HomeMy Public PortalAbout6019 LOMA AVE_Building__ • 'APPLICATION
PP.LIIIIVA,TII®N qFp•,: BUILDING _PERMIT_.'76A83BA CE{80311-57 '-
♦• �
COUNTY OF LOS 'ANGELES BUILDING .
DEPARTMENT OF.COUNTY ENGINEER =ADDRESS --/V
BUILDING-AND .SAFETY DIVISION - [ocALITY
JOHN A.LAMBIE,COUNTY ENGINEER NEAREST !
CASSATT D.GRIFFIN,SUP'T OF BUILDING - CROSS ST.
.-DISTRICT'NO. GROUP" TYPE SEWER. MAP
FOR APPLICANT TO FILL IN ; BK PG
BUILDING P STATISTICAL CLASSIFICATION
ADDRESS r6�1� NORTH LOMA T.C..
LOT.NO: 5® CLASS.NO. ' 'DWELL.UNITS
-_ - BLOCK MAPSTATE
5 (�, - - NUMBER HWY. YES .
TRACTJ90-T - USE ZONE SPECIAL
y
No.OF BLDGS. I CONDITIONS _
SIZE OF LOT SO$� 1 NOW ON LOT fUSEOF
r ] -
EXISTING BLDG. d'DWELLINGS - : BUILDING t. EXIST.
_ .YARD HWY STREET NAME
JOHN E^SU LINA N SETBACK WIDTH
OWNER. VIZ ,,. .. ..... - FRONT -
--MAI L .. I'.L:
. ADDRESS 6019 . N LOMA .< - -SIDE.
T EM�'LE CITY:_T.Y:.:_ - 'P.L. '
CITY jFl INSPECTION RECORD
ARCHITECT OR - - -TEL.
'ENGINEER. - NO. -
ADDRESS -�lfV!
CONT RACTOrrR:E B CxISTIANO N%kTT 2 �f`^�'ry^/
3 9
ADDRESS'. 209- N ROSEMFA'D BLVD-0 SA GA
• DESCRIPTION..OF WORK ...- - _
NEINM 'ADD ' : ALTER REPAIR DEMOLISH i .r-7��''
SQ:FT. �^- NO.OF •� NO.OF
SIZE - 9k". - STORIES FAMILIES' .
uSEw �l1�T PLUS ATTACHED
' , Z0 GARAGE. OyH.¢�� /`
SIGNATURE OF
APPROVAL, S / /.'•rO�GV/f.
APPLICANT _
_ DATE INSPECTOR'S SIGNATURE
ADDRESSGORMS, AT LOCATION .nY�/.s/..y�/`�. 1 jf�%• .
FORMS.MATERIALS
$
TFEE
FRAME: FIRESTOPS.
BRACING, BOLTS FURNACE: LOCATION,
VALUATION _GAS VENT.DUCTS ��•'""LJ"��i' Jit'/fir �}
I-HEREBY ACKNOWLEDGE THAT ]'HAVE READ THIS AP- LATH,INT. - . 9 if�A,(y�Qft%�J'
PLICATION AND STATE-THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH AVLL ORDINANCES AND - / ��0 �. ,Q«;A,�-�1� 6
STATE LAWS REG�jl7LAT G UILDIFI CTION. LATH.EXT. - l 6 70/Jt P
SIGNATURE OF , HOUSE NUMBER COR-
PERMITTEE
/'/ �Ivs itr/.G RECT AND POSTED
FINAL'
"ADDRESS
_ CLYDE N. DIRLAM, PRINCIPAL STRU9.MURAL ENGINEER
PLAN'CHECK VALIDATION' cK. M.O. cnsrt .:PERMIT VALIDATION c1c, m.o. cwsFt
a 3 1.4` 2 . . A 15-00 n ®�--��-
t ��+ .3 1. 5 DEC �' 1. A -*
3 �
76A638A CE #803 12/69 �` ✓�/�,' 4,' y
APPLICATION FOR BUILDINGPERMIT , ;? �.
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS,..SUP'T OF BUILDING LOCALITY - Tem l e City
FOR APPLICANT TO FILL IN NEAREST ,
CROSS ST.
Print ort a onl
DISTRICT NO. GR O TYPE PROCESSED BY
BUILDING '" CONST. 2 �•
ADDRESS 60-19 N Lorpa' A-yenue �
STATISTICAL CLASSIFICATION'- SEWER MAP
LOT NO, BLOCK CLASS NO._ DWELL,UNISS B G
TRACT - - USE ZONE MAP '
NO.OF BLDGS. NO. D
SIZE OF LOT NOW ON LOT SPECIAL
USE OF CONDITIONS
EXISTING BLDG, . TE
n
OWNER Ida M . Sul I Cyan. NO�287^`('p 98?
BLDG.SETBACK FROM 4 '
ADDRESS 6 0.1 9 N Loma Ayre n u e FRONT PROP.LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
-
CITYTe e Cit _F41GHWAY WIDTH
ARCHITECT OR TEL. \ } _
ENGINEER NO.
- BLDG.SETBAC FROM
ADDRESSLLJ� _ p p SIDE PROP.LINE OF`` (STREET)
CONTRACTORI . L .:R.an dg l'�:Go TENp�- 2H8'404 HIGHWAY TYPE OF EWDTHG ROMC.L`.H-f6� �Y } 'YARD = TOTAL
LIC
ADDRESS NO.. 718
LIC.
CITY S a n G a 6 r-, e C a CLASS CORNER CUTOFF YES ❑ NO\❑\
CONSTRUCTION LENDER
NAME AND BRANCH. SEE REVERSE SIDE FOR SPECIAL APPROVALS W
ADDRESS N
SQ. FT. NO. OF NO. OF ❑ z
NEW
SIZE STORIES FAMILIES
USE OF ADD ❑-
STRUCTURE -
ALTER ❑
REPAIR
SIGNATURE
APPLIC N DEMOL ❑
-VALUATION S 54.5 . 00 APPROVALS DATE IN5PECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE $ FEE 'QQ FORMS, MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ HIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .FURNACE: LOCATION, '
WITHALL ORDINANCES AND' LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUC TION. 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 STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION IN NCE. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-'
PERMITTEE RECT AND POSTED A '
ADDRESS ' 'FINAL ,e
JOHN F. LEWIS. PRINC1 PAL ST exNRAL ENGINEER ,
PLAN CHECK VALIDATION CK. ' M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
DBS-3 25M SETS S-45 '
'DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES DEC 13 994 I ` ® I G.
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING P� yy� �+� DISTRICT NO. PLAN CK.. NN'yrO�. PERMIT NO.
'ADDRESS �� �/1'l]Y` �1 L...C�//SCG �Lye ,10 V
LOCALITY J/C�ip/l° A / ) RECEIVED BY DATE OF APPL` DATE ISSUED
L
CROSSSST. V /'I A�sGuf4rf' F'd`"!J-`Gfiv'✓J..� ,,.�`/ / ,/ J .
BUILDING
OWNER �. L-e/PO Z-;:k F� O7 ADDRESS /9�
ADDRESSMAIL * �.� /r '11z O���iN C4y LOCALITY/���'+"L /'�'�
CITY
pA •
/ 'NO. JT�"P' .T a CROSS5T.
NEAREST �
P/:s C�
FIRE _N O.OF TYPE + GROUP
ENGINEER
OR �A IA * /ri NOL. ZONE /�I PLANS
9 ,�j ��, BLDG. / ORD. NO.
ADDRESS ! ZP� et ml^ O��AQ rd I/ d SETBACK LINE
- APPROVED
TEL. BY DATE
CONTRACTOR NO. _
• USE APPROVE n
ADDRESS _ ZONE �l BY DATE f �y
LEGAL _ CORRECTIONS
f
DESCRIPTION LOT NO. BLOCK
TRACT O �✓�
NO. OF BLDGS. _
SIZE OF LOT YDSy }( I NOW ON LOT / \
USE OF ('J / NO:OF NO. OF 3 _
EXISTING BLDG. h>eS/dl.'F?C4.� I FAMILIES I ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION O
REPAIR MOVING DEMOLISH O_ \\�
SQ. FT.. NO.OF "" �- Z \
SIZE ROOMS STORIES ,. D
WALL ,,ss��11
COVERING CC..V I COVVERING
USE'OF NEW
BUILDING/�6-;—
0
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 BUILDING CONSTRUCTION. FRAME: .FIRE STOPS,
SIGNATURE OF ///JJ�' t BRACING, BOLTS
OWNER o�� '// LATH, INT.:
AUTHORIZED AGTx LATH, EXT.:
- -- ---
p�� /�/•/,(�+ V`� P. C. $ V� PLASTER, INT.
FEE PLASTER, EXT.
.VALUATION FEE - FINAL
l1pPCL�TQrsPE #1IT
DEPARTMENT OF BUILDING AND SAFETY
Ty�,TY:'OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
NO.OF BLDG. ORD.,NO. DISTRICT NO. PLAN CK. NO. PERMIT NO.
PLANS SETBACK LINE �/ �/q j,/{�!/�l
FIRE APPROVED
ZONE BY DATE RECEIVE D- BY DATE OFAPPL. F DATE ISSUED
ZUSE ONE APPROVED BY DATE` / i�'Y 2 —4W 7 '
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
OBUILDING/
E NAME ADDRESS
wZ ADDRESS LOCALITY .
NEAREST _,S �_,
UX W CITY ///��`J�'1 _ CROSS ST. n 7Afs,,i�i/i� /i�/a�
Q' STATE I f`I '� NO TEL• .. NAME2T , mil ��
LICENSE NO. / 1 I �/� ^y� � / -
It NAME ) V 3 ADDRZ MAIL ESS/f / //�3 ✓5 ✓3��s
O
U --y' TEL.
Q ADDRESS CITY .A S�,•P.x4'3.�ie.� 4t�.1 .n. NO.
F 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
Z
U CITY APPLICATION AND STATE THAT THE ABOVE IS CORRECT
STATE TEL. �/ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES.:
LICENSE NO. NO• F/ JI AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
ZO LQ NO.-- SIZE OF LOT�D^//3 2 SIGNURE OF �� g
Q a `� NO. OF HLDGS. 1 n AUTHORIZED AGT.(20
BLOCK NOW ON LOT
.UW! U
N TRACT.
Q CORRECTIONS
W
D USE OF BLDGS.
NOW ON LOT
DESCRIPTION OF WORK
BUILDINGUSE OF , /1 4e7�, /ll 56 b�f'' Asm a,
_ �
.f a:•,;.Ti. .i.. yG s°il.,�.e..-+.r°/SAA.,-v�/2 /A/I^L l�L[ O
y D
NEW TYPE y/ GROUP
NO.OF NO..OF
ALTERATION- ROOMS FAMILIES !
ADDITION SIZE Al"/. Y l D
REPAIR STORIES
MOVING WALL COVERING i/,plz
DEMOLISH ROOF COVERING aifif�
Is P.FEB$' L� FINAL APPROVAL
INSPECTOR'S 1% �J
VALUATION //�Y/ FEE [�✓ DATE 1 I NAME -
DIVISION OF BUILDING AND SAFETY BU-1
Department of County Engineer I
County of Los Angeles � APPLICATION
WM. J. 'FOX, COUNTY ENGINEER - -
FOR APPLICANT TO FILL IN ; FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK. OR REc.No. p�PERMIT NO.
ADDRESS Q 9 (/ . ' r -15'
j 'NAG /� _
RECEIVED ABY DATE 13F APPpL.. A DATE 1BOUED
_LOCALITY `�� o �LQlcirC.S!/l I lJ v 6► 15 Is�'.
NEAREST
.CROS13ST. BUILDING / Q, -7 OL,ADDRESS (�
OWNER
MAIL
�/J LOCALITY
AODRE9 V• ^'o�+ /.f O a ✓4- I NEAREST p
r/ TEL J CROse ST.
CITY '� NO. °'/ ! FIRE I NO.OF I TYPE GROUP
ARCHITECT OR TEL ZONE PLANS
ENGINEER NO. BLDG. n� ORD. NO.
1 SETBACK LINE
ADDREBB ���
USE.j APPROVED
TEL ZONE! r BY DATE
CONTRACTOR NO. HOUSE NUMBERING
ADDR Bs MAP NUMBER NO.'ASSIGNED BY
LEGAL /, CORRECTIONS
DESCRIPTION LOT NO. ✓ V BLOCK
TRACT ?J
D. DF BLDG".
SIZE OF LOT NDW ON LOT� • �/� J��-y �-
USE OF NO. OF /
EXISTING BLDG. FAMILIES i
DESCRIPTION OF WORK � C o
NEW ALTERATION ADDITION Z
• D
REPAIR +� DEMOLITION r
BIZ
E FT'- X' / -.--ROOMS STORIES
EXT.WALL RDOF
COVERING I COVERING
USE OF UCTURE �•
INSPECTION FOR _ APPROVALS
OCCUPANCYAS INSPECTOR'S
/J/9113NATURE D/A�TEE-]
FOUNDATION: LOCATION AV//Y[ /) v V
FORMS, MATERIALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- _
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIREBTOPS, (1 Y4/ //��'�/
CORRECT.AGREE TO COMPLY WITH ALL CO NTY ORDINANCES ! BRACING, BOLTS /`
AND STATE LAWS REGULATING BUILD G CONSTRUCTION. FURNACE: LOCATION, -
GAS VENT, DUCTS
SIGNATURE OF e- LATH, INT.
PERMITTE / {�
LATH, EXT. 1 I
ADDRESS �QO � � v
PLASTER, INT.
AUTHORIZED AMT.
,1 PLASTER. EXT.
IIIFEES HOUSE NUMBER COR-
�� RECTAND POSTED
VALUATION FEE �� �® + FINAL
76AG3SA DBS 3 1-52 r l
.pEPARTMEIVT OF BUILDING AND`SAFETY 1 'iaiPPLICATIORlc. FOR, PERMIT
COUNTY OF LOS' ANGELES + { gw'{
WM. J. -FOX, CHIEF ENGINEER ` I � `°'
APPLICANT,TO FILL IN
',.FOR OFFICE?FUSE ONLX-
FOR,
DISTRICT'NO PLAN CK NO. PERMIT,NO
''BUILDING ►`y',t.- . `
ADDRESS
LOCALI ../���f �R DATE 18$UED
TY ICJ�I :BY DATE OF APPS. r
'NEAREST
RECEIVED
µ �m
/ is),tom/
CROSS ST.,'FfTz7' /^`!I' I �.
r�
•71 BUILDING _ � pa
.'OWNER ? • O� •7/f','6;�_ ADDRESS
MAIL j LOCALITY (Q
•.ADDRESS ��� L+� � � • i. • ':. �' .
• .I 4 '
. :, NEAREST
rTEL.A CROSS'ST.
:CITY./,C'i■11�4,F ,L.1��lL� ', NO ".T T .IT
;• .." F
FIRE NO.O I TYPE, GROUP
'•'ARCHIT,ECT OR j TEL ,.•: _ ZONE PLANS
°ENGINEER .'...'', ,`.'•.ND. +,•• �`^ I•..L '
BLDGt. :` ='OBD NO:
ADDRE39 aSETBACK LINEc ••.
APPROVED
- � �+!�+ TEL: : -
CONTRACTOR,. _ NO - BY DATE
} `..
•., .. YSE APP _
U ED
ROV
i ADDRESS ZONE" ..�1` :''BY. ,.=DATE -
.• . : - -
:;.LEGAL SCORRECTIO S
DESCRIPTION - I' LOT. NO.• -BLOCK-,
_
TRACT, '. `md .���� .. "•_. i - / •.
`' �g ND. OF..BLDGS
-;SIZE 'OF. LOT• , A�. cl ,I,_.'NOW ON LOT /.. - "\
U5E"OF' NO.;OF
EXIST[NG.BLDG. ji a0, .`I FgMiLi[8'/. I ROOMS•7-"'. }"v �• -
r.,,,:DESCRIPTION OF,-WORKS , `
-.NEW :`;ALTERATION ADDITION '7i' a ..
REPAIR. MOV.INO'»- DEMOLISH '')/\
94
'. FT, / , . ' � .%k-59 Jt
w D
•SI � ROM® STORIEF.
.
WALL' �q ROOF...
•COVERING p�A D'G:,qp`� !•I�COVERING �� } ,�
USE OF,F,
''BUILDING
_ e
s= ,
yAPPROVALS
I �HEREBY`ACKNOWLEDGE' THAT 'I HAVE READ
THIS , - N5PECTOR-• .DATE
APPLI•CATION. AND STATE THgT THE ABOVE`19 CORRECT FOUNDATION:`LOCATION 4
"'- " ' •FORMS, MATERIALS- ,,44
AND AGREE TO COMPLY WITH-ALL COUNTY..ORDINANCES'° ��Y w
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
1- S; 1
SIGNATURE OF ` BRACING .BOLTS
FRAME FIRE, STOP
OWNER : LATH, INT
AUTHORIZED AOT h.#V
�. LATH,-EXT
P. C. ®- .. PLASTER-i INT. - r.
_._
y00
FEE PLASTER, EXT
1
a-
-VALUATION•VALUATION FEE FI NAL:
D>5:-3 15:43 25M 36T3. - APPLICATION I'VK IMMIT
DEPARTMENT OF BUILDING AND SAFETY k
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
NO.OF BLDG. ORD.'NO. DISTRICT* NO. PLAN CK. NO. PERMIT NO..
.PLANS SETBACK LINE ••t»�'21�L 9 1/ 9
FIRE f~ APPROVED �J J `1' j_
ZONE BY DATE RECEIVED BY. DATE OF APPL. DATE ISSUED
ZUSE AONE 1 APPROVED \ elk- M�
BY 6 � L
DATE 4I4Lp
APPLICANT FILL IN .HEAVILY OUTLINED PORTION ONLY
BUILDING� NAME
ADDRESSI.
U z ADDRESS . Al LOCALITY. TF M I L C C--(TY
u CITY. c OSS ST. G A R I 14 L I�1
Q "TATE '
r TEL. NAME La I=—LL I
LICENSE NO. I{ NO. y
Z MAIL Pi-1"1 F—
E NAME ADDRESS [l J-1
U O TEL.
q ADDRESS CITY NO.
K
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
Z
0 CITY APPLICATION AND STATE THAT THE ABOVE IS CORRECT
STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
Z LOT NO. SIZE OF LOT p (a T(p,� SIGNATURE OF
OWNER
< NO. OF BLDGS. ( AUTHORZED AGT. _�/—"- VI/97.f 1 AsG.i3'
BLOCK YYY NOW ON LOT �. ,�-
w m s 'W,TRACTCORRECTIONS
W D
D USE OF BLDGS.>� �LI-I , Cf+
NOW ON LOT W N LY
DESCRIPTION OF WORD" /
USE OF � �
BUILDING wV n CL S F4't�h
t7Sl r-3 Y wl Irl 1
This construction may b:, in violation
War Product,on boa-rid orc,ers. You ar
1,-,.l AAT 0
prCCiUC'iofli�"_Oa':Ci�%f r__,.�JJ' Zr;?'��Czr:lin('n(- �tl
Inn, V.7 O:1�
Z
NEW ✓ TYPE —l(r. GROUP ej r
NO.OF NO.OF
ALTERATION ROOMS FAMILIES
ADDITION SIZE 1 �' X 3 n
REPAIR STORIES (f ,}
MOVING WALL COVERING (S'TUCC U
DEMOLISH ROOF COVERING
FEE $ Fl.AL PPR VOVO AL
�) � INSPECTOR'S
VALUATION V�OO FEE //J^d DATE I 'NAME
r WORK€ ENSATION DECLARATION (°•
hl hereby raffirm that I hove a certificate of,consent to self
nsu4, or a certificate of Workers' Compensation Insurance, 11 I ��
or a certified copy thereof (Sec.'3800, Lab: C.) �J
- COUNTY.OF: LOS•ANGELES BUILDIP�IG'.AB�ED SAFETY ,
Policy No ' Company,
;t BUILDING.
Certified copy is hereby furnished: FOR APPLICANT TO FILL IN ADDRESS
Certified copy is filed with_th'e cobtity building inspec- BUILDING:
tion'departirient. ADDRESS V' LG>rh •
c
Date Applicant CITY ' _ [y� .0 —1 ZIP d LOCALITY.; -
CERTIFICATE OF EXEMPTION FROM WORKERS F BNEA
- O OF S G . � REST, ` t
COMPENSATION INSURANCE-
SIZE OF LOT h O NOW ON'l0T l CROSS SL
ASSESSOR
(This section need not'be completed if:the perm it.is for one - TRACT BLOCK LOT NO. MAP.BOOK` PAGE PARCEL
hundred dollars ($100)or less )
O ;, _ PONE MAP
EL.I certify that in the performance'of the'work for which this wNER v17' IN b NO rpermit isissued, I shall not employ any person many manner. SPECIAL
ADDRESS ,60 l � CONDITIONS 01
so as to become subject to the Workers'Compensatwn'Laws. -
d'6/aI L.3D CITY... ( ZIP Q
.Date Applicant.
ARCHITECT OR L. 0
NOTICE O A PLICANT: If, after making this Certificate of ( DISTRICT GROUP TYPE FIRE ESSED BY Q
ENGINEER I t� �. IV�G' -N9. ,/V 'Z%ZJ .
Exemption, you 'should become-.subject to.the Workers', ZONE
U
tt ,�,,, Q �j� CONST. NE
Compensation provisions,of'the Labor Code, you must forth ADDRESS 7i�� rvwL�L'QP A�(t7A;YWViAr %d'U 'J4 3 / ` W, '.
;with comply with such+provisions or this permit .shall be TEL
deemed revoked. , CONTRACTOR L 1;1 aQJ NO �/ - c `STATISTICAL CLASSIFICATION APT. CONDO .
LICENSED CONTRACTORS DECLARATION LIC.. CLASS'NO. Z ( DWELL UNITS —
I hereby affirm that l am licensed under provisions of Chapter 9 ADDRESS < (� NO.r'
(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'
SQ. FT., Cl n NO. OF NO:OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
VALUATION
DESCRIPTION OF WORK' j1 NEW.. a
Contractor Date ADD $
am exempt under,Sec.
ALTER `^
FT
B.BP.C. for this reason REPAIR $'
� <
Date: USE OF DEMOL
EXISTING BLDG. fD a
APPLICANT TEL', ✓ 1
Signature 'INA y
OWNER-BUILDER DECLARATION PRINT NO. Z DATE -'
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS dj 1 w�� FI
Professions Code):
BUILDING
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and `r .`s' }`,t � ) ° - 4 q; irk �,_
LADDRE
Y 8 6 8-8 A
the structure is not intended or offered for sale(Section' e h #� ,
7044, Business and Professions Code). G TEL. "aj #'m o 0 0 a..
I, as owner of the-property,.am exclusively contracting CTOR NO. .y
with licensed contractors to construct the•project (Sec- [ ' 3 0 6:7 5
tion 7044, Business and Professions Code): S ��� <`,� �' °43 j o)io-3 7'j
IRED YARD HWY' TOTAL SETBACK y'nt0.? a
CONSTRUCTION LENDING AGENCY :" ACK PROP. LINE WIDTH. t ° = 5 6 Ft. O '
I hereby affirm that there is a construction lending agency for Tr.*';' � 2`3 0
the-performance of the work for which this-permit-is issued, �`� .,t ) #;• t
(Sec. 3097, Civ. C.).
Lender's Name �"d��+ ' Imommygmn—
.\
m... , e$ - `. -' ,Permit-Fee
Lender's Address /1111)
g I certify that I have read this application and State.that the issuance Fee., (�
9 comply y ation Pee ) `
above information is'correct. I a ree to cam I with all Count s c
0 ordinances and State-laws relating to building construction, . : Total Fee .� 'J� LDMAP.erm N ,., r '.•� ' -
' -and hereby quthorize-representatives of this County to enter _
upo tw�:mentioned property'for inspection purposes. .
e
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signoture of•Applicant or Agent - •Date " - • -
_WDRKERS' COMPENSATION DECLARATION
I' Eer y affirm that I have a,cgrtificate,of consent to self
insure, or a certificate df:WaTers' Compensation Insurance,
CAT M - �'� ®� �
AmPtl
or:a E2rtif;ed copy thereof (Sec. 3800, Lab. C.)
C
�. OUPlTY.OF LOS ANGELES. . BUILDING AWD`SAFETY .
Policy No Company
Certified copy is hereby furnished FOR'APPLICANT TO FILL IN Q C�. A.;
BUILDING__*
❑ 'Certified copy is filed_ .with the county building,inspec BUILDING.
tion department. ADDRESS 0. w
Date
Applicant CITY /. . ZIP hf ' LOCALITY
CERTIFICATE`OF,EXEMPTION FROM WORKERS' _ .NO. OF;BLDGS. NEAREST,
COMPENSATION INSURANCE SdE OF.tOTa �. NOW.ON'LOT CROSS S7. l�! �/'111GSCL
(This section need'n
BLOCK LOT N0. MAPot.`be completed if the,permit is for one . TRACT �V >. v BOOK PAGE. PARCEL
..hundred dollars ($100)or.lei.s,•) RNO /
/i : ..� MAP.
'I certify that'`in the performance of the work forwhich''.thiOWNER .5.s NO,
P is sued,'I shall not employ any person in any manner ADDRESS ko OL / ' CONDITIONS _
sous to..become subject to the Workers'Co�my/pennss�attionn-La�w�s. / C1.
Date y APPlicant- �( (il [/L�/J[iw CITY `' ZIP 7
NOTICE' TO APPLIC NTi If, after'makmg this Cerirficdte of ARCHITECT OR TEL. "1 GJ _l �j/ DISTRICT GR UP TYPE FIRE PROCESSED BY
ENGINEER' NO. (�71P y� CONST. ZONE F—
Exemption, you. should become_.subject`.to the Workers'
,Compensaiion;'provisions of the.Labor Code,.you must.forth ADDRESS' /� ULU
with c y 'Aiprovisions or',this permit shall be , TEL.-. STATISTICAL CLASSIFICATION APT. NDO. N
deemecl,evokedh,.such CONTRACTOR'I NO.'
«-
LICENSED CONTRACTORS DECLARATION, uC.,. '
CLASS NO., DWELL. UNITS Z
i' I hereby affirm.that I am,licensed under provisions of,Chapter 9 ADDRESS NO. SEWER MAP
mmti
(coenng with-Section 7000)of Division 3 of the Business and LIC.
Professions Code,-and my license is m full force and effect. CITY CLASS BK �' .VALIDATION
License Number Lic.Class
SQ. FT.5-/ NO.OF l NO.;OF CHECK -
SIZE �r 15. STORIES .1 FAMILIES ONE
DESCRIPTION OF WORK vlr'� C. V
�"
VALUATION
NEW , /1 `l
Contractor' Date ❑ $ o� V
ADD: -
❑ I am exempt under Sec.
- ALTER ❑
B.BP.C.for this reason REPAIR ❑ S -
' Date:' DEMOL ❑
USE OF
EXISTING BLDG.
. Signature FINAL,
APPLICANT TEL. / R
PRINT (�
OWNER-BUILDER DECLARATION. "` NO `2 DATE
I hereby affirm that I am exempt from the Contractors License � �7 1 :9 3 A-
Low for the following reason (Section 7031 5, Business and ADDRESS IN
Xo ssions Code). - PRESENTBY
r.,;, !a el
•
BUILDING
I, as owner of the property, or rnyCemployees with. ADDRESS I„o ro 9
6,'7 5
wages as their sole compensation,will.do the work and.
the structure is not intended or offered for sale(Section LOCALITY i #
7044, Business and-Professions Code) - MOVING l TEL• o,o o'q 5 v
I as owner of the property, am exclusively contracting CONTRACTOR NO.
�.7
with licensed contractors to.construct the project.(Sec ADDRESS 5�8 7
tion 7044,Business and Professions Code).
REQUIRED' YARD TOTAL SETBACK FR
CONSTRUCTION'.LENDING AGENCY SET BACK 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,.
P.L.
Lender's Name
m . . P.C:Fee$
Permit F.ee
Lender's Address
LDMA Ref q
r
certify that I hove read this application,and state that the..,• Issuance, e O t LDMAtP/C N
•g above information is correct.:I agree to comply-with all Count 1• w
9 Y Investigation'Fee
-0 ordinances and Stafe laws relating to.building construction, . Total Fee J LDMA.Perm. q w}
and hereby authorize representatives of this'County to enter
upon the above-mentioned iroperty for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
-
-Signature of Applicant or Agent Date