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Home My Public Portal About9126 BROADWAY_Building__ -IOA630A CE#8035-GIAPPLICATION' FOR - BUILDING PERMIT COUNTY OF LOS ANGELES BUILfl z2 f1 ✓/ Ell- - DEPARTMENT OF COUNTY ENGINEER y BUILDING AND SAFETY DMSION LOcnuTr JOHN A. LAMBIE.'COUNTY ENGINEER NEAREST I WILLIAM A. JENSEN`.SUPT OF BUILDING CROSS ST. ` FOR APPLICANT TO FILL IN DISTRIgT NO. GROUP_[TYPE PR ED BY "7/ CONST: .G .BUILDINGSTATISTICAL CL6SSIFICATION SEMERMAP ADDRESS 9126 E. Broadway CLASS.NO. / DWELL.UNITS 114,BK PG LOT NO. «� J� !a ..y�j BLOCK WATER NOT REQUIRED ❑ RECEIVED CERTIFICATE,/N TRACT NO.OF BLDGS. NOP (/-/r HIGH EY STATE MAJOR SECOND, OCAL� SIZE OF LOT NOW ON.LOT USS ZONE SPECIAL, USE OF CONDITIONS EXISTING BLDG, /'i. ' OWNERHnrarry 1'I'. Harper NO. B(�UILDINGEXIST. ADDRESS 9126 E. Broadway- T SETBACK YARD HWY STREET WIDTH' _ FRONT 1 ARCHITECT OR TEL. P. L. / ENGINEER .NO. SIDE O ADDRESS TEL. INSPECTION RECORD CONTRACTOR Virgin Roof Co.NE; AT7050 p ADDRIESS-6O0_S. San Gabriel Blvd, U W j DESCRIPTION OF WORKS. G'. Z NEW ADD ALTER REPAIR DEMOLISH SO. FT. NO.OF NO.OF IZE STORIES FAMILIES USE OF^ STRUCTURE Re-ro se & Gai age SIGNATURE O APPLICANT t vALunnory 5334.00 APPROVALS DATE INSPECTOR'S SIGNATURE FEE $ FEE $ 6.00 FOUNDATION: LOCATION FORMS.MATERIALS FRAME: FIRE STOPS, - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT A D AGREE TO COMPLY FURNACE: LOCATION. WITH ALL-COUNTY ORDINANCES AND ST E LAWS REGULATING GAS VENT DUCTS ' BUILDING CONBTRUCTION C TIFY T { IN DOING TME WORK. - - AUTHORIZED HEREBY L N E L Y ANY PERSON IN VIOLA- LATH, INT. I TION OF THE LABOR CONSTRUCTION OF HE T ! OF CA,IFORNIA RELAT ING TO WORKMEN'S `PEN TI I ISURANCE. ` LATH,EXT. '] AI PERMITTE SIGNATURE O HRECT AND POSTEDUSE NUMBER X11.I n q; AN ADDRESS i .i Roof C . FINAL l I I I (s',1AVIVA ' 00 S.San r e B v .S. . CLYDE N. DIRLAM1, INCIPAL ST_OG RAL ENGINEER PLAN CHECK VALIDATION CIL M.o. cABH PERMIT VALIDATION GIL M.o. cABH �`:� 1,2926 � hA'f2 2 1 U. 6 .00 • 1 76"38A CC 8036-62APPLICATIONFOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 2¢2[ BUILDING AND SAFETY DIVISION LOCALITY l Lf JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. DIST�JCTN P TYPE P S ABY" - Y GI J FOR APPLICANT TO FILL IN "J) [) l � consr. BUILDING wr STATISTICAL CL (CATION E R MAP ADDRESS 9124DAc{ / 7 C. BK_ PG v h CLASS. NO. DWELL. UNITSCI�I LOT NO. BLOCK' WATER CERTIFICATE IIJJ �� ' NOT REQUIRED•T?d_RECEIVED - TRACT X I S - MAP I MIGNWAY NO.OF BLDG$. NO. / (CIRCLE( STATE MAJOR SECOND LOCAL SIZE OF LOT .646 K/6 0 NOW ON LOT USE ZONE PECIAL USE OF /�'�/66 CONDITIONS , EXISTING BLDG. %d N OWNER AR 1 AX Br♦ NOTIEL. T.72 jy BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS qjfiffJraA,l WA FRONT ^ ARCHITECT OR TEL, P. L. 'L'L G( YpL'L ENGINEER NO. SIDE ^ % // 4 )- ADDRESS - �/A/ *3 � / O CONTRACTOR/J/( fR///�(�AR TEL..b NO.pJ'Bd$>t �1 -/ ✓ / - U ADDRESS % / N DESCRIPTION OF WORK I �t �6N a;f l 0 NEW ADD ✓ ALTER REPAIR DEMOLISH SO. FT. NO. OF NO. OF \ Z SIZE STORIES FAMILIES USE OF 9 STRUCTURE /l Bf e'j ,.T4 Apc ' SIGNATURE APPLICANT p �� VALUATION 5-3 /YA/ l n� I �n (V/ ll%% I 6/l l APPROVALS Dl,ATI E INB/P{ECT/1OR/'S{�IG/NATURE P.C. PMT. �) FO FORMS(ON:MATERIALS 1N I ' ///L,I/✓�J FEE $ FEE $ j_:0 � C/ ' FRAME: FIRE STOPS, q /A II HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS I / ANO STATE THAT THE ABOVE IS CORRECT AND AGREE E COMPLY FURNACE: . DUCTON. ,F WITH ALL COUNTY TION. INCEB AND STATE LAWS REGULATING GAS VENT. DUCTS I I� `/!J AUILDINGTHORIZED CONSTRUCTION. CERTIFY THAT Y DOING ERSO THE WORK AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLA ' S TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. LATH. INT. ING TO WORKMEN'S COMPENSATION INSURANCE. ( ~ LATH. EXT. / SIGNATURE HOUSE NUMBER COR- / I PERMITTEE REST AND POSTED 1 /I I/ • ADDRESS FINAL I l / //J/ YLI JOHN F. LEWIS, PRINCIPAL ST C URAL ENGINEER M PLAN CHECK VALIDATION CK. M,O. CASH _ PERMIT VALIDATION cK. M.D. CASH t.l,I r1 H 0 5 e dAR i 1 1 D 1 0.5 0 ' DI APPLICATION, FOR BUILDING: PERMIT �- _ e- -• COUNTY.OF:LOS'ANGELES - .BUILDING�AND.SAFETY ,- •• WORKER .OMPENSATION DECLARATION.. FOR APPLICANT TO FILL IN _ 5 BUILDING ADDRESS I hereby-affirm that I have acertificate of consent to self Insure, BUILOIADDRESS -or a;certificate of Workers:Compensation Insurance„or a certified. r/ a 6 -- copy thereof ISac13800],Lagb..C.) !1 CITY -1 , Ipl1_ PONcY ND.�,>la.`Y(05 J-7 3 Company T/Q fG;�'hyN� CMI �e C r J 1/ 7Jy � LOCAuiY- -•, _ - LJ SIZE OF LOT ', -- NO.OF BUD S.NOW ON LOT f Certified copy is hereby furnished. NEAREST CROSS ST. r •. .❑ Certified copy is•filed.with the countybuilding inspection TRACT J,.SLOCK .LOT NO: - ` department.n �� //A /,/ USE ZONE MAP NO. Date 010-> Applicant Y U�— , ASSESSOR MAP'BOOK .;PAGE PARCEL' e - 1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' - OWNER TEL No. • COMPENSATION INSURANCE,,,, ; 2 �L 7a Jar' 6THIN +000 FT of SCHOOL? - YES Nor - (This section need not be completed if the permit Is for one hundrIad - ADDRESS -• `DISTRICT GROUP TY ONST. FIRE ZONE PROCESSED BY doliam.($100) or less.) , - :- - l a 6 2�SD'b./ J{': Q I certify that h l not performance of,the work for which this permit CTL C 'Zr i ��(,- OQ �_/J -t , Li 2n -1-„1- •+ is+issued; shall not employ.any person i0'any manner so as=tD gRCHITEGT,OR ENGINEER. TEL NO. - become subject to the WorkersCompensation Law,. - STATISTICACCLASSIFICATION _ APT' - CONDO Date- Applicant ADDRESS': - i - - CLASS,NO. ` DWELL UNRS N077CE TO' APPLICANT. If,'after making this Certificate of REQUIRED - - TOTAL SETBACK FROM EXIST Exemption, y0U Should become Subject 'to','the Workers' CONTRACTOR - -- : . TEL NO, SET BACK' YARD' HW Y PROP LINE ' .Compensation provisions of the Labor Code;you must forthwith + 'Q l e O 2 A _ 7 0 0 FRONT WIDTH, - comply�wilh such provisions or this permit shall be deemed revoked. ADDRESS - LIC.NO1 .p L, - LICENSED CONTRACTORS DECLARATION •�'OR0.,� /� 6d y - SIDE , - CITY LIC.LLQS PL thereby-affirm that I am licensed underprovisions of Chapter 9 A JL C RC/+ L SS SEWER MAP - (Commencing with Section 7000)of Division;3 of.the Business antl, SO,F.SIZE „NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. - NEWI . • ❑ BK PG , - d LicenseNumber /� •76l�1 Lic.Class-� - 39 DESCRIPTION OF WORK - - ADD ❑ VALUATION - ContractorQt.i C••!S Date ZeZ_a6 �3 - / Net/ Kav F o tI ALTER ❑ $ a a �7 0 O ❑ 1 am exempt under Sec. - _ , . _ - - REPAIR _❑ B&PA.for this.reason GDM Pr 5 r'hU DEMOL ❑ LDMAIP/C s ' -1” W Data: USE OF EXISTING BLDG. 'URM ❑ - ° .,_.d 0 Signature -' '•I, APPLICANT(PRINT) - TEL NO. -c LDMA Perm♦ - j, . Z ❑ I, as Owner of the property, or my employees with wages as',` - aZ 'CPT.a. ' their sole compensation;will do the,work and the structure Is - ADDRESS _ _ A ''O ' rwt.intended Or Offered for sale (Section 7044, Business and - FINAL DATE Professions Code.)., _. - /j_ Zq - WILL APPLICPM OR FUTURE HAN0.E A HAZARDOUS MATaSk - _ J Tr r OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I,`as Owner Of the'property, am exclusively Contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �� > ! , _ licensed contractors t0 Construct the project (Section 7044, . 2, 3 Business and Professions'Code.) YES El No❑ n`Qp�- - TOTAL ,moi WILL THE INTENDED'USE OF THE BUMUNG By THE APID-I OR FUTURE BUILDING CHECK CE '/ A t+ - ( i� OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - `-L1-4f'- 1 -- YCONSTRUCTION LENDING` AGENCY COAST AIR.OUALITY MANAGEMENT DISTRICT($CAOMDI SEE PERMITTING CHECKLIST FOR. 1 .GUIDELINES _ A - 1-.IJfIYfCL ).iI_I I hereby affirm that there is a construction lending agency for "VES❑ NO❑ + the performance of the work for which'this permit is issued(Sea A - I HAVE READTHE HAZARDOUS MATERIALSINFORNVTION GUIDEAND THE SCAOMD PERMITTING' ' 3097,CN.C.) _ CHECKLIST I UNDERSTAND MY RECUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, • nr -1 D` TITLE 2,CHAPTER'2.20 SECTIONS 2.20,100 THROUGH 2.20.140 CONCERNING HAZARDOUS. IJ�I!1I-I��I)11 �,� V -: LBndar S,NamE MATERIALS REPORTING AND FOR OBTAINING APERMIT FROM THE SCAOMD. - . . ' 'ills t 1 'n��7 iL o•• Lender's Adtlress 1 -� .0 - avneR oa AM.n _ o I cehify-that I have read this application and state under penalty - 'q of perjury that'the-above information is correct.I agree to comply 4- PC.FEE PERMIT FEE - - -� - with-all-county ordinances-and State laws.,relating to=building IX C005[TUCfiOq.and hefeby authorize representatives 0(.Ih15 County -- ISSUANCE FEE m to nter u on the above-mentioned property for mspecti purposes. �(p A%L� A- � ,�a,`v,�\ ' g•, �' ,t v w• �. .vI�—,�6- �S. INVESTIGATION FEE TOTAL FEE _ Y I _ ♦ T 1 ' ' � SEE REVERSE FOR EXPLANATORY LANGUAGE, - -