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Home My Public Portal About5938 BURTON AVE_Building__ vrAmrn ceeor r,rr APPLICATION FOR BUILDING PERMIT .. �. COUNTY OF LOS ANGELES SIDIR s DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE.COUNTY ENGINEER NEAREST CAESATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE _PR/OCESSED BY FOR APPLICANT TO FILL IN // J CONST. V I � BUILDING 'ADDRESS Ry-*,jt STATISTICAL CLASSIFICATION SEWER M//AP LOT N , , BLOCK CLASS.NO.�WELL. UNITS K LO L� MAP STATE YES O NUMBER HWY. TRACT - - USE ZONE SPECIAL � jV / I NO.OF BLDGS. ,, CONDITIONS L SIZE OF LOT J NOW ONrLOT eA USE OF EXISTING BLDG. � (r�T BUILDING EXIST.' y�yr.. c �/ " SETBACK YARD . HWY STREET NAME WIDTH OWNER'??ltI"py . G. n �O C,C_CL. FRONTMAI L 'y A �✓ - ADDRESS L/ " (� 4 -P.L. SIDE TEL. 3 / P.L. ARTY IT rl ARCHITECT OR TEL.NO. 6 INSPECTION RECORD / ENGINEER NO. 0�' �' F S.�cFl�- i• �y � ADDRESS CONTRACTOR 671L.J�_Vr •.1r�� TE, 7T i ADDRESS �f�� /ry[. A_11i.'r 4.0 L y-73 /n ATF lo.OedL PL F_O ns u<•r DESCRIPTION OF WORK "- /iF ST .4-F o A•r-r. NEW . `ADD ALTER REPAIR DEMOLISH SO:FT. // NO.OF NO.OF ,{,C e- F-0 R p� 997 J SIZE �(O STORIES FAMILIES USEOFSTRUCTURE SIGNATURE OF `, APPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION qq p $ FORMS.MATERIALS �QQd FEE 6 _�� FRAME BRACINGRBOLTSS VALUATION $ou FURNACE: LOCATION, FEE .'J GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. (\ A PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS R$GULAXING B DING GONSTRIJCTION. LATH, EXT. SIGNATURE OF .Kn JI\ J�[]%// HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ` ADDRESS !E- 3J �k��eh FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN'GHqSE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH =` .LACO2 1 2'9 u; JAN 26 1 A 0 0 6.0 0 A 7BA638A CE#009.10.56APPLICATION FOR BUILDI NG- PERMIT BUMDING AND SAFETY DIVISION BUILDING Department of County Engineer ADDRESS County of Loa Angeles LOCALITY JOHN A. LAMBIE. COUNTY ENGINEERNEAREST C A59ATT D. GRIFFIN. SUPT of Bu u.oiNc CROSS ST. V✓ k DISTRICT NO. I GRO TYPE SEWER MAP FOR APPLICANT TO FILL IN BK PG BUILDING /�} � CONST.` ADDRESS.? / � i eel rA6�QiL✓�• STATISTICAL CLAS IFICATION n'�q ��J �- - �y CLASS. NO. DWELL. UNITS a LOT NO. { j� BLOCK MAP of .fin STATE NUMBER -.yc� IO HWY YES O TRACT �V 7 !/ c� USEZONE SPECIAL NO. OF SIZE OF LOT c7 D /�/ ✓ I NOW ON LOTS a_i�_. f CONDITIONS USE OF G/ v— EXISTING BLDG. BUILDINGE%IST. J SETBACK YARD HWY STREET NAME WIDTH OWNER Edi/�j� • l//¢ �8��C.UJ� FRONTMAIL ADDRESS J ��/�/ '� �/J^^"'KM,,,✓./�J /� SIDE P. L. . CITY INSPECTION -RECORD p ARCHITECT OR TEL. - - ENGINEER NO. ADDRESS TEL. f/ CONTRACTORs_T r/N•.O. v ADDRESS /e/.s DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE ST RIES FAMILIES ,• USE OF STR CTURE/_ APPROVAL$ SIGNATURE OF, APPLICANT DATE INSPECTDR'E SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS. MATERIALS p, C, g FRAME: FIRE STOPS. FEE BRACING. BOLTS VALUATION S FURNACE: LOCATION. ' FEE GAS VENT. DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STA THAT THE ABOVE IS CORRECT AND _ AGREE TO COMPLY WITH ALL COUNTY 0N NC AND LATH. EXT. STATE LAWS R TING BU LDING ONSTRUCTOON. SIGNATURE OF / w : // 1 HOUSE NUMBER COR- PERMITTEE . 7/ r RECT AND POSTED a o� ADDREsS �� FINAL DSO .S7 JOHN A. LAMME. COUNTY ENGINEER. CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PE WT VALIDATION CK. M.O. A LACO1 0 3 0AUG _ 6 , 1 . 2.00: 76A638A CE 980312Y6APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR4 DEPARTMENT OF COUNTY ENGINEER MAP BOOK 'r, AGE PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT or BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST U Print m t e on CROSS ST. BUILDING DISTRICT NO. I GROUP TYPE 1, PROCESSED BY ADDRESS 8 Burton San Gabriel j coNs STATISTICAL CLASSIFICATION SEWER MAP LOT NO. Lq I V 'BLOCK -2 ' _ 2 CLASS NO.__ I_OWEL L.UNITS_ BK RG TRACT J USE ZONE MAP _ NO.OF BLDGS. SIZE OF LOT �� NOW ON LOT ,'I—, ' SPECIAL USE OF CONDITIONS EXISTING.BLDG. Re SidenCe. TEL. OWNER Oreste Toni NO. BLDG.SETBACK FROM ADDRESSFRONT PROP,LINE OF (STREET) TYPE OFIEXISTING1 SETBACK HIGHWAY _+ YARD = TOTAL CITY - San Gabriel HIGHWAY1 WIDTH I FROM C.L. ARCHITECT OR TEL. + _ ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINEOF (STREET) TEL. TYPE OF EX STING SETBACK HIGHWAY + YARD = TOTAL CONTRACTOR Rigid Mfg. Co. NO. 263-5181 HIGHWAY WIDTH FROM G.L. - ADDRESS Box 6782, NO. 159496 CITE' LOS Angeles 90022 CLASS C-39 CORNER CUTOFF YES ❑ NO ❑ U CONSTRUCTION LENDERCD NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS w ADDRESS _ N Sq. FT, NO. OF NO. OF NEW ❑ � 1 Z SIZE STORIES FAMILIES STRUUSE OCTURE Re-roofing house With ADD ❑ composition ALTER ❑ �� SIGNATURE OF REPAIR APPLICANT DEMOL ❑ VALUATION $ 425.00 APPROVALS DATE INSPECTON'S SIGNATURE P,C. PMT. O rO FORMS.(MATERIALS FEE 5 FEE S B.00 FRAME: FIRE STOPS, IH ATT ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRACING, BOLTS ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, _ WITH ALL ORDINANCES AND LIN D REGULATING BUILDING CON- GAS VENT, DUCTS HERECTION. CERTIFY THAT IN DOING THE WORK ICN OF ZEE _ HEREBY WILL NOT EMPLOY ANY PERSON NI VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. RIGID MFG. CO. LATH. ExT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS BOX 67,qP- T/-t4L- 'QQ022 FINAL O- 1- JOHN F. LEWIS.'PRINCIP L TR RAL ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDAT cK. M.O. CASH LAW o 4 9 4'v. OCT 26 1 A 8.00— K WORKERS'•COMPENSATION DECLARATION /� --, T�p I hereby affirm that I,have,a certificate.of consent to self � O O ( l ... `D //p�� (//��- Icy. WRONG �^y!gyp}�rte-[�//�'T� insure, or a certificate of Workd*s' Compensation Insurance, Q��V! ��IIV -FOR ��UVCJ! 11 IS U�IUVII�� ' of a certified copy iFerEof'(Sec 3800, Lab:C:)' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy,No. -7 711-gCo pany�L•- ' 7)1Ci-1� } - - - -- - R BUILDING 5-613S ,) Certified copy is hereby furnished. t FOR APPLICANT TO FILL IN I ADDRESS F-1Certified cody is filed with the county builds o`g mspec- BUILDING -{�� -G+ - tion departments ADDRESS �l L � p -�v{may G N 7 Date Applicant^... t' CITY I 'Q.r \l Cl'CY ZIP 91-66'C LOCALITY -v CERTIFICATE OF EXEMPTION FROM WORKERS' - - - NO.OF BLDGS: - - - ' NEAREST.. COMPENSATION'INSURANCE' r• SIZE OF LOT NOW ON LOT I CROSS ST. - (This'section need not be`completed if the'permugis'for:one - TRACT BLOCK..- LOT NO. '- ASSESSOR, r ' '••S hundred dollars ($100)or-less ) - Y -, MAP BOOK - PAGE PARCEL - ` •' OWNER. KGS 1'.P� TEL. p,� 1 USE ZON£ MAP _ 'I certify that in_the performance of ihe`w+ork for wgil th s ,/� NO ,t permit is issued, I shall not employ any person m any mariner pp f/- - SPECIAD=f- -- -- -- - -- - - i a ADDRESS SGY30 :�2T'6 rJ - -`� /N- CONDITIONS O soy s io became sublecl to the Workers'Compensation Laws. o V .i -. „ t ` +, '4 . ., .CITY 1 `�.�'�\Ic CL�r f. _ ZIP _.1 ILY(c.. - ... K Date Applicant - - NOTICE TO APPLICANT: If, after making this-,Certificate of - ARCHITECT OR TEL, _DISTRICT GROUP TYPE � FIRE PROCESSED BY _, Exemption, you-should become'subject to the, Workers' - - ENGINEER NO. CONST.� ZONE (/OCE lW! Compensation provisicI the Labor Code;you must forth- J •r/b _�-,3 _ NE_ , ' IL with comply with such provisions or. this permit shall be ADDRESS -� N /^� TEL." STATISTICAL CLASSIFICATION APT. C NDO • , Z deemed revoked . . CONTRACTOR t• Cr,` ICF4 W NO 91' 1 -1 _ �S,/ _ LICENSED CONTRACTORS DECLARATION - CLASS NO. DWELL. UNITS— ..y I he reb affirm that I am licensed under provisions of Chapter 9 ADDRESS y 03Y DVCKt^B 3.1. - LIC. &'U i 3 Y P P -_ fi 1r NO,� . (commenting with Section 7000)of Division 3 of the Business and __ .LIC _� SEWER MAP Profis xins Code, and Toy license�is in full force and effect. CITY k.Os ��G zlits CLASS-"f BK - - t - _ -VALIDATION _ + i _ SO. FT. NO.OF NO,OF CHECK_ •' License Nurnb., L p (3y-3 Li,'Class ' SIZE - STORIES- FAMILIES ONE , - - VALUATION. - °>. ]F �S DESCRIPTION OF WORK J-Il/�(Jq- �.V(� NEW -'� $;'f TO�4��. a., U Contractor L' '�Cf)� 1 Cit Date _ ADD ❑ ❑ I am exempt under Sec. C7\i^`2 -Wl%U7 =- .y ALTER B.BP.C. for.this reason - .REPAIR- 0 f -. _ - _ Date:- _ USE OF EXISTING BLDG. DEMOL, ❑ - - '-Signature 1 _-- _ r "__ - _- APPLICANT - TEL. - FINAL ' OWNER-BUILDER DECLARATION PRINT NO. DATE:j� -L-- —. --- --4 I herebyoffirm that-]am exemptfrom the Contractor's Licensel - a • 231611,12A j Law forthefollowing recision (Section7031.5, Business and ADDRESS FINAL ProfessionsCode) _ - ' PRESENT - 'BY' (/// til e • e'• a ❑ - BUILDING y I, as owner of the property, or.my employees with BUILDING ADDRESS. wo9es as their sole compensation,will do the waik and D •!J• UM1: ) e e 6 a b 3 the structure is not intended or offered for sale(Section LOCALITY z .L -- 7044, BusinessandProfessions'Code). - "' MOVING -' - ' -TEL' 6 8,6 3 1- ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. -"with licensed contractors to'construct the-project-(Sec- ADDRESS 12 $ 5-- tion 7044, Business and Professions Code). - - -_ ,. .TOTAL SETBACK F --- CONSTRUCTION LENDING AGENCY _ -" .REQUIRED 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 - Pi-. - - - - - - -- - - - •-- (Sec. 3097, Civ. C.). SIDE 1q m P.1. Lender's Name - _ _ -- ' - -- - - P.C. Fee'$ - -- Permit Fee' - Lender's Address p a _I certify that_I have read this application and state that the _ _ _ _ Issuance Fee -- Ur S U LDMA-P/C 'above information is correct. I agree to comply with all County Investigation Fee y - - ordinances and State laws relating to of construction, - _ �� 6,3 _ f - _ _ , +1 i, and hereby authorize representatives of this County to enter - - Total Fee r LDMA Perm.-I! - - - - m upon the above-mentioned property for inspection purposes. - t S - - EE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent - - Date cam�, oF LOS ANGELES TEMPI cc/T/ aoILoI:uPsuiIT EN' orPUBLIC woR:s 9701 LAS TUNAS xs:zoEurrAL Aoo/xc/nE, AND :Arsr, / LAND osxaoP:cmT TEMPLE c/;, :AY17xo 3L0508040614003-' ,Hm|s: /a;5/ 285'o4eoEXT: iTR; 5903 LT IT), sc). ri STORIES TYPE 0-'�CUP GROUP 5933 BURTON AV N STRUCTURE: 4Q3 1 VN SGAI.3 CA C�-?-.'52630 �.R: GARAGE: NEAREST GRO"S STREET: I-I'S TUNAS EXIST OCC GRP: 09/23/04 JK CN/i3,/05 OWNER: TO DCS. NOW UTI:11 VALUATION: FINAL A�� ____ ___�IWAL—BY' LEE, DAVID (626) 679-C�35 5938 BURTON AV q f� EXTEND Mi�STER 1-�RCOM, ADD NEW STUDY �EMO EXIST -- ----- IFEE DESCRIPTION: QUANTITY: UOM: AMOUKT: GARAGE �EL '�-CAR GARAGE APPLICAN SAN CABilEl. T-A II!72� iAC STRONG MOTION RESID 62000.00 VAL 6,20 i92 PERMIT �;,.,ENERCY 62000.00 VAL 1,011.61 TOTAL FEES t�905.44 TE 611 7. MISSION LIC NO SrILS RAISED I;_ No 21 HK AIR QUALITY: 100TI FEET MATERIALS NO N 01 FIRE SET BACK YARD; IIY PROP LINE: WIDTH: Lcl__� FRONT PL- —SPEAR PP"_4E�Ls SIDE PL- WNS—LILA-i EX ERICT�, i7 I REPORT ID: DPR261 ROUTE TO: BS05D8 |--__-_-----�----------- ---'_-'--_{--'__------_--_-- ___-_-_--------|----_-_-'_-' ______|_------|-�'-----_---'--_-'----_| t COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA SL 0508 9712310003 PHONE: (818) 285-0488 EXT: GAL ID: N0. OF CONSTBUILDING ADDRESS: TR: 5903 LT: 101 SQ. FT STORIES TYPE 5938 BURTON AV N STRUCTURE: 100 SGAB CA 917752630 ASSESSOR INOR NUMBER: NEAREST CROSS STREET: GARIBALDI 5386-014-060 THOMAS PAGE: 596 GRID: G3 LOCALITY: SAN GABRIEL, C TENANT: EXIST BLDG : GARAG USE ZOWF-- ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 12/31/97 VG 12/31/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY CODE: FREDDIE MAC (818) 821-5249- 500 12222 MERRIT DR. DALLAS, TX FEES PAID UNC-R-1-MUN OF WORK DEMOLISH SHED BEHIND GARAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: EL. SOUTHLAND BUILDERS (909) 984-9047- AA BLDG PERMIT ISSUANCE 27.75 02 DEMOLITION INSPECTN 163.50 SPECIAL CONDITIONS: _ TOTAL FEES 191.25 CONTRACTOR: TEL. N0: •'"j � �\-'�J • APPROVALS DATE INSPECTOR SIGNATURE SOUTHLAND BUILDERS (909) 984-9047- 3501 FLETLHER LIC. NO ;� ,��•. .^r �� PEDESTRIA PROTECTION LOS ANGELES CA 90065 6486208 * .M1 I ` •\ SEWER DISCONNECTION 1y ARCHITECT OR ENGINEER: TEL. 0: \' ABANDON PRIVATE DISPOSAL I I _ LIC- NO: - _11J �-1 � UND RGRND STRUCT REMOVAL AND SOIL RECOMPACT[ON MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 150-261 01 y NO. OF FAMILIES�: DWELLING UNITS: APT/CON CLASS: NO 23 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS �-, NO NO NO �;. v * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: SS0508 - •WOPXERS'COMPENSATION DECLARATION .. .by affirm :hot I have a certificate of consent to self ///�� O O (/(� //(]�� M FOR O I�f�gIE1�(/[��. O gyp}RD �f�•LRy/L�� LIILfII -,rsure, ora certificate of Workers' Compensation Insurance, !/1\��`yW��®U V U �� D�11 V�J �IS U�10 C/11�� or a certified copy thereof (Sec. 3800; Lab, C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company _ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 3 9— tion - - ADDRESS O ❑ Certified copy is filed with the county building inspec- BUILDING p '"T� .• tion department. ADDRESS^ S 3 p r 5ILvI �U Date Applicant CITY S � ZIP 9 1 7 7 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' - ' NO.OF BlDGS. NEAREST _ COMPENSATION INSURANCE SIZE OF LOT S O (00 NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL p MA I certify that in the performance of the work for which this OWNER -q MD f� oST 7 TEL' USE ZONE P NO.3- 47 NO. /-:5 permit is issued, I shall not employ any person in any manner _/ SPECIAL D.• so as to become subject to the Workers'Compensatio L ADDRESS CONDITIONS Q Date f 81 Applicant CITY ZIP U ARCHITECT OR TEL. NOTICE TO APPLICANT: If, ar making this Ce ificote of DISTRICT GROUP TYPE FIRE CESSED BV Q Exemption, you should ecome subject to the War k ers' ENGINEER NO. CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS x 11 , W with comply with such. provisions or this permit shall be TEL d deemed revoked. STATISTICAL CLASSIFICATION APT. CONDO. N CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO. DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. 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 CLASS BK PGVALIDATION - ' SQ. FT. NO. OF NO.Of CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW _ Contractor Date ADD_ ❑ f I am exempt under Sec. -tom - ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT - TEL. FINAL OWNER-BUILDER DECLARATION PRINT NO. DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINA Professions Code): PRESENTBy • BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and LOCALITYD, the structure is not intended or offered for sale(Section III��R---y//ttt 7044, Business and Professions Code), MOVING TEL. - �8 6 9.6 Al , 1, as owner of the property, am exclusively contracting CONTRACTOR NO. � with licensed contractors to construct the project (Sec- ADDRESS # • • ••e a ,. tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK I e - 49. 88 CONSTRUCTION LENDING AGENCY � SET BACK YARD HWV PROP. LINE WIDTH 1 hereby affirm that there is a construction lending agency for FRONTe e e.3 "87 4 9.8 8 u the performance of the work for which this permit is issued P.L. I , (Sec. 3097, Civ. C.). SIDE `2 P.L. Lender's Name � LDMA Ref. N m P.C. Fee$ Permit Fee - D Lender's Address ��'F1 I certify that I have read this application and state that the Issuance Fee tDNA P/C M t _ a above information is correct. I agree to comply with all County Investigation Fee q ordinances and State laws relating to building construction, Total Pea y1/X and hereby authorize represe olives of this County to anter • u C1 LDMA Perm. q 5 u on the b e-ma d ro for inspectio purp ses. - 72 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature pplica t or Agent - Date - T I� WORKERS' COMPENSATION DECLARATION /� I� ,LI. /,a / , I hereby affirm that I have a certificate of consent to self /L1\ ISP �LF A II �011 V FOR La UMUNNIG PLSDUNT insure, ar a certificate of Workers'Compenstion Insurance, or T (x011 Il IISS `V- /rll Illi a certified copy the}eof (Sec. 3800, Lab. C.) _ COUNTY OF-LOS ANGELES BUILDING AND SAFETY - Policy No. Company BUILDING Cert'rfiedcopy.is hereby,furnished. - -FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with.the county building inspec- BUILDING u r' tion department. . ADDRESS 8 / Y• Q -V - LOCALITY - L _ NEAREST 'Date Applicant CITY 4r t4f' C1 r ZIP 71S CROSS ST. CERTIFICATE OF EXEMPTION FROM'WORKERS' NO. OF BLDGS, ASSESSOR COMPENSATION INSURANCE' SIZE OF LOT sO I#-I?O NOW ON LOT � MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one t- �� USE ZONE MAP' hundred dollars ($100)or Jess.) TRACT O o 3 BLOCK LOT NO. / NO. J10, _ T - TEL.214W (�'j�/ SPECIAL y '.I certify that in the performance of the work for which this NOfi yEs'� /` CONDITIONS O permit is issued, I.shall not employ any person in any ma n �/ }..�. DISTRICT GROUP TYPE FIRE PRO SEED BY U ADDRESS N. BV / ry CONST. ZONE so as to b come'subjecYto the War o sd s B � O / I \ 7 ( �L j Date J Appica4tAm CITY ZIP l" ��+ STATISTICAL CLASSIFICATION PT, CONDO. V ARCHITECT OR - TEL. - NOTICE TO APPLICANT: If,rthe making this`C ti cote o ' ENGINEER NO. 2— W Exemption, you should be subject to the orkers' - CLASS NO. .2 DWELL UNITS N -Compensation provisions oLabor Code,you must forth- ADDRESS SEWER MAP Z with comply with such prns or.this permit shall be /� / deemed revoked. CONTRACTOR NO. BK. /- PG, G� VALIDATION LICENSED CONTRACTORS DECLARATION IJC. - I hereby affirm that I am licensed under provisions of Chapter 9 _ ADDRESS NO. VALUATION - (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and my license is in full force and effect, CITY CLASS - SQ. FT.. NO. OF NO.OF CHECK License Number Lic. Class 'SIZE STORIES FAMILIES ONE ° Contractor Date DESCRIPTION OF WORK NEW ❑ $ am exempt from the licensing requirements as I am a — AM ❑ licensed architect or a registered professional engineer - e ALTER FINAL /I If fy acting in my professional capacity'(Section 7051, REPAIR DATE (� Business'and Professions Cade). USE OF /'� DEMO FINAL EXISTING BLDG. Q' �/ ❑ BY Lic. or Reg. No. Date APPLICANT - TEL. • ' OWNER-BUILDER DECLARATION - (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS Professions Code): - PRESENT - BUILDING - - I, as owner of the property, or my employees with ADDRESS wages as their sole compensation;will do the work and ' the structure is not intended or offered for sale(Section LOCALITY n -i 3 n A 7044, Business and Professions Code). MOVING TEL 2'0 9, 1, as owner�of the property, am exclusively contracting CONTRACTOR NO. ' #,o • s e a tionlicensed contractors to construct the project (Sec ADDRESS tion 7044,.Business and Professions Code). - - REQUIRED TOTAL SETBACK FROM EXIST, 2 °_• 43.00 CONSTRUCTION LENDING AGENCY - SETBACK YARD HWY PROP.LINE - WIDTH - I hereby offirm-that there is a'construction lending agency for FRONT - ° ° °,q 3 00,0 .the performance,of the;work for which this permit is issued P,L. (Ser. 3097, civ. C.). _ SIDE 0 9,0 1--8 1 PL' Lender's Name Lender's Address - P.C. Fee S Permit Fee w I certify that I have read this application and state that the Issuance Fee _ aabove information is correct I agree to,comply with all County InresfgoYon Fee ordinances and Statelaws.reloti to building construction, Total Fee and hereby auth orize'repr n fives of this County u + Hent''- ert r ' pection p rp ses. - a � - SEE REVERSE FOR EXPLANATORY LANGUAGE ^ ignawre of A ¢at or Agent Dote OO s .7 WORKERS' COMPENSATION DECLARATION ..I heresy affirm that I have a certificate of consent to self �r�! p U O ylLJll insure, oracertificate of Workers' Compensation Insurance, //(��4'1111 PLOC!/EkTHON OR BUOLDDOLfVO PLSRNFIr0 ora certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company / c' Certified copy Is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ( ?J f� ADDRESS ( U r Certified copy is filed with the county building inspec- BUILDING rq �j f�1 ,( ' Tion department. ADDRESS `O 1 M O Is{ . V F,�O nn A ✓ Date Applicant CITY I T ZIP -1 f T7.S LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' r 'NO.OF BLOGS. ' NEAREST COMPENSATION INSURANCE 512E OF LOT .SQ r NOW ON LOT CROSS ST. (This section need not be completed if the permit is fon one TRACT BLOCK LOT NO. ASSESSOR hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL 'Q TEL' USE Z NE MAP I certify that in the performance of the work for which this OWNER BOH OSY I✓NO. �.BL- 70 / NO. sz P ermit is issued, I shall not employ any person in any manner ADDRESS S 3 IY . U✓�T ✓ �/ SPECIAL - i so as to become subject to the Workers' ens L s. I CONDITIONS 0 a�y p 7S 0 Dale .7 0 0 Applican t CITY �Yl LE L ZIP I f 7 ARCHITECT OR TEL. NOTICE TO APPLICANT: If, a ar makingthis Certificate of DISTRICT ROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. CONST,./ ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS S7d V W with comply withsuch provisions or .this permit shall be '�t' TELA. '. `�,`/ . STATISTICAL CLASSIFICATION APT. CONDO. cal. deemed revoked. - CONTRACTOR ! HP SOIL NO.�TT z LICENSED CONTRACTORS DECLARATION - TNO CLASS NO. DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 30S Sq G ('j;f/EZ,WC- NOuy�f 1836 (commencing with Section 7000)of Division 3 of the Business andLIC. SEWER MAP Professions Code, and my license is in full force and effect. CITY ROSE H E CLASS BK L- VALIDATION - SQ. FT. NO, OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE p R VALUg710N _� v Contractor Dale DESCRIPTION OF WORK I UT O 7100 F NEW ® 1 ADD ❑ f �/ D I am exempt under Sec. POS IT p /-( ❑ • ALTER B.BP.C. for this reason REPAIR ❑ $ Data: USE OF C3' EXISTING BLDG. EL S I D EH LDEMOL Signature APPLICANT pp TEL �A// FINAL 9 O a 8A OWNER-BUILDER DECLARATION PRINT P H 3T rV NO.�WS'�J7a _9 �( -p - DATE # se a e••I� I hereby affirm that I g r exempt son ( from the Contractor's License ADDRESS S`T 3$ N. F]V -0 M ✓ ' Law for the following reason (Section 7031.5, Business and FIN ( e - 49.88 Professions Code): BPRESENT UILDING 6T .I, as owner of the property, or my employees with ADDRESS a • 04 9.8 8c=n wages as their sole compensation,will do the work and the structure is not intended or offered for sole (Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 2'8 8 I, as owner of the property, am exclusively contracting CONTRACTOR NO. o3 O with licensed contractors to construct the project (Sec- ADDRESS t tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED SET BACK YARD HWY TOTAL PROP. LINE WIDTH SETBACK ROM EXIST. 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 P.L. Lender's Name r LDMA Ref. N m Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application and state that the Issuance Fee �J� LDMA P/C N D , above information is correct. I agree to comply with all County Investigation Fae ¢ ordinances and State laws relating to building construction, Total Fee v LDMA Perm. R and hereby authorize repres nta've of this County to enter upo ab e- anti inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of AppLm t or Agem Date