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HomeMy Public PortalAbout6203 CLOVERLY AVE_Building__ 65�►��Cu1���tta�p' ��OI [/{�p� �'�',I�i�1,�p'�'7 , fi E LL V{�it L e®f `Lli�i Y tl ' t 76AO30A CE Ceos 1�1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 31 BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEW SUPT OF BUILDING CROSS ST Q DIST CT NO GR UP TYPE P SED BY FOR APPLICANT TO FILL IN �� ' coNsr BUILDING STATISTICAL CLASSIFICATION SE ER MAP ADDRESS ' CLASS NO DWELL UNITS V LOT NO BLOCK WATER CERTIFICATE NOT REQUIRED ❑ RECEIVED TRACT MAP ¢� HIGHWAY NO OF BLDGS NO 'hl, C/ (CIRCLE) STATE MAJOR SECOND, OCAL SIZE OF LOT ��' Z'�k NOW ON LOT USF ZONE SPECIAL USE OF CONDITIONS - EXISTINGBLD/G�- OWNER t44. 144 BUIL ICGYARD. HWY STREET NAME EXIST ,� D - SETBACK WIDTH ADDRESS 6.,:? 03 a dtG / FRONT ARCHITECT OR TEL P L•' ENGINEER NO £IDE _ P Ll CL ADDRESS - INSPEC,TION RECORD p CONTRACTOR 0Qi v9VI463 �/ � 4 ADDRESS 2 yQ, -/ei0T 7,7e 1 „ O DESCRIPTION`OF WORK,NEW D n ALTE REPAIR DEMOLISH H So FT ' - NO OF NO OF I /'._ 1/1' LA /,Iter,�? & /A�y Z IZE I STORIES , FAMILIES OF /'��� �I j , USE r 1/Y v STRUCTURE • _ p SIGNATURE OF 1 . APPLICANT ,' VALUATION$ / APPROVALS (DATE INSPECTOR S SIG /N�AT�URE PC _ - PMT FOUNDATION FORMS, MATERIALS LOCATION 6/ NS FEE FEE //rL"'✓t/ /'.� $ $ FRAME FIRE STOPS, l�/y ":�evl•� /f/./ 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK �/ /f� AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INR' 17 I�7 /'/ /���/� TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA'RELAT- ING TO WORKMEN S COMPENSATION INSURANCE ' LATH,EXT + SIGNATURE OF -HOUSE NUMBER COR- PERM ITTEE OR-PERMITTEE - RECT AND POSTED ' ADDRESS /J L> ! `f' f 1� FINAL . - -7- CLYDE CLYDE N DIRLAM, PRINCIPAL ST RAL ENGINEER } PLAN CHECK VALIDATION CK. U o. CLASH PERMIT VALIDATION cK m o. CASH ; 78A838A CE#803 8-6 3APPLICATION FOR BUILDING PE RM I T LI COUNTY OF LOS ANGELES- BUILDING , y , 1 DEPARTMENT ,OF COUNTY ENGINEER, ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE. COUNTY ENGINEER: NEAREST ✓� WILLIAM A JENSEN, SUP T OF BUILDING - CROSS ST DISTRI T,NO GR TYPE P O S BY FOR APPLICANT TO FILL IN ' _ , coNsr c BUILDINGI •Q STATISTICAL CLA KATION - SEWER MAP ADDRESS hg© ' Y CLASS g5 WELL UNITS BK PG NO LOT NO BLOCK WATER CERTIFICATE NOT REQUIRED ElRECEIVED TRACTf - MAP HIGHWAY NO OF BLDGS - NO � (CIRCLE) STATE MAJOR SECOND LOCAL SIZE OF LOT ' _ NOW ON LOT USE ZONE SPECIAL s USE OF - CONDITIONS EXISTING BLDG TEL y,,, • "NO — � BUILDING EXIST OWNER + , - SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT ,ARCHITECT OR TEL P L ENGINEER - -NO SIDE P L ADDRESS a i TEf r CONTRACTOR K, a_-_N•E}OL S7^ ,r/ 4p� ADDRESS .ld' t+�1�' K / G DESCRIPTIO OF WORELu CL NEW ADD , ALTER REPAI DEMOLISH - Z I SQ FT - N NO OF r SIZE STORIES FAMILIES USE OF STRUCTURE 4 1 t SIGNATURE APPLICANT VALUATION r APPROVALS DATE INSPECTOR S SIGNATURE .PC PMT l FOUNDATION LOCATION FEE,$ - FEE $ 30 I FORMS MATERIALS 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 _ LATH INT ' TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT _ ING TO WORKMEN S COMPENSATION INSURANCE - �, r LATH EXT SIGNATURE HOUSE NUMBER COR- PERMITTEE - • RECT AND POSTED ' ADDRESS INAL !� JOHN F LEWIS PRINCIPAL 5TFiUeTUFZAL E N R PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK MO CASH y - LAL:o 8 5 ,1 0 1.0. 14AY 11 COUNTY OF-LOS ANGELES '^ � `'APPLICATION FOR DEPARTMENT OF CO NTY ENGINEER - ` r- I.' "' PERMIT r: BUILDING AND ETYDIVISION - BUILDING V�—;` FOR APPLICANT TO FILL IN ADDREss L BUILDING _ _ , - . __ _. �` - ADDRESS �O LOCALITY p NEAREST f CITY -r C ZIP; �!�✓� CROSS ST ~ NO OF BLDGS ASSESSOR SIZE OF LOT' i. NOW ON LOT' MAP BOOK PA PARCEL FDISTRICT G PE F7IpRpEESSED BY TRACP r, yy BLOCK LOT NO / - �� Q ONS T 1 OWNER f G'. I��/IrIJeIr NO STATISTICAL CLASSI CAT ON SEWER MAP} p ADDRESS 1602493 �C%f L� CLASS NO DWELL UNITS' h' * -BK,,,-, ;PG.,'; CITY F ZIP"!�7 O a USE ZONE MAP ARCHITECT OR -` _ TEL' NO- SPECIAL O 4 SPECIAL ENGINEEP NO _.•i _ CONDITIONS ADDRESS n Y ROAD DEPARTMENT APPROVAL REQUIRED` -YES ❑ NO ❑ TEL_ r CONTRACTOR r NO BLDG SETBACK FROM •LIC r' . FRONT PROP-LINE OF, (STREET)/. ADDRESS NO �✓ HIGHWAY- + YARD ` = ATOTAL SETBACK FROM TYPE OF EXISTING LIC FRONT PROP'LINE HIGHWAY ;`WIDTH- OTY:^. � CLASS r CONSTRUCTION LENDER + } J a NAME,AND BRANCH. BLDG SETBACK FROM - SIDE PROP'LINE OF —(STREET),,,, ADDRESS CITY' , O ;r TOTAL SETBACK FROM TYPE OF EXISTING SO FT NO OF NO OF-' CHECK HIGHWAY +, YARD- = SIDE PROP LINE HIGHWAY WIDTH C SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW e, ADD _❑ CORNER CUTOFF YES ❑ NO ❑ J ,3; ! ❑ " ALTER IN OPEN SPACE YES ❑ -NO ❑ REPAIR ❑ +- USEEXIOF BLDG _ R DENOI ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ APPLICANT TEL !F �(' (PR NO �' I •- _ + _ 4- v BY(SIGNATURE) IHEPEBY'ACKNOWLEDGE AT I HAVE READ THIS'' PPLICATION SAND STAT07, THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES y -� 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 5 COM PENSATION INSURANCE . - ✓ _ SIGNATURE OFc"tioS aµ Y FINAL � _ BYf� 'PERMITTEE DATE. ADDRESS u /J v t � ���QUO i O Y, TEL PC Fee$ • Permit Fee CITY i�-«� NO Issuance Fee , VALUATION Total Fee PLAN CHECK VALIDATION{ M o CASH _ PERMIT VALIDATION M o CASH r`�ENS6T�IG3i , DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES amh � 1 WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING t r DISTRICT NO. PLAN CK.NO. PERMIT NO. ADDRESS .fp ZG3 Cioverly Ave. - _ S� 70 7 / —9 _ 6oz LOCALITY A RECEIVED BY + DATE OF APPL. DATE ISSUED CEAOREBT Flaherty St. 'Kemple CityU.�SD -4/0- BUILDING OWNER Meeker Land Company ADDREBB CO Lei/ ' AMAIL DDRESS 11236 E. Live Oak Ave. LOCALITY .C NEAREST CITY Arcadia No DO-72151 DRDBs BT. FIRE NO.OF TYPE GROUP ENO ARCHITECT)I;R TEL - .10 ZONE PLANS Z +C BLDG. ORO.NO ADDRESS SETBACK LINE Zo � G _A APPROVED TEL BY DATE CONTRACTOR NO. USE APPROVED ADDRES6 ZONE 4f I BY DATE LEGAL CORRECTIONS 1 ' DESCRIPTION LOT NO. 4 BLOCK , TRACT 17179 /� SIZE OF LOT 44•22x1 .5 I NOW ON LOTS none USE OFnone NO OF NO.OF 6! EXISTING BLDG. FAMILlre ROOMS DESCRIPTION OF WORK NEW X ALTERATION ADDITION O REPAIR MOVING DEMOLISH 0 Bq.FT. NO.OF D ,r SIZE 1106 ROOMS 6 STORIES 1 - ROOF COVERING PWALLlaster I COVERING I,•Shgles USE OF NE BUILDDINGINGw Residence 'Plan 3-D Garage lg x 20 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATION: LOCATION IN$RtE TO DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS 1 �J AND STATE LAWS REGULATING BUILDING CONSTRUCTION FRAME: FIRE STOPS, SIGNATUREOF LAND � BRACING,BOLTS �� PERMITTEr LATH, INT. �n b AUTHORIZED G ff7l J " � LATH, EXT. 76A63BA-3 7-4e $ g 3 P C.$ O PLASTER, INT. ' 7 FEE _ PLASTER,EXT. p _ VALUATION %�� FEE FINAL (� 12 o; l9 i A P P L I CATION FO COUNTY OF LOS ANGELES PARTMENT OF COUNTY ENGINEER ' B U ILD I N G PERMIT BUILDING AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILDING �``� �j/ ADDRESS 4- /40,.J U`�" LOCALITY CITY /-�C.l. ZIP NEAREST , CROSS ST O OF BLOGS ASSESSOR SIZE OF LOT 2/4� NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT 1GROUPITYPE FIRE PRO SED BY TRACT l' ` 1 l BLOCK LOT NO �f� CONS i C TEL CJ OWNER , �+C'��'•V° NO STATISTICAL CLASSIFICATION' f� '/ SEWEMAP ADDRESS �iC - G ©V "L-�'�' ,CLASS NO DWELL UNITS !27 P ,� �'� Z� USE ZONE MAP /7y+�1 , CITY C. ZIP _ NA C->3 _ ARCHITECT OR N TEL — - CONDIIT ONS ENGINEER ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED_ YES❑ NO ❑ CONTRACTOR NoL BLDG SETBACK FROM / LIC FRONTPROP LINEOF (STREET) ADDRESS` 6 d NO�__ P� HIGHWAY } YARD _ TOTAL SETBAC ROM TYPE OF EXISTING LIC FRONT PROP LINE HIGHWAY WIDTH CITY /v�Z�- �'� -• _ CLASS _ CONSTRUCTION LENDER NAME AND BRANCH 6�y a BLDG SETBACK FROM ADDRESS CITY �– SIDE PROP LINEOF (STREET) SQ F,T ` NO OF NO OF CHECK HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING I= SIZE CI STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH DESCRIPTION OF WORKNEW ❑ + _ ADD CORNER CUTOFF - .YES ❑ NO Z ALTER ❑ IN OPEN SPACE YES ❑ NO EPAIR'❑ EUSE XISTING BLDGw �l�Y DEMOL ❑ IN COASTAL PERMIT ZONE YES El -NO A'P (PRINT)ANT N NO _ BY (SIGNATURE) I HEREBY ACKNOWLEDGE AT I HAVE READ THIS APPLICATION AND STATE THAT THE AB IS CORRECT AND AGREE TO COMPLY ` WITH ALL ORDINANCES D LAWS REGULATING BUILDING CON STIR UC TION I CERTIFY MAT IN DOING THE WORK AUTHORIZED- HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STAT OF CALIFORNIA IN RELATING TO -WORKMEN'S COMPENSAT SIGNATURE OF FINAL BY ✓�. _ , PERMITTE '' DATE 12 ADDRESSC� TE���/,,cT��/•�s�np• C Fee$ - Permit Fee CITY T NO Q Issuance Fee VALUATION •D j Total Fee J C� PLAN CHECK VALIDATION CK M o CASH _ PERMIT VALIDATION qK Mo CASH ` 5 2 9N�Dtt 0 1 D .5 C ••50 1. 7GA638A CEO 803B 12/75 eJ WORKERS' COMPENSATION DECLARAT16N, hereby affirm that I have a certificate of consent to self APPL'�AT I O N FOR�- B U I L D I N .. PERMIT o insure, or certificate of Worker's; Compensation Insurance, , Q , ,or a certified copy ��rrthereoff.(SSjjec 3800-Lab C ) s - ' COUNTY OF LOS ANGELES ' - BUILDING'AND SAFETY ' Policy No 10ONJgL4—6oFnpany H *.^ El Certified copy is hereby furnished -I' I FOR APPLICANT TO FILL'IN BUI�oING, V L r ) ADDRESS O LO Certified copy is filed,wrth the county bu�mspec- BUILDING y /1�v� ,r' tion department :1 i ADDRESS �! /� j C ; J ' ` �/S l y ?( t lac C/71""' CITY. 4% 1' G C;, '.ZIP- M, LOCALITY a (Date App NO OF BLDGS Y 5' -CERTIFICATE'OF EXEMPTION FROM WORKERS' .., Y ar- s NEAREST SIZE OF LOT' .v NOW ON LOT CROSS ST V �+ �COMPENSATION'INSURANCE ASSESSOR,. , (This section need not be co'mpleted`if the permit is}for one' " TRACT `« BLOCK u LOT NO MAP BOOK. a ¢ PAGE PARCEL •hundred'doll'ars ($100) or'less') ' ' ` ' TEL (}r �7�p ,, a OWNER W 1/-� �EU/��C NO'Z6 b �A O' US ON w MAP n fl certify that,4n-the'performance of the'wo'rk,for which this x• SPECIAL - } permit is issued;I shall-not employ ony•person in any manner L' ADDRESS s �LfJ�E�t Y" - CONDITIONS swas to,become subject to the Workers'Compensation,Laws _ O l` y r CITY' r�/`1PL� e1,7 zip Date L' Applicant I{"^i ' ARCHITECT OR J// TEL QQ�• DISTRICT GROUP,' TYPE ' FIRE ' 'PROCESSED BY" Q NOTICE,TO APPLICANT If, after'making this Certificate of ENG INEER A /t S0,C; l�/U NO "l'ro3'S�l CONS ZONEExemption, you should become ,subject to the.,Workers= i ° U P Y I ADDRESS IZ W I� .�N� f� w Compensation provisions of!he-Labor Code; you-,must forth .• r, *-7 L`� a wjth:comply`wiTh such provisionsyorthis permit shall be �'� S _ ATEL q(4NO —/S 1� STATISTICAL.CLASSIFI TION AP CONDO N deemed revoked r r CONTRACTOR_ - z w , LIC CLASS NO C DWELL UNITS '"• LICENSED CONTRACTORS-,DECLARATION`s__ ADDRESS P/N GALLS NO x(71 Col I hereby{affirm that I am licensed under provisions of Chapter 9 , LIC - SEWER MAP (commencing with'Section 7000)of Division 3 of the Business _ and Profe'ssions Code,.and my license is in full force and effect CITY `��(�l� U CLASS � BK PG� 1 VALIDATION G} _ SQ FT NO`OF NO OF CHECK,' " License Number W�l�l 1 'f Lic Class` =(�r SIZE STORIES FAMILIES ONE a c Wig'q p VALUATION; , Contractor �/v'Sr�AST: 'Date �_/N / DESCRIPTION OF'WORK (i fAr-T10 NEW ❑ i ,l 9GfiO S t .ADD -( p(�(/ ► ; I am exempt under Sec ALTER ❑ it ' B&P C_ for this reason REPAIR ❑ Date USE OF EXISTING BLDG- DEMOL ❑ ( r "Signature APPLICANT _ TEL , FIN * ; �• (PRINT) _C / �p�AJGGL NO �O�I l� q /� OWNER-BUILDER DECLARATION DATE _ I hereby affirm that I am exempt from the Contractor's License t` _Cie nn� o-l `Law for-the following'reason (Section'7031 5, Business and ADDRESS`/l40 / ��F�Li - FINAL ` Professions_Code)" PRESENT a. - By pGT.4" , BUILDING a ❑ I, as owner'of the property, or'my employees with ADDRESS �t� 8+ - wages as their sole compensation,will'do the work and 'r`' " a A ,i, � •tet-. , the structure is not intended or offered for sale(Section LOCALITY �+ loo, Y f -7044,'Business-and Professions Code ) - MOVING - TEL v y❑ I, as owner of ihe_property, am•exclusrvely contracting CONTRACTOR NO t { Y 49'm., 3 r' 'with licensed contractors_to construct the project (Sec- - TOTAL ADDRESS* r�� pp tion 7044, Business and Professions Code ) a x cw—>y� - �.Cta REQUIRED --+-TOTAL SETBACK FROM ' EXIST •Il'} 4 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH. w Y • { V I hereby affirm that there is a construction lending agency for FRONT. I X , the performarice of the work,for which thiis'per`rrirt is'issued P L y' ' (Sec,,3097, Civ C ) + ' ' '- SIDE a M DO°ry{y- 0MV 9/26/89 Lender's Name A� r` ✓f +-c LDMA Ref # y" CQOif - {1, A i� 8:47 PC Fee$ Permit Fee i Lenders Address 0 I certify that I have read this,application and state that the ssuance Fee I0"- 0 LDMA P/C# ,b 8 above information is correct I agree to comply with all County_,: Investigation Fee 4 - 'ordiri6nces old State laws relating tobuildmg construction, - Total Fee r(J LDMA Perm # < and hereby thor _e re r entatives of this County to enter upon-the ab e= i��v' opertV for inspection pu}poses -< --400'0 SEE REVERSE.FOR EXPLANATORY LANGUAGE, , Signature of,Applicant or Agent Date �•� WORKERS' COMPENSATION DECLARATION ` Lanae a oradfcertif ca+te'of Wo ke certificate' Compensat nt on eInsurance, A_ P P L I CAT I®N F Oto self -R' B U I L D f N ; P E RIUI T oro certified copy thereof (Sec'3800, Lab C )' COUNTY OF LOS ANGELES ' BUILDING AND-SAFETY 'Policy No Company Certified co is hereby furnished FOR APPLICANT TO FILL ININEARE NG i PY Y SS p, LL p ✓ol(�L L/Z Certified copy is filed with,the'county building inspec- "' BUILDING// tion department s•+ ADDRESS(�o1p c 0 r C, �VZ pJIA LCT Ca,Date Applicant• CITY h�iNG// ZIP / aTYLLNO OF BLDGS T CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LO7 ST COMPENSATION INSURANCE(This section need,not be'completed if the permit is foi one �i OR -TRACT BLOCK LOT NOOOK' x PAGE PARCEL hundred dollars ($100)orLIess ) . OWNER lit) N� KE I LAG(/✓ No a6 - NE MAPI certify that tri"the performance of the,work for whch'thisi NO permit is issued, I shall not employ any person in any mannerSPECIALADDRESS- + CONDITIONSso as tobecome subject to the Workers'Compensation Laws 0 r' CITY ZIP ` U Date r ' ;b'I�� Applicant C OtA Sc U�� ARCHITECT OR TEL NOTICE TO APPLICANT If, after making this'Certifcate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become- subject-to the Workers' / ^ CONST ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS w Seo "� LU with comply;with.'such provisions or this permit shall be �•- , TEL J STATISTICALCLASSI C ION APT CONDO N -deemed revoked jl�r- NO / Z' LICENSED CONTRACTORS DECLARATION-` + UC ,' CLASS NO DWELL UNITS — I hereby offirm that I am licensed under provisions of Chapter 9 ADDRESS NO,+ (commencing with,Sectiori 7000)of Division 3 of the Business and LIC L' SEWER MAP Professions Code, and my license is in full force and effect - CITY CLASS BK VALIDATION r ' " SO FT INO OF,. NO OF CHECK PG License Number ; Lc CSTORI Class SIZE �'V ' ES± FAMILIES ONE 11 VALUATION w DESCRIPTION OF WORK 0 011' NEW ,��p Jy Contractor Date ADD ® S &M M I am exempt under Sec' i "a ALTER, B 8P C for this reasonJ Y y REPAIR 0 $ r Date EXISTING BLDG WORK6,tb DEMOL v; APPLICANT > TEL Signature PRINT LDU� `L C61/� No��6—Jd 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 FI L -9 L Q 6,4-A Professions Code) 7- P 9i BUILDING © 1, as owner of the property, or my employees with a ADDRESS �:o wages as their sole compensation,will do the work and the structure is not intended,or offered for sale(Section,' LOCALITY >-` ` >; I'°i- 5925 7044, Business and'Professions Code) MOVING TEL - '' Z CONTRACTOR NO _ 1, as owner,of the property, am exclusively contracting r, i L�i ) oio 0 5 9 2 5,5 with licensed contractors to construct the project (Sec- 4 ` ADDRESS tion 7044,-,Business and Professions Code) ,R � •.�, ,O'� O 1 a 8 YARD HW REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK Y PROP LINE WIDTH " I heieby affirm that there is'o construction lending agency for FRONT t , the-performance of the work for which this permit is issued P L ` (Sec 3097, Civ'C ) ' , ` r [Investigation IDE w i _ L Lender's Name LDMA Ref # _ w - - y -Fee,E - - Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee � LDMA P/C# above"information is correct I agree to comply with all County Fee 0 ordinances and State laws relating to building construction, Total Fee . LD Perm # $ and hereby authorize representatives of this County to enter upon the above-menti ned property for inspection purposes .�— 3 O SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant o Agent Dote