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HomeMy Public PortalAbout9163, 9163 1/2 LAS TUNAS DR_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT'TO'FILL IN (Print or type'only) BUILDING ie. ' . COUNTY OF'LOS.ANGELES ADDRESS (�� ` DEPARTMENT OF COUNTY ENGINEER CITY (5—J ZIP / BUILDING AND SAFETY DIVISION ANO. F BLDGS BUILDING SIZE OF LOT �7 I NO ON LOT ADDRESS y _ cispi r TRACT J BLOCK LOT NO LOCALITY TEL. NEAREST i OWNER (,�.�� NO CROSS ST, ADDRESS ASSESSOR ��_ �� N� MAP BOOK I PAGE PARCEL DISTRICT GROUP TY FIRE SSE1D BY CITY u ZIP ST, ZONE ARCHITECT OR TEL. ENGINEER NO STATISTICAL CLASSIFIC TION SEWER MAP ADDRESS //' ��''rr pp CLASS NO. 2Z-DWELL UNITS BK PG LICCONTRACTOR C �• T 5 lJ�NEOL`�TO 0 USE ZONE NOP D ADDRESS �� a S �j,, NOgap ! _ SPECIAL CITY^ C�ft0+ CIIAS� 5 l� CONDITIONS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM FRONT PROP LI NE OF (STREET) ADDRESS CITY HIGHWAY + YARD - NOTAL SETBACK FROM TYPE OF EXISTING - SQ FT NO OF NO. OF CHECK FRONT PROP LINE .HIGHWAY WIDTH_ SIZE , STORIES •FAMILIES ONE DESCRIPTION OF WORK NEW - CLO ADD ❑ BLDG.SETBACK FROM V % Iv SIDE PROP.LINE OF (STREET). cd ALTER TOTAL SETBACK FROM TYPE OF EXISTING U HIGHWAY } YARD = REPAIR❑ SIDE PROP LINE HIGHWAY WIDTH LSA _ 0- USE cn EXISOT NG BLDG. M EMOL ❑ + Z APPLICANT TEL CORNER,CUTCFF YES ❑ NO (PRINT), N0.4 0 IN OPEN SPACE YES'❑ NO BY (SIGNATURE) /1. � IN COASTAL PERMIT ZONE YES ❑ NO ❑ _ VALUATION;$ . Q Q9 p I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION O� 1 'ret'e•. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- S, �,.?91 STRUC TION 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 COMP NSA INSURANCE SIGNATURE OF t• PERMITTEE ADDRESS / ' Vkh FINAL /DATE BYTE L. / CITY NO AIA KE CHECKS PA}AHLE 70 FEE FEE HARVEY T. BRANDY, COUNTY ENGINEER at a/ •PLAN CHECK VALIDATION (L. M o CASH _ PERMIT VALIDATION CK M o CASH 6,:'9:;2 r-JUL 3 510 0 Ago 2 6 0 t",nrT ,21 2 4.00 A,9' 76A638A CE#8p3_s/71�."'/✓A ^w^ A 2"6, 1 r nf-T- 1 - 3-Q o Q A'-)ON -55 76A63SiAi e9�8 APPLICATION FOR BUILDING PERMIT DIVISION OF BUILDING AND SAFETY BUILDING ADDRESS / _Depar ent of County Engineer County of Los Angeles LOCALITY mj WM.J. FOX, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUDDING CROSS ST. DISTRICT NO. GROUP TYPE, SE MA FOR APPLICANT TO FILL IN J_ TE BK PG I y CONSTBUILDING : ADDRESS � s< N MA ER (7t©'O STATE HWY YeS NO USE ZONE SPECIAL LOT NO. BLOCK �{ ,CONDITIONS TRACT �^�+ NO. OF BLDGS. BUILDING EXIST. SIZE OF LOT NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH USE OF FRONT EXISTING BLDG. .w ,y VVV P L. OWNER [ 6(/6+'L,�6yr� �3.�t�f/LN SIDE _ MAIL � -� ADDRESS f ( (�[�/ O TRACT DWELL. • 1 UNIT 5 INDUSTRIAL CITY-.J.,d1y(-fC. ., 'Np �R"�cS'1�C�� 1 DWELL. _ 1 UNIT g PUBLIC BLDG. �® ARCHITECT OR _ TEL 7 �.ADDN.,ALT.. ETC. �,8 s 2 DUPLEX f UNIT ENGINEER NO. .1(:5 3 APT. UNITS 1 J ADDRE59� ��' �aj+���ps?�70 4 COMMERCIAL MISCEL. _ CONTRACTOR � �t"J NO/W�1'//! l C� " INSPECTION RECORD ADDRESS 1 0PW.Cd �f2��I+Le.✓ CrnV'. ..'fir ` .l ) ZII� AC.5 '`t`•NY Ga Ch 6 .l DESCRIPTION OF`WORK NEW ADD ALTER REPAIR DEMOLISH � 1 �1 SQ. FT. NO. OF NO. OF '"''\ � A ^ SIZE .STORIES FAMILIES 0 11 USE OF STRUCTURE 111 .4l 'd'N X....c) N z� �r Gam �� �1d �� ca[.• n��,. s i to i )'S <:4�n,r, :.�d rz'n len '3] M SIGNATURE OF APPLICANT-44 (• !� 'j (,APPROVALS r r�,1f3 ADDRESS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION P.C. $ FORMS, MATERIALS FEE FRAME: FIRE STOPS, VALUATION !$ s� BRACING,BOLTS FEE Gas FURNACE: LOCATION. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT ' AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. O LATH, EXT. ` SIGNATURE OF HOUSE NUMBER COR- A PERMITTEES l/fJ � YYYv/// RECT AND POSTED ADDRESS mr -� ` FINAL �� J WM.J. FOX,COUNTY ENGINEER VALIDATION C. N. DI LAM.CHIEF BLDG. INSPECTOR _AC06 9 2 AUG 19 1 .0 0 r - 76Aa8BACe#00310-68 APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING / / - DEPARTN= OF COUNTY ENGINEER ADDRESS tr BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER. NEAREST CASSATT D. GRIFFIN, SUPT OF:BUILDING' CROSS ST. - wm7mmDISTRICT NO; ROU fCON E P ESSED BY FLOTNO_- OR APPLICANT TO FILL IN STATISTICAL C SS ICATION I S ER MAP f K CLASS.NO DWELL.UNITS E! BLOCK MAP STATE YES NO NUMBER HWY. TRACT 7` USE ZONE r SPECIAL NO.OF.SLOGS CONDITIONS SIZE OF LOT NOW ON LOT - - - USE OF EXISTINGBLDG BUILDING. YARD HWY STREET NA EXIST SETBACK_ WIDTH OWNER FRONT MAIL P L Q'd , ADDRESS SIDE TEL P L CITY ,�,�,r,� No - INSPECTION RECORD ARCHITECT OR - TEL ENGINEER NO ADDRESS - - TEL CONTRACTOR e� NO ADDRESS v`0 Or, DESCRIPTION OF WORK NEW -ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF r APPLICANT APPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS �TJ � FOUNDATION*LOCATION iv FORMS,MATERIALS VALUATION$ 0- v FRAME:FIRE STOPS, - BRACING,BOLTS _,7"I-S 1-!'Y"z PC PMT �_ FURNACE:LOCATION, F E $ I FEE $ �y "I GAS VENT,DUCTS ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT •' PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND ,STATE LAWS REGULATING BUILDING CONSTRUCTION LATH,EXT. ' SIGNATURE OF ¢� _- HOUSE NUMBER COR- -PERMITTEE• '- L't�4CM/t�l/✓a�-t-I� RECT AND POSTED - ADDRESS q6 FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL O. E CASH R CK, M o cnsH PLAN CHECK VALIDATION . PERMIT VALIDATION t,��,0 9 4 3 4 u JOS 14 -:�l A GO . �F - T-- -76A638A CE#903 5-65 APPLICATION FOR BUILD11�1G P��I /Lp�` COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER. ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A L.AMBIE, COUNTY ENGINEER NEAREST COLEMAN W JENKINS,SUP T OF BUILDING CROSS ST DISTRICT NO. GROUP • TYPE PR SED BY` FEXISTIN APPLICANT TO FILL IN p coNs�� �/� �� STATISTICAL CLASSIFICATION SEWER MAP , - CLASS NO DWELL UNITS BLOCK USE ZONE MAAPc- ® I NO SPECIALNO OF BLDGS CONDITIONS NOW ON LOT ' .- BLDG SETBACK FROM NOL - ^,z FRONT PROP LINE OF�L�' (STREET) • n TYPE OF EXISTING SETBACK HIGHWAY + YARD. = TOTAL ADDRESS (, /F�,,,) --426tr H G WAY WIDTH 'FROM C L - - CITY /oS BL SETBACK FROM ARCHITECT OR TEL ENGINEER NO SID PROP LINE'OF' --(STREET) TYPE OF EXISTING_ SETBACK HIGHWAY + 'YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C-L 'I TEL CONTRACTOiy�.�-L NOW ����j _O ADDRESS !' LIC CORNER CUTOFF, YES NO V �(?• G L (. NO LIC CITY CLASS C SEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK W CL NEW IADP - ALTER REPAIR DEMOLISH - , '• N Z SQ.FT NOOF NO OF SIZE STORIES EWE- FAMILIES USE OF S STRUCTURE 1Q- igIati SIGNATURE OF APPLICANT - - VALUATION APPROVALS ,DATE INSPECTOR'S SIGNATURE / ////��� FOUNDATION, LOCATION FEE FEE$! FORMS, MATERIALS _ FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE. LOCATION _ WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS 9UILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HE211'� NOT EMPLOY ANY PERSON IN VIOLA- LATH INT TION OF THE ICOF THE STATE OFCALIFORNIA RELAT- ING TO WORKMESATION INSURANCE LATH EXT - SIGNATU HOUSE NUMBER COR- ' PERMITTEE RECT AND POSTED ADDRESS - C - -� FI NAL (// ` JOHN F LEWIS PRI CIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK mo CASH LA 0 1 4 41 n SPR �1 1 D 1.:���. !:� � t 76A638A CE4803 6-66 APPLICATION FOR BUILDING ERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W JENKINS,SUP T OF BUILDING CROSS ST - DISTRICT-NO GROUP TYPE PRO SSED•BY FOR APPLICANT TO FILL IN �� CONS BUILDING STATISTICAL CLASSIFICATION SEWER MAP, ADDRESS" � jh/J�� CLASS NO DWELL UNITS LOT NO - BLOCK USE ZONE MAP �a - - i— n NO -' TRACT C SPECIAL NO OF BLDGS CONDITIONS SIZE OF LOT NOW ON LOT USE OF / ,J/1 IST,NG ���� 1L- /< BLDG SETBACK FROM / ,�,p,_i,w/�� ~- _ ` / nn 7�.. TEL FRONT PROP LINE OF /�� / g:y! (STREET) OWNER v1 Ty A�l//c '//�- /NOS"gy p�� TYPE OF EXISTING SETBACK HIGHWAY + YARD •"_ TOTAL ADDRESS/ �7 L+ /Gic V Fi 11"Y Iee#CC- HLQWWAY WIDTH FROM C L CITY S ARCHITECT OR / O ^� + O , BL TEL • SETBACK.FROM - - - ENGINEER NO SI E PROP LINE OF (STREET) TYPE OF EXISTING SETBACK -HIGHWAY •-F -YARD = TOTAL ADDRESS e / c HIGHWAY WIDTH FROM C L CONTRACTOR /�9-FCfI&IF„�L/} C NOLW , � + _ ADDRESS CL's NO �S�.Sy O CORNER CUTOFF YES NO V CITY LA 1�2 C AS C �6 SEE REVERSE SIDE FOR SPECIAL•APPROVALS 0 DESCRIPTION OF WORK tWJ a NEW 'D ALTER REPAIR DEMOLISH - Z SQ.FT NO OF NO OF SIZE C) STORIES SHE FAMILIES USE OF STRUCTURE - - /'a o__ SIGNATURE - APPLICANTOF / • VALUATION$ ts (x--v APPROVALS DATE INSPECTOR'S SIGNATURE _ P C PMT FOUNDATION, LOCATION FEE$ '��— FEE$ C// 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 WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS SUILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK _ AUTHORIZED HERE LL NOT EMPLOY ANY PERSON IN VIOLA- LATH INT TION OF THE L OR Co. OF THE STATE OF CALILNIAING TO WORK EN 5 COMP NSATION INSURANLATH EXT SIGNATURE OF L� i I � HOUSE NUMBER COR-PERMITTEE i RECT AND POSTED ADDRESS II//.''+ ' FINAL LI Gi JOHN F LEWIS. PRINCIPAL/ST -URAL ENGINEER PLAN CHECK VALIDATION CK M 0 CASH ' E�RMI R VALIDATION CK M O CASH 1 LAGo 3 21 1 D 1 1:5-0- 76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEN, SUPT OF BUILDING CROSS ST DISTRICT NCH G OU TYPE "FE Y FOR APPLICANT TO FILL IN (� coNsr O� BUILDING - / STATISTICAL CLASSIFICATION SEWER MAP ADDRESS / _3 7Lf"y �BKG CLASS NO DWELL UNITS LOT NO BLOCK WATER p� CERTIFICATE OT REQUIRED RECEIVED El TRACT D J MAPHIGHWAY STATE MAJO—?SECOND, LOCAL NO OF BLDGS NO 007111 (CIRCLE) SIZE OF LOT NOW ON LOT USE ZON SPECIAL USE OF c CONDITIONS EXISTING BLDG / f TEL OWNERhk, t.�.-f-' NO J r BUILDING EXIST YARD HWY STREET NAME e SETBACK WIDTH ADDRESS FRONT ARCHITECT OR TEL P L fG ENGINEER •---�'�— NO SIDE P L ADDRESS TEL O CONTRACTOR NO V ADDRESS DESCRIPTION OF WORK 0 U W G. NEW ADD ALTE REPAIR DEMOLISH &A SO FT NO OF NO OF ? SIZE STORIES FAMILIES USE OF STRUCTURE / SI NATURE O APPLICANT VALUATION $ "'z00, APPROVALS DATE INSPECTOR'S SIGNATURE PC PMT FOUNDATION LOCATION FEE $ FEE $ f 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 INSURANCE ! A LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE y RECT AND POSTED ADDRESS of FINAL JOHN F LEWIS PRINCIPAL ST UC U L ENGINEER PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION CKM o CASH LALO 0 0 5 4-0 AUG 11 1 D 6,00 . 76A638A CE#803 9-68 I ATI N ArrL C ' • FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS / .S f✓ BUILDING AND SAFETY DIVISION LOCALITY �C G JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS9 SUP T OF BUILDING CROSS ST C O ✓t—' FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE PROCESSED BY h' CONST�- (Print or type only) r VLl BUILDING / STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ��63 dS (� CLASS NO._�_? DWELL UNITS B% PG �} LOT NO, CJ BLOCK USE ZONE NOP QO� TRACTC^ SPECIAL NO OF BLDGS r CONDITIONS SIZE OF LOT - NOW ON LOT aC. USE OF EXISTING BLDG, BLDG KFROM TEL. FRONTPROPCLINEOF L.t,S' Tyi✓�9-S (STREET) OWNER, NO TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL HIGHWAY WIDTH FROM C L ADDRESS A CITY ,4J ` 0/ o f +BLDG SETBACK ARCHITECT OR TEL. SIDE PROP.L NEOFO Qom- AYF (STREET) ENGINEER NO, TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L, 'qj r 11 Y CONTRACTOR NO �b� ­Z `�' ^�7 + 25 LIC ADDRESS NO CORNER CUTOFF YES E] NO C H CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS LL CONSTRUCTION LENDER /' Z NAME AND BRANCH .�O -1 �u ADDRESS �'�-`f' SO FT 7 STORIES FOVOFES NEW ❑ SIZE 7 ❑ USE OF ' ADD STRUCTURE, Q �`e ALTER REPAIR❑ SIGNATUREOF APPLICANT J EMOL ❑ VALUATION $ JOOf ©v APPROVALS DATE INSPECTOR'S SIGNATURE P.0 PMT. FOUNDATION: LOCATION FEE $ FEE $ - FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS til AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE- LOCATION, L WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS j/, STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED -,y�r�"{y HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. / \ LABOR CODE OF TfiE STATE OF •CALIFORNIA/I'N RELATING TO 7: WORKMEN'S COMP 54 ATION INSURANCE. // LATH, EXT, / _ SIGNATURE OF HOUSE NUMBER COR- PERMITTEE PERMITTEE 7 1 4 - RECT AND POSTED ADDRESS -` FINAL PLAN CHECK VALIDATION CK Mo CASH _ JOHN F LEWIS PRINCIPAL STRUCTURAL ENGI EER PERMIT VALIDATION CK M o CASH 2 2 1 0 3 OCt 1 D .0 l7 Y. c a yrs O r COUNTY 02'-, S-i;&,. :LES WM. J. FOX,'CHIEF ENGINEER 1 L ® 'j FOR APPLICANT TO FILL IN FOR OFFICEMSE ONLY BUILDING DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS / I J LOCALITY R C E`I_VEEDDBY DATE OF APPL.. DATE/ISSUED NEAREST _.�..tJ� CROSS ST: BUILDING OWNER ADDRESS /V /C. !.a /�p•/ �iu��'/Y S� MAIL ® � LOCALITY _v__C ADDRESS S ( I d�I TEL. NEAREST �eyC//V �4 CITY / NO CROSS ST. FIRE NO.'OF ARCHITECT OR TEL. ZONE I PLANS I TYPE I GROUP ENGINEER �„ NO, BLDG. ORD. N04 ADDRESS SETBACK LINE APPROVED CONTRACT r .^ NOL I�f BY DATE R USE m APPROVED ADDREBS / ZONE BY DATE - LEGALCORRECTIONS DESCRIPTION I LOT NO. I BLOCK TRACT ' NO. OF LDGS. `ry SIZE OF LOT I NOW ONBLOT USE OF I NO.OF I NO. OF / EXISTING BLDG. FAMILIES_ ROOMS A on DESCRIPTION OF WORK NEW ALTERATION ADDITION REPAIR MOVING _�7 DEMOLISH I J O , SQ. FT. NO.OF SIZE ROOMS STORIES WALL ( ROOF • COVERING" i COVERING USE OF NEW BUILDING 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 BUILDING CONSTRUCTION. FRAME: FIRE•STOPS, - BRACING, BOLTS SIGNATURE OF OWNER LATH,' INT.: AUTHORIZED AOT LATH, EXT.: P. C. 0 PLASTER, INT. 1 FEE PLASTER, EXT. 1 � VALUATION FEES FINAL ��� 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 CAT I O N.•- FOR-.B.U,I L D-I N G PERMIT or'a certified copy thereof (Sec 3800, Lab 'C COUNTY OF LOS ANGELES BUILDING•AND SAFETY a cy No ., Company - - �� - Certified copy`is hereby furnished �'• FOR APPLICANT TO FILL IN BUILDING G ADDRESS '"Certified copy is`filed with the county buildmg'mspec- BUILDING L Lq / .V tion department ADDRESS �`'� Date "Applicant CITY' e1 " C 1 ZIP 0 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 permrt is for,one - ASSESSOR C 7. ' hundred dollars ($100)or less ) TRACT BLOCK LOT NO MAP BOOK' PAGE, PARCEL TEL OWNER - ;.:S'(� `3r'b NO 3y-7-'� USE ZONE MAP I,certify that in the erformance o e ark for which this NO P . , _ ___ permit is issued, I shall not em to a rson in h m ner t �f� SPECIAL - - 0. so as/to�b/eco�,Qm�e'suble t the W r rsP ompe at o s ADDRESS �d�"'�• [ � / tf�i:� `�- CONDITIONS O o% l O J tV��9� CITYc�"rl.ro�!C 4�C ZIP Date Applicant / ARCHITECT OR TEL } DISTRICT PJ FIRE PR SS BY r O NOTICE TO APPLICANT' If, 'after makin 't Certificate of D S G U TYPE _ - g ENGINEER _ NO CONS Z E Compensation you should become subject �the'Workers' --- �/�Q' Tj j LU Com ensation rovisions of the Labor Code, ou must forth- ADDRESS t (/a (/ with comply with such provisions or this,permtt shall be deemed revoked ,, ( rZ NO TELSTATISTICAL CLASSIFICATION APT- CO CONTRACTOR LICENSED CONTRACTORS DECLARATION - • , // LIC CLASS NO DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS' G3r/3 /i�&VX NO (commencing with Section 7000)of Division 3 of ihe'Business and _ — - ---- LIC - SEWER MAP Professions Code,'and_ my license is in full'fo�ce and'effect CITY �"� CLASS ~BK "' ” " - ``VALIDATION SQ FT NO,OF - _ NO-OF _ CHECK , License Number Lic Class SIZE STORIES FAMILIES ONE DESCRIPTION-OF'WORK NEW ❑ VALUAT O - ZIA Contractor Date ( -ADD $ (((//J I am exempt under Sec ,r����n� p �h � ALTER B 8P C for this reason v, v��` REPAIR -Q ; -448(16 A ` USE OF Date EXISTING BLDG DEMOL Q Si riature APPLICANT // / TEL ^Z _ #,o o o o 2 3 Signature PRINT �Ll (A C VV( � NO r FINAL OWNER-BUILDER DECLARATION _ _ -DATE -�/ 1' -,.3 7.5-0- I hereby affirm-that I am exempt from the Contractor's License � �F� �- ADDRESS�J� Cs`i `�I "� i = - t S Law for the fol lowing.reason (Section 7031 5, Business and -FINN (L o L0 10 3 ],5 0 t� Professions Code) PRESENT BUILDING � � �/Ts�,q t 061 1 2`8,6 1, as owner of The property, or my,employees with A_DDRESS__ wages as their sole compensation,will do the work andLOCALITY �r2t... i`e ' the structure 1s not intended or offered for sale(Section ' 7044,-Business and Professions Code) MOVING- "' ',//-TEL - - 1, -TEL - - - I ` I, as owner of theproperty, am exclusive) contracting CONTRACTOR NO r Y 9 _ t __ �l$a.7A ', - with-licensed contractors to construct'the prolecT (Sec- �� ADDRESS - - _ � tion 7044, Business and Professions Code) # q 0 0 o e,'l REQUIRED_ TOTAL SETBACK-FRO CONSTRUCTION LENDING AGENCY' SET BACK YARD HWY" PROP LINE WAST V v - + I hereby affirm that there is a construction lending agency for FRONT o o 2 a'5 0 the performance of the'work-for which this permit is issued - -P L - - - - - - _._ _ - - (Sec 3097, Civ C ) SIDE 0,° o 2 a 5 0,5i", - PL - - Lender's Name _ 6 1 2-8 6 i LDMA Ref # Lender's Address PC' Fee S• - Permit Fee Lot - ` I certifythat I have read this application and state-that-the __ _ _.. __ PPlhhIssuance-Fee- �ti V� -LDMA•P/C�# ,�- Q above information is correct I agree to comply with all County Investigation Feef- S _ ordi nces and State laws relating to building construction, _ Total Fee O .J- LDMA Perm' # - b an fie eby authorize representatives of this County to enter m u n th above endo ed propert for inspection purposes y ✓ �`��^��+ SEE REVERSE FOR EXPLANATORY LANGUAGE ignatu 'of Apphc nt or Agent "' Date QQi WORKERS' COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT i y affirm that I have a certificate of consent to self �syre, or a certificate of Workers' Compensation Insurance, err fl d cop thereof ec 3 , Lab C w , COUNTY OF LOS ANGELES BUILDING AND SAFETY C Ompa I Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING ADDRESS 3 Certified copy is filed with the county building Inspec- BUILDING •5 pariment ADDRESS 4Z9 :4CYETIIFICATE Applican CIT ZIP So LOCALITY 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 NqO�. / MAP BOOK PAGETEL PARCEL OWNER agn-� /{/r6rn'iv NO X. USE ONE MAP I certify that in the performance of the work for which this NO permit is Issued, I shall not employ any person In'any manner ADDRESSSQ W. SPECIAL so as to become subject to the Workers'Compensation Laws CONDITIONS O CITY '?16716 U Date Applicant ZIPd' NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NOJ CONST � ZANE ADDRESS 1 LLI U Compensation provisions of the Labor Code, you must forth- UIQ/ V �^J� with comply with such provisions or this permit shall be deemed revoked ' STATISTICAL CLA$$IF!4TION APT CONDO Z CONTRACTO O/` / _ LICENSED CONTRACTORS DECLARATION �]� ® LIC / CLASS NO /�–' DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESrS(/ N (commencing with Section 7000)of Division 3 of the Business and '�J� ] �7/ / SEWER MAP V D9 7'3'A Professions Code, nd my license is In full force and effect CITY �pTi �/►/ CLASS �/(Y/ 3 _ / SQ FT NO OF NO OF CHECK vp BK PG Licg� e N r Llc Class v SIZE STORIES FAMILIES ONE �J VALUATION Co Date zP11-aDESCRIPTION OF WORK NEW ❑ s OL o o e 3 7.5 0' I am exempt under Sec ; 4J ADD ❑ � g ALTER ❑ , 0229"880 2 2 9 8 B 8P C for this reason A, REPAIR $ Date USE OF EXISTING BLDG I DEMOL ❑ Signature APPLICANT 4 TELy� FINAL OWNER-BUILDER DECLARATION PRINT /V//Y NO DATE I hereby affirm that I am exempt from the Contractor's license ` Law for the following reason (Section 7031 5, Business and ADDRESS sw/V � !e- FIN Professions Code) By ❑ BUILDING 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,well do the work and ff. , the structure is not Intended or offered for sale(Section LOCALITY 7044, Business and Professions Code) MOVING ^,• TEL 1, 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) 9 2 9 A REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY- PROP LINE WIDTH FW)M EXIST I hereby affirm that there is a construction lending agency for FRONT # 0 0 0 o toil the performance of the work for which this permit Is Issued P L (Sec 3097, civ C ) SIDE -I,•°,° 4 Q 5 0 PL Lender's Name m 0:0.0.4 Q 5,0 ci LDMA Ref N Lender's Address PC Fee Permit Fee 028+88 I certify that I have read this application and state that the Issuance Fee I�l/ kLD P/C N ' v o above information is correct. I agree to comply with all County Investigation Fee 9 ordinances and State laws relating to building construction, N and hereby author a representatives of this County to enter Total Fee LDMA Perm q a - upo bove bone property for inspector pur 00 SEE REVERSE FOR EXPLANATORY LANGUAGE to Signa ure of-Applicant or Agent