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HomeMy Public PortalAbout9200 BROADWAY_Building__ 76A638A CE4803 B-64 APPLICATION FOR-BUIL �P DIN P RMI COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEERADDRESSiLCYstsLjtt z BUILDING AND SAFETY DIVISION LOCA LITQ:za_� �. JOHN A. LAMSIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. - - DISTBLCT p4P1^ < GRO TYPE - R S FOR APPLICANT TO-FILL IN- JL q 6 CONS. BUILDING 9200 East Broadway, Tem le Cit' STATISTICAL ASSIFICATION SEWER MAP ADDRESS P CLASS NO, _OW ELL UNITS ._BK' PG LOT N . -BLOCK USE ZONE MAP.�J O NO, b TRACT 1', I SPECIAL ,. -NO: OF BLOG9. CONDITIONS SIZE OF LOT' NOW ON LOT USE OF 14G BLDG, BLDG. SETBACK FROM �< l� /�s TEL. FRONT PROP. LINE OF ✓ : ET) OWNER Mrs. Rose HOUde NO, TYPE OF I D%ISTI NG'. SETBACK HIGHWAY YARD TO ADDRESS 9200, E. B roadwayHIGHWAY 'F -9M c.L. CITY Temnle CityBLDG. BET BACK FROM . ARCHITECT OR .TEL. ENGINEER N0: SIDE PROP. LINE OI (STREET) TYPE OF ES19T1 N0 SETBACK I HIGHWAY } YARD C: TOTAL r ADDRESS HIGHWAY WIDTH FROM C.L. - CL CONTRACR id A'if TOL. 263-5181 + 0 ADDRESS 337 S. {'foods Ave. NO 159496 � CORNER CUTOFF YES � NO E] O Y Los Angeles cLlLCA,F 39SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK. Z NEW ADD ALTER REPAIR% DEMOLISH -SQ.FT. NO. OF NO. OF SIZE STORIES FAMILIES - - - USE OP. STRUCTURE �'eroof house arae SIGNATURE.OF APPLICANT - - VALUATION$ 600.00 APPROVALS DATE INSP ECTOR'9 SIG NATURE P.C - pMT FOUNDATION, LOCATION FEE FEE S$ �00 FORMS, MATERIALS - FRAME, FIRE STOPS, - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE,TO COMPLY FURNACE ,LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILUC DING CONSTRUTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN-VIOLA. LATH. INT. TION OF THE 4,A5OR COD OF THE STATE OF CALIFORNIA RELAT. INC TO`,'L2$I,MEN'SC MP 4 10 IN54RAN F,) LATH EXT. r' V S UR F - l USE NUMBER COR- PERMIN2 REC AND POSTED ADO RE'S NAL 00, PLAN CHECK VALIDATION CK. Mo. 2N1 t� ' JOHN.F. LEWIS. PRINCIPAL STo. URAL ENGINEER PERMIT VALIDATION cK. M.G. CASH ._ a> ,. Lnto:6 7 5.7JA.N17 1 D 6.00 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY �������� COUNTY OF LOS ANGELES WIA. J. FOX, CHIEF ENGINEER NO, OF BLDG. ORD.NO. DIST NO. PLAN CK. NO. PERMIT NOS\ PLANS SETBACK LINE FIRE APPROVED 777 ZONE BY DATE REggiVrO BY/I OAT OF PPL. OATE•ISSUED USE k APPROVED �,L,F„ l/ rl-�T ,//Y/e ]_ONE BY DATE QLW�ifV` �J / 9 APPLICANT FILL IN HEAVILY OU'T'LINED PORTION/ ONLY . K NAME O C NAE ADDRESS ! � :� ` l//T W Z ADDRESS LOCALITY d- �^" � \j I Z NEAREST �-� �•'J A i UW CITY CROSS 5T. ypp��',�{A/r(�/� 1 n It NO. K NAME < STATE / TEL. r LICENSE NO. W KY MAIL �J D NAME ; AD DR F O < ADDcv RESS CITY NIL K Z CITY I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS U APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE/N�/JO. NO. /y� / AND STATE LAWS REGULATING BUILDING�CONSTRUCTION. O LOT NO./C/f , l SIZE OF LOT!/ ��J� SIGOWNERE OF �/ /C'! �.r's�✓� JF NO. OF BLDGS. <1 BLOCKNOW ON LOT AUTHORIZED AGT. Op y i 'W TRACT 6C, VV) Afl C #4 FRS" / / CORRECTIONS D USE OF SLOGS. / NOW ON LOT /�/�� -���^^�•© y/ � DESCRIPTION OF WORK. USE OF BUILDING ` / �7T141•✓tL..✓� '/G/O L/A/ / (r/.�li:t' PLOC Pe5-ro NNEr_-r Y rr,gi r. MsirFN --?rpr: /R},nr'Rr,) PMT (.ASA af••� /.s trR-'�' !V 5 F_b s D . A 2 D r NEW TYPE GROUP NO. OF NO. OF ALTERATION ROOMS FAMILIES ADDITION SIZE REPAIR STORIES MOVING WALL COVERING DEMOLISH I ROOF COVERING s ® � P. C.s FINAL APPROVAL j -J / ) FEE (J S62 ,rU INSPECTOR'S VALUATION FEE DATE ^I � �- 1) �(�� I NAME �Alq YY1 Ern MW T" ARTMENT OF BUILD&NG AND SAFET' _N'APPLICATION FOR PERMIT COUNTY OF LOS ANGELES` n ' � 11 L� © N�n .♦ WM. J. FOX, CHIEF ENGINEERII' -,: u LLLVVV s FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY •'� BUILDING (�// n - //-- l DISTRICT NO. PLAN CK. NO. ,,PERMIT NO. ADDRESS .LOCALITY / /�/�j 4/-. ( -/�/ ��- / RECEIVED Y DATE OF APPL. DATE ISSUED NEAREST/ �/N/ � 'CR05S 9T. o ✓11, F.'�C��'K .BUILDING OWNER /%/�Y"rAIL /J,RS� ��//��''' I, '1 ADDRESS ,} ^ ADDRE39./r�9Ut� fes-. (y(J�UAL WA-Y/J/'�/ LOCALITY NEAR CITY ' / G/yR�/' t..// /�IL ,,N0.� 17/2/0�/ ,�� .CRO355ST.' Cie FIRE OF' NO. TYPE �/ GROUP "may ARCHITECT OR, TEL. ZONE `�"�'I-PLAN9�` I 1 ' ENGINEER ryp; � / BLDG. ORD. NO. v / ADDRESS / - - SETBACK LINE TEL APPROVED _CONTRACTOR AJ NO: BY DATE USEAPPROVED ADDRESS - ZONE /. BY DATE LEGAL CORRECTIONS DESCRIPTLION�`�- �AtI L,(O,T� NO: ^aJ'' 'BLOCK �� /J� /f--•. F TRACT /. -(lV{pp. // � f'777'I'//'- F. _ ;pf-c w A". -C' T.�I" '.fi V�I/h.S ��F/� ✓b 07, "X 1?'./ !'•I NOW ON LOTS SIZE Or'LOT S2. y� USE OF• NO.OF NO. pF /\ EXISTING BLDG. y IFAm1LIEn I ROOMSI.� DESCRIPTION OF WORK NEW j ALTERATION ADDITION - '0 REPAIR I MOVING DEMOLISH�J, - ,G SQ. FT. N / - O.GIF 2 SIZE ROOMS STORIES r WALL �y. 2DOF �QnP - ... COVER I NGp>,/ /f('_LD S �L fC OV.R I Nay, 'y-E RII;,f4E( - O USE OF NEW '��/AR I< USEBUILDING IY'VV' �S NtA/-1 C�Ov/f//=r�.c7`��ry✓) ,per /9A.l'i A o�� Awl Fa;e THLr Ra N, a- APPROVALS, JAeClIVtbCD ;A1 I HEREBY ACKNOWLEDGI A E THAT I HAVE READ.THI9 . APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATIDN: LOCATION, 9P OR DATE FORMS, MATERIALS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, U GIGNATU RE OF /]�/n BRACING, BOLTS , OWNER //v �//.,(✓' ,CATH, INT.: AUTHORIZED AST- /.✓d/,i,5 -. - LATH, EXT.: ` h J P.C. S PLASTER, INT. ' FEE �/Ec- PLASTER, EXT. .- VALUATION T FEEty FINAL � ',nas JJORKERS'COMPENSATION DECLARATION I-� rte. gr' /� �fE��Lp� {per I���sAp LB�pIp��..r PER I��yr��ryL g��L� �tfirm that have a certificate of consent to self /r'1 f}vlyr��'[ /(���®U V ®Ltd ✓�OL®O11 W W/' 0 ��C 1101100�T LJ into.e, ora certificate of Workers' Compensation Insurance, A ll C!/-V EC or a Yertified copy thereof (Sec. 3800, Lab. C.) - . els COUNTY OF LOS ANGELES BUILDING'AND SAFETY Policy No. Company. ^ — e _ Crtified copy Is hereby furnished. - - FOR.APPLICANTTO-FILL IN BUILDING - ADDRESS OQ. F-1Certified copy is filed with the county building'inspec- BUILDING - - - - tion department. " ADDRESS +. Dote Applicant CITYL' ZIP �OO LOCALITY 'CERTIFICATE OF EXEMPTION FRO ' OR R _ / NO. OF BLDGS J NEAREST - _ - COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT / CROSS ST (This section need not be completed if the permit is for one TRACT BLOCK LOT NO.' l2 ASSESSOR ; hundred dollars ($100)or.less.) . MAP BOOK - - PAG PARCEL TEL. USE ZONE MAP OWNER I certify that in'the performance of the work for which this Gx0 x"3'6 SNn PE permit is issued, I shall not employ any person in any manner, ��1�5���. v SPECIAL. 0 so as to become'subject to the Workers'.Compensation Laws. ADDRESS CONDITIONS . . CITU fid ... _. V Data ' � Applicant � � - �'G' ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR - TEL. DISTRICT. GAO UP TYPE FIRE PRO ED By O Exemption; you should become subject'to the Workers' -- ENGINEER NO. ' `/ /f J\� CONST. i Z W Compensation provisions of the'Labor Code, you must forth- ADDRESS with comply with ,such provisions or this ,permit shall_be .. O..' deemed revoked. t TEL. STATISTICAL CLASSIFICATION -APT. NDO. cn CONTRACTOR NO, Z LICENSED CONTRACTORS DECLARATION LIC,7 GS `Y CLASS NO. 17//DWELL. UNITS_ I hereby affirm that I am licensed under,provisions of Chapter V ADDRESS NO. ( SEWER MAP (commencing with Section 7000)of Division 3 of this Business grid LIC - Professions Code, and my license is in full force and effect. CITY CLA55I BK - - VALIDATION' - SO. FT. O.OF NO.OF CHECK - License Number Lic.Class" SIZE z� STORIES - " FAMILIES ONE VALIJATI - Contractor Date - DESCRIPTION OF WORK NEW ' $ 6 -f� ADD - ❑ 1 am exempt under Sec. ALTER ❑ D .�0889A B.BP.C. for this reason - ,. , .� REPAIR. ❑.. $ - ` '# • e-e a 23 USE _ Date: _ - - EXISTING BLDG. - DEMOL ❑Q ( • G 73.3.Z Signature ' - - APPLICANT - 'TEL. - FINAL PRINT �O N0. 6i„/�Er.J� 2 V OWNER-BUILDER DECLARATION -0ATE - '• a -7-3.3 Ihereby affirm that I am exempt from the Contractor's License' �'/j2„�r ' + ADDRESS Law for the following reason (Section.7031.5, Business and �"- FINAL � ' Professions Code):. , - • .. - - By t ( Q1 f1 —88 ❑ BUILDING r . I, as owner of the property, or my employees with ADDRESS y„ t wages adtheiPsole comperisdtion,will do the work and •� t •-;' 1. 1 the structure isnot intended or offered for sole(Section LOCALITY D l .7044, Business and Professions Code) --.. - MOVING TEL 'S I, os owner of the property, am exclusively contracting CONTRACTOR NO. 7� with licensed contractors to construct,the project (Sec- tion 7044„Business and Professions Code).[. TOTAL SETBACK "CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH g 1 3 3.,0 A ' I hereby off irm that there is a construction iendiag agency for FRONT - ♦ • • e 0�1 the.performance of-the work for which this permit is issued P.L- .- . (Sec 3097, Civ._C.). _ SIDE • I �•'•9 6 7 5” P.L. . . .`91x756 Lender's Name LDMA Ref. M o m „ -te P.C. Fee ✓ 2, Permitfee ( 2 1 5=88" Lender's Address - - - I , I certify that 1 have read this,application andstate that the - Issuance Fee .. �(/ -tDNA P/C M - above informationis correct.I�ogree.to comply with all,County Investigation Fee ordinances and State.lowsirelatmg to�building Construction, Total Fee LDMA Perm. B and here authorize representatives of this County to enter uPon the ab ve-mentioned prcpert r mspe i n'purpos S. �•+ _ ���!?O SEE REVERSE FOR EXPLANATORY LANGUAGE Signet f App' ant o 9