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HomeMy Public PortalAbout6038 AGNES AVE_Building__ _%�' P L 1 CAT 1 O N FOR r COUNTY OF LOS ANGELES OF COUNTY .B U fL D 1 N G PERMIT DEPARTMENT BUILDING AND SAFETY DIVISION ENGINEER BUILDINGFOR APPLICANT TO FILL IN ADDRESS BUILDING //, ADDRESS (Cr C/ 1-f G� LOCALITY �r�� ` NEAREST CITY / /� QZIP CROSS ST -NO OF BLDGS ASSESSOR SIZE OF LOT SG' 'X�9U NOW ON LOT '3 MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ESSED Y TRACT 56 BLOCK 7 LOT NO S?�� CONST ZONE A TEL ad OWNER c09//e ���J�C/ NO STATISTICAL FICSE LASSIATION WE P ADDRESS®G_?7 CLASS NO DWELL UNITS BJ3,/PG CITY �G' /�J ZIP US ONE OP G ARCHITECT OR TEL r � SPECIAL ENGINEEp NO `����((, CONDITIONS ADDRESS - ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONTRACTOR,,P�,t5- TEO�k77 DG SETBACK FROM / / fes RONT PROP LINE OF (STREET) q ADDRESS 7la�y �!�/✓/1� �j NO��T, !7TOTAL SETBACK FROM TYPE OF EXISTING te/ LIC p / HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH CITY / r/ CLASS s0 _ r CONSTRUCTION LENDER + _ } �a NAME AND BRANCH LDG SETBACK FROM OU ADDRESS CITY S PROP LINE OF ISTREETI 0 SQ FT NO OF NO OF ) CHECK HIGHWAY O ALS ACK FROM TYPE OF EXISTING ' SIZE �� STORIES FAMILIES / ONE LINE HIGHWAY WIDTH wa N + _ �Z DESCRIPTION OF WORK NEW El w�� Qf�/ oar ADD CORNER CUTOFF YES ❑ NO �� rooya "g�y ALTER ❑ REPAIR � IN OPEN SPACE YES ❑ NOUSE ❑ EXISTTIING BLDG �S/ Q/002 It-E5 pDEMOOLL�j❑ IN COASTAL PERMIT ZONE. YES ❑ NO ❑ APPLICANT ,./C' TEL (PRINT) �!/L � E BY ISIGNATUR t t IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 1 N� >, { • 1 l 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 NOT EMPLOY ANY PERSON IN VIOLATION OF ' THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM t PENSATION INSURANCE SIGNATURE OFFINAL /' l 7 BY PERMITTEE DATE I ADDRESS ,/�� L✓tel/' �/"� �E CITY��v � 91 77s Np P C Fee $ PermitFee Issuance Fee VALUATION / Q Q 0 Total Fee PLANkCHECKIVALIDATION —CK M o CASH PERMIT VALIDATION K M o CASH - Bui. Uou ^� �Z�°"7 ti > 3 4 1 JUL� 3 -1 1 6 9 A036� t OS 76A638ATCe��++ ?803A 8%77+/v 1 t M r C `- ATlantic 74751 1 _�� ©s 76A638A, , CE/803 L7tEV 8/78) ` A.sr t �1M APPLICATION FOR BUILDING,PERMIT I COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING p ,/ ADDRESS 4 /V BUILDING ' q �p ADDRESS Q, 14 Ci 7 LOCALITY L ` NEAREST CITY �y� CsLiIi ZIP 0,9 BLDGS CROSSST Gr SIZE OF LOT J V[\ 1 /O NOW ON LOT 7 ASSESSOR MAPBOOK PAGES PARCEL / ` / DISTRICT GROUP TYPE FIRE PROCESSED BY TRACT lQ D(a /BLOCK LOT NO Z CONST ZONE TEL OWNERZ tAC` ` 1 'G NOS 41 STATISTICAL CLASSIFICATION SEWER MAP ADDRESS00S�8 4. i,IP u(> CLASS NO DWELL UNITS BK.36G CITY 9'� ZIP 08 ARCENGIiITECT NEER O� J 1, NOTEL' JrM1 i VALUATION $ ., V ADDRESSBLDG SETBACK FROM ~ TEL FRONT PROP LINE OF (STREET) CONTRACTOR Q j t NO TOTAL SETBACK FROM TYPE OF EXISTING LIC HIGHWAY t YARD = FRONT PROP LINE HIGHWAY WIDTH ADDRESS NO LIC + CITY CLASS CONSTRUCTION LENDER BLDG SETBACK FROM NAME AND BRANCH SIDE PROP LINE OF (STREET( HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH O SO FT NO OF NO OF CHECK + = U SIZE Q STORIES FAMILIES ONE l CS DESCRIPTION OF WORK NEW PC Fee$ Permit Fee /� 9 CA-- I Vv ADD ❑ Issuance Fee Z ALTER _ REPAIR ❑ Total Fee USE OF DEMOL ❑ EXISTING BLDG Z APPLICANTS�� 1C � f TEL C Q(PRINT) W. NO,2U� 7 (y O Z BY(SIGNATURE( C ; A 0 6 3 0 A IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y # 0 0 0 0 0 1 THATAND THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W WORK AUTHORIZ DLAWSTHEREBYI IDWILLL NONG TEMPLOYANY PERSON INTRUCTION I CERTIFYTVIOLATI ONG NTHE OF V - 2002200 THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM Z PENSATION INSURANCE 0 0 0 2 2 0 0 SIGNATURE OF0 0(��'�8 PERMITTEE ADDRESS,(0(51fiL) Z TEL G CITY` NO ~, r O USE ZONE [MAPNO zb6 Q SPECIAL CONDITIONS FINAL W DATE � • ` 76A638A'E#803 263,APPLICATION FOR BUILDING PERMIT{ nklc , COUNTY OF LOS ANGELES N BUILDING s F{DEPARTMENT OF COUNTY ENGINEER _ ADDR, p (r t BUILDING AND, SAFETY DIVISION LOCALITY, } t JOHN'A LAMBIE COUNTY ENGINEER NEAREST , WILLIAM A JENSEN 'SUP T OF BUILDING 3 CROSS ST R,e, I r DIST ICT GRO� CTYPE ONST PROC D BY t r FOR APPLICANT TO FILI: IN "� , 0_ d t - BUILDING �- f+ < <STATISTICAL CLASSIFICATION SEWER MAP ADDRESS C r� ; � CLASS NO J DWELL UNITS LOT NO pZ - BLOCK WATER CERTIFICATE NOT REQUIRED 11CII RECEIV1ED{❑ TRACTa + MAP HIGHWAY STATE MAJOR SECON LOCAL r - NO OF BLDGS n NO L DIr+ , (CIRCLE) SIZE OF LOT q t} NOW ON LOT USE ZONE PECIAL USE OF ,, CONDITIONS EXISTING BLDGm*:&yArAt ( ( o 'yTEL v r OWNER -� NO �j / B I INC YARD HWY F +STREET NAME EXIST SETBACK 111 , WIDTH ADDRESS st h erFRONT ARCHITECT OR TEL P L ENGINEER l t i NO SIDE P L * r a YADDRESS I TEL O CONTRACTOR441i NOe 6aZ[Q / ADDRESS Y G✓(�" /1} ..I/7Ll DESCRIPTION OF WORK { / 0 r a H NEWFT T ADD ALTER REPAIR n DEMOLISH _i s,jl I /p � - � �a v C/ Z SQ NO OF NO OF l7 SIZE Q STORIES FAMILIES i �Ic- USE OF a i e vSTRUCTURE - - A 9 SIGNATURE OF APPLICANT i n VALUATION -!4! Om I APPROVALS i DATE INSPECTOR S SIGNATURE FOUNDATION LOCATION FEE FEE $ l FORMS MATERIALS FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION r WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS + , BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORKT AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT y- A ING TO WORKMEN S COMPEN SATION'IN5URANCE A ���j �,,.✓f LATH EXT SIGNATURE OFO HOUSE NUMBER COR a 6 s PERMITTEE / _+0 �- RECT AND POSTED ADDRESS (o FINAL; J�3� PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRINCIPAL ST TU RAL ENGINEER PERMIT VALIDATIO CK4 M O CASH Lr+ 07 3 2 2 JAN 61 1 _Q 11.50— � l T 1 Iv r , A WORKERS COMPENSATION SECLARATION here, y affirm that I have a certificatpe of consent to self APPLICATION M F O R BUILDING PERMIT i sure or a cer�iricate of Workers Com ensahon Insurance i a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY y olicy No Company Is Certified copy is hereby furnished FOR APPLICANt TO FILL IN ` BUILDING ADDRESS ❑ Certified copy is filed with the county building enspec BUILDING tion department ADDRESS ejr C1 3 I - V .G LOCALITY 4 _— _ NEAREST /L I? Date Applicant CITY ZIP CROSS ST 1 /�✓LV I CERTIFICATE OF EXEMPTION FROM WORKERSe NO OF BLDGS ASSESSOR i COMPENSATION INSURANCE SIZE OF LOT -0 r., NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one — USE ZONE MAP hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO TEL +, SPECIAL I certify that in the performance of the work for which this OWNER i _ NO5122 4, 5 CONDITIONS d permit is issued I shall not employ any person in any manner ADDRESS � (STRICT GROUP COTYPE FIRE PROCESSED BY CI NST ZONE V sso as to become subject to the Workers Compensate n Laws U / Date Applicant CITY C- ZIP STATISTICAC CLA SIFICATION CONDO O G NOTICE O APPLICANT If after making t s Certificate of ARCHITECT OR TEL V Exemption you should become subject to the Workers ENGINEER Q U." X.,ti- 2 NO CIASSNO �DWELL UNITS a Compensation provisions of the Labor Code you must forth ADDRESS '_�_ - r SEWER MAP Sys with comply with such provisions or this permit shall be _Z deemed revoked CONTRACTOR 4 = NO S BK PG TI VALIDATION LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 - ADDRESS P a G2 3 Z NO 3G Gv V LUATION (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code and my license is in full force and effect CITY A;M CLASS - C , C SQ FT tVOF JNO-OF CHECK License Number J /S Lec Class SIZE (< IES r FAMILIES l ONE (\ NEW ❑ $ Contractor Date G!—/-> l DESCRIPTION OF WORK / _ ADD ❑ I am exempt under Sec ALTER FINAL B&P C for This reason - REPAIR ❑ Date USE OF DEMOL ❑ FINA -24204A s EXISTING BLDG BY Signature APPLICANT Ll. NO TEL _ �S # eta o a o 1 OWNER BUILDER DECLARATION PRINT +// I hereby affirm that I am exempt from the Contractor s License 7ojjj� +9 28, 00 Law for The followingreason Section 7031 5 Business and ADDRESS )S pC /�n�JJL, _ S 0 U6 Professions Code) ( PRE N o o 2�' ❑ v BUILDING I as owner of the property or my employees with ADDRESS wages as their sole compensation well do the work and the structure is not intended or offered for sale(Section LOCALITY 7044 Business and Professions Code) MOVING TEL o9 1 7—8 4 ❑ 1 as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec ADDRESS tion 7044 Business and Professions Code) REQUIRED TOTAL 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 - ti (Sec 3097 Civ C ) SIDE m P L r j Q Lender s Name � I Lender s Address PC Fee$ PermitFee ' I certifythat I have read this application and state that the t PP Issuance Fee r above information is correct I agree to comply with all County Investigation Fee �i ordinances and State laws relating to building construction Total Fee Fer>Q d and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes Mw ► — - i �- q L SEE REVERSE FOR EXPLANATORY LANGUAGE \ / Signature o pp`ant or Agent / Date M Y ' L / / ®_ y -�� APPLICATION FOR.BUILDING PERMIT {r�,111/'111r111 C Y COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION NFOR APPLICANT TO FILL IN BUILDING a�DDFF, 1 hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS (QGL'f vV/� or a certificate of Workers' Compensation Insurance,or a certified - �/J]�NE� &1_�nl c L"/�� eA Copy thereof(Sec.3800,Lab. C.) CITY-7-7/ �LE /�,T� ZIP �j�� LOCALITY / Policy No.Z�cS r/y U'✓,T<3c� Company S*1rA7__) L SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CRO&S ST. Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. &WZ/.f (-A - departmp /// USE ZONE MAP NO. Date 2/ Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNEFj JC '/ d�ET�i TEL 2� 7S3I.r COMPENSATION INSURANCE ,C/�GSS �� WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS Q dollars ($100)or less.) (po30 N• q61/�s DISTRICT GROUP TYPE FIRE ZONE PROCESSED BY CIT1-- ZIP I certify that in the performance of the work for which this permit �C/wl L �iTi , ��� is issued, I shall not employ any person in any manner so as to subject t0 the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. become sub f P STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. r� / DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CQ4TRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith EitiVAN(�t2ti�,�CI��2rJEs 3jr�^�'2�S FRONT comply with such provisions or this permit shall be deemed revoked. LIC.NO. P L LICENSED CONTRACTORS DECLARATION T !;-b 7Z PILE CI�L.�- ��T•! LIC.�yLA P L I hereby affirm that I am licensed underprovisions of Chapter 9 �Em « L — SEWER MAP (commencing with Section 7000)Of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code, cand my license is in full force and effect. Zaprj / NEW BK PG d Li e,�rase Nu ber J�Z 2CAC LiC.Class / DESCgRRIIPTION OF WORK ADD ❑ VALUATION Q �b5it,'ccttoor���1' � IL�JQ Date Z'fi'Y OdE �1vcT:.✓6' �QVF l.9yE�s- $ ZS00 U ALTER ❑ I�tPcACE �AM�lBE� G�Ippr� .1'//E�3r/A'-'✓6' ElI am exempt under Sec. REPAIR El $ 0 BAP.C. for this reason �I[i �J/CT'uJ )DOF Sid T6/97. DEMOL ❑ U LDMA P/C# III Date: USE OF EXI I(N`G BLDG. URM ❑ [L V Cc III:,r s Signature APPJ,IFFANT(PRINT) _ TEL NO. LDMA Perm# Z (/ie i�.�, �+L ��E c2 UR.�vvE Z 3Sp-�Zd� Z r ❑ 1,'as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is ADD�jS „ J �y O not intended Or Offered for sale (Section 7044, Business and �lxetIC�i I EE ,t/ a ���� ev, FINAL DATE Q Professions Code.) 5 �'Z —�S M ; `_ EM, WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting 44,ith AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? > +� licensed contractors to construct the project (Section 7044, FINAL BY > (1;t j�[ �,; � � __5 =a Business and Professions Code.) YES 11 No (�}ti r•, � WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �f,.s. CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR l l�j�(ji�� ui . GUIDELINES. I hereby affirm that there is a construction lending agency for YES 1:1 NO(a N the performance of the work for which this permit is issued(Sec. SCHECKL,ERE .THE AZARDOUS ATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, E f_IDO! 1 I`E 2,CHAPT 2.20 S IONS 2.20 100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name RI S REP RTING A FOR O TAINING A PERMIT FROM THE SCAQMD. {'r? j -? yf o Lender's Address ,C Vi t OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to Comply P.C.FEE PERMIT FEE wl unty inances and State laws relating to building m constru on, a hereby authorize representatives of this County ISSUANCE FEE ato enter on t above-mentioned property for inspeQction purpo�s/eS. �[ 1�'✓�i C_Zy47 INVESTIGATION FEE TOTAL FEE r Sgnat of A ant Agent Date SEE REVERSE FOR EXPLANATORY LANGUAGE CI'T'Y C �~ Y 7YAE]EAC.#.o, ,—e, APPL.ICA�T'10N FOF�6I:3�11t_Dis V , PERMIT r COUNTY OF LOS ANGELES q,'jp`N DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOJVL x- JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUPT OF BUILDING CROSS ST DISTRICT N GR UP TYPE SED BY FOR APPLICANT TO FILL IN j�} CONST BUILDING STATISTICAL CLASSIFICATION SE ER MAP ADDRESS 6038 N. Agnes �K PG CLASS NO ELL UNITS - LOT NO BLOCK WATER Lt CERTIFICATE NOT REQUIRED RECEIVED TRACT MAP HIGHWAY NO OF BLDGS NO (CIRCLE) STATE MAJOR SECOND VOCAL) SIZE OF LOT I NOW ON LOT USE ZONE!' PECIAL USE OF CONDITIONS EXISTING BLDG TEL dT I OWNER W. R. Chandler . NO BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH ADDRESS Same FRONT ARCHITECT OR TEL c L ENGINEER NO SIDE P L G ADDRESS INSPEC ON RECORD c CONTRACTOR Virgin ROOF C O NOH T70507 600 S. San Gabriel B1. " � ` j � C � ADDRESS - ` DESCRIPTION OF WORK t n V NEW ADD ALTER REPAIR DEMOLISH SQ FT Nb--e-p- NO OF IZE STORIES FAMILIES USE OF STRUCTURE I SIGNATURE OF APPLICANT VALUATION$ 240 00 APPROVALS DATE INSPECTOR S SIGNATURE PC FOUNDATION LOCATION FEE $ FEE $6 00 FORMS MATERIALS FPAME FIRE STOPS N I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE�EFN JCONLI'PENSA71�OF THE STATE OF CALIFORNIA RELAT ING TO WORKON INSURANCE (,, LATH EXT SIGNATURE �t r/ 4L i / �� HOUSE NUMBER COR PERMITTEE Ate' C., RECT AND POSTED 1 1 ADDRESS 600 S. San Gabriel Bl. [FINAL moi'- � `(,� L �2.e-r , San Gabriel CLYDE N DIRLAM PRINCIPAL STRcK URAL ENGINEER PLAN CHECK VALIDATION cm M o cA$H PERMIT VALIDATION MO CASH LALIO 6 6 0:n �JGU �, 1 D 600- COUNTY OF LOS ANGELES, t''- L ICA,eI IQN FOR DEPARTMENT OF" OUNTY'ENGINEER ui L_b I I�G PERMIT r BUILDING" ND'SAFETY DIVISION " BUILDING FOk'APPLICANT TO FILL IN ADDRESS 0'.- � GL LDING ADDRESS �� V� t �V1� �� LOCALITY— NEAREST [ 4iCf 't r Pt ` LOCALITY— NEAREST CITY Z'll ,- '9-W - NO r OF BLDGS ` ASSESSOR { SIZE OF LOT r]�1 x �( _NOW_ ON'LOT ��r � l"� _"' MAsP BOOK PAGE _ _ PARCEL T TRACT Cp �Q BLOCK' LOT NO IR+d A DISTRICT GROUP r TYPE FIRE ROCE EDBY If C� p) 'j Q�j +�//p �� �f✓ w�G �cONSq /m e e ZE %6 ° OWNER' , 1�1C£. 1'11 b ° ^�N0��7�l', Ib 7 r y M K STATISTICAL CLASSIFICATION ' SEWER MAP ADDRESS � [���1 � , ��{ Q U1f CLASS NO __DWELL UNITS ' ''�r/=a'"'BK 1134?-^°' CITY 1. G ZIP q~ J �rsvhr d Mtdt f y USE ZONE MAP t� ENGNEE ARCHITECT OR NO /` r SPOECIAL 4 r' r 7 R j�, +r 'r-, ;1 _ CONDITIONS r _ I ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED 'YES'[!] r�yL N0 a r `TEL r vu _ ..,t.,, CONTRACTOR - �V O - NO - BLDG SETBACK FROM µ �° "— — — °r a - LIC— ADDRESS aA. FRONT PROP LINE OF t (STREET)' ADDRESS NO HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC FRONT PROP LINE HIGHWAY WIDTH CITY a r+ (JJ-pn r i ' 'CLASS p r P j CONSTRUCTIO 'L NDER �! + R' NAME AND B ANCH w e y f s i res 4'BLDG SETBACK FROM v SIDE PROP LINE OF r - (STREET) ADDRESS CITY O SQ FT t 1 NTORIES FAMILIES ONEO OF NO OF CHECK "H GHWAY + YARD = TOTAL SETBACK FROM TYPE OF" EXITING U SIZE IS TORIES SIDE PROP LINE HIGHWAY WIDTH w S k w 0M _ p Z I DESCRIPTION OF WORK_ � NEW '' + I h-1--o�' ��+t ADD ,® CORNER CUTOFF YES'0` NO` ❑ ALTER �L_J IN�OPENSPACE _t YES `Q Y� NO ❑ 4 r REPAIR , USE OFt( yO saw COASTAL PERMIT ZONE - YES-Q w NO � EXISTING BLDGybC.AJI^Q.F l4 lot _ DEMOL ^ RA` 1 APPLICANT TEL -7 ��� � i ...(PRINT),._._ NO {{ re'a 1 1"l/ 1n� it k I A-Z AN,T BY(SIGNATURE( _, ` I HEREBY ACKNOWLEDGE`THAT II HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE ISw CORRECT AND-AGREE TO COMPLY WITH ALL ORDINANCES A r `f r AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE 'y� v�' WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF ""`+�.� r�NV ,, �t w1r f THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM "T s I PENSATION INSURANCE SOFINAL BY PERMITT _ teDATE- ` ° eADDRESS !j pr i �` ti TEL C_Fee ! i Permit Fee CITY J a C NO .77�Q pi ` ^ ! , � Issuance Feed t� W J I } VALUATION 4, Q,c? ° Total Fee 6 ti p{p{PLAN CHECK VALIDATION CK M O `CASH = " ,>t PERMIT VALIDATION —A ''M o'L T CASH i �4 r ' � I — 57 "0 4AY �r 1 u ro _ .».5 il � 1 i k T)S 76A638A CE#803A 8/77 y » r k� 1