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Home My Public Portal About9711 BROADWAY_Building__ APP L I CAT 1 O ISI FOR COUNTY OF LOS ANGELES OF COUNTY rBUILDING PERMIT DEPARTMENT BUILDING AND SAFETY DIVSIONR FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS y t LOCALITY /y NEAREST CITY �E `/� ZIP CROSS ST. _ O.OF BLDGS. ASSESSOR - SIZE OF LOT NOW ON LOT MAP BOOK I PAGE P RCEL DISTRICT GROUP TYPE FIRE PROC SED V TRACT 1-6D BLOCK LOT -'T��o COIN SIS I' J' TEL. OWNER /�'./(/ r� .O O' STATISTICAL CLASSIFICATION SEWER AP ADDRESS ` CLASS NQ _DWELL.UNITS BK PG CITY y/��'+��L'i� ZIP U ONE NO, U ARCHITECT OR TEL, ENGINEEP NO. SPECTlAL CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED _ YES ❑ NO❑ CONTRACTO �09bl BLDG.SETBACK FROM J NC. FRONT PROP.LINE OF (STREET) ADDRESS gd- 1% ��rJ"'� 'r' NO.J✓3 -/ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING CITY Lam " LICCLASS FRONT PROP.LINE HIGHWAY WIDTH CONSTRUCTION LENDER + NAME AND BRANCH ��D N Y d BLDG.SETBACK FROM 0 ADDRESS CITY SIDE PROP.LINE OF ISTREETI U SO.FT. 9 NO.OF NO.OF CHECK HIGHWAY + YARD TOTALSETBACK FROM TYPE OF EXISTING SIZE C STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH O ❑ + = F— DESCRIP IONOF WORK NEW („) ADD CORNER CUTOFF YES ❑ NO ❑ W a ALTER ❑ U) ,y REPAIR ❑ IN OPEN SPACE VES ❑ NO ❑ Z EXISTTIINGUSEBLDG. S/l(��HCG.- DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ /� APPLICANT TEL �j}z �2D /US/�. �io�-/ sr+E 43-y" IPRINi ,n//Q� jff��' NO. =�0�� I HEREBY ACKNOW DGE THAT I HAVE READ THIS PPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES .. AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE - WORK AUTHORIZED HEREBY I WILL NOTEMPLOYANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE LIFORNIA IN RELATING TO W MEN'5 COM- ION SIG A TUR INSURANCE. l//L SIGNATUREOF u1 FINAL :�',J /8 BY PERMITTEE -Cf'l�' / DATE ADDRESS j�� 'o CITY NO. �(S� P.C. Fee$ Permit Fee (J �f Issuance Fee VALUATION /.: C/ Total Fee PLAN CHECK VALIDATION \ CK., MO." CASH PERMIT VALIDATION cK.` m.o. CASH 1 6 3 w-MAR ao 1 D 7 0.0 0 76A638A CE X803A 6/76 '•.`• I��+[) `61�+IJ� AODREHB G I.J/7d� APPLICATION LOCALITY 7� !' �' G'_e/ CIl NEAREST 7 LIU�+- .G l 42 /1 �� DIVISION OF BUILDING AND SAFETY CROSS ST. �p� y��(' �/ (�1�� Department of County Engineer DISTRICT NO. (RECEIPT NO. V PERMIT NO. County Of Los Angeles �� n 3 / '7 '? WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED ` GTE ISSUED CABBATT D. GRIFFIN. BUP•i Or BUILDINBI I6, /w�FOR APPLICANT TO FILL IN Tr ONBT. RECEIVED BY ISSUED BY OWNER A S( w �•7a `O '('i�. MAP /y- /wV MAIL �/� / / \/ NUMBER AlPV O- $HSE YEB �O ADDRESS GY J CITY /ASM TV USE ZONE SPECIAL CONDITIONS i ARCHITECT OR / TEL. ENGINEER NO. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADORERS FRONT CONTRACTOR 1� /Q N0. �/.✓✓L `P P.L o� 12 ADDRESS Z / � _.. 7t 1 P. L. E BIDE HUILDING /j .�f r✓ D TE CORRECTIONS INSPECTOR ADO REBB/J 57 LOT R1 'j 7 LOT NO. ! / 31& W I /3 /3� 1 3 BLOCK /• /T nvr+.I� S.An! , TRACT __)n4 ? �. � a L ZU I NO.OF BLDGS. AP clef 1ti G-nR L/Ai$ SIZE OF LOTI NOW ON LOT USE OF / EX113TIN93 8 LOU, DESCRIPTION O£ WORK ? '"n y G v tc AJ r U• 1 P A uA pa �� cl n NEW ADD X ALTER REPAIR DEMOLISH = Bq.FT. ^ NO. Of NO.OF D HIZE Z7' STORIES j FAMILIES F USE OF STRUCTURE JlOVC J'n An NO.OF EMPLOYEEO I 'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS APPROVALS INSPECTOR'S SIGNATURE DATE CORRECT. IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION [, e! AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS.MATERIALS /6J .ire[t.+F� l/5 T FRAME: FIRE STOPS. / 81ONATURE Or'14 ��M BRACING.BOLTS PERMITTEE— � �/ ,N FURNACE: LOCATION. e�L iC% Wrl�hU�r/rT VVIH [i'pVSh iL OAS VENT.DUCTS ADDRESS LATH. INT. z AUTHORIZED ADT. LATH. EXT. HOUSE RECT NUMBER ED — FEE REST AND NUMBER CD VALUATION I ®� U FINAL I1 FEE 76A638A DBS 3 4.84 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self !///—$$P P V(OOM�M N pR R S M V - OpRN Tinsure, or a certificateof Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) - COUNTY OF LOS ANGELES BUILDINGAND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy.is filed with the county building inspec- BUILDING �- tion department. ADDRESS IV Date Applicant - cla ZtI LOCALITY G - . CERTIFICATE OF EXEMPTION FROM . OF BLDGS.WORKERS' SIZE of LOT NOW ON LOT NEAREST ' COMPENSATION INSURANCE ' CROSS ST. ASSESSOR (This section need not be completed if the permit is for one J .- TRACT - BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less:) - / r .NE �Z , OWNER. C -I 24, C4 USE ZONE MAP I certify that in the performance of the work for which this I O. permit is issued, I shall not employ any person in any manner ADDRESS Q 1 SPECIAL , a, YY" 7 CONDITIONS so as tobecome subject to the ark rs' Co ensation Lows. � - _ _. O CITY -�� ZIP Date Applica ARCHITE T OR TEL r 2 NOTICE E TO APPLICANT: If, ft r makingthis Certificate of ENGINEER NO D STRICT GROUP TYPE FIRE PROCESSED BY Q Q� CONST. ZONE V Exemption, you .should b me subject to the..Workers' Compensation pro"visions of the Labor Code, you must forth- ADDRESS a with comply with such provisions or this permit shall be deemed revoked. I ,e f CONTRACTOR7c/7z//(b T STATISTICAL CLASSIFIC TION APT.. CONDO.. N Z LICENSED CONTRACTORS DECLARATION - fA t CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRES NO. 'LV LIC. SEWE P (commencing with Section 7000)of Division 3 of the Business yL •L� A'9/� /� and Professions Code,and my license is in full force and effect. CITY' A IJL /v'/'T CLASS L^" BK�� VALIDATION '` /1 SO. FT. NO. OF NO. OF CHECK License Number pp 72 Lic. Class ^^7—/ c� SIZE STORIES FAMILIES ONE VALUATION Contractory r)IML-K Date _7',[.(- D y DESCRIPTION OF WORK NEW ❑ s Ob ❑ ADD 1 am exempt under Sec. fO C,6 - ❑ D .ALTER. ❑ B.&P.C. for this reason S 2� `( USE OF REPAIR Date' �� -+ EXISTING BLDG. DEMOL Signature - APPLICANT .P TEL. FINAL i NER-BUILDER DECLARATION - (PRINT)„ O NI �� DATE I hereby offi that I am exempt from the Contractor's license ADDRESS' C, 0YZ( FINA Law for the following reason.(Section 7031.5, Business and Professions Code). PRESENT - - By - - ` - - -J M1 El J,I, as owner of the property, or my employees withBU ADDRESS _ _ `_ - AL'�T•i - wages as their sale compensation, will do the work and LOCALITY D 3CC •�1 the structure is not Intended or offered for sale(Sectio . - —' 7044, Business and Professions Code:) - MOVING - TEL. - - ' - _❑ T HS I, as owner of the property, am exclusively contracting CONTRACTOR NO. 1 ITEHS with licensed contractors to construct the project (Sec- ADDRESS I OTAL 68 a 63 tion 7044, Business and Professions Code;) - t CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY ED TOTA PROP LINEFROM yyIDTH —'T_'•"• &•v3 1 hereby affirm that there is a construction lending agency for FRONT. _ CHANGE .Gil -the performance of the work for which this permit is issued P.L: (Sec. 3097, Civ. C.). SIDE Lender's Name 0000-0001 7/31/877 LDMA Ref. # qt m .1_ P.C. Fee$ Permit Fee J - 47.r0 C�•-38 Lender's Address <7� I certify that I have read this application and state that the Issuance Fee J v LOMA P2# D 8 above information is correct. I agree to comply with all County Investigation Fee / R ordinances and State laws relating to building construction, Total Fee LDMA Perm. IT r a hereby auth rize representatives of this County to enter u n 11 abov ntioned property for inspection purposes. a ,T'-�Z- _ SEE REVERSE FOR EXPLANATORY LANGUAGE . .. Signature of Applicant or Agent Date ;w , WORKERS' COMPENSATION DECLARATION V / I hereby affirm that I have a certificate of consent to self ////pp�L�� O O ��//((��////pp�� I�1��I��IppI�� FOR DR �p1 M O insure, or a certificate of Workers' Compensation Insurance, lrUPPUC-4'111r��UV Il OR BUMOUNG PISUYIIIVLIOT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OFACIS ANGELES BUILDING AND SAFETY PolicyNaIV83-22515�6mpany Fremont Indemnity Certified copy is hereby furnished. BUILDING_ FOR APPLICANT TO FILL IN ADDRESS —1 C 4' Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 97.11 Broadway LOCALITY p, NEAREST Date 9/20/83 Applicant Virgin Ronf Cn_ CITY Temple City ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE - SIZE OF LOT NOW ON LOT MAP BOOK I PAGE PARCEL (This section need not be completed if.the permit is for one • p L USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK ' LOT NO.P�r 3,6 NO. 'Z-O L) TEL ,_� SPECIAL I certify that in the•performance of the work for which'this OWNER NO. CONDITIONS CL . - permit is issued, subject O shall not employ any parson in any manner GROUP TYPE FIRE PROCESSED BY CONST. Z so as to become subect to the Workers'Compensation 9711 Broadway DISTRICT Compensation Lows. � ,y ONE UU Date Applicant CITY ARCHITECT OR ZIP STATISTICAL CLASSIFI TION APT. CONDO. O TEL. NOTICE TO APPLICANT: If, after making this-Certificate of ENGINEER. ' ' NO. U Exemption, you should become subject to the Workers' CLASS NO. DWELL. UNITS_ d Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be Z- deemed revoked. TEL' BK. I VALIDATION CONTRACTOR Virgin Roof NO. LICENSED CONTRACTORS DECLARATION UC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P-0, Box J NO. Ifin6SOVALUATION (commencing with Section 70D0)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY San Gabriel 9177.8 Cuss C39 $ 1425.00 D 160650 '' NO. NO.OF CHECK License Number Lic.Class C39 SIZE STORIES FAMILIES ONE $ Contractor Virgin Roof CO. Date 9/20/83 - DESCRIPTION OF WORK Re—roof NEW ADD I am exempt under Sec 2 •F S A ALTER � FINAL ❑ 6.8P.C. for this reason COm OSi tlOn shingles. ' REPAIR DATE 17.5 —e4 Date: USE OF DEMOL E] FINAL /� � .EXISTING BLDG. BY c9'"'. 4—ill <5 6 0,3 A Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT Vir in Roof CO No. 2870507qe o o s o I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS P.O. BOX J San Gabriel 91778 P 2.o a (19,'8 a Professions Code): PRESENT :-i- o 49,8'8 Q ❑ I, as owner of the property, or my employees with BUILDING Q 9,2 7783 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY - 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- gpORE55 tion 7044, Business and Professions Code). _ REQUIREDTOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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.L. (Sec 3097, Civ. C.). - SIDE ' P.L. Lender's Name $ Lender's Address P.C. Fee$ Permit Fee 39.38 ' certify that 1 have read this application and State that the Issuance Fee 10.50 above information is correct. I agree to comply with all County- Investigation Fee g ardi neer and $totaaaws'relatin tobuildmg construction, 49 ''$$ - u and ereby authonze re pr saotativ s bf this County to enter TotbL Fee u the obnye-ri�ntion d prop rt dgkifispection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S' azure of Applicam or Agent _D' nte. .' �, .� � � - " - -