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HomeMy Public PortalAbout9139 LAS TUNAS DR_Building__ 16A638ACE#803'-7.58 APPLICATION FOR BUILDING PERMIT ], BUILDING .AND SAFETY DIVISION aooRess Department of County Engineer ' County of Los Angeles LOCALITY )V ' AC- ', JOHN A. LAMBIE, COUNTY ENGINEERNEAREST I CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST. , DISTRICT NO. : GROUPI TYPE -•. SEWBER MAP PG FOR APPLICANT TO FILL IN � ,+� CONS _ ' T BUILDING - I ADDRESS STATISTICAL CLASSIFIC TION LOT NO. / BLOCK CLASS. NO: DWELL. UNITS MAR STATE YES a NUMBER HWY TRACT USE ZONE. SPECIAL � may/ NO. OF BLDGS. CONDITIONS SIZE OF LO"O6, ✓ NOW ON LOT r USE OF EXISTING BLDGBUILDING YARD HWY STREET NAME EXIST. '+ ,t SETBACK •-�. WIDTH OWNER FRONT MAIL P. L. ADDRES a SIDE- TEL { P. L. - CITY NO c INSPECTION RECORD ARCHITECT OR TEL. ENGINEER �\ �p ADDRESS r TE CONTRACTOR , NO ADDRESS 7 06 a]7 &' ( n g DESCRIV4kON OF WORK NEW AD% ALTER REPAIR DEMOLISH FT. � ` � NO. OF NO. OF SIZE -/ C3 STORIES FAMILIES USE OF STRUCTURE APPROVALS ' SIGNATURE OF APPLICANT A41A W&AnxDATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS, MATERIALS $ P.C• $ FRAME:-FIRE STOPS, ✓`� '�O� ¢FEE —� BRACING, BOLTS r i FURNACE: LOCATION. FEE VALUATION $ � GAS VEW, DUCTS ~ , 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COU RDINANCES LATH, EXT. STATE LAWS R EATING JI L 1 CONSTRUCT O SIGNATURE OF.–\ HOUSE NUMBER COR- - PERMITTEE RECT AND POSTED ADDRESS ,,FINAL JL.,__ JOHN A. LAMBIE, COUNTY ENGINEER, CLYDE N_ DIRLAM, PR NCIPAL STRUCTURAL E PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS ISI o.F3 .4 4 4,- My 2 2 2 2.0 U In WORKERS' COMPENSATION DECLARATION insure,hereby certificate of Workers' Comtpen'sat on eInsuran ent to lf '-A P P L I CATION FOR- or PERMIT a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LO&ANGELFS" BUILDING AND SAFETY' Policy No. Company_ BUILDING ❑ Certified copy is,hereb rnished.. FOR APPLICANT TO FILL IN ADDRESS r G ❑ Certified copy.' 'ed with the county building inspec- BUILDING I tion depa ent. ADDRESS Y CITY ZIP LOCALITY Date Applicant O. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION•FROM WORKERS' SIZE OF LOT OW ON LOT COMPENSATION INSURANCE CROSS ST. ASSESSOR �• AA (This section need not be completed if the permit is for one TRACT BLOCK LOT NO.' MAP BOOK 5aJ PAGE 0/ PARCEL V v hundred dollars ($100) or less.) TEL. OWNER. JV, NO. USUZONE MAP I certify that in the performance of the work for which this SPE permit is issued, I shall not employ any person in any manner ADDRESS SPECIAL a} CONDITIONS so as to become subject To.the Worke Compe soli n Laws. O CITY. ZIP I U Date pplicanT. ARCHITECT OR T Date TO APPL ANT; if, after makin this Cer rficate of ENGINEER O DISTRICT GROUP TYPE FIRE PROCESSED BY 9' CONST. ZONE Exemption, you should become subject to the Workers' // U Compensation provisions of the Labor Code,,you must forth- ADDRESS �©� l� a . with comply with such provisions or this.permit shall be TEL ]]�� STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR / NO •'CL� h Z LICENSED CONTRACTORS DECLARATION n IC. A ' CLASS NO, -; c� DWELL. UN S I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS c J f//1 O. 7� (commencing with Section 7000)of Division 3 of the Business F LIC. SEWER MAP and Professions Code, nd my licens in full force an CITY S CLASS C BK PG VALIDATION / SQ. FT: NO. OF NO. OF CHECK License,Number ic. Class v SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW J4 S dpt r ` ADD ❑I am exempt under Sec. a a- ALTER' ❑. ..B. C. for this reason / REPAIR ❑ $ Date USE OF - EXISTING BLDG. •DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUIL DECLARATION (PRINT). I I NO DATE I hereby affirm that I am exempt from the Contractor's License L �� S Law for the following reason (Section 7031.5, Business and ADDRESS �• r FINAL / Professions Code): PRESENT By Z15 ❑ I, as owner of the property; or m employees with BUILDING P P Y% YADDRESS 37-_ wages as Their sole compensation,will do the work and .3 � LOCALITY the structure is not intended or offered for sale(Section - 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the.property, am exclusively contracting CONTRACTOR NO. with licensed contractors.to construct The project (Sec- ? T.- ADDRESS i s tion 7044, Business and Professions Code:) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST: :y r-» 4.iw:. CONSTRUCTION LENDING AGENCY SET BACK PROP. UNE WIDTH )Et c I hereby affirm that there is a construction lending agency for FRONT - �j the performance of the work for which this it is issued P.L. p 3_Lf _ � s- ' ., , a=;= (Sec. 3097, Civ. C.). - SIDE {.ttt._ I -' Lender's Name. 's_•`_•:- �O LDMA Ref. If :t z; R .t P.C. Fee$ . Permit Fee j - Lender's Address ; 0 1 certify that I_ have read this application and state that the Issuance Fee LDMA P/C# , >13 t :r. rr above information is correct. I agree To comply with all County Investigation Fee // Q •• • - 8 ordinances and State laws relating to building construction, Total.Fee (O✓ LDMA Perm. q y ft^ {t l Q. and hereby uthorize epresentatives of this County to enter 'I upon the ove- one &t -tion purposes.' ! " •o ` f SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of kl5plicanfor Agent Date \ { WORKERS'COMPENSATION DECLARATION Y Iherea 1 5 C affirm that I have a of Workers' ComtpensatoneInsuran elf! orAPPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT'TO FILL IN ADDRESS ❑ Certified copy'is filed with the county building inspec- BUILDING tion department. ADDRESS (� :) LAS 7113 N,RS D 1 1� . - CITY T�ML E C4TT ZIP 91 I CJ 0 LOCALITY •Date Applicant �(-•15'X 1'1rK X I NO. OF BLDGS. ' NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF-LOT -NOW ON LOT CROSS ST. COMPENSATION INSURANCE (x - Book I1 ASSESSOR (This section need n $ riot be completed if the permit is for one TRACT 5-t' BLOCK" LO.OT NJ MAP BOOK PAGE I PARCEL hundred dollars ($100) or less.) Q TEL (� q 4 p OWNER N C \fs/1LT`� Cn7� .NO.OIO'`�J���3 USE ZONE MAP I certify that in the erforrnance of the work for which this /� /�^ NO. SPECIAL > permits issued, I'shalI not employ any person in any manner ADDRESS-`1� - LAS TL�ttS b Y v �� COND TIONS C so as to become subject to the Workers'Compensation a s. Q /� �7p� O ^ �b VjF1�lOG &Vq vorwkr� CIT. TEM p LC �i(T ZIP Cq ci l I(7 O U Date `i! ` Applicant 4102177KIA01104 r I/dG - ARCHITECT OR TEL /1� y NOTICE TO APPLICANT:. If, after makingthis Certificate of ENGINEER AUL C, . WAN(, p,01R) 1A CONST.DISTRICT GROUP TYPE ' FIRE PROCESSED BY O CONST. ZONE U Exemption; you should become subject to the Workers' a �N p�� T.EN�L� C� / J W Compensation provisions of the Labor Code, you must forth- ADDRESS rJ a T �QO' J a rovisions or this permit shall be i N DI L Ex TEL. STATISTICAL CLASSIFICATION APT. CONDO. N with comply with such.p deemed revoked. CONTRACTOR ( O. Z A LIC. /3 CLASS NO. DWELL. UNITS LICENSED CONTRACTORS DECLARATION C4 ^� `P NO. 47 I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS SEWER MAP (commencing with Section 7000)of,Division 3 of the Business LIC.' r,- CITY QN'( K_Sz'' �I��-- CLASS and Professions Code,and my license is in full force and effect. BK. PG. VALIDATION {, SQ. FT. NO. OF NO. OF CHECK 034.01) ,C! • SIZE duo STORIES FAMILIES ONE �7'T. License Number Lic: Class VALUATION Vjt4 otQ0Vr) Dr-12116 M* 6,p 3"x17 w Contractor"t6TRbIC7 04, UC.; Date �`�` Z' DESCRIPTION OF WORK NEW $ i� 0 p Q ; •_• ; " ,'t TP_/J A/J T I M R oV Ia H C/J T ADD 10. Arm.�. ? ��t__r l y.e;I am exempt under Sec. ALTER �.-_•,..,;i__.- „a BAP.C. for this reason / REPAIR E ; :. 4` a e. CLl y EXISTING BLDG. v�, GA ? DEMOL ❑ f 3 i;;_ _"- APPLICANT [� TEL. 1J, i s'J s Signature (PRINT) PA y U L L, I 'WA -1 NO FINAL fFINAL NER-BUILDER CLARATIQ6r DATE 1 hereby affirm that I am exempt trom the Contractor's Licensepp p �i (ct l b p V i Z-� Q(_� C(j Law for the following reason (Section 7031.5,,Business and ADDRESS 44 0 �E FINAL Professions Code): PRESENT By s BUILDING A u,: at ❑ 1,'as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY , the structure is not intended or offered for sale(Section 7044,-Business and'Professions'Code.) MOVING - TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to.construct.the project (Sec- ADDRESS tion 7044, Business and-Professions Code.) CONSTRUCTION LENDING AGENCY SET BACKK YARD HWY TOTAL ROP.SETBALINECK FROM WIDTH hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name $ LDMA Ref. # Lender's Address P.C. Fee$ i- S Permit Fee 7 1 certify that I have read this application and state that the Issuance Fee - 76 LDMA P/C# , 8 above information is correct. I agree to comply with all County Investigation-Fee R ordinances and State laws relating to'building construction, Total Fee LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date WORKERS' COMPENSATION DECLARATION aa certif cate of Worke srlificate Compensat on eInsuran e, APPLICATION FOR BUILDING PERMIT to sf or or a certified copy ere M. 3800 Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy NoY 45�Z Company /L BUILDING �Q ❑ Certified copy is hereby furnished.. FOR APPLICANT TO FILL IN ADDRESS 1 ✓ ! t4-5 f ut&&_S Dv, ❑ Certified copy is filed with the county building inspec- r BUILDING ze tion department. ADDRESS 1 a7 7 acv .2 ~ ' n L� G CITY Brim le ZIP LOCALITY - Date Applicant NO. OF BLDGS. NEAREST / CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE 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.) Cznc�. ,�-he� Nk�'JreJI�L -�q� USE ZONE MAP' f _ OWNER NO. f I certify that in the performance of.the.work for which this [ SPECIAL >- permit is issued, I shall not.erriploy any.person in any manner ADDRESS -X20 A0,C4.0 d, CONDITIONS CL so as to become subject to the Workers'Compensation Laws. O CITY ZIP foo (> Date. Applicant ARCHITECT Ot�. TE 0 pp DISTRICT GROUP TYPE FIRE P C SSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER .7%'/�11,7 Zee N QiS _.t /\ in CONSL: Z`�E Exemption, you should become subject to, the Workers' ADDRESS ��S(J✓ lrw�v � `� v� � Lv—lq ./ w Compensation provisions of the Labor Code, you must forth- a with comply with such.provisions or this permit shall be n�+"" TEI/� _03� STATISTICAL CLASSIFICATION AF'r. C D Z deemed revoked., CONTRACTOR s. l.ro� NdJ' — LICENSED CONTRACTORS DECLARATION r�t LIC. CLASS No. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter ADDRESS r--PQ_My 4 /%, NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC' CITY `J�e1►l CLI�a CLASS VALIDATION and Professions Code,*and my license is in.full force and effect. SQ. FT. NO. OF NO. OF CHECK BK. PG. License Numbef� +�✓�{ 1�7 Lic. Class SIZE UU� STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW ❑ Contra cto Date $ � ADD El , ❑1 am exempt under Sec. ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ ate: USE OF Q�- rT (STING BLDG. c�J�'�� DEMOL :(: zF APPLICANT �- TEL. SignaTur (PRINT). t NO. G d3 FINAL /� j_' ti t,_5I1 WNER-BUILD DECLARATION DATE I hereby affirm that I am exempt from the Contractor's LicenseG�J 7(/� h t t 1 ,L!E• _t Law for the following reason (Section 7031.5, Business and ADDRESS '!` N TO fAL _ Professions Code): PRESENT � • 50 BUILDING -•� Cr ❑ I, as owner of the.property, or my employees with ADDRESS' PCK _rll wages as their sole compensation,will do the work.and the structure is not intended or offered for sale(Section LOCALITY C. c GE .00 7044, Business and Professions Code.) MOVING TEL. ��-!r�€,i 3G - ❑ I, as owner of the property, am exclusively coCONTRACTOR NO. with " with licensed contractors to construct,the project (Sec- ADDRESS 113!I!E01-1'si€0 i tion 7044, Business and Professions Code.) •. __ sti,- REQUIRED YARD HWY TOTAL SETBACK FROM EXIST.' 213312 .1 Ail CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there.is a construction lending agency for FRONT, the performance of the work.for.which This permit is issued P.L. (Sec. 3097, Civ. C.). SIDE. P.L. Lender's Name. LDMA Ref. # P.C. Fee$ Permit Fee o = Lender's Address 1 certify that I have read this application and state that The Issuance Fee • LDMA P/C# , a Y PP� 8 above information is correct. I agree to comply with all County Investigation Fee . ordinances and State laws relating to building construction, Total Fee • LDMA Perm. # a and hereby authorize representatives of this County to enter u th a ve- %17036Vroperty for inspection pu poses. SEE REVERSE FOR EXPLANATORY LANGUAGE • Sigitature of pplicant or Agent Date J �JORKERS' COMPENSATION DECLARATION i re y afrm that 1 have a certificate of consent to self _ ensure or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT -or u\certified•copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING F_�,•,Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 13 �/ TUwf" i Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESSv Z" ,� p 1-V y. Date Applicant CITY G • ZIP ` LOCALITY } q�,� CERTIFICATE OF EXEMPTION FROM WORKERS' (��Z,� NOW ON LOTNO.OF S f C OSSNEARESST. �oA1 `h / '�F/ COMPENSATION INSURANCE SIZE OF LOT (This section need not be completed if the permit is for one .p b 1 ASSESSOR hundred dollars ($100)or less.) TRACT Q BLOCK LOT NO. 1 v MAP BOOK PAGE PARCEL _�/ TEL. Q USE.ZONE MAP 1 certify that in the performance of the•work for which this OWNER C.�7 NO. NO. ��lp permit is issued, I shall not employ any person in any manner ADDRESS Qd C-Z SPECIAL so as to become subject to the Workers'/Compensation Laws. • CONDITIONS O (x� 1 / (� CITY ZIP f 006. U Date `�" Applicant �/ `� ?kdt ARCHITECT OR ( � TEE.. 0 J NOTICE TO APPL CANT: If, .after making this Certificate of E , Mo 1v Lle NO /� �Q(S DISTRICT- GROUP TYPE FIRE PR ESSED BY O / Exemption, you should become subject to the Workers' /J.� ,- r, CONST.-� -- N/ ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS ; .- r '� /y Vf/ 3 V2 v 'v a, with comply with, such provisions or this permit shall be l�TEL. STATI ICAL CLASSIFICATION I AP C N deemed revoked. �' �' c �r7�T CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.'—/ DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS VALIDATION SQ. FT NO. OF NO. OF CHECK BK. License Number Lic.Class SIZE STORIES FAMILIES ONE '069.0 A U , VAlUAT10N DESCRIPTION OF WORK ^ U�'� NEW ❑ # o - 0-0 21.Contractor Date �/4/� C PAI, i- //� ADD $ t7 i ��D r I am exempt under Sec. P" ALTER ❑ '1 - 984,95 B.BP.C. for this reason REPAIR $ o 984,955) USE OF �� LLQ G- DEMOL ❑ 9, b 8 Date: EXISTING BLDG. G� Signature APPLICANT TEL• FINAL PRINT /�/ "Uv g OWNER-BUILDER DECLARATION LN� v' ' NO. DATE I hereby affirm that I am exempt from the Contractor's License 5 �+ 0 % , Law,for the following reason (Section 7031.5, Business and ADDRESS FINAL r Professions Code): PR N j �, 1/v4 BY / Z BUILDING L!a> v ��7 a I, as owner of the property, or my employees with ADDRESS hl! s wages as their sole compensation,will do the work and ff L-O� �'(� r :-,� the structure is not intended or offered for sale(Section LOCALITY �� i ® {j T }t,y? 7044, Business and Professions Code). MOVING TEL. �[ I, as owner of the property; am exclusively contracting CONTRACTOR NO. i F Et S with licensed contractors to construct the project (Sec- i j# A i �� 'tz tion 7044, Business and Professions Code). ADDRESS ;• •a•. HL !1•�7=�•- REQUIRED YARD HWY TOTAL SETBACK �_: 169.'25 CONSTRUCTION LENDING AGENCY SET BACK PROP. UNE WIDTHEt� =+ay I hereby affirm that there is a construction lending agency for FRONT JA the performance of the work for which this permit is issued P.L. rlt�E )-1 (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name - z LDMA Ref. q Permit Fee m P.C. Fee$ i 5%• Lender's Address o I certify that I have read this application and state that the 10• �� LD A P/C q Issuance Fee I above information is correct. I agree to comply with all County Investigation Fee �f 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. q a and hereby authorize representatives of this County to enter m upon he above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignoture of Applicant or Agent Date - WORKERS'COMPENSATION DECLARATION — hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure; or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SIiIllkFETY Policy No, Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS ill—. t Date Applicant CITY L ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one. ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL 02 QQN TEL. ����/- rQZ USE ZONE MAP I certify that in the performance of the work for which this OWNER �.,/ G/ l NO. �t'���a NO. permit is issued, I shall not employ any person in any manner ADDRESS ��GO Q SPECIAL so as tobeYbeccome subject to the Worker�Co' tw4w s. d a f CONDITIONS O Date ./ / L49 Applicant , CITY rf ZIP NOTICE TO APPLICANT: If, after making'this Certificate of ARCHITECT OR �nQ NO DISTRICT GROUP TYPE FIRE PROCE ED BY O ENGINEER //C K2CONST. ZONE I� Exemption, you should become subject to the Workers' V Compensation provisions of the Labor Code, you must forth- ADDRESS S t W v 115 with comply with such provisions or this permit shall be TEL: STATISTICAL CL6§SIFICATION APT. I C DO. (� deemed revoked. CONTRACTOR NO. _Z� LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.. DWELL..UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK VALIDATION S.Q. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATI/O�N Contractor Date DESCRIPTION O WORK NEW s ADD $ "" °� 9 2 Q'0 A I am exempt under Sec. ALTER 0 , #ao 0'0 a 2 3 B.BP.C. for this reason USE OF REPAIR $ :d.o o 9 8.6 Date: DEMOL EXISTING BLDG. Tan Signature APPLICANT TEL. FINAL O 0 3 1 8 8 8 OWNER-BUILDER DECLARATION PRINT NO. DAT `6 Zr 1 hereby affirm that I am exempt from the Contractor's License ProPRESENT Law for the following reason (Section 7031.5, Business and ADDRESS ssions Code): BUILDING I, 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 sale(Section LOCALITY ® 9. 7044, Business and Professions Code). MOVING' TEL. ;22 Q A I, as owner of the property, am exclusively contracting CONTRACTOR NO. # o,o o e+o with licensed contractors to construct the project (Sec- ADDRESS �, o 63,300 tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARDT HWY PROP. LINE WIDTH 'o.o a 3,.O 0 I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE 0 3 8; . $8 P.L. Lender's Name LDMA Ref. # Lender's Address P.C. Fee$ ,. Permit Fee •✓'' ' I certify that I have read this application and state that the Issuance Fee LDMA PIC p above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State lows relating to building construction, Total Fee ♦0— LDMA Perm. # ' and hereby authorize repysentfives of this County to enter < upon t ve- doerty forinspection purposes. /7 SEE REVERSE FOR EXPLANATORY LANGUAGE . Signature of Applicant or Agent bote