Loading...
HomeMy Public PortalAbout9932 DUFFY ST_Building__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1211280008 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: 1 ITR: 17200 LT: 8 SQ. FT STORIES TYPE I 9932 DUFFY ST 1 I ISTRUCTURE: 27 V-B I TEMP CA 917802607 I (ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: BALDWIN I 18588-014-008 1 i THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY (TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 IISSUED ON: PROCESSED BY: 1 IEXIST OCC GRP: 111/28/12 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1 IYUE DONALD;KATHLEEN TRS YUE TRUST (524) 206-8287- '1 2,000 12055 ROBIN RD I J n ISMAR 911082831 ;1 FEES PAID IDESCRIPTION OF WORK 1 I `1 ICOMPLETE TEAR OFF RE-SHEATING RADIANT BARRIER AND INSTALLINGI I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 130 YRS COMPOSITION SHINGLE DETACHED GARAGE 1 (APPLICANT: TEL. NO: 'I I - I ISOZA, MARIA E (626) 285-9016- -IAA BLDG PERMIT ISSUANCE 27.80 1 14533 SHIRLEY AVE lAB STATE GREEN BLDG FEE 2000.00 VAL 1.00 ISPECIAL CONDITIONS: 1 1EL MONTE CA 91731 IAC STRONG MOTION RESID 2000.00 VAL 0.50 1 .1D2 PERMIT W/O EN-HC 2000.00 VAL 82.20 - I 1 TOTAL FEES 111.50 1 ICONTRACTOR: TEL. NO: 1 - 1APPR.OVALS DATE INSPECTOR SIGNATURE 1 IGOLDEN KEY INC (626) 285-9016- 1 1- I LIC. NO 1 ILOCATION AND SETBACKS 14533 SHIRLEY AVENUE 775115 1 1 _ I IEL MONTE, CA 91731 (SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: - TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I I I I I LIC. NO: 1 (SLAB%UNDER FLOOR I I RAISED FLOOR FRAMING I 1MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I 1150H269 3 001! 1 1 I I - I 1FLOCu. SHEATHING I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 1 0 NO 21 i 1ROOF,, SHEATHING �- 1 SCHOOL WITHIN HAZARDOUS j ISHEAR PANELS I1 1 (AIR QUALITY: 1000 FEET MATERIALS iI- 1 1 NO NO NO 1 IFRAME INSPECTION I I I I i IFIRE SPRINKLER HANGERS I I "11NSULATION/WEATHER STRIPI I I I I I INTERIOR LATH/DRYWALL I I IEXTERIOR LATH I I I I 1 IRATED FLOOR/CEIL ASSEM. I I IRATED WALL ASSEMBLIES I I I 1 IRATED SHAFTS/OPENINGS I I j IT-BAR CEILINGS I I I* ADDITIONAL DATA ON FILE ILOT DRAINAGE I I I I !REPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9:701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1211280006 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 17200 LT: 8 SQ. FT STORIES TYPE 9932 DUFFY ST I _ISTRUCTURE: 27 V-B TEMP CA 917802607 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN I 18588-014-008 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY 1 ITENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1 1 (EXIST OCC GRP: 111/28/12 SR (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINNAL BY: CODE: I IYUE DONALD;KATHLEEN TRS YUE TRUST (524) 206-8287- 1 6,000 12055 ROBIN RD SMAR 911082831 FEES PAID IDESCRIPTION F WORK ICOMPLETE TEAR OFF RE-SHEATING RADIANT BARRIER AND INSTALLING( 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:130 'IRS COMPOSITION SHINGLE 1 1APPLICANT: TEL. NO: I 1 1SOZA, MARIA E (626) 285-9016- 1AA BLDG PERMIT ISSUANCE 27.80 1 14533 SHIRLEY AVE IAB STATE GREEN BLDG FEE 6000.00 VAL 1.00 1SPECIAL CONDITIONS: 1EL MONTE CA 91731 IAC STRONG MOTION RESID 6000.00 VAL 0.60 1 1D2 PERMIT W/O EN-HC 6000.00 VAL 149.40 I 1 TOTAL FEES 178.80 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE I 1GOLDEN KEY INC (626) 285-9016- 1 1 - I 1 LIC. NO 1 ILOCATION AND SETBACKS I 14533 SHIRLEY AVENUE 775115 1 I_• 1 I I 1EL MONTE, CA 91731 I ISOILS ENGINEER APPROVAL 1 1 1 1ARCHITECT OR ENGINEER: TEL. NO: _ 1FOUNDATION/TRENCH FORMS 1 1 1 LIC. NO: 1 1 ISLAB/UNDER FLOOR I 1 1 I ! 1 I IRAISED FLOOR FRAMING I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 1UNDERFLOOR-INSULATION I 1150H269 - 3 001 1__._ 1FLOOR SHEATHING 1NO. OF FAMMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: ' 1 i 1 1 0 NO 21 I , 1ROQF SHEATHING 1 1 _ I «' SCHOOL WITHIN HAZARDOUS - 1SHEAR PANELS (AIR QUALITY: 1000 FEET MATERIALS I i NO NO NO FRAME INSPECTION 1FIRE SPRINKLER HANGERS I (INSULATION/WEATHER STRIPI I I I (INTERIOR LATH/DRYWALL I 1EXTERIOR LATH I I I IRATED FLOOR/CEIL ASSEM.. I I I I I 1RATF.D WALL ASSEMBLIES I I I i IRATED SHAFTS/OPENINGS I I IT-BPR CEILINGS 1 I I 1* ADDITIONAL DATA ON FILE I I 1 ILOT DRAINAGE 1 1 I i IREPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I I I I I I i ©s 76A638A,T_•.- 'v"' CE#8 GO(REV.11/78) /"r -AliPLOCA ION FOR. BUILD 701N.G*.'OERM'07� COUNTY OF LOS ANGELES BUILDIRG AND,SAFETY _- BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILDING 0 ADDRESS_ _ LOCALITY �y / NEAREST, CITY C G ZI CROSS ST OF BLDGS. ASSESSOR SIZE OF LOT d-0 .33 NOW ON LOT . MAP BOOK PAGE PARCEL• `1 DISTRICT GROUP TYPE ( FIRE PROC CONSSED.BY TRACT QV BLOCK LOTNO.. /)� ST ZO E ��7/ _ TEL . v OWNER xi NO. - STATISTICAL CLASSIFICATION T SEWER MAP ADDRESS J ..,�� CLASSNO. e/ DWELL,UNITS-'- _BK/t7PG CITY. ZIP• ' _. ARCHITECT OR TEL VALUATION ENGINEER NO: ADDRESS: BLDG.SETBACK FROM/ TEL. �j FRONT PROP.LINE OF (STREET) .ONTRACT 0R ,fes NO. L HIGHWAY + YARD -' TOTALS TB CK'ROM TYPE OF EXISTING . LIC � FRONT PROP..LINE HIGHWAY WIDTH ADDRESS C AJ NO. . ` LIC. Z9' CITY CLASS BLDG.SETBACK FROM CONSTRUCTION-LENDER SIDE PROP.LINE Of '• !STREET! ,• NAME AND BRANCH HIGHWAY + YARD '-TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH, 0 SQ.FT. NO.OF NO.OF CHECK + — ` SIZE J.STORIES FAMILIES' ONE ' 0' _ USE ZONE MAP 0 DESCRIPTION•OF WORK NEW ❑ j> U"NO l SPECIAL - ADD ❑ -I �4 CONDITIONS ALTER ElFINAL J ) REPAIR DATE,i2".'"G� USE OF7s: DEMOL EXISTING BLDG. ❑ Z APPLICANT TEL �y �j 2 (PRINT) o rNO. � .- / BY ISIGNATU _ .. Q I HEREBY ACKNOWLED HAT I.HAVE READ THIS APPLICATION AND STATE ' THAT THE ABOVE IS CORRECT,AND AGREE TO COMPLY WITH.ALL ORDINANCES .. ..- «. WA AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE _ o p p n' •- WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF - u Z CJ O, A THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING.TO WORKMEN'S COM- PE NSATION OM-PENSATION INSURANCE.' J O O O 0.0 SIGNATURE 0 0 r 2'- 1 51.-00 PERMITTEE ADDRESS j ' _ v i01- 1 51.005 z TEL. `C' CITY _ J c Oil.3 O r 8 0' . . P.C. Fee$ Permit Fee > Issuance Fee W • r v d LL ITotal FeeZJ r,_ DEPARTMENT OF BUILDING AND SAFETY..' APPLICATION FOR:PERMIT COUNTY OF-LOS ANGELES FOX, CHIEF ENGINEER. " FOR APPLICANT TO FILL IN FOR OFFICE USE.,ONLY.- ' JJ�� � J DISTRICT NO.; -[PAN CK.�NO. :PERMITT NO BUILDING Jk - ADDRESS /-:..�L�"oa�-'l ® /'"i.� �. w _.,3 7 oo (� 6 LOCALITY - RECEIVED BY} DATE'OFAPPL. _ DATE ISSUED NEAREST CROSS ST �•� ,. '..!l', .Y,a` .P�`` ,eP� ....�.�...."_. ` BUILDING y ADDRESS z MAIL .LOCALITY, - ADDRESS. A - /f'�s� �:-r ,yt,+o1' _. i '...• : NEAREST �� r ,.'.TEL. 'CROSS ST. Y. // r� CITY ��,,,�:'} --y6� ir°I.�aza✓P.r3f 'NO. rA .- 4 FIRE I NO. OFPII TYPE.� I GROU ARCHITECT OR -:;TEL. ZONE - PLAS '. ENGINEER ,.,- ;,� _ 'NO BLDG + D._NO. v - SETBACK LINE . ' ADDRESS �1�� f6�' _ APPROVED - _' i —� TEL BY _ n, DATE CONTRACTOR /,,M •/'��jj*�-�fy .NO. ���' ,USE - �. / APPRO�� a. i - - ZONE BY 0, I DATE ADDRESS' R , ,'HOUSE: NUMBERING LEGAL ^ + DESCRIPTION, Lo -,NO. � `I'BLOCK - MAP NUMBER�J a FIELD CHECK BY .. p TRACT �.•�.,,! ��. - ,NO. -ASSIGNED 13 'DATE , NO.OF BLDGS. CORRECTIONS SIZE OF LOT .NOW ON LOT •. USEOF NO. OF, '.y� r�., EXISTING BLDG., I FAMILIES - DESCRIPTION OF WORE NEW t�X I_:ALTERATION' I - 'I ADDITION �I ...-5� r—Av y- REPAIR : DEMOLI,TION SQ. FT.: Q7� ;NO, .OF D SIZE ROOMS ,(i', STORIES -- - - - - Z Y EXT..WALL' ./J. , . . ..ROOF: .® i - - C. COVERING, .,> :. 4" .I COVERING .. USE OF,-STRUCTURE.; .. .. - V PPROVALS' NSPECTOR�S SIGNATURE -- DATE I HEREBY ACKNowLEDGE'THAT I HAVE READ THIS AP- 06UNDATION: LOCATION - PLICATION AND 'STATE THAT THE INFORMATION GIVEN IS •FORMS, MATERIALS CORRECT. I AGREE TO. COMPLY WITH THE .CORRECTIONS LISTED': FRAME: FIRE STOPS,,, HEREON,AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING .BUILDING CONSTRUCTION. .FU RNACE: LOCATION, SIGNATURE OF �JA Y✓. �1' < Pyr � � GAS VENT, DUCTS X - PERMITTE /.vs �./- .S•3 w'.+! .A -. .t - .--� LATH, INT. ADDRESS - - _ v „ - LATH,,EXT.. - AUTHORIZED AGT: - - PLASTER, INT. - - 7ewe3ew, Dass io- $ P. C. $ FEE 3� J �_ �^ PLASTER, EXT. $ VALUATION .o. _. : FEE . a� FINAL e 7 76A638A CE08031-67 APPLICATION FOR 861LD1 G PERM1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS J BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST. - ' �vv DISTRICT Nr GRS TYPE PR Q CZS^Ssd5_`eY FOR APPLICANT TO FILL IN ) CONST. 1/ BUILDING J� �+_ �^ r_ STATISTICAL SSIFICATION SEWER MAP ADDRESS L?� Lop'- � G� f CLASS NO. .DWELL UNITS. BK PG - LOT NO. BLOCK USE ZONE MAP �} NO. V TRACT SPECIAL �] NO. OF SLOGS. % CONDITIONS SIZE OF LOT J Q`/C ��7 ca7 NOW ON LOT USE OF 17"D�/f ' t� n BLDG. SETBACK FROM OWNER ✓mak�fOn.� `"'�li�a NOLs>{�� OE- T YPE OF FRONT ROEXISP. ITINONE F SETBACK HIGHWAY + YARD = (STREET) ADDRESS f/�.7�, Ursa S-7- ( ` HIGHWAY H FROM C.L. CITY c 17y-, BLDG:SETBACK FROM - ARCHITECT OR - _ TEL. -�--. r SIDE PROP. LINE OF (STREET) ENGINEER �" NO. _ TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHW AY WIDTH FROM C.L. TEL. + CONTRACTOR NO - LIC a ADDRESS NO CORNER CUTOFF. YES. NO F C C CITY 5;LA55 LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK LL CL NEW ADD ALTER REPAIR DEMOLISH v Z SQ.FT. NO. OFNO. OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT ,0 d VALUATION$ - Q ,Doo APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. �,(� FOUNDA I MATERIALS N, ION FEE$ FEE$ . i //- �/ 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILD I NG CONSTRUCTION. I.CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S CO; NSATION INSURAN E. LATH. EXT. PERM Tt URE SIGNAITTEE OF ^�' L '�`� HORECT ANDUSE EPOSTOED %1 ADDRESS -� FINAL JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O CASH I 1 n 9- OCT25 2 D 9.010- Ac) 76A698A CE#808.7.56 APPLICATION FOR BUILDING PERMIT 1-J BUILDING AND SAFETY DIVISION BUILDING Department of County Engineer ADDRESS County of Los Angeles LOCALITY ~- JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN. SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRI�J NO. GROUP I TYPE -_ - I SEWER MAP +.j. BK PG CONST: BUILDING ADDRESS - J STATISTICAL 7ASSIFICATION LOT NO. BLOCK CLASS. NO. DWEL.6 UNITS / MAP STATE yES ~ NUMBER =-•4- HWY -116 TRACT USE ZONE SPECIAL NO. OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH OWNER FRONT MAIL P. L. ADDRESS SIDE TEL. P. L. CITY NO' INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ADDRESS TEL. CONTRACTOR NO. ADDRESS � DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ. FT. - NO. OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE APPROVALS SIGNATURE OF APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS - FOUNDATION: LOCATION FORMS. MATERIALS i P. C. S FRAME: FIRE STOPS. FEE BRACING, BOLTS SFURNACE: LOCATION. VALUATION GAS VENT. DUCTS FEE / I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT. STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN A.LAMBIE. COUNTY ENGINEER, >" CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH BUILD ING ADDRE69 -7-7 / APPLICATION LOCALITY NEAREST r J..-+I.-.C.�+-.�C.j„P••-r�.t/`,'......! . DIVISION OF BUILDING AND SAFETY CR099 9T. .,-1-I I Department of County Engine? DISTRICT NO. RECEIPT NO. PERMIT NO. County Gf Los Angeles fj '� / ,6 WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISSUED CABSATT D.. GRIFFIN, PT 5 SUOF BUILDING r, - ...e - .; ..., ;.y :, u m: . til f '� . FOR APPLICANT TO FILL IN TYPe4MNST. RBC6?VED BY SSUED BY `OWNER MAP <' d 4"% STATE YE9 N. MAIL NUMBER HWY ADDRESS USE ZONE SPECIAL .CITY «p77'��.AIVAZ e/>rz TELNn.. r7jia �. CONDITIONS j/j) J/ ARCHITECT OR -• TEL. _ `:•f p / ' ENGINEER NO. BUILDING ,YARD HWtY STREET NAME EXIST. .. - SETBACK WIDTH ADDRESS FRO4/T I " TEL i P.L. 7ML ' CONTRACTOR NO. - •'• i; SIDE P.L. AD REBS = DATE QORREQTIONS INSPECTOR BUILDING g.2 1p.•�,.•F -M1 ADDRESS cf b/� ' LOT NO. BLOCK 4 TRACT 7;X®O NO. OF BLOBS. .g SIZE OF LOT J:b =C + I NOW ON LOT a • USE OF d XIS IN BL �.d0pe R' �'H9.�tS�g ' M DESCRIPTION OF WPIIC": NEW_ ADD ALTER I REPAIR DEMOLISH p FT. I� NO OF NO.OF ` Y SIZE, bre® ga:,•,�.BT.ORIEBFAMILIEH 4' i m USE OF STRUCTURE. NO.OF MPLOY S I HEREBY ACKNOWLEDGE THAT I HAVE,READ THIS'AP- PLICATION AND STATE•;THAT THE INFORMATION MIVEN IBAPPROVALS INBPECTORIS SIGNATURE, DATE CORRECT. '- .. 1 A&REE TO COMPLY WITH'•ALL.COUNTY.ORDINANCES FOUNDATION: LOCATION AND STATE LAWB REGULATING BUILDING CONSTRUCTION.,' FORMS,MATERIALS f FRAME: FIRE STOPS. SIGNATURE OF BRACING,BOLTS PERMITTEE { �'1 - - FURNACE: LOCATION, GAS VENT,DUCTS ADDRESS i •a �.,,' LATH, INT. AUTHORIZED AST. 1 • LATH, 'EXT. �. P.C.B HOUSE NUMBER COR- �? RECT AND POSTED VALUATION FEE ��•' � FINAL ' 76A636A k.'DSS 3 4-54 WORKERS'COMPENSATION DECLARATION � "i"nsurebor.a crrm that erttificatelof Workers'Colmpensotionol suranoself M ce,or app d O CAIN 0�� F O R S U��D,��G p C�Q�0 U a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES ge,,2� BUILDING AND SAFETY, Policy No. Company' x Certified copy is hereby'furnished., FOR'APPLICANT TO FI LIN ADDRESS t ' Certified copy is filed with the county building inspec- BUILDING. 7 � tion department. ADDRESS L LOCALITY _ • � - NEAREST Date ' Applicant CITY Z CROSS T. Gt F CERTIFICATE OF-EXEMPTION FROM WORKERS` i ( O.OF BLDGS.` ASSESSOR COMPENSATION INSURANCE f, � . SIZE OF<LOT� NOW ON LOT - PAP OOK PAGE PARCEL (This section r eed.not-be completed if,the permit is for one NE- P " hundred dollars ($100)or less.) TRACT BLOCK LOT N / NC7. C/ TEL ECIAL OWNER T O. CONDITIONS CL 1 certify,fhat in the performance of the..work for which`this O permit is issued,.Lshall Pot employ any person,in a manner. ICT GROUP TYPE- FIRE PRO ESS BY U CONST so a_s f become subject to the Workers'Co p _satin L ws. ADDR SS ' ` CITY ZIP �• �— ��- pelican"t STATISTICAL CLAS ICATION APT. CONDO. NOTICE T APPLI NTi If aft r making this erfificate.of ARC ITECT O TEL.: W Exemption, you should• becol�m subject. to the Workers' ENGINEER NO. CLASS NO:c=T� DVIELL. UNITS - Compensation provisions-6f th abor Code, you must forth- ADDRESS L SEWER MAP, with comply with such provisions or this permit shall be TEL. deemed"revoked, CONTRACTOR NO. BK. G, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. - I hereby affirm that I am licensed under provisions of Chapter 9 pt 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..F1 T N0-0 F NO, OF CHECK License.Number. Lic.Class" SIZE ISTORIES FAMILIES ONE DESCRIPTION OF WORK NEW $ Contractor Date" ❑T I.am exempt from the licensing requirements as lam a ` _ ADD licensed architect-or a registered professional engineer ALTER FINAL �,7 acting in 'my professional capacity.(Section 7051, "rGyytQ REPAIR DATE Business and'Professions Code).. USE OF EXISTING BLDG. _ ` DEMOL a B NAL ` Lic or Reg No. _Date APPLICANT TEL. Y 1 OWNER-BUILDER DECLARATION (PRINT) �'. phNO. /3- ; I herebyaffi�m tliat I am exempt from the Coni actor's License Law for the following reason.(Section 7031..5 , Business and ADDRESS Professions Code): PRESENT BUILDING 1; '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, am exclusively contracting" CONTRACTOR NO. 22 1 6„5 A. with.licerised'contractors to construct the project (Sec- ADD RESS tion 7044; Business and Professions Code).. REQUIRED HWY TOTAL SETBACK FROM EXIST, CONSTRUCTION LENDING AGENCY _SET BACK YARD PROP. LINE WIDTH - _ 2 0•0 2,5 0 0. 1-hereby affirm that there,is a.construction'lending agency for FRONT the:performance of.the work for which thisermit•is Issued P.L. o 0 s (Sec. 3097, Civ. C.)..: P SIDE 02 5 0 Ow ' P.L.. Lender's NameO 9. 1 7 8 0, F r Lender's Address P.C. Fee$ Permit Fee > I.certify that I have read this application and state that the Issuance Fee .. above information is•correct. I agree to co'm'ply with,all County Investigation Fee ordinances and State,Ia elating to building construction, nd herebyouthoriY repre entatives of this County to enter Total Fe C� �J` ceon thea ve'�i entioned pr er specti ^n purposes. �aSEE REVERSE FOR EXPLANATORY LANGUAGE t Signature of`pplicant or Agent. Dote i ©s