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Home My Public Portal About5218 FARAGO AVE_Building__ ADes.a 11.55 APPLICATION FOR BUILDING PERMIT ,,.gs DIVISION OF BUILDING AND SAFETY BU ess 14W �/, PA P ' 1 � Deportment of County Engineer County of Los Angeles LOCALITY c' JOHN A. LAMBIE, COUNTY ENGINEER �9 CASSATT D.GRIFFIN, SUPT OF BUILDING NEAREST CROSS ST. � V�e_ DISTR LCT NO. GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN CONST (gK- BUILDING _r.2 r� I R, 491 p A, ,lm NUMBER ® / HWY(�' YES (NO ADDRESS m� 6"(' K 63"i + � LOT NO. BLOCK USE ZONE SPECIAL CONDITIONS TRACT / f �a �= . I� NO. OF BLDGS. /� SIZE OF L T I NOW ON LOT BUILDING EXIST. USE OF SETBACK YARD HWY STREET NAME WIDTH EXISTING BLDG. FRONT 19:a. 49� OWNER !C'� a .. /� SPIDE MAIL EEaa L. ADDRESS O TRACT DWELL. 1 UNIT p� TEL 5 INDUSTRIAL CITY i NO. ®j=„ I DWELL. 1 UNIT 6 PUBLIC BLDG. w ARCHITECT OR 1 ( TEL. 2 DUPLEX 2 UNITS ADDN..ALT.. ETC. ENGINEER �r NO. 3 APT. UNITS ' M SCEL. ADDRESS / 4 COMMERCIAL CONTRACTOR NO" INSPECTION RECORD- ADDRESS pA-,'(O DESCRIPTION OF WORK t2 0 p' 61411 NNW ADD ALTER REPAIR DEMOLISH �S SO. FT. NO. OF NO OF ( /7 SIZESTORIES FAMILIES USE OF STRt.I.��',TURE 14/ r X GNATURE OF Tf�✓�ry. ,� APPROVALS APPLICAN �3 p� ADDRESS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION ® 9 � P. C. $ FORMS,MATERIALS ip FEE FRAME: FIRE STOPS. VALUATION $ /i 0 g) BRACING. BOLTS FEE V � FURNACE: LOCATION. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT, DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE {{{[ �i �� RECT AND POSTED ADDRESS FINAL JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR CK MO CASH .iCo 5 5 4 6 APR 3 0 1 1 0.0 0 APPLICATION FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILG DINi E ADDRESS LOCALITY NEAREST CITY IP- CROSS ST. qq /I NO.OF BLOGS. ASSESSOR SIZE OF LOT "Cd d NOW ON LOT MAP BOOK PAGE PARCEL pp - I DISTRICT GROUP TYPE FIRE OC SED BY TRACT( BLOCK LOT NO. � ��--.�� CONST. Z ` TEL. IONS f OWNER r NO. 132 STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 7.23 1124--L CLASS NO.� DWELL.UNITS BK PG ei_ I7 � USE ZONE MAP CITY ZIP NO. ARCHITECT OR EL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONTRACTOR TEL. BLDG.SETBACK FROM LLICFRONT PROP.LINE OF (STREET) ' ADDRESS NO.* HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING - LIC. FRONT PROP. LINE WIDTH HIGHWAY CITY CLASS CONSTRUCTION LENDER } NAME AND BRANCH BLDG.SETBACK FROM a ADDRESS CITY SIDEPROP, LINEOF (STREETTOTAL SETBACK FROM TYPE OF EXISTING ) V SQ. FT NO. OF NO. OF CHECK HIGHWAY } YARD = SIZE STORIES FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH O III I t3 LLJ DESCRIPTION 9F WORK NEW ❑ } � Q- ADD CORNER CUTOFF YES ❑ NO ❑ Z ALTER ❑ REPAIR❑ IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG• R�Q• DEMOL ❑ APPLICANT TEL (PRINT) N - ,-Qi - V BY (SIGNATURE I HEREBY ACKN WLEOGE THAT I HAV EAD THIS APPLI ION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION.- 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'S COMPE T N INS URA NC SIGNATURE O FINAL BY PERMITTEE - DATE ADDRESS �7 TE L. / P.C. Fee$ Permit Fee CITY NO. Issuance Fee _ VALUATION Q� �� 0(9� Total Fee ��7-6 PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION K.? M.O. CASH 894CICT 22 1 0 21.75a�,i 76A638A CE*803B 12/75 ^ A ROAD DEPT. PE1,17%41T IS RECUIRE3 FOR ANY AA_"TER.AL SrORP, '- OR WORK DONE IN THE ROAD RIGHT OF WAY. FA1338ACE38-89 APPLICATION' FOR BUILDING PERMIT 1. COUNTY OF LOS ANGELES BUILDING ADDRE DEPARTMENT OF COUNTY.ENGINEER ' LOCALITY Y . BUILDING AND SAFETY DIVISION LocauT ��` " I JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRI.9T NP. GROUP I TYPE FOR APPLICANT TO FILL IN .�' = CONST. BUILDING ¢ STATISTICAL CL IFICATION 1 SEWER MAPPGADDRESS �.C � CLASSNO. WELL.UNITS I LOT NO. -BLOCK MAPNUMBER � STATE YES USE ZONE TRACT SPECIAL NO.OF BLDGS. CONDITIONS 220 SIZE OF LOT7,214 a I NOW ON LOT USE OF c �� p -ILDI �G EXIST. EXISTING BLDG. A� �Ydv�`, - iY/.,f�-�P - / SETBACK /YARD HWY STREET NAME WIDTH OWNER ,{�?r,� r FRONT MAIL C,� /// P. L. ADDRESS c7 flr"• i,7G, :.mac- / SIDE - - JY TEL. P. L. CITY _7`'_Ps2�T No. INSPECTION RECORD' ARCHITECT OR ` _ TEL. ENGINEER NO. PADDRESS ��,/,yam TOR �W/VPI�o b'y'e "• NO /�d/JG:DESCRIPTION OF WORK ADD ALTER REPAIR DEMOLISH Nb. OF NO. OF// STORIESFAMILIES RERE% F'ANTQ�C _ rC �• APPROVALS DATE .INSPECTOR'S SIGNATURE S d' �^w `` �` FOUNDATION: LOCATION Q-�` ) `_p�yp FORMS, MATERIALS ' "V FA--'-1VALUATION $ °!JG-V �e I FRAME:FIRE BOLTS S P.C. PMT. 7 FURNACE: LOCATION, - FEE $ I FEE $ � `— I GAS VENT,DUCTS .� I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PL P- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REIIWLATIN DING CO TRUCTION. LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- - PERMITTE — RECT AND POSTED ADDRESS r�E `SLE -!-+v FINAL CLYDE N. DIRLAM, PRINCIPAL S(-�rfcy��URAL ENGINEER PLAN CHECK VALIDATION K. M'O• °ASH PERMIT VALIDATION ( —c M.O. CASH *APPLICATION FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS / BUILDING w'c ADDRESS `-' LOCALITY CITY ZIP NEAREST CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT 6 NOW ON LOT 3 MAP BOOK PAGE PARCEL DISTRICT IGROUPITYPE FIRE PROCESJkED BY CONST. ZO E TRACT/J-/9 BLOCK LOT NO. �✓ f� 1/ TEL / v Y OWNER NO. STATISTICAL CLASSIFICATION ''} SEWER MryAP/ ADDRESS3 CLASS NO._—LDWELL.UNITS el BK/-VG CITY ZIP ?1733 USE ZONE MAP NO. oL J ARCHITECT OR TEL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES NO ❑ CONTRACTOR TEL. BLDG.SETBACK FROM NO FRONT PROP.LINE OF (STREET) LIC. ADDRESS - NO. HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP. LINE HIGHWAY WIDTH CITY CLASS _ CONSTRUCTION LENDER + C}. NAME AND BRANCH BLDG.SETBACK FROM C) ADDRESS CITY SIDE PROP.LINEOF (STREET) V SQ. FT r. NO. OF NO. OF CHECK HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING SIZE �.� STORIES ` FAMILIES J ONE SIDE PROP. LINE HIGHWAY WIDTH O DESCRI TION OF WORK NEW ❑ + _ N ADD CORNER CUTOFF YES ❑ NO ❑ Z —TER ❑ ' 11EPAIR❑ IN OPEN SPACE YES ElNO ❑USE OF IN COASTAL PERMIT ZONE YES NO EXISTING BLDG. EMOL E] APPLICAN TEL 713 7 O ar/d'4. (PRINT) 0. BY (SIGNATURE) I HEREBY ACKNOWLEDGE THAT I READ THIS A LICATION AND STATE THAT THE ABOVE ISCORRECT AND AGREE COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. 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'S COMPENSATION iNS URA NC E. SIGNATURE OF FINAL FFF�� q BY PERMITTEE DATE �P17/ ��P\a4 0-(a„ ADORES GGG F FC <3 C^� CITY No , P.C. Fee$ Permit Fee v2 (51. V Issuance Fee VALUATION s-3J V v 0 otal Fee 5w ,�� PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VA ACTION K. M.O. CASH 9 5 9'0:MIS 31 1 D 2 8.5 p-Au,3 76A638A CE#8038 12/75 i APPLICATION -FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING _ •� COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER ' CITY v zIP BUILDING AND SAFETY DIVISION y ,. •' NO.OF SLOGS. r BUILDING SIZE OF LOT•' — r r+'� a NOW ON LOT ADDRESS /3 TRACT z BLOCK LOT NO. LOCALITY TEL r. NEAREST ., NO. t r" CROSS ST. ' ASSSSOR ADDRESS!!!�~' ;,,� ! .. Q.-V--i'_ MAP BOOK PAGE PARCEL DISTRICT JGROUP TYPE -FIRE PR ESSED BY CITY �,� r1'1 Y+ F .ZIP 2i,7 -2? g—^ CONST, ZONE. ARCHITECT OR' TEL. 7�`' _j .�" .v,✓ _E.NGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL.UNITS ..BK 2./PG TEL. CONTRACTORNO, USE ZONMA E LIC. NOP ADDRESS NO. SPECIAL CITY LIC. CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER �f�9 NAME AND BRANCH /, ls,�J' ) BL G.SETBACK FROM ' FR NT PROP.LI NE OF (STREET) ADDRESS CITY HIGH AY } YARD 'TOTAL SETBACK FROM TYPE OF EXISTING SQ. F,T,P •NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK, • NEW ❑ CD BLDG.SETBACK v \, ADD ❑ SIDE PROP. LINE OF (STREET) /1 TOTA ALTER L SETBACK FROM OF EXISTING F— '� \ HIGHWAY } YARD = U ! REPAIR❑ SIDE PROP. LINE HIGH WIDTH LLL USE OF = a c/3`` �., EXISTING BLDG. ! + ,�,�, DEMOL ❑ t Z APPLICANT nTL „� CORNER CUTOFF YES 13, NO ❑ (PRINT) ,r ! NO l II"0. � � /� IN OPEN SPACE YES ❑ NO ❑ BY (SIGNATURE) ♦, _.. �6♦/ IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION,$ I HEREBY 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 CON- h %�x �'� �f/� 7:0 C � STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZEDHEREB (((JJJ v ��`�JJ" LABOR CODE OF NOTEMPLOY MSTATE ANYPERSON CALIFORNIAN INLATION OF RELLATIINGTHE TO /N A✓ ♦ /�� ♦/4.YC/ Q� WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF PERMITTEE. nd t«(�fv♦` ADDRESS _ 1 "'�- _ FINAL BY T E L. CITY' ( / V a1 NO. ,� DATE 7 3 olt2/EtiCJ(..+ MAKE CHECKS PA)'ABLE 70: FEE' FEE HARVEY T. BRANDT, COUNTY ENGINEER 3J PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION(cK,_") M.O. CASH 8'7 'SFP 26 1 D 2 8.5.U ® 8 76A638A CE#603 574 - .' , 4 . APPLICATION FOR BUILDING PERMIT FfDR APPLICANT TO FILL IN (Print or type only) BUILDINGCOUNTY OF LOS ANGELES ADDRESS �2� m'L4 CiDEPARTMENT OF COUNTY ENGINEER CITY, 41P BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING ] SIZEOF LOT ( Q NOW ON LOT �— ADDRESS �^ (� (/� TRACT BLOCK LOT NO. LOCALITY ff TEL. NEAREST OWNER NO. �� CROSS ST. ASSESSOR ADDRESS a MAP BOOK PAGE PARCEL CITY C"f'I/tY ZIP ��.j 3 DISTRICT GROUP TYPE CONST. ON FIESSED BY CON ARCHITECT OR TEL. y ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. 2-4 DWELL.UNITS TEL. BK 121 PG CONTRACTOR NO. ZONE MAP LIC. NO. ADDRESS NO. .3 SPECIAL LIC. CONDITIONS CITY CLASS CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF ISTREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SFT. NO.OF CHECK HIGH AY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES S FAMILIES A ONE } DESCRIPTION OF WORK /r,r NEW ❑ + - Q ADD ❑ BLDG.S BACK FROM SIDE PRO NE OF (STREET) O _D- 11 Q ALTER � _ CK FROM TYPE OF EXISTING U 0 1.� I.t/t�yyQ�WG xt. HIGHWAY + YARD SIDE PRO P. IGHWAY WIDTH N USE OF REPAIR ® Z EXISTING BLDG. DEMOL ❑ + A(PRINT)PPLICAK)/> O NO IEL 3 CORNER CUTOFF YES NO J � IN OPEN SPACE YES ❑ NO BY(SIGNATURE( IN COASTAL PERMIT ZONE YES NO VALUATION $ d IHEREBY 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.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'S COM- PENSATION INSURANCE. SIGNATURE OF PERMITTEE ry ADDRESS o�< FINA CITY NO. j 3 DATE /' f / BY MAKE CHECKS PAYABLE TO: FEE $ FEET $ r -7 HARVEY T.BRANDT,COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 9 5M1Il�y + i V 1 ./ JCS ®s 76A638A CE 0803 3:75' A ROAD IS r_-2"'"ED FOR AN( DONE IN THE ROAD RIGHT OF WAY. B 76A688A C »8098-49 APPLICATION 7 ION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ABUILD DD EIS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY .DIVISION LOCALITY JOHN A. LAMBIE° COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE FOR APPLICANT TO FILL IN I CONST. 'BUILDINGy �J STATISTICAL CL SIFICATION I SEWER MAP ADDRESS .�°uC �OjJ/t SK. PG CLASS. NO. DWELL: UNITS_ LOT NO. BLOCK MAPNUM ER `,, ,� STATE yE5- NO HWY. TRACT USE ZONE SPECIAL ' NO.OF BLDGS CONDITIONS SIZE OF LOT a f I NOW N LOT USE OF EXISTING BLDG. �/Y;Y'b'�LL�^ �.g BUILDING YARDHWY STREET NAME EXIST. �� SETBACK WIDTH OWNER �f h441 ®!s(ii"� FRONT-MAIL P L. ADDRESS ��iL/ p r SIDE ®e �� TEL. _F.L. CITY �/C�- �f'6 No. INSPECTION RECORD ARCHITECT OR TEL. _ ENGINEER NO. ADDRESS - TEL. �' CONTRACTOR /gA ,,✓n �p�� NOl ADDRESS DESCRIPTION OF WORK NEW ADD ALTER ! REPAIR• DEMOLISH SQ. FT. NO. OF . SIZE STORIES FAMILIES _ USE OF STRUCTURE a SIGNATURE OF APPLICANT •Ji � �°�� APPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS J FOUNDATION: LOCATION FORMS, MATERIALS VALUATION $ °�'� FRAME: FIRE STOPS, BRACING, BOLTS FURNACE: LOCATION, P.C. PMT. s &-o GAS VENT,DUCTS FEE I FEE $ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PL P- - LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AND STATE LAWSMRLY LATING AGREE TO WITHLBUIILD NG COUNTYRDIN A RUCTION LATH,EXT. SIGNATURE (?)( 'e HOUSE NUMBER COR- PERMITTE `9r�' �^ t RECT AND POSTED ADDRESS v; ✓ a FINAL CLYDE N. DIRLAM, PRINCIPAL STR? T RAL'ENGINEER PLAN CHECK VALIDATION CK. M.o.. °ASR PERMIT,VALIDATION U -... CASH 3.60 OF ►'10 / APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS J DEPARTMENT OF COUNTY ENGINEER r Z.P BUILDING AND SAFETY DIVISION CITY I �y NO.OF BLOGS. BUILDING SIZE OF LO /J O NOW ON LOT Z. ADDRESS (� TRACT _ BLOCK - LOT NO. LOCALITY - TEL. /' (// NEAREST OWNER It NO. j' 7 CROSS ST. IN I ASSESSOR ADDRESSo2 .0 MAP BOOK PAGE PARCEL DISTRICT' GROUPTYPE FIRE SED-BY CITY ZIP � V� CONST.. _ ZNE ARCHITECT OR TEL. V/J` SON JE ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. �Z^I DWELL-UNITS BK/1I PG E CONTRACTOR - TNOL. ZONE MAP' LIC. NO. ADDRESS NO. SPECIAL . LIC. _ CONDITIONS CITY C LASS ROAD DEPARTMENT APP ROVA-L REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLD .SETBACK FROM FRO PROP.LINE OF (STREET) ADDRESS CITY HIGH AY + YARD —_ ',TOTAL SETBACKFROM TYPE OF EXISTING ` SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ + V ❑ BLDG.SE CK FROM • ADD SIDE PROP.L (STREET) ALTERI TOTAL SETBACK TYPE OF EXISTING U ❑ HIGHWAY + YARD — '71,uAf 4- .. REPAIR SIDE PROP. LINE H Y WIDTH � USE OF 1 } _ N EXISTING BLDG. DEMOL ❑ Z APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) � � Q� Y NO. IN OPEN SPACE YES ❑ NO ❑ BY (SIGNATURE) _ IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ 3®V,{ I HEREBY 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 CON- STRUCTION. ON- STRUC TION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OFLAL IFORNIA IN RELATING TO WORKMEN'S COMPENSA T ION IN SU RANCE. SIGNATURE OF •. p ts' 7 r:h�a�n tx, PERMITTEE ADDRESS CITY C2A //IV7V� NOA L•. FINAL , � � BY �� `1"A, DTE ;HAKE CHECKS PAYABLE TO: FEE' ` FEE. HARVEY T. BRANDT, COUNTY ENGINEER PLAN'CHECK VALIDATION K. M.O. CASH PERMIT VALIDATIO CK. • M.O. CASH 2 6 6: nrT 1 9.0 U d:< 76A638A CE#803 574 T_ Go WORKERS'COMPENSATION DECLARATION i I hereby affirm that I havecertificate of consent to self Y insure, or a certificate of Workers' Compensation Insurance, APPLICATION OiUI L D I N G PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY P❑oIicy Md.- Company BUILDING Certified copy is hereby furnishe . FOR APPLICANT TO FILL IN ADDRESS J ❑ Certified copy is filed with the t u' in pec BUILDINGJ i 9 tion department. ADDRESS tiy a LOCALITY < NEAREST Dat 'Zt Aplicant CITY -fi ZIP CROSS ST. RTIFICATE OF EXEMPTI N`FR� R E S' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the per is for ne USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. TEL. SPECIAL ¢ I certify that in the performance of the work for which this OWNER NO. CONDITIONS 0. permit is issued, I shall not employ any person in any manner IST CT GROUP TYPE FIRE P CESSED BY O ADDRESS t y CONST. ZO E Uso as to become subject to the Workers'Compensation Laws. �.0Y f) Date Applicant CITY fi IP STATISTICAL CLASSIFICATION V APT. CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers'' ENGINEER NO. CLASS NO. DWELL. UNITS IL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP to with comply with such provisions or this permit shall be ifTEL °7 z deemed revoked. CONTRACTOR . ��; 7(j / BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION IC. `I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ""� NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. p� Professions Code, and my license is in full force and effect. CITY [/�� d i CLASS — $ e�gd Q� , -7- SQ. INC.OF NO. OF CHECK Number Lic.Class cSIZE � STORIES FAMILIES Q ONE(iocense niractotL / �J�/K�1///f��1�st C� �J DESCRIPTION OF WORK NEW ❑ ❑ T--•--Jr-----w�r�a I amr � exempt under Sec. i} f ADD ALTER ❑ FINAL I ❑ DATE ,? B.&P.C. for this reason ! L`J13T3 REPAIR USE OF FINAL y Date: EXISTING BLDG. DEMOL E] _( Y Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT 7 r, l n ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and o 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. with licensed contractors:to construct the project (Sec- ADDRESS r tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. �' L •.. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE 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 'P.L. . Lender's.Name r . P.C. Fee$ ' Permit Fee f Lender's Ad ss I certify at I civ read this p ication and state that the Issuance Fee above ' forma on is correct. I re¢to comply with.all County Investigation Fee r g ordina ens a d Stat f' -s rel tigg to building construction, Total Fee D and y uthor' a `re e t fives of his County to enter upo t e ove- a toe p erty fo i spection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE Si a e o pplicant or a Date ®t