HomeMy Public PortalAbout6022 CLOVERLY AVE_Building__ APPLICATION FOR BUILDING PERMIT
FJR APPLICANT TO FILL IN (Print or type only) I
BUILDING 6OZt fjaj�,L�/Z,L` ,/�Ut COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY ,l LJ !� ZIP - BUILDING AND SA TY DIVISION
NO OF BLDGSBUILDING
SIZE OF LOT// NOW ON LOT 3 ADDRESS �DoZ 2 1 + V )
TRACT {Q BLOCK LOT NOV, LOCALITY
TELNEAREST
OWNER fj''�� N044OOvv CROSS,ST
ASSESSOR
ADDRESS {��( ,�Q��/ZL MAP BOOK PAGE PARCEL
7 ��� r DISTRICT GROUP TYPE FIRE ESSED BT
CONST ZONE "
CITY ZIP
ARCHITECT OR TEL .,� OQD . T
ENGINEER NO
, STATISTICAL CLASSIFICATION SEWER AP
ADDRESS A
A f CLASS NO DWELL UNITS L BX_p'�G
CONTRACTO /J U ZONE INO
MAPLIC b '
ADDRESS NO � rL'(I� f SPECIAL D ,
/. CLICLASS CONDITIONS
CIT f/"'+2 i 4 �I
[4. ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG ETBACK FROM
FRON PROP LINEOF (STREET)
ADDRESS CITY HIGHW Y + YARD =1 TOTAL SETBACK FROM TYPE OF EXISTING
SQ FT Ojy NO OF � NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE y7 STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW ❑ + U
ADD I�
ICl BLDG SETS
AM — SIDE PROP LINE OF - TOTAL SETBACK FROM (S OF(STREET)
O
ALTER ❑ E—
L' �; ❑ HIGHWAY +' YARD - HIGH WIDTH W
E PAIR SIDE PROP LINE CL
USE OF + + _ - Z
EXISTING BLDG DEMOL ❑
APPLICAN /j' .�!� TE CORNER'CUTOFF YES [3 NO ❑
(P /VI l , N4 1' l
BY ATU E IN OPENSPACEt, YES ❑ NO ❑
IN COASTAL PERMIT.ZONE I YES ❑ NO ❑
VALUATION,$
I HEREBY ACKNO LEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL ORDINANCES AND LAWS REGULATING BU'L" G CON-
STRUC TION I CERTIFY THA .IN DOING THE WORK A HORIZED
HEREBY I WILL NOS EMPL ANY PERSON IN VIOLA ON SOF THE r +
LA BO ODE\OF TN S F CALIFO NIA ELATING TO
WOR EN'S C MPEN AT I U NCE ,
SIGNATURE
PERMITTEE J
ADDRESS
NTE
OL /� �� FINAL /D BY y
DATE PMT
AIA&E CHECKS PAIABLE 70 FEE $ FEE /
HARVEY T BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH _ PERMIT VALIDATIONCK M C CASH
1 `7 S AItG �2 1, o _ . 6 2.2 5 ,&06
76A636A CE#003 5/74,
' , f
-Tr FA l'L_e7 CIT y
76A538A CE#8091058 APPLICATION FOR BUILDING PERMIT ` 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGU EER ADDRESS A 2"L a GLO v�2Ly
BUILDING AND SAFETY DIVISION LOCALITY EM LE �I
JOHN A LAMBIE,COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST �iVL
DISTRICT NO GROUP PROCESSED BY
FOR APPLICANT TO FILL IN �•p� I c PNST I 0 -Oytc�
BUILDING / ,/n SEWER MAP
ADDRESS dY `y'� ��� f ISTICALCLASSIFICATION BK PG ,
CLASS NO DWELL UNITS L /S
LOT NO / BLOCK MAP ,{ ,�/ STATE YES NO
/. NUMBER [/ "/ HWY
TRACT USE ZONE SPECIAL
NO OF BLDGS CONDITIONS
SIZE OF LOT I NOW ON LOT - !
USE OF ` �`
EXISTING BLDG '
BUILDINGEXIST"
SETBACK YARD HWY STREET NAME WIDTH
OWNER FRONT
MAIL �/ P L
ADDRESS q��'/1 I �• SIDE
CITY ��r V NO 1_- ,.si 3 P L INSPECTION RECORD '
ARCHITECTOR TEL
ENGINEER NO ,
D RESS
TEL �
CONTRACTOR
j P. J NO /
ADDRESSf I �C�T
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ FT NO OF
SIZE STORIES FAMILIES
USE OF STRUCTURE -�
c�
c)Gam! C Y
SIGNATURE OC'F �3.�jLG�/�,�/I1I�/L ' APPROVALS `
APPLICANT - /
/� yy11 + DATE INSPECTOR S,SIGNATURE
ADDRESS t� !c^ e FOUNDATION LOCATION -
FORMS MATERIALS
�VALUATION
0O P C $ FRAME FIRESTOPSFEE BRACING BOLTS
Ls $ FURNACE LOCATION
FEE GAS VENT DUCTS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP +
PLICATION AND STATE T THE ABOVE IS CORRECT AND LATH INT
AGREE TO COMPLY W,,11 THS/jAAL1�ICOUN,TY QRDINANCES AND
STATE LAWS REG�'P1NG//Ic I G M
LATH EXT J
SIGNATURE OF �ti tHOUSE NUMBER COR-PERMITTE RECTANDPOSTEDADDRESS FINAL
CLYDE N DIRLAM PRINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION CK mo CASH PERMIT VALIDATION CK M O CASH
,
DEPARTMENT OF BUILDING AND SAFETY f APPLICATION FOR PL7tW=
COUNTY OF LOS ANGELES
WM. J. FOX. CHIEF EN13INEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING DISTRIC NO PLAN CK NO PERMIT NO
_ADDRESS L7 /G i l Y 1P J�� li �- D I
LOCALITY �,���,s /� (�� 7 ,/ RECEIVED BY DATE OFAPPL DATE ISSUED
NEA
CRREST /� � G
O T (�
/�/�
BUILDING ",��
OWNER f /f l �® ADDREBB
` CL Q C+ .. LOCALITY -
ADDREBB
/1 �j,r/ NO
d q NEAREST At
CITY �k-A /r
`�,/ /T �9J` CROSS BT '1 ai ep
FIRE NO OF TYPE GROUP—
ARCHITECTORTEL ZONE PLANS
ENGINEER NO
BLDG - _ _ ORD NO
ADDRESS SETBACK LINE -
j[ y- APPROVED Y
CONTRACTOR /-/]/'/� //�7 e C/G NOL,4/ 1-Q11/f BYUSE - DATE
ADVRE9F
3 / w I C ZONE —' BY DATE DATE
LEGAL �q p CORRECTIONS
DESCRIPTION LOT N 7 V BLOCK
TRACT & _Gr '
LD
SIZE F L
T J 0 a ,] I NOW ON LOGTB
OO �(
USE
NO OF
EXISTING BLDG F� [B I RO MS /' r�. Ef !� ,r
DESCRIPTION OF WORK _ E
NEW ALTERATIONADDITION 1 " r
O
A_
REPAIR MOVING F DEMOLISH
Bq FT NO OF . <' A Z
SIZE ROOM, ST13RIEB �'
WALL ROOF
COVERING „d! COVERING { 1" i
USE OF NEW .(moi° /1 ^ �
mai
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE 19 CORRECT, FOUNDATION, LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 1 FORMS,MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION
FRAME* FIRE STOPS, 2-0 ��
SIGNATURE O BRACING,BOLTS
44
PERMITTE LATH, INT
i
AUTHORIZED AO LATH, EXT
76A636A-3 2-80 $ P C/S PLABTER,INT.
FEE PLABTER,EXT
_ 18
VALUATION FEE ed FI NALF 1 , r i i ED
t
76A688A Obb 8 Y 83 -
APPLICATION FOR BUILDING PERMIT �.
DIVISION OF BUILDING AND SAFETY BUILDING
ADDRESS
Depaxtment of County Engineer
County of Los Angeles LOCALITY
WM J FOX COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN, SUP T OF BUILDING CROSS ST �S-i1�'✓ClS3xQ'.Li
FOR APPLICANT TO FILL IN mma� 12 D16TR-V NO GROUP I TYPE ,r I SEWER - PG
..� CONST -- � � G.��
BUILDING / MAP O •" TWATE VgS
ADDRESS] � ® ge,* L ,[V/i-, yL,..� NUMBER
LOT NOJdq7 - EX GPP?' �..�SY< <h BLOCK USE ONE SPEC IO
!�L r CONDITIONS
TRACT ��
SIZE OF LOT I NOW ON LOTNO OF S BUILDING YARD HWY STREET NAME EXIST'
SETBACK WIDTH
USE
EX STOING BLDG R
/ES / O N C E FPROL T
OWNER J� U S (� �, SIDE
P L
MAIL // /' E C ,/�
ADDRESS IG G v r L O V P 0 TRACT DWELL I UNIT
S INDUSTRIAL
CITY T ' Pc.G I�°t' Y� NO
M DWELL 1 UNIT 6 PUBLIC BLDG
ARCHITECT OR TEL 2 DUPLEX 1 UNIT
ENGINEER NO 7 ADDN ALT ETC
3 APT UNITS 8 MISCEL
ADDRESS 4 COMMERCIAL
CONTRACTOR p E' NO INSPECTION RECORD
ADDRESS A-1 E
DESCRIPTION OF WORK aj—/,?-f S-
NEW ADD ALTER REPAIR DEMOLISH 4)1Y, p7n ,/, ,-
SO FT , / NO OF NO OF /✓/V A'
SIZE A.1
O L9 STORIES FAMILIES
USE OF STRUCTUR ^ G A r� P3 G E-
/9 re IM141
SIGNATURE
APPLICANT APPROVALS
r -
ADDRESS DATE INSPECTOR S SIGNATURE
FOUNDATION LOCATION
P C $' FORMS, MATERIALS / 1/!!•
Cd FEE FRAME FIRE STOPS n
VALUATION BRACING,BOLTS ( _ v,A ,YJ
FEE (G '� FURNACE LOCATION
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT I
AND AGREE TO COMPLY WITH ALL COUNTY OgINANCES LATH INT
AND STATE LAWS REGULATING BUILDING ONSTRSJ�-
TION LATH, EXT
-��`•I�� J
SIGNATURE OF HOUSE NUMBER COR-
'
PERMITTEE RECT AND POSTED �y
ADDRESS FINAL _u a v
WM J FOX,COUNTY ENGINEER VALIDATION C N DIRLAM, CHIEF BLDG INSPECTOR
105 8 6 3 5 JUL 2'1 1 600 in
76A836A CE:#803 9-67 / "�
APPLICATIO OF�,yBUIL�DING PERMIT
COUNTY OF LOS ANGELES BUILD'TNG
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS, SUP T OF BUILDING NEAREST
CROSS ST
;NG
OR APPLICANT TO FILL IN DISTRICT NO GR��ll11PP TYPE P E BY
CONS
Print ort pe only) Q
BUILDIZV
Cl
STATISTICAL CLASSIFICATIO SEWE,P MAP
ADDRE � V N CLASS NO DWELL UNITSLOT NO � BLOCK USE ZONE MAP
NO �Z FJTRACT (!J SPECIAL
_ NO OF BLDGS CONDITIONS
SIZE Oc7 -OX NOW ON LOT
USE OF
EXISTING BLDG BLDG SETBACK FROM
TEL X FRONT PROP LI NE OF —(STREET)
OWNER C! TYPE OF EXISTING SETBACK HIGHWAY + YARD TOTAL
ADDRESS 0 ;t2 o U-e2L 4d HIGHWAY WIDTH FROM C L
Cl TY
ETBACK FROM
ARCHITECT OR T L BLD S (STREET)
ENGINEER NO SIDE PROP LINE OF -
TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS HIGHWAY1 WIDTH FROM C L
TEL + _ >_
CONTRACTOR D /�+ NO a
LIC CD
ADDRESS NO CORNER CUTOFF YES E] NO V
CD
CITY c ASS SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK a
r' rn
z
NEW AD LTE REPAIR DEMOLISH
SQ FT NO OF NO OF
SIZE7'6-XWSTORIE_� FAMILIES
USE OF
STR TUR
t
SIGNATURE O
APPLICANT
VALUATIONS �d��� d'v
J APPROVALS DATE INSPE TOR 5 SIGNATURE
PC PMT G o FOUNDATION LOCATION 7..
FEE$ FEE $ O1-5 FORMS MATERIALS �7
FRAME FIRE STOPS
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
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT LATH INT
ING TO WORKMEN 5 CO��ATIONSURANCE
LATH EXT
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS a2 FINAL
JOHN F LEWIS PRINCIPAL STRUCTURAL EN ER
PLAN CHECK VALIDATION CK M D CASH _ PERMIT VALIDATION CK M O CASH
`
295 # FEB 5 3 0 12.0 � �
7GA630A CE#00310 ea APPLICATION FOR' BUILDING PERMIT 1 '
!r
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS t z
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUPT OF-BUILDING CROSS ST
DIST RI NO G OUP TYPE P SSED BY
FOR APPLICANT TO FILL IN _ cortsT
STATISTICAL CLASSIFICATION I ER MAPS
BUILDING !� ��JE ` � _ �
ADDRESS- : ,CLASS NO WELL UNITS
S
LOT NO J V C &Q BLOCK NUMABER 'WYE YES
TRACT (p USE ZONE SPECIAL
CONDITIONS
NO OF BLDGS / ^`
SIZE OF LOT 1, � I1 NOW ON LOT
USE OF
EXISTING BLDG GUC A•�//✓G' BUILDING EXIST 1t
YARD HWY STREET NAM
SETBACK WIDTH �
OWNER O G�/•S FRRON T eq
AIL IDE
Mp�
ADDRESS 00�IlL ISP
CITY t NO %�' INSPECTION RECORD - _s
ATELRCHITECT
OR SEL NO
r�
ADDRESS
TEL 2
CONTRACTOR NO
ADDRESS t - `
DESCRIPTION OF WORK _
f 6 AlTo =
ADD ALTER REPAIR DEMOLISH ti NO OF NO OF, _STORIES FAMILIESI"",RELc AJ& cW n/ L�REOF
ANTAPPROVALS DATE INSPECTOR S SIGNATURE
FOUNDATION LOCATION
4FORMS MATERIALSONS` FRAME FIRESTOPS.
BRACING BOLTS
PC PMT 'FURNACE LOCATION.
FEE $ I FEE $ J+ ! GAS VENT,DUCTS `
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT
PLICATIONrAND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO ,AND
WITH ALL COUNTY ORDIN NCESAND�' _
STATE LAWS REGULATING BUILDING STRUCTION ' LATH,EXT
k—., I HOUSE NUMBER COR- '
SIGNATURE OF !f / - RECT AND POSTED
PERMITTEE D
ADDRESS o?a �, e �� r FINAL / � "ts �1I/
r . CLYDE N DIRLAM, PRINCIPALS U RAL ENGINEER E
CK
PLACHECK VALIDATION O 'CASH _ PERMIT VALIDATION D,�
tX,,3 7 5 9 OCTa 1 A -� rJ.Q in
rep
L - '
76A538A DBS 3 12 54 V
APPLICATION FOR BUILDING PERMIT
DIVISION OF B=ING AND SAFETY ADD EISS ✓��
Deportment of County Engmeer
County of Los Angeles LOCALITY Iay.—i Vic �tl
WM J FOX COUNTY ENGINEER
CASSATT D GRIFFIN,- NEAREST T of BUILDING NEAREST
CROSS STImmsmsommim
DISTRICT NO GROUP SEWER MAP
FOR APPLICANT TO FILL IN - TYPE BK _ PG
BUILDING ,I J'] /��/r CONST
ADDRESS '1 h ( (' MAP STATE YES NO '
`-T^,�J NUMBER HWY
LOT NO 304- BLOCK USE ZONE SPECIAL '
TRACT
16S,61 CONDITIONS
!pj NO OF BLDGS
SIZE OF LOT �O'�C�p ( NOW ON LOT 1 BUILDING YARD HWY STREET NAME EXIST
USE SETBACK WIDTH
__EXISTING BLDGO
r � �/�)
/rs
`, FPL T 9C,VL i
OWNER )G� - 04 " V.') -told/ SIDE '
MAIL 6.)
L P L
ADDRESS rn De /D a6.)� "
TEL DWELL 1 UNIT 5 INDUSTRIAL
CITY rV v/ 03) NO r - -
2 DUPLEX UNIT- 6 PUBLIC BLDG
ARCHITECT OR TEL
ENGINEER NO 3 APT UNITS 7 ADDN ,ALT, ETC
ADDRESS 1, J ) �/ 4 COMMERCIAL 8 MISCELrrO/�-���
CONTRACTOR
f L/J"J V(�7� s ll NO/.7��� /r� ' INSPECTION RECORD
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPA DEMOLISH
r
SO FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF STRUCTUR �/D L
,`��
SIGNATURE OF
APPLICANTJ ,////� ,�,/ �jyjJT+yyq APPROVALS
ADDRESS S,N(,s►�/Y"=GJ '//K�"�Qy2)/-�/""'`-' DATE INSPECTOR S SIGNATURE
FOUNDATION LOCATION
P C S FORMS MATERIALS
((✓✓ FEE FRAME FIRE STOPS
VALUATION E O �f BRACING BOLTS ?-0
FEE ./ FURNACE LOCATION,
GAS VENT DUCTS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT r
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT
AND STATE LA ¢ REGULATING BUILDING CONSTRUC-
TION
J /�
TION I I,L�1/ LATH EXT
SIGNATURE C�Fj `� � HOUSE NUMBER COR-
PERMITTED! A_?, RECT AND POSTED
ADDRESS-// 1 FINAL
WM. J FOX. CouNTY ENGINEER VALIDATION
BY - wCO2y T 3'3 US AM 18 1 6.0 0 in
DEPUTY - DEPUTY
BY, BY
® DEPUTY ; q#"pU
TY
- 1 ceryl/
WORKERS'COMPENSATION DECLARATION
to self
nsu eeor a ccertif ca'te ohf Worke s' Compensat on a certificate of coent Insurance, APPLICATION FOR BUILDING PERMIT
or a certified copy thereof Sec 3800, Lab C ) !� -
/�r "� 1C+�Ck�ss6:tC� �oiYs� COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No o 7 327Y Company
Certified copy is hereby furnished FOR APPLICANT.TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building inspec- BUILDING
tion department ADDRESS (> ��'� l► 6 P/��! LOCALITY
rte- NEAREST
Date -T,FSC— =Applicant CITY +� C/�/ ZIP CROSS ST
CERTIFICATE OF EXEMPTION FR WORKERS NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK I PAGE PARCEL
(This section need not be completed if the permit is for one USE SONE ESPECIAL
hundred dollars ($100)or less ) TRACT BLOCK LOT NO K TEL e. /I certtfy'that in the performance of the work for which this, OWNER �� .c NO ONS 0.
permit is issued, I shall not employ any person to any manner DISTRICT GROUP TYPE FIRE :AED BY O
so as to become subject to the Workers'Compensation Laws ADDRESS S.a�h,e � ��/ � n CONST ZONE U
eg
CITY ZIP F a A-5 ? O
Date Applicant STATISTICAL CLASSIFICATION / APT JCtDO F-
ARCHITECT OR TEL ll
NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO` CLASS NO Z DWELL UNITS_, til
Exemption, you should become subject to the Workers' p,
Compensation provisions of the Labor Code, you must forth- ADDRESS - = SEWER MAP N
with comply with such provisions or this permit shall be ` _Z
deemed revoked, - CONTRACTORS. /� [ O 7 _ -/!@ BK ` n VALIDATION
LICENSED CONTRACTORS DECLARATION �. LIC u {y '
I hereby affirm that I am Ic /d �ensed under provisions of Chapter 9 ADDRESS ' J NO !T7 7� 7 VALUATION
(commencing with Section 7000)of Division 3 of the Business and `
LIC o-�r
Professions Code, and my Icense•is to full force and effect CITY ee' ¢d-1/ e CLASS
d SIZEFTS'VO STORIIEES FAMILLIIES CHEC
ONEK
License Number /�� / Lc Class
Q //�� ��rr� !! DESCRIPTION OF WORK �¢�LC! �,¢_ 7/� NEW $
Contractorkl-4ki a cl� CO4!46e
I am exempt under Sec s - - - ADD
ALTER FINAL I
B&P C for this reason REPAIR DATE i ff
USE OF FINA
Date EXISTING BLDG DEMOL B a c 59.25
Si nature APPLICANT TEL Y ° ° ° 5 9 2 5 c=.,
g _ -
OWNER-BUILDER DECLARATION PRINT NO
I hereby affirm that I am exempt from the Contractor's License ,l ,%�� 07.05-85
Law for the following reason (Section 7031 5, Business and ADDRESS
Professions Code) ENT ^
QBUILDING - -
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
7044, Business and Professions Code) MOVING TEL
I, as owner of the property, bm exclusively"contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code) h
REQUIRED TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIN 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
(Sec 3097, Civ C ) • SIDE
m PL -
Lender s Name
rr Jr-^
Lender's Address P C Fee b Permit Fee
� I certify that I have read this application and state that the Issuance Fee
above information is correct I agree to comply with all County Invest'gouon Fee C
ordinances and State jaws relating to building construction, Total Fee J
and hereby authorize representatives of this County to enter
upo 1 the above-mentionedproperty for inspection purposes - - -^ -
{ + SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date ®s