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Home My Public Portal About9860 VAL ST_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT CO TY OF LOS ANGELES �� Q D W . J. F��c, CHIEF ENGINEER FOF APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING <�1 „/� r� ADDRESS 1 � /2 ` �s [ LOCALITY p . 7 RECEIVE1/D BY DATE OF APPLL/qL DATE ISSUEDNEA EST _ 13R089 ST. BUILDING ADDRESS �410 G. I OWNERMAIL �� p [J p ¢��. LOCALITY Q /.7NEAREST �. TEL "7 CROSS 9T. CITY • NO. FIRE N.O.OF TYPE GROUP I ARCHITECT OR L ZONE PLANS ENGINEER NO. BLDG. p ORD.NO. ADDRESS ,. - '�� SETBACK LINE "it, �d APPROVED EL" BY DATE CON RAOTOR � � � Qs .�. -. O. y USE //�yy� APPROVED ADDRE .�/ �� ZONE /r7�I BY DATE LEGAL �gg ®r 2_6C 5 CORRECTIONS DESCRIPTION L_c=NQ.-IY_P� LOCK Jj o� ��% v TRACT U .:S ._ifa/ �� .-.o 91ZE of LOT /rl p �15%_d I NOW ON LOT I r USE of NO.OF O.OF go EXISTING BLDG. FAMILIES I RNDoMB DESCRIPTION OF WORK NEW ALTERATION ADDITION O REPAIR MOVING DEMOLISH • AO 60.FT. NO.CF Z SIZE a ROOMS em BTORIE WALL ROOF COVERING i� ( COVERING USE OF NEW BUILDING o � ,aoc) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION ,JNSPECTGR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS PERMITTEE LATH,INT.: AUTHORIZED AOT- G%t ;� LATH,EXT.: "�2-1-4 ct nee-e 5OM BETS 1-48 $ O® P.C. O PLASTER,INT. �J PLASTER,OCT. VALUATION FEE C? FINAL ..y-� �� /.'.. APPLICATION FOR-BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) ABUILDING DDRESS O COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER CITY C ZIP BUILDING AND SAFETY DIVISION 110.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT _ ADDRESS ' TRACT U BLOCKLOT NO. /� LOCALI 'Y TEL. NEAREST OWNER NO. CROSS ST. ` n ` r ASSESSOR ADDRESS L MAP BOOK PAGE RCEL DISTRICT GROUP TYPE FIRE PRO SSED BY CITY , �� ZIP p CONSTT..J' ZONE 13 44� ARCHITECT OR TEL. QB V� "ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS N��,, DWELL.UNITS BK PG CONTRACTOR �, NEOL y USE ZONE MAP ADDRESS N0'- .4�p(3J SPECIAL LIC, n )� CONDITIONS CITY CLASS O D DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDd.SETBACK FROM FR95NTPROP.LINEOF (STREET) C ADDRESS CITY HI WAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING C SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE o + C NEW ❑ - C DESCRIPTION OF WORK tr C ADD ❑ BLOG,S CKFROM o b SIDE PROP,L (STREET) v T T ET�ACK FROM TY F EXISTING �� ` ALTER ❑ HIGHWAY t YARD - SIDE PROP. LINE HIGHWA WIDTH ❑ USEEXISOREPAIR T NG BLDG. DEMOL ❑ + APPLICAN TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) e) MVCN0. Vr(dm:0% BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ Q Ov CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO y`� WORKMEN'S COMPENSATION INSURANCE. G7// ) i�� r�C_ 1, I •1 SIGNATURE OFVj PERMITTEE[) ADDRESS C l L r� CITY TYLCCAc�IFA NOL•�'i'�b`�y DIATE 7_,7 � BYG -�C��`'. MAKE CHECKS PAYABLE TO: F E � FEE HARVEY T. BRANDT. COUNTY ENGINEER �j OG PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH ! A�.. 3 2 1 9f3 SEP 17 1 D 12,0 0 A 76AG38A CENS03 12/72 nv �., APPLICATION FOR BUILDING PERMIT LICANT TO FILL IN (Fr(nt or type only) BUILDING COUNTY OF LOS ANGELES . ADDRESS xgz DEPARTMENT OF COUNTY ENGINEER CITY ZIP ! BUILDING AND SAFETY DIVISION O.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS D TRACT BLOCK LOT NO./ LOCALITY I TEL. NEAREST OWNER ' ;!T�jE NO. CROSS ST. `v - �- ASSESSOR ADDRESS V MAP BOOK PAGE PARCEL / DISTRICT GROUP TYPE FIRE SED Y CITY ZIP ! , $ �/' CONS ZONE ARCHIT TOR TEL. ` , .4 -�F�' ENGINEER NO.' STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NOrDWELL,UNITS BK ` PG CONTRACT R f Al HEEL. t.75/% ZONE MAP p2o A- > ADDRESS I C z/("j _;_Ka'� oc.27 - V�� SPECIAL CITY LIC. 7/0 CONDITIONS CLAS CONSTRUCTION LENDER .ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ NAME AND BRANCH BLDG. ETBACK FROM FRON PROP.LINEOF (STREET) ADDRESS CITY HIGHWA �• YARD = ,TOTAL SETBACK FROM TYPE OF EXIST ; FRONT PROPING SIZ SQ. FT. NO. OF NO.-OF CHECK . LINE HIGHWAY WIDTH E g� STORIES FAMILIES 'ONE } D'ES'CRIP-TION OF WORK NEW ❑ 0 ADD a LOG.SETBACK FROM CJ SIDE PROP.LINE OF (STREET) o ALTER ❑ HIGHWAY } YARD = TOTAL SETBACK OM TYPE OF EXISTING V �- REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH _ y EXISOT NG BLDG. DEMOL-❑ + Z APPLICANT TEL = CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION, O'D Yr ,, �! s ��// f� ��♦♦ J �,f� '1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE.15 CORRECT AND AGREE TO COMPLY ,WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL. NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF •CALIFORNIA IN RELATING TO r-� � Wir -1e(_;0AY WORKMEN'S COMPENSATION INSURANCE. r SIGNATURE PERMITTJF J�i.7 /1 it fes! TEE ' ADDRESS :ells'? /VOT- J`�r� CITY. NOL DIATE ` _.q�F"� BY MAKE CHECKS PAYABLE TO: FEE � FEE HARVEY T..BRANDT. COUNTY ENGINEER PLAN'CHECK -VALIDATION CK. M.O: CASH - PERMIT VALIDATION CK. M.O. CASH 566N ( V 4 1 D 7 -9.75A98 76A698A CE#808 574 I APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI BUILDING DR SS c� I hereby affirm that I have a certificate of consent to self insure, d or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CP-11 �-� /v, zip e (� 9 LOCALITY Policy No JI.� `� �� Company 7�J�-`f A25 i SI7 OF NO.OF BLDGS NOW ON LOT / 11 rrr Certified copy is hereby furnished. NEAREST CROSS ST. Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. vf/ p I USE ZONE MAP NO. Date yi_-Z -IrApplicant�� / /�Ya`��/ ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERTEL NO. COMPENSATION INSURANCE I C. , WITHIN 1000 FT.OF SCHOOL? YES NO � (This section need not be completed if the permit is for one hundred ADD ESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CITY ZIP is issued, I shall not employ any person in any manner so as to " �— become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. Q DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' TOR TP.,Nq7SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith _ � rf 0 210--A= /�a FRONT comply with such provisions or this permit shall be deemed revoked. ADD ESS UC.NO. PL C 1C d r SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.C S PL I hereby affirm that I am licensed underprovisions of Chapter 9 "1 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG , a License Num er ��n— 4_� G' Lic.Class —7 C? D CRIPTION OF WO ADD ❑ VALUATION O we�T__ ,� Contractor r- 'IZ ate /h-2�^��r a10ALTER ❑ $ U El I am exempt under Sec. (3 L e REPAIR 11ACCT.a O $ 41 �' ~ BAP.C.for this reason �}"� 9 �j DEMOL ❑ t��i.i 172. L LDMA P/C# _ Date: US F I TING URM El I 1 ENS co Signature I -� +-h APPLICAN PWNT) TEL NO. LDMA Perm# I� 1 (SCJ i `'-•� ❑ I, as owner of the property, or my employees with wages as O their sole compensation, will do the work and the structure is ADDR S _ not intended or offered for sale (Section 7044, Business and lr� MW m LFINAL DATE QCHANGC ' w Professions Code.) WILL THE APPLICANT OR FUTURE ILDIN OCCUPANT HANDLE A HAZARDOUS MATERIAL ? � 1 � J ��`� ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Y Y 9 AMOUNTS SP�NO CIFIE ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY C licensed contractors to construct the project (Section 7044, YES❑ 0000-001- l �r ) /�7 Business and Professions Code.) WILL THE I DED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING V�rr-i(0j00-0 -11 6J 0 7C' COAST AIR QUALITY MANAGEMENTRDISTR CT(SCGMD)SEE PON OR IERMMI�TTING CHECKUSN FROM THE TOUTH FOR 0/C` �' f CONSTRUCTION LENDING AGENCY GUIDELINES A'�1 '`'t I hereby affirm that there is a construction lending agency for YES❑ NO iA the performance of the work for which this permit is issued(Sec. IHAVE READTH HAZARDOUS MATERIAL N RMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CH ST I UNDERSTANJM V UNDER THE LOS ANGELES COUNTY CODE, Lender's Name R REPORTING AC11 TITLE 2. APTER 2 20 S A R MH 2 SCGMD.G HAZARDOUS o Lender's Address � IX! OR NGENT o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE / Gv $ with all county ordinances and�S to laws relating to building a7 O m cons n, and hereby autho' e presentatives of this County ISSUANCE FEE �. o96 m to nter up n he above- t' e ro r inspection purposes. -ZV-G INVESTIGATION FEE TOTAL FEE / / J! `O CJ n lum 0 AW—t Or hp 1 . SEE REVERSE FOR EXPLANATORY LANGUAGE • <-WORKEIRS'COMPENSATION DECLARATION •I hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, or•o certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli •�a._CompanyBUILDING O/O Vified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS dr/ ❑ Certified copy is filed with the county building inspec- BUILDING 67?6 7 v�L ST tion department. ADDRESS c�77 Date�'� Applicant CITY Y�E ZIP �/��0 LOCALITY �/&-I;- r NO.OF BLD T NEAREST CERTIFICATE OF EXEMPTION FRO WORKERS' SIZE OF LOT tf / -I NOW ON LOT CROSS ST. COMPENSATION INSURANCE 1'234W l 0 ASSESSOR ; �-3 O (This section need not be completed if the permit is for one TRAGI' BLOCK LOT NO. MAP BOOK .7 .J Q PAGE Q PARCEL hundred dollars ($100)or less.) p�yypTEL p r� OWNER D`sc*� doe N O pal USE ZONE MAP I certify that in the performance of the work for which this �//,� �^-+ NO. permit is issued, I shall not employ any person in any manner ADDRESS V 4 `l J ( SPECIAL CL /n�,, CONDITIONS so as to become subject to the Workers'Compensation Laws. CITY �� C ZIP I/ZP0 0 Date ApplicantARCHITECT OR TEL. W NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' CONST. ZONE b Compensation provisions of the Labor Code, you must forth- ADDRESS .Dr `3 a. 5 w with comply with such provisions or this you shall be TEL• Q� v STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTOR `- m L NO. 7( V �j--// Z_ LICENSED CONTRACTORS DECLARATION LIC. pia?/p3CLASS NO. CO24 UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS Gid BK PG VALIDATION p� , �, SQ. FT. NO. OF NO. OF CHECK p�@ License Number J�1w � Lic. Class SIZE STORIES FAMILIES ON 't�,�` .. n / a VALUATION Mc Sy 3 '�/�r I DESCRIPTIO OF WORK o ❑ Contractor Date _3k- / C-11417 $ //10"' r ❑I am exempt under Sec. - i S•CLfCO ADD ❑ 11011.B.BP.C. for this reason ��, � ALTER 10:13 $ REPAIR t� Date: EX STUNG BLDG. (,IJ/'� Signature ��"` a APPLICANTTEL, OWNER- ALDER DECLARATION (PRINT) 9/Z_*y/_0J S1 NO ?7 FINA Z I hereby affirm that I am exempt from the Contract License Y DATE Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT By ,-.- A. ❑ I as owner of the property, or m employees with BUILDING li4,i•►°a P P tY� YADDRESS -•- wages as their sole compensation,will do the work and 3337 1:`_�•'1 i the structure is not intended or offered for sale(Section LOCALITY i ,!_4'� 7044, Business and Professions Code.) MOVING TEL. 1 !17 Ei ME ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. I � with licensed contractors to construct the project (Sec- 717-1-1 tip J .s m -a- tion 7044, Business and Professions Code.) ADDRESSLl.�i 1-r° REQUIRED TOTAL SETBACK FROM • EXIST. CHECK CONSTRUCTION LENDING AGENCY EInvestigation YARD HWY PROP. LINE WIDTH 'CHANGE I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued P.L. P. (Sec. 3097, Civ. C.). r Lender's Name ° _ $ Permit Fee o LDMA Ref.# ft�`75 1 AM111 ,,- Lender's Address , I certify that I have read this application and state that the Issuance Fee LDMA P/C N 3 above information is correct. I agree to comply with all County ee Is r ordinances and State laws relating to building construction, Total Fee i LDMA Perm. 0 and hereby authorize representatives of this County to enter the above-mentions rop Fry for inspection purpo s. o SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Applicant or6bent Date