTED A ADDRESS FINAL 41. �� SZ JOHN A.LAMBIE, COUNTY ENGINEER VALIDATION CLYDE N. DIRLAM. CHIEF BLDG INSPECTOR , CK MO CASH 98 33'A SEP -' 6 1 7.0 0 • w }� 0;0 4, 5%,9 SEP 1 1 3.4 0-0 �, ®, 7SA838A CE#809.10 SB APPLICATION FOR ,BUIL.®INGa _PERMIT BUILDING AND SAFETY DIVISION BUILDING Department of County Engineer ADDRESS County of Los Angeles LOCALI L JOHN A LAMBIE, COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUPT OF BUILDING CROSS ST DISTRICT NO GROUP-1r- ROUP•- .r SEWER MAP O FOR APPLICANT TO FILL IN K G � NS BUILDING ADDRESS ' c STATISTICAL CLASSIFICATION LOT NO / S LOCK CLASS NO DWELL UNITS d MAP _ sHWY YESNUMB R NO TRACT Ca.S-t.-O-.w �-� US ZO E SPECIAL .. t NO OF BLDGS CONDITIONS SIZE OF LOT 1 Q-o� ( NOW ON'LOT USE OF t - EXISTING BLDG j, BUILDING EXIST YARD HWY STREET NAME SETBACK WIgTH OWNER FRONT MAIL P L oC ADDRESS SIDE ; TEL P L CITY05�_ad�� No INSPECTION RECORD ARC ITECTTEL ENGINEER 9& NO ADDRES TEL CO NO ADDRES DESCRIPTI WO NEW ADD ALTER REPAIR DEMOLISH _ SO FT NO OF NO OF SIZE QRIE AMI II W ' USE OF STRU RFt- N APPROVALS - SIGNATURE•OF �� r APPLICA DATE Q INSPECTOR'S SIGNATURE ADORES ' FOUNDATION_LOCATION' FORMS;MATERIALS �' + P C ti FRAME FIRE STOPS. FEE BRACING BOLTS 1 FURNACE LOCATION.? VALUATION 5CIO GAS VENT DUCTSoL L FEE 7 I HEREBY ACKNOWLEDGE THAT I HAVE READ HIS AP- LATH. INT ' PLICATION AND ST T AT THE BOVE CORRECT AND 1 AGREE TO COMPL ALL C NTY WRDNAIC AND STATE LAWST TON LATH, EXT SIGNATURE OF OUSE NUMBER COR- PERMITTEE RECT AND POSTED J r ADDRESS t� INAL JOHN A. LAMBIE. COUNTY EN EER, CLYDE N. DIRLAM. PRINCIPAL STIR T RAL ENGINEER PLAN CHECK VALIDON CK CASH PEIIMT VALIDATION CK M o CASH ;n� C3 1 P. 0 j- r APPLICATION AOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY. WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure BUILDIN ADDRESS or a certificate of Workers Compensation Insurance,or a cert[fled 4 � � Q � copy thereof (Sec 3800,Lab C) CITY TG� , ^el l l � ZIP r yo LOCALITY Policy NO Company SIZE OF LCT lT NO OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnished NEAREST CROSS ST - ❑ Certified copy Is filed with the county building Inspection TRACT BLOCK LOT NO department ` USE ZONE MAP NO ASSESSOR MAP BOOK PAG EPARCEL Date Applicant OO � 0 /7 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 7 TEL NO COMPENSATION INSURANCE 1 ��N U� WITHIN 1000 FT OF SCHOOLS YES No (This section need not be completed If the permit Is for one hundred ADDRESS /�t, dollars ($100)or less) RT H u �'I V E• DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY CITY ZIP I certify that In the performance of the work for which this permit �cAD`A CA 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 I STATISTICAL CLA Sl APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If„after making this Certificate Oft REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become Subject to the Workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply wlth'such provisions or this permit shall be deemed,revoked ADDRESS LIC NO PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC CLASS P L I hereby affirm that I am licensed underprov[s[ons of Chapter 9 SEWER MAP >" (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES G. Professions Code,and my license is In full force and effect NEW BK PG ' 0 License Number LIC Class DESCRIPTION OF WORK , ADD E] VALUATIONV Contractor Date0 a Z 00 F ALTER ❑ $ a n G ❑ I am exempt under Sec NS b� `DUsF t0�E REPAIR 1:1 U B&PC for this reasonN► p51TjO DEMOL ❑ LDMA P/C w GW.. Date USE OF EXIS ING BLDG URM ❑ N Z Signature APPLICANT( NT) TEL NO LDMA Perm# »—aT .r " as owner of the property, or my employees with wages as u�� !�u Z their sole compensation, will do the work and the structure Is ADDR� S/ _ O _,__ not intended or offered for sale (Section 7044, Business and C , -W Ave v(A ,1 FINAL DATE Q Professions Code - 9 T WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 'I J 1 t El I, as owner Of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPE IE ON THE HAZARDOUS MATERIALS INFORMATION GUIDE'S FINAL BY 7 ) _j T.- 12 1 m licensed contractors to construct the project (Section 7044, YES ElNoy_ Business and Professions Code) ' rc 1_1 s WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING =- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH --, CONSTRUCTION LENDING AGENCY COASTLIAIR OUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR vSl � +� S 0 L/ 1 ;�r!IK GUIDENES u1 yt I hereby affirm that there Is a construction lending agency for '..< YES❑ NO N the performance of the work for which this permit Is Issued(Sec IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,Civ C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE \ f I�I!trI—�I[i�j t i i`_i�r•}M N TITLE 2 20 SECTIO S 2 20 100 TUROUGH 2 20 140 CONCERNING HAZARDOUS _ Lenders Name MATE [ALS PORTING AND OBTAINING PE IT FROM THE SCAOMD —__ ;in 71 ii o Lender's Address O—ERQW^GENT O o I certify that I have read this application and state under penalty O of perjury that the above Information Is correct I agree to comply PC FEE PERMIT FEE N with all county ordinances and State laws relating to building aconstruction and hereby authorize representatives of this County ISSUANCE FEE m m to n on the ab ve-menti a property for Inspection pu poses (0 a `/ 93 INVESTIGATION FEE TOTAL FEE m [� / O ti a r bbl e 1 wnl a int Date � SEE REVERSE FOR EXPLANATORY LANGUAGE