HomeMy Public PortalAbout9557 GARIBALDI AVE_Building__ I
78A153IA C"8081-ee APPLICATION FOR BUILDIN PERMI''i"
C61 NT OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAR93T
COLEMAN W. JENKINSAUP-T OF BUILDING CROSS ST. -
DIST�T NO OR TYPE P OC a BY
FOR APPLICANT TO FILL IN l CONST. .
BUILDING STATIS-TICAL C IFICATION SEWER MAP
ADD RESS9552 (IRT-lbal di
CLASS NO. DWELL UNITS 8K gPG,2X
LOT NO. BLOCK USE ZONE -MAP
NO.
TRACT SPECIAL -
NO. OF BLDG$.
SIZE OF LOT NOW ON LOT
US" OF
BLDG. SETBACK FROM
TB L. FRONT PROF. LIN[ OF (STREET)
OWN NO. TYPE OF [IISTIN SETBACK HIGHWAY YARD = TOTAL
ADD REIB C .
CITY @ City
SIDE. SETBACK
RCHI EC GID[ PROOP.P. FROM
OR TEL. _
ENGINEER NO. LINK OF STREET
TYPE OF ER TITIN• SETBACK HIGHWAY . + YARD = TOTAI.
ADDRESS HIGHWAY WIDTH FROM C.L.
TEL. + _
CONTRACTOR NO 282-0907
ADDRESS
LIOC CORNER CUTOFF YES NO
S= Clabrie
CITY 1 LASS C-39
LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS S
DESCRIPTION OF WORK
NEW ADD ALTER RA DaMOLIIH
14 FT. NO. OF NO. OP _
SIZE STORIES FAMILIES
USE OF
STRUCTURE
2 • Sb4mgles.
SIGNATURE OF
APPLIC NT
VALUATIbN$ I •oo APPROVAL! BATE INSPECTOR'S BIG NATURE
P.C. PMT. FOUNDATION, LOCATION
FQE$ FEE FORMS MATERIALS
FRAME, FIRE STOPS,-
I HERESY ACKNOWLIOO[ THAT I HAV[ READ THIS APPLICATION BRACING DOLT
AND STAT[ THAT THE ABOVE IS CORRECT AND AORQ TO COMPLY FURNACE! LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS R[OULATINO OAS V T. D
7DI HO CONSTRUCTION. I CERTIFUILY THAT. IN DOING THE WORT(
AUTHORF TH[ COD[ OF TH[ STAT[ OF CALIFOIRI A RELAT-
IZED H SY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TON O
ING TO WORK. . nxo�
cc
• LATH. EXT.
!
SIGNATURE O HOUSE NUMBER COR-
A PERMITTEK
AgDREae FINAL G
JOHN F. LEWIS. PRINCIrAt ST T AL ENGINEER
PLAN CE= VALIDATION cK. mo. urH _ OEEMIT VALIDATION( m J M.O wH
5 2 2,cE .ft j5 -1 D ��9L0
r 1
DIVISION OF nt of Oo NG AND SAFETY BUILDING
DeQa0oulat t of Los A Z�iuear
Q. FrO of OU A.t APPLICATION
WM. J. FOX. COUN`,�r` [[R
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDIMR ' DIRTRIOT M0. PLA.OK.o/R Rm.Mn. PERMIT N0.
ADDRERS .5.� (7
LOCALITY
REO[IVD P [
DAT[OrAPL. DATE I08UD
Q /_� E
o uT E/yP< C, D. BUILDING
f ADDR[J11511 -
OMRi[R
'MAIL LODALITY
} ADDREp cZ / _ NXARE«
DROSR RT.
DITY rl7,XVodNTS.L �- FIR[ N0.6r O
AROHIT[CT OR TZOME PLANK
IL
[NOINEER MO. BLUR ORD. N0.
�TBADK LIN[
ADDR[!R
USE / APPRIIV[D
TEL ZOM[ ■Y DATE
pT
OOHTADO L � N0.Y vQ HOUR[ MUMSERINO
ADD //�. Cl MAP N0. AMION[D QY
L[OAL
S
DORIPTIOM M SLOOK
[B
T
WUM
Bla OF LOT S / -Now O R�..OT G, ) �r� � 3�./ G � '07Z T,
U6E OF •��T/Z / ' '
IXIBTINB■LDIL �+ FAM�UF� 7Ai6vceA,�
DESCRIPTION OF WORK / r Te A- Ae 4e OW 4
NEW ALTIOlATION ADDITION FS I(p lr& T
Pm Afr ,✓r
REPAIR DEMOLITION DI{/
SQ.FT. N U.OF
Ila ROOM■ RTORIO
w[wieiMuaviRINR �• -z.3 `S-J ;�� 'I q "cp '.S t`.4
UBC OF STRUDTUR[
'7720 Z3A57 .r O .i u" 7'I 'r f r//VL
( � r - /t A frR ! 4,Y-k T,I) r d x�Y
i
I NSPEOTION FOR WH"N /l✓SP, paF3v*LS re p 'f f
OOOUPANOYAB NSP[DTOR'RBIOHATURK DAT[
FOUNDATIOMILOIIATIOM
1 HEREBY AOKMOWLEDDE THAT 1 HAV[ READ THE■ AP- FTZItlll6 MATERLAL
PLIOATIOM AND STAT[ THAT THE INFORMATION GIVEN is FRAME,, FIR[RTO PB,
OORRCOT. BRADIM SOLTR
1 /y0A TU DOMPLY WITH ALL COUNTY ORDINANO[R URNAD[1 LOBATION,
AND STATE 1VR REOULATIMo SUILDIMO OONRTR/UO/T�ION DAB 1391 DUOT1
■IOMATURE OF / LATH, INT.
P[R M
.�� LATH, KKT.
ADDR "
PLASTER, IMT.
AUTHOIlIan ART.
FEE // HOLlB[HUNKER OOR-
R[OTAND PORTED
VALUATION FQ
7A-628- DAR 2 1-"
-
TEMPLE CRTY
P
A PLIT
'l�ATION FOR BUILDING PERM
COUNTY OF LOS. ANCMM BUILD!
DEPARTMENT OF�Y ENGINEER ADDR
BUILDING AND DIVMON LOCALmr
JOHN A. LAMBIE, COUNTY ENgINmm NEAREgT
J or lluiLgimcp CROSS ST.
FOR PLI
APCANT TO FILL IN CONST.
P B
CONST.
]BUILDING Ll A, STATISTICAL IFICATION H YAP
ADDR ESSfS 6f —�
LOT „-` � ��rJ `s.b CLASS.NO LL.UN
Y3 OCK WATER NOT REQUIRED RECEIVED
CERTIFICATE,
TRS MAPHIGHWAY
NO.OR BLDGS. NO. O�3 (CIRCLE) STATE MAJOR SECON LOCAL
SIZE OR LOT. NOW ON LOT USE ZONE SPECIAL
USE TI CONDITIONS
EXISTING]BLDG.
OWNER FLAAIC& N BUILDING YARD HWY HTREST NAME EXIST.
SETBACK WIDTH
ADDR FRONT
ARCHITECT OR TEL P. L.
ENGINEER NO. SIDE
}
ADDRE6S TEL. INSPECTION RECORD O
CONTRACTOR NO. u
. CC
ADDRESS O
DFSCREMON OF WORK
a
NEW ADD ALTER REPAIR DEMOLISH h
Z
80. NO.OF NO.OF
—
IZE ZEORIES FAMILI
USE OF
STRUCTURE
17
SIGNATURE OF
APPLICANT
VALUATION;
APPROVALS DATE INSPECTOR'S SIGNATURE
P C PMIT FOUNDATION: LOCATION
F E FEE a FORMS MATERIALS
FRAME:FIRE STOP".
I HEREBY ACKNOWLLDGE THAT I HAVE READ THIS APPLICATION BRACING DOLTS
AND STATIC THAT THE MOVE 15 CORRECT AND AGREE TO COMPLY FURNACE:LOCATION,
WITH ALL COUN7Y ORDINANCES AND STATIC LAW REGULATING GAB VENT,DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
A UTHORIZID HERESY IWILL HOT EMPLOY ANY PERSON IN VIOLA- LATH INT
TON OF THIC LABOR COOS OF THE STATE OF A
CLIFORN A RELAT-
ING TO WOR KL PENS ON INAI t.
_ LATH,EXT.
SIGNATURE OUSE NUMBER COR.
PERMITTEE RECT AND
ADDRES
CLYDE N. DIRLAM, PRI&CIPAd STRucTUL G
". aAPLAN CHCVALIDATION cAaPERMIT VALIDATION ax
LISA 6 3 7 5 JU�J 18 1 D 8,C).0 '
7""@A CIE IN3.a So APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUD`DIN �- `
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION r-,C L
JOHN A. LAMBIE, COUNTY ENGINIIR NEAREST
J e OF,Cul a CROSS
DISTRICT NO. GR -TYPE P 11"ED BY r
FOR APPLICANT TO FILL IN 57 4 V CONST
BUILDING VJ STATISI'IC,ALCLASSIFICATION 8 ER MAP
ADDRESS (,p;• CLASS. NOLL.UNI
LOT N BLOCK NIMJM�BER��tJ TAT YES NO
IWIEE
•RA USE ZONE SPECIAL
NO.OF.SIZE OF LOT. / N NOW ON LOTS CONDITIONS
USE OF F
EXISTING BLDG C/ BUILDING YARD HWY RELrT NAMED'
TEL. SETBACK W
OWNER O. FRONT
Q� P. L.
ADDRESS �/ SIDE _
ARCHITECT OR TEL P.
ENGINEER NO. INSPECTION RECORD
ADDRESS 0
0
TEL
CONTRACTOR NO
DC
ADDRFr O
DESCRIPTION OF WORK
NEW Anp.F ALTER REPAIR DEMOLISH N_
Z
SO.FT. NO.OF NO.OF
SIZE STORIES FAMILIES
USE O
STRUCTURE
q3IGNATUFa OF
APPLICANT
VALUATION s
APPROVALS DATE INSPECTOR'S SIGNATUIZE
P.C. PMT FOUNDATION: LOCATION
FEE Q� FORMS MATERIALS
FEE FRAMH. FIRE STOPS. '
I HKREJY ACKNOWL[DUK THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ASOV[ 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCE! AND STATE LAWS RSdULATINa GAS VENT' DUCTS
BUILD Na CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT 15ISSUED I SHALL NOT LATH INT
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUSUECT
TO THE WORKMEN'SCOMPENSATION LAWS OF CALIFORNIA. -
CATH EXT
.SIGNATURE OF HOUSE NUMBER Cr
M r-T R ECT AND POST .
ADDRFRR FINAL, .
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN
PLAN CHECK VALIDATION m wo. . cAm;i PERMPt VALIDATION CK. mo.
U��7 4 4.4 1 MAY 3 1 D 2.0 0 u
mm"C[Swm•a-aO APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ABUILDING
DDRESS A A A
DEPAMMM OF COUNTY ENGINEER
Bl7II.DING AND SAFETY DIVISION LOCALITY LL L-C
JOHN A. LAMBIE. COUNTY LNGIN"m NWEST L L y
Y A. J[ • or mmt.Dimm CROSS BT.
DISTRICT NO. G P TYPE �% P EBBED Y
FOR APPLICANT TO FILL.IN . CONHT.T ,� .
BUILDING ! ATISTICALCLASBIFICATION ,$EWER HAI
JIK
ADD EBB / r ..
CLASH.NO LL I-
L
LOT NO. S L BLOCK MAP STATE YES
NUMBER •l�� HWY.
USE ZONE
TRAIri' NO.OF LDCiB. G CONE TIIONB
SIZE Or LOT L NOW ON LOT2 I
USE OF
EXIBTINGBLDG. /'A' �{ f,��jj� SEILDIN `(ARD HWY STREET NAME pST'
OWNER '* AL LAN iF N pjeKOI. n FRONT
L T / � � R � A !'
ADDRESS GIDE
ARCHITECT OR - TEL.
ENGINEER NO. INSSPF.CTION RECORD
ADDRF
TEL � Q
CONTRACTOR NOx
ADDRESS 7 w O,
•DESCRIPTION OF WORK Its'
05
NEW ADD ALTER •REPAIR i IDEMOLIHH Z
gq, p1, O.OF NO.OF
SIZE STOR'E'
TLlT�
USE OF
STRUCTURE
BIGNATURH OF
APPLICANT �y
VALUATION s �.• Q _
APPROVALS DATE . INSPECTOR'S SIGNATURE
P C PMI. ^ FOUNDATION: LOCATION
FEE FEE C.r FORMS MATERIALS
FRAME: FIRE STOPS.
I HEREBY ACKNOWLEDGE THAT I HAV[ READ THIS APPLICATION BRACING BOLTS
AND fsTATE NAT THE ABOVE IS CORR[CT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND NATE LAWS R[GULASING GAB VENT DUCTS
ISUILD I NG CONSTRUCTION. I CERTJFY THAT H•1 THK FERPORMANCK -
OF THK WORK FOR WHICH THIS PERMIT I/ IBbUED I SHALL NOT LATH INT
EMPLOY ANY P[RSON IN ANY MANNER BO AS TO BECOMR SUSUECT
TO THE WORKMEN'S COMPCNEATION LAWS OF CALIFORNIA, LATH 'EXT.
s�
HIGNATURE OR HOUSH NUMBER COR-
PERMI RECT AND POSTED
ADDRESS— ANAL,
I CLYDZ N. DIRL.d.M, PRINCIPALS RAL ENGINED '
PLAN CHECK VALIDATION m U.o. CLk++ PERMIT VALIDATION wo. CAWK
LY
71 4 21.0
78A688A CE#803-1-61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING . , -
DEPARTMENT OF COUNTY ENGINEER ADDRESS- r-"= �-= -
BUILDING AND SAFETY DIVISION LOCALITY %_ T
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A, JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUPTYPE - PROCESSED BY
FOR APPLICANT TO FILL IN -"7— CONST
UILDING
B - }
STATISTICAL CLASSIFICATION I SEWER MAP
ADDRESS % ter i- �'"� BK PG;
CLASS.NO. �' DWELL. UNITS
;-
L TFes'
BLOC KA WATER NOT REQUIRED RECEIVED
`r 1 CERTIFICATE: Li
TRACT�,�'�1f I dA. l7/ �,c. 'i l j4.8\_ I MAPHIGHWAY S
.� NO.OF BLDGS.
NO. (CIRCLE) TATE MAJOR SECOND„ LOCAL
SIZE OF LOT / '; k � � � NOW ON LOT USF ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. �/ /� I�
OWNEI�g�PI fy k/(._f•'/ N01�4�� + BUILDING YARD HWY STREET NAME EXIST-
/ SETBACK WIDTH
ADDRE�ry.�y IZ
� �`-' (T /'S/Y F- FRONT
ARCH IT CT OR TEL. P. L.
ENGINEER NO. SIDE CL
P.L. O
ADDRESS TEL. INSPECTION RECORD uJ
CONTRACTOR NO. —I
W
ADDRESS
DESCRIPTION OF WORK Q
NEW ADD ALTER REPAIR DEMOLISH O
SQ.FT. - NO.OF NO.OF
IZE - STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF, ,� f
APPLICANT
VALUATIONS
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
FEE S FEE'$ t"� --+" 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 Co NSTRUCTI ON. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
LADDRESS.'
OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT.
O WORKMEN'S COMPENSATION INSURANCE-,
1, A LATH,EXT.
ATURE OF - F' ,/ HOUSE NUMBER COR-
MITTEE .._,+�'° 1 I .d.s L� RECT AND POSTED
FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ErjGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. (CASH
1 G{Z CERS -_bA NiSA'N� k DECLARA71CrN -_ .. (j J S�'k 5 g- •-- t •_ y - -
.:
eby c rm.thot !qia.certfffcate of gortsgnt to self
Insure or d certtffoate of Wof}cgrs GompenspllorS Iniurunce, A P P L I CAS'IO i� F O R�. a,I L - P E R111�I T
Q*'b-certtfted copy'4 reof (9ec. 3800; Eab. C.-) _ _ ._ -
IISy.Tro.,, pony fM1 rennet I nr��nn 1 t COUNTY OF LOS ANGELES BUILDt G AND, FOY `.
Y BUILDING
_
FT,-CeftNed copy furplshed�•, :.iK ,:,• FOR APPLICANT TO FILL IN ,.,DDS.
0' 'Certlfled':o Is f{(ed'wiW%a codnty�illldid' 1*-ec- - BJJIWlNG -
`Hon+dedarimenf. r ti• ADDRESS 9557 5arlb�ajdl
Date. ':5`,7-Ak. Applicant V Uiru th;RaBff fQ_ ?• CflY T np LOGVLTY
fIC.4TE-bF N-FROM WOR FS' ;4NO-OF BLDGS-
' OOMPEiJSA2igMINSURAN(� SIZE OF LOT' NOW T COT ST. -
(Th7s'sectlon44ad not bd•co"nipleted if the,pertnit 14 for one J,_ .
hundred.doll4rs (=1OQ�oc�¢ �• BiO c [bT Nb. hMp' az,_1 PAGE~ PARca
TEEL
• 4hcA of 4ha work fot_`yfllc{Z this - Ogyt32 NO ' S _
Qer it Is'lalued, I IEiokdmpl0Z.
yariy.pir}ori-1ri`pny,manner ADDRESS - _ __ CCXDffIOtJS -
:os to-bec iO4'*UbJe0 to ttie WorftArs fiornpb`ni2ittcn'Ldws. J
Dc41e. ri v7-
2, App llcblif _ - -
n
10. I _ "lf; Inaklrlp'thls Certtfitote'of ARdItTCCT� NO.'. DISTRICT. _ce1CIP TYPE _ FIRE BY
tem ori+`y u oufd becbrAa�subletr,to the•�bt-kers - ODNST Z
Compensation provtsjons,of,•the LBbgfYt db;-ypin must-forth-
with comply..wltf7,wc(i`provltloAs ar4•thA(ijbrTTifhihQll be
CONTRACTbR l� r STATISTIG�1 CLISSrFIC, AFF.
110E q� m goKTRA oizs DEaA1 RAllce.,[� UC 'i7°SS1Jb_ DW�1_ UNrrs
I 7j` rtp,t*Ilam II ansa under prpvls]Qrtf of Ox"ar 9 ADDRESS P i0• Box J NO.. t t
(corn nG w)ih S?o.-7M)of Divti�pn 3 0 Thq�dlnes and _. 1-_ _ _._- ba.- _ .. SEM ER MAF
Rbfessldro Coderrty llcelise'la'Jn f611 force am effect. CITY CLASS - -- - t
S9_ FI. NQ.aF f� BK TFC'. - k r
[nL a r O�
�tccrt>ke�lurnber. )�50' LfG�Ids♦ C�Q ' SIZE STORIES" FAMI ' i
U=•ri.- r _ r VhILUATF31M.
Ccihtrpdof Vt'reTrlf`rri-..} v�'f.,•�1n Bate.,-h am .- DFSC3t1PT1dt�Oi --Over,eX �` 1 252.'00
'}' 7-•,s-;•. 'ry
AM $
I am ex.mpf udder c
or' f,-wLtb- StorI11- - - --'r
�
, n _ �i- _ , 'Shtagl es,' front hst6. o 1 APERP - __... _
B&P.c, f«,Mils reason �T n y• RHAIR - - :9:4 5$7 A' '
US�OF
EXUBLDG
_ $.IQria ure _ - PKAL
TEL
QWNER-BUILDER DECIARATl01k _ _ _ .__ -.v ._ _ _ _ NO -_ _07 DAT$ '_ .= � . :1 o. o.4(� -
_.l.heafflrm-that-I am axe.n t ftprrmthe Cbritracth,"Ice-rum �,to41 ' .
Law Xhe folloN7ing rb8io&(Settrdrr 7031.5, 1 uslne& and ADDRESS 0 a.gca 91,8 8�.I
f F6feas18M Way:;�._- � - . ._ . .._. -_._ -{ r'
BUILDiNG
1',ft owner of the property, or my •mploycom-Mth ADDRESS + t'
as fliek sole compensgtlon,My
o tfia w'rk' nod
th astnr8ture 14 not ljntanr ed or offered for dale(Seolon• LCCuuY
,9044, Bµslneu and Ftpfeasloru Code --- - _ RAdJaNCT`- -- -"' TEL
�} 1,.as owner,of the Properly, am excltrslvoly controctlgp'
` .with IlcenseAconfradors-to construct-the project{Sec- ADDRESS
tion 7044, Butlness and Professions Code •r
i<-�_ 'COtaSTR UCTI ON LrIJ D)NGCx
-AETVCY__ _ __.�_ BACK -i-WYPROP..La
I� . - -w1DTH'
- '
I bereby'afflr4n•thai there'is o constructfort_land]o9 ogencyfor FROM
fl-ire-perfor(nance--of-the-workfor which-this-permlt is Issued P.L
(Seca 3OW, Clv-C_) SIDE `
Lenders Name. LDMA Rsf. I ts. - -
Lenders Address '' _�_V _. P.0 - 1 Permit Fee r ; r
Lceritfy that J,ripw.reod-thls_appllcation and stats-that _ -- -• - -
tfM taswnoe Fee - CDMA P/C - -
above Informatbn Is corned. I agree to.cvmply with cill County InvW Fie.
y?rdlnanceL ih< , tq.lows rolatlnp-to building constructl4n, - • _ -. -. -.- _—
dr>d hereby'buthOflYe ieprdsentattvas of thisCounty to..enter TdolFee• 4 Perm. f'
upon a above7rtentloned propbrty for Irtspectlon purpos4s - -
T
so klVM1111 �L
70k DANATO[Y LANOUAO#
- �
-- --Slpnaturraf-Applfmnt or- WAt-.-. . .. Date -- -
1_y-14{j i
t,O ORKERS'COMPENSATION.DECLARATION,_
hereby affirm that I have a.certificate of n hent Jo self- ,, APPLICATION �-�O. U I L D I N� PERMIT
Jr)sure, pr d certlflcptd of VJorken'Com Ion Inryu no*,or ,.'
a certified coy t�reof (Sec. 3BQOt Lab. :•) ._ r COUNTY OF LOS ANGEL � � BUILDING AND SAFETY
Poflty N. Y
dertlfleacopy Is hereby furnlshed. _ BUILDING
O , N FOR APPLICANT TO F LL IN-. UI
p ertlfred copy Is filed with the unty bull I spec- BUILDING_
4��SaG tion d- rtm t. ADDRESS L
NEAREST 1
(>a to l l ca CITY zip CROSS
R-FIFI TE OF E.XEM'PTIOfq-FS' NO. OF BLDGS.
CbMPFNSATION INSURA14CE' SIZE OF LOT NOW ON.LOT MAP BOOK PAGE P
'(This section•need not be_completed If.the; It Is for one USE ZOO
huhdred dollars'(1IUQ)or leas.} TRACT BLOCK LOT NO. NO. }
t ! SPECIAL Ol .
I cert.Lfy that In the.perf&ma'.nce of the work for which this OWNER �.7 CONDMONS O
rmlt Is Issued, I ihpltnol employ any person In any manner r DISTRICT GROUP TYPE Fi,RE BY (�
ab.as tq 6ec'drrie sublets to`the Workers'Co'mpensatlon Laws. ADD� �C z OC
� r o
,�pTe Applicant CfTY ZIP �/ y, C1PS5 IUT10N CONDOFTEC7 OR .
NOTICE .TO. APPLICANT: If, after maklhq"this ICertlflcate of" �NEERd aAss t}0 pyygl_ UNITS—
Compensation
100'.-Exe.mptlon;; you should become subject to the•Wodkors:' .
t/!
Compensation provlfloru of The Labor Code; you must forth- ADDRESS SEWEPR MAP Z.
wlth.,comply with sucKs'prc,Vlslons. or this permit shdll be T�QC-�
deemed revoked.: CONTRACTOR rJ(T��� RI PG, VALJDA7FbN
,LICENS9D CONTRACTORS DECLARATION, tl
1 hereby arfflmtithat i am licensed underproylslons pf Chapter 9.. AbORESS_
(commencing v�Ith Section 7000)os:f PlvWon 3 of the Basincrud VALUA710N
profesylons Code, sad m
y yIlcq Is In full force and effect. CfTY,
_UC_ r F a
t SQ. Fr. NO. OF NO. OF CH
Llcense Number - ��� ,�Llc."tl r SIZE STORIES I FAMlUF5 ONE
_ b;a f Q _
Contractor 7'� ! 1� Date O DESCRIPTION OF wow NEW 2"546L 2 A
•f am exetnpt from the Ilcpnsing cequlr en 6s ram a _ ADD-
Ilcensed architect or'a tegltitered profeaslonol'ergineer ALTER` � - FINAL. #lo o'_O! 2.3
bdLn¢ In my professional capa5lty' (Section 7Q51, r C REPAIR D-A� ! ^ — i'' -
Buslness and Profeaslons Code). USE °•o 2�7'6 Q,.
EXWNG lji DG. •. liJ �Ir{AL
Licr ReQ.No Date CANT l T TEL Er r_ ..°-0
:10'r2.7,'6
o5
— OWNER BUILDR.DECLARATION PRINT `
9 T
I hereby afflhn that I am exempt from flys Contractor's License /�,}� /� 0't}•0'6 82
Law for the-following,
¢ reawn (Section 7031.5, Bwlness ander s ti CJ d
Professl6nirCo .e): -, -. .
BUILDING. .
I, as owner.of the property, or my employees With ADDRESS
wa¢ei as thelrsolecompensation,will doth•work and
the structure Is not Intended or offered for-tale(SectloP LOCAbTY.
7044; Businesn,andl�rofesnlpns-Code). MWING Tli '
` I, as owner of the property, pm.ekclusiv0ly cohtrading � ' NO.
with Ilcensed contractors tb co'nstrud•ihe project{Sec-
tio
Set- ' r
t. tion-7W4, B.uslness and Professions Code).`
CONSTRUCTION LENDING AGENCY REWsaw ggIX ED YA)2D. +rWY TOT ur>E dM%S$
Thereby affirm-that there it 4 constructlonJendlno agency for - FRONT - #Ld!o' o o'o
the perform6nce.of the work,foc which this permit Is Issued P.L
(Sec. 3097,-Civ.C.).. . SI
D£ O; .
- P.L O
Lender's NameI '
_ _ . _ ,. ._. _ I • 4'a-0,0Z
Lgnder's Addtess ' P.C. Fee S C1 Pefmlr FaeI certify thatI have read this application and state that the nc��s 404above Informcrilon Is cbrrect. I agree to comply with all CountynVgt gallon Fee"ordInancet-and State lawsirelatln¢'to:building construction, Total Fee _
and hereby authorize re resentatly of this-County to enter
apo abo me n p or inspedlon.pkg-J,
' SEE REMM FOR DMLAIIATOt<Y tAW-UA¢!
Slgnafvra Applicant en
r. .