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HomeMy Public PortalAbout9914 LAS TUNAS DR_Building__ APPLICATION FOR -BUILDING PERMIT 76AGS'SA DBS-3 11-55 'DIVISION;OF BUILDING AND SAFETY BUILDING ADDRESS ,uDepfatmEngineer of County Engine ^_ County of Los Angeles LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,,SUP•T OF BUILDING - - _CROSS ST ' FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE ���! SEWER MAP �/• BK PG � CONST. I BUILDING ® .% { NUMAP MBER 0 STATE _YES ADDRESS / O 'T/�rfHWY LOT NO. O BLOCK USE ZONE SPECIAL- , _ � - � , CONDITIONS TRACT SIZE OF LOT Q A 01 NO.OF BLDGS. NOW ON LOT BUILDING EXIST. YARD HWY STREET NAME SETBACK WIDTH USE OF /f /� FRONT q EXISTING BLDG. �` C. '/�f/Y S� P L. OWNER g M-2.4,1A. ,SIDE 6- P. P. L. MAIL - ADDRESS QA O TRACT DWELL. 1 UNIT i TEL. 5 INDUSTRIAL CITY NO. 1 DWELL. 1 UNIT 6 PUBLIC BLDG. ARCHITECT OR TEL. - 2 ',DUPLEX 92 UNITS ENGINEER NO. 7 ADDN.,ALT., ETC. 3 ,APT. UNITS 8 MISCEL. _ ADDRESS oidt-- 4 COMMERCIAL TELINSPECTION RECORD . CONTRACTOR - NO. ADDRESS ®® DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH V SO. FT. h O. OF ' NO OF SIZE '� 1!� V STORIES FAMILIES USE OF STRUCTURE Co t/eor�" ,- r��1iC 0 FFi �2 SIGNATURE OF APPLICANT - APPROVALS ADDRESS'I'G„Ze - DATE ,INSPf-CTOR•SSIGNATURE FOUNDATION: LOCATION C P. C. $'- FORMS, MATERIALS FEE FRAME: FIRE STOPS, VALUATION $ �� BRACING. BOLTS y ssn JL.+ � FEE 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. Q. AND STATE LAWS REGULATING-BUILDING '' _ CONSTRUC-, TION. LATH, EXT., SIGNATURE OFf HOUSE NUMBER COR- "PERMITTEE - RECT AND POSTED' - I ADDRESS r FINALJOHNA.LAMBIE, COUNTY ENGINEER _ r ATION', CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR MO CASH �` L 8 8 "3 0 AUG ETS �OEPAR'iMENT OF BUILfDING AND SAFETY APPLICATION FOR 'PERMIT ` COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER• BU 1WING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING ADDRESS LOCALITY RECEIV D By DATE OF APPL.- (DATE ISSUED NEAREST CROSS ST. ' - - BUILDING q er OWNER 'El - ADDRESS per{ ' MAIL - LOCALITY ADDRESS B y NEAREST P /• ..TEL. CR SS BT. -• -{, y,,,�Q S+�'1�� - CITY NO. FIREO. TYPEGROUP N ARCHITECT OR TEL. ZONE `;' -I PLANS ENGINEER NO. BLDG. ORD. NO. 'ADDRESS _ SETBACK LINE ' • APPROVED - TEL. �f C - • ' CONTRACTOR BY DATE NO. �oC -J USEAPPROVED • ADDREBS�/2/�• ta—h ,1 7 ZONE BY DATE LEGAL_ t_ �,s�y CORRECTIONS DESCRIPTION II L9OT NO. o6 r,II BLOCK vp f lr TRACT /"�!� / G:' 3 '.o•�..+V � � ® I NO. OF BLOT SIZE OF LOT NOW ON LOT - USE OFn/� NO.OF NO:OF • ^ ' EXISTING'BLDG. f(h� I"FAMILIES I ROOMS ff DESCRIPTION,OF WORK NEW ALTERATION' ADDITION , O REPAIRMOVINO _ DEMOLISH O_ • SO. FT. NO.OF SIZE ROOMS STORIES — -, D WALL - I ROOF COVERING, �s - _i COVERING USE OF NEW `_ _ _ ' _• BUILDING •af�y' //�/'�j,'/� 't ' / _ - "J APPROVALS ' 1, HEREBY ACKNOWLEDGE' THAT ,I HAVE READ -THIS - INSPECTOR ' DATE APPL-ICATI ON%AND STATE THAT THE,ABOVE,19 CORRECT 'FORMS, MATERICATION, _ AND AGREE TO'COMPLY=WITH ALL COUNTY ORDINANCES 'FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS,- • BRACING, BOLTS c - •• SIGNATURE, OF, - • OWNER• LATH, INT.: AUTHORIZED- AOT.Il�''Oa LATH, EXT.: JFEE . C. .PLA9TERr INT. • -s: EE v� ,PLASTER, EXT. `-VALUATION -I' - S- �' FINAL ,�� `1� y* �,� � •���� ;"1 DMSION OF BUILDING AND SAFETY Depm ent of County Engineer BUILDING County of Los Angeles WM. J. FOX, COUNTY ENGINEER s �,,: APPLICATION BUILDING •/ T FOR APPLICANT TO FILL IN ADDRESS /�►� /'� f� l BUILDING I I c LOCALITY ADDRESS -_ - _ NEAREST- r /�. /1 +� o, LOCALITY .- lT •CROSS'ST._ KJ/�/ r- NEAREST - DISTRICT NO. PLAN CK. OR REO. No. ..PERMIT NO. CROSS ST. - 6Q&lQC v OWNER - RECEIVED BY DATE OF APPL. DATEISSUED AMAIL DDRESS V CA f ! i USE ZONE NO. OF' TYPE GROUP FIRE ZONE _ PLANS _ '�I f� NO. r a 10 CITY �'�. ARCHITECT OR ' - TEL. r 'ZONING. DAI ENGINEER NO. APPROVED BY- BUILDINGOD.N ADDRESS SETBACK LINE: • TEL, APPROVED DATE CONTRACTOR NO. Ci • BY, G� _ HOUSE-NUMBERING _ ADDRESS I - LEGAL MAP NUMBER Q 7 NO. ASSIGNED BY DESCRIPTION LOT NO. . ,1 'iD_ BLOCK A lAf. �., DATE CORRECTIONS J INSPECTOR TRACT' • - -NO. OF BLDGS. - SIZE OF LOT Sc _ NOW ON LOT NO. OF - EXISTING BLDG. ti, - FAMILIES USE OF I I O• 'b`s C DESCMPTION OF W RB NEW ALTERATION ADDITION - - m REPAIR DEMOLITION - SQ. FT. =moi '_ NO. OF • SIZE ROOMS STORIES EXT. WALL - I COVERING I - ROOF COVERING- - USE OF STRUCTURE APPROVALS INSPECTOR'S SIGNATURE DATE- FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS AP- FRAME: FIRE STOPS,• ' PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS �I ' CORRECT. - 1 AGREE TO COMPLY,WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, #Zj AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS - Y SIGNATURE OF = LATH,, INT. " PERMITTERk Al •LATH, EXT. K i ADDRESS _ PLASTER, INT. AUTHORIZED AGT. i PLASTER, EXT. I $ G•d'� FEE,-C.$ HOUSE NUMBER COR-RECT AND POSTED VALUATION FEE $j�„i+� FINAL - 3 76A68A 10138 S 2-88 .- ,76A638A CE #803 1/71 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER ` MAP BOOK PAGE PARCEL BUILDING, AND SAFETY, DMSION BUILDING ff JADDRESS.. COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST y Print ort a onl� CROSS ST o DISTRICT NOGROUP TYP PROCESSED BY BUILDING r t 'CO r ONST p ADDRESS LOT NO BLOCK �TATISTICAL CLASSIFICA-TION _ SEWER MAP - �. � S - CLASS NO.�DWELL,UNITS •BK , PG TRACT USE ZONE MAP NO OF BLDGS_ _ NO SIZE OF LOT NOW ON LOT /f' SPE IAL USE OF C_ CONDITIONS EXISTING BLDG. ` TEL. OWNER (r NO _ BLDG SETBACK FROM tl ADDRESS FRONT'PROP LINEOF `' (STREET) ` TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY �/Vt- Q�_ C'r HIGHWAY WIDTH FROM C L - ARCHITECT OR TEL ENGINEER NO. VV ' - BLDG-SETBACK FROM ADDRESS' SIDE PROP. LINE OF (STREET) EL TYPE OF EXISTING SETBACK HIGHWAY +_ YARD = _TOTAL �.. CONTRACTOR L V ' HIGHWAY WIDTH FROM C.L U ADDRESS \10LI t + _ ppO' CITY �� l/1/r<6 �'� CLASS . CORNER CUTOFF - YES ❑ NO a CONSTRUCTION LENDER NAME AND BRANCHSEE EVERSE'SIDE FOR SPEC IAL'APPROVALS ADDRESS 44 / SO FT NO OF NO. OF' - O SIZE v STORIES FAMILIES NEW El USE OF c /- ADD• ❑ �I STRUCTURE J ' ` ALTER ❑ ,SIGNATURE OF` EPAIR❑ APPLICANT EMOL ❑ , VALUATION $ APPROVALS DATE INSP TOR'S SIGNATURE ,N P.0 PMT. y 0 FOUNDATION. LOCATION / FEE $ / FEE $ .r�'� FORMS, MATERIALS fl/If , FRAME* FIRE-STOPS, I HEREBY ACKNOWLEDGE'THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE•ABOVE IS CORRECT AND AGREE TO,COMPLY FURNACE- LOCATION, ' WITH ALL ORDINANCES AND LAWS ULATING BUILDING CON- GAS VENT, DUCTS _ STRUCTION I CERTIFY THAT IN D ING TH WORK AUTHORIZED , HEREBY I WILL NOT PLOY, ANY ERS N VIOLA N OF, THE LATH, INT. LABOR CODE OF ST CA FO NIA IN LATING TO WORKMEN'S COM ATI INSUR , LATH,'EXT• SIGNATURE-0 UMBER HOUSE NUMBER COR= PERMITTEE RECT-AND POSTED' _ADDRESS Lw '/ • FINAL JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER PLAN, CHECK VALIDATION CK M o CASH _ PERMIT VALIDATION , CK M O CASH ;02,7.0 2 2 3 D 5.40 2-7. 0 31 9.0 CJ' Y , 76A638A CEN803 5-65 APPLICATION FOR-BUILDING --RMIT - - - COUNTY OF LOS ANGELES BUILDING ' DEPARTMENT OF COUNTY ENGINEER ADDRESS �J o -BUILDING AND SAFETY-DIVISION LOCALITY•C/ -- - JOHN A. LAMBIE. COUNTY ENGINEER NEAREST - COLEMAN W JENKINS,SUP'T-OF BUILDING CROSS ST - - - - _ DIST NO ROUP- TYPE PRO S BY .' FOR APPLICANT TO FILL IN - - CONST = BUILDING STATISTICAL ASSI FICA TION - SEWER MAP ' ADDRESS - G�s CLASS NO DWELL U,NI TSS BK -PG/Q LOT NO Q BLOCK USE ZONE MAP - - - - - --- - ..y--` -`- - TRAOT •"')• SPECIAL' NO OF BLDGS CONDITIONS - SIZE OF LOT rV>C �J NOW O!N LOT USEUSE OF ��6/s$ -J�-�00� - - - OF y py pq BLDG SETBACK FROM f OWNER Q V/ NO yj , FRONT PROP LINE OF' l - REET) / TYPE OF EXISTING SETBACK HIGHWAY +'• YARD - 'TOTAL, ADDRESS CS C/Aat-S HIGHWAY WIDTH 'FROM C L CITY �~jBLD SETBACK FROM •I - ARCHITECT OR - TEL p �j SID PROP LINE OF ` (STREET)_. _ ENGINEER ���✓/' �RlVII,r� NO O OO7/0 TYPE OF EXISTjNG� SETBACK HIGHWAY _+ _ YARD_ TOTAL ADDRESS OO.J /�7�/f'�Gt KJP 4p HIGHWAY WIDTH FROM C L TEL- +.. CONTRACTOR /A1-y1 �uc ;NO 7-11941 - - O LIC ADDRESS �J/6 cs/¢��'-N0 Z 3CORNER CUTOFF f YES NO C� OC CITY yv S LCI-` - '• SEE REVERSE-SIDE FOR SPE CIAL-A_PPROVALS - O . DESCRIPTION OF WORKLu _ v a NEW DD ALTER - REPAIR DEMOLISH - h .Z ;SQ-FT NO OF NO OF =SIZE D 0 STORIES / FAMILIES r USE OF STRUCTURE �L4/f'� S O r , - SIGNATURE OF 9Z.0'/►1 C C_ - APPLICANT - - - - Pl� r ' VALUATION$ APPROVALS •DATE_'",, INSP•CTO_R'S SIGNATURE FEE FEE$_3& v 60 FOUNDATION, LOCATION • r/.f / ;/ FORMS, MATERIALS FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNAOE' LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS 13UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT ' ' - ' TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN 5 CO PENSATION INSURAyL E - , a/h7,�✓ C,"_f� C. LATH EXT- ; SIGNATURE OFAy �"`y�r � HOUSE NUMBER COR- ' PERMITTEE!/ ` ' __�� '�'�' `�/ RECT AND POSTED F n ADDRESS 7tl L•� �a�1 �-,,[ Fl NAL JOHN F LEWIS PRINCIPAL STIR TURAL ENGINEER •PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK MO CASH 0337 .40 JUL 823 .D.. 18.00i L?jLQ'3 8' 5, 0"2-- AUG 3 1_ Ds- . 3 0.0 0- ,- _ 76A638A CE4603 5-65 -APPLICATION FOR BU ILDU G PERMI rU COUNTY OF. LOS ANGELES' BUILDING j "- DEPARTMENT OF. COUNTY ENGINEER ADDRESS BUILDING -AND--SAFETY DIVISION LOCALITY• - _--- { JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W JENKINS,SUP•T OF BUILDING CROSS ST - - DIS•�1CCN0 TYPE '7 PR Sy BY FADDR OR APPLICANT TO FILL IN IJN// CONST j �� ��� STATISTIC SSIFI ATIO-N - "S BKER MPG _ _ CL ASS'NO DW EL L'UNI TS--"--' "BLOCK USE ZONE -NOAPJ SPECIALNO OF BLDOS CONDITIONS LOT �y� NOON LLO/T B G SedelOL. • 'w_5 ^�`/T�f• BLDG SETBACK FROM` pEL FRONT PROP LINE OF - .(STREET) USTYPE OF EXISTING SETBACK HIGHWAY '•+ YARD ' - 'TOTL�� HIGHWAY WIDTH 'FROM CITY ARCHITECT OR TEL BLDG SETBACK FROM - ENGINEER NO SIDE PROP LINE OF - '-ISTREET) _ TYPE OF EXISTING SETBACK HIGHWAY-, + -YARD, = TOTAL, ADDRESS HIGHWAY WIDTH FROM C L -3J _5C/-/ ,eLO LO �l✓ - - _D_ O ADDRESS, CORNER CUTOFF YES NO--[:] V CITY 1eeA 1W CI iLAS C SEE REVERSE-SIDE FOR SPECIAL APPROVALS* . 0- DESCRIPTION O,F,WORK _ L OK 49 a NEW ADD ALTER REPAIR DEMOLISH SQ.FT ` NO OF NO OF ' SIZE STORIES FA MI LIFS USE OF L STRUCTURE SIGNATURE OF r ' APPLICANT r VALUATION$ �? APPROVALS /INSP ECTOR'S SIGNA7UAE' FOUNDATION, LOCATION P�,� ` !'•� P C- PMT FORMS, MATERI-ALS w �L •„�. � - FEE$ FEE$ FRAME, FIRE STOPS, J HEREBY ACKNOWLEDGE THAT I HAVE READITHIS APPLICATION t 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 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA=- LATH INT _ TION OF THE LABOR C DC OF THE S OF ALIFORNIA RELAT- ING TO WORKMEN PE NSATION I SU AN �7 (PLO LATH EXT _ - SIGNATURE A_/ 'HOUSE NUMBER COR- PERMITTEE e4Y RECT AND POSTED ADDRESS FINAL PLAN CHECK VALIDATION CK M O • .CASH •» JOHN F LEWIS PRINCIPALS RUCTU RAL EN R - PERMIT VALIDATION CK MO CASH �tl(:O12 1 9 4 MAY 2 0 1 D 3.0 0 DMSION OF BUILDING AND. SAFETY �'H Depostasent of County Engineer L J� County of Loa Angeles WM. J., FOX, COUNTY, ENGINEER APPLICATION_ FOR APPLICANT TO FILL:IN ADD EISA BUILDINO L O 1 _ �•*- , ADDRE88 1 LOCALITY /�•�•1 REST LOCALITY I -r .-•.� o �f�T ,� �1— CROSS T. MA/-,0 �Lt DISTRICT NO. PUN CK. OR RBc. No. PERMIT NO. NEAREST CROS9 ST. L_ \V - OWNER RECEIVED BY ; DATEOFAPPL. DATE ISSUED' MAIL O F//f�vC.:G'/'�' •��/��`�� �'�'!J�,-F" �n, ADDRESS USE ZONE NO. OF TYPE, GROUP FIRE•ZONE TEL PLANS I 'I I CITY , NO. C- 31 ARCHITECT OR _ • TEL. ZONING,. - _ •-� DATED ENGINEER NO. APPROVED BY ` �* r ORD.MO. 'ADDRESS - SETBACK LINE:� �� a �� TEL. APPROVED DATE. CONTRACTOR NO. ball BY, - ���A O T HOUSE• NUMBERING- ADDRESS LEGAL - MAP NUMBER' ,2- D © NO.-ASSIGNED BY FX/Irr" DESCRIPTION LOT NO. BLOCK - - i DATE CORRECTIONS I INSPECTOR TRACTNO. OF i SIZE OF LOT56 NOW ON LOT BLDGS USE OF NO. O J EXISTING BLDG _ FAMILIES - / '� -� - //1i.I 1 .!-!� 0 ' DFSCREMON OF WORg a { z NEW ALTERATION " ADDITION REPAIR DEMOLITION Sq. FT. NO. OF _ SIZE ROOMS STORIES ' EXT. WALL ROOF _ -} COVERING COVERING USE OF STRUCTURE _ /tel d0 S- 1- U C-%, - ' - /�L ,APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION - isFRAME: FIRE STOPS,FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS , PLICATION AND STATE THAT THE INFORMATION GIVEN IS' CORRECT. BRACING, BOLTS _ I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, _ AND STATE LAWS REGULATING BUILDING CONSTRUCTION: GAS VENT, DUCTS ' SIGNATURE OF LATH, INT. ' PERMITTEE 4 + ADDRE86 N LATH. EXT. , 1 ' AUTHORIZED AGT. PLASTER, INT. , PLASTER, EXT. HOUSE NUMBER COR- ' FEE RECT AND POSTED VALUATION FEE !��"'� FINAL 76ASSBA DBS S 2-SH - _ WORKERS' COMPENSATION DECLARATION . '7 hereby affirm that I have a'certrf of consent to Self APPLICATION FOR BUILDING PERMIT insure, ora certificate of Workers'Compepenstion Insurance, 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 �� F1 0 Certified copy is filed with the county building mspec- BUILDINGftp tion department ADDRESS ��i4 L N DR LOCALITY ;�- ' NEAREST, \' Date Applicant CITY ZIP p� CROSS ST 'CERTIFICATE OF EXEMPTION FROM WORKERS' ' 1 NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE,OF LOT NOW ON LOT* , MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one / USE ZONE MAP 6G hundfed dollars ($100)or less ) TRACT -r BLOCK LOT NO {�- NO � // TEL SPECIAL 'Ali �� d I certify that in the performance of the work'for which this OWN r L1VK.N0 CONDITIONS o�0i O DISTRICT GROUP TYPE FIRE PROCESSED BY V permit is issued, I shall not employ any person in any manner CONST ZONE > so as to become subject to the Wo ers'•Com nsation Laws ADDRESS 1 �.. � O 'Date Applt �� CITY ZIP - STATISTICAL CLASSIFICATION APT CONDO V NOTICE TO APPLICANT If,-after•maki'ng this Certificate of ARCHITECT OR. TEL Ly •Exemption,-you should beeome'subject to the Workers' ENGINEER CLASS NO DWELL UNITS N Compensation provisions of the Labor Code, you must forth- ADDRESS ` , A SEWER MAP - Z with,comply with such provisions or this permit shall be > .deemed revoked r � :TEL BK �PG d / VALIDATION CONTRACTOR NO LICENSED CONTRACTORS DECLARATION' LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (commenting with Section 7000)of Division 3 of the'Busmess and LIC Professions Code, and my license is in full force and effect CITY CLASS $ SQ FT NO OF NO OF CHECK License t�u�r t �Lic_Clas SIZE STORIES FAMILIES ®. ONE L 1 Date DESCRIPTION OF WORK- �Cclrlil� NEW ❑ $ Contractor- " ' ElI am exempt from�the licensing requirements as I am a ADD licensed architect or a registered professional engineer ALTER ❑ FINAL =�) acting in my professional capacity I(Section 7051, Du N3 Y � ove REPAIR ❑ DATE Business and Professions Code) USE OF r115, 0 _ FINA � EXISTING BLDG y DEMOL B Lic or Reg No C 0-71 Date APPLICANT TEL By OWNER-BUILDER DECLARATION PRINT) A�2G GT' NO o 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) PRE EN 'BUILDING I, as owner, of the property, ori my employees with ADDRESS wages as their sole compensation,will do the work and L the structure is not intended or offered for sole(Section' LOCALITY x,4,3'3,1-A ' 7044, Business'and Professions Code) ' MOVING TEL CONTRACTOR :NO #'0 0 0 0 0-� �• ,I, as owner of the property, am exclusrvely'coniractmg - - with licensed contractors to construct the project (Sec- ADDRESS 2 0 0-3'8&15 0 j tion 7044, Business-and-Professions Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH oio.o 3,a 5 O v 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 03. 0 9,-8 1 (Sec 3097, Civ C ) , SIDE PL Lender's-Name m - - - P C Fee`s$ Permit Fee Q i - Lender's Address w 1 certify that I have read this application and state that the Issuance Fee '� O aabove information is correct I agree_to comply with all.County Investigation Fee.: t �) 0 ordinances and State jaws relating to�building construction, Total Fee i� 2 and hereby authorize representatives of this County to enter a upon th boVe-mentloyed pro'erty To inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE PS r Signature of Applicant or Agent 5ate' ,. ,