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HomeMy Public PortalAbout6355 ENCINITA AVE_Building__ DfiPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES " �ad'9 � L® I N G ' WM. J. FOX, CHIEF ENGINEER I� �7J FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING /� p p �/ �• ADDRESS `j 3 (GjA��-.� �J ( .( O -L �j OV �O LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST r L•/l/I�r 11�O R I s CROSS ST. BUILDING �{T Y � ADDRESSOWN MAILER,V�_4'- iLOCALITY ' /'e �i H��D /Y !�i•t,���9 ADDRESS NEAREST ' TEL. 1 TL/. 1, CROSS ST. CITY �,ti NO.TT / y, ZFIRE NO. OF ONE PLANS Z I TYPEGROUP ARCHITECT OR 'y / TEL. ENGINEER ji[„l�.yli �/ NO. BLDG. SETBACK LINE ADDRESS �n] [[11 APPROVEDBy �1 CONTRACTOR L ��/y. NO..p S82(�• USE APPROVED DATE t'5­4 . ,/'� ZONE BY DATE o ADDRESS D �.�. ,y 1 rv(4/lu./„ � HOUSE NUMBERING LEGAL DESCRIPTION I LOT NO. �1 / BLOCK MAP NUMBERS -FIELD CHECK BY TRACT w (�a NO. ASSIGNED BY nATE B IZE OF LOT 4 ,)I Now ON LLODT s. �. CORRECTIONS . USE OF - - NO. OF _ EXISTINGBLDG. (fj�-, FAMI U's DESCRIPTION OF WORK �LA NEW I /I'ALTERATION I' I ADDITION I - 0 - REPAIR I I DEMOLITION I -- - FSO ' SIZ FT. O O ROOMS STORIES / ^NO. OF O 61Zfi o EXT. WALL COVERING I ROOF COVERINGyyV64<0 / " I {fit USE OF BTRUCTURE LI APPROVALS INSPECTOR'S SIGNATURE DATE REBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION ON AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS A� T. IREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, 1 AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS REGULATING BUILDING CONSTRUCTION. Q(� FURNACE: LOCATION, URE OF l%t?�A�/T l ��91^ti'�IA'_q GA6 VENT, DUCTS RMITTAD R /yJE (t I/ iA -< '� / ,//Py LATH, INT. IAGLATH, EXT.PLASTER, INT. - DB00 10.00 . .(�cd FEE / `�� PLASTER, EXT. ION FEE B /�^'�� FINAL I Ce 08 03 IRE V.6/761 LII11S •- V APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING syr FOJR AP`PLICAANT TO FILL IN ADDRESS o 3.S // ✓yL.,. ADDRESSNI a� S V '4',/ Ir LOCALITY NEAREST ary ZIP r{� NO.OF SLOGS. ASSESSOR SIZE OF LOT r NOW ON LOT �L MAP BOOK PAGE PARCEL iRACT/3.-/ /V 'N BLOCK i l07 NO. J— DISTRICT GROUP LYONS FIRE E PROLE By /" - _//S�TEL. O. mo os/ 4i IV Z1. OWNERA/0 MA.l .//i�`.(•NO.12.gcaG 0. STATISTICAL CLA��LSLSIFIC''ATION WER MSAP. ADDRESS •) " y- L//` 0)`4 CLASSNO.�DWELL.UNITS BK% SPG CITY, 1�-i"%JL c: SII` zip ARG EOR . VALUATION ENGINs O O ENGINEERR N NO. - ADDRESS r BLDG.SETBACK FROM_ •�•+. TEL. - FRONT PROP.UNEOF [STREET) ^, T•i CONTRACTOR / of /'-'c /z NO. HIGHWAY + YARD = TOTALSETBACKFROM TYPE EXISTING C FRONT PROP-LINE HIGHWAY Y WIDTH ADDRESS f' -F� LI / NO. LIC. + CITY CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER SIDE PROP.LINE OF [STREET[ NAME AND BRANCH TOTAL SETBACK FROM TYPE OF EXISTING } HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH ADDRESS CITY V SO.F . NO 0' NO.OF CHECK + SIZ STORIES / FAMILIES ONE C� ac DESCRIPTION OF WORK 4-:-,41 Q fti NEW ❑ P.C. Fee$ a� Permit Fee / O ADD ®❑ Issuance Fee g ALTER REPAIR ❑ Total Fee USE OF DEMOL C1EXISTING BLDG, C APPLICANT p TEL, /• - IPRINTIq//1/I/U • G/r/�/l- 4'//NO. /�� - Q 152&ErA i0 pee . e23 BY(SIGNATURE[ // > - I HEREBY ACKNOWLEDGE THAT I HAVE EAS THIS APPLICATION AND STATE - R_YA 2 a O 72 0'0 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION.1 CERTIFY THAT IN DOING THE - 720 O U WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION CF V o'0 0 THE LABOR CODE OFTHESTATEOF CALIFORNIA IN RELATINGTOWORKMEN'SCOM- .Z PENSATION INSURANCE. - Q 0710 5r_ s j1 7/ x 9 1 SPIGNATURE OF � jY 5 2 b,9 A ERMITTEE _ ADDRESS Y '�'�/ _ o e e e e 7� O CITY Ll:- NO?' Q 2 ° ° 97.00 O USE ZONE MAP NO. 9 ],G ��U q O- U� / CONDTIONN ' 9e'9 f 07.05-79 �T FINAL ��J//� Y DATE (f` Ii 76AG30A CEA803 5-65 APPLICATION FOR BUILDNG ERMV� COUNTY OF LOS ANGELES BUILDING C DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY % JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T.o F BUILDING CROSS ST. %/, DISTRICTN TYPE1/ P E B FOR APPLICANT TO FILL IN �) G!� CONST. BUILDING <2 !j3,V }f, ENG(u ITA A� STATISTICAL SSI FICA TION SEWER P ADDRESS 'TC L Gil CLASS NO, DW ELL UNITS EKG LOT NO. BLOCK USE ZONE MAP i'I H /f:1 NO. V TRACT ` ` �� '/11 / SPECIAL AA� II�� NO. OF BLDGS. ,I CONDITIONS SIZE OF LOT �$ X140 NOW ON LOT Z USE OF D0G5M CrA2AGC- EXISTITING B / BLDG. SETBACK FROM L TE . g& ^ FRONT PROP. LINE OF (STREET) OWNER 06' EiNMAIJ NO. Z W •T TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS iO3SS .EAaINIIA AVG HIGHWAY WIDTH FROM C.L. CITY Ti=_MPLa_ ci" + BLDG. SETBACK FROM ARCHITECT OR TEL. ENGINEER 00F3 W15-III N NO. 2QfL�o6-eb4nq.4 SIDE PROP. LINE OF (STREET) y lY.� TYPE OF E%ISTI NO Sf TBACK HIGHWAY } YARD ` TOTAL ADDRESS a3S"S u• �Naiu1TA AVC'; fEMR.c G{ HIGHW AT WIDTH FgOMGL. TEL. + _ CONTRACTOR 9ai-G NO 066-E54Q O LIC CORNER CUTOFF YES NO U ADDRESS NO IC CITY IL' SEE REVERSE*SIDE FOR.SPECIAL'APPROVALS O DESCRIPTION OF WORK NEW ADDy ALTER REPAIR DEMOLISH /;'�As'� Sni• L ../J' � yy j( Z SQ.IZ FT. ! '� -STORIES FAMILIES NO OF NO. OF SIZE 9- f _�/ USE OF /7�� �7 SG !'6!-I� GlJ"�/jK STRUCTURE PMOIZOOM y� k SIGNATURE OF //y�f LCA L LK�lLG-1�.M1F�� / ` //� l / l _AP V Tl VVALUATION$ 4G APPROVALS DATE INSPECT 'S SIGNATURE FEE SS FEES (h G FOUNDATION, MATERIALSON Ip FRAME, FIRE STOPS, � I HEREBY AC N NOWLEOGE THAT I HAVE READ THIS APPLICATION BRACING BOLT e AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING EN DUCT$ 9UILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK y 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 WORK MErv'B COMPENSATION INSURANCE. LATH. EXT. _ -,6 /KIIII SIGNATURE OF }� /� d'' HOUSE NUMBER COR- PERMITTEEY !'1�4✓ - ©.•WRECT ANO POSTED �T A ADDRESS rid^S ,i! EdG%;C/ITA HYF FINAL JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION CK. M0 cAGH X 4 5 3 7 SEP 2 1 D 1 8.50— 16A638A CEaSOB d-6- APPLICATION APPLICATION FOR BUILDING PGR ITL_ U. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND'SAFETY DIVISION LOCALITY JOHN A. LAMBIE COUNTY ENGINEER NEAREST /7 COLEMAN W. JENKINS.SOP'T.D' BUILDING CROSS ST. CL DISTRICT NO. GROUPTYPE. PRO SE FOR BV FOR APPLICANT TO FILL IN — T CONST. < BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS _ A), AM /N /7HQ - BK PG CLASS NO..fLDWELL UNITS LOT NO. `�, BLOCK USE ZONE MAP /lO NO. - O' TRACT -* I J/S �_/ SPECIAL r N0, OF GLOBS, CONDITIONS SIZE OF LOT S, /' 1 NOW ON LOT USE OF STING BLDG, ��O hn L SLOG. SETBACK FROM ! yEL. �" p I' FRONT PROP. LINE OF (BTREBT) OWNER 0 WC-/un/AN40. A76-p S'V' TyPl 01 !%ISTI NO SETBACK HIGHWAY YARD = TOTAL ADDRESS •� /S/ . - A!0 /AJ)T Xla Y' 'F M C.L. } CITY ARCHITECT OR TEL. BLDG. SETROP. LIN FROM - ENGINEER NO. BIDE PROP. LINE 01 (STREET) OTAL TYPE 01 !%18TIN0 SETBACK HIGHWAY } YARD = TOTAL r ADDRESS HIGHWAY WIDTH 'ROM C.L. 1 TEL. } = O CONTRACTOR NLIC O ADDRESS NO CORNER CUTOFF YES NO O CITY LIG SEE REVERSE SIDE FOR SPECIAL APPROVALS LU DESCRIPTION OF WORK �Z NEW ✓ ADD ALTER REPAIR DEMOLISH - SO-FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE L -- 7e ELCIP& SIGNATURE OF APPLICANT =7IZ VALUATIONS ', APPROVALS GATE IN9P EC TOR'9910 NA R! P.C. FIATDATON, LOC REES FEES34-V FO UNFORMS,MATERIALSONn v FRAME, FIRE STOPS, / - -� / ' 1 HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS / 9UILOING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK E / I AUTHORIZD HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORK MEN'S COMPENSATHON INSURANCE,. i �(f/)L/l Srrr�s✓ LATH. EXT. / SIGNATURE OF HOUSE NUMBER COR- PERMITTEE '� PECT AND POSTE ADDRESS S f 77 - FINAL JOHN F. LEWIS. PRINCIPAL ST CT AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION OK. M.O. CASH LAC0 6 9 7 4 e NOV 1 1 D 3.00- o APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (PFinr of type only) COUNTY OF LOS ANGELES BUILDING ADDRESS S / DEPARTMENT OF COUNTY ENGINEER L CITYzIP / p BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT �� /w NOW ON LOT ,p' ;#�a ADDRESS `l TRACT .` 1 BLOCK LOT NO. LOCALITY TEL NEAREST OWNER E O. CROSS ST. ^ ASSESSOR ADDRESS MAPBOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE CESSED BY .CITY /yJ ZIP ONST. ZONE ARCHITECT OR TEL. : 6 ENGINEER NO. STATISTICAL CLASSIFFI/ICCJA/TT��ION SEWER MAP ADDRESS CLASS NO DWELL.UNITS FBK I�G El. �/ CONTRACTOR NO. USE ZONE NOPO� U D C. I SPECIAL LIC. ADDRESS NO. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REOUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) 'ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SO.FT. SIT OF NO. LF CHECK HIGHW Y + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE _ a DESCRIPTION OF WORK / NEW ® + O BLDG.SETBAC Q ADD ❑ SIDE PROP.LINE OFSTREET) O ` ALTER ❑ TOTAL SETBACK FROM TYPE OF TING w HIGHWAY. + YARD = SIDE PROP.LINE HIGHWAY WI u USE OF . REPAIR ❑ Z EXISTING BLDG. DEMOL El + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ IPRINTI NO. IN OPEN SPACE VES ❑ NO ❑ BY(SIGNATURE( - INCOASTALPERMITZONE VES ❑ NO ❑ VALUATION $ SD 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.1 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 WORKME 'S COM. PENSATION INSURANCE. SIGNATURE OF f PERMITTEE ADDRESS a TEL, FINAL BY DATE NO -611 MAKE CHEC S PAYABLE TO! FEE $ FET $ HARVEY T. BRANDT.COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O.' CASH 8 3 4 1pV 17 1 U 9.0 0 &�b ®1 76A63BACEN8033J5' , APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (P,iDI a ivPB c H1 .. BUILDING ,... COUNTY OF LOS ANGELES ADDPESs S � IA,'; DEPARTMENT OF COUNTY ENGINEER 'CITY -/y � ' / ZIP / p' /BUILDING AND SAFETY DIVISION INO IJUILDI NO SIZE OF LOT S' 11151 NOWOON LOTS. ADDRESS 15 IV :14 ✓L TRACT ✓ BLOCK LOT NO.- LOCALIT TEL 4" NEAREST OWNER /L� NO. V CROSS ST. . ASSESSOR ADDRESS - �F I' MAP BOOK PAGEPARCEL DISTRICT GROUP TYPE FIRE SSED BY CITY �[ ZIP . (� CONST. ZONE ARCHITECT OR - TEL - og ••--� ENGINEER -/ NO. ' S _ STATISTICAL CLASSIFICATION''77 C� $E� WER M ADDRESS (CLASS NO.S?OWELL.UNITS r BK PG TEL. . CONTRACTOR - (a/L NO 'USE ZONE NOP O LIC. r I ADDRESS NO. I SPECIAL .LIC. CONDITIONS CITY CONSTRUCTION (ENDER CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO [] ' NAME AND BRANCH FLOG.SETBACK FROM - - - 'FR NT PROP.LINE OF (STREET) ADDRESS CITY H GNWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING SO. FT. ST OF NO. OF CHECK' FRONT PROP. LINE HIGHWAY WIDTH .SIZE STORIES FAMILIES 'ONE } = a DESCRIPTION OF WORK NEW BLDG. ADD CK FROM PROP. L (STREET( o ALTER TO AL SET. TYPE OF EXISTING HIGHWAY } YARD = U REPAIR❑ SIDE PROP. LINE WAY WIDTH W a USE OF ._ ..'}. _ - ... h EXISTING BLDG. OEMbL13 Z APPLICANT TEL `) CORNER CUTOFF AYES ❑ NO ❑ - (PRINT) G + NO.;Z, �Q _ BY ISIGNA TUR \ IN OPEN.SPACE YES 11NO ❑ f �T IN COASTAL PERMIT ZONE YES ❑ E]. NO ` VALUATION;$ . 3a U- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AHD STATE THAT THE ABOVE'IS CORRECT AND AGREE TO COMPLY WIT HALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY IWILL NOT EMPLOY ANY PERSON IN VIOLATION"OF THE - LABOR CODE OF THE STPTE O F 'CALIFORNI A,.IN RELATING,TO - WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF _ •�� PERMITTEE _ ADDRESS �I TEL. FINAL..: BY CITY NO. DATE /'Zz JIA FH CHGCFS PAI'ANLE '(Or P.c s. - JFPEMET. - HARVEY T. BRANDT, COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION cN. M, CASH 3 8 9E�.AUG 29 1 0 9,0 0 A90 7BA030A CE#803 5/71 ^ APPLICATION FOR BUILDING PERMIT, FOR APPLICANT TO FILL IN (Pdnr o, +YoB ..IV) Nle - .S E COUNTY OF LOS ANGELES _ ADORE ss DEPARTMENT OF COUNTY ENGINEER CITY - 17 fl ZIP Q BUILDING AND SAFETY DIVISION OF SLOGS. /B BUILDING SIZE OF LOT .s NOW ON LOT IE, ADDRESS �JJ //,� ` Ql (,CN•C' TRACT/,2//,:5'" BLOCK C^ >� LOT NO. Z LOCALITY OWNER (7L �j/ NOL ,O CROSS ST. ASSESSOR ADDRESS e,3 /y MAP BOOK PAGE' PARCEL y' DISTRICT GROUP TYPE FIRE ROC SSED Y - CITY l/ ZIP YO C? CONST. ZONE ' ARCHITECT OR �rB 'I, TEL. CJ ENGINEER C/ ((/ NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS TEL. CLASS N�DWELL.UNITS BK/IPPIG CONTRACTOR Np -U ZONE No D.-3 LIC. .-I SPECIAL ADDRESS NO. CONDI TIONS CITY LIC. ' CLASS ROAD DEPARTMENT gPPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG. BA" FROM FR - FRONTNT ROP.LINE OF (STREET) ADDRESS CITY NIGH WAY } YARD -_ TOTq NT PRO CK FROM TYPEOF EXISTING SQ. FT. ST I NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE _ Y DESCRIPTION OF WORK NEW ❑ ~ Ai DDT d�G ADD ® SI DG.SETBACK - U SIDE PROP.LINE OF - (STREET) O _ _ ALTER ❑ HIGHWAY }' YARD - TOTAL SETBAC TYPE OF EXISTINGocvV U REPAIR❑ SIDE PROP. LINE HWAY WIDTH a3 USE OF d _ H EXISTING BLDG. DEMOL 1:1 } Z APRIL I CAN L CORNER CUTOFF YES ❑ NO El(PRINT( D BY (SIGNATURE IN OPEN SPACE YES ❑, NO, ❑ { IN COASTAL PERMIT ZONE YES.❑ NO ❑ VALUATION;$ 07,vo, P� I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY t WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILLNOT EMPLOY ANY PERSON IN VIOLATION OF THE , LABOR CODE OF THE SiPTE OF 'GLIPOR NIA IN R ATING TO WORKMEN'S COMPENSATION INSURANC f. SIGNATURE OF PERMITTEE _ ADDRESS yS FINAL L DATE BY CITY _o- NO _ _J MAKE CHECKS PAYABLE TO: Pc. PM FEE'H' FET%$r HARVEY T: BRANDT, COUNTY ENGINEER PLANCHECK VALIDATION «. M.o. uBH _ PERMIT VALIDATION CK. M.D. CASH 9 .9 OCT 3 D 610 V 71A638A C9*403 5/74 nl"� < WORKERS'COMPENSATION DECLARATION I- -� _ ?..+* 'fi'* - -,�� - r .,. r. +i` - - •---_ _ •I here affirm that I have a cerhficate of consent to self _ O ././(��� ^p 1r/�a //[���: �Ft�plp�. FOR �r��( ��P�Ip�[/[��r insure ora certificate of Workers' Compensation Insurance, /!'l1P_ Il LOCAT9®U V -L1 O,UO L3,U-MD V @-J 'P��I1V - or'o'cenified copy thereof (Sec` 3800, L'ab. C) °� ' _ ' -"-` --' ?E_. t . I COUNTY OF LOS ANGELES. BUILDINGAND-Si4FETY Policy No - - ,+' Company BUILDIN FT Certified copy is.hereby'furnished .. C". FOR APPLICANT TO FILL IN ' -i ADDRESS . 1... ADDRESS ..CJ Certified'copy rs'file'd with the County bwldmg'inspec :BUILDING- 'hon'deporimend' I'• '` ADDRESS / + Daten. "rA•ppltcont. . .e CITY , it ZIP LOCAUTY CERTIFICATE_OF EXEMPTION FROM'•WORKERS '- - ' -" " ' ---NO.OF'BLDGS:-;-� —^- NEAREST.___. .. . M.-_. -_..... . ., i •' + •- i -COMPENSATION INSURANCE •• • •x.. SIZE OF LOT - S Lf NOW ON LOT TTI CROSS ST. •. .__ __-_ s ...._ _.-._._ --+ 1 ASSESSOR - t 1 r•.,- 'i+i t' ,(This secttom need-not be com leted if the ermit'is.forlone - -- - 65f_"Or +„ r p p TRACT BLOCK LOT NO. f - hundred dollars ($100)or,Iess.) =p.�e •- MAP BOOK' PAGE, PARCEL , o z I _^ OWNER" /. ' •. (�• G Tiao.-n1`f1G cS6'OJ USE ZONE MAP 1, I.<efhfy that ui the'performance of the work for whitht this •, � NO. 'permit is issued, 1 shall not employ any person m anymdnner_ S -y- ' - t` r': '. 1 "" ^j"- 'SPECIAL;}- --- - - - I so as to become sublect'to the Workers"Co -ensatiori'Ldws. ADDRESS "� �• - '-- - - CONDITIONS' . 'U arY._ Lc'_ �` ,ZIP_._ . G m Date rs -, Applicant ARCHITECT OR ,/ - TEL t DISTRICT GROUP ,TYPE. EIRE - ,PRO SSED BY NOTICE TO`APPLICANT; If, after maki- 'This Certificote of Yom' ENGINEER k J✓ NO. 1 ' - - O ,+'Exemption .you should,`become subject to!Ihe•'Workers '- _ ��� Q 97S CONST ZONE W 'S1 `/} V, Compensation provisions of:the-tabor,Code, 'you-must forth- ADDRESS d W6,comply.with such provisions or ithis permit shall be TEL STATISTICAL CLASSIFICATION APT. NDO ,Z deemed revoked CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION- ..4- - .- - ^1-• —' --'^ TIC • __..._,_ -- CLASS NO. DWELL. UNITS- I' I hereby.affirm that I am,licensed under provtstons of Chapter 9. ADDRESS �, NO. SEWER MAP 1 commer;6n with Section 7000)of Division 3'of the Business and _ _ -. . _ ____ _ _ - LIC. - -- - `- ProfessionsCode,`dnd mylicense is in'full foice'and'effect CITY. CLASS _- �' 6K �`` _ ., VALIDATION' _3"I .Y.:a,T•.e - t ryt t••vin' 'OF _ CHECK +• ' �, _ SQ. FT_ -. NO.. _ _ _ . •icen' t.- '• m, Ii- - $IZE STORIES ''-- FAMILIES ONE r tuber Lic Class I 'license Nu ,..,. s VALUATION • + - t - c DESCRIPTION OF WORK'-- --T NEW- /�/( Contractor r�� Date ADD -� $ `�•' y O I am exempt under Sec.y " P ALTER rTBBPC. for4his reason - _ n REPAIR' .Q - '- t L.0 USEt - Date' - EXISTING BLDG. � ' "� J'� , ' DEMOL - ' - ,,. •J' . APPLICANT. .'. - TEL. t - •____ ._,$Ignatwe PRINT &,Z /` fNO. �� G' I FINAL 1. . /p. OWNER-BUILDER DECLARATION _'_' _ _... .._ - -DATE .7• _ .: . __ ,•..- I.- _._. + . Lhereb affirmdhaLlamexempt fromthe Contractor's License:. ., •, t i Law for the following reason (Section 7031.5, Business and ADDRESS C`1 r(/L C FINAL '' + ¢•r n r Professions Code) '"" " "-- >-' ''' PRE ENT _ - "-- By -� i 8,A . _ BUILDING - I, as owner of the property, or my employees with ADDRESS �?8�':e •� e.1 _ _ __- _ r viages as their sole mmpensafion, will do the workand - - - � _ , l+ the structure is not,infended oroffered for sale(Section LOCALITY I' " -'^-7044;Business and-Professions Code). _-' MOVING' -" A'i l -' ^TEL -- _' -' - ' "-' '• z.) • • 4 9,8 8- �l� G— �y I, as owner of the property, am exclusively contracting CONTRACTOR NO - M _ �� i 'with licensed contractors-to construct the'project'(Sec `ADDRESS - m • • • 4 9,8 8 tion 70A4, Business and Professions Code). j I a ' _REOU I RED 'YARD'-'HWY -TOTAL SETBACK FROM .- CONSTRUCTION'.LENDING AGENCY J SET BACK PROP. LINE WIDTH - ,0 9.0 9-.8 5 thereby affirm that there is a construction lending agency for FRONT I 4 ' the performanceofthe work for which-this permit is issued • - (Sec. 3097, Civ. C.). SIDE P.I. _ Lender's Name -.- - P.Cr Fee.$_-._ ` '_•__-'z _-.Permit Fee.. __ \. - - LDMA Ref. R Lender's Address .,I certify that I have read-this application and state.thaL the Issuonce Fee- - � •-- � -LONA P/C Rp- a above information is correct. I agree to comply with all County I esrigmionFee ' r ' ordinances and State laws relating to building construction, - _ __. .._ .TmaLFee- -• • 0• ^LDMAPerm. N d and hereby authorize'representatives of this County to enter y t m upon theob re- entioned property for inspection purposes. a _ _SEE REVERSE FOR EXPLANATORY LANGUAGE ure of Applicantor Agent- -•- - Date,- V, ate, .qr,