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HomeMy Public PortalAbout9539 BLACKLEY ST_Building__ 7GA930A ca#ao31-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND"SAFETY DMSION LoCAL1TY C JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST DISTRICT NO. G TYPE A E SED BY FOR APPLICANT TO.FILL I ' Ic co NST. STATISTICAL CLASSIFICATION SE R MAP BUILDING 7 `� PG'ADDRESS .7 r CLASS NO DWELL UNITS •LOT NO.0 (e- D BLOCK WATER /,,_ / CERTIFICATE NOT REQUIRED RECEIVED TRACT (/�cC./� MAP HIGHWAY NO OF BLDGS NO s (CIRCLE) STATE MAJOR SECOND. LOCAL SIZE OF LOT/o y7 0 NOW ON LOT USE ZONE SPECIAL USE OF j, CONDITIONS EXISTING BLDG 44 TEL ' OWNER NEO10' 7 BUILDINGEXIST SETBACK YARD HWY ST EET N E WIDTH' ADDRESS J 3 FRONT ARCHITECT OR TEL.Q IP L i ENGINEER NO SIDE �P L ADDRESS' CL TEL. I - ,/ INSPECTION RECO O CONTRACTOR 6� - NO c u ADDRESS ` / �- ^/ •� ix DESCRIPTION OF WORE W CL QE FT . ADD ALTER NO OF DNO OLFSH �I14� ule I K- l W`� It Yl�' •Y92i�"�' �"7'l,�Z IZE STORIES FAMILIES USE OF r STRUCTURE SIGNAT RE OF APPLICANT :VALUATIONS APPROVALS- DATE INSPECTOR S SIGNATURE FOUNDATION. LOCATION' F E FEE FORMS,MATERIALS ` FRAME. FIRE STOPS, PMT • IHEREBY ACKNOWLEDGE THAT I HAVE READ.THIS APPLICATION BRACING, BOLTS I 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 1 CERTIFY THAT IN DOING THE WORK - AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO'WORKMEN S COMPENSATION INSURANCE 3 LATH,EXT, r, SIGNATURE O HOUSE NUMBER COR- PERMITTEE.- RECT AND POSTED ADDRESS FINAL CLYDE N DIRLAM, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION cK. M.o. H PERM VALIDATION cK. M.O. CASH t 4 , - TEMPLE CITY. 79As2aA CE • APPLICATION FOR BUILDING 'PERMIT � COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER _ ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST DISTR CT N . GROU TYPE SED BY FOR APPLICANT TO FILL IN -.510 CONST. t BUILDING �-� STATISTICAL CLASSIFICATION SE ER MAP ADDRESS �J K ` J� CLASS NO DWELL UNITS LOT NO. (p /� A" .G S LOOCK WATER NOT REQUIRED RECEIVED �,,, ) CERTIFICATE TRACT V^�"`•' MAP ,¢ HIGHWAY IV ,i NO OF BLDGS. NC (J (CIRCLE) STATE MAJOR SECOND, OCAL SIZE OF LOT T ''J- b [NO ON LOT USE ZONE SPECIAL USE OF y CONDITIONS EXISTING BLDG ��•' JJ OWNER N j 3-e BUILDING EXIST SETBACK YARD HWY ST EET N E WIDTH ADDRESS TS a ot1 �(•iA ,FRONT - jl ARCHITECT OR TEL V P L ENGINEER NO SIDE ADDRESS / TEL. /INSP TION RECORD„ a CONTRACTOR [J NO ADDRESS DESCRIPTION.OF WORK _ f X �. t'Iv // �` O W CL NEW ADD ALTER REPAIR DEMOLISH N NO OF NO,OF Z IZE STORIES FAMILIES r - -- - USE OF. ' STRUCTURE - "I SI ATURE OF A PLICANT , VALUATION$ /F_/ J v v APPROVALS ATE Lr INSPECTOR'S SIGNATURE - FOFORMS!MATERIALS LOCATION /v( FEE. $ FEE $ d 'FRAME FIRE STOPS, /J / I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT$ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, / I 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 LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION'INSURANCE ' LATH,EXT SIGNATURE O - - - I HOUSE NUMBER COR- / /, I n✓ /J// PERMITTE RECT AND POSTED / ADDRESS -1 S ' FINAL CLYDE N DIRLAM, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASs PERM VALIDATION cK , M.O. CASH 3 o O.4 SEP 2 5 2 .0 5 .00 n DEPAM ENT.OF COUNTY ENGINEER DPnSIOC LIOF NTY o Lo ANGELESAND SAFETY BUI'`®I k�% WILLIAM J. FOX, couNTY.ENGINEER APPLICATION CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR,OFFICE USE _ONLY• ' DISTRICT NO. i PUN CK.OR REC.No, PERMIT NO BUILDING t..+ .31620 DRESS RE EIVED BY } DATE OF APPL, ;r7)AE:ISSUED LOCALITY / •7 " NEAREST CROSSST. T BUILDING ADDRESS! u7 F OWNER , MAIL -'LOCALITY •` 1 G/ ADDRESS NEAREST! S i TEL CROSS ST. CITY _ •NO D FIRE NO. —11 ENGIARCiNEE OR No,L. ZONE PLANS- s TM GROUP ADDRESS i SETBACK'LINE �© , -�'_` / Dpi TEL. ZONE M USE • APPROV CONTRACTOR NO BYP rDATE / 4 J� ADDRESS HOUSE ?W BERING LEGAL S �°L_I"� MAP NUMBER- ©La ` NO. ASSIGNED BY - ----N PTION LOT NO. BLOCK t ` r CORRECTIONS TRACT O. OF BLDGS. SIZE OF LOT�� I NOW ON LOT _ � t USE OF r NO. OF EXISTING BLDG. FAM Iue �� 6 C7 4C•- - DESCRIPTION 'OF ORS j /2/! y o - NEW ALTERATION ADDITION yin C° �+ Q REPAIR �) EMOLITION I RG�./L[7�1� �' .ys� /aJ S.'/O �A•i' -�+••D•....,,,_ SQ. FT \ NO. OF / SIZE U ROOMS STORIES EXT. WALL -ROOF a - - COVERING L I COVERING - r _ USE OF STRUCTURESI 13 , '7 ea •�oK� �/I� a' !� h�XifT/n/G F•�7as^/�G ��Cea�/AT�1) C�M�Q O APPROVA S INSPECTO 'S SIGNATURE FOUNDATION: LOCATION fq r - SS S ry FORMS, MATERIALS /i i �'. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS XP-� FRAME, FIRE-STOPS, f PLICATION AND STATE THAT TH6 INFORMATION GIVEN IS BRACING, BOLTS yyAAJ///'''' J CORRECT.GREfi TO COMPLY ALL COUNTY ORDINANCES FURNACE: LOCATION. �N / %1. AND STATE LAWS REG T N BUILDING CONSTRUCTION GAS VENT, DUCTS / LATH, INT. ��/ SIGNATURE OF, PERMITTE �_ d / LATH. EXT. ADDRESS _ • v PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. /3 T�J^-/ G+• ^ FEE >8 —� HOUSE NUMBER COR- RECT OR- QQ _ RECTAND POSTED VALUATION FEE $ r'2"^ FINAL II r 76A888A 08113 8-5II - yy 79AO90A C6y009.9 BD APPLICATION FOR BUILDING , PERMIT COUNTY OF LOS ANGELES BU'LDINQ9Y3 DEPARTMENT OF COUNTY ENGINEER ADREss D BUILDING AND. SAFETY DMSION LOCALITY- JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST DIST T NO GROUP TYPE PR Y FOR APPLICANT TO FILL IN r/Q CONSr. BUILDIN •STATISTICA"CLASSIFICATION SEWER MAP ADDRESS B CLASS NO DWELL UNITS�I P LOT,NO .,7` BLOCK I`'IAP �f O STATE WY YES O �-y, /� NUMBER �K. TRACT/i ` 61AyQ,v USE ZONE SPECIAL yl 5C ` 7 x I NNO OF OW ON LOTS Q I ) /` CONDITION � ' ;C SIZE OF LOT '` J'�- USE OF EXISTING BLDG 'BUILDINGEXIST TEL SETBACK YARD STREET NAME WIDTH OWNER _ PAL &ACyUf J: NO ' FRONT _ _ / / t P L ADDRESS 4[,,Vd. SIDE ARCHITECT OR TEL P L ENGINEER NO INSPECTION RECORD ADDRESS /y ,{/ �. a tt,�, TEL.,/ / / 1 � /'-"` E� 3_-�� O CONTRACTOR MI/LLPA.M Vpa� NO ,(,!/_413./ U ADDRESS W• /(J - ' O DESCRIPTION OF WORK A,-'0Nlrl rA e Olt Al NEW ADD ALTER REPAIR DEMOLISH ' �_ �![•' SQ FT p NO OF ' NO OF SIZE / d V STORIES FAMILIESUSE OF, STRUCTURE 6dEL4I A//► GPceA Gtr' u •� •.+ -x,_� / r SIGNATURE OF APPLICANT VALUATION S ,�� ..I ✓ APPROVALS DATE INSPECTOR S SIGNATURE PC PMT U FOUNDATION LOCATION FEE $ FEE $ ,J FORMS MATERIALS yy'/ FRAME FIRE STOPS, IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS {��..• AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE OF' THE WORK FOR WHICH THI PERMIT 15•ISSUED I SHALL NOT LATH, INT EMPLOY ANY PERSON IN ANY M NNER SO AS TO BECOME SUBUECT TO THE WORKMEN 5 COMPENS TON LAWS%OF C LIFORNIA T LATH,EX > r SIGNATURE OF ' HOUSE NUMBER COR- ' PERMITTE RECT AND POSTED / ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRUGTNRAL ENGINEER PLAN CHECK VALIDATION cK: M.O. CASH PERMIT VALIDATION CK. M O. CASH r.� 4902 1.0, 011 5 _ 16.5 k L1=05099 A'A10 1 D 3 3 .0 0 WORKERS' COMPENSATION DECLARATION ` I hereby'ciffam that,I ha,3e a certificate•,of consent to self insure, or a rtificate af'Workers;Compensdti0n Insurance, AP P L I CAT IO N-;'FOR` RU I.L'®'I iol C, PERMIT' or,a certified copy thereof (Sec' 3800,Laki'C•)., ,'_ . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No' "- � ,brhpariy a ` ' ' r FOR APPLICANT TO FILL IN BUILDING Certified copy'is'hereby furnished rb.' .,,i- ADDRESS i Certified copy is the'county kiu Idmg mspec° FAUDDRE NG7' { r i" u, „- tion'department. ,. �l >� SS 3 9 t •Date >Applicant' �` ' G� ZIP LOCALITY 'OF BLDGS • NEAREST `CERTIFICATE OF 0EMPYIO FROM WOR OF LOT NOW ON LOT - �, CROSS ST COMPENSATION INSURANCE r ASSESSOR Thia'secTion need not'b'e com leted'if'the. ermiT is`for one TRACT% ' BLOCK- LOT NO V" 'F ( p p MAP BOOK, PAGE- PARCEL hundred dollars ($100) or-.less.) • ( TEL OWNE_Rr NO- USEIZONE,•, MAP /L, I certify that in,,the performance 4 the_work for which this SPOECIAL ,�. dy permit is issued„I shall not employ any,person in any manner ., ADDRESS_, ”"' fV - CONDITIONS so as to become subject to the Workers'Compensation Laws _ -O' U S� ;;r.; CIN `.. �I ZIP. f' Date 8 �l ApphcanT � `f�-' d N ARCHITECT-OR TEL ' DISTRICT GROUP TYPE FIRE PROCESSED BY' NOTICE`TO 'APPLICANT If,,after�making•this.Ceiiificate',of ENGINEER- „/4/dR�. NO•' - CONST � . Z E Exemption,_ you should become subject to.The Workers' F �• LU Compensation provisions,of the Labor Code, youkmust forth ADDRESS _ with-cdmply with such provisions,or 'this-permit shall be TEL s� STATISTICAL CLASSIFICATION ` APT CONDO N deemed revoked , 'T,; CONTRACTOR NO 0 Ud Z LICENSED"CONTRACTORS DECLARATION - LIC :CLASS NO DWELL UNITS ` •NO I'herebyaaffirm that I cirri licensed under provisions of Chapter 9'_ , ADDRESS t� SEWER MAP ^_ T (commencing with,Section 7000)of,Division 3,of'•the Business ' LIC and,Professions Code,and'myyy, icense is in full force.and effect CITY �Jll U �' CLASS C 3 BK PG t VALIDATION" • • }�,/ � SO FT NO OF NO OF CHECK , License Number (� be-Class �r:`�9 SIZE STORIES FAMILIESV ONE VALUATION � O J`�1/e- �U� ate .�- 3 1 7 12- Contractor' G' DESCRIPTION OF WORK 1 NEW p' t ADD ❑ r i Q I am`exempt under,Sec E l� ALTER ❑ <, &P C-for this reason �( f - - � REPAIR ❑ S - _ ' 1 `,� l 1 USE OF Date EXISTING BLDG yy DEMOL❑ - 4_ Signature .APP.L'ICANT "� .. TEL J •i FINAL' 'OWNER-BUILDER,DECLARATION. ,s (PRINT)" NO DATE I hereby affirm•that I am exempt from'the Contracto'r's•License �•• •' - - y '1 Law for the following-reason•(Section 7031.5,,Business'and ADDRESS FINAL , .,• �' •>, Professions Code) t PRESENT _ x By ' < BUILDING_ 0 I, as owner`of.they,property, or-my employees wrth' 4 ADDRESSt- ,wdges as their sole'compensation,will do the,work and ihe,siructure is not iritended'oroffered for sale(Section LOCALITY' _ .� ;��� ;� _11� - - 7044, Business and Professions Code MOVING - .TEL -- i - t.. - ) CONTRACTOR NO } i� I, as-owner of the property;-ani exclusively' xclusively contracting { yT_r��' a 4 wrth licensed contractors to'construct the project (Sec' • % Tion 7044, Business and Professions Code ) *ADDRESS i iY L' �,,,,•�'&,�3,,�' �'• REQUIRED' TOTALiSETBACK FROM--.- EXIST, ''CONSTRUCTION LENDING AGENCY. SET BACK "YARD HWY` PROP LINE WIDTH t •�.•t��'-`} - °j,hereby affirm that there is a construction lending(agency fog, FRONTa `•'the performarice of'the'work for,:wliich-this permit is issued �' P L "' E�I tHNIm ='1 (Sec• 3097.;Ci`C ) SIDE P L' '•°Lender's Name` - .Tf7 `LDMA Ref i I =` P C Fee$ Permit Fee v Lender's Addresspoll or 4•' (yl'f j';i� o �I`certify that,I have.read this application and state that the Issuance Fee �'w LDMA•P/C# oil .,above informaiion is correct I agree to comply with all County t Investigation Fee , ^► _-g_ 'ordinances and State laws,relating to building construction, Total Fee /' LDMA Perm #' Q and hereby authorize representatives'of this County to enter _ - upon,t above-mentioned prop ty;for•)nspection purposes' 4}•� SEE REVERSE FOR EXPLANATORY LANGUAGE ,e Signature of Apphcan r Xg.en,t Date •, - �,( 1,