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HomeMy Public PortalAbout5000 ENCINITA AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION� LD� PERMIT ,CO,UNTY OF LOS ANGELES _ WM. J .FOX, CHIEF ENGINEER i ING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY UILDINGa DISTRI�`�LNO PLAN CK NO PERMIT NO ADDRESS J d �"Y , D 72 3'- LOCALITY . I CEI ED BY ' DATE OF APPL DATEISSUED NEAREST CROSSST ,�1,. BLALDING ADDRESSw!T/� " OWNER MAIL .- LOCALITY ADDRESS NEAREST EL CROSS ST � Q liJ v CITY NO / RE NO OF TYPGROU ARCHITECT OR TEL ON6 PLANS ENGINEER NO BLDG ORD NO SETBACK LING ADDRESS APPROVED ' TEL, . BY ' DATE CONTRACTOR,4 �f' Q NO V USE /_/ APPROVED ZONE -1 BY DATE ADDRESS _ t HOUSE NUMBERING ' LEGAL' DESCRIPTION I LOT NO BLOCK MAP NUMBER IELD CHECK BY i TRACT- NO ASSIGNED BY j� ATE I y /_ NO OF BLDGS CORRECTIONS SIZE OF LOT { •D I! NOW ON LOT _ USE OF I NO OF EXISTING BLDG, FAMILIES - ESCRIPTION OF WORK NEW I /� I ALTERATION y I ADDITION 0' - REPAIR 'I I DEMOLITION SQ FT J NO OF SIZE J` ROOMS STORIES Z EXT WALL ROOF , 'r COVERING COVERING USE OF STRUCTURE' ' i APPROVALS INSPECTOR'S SIGNATURE DATE I HERESY ACKNOWLEDGE THAT"I HAVE READ THIS AP- FOUNDATION LOCATION Z f PLICATION AND STATE THAT THE,INFORMATION GIVEN IS FORMS, MATERIALS �y,�yr;,y,�. /1% 1 ct/ CORRECT 11 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOP$, / HEREON AND WITH ALI, COUNTY ORDINANCES AND STATC BRACING, BOLTS / r� / f� Y LAWS REGULATING BUILDING CONSTRUCTION FURNACE LOCATIOIK� S16NATURE OF - /' GAS VENT, DUCTS PERMITTEE / •TiC.Y75.� ' LATH, INT ADDRESS , LATH, EXT AUTHORIZED AGT PLASTER, INT L1323 Io-eo $ P C $ FEE PLASTER, EXTN D SL.—' FEE $ V�� FINALrs+ a� '°- l J ' APPLICATION FOR COUNTY OF LOS ANGELES BUILDING PERMIT DEPARTMENT,r� AND SAFETY DIV SICZN ENGINEER ,,eecl F,,OR APPLICANT TO FILL IN ,j ADDRESS LJ L° ADBUIDRESS V G N C ry �A Y LOCALITY NEAREST CITY (ft ZIP (� �✓ CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT �i c�X (t NOW ON LOT MAP BOOK PAGE I PARCEL DISTRICT GROUP TYPE FIRE SED BY TRACT 0 BLOCK LOT NO a� �l CONST � ZO�t OWNER + TEL 0 A NO ZZ STATISTICAL CLASSIFICATION SEWER ADDREsSwf LAs J-0tjAS CLASS NO 2-2L"DWELL UNITS BK PG CITY Pw b l� ZIP Q O �s USE ZONE �MAP`t::� ARCHITECT OR TEL ENGINEEQ NO kl �' CIAL NDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ TEL CONTRACTOR NO BLDG SSFTBACK FROM 1 LIC FRONT gROP LINEOF (STREET) ADDRESS /v" NO HIGHW Y + YARD = TOTAL SETBACK FIROM TYPE OF EXISTING LIC FRONT PROP LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER - �- NAME AND BRANCH BLDG SETBACK FROM a SIDE PROP LINE OF (STREET) ADDRESS CITY U SO FT NO OF NO OF CHECK HIGHWAY + YARD - TOTAL SETBACK FRO TYPE OF EXISTING m SIZE STORIES FAMILIES ONE SIDE PROP LINE 16, WAV WIDTH O DESCRIPTION OF WORK bb ` WJkL.L. NEW ❑ + W ADD ❑ CORNER CUTOFF YES ❑ NO ❑ p_ ALTER ❑ N IN OPEN SPACE YES ❑ NO ❑ Z REPAIR El USE STONG BLDG �"L DEMOL ElIN COASTAL PERMIT ZONE 4 YES ❑ NO ❑ APPLICANT TE i:a�f� ���/� � 61C) M�7-- (PRINT) N ,� �� � BY(SIGNATURE) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS P ]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VI CATION OF THE LABOR CODE OF STATE OF CALIFORNI RELAT NG TO WORK EN 5 COM , PENSATION INSURA CE SIGNATURE FINAL �� h BY PERMITTEE DATE ADDRESS '94 S TEL �. PC Fee$ 6 Permit Fee CITY NO Issuance Fee VALUATION� / O !C1 Total Fee PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M o CASH 0 1 7�n1TtR 1:5 2 3 D 2 1.6 0_[,-,;. -- - 0 1 8 11*`ItiR 13 1 a 34.0 0 ®=--' 76A638A CE N803A 6/76 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY.OF LOS ANGELES I L® I G _ 1 •WM "J FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY CT_�{iJ BUILDING DISTR'IPLANCKNO PERMIT NO ADDRESS / / /A l,�+- � - �s�I �;x- a .` LOCALITY RECEIVE Y DA'TF,OF APPL DATE ISSUED NEAREST _ � /'�+ CROSS ST ,+r�-tet/ G�/ / BUILDING �-• / / ADDRESS OWNRR �Oe✓I.Ir ' �y MAIL LOCALITY pan+ ADDRESS •� �/', NEAREST / �� �J TEL CROSS ST CITY S✓f-{i7 NO �� d ~� FIRE- NO OF TYPE GROUP' ARCHITECT OR / // TEL ZONE PLANS ENGINEER v NO BLDG ORD NO SETBACK LINE ADDRESS APPROVED TEL BY DATE CONTRACTOR NO � USE APPROVED � ZONE BY DATE ADDRESS HOUSE NUMBERING LEGALDESCRIPTION TNO BLOCK MAP NUMBER >0 _FIELD CHECK BY TRACT / NO ASSIGNED BYDATE NO'OF BLDGS CORRECTIONS SIZE OF LOT © X lib I NOW ON LOT , USE OF NO OF _ EXISTING BLDG, FAMi LIES , -DESCRIPTION OF WORK NEW I I ALTERATION I I ADDITION REPAIR I ( DEMOLITION Ajrzc;Za ,D l-a os 6? 1 M4I () SQ FT © D NO OF J U _ SIZE }� ?'DROOMS STORIES (� EXT WALL 4 `m c I: tq A A 4. 1 6.v /Irb4•�Ta�,n---..r COVERING 7/�/ IROOF COVERING Cd-eO'L . .. USE OF STRUCTURE a ��}� P. / APPROVAL INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION LOCATION CA PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRESTOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION 1 FU SIGNATURE OF PERMITTERs S"3 f LATH, INT ADDRESS , LATH, EXT i AUTHORIZED AGT PLASTER, INT A538A 1313713 10-50 P C !8` Y / FEE PLASTER, EXT ./ VALUATION FEE $ �) �� FINAL 76A698A CE#009-10'SB APPLICATION FOR BUILDING PERMIT 1 BUILDING AND SAFETY DIVISION ADDRESS e ' Department of County Engmeer " ; County of Loa Angeles LOCALITY JOHN A LAMBIE. COUNTY ENGINEER NEAREST y CASSATT D GRIFFIN. SUP T OF BUILDING CROSS ST DISTRICT NO I GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN , BK PG CONST BUILDING © I ADDRESS STATISTICAL CLASSIFICATION LOT NO BLOCK CLASS NO DWELL UNITS MAP STATE YES NUMBER - HWY TRACT USEZONE SPECIAL NO OF BLDGS CONDITIONS SIZE OF LOTX I NOW ON LOT I USE OF EXISTING BLDG BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH q OWNER / FRONT MAIL P L ADDRES3 SIDE CITY / NOTEL,4 /ems P L ARCHITECT OR TEL -INSPECTION RECORD --- - ENGINEER NO ADDRESS i CONTRACTO �L RO ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF SIZE STORIES FAMILIES U S)OyF S�R U� i 19 APPROVALS SIGNATURi OF �s APPLICANT D► DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION LOCATION -q FORMS. MATERIALS $ �✓C1 P C g FRAME FIRE STOPS. FEE BRACING BOLTS FURNACE LOCATION. VALUATION $ 4 GAS VENT DUCTS FEE HEREBY ACKNOWLEDGE THAT t 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, BUILDIN CONSTRUCTION SIGNATURE OF HOUSE NUMBER COR- 1 PERMITTEE RECT AND POSTED' ADDRESS _1m=2 C12A"-� FINAL JOHN A LAMBIE. COUNTY ENGINEER CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION M O CASH E.d°CO2 4 8A V; SEP20 1 2,00 , M 76A638.,.CE98035-65 APPLICATION FOR BUILDING PERMIT LJ r COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY' JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS SUP T OF BUILDING CROSS ST DISTRIOCT NQ GRP TYPE PROCESSED BY FOR APPLICANT TO FILL IN �.C7r' C(7/ CONST BUILDING L. STATISTICAL CLASSIFICATION SEWERMAP ADDRESS CLASS NO --Z&DWELL UNITS BK/„PG 6� LOT NO pox"' BLOCK USE ZONE _NOP /J�// - II TRACT �Q /O - SPECCONDIAL TIONS O r NO OF BLDGS SIZE OF LOT (Q /� NOW ON LOT USE OF E (STING SLOG DG SETBACK FROM T L - ONT PROP LINE OF (STREET) OWNER TYPE OF_ EXISTING SETBACKHIGHWAY + YARD = TOTAL ADDRESS - HIGHWAY WIDTHFROM C L CITY BLDG SCTBACK FROM - - ARCHITECT OR TEL SIDE PROP LINE OF (STREET) ENGINEER - NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L TEL + _ CONTRACTOR - NO - O LIC CORNER CUTOFF YES NO V ADDRESS NO 9z CITY cLA S SEE REVERSE SIDE FOR SPECIAL APPROVALS 0 DESCRIPTION OF WORK w a N NEW ADD ALTER REPAIR EMO LIS ��T /l�' ` I Z SO FT QQ NO OF NO OF `7 �/ SIZE (JOlJ STOORIIES FAMILIES �+. USE F STRUOCTURE s - • SIGNATURE OF APPLICANT VALUATION$ V APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT Ud FOUNDATION, LOCATION FEE$ FEE$ - 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 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 COD OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S Cr)RG E=SATIO INSURANCE LATH EXT SIGNATURE O �G( HOUSE NUMBER COR- - + PERMITTEE RECT AND POSTED ADDRESS FINAL t ' /!% F LEWIS PRINCIPAL PLAN CHECK VALIDATION CK M o CASH _ JOHNPERMIT VALIDATION TRCKTU RM o EN GR - LI1,0 2 4 68— jum 2 1 D 4.00- 76A638A CE9803 5-65 APPLICATION FOR BUILDING PERMIT ' / COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY /C i �« - JOHN A LAMBIE COUNTY ENGINEER NEAREST �•7s COLEMAN W JENKINS,SUP T OF BUILDING CROSS ST DISTRICT NO GROUP TYPE PROCESSED BY + _ FU APPLICANT TO FILL IN Sv CONST ?d� j STATISTICAL CLASSIFICATION SEWER MAP Q® T CLASS NO DWELL UNITS - BLOCK USE ZONE�No MAP �,/ SPECIAL - -- ! NO OF BLOBS CONDITIONS r- NOW ON LOT _ O BLDG SETBACK FROM ' EL Q FRONT PROP LINE OF (STREET) O TYPE OF EXISTING SETBACK H WAY '� YARD TOTAL ADDRESS �J VTOL E p HIGHWAY WIDTH FROM C L CITY ` + BLDG SETBACK FROM ARCHITECT OR TEL ! SIDE PROP LINE OF �' (STREET) ENGINEER " No 71?(j" S,Si3 - TYPE-OF EXISTI SETBACK HIGHWAY + YARD - TOTAL' ADDRESS Q S QsE' // HIGHWAY WIDT FROM C L TEL —(ob _ + _ CONTRACTOR O O ADDRESS G d NO �. I CORNER CUTOFF YES NO U OC CITY CLA S SEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK LLI u CL NEW ALTER REPAIR DEMOLISH Z SO FT NO OF NO OF SIZE STORIES FAMILIES USEOF STRUCTURE SIGNATURE OF APPLICANT 52t VALUATION$ /J O(j - APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT Q FOUNDATION, LOCATION FEE$ FEE$ 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS 9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK , AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT SIGNATURE OFHOUSE NUMBER COR- PERMITTEE ,' /'6 � /� RECT AND POSTED ADDRESS ?O q 6 FWal2 012y, FINAL PLAN CHECK VALIDATION CK Mo cnsH — JOHN F LEWIS PRINCIPAL STRUCTURAL EN R PERMIT VALIDATION CK M C CASH ��;+�0 4 ,3 8 ? i�l!c 2 6 a 4.0 O N 7eweadw 0@H-8 3-8APPLICATION PPLICATION F®R BUILDING PERMIT I ■ 1 DIVISION OF BUILDING AND SAFETY BUILDINGS ADDRESS Deportment of County Engineer County of Los Angeles LOCALITY WM J. FOX, COUNTY ENGINEER NEAREST V CASSATT D GRIFFIN, SuP•T OF BUILDING CROSS ST 1--'1 0/� An -I DISTRICT NO. GRP ,.irPESEWER MAP FOR APPLICANT TO FILL-IN 3— B PG CONST —46 BUILDINGI MAP C� STATE ADDRESS ) :74 .+� NUMBER OC - HWY, YES N LOT NO. BLOCK USE ZONE SPECIAL _ CONDITIONS TRACT NO. OF BLOGS. BUILDING - EXIST. SIZE OF LOT NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH USE OF EXISTING BLD G• /I t7G v ul O FRONT P L OWNER SIDE P L MAIL ) O TRACT DWELL. I UNIT " ADDRESS r to 5 INDUSTRIAL C N DWELL. I UNIT CITY "� /I' I NO - 6 PUBLIC BLDG ' . YA ARCHITECT ORT L 2 DUPLEX 1 UNIT 7 ADDN ,ALT ETC. ENGINEER NO 3 APT UNITS 8 MISCEL-. ADDRESS� 4 COMMERCIAL TEL CONTRACTOR NO INSPECTION RECORD ADDRESS DESCRIPTION OF WORK o NEW /A ALTER REPAIR DEMOLISH r SO FT eq NO.OF NO OF SIZE STORIES FAMILIES ' USE OF STRUC URE SI NATURE , APPLICANTOF APPROVALS ADDRESS DATE INSPECTOR'S SIGNATURE FOUNDATION LOCATION FORMS. MATERIIALS �e P C $ / FEE FRAME FIRE STOPS, ` VALUATION $ fj O BRACING, BOLTS FURNACE LOCATION, 1 E HEREBY ACKNOWLEDGE THAT 1AHAVE READ THIS GAS VENT, DUCTS APPLICATION AND STATTHAT THE BOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT AND_STATE LAWS REGULATING BUILDING CONSTRUC- TION �a� �� LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE � A RECT AND POSTED ADDRESS .:-,: FINAL WM.J FOX,COUNTY ENGINEER VALIDATION C N DIRLAM, CHIEF BLDG INSPECTOR X08 3 b 9-in sir 2 6 1 b J U in - 76A638A CEu803 5-65 FOR B DI G PERMIT APPLICATIONO UIL COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION L O C A L I T Y --rio-nna JOHN A LAMBIE COUNTY ENGINEER NEAREST _ COLEMAN W JENKINS SUP T of BUILDING CROSS ST DISTR_ T NO G P TYPE - P B FOR APPLICANT TO FILL IN � CONST , .it— BUILDING 'STATISTIC ASSIFICATION _ _ S W R-MAP , ADDRESS �O I G BK' -PG C UASS NO DWELL UNITS_ LOT NO BLOCK USE ZONE MAP 0 NO V-` TRACT O SPECIAL _ S _ NO OF BLDGS CONDITIONS SIZE OF LOT O I� NOW ON LOT - USE OF E "STING BLDG BLDG SETBACK FROM - _ f- - - -•--�_ TEL FRONT PROP LINE OF (STREET)- OWNERIF TYPE OF EXISTING SETBACK_ HIGH-WAY + YARD" = TOTALS ADDRESS HIGHWAY WII H FROM C L CITY —1 BLDG SE BACK FROM, ARCHITECT OR TEL V� SIDE PROP LINE OF T y - (STREET) ENGINEERJd Ali TYPE OF EXISTING SETBACK HIGHWAY + YARD - -TOTAL ADDRESS HIGHWAY WIDTH FROM C L ' CONTRACTOR 0 ADDRESS NO CORNER CUTOFF YES NO O a CITY CLASS EE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK �� /N7 r� a NEW ADD LTER REPAIR DEMOLISH rr t_ i Z Q FT NO OF NO OF ,a Q/ y Po SIZE STORIES FAMILIF_ USE OF STRUCTURE e ��OCIt f�rt I SIGNATURE OF • / ���� �P',i" r �/ �r"a" � APPLICANT VALUATION?$ APPROVALS, /1 DATE INSPECTOR'S SIGNATURE P C .y PMT FOUNDATION, LOCATION FEE$ i✓ FEE 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS SUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK .( �.. AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABO�CO OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN NSATION INSURANCELATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS r © Ycd (2FINAL / - 1 PLAN CHECK VALIDATION 0 M o cnsH — JOHN F LEWIS PRINCIPA LAST URAL ENGINEER PERMIT VALIDATION , CK M- CASH 'LA"W' 3 0.1 6'- JUN 2 3 2 3 D 2 8.5 0 A ,I 3 2 1 8 JUL 1 1,D 5 7.0 0­ rgWORKERS' COMPENSATION DECLARATION I affirm that I havecertificate of consent to self APPLICATION FOR BUILDING. PERMIT insure,, or�' certificate of Workers' Compensation Insurance, orva c,r,�'rtif4�i'clopy thereof fSec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PollCy No. 0 77J CompanyS�e1 Q, U 17 BUILDING /[f 1�]I /1 /(.I/�^ ' Certified copy is hereby furnished. FOR APPLICANT TO FILL IN - 5-00o r,-r, -rA /"1vl� ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING D ��{, , K( (.�q. /(�/r tion department. ADDRESS ] 'W' I� A Ct/`"TN 1�- "� L� (�q7 P Date _ Z- Applicant CITY _TfVF ZIP l 1 �� LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' �" NOW ON LOT NEARI CROSSNO. OF BLDGS. ST. r (/S G� COMPENSATION INSURANCE SIZE OF LOT O (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 11 NOTEL.. 8 �Q(7 USE ZONE MAP ' 1 1_ I certify that in the performance of the work for which this OWNER S+ IN NO lT r permit is issued, I shall not employ any person in any manner ADDRESS2� O" , f1, I SPECIAL so as to become subject to the Workers'Compensation Laws. f^7 CONDITIONS Date Applicant CITY Kd5 1"17?S"' ZIP ' l ( 0 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 Compensation provisions of the Labor Code, you must forth- ADDRESS OV 0V I 9 A05 with comply with such provisions or this permit shall be �1 V(�yyL�,���yA� TEL. S TISTICAL CLASSIF�ATION APT. CONDO. deemed revoked. CONTRACTOR-P1`( XVwFEf�f%� NO. "flat- LICENSED CONTRACTORS DECLARATION LIc. -2-16137 CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS -4-0:2-35t qfi( � No. B (commencing with Section 7000)of Division 3 of the Business and ^ �r ` LIC. SEWER MAP _ Professions Code, and my license is in full force and effect. .( I`J CITY :56 � �N L 1� CLASS `w-`� VALIDATION 1` SQ. FT O. OF NO. OF CHECK BK.• l PC'. I'' - __ y z f _ 2 ✓ / SIZE STORIES FAMILIES ONE L y_£• Yt y a � License Number 7 Lic.Class � � Iy;_ VALUATION Contractor Date pate rOESCRPTIONOFWORK NEW ❑ s � aT`N.; � p /(VTI Q, t t,(,Ar , ADD , 1 =z ❑ I am exempt under Sec. 1✓Y /'JFL 1� tV yYfTli(� t_IIAL 1`5 per..► ALTER REPAIR / /• B.BP.C. for this reason aV HE K 251.8W• Date: USE OF -.t=:_: (0 EXISTING BLDG. DEMOL ❑ L.;i !'?!�� o lte Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT) F-fNO. afl2 DATFa 1 hereby affirm that I am exempt from the Contractor's License .Zv13M Law for the following reason (Section 7031.5, Business and ADDRESS �rnlA� �`� B 1.E6; 1 i-til11:4.5 Professions Code): BUILDING ��p `WCUe4A AVC-. —"KC-C4 `' ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and LOCALITY the structure is not intended or offered for sale(Section ' ACCT.T 7044, Business and Professions Code). MOVING TEL. 'T ❑ CONTRACTOR NO. 3307 - with ' 7c I, as owner of the property, am exclusively contracting 3317 ti1 �a t•_ i CM ........... .. ... with licensed contractors to construct the project (Sec- ADDRESS 1 ITEt9S tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FRMM EXIST: .... �y ` .-yam' CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH TOTAL"" 30a s d _� I hereby affirm that there is a construction lending agency for FRONT ru u' the performance of the work for which this permit is issued P.L. 4C1E�[ �� ■� (Sec. 3097, Civ. C.). SIDE CHOct P.L. . Lender's Name h LDMA Ref. # P.C. Fee$ 261. 9- - Permit Fee A������ i 6/13/89 Lender's Address - V 1 oI certify that I have read this application and state that the Issuance Fee LDMA P/C# 0 3940 1 AM11-021 above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fe. U .] LDMA Perm. # o and hereby authorize representatives of this County to enter upon the above-menti o ed property for inspection purposes. .2H SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent --Date /-