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Home My Public Portal About9229 HECLA AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING' ' ', _ •�'+°'- t �.a2 �` �f1 ADDRESS/ /.�• ��- -ST 1- -: � �.,� 7 t� � Z �. LOCALITY RECEIV/E�D�BY DATE OF APPT DATE ISSUED NEAREST" � ' _ 14 CROSS STI"L/././ j/' %? B DINADDRESSG / OWNERiy.. /. MAIL LOCALITY ADDRESS.'j'z!_ / T+r' L LJ NEAREST - 1 - TEL./ CROSS ST. CITYT�71'J.�/�'_(�i'/��/' NO•/7��'�sZ��J,• FIRE NO. OF TYPE GR.QUP_ ARCHITECT OR TEL. ZONE I PLANS Z I I -J.- - ENGINEER NO. , BLDG. - ORD. NO. 'SETBACK LINE ADDRESS APPROVED •- TEL. BY DATE CONTRACTOR-f' r "'• r'�PD. 7 j 1 USE //^/ APPROVED ZONE) BYDATE1rJ ADDRESS 1C-."^-,N,.L HOUSE NUMBERING _ LEGAL '` DESCRIPTION I LOTNO- 47I BLOCK MAP NUMBER FIELD CHECK BY TRACT / • 3 'yNO. ASSIGN ED-BYE-�_'�l-'� ❑ATFL - 7 NO. OF BLDGS. CORRECTIONS SIZE OF LOT/•3� / ' I NOW ON LOT D ��• I USE OF NO. OF ,.yq^"'yp• 4'7" �� °z= 1�.�✓N EXISTING BLDG. I FAMILIES • /��1.! ., n, o DESCRIPTION OF`WORE ! P✓ NEW yI. �I-ALTERATION I I ADDITION y 0 REPAIR DEMOLITION I SQ. FT. * /'�,+ NO. OF / SIZE 13 v+ 0 s ROOMS !G' STORIES f j � D EXT. WALL '�- - ROOF _ - P COVERING I -f/�"'�^t:1 COVERING /l - C USE OF STRUCTURE._ APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION,AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS �{�►y/r'`�� CORRECT. I AGREE .TO COMPLY WITH THE- CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS „G" LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, �p SIGNATURE OF. '/� GASVENT,.DUCTS ! r•/ ,,,�' PERMITTEE LATH,'INT. ADDRESS ' LATH, EXT. f. AUTHORIZED AGT. PLASTER, INT. 76A688A• DBSB 10-50 $ - P. C. $ - ® t (=..z® FEE !� y PLASTER, EXT $ VALUATION �' 1 �-s+ p p• FEE � y / ��. FINAL /• �at,G+---'^'!y r:3-3'� x .,® p}.�+�yl ® ppp-\_� p}..�� .B ' a'p`' PERMIT- . ��/lp}.�� p�/�II } Y 76A638A CE`k 5032-63 5�P -6r'-CAT,'TON I. -®'R- Bim/IL®A, YG Y 9�RMIT- _ I COUNTY OF LOS--ANGELES `. suiLOIN'G DEPARTMENT'OF COUNTY ENGINEER - - /. BUILDING AND SAFETY DIVISION �OcaurY {` 1 JOHN A. LAMBIE. COU NTY�{ENGINEEJR... NEAREST N WILLIAM A. JESEN,-SUP'7 OF;;BUILDING� CROSS ST: DIST CT N=O. ROU TYPE- _PESSED By- FOR Y_FOR APPLICANT ,TO FILL IN- • CONS U�f .BUILDING STATISTICAL CLASS IFI ATI ON R S WEMAP " '.' C ' .: ADDRESS: -'.Z,. ''.:. L *.. ti. K .PG CLASS. NO. -DWELL. UNITS '• - -- LOT NO. _ BL•"OCK"" -WATER. NOT REQUIRED RECEIVED' CERTIFICATE - TRACT •�, MAP.ry' , 1�'/ HIGHWAY STATE MAJOR-SECOND, LOCAL NO. OF BLOGS. NO. //16�R- 4 ICIRCCE) SIZE-OF`LOT. NOW ON LOT USE ZONE - -SPECIAL. USE.OF CONDITIONS EXISTING BLDG. } /,p'..Y• ' . ./' ,�,,. '",TEL. r,`. V OWNER f- @ 1 a NO �� BUILDING - EXIST. _ SETBACK YARD HWY TREE T AME - WIDTH `ADDRESS 1 �7,,.'L, L" �`-' D 'dei` ( FRONT : ARCH.IT,ECTOR. TEL P. L- i ENGINEER- SIDE �"' a ADDR ESS �•..T �.• �„/ .. ,�. fPEaGrL lJ' ..�- .+ ' OV 'CONTRACTOR' _ ' & �S' NO, ADDRESS ,, `j R'l lJ �r; ..rtdc•""` ._:;e'.�ts•f9 0 t DESCRIPTION OF .WORK ' }' a NEW" ADD —ALTER, REPAIR-• DEMOLISH: _ -SQ. FT. - -NO. OF. NO.'OF _ SIZESTORIES. FAMILIES . -USE OF - .....• Jw i iFA Out `.:. . . SIGNATURE OF'",� APPLICANT P � _ VALUATION-$ SAd - �a ..� _ APPROVALS I - DATE INSPECTOR'S SIGNATURE ' FEE $� R� FEE $ ^• FO FORMS,,MATERIALS ON /j✓/ �a ' IJ'�$%•r,Y'"L.ef�'1 ' . FRAME: FIRE'STOPS.y s - � ''e• y' f 1 'HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE•THAT THE ABOVE IS CORRECT AND,AGREE TO COMPLY FURNACE: LOCATION, WITH- ALL',. COUNTY'.•ORDINANCES AND STATE' LAWS REGULATING -GAS VENT, DUCTS BUILDING.CONSTRUCTION-1 CERTIFY THAT IN DOING THE WORK ,AUTHORIZED HEREBY I WILL-NOT- EMPLOY ANY PERSON IN VIOLA- LATH, INT.- ',TION'OFTHE LABOR CODE OF THE STATE OF CALIFORNIARELAT- ' ING TO WORKMEN-S�COMPENSATION INSURANCE. - s � LATH,.EXT.- SIGNATURE O r``�' HOUSE NUMBER COR-' / O PERMITTEE ` RECT AND POSTED 1�(((//LJ � ,��p,/�•iy,.y,�f� ADDRESS FINAL � �,� "+1G JOHN F. LEWIS. PRINCIPAL'ST UCTORAL ENG IINEER PLAN CHECK`VALIDATION cK. M.O. CASH _ PERMIT VALIDATION CK. M.O. 'CASH 2 .3 .1 2.1.21. IDV 6 2 3 D 4.6 3 011 _. " NOV 6 1 D 1 8.50-- t` A ROAD DPT. [�[P VdT FOR AiJY /A 7tF Rl aA u'c)f�,7,QF J'C �� ell DQF�L: IN THE .MJF. 1,N.^",i •�� .. -. .. _ .. ✓ P'. -lir-!�'Qc'E✓��' _ - _ _ . 76A838A;CE i#8038-88 . .APPLICATION LICATION FOR UILDIN'G.. PERMIT"- COUNTY-OF LOS-ANGELES: ADDREss DEPARTMENT.OF COUNTY ENGINEER BUtDING AND` SAFETY DIVISION LOCALITY •_LJ ?� ''• - NEARET JOHN A: LAM BI E, COUNTY ENGINEER GROSSS T. •J CASSATT D GRIFFIN SUPT OF BUILDING- . - DISTRICT NO: GROUP •TYPE PROC SSED BY - =FOR.APPLICANT•TO FILL:IN corlsT. ..BUILDING':' C—�D - ,'..BKR SLG .STATISTICAL` IFICATION IMAP ADDRESS , CLASS. NO. •� WELI_.UNITS LOT NO._,:', BLOCK O .. •' '.MAP '. '- 't ..STATE - _ NUMBER ',..P^yLi / HWY. YES ,r ., _TRACT .. SPECIAL ?^ - - USE'.ZONE - - NO:OF BLDGS:• CONDITIONS - - SIZE OF:LOT - _NOW ON LOT' USE OF' EXISTING BLDG:, .Wn - _ BUILDING- _ EXIST. - - - - - zJ : YARD HWY STREE%NA SETBACK _E .'WIDTH OWNER RONT' .. P.Lwig . ADDRESSSIDE TEL.. P,:L: _ - .- clrY ��TI` No. - �� IlV$PECTION'RECORD :. ARCHITECT,OR/ TEL. ' - °ENGINEER ... - NO. ADDRESS , CONTRACTOR s U/ . ADDRESS' DES'GRIPTION OF WORE AS 7p'. ,NEW r"ADDALTER REPAIRDEMOLISH SQ:FT:_ NO. OF NO..OF SIZE. - : STORIES FAMILIES -- USE,OF-`. .-, ,��tJ� ..�•{y� STRUCTURE ( •At�nl//'C/!U F•. ; ...SIGNATUREOF.. --'a /�OO�Ir ��f. -Pe . T.-.G-} APPLICANT �• APPROVALS.-' - DATE- INSPECTORS SIGNATURE S` ADDRESS/ 2 � Q/7��/�,r W.I �O(�/?f/� FOUNDATION:;LOCATION �,l ✓{ / LrLt#, '2. fI /// FORMS, MATERIALS l0 ( (,�' l PAA VALUATION$. Q 4...f I FRAME: FIRE STOPS, _ BRACING, BOLTS`_, - > FURNACE: LOCATION, P;C I PMT. QUI GAS VENT, DUCTS - FEE $. FEE_ ' _SZE .1 HEREBY,ACKNOWLEDGE THAT I HAVE READ THIS AP= PLICATION AND STATETHAT THE`ABOVE IS CORRECT AND INT.. AGREE-TO.CO PLY'W;IT.H L COUNTY ORDI ANCES AND `•" -' STATE LAWS EGULASI_ ILDI STRUCTION.•; LATH, EXT.. SIGNATURE OF -i HOUSE NUMBER COR --�- �. 0 RECT.ANDPOSTED' - ".'�' PERMITTE _. ADDRESS ' ' FINAL. .3- :,� � .. _5 CLYDE N. DIRLAW PRINCIPAL ST RAL-ENGINEER"! PLAN'-CHECK. VALIDATION CK., M.O. CASH PERMIT. VALIDATION CK: M 0.1' SASH': . . r APPUCAMON _FqRBUL0WG F COUNTY.OF LOS'ANGELES < BUILDING AND SAFETY j WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL-IN ,BUILDING-AD I=s p I I hereby affirm that ll have a certificate of consent to self.insure, BUIL Gp R S or.a certificate of,Workers' Compensation Insbrance,or a certified - copy thereof(Sec.3800,Lab.C.) CITY ZIP --- - -Policy--No. -Company- " • - _ LOCALITY . _..-`01ZL Ur LOT--- -- ---- ---- ---NO.OF BLD S.NOW-ON LOT--- ..- — ----' ------ -... -.-"-T.--- '- ---= - --------- --- ❑ Certified copy his hereby'furnished " NEAREST CROSS ST.•,<, - ❑ Certified copy is"filed with the county building inspection :TRACT � BLOCK LOT NO. .:department. '.. - USE ZONE. ... MAP NO. Date Applicant - - ASSESSOR MAP,BOOK r PAGE. PARCEL d�� SPECIAL CONDITIONS - CERTIFICATE OF'EXEMPTION FROM WORKERS' OWNER y TEL NO. COMPENSATION INSURANCE ��'Irl Z�_ WITHIN 4000 FT OF SCHOOL? n YES' NO ,.. -ADDRESS (This section heed not be completed'if the permit is for one hundred; •. .�1,..✓1 GJ _ - - " - DISTRICT -GROUP C T FIRE ZONE.1 PROCESSER'BYa - dollars ($100) or less.) J . - CITY - � -ZIP I Certify•that in the performance of he work for w ch this permit is issued,•I shall not employ any erson in any nner so as to - ARCHITECT OR ENGINEER .TEL NO. ' �� •� - _ become subject,to e.,Worker cation a STATISTICAL CLASSIFIC ION AP.,T 'CONDO DateApplic t:' _ SS - - ° ; CLASS NO.. DWELL UNITS .. NO C O- P T.' m <ing this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Ex motion; you hould become subject t0 -the Workers" TRC fC N / SET BACK YARD HWY PROP LINE WIDTH provisions of the•Labor Code; you-must forthwith ( ' f�' Compensation FRO •NT. .. comply'wlth such provisions or this permit shall be-deemed.revoked AD RES C.N _ p L *' / ..SIDE LICENSED'CONTRACTORS DECLARATION T q /�- //'�n uc •LAs e L l• hereby affirm that-I am licensed underprovisions of Chapter.9' /" wu SEWER MAP " '(Commencing with Section 7000)of Division'3'of-the Business;and SQ.FT.SIZE NO.OF STORIES- - NO.OF FAMILIES Professions Code,and ,\Y�ic In full force and e fec#!' NEW ❑ BK PG D d License Number ✓/ Lic.�Class �-� ' DESCRIPTION OF-WORK- ADD ❑." VALUAT - Q - _ ° .,- ContractolA to 1 49— ~'� ALTER ❑ $ U ❑ ham exempt under Sec. REPAIR . CB.&P.C.for this reason - - 'DEMOL CDMA.P/C# U U OF EXISTING BLDG. - ' Dater URM ❑.. a Signature APPLICANT(PRINT) - - TEL•NO. ->-` ' LDMA Perm# Z ❑ I, as owner of the property, or my,employees with wages as ZO s their sole compensation, will do the work and the structure is ADDRESS. not intended or offered for sale (Section 7044', Business and FINAL DATE Q a_ �� r Professions Code.). -: - WILL THE APPLICANT OR FUTURE BUILDING°OCCUPANT HANDLE A HAZARDOUS MATERIAL J i�`�.v- ' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN•THE , ❑ I, as owner of the property, am exclusively contracting with FINAL BY licensed contractors to construct the.project (Section 7044, AMOUNTS<SP o El ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? 5 I f I �5 65 YES El NO❑.,: �i�_' ec _ Business and Professions Code:) T'. GGG ` WILL THE INTENDED USE'OF,THE BUIDLING.BY THE APPLICANT OR FUTURE BUILDING t OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION-OR'MODIFICATION FROM THE SOUTH- CONSTRUCTION LENDING AGENCY - •COAST AIR QUALITY.MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR . - GUIDELINES. I hereby affirm that'there.is a construction lending agency for 'YES❑ No❑ /� A�/ N the performance of the work for which this permit is issued(Sec. S .��G�JI/V 3097,CIV.C. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING N ) - - CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, - •; - r r} III SI Lender's Name TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS �y ', 1 +l 3 MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address O • OWNER OR AGENT o I certify that ,have,read this application and state under penalty... o P.C.FEE PERMIT FEE of perjury t the above information is.correct. I agree to comply o with all unty ordi nces and State laws relating to,building r a cons n, and h b authorize representatives of this Count ISSUANCE FEE 00 CD to t pon.the e-mentioned property for inspectlo urpo s. /� i 9 , INVESTIGATION FEE - -,TOTAL FEE y �� r Sg� tl of App mnf or Agent Da - SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES.,,, BUILDING''AND SAFETY FOR APPLICANT TO FILL IN BUILDING RESS WORKER'S COMPENSATION'DECLARATION - 5 BUILDI ADDREss '� , ' - Gs✓{-� _•_. I hereby affirm that I Rave a certificate of consent to self insure, .ya.0 � f or a certificate'6f Workers' Compensation Insurance,or a certified �" copy thereof (Sec.3800,Lab.C.)Company J _GC ZIP 9 /yLOCALPX Policy No�G � f Lc c/( (/� S1Z_E'OF .T.' •a NO70F.BCDGSINOW ON`L_OT• ' Qi+� /�l�(.- Go _ _ ❑ C tified copy is hereby furnished. NEAREST CROSS ST. _ e E� Certified copy Is filed'wlth the county building inspectionC--TRACT BLOCK LOT NO.• t department. Irl t��(t)4;K,} USE ZONE MAP NO. Cate / Applicant, U ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS q. CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER - TEL No. COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO •' (This section need not be completed if the permit is-for one hundred ADDRESS P - p / 'DISTRICT GROUP�- TY CONS F E "PROCESSED BY dollars($100) or"less.) 2- &`-G >;' - CITY— - / ,__ - ZIP /v`r I certify that in the performance of the work for which this permit QiL't� l V G c is issued, I shall not employ any person in any manner so.as to C become subject to the Workeis�Compensation'Laws. ARCHITECT'ORENGINEER TEL NO. _ -'STATISTICAL CLASSIF CATION' '�APT• CONDO' Date -- Applicant, - _ -` ADDRESS- - _ .. -. CLASS NO.- DWELL UNITS '' - NOTICE TO APPLICANT.' .If after making this Certificate of REQUIRED TOTAL SETBACK FROM: _.EXIST,., Exemption, you should,'become subject to .the.. Workers' CONTRACTO . •TEL NO. SET BACKYARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ,C--(J S'`�(it-L 2. – �1_(} FRONT comply with such provisions,or:this permit shall be deemed revoked. ADDRESS _ LIC.NO. PL LICENSED CONTRACTORS DECLARATION w0� 'J ✓1 +� S✓I Q 20 Z SIDE CITY _ L� .�. LIC.CLASS PL I;hereby affirm that I am licensed underprovisions 'of Chapter 9 �� lT F� �- di EWER MAP } (commencing with Section 7000)of Division 3 of-the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES NEW BK PG - - - O Professions Code,and my license is'in full force a effect:' v License NU ber o LiC.Class ' �^�1 DESCRIPTION OF W RK - ADD •❑. VALUATION - ,�'j vContractor lJ� ��tT /Date yT �q WI�V �L(� tf.� ALTER. $ �(� eC3�' o U . Eft�L"►I'�{ -REPAIR ❑ a ❑ I am exempt under Sec. n $ rn B.&P C. or,this reason v �j` G'!7 vt t/i ' DEMOL `❑ z LDMA P/C# Date: - USE OF EXISTING BLDG. - -, URM -❑ • - .-- _ - - - Signature .- APPLICANT(PRINT) TEL NO. LDMA*Perm# .- _ .. .. sir ❑ notssoleintended compensation, for sale (Section and he structure as ZO IT-- owner of the property, Y employees 9 t t or their sole compensation, will do the work and the structure is � ADDRESS _ ( .. and – ' FINAL DATE PfOfeSSIOr1S Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALS' n q OR A MIXTURE CONTAINING A HAZARDOUS'MATERIAL EQUAL TO OR GREATER THAN THE i_.,-t I, as owner of the property, am exclusively contracting`with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, FINAL BY Q Business and Professions Code.) Yes 11 No El -• �///��` C'" a_•` i __ t WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING r OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - CONSTRUCTION LENDING AGENCY COAST'AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR ffUr-� GC( -,—a - GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ _ w the performance of the work for which this permit is issued(Sec. IHAVEREADTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING -- •••• '' 3097,CIV.C.) - CHECKLISTTLE .I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE2,CHAPTER 2.20 SECTIO2.20.100 , Lender's Name MIATERIALS REPORTING AND FOR OBTAININGTHROUGH A PERMIT FROM HE SCAOMD,NCERNING HAZARDOUS — a. Lender's Address ..� OWNER OR AGENT o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comply P.C.FEE - PERMIT FEE - - - -- - -� N with all county ordinances and State laws relating to building CD construction, and hereby authorize representatives of this County hSSUANCE-FEE T" to enter upon the above m tionedpr erty for inspection purposes. (0 - INVESTIGATION FEE TOTAL FEE - ^ s a,uw .I gram o,AWIt SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION . affirm rcertificate tteself ocertifcate of WorkersCompensaTonnsurancebAF LF L E C! 1L �®N F(a I JBUELDW G 'I MV or a certified copy thereof (Sege. 3800, Lab. C. a> COUNTY OF LOS ANGELES BUILDING AND'SAFETY Policy CertifiedNo mommy copy is hereby furnished. �, FOR APPLICANT TO.FILL IN` BUILDING ADDRESS' Certified copy is filed with t/coty b';,�lens.pec- BUILDING _�tion deportment. ADDRESS �- - / `CIT-Y - = - _- ZIP .<- LOCALITY - - - - -- CERTIFICATE OF EXEMPT FRO ORKERS' NO.OF BLDGS. NEAREST-_ COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This•sectjon need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT y�. / BLLOCK qt LOT NO MAP BOOK PAGE PARCEL OWNER u .�> ia" 11- SE�� {. USE ZONE MAP !,certify that, in the performance of.the,Work for which:this - NO. permit is issued, I shall not,employ any,person'in any manner f� SPECIAL; i ADDRESS g' _' d1 CONDITIONS'. so as.to become subject to the Workers'Compensation Laws. 0, Date "Applicant CITY - ZIP- 1 2W - NOTICE`TO APPLICANT: If,.after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE_ FIRE PR CESSED BY U Exemption, you should become subject to the Workers' 03 ENGINEER NO. CONST: ZONE V Compensation provisions of.the Labor Code,'you,must forth- ADDRESS ✓ Owt with.comply with such provisions or this permit. shall be � • TEL deemed revoked. --" 61,' ' STATISTICAL CLAS (CATION APT. CONDO.,-' CONTRACT R ,1r y _ - O• i LICENSED CONTRACTORS DECLARATION uC. CLASS'NO. DWELL:'ONITS "' hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS '`± "" NO. ' commencin with Section 7000 of Division 3 of the Business and SEWER MAP Professions Code, and'my license is.in full force and effect. CITY , CLASS `� BK. VALIDATION: to SQ. FT. NO.OF NO. OF CHECK license Nu it,Class SIZE STORIES'; FAMILIES ONE" VALUATION Conti, Date t ��' ��a DESCRIPTION OF WORK $ i , ❑ NEW ,- ADD - al am exempt under Sec ALTER B.BP,C. for this reason REPAIR $ USE.OF Date: EXISTING BLDG. - r '' DEMOL Q I� �f - 6 r� Signature T." APPLICANT 1L `f i� r TEL. ' FINAL e o 0 0° OWNER-BUILDER DECLARATION ) DATE'' I hereby affirm that.1 am exempt from the Contractor's License ! Law for the following reason (Section 7031.5, Business and ADDRESS -" " R. '1 FINA Professions Code): PRESENT - BY BUILDING E 1, 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 o ° 'o•e o 7044, Business and Professions Code):, MOVING TEL. 1, as owner of the property, am exclusively contracting CONTRACTOR NO.' ��}} with licensed contractors to construct the.project (Sec- - Nr 2 B O ,8 8 0 tion 7044, Business and Professions Code). ADDRESS' REQUIRED TOTAL SETBACK FR I CONSTRUCTION LENDING AGENCY SET BACK YARD: HWY PROP.LINE WIDTH- 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 P:L. ti „ ' 1 2,9,4.A Lender's Namea' ---� LDMA Ref.`#: o,o 0 0 0 P.C. Fee$ Permit fee• #' t1 Lender's Address �,w o .1 certify that I hpve read this"application-and state that the Issuance Fee ( D LDMA P%C#.� �`,' TM_ '0 ° 4 9 8 8 o above information is correct. I agree to comply with all County Investigation Fee e+ � L ;3..J �iS'� = 0 ordinances and State laws relating to building construction, t o 1 y 4 9 8 8 co, Total Fee .LDMAPerm. #. 4} z R and hereby authorize representatives of this County to enter m upon the-above-mentiiooned proopperty for inspection purposes. .' " 1'2,0 Sr`i8 8 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date -