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HomeMy Public PortalAbout9535 BLACKLEY ST_Building__ DEPAM COUN DIVISION F UI DING ENGINEEEt BUILDING DMSION OF BUILDING AND SAFETY COUNTY OF LOS ANGELO WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, SUP'T OF BUILDING FOR APPLICANT JO TIU IN FOR OFFICE .USE ONLY BUILDING 2 DISTRICT NO. PLAN CK.OR REc.No. PERMIT NO. ADDRESS s a I e3 a LOCALITY f RECEIVED BY DATEO�PL. DA E/�I^^S;s9ED NEAREST ' CROSS ST BUILDING OWNER ADDRESS MAIL LOCALITY C7 A ADDRESS TEL. NEAREST � CROSS ST. Won V42 r—�CA CITY NO ARCHITECT OR TEL. FIRE I NO. OF I TYP I GROUP ENGINEER O ZONE PLANS i SLOG. I ADDRESS SET ACK LINE a } ' t % �+L 04 TEL. U APPROVE 1 CONTRACTOR NO. ZONE BY ^���. = DATE ADDRESS HOUSE NUMBERING Aee LEGAL MAP NUMBER �r+i�' NO. ASSIGNED BY DESCRIPTION I LOT NO.P BLOCK CORRECTIONS TRACT NO. OF SLOGS. - SIZE OF LOT I NOW ON LOT USE OF I NO. OF EXISTING BLDG. FAMILIES y.e GL �� Ff CS ct1 jl:,�Ur DESARIPTIOlf OF WORK .� ( C°.d � , ! (_,—c. o — NEW 14,1 TOLITION I_I__.ADDITION Z REPAIR DE _ D r SQ. FT. �i�G� NO. OF SIZE ROOMS STORIES EXT. WALLI ROOF COVERING G C49® COVERING USE OF STRUCTURE APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. FURNACE: LOCATION. I AGREE TO COMPLY ALL COUNTY ORDINANCES GAS VENT, DUCTS AND STATE LAWS REG TI G BUILDING CONSTRUCTION. I LATH, INT. SIGNATURE OF PERM 17 TE LATH. EXT. ADDRESS PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. FEE _ HOUSE NUMBER COR- �/ Com`/ Y.��• RECT AND POSTED VALUATION FEE $FSB FINAL 76AS30A Das 3 5-82 I APARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES B U 1 t•,r^' L' YAM. J. FOX. CHIEF ENGINEER L imam FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING �L4C!J iCV .5-fADDRESS c7z;__ c/ _) 9 34) LOCALITY ���..z,f-,-4j; tti�. !/ '2- °`- RECEIVED BY DATE OFAPPL. DATE ISSUED CROSS STNEAREST. !� f�:I_ w!' i( 7 f OWNER `7€ 6-:1^ .iO.'7er �_S ~_-,� rPr�:%i.�°-n.Ii }�..- ADDRESS MAIL �v j /-�. !A a s /I v LOCALITY �-•�/Y,r,,G�z- C�'0"T ADDRESS NEAREST CROSS ST. �.�. CITYe"<<`•e;� f��"lam?--a o'+ NO. d''i ��c4^.n?�C"i k-.' _� ��� �• FIRE / NO.OF TYPE GROUP ARCHITECT OR TEL.• 1ONE,30 PLANS ENGINEER NO. BLDG. y� ORD.NO. ADDRESS SETBACK LINE �O / / ' i �i `j Ll E y� //// {{ APPROVED CONTRACTOR -.�'-� 1 �`- L-d (� '?- N0, 6 fi BY ':!/ DATE f USE APPROVED ADDRESS ZONE BY DATE LEGAL 0 CORRECTIONS DESCRIPTION LOT NO.Ste_ c BLOCK TRACT ©` -//4-- ' /aD 'EF NO.OF SIZE OF LOT /"(�.� J�' �a�' I�A ' NOW ON LOTS USE OF G�.. I ND. ROOMS OF I NO.OF EXISTING BLDG. rl -/' FAM LI E9 ' DESg CnRIPTION OF WORK NEW i ALTERATION ADDITION REPAIR MOVING DEMOLISH cl SQ.FT. NO.OF 1 Z SIZE ROOMS f.d STORIES n COVERING A s,�' /� I COVERING USE OF NEW I BUILDING .' L ,Z ?rr.., r� ,Sv-�.a.: O I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION;: LOCATION INSPECTOR DATE y AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS �lri_ 2 /�� l AND STATE LAWS REGULATING BUILDING CONSTRUCTIONy FRAME: FIRE STOPS, SIGNATURE OF PERMITTEE BRACING,BOLTS T, ��- / ,rsf4-$-'� �w '� -LATH, INT. AUTHORIZED AGT LATH, EXT. 76A638A 9-40 DSS-3 saM SETS $ / 40 P.C.$ PLASTER, INT. �S��rJ • FEE PLASTER,EXT. $ l q VALUATION FEE �_ FINAL i�`vyiey �G- 9 c ' ' 1• DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY *� DISTRICT NO. PLAN CK.NO. PERMIT NO. 13LJILDING �/ ADDRESS Ot zo- LOCALITY R£CE VED BY DATE OF APPL. DATE ISSUED NEAREST CROSS 8T. .� BUILDING / --y �� OWNER ADDRESS MAILtOCALITY y / a^ ADDRESS NEAREST CITY - NG' .. .� CR088 9T. FIRE NO.OF TYPE ®ROU ARCHITECT OR TEL. ZONE PLANS LaJ ENGINEER ✓�~ NO. BLDG. ORD.NO. ADDRESS SETBACK LINE TEL. - APPROVED E DAT CONTRACTOR � NO. BY USE APPROVED ADDRESS ZONE,/' BY DATE LEGAL CORRECTIONS DESCRIPTION LOT NO. /- BLOCK,elm _ TRACT lNO.OF BLDG k _ SIZE OF LOT ;/ , I1`?NOW ON LOTS USE OF 'NO.OFNO.OF EXISTING BL G. FAWLIEs ROOMS DESCRIPTION OF WORK NEW I,/ ALTERATION ADDITION _ O A REPAIR MOVING DEMOLISH ,p Sq.FT. NO.OF ,r, ; 6SIZE ® ® ROOMS e1 STORIES _ IF WALL ROOF COVERING I COVERING USE OF BU LDINGW i 1 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS - APPLICATION AND STATE THAT THE ABOVE 19/613RRECT INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUFORMS. NTY ORDINANCEe FLOCATION i FORMS.MATERIALS , AND STATE LAWS REGULATING SU LDING?CONSTRUCTION. e"1al` N- 'P' FRAME: FIRESTOP9. •� .mss ✓` f SIGNATURE OF !! ' A�t/� ,, _ BRACING,BOLTS PERMITTEE t' � Q"'�t„J c=..�� __�. . LATH, INT. AUTHORIZED AGT 'Jn. LATH, EXT. 76A63BA-3 2-S13 $ P.C.S PLASTER,INT. FEE PLASTER.EXT. /+ VALUATION FEE FINAL � WORKERS' COMPENSATION DECLARATION `om herel< ;f m That I have a certificate of consent to self APPLICATION "FOR BUILDING PERMIT ,• irys4e, or p`Nartificate of Workers' Compensation Insurance, or r.certifiedopy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company, BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS dJ ❑ Certified copy is filed with the county building inspec- BUILDING - 5-3 5- �c fC!_6e tion department. ADDRESS Date Applicant CITY' (/I/t ,' ZIP 1 LOCALITY GG'�J) NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF.LOTO`t NOW ON LOT CROSS ST.. C COMPENSATION INSURANCE ASSESSOR Q C /l (This section need.not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK U V PAGE V�J PARCELO hundred dollars ($100) or 1ess:) DR- - —a TEL. p q USE ZONE MAP - OWNER DFAW W t�v A(-C\O l 1 NOi�S��7— 7� NO. 7 7 I certify that in the performance of the work for which this d permit is issued, I shall not employ any person in any manner ADDRESS 1�3� d�C [12 cV AV--e- �-� SPECIAL CONDITIONS a _ so as to become subject to the Workers' Compensation Laws: O CITY f y�.t ZIP '11,790 u Date Applicant ARCHITECT OR EL. � DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making.this Certificate of ENGINEER AJ 'PA r L 2 0,L,_ �13 O. CONST. Z E Exemption, you should become subject to the Workers' 4 l7�(?0 l3� �D� � .+4 U,` provisions of the Labor Code; you must forth- ADDRESS �i.>�a �[ 6-50— Compensation �' ✓ \ with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO, Z deemed revoked. CONTRACTORS NO. _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG. VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE 2 C? STORIES FAMILIES r ONE f?'"`•'� e•, VALUATION ?,E Contractor Date DESCRIPTION OF WORK OrUi1 NEW _❑ / ) q / > p`�, s p ADD (Q(p ( C J V , I i 4 L,i ❑1 am exempt under Sec. ),IV••�L 5 - \ "� ;, B.BP.C. for this reason � • - 'ALTER., ❑ •s, ;yam �•�,,;.�,° :� •� �_ REPAIR Ela —;-. DUSE OF ater _a,,.i•r: __ ra . EXISTING BLDG. DEMOL ❑ Signature APPLICANT•. TEL FINAL OWNER-BUILDER DECLARATION (PRINT). NO. 12-1-7-ft.)V '?-�l�t .) DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL _sj „• L�••� Pro ssions Code): PRESENT Byrvpi I, as owner of the property, or my employees with BUILDINGADDRESS 1411 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 dW'XID'STTH CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE LD. v I hereby affirm that there is a construction lending agency for FRONTr r `, the performance of the work for which.this permit is issued P.L. (Sec. 3097,Civ. C.). SIDE C r rat P.L. Lender's Name .y sl p: P.C. Fee$ �`. Permit Fee f. # 3 Lender's Address 1-7i r 0 1 certify that I have read this application and state that the Issuance Fee C# 8 above information is correct. I agree to comply with all County Investigation Fee n ordinances and State laws relating to building construction, Total Fee S�rrm. # ''T a and hereby authorize representatives of this County to enter t p -'• upon t above-mentione plop for inspect' n pure ses. 4_.1 ptitijO SEE REVERSE FOR EXPLANATORY LANGUAGE i• '- •„`s 'n' F•; i i' Signature of Applicant or Agent DR4e APPLICATION FOR. BUILDING PERMIT �1 COUNTY OF LOS ANGELES BUILDING AND SAFETY E WORKER'S COMPEASATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS B ILD GADDR f K G� I hereby affirm that I have a certificate of consent to self insure, c} l�C /,eor a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.380,Lab.C.) 03:)� ZIPI17,$ if n LOCALITY L C i Policy No. Company SIZE OF LOT\' �7 �/ NO.OF BLDGS.NOW ON LOT CROSS ❑ Certified copy is hereby furnished. ra �l < / NEAREST C/G ❑ Certified c0 is filed with the county building inspection TRACT BLOCK LOT NO. department.PY g � USE ZONE MAP SIO,f Date Applicant ASS AP BOOK PAGE PA6EL� / r9FECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OW IWt /Vl V TEL. O. t II' 'YES NO COMPENSATION INSURANCE A rte' OE M1 ,(e—T S WITHIN 1000 FT.OF SCHOOL? ADDR S - ^ (This section need not be,completed if the permit is for one hundred /9/A C�'� M-e- DISTRICT '' GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) C11Y ZIP I certify that in the performance of the work for which this permit T-I.v- /Y 917 YO �p r is issued, 1 shall not employ any person in any manner so as to ARCHITECT R ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS / CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of 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 with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL 00 LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PIL 0 I hereby affirm that I am licensed under provisions of Chapter 9 SQ.FT SIZE NO.OF STORES NO. FAMILIES SEWER MAP CS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect., s01 S NEW BK PG �. D CRIPTI N OF ORK ADD ❑ VALUATION , W License Number Lic.Class ` (76-0. y Contractor Date ALTER ❑ Z ❑ I am exempt under Sec. REPAIR ❑ $ B.BP.C.for this reason DEMOL ❑ LDMA P/C# ' Date. (USE F EXISTING ByL�DG. t URM. ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# Z i r"•:'•'s' 3 I, as owner of the property, or my employees with wages as O ri' •i e s their sole compensation,will do the work and the structure is D S / -S not intended or offered for sale (Section 7044, Business and �C 2 V . FINAL DATE G _ g'_: �. n ti PfOfeSSIOnS Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > licensed contractors to construct the project.(Section 7044, YES C3 NO =`i � � -1 95 p- Business and Professions Code.)• _ WILL THE INTENDED USE MI THE BUILDING BY THE APPLICANT IO FUTURE BUILDING (�:'1.'IS. _I, »'? ' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH [. �'•-'�•_• CONSTRUCTION LENDING AGENCY FCOAST OR GUIDELINES.IQUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST C F A.ty-M I hereby affirm that there is a construction lending agency for YES❑ NO e the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES. n iM225� . . . OUGH2.20.14000NCERNING I»�.?(9'•_ URULi L.-' '.„-:","I_€Lender's Name NG AND FO ING A PERMIT FROM THE SCAQMD. Lender's Address owtfvR 0R Acvar �� �e_ r-_i I .3 sI-.,a o' I certify that I have read this application and state that the above - P - Q information is correct. I agree to comply with all county P.C.FEE PERMIT FEE xSi ordinances and State laws relating to building construction,and d• ' a- hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. a INVESTIGATION FEE TOTAL FEE to Signmm of Appy t o Agent Dery . SEE REVERSE FOR EXPLANATORY LANGUAGE