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HomeMy Public PortalAbout9812 LIVE OAK AVE_Building__ FOR APPLICA NT,TO FILL IN (Print or type only) �- ' BUILDING COUNTY OF LOS ANGELES ADDRESS J t. i= / t" DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION/ O- h NO OF BLDGS � ADIDRESS �2 - SIZE OF LOT (f NOW ON LOT 2- TRACT BLOCK LOT NO r LOCALITY OWNE /7 i('/�i�xb TEL NEAREST NO CROSS ST ASSEMR ADDRESS MAP BOOK PAGE PARCEL )�` DISTRICT GROUP TYPE FIRE PR ESSE BY CITY- /" ZIP '�� B CONN/ ZONE ] ARC ITECT OR• TEL - U o � 8•-Lxp�( -ENGINEER NO STATISTICAL CLASSIFICATION SEWER M P ADDRESS CLASS NO,ZL-DWELL UNITS BKld G CONTRACTO /O /Y�F�L-�/rQjSNO 06 USE ZONE �MAPLIC ADDRESS (�� 7/� // NO �' CIAL LIC 3-33 41NDITIONS CITY ,fL��J��7 Z� CLASS Z / ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO`❑ CONSTRUCTION LENDER NAME AND BRANCH BLPG SETBACK FROM FF40NT PROP LINE OF_ (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SO FT NO OF NO OF CHECK HI HWAY +• YARD = FRONT PROP-LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONECL } DESCRIPTION OF WORK NEW ❑ + O BLDG SETBA OM � /1 ADD �I SIDE PROP LINE O (STREET) O 1(/ ALTER ❑ FROM TYPE OF EXISTING w REPAIR ❑ HIGHWAY + YARD = EXISTSI ROP I HIGHWAY WIDTH N OFUSE REPAIR BLDG `Ks� ��L /��� DEMOL ❑ + = Z APPRINAINT /� ��^`,�fNo/( �� CORNER CUTOFF YES ❑ NO ❑ IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) -Iti 19• Q - IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION $ v y , I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE -Z� ®��/��Tv� THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I ILL NOT EMPLOY ANY PERSON INV TION OF THE LABOR CODE OF THE ST O CALIFORNIA IN RELATING TOW K N S COM ! PENSATION INSURANCE SIGNATURE OF PERMITTEE ADDRESS �/ l q CITY No0�6 G DATE r /j 7 BY MAKE CHECKS PAYABLE TO PC $ ! PMT 2 �V HARVEY T.BRANDT,COUNTY ENGINEER FEE FEE PLAN CHECK VALIDATION CK -M o CASH a PERMIT VALIDATION CK' M O CASH 589 28.5 (: ®3d ®i 76A638A CE#803 3 75 V Vn 76A63BA CE #803 1/71 �"j�� APPLICATION FOR EIJILDING PERMIT � COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS COLEMAN W. JENKINS, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL-IN NEAREST Print or typo only) CROSS ST. -nua DISTRICT NO. GROUP TYPE rte- PROC SSED BY BUILDING ta�j� /' O .� CONST ADDRESS G < ..JJ��� STATISTICAL CLASSIFICATION SEWER MAP LOT NO BLOCK CLASS NO. ck I DWELL UNITS BK PG TRACT US ZONE MAPS NO.OF BLDGS NO .C.�(�0� SIZE OF LOT 7 NOW-ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG OWNER Q �� - �l NO. 2 % BLDG SETBACK FROM ADDRESS 47047/2- F Ijv.e 4 FRONTPROP,LINEOF (STREET)I TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY lj'CC, 7 74 HIGHWAY WIDTH FROM C L ARCHITECT OR TEL + _ ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP. LINE OF (STREET) TEL -7 TYPE OF EXISTING TRACK HIGHWAY } YARD = TOTAL O LI CONTRACTOR HIGHWAY WIDTH FROM C.L V LIC. - ADDRESS Z101- + I=Np, _ � I LIC H" CITY CLASS .`CORNER CUTOFF YES ❑ NO ❑ W CONSTRUCTION LENDER h NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS Z ADDRESS SO FT NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES ❑ USE OF �'�� ADD STRUCTURE ALTER ❑ SIGNATURE OF REPAIR❑ APPLICANT DEMOL ❑ � I VALUATION $ Ll�lAPPROVALS DATE INSPECTOR'S SIGNATURE P.0 PMT, FOUNDATION- LOCATION FEE S FEE $ �� FORMS, MATERIALS FRAME: FIRE STOPS, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY —FURNACE- LOCATION, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STIRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY i OWILL EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT LABOR .CD F H STATE OF CALIFORNIA IN RELATING TO WORKMENCOM N TIO I URAN E LATH, EXT, SIGNATU HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL - L JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M O, CASH LjiUo3 8 1 7- JAI 3 1 D X7.0001 a4 a Tit t� ,.S CE,#803 12/69elL'DING APP I ATION FOR E3P RMT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE RCEL BUILDING BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUP T OF BUILDING (_ r- LOCALITY FOR"APPLICANT TO FILL IN CROSS sT Print or tXpe Onl DISTRICT [J GROUP TYPE RO SED BY BUILDING ck AQ CONST '/ ADDRESS t /� jf f` /� �-1� STATISTICAL CLASSIFICATION SEWER MAP LOT NO BLOCK CLASS NO. DWELL UNITS BK r_PG b TRACT ONE MAP NO OF BLDGS iy NO 2do SIZE OF LOT NOW ON LOT L.� _ / SPECIAL USE OF /' CONDITIONS EXISTING BLDG. TEL. OWNER I /,E �/�.i/ NO _ BLDG TBACKFROM- > ADDRESS 2- %f//� ©/�Ar- - FRONT PR I NE OF (STREET) �-- TYPE OF EXISTING ACK HIGHWAY + YARD - = TOTAL CITY / J �/ • HIGHWAY WIDTH FRO ' ARCHITECT OR TEL + _ ENGINEER NO. BLDG SETBACK FROM ADDRESS SIDEPROP LINEOF (STREET) TEL TYPE OF EXISTING SETBACK HIGHWAY + YA4111 = TOTAL CONTRACTOR p/V; ��'.( NO NO HIGHWAY WIDTH FROM C.L ADDRESS a C�-r E -fes S-3 4/ +- LIC, J CD CITY �A �/jti CLASS Q� CORNER CUTOFF YES ❑ NO V CONSTRUCTION LENDER O NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS W ADDRESS n- SQ FT � NO OF NO. OF ❑ L' 2 Z SIZE : C STORIES FAMILIES NEWUSE STRUCTURE /C q/1/// ��'v� ALTER ❑ SIGNATURE OF _ REPAIR❑ APPLICANT. G 'Q'� EMOL ❑ VALUATION$ O D APPROVALS O TE "I NSP CTOR'S SI NATURE P,C PMT, �I}} FOUNDATION, LOCATION FEE S FEE S L_p ' FORMS, MATERIALS . I - 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, G� WITH ALL, ORDINANCES ,AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS 4 STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED _ HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT LABOR CODE OF THE IO OF CALIFORNIA ELATING TO WORKMEN'S CO MPENSATIO I URANCE LATH, EXT. L�v SIGNATURE OF �iJ` HOUSE NUMBER COR- I PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F LEWIS PLAN CHECK VALIDATION cK o CASH _ TVALIDATION PRINCIPAL STRcK L O EN M PERMIT VCASH, u1i3O -1 6 7 r;,.- DEC 16 A D 28,50- IMPAR?'AIENT OF BUILDING AND SAFETY APPLICATION FOR PERM COUNTY OF LOS ANGELES W SWM._J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY - DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS s BUILDING I ' / 3 110-0.q elf 3 1 LOCAL U r`, RECEIV VY DATE OF APPL. DATE ISSUED ' NEAREST �,. V , CROSS ST. BUILDING ADDRESS OWNER MAID �P/� LOCALITY ADDRESS ` NEAREST TEL. �� CROSS ST. CITY NO. FIRE NO. OF I PE�^ I GROUP ARCHITECT OR TEL. ZONE PLANS ENGINEER .NO. BLDG. ORD. NO. _SETBACK LINE 7 y 7 7 ADDRE88 .,�� APPROVED r TEL. BY - DATE ' - - CONTRACTOR . NO. USE APPROVED ' ZONE - BY DATE - ADDRESS �� HOUSE NUMBERING LEGA DESCRIPTION LOT NO, BLOCK MAP NUMBER X�•® 1 FIELD CHECK BY TRACT NO. ASSIGNED BY �� DATE No OF eLDGs. CORREGTIONS - SIZE OF LOT a ® I NOW ON LOT pfi USE OF I No. OF - EXISTING BLDG, FAM JURS p �q DESCRIPTION OF WORK _ (1 n NEW I y I ALTERATION I I ADDITION I ..c4� �,FL REPAIR . I I DEMOLITIONI I I A�7�/ -� SFT. NO. �/ SIZE E / ROOMS STORIES / y' f�� ,�a•G.L! D EXT WALLROOF COVERING I COVERING USE OF STRUCfURE APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS /7 CORRECT. 1 AGREE TO.COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, c - / HER AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS A^ LAWS REGULATING BUILDING CONSTRUCTION. � FURNACE- LOCATION, SIGNATURE OF GAS VENT, DUCTS PERMITTE - J _ LATH, INT, ADDRESS ` (� y/- �y .f• L r LATH, EXT. AUTHORIZED AGT. - 1v PLASTER, INT. A638A- DOSS 10-50�.�. 7 P C. $ J 'VT FEE PLASTER, EXT. `. �r VALUATION 2 Do $ �/ FEE FINAL I ^76 6384 CE#803 2-63-APPUCATION 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, SUP T OF BUILDING CROSS ST ja • ,DISTRI T NO R BY 'GROU TYPE P , FOR APPLICANT TO FILL IN - coNsr BUILDING STA ISTICA CLAS IFICATION SEWER MAP�n, ADDRESS / ' Br - CLASS,NO DWELL UNITS- LOT NO WATER CERTIFICATE NOT REQUIRED RECEIVED TRACT MAPHIGHWAY - ' NO OF BLDGS NO (CIRCLE) STATE MAJOR SECOND LOCAL SIZE OF LOT NOW ON LOT USE ZONE SPECIAL 'USE OF .y CONDITIONS ' EXISTING BLDG T OWNER BUILDING EXIST j YARD HWY TREET NAME ` SETBACK WIDTH ADDRESS ,u(� C.-itFRONT fa 1 ARCHITECT OR 'TEL - a P L .�_ ENGINEER NO 'SIDE _ P L G.. ADDRESS 't O TEL V 'CONTRACTOR NO - - ADDRESS O F DESCRIPTION OF WORK a N NEW ADD- ALTER REPAIR DEMOLISH SQ FT ,i-y NO OF NO OF SIZE t^' STORIES FAMILIES _ USE OF STRUCTURE SIGNATURE OF _ APPLICANT VALUATION.$ _ APPROVALS ATE, INSPECTOR'S SIGNA,� RE P C PMT - d`{J 'FOUNDATION LOCATION , FEE $ �/ FEE $ �- FORMS MATERIALS FRAME FIRE STOF I HERE ACKNOWLEDGE THAT 1 HAVE READ�THIS APPLICATION BRACING BOLTSPS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY`ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS t ' 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 I SU RANCE LATH, EXT 'SIGNATURE OF •-I HOUSE NUMBER COR- -PERMITTEE RECT AND POSTED ADDRESSFINAL -4�G6f JOHN F LEWIS PRINCIPAL STRUCTURAL R PLAN CHECK VALIDATION' CK M 0 CASH _ - PERMIT-VALIDATION CK M CASH:' A1'P--'PUCAT0H FOR R BMLIO G PERMr --—�° COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL INEBUILDING ADDRSS , L E r, I hereby affirm that I have a certificate ADDRESS Q 4icate of consent to self Insure, - `l` (1• or a certificate of Workers'Compensation Insurance,or a certifiedDU f copy thereof(Sac ,Lab C) CITY15 ZIP / LOCALITY POIICy NO Company SI E OF OT NO OF BLDGS NOW ON LOT ❑ Certified Opfy-,S ereby U Shed NEAREST CROSS S ' ^ p) TRACT BLOCK LOT NO 0-4./LJ ❑ Certified copy Is filed with t c my bul Ing s tion USEZONE MAPNO departm nt P ASSESSOR MAP BOOK PAGE PARCEL Date _ Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNE /�� TEL N YESNO / COMPENSATION INSURANCE TI—r- `"Q'" //J,/2 WITHIN 1000 FT OF SCHOOL? ADDRESS - '/ (This section need not be completed if the permit Is for one hundred Z Gz y G ll DISTRICT GROUP TYP�ST' FIRE ZONE PROCESSED BY dollars($too)or less) CITY _ �/ zip 0 �Q I certify that in the performance of the work for which this permit hl L 0 GZ 7/ ,/ 7 Z L�� ,� Is Issued, I shall not employ any person-in any manner so as to ARCHITECT OR ENGINEER TEL NO ✓✓ become Subject t t e rkers'Compensation STATISTICAL CLASSIFICATION APT CONDO Date pplicant " ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONFACTOR �/ /n�,,,�,, TEL NO L SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ( /�i/� � _� 3 5�`J FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS �J LIC NO /�y�j PL Al /v Z�J� .�II S O"C., � % 0 /" SIDE LICENSED CONTRACTORS DECLARATION CITY LIC c PL o I hereby affirm that I am licensed under provisions of Chapter 9 LA- /01(b/✓t E /L SEWER MAP C.3 SO FT SIZE- NO OF STORES NO OF FAMILIES (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG � Professions Code and m license Is in full force and effect v _-� DESCRIPTION F WORK ADD ❑ VALUATION License Number Lic Class ��� j,� Contractor e�X L,1 k Yr a U "3 I—`� Z T ALTER ❑ Z D e• `�/" SE��S/1�4L REPAIR ❑ I am exempt under Sec B&PC for this reason 0r/� DEMOL ❑ LDMA P/C N Date USE OF EXISTNG BLDG URM ❑ Signature APPLICANT(PRINT) TEL NO LDMA Perm# 1 ❑ I, as owner of the property, or my employees with wages as O ACCT■s their sole compensation,will do the work and the structure is ADDRESS F not Intended or offered for sale (Section 7044, Business and FINAL DATE / C 33n403 125.55 Professions Code) g 1 ITEMS THE APPLICANT OR FUTURE BUILDING HANDLE MATERIAL u �- ❑ I, as owner of the r0 8 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN property,rty, am exclusively contracting With THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE1 FINAL BY licensed contractors to construct the project (Section 7044, TOTAL IL25.5 Business and Professions Code) YES❑ No❑ ((��((}}��//��IIJJ �'yC� WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING �.'f C K 125.55 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST (tJ ►I('C FOR GUIDELINES - C• MGE .00 I hereby affirm that there is a construction lending agency for YES ElNO 1:1the performance of the work for which this permit is Issued(Sac I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD (� 4/95.3097,CIV C). PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES QOQa—��1 1L2/ 7,p� 7•! F' COUNTY CODE,TITLE Z CHAPTER 2 20 SECTIONS 2 20 100THROUGH 2 20140 CONCERNING / �b Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD ; 1 !1!111.0 10 Lenders Address OWNER OR AGENT o I certify that I have read this application and state that the above Information Is correct I agree to comply with all county PC FEE PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize rep ntativ&4 of this County to enter upon ISSUANCE FEE the above-mention p party fobinspection purposes Q i INVESTIGATION FEE TOTAL FEE �.� b) o ApplunlcrAgM SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION '- hereby affirm that I f Woe,k certificate-of n lnsunt•to-se=f E C n U E®H F O 0 p U E L D E Dd 6 [P E RM nn E U sure, or a certificate of Workers'Co n n Insurance, t� LI Lr�1 LI LIv(JL/u tifie tr r of Sec 3800, ab C COUNTY OF LOS ANGELES BUILDING AND SAFETY olicy o / Company ��- & -`- Certified copy is hereby furnished �/G?_ FOR APPLICANT TO FILLdN BUILDINGkf �- JJ ADDRESS Certified copy is filed with the county building inspec- BUILDING ' tion department ADDRESS (r- ��rf LOCALITY NEAREST ate Applicant CITY /7 49L� ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR COMPENSATION-INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL �unclred his section need not be completed if the permit is for one / USE ZONE MAP TRACT BLOCK LOT,NO NO dollars ($100)or less ) J > TEL �/ SPECIAL certify that in the performance of the work for which this OWNER IC' ( C /y (G7Q/j NO CONDITIONS O )ermit is issued, I shall not employ any'person in any manner DISTRICT GROUP TYPE FIRE C D BY U o'as to become subject to the Workers'Compensation Laws ADDRESS ZZ CONST / E OC CITY /���-er c/ ZIP [7!/ )ate Applicarit STATISTICAL CLA ATION AP-71C ONDO U JOTICE TO. APPLICANT If, after making this Certificate of ARCHITECT OR TEL • W ENGINEER' NO CLASS NO / DWELL UNITS t1 'xemption, you should become subject to the Workers' y :ompensation provisions of the Labor Code, you must forth- Z vith comply with such.�provisions or this permit shall be ADDRESS" SEWER MAP leemed-revokedG.•) TEL BK PG, VALIDATION CONTRACTOR �G//j iQ NO LICENSED CONTRACTORS DECLARATION ,q LIC hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS '� G �L� �' �L�NO VALUATION commencing with Section 7000)of Division 3 of the Business and y� LIC 'rofessions Code, and my license is in full force and effect CITY 4!5: / /7 GL , CLASS $ SQ FT NO OF NO OF CHECK icense Number V.93��Lic Class, �� SIZE STORIES FAMILIES ONE Sr $ :ontract, �RtaC/�l�af �n f�Date y DESCRIPTION,OF WORK G�J7d(!L� /rj NEW ❑ ] I am exempt from the licensing requirements as I'am a Z CO �°I/V p(w- ADD ❑ P 9 9 .S� /t/ T/d L� licensed architect or a registered professional engineer ►�y ALTER FINAL acting to my professional capacity (Section.7051, AIR ❑ DATE Business and Professions Code) USE OF FINAL EXISTING BLDG DEMOL ❑ 9 tc or Reg No _Date APPLICANT TEL Y OWNER-BUILDER DECLARATION PRINT) NO hereby affirm that 1 am exempt from the Contractor's License aw for the following reason (Section 7031 5, Business and ADDRESS 'rofessions Code) _ PRESENT 8,7,b A BUILDING I, as owner of the property, or my employees with ADDRESS # o!o 0 0 0 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 2 ' 7044,'Business and Professions Code) MOVING TEL ;2'O ° 2 a O O j, as owner of theproperty, am exc lusively contracting CONTRACTOR NO with licensed contractors to construct the protect (Sec- ° o o 2 a O O c=i tion 7044, Business and Professions Code) ADDRESS C REQUIRED TOTAL SETBACK FROM EXIST 050 O 4-H 2 • CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH hereby affirm that there is a construction lending agency for FRONT he performance of the work for which this permit is issued P L Sec 3097, Civ C ) s SIDE ' .ender's Name PC Fee$ Permit Fee .ender's Address certify that I have read this application and state that the Issuance Fee above information is correct I agree to comply with all County Investigation Fee rdinances and State laws relating to building construction, Total Fee and y out raze r res ntatives of this County to enter ip t abo me rt�for msp tion purposes Signature of App SEE REVERSE FOR EXPLANATORY LANGUAGE scant or Agent /�