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HomeMy Public PortalAbout9306 BROADWAY_Building__ >e saA=en�„o-ea. APPLICATION FOR. BUILDING PERMIT' COUNTY OF LOS ANGELES BUILDING'61.7: C ? DEPARTMENT OF COUNTY ENGINEER= ` ADDRESS ., Cat BUILDING AND SAFETY DIVISION I LOCALITY JOHN A. LAMBIE, COUNTY ENGINEERNEAREST j CASSATT D. GRIFFIN, SUPT OF'BQILOINa CROSS ST. IC�iotiGr.�-�bL.• DISTRICT ANO. OUP TYPE PR ESBED BY FOR APPLICANT TO FELL IN v` CONST. BUILDING 'I - STATI STICAL CLASSIFICATION S�EfWER MAP ADDRESS i7QLJ CLASS.,N99O�9l ELL.UNITS O' I VABK ..3_ LOT NO.. .3. O BLOCK NUMA”ER�(J IT 'STyA�TTE Y. YES NO TRACT /�•% - I USEZONE SPECIAL SIZE OF LOT .NO.OF.BLDGS RA CONDITIONS NOW ON LOT USE OF EXISTING SLOG. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH OWNER FRONT. MAIL - P.L. ADDRESS - SIDECITY Y4 - No ARCHITECT O 1 INSPECTION RECORD TEL. . ARC ENGINEER NO. 2- -60 — /bO /�j},% ADDRESS 'l YY7 TEL. CONTRACTO NO n �� r •" ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH / _ SQ.FT. NO.OF NO.OF S Z7�60 GLf�)/ AG 'TAlAv/J' SIZE STOR 5 AMILIES USE OF 07• STRUCTURE _ SIGNATURE OF /�� APPLICANT j`.• ��p APPROVALS�d/EfZ.DATE INSPECTOR'S SIGNRTURE ADDRESS �O©lo 'v " S�IU.VU.Y-J FOUNDATION: LOCATION' ry /O AA�J� FORMS.MATERIALS , f) !• VALUATIONS S �T� FRAME: FIRE STOPS. -BRACING,BOLTS F .( r URNACE:LOCATION. FEE. FEES I GAS VENT.DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH.INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY.WITH ALL COUNTY ORDINANCES AND. - STATE LAWS REG LATING BU/ILD'`ING CONSTRUCTION. -LATH.EXT. "•-SIGNATURE OF \ 1/ � HOUSE NUMBER COR- PERMITTEE J �� lJG�( _eo RECTANDPOSTED ' (y / ADDRESS FINAL CLYDE N.'DIRLAM. PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION. g!5:;) M.o. CASH PERMIT VALIDATION CK. , M.O. CASH t ao56 'KAR22 2 ,31 A 3 .75 L,�Co a 0 5 7 HAR 2 2 . 1 A 1'5.00 '. WORKERS'COMPENSATION DECLARATION �pJ p p (gip 2n h ,by affirm that I have r certificate of consent to self /py �o O G� Ir� LS� J'SI sure, or a certificate of Workers'Compensation Insurance, 'sure, or a certificate of Workers'Compensation Insurance, 1Il 11 r a certified copy thereof (Sec. 3803 Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Cc2Q-41(a;- 327 Argonaut Ins_. - ❑ Certified 'copy is hereby furnished. - FOR APPLICANT TOFILLIN BUILDINGADDRESS � . V.� y`Ot9 61/0- ® Certified copy is filed with the county building inspec- ' BUILDING yycc tion department. ADDRESS 9306 B.r oa dway LocquTv 11-1-8 nd01 Roof in NEAREST Date a prc ra $ ary Tem .1 e. Cit P 9.1 7 8 0. ceoss ST. 'CERTIFICATE OF EXEMPTION,FROM WORKERS' _ NO. OF BLDGS. - - 'ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one - USE ZONE MAP ��0 ..hundred dollars ($100)o1 less.) TRACT BLOCK LOT No. NO. TEL SPECIAL - 'I certify that in.the performance of the work for which this OWNER Chuck Fastlhen NO. 28 CONDITIONS 6 DISTRICT GROUP ITYPE FIREPROCESSED BY O permit.is issued, I shall not employ any person in any mannerADDRESS .9 3 Q�1 'Ar O a d W a , CONST. ZONE - U so as to become subject to the Workers'Compensation Laws. CITY .Tem le Ci.t zip 9178(lb � O Date Applicant - STATISTICAL CLASSIFICATION - APT. CONDO. H NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. w "Exemption, .you should become subject to the Workers' ENGINEER NO. CLASS NO. _7 I DWELL. UNITS_ - a Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall,be ? deemed revoked. . BK PG !�3 VALIDATION coNTRAaoRRan8o1 Roofin TELNo. 2884040 LICENSED CONTRACTORS DECLARATION •' C. ' I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 5 2 9L E. _ V a 1 l e. - LINO. VALUATION (commencing with Section 7000)of Division 3 of the Business and - LIC Professions Code, and'my license is in full.force and effect CITY an Qabriel CLASS Cc39' $ 830 . 0.0 186386 .0c32 SQ F NO OF NO.OF CHECK License Number 'Lic.Class SIZE STORIES FAMILIES ONE Contractor Ran Lid 1 Roofin&ate, 10.-17c83 DESCRIPTION OF WORK Tide. re-pair on NEW ❑ $ A ADD ❑ am exempt under Sec houae. ❑ a - ALTER ❑ FINAL r� �f •+!.z /T o1 �,at�,_ B.BP.C. for this reason © DATE 7T�` REPAIR USE OF DEMOL Date: EXISTING BLDG. t E] By AL Signature APPLICANT - TEL -OWNER-BUILDER DECLARATION PRINTg2pdo] No. 2884040 I hereby affirm that I am exempt from the Contractor's License D - - - Low for,the following reason (Section 7031.5, Business and - ADDRESS 529_ R Valley- 2 o.o 6 Q60 Professions Code): PRESENT - - ❑ BUILDING , I, as owner of the,property, ormy employees with ADDRESS wages as their sole compensation,will do the work and. -4 ' ' - the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ' ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO, with licensed contractors to construct the project.(Sec- ADDRESS tion 7044, Business.and Professions Code). - 'o o-o 4 Q�0 REQUIRED TOTAL SETBACK FROM EXIST. 'I ,QZ h'S'J - CONSTRUCTION LENDING AGENCY' SET BACK YARD HWv PROP. LINE WIDTH I hereby*affirm that there_ is a construction lending agency for FRONT the performance of the work for which this permit is.issued P.I. (Sec. 3097, Civ. C.). SIDE t P.L. Lender's Name Lender's Address P.C. Fee$ Permit Fee - � - I certify that I have read this application and state that the - Issuance Fee 1 - above information Is correct.I agree to comply.with.all County In eitigmwn Fee - ' ordinances and State,laws-relatingto building construction, ...4'0'. 5 Q' - and hereby authorize representatives of this.Count o enter Total Fee upon abovve-mentio d r err br inspe rp�oys'es. SEE REVERSE FOR EXPLANATORY LANGUAGE .. ®s - Signature of Applicant or Agent Date • -