Loading...
HomeMy Public PortalAbout10134 LA ROSA DR_Building__ >.•.E.A=ex....... APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING Q/ DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY _ JOHN A.LAMBIE.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRIC GROUP- TypE //' PR ES ED BY FOR APPLICANT TO FILL IN I CONST. `!o BUILDING ! � /T SEWER MAP ADDRESS /d1� {L. N f/�Q STATISTICAL CLASSIFICATION I BK PG T CLASS. NO. qg3_DWEL�LI. UNITS LOT.NO. ��Cl �� f T BLOCK C' NUMAPMBER o'er !/ STATE YES NO TRACT 10 U ZONE SPECIAL NO.OF SLOGS. �J CONDITIONS SIZE OF LOT ^O .Z GS NOW ON LOT J USE OF EXISTI NG BLDG. /L/N[F BUILDING EXIST. YARD HWY STREET NAME SETBACK WIDTH OWNER (2FRONT I —�••-�T MAIL P.LO ADDRESS I SIDE CITY L0'/7 P L INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ADDRESS ( I TEL. L-l� Kl W'6 CONTRACTOR NO. 'V ADDRESS DESCRIPTION OF WORK �� b NEW ADO) ALTER REPAIR DEMOLISH SO..FT. NO. OF fT J SIZE H2O D STORIES FAMILIES FAMILIES USE OF STRUCTURE \ SIGNATURE OF APPROVALS APPLICANT ��// ADDRESS .7 !Z0 `. FOUNDATION: LOCATION DATE INSPECTOR'S SIGNATURE FORMS.MATERIALS (A RC. S FRAME: FIRE STOPS. FEE BRACING, BOLTS VALUATION S l — V FURNACE: LOCATION. FEE �l GAS VENT. DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH.EXT. STATE LAWS REGU TING I I CONS UCTION SIGNATURE O e 11 HOUSE NUMBER COR- SIGNATURE RECT AND POSTED aooRE55 FINAL CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL EN ER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS IAC6530M NOV10 1 A 5.00 M CCUf DSION N> F OF EIMIG ENCaII AF BUILDING � /� DIVISION OF OF DING AND SAFETY (`IIIA COUNTY OF LOS ANGELE4 WILLIAM J. FOX. COUNTY ENGINEER �r-=APPLICATION-- CASSATT D. GRIFFIN, SUPT OP BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUI ,Jv� / DISTRICT NO. PUN CK.Da R.C.NO. PERMIT NO. ADD RE186G OL`I �JG 5 �� 7 LOCALITY //JJ/JL LL J�� y// y%�� RECEIVEDB DATE OF APDL. DATE SUED CR089T Cf✓/ �� /Y/K/7i P �� 60 �J� /J� BUILDING rJ D OWNER F J 0 11144'4 P �,//Y/ea -A/, ADDRESSMAIL !! ADDRESS �V �/ Y- /�— (C D1 LOCALITY /J / I/ NEAREST CITY �i�4t/..�,/'w �� TOL �DIh Y-Z CRDES ST. ARCHITECT OR ,` , TEL. FIRE NO. OF ZONE PLANS TYPE GROUP ENGINEER `" `>•+ NO. �� I I ADDRESS BLDG. ��/ RR N . SETBACK LINE �! /7 CONTRACTOR ©W� LFA TEL.�Q /iL APPROVED ONE AT /4 �J HOUSE GN UUMBERI ADDRESS /� LEGAL MAP NUMBER �/4 NO. ASSIGNED—DESCRIPTION SSIGNEDDESCRIPTION (I LLOT NO.T�f I BLOCK CORRECTIONS TRACT SIZE OF LOT NOW ON LOT USEOF1Y+�[ T NO. OF EXISTING BLDG. `J �" / �FAmILI¢ DESCRIPTION OF WORE p - e NEW ✓I ALTERATION DEMOLITION ADDITION I Z Z REPAIR r SQ. FT. NO. OF / SIZE � 'Z0 ROOMS STORIES EXT. WALL �+ ROOF /f .y OJSJ7JJ✓ COVERING WsOD S/Q �r COVERING US OF STRUCTURE APPROVALS INSPECTOR' SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS /. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRESTOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS ✓ .�l1i.-..• J ��� j CORRECT. FURNACE: LOCATION. I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT. DUCTS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF t / LATH, INT. PERMITTE ADDRESS A "j LATH. EXT. PLASTER, INT. AUTHORIZED AGT. C PLASTER, EXT. O. B FEE HOUSE NUMBER RECT AND POSTEDED VALUATION FEE B - FINAL Taws" Des a s-es 1 O DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES B , G U e ' L D I N WMI. J. FOX, CHIEF ENGINEER V FOR APPLICANT40 FkLL IN FOR OFFICE USE ONLY DISTRICT NO.- PLAN CK.NO. PERMIT NO. BUILDING ADDRESS " LOCALITY /L/ '� RECEIVED BY DATE OF APPPL.L. DATEISSUEED9 NEAREST O CROSS OWNER A �. / BUILDING Ci //A ADDRESS MAIL ADDRESB� e�/ten�(..( '-�'�'/F LOCALITY NEAREST /� TEL \ CROSS HT. 7 CITY/��/! FIRE /NO.OF TYPE ✓ GROUP/ EN6 ARCHITECTOR OR NL n 'EOL ZONE PUNS BLDO. / OppppD�.NO. ADDRESS9ETBACKLINE �,/ /yH.�✓�/ - �'TZ3 APPROVED TEL BY DATE CONTRACTOR NO. / USE APPROVED ADDRESS ZONE BY DATE LEGALZo /'p CORRECTIONS DESCRIPTION 1 LO f BLOCK TRACT X 1/ NO.OF BLOCS. 51ZE DF LOT ✓ ,J� V NOW ON LOT USE OF � NO.DF NO.OF EXISTING OLDS. FAMLLICY ROOMS - DESCRIPTION OF WORK NEW ALTERATION ADDITION v O A REPAIR MOVING DEMOLISH p so.FT. NO.OF `— Z SIZE ? ROOMS STORIES '/ r WALL ROO .�,. COVERING COVEF RING /Df��yy p'f ©-D USE NEW BUILDIDI NG I HEREBY ACKNOWLEDGE THAT 1 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 BUILDINZiC NBTRUCTIDN. _12FRAME: FIRE STOPS, SIGNATURE OF / 1 BRACING, BOLTS PERMITTEE—/, GV//,L��/J LATH, INT.: / AUTHORIZED ACT " / n LATH,EXT.: fLVALUATION SUM SETS I-48 $ P D. PLASTER,INT. � O J. PEE PLASTER,EXT. FEE �1/ FINAL �-.,����.- .��'�/i/.�•� DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT � COUNTY OF LOS ANGELES , e ' p L D iWM. J. FOX, CHIEF ENGINEER {d FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING �/1 DISTRICT NO. PLAN CK.NO. PERMITNO. ADDRESS / LOCALITY /.��,1//j / L-.rf�i(/L�)�% ) RECEIVED BY DATE OF APPL. DATE ISSUED CNEAREST ROSS ST. _ BUILDING OWNER / I.Y// �/ % '.Q�'LE/ /�'^"'��'�! ADDRESS '— IIJC 1S �JJ /•/O•'o1 G`�� IZi �� MAIL ' 7 �/^A� /y'/A LOCALITY ADDRESS fes./ �� � AI eel/i4 ((AI^{/// } /�I!fY��/1/ NEAREST �NOL CROSS ST. � TE )C.L-VLA f I IBJ FIRE NO.OF TYPE/ GROUP ENGINEER c5 A-/ /G64wj NEOL. BLDG. �. PLANS �-7 _D.N ARCHITECT V /I C./ •� BLDG. /�/�� �D ORD.NO. ADDRESS SETBACK LINE //J LXL/'S APPROVED CONTRACTOR CONTRACTOR / /.tel i" �I�NOL BY DATE v - - - USE ( APPROVED ADDRESS ZONE '/ BY DATE LEGAL CORRECTIONS DESCRIPTION I LOT NO. BLOCK ( j 1. TRACT ��yy !�T SIZE OF LOT/O!¢,Y .L./ \ 1 NOW ON LOTS % USEOF NoEXISTING BLDONN��✓�L I FAMIOi../ I ROOMS DESCRIPTI d N OF WORK NEW ` ALTERATION ADDITION A REPAIR MOVING DEMOLISH m BO.FT/ L' NO.OF Z SIZEROOMS STORIES/'�N'/. y WALL COVER)No IJ f,.0'�}S I COEERING /I f.JW'FZ/Q� r USE OF NEW BUILDING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALL.S �J _ APPLICATION AND STATE THAT THEABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE .AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUYCTION. '4 r FRAME: OPB, SIGNATURE OF BRACING,BOL G,BOLTS PERMITTEE , , LATH, INT.: AUTHORIZED AGT LATH, EXT.: /—I DBS-3 SVM SETS LLLJ C 8 PLASTER, INT.FEE PLASTER,EXT. // r / VALUATION FEE FINAL DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF,LOS ANGELES ' L ® � /�► WM. J. FOX, CHIEF ENGINEER V ®® FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY 3.:F, DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING — LOCALITY / '9/Lt_O/Pi ! G RECEIVED BY DATE OF APPL. DATE IHBU NEAREST CROSS ST. —' BUILDING OWNER �(�(�(r{f^/I 'Ei�/ !/N; AGGRESS MAIL .3// l._ Q� e I LOCALITY �J�A.• Je (2 , `. ADDRESS NEAREST ^�7I TEL CROSS ST. FIREO,OF GROUP ARCHITECT OR TEL N ZONE PLANE ENGINEER NO. BLDG. / ORD.NO. ADDRESS n I SETBACK LINE '.ZI /✓I /V, ..- �� h ��'� TEL APPRO �V CONTRACTOR NO. B . DATE .r I U9[ APPROVED ADDRESS ZONE �I—I 'BY DATE ieowL �J //� _ CORRECTIONS DESCRIPTION OT N BLOCK ,(2 ZO UJ TRACT OF LOT So X v � NOW ON LOOS �yhy fL P.;{a �--,/ / /� , lv / h )4 7( F I FO O[S >/ ROO M9Y:!/ (r-S Y� / G. CRIPTION OF WORK gn/�-6 �- NEW ALTERATION ADDITION �QI��n }gyp /�//,(jy //�,� ,$ P. O REPAIR MOVING ? DEMOLISH y Q O so.FT. NO.OFSIZE L 7/0ROOMS STORIES F WALL � COVERINBma/� COVERING"a" D USE OF NEW ,C BUILDING �An,//[ . v.• � ,.t�/_ � v ! t\ice _ I 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 RE ULATING BUILDING CON fi U TION. y FRAME: FIRE STOPS. SIGNATURE OF / I^ BRACING,BOLTS /2-G-Vf PERMITTEEl/ LATH,INT.: I' �p� �y` Y J AUTHORIZED AGT LATH,EXT.: Des'3 60M SETS 1-45 $ PP C PLASTER,INT. a �A]'/O� PEE PLASTER,EXT.VALUATION / TFEE FINAL lx'�zk. .--� V V / ✓08.3 9.43 SM 3el8 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND 'SAFETY .'.'"COUNTY OF LOS,ANGELES j BUILDING WM. J..FOX. CHIEF ENGINEER NO.OF1- _ BLDG. ORD:NO. DISTRICT NO. PLAN CK. NO. PERMIT NO PLANS SETBACK LINE GS�Ip FIRE 1111- APPROVED v ZONE 1'SYDATE - RE EIV DATE OF ADPL. DATE ISSUED USE APPROVED L . �,e t✓— L/� Gid/ ZONE BY APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY — JaI BUILDING 1 p NAME' ADDRESS' /X / A/ /p► (/�7 OT�y.�+-A FZ ADDRESS LOCALITY V /X -4 s NEAREST U,W 'CIT• CROSS 8T. STATE TEL. i' / LICENSE NO. NO. K HAM E-tt J� /U x ^ W W MAIL (OGm NAME •, ; ADORE/6/5J �.c 2y�2�.��-y1�.1Ff�'R�S j ADDRESS /I � O CITY /.f .'{ �IF✓�/'f NO.TEL' 6 A/Q. It i HEREBY ACKNOWLEDGE THAT 1 -HAVE READ THIS Z V CITY U APPLICATION AND STATE THAT THE ABOVE IS CORRECT. STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. ANDSTATELAWS REGULATING BUILDING ONSTRUCTION. y n 2 �GSIGNATURE ZO "LQT NO. J SIZE OF..LOT �� SIG OWNER OF <6 _ NO. OF BLOTS. AUTHORIZED AGT. f W BLOCK NOW ON LOT < ° TRACT G CORRECTIONS yGj �0 /J � ` O USEOFSLOGS. e � e NOW ON.LOT G1 7 — y4/ h; A45 7e DE/SSCCRIPTION/OF WORK �'i —��� ✓� „����/ � BUILDING .I / 117 o /�J'9r �9+1J.✓� i� ��. /' f. BUILDING WARNINGI This construction may be in violation or j V� , cautioned to consult with your local War Z Productionpoarduluce Before commencey 'NEW Y v • TYPE^ I GROUP O NO.OF I NO.OF ALTERATION ROOMS FAMILIES _ ADDITION SIZE Q /l REPAIR STORIES MOVING WALL COVERING., ''i'V Z09Gv.� DEMOLISH ROOF COVERING t�~iJ'l�aac-�ll a PFEE .D FINAL APP/R/IOhV--AL INSPVALUATION I PEE S r X014 DA/ E NAM /i DEPARTMENT OF BUILDING.AND SAFETY - APPLICATION FOR PERMIT COUNTY OF LOS ANGELES p ® LD L. ® � ' WM. J. FOX, CHIEF ENGINEER U FOR 7APPLICANT T�O'FILL /IIN{� FOR OFFICE USE ONLY ADILDING DRESS / !� tJ V1� 1/L.U�.L/J /11 l/(� n DISTRICT NO. PLAN CK.NO. PERMIT NO. LOCALITY RECEIVED BY DATE OF APPL..� DATE^ISSUED NEAREBTOR OWNER V N1���/L/.//I ADDREBB _ ` t _ MAIL �/ ��/) .7; /�V)` y{ LDDaurY T. .+s-i/��F G��9• ADDREHB / /l T 4/(AA dlr�i'%LL%/��A/ �,///•,/ rTioi� -��L, 7 caoeeaT. In / FIRE NO.OF TYPE GROUP ARCHITECT OR / TEL ZONE PLANS - '�=• J 1 ENGINEER ! NO. I BLDG. __�•`1 ��'-`—�_ _PpC.�:�: AGGRESS 6ETRACK LINE F]'i1r.o ,'+zL.+•f �iY /y S.�~ - --- APPROVED a / TEL CONTRACTOR NO. BY DATE '•I USE APPROVED � ADDRESS ZONE BY DATE LEGALI CORRECTIONS DESCRIPTION LOT NO. 1 BLOCK ( 1. TRACT � ld D 'fir. 1 /06 X 2 (fj 7% I NO' ON LOT OF SLOGS.NOW •� SIZE OF LOT USE OF �. -` //� EXISTING BLDG.QI�f�Y.L'/ F�O[e/ I RO MS:S DESCRIPTION OF WORK t NEW ALTERATION ADDITION 1 - O REPAIR MOVING / DEMOLISH SIZE I ROOMS STORIES ✓ I D WALLROOF J^ / r C a V E R I NO YLG/fjLW/�,/,,/I I COVERING C/�{�/Ve�r��cI4q'i _�Y.�•�� USE OF NEWBUILDING .nciW✓A S/��i�✓/Yi _ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT, FOUNDATION! LOCATION INSPECTOR DATE AND AGREE4Yb!caMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWB"REGULATING BUILDING CONSTRUCTION. / 1 FRAME: FIRESTCPH, �yy]/�/ �/ 1'//�1 ✓// /'/� BRACING,BOLTS SIGNATUREP � OF ///��/1• /t/f�R •�/ /�d�J�.'.�/''r LATH.INT.: IJ /n AUTHORIZED AST •/ LATH,EXT.: G� �a r oes-3 soM sErs 1-40 $ P C ® ( PLASTER,INT. lam- FEE I PLASTER.EXT. VALUATION - I FEE / �� FINAL + 76A636A CE$tS0310.36 APPLICATION FOR, ,BUILDIN.G- PE_RMIT BUILDING AND SAFETY DIVISION D'LO DRESs /�y S �( Department of County Engineer ADDREsQ. .�.�.'1- /CJ ` 'County of Los Angeles LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASS_ATT D.GRIFFIN, SUP'T OF BUILOINc_ CROSS STS DISTRICTO. GR P- TYPE _ SEW ER MAP FOR APPLICANT TO FILL IN I,C CONST -BUILD[NG�/�/�'/• /_,g q 7 �n STATISTICAL CLASSIFICATION ADDRES G/ _Yy �L. OSA ".Y/L _ - / I CLASS NO:' - `DWELL:UNITS LOT NO. / O F Lal. /' BLOCK-<Q`. MAP q STATE YES NO Q NUMBER: I HWY TRACT Of qUSE ZONE SPECIALNO. OF I SIZE OF LOT--•� O' .C� NOW ON LOTSLDGS ,Jy� CONDITIO ,w p� USE OF O 'EXISTING BLDG. �V'/17. /GAM /C dS BUILDING YARD Y WY STREET NAMEXIST. ¢J wO SETBACK - E WIDTH � OWNER /[ C q 0 M /V!//V/e-/SFRONT I �✓30 MAIL- /J ^ P. t. o7O GiI IPI A//NGS l�(/ ADDRESS �OY �y. � Z /iq Old /_A< /t! SIDETEL. L. CITY �E�wLE L, ry No. INSPECTION RECORD ARCHITECT OR� L.�•/ ENGINEER /I TO/Q t&.Lr ILE ' /, / ADDRESS , / r - �/®� - TEL. y `p ,':`..i' M•i^..1 h. )S - ���`�>)) CONTRACTOR1271'�n'IB ZaiQ-//KG NO 00/ ADDRESS /�S�Gd/ NJH/1�/E.P BZ✓10' W - DESCRIPTION OF WORN c - �-Zv NEW^ `/ /l ADD: ALTER' -REPAIR DEMOLISH 50. FT. e! NO. OF NO. OF �-•r� wTL� ���`' SIZE •-f• ["STORIES / . FAMILIES - USE qF ST `• Ll_C- e— _ . -1,41 -A RUCTURE1•��•-•��•^ rte, - Pl_ _t 2a D GG APPROVALS` SIGNATURE OF ' - APPLICANT '7 4's ATE INSPECTOR'S SIGNATURE ADDRESS L(,f / FOUNDATION: LOCATION . FORMS. MATERIALS $ ' P. G. S FRAME: FIRE STOPS. . FEE / /"��•� BRACING. BOLTS A VALUATION / FEE $ % FURNACE: LOCATION. GAS VENT. DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT. /�✓� STATE LAWS R ULATING BUILDING' CONSTRUCTION. �" HOUSE NUMBER COR- A �- 31GNATURE OF' TEE - RECT AND POSTED PERMIT - •\. ,"LP•v' FINAL ADDRESS - � JOHN A. LAM E. COUNTY ENGINEER. CLYDE N. DIRLAM. PRINCIPAL STRyr.TpRAL ENGINEER PLAN CHECK VALIDATION. CK. M.O. CASH .e PERMIT VALIDATION r CK M.O. GSH 5. 1 4 _8.5A hPR 15 2.3 A 19-5 = U,Co53 880% LPi, 21 1 -A 3 9.0 0 ' e : WpRKERS'COMPENSATION DEQ,ARATION i, nerioy-affirm that'l have a certificate of consent to self - - APPLICATION, FOR BUILDING PERMIT �_ igsuFe, or a certificate of Workers'Compensation Insurance, ' or'd<cerefied copy thereof (Sec. 3800;'Lab. C!)•'" - ' COUNTY OF LOS.ANGELES BUILDING AND SAFETY - Policy,No..Company. - t El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN- BUILDING ADDRESS 7 Certified copy is filed with the county building inspec- BUILDING 2 - /I ,,LL - - - r tion deportment:' ADDRESS � 3 tom,/+' (; , /+p� Date •Applicant 1 -, _ CITY C. ZIP - � ( LOCALITY • CER TIFICATE'OF EXEMPTION FROM WORKERS' - t I NO.OF BLDGS. - NEAREST _ - - - COMPENSATION INSURANCE SIZE OF LO; y NOW ON LOT CROSS ST. (This section need not be completed.if the-permit is for one �TC ASSESSOR hundred dollars ($100)or less.):t •,'t , TRACT �i Z BLOCK �--^ LOT NO. MAP BOOK '! PAGE PARCEL . r ✓ TEL 1 USE ZONE MAP L,certify that in the performance of the work for which this OWNER' - (G /x+ /GF— NO. QZ -Z:i 2J NO. > permit is issued, I shall not employ any person in any manner 1} SPECIAL - - - - - - d so as�tto become subject to the Workers'Comp nsation ave I ADDRESS © � 3 -/� O 5 - /�7• _ f CONDITIONS u Data4 Applicant - CITY_ c- ` _ ZIP .C/ 4v O NOTICE-TO APPLICANT: If, after making th' �ert'.(.'fat�$f� v ARCHITECT OR •��_ TEL. DISTRICT GROUP TYPE FIRE PRO SSED.BY (t s/r GINEER NO. Q CONST. ZONE Exemption, you should become' subject to he War er . - p L// 10 Compensation provisions of the Labor Code, you must forth- ADDRESS -5 with comply with,such provisions or this permit shall be - '' TEL. - STATISTICAL CLASSIFICATION - APT. C NDO. Z deemed.revoked. - CONTRACTOR -i'xT N� G NO. - LICENSED CONTRACTORS DECLARATION . I LIG- - - CLASS NO. DWELL. UNITS_ I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS NQ SEWER MAP - (commencing with Section 70D0)of Division 3 of the Business and _ _ - _ LIC. - . Professions Code, and my license is in full force and effect. CITY CLASS BK - VALIDATION ._ . t,-. 50. IT. vv NO.OF NO. OF ++ CHECK License Number `Lic.Casa SIZE YR�A� STORIES ' FAMILIES -I ONE ,- - /J57-0e_4 VALUATION Contractor Date DESCRIPTION OF WORK Lf S O v ADD ❑ $ Q o os DOa El , I am exempt under Sea R ;24 2 4,2 A ALTE B.BP.C. for this reason _ REPAIR $ ` ' •.u.• e C 3 USE OF ❑ - --- Date: _ "r DEMOL EXISTING BLDG. L'.1 G� - Signature - ' -" _ - APPLICANT . TEL. - FINAL -( 478, 1 3 OWNER-BUILDER DECLARATION (PRINT) I G I /.I I C, ND. -252" DATE �_y/,,q/_ - -..- - _'.•'• 4 7 8 1 3 s�� .I hereby affirm that.1 am exempt from.the Contractor's License // �L c. . _ U 1� Law for the following reason (Section 7031.5, Business and ADDRESS 1.� 3 4 t G' FINAL ` 03 1 7_8 b - 'Professions Code): - `'I- PRESENT - BY KI I, as owner of the property, or my employees with BUILDINGADDRESS wages as their sole compensation,will do'the Work and Lt el� the structure is not intended or offered for sale(Section LOCALITY ' -�. E', ' -7044,-Businessand Professions Code). MOVING - - - TEL. - - -- - I, as owner of the property, am exclusively contracting CONTRACTOR NO. :2 4 43,2 A r with licensed contractors to construct the project (Sec- ADDRESS - �# • • • • •.1 tion 7044, Business and Professions Code). •. REQUIRED TOTAL SETBACK F - - CONSTRUCTION LENDING AGENCY -' '- SET BACK YARD HWV- PROP. LINE WIDTH� - ( �,Jr 7 3 O 0 . I hereby affirm that there is a construction lending agency for FRONT t - ti (Sec, 3097, Civ. of the work for which this permit is issued P.I. _ - .. - , • • 573-000 s (sea ao97, Civ. c.). SIDE _. .,. 0 4, 1 4--8'6'-_ P.L. Lender's Name - _ Sp LDMA Ret. It 1 Lender's Address -' P.C.-Fee E O I Permit Fee vl 1 �1O -_ r > _ /1 above information t I have read thiI agree i to on and state that the _ Issuance Fee - O SD LDMA P/C q -- - - a above information is correct. I agree to comply with all County. Investigation-Fee �1 2 //�� �1L ordinances and State laws relating to building construction, Tool Fee S /V Y I/ (/ LDMA Perm. M - - -- and hereby authorize representatives of this County to enter mupon i above-mens' d property f r inspection purposes. a 3Zc/[� 4_16- EEE REVERSE FOR EXPLANATORY LANGUAGE 0 •SignaNre of Applicant or Agent - Data' - - - -- -•---• - - - - ' _ _ "_ ✓ ._