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Home My Public Portal About8723 HERMOSA DR_Building__ IB'+ 76A638A .. CIF60-3(REV.,11/78)«.- APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ADDRESS ;) �•7. 3 %`/�/� ti.r' �z.. ADDRESS -7,2 3 4E 6 LOCALITY ' ,�v �•,/L.�.�_� CITY G, T 2L. ZIP I7/� NEAREST CROSS ST. NO.OF BLOCS. ASSESSOR ' SIZE OF LOT S NOW ON LOT MAP BOOK PAGE PARCEL p p DISTRICT GROUP TYPE FIRE �RQCESSED BY TRACT S f�J BLOCK IL CON OO H !� CONST. ZONE OWNER / / +� NO. q. CD_ /Z ,/ STATISTICAL CLASSIFICATION SEW ER MAP ADDRESS +' .3 E. �HP CLASS NO. .71 DWELL UNITS BKPG CITY Jail G� ZIP i77T ARCHI7ECi0 •` TEL.2.09 VALUATION ENGINEER !< PS$Q- NO. `p,33'iGD. p (J ADDRESS //,p.T -F-� BLDG.SETBACK FROM —STREET) TEL FRONT PROP.LINE OF A /F'E/'�-�-� CONTRACTOR 4I Lf.0 NO. HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING . LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. / r� LIC. + - Y/ CITY CLA55 CONSTRUCTION LENDER - BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP.LINE OF ISTREETI HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF 1EXISTING y ADDRESS CITY SIDE PROP.LINE HIGHWAY1 WIDTH V 50.FT. NO.OF NO.OF CHECK + _ w SIZE 0 STORIES FAMILIES ONE ❑ USEZ NE NOP i / 0 DESCRIPTION OF WORK •C.e /' A NEW ( A ADD W K Y SPEC AL S g D� CONDITIONS N ALTER ❑ FINAL BY Z REPAIR ❑ DATE USEOF DEMLJEXISTING BLDG. /OL %J z O APPLICANT TEL FO PRINT( No SSG-172 023 c BY(SIGNATURE) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE i0 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 ;19 0- A 8.4 THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'5 COM- fV. PENSATION INSURANCE.' o o e SIGNATURE OF: / �� u �I e2'S'.00 PERMITTEE ADDRESS 3 4 ' ^"oJt � � � = ee = 5300v TEL.2Y6.-y 2S /�� ,rf o5104T—$0 CITY -b NO.�g�-.SY/9 P.C. Fee$ Permit Fee 0 !v C \ j Issuance Fee W Total Fe 'Es ] A o C3(REV.11/]8) - APPLICATION FO.R BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY .. FOR APPLICANT TO.EILL.IN7?x PADDRESS �3 BUILDING9-7ADDRESS Q/ � I (? ^_CITY C' J/ GR.6('i.L ZIP 3 I NO.OF BLDGSIZE OF LOT •� V A 'Y'J NOW ON LOTPAGE PARCEL j GROUP TYPE FIRE PROC SSED BY TRACT L 0, BLOCK LOCONST ZONE TE3LJ OWNER J in.. O/.a? N . [ 7� STATISTICAL CLASSIFICATION SEWER MAP ADDRESS : 7-2,? /- 2 :m0.T4 D CLASS NO. Ok3 DWELLUNITS BKi PG CITY S[• 64- 6 i, ( .ZIP [%/;7;2 S ARCHITECT OR TEL VALUATION $ ENGINEER ' ADDRESS J cal / __ BLDG.SETBACK FROM TEL FRONT PROP.LINE OF (STREET) CONTRACTOR NO. .HIGHWAY + YARD = TOTAL SETBACK FROM TVPEOF EXISTING . LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. LIC. + CITY CLASS BLDG SETBACK FROM CONSTRUCTION LENDER -' - SIDE PROP,LINE OF ISTRFETI NAME AND BRANCH HIGHWAY + YARD = TOTAL SETBACK FROM T TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE IHIGHWAY WIDTH_ Q SO.FT. NO.OF NO.OF CHECK + V K SIZE STORIES - FAMILIES' ONE C �J L MAP /1 � / ` DESCRIPTION OF WORK l[2 ['f' !J NEW- ❑ (/ X� 1iL> CONDIT SPECIAL ADD ❑ - NDIT ONSFINAS " L_4/O• LL/ /�tl R PARR O /(} 8V / _ USEOF DEMOL ly EXISTING BLDG. ZO APPLICANT TEL IPRINT) NO. Q BY(SIGNATURE) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y 1HAi THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES _ _ _ Yi AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAI IN DOING THE _ ^895.31', WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF U THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COW Z _ PENSATION INSURANCE. e e ... 0 SIGNATURE OF PERMITTEE ADDRESS ' �. -a"• _ 0 0 0 3 � Q . / TEL. L. �,7 O CITY �,4 e,4�i.Q.�� NO. �J 6' /�-2� a U 2 I C. _ C _ Tom[ P.C. Fee$ Perm >i) Fee vt / > Issuance Fee n ' W Tolol Fee _ APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES BUILDINGWM. J. FOX. CHIEF ENGINEER NO. OF BLDG. ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO. PLANS SETBACK LINE Jr a �� FIRE APPROVED ZONE BY DATE RECEIVED BY DATE OF APPL. DATE ISSUED USE APPROVED � n /[/_ yr //-/Y-gs` ZONE BY DATE APPLICANT FILL IN,HEAVILY OUTLINED/ 10PORTI(OWN ONLY K BUILDING % !S / 7 /"� O E NAME ADDRESS //7V WZ ADDRESS LOCALITY ZU NEAREST UN CITY CROSS ST. R Q STATE TEL. LICENSE NO. NO. E NAME W E MAIL '/ u ONAME ; ADDRESS U n/ D TEL. 6 ADDRESS CITY / NO. It Z CITY - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS ❑ APPLICATION AND STATE THAT THE ABOVE IS CORRECT U STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NOe NO. ./ AND STATE LAWS REGULATING BUILDING CONSTRUCTION. O LOT NO.�FQ�1(.�Iy�/(I V,( 1o SIZE F LOT/ SIGNATURE OF NO. OF SLOGS. I�/W�+% f ICCCi `NV Q - BLOCK �� NOW ON LOT AUTHORIZED AGT:_ w J U ✓!�� 0 3 CORRECTIONS W TRACT ❑ USE OF SLUGS. ��iP7l A ✓ � F2, �/ NOW ON LOT L (/�^cL Z* P • DESCRIPTION OF WORK USE0BUILDING Gi .I - . P1.� :.,=-, _ Lrr ,t.�.0 ' v• v- r /lw,..,_ v U dr' oo f7-7 O A O Z s NEW TYPE GROUP NO. OF NO. CF ALTERATION ROOMS [( FAMILIES ADDITION lt�— SIZE / ] f I- a , REPAIR _ STORIES MOVING WALL COVERING DEMOLISH ROOF COVERING -4 ABY !c 5a S / 0-0P.EE C.s d FINAL APPROVAL F V �- S � INSPECTOR'S VALUATION TFEE DATE NAME DEPARTMENT OF BUILDING AND SAFETY - APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING- FOR t ® � Q� WIA. J. FOX. CHIEF ENGINEER U `�i1 FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING / / C� O OO ADDRESS L (l n LOCALITY !-� //'l- RECEIVED BY DATE OF A(P�P�I,./� IDATE ISSUED NEAR EBT i/ L�� /V VU V —/�—V 0 C ROBE T✓./L.� V/IP OWNER /1%)l /f y,Q.h(� BADORE UILDI88 NG ADDREBB�J j"/MAILLOCALITY 4 �F t/ 4 CITY NO. �.// / 769 CROWNEAREST. /�//J ( q T TEL. / D i CRO666T / �� _ FIRE NO.OF TYP� GROUP ARCHITECT OR /NO / ZONE PLANS ENGINEER ADDRESS ` / SETBACK LINE 20 F7"I'J/A/"P L APPROVED CONTRACTOR TEL. BY DATE NO. USE APPROVED ADDRESS ZONE BY. DATE LEGAL Jr0 FTOF OT Ar-2- 200 CORRECTIONS DESCRIPTION LOT NO. BLOCK r TRACT 0 (�^[/ NO.OF BLDGS. r SIZE OF LOT ( X Z NOW ON LOT jr- USE OF ES GAR (f/75FAApNO.OF HO.OF r EXISTING BLDG. FAMILIE. /1/I ROOM6 1 DESCRIPTION OF WORK _ NEW ALTERATION ADDITION A_ _ REPAIR MOVING I DEMOLISH /� O SQ.FT. COV2 r NO.OIF Z SIZE ROOMS STORIES � D WALL ROOFCF ER .VERING USE OF NEW GUILDING AA �FnPAAM T//n . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AMC) STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS. MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS. IvBRACING. BOLTS PERMITTEE LATH, INT. SIGNATURE OF NAV' AUTHORIZED AOT LATH, EXT. 964639A-S -asP.C.$ $ PLASTER. INT. `EE PLASTER,EXT.V $ VALUATION l FEE � FINALMAXIMUM ACCOMPLISHED 8-15-51 DIVISION OF BUILDING AND SAFETY BUILDING® � Department of County Engineer U G County of Loss Angeles ® ' �i WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DIBTRI Of N0. PL�� [ /bT /B BUILDING � � S ADDRESS R EIVED BY DATE OF ADPL. .PATE ISSUED NVARLOCAY /— c/ EAR[HT Q d a ROBB ST. BUILDING Y 7 2 ADDREBI �/ � V OWNER MAIL LOCALITY ADDRESS NEARESTTCL- CROSS ST. CIT NO. FIRE I NDF ENT1WG�- D PO Ll ZONE PLAN9 APO DR TEL ENGINEERR N0. / BLDB. ADDRESS 4 SETBACK LINE USAPPROVED CONT D (S� ZONEE //BY DATE J 'r HOUSE NUMBERING ADO gE9S MAP NUMBER /Y NO. ASSIGNED BY-6 .S/ DEBeRIP`ION LOT H O y BLOOK CORRECTIONS TRACT S% 3 SIZE OF O I NOW ON LOTS USE OF N0. OF EXISTI FAwlLI6B DE CRIPTION OF WORK A 0 NEW ALTERATION ADDITION Z r REPAIR DEMOLITION SIZE ROOMS BTORIEa /„// /,y/L/ 6/f T{l/�/Jl✓.IAF/T EXT.WALLROOF COVERING I COVERING OF BZRU RE N S i Ee, k a OI J:-3a- r-j/ INSPECTION FOR APPROVALS OCCUPANCYAB INSPECTOR'S SIGNATURE DATE FDU INS, MA LOCATION I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FONDA NTLOC T c KE J_ IV PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS, CORRECT. BRACING, BOLTS I AGREE LL UMT� AND STATE LA RE ULAT H ABU ILDINO CONOSTR NCTIO® FURNACE: LOCATION, OAS VENT, DUCTS SIGNATURE F LATH, INT. PERMITTE ADDRE TH. EXT. AUTHORIZED ADT PLASTER. INT. PLASTER. EXT. S P.C.0 FEE G .l HOUSE NUMBER COR- VALUATION RECT AND POSTED 'J � FEE 76A639A OBS 3 1-52 7e5eaeA oee.s 11.55 APPLICATION FOR BUILDING PERMIT DIVISION OF BUILDING AND SAFETY BUILDING H G p q pe Meal h Depaxtment of County Engineer ADDRESS O County of Los Angeles LOCALITY 41L JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRICT-VO. GROUP I TYP sew MAP B G BUILDING 87 SS CO S ADDRESS "f 2� •✓tie rmY`Sa MAP ��tt STATE YES �O NUMBER 0 HWY LOT NO. AO•. SD 00-2– BLOCK UI SPECTA I CO NOIT IT TRACT S�Q03 Q - ./ NO. OF BLDGS. SIZE OF LOT �0 /� 2.OQ� NOW ON LOT BUILDING EXIST. USE OF - � SETBACYARD HWY STREET NAME Dwillin } K WIDTH EXISTING BLDG. Q FRONT Bert EL+ V �{ P.L. B OWNER ert *Young SIDE MAIL 7 .3. Hermosa P. L. ADDRESS O TRACT DWELL. 1 UNIT TEL 1 / 5 INDUSTRIAL CITY San Gabriel NO.AT 6 176 1 DWELL. IUNIT 6 PUBLIC BLDG. ARCHITECT OR TEL. Z DUPLEX 2 UNITS 7 p,DDN..ALT., ETC. ENGINEER NO. 3 APT. SIV//—UNITS $ MISCEL. ADDRESSL� 4 COMMERCIAL CONTRACTORHoDurham & Senrlo FO 8 393 INSPECTION RECORD 2 0MKAve OAte ADDRES DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SO. FT, NO. OF - NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE kiereer @emp0 dwelling, SIGNATURE"OF APP LICA a� APPROVALS ADDRESS � GebLema Ave DATE INSPECTOR'S SIGNATURE $225-00 FOUNDATION: LOCATION P. C. S FORMS. MATERIALS FEE FRAME: FIRE STOPS, VALUATION S "1 BRACING. BOLTS FEE oL• FURNACE: LOCATION, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION, _ LATH. EXT. SIGNATURE OF HOUSE NU IBER COR- PERMITTEE RECT AND POSTED 2226 Lema Ave ADDRESS FINAL ;5 .JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR CK MO GASH i.ACOO 6 2 8 SEP 2 5 1 2.0 0 n WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Compony �p r El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BU DINS p Y uQ !'P�d,$c Certified copy is filed with the county building inspec- BUILDING /� tion department. ADDRESSF723 1" ,Sf r Date Applicant CITY lk ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' � (( ` NO. OF BlDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT T S� NOW ON LOT p� CROSS ST. (This section need not be completed if the permit is for one TRACT O BLOCK LOT NO. O 2 ASSESSOR hundred dollars (§100)or less.) MAPBOOK / �"P,,A/GE /- PARCEL TEL. aV C USE NEI NO. Gd Ti (//(/ D C I certify that-in the performance of the work for which this OWNER 1 1�10.�+- N 'rI NO. 7 / (t i permit is issued,'I shall not employ any person in any manner ADDRESS F, i' e(i rc+Q� SPECIALCjWrJ so as to become subject to the Workers'Compensation /Laws. S=i CON T17Lam//�/O CO 2 S/ y Date icant CITY � V ZIP ..T ARCHITECT OR TEL. 0 NOTICE TO APPLICANT: If, after making this Certificate of — DISTRICT ROUP TYPE FIRE PROCESSED BY O ENGINEER NO. A ' CONST, 1 ZOJyE U Exemption, you should become subject to the Workers' VRY''h V 3 Compensation provisions of the Labor Code, you must forth- ADDRESS L' GtX Com'` 6 W with comply with such provisions or this permit shall be NO. STATISTICAL CLASSIFI TION APT. CONDO. Ln deemed revoked. CONTRACTOR L,() NO. Z LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. Z DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION SO. FTNO.OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATIOJi ` Contractor Date DESCRIPTION OF WORK_ 1 ddQ_ ge NEW ❑ $ LQ ADD 13 , I am exempt under Sec. J/� S-GC/K Oh LJB.BP.C. for this reason ALTER r REPAIR ❑ $ 0 8 8 3 A Date: USE OF DE # a eye_e s MOL EXISTING BLDG. C] Signature APPLICANT ) p TEL. �0��' ` FINAL 'I • • 6 8,6 3 OWNER-BUILDER DECLARATION PRINT 11�1Q`` �O/ NO. e'x0 2Q DATE a eye I hereby affirm that 1 am exempt from the Contractor's License 613635 Low for the following reason (Section 7031.5, Business and ADDRESS FINAL ( 0.1 0-88 Professions Code): PRESENT By Kf BUILDING �I\ I, as owner of the property, or my employees with ADDRESS wages as their sola compensation,will o the work and the structure is not intended or offered for sole(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 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SET BA K YARD HWY TOTAL PROSETP L INE WIDTH •�s I hereby affirm that there is a construction is ing agency for FRONT ^�^ theperformance097, Civ. of the work for which This permit is issued P.L. 0 (Sec. 3097, Civ. C.). SIDE r P.L. Lender's Name LDMA Ref. N m Lender's Address P.C. Fee$ Permit Fee I certify that 1 have read this application and state that the Issuance Fee Gt/ � LDMA P/C M above information is correct. I agree to comply with all County Investigation Fee $ ordinances and State laws relating to building construction, Total Fee LDMA Perm. M £ and hereby authorize representatives of this County to enter upon,the /above-mentioned pppJJJ��pert for inspection purposes. 0 Q SEE REVERSE FOR EXPLANATORY LANGUAGE Signoture of Applicant or Ag.V1 Date I WORKERS'COMPENSATION DECLARATION "ire y affirm that I havecertificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensationion Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF l05 ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING F-1 �J SS - (/•J Certified ropy is filed with the county building inspe<- BUILDING 72 ADDRE F-1tiondepartment. ADDRESS 3 2 Dale Applicant CITY U e ZIP /I 2 -� LOCALITY NO.OF CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 127 YSV NOW ONLOTC OSSSST. COMPENSATION INSURANCE _ (This section need not be completed if the permit Is for one TRACTS8'03 ASSESSOR hundred dollars ($100)or less.) BLOCK LOT NO. L MAP BOOK PAGE ia PARCEL TEL. �7 USE ZONE MAP OWNER tr` NO. 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 SPECIAL so as to become subject to the Workers'Compensation /Laws. ADDRESS 3 E =6/�^'�O.,f K. •'` C/O�jNDITIONS ) ,s,� O `j0'- Ua .cam SL CITY ,/'- ZIP ��N 4/F ,T G Yr• /�0 Data��•� pplicartt Ulf �/[!1 �1 '°�' ARCHITECT OR TEL. . NOTICE APPLICANT: If, after making-this Certificate � Z. DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption,n, you should become subject to the Workers' ARCi ENGINEER �s CONST. ZONE pU Com ensation provisions of the.Labor Code, you must forth- .8 9 with comply ith such provisions or this permit shall be ADDRESS kJ� deemed revoked. TEL STATISTICAL CLASSIFICATION APT. CONDO. to CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS_ I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION SO. FT. NO.OF �T NO. OF CHECK License Number Lic.Class SIZE «o STORIES /l FAMILIES ONE ❑ VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ s 2 _ 2 0 0 4,9 A ADD Fit am exempt under Sec. CO] .J ALTER B.BP.C. for this reason REPAIR ❑ t C- * 59.25 °""F Mot ❑ e`• i 5 9, 2 5 Date: p ( ,�.�f�S' r.,� 0 6 3,0;-8 8 Signature APPLICANT TEL. L FINAL _ OWNER-BUILDER DECLARATION PRINT %4-�...-- O. O DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Prafessions Code): FRtbtN1B I, as owner of the property, or my employees with BUILDINGADDRESS 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). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). - CONSTRUCTION LENDING AGENCY SETREQUIRED BACK YARD HWV TOTA 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.I. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Nome $ - LDMA Ref.♦# - Lender's Address P.C. fee$ Permit Fee i I certify that 1 have read this application and state that the Issuance Fee Q LDMA P/C It above information is correct. I agree to comply with all County Investigation Fee ordinances and State lows relating to building construction, Tocol Fee �� and hereby authorize representatives of this County to enter LDMA Perm. # upon the above-mentioned p operty for inspection purposes, 7 SEF REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS f/ BU IN A7nSS 822-3 I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified ' Copy thereof(Sec.3800,Lab.C.) UITY Policy No. Company =2''t�jl LOCAUTv /�+ SIZE OF LOT NO.OF BLDGS.NOW ON LOT C` 11 Certified copy is hereby furnished. ) V NEAREST CROSS TSyT.� 1 INA, BLOCK LOT NO. 7 rL'USEZONE MAP NO.ILs ChiI`e- ❑ Certified copy is filed with the county building inspection � department. :5 03 1 G� ASSESSOR MAP BO PAGE PARCEL RC PARCEL Date Applicant 13 SPECIAk CONDITIONS T CERTIFICATE OF EXEMPTION FROM WORKERS' OWN /��] F T�� TEL.NO. COMPENSATION INSURANCE `�, R. `� - WITHIN 1000 FT.OF SCHOOL? vas No ADDRESS p (This Section need not be completed if the permit is for one hundred r--. (P+O � 6 r.! DISTRICT ' GROUP TYPE CONST.' FIRE ZONE ROCESSED dollars(Shat)i Hess.) �Tv /� ZIP ' I certify that in the performance of the work for which this permit ern C�-� C L is issued, I Shall not employ any person in any manner s0 as t0 ARCHIT CT DIP ENGINEER TE NO. beco!mJe—sub.ec-t the Nbrkers'C�Dr/(leen/�.ation Laws. /J � {. �.5 $ /gyp fs' 07.._"fu-f 3yk STATISTICAL CLASSIFICATION APT CONDO Date/Applicant ls/-L�rr/1-+� IV�'�'• ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of ynel�ee�( I C-._. gspWBED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL.NO. SETBACK YARD HWY PROBLINEACK WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT Comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO, FR LICENSED CONTRACTORS DECLARATION clTv LIC.CLASS 010E 0 I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP U (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.01 TORIES 0.OF FAMILIES C Professions Code,and my license is in full force and effect. 60 1 NEW ❑ BK PG DESCRIPTION OF,�RK �( � ADD ❑ VALUATION O� License Number Lic.Class Contractor Date _ Y y� ALTER ❑ $ z ❑ ❑ I am exempt under Sec. REPAIR $ B.SP.C.for this reason DEMOL ❑ LDMA P/C V Date: USE OF EXISTING BLDG. 'URM ❑ Signature fARR/LICA T(PRINT) JJ TEL.NO. LDMA Perm# L as owner of the property, or my employees With wages as w ) ��f 0.'" �T 7 Z A�- ,- I their sole compensation, will do the work and the structure is ADDRESS F M."� I •T not intended or offered for sale (Section 7044, Business and Q'�� fl/UL DATE G Professions Code.) 330.7 2214. ,; WILL THE APPLICANT OR FUTURE BUILD INO OCCUPANT HANDLE A HAZARDOUS MATERIAL fi{ ❑ I, as owner of theproperty, am exclusive) contractin with OR A MIXTURE CONTAINING A HAZARZUS MATERIAL EOUAL TO OR GREATER THAN a ITE+ICS y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FI licensed contractorS to construct the PTDjBct.(Sec1ion 7044, Business and Professions Code.) YES El NO ElT13 T fyL s .5.3 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDINGMn, �J2224. /� OCCUPANT REOUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH //� CHECK 14.57' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. _ fH��4 I hereby affirm that there is a construction lending agency for YES EJ NO C1 _ themanCO Of the Work for which this permit IS ISS08d(SBC. 3Og7, I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD �{�y.✓/ � i� 1 7,Civ.CIV.C.). PERMITTING CHECK MT.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES P' COUNTY CODE,TITLEZ CHAPTER 2al SECTIONS22D1WTHROUGH2W.11000NCERNIN6 QQITI?-�.)(.iil�yi /tf'��j'(�1_I 3 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SOAOMD." 13 .15., 1 LentleYS Adtlress0-CJ 1 AN10.05, 0 �`I I certify that I have read this application and state that the above g information IS Correct. I agnse t0 comply With all county PQ FEE PERMIT FEE �� Q ordinances and State laws relating to building construction,and hereby /(\t- authorize representatives of this County to enter upon ISSUANCE FEE I bov owned p o e f tion purposes. n 5, qq v /��W � V INVESTIGATION FEE TOTAL FE SEE REVERSE FOR EXPLANATORY LANGUAGE. WORKERS' COMPENSATION DECLARATION - - - liaereb'y aiirm,;ha'J.haWor certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, 'ira•Cerrifimte of Workers' Compensation Insurance, of o ce+tified copy thereof (Sec- 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished, FOR APPLICANT TO FITIOIGBULLowG &j )13 ��ADDRESS❑ Certified copy is filed with the county building inspec- BUILDING -� �jtion deportment. ADDRESS2, �r . p ) ��/,iDale Applicant Crtv/-e. ` + ZIP / �J LOCALITY 1..._!CERTIFICATE OF E%EMPTION FROM WORKERS' NO.OF BNEAREST _COMPENSATION INSURANCE SIZE OF LOT X NOW ONCROSS SL zL._ '((This section need not be completed if the permit is for one C �-z ASSESSORhundred dollars ($100)or less.) TRACT ,SBLOCK . ` MAP BOOK PAGE PARCEL ' 'T r, p USF 'YN� MAP I certify that in the performance of the work for which this OWNER +} t v-� C - t��77 YnJ/T NO.permit is issued, I shall not employ any person in any manner /' / SPECIAL /so as to become subjjecc/t to the Worrkers'CoompensationLaws.. ADDRESS /� 1— �l`��. �Jy(�1� LCONDITIONSDate"AaPli ca nt(' / [/ � // ICJ �s CITY Q.✓ VC.W./' ZIPc/� � K''" DI 3 S�f!5 rn A 'T7NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT O - / DISTRICT GROUPTYPE FIRE PROCESSED BV Jf ZOISIE Exemption, you should become subject to the Workers' ENGINEER /� — 3 �+ `�, / CONCompensation provisions of the Labor Code, you must forth- ADDRESS C-42— CCS_ Oy JVI�// with comply with such provisions or this permit shall be ��ll TEL STATISTICAL CLASSIFICAT ON APT. CO deemed revoked. CONTRACTOR [/0 NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. 2 DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NC SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION } SIZ FT{9 NO. OF NO. OF CHECK License Number Lic.Class SIZE /alO STORIES FAMILIES ONE Q cl VALUATION�� t.9 Contractor Date DESCRIPTION OF WORK QQ�M}�cfr�f��La��/eyy Y A D 0 f (-- O 1 am exempt under Sec 12� HJ ti.+L gr ✓I d 0. a, V , . y _ ALTER ❑ 1 3 61 A LLI- IT&P.C. for this reason REPAIR ❑ $ e a a 1. L3.' N Date: USE OF DEMOL EXISTING BLDG. Z Signature APPLICANT TEL FINAL ( e - 6 8.63 OWNER-BUILDER DECLARATION PPINTI Gum /' No.2.be "9f 1—�� DATE z 1 hereby affirm that I am exempt from the Contractor's License ° • • 68.6 3 cT Low for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): ADDRESS ByJyr ( 2 1 9 88 BUILDING 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 (' (Y 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 , /IJµ1 `S IMM �r 1 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK H (^ )vl Q r3D��-0'(')SET BACK YARD HWY PROP. LINE WIDTH C 1t. G 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, Ci, C.). SIDE -P.I, Lender's Name C-CC LOMA Ref. X m Lender's Address P.C. Fea E Piano,Fee o I certify that'I have read this application and stole that the Issuance Fee �Q+ J LDMA P/C X above information is correct. I agree to comply with all County Invevigdtion fee ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this County to enter �+ IDMA Perm. X upon thea ve-mento pCro� qty for inspection purposes. l✓ 'I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or A§&fiI Date WORKERS' COMPENSATION DECLARATION ^ 'J c I�nsuret r a certificate of Workers Compensation Insurance,hereby affirm that I have a certificate of consent to self _ APPLICATION FOR BUILDING PERMIT (e a certified copy thereat (Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING �•�y Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS . ! r Certified copy is filed with the county building inipec- BUILDING ;2 -p tion deportment. ADDRESS �4J Date Applicant CITY Lt-^! CAS/' ZIP �7� LOCALITY - r CERTIFICATE OF EXEMPTION FROM WORKERS' ��(� - NO.OF BLDGS. NEAREST 'COMPENSATION INSURANCE SIZE OF LOT ��7 xNOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ` 2 - p ASSESSOR D . hundred dollars($100)or less.) TRACTS `-' BLOCK LOT NO. O � MAP BOOK PAGE: PARCEL TEL. SE ZONE MAP OWNER ♦ / (,certify that,in the performance of the work for which this / "" � NO, I ,^I 1 NO. permit is issued, I shall not employ any person in any manner ?? �C.�-o ca /T- pt. SPECIAL - IL so as to become subject to the Workers'Compensation Laws. ADDRESS' 7.�_J L' - J /�1 /` CONDITIONS V rr C 6�: �P ZIP Dates ' '1S APPlicant /l ;/I�-4.�•�/ '•C71.17�- cITY. �C+y_ O NOTICE TO APPLICANT: If, after making-this Certificate of ARCHITECT OR TELCO DISTRICT GROUP TYPE _ t FIRE _ PROCES D BY F Exemption, Y r\ you should become subject -to the Workers' ENGINEER Lt.- ? NO. - 3` / CONST. ZONE V W Compensation provisions of the Labor Code, you must forth- ADDRESS _eACQ CK- U` R/� I 3 d with comply with such provisions or this,permit shall be TEL. - STATISTICAL CIASSIFI ATION APT. CON Z deemed revoked. CONTRACTOR ,Q Ctl/r-r NO. LICENSED CONTRACTORS DECLARATION - LIC . . CLASS NO.=DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and - LIC SEWER MAP Professions Code, and my license is in.full fore and effect. CITY CLASS BK - VALIDATION SO. FT NO.OF .q NO.Of CHECK License Number Lic.Class ' SIZE �V STORIES FAMILIES ONE - - - AA VALUATION , I _ Contractor Date DESCRIPTION OF WOgRK �{. Cy�OO NEW ❑ $ I am exempt under Sec. _ e / , t a s/ Ol,�s �Q� ADD O , - ;2O 2 8 A " ALTER B.BP.C. for this reason - _ REPAIR. ❑ $ - - e e s e 1 .. Date: ._ F USE 1 7 7.4 8 ... DLDG. DEMOL E% ❑ Sigiiature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINTa� / NO. DATE e e 1 7 7;4 8 v (,hereby affirm-that I.am exempt from the Contractors License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL ''" 'Professions Code): -' - PRE ENT gY .. - .O 5 1 4t8 5 -. I, as owner of the property, or my employees with BUILDINGADDRESS wages os their sole compensation, will do the work and ' the structure is not intended ar 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 tion 7044, Business and Professions Code). t CONSTRUCTION LENDING AGENCY REQUIRED YARD HWV TOTALETPROACK F M WIDTH hereby affirm that there is a construction lending agency for SET BACKFRONT - -the performance of the work for which this permit is issued . P.L. - (Sec. 3097, Civ. C.). SIDE - .. ._ . P.L. _ m Lender's Name S / O LDMA Raf. N Lender's Address P.C. tea S - Permit Fee (/l o - w / I certify that.l have read this application.and state that the - Issuance Fee- Cd c SQ LDMA P/C N - - ¢, above information is correct. I agree to comply with all County Investigation Fee Y $ ordinances and State laws relating to building construction, - _ tocol Fee LDMA Perm. If - t� and hereby authorize representatives of this County to enter m upon the above-mentioned ro er for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Ag - Date