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Home My Public Portal About9957 BROADWAY_Building__ Cs 7('A638A�� CF#803 UI 6/76) 1 ( � APPLICATION FOR' BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN DI ADDDRESSRESS Ad BUILDING p (� ADDRESS , ✓ W LOCALITY m �+ NEAREST CITYrEm 4{�^ 1... ZIP CROSS NEAREST. NO.OF 8LDG5. ASSESSOR SIZE OF LOT p Q NOW ON LOT MAP BOOK PAGE PARCEL TRACT �Zp 0S BLOCK LOT NO.J DISTRICT GROUP TYPE ZONE P SED BY i? /� CONST ZONE OWNER /L�/�� 1/ TELINCA •� J VO `41 V 3 STATISTICAL CLASSIFICATION EWER MAP ADDRESS S7 CLASS NO. —1 DWELL.UNITS � SKI PC CITY ZIP ARCHITECT OR TEL. VALUATION $ ENGINEER ` NO. ADDRESS BLDG.SETBACK FROM '/ TEL no FRONT PROP.LINEOF ISTREETI CONTRACTOR G ,(� NO. 8� HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXIS➢NG ADDRESS /� I7 L AI M6 LICNO. Qy FRONT PROP. LINE HIGHWAY WIDTH CITY AA2cop-[Af C4, C ASS 5- 1 + CONS UCTI LENDER d�. BLDG.SETBACK FROM NAME AND BRANCH �0pv�", SIDE PROP.LINE OF (STREET) HIGHWAY + YARD _ TOTAL SETBACK FROM I TYPEOF 1EXISTING ADDRESS �� CITY SIDE PROP.LINE IHIGHWAYI WIDTH C SO.FT. NO.OF NO.OF 7 CHECK + V SIZE STORIES /} FAMILIES / ONE cc DESCRIPTION OF WORK DD NEW C1P.C..Fee$ Permit Fee 0 �/V ADD J7 9 ❑ Issuance Fee z ALTER 'f, REPAIR ❑ Total Fee 160 USE OF EMOL ❑ .l EXZT NG BLDG. / f�M/!. l� cT..h� Z APPLICANT TEL (P I TjAf,1< iffQmAlpy No. vX 1, /1- /9 "7`/-2-22_J BY ISIGNATUR I HEREBY NOWIEDGE THAT HAVE READ THIS APPLICATION p STATE Y THAT THE A E IS CORRECT AND AGREE i0 COMPLY WITH ALL DNANCES IViI AND LAWS ULAUNG BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE S WORK AVi RIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF U THE LABOR DE OF THESTATE OF CALIFORNIA IN RELATING TO WORKMEN 5 COM- Z PENSATION INSURANCE. Q o. SIGNATUREF >' X 4 6 0.2 A PERMITTEE n A ADDRESS # o opo °'o � Z �' p4pM TEL _ ° 2 16000 CITY /1 NO. Q us�ZON� MAPa 0� ° 1 60.000 NO. SPECIAL 0 a2 9'-7 9 CONDITIONS F FINAL pt')� BY DATE G` d�/ Y A ROAD DEPT. PERANT IS REQUIRED FOR ANY IJ•.AT"LR1.=.L S:- :T'-�E OR V✓GRK DONE IN THE ROAD RIGHT OF WAY- .. AY. onAeneA=e se=„_e, APPLICATION FOR BUILDING PERMIT �. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS G ti -O BUILDING AND SAFETY DIVISION LOCALITY C. JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. / fy� DISTRICT NO. GROUP TYPE CESSED BY r FOR APPLICANT TO FILL IN ,j I CONST. z sIL t BUILDING C STATISTICAL CLASSIFICATION _ EWER MAP ADDRESS J (� �� /.BK. PG CLASS.NO._j�DWELL. UNITS [- /L LOT NO. ,7 BLOCK MAP STATE YES NO- NUMBER - C+ HWY. TRACT USE ZONE SPECIAL ��(( NO.OF SLOGS. �/ CONDITIONS - SIZE OF LOT •rL NOW ON LOT USE OF EXISTING BLDG. BUILDING EXIST. SETBACK YARD HWY STREET NAME I WIDTH OWNER S FRONT .{ - MAIL //JJ P.L. ADDRESS 976~ ,$ Q Q SIDE TEL. CITY 2 B C No. INSPECTION RECOR ARCHITECT OR TEL ENGINEER NO. /�,�/ �J ADDRESS �-7 TEL:_ / J /�//ILII /f/I (V'L CONTRACTOR { � q NO. ` /NO Oft9T 7 r rT/ ADDRESS Y ./1;J P Z DESCRIPTION OF WORK 14.F -1' 19 4h[L tele A1SPl1 A/'fJ/N AIA4:741 NEW ADD ALTER REPAIR DEMOLISH Sq. FT. _gni NO. OF NO. OF Ft7dIY TU AnL I G // SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF ,,-/ u/ +L7D ✓W�?I /��r/Y �L'QUI.-�/r'D \ APPLICANT_wI G� APPROVALS DATE INSPECTOR �'S[SIGNATURE OUNDAADDRESS • � � FFOR MS. MATERIIALSION /, - Z7-lO /�/i .�✓L✓.G^��/� VALUATION $ I FRAME: FIRE STOPS, (J BRACING, BOLTS - S' L/7 44 P.C. I PMT. FURNACE: LOCATION, O FEE $"�--�1 FEE GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH, INT. AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS EGULATING BU DI G C NSTRUCTION. LATH, EXT. —/47J Q' SIGNATURE O HOUSE NUMBER COR- PI OR- PERMITTE RECT AND POSTED ADDRESS L� ✓ 'FINAL t, 22 CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL M. EL./R PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. O. CASH U!eo93222 AFR15 1 A ' 5.010 . $- WORKERS'COMPENSATION DECLARATION ae ` 4 �IUI I hereby affirm that I have urcertificate of consent toself APPLICATION FOR BUILDING PERMIT insure, or o certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SIIIFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING n ,Y� ADDRESS F1Certified copy is filed with the county building inspec- BUILDING _ tion eportment. ADDRESS r- Date 5'-a�-BD Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. ASSESSOR hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL TEL' USE ZONE MAP I certify that in the performance of the work for which this OWNER NO. - NO - permit is issued, I shall not employ any person in any manner SPECIAL so as to b come subject to the Workers'Compensation Compensation Laws. CONDITIONS Cl �sU Date Applicant • r ��s CITY _ ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT O TEL. DISTRICT OUP J TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. CONS `NE U W Compensation provisions of the labor Code, you must forth- ADDRESS 5� with comply with such provisions or this permit shallbe d deemed revoked. TEL s STATISTICAL CLASSIFICATION APT. DO. f/) CONTRACTOR O. 'L�J '�7s /� Z LICENSED CONTRACTORS DECLARATION IC CLASS NO.1L.�DWELL. UNITS_ hereby affirm that am licensed under provisions of Chapter 9 ADDRESS NO. Z SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and my license is in full force and effect. CITY JZe4oCLASS 19 BK PG VALIDATION SO.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES IFAMILIES ONE y VALUATION ❑ 9 L DESCRIPTION OF WORK NEW Contractor Es.. C.oZ�"� Date� 7 k� ADD ❑ $ 101.I am exempt under Sec. TERR $ B.BP.C. for this reason r� A � � ❑ Date: USE EXISTING DEMOLNG BLDG. ❑ a Signature APPLICANT TEL. FINAL �yt OWNER-BUILDER DECLARATION PRINT NO. DATE !/ 1 hereby affirm that I am exempt from the Contractor's License 2 94 7.0 A Law for the following reason (Section 7031.5, Business and ADDRESS FI Professions Code): PIESENT RISE #(e • e °.0.1 O I, as owner of the property, or my employees with BUILDING ADDRESS wages as their sola compensation,will do the work and ) ° ° 2 a 5 0 the structure is not intended or offered for sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. e - - 2a505 1, as owner of the property, am exclusively contracting CONTRACTOR NO. \ with licensed contractors to construct the project (Sec- \ Q Q 2 7 8 8 tion 7044, Business and Professions Code). ADDRESS - .;` ,�� l CONSTRUCTION LENDING AGENCY RSET BACKEQUIREDYARDHWY OP, 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 LDMA Ref, # m Lender's Address P.C. Fee S Permit Fee I certify that I have read this application and state that the Issuance fee O.�v LDMA P/C p 4 above information is correct. I agree to comply with all County Fee Investigation _ I? ordinances and State lows relating to building construction, g Total Fee LDMA"Pe m.'8& -� .} �,�\ •s a` � s,` and hereby authorize representatives of this County to enter - upon th above-mentioned pro a for inspection purposes. 1 —Z 7— _ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of App 1 or Agent Dote