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HomeMy Public PortalAbout9483 BLACKLEY ST_Building__ 7A696A DBS-3 3-86 " t - - 'r.2}f APPLICATION FOR BUILDING -PERMIT DMSION OF BUILDING AND SAFETY ADDRESS� 15 ,P 3 G /'G�7G/f Li Depaitmeat of County Englaeer County of Los Angeles LOCALITY T 7' . WM.J. FOX. COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN;SUPT OF BUILDING CROSS ST. - DISTRICT NO. GROUP - SEWER MAP FOR APPLICAN TO F L IN {' �- I TYPE I BK _ PIGCONST. +'� MAP STATE YES' ,NO ADD EISS ' G �' /' UMBER HWY LOT NO. /�_t/y,�" °dr 1.+�/x.19 �� BLOCK U/SE�ZO�NE AL CONDITSPECIONS ONS O - 0 TRACT rJ `e /J/d NO. OF BLDGS. /BUILDING EXIST. ` SIZE OF LOT - NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH USE OF - - FRONT - EXISTING BLDG. e t - jj P:L. - - 1!I/� S d�✓� "SIDE", OWNER - P:L. MAIL O TRACT,DWELL. I UNIT ADDRESS L ICL - - 5' INDUSTRIAL,:TEL t J 1 DWELL. 1 UNIT CITY NO 5c7 6 PUBLIC BLDG. 2 DUPLEX I UNIT 7 ADDN.,ALT., ETC. ARCHITECT OR TEL. - - ENGINEER NO. 3 APT. UNITS ADDRESS 4 COMMERCIAL , ' CON -C-E/il �p�//vG T o• 6r-6 3 -�'"'f INSPECTION RECORD I ADDRESS J'' J L��G LY�C %•C _ - , DESCRIPTION'OF WORK. ' NEW ADD ALTER REPAIR DEMOLISH SQ."FT. NO. OF NO. OF SIZE STORIES - FAMILIES USE OF STRUCTURE T - iv SIGNATURE APPLICANT - APPROVALS - ADDRESS -DATE INSPECTOR'S SIGNATURE _FOUNDATION: LOCATION ��� dA - P. C. $ FORMS, MATERIXLS ' FEE FRAME:'FIRE STOPS. VALUATION $ BRACING,BOLTS FEE _1K FURNACE: LOCATION. - - I HEREBY ACKNOWLEDGE THAT 1 HAVE, READ THIS 'GAS VENT,DUCTS - I - APPLICATION AND STATE THAT,THE ABOVE-IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT. - AND rpTATE WS 'RE LA a pul I C TIO TH. EXT. SIGNATURE OFHOUSE NUMBER COR- PERMITTEE i- RECT AND POSTED ADDRESS FINAL - - :WM:J. FOX,COUNTY ENGINEER VALIDATION C. N. DIRLAM.CHIEF BLDG. INSPECTOR ' 9, 0 1 ,^ OCT 17 1 4 .d C} v, - • �?",, ��,�.��^-t�--r 1. --'�"- - i ©i 76A638A �-' � O C� F803.�CEV 11/7 8) 'J APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES -BUILDING AND SAFETY FOR APPLICANT TO FILL.IN .`p ADDRESS ffn BUILDING l G L e- sl ADDRESS LOCALITY, �� / �7 CITY ens /& 1. - ZIP / �!V CROSS ST NO OF BLDGS SIZE OF LOT •3 w. 1.3.3 NOW ON LOT / MAP BSOOK PAGE PARCEL a DISTRICT GROUP TYPE AFIRE PR ESSEP BY TRACT / LOCK 5/.V LOT NO O CONST' t ZONE s TEL OWNER ( 1P-'r OM SOI✓ NO�gd // STATISTICAL CLASSIIFICATION _ SEWER MAP ADDRESS / C Q S CLASSNO,�aa // DWELL UNITS ' BKq V.PG . CIT L I� C.r ZIP �� o ARCHITECT OR TEL VALUATION ENGINEER 6 NO xg �'3l> a ,cl ADDRESS ,YaZ►14 L65s N a ' BLDG SETBACK FROM EL FRONT PROP LINEOF (STREET) CONTRACTOR NO 7�. HIGHWAY + YARD = TOTAL SETBACK FR TYPE OF EXISTING LIC FRONT PROP LIN HIGHWAY WIDTH- ADDRESS3 I O NO O.'S C1 / LICQ + CITY S CLASS CONSTRUCTION LENDER - - BLDG SETBACK FROM y NAME AND BRANCH SIDE PROP LINE OF (STREET( HIGHWAY + YARD = TOTAL-SETBAC FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH „Q SQ FT NO OF NO OF CHECK + ' _ / SIZE STORIES FAMILIES , ONE - Q O USE ZONE No - O Zo� DESCRIPTION42F WOR NEW, l( •� D SPECIAL ,r ate H'o f ADD 1^J /� CONDITIONS - z ALTER DATE L BY 7 (AiT� �I16 REPAIR"❑ CP I �..,.�,�al�� USE OF DEMOL / EXISTING BLDG i JEis! - G(iCJ' - Z - APPLICANT TEL U �t { O (PRINT) NO BY(SIGNATURE( 7 IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y '• , THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL,ORDINANCES �. .. .,. ., . AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE V WORK AUT O HEREBY I WILL NOT EMPLOY ANY PERSON IN'VIOLATION OF THE LABOR DE OF STATE OF CALIFORNIA IN RELATING TO WORKMEN 5COM ,__ .. -. z Q 8 A PENSATION I URANCE A # 0 O O. O .O 1 SIGNATURE 0) f 1 PERMITTEE 2 0 1 9 6t b Q' HYD, ADDRES o Om19600, TEL ` CITY NO �',7J'Co Q Q -05,23-80 . P C Fee$ Permit Fee > Issuance Fee W , d Total Fee 4 r I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES B U I L ® 1 N G y WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN• FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING ADDRESS LOCALITY �sy}y .f'�(' N'7/ RE CEh EDS Y DATE OF APPL. DATE IS�S/UED NEAREST ///f� / (//g ... CROSBST �' BUILD NG OWNER //( �/. / //>�.�'2J� �..y�a ADDRESS rrL .a eeCp�gp��gtdyy' :J ,/ MAIL 1pv� A LOCALITY CRI1.4"L ADDRESS �" �s1� G �TEL..,.`=V �l l`fi.tt `CROSS ST. CITY .Jr�t.,rl:� .�1rJl .�}�i�f1N0. 7� FIRE NO.OF TYPE GROUP/' ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. BLDG. +� - ., I ORD.NO.- ADDRESS SETBACK-LINE APPROVEDS / f�/ �+ 1 TEL. BY ' - ��/�-(BATE CONTRACTOR '1„(„/� NO. UDE APPROVED i• ADDRESS ZONE y, BYI 1 DATE DESCRIPTION L�O�FJTNO C BLOC 1 r `r / ' CORRECT'IO�NfS 1 TRACT .� _.CA,tiii-a� /�.LI'1 A'�/ i(��t.s wry _ ~�� �. x;_ a /• �fO / t� /'fY E'r� C•� I NOW ON LOTNO.OF S. SIZE OF LOT n /YjtJ'Y� �..r USEI OF I NO OF n Y/'• .��(�/�+. EXISTING FAM NG BLDG. FAMIUE$ ROOMS ,(/v r I V J•/ - -"'-• - "- DESCRIPTION OF WORK NEW A. ALTERATION ADDITION /A R -V ' RLb:', �y O f A REPAIR - MOVING DEMOLISH+_� '. =GJr-� SQ.FT. / NO.OF �� '.!. ,tom SIZE ROOMS STORIEB 'i D .� WALL ROOF t�.'�y '0� z"I",t I COVERING I COVERING �✓ �:'� �� . rr rj USE DI NEW f� ( .` BUILDING _1Z.[�..f ,.w •" aw�' 3oR� ' = dvo 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS' APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. `/�r//+t' � FRAME: FIREOLTS SIGNATURE OF ,Y BRACING,BOLTS PERMITTED ��� � LATH, INT. AUTHORIZED AOT LATH, EXT. 76A636A 9-48 DBS-3 SOM SETS $ /�� � p,C,$ � v PLASTER,INT. /V�ry/ rf FEE PLASTER,EXT. !6 VALUATION FEE v' is FINAL I, �,4� • -�f APPLIC�4TI0 FOR BUIL DINSPER,n I 1 COUNTY OF LOS,ANGELES -BUILDING`AND'SAFETY '' • FOR APPLICANT TO FILL,IN•'. BUILDIN A WORKER'S COMPENSATION DECLARATION • ' ,, 1 ' � - � n• - - BUILDI ' ADD SSy �'.„{a 'f-• •.}�1,>. • ".�,1"+y IV ' I hereby affirm that,I have a certificate'of consent to self Insure, or a certificate of Workers' Compensation Insurance, or a certified , Y z - CITY- ZIP.^ - - CITY- copy thereof f((SSecCt3800,,L b C) r' /' LOCALITY Policy Nmc�.' /S � Company_ ✓ - : .SIZE OF LOT' NO.OF BLDGS NOW ON LOT r•• - ❑ Certified copy is hereby furnished' - " "� • R ' =NEAREST CROSS ST =, ❑ Certrfied copy is filed with the county bullding''InspectiOn TRACT r BLOCK LOT NO - department •, I � • --- I USE ZONE MAP NO- �r � j_'Q �� - ASSESSOR.MAP BOOK PAGE •- IT PARCEL Date Applicant, ���� SPECIAL CONDITIONS . CERTIFICATE OF EXEMPTION FROM+WORKERS' OWNER' o TEL NO- COMPENSATION INSURANCE r" � WITHIN 1000 FT OF SCHOOLS YES NO L` (This section need not be completed If the permit is-for one hundred ADDR + - ,DISTRICT, GROUP " 'T 111RE ZONE PROLES BY dollars ($:100) or less) +� c- CITY - r - ZIP ' I certlfy that In the performance of the'work for,vihich this permit �17�'�• ,�� ' is Issued, I'shalI not employ any,'per§on in any•manner so as to become subject to-the Workers'Comperisatlon1Laws ARCHITECT R ENGINEER ',-TEL-NO -STATISTICAL CLASSIFICATION APT DO ' Date Applicant ADDRESS CLASS NO DWELL UNITS, _ NOTICE TO APPLICANT If,' after-•=makirig this Certificate,'Of -"'REQUIRED - TOTAL SETBACK FROM' EXIST Exemption, you -should become' subject•, to,'•the. Workers' CONT CTOR TEL 0,.-y SET BACK YARD- HWY PROP LINE WIDTH Corf pensation;provisions.of-the Labor Code,'you.must forthwith. /� Je'�VzT7�/VG �3 13a Z FRONT - W comply with such provisions or this permit shall be,deemed revoked f• AD DR S$ ' A ,' LIC,NO P L 7, SIDE LICENSED,CONTRACTORS DECLARATION -' CITY- ��.•�'o LIC CLASS PL' I hereby affirm that I am licensed underprovisions of Chapter 9. 3 2SEWER MAP (commencing with, 7000)of Dlvision.3 of ttie Business arid" SQ Sib NO OF STORIES NO OF FAMILIES • NEW ❑ Professions Code, L7 PG and my,license is in full force and"effect LF BK Q � �� ,G'�3� .,► - ADD ❑ - ON ' License Number 7 Llc ClassDESTION OF WORK VALUATION Q � _ � '' ,� Contractor ��^"/'4Fo�M Date / d � r ALTER El $ `}�© t ' ❑ I am exempt under Sec I� REPAIR El _ 0 4 B&PC for this reason y/ 6✓61i r,E�l/G DEMOL ❑ LDMA P/C`# '`'Date USE OF E I ING BLDG URM ❑ Signature APPLICA T NT) TEL LDMA Perm# - , +• • Z ❑ I, as,owner of the;plroperty,'or my employees.with wage's as their sole compensation, will do the work_and the structure.ls ADD E not Intended or offered for sale (Section 7044, Business and7/j yFINAL DATE Professions Code) :, WILL THE APPLICANT-OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS,MATERIAL ❑-1, as owner:of the property, am exclusive) contracting Wlth OR MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE U t P P Y. Y 9 AMOUNTS'SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > LtCCT a 3 licensed contractors to construct the project (Section 7044, YES❑ NO❑•'< ,ti - - Business and Professions Code) _ WILL THE INTENDED USE,OF THE,BUIDLING BY THE APPLICANT OR FUTURE BUILDING q C fr=•'d Gj , _ - OCCUPANT REQUIRE A PERMIT FOR.CONSTRUCTION OR MODIFICATION FROM THE SOUTH 3. t' CONSTRUCTION,-LENDING AGENCY COAST AIR QUAUTY,MANAGEMENT DISTRICT(SCAQMD)SEE'PERMITTING CHECKLIST FOR GUIDELINES T•-' ' I hereby affirm that there is a construction lending agency for ' YES 11No❑ Y' , I3 N the performance of the work for which this-permit Is Issued(Sec - T iTA; 5,� I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097, CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, _ _ +• ' N " TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS ' 1'�I_�•S 156. �i 3 _ Lender s Name - MATERIALS REPORTING AND FOR OBTAINING A,PERMIT FROM THE SCAQMD r •,l• � 3�• C, Lender's Address' �) '1 3 ' ' _Cc ' O ONNER'OR AGENT o I certify that I have'read•this appll6tion•and state under penalty- PC FEE PERMIT FEE 0 of perjury that the above Information'is correct I agree to comply I with all county ordinances and State' laws'relating to building ` f t(( �(T a construction, and hereby authorize representatives of'tt1iS County ISSUANCE FEE �J // ' -U-�� 00 �G gs !e= s to enter upon theabov - toned property for Inspection urpo es o(/' ���� F t- ' INVESTIGATION FEE - + TOTAL FEE . - �s SEE REVERSE FOR EXPLANATORY LANGUAGE,- '