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HomeMy Public PortalAbout6210 KAUFFMAN AVE_Building__ D;$AFE•TY SION OF BUILDING AN � BUILDING I Department of-County Engineer-, ti County of Los Angeles - APPLICATION WM. J. FOX, COUNTY ENGINEER FOR APPLICANT TO FILL.'�IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. ORRec.ND. P/yE�RMIT NO. ADDRESS .S � 7,:�/D RECEIVED BY DATE OFAPPL. DATE ISSUED NEAREST • (,.a},'/�''j''�� -7��"[�L-�� 5V CROSS ST. LOn dOn ADDRESS- -�•^r•^�-'�`. I�.E�/�LGf// _ OWNER Eugene & Henerrs etta Hart-1 8 LOCALITY MAIL Z( O ADDRESS NEAREST CROSS ST. l�- TEL CITY NO. FIRE NO.OF TYPE GROUP ARCHITECT OR TE ZONE PLANS L ENGINEER NO. B ` O}R`Dy NO. BYT®ACK LINE �Y D �_ /4 T ( 7� ADDRESSUSE //�, APPROVED 7 EL' ZONE/ I —/ BY >�DATE ' CONTRACTOR Eo No Duncan ND. AT 4455? HOUSE NUMBERING ADDRESS 61 a ii MAP NUMBER d NO. ASSIGNED BY LEI?AL BLOCK CORRECTIONS DESCRIPTIONLOT NO. TRACT NO. OF H. NOW ON LOT - SIZE OF LOT USE OF I NC.DF / !K ✓ __EXISTING BLDG. FAMILIES f,i(,'A- he•�-- --lv, ' DESCRIPTION OF WORK , _ N Ci tG A NEW ALTERATION ADDITION "� Z d•l T1l ID. REPAIR DEMOLITION 8 ZE FT' 484 ROOMS 4 STORIES /1 RA)r- ��� 5/ OV COVEWR,ING StUCCo I COVVEERING Rock USE OF STRUCTURE Dwelling �_L 4,6_ U r 7-.1 C/9/✓�3,� OG/✓ To INSPECTION FOR rM�eJAPPROVALS OCCUPANCYAS INSPECTOR'S,SIONATURE DATE FOUNDATION: LOCATION A j FORMS, MATERIALS / u I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-• 11 PLICATION AND 13TATE THAT THE INFORMATION GIVEN 19 FRAME[ FIRE STOPS, Ur� CORRECT..- BRACING, BOLTS 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, v AND STATE LAWS/REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS . I/ i SIGNATURE OF /Sr LATH, INT. PERMITTEE �!w Tunas, - d ADDRESS 832!`, L' - Las Tun&B S -, S. (1p LATH. - v PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. HOUSE NUMBER COR- �j RECT AND POSTED VALUATION —LLJ FEE /` a� FINAL • 76A63BA DBS 3 1-52 APPLICATION, FOR BUILDING PERMIT- COCINTY.OF LOS'ANGELES - BUILDING'AND SAFETY• WORKER'S COMPENSATION DECLARATION s' FOR APPLICANT TO;FICL,IN ? BUILO/1I�G ADDRESS' BUILDING ADDRESS , / I hereby-affirm,that I tiave a certificate of consent to,self insuie; -L,h /v or a'certificate of Workers''Corripensation lnsura6ce,'or a'certified copy thereof,(Sec 3800,.Lab.-C) 1". 7_ ,t`. . CITY' Gt% - ZIPG/� J�� LOCALITY Policy No' Company:• SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified'copy is hereby fu7nrshed '' NEAREST CROSS ST; ❑ Certified copy,is filed with the county "inspection TRACT BLOCK ' LOT NO department - - - USE ZONE MAP NO ASSESSOR MAP BOOK - PAGE PARCEL Date Applicant SPECIAL CONDITIONS CERTIFICATE'OF EXEMPTION FROM WORKERS'- OWNE�t'- , � lai+�i NE TEL No ' COMPENSATION INSURANCE A, ► WITHIN 1000 FT OF.SCHOOLI YES No (This section"need not be completed if the'permd is for one hundred ADDRESS ' ' 'o , ' �/.,, �,, lrv� DISTRICT GROUP TYP ONST FIRE ZONE PROCESSED RV dollars*($100)or less.). '' '' ,-•. ��rt�r` •- _ CITY ) ZIP ' I.certify that iri the performance of the,work for'whK A this permit �rn �� L� d I!" � 0 3 is issued,•I shall not employ any person in any mahner so las to ARCHITECT OR Et4GINEER TEL NO become subtect'to the Workers'-Compensation Laws.' STATISTICAL CLASSIFICATION i APT- CONDO. Date •' Applicant ADDRESS CLASS NO• DWELL UNITS ` NOTICE, TOAPPLICANTIf, after making this Certificate Of' REQUIRED ; TOTAL SETBACK FROM EXIST .Exemption,' you should become subject ,to 'the Workers' CONTRACTOR TEL NO ,SET BACK YARD- HWY - PROP LINE _ WIDTH i 'Compensation provisions of the Labor'136d6, you must forthwith FRONT t `- I- comply with such,provisions orchis permit.shall be deemed revoked ADDRESS LIC NO P'L } < LICENSED CONTRACTORS'DECLARATION CITY LIC CLASS PIDE _ ` ;0 U I- hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (corrimencmg with Section 7000).of•Division 3 of the Business and SO F7A47 1ZENO OF STORIES NO'OF FAMILIES Professions Code,and my license`is In•full'for9e•and effect (P NEW ❑ BK PG' DE IPTION OF WORK ADD ❑ VALUATION U License Number Lic .Class _ %' p�J W LGC $ o�j �fJ• -- n. Contractor• Date,' ALTER ❑ Cn ❑ I am exempt under Sec REPAIR ❑ $ Z B.&PC for this reason r lij DEMOL ❑ LDMA PSC# Date t USE OF EXISTING BLDG URM ❑ ' ''.Signature APPLICANT(PIRWT) TEL NO LDMA Perm N Xheir , as owner'of.the'property, or my employees with wages as Z' ' sole compensation,,will do the'-work'and the structure is ADDRESS •.1.•_, not intended or offered-for_sale(Section 7044, Business and - T' - FINAL DATE Q Professions.Code.) C.CT. WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL JO OR GREATER THAN THE T � Q �r1yJ 11 ❑ 1, as Owner of the-,property, am exclusively contracting with AMOUNTS SPECIFIED ON-THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY 3303`,S. '' ',�`•`'`T°� '' licensed contractors to construct the project (Section 7044, yes❑ N6 E3 Business and Professions"Code) 1 1 ITEMS EMS • _ WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '.,' - TOTAL CONSTRUCTION-LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ® � - GUIDELINES - - - •{� 1iJ('�8.90 CHECK I hereby affirm that there is a construction lending agency for YES❑ No❑ L t_•I the performance of the work for which this permit is issued(Sec 1 CHANGE, .00' I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING - ilt-II'i •3097,CIV C.) L - CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, - a - 0 .- TITLE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS ^` - p, Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD Lender's Address `{ f3ofio-013101 4/25/96i, • -' Ok"ER OR AGENT _ 3 I certify that 1"have read this application'and state under penalty 1' 5`03,a CL - PC FEE PERMIT FEE .6076 0 of peryury'that the atiove'information is correct I,agree'to•comply ^ / L ; rn with all county ordinances and State laws relating to building ' ry - _.• CD construction, and hereby authorize representatives of this County. ISSUANCE FEE to enter u ect n the a ve- ntioned property for inspn pyrpo es `JLJ INVESTIGATION FEE - TOTAL FEE N rpwture d AparoM b Aq- SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION' affirm ncertificate ltself •I O N .-FOR:. B U It D I N G PERMIT I T insure, or 'certificate,of Workers' Insuran APPLICAT : or a certified copy thereof'(Sec. 3800, Lab: C.) coups*Y OF LOS ANGEk-'�;� BUILDING`AND SAFETY NJ Policy No: Company 4 BUILDING - ❑ Certified copy is hereby furnished: °;, FOR APPLICANT.TO FILL- IN }. ADDRESS cotio cHAr! ❑ - Certified copOs filed with the county building inspec-- BUILDINGS tion department.- ADDRESS fj /� 7YLR►t �V� ��y� CITY Q ZIP• LOCALITY Date Applicant NO OF BLDGS NEAREST• _ CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE'OF LOT We X I(OS NOW ONAOT CROSS ST. ; COMPENSATION INSURANCE~' ASSESSOR .(This section need not be completed if the permit-is for one TRACT BLOCK LOT NO. MAP BOOK` 5s -PAGE°(��/' PARCEL hundred dollars.($100) or-less.) / TEL 6 oq USE ZONE - MAP.' �1 p OWNER G �{ l Gv/4� NO. Sib & / [ I certify that in The perfor.mance`of.the work for which this SPECIAL• - permit.is issued,.)shall not employ any,person.in-any manner ADDRESS 6.10 At. 7ytA« 1 �' CONDITIONS so-cis;to-bec6me,subject to the Workers'Compensation-Laws. O CITY (12Z ZIP64 11.2POU Date! Applicant ARCHITECT R. TEL. DISTRICT, GROUP. TYPE FIRE, PROCESSED BY O NOTICE.TO APPLICANT:.-If; after making this Certificate of ENGINEER _R- NO. CO 5 . ZONE (— Exemption, ,n;you-'should becomes sub ect:to the Workers' y U CompensatiopcoListons of The Labor Code,•you'must•forth= ADDRESS: with,comply,with,such provisions•oc;this.permit shall be TEL- T STATISTICAL CLASSIFICATIO APT CONDO. N deemed,reyoked:k o CONTRACTOR NO. '.y /� Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS — I hereby affirm that,I am licensed under provision's'of Chapter,9 ADDRESS NO _ SEWER MAP .(commencing with Section°7000),of Division 3 of-the-Business LIC. and Professions,Code,*and my license is in full force and effect. CITY• CLA55 . Ek' PG 76 VALIDATION SQ. FT'• NO OF �'" NO OF ';CHECK' _ , License Number Lic. Class - `' SIZE 2Q O STORIES FAMILIES ONE ^ VALUATION Contractor- Date' DESCRIPTION OF WORK. l0 NEW ❑ ; 4�M" - ADD. ,.El1���/�"' ► -. ❑I am exempt,under Sec"" . - ALTER ❑ B.BP.C. for this°reason REPAIR ❑ $ ' Date: EXISTING BLDG., y DEMOL 1-1 Signature APPLICANT TEL. < ' FINAL OWNER-BUILDER DECLARATION (PRINT). NO. DATE . I hereby affirm•that I am exempt.from the Contractor's License ' Law for the following•reason- (Section 7031.5;Business and ADDRE^SS FINAL 2'2• , . Professions Code): . +• PRESENT _. sy - - '< BUILDING ° I, as owner of the. property, or my-'employees with ADDRESS r_ `, y �� wages as their sole compensation,will do the work and - mac#` it +°!:-' the structure is not intended or offered for sale(Section LOCALITY- MOVING 'tTEL ��•'$ ` �' 744 ,0 , Business and Professions Code.) _ �' Z CONTRACTOR• NO. 1 ❑ I, as owner of the property, am exclusively contracting with licensed contractorsto construct the prolect•(Sec- a . '1 _- ADDRESS — t tion 7044,-Business and Professions Code.)' Its �y ',,_•_„ REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SETBACK- YARD HWY PROP,.LINE WIDTH t TTP I hereby affirm that-there is a construction lending agency for FRONT ` '� the'performance of the work fog which-this permit is issued P'L. j i!EI .192-. 33 (Sec. 3097, Civ. C.). 'SIDE, Lender's Name Pa.'•r t•[I"ss�GhhC LDMA.Ref # i 14 A.f�{? P.C.;Fee$ Permrt'Fee Lender's Address f l,� , o I certify that I have read this'application and state that the Issuance Fee ,q LDMA P/C# above information is correct.:)agree to comply vwith all County Investigation Fee. / 1!i Ik li(—!END 1 w 7`' =•'t ordinances and State laws relating to building construction, Total Fee b LDMA Perm # r° Q•, and.hereby authorize representatives-of this County to•enter i�; :°1_,? ' upon the above mention d'property for insp ec tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE1 Sig nature of Applicant or, t ; Date WORKERS'.COMPENSATION DECLARATION - _ I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers''-Compensation Insurance, - A P P-L I CATN , IOFOR•,�U I L D I N G P.E RM i T - or,a certified copy thereof (Sec: 3800,,Lab: C.)' - COUNTY OF LOS ANGELES BUILDING'AND SAFETY ' Policy No. Company BUILDING' •FOR'APPLICANT TO FILL"IN"• to /, .,-'❑ Certified copy�s hereby furnished: •• • � ADDRESS• ' BUILDINGCertified copy is filed with the county',building insPec- SIO N- aK _M4_YADDRESS (/ ' tion department. „ CITY , ZIP ( /7 LOCALITY ,Dater Applicant NO'OF BLDGS IF, CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE-OF LOT NOW ON'LOT NEAREST CROSS ST. a COMPENSATION INSURANCEASSESSOR' .i (This section need•not be completed if theperm .it is for one TRACT' BLOCK LOT NO MAP BOOK"" PAGE• PARCEL ' hundred,dollars ($100) ori'less:) - a JJ TEL ,�y p OWNER F�N� , W�n `NO 8rb �-O6' qq-ol 1 USE'ZONE: . MAP NO. / �J I certify that.in the performance'of the work for which this SPECIAL. permit is issued, I shall.not employ any-person in"any manner ADDRESS. > �,_ � CONDITIONS. O so as to become subject to-the Workers"-Compensafion Caws. r� e CIN - ,.Q `, zlP.:'G�' .! .amu••.:: ., - U' Date Applicant, y ARCHITECT OR t TEL. DISTRICT GROUP. TYPE' f. _. FIRE. . PROCESSED BY, NOTICE TO APPLICANT: -If, after'making this Certificate of ENGINEER- NO. CONST.Exemption, you •should-become- subject to" the Workers' pp w Compensatiornprovisions of the Labor Code„you must forth- "ADDRESS -with comply with such provisions or-This permit;shall be T STATISTICAL CLASSIFICATION APT. CONDO. ; Z, deemed revoked. : i TRACTOR LICENSED CONTRACTORS.DECLARATION LIC CLASS NO. DWELL UNITS ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 NCO - SEWER MAP } (commencing with Section 7000)of Division'3'of the Business CITY•. CLASS and Professions Code,and my license is in full faice and effect. BK. PG. VALIDATION ' SQ. FT NO.;OF NO OF CHECK' _ SIZE. STORIES FAMILIES ONE” 'License'Number { Li c. Class VALUATION ""• DESCRIPTION OF WORK NEW Contractor Date- S d Oti�'! ►- ADD ❑ ❑I am exempt under.Sec. ALTER, ❑ B.&P.C. for this reason' REPAIR ❑ $ " USE OF S Date-' EXISTING BLDG DEMOL ❑ APPLICANT -TEL.- Signature' � - _ . r •FINAL i ' OWNER-BUILDER DECLARATION ' (PRINT) NO. E °: DATE CZ-'1Z I hereby affirm that*1 am exempt from the Contractor's License a "' 47C,,.7' ; °{ Caw for'the 'followi'ng reason (Section 7031.5,;Business'and ADDRESS FINAL Pr essions Code): - PRESENT • . By.,*_. - - BUILDING as own of the property, or'my employees•with ADDRESS r` ' ir s. wages os,their•sole compensation,will do the work and.4 �+ ; t ) °g the structure'is not'intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) - — '- MOVING. TEL' i t•)' �' 4 :°.;�_�- CONTRACTOR NO. I, as owner of the property, am exclusively contracting iT_i.'•_= with licensed.contractors to construct the project (Sec- ADDRESS ' tion 7044; Business and Professions Code.) J " ' = REQUIRED. .' - TOTAL SETBACK FROM EXIST, t _ CONSTRUCTION LENDING AGENCY SET BACK - YARD HWY` PROP LINE WIDTH' L•€71 L_• �' ' I.hereby affirm that there is a construction lending agency for FRONT 'the perfofmance of the work for which this-permit is issued "PI:• "- i.•H NG e•_. e)_€![ (Sec 3097, Civ. CJ.• - ., ,/ , I SIDE,. Lender's.NameJLliu/V 'L�1 P L $ LDMA Ref # i it �/D �/�� P.C..Fee S Permit Fee O i Lender's•Address - :. t7�•=t. i lf[• oaf. o I'certify that I have'read this application and state that itie Issuance Fee Ol CDMA P/C# ,^ -8• above information is corfect.:l agree to comply,with oll'County, Investigation Fee ordinances and State laws relating'to'Liuildmg construction, Total Fee CDMA Perm # a and hereby authorize representatives'of this County to enter upon the ove-mentione-d'pr perty-for inspection purposes. A _ SEE REVERSE FOR EXPLANATORY LANGUAGE` y Signature of Applicant or Agent Date— WORKERS'COMPENSATION DECLARATION" T'hereb 'd cit r that I have 'r certificate of consent to self APPLICATION :FOR BUILDING -PERMIT •" e,,,iir d certificate'of Workers' Compensation Insurance; c6rtified copy thereof (Sec: 3800, Lab. C.) ti .�_f•, � 'COUNT.Y.'OF LOS:ANGELES•'..- BUILDINGA14 SAFETY Policy No. ' Company , ' BUILDING / J a Certified copy is hereby furnished. :':FOR'APPLICANT TO'FILL-IN, ADDRESS ' aCertified copy is filed with the county building•inspec- BUILDING , department. •- ADDRESS ">'� � {� - /] p� NEAREST Date. Applicant CITY ZIP R1 3v CROSS S. CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS: ASSESSO COMPENSATION INSURANCE, SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be-completed if the permit is for one USLZONE. MAP 7�_ 6 hundred dollars'($100)or less.) TRACT BLOCK - LOT NO. NO o .TEL Com$ •. SPECIAL y Itceriify+that in the CL performance of the work for which this OWNER 1 NO ��/���TTT CONDITIONS �- ermit is issued, I shall not:em to an 'person in an manner DISTRICT GROUP TYPE-' FIREC' P SSED BY O P P Y Y P Y ADDRESS © CONST.- ZONE V' so as to become subject to the Work s, Compensation Laws. a = ` CITY. ZIP 3w Date A Applicant s" STATISTICAL CLASSIFICATION ,APT•, CONDO° 0 NOTIC ;TO APPLICANT: If, after makingthis Certrficate o ARCHITECT OR TEL. ENGINEER NO. CLASS NO.' DWELL UNITS- til. Exemption, you should become subject to the Workers d Compensation provisionsa4 the Labor Code, you must forth- ADDRESS 0 SEWER MAP' with comply with such,provisions or-this permit shall be TEL. deemed revoked. CONTRACTOR NO. BK PG, VALIDATION ;' LICENSED'CONTRACTORS DECLARATION LIC - I hereby affirm that I am licensed under provisions of Chapter 9' ADDRESS 40 NO VALUATION ••- (commencing with Section 7000)of-Division 3 of the Business and LIC O ti Peofessions'C6de, and my license is in full force'a6d effect CITY CLASS $-'� �Q ; SQ FT NO OF NO. OF .CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE ► Contractor Date DESCRIPTION OF WORK y NEW O $ < ADD a am exempt under Sec. ALTER .E] FINAL B.BP.C. for this reason DATE REPAIR M - SE OF � = FIN Date: ��JJ��((II 7.� DEMOL _❑ B • EXISTING BLDG"r'""��' Signature APPLICANT, TEL OWNER-BUILDER DECLARATION PRINT NO I hereby affirm that I arr exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Pro essions Code): PRESENT BUILDING I, as-owner of the property, ar 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 7044, Business and Professions Code). MOVING TEL :} CONTRACTOR NO. I, as owner of the property,am exclusively contraciirig STA 8 A with licensed contractors to construct the project (Sec- ADDRESS . - i. .. y ; ?F.' \` tion 7044, Business and Professions Code). 1` "�. #'e o e o'io; REQUIRED' TOTAL'SETBACK FROM EXIST. ` CONSTRUCTION-LENDING AGENCY SET BACK YARD HWY PROP. LIN WIDTH I hereby affirm thafthere is a construction lending agency for FRONT ' Z•',` \ a, 59.25 - M 9,2 5 the performance of.the-work for-which this permit,is issued PL (Sec.-3097; Gv. C.): SIDE = •`ti),it. �' ` ;, z•-> e'.o 05 9 2:5 m P.L. `,.�,• :r Lender's Name C +- �; '- r.;•.�.,F. -', n t,Q 2 3-8-6. Lender,'s'Address y P C Fee$ Permit Fee c 7✓ q �' `' _ ' I certify that I have read this application and state-that the Issuance Fee' 6' above information is correct. I agree to comply with all County Investigation Fee - <' g ordinances and State laws relating to building construction, Total Fee r >j and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. ;• I• " G _L;' , : SEE REVERSE FOR EXPLANATORY LANGUAGE _ ! Signature of Applicant or Age Date R -„WORKERS'COMPENSATION DECLARATION hereb1+s4;ffirm 1h6t I •havecertificate,of consent to self” APPLICATION-FOR B U I L D i N G r P E RM I T irf'ureb'or a certificate of Workers' dmkers' Compensation Insurance, 'or'a certified copy thereof (Sec. 3800, Lab. C ) COUNTY OF L6S-'ANGELES - ;••, BUILDING•AND;SAFETY -.P.Iicy,No Company, Certified copy is hereby'furnIshed.' FOR APPLICANT T_O FIL'L=1N Ao�Rlss ❑ �• Certified_copy is filed with•the county building mspec- BUILDING x • �` •.tion department:, ADDRESS LOCALITY NEAREST ,Date' Applicant CITY ZIP v s �_ CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' .,,• ;. NO OF BLDGS ASSESSOR ' t COMPENSATION INSURANCE SIZE OF LOT �� NOW ON LOT MAP BOOK PAGE. , PARCEL (This'section neednot be completed'if-the.'permit is for one' '" PQN��, MAP, hundred dollars'($100)or,less.),' _ TRACT BLOCK LOT�NO. NO', .! ✓ v// ��) TEL. Aq SPECIAL I certify'ihaT m the performance of,The work•for,which this OWNER ,0 J'I!A- h RV NO��g� •11 CONDITIONS IL DISTRICT - GROUP TYPE- FIRES;.;'. permit is issued,,I-sholl not employ an erson•in an manner. ,, ESSED BY •, O P P y y P y ADDRESS �'d. m �fiV� n CONST.• ZONE tJ `so'as to-become sublect'to the Workers',Compensation Laws. �� O ! � Date �" Applicant CITY l ZtP Crr1 -l6 !O �— O ,NOTICE TO:APPLICANT: If, after making this Cerhficat f ARCHITECT OR TEL. STATISTICAL CLASSIFICATION APT. ]CONDO.':7' ENGINEER• NO. CLASS NO: DWELL. UNITS LU Exemption, ,you should, become' subject to the Workers' tL Compensation provisions of the Labor Code, you must forth- ADDRESS'•* SEWER MAP with comply with'such provisions or this permit shall be "z .0 deemed revoked:` "' ' TEL. BK VALIDATION h CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I-am licensed under provisions of Chapter 9. ADDRESS NO VALUATION (commencing with Section 7000)of Division 3 of the Bdsiness and LIC Professions Code, and my,license is in full force'and,effect. CITY*/ CLASS a , w SQ'.'FT O OF NO. OF CHECK License Number 'Lic.Cldss SIZE �O'D STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑ !' am exempt under Sec. ADD ALTER ❑ FINAL �J B.BP,.C. for reason REPAIR ❑ DATE Date: USE,OF DEMO[ F L EXISTING BLDG. ❑ Signature APPLICANT TEL., OWNER-BUILDER-DECLARATION PRINT NO I hereby affirm that I am exempt from the Contractor's License` Law for the following reason (Section 7031.5, Business and ADDRESS _ Professions Code): NT t ' BUILDING ; 1, 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'sole(Section LOCALITY 4 r•_' 7044,•Business and Professions Code). MOVING TEL " 1,'as owner of the property,•ani exclusively contracting ONTRACTOR NO with licensed contractors to construct the project (Sec-. ADDRESS V. •_ tion 7044, Business and Professions Code). 5 5 a,9 A CONSTRUCTION LENDING AGENCY. r REQUIRED TOTAL SETBACK FROM EXIST. ;`* ' SET BACK' ' YARD HWY PROP LINE WIDTH # s o o e o hereby affirm that there is a construction lending agency for LInveitigation = !,he-performance of:the work for,which this permit is issued e,l 5 5 0 ` (Sec. 3097, Civ. C.). 1 1 5 5 0.6 Lender's Name' , .-07:=86 'Permit Fee - `Lender's AddressI certify that I haveread this application and state that the Issuance Fee'above information +s correct I agree to comply with-all County Fee ordinances and State laws relating to building construction, d and hereby'authorize representatives o is County to'enter Total Fee upon the above-mentioned propert r inspection purposes. s o /U�7 SEE REVERSE FOR EXPLANATORY LANGUAGE _ Signature of Applicant o ent Date ®j �. r