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Home My Public Portal About9661 BROADWAY_Building__ 76A638A CE A803 3-69 APPLICATION FOR BUILDING ERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADORESS Z11 e,11 BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST _ I CROSS ST. FOR APPLICANT TO FILL IN Dl:jal T N0. GRO TY�G ST. (PRINT OR TYPE ONLY) f D BUILDING STATISTICAL CLASSIFICATION SEWER rMAP ADDRESS CLASS NO. DWELL.UNITS BK, G PG LOT NO. Q la�BLOC USE ZONE 'MAP O NO. 1.0 TRACT I SPECIAL N0. OF BLDGS. CONDITIONS _ SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM ' TEL. FRONT PROP. LINE OF - (STREET) OWNER _ tlI- NO. - - TYPE OF EXI5TING SETBACK I HIGHWAY + YARD = ' TOTAL ADDRESS t HIGHWAY WIDTH FROM C.L. CITY IQ D f 2C3 = ARCHITECT OR T L. SIDG.SETBACK FROM ENGINEER - O. SDE PROP. LINE OF STREET)! _ TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL ADDRESS �— HIGHWAY WIDTH FROM C.L. CTEL/� ONTRACTOR f r- �I N0. Q S/ p}, ADDRESS _5 � !(, N0. /�/2 I CORNER CUTOFF YES ❑ NO _❑ ` LIC, p CITY L' j �, CLASS ` SEE, REVERSES E FOR SP IA PRP OA LS C CONSTRUCTION LENDER NAME AND BRANCH 7 / Q y� ADDRESS Z � -(I ✓�„ SIZE U0 STORIES FAMINO OF NO. LIES NEW ❑ - 7 C n L�r-- ,� 0/1 l A/9lnf'r Ti VAI. USE Fl? ADD STRUCTURE ALTER ❑ A/110".1- HOME- A'/-- CAO 4,L l'O A. REPAIR ❑ SIGNATURE OF OEMOL E)APPLICANT VALUATION S Oe APPROVALS TE INS E TOR-5 sI IJRE FEE 5 FEE S .-� (/ FOUNDATION: LOCATION FORMS MATERIALS III A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, AND STATE THAT THE ABOVE IS COOT AND AGREE TO COMPLY BRACING BOLTS FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON BUC- . GAS VENT DUCTS TION. CERTIFY THAT IN GOING THE WORK WORK AUTHORIZED HEREBY , WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE BOO CODE LATH, INT. f OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURA NS.F,. LATH, EXT. {,E. SIGNATURE OF / l PERMITTEE HOUSE NUMBER CORRECT AND POSTED iq ADDR ES FINALC7 I JOHN F. LEWIS, PRINCIPAL ST URAL ENGINEER r PLAN CHECK VALIDATION' CK. M.O. CASH - PERMIT VALIDATION CR. ..0. EAS. pP_ 4 4 5 41� APRl 3 1 6 2 72' —513 JAN 9 1963 76AC38A CE 4{'11036-62APPLI.CATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING UIL N DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION k LOCALITY / JOHN A. LAMBIE. COUNTY ENGINEER NEAREST y & WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. �Q�jy Q � (l DISTRICT N9. GRO TYPE ESSED BY , FOR APPLICANT TO FILL IN CONST. BUILDING STAT ISTICAL CLASSIFICATION WER MAP ADDRESS BK - G CLASS. NO. DWELL. UNITS CL GT L WATER NOT REQUIREDIS RECEIVED ❑ �t^� ) CERTIFICATE: TR l MICIR0.AP y,� _ HIGHWa NI STATE MAJOR SECOND, CAL NO. OF BLDGS. O�>"l� SIZE OF LO USE ZONE SPECIAL USE OF CONDITIONS CONDITIONS EX'ST IN LOG. .� . OWN ( BUILDING YARD HWY STREET NAME EXIST. � / SETBACK WIDTH ADORES (p( cR ^✓� ` ARCHITECT OR TEL P, L. ) ENGINEER NO. SIDE ADDRESS �7vV d"/0'�'^✓ r+'�."'YI /A✓t / /I I., -O CONTRA N ADDRESS DESCRIPTION OF WORK ��r�/ 3 fY//L J a�c6�CFi1PU✓G. O w EW ADD ALTER REPAIR DEMOLISH - /J / / . FT. NO. OF NO. OF �I N :A'L X12+ /J l ; ,MIA . JI Z SIZE j Z;)� ST RIES AMILI ES I '1 -- ��j � ( //J/ STRUOCTURE L1C` 5 '+JG/• /jam(•/ � 7'� r>�1vuy..n�/Y"�. py�-}Iy'� FK, -SIGNATURE OF KI j / APPLICANT / VALUATIONS 'APPROVALS S � J'DATE INSPECTOR'S SIGNATURE FORMS, U�RE FORMS. MATERALS � G_sPMT. FO CON FE S FEE VA/0 , FRAME: FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS • I , AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPL ,FURNACE: LOCATION. 2 IIS YT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULAT GAS VENT, DUCTS BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING AUTHORIZED-HEREBY 1 WILL NOT EMPLOY ANY PERSON IN LA- LATH. INT. TION OF THE LABOR CODE OF THE 5 TE OF CALIFORNI EL ING TOWORKMEN'S CO SURANCE. I LATH, EXT. fi4/ / SIGNATURE OF HOUSE NUMBER COR- PERMITTEE NSA- RECT AND POSTED ID ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL ST TURAL ENGINEER PLAN CHECK VALIDATION DK. M.D. CABH _ PERMIT VALIDATION CK. M.D. CAB. L"Co9 1. 4 7G jAN 7 2 3 D 2 8.500 pp LX0 0 7 3-2:d FEB 8 1 D 51 7//r)0� s - • WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent•to'self, O �/p�� ( n �( M(J (,�/� insure, or a certificate of Workers' Compensation Insurance, - �P PLD.C�Q�.�.®�,' ®� �,�/�(��.�(f�'f�.. ��u�u�� '. of a certified co y t++h77ereof (Sec. 3800,' b C.) y /' ,/ COUNTY OF LOS ANGELES - BUILDING AND,SAFETY Policy No. -d0 Compcny W7E /Ury0 '� - _ �J ,s .•-/�/ - I—� 12„ BUILDING.. pp❑� Certified copy is hereby funis ed. FOR APPLICANT TO FILL IN' ADDRESS iCO(jJ . Yy Certified copy is filed' h the count uilding•inspec- BUILDING J / / ,�/A /J _-, hon department - ADDRESS T E n En � �- ,\ ciTr/E PL'E L/i •Zip LOCALiry Date Appbcant NO. OF BLDGS: NEAREST ^� _ CERTIFICATE OF EXEMPTI N'FROM WORKERS' - SFZE'OFLOT• " " -'NOW ON LOT` CROSS ST: d not b ATIONcompleted if the E• ASSESSOR p��jp O �/ (This section need not be completed if.the permih is-for one TRACT " BLOCK - LOT NNqOp. / "' MAP BOOK CJ O P PAGE O9 PARCEL ��/ • hundred dollarst($100) or less.) - A5-CNO.B ,q- NQp'(J(p p/60 _ o OWNER USE ZONE MAP % 9 certify that.in the.performance NO,of the work for which this ,r ,AL ) / SPECIAL: - - - - a permit is issued, I shall not,employ any person in any manner ADDRESS �rf/V,G ,' CONDITIONS sobs to become.subjecbto the Workers' Compensation Laws. - - Q . . CITY- _ ZIP - Date Applicari r , ARCHITECT OR - TEL. NOTICE TO,APPLICANT:, If; after.making this Certificate rof - ENGINEER _ _ NO DISTRICT . .:GROUP TYPE _ _FIRE - PROCESSED BY CONST. - ZONE 0 Exemption,. you should become subject'to the!Workers' y �, T - U Compensation provisions of the Labor Code, you must forth- - ADDRESS 7/Z/ �0 • .� - �G� ��Ef a with comply,with such provisions or this permit shall be 4 E O !.I'( OOF T ff(•.TEL Z '' 879.-/58 STATISTICAL CLASSIFICATION APT LONDO. - deemedrevokedf CONTRA TOR {ZE DOF/Nf NO. - ` LICENSED CONTRACTORS DECLARATION yy y� LIC. //r I� CLASS NO. DWELL. I hereby affirm that I am licensed under provisions of Chapter ADDRESS//l CEM /N//7✓EA�IIE NO.-# / /&- //�� LIC. CJ SEWER MAP t (commencingProfessions Section 7000)of Division 3 of.the'Business B/2EA L-A. 9a&,�L CLASS —9/ and Professions Code,and my licenseis in full force and effect. CIN' BK PG. VALIDATION i/,6/7/ 3__ '/J_ .?9. SO. R. - SNO.TORIES OF FA OF -- 'CHECK _ License Number lic. Class SIZE 'G- STORIES FAMILIES ONE OR/WCTE GOUAITy Ol,OyyfF�IZT �j ((�� a VALUATION Contractorob3 13 REq'/c00F4V�(Dafe /�./r� DESCRIPTION OFWORK/,//EMoJF XII/LLST/pN[ NEW ❑ '$ /0 0d - ❑1 am exempt under Sec. A,IOOD SMWE. /�Ji'r4ii /Gn p 1ty00 ADD -❑ ALTER TTp❑y� B.BP.C. for this reason - (Z),3QFELTLA ERS ALPoA H9k7E REPAIR USE OF Date: EXISTING BLDG,. �/"/!��. - DEMOL. ❑ -- - • APPUCANi - s - .TEL 7/ 1 „Signature - . OWNER-BUILDER DECLARATION (PRINT)X ��\' kY C:'NO. 9«8 .DATEL L•� + I hereby affirm that I am exempt from the Contractor's License ' /�/ /�,i/,�/ . Low for the following reason,(Section 7031.5, Business and ADDRESS G /V7 Y �Y FINAL _ - ,k `�U7 :,,r y`{, -` Professions Code)' ' PRESENT' By - �/ ._ `' _ BUILDING ❑. I, as owner of the property, or'my employees with - ADDRESS' -- < / - 1 ITEMS . wages as their,sole compensation,will do the work and LOCALITY D ""'"T' �`C TOTAL 234 --'53 the structure is not intended or offered for sale(Section 7044, Business and Professions Code. MOVING _ TEL. NECK= ❑ 1, as owner'of the property, am exclusively contracting CONTRACTOR NO. NEC2._i4.5- ✓ with licensed contractors to construct-the project (Sec- - — - - - - - f_NAF117E •l 1 tion 7044, Business and Professions Code.), - ADDRESS � � • w ' REQUIRED . .TOTAL SETBACK FROMEXIST. - . " CONSTRUCTION LENDING AGENCY- .SET BACK. YARD' HWY - PROP. LINE WIDTH - - - rr'' hereby affirm that there is a construction lending agency for, FRONT - JVIiR�IU1 vi ly: = the performance of the work for which-this permit is issued - '-P:LC - - -- - - - (Sec. 3097, Civ. C.). SIDE, 51141 1 AM ,8:51 Lender's Name - -7 P.C. Fee$ - erm Pit Fee / LDMA Ref. #' Lender's Address I certify that I'have read this application and state that the .- - lseoonce FeeLDMA P/C k 8 above information is correct. I agree to comply with all County Investigation Fee . - o)- `L S� C ordinances and'State laws relating to building construction, Total Fee O_ 7 5 TDMA Perm. p a nil hereby authorize representatives of this County to enter u n the above an re ti }m'o" for i nspection'purposes. . SEE REVERSE FOR EXPLANATORY LANGUAGE Signoture App icons;or Age Date - -