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HomeMy Public PortalAbout9233 HECLA AVE_Building__ 7D1VI51QXT OF BUILDING AND SAFETY Department of County Engineer S U M L D 0 Ru County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION " FOR APPLICANT TO FILL I : li °. FOR OFFICE USE ONLY DISTRICT NM PLAN CK. OR REC.NO. PERMIT NO. BUILDING ... _ S / Z 4,7 C I ADDRESS rl 7 RECEIVED BY DATE OF APPL. DATE ISSUED LOCALITY // �y NEARE13T I' / ( �' . /O/ A/ It, TP BUILDING r� 7 paad' ,�/ ADDRESS "�L." OWNER /!!!`MAIL �� s j��/ ®'� yt' LOCALITY �r G ry. DDR-. 3-031 ,f 4®,{0 4 kc•c��/ =>�� PIP, ~' NEAREST '7^ �J'f CROSS ST. CITY / . . NO FIRE NO.OF TYPE GROUP ARCHITECTOR TEL _ ZONE PLANS ENGINEER NO. BLDG. , ORD. NO. SETBACK LINE 2—C_-__1 ADDRESS _USE APPROVED '�""" `RR 1 A� .TEL: ZONE BY DATE/ d ! U ''Z � CONTRACTOR (ry � NO. - HOUSE NUMBERING ADDRESS MAP NUMBER NO. ASSIGNED_ BY LEGAL CORRECTIONS DESCRIPTION^t LOT NO. BLOCK _ TRACT I V d�LJb� TC. NO. OF BLDGB. SIZE OF LOT /0 ,gip �( Cha I NOW ON.LOT USE OF NO.OF EXISTING BLDG. �"'-- I FAMILI&8 DESCRIPTION OF WORK X 0 NEW ALTERATION ADDITION Z b REPAIR FT. 1 DEMOLITION / r or 9 ZE .L7~® ROONO' MS (,r STORIES - EXT.WALL }'? ^ ^ ROOF ��jj,,rr COVERING he y Gs G- D' I COVERIN11014TT R-r/4 C _I USE OF STRUCTURE p v 2 e1 2n INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- s — PLICATION*AND STATE THAT THE INFORMATION GIVEN IB FRAME: FIRESTOPS, CORRECT. .BRACING, BOLTS 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, G - ! AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OF LATH, INT. PERMITTEE {/w ADDRESS LATH, EXT. / �� -✓ v PLASTER, INT. AUTHORIZED AOT. y q e,b �.P.C >a} PLASTER. EXT. REE �6 '3 S HOUSE NUMBER COR- RECT AND OR- RECTAND POSTED VALUATION �t7/8S0^ 7p "^" �Q / V FEE 3 --•— FINAL -ate 76A63EA-.D9S 3 1-52.. ' CE N803(RE V.6/78) AISPLECAS'0®ISN FOR, 'S11.E0LDIlelG PERmil1 COUNTY.OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ; BUILD oo Ess BUILDING ADDRESS LOCALITY ?C . NEAREST CITY Temple C f v ZIP' 7 8 CROSS ST. �^— NO.OF BLDGS. ASSESSOR SIZE OF LOT ut} NOW ON_LOT 'MAP BOOK - P,AGE PARCEL DISTRICT GROUP TYPE ' FIRE PRO SSED BY . TRACT 3 BLOCK LOT NO. ' CONST ZONE TEL... `j Q•� 11�7 .t 3 OWN" _ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS.9! CLASS NO.tDWELL UNITS` BKPG CITY Temple ci ty ZIP• ARCHITECT-OR TEL. VALUATION ENGINEER NO. ADDRESS BLDG.SETBACK FROM TEL, FRONT PROP.LINE OF (STREET) CONTRACTOR Randel,NO. _ TOTAL'SETBACK FROM TYPE OF EXISTING LIC. HIGHWAY, .+ .YARD = FRONT-PROP;LINE HIGHWAY WIDTH .ADDRESS. NO. LIC. + _ CITY San Gabriel CLASS CONSTRUCTION LENDER BLDG.'SETBACK FROM NAME AND BRANCH SIDE PROP.LINE OP ISTREET). TOTAL SETBACK.FROM TYPE OF EXISTING HIGHWAY +"YARD .. ADDRESS CITY SIDE PROP.LINE - HIGHWAY-WIDTH 'SO.FT. NO.OF NO.OF CHECK +. = 7 'SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK R e• NEW. ❑ P.C.-Fee,$ Permit'Fee . 6d8 ADD ❑ Issuance Fee y ALTER. ❑ Z REPAIR Total'Feel . USE OF DEMOL EXISTING BLDG. ❑ Z APPLICANT TEL IPRINTI N Q D BY(SIGNATURE) Q I HEREBY A KNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL-ORDINANCES - W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE S - WORK AUTHORIZED HEREBY I WILL-NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN VLATING.TO WORKMEN'S COM Z Q Q Q (� ' PENSATION INSURANCE. :28$•.a 0 A 6' o o .o o - SIGNATURE OF ` o. PERMITTEE • 2'0'02,500 ADDRESS Z TEL.. O 0-0 02ao03 CITY San n C d b rviPI NO. - Q P E ZONEMAP 73NO. >60 SPECIAL\ CONDITIONS.- AL // '! / �) BY [4,' dTE �" �, 1 (/ a.^"'�.J 76A638A CE 9803 3-69 APPLICATION FOR BUILDING PERMIT y COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS ti {7/.l—c=C vii 1 BUILDING AND SAFETY DIVISION LOCALITY ( I JOHN A.. LAMBIE, COUNTY ENGINEER ttl COLEMAN W. JENKINS, SUPT OF.BUILDING NEAREST / / Q CROSS ST. L� FOR APPLICANT TO FILL IN DISTRICT No GROU�P� TYPE CONST. SSED BY, T. 1- 7(PRINOR TYPE ONLY), BUILDING STATISTICAL CLA ,SIFICATION SEWER MAP ,/ ADDRESS 2 F, Hecla Te le Cit CLASS N0: OWELL.UNITS BK `P C{.' LOT N0. BLOCK F-,z,6NE, NO.PTRACTSPECIAL ` • - N0. OF BLDGS. CONDITIONS SIZE OF LOT - - ---- NOW ON LOT ' USE OF EXISTING BLDG. - BLDG. SETBACK FROM TEL. FROJNT PROP. LINE.OF - (STREET) OWNER Dale C.- Sanders NO. _ TYPE 0 (STING SETBACK HIGHWAY + YARD - TOTAL E. H®Cla HIGHWAY H FROM C.L. - ADDRESS 9233. - CITY ARCHITECT OR TEL. SIDG.SETBACK FROM IS ENGINEER N0. DE PROP. LINE OF TYPE OF EXISTING SETBACK HIGH + YARD = TOTAL- ADDRESS -' - - HIGHWAY WIDTH FROM C.L. Comaan No.' 263-5181 CONTRACTOR: Rigid Mfg 0- y pLIC. nL + ADDRESS 337 S, Woods Ave.- NO 15 496 CORNER CUTOFF YES ❑ NO ❑ C CITY Los Angeles 90022 CLASS C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS CONSTRUCTION LENDER NAME AND BRANCH LLL ADDRESS n V SQ. FT. NO. OF- _ N0. OF ❑ Z SIZE STORIES FAMILIES NEW USE OF ADD ❑ STRUCTURE Reroof ❑ ALTER REPAIR SIGNATURE OF DEMOL ❑ APPLICANT VALUATION $ ry90owM - APPROVALS- DATE iNs PECTOR'S SIGNATURE P.C. PMT. L, FOUNDATION: LOCATION FEE $ FEE $ 1 FORMS MATERIALS ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, BRACING BOLTS AND STATE THAT THE ABOVE 'IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION_OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFQQNIAj RE,1�Fj,TING T,pOmTaM�E�N'S COM- PENSATION INSURANCE. jj''(( 11QQ 11 ((jj nip ✓✓ SIGNATURE.OF ' Q�' _ PERMITTEE // HOUSE NUMBER CORRECT � AND POSTED A/ ADDRESS-337- t��S.. cods Ave, L. A,. 90022 FINAL i E JOHN F. LEWIS, PRINCIPAL STRU URAL ENGINEER PLAN CHECK VALIDATION CK. M.0. CASH _ PERMIT VALIDATION CK. M.O. CASH A ;2 '5 .0 ;9 0 NO 6 1 D 1 200�: :�, �APPLICATION FOR BUILDING HERMIT.- FOR APPLICANT'TO`FILL IN (Print of tvve onlvl euILDINc:' COUNTY OF LOS ANGELES ADt)RESs- .. .. _ - DEPARTMENT OF'COUNTY`'ENGINEER - -BUILDING AND' SAFETY DIVISION CITY, '. Z.IR N .OF BLDGS. _W : BUILDING SIZE OF LOT 1[�/ V W-ON LOT '' ADDRESS - TRA"CT LOCK; LOT.NO.11 LOCALITY slet .TEL. //,, :NEAREST- OW_NER NO:- l.1.. 'CROSS..ST. __ � . «;" , - ASSESSOR ADDRESS )�'; MAP,BOOK PAGE PARCEL. " - DISTRICT- GROUP TYPE' " ' I FIRENSSED BY /t.' CONST. '.20E 1 'CITY / - l✓f �L ZIP wJ•'� -^� ,�/ ARCH CT OR =' T$L. •ENGIN ER.: ` NO. STAT STICAL CLASSIFICATION •"' S" WEIR MAP. ADDRESS,. , CLASS NC(>,:�� LL .- .. -; DWE ,UNITS CONTRACTOR .�. NEOL b' 2A USE ZONE MAP. LIC _ NO. - •ADDRESS (p< �; - NO QPECIAL - :prYL'IC l- ' CONDITIONS " CONST UC �• LASS, ROAD DEPARTMENT"APPRO'V'AL REQU�6RED 'YES F N.O ❑ CITY £ C TIO LENDER NAME AND.BR NCH " BLDG.SETBACK.FROM" FRONT PROP:LI NE'OF-`- ''' -('STREET), . ADDRESS CITY :. - - • ...r - -" : YARD - __ TOTAL SETBACK FROM'TYP.E.OF EXIST bNG ' 'SQ. FT" NO .OF ;"NO. OF .CHECK HIGH AY ;+ FRONT PROP.."LINE: HIGHWAY .WIDTH- - SIZE ' - • STORIES FAMILIES 'ONE,' DESCRIPTIONOF�WORK, NEW .� _ .O ADD. 'BLD'G. TRACK FROM ' - ..: SIDE PR• • - .•" '- �` � %.(STREET)' � ALTER".❑ _ TOTAi SETBACK TYPE-OF EXISTING -U _ HIGHWAY, + YARD". HWAY WIDTH r ^r SIDE PROP: LINE REPA�IR�Q � m .t/7 USE OF DEMOL"O f EXISTING.,BLDG."'fJ�1�LLLC (.n.Z{.. APPLICANT. TEL ' /X+ �} 7 CORNER CUTOFF YES: ;.,NO • IP RINT) [ B Y,(SIGNATURE): IN OPEN SPA C;E YES �, .NO ,�, Q�•• - - IN COASTAL PERMIT ZONE YES.', 'NO .. POO- I.HEREBY'ACKNOWLEDGE„THA•T I HAVE READTHIS APPLICATION • •.�� ” AND'STATETHAT THE ABOVE IS CORRECT AND AGREE,TO COMPLY' - - - - . W I.TH ALL.,ORDINANCES AND LAW'S-REGULATING. B61LDING CON yL . „ST RUCTION. 'I.CERTIFY'- THAT IN DOING- THE WORK AUTHORIZED- - _ HEREBY I-WILL NOT'EMPLOY,,ANY PERSON IN VIOLATION'OF THE _ + - ' LABOR CODE OF..THE•S.T�1TE^OF,CALIFORNIA IN' .REL ING'TO - ---f� WORKMEN'S,..CO MPE S TI0NANS URAN C - - . SIGNATURE'OF - - PERM.ITT.EE �'• c. c " AODREs• t(y J` '��7�►i/✓-S•e�:I"', /St 0;fl—''�.�./3-_LI{, .. P - .FIN'AL - BkY f�r TEL 7 �J/ CITY ...v„'Gr" �NO.i � �J�_ 'DATE �..Y "- /L F EE Q b A KE 'CHEC S P t S'A(3LE TO: Al HARV Y T.:BRAN COUNTY ENGINEER ' ' PLAN'-CHECK VALIDATION CK." M.O. CASH a '. PERMIT VALIDATION CK. MC. CASH U' 2`1.7 5 A" 76A638A CE#803 5/74 696A CE#609_6_57 APPUCAT` ONTORBUILDING PERMIT" :a'� �• COUNTY OF LOS ANGELES BUILDING / ..- DEPARTMENT :OF_COUNTY ENGINEER ADDRESS 3- BUILDING .AND SAFETY DIVISION LOCALITY / C JOHN A. LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRIRT NO. GROUP TYP SEWER MAP\, FOR APPLICANT TO FILL IN d! ^�1 I I BK PG CON9 " ',BUILDING STATISTICAL CLASSIFICATION ' (ADDRESS / Ol - .LOT NO. (� BLOCK CLASS.'NO. DWELL.UNITS-- ` �/ MAP STATE YES NO TRACT / s� l3 / NUMBER © HWY.- - USE ZONE - SPECIAL NO.OF BLDGS. � '/ CONDITIONS SIZE OF LOT e� O/� G` NOW ON LOT USE OF EXISTING BLDG. a' _ BUILDINGEXIST. YARD HWY STREET NAME SETBACK � - WIDTH OWNER FRONT ' .L ✓' (1�se MAIL /a� P. ADDRESS `�, SIDE P.L. CITY f "OL" - INSPECTION RECORD ARCHITECT OFY�11 TEL. ENGINEER ADDRESS 6� ��/� �y�.s- f• e7� TEL:.. /�/.�S:I 4- ACIA / Ir�D _J CRI/f . CONTRACTOR - NO '� D IL • ADDRESS ( DESCRIPTION OF WORK NEW ADD ALTER - REPAIR - _DEMOLISH SQ.FT. / NO.OF - NO.OF - - a SIZE ��� LT STORIES FAMILIES USE OF STRUCTURE f SIGNATURE OF APPROVALS APPLICANT TE INSPE ORS SIGNATURE ADDRESS - FOUNDATION: LOCATION FORMS,MATERIALS P.C. $ FRAME: FIRE STOPS, BRACING, BOLTS .VALUATION .ago ® FEE $ U FURNACE: LOCATION, �� FEE �,.� - GAS VENT,DUCTS .-, .. . ... ,.,. ...,.:..�...... _ ..., • THEREBY ACKNOWLEDGE THAT I HAVE READ.THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH, EXT.. SIGNATURE OF J HOUSE NUMBER COR- PERM[TTE RECT AND POSTED Ls ADDRESS FINAL. ![y / JOHN A. LAMBIE. COUNTY ENGINEER. _ CLYDE N. DIRLAM, P INCIPAL STRUCTtJRA�ENQy 4EER PLAN CHECK VALIDATION K. M.O. CASH PERMIT VALIDATION CK.-. M.O. CASH - �..tP1 75 7 0 , q 12 .. 11 .00 WORKERS"COMPENSATION DECLARATION: I hereby affirm`that I' have• a 6j tificate,of consentto self //l� lJ L5 L/11 ®G3 C3 M h LI assure, or a`cectificate`of:Workecs Compehsation'Insurance, nnnn or a certified copy thereof (Sec.A800 Lab C.) COUNTY OF LOS ANGELES BUILDING-AND SAFETY.­ .''_ Policy No company Y` BUILDING ❑ •=,'Certified.,copy is Fereb .furnished. '. FOR APPLICANT TO FILL IN Y ADDRESS , PY. BUILDING ❑ Certified co is filed the co nty,building•inspec- ADDRESS ��mQ Tion department. Date/ /� �' APPlicant CITY! ZIP �Tv LOCALITYNO. -. OF ARE NE 'CERTIFICATE OF EXEMPTION FROM WORK S' SIZE OF LOT NOW ON LOT' ;'COMPENSATION INSURANCE CROSS .(This'section.need not`be completed`if the permit is for"one TRACT "" BLOCK LOT NO. K -'� ASS hundred dollars ($100)'or less.).. TEL. .:' MAP BOO SSOR OWNER USEEZONE MAP. PAGE PARCEL SIiO (�. h4 NO. I certify,that in the,performance of the work for which'this permit is Issued; I shall not empI y'any person in any mgnner ADDRESSZ3 of so'as to become sublect:,to the Workers_'.Corn pensation�Laws'. CITY ZIP U , t SPECIAL CONDITIONS ,: =� Date Applicant ARCHITECT OR TEL. ENGINEER NO, DISTRICT GROUP'TYPE ' . FIRE P 0CESSED BY O NOTICE JO APPLICANTc>If,, after,making;This<Certificate .of CONST..,- i ZO E �.• Exemption you should become subject to', the Workers 2 _ V U5 Comi"p'ensation provisions of the Labor'Code, you,must forth ADDRESS: /� J ✓ a %�f. with comply-viith such provisions or,this permit shall be TEL - STATISTICAL CLASSIFICATION APT. CONDO deemed revoked CONTRACTOR / f NO. J. 7/OJ !Kr / ; LICENSED CONTRACTORS DECLARATION �d � ��� LIC. CLASS NO.,=.)--- Z ' l hefeby affirm that I atn'licensed under provisions;of,Chapter9 ADDRESS �T�. NO � .,.(corrimencing with Section 700.0)of Division 3 of the.Busineas CL j LIC. U SEWER MAP and Professions Code;on'd my license isin.fulrforc nd effect.. gK PG: VALIDATION CIT ASS1� SQ.'T. NO. O NO. OF :. CHECK License Number J/7 Lic:.Class - SIZE STORIES FzA�MILIES ONE- h Contractor DESCRIPTION OF WORK ;.4 dQL NEWEl ❑, T �Y��� Date VALUA ION' - •ADD - EJ I am exempt under Sec, L B.&P.C. for This.reason A TER ❑� � cc .USE:OF REPAIR ❑. • , Dater J� EXISTING BLDG.�.CJ d-t' DEMO[ Signature /� ,!� APPLICANT') ✓f✓i�' TEL. FINAL. OWNER-BUILDER D LARATION (pRINTj - NO., —Df DJ4TE0�2 X71 I hereby affirm that l am exempt om the Contractors License 7 ADDRESS/©�GGr� t� (� � - � Law for the following.reason (Section 7031,5; Business and • FINAL Professions Code). ..`, PRESENT. _ By " BUILDING cs•owner of the,property,, or my employees with ADDRESS _' _ _ J wages'as fheir sole-compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044; Business and-Professions`Code.) MOVING TEL. D CONTRACTOR NO. I, as owner of the property;am exclusively contracting' ;n3.t -with licensed contractors to;construct the,prolect (Sec' ' ADDRESS a Y tion 7044, "Business and Professions.Code.) REQUIRED-* TOTAL SETBACK FROM EXIST. ' s ,. CONSTRUCTION LENDING AGENCY SET BACK- YARD HWY PROP. LINE WIDTH s I hereby affiem-thcit there isa construction-lending agency for FRONT: the performance,of'the work:for which this permit is'issued P'L:'` ' .' € r (Sec. 3097, Civ. C) SIDE' 'y Lender's Name," LDMA Ref. # 1IF t3" Gender's Address P C. Fee$ Permit Fee , 0 I certify thoT I have•readythis application and state That the ?' Issuance Fee / LDMA P/-C# t x i , above information is;correct. I agree to,comply with all-County Investigation Fee_ 8 " ordinances and State laws.relating to building'consfruction, Totol Fee / D ✓ LDMA Perm. # e ,and hereby authorize representatives of this County to enter upon t e ab o4 One 'oned',property for inspection purposes. SEE REVERSE FOR EXPLANATORY,LANGUAGE Signature of Applic/ant`or'Agent Date , WORARS' COMPENSATION DECLARATION nn. insure,bor a certifi�Atte of WorkersrtComtpensahon Insuran eof.c6nseni to lf A P IPU CAU P0 LI M V F OR-. or o'ce'rtified coy thereof (Sec: 3800;Lab t) •'� COUNTY OF LOSANGELES 7 BUILDING AND'SAFETY Policy No. J"gOCompan � TCP?•%675(CNhGr '?i + a - FOR APPLICANT TO FILL IN BuiLpIN Cy /� ❑ Certified"copy is hereby furnished. ADDRESS /a3 Certified copy is°filed.with the county.bujlding inspec- Ii�J �L�. BUILD7717 ING ADDRESS• ST ' • tion department. ' -. a- may/ � f �I/, II DGN L:UA1S�:,. CITY �u!L'.LPI L ',CL ZIP �.L1.OV LOCALITY.NO. OF BLDGS. ' Date Applicant CERTIFICATE,'OF EXEMPTION FROM WORKERS'_c': SIZE.OF LOT NOW ON LOT COMPENSATION INSURANCE- _. CROSS ST. �. .. � ��j`. __ _ ASSESSOR' n �•,� � . (This secTion need`noi'be completed°if the permiYis for,one TRACT BLOCK LOT NO. r MAP BOOK �,�5 PAGE PARCEL (� ) I.certify That m The performance of,the work for ~ OWNER hundred dollars 100.o Pak G o..28'I=40 7,. USE ZONE. MAP which this } /� NO. �7 - permit is issued, I shall not employ onyperson'in,any manner ADDRESS =gZ33 LA - ' CL so as.tobecome.sublect.to-the War kers.,'Compensat ion Laws. A `» 0 I CITY:�a�P C� ZIP �'D® PE AL CONDITIONS Date Applicant- ARCHITECT OR, TEL NOTICE TO APPLICANT: 1f, after makin -'this Certificate of ENGINEER NO DISTRICT`. GROUP- TYPE FIRE PROCESSED BY g CONST. ZONE 0 . Exemption,,you should -.become subject to',the 'Workers'. �/ ' Compensation provisions of the-Labor Code, you must.forth- e.ADDRESS :�0 3 Y' 3. �G CL with comply with,such,provisions or,This.permiT:-shall be TEL STATISTICAL CLASSIFICATION AP.T. CONDO J- N deemed revoked r _ CONTRACTOR ]c" (-Q61?,t •. NO. /�' Z LICENSED CONTRACTORS,DECLARATION /n1 LIC. //�� CLASS NO DWELL. UNITS " I hereby affirm that I am'licensed under provisions of Chapter 9- ADDRESS • C� NO. LIC. SEWER MAP ' (commencing:with Section'7000)'of Division 3 of the Business M : Cl CLASSF CITY and Professions Code,and my license is in full force and effect. _ BK. PG. VALIDATION ' ll 7- 40 j� SO. FT. NO. OF l NO. OF CHECK i `V r�1 SIZE. J STORIES I FAMILIES 1 ONE License Number Lic. Class 9. c VALUATION Contractor 11 W/ut' Rafe :� DESCRIPTION OF WORK •RGPR''00k- NEW 0 .- �Ov . . ADD' ❑I am exempt,under-Sec.' r, D �lN DiiIOAJ ALTER .0 B.&P.C: for this reason Dat ,. USE OF r �:. RE I R El EXISTING BLDG. DEMOL Signature TEL..✓//'�5.. APPLICANT - OWNER-BUILDER.DECLARA N- (PRINT).' S�J NO_' ..�L I he the that I am exempt from The, ontractor s License ', FINAL . . • DATE :. • Law for the following,,reason (Section 7031 5, Business and :' ADDRESS FINAL Professions.Code) > PRESENT .•� By I ' T'. EPLE ' ❑ I, as owner of th"e ro ert or m em to ees`wiTh" BUILDING S p p. Y y P y ADDRESS' wages as their sole compensation,will do.the work and the structure i's-not intended or.offered for.sol'e.(Section LOCALITY 7044,•Bbsin'ess and Professions'Code.) n MOVING �. : . CONTRACTOR NO. ❑ I, as,owner of The property, am:exclusively contracting r with licensed contractors to constructthe'project:(Sec- FADt^`- tion 7044; Busi'n'ess and Professions.Code.) DRESS AD S . ' CONSTRUCTION LENDING-AGENCY SET BACK TAPREOTPAINEFRO EXIST., IDTH -- - F' YARD. HWY TO M' 1 hereby affirm that there is'a construction lending agency for FRONT r_ s the'performance.of the work for-which this'permit.is issued P.L'. M (Sec. 3097,.Civ:,C:,), SIDE.,. _ : sL s' --Y3°i P:L:` - Lender's Name ' 4 J. m LDMA-Ref #' a P.C:_Fee$ Q " Permit Fee O!' O1-/ _ S" :} • ' J t Lender's Address ' a,Lt,'. o I certify`that I have read this application and state that the Issuance Fee 0�7- ' %� LDMA P/C# � - above information is correct. I agree to complywith all County Investigation.Fee 8 ordinances and'State laws relating'to building,co'nstruction, Total-Fee ' r (f LDMA Perm. # "`"I '}}�; and hereby authorize representatives of.this.County to-enter � t-r4 { - �' upon the above-mentioned property for inspection'purposes. SEE-REVEIISE-FOR-EXPLANATORY LANGUAGE Signature of Appiicant or.Agent Date