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HomeMy Public PortalAbout4913 KAUFFMAN AVE_Building__ L�s7Y BUILDING ADDRESS APPLICATION LOCALIITY �✓ o ��� � i /�� NEARESTIi6„ DIVISION OF BUILDING AND SAFETY DROSS 5T.. 1Department Of County Engineer DISTRICT NO: RECEIPT NO. PERMITtNO. County of ]Los Angeles �� WM. J. FOX, COUNTY ENGINEER GROUP �. DATE RECEIVED DATE ISSUED CASSATT D. GRIFFIN, SUPIT OF BUILDING i/ FOR APPLICANT TO FILL IN ' , TYPE CONST. RECEIVED BY ISSUED OWNERN/ / /� _ p/./�/�_+ � ,1/ �,/,� e`MAP /� �x� '.i STAT YEH✓CtJO ') ADDRESS iy] /L� , /(,C4� *6,. �•.1<j1 Ffu l_ NUMBER �/ (/p' SPECIAL 4 r UVT EL�p yj�& Q` ,ASF USE ZONE CONDITIONS CITY (�X�/IYVT/ dw 6 , NO.//t.':Is�tU^/ ARCHITECT_0 R/ TEL. ENGINEER NO. C jBUILDING YARD HWY .STREET NAME EXIST. ADDRESS - 1. SETBACK WIDTH FRONT t CONTRACTORTELA,G�/y--�_ NO.•\'�3`'^ft/�/VL-Q� j P.L. �t - - SIDE P.L ADDRESS BUILDING �e..� ,{� 1 DATE CORRECTIONS' - INSPECTOR ADDRESS LOT NO. /.e-� O.' BLOCK TRACT y �,I NO.OF SLOGS. / SIZE OF LOT �P ^ > I NOW ON LOTUSEOF EXISTING BLDG. DESCRYPTIOk OF WORK # ° NEW �DD ALTER REPAIR DEMOLISH:E D SO.FT. �j �yy0 ND.OF NO.OF�' r SIZE �s/J STORIES / FAMILlea USE OF STRUCTURE / NO.OF EMPLOYEE$ 1 HEREBY, ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS , APPROVALS INSPECTOR'S SIGNATURE DATE CORRECT. I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION / AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS,MATERIALS r r l��rY//1/�1 ./ /•T//..�.��/Z�'L , FRAME.BRAC I N G,B O L TS H� SIGNATURE OF °X- � ` , PERMITTED - FURNACE: LOCATION, ADDRESB UC7/ //�'�`"�����`O'`�� GA3 VENT,DUCTH o L l� G h LATH, INT. / AUTHORIZED AOT. g d _ LATH, EXT. ►L1sx Q/cLa/ P C.$ HOUSE NUMBER CDR- FEE RECT AND POSTED VALUATION - w..�a _ FEE FINAL •7�Lr�/P' il..bs-._..._t�tQ/�c�l��'o 76AG38A -DBS 3 12-53 76A638aIE APPLICATION FOR BUILDING PERM COUNTY OF LOS ANGELES BUILDING ` DEPARTMENT OF COUNTY ENGINEER ADDRESS / s BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. DISTRICTP TYPE E_ BY FOR APPLICANT TO FILL IN •,� Q CONST. cL/ 1 3 BUILDING 'S STATISTICAL CLASSIFICATION S R MAP ADDRESS ,ft Vr K I7 CLASS. NO. _DWELL. UNITS jy LOT NO!&4 - ', C% BLOCK WATER NOT REQUIRED RECEIVED ❑ /) (� CERTIFICATE: �CCf TRACT U O NO. �4�MAP ({CG CVLE) STATE MAJOR SECON LOCAL r�/ AY NO. OF BLDGS. SIZE OF LOT .1� NOW ON LOT USE ZONE SPECIAL USE OF .�/ /J A I CONDITIONS EXISTING BLD'-'4 •� (J' r[1 TE ' OWNER -g, ,[ laZZ I NO - L�egp BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS �� , FRONT :' ARCHITECT OR TEL. P• L. CJS2 Q•L�IL rl.-� �S ENGINEER NO. SIDE P. } ADDRESS . _ O TEL. U CONTRACTOR NO. " ADDRESS .• �Y r O DESCRIPTION OF WORK W »t ,yl CL DE NEW Dom/ ALTER OLISH N v Z SQ. FT. �/ F NO. OF SIZE ,�Y' OR Es FAMIL ES USE OF STRUCTURE ` -71 SIGNATURE OF APPLICANT 4% ti VALUATION S. f �-- ���+++��� APPROVALS DATE INSPECTOR'S SIGNATURE 1 FOUNDATION: LOCATION . FEE $ h �_) FEE $ 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 CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCf_ OATH, EXT. SIGNATURENUMBER PERMITTEE OFL A' - Ll-a�' L��{/t� HOUSE RECT AND POSTEDR -' ADDRESS_ ov FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. MO. CASH _ PERMIT VALIDATIONO M.G. CASH I • 4 _ 78A888A CE#809. 1-61 APPLICATION FOR BUILDING P :RM 0T,' COUNTY OF LOS ANGELESBUI ESs Fit' DEPARTMENT OF COUNTY ENGINEER f BUILDING ARID SAFETY DIVISION LOCALITY JOHN A. LAM BIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. ' - DISTRIC NO, - TYPE .P ED BY FOR APPLICANT TO FILL IN CONST BUILDING ; < STATISTICAL CLASSIFICATION - E R MAP ADDRESS / �q��� "" CLASS..NO. WELL.UNITS- �P LOT X10. BLOCK WATER NOT REQUIRED RECEIVED _ / ���� -, CERTIFICATE: TRACT J�/ MAP HIGHWAY STATE MAJOR SECOND, LOCAL SIZEOFLOT. �7"(t , /� /�d�/ .I NOW ON LOTS US.ZONE SPECIAL.LEI ..USE OF. / CONDITIONS- ' 'EXISTING BLDG. .L//° 1✓I NG' I �(/ �v /�• /`I OWNERJ�'/U6FL t1 (/�-L�/U�.ZINE�Lg�1.7U6�. / ' 1 . Q� j� ,/ 64 t� BUILDING EXIST. ADDRESS %�� /S/`f •y�ph. �p SETBACK YF`RD, HWY STREE AME" WIDTH �T�• FRONT ARCHITECT OR r - `TEL.- P.L. ENGINEER NO. - SIDE ADDRESS TEL. INSPECTION RECORD O CONTRACTOR NO. V 71316P /1 0 'ADDRESS � � ' ' DESCRIPTION OF WORE � / :� ` � � � '/ �; a NEW- ADD ALTER REPAIR. DEMOLISH „/ �c'` /�a Z SQ.FT. NO.OF NO.OF IZE 2 Gam+ STORIES FAMILIESar- USE OF. - 6e-I,.C..J2,i_ •/.1 ( .fPi - !�''�!1 `•' STRUCTURE - 4 SIGNATURE OF - APPLICANT VALUATION$ � APPROVALS ,DATE INSPECTOR'S SIGNATURE ' P.C. PMT. ' FOUNDATION: LOCATIONI FEE $ C`—�3 I FEE- $ O FORMS.MATERIALS -'/� �o ,rte G ••rIs�a ;�/' - FRAME: FIRE STOPS, r s N I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS ,�, '',�2 // •� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .FURNACE: LOCATION, 1 " WITH ALL COUNTY ORDINANCESANDSTATE LAWS REGULATING .GAS VENT DUCTS (/ 1 7 BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK Q -AUTHORIZED HEREBY I WILL.NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.. �1'"" ¢ TION OF.THE LABOR CODE OF THE STATE OF-CALIFORNIA RELAT. ING TO WORKMEN'S COMPENSATION'INSURANCE. LATH,EXT. . SIGNATk,_7F1��E'OF �(71 HOUSE NUMBER COR- PERM ITT�,E - RECT AND POSTED ��[�/—.'/2'. .:ADDRES/S` v e FINAL CLYDE N.-DIF2LAM, Phi NC PALSTR T RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VMMATIO14 CK. M.O. CASH DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PE . COUNTY OF LOS .ANGELES WM. J. FOX. CHIEF ENGINEER I FOR OFFICE USE ONLY FOR APPLICANT.TO FILL IN W DISTRICT NO. PIAN CK.ND. PERMIT NO:" BUILOINO - ADDRESS r ` t LOCALITY f t ( +� / '; REC IVED BY DATE OF APPL. DATE ISSUED NEAREST. ,� ;. .�_.,, CROSS STc'� : `t- - BUILDING OWNER .'*' t - t ADDRESS Fr— MAIL LOCALITY ADDRESSNEAREST E L � 1y�j`'-• qmg 'meq+ �" 0 ` /U`� - . ..,t o ^�' Ei NO. CROBH ST. �i l R R PC t 9 . . CITY FIRE , jNO.OF TYPE GROUP E,. F ARCHITECT R j TEL ) ZONANS ENGINEER / NO'./ { _ J/ BLDG. ORD.ND. ADDREf>H ! SETBACK LINE ,y- APPROVED $'e. / TEL. By DATE CONTRACTOR NO. USE APPROVED AD RE ia "<� -- Rx ZONE BY DATE LEGAL - ,1O! CORRECTIONS DESCRIPTICONyy�� P'L'OT NO. BLOCK TRACT - / NO.OF BLDGS. r SIZE OF LOT Q ( (�, I NOW ON LOT.. �- ry ( {/: , " - - G USE OR [s 0ar M8 —EXISTING BLDG. DESCRIPTION OF WORIg v v NEW ALTERATION ADDITION �, O A REPAIR MOVING DEMOLIBH� p Bq.FT. / NO.OF / - - D SIZE 230 ROOMS BTORIEB / r WALL' Jy I ROOF COVERING COVERING UHE OF NEW, BUILDING .�L✓ 6A c 6> r F'X/S7,,/ GRAS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND 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.' '4 �lfn' FRAME: FIRE STOPS, • SIGNATURE OF �/ j �YBRACING,BOLTS PERMITTER .. LATH, INT. '- AUTHORIZED AOT LATH, .EXT. ' . 76A63BA-3 2-50 P.C.SPLASTER,IN - oc FEE PLASTER,EXT. VALUATION FEE FINAL ,/�� WORKERS-COMPENSATION DECLARATION . 1 hereby-affirm,that I have a certificate'of consent to self �:� ����'���H ®� p U �D O M'(� nn , �sure�or a certificate of Workers' Compensation'Insurance, Ll�sLl /l�1 LI V PER LIl/U ora certified copy thereof (Sec.'3800,:L'ab C.) ' COUNTY.OF;LOS ANGELES BUILDING.AND SAFETY. Policy No > . Company BUILDING'. ❑ ',Certified copy is_hereby furni9he'd: FOR APPLICANT TO FILL IN' ADDRESS El Certified copy is filed with the county building inspec- BUILDING:, , _ tion deparirrtent:. 7. 2.. ADDRESS ,�- CITY` ! �C�i'l.r a—ZIP LOCALITY. Date' ° Applicant' i N F BLDGS NO ] NEAREST tom! CERTIFICATE OF EXEMPTION FROM,WORKERS - SIZEOF.LOT (�X '%6.C> NOw'"ON LOT CROSS ST. J ce�i°- "COMPENSATION:INSU RANCE '' ASSESSOR �• /7� /' (This section need not 6e completed tf the permit is for one TRACT BLOCK LOT NO MAP BOOK PAGE V/ PARCEL. / hundred dollars'($100) or less ) `. _ T "~� OWNER ,: i J ZS USE ZONE MAP ' 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 1 t�LYg� a NO. so°as:to.b6corne subject.to the Workers' Compensation Laws. ' z O (� y SPECIAL CITY �' C��' ZIP 7 �/ �� _ CONDITIONS Date' 22-9 .Applicant' ARCHITECT OR TEL. . DISTRICT GROUP TYPE FIRE PROCESSED,BY NOTICE TO APPLICANT:,.lf after.,'-making this'Ce•tificate of ENGINEER NO. CONST Z 'Exemption, you should become subject to the Workers Compensation provisions of the Labor Code,=you must forth ADDRESS (�� ° ,r .• CIL with comply with such,provisions or, this permit shall.-be S7C TEL.O. STATISTICAL CLASSIFICATION APT. CONDO' N deemed.re-Voked s. .o. : ,. CONTRACTOR' °7ttt NC��� _ LICENSED.CONTRACTORS DECLARATION; LIC. CLASS NO.�L=DWELL. UNITS I hereby,affirm that I.am licensed'under provisions of Chapter9 ADDRESS NO. LIC SEWER MAP (commencing with Section7000)'of Division 3.of th'e'Business. - ancl Professions Code and my license is in full force and effect. gK PG. CITY- CLASS VALIDATION - . SQ:FT. NO. OF NO. OF CHECK,'. License',Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date, NEW DESCRIPTION OF WORK. '(��. ❑I am exempt under Sec .... `ADD ❑ :. .. ... ... .. ALTER El , B.&P.C. for'tt is reason Date: USE OF - REPAIR ❑. $ `EXISTING BLDG.' DEMOL ❑ Signature, APPLICANT, TEL.(PRINT) FINAL OWNER-BUILDER DECLARATION - , NO. y DATE' _o I her affirm that I am,exempt frorn the Contractors License _ L`aw for ihefollowin ADDRESS (� g,,reason (Section 7031,.5, Business and FIIdAI Professions Code) = PRESENT By. BUILDING 5 I, or owner of-the property,`or my,employees with ADDRESS aqip wages as their sole anwill do the work and the structure is not i= ar offered for sale(Section LOCALITY '7044,$uainess and Profess ions'Cod34 e:) MOVING TEL. , D- CONTRACTOR NO: t = ❑, `I, as owner of the'property;amsezclusively contracting ' (_ with licensed contractors to"construct the project (Sec- ADDRESS {'s - tion 7044,:$usiness and Professions Code.) CONSTRUCTION LENDING A REQUIRED: TOTAL SETBACK FROM EXIST.- WY PROP. LINE GENCY,: SET BACK YARD H . WIDTH -'- `I hereby'affirm-that there is a construction.lending agency for FRONT', the performance of the work',for-whtch.this permit is'issued :'P.L. (Sec. 3097, Civ.'.0 ).. SIDE, r AM Lender's Name �( _ P-6.'Fee$.__ .. _ Permit Fee (1 LDMA Ref. # i Y y t 3 Lender's Address �✓ I certify that I have read.this application and state that theT 7 . Issuance Fee � 7 - TDMA P/C# D above information is correct, I agree to comply,with all County. Investigation Foe 8 _ordinances and State laws-relating to building construction; Total Fee + LDMA Perm. # 'Q and hereby authorize representatives of this County to enter Upon t e abov ti ' ed-p party for inspection purposes. ' -o ��,.�� SEE REVERSE FOR EXPLANATORY LANGUAGE Signal of ApplicaM or Agent Date . is •. ,. - - ,. . , WORKERS' COMPENSATION DECLARATION' °' I herety affirm that I'have a certificate:of consent to self D Q insure, or a certificate of Workers' Compensation'Insurance, /fV �j[r—v�� ®� �.• ora certified copy thereof (Sec. 3800, Lab: C. . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Q Cer fled,copy is,hereby:furnished. '_ BUILowG /3 . !t1 ertified FOR APPLICANT TO FILL INADDRESS copy is filed with the county building inspec BUILDING. �6a tion"department. ADDRESS Date APPlicant _ M`• CITY �% C;1 U ZIP °LOCALITY CERTIFICATE OF EXEMPTION F.ROM WORKERS' NO.OF BLDGS. ., NEAREST •,:COMPENSATION'RN&RANCE =' SIZE OF LOT NOW ON LOT CROSS ST: Sy�I (This section,need not be completed',if the permit is for one ASSESSOR hundred dollars($100)or less.)` TRACT BLOCK t0T"tVO. MAP BOOK PAGE PARCEL I certify that m the pecfarmance of' work for which thisC US ,yD,�p TEL. OWNER Ne,-_" .E�2 NO S� 5... E ZONE, OP permit is issued, I shall'.not employ any person in any manner �, / SPECIAL ; ADDRESS � ✓ - CONDITIONS so as to becorne subject to the Workers'Compensation Lows. O, CITY ZIP Date Applicant NOTICE TO'APPLICANT:'If, after making this 'Certificate of ARCHITECT OR TEL. DISTRICT. GROUP TYPE. FIRE PR ES,SED B O ENGINEER NO. Exemption, you should become subject 'to the Workers' U CONST" ZONE Compensatton:provisions•of the Labor-Cod you must forth- ADDRESS .�� L1J with comply;with such.,provisions or,this permit' shall be /� � TEL. /� STATISTICAL C SSIFICATIO APT. CONDO/ fn deemed,revoked. CONTRACTOR _mss 4,� S NO,f fG s 7 LICENSED CONTRACTORS DECLARATION ` `;LIQ. CLASS TVO:` DWELL. UNITS- - Ihereby affirm that I am licensed under provisions of Chapter 9. ADDRESS �/G /r } : C NO �o (commencing with Section 7000)a Division`3,of the.Bvsiness and LIC. SEWER.MAP Professions Code, and my license is in full force effect. CITY 'cr CLASS BK,',, ' < . "VALIDATION SQ'. FT: INC. OF NO.OF CHECK' License Number _Lic.Class' /� SIZE STORIES FAMILIES" ONE V �p/� /% �yQ DESCRIPTION OF WORK Contractor ! �`�� TDate O NEW TIOR1. ALUA A ( �Yr S $ I am exempt under-Sec. �E ADD 9 017 A B'.8P C::for this reason $ # om .o o,o'J REPAIR a Date USE OF EXISTING BLDG. o o, r APPLICANT TELt 0'0 .0 4 DEMOL q 'g 9,8 8'= Signature d-'- - .., FINAL �� v ':OWNER.-BUILDER DECLARATION PRINT NO. DATE 1.,,.8 I hereby.affirm that Lam exempt from the Contractor's License ~" 0 0 8 Law for the following reason,.(SecTion 7031_.5,Business and'. ADDRESS FIN Professions Code): PRESENT B - BUILDING I, -as owner of. the property, or, my employees with ADDRESS e t wages as*their sole;compensation,-will do the,work and "• " i LL''t -' LOCALITY t t - ' the'structure is not intended or offered for sale(Section. � r •. r� - 7044, Business and Professions bode): MOVING ;TEL` Q I, as owner of the property; am exclusively contracting CONTRACTOR with-licensed'contractors to construct the-project-(Sec- •ADDRESS tion 7044,:Business and'Professions.Code).- " o REQUIRED TOTAL SETBACK CONSTRUCTION LENDING"AGENCY SETBACK YARD, HWY PROP. CINE WIDTH I hereby affirm that there is a construction lending agency for. FRONT ' .the performance of the-work for which this peimit',is issued P.L. (Sec. 3097, Civ. C.). SIDE. P.L. Lender's Nome m P.C. Fee.$ Permit Fee- LDMA Ref. # . Lender's Address n I.certify that I have read this application and state that the. Issuance Fee •.� _ 7LDMA P/C# D above information is correct. I agree to comply with all County Investigation,Fee o. ordinance's and State laws relating to building construction, Q - , ,�•. R and hereby authorize representatives of this County to enter Tota(Fee CJ LDMA Perm. # upon the bove-mentioned property for inspection urp ses. a - SEE REVERSE-FOR EXPLANATORY LANGUAGE Signature of.Applicant or Agent Date WORKERS' COMPENSATION DECLARATION § t -. Qppd9:CQ��OO G�1 *�OG3 -Co3M�d`D� 1'C p�QGv���.... . , "rl hereby affirm that I have a certificate of consent to self D O O o D D insure,ora certificate of Workers' Compensation Insurance, or a certified copy•thereof (Seca 3800, Lob.'C. - n ; SAFETY COUNTY-OF LOS ANGELES BUILDING-AND Policy Nb . Company ❑ BUILD FOR-APPLICANT TO FILL IN ING " r,Gertified copy is hereby furnished... ADDRESS ❑ -Certified'`copy-is filed with the courity building inspec- " - BUILDING ) t "'tion deportment: ADDRESS �.7 A(,L y/. ice. t r _ �+ fi Date ` Applicant CITY ��*P ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM,WORKERS NOrOF BLDGS: - NEAREST 'COMPENSATION INSURANCEo- SIZE OF LOT NOW ON LOT ' CROSS ST. jlhis'section-need'not,be-completed if the•permit.is:for'one - - ASSESSOR +a C hundred dollars ($100)or,.,less.,) TRACT BLOCK,�pp LOT NO. MAP BOOK' '" PAGE PARCEL . OWNER' G LC:' 'C.0 8 19RJ NEL O. P USE ZONE 1.-"c er t i fythat m ihe,peifarmance-of the work for which this NO. permit is issued, I shall not employ any person m any manner l SPECIAL - ADDRESS �� ✓4/Z' c' / so as to become"subject to the Work rs Compensatio laws. V �' .CONDITIONS //��,'�� _ CITY f7 ZIP--?z Date. _ S.Applicant` (.<(J•.. r `—/ _ �- SE O NOTICE TO`APPLICANT: If;'aft ' making this Certificate of ARCHITECT OR TEL. DISTRICT_- GROUP TYPE FIRE PROCE D„BY. -; Exeni tion, you should bec e'subject to the Workers' ENGINEER O� �j' Compensation provisions of the labonCode; yourmustsforth- ADDRESS -" :• _ - - - CONST. ZONE with comply..with such,'prov,isions or.`.this permi('.shall. be r TEL. STATISTICAL CLASSIFICATION APT. ONDO. t' . deemed revoked. ; -, CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION,--,-,,.,-.-, �.t -- - -tIC.` CLASS NCI: DWELL!UNITS -r I hereby affirm that.l am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Sectjon 7000)of Division 3'of the Business and -._, LIC.- ,.- . _., SEWER MAP. Y *. �. ,• ' SQ. FT. I V NO.ROS-- NO..OF • _ CHECK BK. :�. Professions Code, and m license is in full'force"and effect CITY CLASS VALIDATION S ]STORIES /.- FAMILIES ( _ License Number' Lic Class t'+:+: t... r t..• _.... DESCRIPTION OF WORK fAj o+ NEW ❑— .G VALUATIOW^ Contractor Date e ADD ❑ I am'exempt under Sec. ` ALTER _ ' B.&P.C. for-this reason REPAIR USE OF Date: DEMOL EXISTING BLDG. ... Sig`n`ature '. ,. _- _,- _ _._ / .. FINAL./�.� / APPLICANT `` /� TEL L PRINT) a Q •` G� G-© e NO. :S 7s` t OWNER BUILDER DECLARATION .' _- [ADDRESS DATI hereby-affirmAcit I am exempt.from the-Contractors LicenseLaw'for the followin reason a Section 7031'5, Business andFIN LProfessions Code):` g ( „. '.. PRESENT U !s moi/ B -x f I, as owner of the "property, or my employees with ADDRESS t i 1 LOCALITY I. -4050 cadges as their sole compensation,will do the work and the structure is not intended,or offered for sale Section 7044; Business-and Professions Code).- ----- ( MOVING - TEL. - p o a.o 4-0.506, I, as owner'of the property, am exclusively contracting CONTRACTOR NO. -� - with licensed contractors to-construct the'project (Sec- - - - tion 7044, Business and Professions Code). ADDRESS i CONSTRUCTION LENDING AGENCY - SETQBACKUIRED- YARD'` HWY TOTAL REOTP ACtKEFROM, y�IDTHIST.. _ t I hereby affirm that there is a construction lending agency for FRONT ' the performance of thework.for -this'permit is issued P:L•. _ (Sec.-3097, Civ. C.). SIDE ' '�� t Lender's Name - i N. o' LDMA Ref # P.C.-Fee$ Permit•Fee.-: - f Lender's Address > J certify that.I-hove read.this application and.state_thaf the Issuance-Fee - - -,� tDNA P/C#-• D; ?, ° _ { above information is correct.'I agree to comply with all County. Investigation Fee m ordinances and.State laws 'relating to_building.construction, Total Fee— - (f• LDMA Perm # - - - - --- 0-. v and hereby authorize-representatives of.this County to enter - ' m upon th above-mentioned property for inspection purposes. -- < � SEE REVERSEFOR EXPLANATORY LANG A E - - Signature of Applicant or Agent --- -- - Date