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HomeMy Public PortalAbout9588 BLACKLEY ST_Building__ APPLICATION FOR BUILDING PERMIT F R APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES BUILDING /n�/� ADDRESS nn`, �n0IG L - DEPARTMENT OF COUNTY ENGINEER CITY _ 1�'l C l f ZIP BUILDING D SAFETY DIVISION SIZE OF LOT ,5- -,Y,( X 3-� NO.OF N LOT L BUILDING �/ j NOW ON LOT ADDRESS TRA / a I BLOCK ` ' LOT NO S LOCALITYNEAREST OWNER V C� �UIJT TN/ t?_,? ./ALL!J- CROSS ST. ASSESSOR ADDRESS �/�,��l/V MAP BOOK P PARCEL DISTRICT UP YPE FIRE ES$E�D�BY -CITY L l� / ZIP ; CONS ZO _ ARCHITECT OR -� TEL c)ale y �_Ozlo ENGINEER - NO -. //�� _/� h 'STATISTICAL CLASSIFICATION SEWER MA ADDRESS 0 6 .. �/ ',��//`J��`� `� CLASS NO �3 DWELL UNITS �BK/2-&G CONTRACTOR ```` C)1 � bf I�SZL (1133 ZO E MAP ADDRES V. /I/Vl.c/�rct C��� `tel SPECIAL CITY• Ivj LIC CLASS L"-S3 Z0" CONDITIONS CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ NAME AND BRANCH BLDG SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING HIGHW Y + YARD SI FT Z SI ST OF FA OF CHECK - FRONT PROP LINE HIGHWAY WIDTH -SIZE �•J b STORIES FAMILIES ONE } DES RIPTION OF WORK NEW + a O ADD ❑ BLDG SETBA K SROM SIDE PROP LINE OFA_` (STREET) O ALTER ❑ TOT-AL SETBACK FROM TYPE OF EXISTING w HIGHWAY + YARD = SIDE PROP CINE.-_ HIGHWAY WIDTH N USE OF REPAIR ❑ Z EXISTING BLDG DEMOL ❑ + APPLICANT TEL ,�j( CORN ER'CUTOFF YES ❑ NO ❑ (PRINT) I NO W IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE( / IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ (y— _ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND,STATE THAT THE'ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION 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 5 COM- PENSATION INSURANCE ' PM SIGNATURE OF PERMITTEE �l ADDRESS FINAL CITY NO 30 DATE �- MAKE CHECKS PAYABLE TO. FEE $ V FEET $ HARVEY T.BRANDT,COUNTY ENGINEER PLAN CHECK VALIDATION M. . CASH _ PERMIT VALIDATION M.O. CASH 6 1 0��rptr 9 3. D 2 5.20 © 6 Wit'."•AR 9 i D 42.(1_0 0 Os 76A63BA CE#803 3-75 76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS o BUILDING.AND SAFETY DIVISION LOCAL I Y t JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF 8uILDING _CROSS ST DISTR T N GROUP TYPE OC S B 'FOR APPLICANT TO FILL INQ L CONST. ADDRESS S�� STATISTICAL CLASSIFICATION SEWER MAP CLASS. NO _DWELL UNITS LOT NO BLOCK WATER CERTIFICATE. NOT REQUIRED RECEIVED' TRACT y9 �� NO � Q ` HIGHWAY STATE MAJOR SECOND OCAL - NO OFOBLDGS (CIRCLE) SIZE OF LOT 3� NOW N LOT USE ZONE SPECIAL USE OF FJ CONDITIONS EXISTING BLDG . GG'yY.f T E L (�Z��� OWNER _ NO 'BUILDING EXIST. y► SETBACK YARD HWY STREET NAME WIDTH ADDRESS �( /�; � �- �O. /.� FRONT ARCHITECT OR TEL. P. L ENGINEER NO SIDE / P L ADDRESS cy pOff. Ell TEL CONTRACTOR O T ADDRESS s � �� �' ad O DESCRIPTION OF WORK W a NE ADD ALTER REPAIR DEMOLISH Vf SQ. FT. NO OF NO OF SIZE p / STORIES FAMILIES USE O STSTIRUCTU RE SIGNATURE OF APPLICANT , VALUATION $ APPROVALS DATE INSPECT R'S SI NATg)RE FOUNDATION LOCATION P C. PMTFORMS. MATERIALS _ FE FEE $ (v/ FRAME FIRE STOPS, i / , I HEREBY,ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS r AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION. '� f •� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS J BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK E AUTHORIZD 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 CO PENSATION INSURANCE. ' LATH. EXT. SIGNATURE OFHOUSE NUMBER COR- PERMITTEE >101 /" - RECT AND POSTED ADDRESS /�C 111::6- 7 -G' - FINAL PLAN CHECK VALIDATION CK M O ' cASH JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG' ER PERMIT VALIDATION, CK M OCASH a 1Co 73 1 3 JP��1 6 1 D 6'.O ON i 76A636A CE#0032-63 APPLICATION_ .FOR BUILDING. PERMIT - COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION• LOCALIT JOHN A. LAMBIE, COUNTY ENGINEER• NEAREST -WILLIAM A. JENSEN, SUPT OF BUILDING - CROSS ST DISTRICT NO GF�JJP TYPE f PR BY FOR APPLICANT TO FILL IN CONST. BUILDING STATISTICAL CLASSIFICATION, SEWER'MAP I ADDRESS � � : cS BKPG C�/� CLASS NO DWELL UNI�TSS-^v LOT NO `'� BLOCK WATER NOT REQUIRED I YI RECEIVED ❑ CERTIFICATE 111!!!VVV TRACT pC 7 �iMAP �O/ HIGH WAV �'/ NO (CIRCLE) STATE MAJOR SECOND OCAL SIZE OF LOT ,�j`j-4'j � NOW ON LOTS//'One USE ZONE SPECIAL ' USE OF ONDITIONS EXISTING BLDG _ ` /lTEL p OWNER .d g, Cr' C"- s�-/PU�Cp,NO �Zp�O B ILDING EXIST � /� SETBACK YARD_ HWY STREET NAME WIDTH ADDRESS �C: /PIPJ /� C�%�CO JG�� FRONT 3 - _ _• ARCHITECT OR I TEL P. L -ENGINEER NO SIDE , ADDRESS TEL �7 �7 A .Y rT/VJ�^ `�'!LB"` �IIN'tl`R /"dEM O CONTRACTOR V• c/--,OPr NO Q Q( 1 ADDRESS ��` e/T/ �� C:/ - ',O�vS/' _ ? `•i 6� O DESCRIPTION OF WO K �j` � /� r' ! "�� -� -� '' a NEW - ADD ALTER REPAIR DEMOLISHy SQ- FT -7 NO OF _NO OF (J, i✓ -_ SIZE /�G STORIES FAMILIES USE O FJ / •f� / v Y !�^'K �+•V' YAW' r ._d.✓ ..1twtTr4 - STRUCTURE �'Q SIGNATURE OF ' APPLICAN - �'c•� VALUATION - '� APPROVALS DATES INSPECTORS SIGNAX g_ PC PMT FOUNDATION' MATERIALS FEE $� � FEE � 8 (�i ✓� �.. - FRAME FIRE STOPS I HEREBY 'ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS •� w A�171 J 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 I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT �,� D !„^'"T TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- INGTO WORKMEN S COMP TION INSURANCE LATH, EXT. I SIGNATURE OF ,HOUSE NUMBER COR-. PERMITTEE RECT AND POSTED ADDRESS �� ` -�7 % u� FINAL JOHN F. LEWIS, PRINCIPAL STR URAL ENGINEER PLAN'CHECK VALIDATIONCK M O CASH _ PERMIT VALIDATIONUK M O CASH U'Lo3 8.5 •11 SEP-16 1 D 78.00— a APPLICATIONFOR, BUI,L®ING PERMIT �1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ♦ BUILD G ADDR S hereby affirm that I have a certificate Of consent.to,self insure, 59 G or a certificate of Workers'Compensation Insurance,'osa certified copy thereof(Sec.3800,Lab.C.) CI trCC— C.� //I . IP LOCALITY Policy NO. - Company SIZE OF LOT Y / NO OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. �S� ) (� NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department.' USE ZONE MAP NO. / �/ _ / _Z6 ASSESSOR MAP BOOK PAGE ARC n Date Applicant � 00 (o PQ�5— Iv(r\' SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O ERce, v TEL.Np_ _7 y d�OGJ .YES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOLS ADD ESS ry (This section need not be completed if the permit is for one hundred b DISTRICT GROUP TYPE CONST. FIRE ZONE PR SSED BY dollars($100)or less.) CI / ZIP I certify that in the performance of the wWt for which this permit � r p 4 GST v f is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become S bje/0t t0 the Workers'C p SatiOn aw STATISTICAL CLASSI ICATION APT CONDO Date-j �Applicant ADDRESS CLASS NO. 2 DWELL UNITS NOTICE TO APPLICANT. If, iter making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRACTOR TEL.NO. SET SETBACK YARD HWY PROP LINE WIDTH Compensation,provisions of the Labor Code, you must forthwith Z F N FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS / Ave. IC N• P L AIN Ai SIDE LICENSED CONTRACTORS DECLARATION CLIC.CLASS PL AG �N IDI4 f7� ! I hereby affirm that I*am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and So.FT.SIZ NO.OF STORES NO.OF FAMILIES I Professions Code,ajWLic.lice sen full force and eff NEW ❑ BK PG DESCRIPTION OF WORK ADD ❑ VALUATION W License Num Class — SIC L a /�EMo L �Ali 5 1 i NrC SNff Contractor Date — ALTER � ❑ v Z /NS?ALL. � t GD LY'' EPAIR 8 ❑ I am exempt under Sec. B.BP.C.for this reason I�-u ��/--AS 5 S,! 4" G�'ass EMOL 11LDMA P/C# USE OF EXISTING BLDG URM ❑ Date: Signature APPLICANT(PRINT) e1__1_ T lL.NO.r��� LDMA Perm# Z ❑ I, as owner of the property, or my employees with wages is `✓` �� .J3 O their sole compensation,will do'the work and the structure is ADD ES J� H FINAL D not intended or offered for sale (Section 7044, Business and Nti �v� �l aL f �4' S Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE AHAZARDOUSMATERIAL J i i OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a 3•h�(� Z11�e';• ❑ 1, as owner of the property, am exclusively contracting With THEAMOUNTSSPEC D ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL; licensed contractors to construct the project (Section 7044, res ElNo `) Business and Professions Code.) i1 ,WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING -I;- � -� _ OCCUPANT REQUIRE A PERMIT FORCONSTRUCTION ORMODIFICATION FROM THESOUTH ,U. -�•% ` Z CONSTRUCTION LENDING AGENCY COAST AIR QUALITY M!!l���WWNAAAGCCEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST -• !+v a L FOR GUIDELINES / )� wee I •' I,hereby affirm that'there is a construction lending agency for YES❑ NO J��/L!� Wil}{ Jofrthe performance of the work for which this permit is issued(Sec. �f�11 /ii(/ �(!/✓ ®/� -'� L _ I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD _I I•_: 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND Mr REQUIREMENTS UNDER THE LOS ANGELES m COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2 20 100THROUGH 220140 CONCERNING '�' Lender's Name HAZARD S MATERIALS REPO ING AND FOR OBTAI NG A PERMIT FROM THE SCAOMD. j I-ITAL. ?3 63 Lenders Address ¢i��_: i.st 0 1 certify that I have read this application and state that the above P.C.FEE PERMIT FEE CHANGE AN information is correct. I agree to Comply With all County _ _ 52TG� ordinances and State laws relating to building construction,and D l.•I'iE r Q hereby authorize representatives of this County to enter upon ISSUANCE FEE th mentioned pr arty for inspection purpotib-(jfji a p `;`5.0 Q °4± � INVESTIGATION FEE TOTAL FEE _ . rrl Mlmni or At `1 �'j L•� �1 n i j, CID ! til J (•�]I 1 C Lr� SEE REVERSE FOR EXPLANATORY LANGUAGE,