HomeMy Public PortalAbout9448 BROADWAY_Building__ DIVISION OF BUILDING AND SAFETY [�
- Department of County Engineer t�
County of Los Angeles APPLICATION
WM. J. FOX, COUNTY ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
UILD // �J �r .e J r DISTRICT NO. PUN C[.OR Rcc.No. PERMIT N
ADDRESS �1��l i 1_l_Y �'L (%.tN'°�/
RE IVED BY DATE OF APPL D EIB U
NEAREST
LOCALITY �N}/' '1 ��J _ `,��� `. _
CR089 ST. N X /� )I�.Y/{ Y:CF_I ) - . BUILDING
BUILDI B y
OWNER
MAIL LOCALITY e-/7--/ }
/'' /�
ADD RE89 '7 /� } /J .V�X('/,�yV � NEARES
CR09B BT.T q' 1
CITYF7.e...>r..•tL(1n. C,�:'!rc.f NO. • � I ZONE I PLANS nBE— , ( OR 1
ARCHITECTORI TEL ,
ENGINEER (( NO. BLDO. n ,�4pFfjjDD.. ��ttllll,,,,
SETBACK LINE )
ADDRESS
USE __ /APPROVED
TEL ZONE /T •JBY DATE
R N
CONTRACTOO. HOU9�E]NUMBERING
ADDRESS i� MAP NUMB ERNO. ASSIGNED BY
LEGAL J-i`T < CORRECTIONS
DESCRIPTION LOT NO. BLOCK
TRACT %/U[!/y-a•hl/�� /� (n/�/}/C�'
No. or
SIZE OF LOT /AV/A/L1 fT/�/y„-�NlpO�W+ONLOTUSE �pI
EXISTDNG BLOC.I/ !'_J"'l � FMIu68o(
DESCRIPTION OF WORK
9
E:
NEW ALTERATION ADDITION D
REPAIR DEMOLITION R
eZE-AL �e��� -1 ROOMS / STORIES
COVEXT-ERING/�/VI�r�•V I COVERINp/,/�/Lr?1.ffC
USE 07TRUCTURE /
INSPECTION FOR v APPROVALS
OCCUPANCYAS INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION
FORMS, MATERIALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATIOGIVEN 18 FRAME: FIRESTOPS,
N
CORRECT. 11 BRACING, BOLTS
IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION,
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
a' GAS VENT, DUCTS
SIGNATURE O% /d � � 6��� LATH. INT.
PERMITTEEEE� A.lI3�
ADDRESS l • �II �[�f�'Y/1rI.IV }+ LATH. EXT.
�
AUTHORIZED AS1 �,�.� y _ (1 PLASTER. INT.
T. •�• �'� V
PLASTER, EXT.
S
FEE
® HOUSE NUMBER COR-
RECT AND POSTED
VALUATION
FEE FINAL
76As BA DBS 3 1-52 "
CE 080�IREVj6/761 1
APPLLCATION OR BUI ING PERMIT /
COUNTY OF LOS ANGELES BUILDINGANDSAFETY /r
FOR APPLICANTTO FILL IN ADDRESS
BUILDING O �-
A
ADDRESS L LOCALITY 'Ye.'.
NEAREST
CITY c ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT . NOW ON LOT MAP BOOK PAGE PARCEL
CL\\SSU �!+•+ QOCt DISTRICT GROUP TYPE 'FIRE ESSED BY
TRACT S BLOCK LOT NO. - r - �!�O CONST Z1
OWNER I a .NO�y'1'O .�C _ /"E-I
STATISTICAL CLASSIFICATIONEWER MA#e
^^��
ADDRESS \ - a CLASSNO.�DWELL.UN ITS D BK//3PZ—
CITY - ZIP C��Do C, y
ARCHITECT O L�` TELM VALUATION $ ' 3 Ap- O
ENGINEER \ `V' 0.� NO. ♦ rS `{ ...///
ADDRESS S C r s BLDG.SETBACK FROM
TEL FRONT PROP LINE OF (STREET)
CONTRACTOR NO. HIGHWAY + YARD _ TOTAL SETBACK FROM TYPEOF EXISTING
LIC. FRONTPROP.LINE- HIGHWAY .WIDTH
ADDRESS NO.
LIC +
CITY ICLASS BLDGSETBACKFROM
CONSTRUCTION LENDER S1DE PROP.LINE OF ISTREEN
NAMEANDBRANCH _
TOTALSETBACKLINE.
TYPE A EXISTING IL
- HIGHWAY + YARD 6
ADDRESS �" CITY - SIDE PROP_LIN6 HIGHWAY WIDTH G
SO.FT NO.OF NO.OF CHECK + - _ V
SIZE - STORIES. FAMILIES ONE O
DESCRIPTION OF WORK NEW. P.C..Fee$ Permit Fee �/n -
ADD
Q Issuance Fee _ y
ALTER
REPAIR ❑ Total Fee
USE OF DEMOL ❑
n
EXISTING BLDG. - •1 O \-
APPLICANT - TEL tri'"/
.1 PRINT( ` NO.
BY(SIGNATURE(
IHEREBY•ACKNOWLEDGE THAVI HAVE READ THIS APPLICATION AND STATE• - Y
THAT ME ABOVE IS•CORRECT AND AGREE-TO COMPLY WITH ALL ORDINANCES /
AND LAWS REGULATING BUILDING CONSTRUCTION..I CERTIFY THAT IN DOING THE Y
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF / �'4 1 41 A
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'5 COM- Z
PENSATION INSURANCE.
q o o.. o 0SIGNATUR1
PERMITTEE OF �� . . J 2'a0 5 2 0 0
ADDRESS LN Z 'a o ro 5 2 0 0
O
CITY C aff (�(tiifti Q
TEL G c 0502-79
JNOP O V _
SPECIAL
` CONDITIONS ' F
a
FINAL BY ( i
DATE
76A638A CE#803.7.56 APPLICATION FOR. BUILDING PERMIT Z
BUILDING AND SAFETY DIVISION BUILDING
Department of County Engineer ADDRESS
County of LOB Angeles LocnurY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN. SUPT OF BUILDING CROSS ST.
DISTRICT NO, I GROU.rP TYPE S ER MAP
FOR APPLICANT T FILL IN A eK PG
CONST.
BUILDING �j
ADDRESS �J Q 1 STATISTICAL CLASSIFICATION
LOT N ,L VT-1 BLOCK -CLASS. NO.�_DWELL. UNITS
MAP q �p STATE YES O
NUMBER �Cs(./ 'WY
TRACT ` USEZONE SPECIAL
/,�^� ry pl / NO. OF BLDGS. 9 .O/JTI- CONDITIONS
SIZE OF LOT/J /I L (. NOW ON LOT
USE OF 6
EXISTING BLD tea- BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
OWNER FRONT
MAIL P. L.
I ADDRES �we 4
TEL. <� P. L.
CITY NO. J INSPECTION RECORD
ARCHITECT OR I-r EL.
ENGINEER NO.
ADDRESS
TEL.
CONTRACTOR NO.
ADDRESS
DESCRIPTION OF WOR%
NEW ADD ALTER REPAIR DEMOLISH
SO. FT. NO. OF NO, OF
SIZE D STORIES FAMILIES
USE 'j,RUC�TURE
('{'( APPROVALS
L
DATE INSPECTOR'S SIGNATURE
) FOUNDATION: LOCATION
FORMS, MATERIALS _�. Al
PFBRACING•BOLTTSS FEE § Q FURNACE: LOCATION.
FEE GAS VENT, DUCTS nn
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH. INT.
PLICATION AND STATE THAT THE ABOVE 5 C09R ECT AND
AGREE TO COMPLY ITH ALL COUN Y.- RDI I NOES.A ND LATH. EXT. `-•-�/
STATE LAWS RE ATING BUI C STRUCTION.
SIGNATURE OF HOUSE NUMBER COR-
' PERMITTEE RECT AND POSTED
ADDRES FINAL A-2«✓ l ✓r/v�+�7 ��
JOHN A. LAMBIE. COUNTY ENGINEER, CLYDE'N.-DIRLAM. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONCK. M. CASH
5 7 1 OL MAR. / 1 8.0 0 `/°1st
1 " �� L
6A 639A Ct#803-]-58 APPLICATION FOR BUILDING PERMIT �.
BUILDING AND SAFETY DWISION BUILDINGESs 7�i
Department of County Engineer AD'
R 7 T lP
County of Los Angeles LOCALITY _r) i. l
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN. SUPT OF BUILDING CROSS ST.
DISTRICT NO. GRP TYPE Y SEWER MAPPGFOR APPLICANT TO FILL IN sf CONST.. EN
BUILDING
ADDRESS STATISTICAL CLASSIFICATION
0 CLASS. NO.._L�LDWELL. UNITS
LOT NO. / S 0 LOCK MAP STATE i
NUMBER �Q O STATE
YES NO.`
TRACT / Ll U NE SPECIAL
r / NO. OF BLDGS. CONDITIONS
SIZE OF LOT . cO NOW ON LOT - �A
USE OF
EXISTING BL G. BUILDING YARD HWY STREET NAME EXIST.
SETBACK WIDTH
OWNER FRONT
MAIL P, L.
ADDRESS SIDE
TEL.
CITYA NO.
ARCHITECT OR TEL. (+ INSPECTION RECORD
ARC
ENGINEER NO. -
ADDRESS
TEL.
CONTRACTOR NO.
ADDRESS
DESCRIPTION OF WORK
NEW ADD AlLTER REPAIR QEMOLISHI
SO FTNO. OF NO.
G ' STORIES FAMI
' SIZE
USEOP RUCTU E
t
APPROVALS
SIGNATURE OF
APPLICANT DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
FORMS. MATERIALS
$ �/J FRAME: FIRE STOPS.
O v' FEE BRACING. BOLTS
RNACE
VALUATION FEE 5 �� %AS VENT, DUA TISN
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT.
PLICATION AND STATE THAT THE ABOVE IS CDR R T AND
AGREE TO COMPLY,)WITH ALL COUNTY O INAN SAND LATH. EXT.
STATE LAWS RE TING BUILDI� ONS UCTION.
SIGNATURE OFHOUSE NUMBER COR-
PERM
ITTE ZC
RE
CT AND P STED
ADDRESS FINAL ! (�
JOHN A. LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL EN ER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
lfo 5 7 1 1 MAR 4 1 1 .0 0 In
DEPARTMENT OF BUILDINGAND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
BUILDING;,4M.- :JS 4 �
" . FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK. NQ._ PERMIT q-.2
NO.
ADDRESS
BUILDING . l^ S' / i;f e)
LOCALITY
RECEIVED BY ,-- DATE OF APPL. ' DATE(,I/66U ED/
' �. /'NEAREST
j I
CROSS 6T. .(/ f[�] EC
BUILDING
OWI�`R �
ADDRESS // f/�QiQO G(/, l q 1/
MAILi ' LOCALITY�/7.1 4 z/
ADDRESS L� ' NEAREST /
TEL. CROSSST. {. Al, �
CITY NO. FIRENO. OF TYPE ' / GROUP
ARCHITECT OR TEL. ZONE �� PLANS V
ENGINEER NO. BLDG. ORD. NO.
SETBACK LINE
ADDRESS APPROVED
TEL. BY DATE
CONTRACTOR NO. USE APPROVED -"
ZONE�-t BY DATE
ADDRESS HOUSE NUMBERING
LEGAL �-
DESCRIPTION LOT NO. I BLOCK MAP NUMBER FIELD CHECK BY
TRACT 0WA--l) NO. ASSIGNED BV - DATE
JJ•C NO. OF BLDGS, - = CORRECTIONS
SIZE OF LOT J Q ^ !Vi7 IN ON LOT
USE OF NO.1
EX(STING BLD ,A/, �4A Iil -.
DESCWTION OF WORK _
NEW I I ALTERATION I I ADDITION
REPAIR DEMOLITION
SQ. FT. NO. OF
SIZE ® ROOM9 STORIES O'YL.e Y -
EXT. WALL j ROOF 1
COVERING ( COVERING
USE OF STRUCTURE
V APPROVALS
INSPECTOR'S SIGNATURE DATE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS
CORRECT.
I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRESTOPS, .
HEREON AND WITH'A�eII COUNTY OROINANgES/AND STATE BRACING, BOLTS
LAWS REGULATING ILDING CONSTRRCT ON,/ FURNACE: LOCATION, v
SIGNATURE OF GAS VENT, DUCTS
PERMITTE
j/ r LATH, INT.
ADDRESS
'7 `/�
' LATH. EXT. , -^i
AUTHORIZED AGT.
PLASTER, INT.
�1/ 'FEE PLASTER, EXT.
VALUATION /�fJ' d 0 .� L
_ FEE FINAL
I -
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self I
insure, or a certificate of Workers' Compensation Insurance, A P P L O CQIN pR U O L D O N G PONT
or a certified copy thereof (Sec. 3800, Lab. C.) -
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Compony BUILDING
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRFSS
Certified copy is filed with the county building inspec. BUILDING ��{{
tion department. ADDRESS LOCALITY
NEAREST
Date Applicant \ EITY ZIP / (� CROSS ST. 4"A
OF EXEMPTION FROM WORKERS' N Of SLOGS. 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 IMAP
hundred dollars($100)or less.) TRACT BLOCK LOT NO. I NO.
TEI. (y� P�''J SPECIAL _
I certify that in the performance of the work.for which this OWNER' dd 7% A CONDITIONS O.
permit is issued, I shallnot employ any person in any manner DISTRICT GROUP, TYPE FIRE PROLE D BY O
so as to become sub' ct to the Work i Co pensat ion Laws. ADDRESS J'�%�"C� CONST. ZONE ad
V .
/ 3 0
'
Date .pplicant CITY ZIP f - STATISTICAL CLASSIFICATION APT. CONDO. - 0
NOTICE.TO APPLICANT: If, after making this'C tificate'of ENGINEER OR .TEL,'-.
Exemption, you should become subject to the Workers ENGINEER NO. :CLA55 NO� DWELL. UNITS_ W
Compensation.provisions of the Labor Code, you must forth= ADDRESS SEWER MAP
with comply with such provisions or this permit shall be - _ ?
deemed revoked.
TEL. J�-2- VALIDATION -
CONTRACTOR NO. BK.O PG,
LICENSED CONTRACTORS DECLARATION - LIC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO: VALUATION -
(commencing with Section 7000)of Division 3 of the Business and LIC. B O 0
Professions Code, and my license is in full force and effect. CITY CLASS S D
SO. FT. NO.OF NO. Of CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
Contractor Data DESCRIPTION OF WORK
NEW §
ADD
am exempt under Sec ALTER ❑ FINAL'
B.BP.C. for this reason 107
REPAIR ❑ DATE
Date: USE OF DEMOL FINAL
EXISTING BLDG. ❑ By
Signature APPLICANT TEL. .
OWNER-BUILDER DECLARATION PRINT NO.
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5,Business and ADDRESS -
Professions Code): PRESENT -
QI, as owner of the property, or my employees'with BUILDING
wages as their sole compensation,will do the work and LOCALITY '�''� .b .9 {+-
the structure is not intended or offered for sale(Section
7044, Business and Professions Code). MOVING TEL. `°'°
1, as owner of the property, am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec. ADDRESS 2.° °�S 0.,0 8
tion 7044, Business and Professions Code). _
REQUIRED TOTAL SETBACK FROM EXIST. -
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH D 'o e e .5 00 8,J F-
I hereby affirm that there is a construction lending agency for P.I,
the performance of the work for which this,permit is issued P.L.
(Sec 3097, Civ. C.). SIDE
-PL.' - -
Lender's Name
Lender's Address P.C. Fee.S Permit Fee �q ,{
V SN
I certify that I have read this application and state that the Iuuanca Fee '
above information is correct. I agree to comply with.all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee
D and hereby authorize representatives of this County to enter
upon t a ave-mentioned pro rty for in pection purposes. '} -
SEE REVERSE FOR EXPLANATORY LANGUAGE
/JC\ Sign re of Applicant or Agent Dote ®s