HomeMy Public PortalAbout4946 KAUFFMAN AVE_Building__ FOR AI? LICANT TO FILL IN (Print or type only)
BUIWDING Q K —„F A� � .. COUNTY OF LOS ANGELES '
ADDRESS -1 -DEPARTMENT OF-COUNTY ENGINEER .
CITY -rFLE G lYY z I P BUILDING,AND SAFE DIVISION
{�
NO.OF EiLDGS. '7 _ BUILDING
SIZE OF LOT✓VX ).�,L' NOW ON LOT,- - ADDRESS
TRACT .�Qc � BLOCK LOT NO. _ LOCALIT26 .
Y
- I TEL. NEAREST `
OWNEiRSAUDgmLNO: 2gs—oMb CROSS ST.-
F ' _ ASSESSOR- -
ADDRESS LJrF"AIV ,'4_U& MAP BOOK - PAGE PARCEL
rr Ty - DISTRICT GROUP TYPE - FIRE' SED BY
CITY . Lc- �.. t./ ZIP - CONS .. ppl�.. _.
ARCHITECT OR TEL.- �p$
ENGINEER - NO. - „.
STATISTICAL CLASSIFICATION SEWER AP'
ADDRESS - CLASS NO.,2/ OWELL,UNITS 77�J BK . fP,G'.
TEL.
CONTRACTOR .NO ,O
LIC. NE NDAP
ADDRESS NO. - - _J SPECIAL
' '
'LIC.' CONDITIONS
CITY CLASS -
ROAD DEPARTMENT-APPROVAL REQUIRED - YES❑ NO❑ ,'
CONSTRUCTI CK LENDER
NAME AND BRANCH BLDG.SETBACK FROM
- - - FRONT PROP.LINE OF (STREET)
ADDRESS CITV-
HIGHWAY }' 'YARD TOTAL SETBACK FROM TYPE OF EXISTINGr.
SQ. FT. NO. I Y,� NO..OF , CHECK . . � 'FR.ONT PROP. LINE HIGHWAY WIDTH
SIZE ,(1'd'Q STORIES ` FAMILIES 'ONE
- - •. } ? }.
d
DESCRIPTION OF WORK NEW -O
ADD ❑ BLOG..SETBACK FROM
SIDE PROP.LINE OF _ "' (STREET)•
ALTER ❑ TOTAL'SET.B.ACK FROM TYPE OF, EXISTING 'U'
HIGHWAY }�. YARD','- HIGHWAY -WIDTH
REPAIR❑ SIDE PRO-P. LINE
USE OF }
EXISTING BLDG, PC-S. Cd DEMOL ❑ • Z
APPLICANT _ II ' TEL /Q CORNER.CUTOFF YES ❑ NO C3(PRINT) G Pr` •NO 28�".' /.[J , .. '
BY (SiGNA TORE) IN OPEN.S.PACE ..3 YES-,El ..NO�❑
QQ•• IN COASTAL PERMIT ZONE', - YES ❑. NO' ❑. ,
VALUATION�•P �' 2L CGoo1/�. /
,til .HEREBY ACKNOWLEDGE THAT I HAVE READ THIS-APPLICAT ION a, r16.* rfq'� - '' -•�"�K,•�'•GY
AHD S ALL ORDINANCES
THAT HE ABOVE IS CORRECT AND AGREE TO COMPLY ` `���• :'Aw�
,W.ITH ALL "ORDINANCES AND LAWS REGULATING BUILDING CON- C717`P� a�
STRUC TION.'% 1,CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBYI WILL NOT EMPLOY ANY PERSON IH VIOLATION OF THE
LABOR CODE OF THE.-STFTE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURAN E. 579,5••800 _ _ ,. r -
SIGNATURE OF
PERMITTEE
ADDRESS C �► _
TEL.. FINAL El
CITY
Bl �'C''
CITY NO.
DATE
MA L CHE.0 S PAYA13LE 7O: P;C. $ - PMT.,G
HARVEY T. BRANDT,.COUNTY ENGINEER FEE' FE£ P
9 , a 75
PIAN CHECK VALIDATIONM.O. ' CASH. o PERMIT.VALIDATIO CK. 1 M:O. ' :{ASN
2 `0 R 1 3. D9,4-0 5 5 1,5 6e75-A9a
76A638A CE tl7803 5/74
t (P ` � V�
APPLICATION FOR BUILDING PERMIT
FbR APVLICANT TO FILL IN (Print or type only)
BUILDING COUNTY OF LOS ANGELES
ADDRESS (o K - DEPARTMENT OF COUNTY ENGINEER
CITY `TE _ e_ zip BUILDING AND S.AfETY DIVISION
1 NO.OF BLDGS. BUILDING / //
SIZE OF LOT.S0X 1 20 NOW ON LOT ADDRESS .fes (i
TRACT b$O BLOCK LOT NO. LOCA L''ITY
TEL, NEAREST
OWNER 3 0E-SA oUfFL N0.2 S' CROSS ST.
_ -ASSESSOR,
ADDRESS �Il.^/��,} ()es' MAP 8001( PAGE CEL
_ DISTRICT JGROUPJT�YPE FIRE" ROC SSED BY
NST, - ZONE
CITY �L L..�7 G.� � / .21P -�" -
ARCHITECT OR - TEL.
ENGINEER NO. -
STATISTICAL CLASSIFICATION SEWER MAP
g
ADDRESS CLASS NO. (LElk K PG
CONTRACTORHEE0.
L. - USE ZONE NOP MA
U�
LIC. SPECIAL
LIC
ADDRESS 0 - - CONDITIONS
CITY LIC. ....
CLASS -ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH B DG.SETBACK FROM
IFPONT PROP.LINE OF (STREET)
ADDRESS CITY
H GHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING U
SQ. FT. "NO.-OF -- NO. OF CHECK - FRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
} _ O
DESCRIPTION OF WORK - NEW U
"BLDG.SETBA;C-K.E.ROM
�oG �.YAL.Lr - " f{ ADD - .SIDE PROP. LINE OF' - (STREET)
ALTER ❑ _ TOTA L'.,S E.T BA CK.FROM .TYPE OF EXISTING
-(III LA c - el oft&_TY HIGHWAY } YARD -
F Il 7 SIDE PROP: LINE HIGHWAY WIDTH
REPAIRQ
USE TI DEMOL }
EXISTING BLDG. ❑
APPLICANT TEL CORNER CUTOFF YES ❑. NO. ❑.
(PRINT) NO.
BY (SIGNATURE) �`��- �F IN OPEN SPACE YES NO
❑ ❑ '
Q IN COASTAL'ZONE- YES ❑ NO ❑
VALUATION$ e CATEGORICAL EXEMPTION YES❑ N.0 ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE-IS CORRECT AND.AGREE TO'COMPLY IMPACT EXEM.PTI ON'DEC LA RATION SIGNED - (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING_TO /
WORKMEN'S COMPENSAT N INSUR NCE.
SIGNATURE OF/
e 3
PERMITTEE
ADDRESS
TEL. /y�� .
By
CITY NO. � DATE fp
11;1 hf_' CHECKS /?:1 YA L31 7"0: PEE $ PME
HARVEY T. BRANDT. COUNTY ENGINEER !, h
V(J
'PLAN CHECK VALIDATION CK. M.O. CASH a PERMIT VALIDATIO K. M.O. CASH
- I"0 1 55 4 473 -JUN 7 1 D 9.0 0-
76A638A CE 4803 12/72
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES'
'WM., J. FOX, CHIEF- ENGINEER
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN
B DINGf DISTRI T'NO: PLANCK. NO. PERMIT NO.
UIL EBB
Al.R 7414460
LOCALITY R EIVED BY DATE OF APPL. DAT SSUED
/c•...,,.�..,./,�m6• II ..fs - �E/rye
NEAREST +.� / .
CROSS ST., _ BUILDING
_�•l7` r�'
/ ADDRESS
OWNER
MAIL' ' .. LOCALITY
ADDRESS ct of f. °e.. - ,c i`�.sa++ti_ u.»..rr.,. NEAREST
TEL.. .. CROSS.ST.
CITY g„ ,..,.� ''n• p1. NO. ZFIRE I
ONE �NO: OF _.I TY I GROIN
ARCHITECT OTF` ' . - `TEL., PLANS
ENGINEER .�/ O.K BLDG:.SETBACK INE
ADDRESS -
A •'�. APPROVED .r"►� .� (,� Y' C Rte.
L. a BY . - DATE
CONTRACTOR NO. USE APPROVED'
ZONE / BY DATE
ADDRESS - HOUSNUMBERING
LEGAL ` (g/
DESCRIPTION .I,LOT NO. r 3. I BLOCK �^ MAP. NUMBER -'o'" `+ /`� FIELD'CHECK BY
�D NO. ASSIGNED BY _.� /(
' TRACT A!VDTF_
NO. OF BLDGS. CORR'ECTIONS.'
SIZE OF LOT'.0 1 f I.NOW ON LOT
USE OF - NO. OF
EXISTING BLDG,.. ,Q,/�-" - I FAMILIES JI
z
DESCRIPTION OF WORg
NEW. I (:ALTERATION I I,ADDITION
REPAIR ',I., (.DEMOLITION I
SQ. FT. ...„ NO. OF .: G
_. SIZE ,x ROOMS j Y. STORIES
.EXT. WALL ROOF - - r
COVERING `;,�/�„�. I COVERING _.
USE OF STRUCTURE,.
APPROVALS
INSPECTOR'SSIGNATURE DATE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION, '.
PLICATION AND.STATE THAT, THE INFORMATION GIVEN IS FORMS, MATERIALS %V'Q�
CORRECT.
I' AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS,'
HER
AND WITH'ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS.
LAWS REGULATING BUILDING 'CONSTRUCTION. �` � FURNACE: LOCATION, -SIGNATURE-OF /V // tA/� 0��L.:�:_, GAS VENT, DUCTS .
" PERMITTEE.c -✓�+ .•r-"��' �1I ll..-- /(I/�WPL-iiJJ�
_ LATH, INT.
ADDRESS `� � A A .�VIA.G1nVt:,.. �� - -
- LATH, EXT. - I A.T!J '-
AUTHORIZED AGT, r v
PLASTER, INT.
7GASSSA-- DBSS 10-60 „$. P. C.
® 29� FEE PLASTER, EXT.
VALUATION �• ? '✓ D -- $ (7 �
®
FEE FINAL v>
DEPARTA= OF COUNTY MGIIV=
`-'
DIVISION OF BUILDING AND SAFETY .
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER APPLICATION
CASSATT D. GRIFFIN. SUPT OF BUILDING
FOR APPLICANT T IN FOR OFFICE USE .ONLY
DISTRICT NO. .PLAN CK.OR REc.No. PERMIT NO.
BUILDING V a6�
s ADDRESS r J�1J
LOCALITY•J� RECEIVED BY DAT/E�OF APPL. DATEISSUED
NEAREST
CROSS ST. BUILDING
OWNER �� ADDRESS
MAIL L LOCALITY
° ADDRESS T NEAREST
J TEL. CROSS ST. LA e o, /Sea D L-.
CITY NO
ARCHITECT OR FIRE NO. OF TYPE GROUP
TEL.
ARCHITECT Ot� ,
ENGINEER NO ZONE I PLANS I `-
ADDRESS - SET ACK LINE
TEL. USE APPROVEDi
CONTRACTOR ' 0 NO. ZONE d- BY Y DATE
HOUSE NUMBERING
ADDRESS -
° LEGAL I °� MAP NUMBER -� I•�� NO. ASSIGNED BY I
DESCRIPTION LOT NO. v BLOCK
CORRECTIONS
TRACT �I
SIZE OF LOTNO.
D I NO.OFBLOGS.
�,d�-�� _-�.., a NOW ON LOT
_MISTUSE ING BLDG.l •l`� (A�/l./(� I FAMINO.LEB
- e DESCRIPTION OF WORK o —
NEW
ADDITION
IR I-I DEMO(TION
r
R
SO. FT: r NO. OF '
SIZE ROOMS STORIES
EXT. WALL I ROF
COVERING COOVERIN
USE OF STRUCTUR s
APPROVALS
INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION
w FORMS, MATERIALS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, t
PLICATION AND STATE THAT'THE INFORMATION GIVEN IS ' BRACING, BOLTS
" CORRECT.
IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION,
AND STATE LAWS REGULATING UILDING CONSTRUCTION. GAS VENT, DUCTS
SIGNATURE OF .,,,icy a LATH, INT.
PERMITTE
LATH. EXT,
ADDRESS '
PLASTER, INT. -
AUTHORIZED AGT.
!/��•� PLASTER, EXT.N � FEE S HOUSE NUMBER COR-
RECT AND POSTED
O
VALUATION FEE $ ` FINAL
7CA688A 0863 8-82
DEPARTMENT OF COUNTY 005_ING
AND SAFS ETY � ® 11 >f APPLICATIUN vK Jt'�tttvxl l
• _ M/P9. J. FOX. CHIEF ENGINEER E '
O L -
i FOR APPLICANT TO FILLI
.IN" . FOR.OFFICE USE ONLY
DISTRICTWO.. PLAWCK.:NO:;' PER141T'NO.
ADD EISS AVM A !l/
LOCALITY E'^4 P L ie C, RNEARESTECEIVED BY /DATE OF ADPL. DATE IMBUED
CROS ST. 1/ Je ✓" �a� ��^` �I
NG
DD EI
ASS 42Zft IS i
OWNER
MAIL / / LOCALITY' !^- 4- 440 ! , G'
ADDRESS (� 2 Gtl /Al S OA/
NEARESTTEL.
CITY Z!l7NO. i - CROSS ST. �J*
FIRE NO..OF TYP_ @ROUP
ARCHITECT OR TEL. ZONE PLANS, Z/
ENGINEER NO.
BLDG. / l a ORD fC r
ADORER SETBACK LINE ?�,J
APPROVED
TEL BY DATE
CONTRACTOR S p�NO.
tt Lj USE APPROVED
O-�
ADDRESS 0/h Q NT�s ZONE fI BY DATE
-LEGAL CORRECTIOMS
DESCRIPTION LOT NO. BLOCK
TRACT S,
NO.OF BLDGS.
SIZE OF LOT O ® I NOW ON LOT IV D N
USE OF NO.OF NO.OF
EXISTING SLOG, FAMILIES ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
REPAIR MOVING DEMOLISH A
VB•v s- C 000E�'4T p
Sq �. = � ROOMS STORIES
SIZE'' /✓UT C/T i�•v a—c� /�u�!✓
"WALL ROF
COVERING '54 V c_c_ 0 I COVERING DOL LfM I t a
USE OF NEW 7t�1 l,�
Bf✓UILDING uj t? L L I /V G '� 0,41Z.,f
' C_
FA 1A 1 L
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS "PROYkLS/
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR .D'Aj�9
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS
AND STATE LAWS REG L'ATING 8191-DING CONSTRUCTION.
FRAME: FIRE STOPS, L�Vjg✓ /r7
_ SIGNATURE OF - BRACING,BOLTS
PERMITT •/ '
f
LATH, INT.
C AUTHORIZED AOT LATH, EXT. • ��
.. +... ay-"
7GA63BA-3 2-50 $ P,C.6 �' PLASTER.INT.
FEE Oi
PLASTER.EXT.
VALUATION .
FEE O , FINAL ��J�-f-
76A638A CE#803 L-67 APPLICATION F „ . le(��il
BBUIL®ING P �`�
®
COUNTY OF LOS ANGELES 'IBUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER ,NEAREST
COLEMAN W. JENKINS,SUP'T OF BUILDING ACROSS ST.
DISTRICT NO.. GR P TYPEC_ "" PF.00 �S Y,_
FOR APPLICANT TO FILL IN c �. t�'' � CONST'. >/ �/
r _
BULLDING STATISTICAL - SE R MAP
AODRESS.` 9' U�TBry CLASS NO. DWELL U-NITS BK PG
i LOT NO. - BLOCK'
USE ZONE MAP,
NO.
TRACT _ ✓: /J . i
/r 'SPECIAL _
QNO. OF�BLDGS.
SIZE OF LOT L CONDITIONS
rX ZO NOW.ON LOT -
'. USE OF
EXISTING-.01,0Q.. �'` -0 BLDG. SETBACK FROM _
T EL FRONT PROP. LINE OF (STREET)
OWNER N CO �r ^I�GM�nN O. 1,”^L (oZ- 5 TYPE OF EXISTING SETBACK HIGHWAY + YARD TOTAL -
ADDRESS -:k �Lj -� 1 t1Li F�1 ') - HIGHWAY WIDTH FROM C.L. S�• .
CITY
. �L.•—��I�L. �l� —1 g tel/ i + .1 c
= Cl(J
ARCHITECT - �•- TEL
BLDG: SETBACK FROM -
ENGINEER ' ,ILP NO. ) -Z�I.Z SIDE PROP. LINE OF (STREET)
.0 ^TYPE OF .EXISTING SETBACK HIGHWAY + YARD TOTAL
` %=
ADDRESS �p FvA�'J>N.� HIGHWAY. WIDTH- FROM C.L'.
�A 7 _
CONTRACTOR NbL �.p _�Zq�OZ + -
nn ,, ►[+ a
. ADDRESS OtL !'V Y�(�{,(�/)'ltq '' •'��' - CORNER CUTOFF YES NO _C
CITY =1A'LpIC Lic SEEREVERSESIDE FOR SPECIAL APPROVALS
C
DESCRIPTION OF WORK
CL
NEW' ADD - ALTER EPAIR• DEMOLISH - z
SQ.FT_. `•.NO. OFNO. OF
SIZE STORIES FAMILIES " " -USE OF
STRUCTUREcr-
f4uA
SIGNATURE
APPLICANT
VALUATION _ J
�+ "oo APPROVALS DATE INSPECTOR'S SIGNATURE ' -
P.C. PAgT, FOUNDATION, LOCATION - -
FEE$. FEE$ . / ( 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 TNA DOING WORK
AUTHORIZED,HEREBY 1 L NOT EMPL ANY ERS IN VIOLA- LATH-. INT..
TION OF THE LA E O TH E OF LIF RNIA RELAT-
ING TO WOR E S 10 1 RAN E. LATH. EXT. - •
SIGNATURE O HOUSE NUMBER COR-
RECT AND POSTED
ADDRESS '� L FINAL
JOHN F. LEWIS. PRINCIPAL ST URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.0 CASH
Lht o y 6 4' NOV 3 0 1 0 9.0 0
WORKERS' COMPENSATION DECLARATION
I hereri affirm that I have.a certificate of consent to self D D �( M
insure, or a certificate of Workers' Compensdtion Insurance, . �A AUPOM O� [.0 n [ U L O�.0 :��_', E.. M'd
y,or a certified copy thereof (Sec. 3800, Lab. C.):. COUNTY OF LO&ANGELES• •BUILDINd-AND SAFETY
Policy No. Company
- . BUILDING
❑ Certified'co y is hereby furnis'hed. ,,-:FOR APPLICANT TO IN ADDRESS'/414,e,'
❑ .Certified copy is filed with the.'county building inspec- BUILDING
tion department.. ADDRESSG/g 411, KA ek P F M !/
Date Applicant, CITY elT - ZIP.'. O'' CALITY .*� ...
nI LO
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF-BLDGS., NEAREST
COMPENSATION INSURANCE SIZE OF LOT 7C Q NOW.ON LOT' CROSS ST. /L K G.f ZIT,
(This section need noY be completed if the permit is for one TRACT.• BLOCK
LOT NO MAP BOOK, PAGE. , PARCEL
hundred*dollars ($100)or less.) ` TEL p
USE ZONE
I certify thac',in the performance of the work for which this OWNER O s y NO.�
MAP
N0.
permit is'is
becsued, I shall not me subject to the Workemploy any person in any manner SPECIAL •'•:
so as to oers'ComADDRESS /q CON
pensation Laws. CONDITIONS
Date Applicant_
' CITY .' .°'�� ZIP �--
NOTICE TO'APPLICANT: If, after, making, this Certificate of ARCHITECT-OR.ER, TEL_ �_
Exemption, you should become subject to the .Workers' - ENGINEER - NO.,-
DISTRICT, GROUP TYPE FIRE OCESS Y
CONS
Compensation provision's of the Labor Code, you must forth- - ((�� Q
P P Y ADDRESS * V 1
with comply with such`provisions or' this permit shall be TEL.
>
APT• COSTATISTICAL CLASSIFICATIONdeemed revokedCONTRACTOR NO.
.LICENSED CONTRACTORS DECLARATION : UC. _ CLASS NO., DWELL. UNITS'
I hereby affirm that,l am licensed under provisions'of Chapter 9, ADDRESS NO: SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and;' LIC: q.
Professions.Code, and my license is in full force and effect..; CITY CLASS BK VALIDATION O
SQ. F NO_OF NO:OF ) CHECK
License Number Lic.Class SIZE. STORIES FAMILIES !' ONE ° V
VALUATION
DESCRIPTION.OF WORK.'G A! ��£ NEW
d
Contractor Date ADD ' C9 O
0I.am exempt under Sec. w
1. B.BP.C.for this reason B GvtV'S2 hU/c.l)£d2 $'
ALTER
REPAIR ❑ k
Date: USE OF DEMOL ❑ Z
EXISTING BLDG. Lc S wC, .
OWNER
APPLICANT TEL:
Signature;. FINAL u
BUILDER DECLARATION PRINT) JOF: s AN/ U L NO v DATE r $ - -
I hereby affirm that I am exempt from the Contractor's License
ADDRESS' /�. G %lY /IJ `.- FIIdAJ
ProfessionLow for s Code)following reason (Section 7031.5, Business and PRESENTRBT j.tr y
1. BUILDING -. {.,tri nF.
wades as their sole compensation,will do he work and ADDRESS ��r
1'.as owner of theproperty, or m employees with � 171
11 s
the structure is not intended or offered for sale(Section. LOCALITY
�,163137
1
ii MM
' 7044, Business and Prof essions,.Code). MOVING TEL.. y kFi
CONTRACTOR NO.'
I, as owner of the property, am.exclusively contracting . ? TOTAL,,' y,'�.� m'�
with.licensed.contractors to construct the project (Sec
ADDRESS, " o £Y 1
tion 7044,Business and Professions Code). �.v
REQUIRED TOTAL SETBACK _
CONSTRUCTION LENDING AGENCY YARD HW.Y
O SET BACK PROP."LINE WIDTH' ! {3` 1 e1313
'I hereby affirm that there is a construction lending agency for FRONT '. CHA
the performance of the work for which this permit is issued P.L. J V
(Sec. 3097, Civ. C.)! SIDE {F � /
P.L. - a _ ,'. ) iJ It
Lenders Name t
A' r� (�/ LDMA/Ref. # I�,fib i i 8
- P.C. Fee$'- Permit Fee 1103. t/ ., .. - .
lender s Address
g I certify that I.have read this application and state that,the Issuance Fee ✓+ 0 `� -LDMA'P/C#
•� above information is correct.:I agree to comply with all County
Investigation Fee
o ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
o and hereby thorize reps entatives of this County to enter
. upo� the a o e-mentione property f inspectio purpo S.
sEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Da