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Home My Public Portal About9963 BROADWAY_Building__ DEPARTMENT OF BUILDING AND SAFETY AYYLICA"11U14 rvn kr-XU iI COUNTY OF LOS ANGELESQ u ' L D ' _ WM. J. FOX, CHIEF ENGINEER v FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT NO. PLAN CK.NO. PERMIT NM ADDRESS /. r �77� LOCALITY RECEIVED BY DATE OF APPPL DATE ISSUED NEARESTBT ��QI 6 -/ - 47 Gi/ 2/47 CR099 . BUILDING �9 P {� K .OWNER ADDRESS T'� �/ (J /�/'1 MAIL / - "I F•m/��. ADDRESS LOCALITYNEAREJ� y1 CITY/A A.t`,( NO CROSS ST. ✓A A// O /-Ft/F , FIRE NO.OF TYPFge GRDUP ARCHITECT OR TEL PONE PLANS Y/- T ENGINEER �Y SLOG. WwORD.NO. ADDRESS SETBACK LINE ��rtg4- APPROVED TEL BY DATE CONTRACTOR NO. USEAPPROVED ADDRESS ZONE �I BY DATE LEGAL DESCRIPTION LOT NO. CORRECTIONS I BLOCK �� /' //�� 4 A9 TRACT tGC Ok/ f♦ r 6� OL 912E OF LOT I NONOW.OF BLOGSAy . _n ON LOT ��/C� EXISTING BLDG. FADMILDI[R ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O m REPAIR MOVING DEMOLISH p Sq.FT. NO. OF / Z SIZE ROOMB (O STORIES WALLROOF COVERING CDVERIND USE NEW ^ , US BUILDING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS ✓ 4 „„ �� ✓y AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, �I SIGNATURE OF BRACING•BOLTS OWNER LATH,INT.: I I p 7 AUTHORIZED AG% LATH,EXT.: R�a ee yes-a 25N sers I-nv $9 �'lS 6/ FOG- P.6® + PLASTER. INT.0 /J7R' FEE / PLASTER, EXT. _ 670-2 S 00 VALUATION FEEFINAL APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPUCANT TO FILL IN BUILDING ADDIS ��✓ I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS L.�q o or a certificate of Workers' Compensation Insurance,or a certified CITY nnn14� ZIP copy thereof(Sec.3800, Lab.C.) LOCAuiv Policy NO. Company SIZE OF LOTI I NO.OF BLDG NOW ON LOT d ❑ Certified copy is hereby furnished. NEAREST CROSS T. ❑ Certified Copy is filed with the County building inspection TRACT BLOCK LOT NO department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER T COMPENSATION INSURANCE �50 1^1 WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS tlio� C DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I/I ZIP ocertify that in the performance of the work for which Thi permit is issued, I shall not employ any person any man r as ARCHITEC OR ENGINEER TEL NO. become Ublect o the Workers' tion L ws. STATISTICAL CLASSIFICATION APT CONDO Date �'� Applicant _J� L� ADDRESS CLASS NO. '- r DWELL UNITS NOTIC TO APPLICANT.' If, al r n king this Certificate Of REQUIREDLYARD TOTAL SETBACK FROM EXIST Exemption, you ShOUItl become subject 10 the Workers' CCNTR R $EL NO. O'�'7 SET BACKHWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 00 yl l ly gL48 1 LFRONTcomply with such provisions or this permit shall be Seemed revokea. ADDRESS f egLIC. �•II\�. 1 LICENSED CONTRACTORS DECLARATION CITU - I ASS ifq I hereby affirm that I am licensed underprovisions of Chapter 9 S ! " SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,an I'c ns is in full force a effect NEW BK PG d License NU b r ' Lic.Class DESCRIPTION OF s ADD ❑ VALUATIONS �.'� , Q Contractor 1� Z i Date 9S �r ALTER . ❑ o iN1y y ❑ 1 am exempt under Sec. NS�d X REPAIR ❑ $ 0 B8P.C. for this reason LA5JII C DEMOL ❑ LDMA P/C/ W Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm A j Z ❑ 1, as owner of le r perty, or my employees with wages as Z - T' their sole compensation, will do the work and the structure is ADDRESS 0 not intended or offered for sale (Section 7044, Business and FINAL DATE 2 Q Professions Code.) WILHARIA L THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ~'�`I/ 1?u.b: J _ El 1, as Owner Of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ITEMS AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 1 1 1 EI IJ licensed contractors to construct the project (Section 7044, YES El No Business and Professions Code.) TOTAL 3-28 - 63 WILL THE (REQUIRE USE OF THE BUIDLINR BY THE APPUCANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY coast AIR Ququrr MANAGEMENT DISTRICT IscAomol SEE PERMITTING cHEcxusr FOR -�-� C:HE{:Yi 12$.15'J GumsurvEs _ I hereby affirm that there is a construction lending agency for YES El No El CHANGE" .011 w the performance of the work for which this permit is issued(Sec. SDgT,GIV.Ci. I HAVE READ THE HAZARDOUSMATERIALS INFORMATIONGNDE AND THE SCAOMD PERMITTING - N ) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE _ TITLE 2.CHAPTER 2.20 SECTIONS 2.20 100 THROUGH 2.20.140 CONCERNING HAZARDOUS I}0170—I iL01 1/2b/90 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMO. o Lender's Address avNeRoar.;eNr 795 1AM11:U? Jr_ o I certify that I have read this application and state under penalty O of perjury that the above information Is correct. I agree to comply P.C.FEE PERMIT FEE $ with all county ordinances and State laws relating to building a A d am construction, and hereby authorize representatives of this County tSSUANCE FEE n to enter upon the above-mentioned property for inspection purposes. a INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE