Loading...
HomeMy Public PortalAbout9443 BROADWAY_Building__ r br 76A630A CEA603 3-83 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALIT JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. pIST CT N I GR TYPE P E Y FOR APPLICANT TO FILL IN CON T: BUILDING STATISTICAL CL IFICATION _ S��ENWW�ER MAP ADDRESS CLASS. NO. DWELL. UNITS _j/K' LOT NO.' 0{^'t(O BLOCK WATER NOT REQUIRED RECEIVED ❑ CERTIFIC TRACT }' �.� MAP ATE: HIGHWAY (� NO. OF BL GS. NO. Q ICINCLEI STATE MAJOR SECOND. CAL SIZE OF LOT (,ff d NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. eS / —/—� TEL. / OWNER (, p F NO L' 1,1-f I IRI ING - EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS 17 00 Dh FRONT / ARCHITECT OR TEL.I . L. ENGINEER NO. SIDE R L ADDRESS r 6 TEL. e — 0 CONTRACTOR [ O �E®L. NO. 1/� J� '// �` C 'i//-�' V ADDRESS OU S7-11 A q x P, DESCRIPTION OF WORK _ W CL /N E ADD ALTER REPAIR DEMOLISH _ N Q. FT. NO. OF NO. OF ? SIZE STORIES FAMILIES USEV STRUCTURE RETUC� ,JI,,y�.- L/ SIGNATURE OF A" l / l— /�><.GCP - / APPLICANT VALUATION S �J APPROVALS DATE INSPECTOR'S SIGNATUREFFEE $ U �J FO FORMS• MATERIALSON l0 m 7/xYP/w�� P MT.� / FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THIV 1 HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS �r-"�'_�_ BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN vloLa� LATH. INT. / / \ /_. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- \' ING TO WORKMEN'S<OMPENS N INSURANCE. LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS 4C) FINAL IT(?��� /fjyfJ//� JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG. R PLAN CHECK VALIDATION <K. M.D. CASH PERMIT VALIDATION CK. M.D. CASH LrILo 6 3 6 9 DEC 1 1 D 3.00- TEMPLE-CITY aA E=ao3=-63 APPLICATION FOR BUILDING PERMIT LI COUNTY OF LOS ANGELES BU'LD N 9 J ti DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY I c JOHN A. LAMBIE. COUNTY ENGINEER NEAREST _ WILLIAM A. JENSEN, SUPT OF BUILOw GCROSS ST. DLS�TRICT N UP TYPE P(2 Ejd' W BV • t FOR APPLICANT TO FILL IN 1.0 . (' TYPE -� BU I LD I NG 41 Lt }h A STATISTICAL CLA/S�5/1 B{�ATION S WER MAP ADDRESS ( -f VIC-U j lX w L c X BK_ CLASS. NO._L.1—DWELL. UNITS . LOT NO 6 BLOCK WATER NOT REQUIRED 1�C RECEIVED ' CERTIFICATE: LLJJJ�� TRACT CW Qh E' DA /10� O MAP '�77 //{{ HIGHWAY NO.OF BLDGS. NO�/� L/ lawcLE) STATE MAJOR SECOND LOCAL SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF. �6., - ' CONDITIONS 'EXISTING BLDG. /t '/ - '(.✓� ) 1 S'F14 G1 NO 1/ BUILDING EXIST. OWNER YARD HWY STREET NAME SETBACK WIDTH ADDRESS P7({ Q FRONT ARCHITECT OR EL, - P. L. ENGINEER - NO. SIDE } ADDRESS P L a. � A p�bE�6 EL. 00 CONTRACTOR +��.�\ ( O. IY- ADDRESS pp ^ 1, % V DESCRIPTION OF WORN -- W a a .NEW ADD ALTER REPAIR DEMOLISH Z SO. FT. NO. OF NO. OF SIZE QFC STORIES FAMILIES 'USE OF STRUCTURE 1p SIGNATURE OF APPLICANT_ _ r VALUATION $'45� _ ! APPROVALS DATE INSPECTOR'S SIGNATURE . 'P.C. '/ q� PMT. FOUNDATION: LOCATION FEE $ (� / VCS FEE S FORMS.MATERIALS FRAME: FIRE STOPS. J THEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS Yl AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS SU ILDI NG-CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK ���.�// ,• AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- TI LATH. INT. �'I/Y IV . ON OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- INO TO WORKMEN'S COM NSATION NSURANCE. LATH. EXT. I IA Y( PERMITTEE SIGNATURE OF / .Lf� HOUSE NUMBER COR- _ RECT AND POSTED ADDRESS ' FINAL / v JOHN F. LEWIS. PRINCIPAL STRUCTURAL,ENG R PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION. CK. M.D. CASH c16o 7 1 9 1 PIPR 1 D 6.00— WORKERS'COMPENSATION DECLARATION hereby affirm certificate of r certificate of consent to self j APPLICATION FOR . BUILDING PERMIT insure, or acerhficate of Workers'Compensation Insurance, -'uor acertified copy thereof (Sec. 3800; Lab C.) _ COUNTY OF'LOS ANGELES BUILDING AND SAFETY Policy.No' Company - Ce rtified,copy.is hereby furnished. zFOR APPLICANT TOFILL IN BUILDING ADDRESJ/ S' - `roll(!w'Q+s• ❑ Certified copy is filed with the county build ing'inspec BUILDING tion department. : _ ADDRESS � (.�/� ITT./ LOCALITY .L�[ NEAREST 'J Date Applicants CITY I�-C ZIP I O CROSS ST. .GIOUB•r� CERTIFICATE OF EXEMPTION FROM_.WORKERS' - .NO:OF'BLDGS. ASSESSOR - COMPENSATION INSURANCE - SIZE OF LOT: O NOW ON LOT Q>1 e: _ MAP BOOK PAGE' PARCEL ' ,(This'section need not 6e completed if.the-permit is for one ` ,P USE.ZONE MAP e hu ndied dollars ($100)or less.), - TRACT BLOCK LOT�NO. NO. +© .. _ - .r TEL.`p - SPECIAL _ I certify that in the performance of the rk for which chi OWNER a aze.? BG �. CONDITIONS � d permit is issued, I shall not employ any.pe son in any mon r �`' - DISTRICT GROUP TYPE FIRE' PROCESSED BY O so as to become subject to the Workers' am s. ADDRESS CONST. - -ZONE, L V" ,(1 Y .�% Date V A licant _ _ CITY ' ZIP - '- „O Jy\ PP STATISTICAL LASSIFICATION .A CONDO. H NOTIC TO AP LICANTa If, after maki this Certificateof ARCHITECT OR TEL.' ''77 � �.V Exemption, you should become. Zkbi t to the'Workers' ENGINEER NO.. CLASS NO,�_DWELL. UNITS_ :% W' Compensation.provisions;ofthe Labor. ade;..you must forth- ADDRESS SEWER MAP N with comply with such provisions or this,permit shall be - Z deemed revoked. - - ?.' STEL. `7 - CONTRACTOR NO. - _ BK. PG VALIDATION 'LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NC; VALUATION (commencing with Section 7000)of Division 3 of the Business ando: LIC: - Professions'Code, and my license is in full force and effect. CITY CLASS $ 00 pop. - SQ. FT: NO. OF NO.-0F CHECK` License Number Lic.+Class SIZE STORIES FAMILIES - ONE j NEW Contractor Date - DESCRIPTION OF WORK —/ + ^ ADD ❑'I•am exeqmpt under Sec. a'v/ I 1 a�< ALTER FINAL �•/�:�j c _ 8.8P.C. for this reason - - REPAIR DATE' CC�JlI..-- USE SE OFEXISTING BLDG. ,• ,Signature APPLICANTS TEl Y - OWNER-BUILDER DECLARATION - PRINT al h _�, H O. Z.�7 '• - - r r * ' I hereby affirm that,lam exempt from the Contractor's License AA - Low for the following reason (Section 7031.5, Business and ADDRESS' K �. L+L�Cx 7n' 1Z .. .- Pro esslons Code) _ :. PRE NT BUILDING I •as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do.the work and c'P 9 A the structure is not intended or offered for sale(Section LOCALITY y_ _ - •7044, Business and Professions Code). MOVING TEL - # A e e•�.� 1, as owner of the.property, am,exclusively contracting'. CONTRACTOR NO. y , ) 7, with licensed contractors to construct.the project (Sec- - 2 ^ x'4,9,88 'tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. - - CONSTRUCTION LENDING AGENCY YARD HW4 . - 4 9,.8 8 SET BACK :PROP. LINE ' WIDTH , + I hereby affirm a that there is a construction lending agency for FRONT - 6. 3`'8 4 I the performance of the work for which this permit is issued ' P.L.. _ r (Sec.3097, Civ. C.). SIDE - - - 'P.L. Lender's Name .. lender's Address - P.C. Fee E Permit Fee -1 certify tho,I I.h read this application anc1'stoie:thoi.the - Issvanca Fea !i above mf motion rs correct:I' ree to comply with,all County Investigation Fee _ - g -ordinanc s pnd State laws re atidg building;consiruchon ,T. ' To' I Fee • "I ' .. .. G and her by authonza repres ntativ of the County to'enter - m upon t e above-m tiona'd ropert or.,inspection'purposes - • --• - ' < SEE REVERSE FOR EXPLANATORY LANGUAGE - - norore £Applicant orAgent' � .. .- � t -• .(Bs F APPLICATION FOR BUILDING PERMIT �] COUNTY OF LOS ANGELES BUILDING AND SAFETY . WORKER'S COMPENSATION DECLARATION - FOR•APPLICANT TO FILL IN - BUILDING A�DDD/RESS - - I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS - - >,•♦___ _ __ ...7� 6-s�-sL�l L�YGc.. or a°certificate of Workers"Compem ation Insurance.or certified pp'� r/ A - copy thereof(Sec.38000, b.C.) / CITY r EM pLE t_.1 T ZIP ' pO ; LOCALRV Policy No. G�a Company! T� 2-x <k� D _ _ ) SIZE OF LOT I r NO.OF SLUGS.NOW.ON LOT y Certified copy is here yfurnished. - NEAREST CROSS ST ❑ Certified copy is filed witlrthe county building inspection TRACT .BLOCK LOT NO� department. • ' ` USE ZONE• I MAP NO. T , ASSESS //c - / OR MAP B K ,PAGE Date 1?C / Applicant" ^T "� L ... , i OO o3� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER .TEE NO. l COMPENSATION INSURANCE L!N V 11• K�'N LOa7-,4S' K WITHIN 1000 FT OF SCHODL? ' YES, Till j p L NO ,`,m' [� ADDRESS' (This secti0n need not be completed if the permit is for one hundred ff,,11 ) DISTRICT - GROUP TYPE CONST. FIRE 70M.L..PROCESSED BY bY.1 i1J dollars(5100)or.less.) L604t I certifythat in the CITY / 1.ZIP _ t r °Elf I .performance of'the work for which this permit . 7E/YI Lc C[Ty r <fp. ,A� - 9 '� F _ is issued, I shall not employ any person in any manner sous to , 4 - 3 � .. - become subject to the Workers'Compensation Laws '" - ARCHITECT OR ENGINEER TEL NO / - Lima All /g' ��r STATISTICAL'CLASSIFICATION 1N7 CONDO _ Date Applicant - ADORES y - _CLASS NO. �� DWELL UNITS' I• 'i_I I I}j'I 1 <! rr NOTICE TO APPLICANT. If; after making this Certificate of 33 1 20ADW�/ REQUIRED' TOTAL SETWCkTROM i EXIS'I"i 'Exemption, you should become subjectad0 the Workers CONTR CTOR EL NO. SET BACK yggD HWY PROFUNE WIDTH Compensation provisions of the Labor Code, you must forthwith / �J �i� � Zf/� -r— � FROM - JZ comply wkh such provisions or this permit shalltie deemed revbketl. ADDRESS �' LIRLSIDELICENSED CONTRACTORS DECLARATION Clry /T� ��qq uc:cLAss - PL _�_! 1 I hereby affirm that I am licensed underprovlsions of.Chapter 9 a/JZ+�'yfPe. _ SEWER MAP (commencing with Section 7000)Of Division 3 of the.Business'and SO.FT.SIZE NO,OF STORIES NO,OF FAMILIES 1 til f d Professions Code,and my license is in:fullforce and effect.'' ' - NEW ❑ BK - PG - - — j i I(H{ I -U iJ-O�i' "' �> _ �1"' DESCRIPTION OF WORKW(J ADD- � VALUATION - ® - License Number Lia Class f4 r Contractoq!aAlff�°�LAN•Date !/ ,' ;• / (5-00 �F. 5C oDrrrON ALTER ❑ ❑ l am exempt under Sec. - 1�©� �r' R� P- NovATroN REPAIR ❑. $�..,/?n dDON'� t:���� ."Li BAPC. for this reason71q- 'T (S p 4- DEMOL ❑' USE of XISTING BLDG. LDMA P/C.# I '_:!](l JJ JI'1 '7 Date:, . . URM ❑ _ / Signature _ a E I v' I.?z APPLICANT(PRINT) TEL NO. LOMA_Per -❑ I,.as owner':of the property, or my employees with.wages as 7Y Ufr `their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Se6tion'7O44, Business and 33 ,4P 1A- TEM Za CIT . I (eO FINAL DATE - • a Professions Code.) WILL THE URE CON!OR FUTURE BUILDING OCCUPANT UAL T A HAZARDOUS MATERIAL ) J f _•�' t!tf ❑ 1, as Owner of the property, am eXCIUBNely Contracting with ORA MIXTURE CONTAINING A HAZARDOUS A4IIERWL EQUAL TO Ufl GREATER THAN THE AMOUNTS SPEGFIE N THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAI licensed contractors to construct the project (Section 7044, YES❑' NQ / T TATL �,y.. .Business and Professions Code.) WILL THE INTENDED USE OF THEBUIDUNG BY THE AFPUCANT'OR FUTURE BUILDING - 000URANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTITCT ISCFOMDF SEE PERMITTING CHECKLIST FOR GUIDELINES. Ihereby affirm that there is a construction lending agency for YES El NO/ .. _ •` a' •GHN€'s(1� ;(II; the performance of the work for which this permit is issued(Sec. ' p. HAVEREAD THE HAZARD USMATERIALSINFORMAPONGNDE AND THE SWOMOFERMITTING I•¢ i ' w 3097,(`iIV.(i,) CHECKLIST. Un ERSTAND MY RKUIREMENTS Uf'�AEB THEL05 A(IGELES COUNTY CODE, ' TITLE 2.CHAP '�O SECTI 1$220.IODITH9/Fe1Q.{Gr220140 CONCE NTNG HAZARDOUS • ; 1'j, J+ 3 Lender's Name MgTERIAL PORTING N C'TAININ0'I (4T�ijQ' d I�Mo.'.`, L / I IlI�I_ S�l� 1 4 7'S J- E. Lender's Address v ✓ ` •,t lmv 73{{fj_ '_1. 11=. .11 OF AeevT at -_ o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply RC.FEE �jt 3 PERMIT FEE with all county ordinances and State laws relating to.building of 0-IE,--•••A 'F�' ` - m construction, and hereby authorize representatives of this County .ISSUANCE FEE" / - to enter upon the above-mentioned property for inspection purposes. a ,n �7 INVESTIGATION FEE" TOTAL FE 9' - b� a SEE REVERSE FOR EXPLANATORY LANGUAGE -