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Home My Public Portal About9162 BROADWAY_Building__ I 1 I 76A638A CENS03 8-63 APPLICATION FOR BUILDING PERM, COUNTY OF LOS ANGELES BUILDING / DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SVP'T OF BUILDING CROSS ST. TRICT {y0. GR P' TYPE . C OC SE BY FOR APPLICANT TO FILL IN U CONST. BUILDINGq,/,,1 � �✓�/ TI II/A ' STATISTICAL CLA SIFICATION SEWER MAP .ADDRESS /` 14(/ Y{'/I BK PG� p //�J CLASS. NO. DWELL. UNITS LOT NO. / 0"A AINIV BLOCK WATER NOT REQUIRED ❑ RECEIVED CERTIFICATE: TRACT MAP O 17 H1 GRCYLe) STATE_MAJOR SEGO .LOCAL SIZE OF LOT Q/(4.�7 Q NOW ON LOTS / {� USE OF I/y Z CONDITIONS. EXISTING BLDG. /I J(� p pt, I` OV /ILII 1N JON TEL. C OWNER y r ) a IS BUILDING EX T. ADDRESS / / O LC /C�/1 LY SETBACK YARD HWY STREET NAME WIDTH FRONT _120 1 ARCHITECT OR c- O AA� �- i1OM/�O. - 'SIDE"- -EL_ (/ ENGINEER ` ��6/YA'�'/ Yui/ v ADDRESS 9 CONTRACTOR A/'/'!' �1UA+Cn/ ADDRESS DESCRIPTION OF WORK a NEW ADD ALTER REPAIR.� ,DEMOLISH � ', Z SO. FT. 91 /o NO.OF J NO. OF SIZE / �(� STORIES / FAMILIES / �y USE OF / //v 4 UCp� STRTURE u� `� SIGNATURE OF APPLICANT n/ VALUATION 5 V �A �� APPROVALS 2 )DATE INSPECTOR'S �SIGNATURE L� NDAT FEE $ FEE S FO FORMSI, MATERIALSON FRAME: FIRE STOPS HEREBY THAT THE THAT HAVE READ THIS.ATO CO TION BRACING, BOLTS AND STATE CAC N OON THE ABOVE IS CORRECT TE AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY TI.N. INCER AND STATE LAWS REG,EATING GAS VENT. DUCTS BUILDING CONSTRUCTION. CERTIFY THAT IN PORNO THE WORK AUTHVIOLA- TION THE HEREBY WILL NOT EMPLOY ANY PERSON IN RELkT. LATH. INT. TION OF THE LABOR COPE OF THE 5 ATE OF IFORNIA flELAT. ING TO WORKMEN'S COMP NSATION SURAN LATH, EXT,SIGNATURE PERM TTEE OF L�C.0 v HOUSE NUMBER RECT R- AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION cK. M.G. CASH PERMIT VALIDATION CK M.D. CASH i - - Ia p (01 5 8 6Z JUL21 1 D 36,00- v c C En803 B-63APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING 9lZ r ^tea ` i DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST x WILLIAM A. JENSEN. SUPT OF BUILDING CROSS STz� DISTRICT NO. I GROUP TYPE P ESSBY FOR APPLICANT TO FILL IN ZS L CONST.i/ BUILDING _ ��II// STATISTICAL C SSIFICATION SEWER MAP ADDRESS I O N� -- AlBK_ JJ CLASS. NO. DWELL. UNITS I LOT NO. /l�1` _ 3 BLOCK WATER CERTIF TE: NOT REQUIRED RECEIVED 1:1TRACT .7 MAP NO. / HIGHWAY EI STATE MAJOR SECON LOCAL / SIZE OF LOT sNO. OF BLDGS.O 'T NOW ON LOT USE ZONE SPECIAL USE OF y A CONDITIONS EXISTING BLDG. IL _ / 17/y OWNER ��/� y 6 /1NO. )� BUILDING EXIST. ADDRESS /(p / (?CJ/� [SLI SFRONTK YARD HWY STREET NAME WIDTH ARCHITECT OR i - TEL.- P. L. ENGINEER NO. SIDE -- - --- - - P. L. ADDRESS d TEL. O CONTRACTOR NO. V ADDRESS O DESCRIPTION OF WORK �. W a• NEW ADD ALTER REPAIR EMOLISH N SQ. FT. NO.OF N ? SIZE STORIES FAMILIES USE OF STRUCTURE G•LG-P '�"A--• 1 SIGNATURE OF� � C � APPLICANT VALUATION $ APPROVALS DATE` INSPECTOR'S'21 NATURE P.C. PMT.$ .hV`� - FO ON FEE FEE FORMS. MATERIALSI 1 t $ FRAME: FIRE STOPS. 1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS wTO COMPLY _ BRACING. BOLTS 1 AND STATE THAT THE ABOVE IS CORRECT ANO AGREE E COMPLY FURNACE: LOCATION. WITH ALL CO UNTYCONSTRU ORDINANCES CES ANO STATE LAWS REGULATING GAS VENT. DUCTS BUILDING AUTHORIZEDHEREBY CI W. CERTIFY THAT IN DOING TME WORK TIONFTH HEREBY WILL NOT EMPLOY ANY PERSON IN VIOUA-RELAT. LATH. INT. TION OF THE LABOR COPE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'SCOMPENSATION INSVfl4 E. I ,I � LATH. EXT. SIGNATURE OF �� ✓ /]J 2 ` HOUSE NUMBER COR- PERMITTEE sCu� C L� �'U� RECT AND POSTED ADDRESS 1/ FINAL �� ,J�/�{ --py .yi JOHN F. LEWIS. PRINCIPAL IST R CTURAL ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK M.G. GASH L1tu0 2 4 3 6Z AUG 11 1 D 4.00- v I WORKERS' COMPENSAJCN DECLARATION I�,��,( �FI��1p�'(/�m gyp} �� I-here Dy affirm that I have a certificate of consent to self _ /O\ Ir P II �1( /c.1\��O 11 V Il -O R U U��11 V V P Lei RU V U�T ."insure, w a certificate of Workers' Compensation Insurance, 9-11 U_ LS "VV--//-11 •p, certified dopy thereof (Sec: 3800, Lab. C.) -„ -,. . . COUNTY OF LOS ANGELES BUILDING AND SAFETY . . Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN aooeeSS C. ❑ Certified copy is filed with the`county building inspec- BUILDwG - lion department: .. ADDRESS r�, /• // J/�_ �•.\ Date Applicant CITY' C ZIP LOCALITY NO. OF BLDGS. NEAREST _ CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ONLOTCROSS ST. - COMPENSATION INSURANCE ASSESSOR - (This section need not be'completed,if the permit is for one TRACT'- BLOCK LOT NO' MAP'BOOK PAGE I PARCEL hundred dollars ($100) or less.) : /� p TEL. ) ` OWNER GDONCT- S, •S NO,(&Jp/+f'LP60&,Lc US ON - MAP ' I certify thar-in the performance of the work for which this SPE permit is issued; I shall not employ any person in any manner ADDRESS /d� SPECIAL - d CONDITIONS so as to be<ome,subject to the Workers Compensation taws. r - - � CITY ZIP Date Applicant - ARCHITECT OR TEL./' DISTRICT GROUP TYPE FIRE ROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER Y! .NOI�1� 51O*� N y`� ` ^ CON .5�/� ZONE Exemption, you should become-subject to the Workers' VL/ti, r�/1 U J{ IJ ./�f`_- U Compensation-provisions.of the Lobor,Code, you must forth- ADDRESS / 1 f /c/ (// Jr� w D_ with comply with such provisions•or-this permit'sholl be r TEL. STATISTICAL CLASSIFICATION APT CONDO. N deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION UC CLASS NO. DWELL. UNITS_ I hereby affirm that I am licensed under provisions of.Chapter9 ADDRESS NO. - (commencing with Section 7000)of.Division 3 of the Business LIC. SEWE P and Professions Code,and my license is in full force and effect. CITY - CLASS BK VALIDATION ' SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE. STORIES FAMII r ONE VALUATION Contractor Date DESCRIPTION OF WORK 1rQ S d /0 , NEW El . • JU S R'enw .ADD' - ❑ Ell am exempt under Sec. D • ALTER ❑ - - B,BP.C. for this reason REPAIR ❑ $ Date: USE OF _ - EXISTING BLDG. '�S/DG� DFMOL ❑ "Signature-` -..— _ __`__- :-,- - APPUCANNTT - TEOL.�y./S ., ._.FINAL - (PR OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS IL • 9/✓ L�VC (, Low for'the following reason (Section_7031.5, Business and FINAL 1 Prof sions Code): - - PRESENT _ _. By I as owner of the property, or my employees with qD RESS /F'..? �5. : .ACCT.A wages as their sole compensation;will do the work and - - x ;507 the structure is not intended or offered for sale(Section LOCALITY D 7 j j•' 7044, Business and Professions Code.) - MOVING TEL 1 ITEM' ❑ 1, as owner of the property, am exclusively contracting - CONTRACTOR NO. y with licensed contractors to construct the project (Sec- '- ADDRESS ' .'(. TOTAL 7 1$ . 6'- tion 7044, Business and Professions Code.) .,! , - .REQUIREDTOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWV pROP. LINE WIDTH s - I hereby affirm that there is a construction lending agency for- - FRONTC:HANGE ' the performance of the work for which this permit is issued 'P.r. . . (Sec. 3097, Civ. C.).- SIDE ` - - Pa'' - 0000-0001 Lender's Name � - t r i1/L 9 9/8 C $ tDNA Ref. N P.C. Fee$ Permit Fee'M S rD Lender's Address - - .' 6116 1 AM,9.0t 0 I certify that I have read this application and state that the Issuance fee � i LDMA P/C k 8 above information is correct. I agree to comply with all County- Investigation Fee R ordinances and State lows relating to building construction, Total Fee a It LDMA Perm. It a ond'hereby authorize representatives of-this County to enter upon the above-mentioned property for-inspe ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - Signature of Appl" nt or' gent Date WORKERS"COMPENSATION DECLARATION - - -- �� -4 - ' - -�� - I hereby affirm that I hove.a certificote of consent�to self //(]�� IT�� p insure or a certificate of Workers' Compensation Insurance, •_!lull Pd`9C� T:90o•f l FOR [ MOdD9I�lC� � PERMIT 19T •or`a certified copy thereof (Sec 3800,'Lab C:') COUNTY OF LOS ANGELES BUILDING AND SAFETY Pol;cy No. - Company. .•�pJl� Certified copy Whereby furnished. FOR APPLICANT TO FILL IN BUILDING 9 ❑ , - - .- ADDRESS / 'Certifie'd copy is filedIw, the county building inspec- . BUILDING tioMdepartment. s'�� ADDRESS - - DatApplicant �� CITY C� ZIP LOCALITY - - - - - C CERTIFICATE O EXEMPTIO FRO ORKERS' NO. OF BLDGS. - - - ' NEAREST s •• ' iCOMPENSATION INSURANCE -.• ' SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed•if the'permit is for one - - _ - - -- --- ASSESSOR. - hundred dollars ($100)or less.) ;t. . TRACT BLOCK LOT NO. MAP BOOKc' aF PAGE PARCEL - _ TEL. USE ZONE MAP I - y certify that•Ln,the performaw nceaf the for hich•tOWNER NO.his NO. permit is issued, I shallnot employ any person m any manner _ / SPECIAL- - - - - - - - - - d so as to become sublect totheWorkers'Compensation Laws. ADDRESS �-Z G - i/ CONDITIONS V Date 6 Applicant ' ' CITY . - 64 ZIP __ _ _ r � ARCHITECT OR TEL. - - O NOTICE'TO APPLICANT: If; after making this Certificate of _DISTRICT _GROUP. TYPE_ _ FIRE_ _ PROCESSED,BY - G ENGINEER - NO. Ekemption,,you`•should become subject to, the Workers" '- CONST.• ZONE Compensation provisions of.the Labor Code, you must forth- - with comply !with.such,provisions or.,this permit shall be ADDRESS � �- ._ �}.,. N deemed revoked.. ,. a •` CONTRACTOR` No - STATISTICAL CLASSIFICATION APT. CONDO. ' Z - - - _LICENSED CONTRACTORS DECLARATION;-- r LIC.LIC. - CLASS NO.�L—DwEU'UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS._ _ l t NO. (commencing with Section 7000)of Division 3 of the Business and LIC - _ SEWER MAP -- Professions Code, and my license is in full force and effect. - CITY _ CLASS - _ /�� /]�Jj /� SO. FT. NO.OF _ _ - NO. OF _ CHECK BK. PG. VALIDATION" - s//tr-('S✓('E4/ 'JJ SIZE �� STORIES FAMILIES ONE 'L License Number Lic Class ` /- , I I n' ' NEW ALUATION _ Contractor / '�JL%� (.�yJi •Date Ci?'J-C�7-CJT DESCRIPTION OF WORK- �y�` ADD ❑ I• `.JO(./�a D F-1I am exempt under Sec. - '- ALTER B.BP.C. for Ihis reason - .REPAIR .❑ -$ - _ USE OV - Date' EXISTING BLDG. DEMOL ❑ - Signature _ APPLICANT ! ' TEL. OWNER BUILDER DECLARATION -(PRINT) FINAL f" V NO. -OS• .. DATE -1 hereby ATE-.•Thereby affirm that Iam exempt from the Contractor's License Low for the following reason (Section 7031 5, Business and ADDRESS C7QY' FINAL `Professions Code): - - '•""' '- -' PRESENT By - - - F-1BUILDING ♦ G O, Q- 1'• I, as owner of the property, or my employees with ADDRESS _ _ _ _ _ T -) ' wages as their sole compensation,will do the work and . ' the structure is not intended or offered for sale(Section Ct LOCALITYD '- 7044, Business and Professions Code). MOVING- ""- _ TEC.' ..❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. (7{l - 1 8. 3 5_ A with licensed contractors to construct the project (Sec- ADDRESS _ j tion 7044, Business and Professions Code). _ r m o o n REQUIRED. TOTAL SETBACK F r _ ..,I CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. LINE - WIDTH - - - - fhereby affirm That there is a construction lending agency for FRONT - 2 n-.`4, I16 j the-performance-of-the work for-which this permit is-issued -PL: _ (Sec. 3097, Civ:C:). SIDE m - - . .. -. __ _ P.L. _ Lender's Name �'0;C C 0-01- LDMA Ref. # Lender's Address P.C. Fee$ '- '- - Permit Fee - 1 - - - - - ..I certify.that 1 have:read this application.and state that the -_ - Issuance Fee -- LDMA-P/C -- a above information is correct. I agree to comply with all County Investigation Fee $ ordinances and State laws relating to building construction, - _ _ - Total Fee z LDMA Perm-# - - - -- •^' d and hereby authorize representatives of this County to enter upon the above-menti ned propert. for inspection purposes. - t a ! ---- SEE REVERSE FOR EXPLANATORY LANGUAGE Si a ore of'Apyt rant or Agent