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HomeMy Public PortalAbout9549 GARIBALDI AVE_Building__ 76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING �4 /1/� DEPARTMENT OF COUNTY ENGINEER ADDRESS IUPC BUILDING AND SAFETY DIVISION LOCALITY C lool JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. 1. G/ 4Po� DISTRICT NO. GROPE- TYPE PROCESSED BY FOR APPLICANT TO FILL IN g? CONST BUILDINGAi"-- STATISTICAL CLASSIFICATION SEWER MAP ADDRESS � / _ DWELL. UNITS BK/^�Po CLASS. NO. C< (C--1 LOT NO. '•� I-le # BLOCK WATER CERTIFICATE: NOT REQUIRED ❑ RECEIVED ❑ TRACT MAP�] HIGHWAY NO.OF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND, SIZE OF LOT goO NOW ON LOT USE ZONE SPECIAL USE OF7 CONDITIONS EXISTING BLDG T OWNER fi/' NEL a BUILDING EXIST. YARD HWY STREET NAME _ SETBACK WIDTH ADDRESS '� FRONT ARCHITECT OTEL. P. L. _ENGIN EER /G� NO. SIDE / P. L. /� } ADDRESS O CONTRACT O. zO y//- A / •�� U ADDR DESCRIPTION OF WORKLu CL CQU �L' Paec" NEW ADD V ALTER REPAIR DEMOLISH %n Z SQ. FT. �{ NO. OF NO. OF SIZE �..J(/ STORIES FAMILIES USE OSTRUCTURE f /L SIGNATURE OF f APPLICANT '� ,./ /r , �y�' �•" VALUATION $ © L° APPROVALS DATE INSPECTO&'S/SIGNATURE P.C. PMT ��ra�� FOUNDATION: LOCATION - FEE $ FEE $ FORMS, MATERIALS FRAME: FIRE STOPS, -"- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS `• r'Y-� ✓!# 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 E .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 WORKMEN'S COMP TION INSU AN LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEEiRECT AND POSTED ll ADORES ' '� FINAL '�'�"�' JOHN F. LEWIS. INCIPAL STURAL ENGINEER R PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH y 3 b 4-10- ,hili 2 9 1 D 4 3.5 0- DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES � ' ® � 1 WM. J. FOX. CHIEF ENGINEER lK FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING / � DISTRICT NO. PLAN CK.NO. PERMIT NO. ADDRESS [ LOCALITY RECEIV , BY DATE OF APPL. DATE ISSUED NEAREST ` / Sr ":.� a"`-' .d j .,•*/'.•' �"""�`f CROSS ST. I '' �r^•AA v f BUILDING OWNER ADDRESSMAIL .� •6-� ���A ADDRESS .c. LOCALITY �..' NEAREST y �f AA CROS39T. CITY NO. FIRE NO.OF TYPE ARCHITECT OR TEL. ZONE PLANS tt+ GROUP "j"'• ENGINEER NO. BLDG. \ ,� . r„!C (j,ORD.NO. ADDRESS SETBACK LINEi'� Y APPROVED // L• DAT (j 7 CONTRACTOR BY E q-- USE ` APPROVED ADpRE iAM C ZONE r BY DATE LEGALI - CORRECTIONS DESCRIPTION / LOT NO. � �..s {'�BL/OCK/ TRACT '�/ 11 V'—/ F".- S 1 I V Q f�-- e') 1� 7770' NO.OF BLDGS. , SIZE OF LOT d� I NOW ON LOT USE OF NO.OFNO.OF - EXISTING BLDG , FAMILIES ROOMS DESC IPTION OF WORK ro A:, NEW ALTERATION ADDITION O A REPAIR MOVING DEMOLISH S4•FT• NO.OF / Z SIZE 'Z 5— ROOMS G0► STORIES / D r WALL I ROOF COVERING COVERING USE OF NEW BUILDING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION!: LOCATION INSPECTOR /DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS .. AND STATE LAW? REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, ! SIGNATURE OF BRACING.BOLTSt PERMITTE f LATH. INT. AUTHORIZED AOT ��" � LATH, EXT. 7GA63BA-3 7-49 $ T P.O.� PLASTER.INT. j FEE PLASTER,EXT. VALUATION v{ FEE .%! FINAL 1 i DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLI ANT Tp FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLANCK. NO. PERMIT NO. BUILDING OFh //y ADDRESS RE EIYED BY DATE OF APPL. DATE ISSUED LOCALITY ;/ },�, Z g_ NEAREST a CROSS ST, k'�.1--'�+A'�- BUILDIN A IL_- ADDRESS OWNER �.'/ .<,' � /✓ I� _ LOCALITYMAIL / ADDRESS { t" NEAREST TEL. CROSS S 0 CITY t NO. FIRE NO. OF TYPE—�� GROU ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. BLDG. N SETBACK LINE i ADDRESS APPROVED TEL. BY DATE CONTRACTOR NO. USE APP�P ED i ZON BY DATE ADDRESS F HOUSE NUMBERING DESCRIPTION L N BLOCKLEGAL • i MAP NUMBERv �, IELD CHECK BY TRACT " - '+''� NO. ASSIGNED BY�AT i NO. OF BLDGS. CORRECTIONS SIZE OF LOT `SS 3QQ I NOW ON LOT USE OFZ. NO. OF _ EXISTING■LDG. ""''— FAMILIES DESCRIPTION OF WORE NEW I I ALTERATION I I ADDITION 0 REPAIR I I DEMOLITION 0 SQ. FT. NO. OF SIZE 0,f, ROOMS STORIES Z s EXT. WALL ROOF r COVERING I COVERING USE OF STRUCTURE s APPROVALS INSPECTOR'S SIGNATURE DATE IHEREON HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION TION AND STATE THAT THE IN GIVEN IS FORMS, MATERIALS ECT. - AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, ATURE OF GAS VENT, DUCTS ERMITTELATH, INT. ESSLATH, EXT. ORIZED AGT. PLASTER, INSA• Dass to-so P. C. S FEE -� PLASTER, EXT. ATION ,FEE S ::p�"�� FINAL 1 DIVISION OF BUILDING � .s NG AND SAFETY BUILDING U I LD I N G D.p�tm.at of Co,m17 Fnq . County of LosX, Anyflfs WM. J. FOCOUNTY ENGINEER APPLICATION SUILDINGFOR APPLICANT TO FILL IN ADRaB BUILDING C ADDRESS LOCALITY i NEAR ItT LOCALITY CROC•1'f DISTRICT NO. FLAIL CK.Ow Rm. NO.' PERMIT NO. NGR[ST n OWNER R=KIVXD DAT[Of A L- DA 188LYrD MAIL S ADDRESS UOE ZONK NO. OFTYPE GRO IRK ZONE TEL. '1 M�_ cn-Y No. ARCHITECT OR TEL. / ZONING / QiGINKKR NO. AITlOV<O h BUILDING Za DRKBS •[TRACK LIN;i 'f'- CONTRACTOR IIJ�GY NO.. AlTROV7<D Dw NO. BYE bdSlK ^NU-YE[RING 1 m�� M"NUMBKR ��`,), MO. ADSIGNED CY , DESCRIPTION LAT NO. BLOCK DAT[ CORRElCTIONS INpP[CTOR TRACT ✓ /5- �7- NO. OF■LDGS. SIZE OF LAT OQ NOW ON LOT 60 USK OF NO. OF FAMI O DESCRIPTION OF WORK I Q NEW ALTERATION ADDITION REPAIR DI MOL.ITION Sq. FT. NO. SIZE // 2, ROOMSOF STORIES EXT. W LL /' ROOF COVIRN c-:C6 COVERIN USK OF STRUCTURE i APPROVALS INSPECTORS SIGNATURE DAT[ FOUNDATION1 LOCATIO _ FORMS MATERIALS / i I/�• I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- [: FIRE STOW, 7_ PLICATION AND STATZ THAT THE INFORMATION GIVEN IS GRACING SOLOS Z CORRECT. IAGREE TO COMPLY WITH ALL COUNTY ORDINANClf FURNAC[i LOCATION, AND STATE LAWS RiGUL-ATINCI BUILDING CONSTRUCTION. GAB VENT DUCTS SIGNATURE Of LATH INT. PERM 1 / • LATH QT. ADD r PLASTER INT. AUTNORIZID AOT. PLASTER. KXT. s q� UR HOB[NUMBECOR- Vf/ �[ R[CT AND POST D / V ON /! 74[ANRA Oft• tp 06RKERS' COMPI:NSATLON DECLARATION PI r7/V, .+9 ; I,hereb�Mkk7n that. l have'b certificate of,consent to self APPLICATION — FORBUILDING PERMIT ALfe, bra certlficate'of Workers' Compensation Inwrance, or a certlfi copy thereof ob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY. ��;Olfled 4y copy Is hereby furnls ed. FOR APPLICANT'TO FILL_IN BUILDINGAIDDRESSrtiffed copy•Is fged with the county building In"c- BUILDING n department. ADDRESS ✓ ' Dare App I I ca o f C Fr ZIP LOCALITY 00 CERTIFICATE FEXEMPTIQN FROM WORKERS' NO. &DGS. T COMPENSATION INSURANCE ,' SIZE OF LOT NOW 6N LOT (This section need not be completed If the'permit is for one TRACT ASSESSOR PARCEL LOT NO. AAAP BOOK PAGE hundred dollars ($100)or less.) Pq O T AAAP I tertify that In the performance of the work for which-this CMrtFR permit Is Issued,I shall not gmploy any person In any manner 'SPECIAL so.as_ to become-subject to the Work"'Compensation Laws. ADORf55 �ti �� CITY N ZIP . Date Appplicant ZONE NOTICE TO APPLICPfNT: If, after making this Certificatp.of ARCH ^ NO. ��DCSTRIrC7 TYPE FIRE BY Exemption, .yov should become subject to the Workers �C,I ` P;; ODtEi Compensatlon'tnovlslons of the Labor r-ode, you must forth. ADDS r "9r'�l f k with'compty' with such pcoVlsions or this permit shall be deemed revoked. CONTkACTOR STATISTICAL TK)N 41 APT. CONtaO. LICENSED CONTRACTORS`DECLARATION UC CLASS NO. 021 DWELL UNrTS I hereby affirm rhaf I am licensed under provislons of-Chapter 9 ADDRESS NO7 SEWER16". (commencing with Sectlon 7000)of Division 3 of the Business and VLIC0-1 Profealons Code, and my license Is In full force and effect. C`_L. city CUSS VALIDATION_ 50.FT. NO. OF NO.OF . C7IECIC License Num LIc.CI SIZE STORIES FAMILIES Ofd VALUATIIQN NEW DESCRI Contractor y _ ADD ❑ I am;elcempt under Sec. ALTF,R BAP.C. for this reason REPAIR Date: n USE OF / �?s £X1STING'B1DG. K . DEJWOL Signature APPtK�T TEL — FINAL OWNER-BUILDER DECLARATION Q NO DATE � � I hereby afflrrri that I am exempt from the Conitactor's License J i RtUL ` Law for the following reason (Section 7031.5, Buslneu and CS[� Profealons Coda): PRESENT ❑ BUILDING orL I, as owner of the property, or my employees with ADDRESS F; wages.as their sole compensation,will do the work and the structure Is not Interi4ed or offered for sale(Section L0CA1JTY \ 7i_"3,24 7044, Bu;Ines and Professions Lode). MOVING' TEL ❑ I, as owner of the properly,arh exclusively contracting NO' �' '. 7 with licensed contractors to construct the project (Sec- „ 'a tion 7644, Buslnea and Professions Coded 4 '�'�' 24 CONSTRUCTION LENDING AGENCY SFT BACK YARD HYN PROP. UNE DTH l hereby affirm that there Is a construction lending agency for FRONT the performance of the work for which this permit Is Iaued P.L. (Sec. 3097, CIv. C ). ;SIDE Lenders Name LDMARrf. f. tt FM .S4 $ tenders Addrea P.0 FM f ' ten ' I certify th9t I have read this applicatloh and state that the laniance FM �.5 LDMA P/C P above Informatlon Is correct. I agree to comply with all County Inv*&HgctJon Fes $ ordi"anc d State laws relating to building construction, Q I Tdal Fie •�O LDMA Perm, f and Izre n=atives of this County to enter upon the a ve- Sri1d property for Ihspectlon purposes. c - G't M R waw FM DQLAMATORY LANGUAGE S4gnak"of Appikant or Agent Dante 'F KERS' COMPENSATLOfJ DECLARATION /..IV Imo+ kA y it��yyi�►reby��i�n tF,at I have a certificate of consent to sal - APPLICATION FOR BUILDING PERMIT ,,, Lr[SuX 1, or�certlficate of Workers' Compensation Insurance, or a cern I o t er of Lab. C.) . • cy COUNTY OF LOS ANGELES BUILDING AND SAFETY Po I Nc jied copy Is hbreby furnished. FOR APPLICANT TQ FILE IN �� ING ADDRESS Certified 4opy Is filed with the county bulldln9 Inspec- BUILDING �1 tion department. ADDRESS Date Applicant lkda CITY ZIP ,iv LOCALITY CERTIFICATE EXEMPTION FROM WORKERS' ­ .OF.BLDGS. NEARtST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT ST. +. (This section need not be completed If the permit Is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. Msp BOOK PAS PARCEL orvr�R Steven & Jennifer Sh 2841100 ONE I certify that In the performance of the work for which this � NO. permit Is issued, I shall not employ any person In any manner 905 W. Foothill Blvd. � so as to become subject to the Workers'Compensation Laws. IONS CITY Arcadia ZIP 91006 Date Applicant NOTICE TO APPLICANT: If, after rnaking this Certificate of ARcHR� iIIg NSII Chen 3091240- 4709 ICT 4 TYPE FIRE BY Exemption, you should become subject to the Workers' ZONE Compensation provisions of the Labor Code; you must forth- � 404 E. Las TiAnAs Drive . with comply with such provisions or this permit shall be deemed revoked. CONTRAcroR Hannon Devel . r,2822828 sTAnsTICAi FIG4r10N APT. CONDO. LICENSED CONTRACTORS DECLARATION 1611 Garfield 1100 Ly- 446155 CLAS No. DWELL UNITS 7q__ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. Now (commendng with Sechorr7000)of Division 3 of the Business and LLC Professions Code, and my license Is In full force and effect. CITY Alhambra, CA CLASS B VALIDATION ECK License Num � Llc.Cl— ss1zE� 2113 s oR a 2 NO. UE-S 6 OF ONE VALUA /�� Contractor Date9-01 DESCRIPTION Of WORK NEW : A/� S) I >O z I am exempt under Sec. ADD New COIIdO (�� , �•./v /� ALTER «r/3 B.BP.C. for scion REPAIR s/ � d/� Ai Date: USEDU OF Residential UUU U �} Z EX15TItJG BLDG. Signature "I" Steven Shin TEL 284110a FINAL OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License ADDRESS 905 W. Foothill Blvd. 19NA1 [!l bbb C1 VVV Law for the following reason (SBusiness and 7031.5, Busineand Prgfessrons Code): MR, �y 14 ❑ BU I LDi NG I, 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). MTa - El 7NO. ,, �` "" I, as owner of the'properry, am exclusively contracting OR err with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code} ADDRE �' Ah CONSTRUCTION LENDING AGENCY Sf7 BACK YARD FtYVY TOTAL SETBACK FROM PROP. LIKE WTDTFi .I hereby affirm that there Is a construction lending agency for FRONT the performance of the work for which this permit Is Issued (Sec. 3097, Civ. C.). SIDE P.L. Lenders Name LDMA Rif. 1 $ Lender's Address P. Fief �Jpt Permh Fee 7 I cert) that I have read this a llcation and state that the ' certify PP fast,anc.Fee l0 • � LD/MA P/C - ' above Information Is correct.I ogres to comply with all County ordinances and State laws relatln9 to building constructionInveaigatlon Fee, 3 Total Fee 1' v LDA&A Perm. / and he uthorize representatives of this County to enter upon the v t ned property for Inspection purposes. 10� M R1iVEM POR IDO'LANATORY LANGUAGR Slg�of Applicant or Agent Dole u H '^KERS'.COMPENSAJIDPI DECLA�IONS ieby , that I haves certificate at cbrrient rance,. ' APPLICATION FOR BUILDING PERMIT =ertlficate of Workers' Compensatlori�nfiurance,. Of a cestifi co th re ) - _ Y' ` COUNTY OF LOS ANGELES BUILDING AND SAFETY Poltcy.K.�M' k7-N�*ex- BURD1 ❑ fled copy Is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS�lfled co is filed a lth±he n building In ADDRFSS ll��ii}�'' PY t 9 spec- BUILDING ti iioon department. QQ ADDRESS bateJ ApPll�anl GTY LP LOC,41PY CERTIFICATE 45F F>(EMPTION FROM WORKERS' OF BLDGS. NEAREST ,GQM NSATION INSURANCE SIZE OF LOT ON L 5T. • (This section need not be completed If the permit Is fpr one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL I certify that•In the performance of the work for which this Ow►>ER Steven Jennifer ShiAo. 284-1100 Z E 11W V No /� '� permit is Issued, I shall not employ any person In any manner 905 W. Foothill .Blvd. SPECIAL to as to become subject to the Workers'Compensatlon Laws. ADtJR£55 OOt DfIIONS . an, Arcadia zip 91006 Date Appl leant NOTICE TO APPLICANT: If, after making- this Certificate of A ENGI�� NgII C}len t RC p3091240 STRICT Gil^OUP' TYPE FRE BY Exemption, you should become subject to the Workers' ) 1): Z3 1�" Compensation provisions of the Labor Code, you must forth- ADDRESS 404 E. Las Tunas Drive oq with comply with such provisions or this permit shall be deemed revoked. cofJTRAcroR��on Devel - L-2822828 STATISTCAL I AFT. ODNDo, LICENSED CONTRACTORS DECLARATION 1611 Garfield 100 L '446155 CLASS 1`40. UNITS I hereby affirm that L am licensed under provisions of Chapter 9 ADDRESS NO. �, (commencing with Section 7000)of Division 3 of the Bull and r Alhambra, CA LIC $ Professions Code, and my license Is In,full force and eC %.- CITY CLASS rpcp VALDATFON CHECX : g License Number Llc CI S '2113 STORIES 2 F IL�FS 6 Ot�E "J VALUATION ty Cont-o&o&lils'[l►1 bPA Do,.. IO DESCRIPTN OF WORK NEW " OD 0 (� New Condo er ^D° : 010. I am exempt undSec. ► �v ALTER B.BP.C. for reason REPAIR pd USE OF Residential DEM" Z DJSTING BLDG. / Signature ' Steven Shin TEL 2841100 RIVAL OWNER BUILDER DECLARATION (PRINT) NO. DATE I hereby affirm that I am exempt from the Contractor's License 905 W. Foothill Blvd. , Arcadia Law for the following reason (Section 7031.5, Business and s FINAL Professions Code): my y BUILDING I, as owner of the property, or m employees with ADDRESS -.wages as their sole compensation,will do the work and LOCALff1� the structure Is not Intended or offered for sale(Section 7044, Business and Profeulons Code). MOVING TEL '' I _, _,: ❑ I, as owner of the property, am exclusively controctlnq CONTRACTOR NO. with licensed contractors to construct the prolect (Sec- tion 7044, Business and Professions Code)_ ADDRESS r ` CONSTRUCTION LENDING AGENCY g•« YARD F1Y✓Y PROP. UW 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 _ r- (Sec. 3097, Clv. C.). SIDE P.L. Lenders Name LDMA W. 8 P.C_ Fee f Pen. Fee q:z Ll Lendw't Address I certify that'l have read this application and slate that the Fie Fee 1 c LDMA P/C# ` 4 above Information Is correct. I agree to comply with all County. Invetttgarbn Fee 4 $ ordinances and State laws relating to building construction, Total kee 3 —I •-7 Q and h authorize representatives of thts County to enter LDAN�perm' / upo h a v rrLentloned property for Inspection purposes. ID- M MOM M*E04AMATORY LAP*GUA M Signet"of A*kam or Agent Da"C?_ _ I WORIU:kS'COMPENSATION DEQARATION r r o 't ' have cy ae '��teO� consenttoAP�IArt�aV FOR BUILDING PERMIT I u, Fate CA. Po?sai or a tertffled copyrther•of (Sec 3800,Lab.'C) COUNTY OF F LOS ANGELES BUILDING AND SAFETY �ky N0 Company C•rt)fied^bop y.is hereby fume FOR APPLICANT TO FILL IN pR}�S I ❑ Certified copy is fired wit u Ildir Inspdc- Bu0.Dl , QLD G tion asps LOGAUTY NEAREST I Dat• �" Appl Cf TY VI's �✓[ / ZIP CROSS ST. SIOR CERTIFICATE-OF WORKERS NO OF F>a OT Map PAGE PARCEL COAAPR4 A INSURANCE SIg Of 10T NOW ON (Thb secilpn.n••d not be�com leteo ff thii permit is for na 7RACi LOT 115E ZOO O hundred dollars.($100)or lesy.� _ r o. oo► lorfs om n. I•certtfy tfrart�ln the perforn5onc• whid, this CMrtE DISTRICT GROUP FI BY O permit isissaisd,]'shall not emp ny 4nyTpann•r Al 55 W�� } CONST. ZONE V so as to -Z becortt w to th on L#ws. SA93 OC C I ZIP ( OQ STATISTICAL CIAtSSIFTCATK)N O NOTICE TO AM CANT2 king-this Certffi4ate of ffECT AN s NO. aASS NO.�_DWHL UNrrS� LU LU Exemption, you .should me &object, to the Worker' d Cfompensation provisloris a 'the tabor Code, you,must f ADDRESS SEINER MAP' with tompty yrithl suds provisions or this;.permlt .shall _ deemed revoked. CCNTRACTOR ;R2-442 BK" PG, VAtJDATFON I nt � 3 S hwbby afftrthal am licensed under Wns of aVW 9 kna� NOa VALUATION (comm•r)cinp with Section 7000)of Dtvtslon 3 4f the Business andM Professions Code,and Iitdrrs• Is In full.force I A- CL .. $ S>gTSLI» M � F Ucerse Num � Con Date / DE5C321PTK*OF wow J o ADD El I am exempt YDder'S•c. 1�✓�2 ALTER NNIII -7 _ ..BAP.c"fpr �3lc—! - Rt3'AIFi DA 2- }•, USE Of - EXISTING BLW. DEMOL Slg Ta- + El-Bt1ILIJER DECLARATION f NO. IhwAby affirm that't ani exempt,frbm the Con s Lic•rss 7 f_ �� 2 a 1.34A Law-for the.foll*nq repson•fSectIan 703T Ines• and = i . Professions Code): 5mc .' # 0 0 0 0 0'•1I,- as owner of the property,"or my employbs with ,{wog es as fl eir.sole compensationj will do theworkaril 1A o o 6 Q 5bfine structoro-is-not rnt•nded oroffered for sari(Section 7044, Bunnies and Professions Code), MOVING o 0 0 6 Q 5 Q LT5 FTI, ps owner of-the property, am ezclyslv}ly contrWI'W NO. — - with licensed cohtractors to construct the project ('Sec- «- 'tioaJW4, Businew-and Profession,Co", ) . `, x.'7.0 9 _ 8 5 CONSTRUCTION LENDING AGENCY. SE7 I YARD IrwY TOTAL�SEOTPBAOCOC"FROM WM , I FWe(ay'offirM that there h a'constructlon:lending agency for tfte p•rformahu of the work for which thli*rrnit-Is Issued {o ° (s6G 3097,ay. C. - SIDE ?' P.L. 'Lenders Name Lenders Address P C Fse i Pen.it Fee G I certify hqw read thrs application and stat• that the Marance « - Gbov on Is correct. I ogres to comply wtftt all County Inveeipatlon Fee ordi relating to building-construction, Tool Fee o Ives of this County.to •nW.- • tion•d for.l,rspec lan purposes. _ OF"VIIIfR POR EMANATM T NG isna S7xftre of Appikarrt or - bate .4% -WORKERS' COMPENSATION DECLARATION t-:hereby­6+Q�tn thane haver certificate of consent to self APPLICATION FOR BUILDING. PERMIT �, ') ' If(su'le, or.a certificate of Workers' Compensation Insurance, cr a eSrilfi copy thereof (Sec L .�.) '. . COUNTY Of LOS ANGELES BUILDING AND SAFETY Policy NA. a4 rtlfl•d copy Is hereby furnished. FOR APPLICANT TO FILL IN AD5RINCr' /Ce ADbRE55 LI �Y Certlfled copy Is filed with the QQU"ry plldlnq Inspec- BUILDING LLfl tion department. Q ..a ADS Date 5� D Appllcant L/ . C1TY ZIP LOCAL CERTIFICATE EXEMPTION FROM WORKERS' NO. OF BLDGS, NEAREST. COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT O - ST. V • (This section need not be completed If the permit Is for ooe � hundred dollars ($100)or less-) TRACT BLOCK.. LOT NO. MAP QOOI( PAGE PARCEL OrtRSteven Jennifer Shi� 2841100 USE z05 I certify that In the performance of the work for which this � t'�O• akbo 15 permit Is Issued, I shall not employ any person In any manner _�*�_ � f} n->.�,. SPECIAL R10tY5 to as to become subject to the Workers'Compensation Laws. ADDRESS Date Applicant CrryECT ZIP NOTICE TO APPLICANT: If, after making this C:ertlflcate of ARCH ( TELNO DISTRICT GROUP TYPE FRE BY Exemption, you should become subject to the Worker' CXiN6T ZONE. Compensatlon provisions of the Labor Code, you must forth- ADDRESS p '� �tiDg with comply with such provisions or this permlt shall be deemed revoked. CONTRACTOR _ STATISTICAL CLASSI TION -r1 APT. COfDO. LICENSED CCNJTI ACTORS DECLARATION LIC CLASS NO. UNITS affirm I hereby arm that I am licensed under provisions of Chapter 9 ADDRESS MO. (commencing with Section 7000)of Division 3 of the Buslroess and ' LK_ L, Professlons Code, and my license Is In full force and effoct.C, CITY CLASS $ VAMATKM f1 rim SQ. FT. NO.OF � NO.OF CHECK License Nu be "r/ Llc.Cl- 3Y SLzE STORE ONE _ VALUATION Q Contractor , DESCRIPTION OF WORKADD' 1 = 'OqV• L /� O Q� I am exempt Under Sec. - ALTER . B.3P.C. for this + � RfPA1R � z USE OF d G Dat.: USE BLDG. DEM10L 4 9-5 , q b — SI nature APPLICTELANT Signature—OWNER-BUILDER LARATION I MT �"` NO' 2 -11 PATI 111 1 hereby afflrrri that I amexempt from the Contractor's License Law for the'following-reason (Section 7031.:5, Buslness and ADDRESS s' FfNAI Professions Code): PRESENT Vh El I, as owner of the property, or my employeBUILDING es 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 Co le)L MOVING TIi TRACT I, aerty s owner of the prop , am exclusively contracting OR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Coded ADDRESSREWI;tm TOTAL SETBACK FROCIM CONSTRUCTION LENDING AGESET BAC( YARD HWY NCY PROP. UNE 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. (Sec. 3097, Clv. C.). SIDE P.L. Lenders Nome Q UVALA Ref. $ P.0 fee 3 / mft Perfee Z l polo. Lender's Address r I certify that I have read this applicatlon and state that the I Fee 10 -450 LDMA P/C P above Information Is correct. I agree to comply with all County InvigIQrrtlon Fee Q ordlnan n tate ori laws relating to building construction, Total Fee .59 • LDMA Perm. / and heroby, • esentatives of this County to enter upon the abdv t property for Inspectlbn purposes. o' =.tl"V� POR EUgAfiATO[Y.LANGUA04 Signature of Applicant or Agent Date - 1