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Home My Public Portal About9034 BROADWAY_Building__ CDs 76A63Er CEiieo2j I APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY - FOR APPLICANT TO FILL IN. BUILDING ] , ADDRESS �'CJr BUILDING ADDRESS Cp3LI £, y LOCALITY EA'EST CI1Y IG I ll LZIP 1 CR0555T. p� NO.OF SLOGS. /J ASSESSOR SIZE OF LOT 10—f NOW ON LOT /moi MAPBOOK PAGE I PARCEL 'DISTRICT GROUP TYPE 'FIRE PR ESSED BY TRACT BLOCK gjaq LOT O �`1� ,T 3 CONST. Z3E OWNER IV / 11 s NO, r/185-.1• STATISTICAL CLA'!5\51SS'FICC'ATION I!"/ SEWER MrygP ADDEREELSSS' DZC/ �� ,/3rc)A (�1 CLASS NO. DWELL.UNITS L gK Q PG CITY ICam I{� �.LI zIP q�.7d(/- �J'. ENGIN EC R TEL VALUATION qj J( /1 ENGINEER NO. /J 0 0o J ADDRESS _ BLDG.SETBACK FROM TEL FRONT PROP.LINE OF r ISTREETI CONTRACTOR (� //II'�.,� NO. HIGHWAY + YARD __ TOTAL SETBACK FROM TY OF EXISTING LIC ADDRESS V l.�J he NO. FRONT PROP.LINE HIGHWAY WIDTH LIC. o + / _ /S t�-. Ol CITY CLASS CONSTRUCTION LENDER BLDG.SETBACK FROM SIDE PROP.LINE OF - ISTREETI NAME AND BRANCH TOTAL SETBACK FROM TYPEWOF EXISTING y HIGHWAY + YARD = -SIDE PROP.LINE HIGHAY WIDTH,. C ADDRESS CITY 50.FT. NO.OF NO.OF CHECK + _ 512E �� STORIES FAMILIES ONE 'O ❑ U5 a NSP / DESCRIPTION OF WORK - NEW S /D D 'X/S� CID DIT ADD � CONDITIONS G J /IO R 2- ALTER FINAL I-OOIL ! v By /SQL./�� REPAIR ❑ DATE 6 USEIOFJV EXISTING BLDG. l�SI 'Den( r_ DEMOL ❑ Z APPLICANT y(/_ - /-^ �N DS TEL - IPRINT)lvf Il./I/T H NO BY ISIGNATUREI 4. / Q HEREBY ACKNOWLEDGE THAT I HAVE READ i /APPLICATION AND STATE 1 1 .7.9 A i THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL,ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE U # e e e s e 1 WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF o THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'SCOM ZQ tie e8Goo� PENSATION INSURANCE.' J SIGNATURE OF / �d a e e'e 8 g•O O:U PERMITTEE - _ ADDRESS O {� O 7 S O �1 O- Z _ /nom TEL' O CITY �!� NO D J P.C. Fee$ Permit Fee. > Issuance Fee 7-7 rr W d Total Fee r. APPUCAMON F09 BULLING PERNT i COUNTY OF LOS ANGELES �.' ''1 '. , BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION -f FOR APPLICANT TO,FILL-IN BUILDING DRE BUILDING ADDRESS 1 I hereby affirm that havekers' certificate of consent to self insure, �3 _ Q OG_,! a or a certificate of Workers'Compensation Insurance,or a certified - copy thereof(Sec.3800.ILab C.) A .. CITV��4ti � �\ ZIP \ 8� LOCALITY Policy NO. �C� �^ Company G�\"`� SIZE OF LOT -NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. 'i. NEAREST CROSS ST. Certified copy i5 filed with the county building inspection TRACT - BLOCK LOT NO. - department. C USE ZONE MAP NO.. Date, '�$� wRw.4Al.l�l1 ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS �4pplicant CERTIFICATE OF EXEMPTION FROM WORKERS' owNE TEL No COMPENSATION INSURANCE ko- Q,,". WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the P \ADDRESS _ '� �C Da W 1 DISTRICT GROUP TVP�.§ONST, FIRE ZONE PROCESSED BV - dollars($100) or less.) �ermit �is for �one hundred I certify that in the performance of the work for which this permit a is issued, I shall net employ any person in any manner so as to ITyn �R ZIP '"t D G become Subject f0 the Workers'-0Ompensation Laws. ARCHITECT OR ENGINEER TEL NO. D V o J/ STATISTICAL CIL 955 FICATION APT CONDO Date Applicant ADDRESS - CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REOUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' QONTRACTOR _ TEL NO. SET BACK YARD MY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ��.'�� p 8a\-4(_ FRONT comply with such provisions or this permit shall be Beamed revoked. ADDRESS i UC.NO. PL ' a �L� C ` A LICENSED CONTRACTORS DECLARATION 51 a\ a S SIDE �X uc L 5 P L I hereby affirm that I aCl m licensed underprovisions of Chapter 9 `agck SEWER MAP (commencing with Section 7000)of Division 3 of the Business andSO.FT SIZE NO.OF STORIES NO.OF.FAMILIES Professions Code,and my license is in full force and effect. ' L� \ NEW BK PG - EL License Number D�_�k\"Di S Lio.Class C" ` D CRIPTION OF RK ADD ❑ VALUATION �-0 D Q Contractor 2141 I!—V S Date \\ `2l"I4 ALTER ❑ $ �` ��' spC o�� Qs �co� 0 ElI am exempt under Sec. ` REPAIR ❑ $ B.BP.C.for this reason v�O',+••e,R 5� aC a ..Q DEMOL ❑ LDMA P/C« W Date: L OF EXISTIN BLDG. URM ❑ + IL `tea ,c 41 cR ' Signature CANT(PRINTI TEL NO. LOMA Perm♦ r Z ❑ 1, as owner of the property, or my employees with wages as a AG 7\— OZt'L� their sole compensation..will do the work and the structure is ADDRESS _ 3-07y T not intended Or offered for Sale (Section 7044, Business and r Ga— FINAL DATE Q Professions Code.) TT_ =�{`� WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL _ = W A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE /2— ❑ I, as owner of the property, am exclusively contracting with V 73 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 1 T ♦,I i X15 licensed contractors to construct the project (Section 7044, YES❑ ��--A4 I I I t!t_ 3-�'- - Business and Professions Code.) viii f_yE(,�;,, r'I4� 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 WAST AIR OUAUTY MANAGEMENT DISTRICT(SCAOMO)SEE PERMITTING CHECKLIST FOR CNAta Ji GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NOV(- the performance Of the Work for which this permit iSissued(SEG IHAVEREADTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE Si 3097,C.,Q) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOB ANGELES COUNTY CODE TRUE 2,CHAPTER 2 20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMO. ;O�— j f•yyl i i o Lender's Address \' o onmeA on noeu. " o I certify that I have read this application and state under penalty oP.C.FEE PERMIT FEE N of perjury that the above information is correct.I agree to comply with all county ordinances and State laws relating to building , m construction, and hereby authorize representatives of this County ISSUANCE FEE teru�.on the ab ve-mentioned property for inspection purposes. �(L• 0 �.i tpy�R v\ INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE