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HomeMy Public PortalAbout9718 LAS TUNAS DR_Building__ TEMPLE CITY 76A638A CE#8032-63 APPLICATION FOR BUILDING PERMIT, COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. Iff DISTRICT NO. GROUP TYPE P. ESSED BY FOR APPLICANT TO FILL IN CONST. BUILDING STATISTICAL CLASSIFICATION S WER MAP ADDRESS 9718 E. Las Tunas T.C. BK PG CLASS. NO. DWELL. UNITS LOT NO. BLOCK WATER NOT REQUIREDf�Z RECEIVED CERTIFICATE: MAP HIGHWAY TRACT STAT MAJOR ECOND, LOCAL NO.OF BLDGS. NO. (CIRCLE)) SIZE OF LOT NOW ON LOT USE ZONE ECTAL USE OF CONDITIONS EXISTING BLDG. 7� TEL. (�r OWNER L. P Kearney NO. BUILDING EXIST. SETBACK YARD HWY 5 EET N, E WIDTH ADDRESS 806 Arcadia Ave. Arcadia FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE ADDRESS P L a O CONTRACTORII�T it in Roof CO.NIT 70507 u cz ADDRESS600 S. San Gabriel Blvd. 0 I-- DESCRIPTION OF WORK S.G. W CL N NEW ADD ALTER C-REPAIR_,P DEMOLISH Z SQ.FT. NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE Re-roof Bldg_. SIGNATURE OF APPLICANT VALUATIONS 105.00 APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION FEE $ FEE $ 4.00 FORMS, MATERIALS _ FRAME: FIRE STOPS, 1 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. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSO IN VIOLA. LATH, INT. TION OF THE LABOR C ' OF THE STATE CALIFO IA RELAT. ING TO WORKWENSM NS 71 INS JR E. LATH, EXT. SIGNATUREHOUSE NUMBER COR- PERMITTEEQ1 RECT AND POSTED ADDRESS 00 S. San #abrfel Blvd, FINAL /,- �� San Gabriel JOHN F. LEWIS. PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION cK M.U. CASH Li& 1 6 7 4`12, GCT21 1 0 4.00 DEisARTMENT OF BUILDING AND SAFETY, APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ' D WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING L` ADDRESS �_3 -{' L. •-�l �� - �.. LOCALITY �� ;-'� N L -L / (� RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST CROSS ST. BUILDING OWNER �� 1"1 L L Cl T L> �Lp 1K I ,-r ADDRESS MAIL LOCALITY ADDRESS -- _ NEAREST TIECITY / NO. _CROSS ST. FIRE NO.DF TYP�_ GROUP ARCHITECT OR TEL i ZONE PLANS ENGINEER = NO. v ( ADDRESS BLDG. (/,, ORD.NO. SETBACK LINE - t'♦ Cd,�,+». .' — APPROVED TEL By DATE CONTRACTOR NO. USE APPROVED ADDRESS ZONE---* Ie BY DATE LEGAL CORRECTIONS ' DESCRIPTION/I LOTNO. �-g3. BLOCK '. NO.OF SLOGS. i SIZE OF LOT L ! _NOW ON LOT - -- / USE OF NO.OF i NO.OF /r - EXISTING BLDG. FAMILIES ROOMS - DESCRIPTION OF WORK NEW ALTERATION ADDITION O REPAIR MOVING DEMOLISH 13 Sq.FT. NO.CF SIZE �Q 7• ROOMS STORIES Z D WALL C O G• ROOF r COVERINGCOVERING USE OF NEW BUILDING as 1 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 REGULATING BUILING CONSTRUCTION. ' FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS �i /l PERMITTEE LATH,INT.: 1,!J AUTHORIZED AGT / LATH,EXT.: VDS-a 50M SETS 7-47 $, ^ .� PC * PLASTER,INT. v FEE PLASTER,EXT. VALUATION • _C. ' FEE FINAL - - - DEPARTMENT OF BUILDING AND SAFETY l�YYLlVtillVlV r Vn YLnl�lli COUNTY OF LOS ANGELES ' �® WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY _ 016TRICT NO. PLAN CK.NO. PERMIT NO. SWLDINO J ` ADDRESS /� ) / C LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST / - CROSS ST. l ' _ BUILDING OWNER d~ / ADDREBB f MAIL LOCALITY ADDRESB - - .o � NEAREST , CITY TEL t /�. CROSS ST. 40 !` NO. 7Tt FIRE NO.OF TYPE GROUP ARCHITECT OR TEL ZONE PLANS ENGINEER NO. BLDG. i C ORD.NO. ADDRESS SETBACK LINE e/ APPROVED CONTRACTOR "'� lz NOL BY DATE USE n APPROVED ADDRESBi� �✓ - M/C' (/ C^^T ZONE BY DATE LEGAL �� CORRECTIONS DESCRIPTION LOT NO. BLOCK TRACT NO.OF BLDGB. SIZE OF LOT _ NOW ON LOT USE OF I NO.OFI NO.OF EXISTING BLDG. FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION A REPAIR MOVING DEMOLISH _ p SO.FT. NO.OF Z SIZE ROOMS STORIES D WALL ROOF r COVERING I OVERING USE OF NEW BU DING 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 REGULATING BUILDING CONSTRUCTION. FRAME: FIRE BTOPS, SIGNATURE OF BRACING,BOLTS PERMITTEE LATH,INT.: AUTHORIZED AOT LATH,EXT.: DBS-3 soM SETS 1-48 $ p C � PLASTER,INT. FEE PLASTER,EXT. vALUATION FEE FINAL .. " 78A888A CE#808 9-87 `'`a�V• ' '� �/ C� APPLICATION FOR BUIL PERMI COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 19 zlelp- BUILDING AND SAFETY DIVISION LOCALITY > JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPT OF BUILDING- CROSS ST. rEXISTING OR APPLICANT TO FILL IN DIST�CT NO GROUP TYPE R D BY (Print or type only) D CONST. STATISTICAL CLA SI FICA TION SEWER MAP CLASS NO. DWELL.UNITS BK BLOCK USE ZONE MAP NO. O SPECIAL NO.OF BLDGS. CONDITIONS T NOW ON LOT LDG. BLDG.SETBACK FROM NOFRONT PROP.LINE OF —(STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD — TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CITY ABLDG.SETBACK FROM ARCHITECT OR TEL. ENGINEER NO. SIDE PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. W-L-o&k + a CONTRACTOR /1 1 ADDRESS syi Al IC 2�/ f 7 CORNER CUTOFF YES ❑ NO ❑ L LIC. CITY CLASS �"�- SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPT ON OF WORK n" CA eZ NEW ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF e STRUCTUREjfggj& SIGNATURE OF APPLICANT VALUATION S "„��© � APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, FOUNDATION: LOCATION FEE S FEE S r 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 C LIFORNIA RELAT- ING TO WORKMEN'S COMPENSATI N INSURANC LATH, EXT. SIGNATURE O HOUSE NUMBER- 06L ' RECT AND POSTED ADDRESS//996-.2 FINAL (p� JOHN F. LEWIS. PRI CIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ //., q r► r�PERMIITp VALIDATION CK. QM.O.. CASH LA 7iiU ��•' . oes 25M 4ETS 8-45 ' DE= Ap'1 MENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING r DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS /{� ,� �, f �+`�rj �..�_eyr LOCALITY ' "�' RECEIVED BY I DATE OF APPL. DATE ISSUED NEAREST - CROSS ST. BUILDING OWNER ADDRESS MAIL LOCALITY ADDRESS --- ------ -- --- NEAREST TEL. CROSS ST. CITY NO. — FIRE NO.OF TYPE GROUP ARCHITECT OR TEL. ZONE PLANS ENGINEER ND. BLDG. ORD. NO. ADDRESS SETBACK LINE APPROVED TEL. BY DATE CONTRACTOR NO. USE APPROVED ADDRESS ZONE BY DATE LEGAL CORRECTIONS DESCRIPTION I LOT NO. BLOCK TRACTNO. OF -------- ---- �' 1 / V NOW ON LOT S• SIZE OF LOT USE OF NO.OF NO. OF EXISTING BLDG. FAMILIES I ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O ' A REPAIR MOVING ;.6 DEMOLISH p SQ. FT. NO.OF Z SIZE I �L. ROOMS -fes'" STORIES r WALL "' I ROOF COVERING 4-'l- f COVERING — USE OF NEW BUILDING � -- !e t APPROVALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS — 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, SIGNATURE OF BRACING, BOLTS OWNER LATH, INT.: AUTHORIZED AOT LATH, EXT.: P C. >$ PLASTER, INT. r— FEE PLASTER, EXT. IS VALUATION "- FEE FINAL c_i ty- c' %c"r pI- 2C-7 e 1- i L 76A638A CE*803 8-64 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINZER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST. IL DIST ICTGROUP TYPE PROCESSED BY FOR APPLICANT TO FILL IN Q� coNs BUILDINGSTATISTICAL> SSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL UNITS 'EK PG LOT NO. �� BLOCK USE ZONE MAP N O. C;r TRACT �o��l C -l. SPECIAL N0. OF SLOGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF (STREET) OWNER• NO. TYPE OF EXISTING SETBACKHIGHWAY + YARD - TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CITY BLDG. SETBACK FROM ARCHITECT ORV TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE F EXISTING SETBACK HIGHWAY + YARD = TOTAL O ADDRESS HIGHWAY WIDTH FROM C.L. a TEL + - 0 CONTRACTOR - NO 4�DO U ADDRESS r404r3 n NO CORNER CUTOFF YES NO CC 0 LC CITY CLAS S� SEE REVERSE SIDE FOR SPECIAL APPROVALS v W DESCRIPT ON OF WORK N NEW ALTER REPAIR DEMOLISH SQ.FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE ` SIGNATURE OF - APPLICANT L ti VALUATION$ F J ev APPROVALS DATE INSPECTOR'SSIGNATURE FOUNDATION, LOCATION FEE S FEE S ^' 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 9UILDI NG 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 WORKMEN5 COMPENSATION INSURANCE. LATH. EXT. SIGNATURE OF -'7� HOUSE NUMBER COR- PERMITTEE-(' A`01 RECT AND POSTED ADDRESScK-Z�[�F-���7 F I N A L JOHN F. LEWIS. PRINCIPAL ST.Rtie-T_URAL ENGINEER PLAN CHECK VALIDATION CK. M D. CASH _ PERMIT VALIDATION' cK. 11.0 CASH 7 0 4 r'y, FEB 1 D 8.0 0- la, APPLICATION FOR BUILDING PERMIT p COUNTY OF LOS ANGELES BUILDING AND SAFETY . WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS' y PUILDI ADDRESS -� , 3 I hereby affirm that I have a certificate of consent to self insure, L t y ��1 or a certificate of Workers'Compensation Insurance,or a certified ZIP copy thereof(Sec.3800,Lab.C.) L '�- C{, j -7 CS L7 LOCALITY Policy No. Company I ems , ~ SIZE OF LOT NO.OF(LOGS.NOW ON LOT ❑ Certified copy is hereby furnished. I NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE-ZONE MAP NO. Date ApplicantASSESSOR MAP BOOK PAGE PARCEL' SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OW ER \` WITHIN loon Fr.of SCHOOL?% COMPENSATION INSURANCE TEL NO. t CeC.1\WAV t C3®V`9©LM O YES NO (This'section need not be completed if the permit is for one hundred ADD9SZS3 L , Caa,C.i(4 S� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED 13Y dollars($400)or less.) I certify that in the performance of the work for which this permit C11C,-.%�C ZIP is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant I ADDRESS CLASS NO. 12"1 li� DWELL UNITS N07/CE TO APPLICANT.• If, 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 Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be-deemed revoked. ADDRESS LIC.NO. P.L } LICENSED CONTRACTORS DECLARATION SIDE C CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT:SIZE NO.OF STORIES NO.OF FAMILIES NEW ❑ BK PG C Professions Code,and my license is in full force and effect. Z 0�A7 DESCRIPTION OF WORK o, $LUAey%yam ' ® d License Number Lic.Class t ADD ❑ LL Contractor Date C1.yc.'�+t C4.."d qe^�. ALTER ❑ v,Qk,% z ElI am exempt under Sec. REPAIR ❑ $ BAP.C.for this reason DEMOL ❑ LDMA PIC# Date: USE OF EXISTING BLDG. URM ❑ Signature �Ov Cv Q-6 Y� :Ka 1 APPLICANT IAF ) TEL NO. LDMA Perm# �J I, as owner of the property, or.my employees with wages as � t' u`--� 3(7C i Zti� Z ACCT.s their sole compensation, will do the work and the structure is ADDRESSSY T19 +GS _C_ �'���� Q 9 ?Q a not Intended or offered for sale (Section 7044, Business and q'ii ��'' FINAL DAT �J A 80 Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL!i�j'� f''�. o 1 ITEMS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED N THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYi licensed contractors to construct the project (Section 7044, vEs❑ No� TOTAL t AL e 0 Business and Professions Code.)�Ct �j N WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTHHt'I �l CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR .00 � GUIDELINES. I hereby affirm that there is a construction lending agencyfor , VES❑ NO❑ the performance of the Work for which this permit is Issued(Sec. (HAVE READ THE HAZAR ATION GUIDE AND THE SCAOMD PERMITTING �y ;}i {} 3097,Civ.C.) CHECKLIST.I UNDERSTA MY EOUI MENTS ANGELES COUNTY CODE, 0000-0001 t 4 18f+6 N TRU:2.CHAPTER 2.2 CTI NS 2. .100 THROUGH 2.20.1 ONCERNING HAZARDOUS Lender's Name MATERIALS REPORTIN D ROB TH CAOMD. 5CiTt 7 1 Aim a n 49 Lender's Address 77 V OWNER OR AGENT 3 I certify that I have re ie-eppliCatlon and state under penalty c of perjury tha a ove information is correct.I agree to comply P.C.FEE PERMIT FEE • 0) with all co ty o I n State laws relating to building m constructi a h eby authorize presentatives of this County ISSUANCE FEE e to enter n t ab erty for inspection pujrpo 0 INVESTIGATION FEE TOTAL FEE f� X�yO a ��3pmNre ApphCanl a Alam Oma 1 '// /' !/ SEE REVERSE FOR EXPLANATORY LAN &AGE WORKERS'COMPENSATION DECLARATION IL ss 6 o affirm that I have a certificate of consent to self ® 1 -I C -.-t I L I PERMIT •e, or a certificate of Workers'Compen on Insurance,or I � ® eta �® � •tified copy thereof(Sec. 3800, Lab. I - - b✓ .�CSj r- ,,✓✓ ! COUNTY OF-LOS ANGELEt �� G BUILDING AND SAFETY y No.r /' bmpany BUILDING fj Certified copy is:hereby furni ed. _ FOR APPLICANT TO FILL IN ADDRESS CJ _� ' ( Certified copy is filed with the county building ins ec- BUILDINGf 1' tion department. ADDRESS j LOCALITY NEAREST ' f?Applicant r CITY' i' r� / ZIP CROSS-ST. CERTIFICATE'OF EXEMPTION 4 ROM' RKERS' t 1 NO.OF BLDGS. / ASSESSOR ^ COMPENSATION INSURAN V ` SIZE OF LOT NOW ON LOT / MAPIBOOK PAGE PARCEL section need,not be completed if t, a permit,is for one _ USE ZONE MAP red dollars ($100)or less.) TRACT BLOCK LOT NO. TEL. Ip� q� '/ ` t SPECIAL iify that in the performance of the work,for which this OWNER �+ r�G„� NO.+rC ..�7 1 CONDITIONS it is-issued, I shall not.employ any person iri.any manner - } DISTRICT GROUP TYPE FIRE PR CESS BY V r )ADDRESS- �r `J /-! �CrS' CONST. ZO ,to become subject.to the Workers'Compensat' rt L s. / ®C' 2f�AppIicant �'' CITY - �f J"/ate ZIP STATISTICAL CLASSIFICATION AW.' CONDO, CE TO.APPLICANT: If, after making is Certif at f ' ARCHITECT OR - TEL. Iption, .you should become subject to the orkers'' ENGINEER NO.' CLASS NO. DWELL.UNITS LU •sensation provisions of the Labor-Code, you must forth- ADDRESS SEWER MAP `2 'comply with• such provisions 'or this permit shall be y,�� _ Cy ted revoked.• CONTRACTOR f,�Yt• P r- py / 7� "� i BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION ll pby affirm that I am licensed under provisions of Chapter 9 ADDRESS /7/. �,.��� T -NO & VALUATION G� nencing with Section 7000)of Division 3 of.the Business and LIC P. " _ ssions Code,•and my license is in full force and effect.• CITY j'J/'i E? ,.t! CLASS $ �^ -� SQ. FT NO.OF NO.OF CHECK se Number /�'✓5� Lic.Class- g SIZE '� STORIES FAMILIES ONE ' actor Date' r'2f � 2 DESCRIPTION OF WORK NEW ❑ $I' �^ ,l- ADD ❑ I am exempt-rom th if es;l!ng requirements.as I am a n licensed or itect or registered professional engineer ALTER ❑ FINAL C2-4 7 'acting in my professional capacity (Section 7051, REPAIR ❑, DATE (�G Business and Professions Code). USE OF FINAL I., i•... EXISTING BLDG. " DEMOL ❑ By � l r'Reg.No. Date APPLICANT TEL: VV i OWNER-BUILDER DECLARATION (PRINT) NO. 'by affirm that I am exempt from the Contractor's License Q�/ � For the following-reason (Section 7031.5, Business and ' ADDRESS j17 �rj ssions-Code):. PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS 0,SA wages as their sole compensation,will clothe work and . the structure is not intended or offered for sale(Section LOCALITY - 7044, Business and Professions Code). MOVING TEL. ?'o I, as owner of.the property, am exclusively contracting 'CONTRACTOR NO. j with .licensed contractors to construct the project (Sec- 1 2 ° ° 3 0 J, • tion 7044, Business and Professions Code). ADDRESS 'T h •.c REQUIRED TOTAL SETBACK FROM EXIST. ' CONSTRUCTION LENDING,AGENCY SET BACK YARD HWY PROP. LINE WIDTH L .by affirm that there is a construction lending agency for FRONT terformance of the work for which this,permit is issued P.L. �•J•— y 3097, Civ. C:). SIDE P.L. . er's Name �:..- I �, P.C. Fee$ Permit Fee /�• �✓ _ er's Address '!f that I have read this.a lication'and state.that the ' Y PP Issuance Fee LJ l a information is correct. I agree to comply with all County' Investigation Fee antes and State laws relating to building construction, g Total 'C iereby authorize repres 0Jives.of this,County to enter th�bove-mentione lotSe for inspection p pos s. r SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Signal a of App icantor Agent D e ®s �. WORKERS'I`OMPENSATION DECLARATION I have a certificate of consent to self insure borhereaa certificate of Workers'Compensation Insurance, APPLICATION F®R BUILDING PERMIT or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified co is hereby furnished. BUILDING copy v I FOR APPLICANT TO FILL IN 7 i�$ LA ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS C, Date Applicant CITY 11�t� !��- C+ ZIP 1 i� p LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST r! �� e� �` COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. L7 (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) - TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. MA I certify-that'in the performance of the work for which thiP s OWNER U . 3�w1 t:;t:L1 c]�� NO. USE ZONE permit is issued, I shall not employ any person in any manner `c: :S SPECIAL so as to become subject to the Worke C on S. ADDRESS SCG t, V 3 CONDITIONS J _ � yam' CITY st+�-� 4014 tv s A ZIP 17-7 Co 0 Date Applicant ARCHITECT OR TEL. NOTICE TO'APPLICANT: If, after making'this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIREVPOCESSED BY O Exemption, you should become subject to the Workers' CONST. ZONV Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be ADDRESS TEL STATISTICAL CLASSIFICATION APT. CONDO. Cl) deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. i' CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE �NS�.�c� ❑ • VALUATION Contractor Date ' DESCRIPTION OF WORK ` ADD$ I am exempt under Sec. t✓11lO�s r ❑ (/ l/ loo, , ALTER ❑ B.BP.C. for this reason REPAIR ❑'." $ USE OF Date: EXISTING BLDG. DEMOL ❑' 206 7 8A SignatureAPPLICANT - �C�`' . FINAL _ # 0,? 018,1 OWNER-BUILDER DECLARATION PRINT NO.2SS^ i ° ° 4Q5ODATE I hereby affirm that I am exempt from the Contractor's License '��'3 (��� $} �, _ Low for the following reason (Section 7031.5, Business and ADDRESS FIN o 0 0 4 Q 5,0 Professions Code): PRESENT BY 0 9 1 4 ~8 8 BUILDING I, as owner of the property, or my employees with ADDRESS wages as,their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ' ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK F CONSTRUCTION LENDING AGENCY' SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097,'Civ. C.). SIDE w; P.L. Lender's Name l 4 P.C. Fee$ Permit Fee 40e Q LDMA.Ref. N Lender's Address I certify that I have read this application and state that the Issuance Fee Q ' ~DMA P/C$ above information is correct. I agree to comply with all County Investigation Fee I ordinances ta=e.iews-relating to building construction, Total Fee LD I and he y rize representatives of this County to enter MA Perm.q upon e a - ent' ed property for-inspection purposes. a T —T`1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date