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HomeMy Public PortalAbout9108 BROADWAY_Building__ 7GA638ACE;.. ,.s APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS - BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. OISTRICT NO G OUP TYPE ��µ� P ESSED BY FOR APPLICANT TO FILL IN j CONST. 1// — t� ADDRESS- - 9106 E. Broadway T.C . STATISTICAL C LASSIFICATION r_. S BKR MAG CLASS:NO--_- DWELL. UNITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED ❑ CERTIFICATE: TRACT s MAP /iJ HIGHWAY GHWAY O NO.OF BLDGS. NO. i �// ( RCLE) STATE MAJOR SECOND, AL SIZE OF LOT NOW ON LOT _ USE ZONE SPECIAL USE OF � CONDITIONS EXISTING BLDG. OWNER J. W• Ward NO. BUILDING EXIST. rt� SETBACK YARD HWY STREET NAME WIDTH ADDRESS 9108 E. Broadway T.0 • FRONT ARCHITECT OR TEL. P. L ENGINEER NO. SIDE ' T ADDRESS 0 CONTRACTOR Virgin Roof CowoL.AT70507 u ADDRESS 600 S. San Gabriel Blvd. o DESCRIPTION OF WORK San Gab W a NEW , ADD ALTER REPq R DEMOLISH Z Sq. FT. NO. NO. OF SIZE _ STORIES FAMILIES USE OF STRUCTURE - Re-roof House & Garage SIGNATURE OF APPLICANT VALUATION54 000 APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION - FEE S FEE $ 6.00 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, WITH ALL CwNTY CRUINANCES AND STATE LAWS'REGULATING GAS VENT. DUCTS ' BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WOPK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LgTH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA PELAT- INC TO WORKMEN' �/YC,O(M-P.E,NSSATION INSURANCE./ -/_� LATH. EXT. SIGNATURE O6 %%N CLaiGtG[LF HOUSE NUMBER COR- /7 PERMITTEE �,1--, RECT AND POSTED ADDRESS 600 S. San GCS riel BX'd• FINAL San a P e JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CN. N.O. CASH _ PERMIT VALIDATION SC M.G. CASH Leo4 6 4 8 JAId20 1, D 6.00 7SA63aAE 48032-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY U JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST, c(/ DIST CT NO. G OUP TYPE CESSED B FOR APPLICANT TO FILL IN . �O C CONST. BUILDING O STATISTICAL CLASSIFICATION - EWER MAP ADDRESS V BK PG CLASS. NO. DWELL. UNITS�� LOT NO. 1 BLOCK WATER' CERTIFICATES- NOT REQUIRED RECEIVED ❑ TRACT f /. NO. OF BLDGS. q NOP � / HIGHWAY STATE MAJOR SECOND OC L SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OFT CONDITIONS EXISTING BLDG. f I 'I1,DIJ I • r-At'I/ e OWNER �l AMyS W� ,WflR NO, r /-/SBUILDING EXIST. d E. ��iq�Wl4 SETBACK YARD HWY STREET AME WIDTH ADDRESS 9/66 FRONT APCHI TECT OR s. (C� LG TE Q' I SOP L. IN, //JJ Imo` SIDE ADDRESS!S 1.7 N1 /F_R ^l{T e4v4TE P. L CONTRACTOR I a -Ic60L R13, .CON OL 1.! S O ADDRESS 1336 S, A I A/V r /c- ✓ 0 r O DESCRIPTION OF WORK w D_ NEW ADD 'ALTER REPAIR DEMOLISH H Z SFT. OF SIZE STORIES' STORI FAMILIES FAMILIES USE OF STRUCTURE _fi � .r_In T 10 , F BE12C >955 �eQEc?NiA� ' ` . SI GNATU RE OF I APPLICAN VALUATIONT _ S APPROVALS DATE INSPECTOR'SSIGNAT URE P.C. PMT.. / FOUNDATION: LOCATION FEE $ FEE $ FORMS, MATERIALS FRAME: FIRE STOPS, !` I HEREBY ACKNOWLEDGE THAT I HAVE R EA..THIS:AFPLICATION BRACING. BOLTS 1 �• AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. / f 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. r 1. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN 5 COMPENSATION INSURANCE. LATH, EXT. \ w .SIGNATUREOF HOUSE NUMBER COR- PERMITTEE OO�''&yu I Q'GUGO RECT AND POSTED J -ADDRESS_/J SCJ 5; FINAL r JOHN F. LEWIS. PRINCIPALISTRUCTURAL ENGI PLAN CHECK VALIDATION CK.; M.O. GASH PERMIT VALIDATION CK. M.O. CASH t� lo5368o FEB 7• .1 D. 8.00- $50295---.S8- - . . WORKERS' COMPENSATION'DECLARATION ;' . 1 ?'-•Bk'; �;Ip' I hereby affirm that I have a certificate,of consent*to self - O /ppb 'EL�9,� O O I�l��p�[/(��. O I��} O �f�'Lp//A�� insure, or a certificate of Workers Compensation Insurance, //'-pp PL CJ-0V7 0 �J FOR �D �O.LD�U V�/ PISRUOL T or a certified aCOUNTY OF LOS ANGELES BUILOINGANDSAFETY PoliIl_5AompaoFrPmnni- Indemnity Certifiedcopy is hereby furnished +t ',:. • _ FOR APPLICANT TO FILL IN i BUILDING" yn . _ _;- _ _ O V 1 Certified copy is filed with the county building inspec- ADDRESS BUILDING i ttion deportment.,.' ADDRESS 9108 E. Broadway Date Applicant V{ ruin AlsnF f+0• CITY 'TeInple Clty ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' - NO:OF BLDGS.-- -1 NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. - (This section need'not be completed if the permit is'for one - ASSESSOR �-- 'E - hundred dollars ($100)or less.) _ TRACT BLOCK LOT NO. MAP BOOK v PAGE PARCEL Mrs v Ward _ TEL. USE.ZONE MAP t I certify-thdt io the performance of the-work for which this OWNER NO. 1 NO permit is issued, I shall not employ any person in'any manner ._. 9.108 E. Braodway —' SPECIAL - - -- - -- - 1 so.as fo become subject to the Workers;Compensation Lows. ADDRESS CONDITIONS V Date _ . CITY_ -Temple :City _ zip Applicant ARCHITECT OR TEL. • ' NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GROUP TYPE 1 FIRE _ PROC SSED.BV,_. ENGINEER - NO. CONST.• ZONE • Exemption; you should become subject to the Workers' -'- � l/'y� Compensation provisions of,the Labor Code, you must.forth- ADDRESS �A3 _� W with comply with,such provisions or this - - - - - TEL �� py p permit shall be . -. _ - _ N deemed revoked. • . CONTRACTORVir 171 Roof CO. N6287-0507, STATISTICAL CLASSIFICATION APT. CONDO.. Z LICENSED CONTRACTORS DECLARATION.,- . - -.- r - -_._. -.LIC. CLASS NO. DWELL. UNITS + hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P•Q*• BOX J N6160650 ccm{nencin with�Section 7000 of Division 3 of the Business and SEWER MAP - ( g - San Gabriel LICA . C39 ` BK VALIDATION Professions Code,'and my license is in full force and effect. CITY CLASS 50. FT. _ NO.OF NC-0F _CHECK _ - LicenseNumbei 160650 •Lic'Class , C39 SIZE STORIESFAMILIES ONE r y „ ' - VALUATION - t DESCRIPTION OF WORK Reroof -house-' NEW ❑ D 1- ContractorViiti n Rnnf"Y`mpte 6/_1 R�85 $ 11'317.00 and garage with #220. ADD ❑ I am exempt under Sec. - --❑ f9 - ALTER B.&P.C. for this reason composition shingles.l9sq EPAIR _❑ $ - Date: USE OF EXISTING BLDG. DEMOL ❑ _ -Signature - _ " ' APPLICANT - TEL. g OWNER-BUILDER DECLARATION PRINT) Virgin ROOF O. Np, 2$7-0507 FINAL .� �`,(,�` _ _ DATE �2323A I-hereby affirm that I am exempt from the.Contractor's License P Q $OX J San Gabrie1917 Law for the following reason'(Section 7031.5, Business and ADDRESS P.O. FIN :tet •'u. # a • • � • Professions Code): - .. - PRE EN - .. :. 'B -:- �_ _ l--- ❑ - '• I, as owner of the property, or my employees with BUILDING ADDRESS / ) • • 9. wages as(heir sole compensation,will do the work and 4 8 8- the structure is not intended or offered for sole(Section LOCALITY D - • •;• 4 9 8 8 oxi 7044, Business and Professions Code). - MOVING - ` " - TEL. -' - - ' - - - 1, as owner of thero erl am exclusive) contracting CONTRACTOR - NO. P P Y• Y 9 062578 rJ with licensed contractors to construct the project (Sec- ADDRESS J tion 7044, Business and Professions Code). ,.r - - -CONSTRUCTION LENDING AGENCY - REQUIRED YARD HWV TOTAL SETBACK 1--EXIST.-. . . __ - .. _ 1 -. SET BACK 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 - _PA, - - - - - - - --- - - --- - - --- - - - - - (Sec. 3097, Civ. C.). SIDE ' P.I. Lender's Name ' 1 39 38. DMA Ref. R' Lender's Address - P.C. Fee E - Permit Fee r - - -- - - .50 1-certify that I.have read this application.and state that the - Issuance Fee-10 ee10 - - III P/C M - D----• 1_ . _ - -. •a a above information is correct. I agree to comply with all County Investigation Fee I g ordinances and State laws relating to building construction, -_ - - _ j u and her by au that ize representatives of this County to enter -- Total Fee - - LDMA-Permr#-- - ------ - -• upon th above-mentioned pert for inspection purposes. - (Q�18_��- SEE REVERSE FOR EXPLANATORY LANGUAGE t . Sign t eofApplicantor Agent- - - Dale )'r WORKEFS' COMP +SAVON DECLARATION ^. It he7ek7y affirm that I hdve a certificate• of consent to self — /�p� p n n Fin R F��ry,1p��/1�e.. +insure, or o certificate of Workers' Compensation Insurance, APPLOC ATOQ�l,.�,FOR' BU OL©ONG PERMOT of o certified copy.thereof (Sec. 3800, Lab. C. '\ `��'•-­�r'-COUNTY- OF:LO - 1 =' ) S-ANGELES BUILDING AND SAFETY Policy No.T_Company ' - 1 •'y' / Certified copy is hereby furnished. _. FOR APPLICANT/TO FILL IN BUILDING' ��B �YTNy//V Certified copy is filed with the county building inspec- BUILDING tion deportment. ADDRESS 0# RoA W�7 Dote Appliconl CITY Pq&9 �q G� ZIP �� o LOCALITY f�'n? Pe—'r l CERTIFICATE OF COMPENSATION IN FROM WORKERS' /6��i'i�l NO. OF LOT 2 CROSS OSSNEARESST. (�ol7i.•/ /J L COMPENSATION INSURANCE SIZE OF LOT �w 1 NOW ON LOT (This section need not be completed if the permit is for one TRACT 1d1Q ASSESSOR hundred dollars ($100)or less.) !,� BLOCK s���( LOT NO. MAP BOOK PAGE PARCEL OWNER f kA v fL4ry /FtM14 No369-05LL7 USE Z E FSPPEN�;IIDAJ certify that in the-performance of the work for which this permit is issued, I shall not employ any person in any manner dd yJ,, M� LADDRESS B /JtQvA' WR'1 ' Oso as to become subject to the Workers'Compensation Laws. n, �•- �+ /ynTIONS Date ' Applicant/ � - A CITY (LG L� L _ ZIP ��d s/ ARCHITECT OR A ^ \^ TEL. -s NOTICE TO APPLICANT: If, after making this Certificate of - TCU J1f/ DISTRICT OUP TYPE FIRE PROCESSED BY O ENGINEER N0.5/ .54f3 Exemption, you should become subject to the Workers' p 7��w nom ) M'c� / gyp// CONST. ZONE (-- Compensation provisions of the Labor Code, you must forth- ADDRESS O 46)00N " " / W with comply with such provisions or this permit shall be TEL a-. deemed revoked. STATISTICAL CLASSIFICATION APT. NDO. N CONTRACTOR NO, Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO. DWELL. UNITS_ - I hereby affirm that I am licensed under provisions of Chopter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC, SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK - VALIDATION 1 FT NO.OF NO. OF CHECK License Number Lic.Class - ZE STORIES FAM•I-LL,IEST UNE ;29326A y Contractor Date D tPTI Olic¢/26N-0GEL GA•l7.7N NE s At TON ) • • • 2 3 ADD DI am exempt under Sea - (l -_ - R I - 39207 B.BP.C. for this reason - REPAIR Ely, z� � • • 39207'uiDate: USE OF DEMO( E%ISTING BLDG. r" L WELLt�1 6 8 8 Signature - APPLICANT QA', ^ T" OF o67 FINAL o 06-88 OWNER-BUILDER DECLARATION PRINT Vp�sv Q yT OF M' DATE `9^ / I hereby affirm that I am exempt from the Contractor's License gDDREs59�QO B/YJ/s✓W Low for the following reason (Section 7031.5, Business and FINAL Professions Code): E ) By I IVI BUILDING _ Af '`/ �- ;98x1. 1 A WL , as owner of the property, or my employees with ADDRESS �ti� !� wages as their sole compensation,will do the work and ( _ /� the structure is not intended or offered for sale(Section LOCALITY # o e • e e 1 7044, Business and Professions Code). MOVING ' I, as owner of the property, am exclusively contracting CONTRACTOR NO. 1- ( •l 3 5 q 84 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS -�• \`s` ` i t `�1\ • 0 1 3 9 8 v `�� CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY 'OTA PROP UNE WIDTH \ \` ' `\`• U\ \ - t -_:ate i .a. FROM :xIbT. I hereby affirm that there is a construction lending agency for FRONT -,� 0 7 _8 8 the performance of the work for which this permit is issued P.L. L�''�,A`__s (Sec. 3097, Civ. C.). SIDE Lender's Name \s LDMA Ref. X m Lender's AddressP.C. Fee$ 37_Z6Permit Fee - I certify that I have read this application and state that the Issuance Fee r a LDMA P/C It © �� a above information is correct. I agree to comply with all County Investigation Fee - 0 ordinances and Stale laws relating to building construction, Total Fee LDMA Perm. X and hereby authorize representatives of this County to enter _ $ upon the above-mentioned property for inspectioput oses. 3 �/ SS SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicom or Agent ate 'rv, • .';WORKERS' COMPENSATION DECLARATION � ••I� /� /� �II��1�� FOR �EI���� I�}�R�F��gp/��� ';�}'linlsu j, 00 ce;ri,rn that IofWove acs' Comenstion Insurance,self /Ok Iflf��(( /pk��OUV Il OU�1 �����YV� �LS lIU0L70�� msuR, or a certificate of Workeis' Compensation Insurance, /Hill Il V-4'll or a certified copy thereof (Sec. 3800,'Lab. C.) ' COUNTY OF LOS ANGELES BUILDING AND SAFETY .Policy No.TCompany Certified co is hereby furnished. BUILDING Q' pr v FOR APPLICANT TO.FILL IN ADDRESS /(Q dertlfied copy is filed with the county building inspec- BUILDING /'j-p j] -7Y tion department.- ADDRESS qf�(/ 0 O p Date Applicant CITY I 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 NE� MAP' - OWNER PJ tf N0.3O -OS I certify that in the performance of the work for which this No . permit is issued, I shall not employ any person in any mannerQ� A� �,.c SPECIAL CONDITIONS so as to become subject to the Workers ADDRESS /Compensation Laws. CITY C 11 C C' zip U Dote Applicant ARCHITECT OR ��// T TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER �J .lXJ' .D0U NO. --5. DISTRICT GROUP TYPE FIRE PR ESSED BY Exemption, you should become subject to the-Workers' f � ' CONST./• ZONE U Compensation provisions ofThe Labor Code, you must forth- ADDRESS Lc o �t V W with comply with such provisions or this permit shall be D-' deemed revoked. TEL. STATISTICAL CLASSIFICjQION APT. CONDO. V) CONTRACTOR 1 Z LICENSED CONTRACTORS DECLARATION C - CLASS NO. WELL. UNITS- 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. .(commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full farce and effect. CITY CLg55 VALIDATION SO. FT. NO. OF NO.OF CHECK 9K. � Q 9 A License Number Lic.Class SIZE 1 4 STORIES I FAMILIES "I� ONE LL-ST} R..S�-, G _ NEW VAL ION �.� # e e.e ° 23 DESCRIPTION OF WORK Contractor Date ADD ❑ $ (](] 1 D I - 37&05 I am exempt under Sac. + — f ALTER ❑ 8.8P.C. for this reasonU1� s a? r REPAIR. ❑ $ • • 37ao5� Date: USE Of EXIST NG BLDG. r �/�-I�' W 6 L I tU(Y DEMOL ❑ ` 0 6 0 7 8 8 Signature APPLICANT _-O NK NO3o _a FINAL /� Q OWNER-BUILDER DECLARATION (PRINT) 1 F [[�� T//�� II DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS /J �� Wq Low for the following reason (Section 7031.5, Business and ✓ 19 FINAL Professions Code): PRESENT - B BUILDING I / g 9 8:1.0 A I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 1 � LL� x u #,e�e e e e Il the structure is not intended or offered for sale(Section LOCALITYAd, �1 Y, ` 1 7044, Business and Professions Code). MOVING TEL. I --45S25 n�wUJ1 MI, as owner of the property, am exclusive) contracting- CONTRACTOR NO. A ,(J;^0(/�Q,� with licensed contractors to construct the project (Se - tit Z• ,�°.° 4 5 rJ.2 5 c=i tion 7044, Business and Professions Code). ADDRESSt ' /-t/8'% 1•�� \'x s CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK , / ,i ,`C,�) `.``.`,�.`•�_`4 t} ;, \♦] �j Q 7's 88 SETBACK 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.I. (Sec. 3097, Civ. C.). SIDE - Lender's Nome - t s' .C. Fee$ Permit Fee t-7 � ` Re /` P Lender's Address - /•. 3 L certify that { have read Ifiia otlon and state that Issuance Fee IDMA.P/C.N I above information is correct. agreegree tto comply with all County Investigation Fee r�L ordinances and State laws relating to building construction,- Total Fee d and hereby authorize representatives of this County to anter LDMA Perm. N m upon the above-mentioned property r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE lS Signature o1 Applicant or Agent D to S ' WORKERS' COMPENSATION DECLARATION APPLICATION � F�I� /� �pry111� ^y �r'��( 'EI��Ip��(/�'� �Iy�r' L•hec@by offutt, fhat I have a 5e1tificate:of consent to self A Ir.PLI ATIO �1 FOR BUOL®O.11 V\/_. U L�i00NT ins fe, or a certificate of Workers' Compensation Insurance, - 11 Il `V ora certified copy thefeof (Sec. 3800, lab. C.) - cOUNTY'OF LOS ANGELES - BUILDING AND SAFETY Policy No Company' BUILDING . ❑• .Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ' EJ Certified copy is filed with the county building inspec- •. BUIADDRE55 tion department. DING A. , � ' CITY' e lil r` zip 1'70 ' LOCALITY Date Applicant r 1 NO. OF BLDGS. NEAREST _ CERTIFICATE OF EXEMPTION;FROM WORKERS' SIZE OF LOT 16 0. NOW ON,LOT- - " - CROSS ST COMPENSATION INSURANCE ASSESSOR ' .(This section need not be completed if the permit is for one TRACT'- BLOCK" "'" LOT NO. -s MAP BOOK PAGE' PARCEL hundred dollars ($100)or less.) y TEL. 9�L '- MAP ' • OWNER 'NK i 'f' NO.7 V_. - USE ZONE NO. I certify that in the performance of the work for which this - - r �` - SPECIAL. , - > permit is issued, I shall not employ any person in any manner ADDRESS 51""G S 12 L/6- + CONDITIONS so as to become subject to the Workers'Compensation'Laws. O__ - 0 CITY - ZIP - - Dote Applicant - ARCHITECT OR11ATEL DISTRICT GROUP TYPE FIRE PROCESSED BY IY NOTICE TO APPLICANT: If; after making this Certificate of ENGINEER- .UOUL NO. -- / CONST. ZONE /J 0 Exemption, you;should become subject to the .Workers' ._ \ O� P_Z 3 Compensation provisions of the Labor Code, you must forth-. ADDRESS ..J E� l 1 J N with comply with such provisions or this,permit shall be •TEL STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked.. ; CONTRACTOR S' _6 NO. -- -- LICENSED CONTRACTORS DECLARATION LIC CLASS NO��D%A'F'' UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. LIC. SEWER MAP (commencing with'Sectiom7000)of Division 3 of the Business CIN CLA55 �, and Professions Code,and my license is in full force and effect. _ BK PG, VALIDATION SQ.FT. �l - NO. OF NO.'OF CHECK License Number Lic. Class SIZE �a! STORIES - FAMILIES ONE ' VALUATION ' Contractor Date - DESCRIPTION OF WORK NEW ❑ -$ ' ADD '❑ D .. ❑I am exempt under Sec. _ :TER I ' B.BP.C. for this reason _ (� REPAIR_ rL-JL S - Date: USE OF _ _-. EXISTING BLDG' DEM OL Signature - APPLICANT TEL. PRINT)_ NO." FINAL OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT' _ - BY x •_ - ❑_ property,I, as owner of the or mY with ADDRESS- wages - as their sole compensation,will do the work and - --.-r - r.-� r the structure is not intended or offered for sale(Section LOCALITY _ sy• t' 1,- O'_,C3 .7044, Business and Professions Code.) MOVING .., TEL.❑ DI - {' �E113 CONTRACTOR NO. ,I, as owner of the property, am exclusively contracting - _- - _ with licensed contractors to construct the project-(Sec- tion 7044, Business and Professions Code.) '• REQUIRED -TOTAL SETBACK FROM EXIST. i,. �,r': - t .� r.�pI CONSTRUCTION LENDING AGENCY SET BACK. YARD HWY PROP. LINE WIDTH - I hereby affirm that there is a construction,lendingagency for FRONT {4�LrCH - All the performance of the work for which this permit is issued P.I. - (Sec. 3097, Civ. C.). SIDE , P.1. Lender's Name $ LDMA Ref. fl P.C. Fee$ Permit FeeD 0•I'2 Lender's Address � �•- +' - a I certify that I have read this application and state that the Issuance Fee 0 LDMA P/C N 8 above informationis correct. I agree to comply with all County Investigation Fee ' R ordinances and State lows relating to building construction, Total Fee LDMA Perm. If a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicont or Agent Date '