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Home My Public Portal About4904 KAUFFMAN AVE_Building__ APPLICATION FOR BUILDING PERMIT . F'J'R'AF'PLICANT TO FILL IN (Print or"type only) BUILDING COUNTY OF LOS ANGELES ADDRESS 4t O v _ DEPARTMENT OF COUNTY ENGINEER ciry L� G� zIP BUILDING AND SAF TY. DIVISION ,� N .OF BLDGS. BUILDING SIZE OF LOT a b k I NOW ON LOT ADDRESS TRACT Z BLOCK LOTN `- LOCALITY s- TE / NEAREST OWNER OL G L/��p NO.vCB - CROSS ST. ASSESSOR - _ ADDRESS Q��f /'9U MAP BOOK PAGE. PARCEL DISTRICT GROUP TYPE FIRE ESSED BY CITY L G l ZIP 1-71 CONST, ZO E ARCHITECT'O TEL. � ENGINEER NO. - STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO _DWELL.UNITS BK PG TEL USE MA ,1 P > / CONTRACTOR- - ," CiQ/'J /' NO. nn ��I NO. . Si-1,5_ / (F2 ADDRESSY7< , Q ��.� J �. �NO �bi7�-R i'1 �� SPECIIT ONS CITY d % LIC. /q CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ J NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM a - FRONT F7ROP.LI NE OF (STREET) ADDRESS - CITY - TOTAL SETBACK FROM TYPE'OF EXISTING..-' HIGHWAY } ,YARD - � SQ. FT. NO. OF- NO. OF �. CHECK FRONT PROP. LINE HIGHWAY WIDTH C SIZE - STORIES'/ FAMILIES ONE DES-CRIPTION OF WORK NEW ❑ } - � ADD ❑ BLDG, FROM --• - e- r&_; CC.! .� ASIDE PROP, LIN F (STREET) ALTER IYOT SETBACK FROM TYPE OF EXISTING.. ♦ HIGHWAY } YARD HIGHWAY WIDTH REE PROP. LINE r PAIR J _ EXESOT NG BLDG. es J ✓tC, DEMOL ❑ } •APPLICANT TEL �6j �j, Yy CORNER CUTOFF YES ❑ BY (SIGNATURE) .IN OPEN SPACE YES ❑ NO ❑ Q .y IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ Q(/ CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL"AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- _ STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURA E. SIGNATURE OF ' PERMITTEE ��77 _ .115141C11 ADDRESS t, y .1 'e - ' CITY /�' CJ�I�L NOL. DATE 10 -� BY� . C. _ MAXF_ CHECKS PAYABLE TO: P.C. PMT'Q FEE � FEE •I' HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH a PERMIT VALIDAT NCK. M.O. CASH ' .9-9. CE#803 7/73 81".MAR 11 k _ DEPAR i WNT OF BUILDING AND SAFETY r ,COUNTY OF LOS''ANGELES j WM. J. FOX, CHIEF ENGINEER - APPLICATION-- - - t FOR APPLICANT TO FILL INFOR OFFICE USE ONLY DISTRICT NO. PLAN CK. OR RECPERMIT NO. BUILDING � ADDRESS -RRECEI SY -DATE OF APPL. DATE ISSUED LOCALITY - NEAREST CROSS ST. I"�u _s' , BUILDING ADDRESS' - OWNER f•9/ ' MAIL v /f , ' LOCALITY "C- i ADDRESS /-' 2,0 �Z CNEA ROSS T' Z ~ EL T/�n CITY ( i/. TNC. /.'-+'" 6°'f1�/ FIRE - NO. OFTYE, PGROUP' ZONE I PLANS I, ARCHITECT OR \ TEL - �� y ENGINEER \ NO. BLDG. f /1 ORD. NO. SETBACK;LINE ADDRESS _ USE APPROVED EL. ZON 'r BY , 'DATE CONTRACTOR ., �. ,, NEL - - HOUSE NUMBERING ADDRESS 0 i 77r,r, 7:, cl. MAP NUMBER -2 NO. ASSIGNED BY LEGAL1. p CORRECTIONS DESCRIPTION LOT NO!:) BLOCK _ _ TRACT J .L.. p j NO. OF BLD GB.,�� r - ` -r'YS"`F..�♦d 1�"`C.a"�/ . SIZE OF LOT [/ / I NOW ON LOT Jy�. USE OF ��// �,f NO. OF EXISTIN BLDG. FAMILIES�� ./jrd' ,+°d/ yy ' DESCRIPTION OF WORK � ' �a� 7-= 4-4—Fe� o " NEW ) ALTERATIONS ADDITION Z REPAIR I I DEMOLITION 9[,1.FT. N O. O F SIZE �' � ROOMS a STORIES / COVROOF ER NG� ,,yl I COVE, / USE O STRU CTUREo �� l2 INSPECTION FOR APPROVALS , OCCUPANCY AS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION'AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS, CORRECT. BRACING, BOLTS U I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OFA 3 LATH, INT. PERMITTEE ! iii"' ,y LATH, EXT. ADDRESS /•`-•f' PLASTER, INT. �- AUTHORIZED AGT. , i4 PLASTER, EXT. g dd F.C 4 b HOUSE NUMBER COR- Li - RECT AND POSTED VALUATION �� bd i FEE /,LO FINAL 76AG38A DBS 3 7-Sl WORKERS' COMPENSATION DECLARATION 1 tlhereb7 affirm that I have a certificate of consent to self insure,or a certificate of Workers'.Compensation Insurance, or a certified py thereof (Sec: 3800; Lab.b. C.) - � atl : COUNTY.OF LOS ANGELES BUILDING AND SAFETY Policy`No' 1d17.96i3c-o$tgany 4t Rte Ziind BUILDING �. Certified copy is hereby furnished: FOR APPLICANT TO-FILL IN - ADDRESS 4904 Kaiifmnn ® Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 4904 'Kaufman - LOCALITY. Tem le• Cit 8125189' Applicant P RAMTD� BIJTT,DFR$ NEAREST Lower. Azusa Date CITY . Temple 'Cit ZIP cRoss sr. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT' NOW ON LOT MAP BOOK PAGE PARCEL (This section need.not be completed if the permit is for one TRACT BLOCK LOT NO. USEaNE MAP ' hundred dollars($100).or less.) NPE - 'TEL.: '�' � SPECIAL }"' I certify that in the performance of.the work for which this OWNER • NO. COWWQNS CL permit is issued, I shall not employ any person in any manner DISTRICT,,,/// G TYPE q FIRE CESSED BY O so as to become subject to the Workers'Compensation Laws. ADDRESS 4 9 0 004" Kaufman �r V CONST.. ZONE V' o BL CITY Temple 'City ZIP v O Date Applicant STATISTICAL CLAS$IF;; TION APT. CONDO. I.- NOTICE NOTICE TO APPLICANT: If, after making this Certificate.-of ARCHITECT OR TEL. ITS 0. </� . ENGINEER NO. CLASS NODWELL. UN Exemption, you should become subject to the Workers` 0. Compensation provisions of•the Labor Codei.you:must forth- ADDRESS -- SEWER MAP 4Awith comply with such provisions or this permit-shall be TEL. deemed revoked. CONTRACTOR P D. B BK. -PG," VALIDATION LICENSED CONTRACTORS'DECLARATION ' UC. I hereby affirm that I arim licensed-under provisions of Chapter 9 ADDRESS 16332: San. Bernardal�o Rd. �:VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is m full force and effect. CITY Covina .40028-9 CLASS B QQ 0 D SQ.FT... O NO. OF ' NO OF CHECK License Number 4 O n 2 R A Lic.Class R SIZE 7 STORIES FAMILIES ONE DESCRIPTIO OF WORK Lx• v'b NEW $ Contractor PYRAMID BUILIBdyRS 8-12-3/R9 : ADD I am exempt under Sec. G � �� /✓�`� ALTER FINAL I B.BP.C. for this reason REPAIR C] DATE USE ,�7 Date: EXISTOING BLDG. �r 14 4 DEMOL FI Signature APPLICANT TEL / g OWNER-BUILDER DECLARATION PRINT I hereby affirm that I am exempt from the Contractor's License > D Law for the following reason (Section 7031.5, Business,and ADDRESS Professions Code): PRESENT UILDINGACCT a I, as owner of the property, or my employees with ADDRESS �e wages as their solecompensation will do.the work and 3307 13 e65 ' the structure is not intended or offeied for sale(Section LOCALITY ,4 a t r I M�+ 7044, Business and Professions Cod1 e). MOVING TEL. ' '� 'fit f�Q >t ITEMS a I, as owner ofCONTRACTOR NO. ,the property, am exclusively contracting A L--a —+ with licensed contractors to construct the,project (Sec- ADDRESS TOTALj.�f 3 o 6.3 tion 7044, Business and Profess ians.Code). _ 3 63 REQUIRED TOTAL SETBACK FROM EXIST. " HE �/ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH (� Ctln^ I�,'{{f( I hereby affirm,that there is a construction lending agency for FRONT D x CNAhiGE ot)L) the performance of the work for which this permit is issued P.L.` ' (Sec. 3097, Civ. C:). SIDE FD P.L., v Lender's Name - - 0000-0001• 8/28/89 P.C. Fee$ Permit Fee (33 1 13 , t=""�i� 1 �e�'' Lender's Address ;� 5 3w v. K t I certify that I have read this application and state that the . Issuance Fee 4 a above information is correct. I agree to comply with.all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee o d and hereby authorize representatives of this County to enter m upon the above-mentioned property for inspection purposes. a - �'""Y'�� 8125189 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ' ,,WORKERS' COMPENSATION,DECLARATION I hereby affirmthat I have a certificate of consent to self /U\'pp �Q� O O�':, O M� IOO.�]G. p.EG3G�liv 0U insure,-or dcertificate of Workers"Compensation Insurance, orI . a a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES. BUILDING AND SAFETY -Policy NOU)47Uti3—sc9npany C+a+o ,V1jPr1 El,•Certified copy"is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS' . 4904 Kaufman Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS : 4904 Kaufman Date"�l1glg9Applicant •PZ'RAMTD. BL7IT.DER$ .CITY ' Temple Cit ZIP LOCAUbTY.'Temle Cit NO..OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST: • LOWer Azusa COMPENSATION INSURANCE ASSESSOR (Th-is'section'need not be'completed if.the permit is for one TRACT` BLOCK LOT NO: MAP BOOK PAGE PARCEL hundred dollars ($100) or less.)" TEL. ^ OWNER NO USE ZONE MAP' y I,certify -that in the,performance 'of the work for which this permit is issued,'I shall not'employ any.person in any-manner ADDRESS d NO. ' SPECIAL-- :.so•as to become.subject to the Workers' Compensation Laws. O T ..ZIP CONDITIONS CITY U Date Applicant•.' ' ARCHITECT OR TEL. � NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT OUP TYPE FIRE ., ROCESSED,BY CONST. ZONE" 'Exemption, you _should become subject to''the. Workers' W' Compensation provisions of the Labor Code; you must forth- ADDRESS ,/e ;✓ V a, 11 with,compl'y with such provisions.or this permit, shall. be TEL. STATISTICAL CLASSIFICATION 'APT. CONDO. d_eemed•revoked.. CONTRACTOR PYRAMID. B L Z LICENSED,CONTRACTORS DECLARATION LIC. CLASS NO. DWELT. UNITS I hereby affirm that-I'am licensed under provisions of Chapter 9 ADDRESS 16332 E. San. Berna� d ino. Rd. LIC. "rEB:K ER MAP (commencing with:Section.7000)of Division 3 of`the Business CITY,COV Ina . 4 2 8 9 CLASS .'B and`Professions Code,and my license is,in full force and effect:- PG VALIDATION SQ: FT. 536 NO. OF,. NO. OF CHECK License.Number � 4 0 02 8 9 Lic..Class B SIZE q%jS=r I STORIES FAMILIES ONE VALUATION Contractor PYRAMID AL rjj?_ DESCRIPTION OF WORK �� Y NEW ❑ ❑1 am exempt under Sec. /�"-1 Z_ '9 d�JS'/fc7�A �t�• ADD D ALTER B.&P.C. for this reasonYt��«a� REPAIR ❑ $ Date: . USE OF.'. �j EXISTING BLDG: r 5 DEMOL" ❑ I hereby affirm thatNI APPLICANT TEL Signature (PRINT NO. FINAL , 'S ER-BUILDER DECLARATION DATE O t am exempt from the Contractor s License - . a633.2 _E.' no. Rd. s L'dw for the following reason (Section 7031.5, 'Business and A�DRESan: BernardiFI r 3307- Professions Code): PRESENT. ❑ I, as owner of the, property, or m employees-with' BUILDING VOID YADDRESS � :wages as their sole compensation,will do the work and 7 -� The structure is not intended or offered for sale-(Secfion LOCALITY i E+. - _ 7044, Business and Professions Code.) MOVING TEL D V� El1, as'owner of We property; am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the,:protect (Sec- ADDRESS. AC:C oas tion 7044,Business and Professions Code ) ., .. _ •7 -� REQUIRED TOTAL SETBACK.FROM:; EXIST: �. %' "3D0f ?7r�ls(•: CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE. WIDTk I hereby affirm that there is a construction lending agency for FRONT '" 'F 1 ITEMS the performance of the work for which this permit is'issued P. L. y y^i y (Sec. 3097, Civ. C.):. " ti� tiw; SIDE•Y ` .. -� e 1 �, `iI�1AL ® d 5r P:L: Lender's Name, .-HECK 273, 75 LDMA Ref. #` Lender's Address P.C. Fee$ Permit Fee CHANGE .00 C a 1 certify that I have read this application and state that the Issuance Fee 5(7 LDMA P/C# D.. 0 8 above information is correct.I agree to comply with all County Investigation Fee R ordinances and State laws relatin to buildin 'construction, 9 9 Total Fee LDMA Perm. # VVUV�VVtJl V�iVt St. a and hereby authorize.representatives of,this County to enter upon the above r--m�entione'd..property for inspection purposes. 5329 1- AMS., 8/18/89 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date �. WORKERS' COMPENSATION.DECLARATION 1 M nn I hereby affirm that I have a certificate of consent to self -insure, or ocertificate of Workers' Compensation In or a.certified copy thereof (Sec. 3800,`L'ab C.) . COUNTY OF LOS ANGELES'' "' " 'BUILDING AND"SAFETY Policy NoIty7 4 $�Compahy st�2 `ti ' BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS -*15&0`l 100W v ❑ Certified'co is filed with"the count 'builcli ins ec- BUILDING PY Y 9 P /�,/� /�/► IGM/��l% f �G lL; vl tion-department. ` ADDRESS ` < CITY � Ati ZIP _ Date Applicants "'¢"y LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' '. � SIZE OF'IO' CROSS'ST. NOW ON LOT ROSS'NO. OF BLDGS. r CST. � <7 COMPENSATION INSURANCE ' ASSESSOR- , (This section need not be'completed if the permit`is for one TRACT BLOCK LOT NO. MAPBOOK r PAGE PARCEL hundred dollars_($100) or less.) TEL OWNER' /i�/L-Ji NO. USE.ZONE,q�.MAP. I certify that in the performance of the•,work.for which this (((( NO: permit is issued, I shal l not employ any person in any manner ADDRESS 7�% ✓ ig 1 SPECIAL - CONDITIONS so as'to become subject to-'the Workers'Compensation Laws. ' O CITY I y/tt t lv�_r. ZIP - U Date Applicant: •'•• ARCHITECT OR' TEL. NOTICE TO,APPLICANT::If; after makingthis ,Certificate of' ENGINEER NO. DISTRICT GROUP TYPE FIRE ROCESSED BY O CONST. ZONE U Exemption, you should .become ,subject to. the. Workers' 0 --�� Compensation provisions of the Labor Code; you must forth- ADDRESS r D U / c a' with comply.with .such provisions or;this permit shall be �/�,y TEL. ,r7 N p deemed revoked. CONTRACTOR 1Gwl4�p '� NO. STATISTICAL CLASSIFICATION `APT. C NDO Z LICENSED CONTRACTORS DECLARATION C�[ 2qq�� LIC. CLASS NO. DWELG. UNITS I hereby affirm that I am licensed under provisions of Chapter 9' " ADDRESS 46J7,K- 5,"— !i�t""��Lr O NO. LIC. SEWER MAP (commencing with Section'7000)of Division 3'of the'Business f� ,-and Professions Code,and my license is in full force and effect. CITY cs' CLASS BK VALIDATION ,2 SQ. FT. NO. OF NO. OF :. CHECK 7. License Number �OO�q2' Lic. Class /-� SIZE STORIES FAMILIES ONE - VALUATIOIN CbnlractorP �� Date. DESCRIPTION,OF WORK �� NEW ❑ $ _ ADD` El ❑I am exempt under'Sec. _ .ALTER _E1 D B.BP.C..for this reason` REPAIR ❑ $ Date: USE OF EXISTING BLDG. - DEMOL Signature APPLICANT TEL. 9 (PRINT). /��Y�+�� :5 NO. %3 y'Z: FINAL OWNER-BUILDER DECLARATION DATE. hereby affirm that I am exempt from the Contractor's License. �y 1�3�� 34� �� - Law for the following reason.(Section 7031.5, Business and � ADDRESS. -,0 �FINProfessions Code): PRESENT- A/�rr ❑ I, as owner of.the' ro ert or m employee's with. BUILDING ACCT. . P P Y, Y �'; ADDRESS � _ wages as their sole compensation,will do the work and 3=� c the structure is not intended or offered for sale(Section LOCALITY Ds07 �I�o-r 70 , Business and Professions Code.) J MOVING TEL. 441' ITEMS I, as owner of the property,,am exclusively contracting Cl CONTRACTOR NO. , with licensed contractors to construct the project (Sec- }CITAI: 60. 50 - . tion 7044, Business and Professions Code.) ADDRESS ruC��r 60.50 n "V REQUIRED TOTAL SETBACK FROM- EXIST.' 4I�[\'(\ .` QV o l CONSTRUCTION LENDING AGENCY (� SET BACK YARD HWY PROP. LINE WIDTH' I hereby affirrn that.there is a construction lending agency for FRONT �' t-HA�iGE _ .1 30 the performance of the-work for which this'permit.is issued —P.L. ' (Sec. 3092, Civ. C.). - SIDE .. P.L.- Lender's Name, 0000-0001 328/89 0 U LDMA Ref.# P C. Fee$ Permit Fee 50 i C-r-, 3 Lender's Address O / •- 30 1 AM'80 53 . I certify that I have read-this oipplicction and state,that the j Issuance Fee .v5 LDMA P/C# D above information is.correct. I agree`to comply with all County. Investigation,Fee- �s ordinances and State laws relating fo building construction, Total Fee Fv LDMA Perm. # a' .and hereby authorize representatives of this County to enter upon-the above-mentioned property for inspection purrposes SEE REVERSE FOR EXPLANATORY LANGUAGE. Signature of Applicant or Agent Date WORKERS' COMPENSATION DECLARATION insurtboraafcertif cafe of WorkersrtCornpensaT otific'.bte of n Insura.n ent lf L�U � IDI'M 0 Lod:[�]Com_ p C G3G ora certified'copy thereof (Sec,',3800,'Lab C.) ,COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy'Nol � ompany ❑ Certifieopy is hereby.furnished ',, ``FOR:APPLICANT TO FILUIN gppREss d c Certified copy is filed with the county building inspec- . /�/� ''�✓' - BUILDING' tion:department.' ADDRESS c/ y `�0 " CITY TZ .-ypa 9 � `ZIP LOCALITY Date Applcan�• NO. OF BLDGS CERTIFICATE'OF EXEMPTION'.FROMNWORKERS " ' SIZE OF'LOT, NOW ON.LOT.. COMPENSATION'INSURANCE- ASSESSOR NEAREST:- SIZE CROSS ST. (This section need not,be completed'if the permit, for one :; TRACT BLOCK` LOT`NO. i hundred-dollars ($100)'or less.,) i, TEL. MAP BOOK PAGE PARCEL OWNER FAL[ YFi%�OGa`�Z NO: � . . �1 USE ZONE MAP I certify that in the performance'of the.:Wor'for which this, NO; permit is issued,I shall riot ern to an person in an manner ADDRESS . OS! '_ (Sf G SPECIAL so as,to become subject to the Workers,.Compensation'Laws. 0 CITY .. i-�/�cl�;'G�� ZIP - CONDITIONS Date :Applcant ARCHITECT OR TEL. TYPE B NOTICE TO. If, after` milking this Certificate of ENGINEER NO. I_Q_ROLJR' CONSTRE EDISTRICT. FI PROC SED.BY Exemption, you should become subject:to the Workers' U 3 W Compensation,provisions of.the Labor;Code,•you must„forth- ADDRESS t D� n with comply with such provisions or.this.,permiT shall,be �` TEL. �6 STATISTICAL CLASSIFICATION A T. CONDO. deemed revoked.- :' CONTRACTOR., /fni7�/� �(ii fiA9 NO. 21 �: _ Z LICENSED CONTRACTORS;DECLARATION, A D s27 LIC. /O� � CLASS.-NO DWELL;UNITS I hereby affirm'that,I am'licensed under provisions of,Chapter.9 D RES ., `f �iiiliLf/Zt7� '' .NO. �' (Commencing with Section;7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code;.and mylicense.is in full force and effe`cl. I.14 BK: PG. VALIDATION CITY... C�di/v SS SO'. FT. •� NO.'OF NO. OF C CHECK '•• LA License Number SIZE S2 STORIES FAMILIES ONE /� ��' tic.'Class .s� VALUATION Contractor /yiJ�/^�✓' "'°f°`� Date' DESCRIPTION OF WORK ,' /Q C vd NEW. '❑ ❑I'am exempt under Sec. ” ��0 ALTER .❑ - Bt&P.,C..for'this reason $ REPAIR Date: USE.OF. - EXISTING BLDG. rC� DEMOL .Signature APPLICANT._ TEL. ia �--' FINAL OWNER-BUILDER DECLARATION (PR _j� !vJ%Q:: //L�a " NO. ��` I hereby that I am exem t:from the Contractor s License DATE. P. ADDRESS .[� :,..=9 LQ%s'l ' ;Law:for the folloviing reason`(Section 7031 5; Business and FINAL Professions Code) PRESENT - By, + f tT ❑ .I,•as owner of-the 'ro ert or my-employees with` BUILDING ° - P P YADDRESS - wages' s'their'sole compensation',will do ifie work and - _; i7 r;°x 'the.structure is not intended or offered for-sale(Section LOCALITY - , 7044, Business and Professions Code ) MOVING TEL ) • D . COINTRACTOR NO. _ EITF ADDRESS ' I, as owner of the ro-ert am exclusive) contractin t' r —� P P Y, Y. 9 , , 6, • With lice rised contractors to construct the prolecf.:(Sec- -- - , tion 7044, Busriiess-.and"Professions Code.) *• REQUIRED YARD TOTAL SETBACK FROM•' EXIST: CHECK a., CONSTRUCTION LENDING,AGENCY '' :SET; BACK • HWY ;:-'PROP. LINE WIDTH. - I hereby affirm that;there is a construction lending agency for FRONT CHANGE a,a the',performance of;the'work-for"which.this'pgrmit,is issued P.L. (Sec. 3097, Civ, C,).- SIDERU. - c:=% ifi)1 i Lender's Name. - iii i�, �•� LDMA Ref. rJ¢{ P C.•Fee$ Permit Fee a •':t • t ;yw, Lender's Address 00 63 1 AN' o Icertify that I have read this,application and state that the Issuance Fee t 0 LDMA P/C# D above information is,correct. (agree to comply:with all County Investigation Fee. 0 ordinances and'•State laws relating to building construction, Total Fee �,..�, LDMA Perm. q , and hereby authorize representatives of this County.to enter upon`the above-mentioned*property for inspect ion purposes. " - �4- --� sem - /�%-af(� SEE REVERSE.FOR EXPLANATORY LANGUAGE � - Signature of Applicant or Agent' ' Date • _ - .. WORKERS'-COMPENSATION DECLARATION herr by affirir. that I have a certificate of consent to self PLOC�.� p insure, or a certificate of Workers''Compensation Insurtinse,. L/�1 L/�1 LIQ LI V LI V lJ or a'certified copy thereof'(Sec_3800, Lab. C.) -6 -QI�L"��31�b 1 COUNTY OF LOS ANGELES BUILDING AND-SAFETY . Pol icy No. f1 d.7 Q ti-(&g)PanY 2 tat2 F-3ji�d — BUILDING n� Certified-copy.is hereby.fyrnished: . :. FOR APPLICANT TO FILL IN ADDREss 4904 Kaufman Certified copy is filed with,the county building inspec- BUILDING tion department. ADDRESS 4 9 0 4 Kaufman Date 3/20 Applicant .PYR.Awn RuTT•n*ERS CITY Tem 1e:'City ZIP_ LOCALITY Temple Cit NO..OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROMWORKERS' SIZE OF LOT NOW ON LOT CROSS STLOWer Azusa COMPENSATION;•,I NSU RAN .CE ASSESSOR (This"section need not be completed if the:permit is for one TRACT BLOCK LOT NO. MAP BOOK. PAGE PARCEL hundred dollars ($100) or less.). TEL. OWNER Bi'l'l .Fetner. NO2 g rj. 2 2 USE ZON MAP I.certify that`in the performance of the.work for which this NO. permit is issued, I shall not employ.an erson_in an manner ADDRESS 4904 Kaufman SPECIAL a- P P Y' Y'P. Y. ' " �� CONDITIONS so as to become subject to,the Workers'Compensation Laws. 0, 1. CITY Temple City ZIP Date Applicant ARCHITECT OR' TEL. DISTRICT GROUP TYPE FIRE 'PROCESSED BY .NOTICE TO APPLICANT:,_If,:,after. makingthis Certificate of ENGINEER NO. CONST ZONE Exemption, you"should become subject to' the Workers. w Compensation provisions of The Labor Code, you must:forth- ADDRESS i (J� 3 with comply with.such, provisions or this permit_ shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR PYRAMID. BUILDEl4: 967, 1342 — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 1 DWELL.,UNITS / I hereby affirm that Lam licensed under provisions of Chapter 9 ADDRESS 16332. .E E. Sana Be'rTr rd.ino ER MAP (commencing with,Section_.7000)of Division 3 of the Business LIC. SEW CITY Covina 400289 CLASS B and Professions Code,and my license is in full force and effect. NO O CHECK BK. PG. VALIDATION License Number 4 n n 7 R O Lic:Class R SIZE FT STORIIEES FAMILIES ONE K VALU TION j� Contractor PYRAMID.• BUILDS .3 2 0 9 0 DESCRIPTION OF WORK wl"JG NEW ❑ $ O t/ Cid 1/�f✓ 'ADD D ❑I.am exempt under Sec. Gr ALTER BAP.C.,for this reason $ Date: USE OF �/,/� REPAIR ❑ • EXISTING BLDG. �/ `� DEMOL APPLICANT' TEL.. Signature (PRINT).'PYRAMID: BUILDER9409 6 7. 13 4.2'. FINAL OWNER=BUILDER DECLARATION DATE I hereby affirm that Lam exempt from the Contractor's.License ADDRESS 16 3 3 2 San Bernardino .CoVin Law`for the following,reason'(Section'7031.5, Business and FINAL' Professions Code):" PRESENT BYy XI=1E as ❑ BUILDING I, as owner of the property, or,my.employees with ADDRESS' -,-. 'vj" wages as their sole compensation,will do the work and �u � z '-` the structure is not intended oLOCALITY'r offered for sale(Section � • � •• R „ ii ITEM f�h 7044,-Business and Professions Code.) MOVING TEL: D 1 1 1 GI i� CONTRACTOR' El 1, a I, as owner of the property, am exclusively contracting -with licensed contractors to construct the project (Sec- TOTAL. tion 7044, Business and Professions Cade:) ;[�� ; ), REQUIRED TOTAL SETBACK FROM EXISTc CONSTRUCTION LENDINGAGENCY SET BACK YARD. HWY PROP. LINE WIDTH "• i I hereby affirm that there is a construction lending agency for FRONT ,y � �� the performance of the work for which this permit is issued P.L." (Sec. 3097, Civ. C.). SIDE ntt.''i� fYi P.L. Sf;JVV-i��IJi 330i ''. Lender's Name, ;,+ _ _ a -25 LDMA Ref. # C '_ Lender's Address P.C. Fee.$ Permit Fee ✓/ t' f' t �` a I'certify that-.1 have read'this'application and state that the Issuance Fee iV LDMA P/C# D above information is correct. I agree to comply with all County Investigation Fee 6 ordinances and State laws relating to building construction, Total Fee o i LDMA Perm. # < and hereby authorize representatives of.this County to enter. upon the above-.mentioned property for inspection purposes. .3/'13/90 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date