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HomeMy Public PortalAbout9402, 9404 LAS TUNAS DR_Building__ 7A6eA DBS 3 3-55 �'•� d 6 % APPLICATION, FOR,-BUILDING PERMIT DIYISION'OF BUILDING AND SAFETY. BUILDING' ADDRESS L;fJf/i N'Department of 'County. Engineer �T r cm v-• + County of Los Angeles LOCALITY �s 8 _ f r s' • �WM^'J..FOX.'COUNTY ENGINEER - NEAREST "• •CASSATT D. GRIFFIN. SUPT-OF BUILDING, CROSS ST. :�' .• •'� .+•i 'I _ DISTRICT NO`.`rrG'ROUP:'} L"j'F" .[SEWER --MAP FOR APPLICANT TO FILL IN I ®1` - - PG - r 7 CONST. FY - ., MAP ,t _ - "STATE. ESS. HWY YES- "'ADDfNO' r' .. NUMBER .r-r...-. . s. USE ZONE 'SPE IAL BLOCK CONDITIONS' { TO C ACT NO (J. i'OF BLDGS. - SIZE O L"3'f"` "i,., I,NOW"ON LOT' - BUILDING ,YARD ' HWY STREET NAME EXIST. SETBACK, WIDTH -USE OF FRONT EXISTING BLDG. P. L. SIDE y OWNER.. �..�-:.� t i a....•-. - _ ..P. L. I MAIL ADDRESS ri ; - .' .y O' TRACT DWELL. I UNIT. " '„'.#r'I `r� - 5 INDUSTRIAL - �•, TEL. i DWELL. ,,rr}} i UNIT .CITY -,:�;•,.. dpi { �,` ”" NO.-. '9 d '?' _ y 6 PUBLIC BLDG. LLu,- e g}}}}°>'•\ r } d,r 7 2 DUPLEX r i UNIT ARCH ITV6` R Y TEL. - 7 ADDN., ALT.. ETC. ENGINEER 'S i c'•y'ii NO. - -'s' $ APT. UNITS r. 8 MISCEL., ADDRESS f-" - 1 4 COMMERCIAL - ` T^TE . INSPECTION RECORD CONTRACTOR i•. P ,< NO. � C,1...•. ADDRESS ESCIIIP'TIOrl�d'OF''W/bR �'' � - NEW „ADD ALTER REPAIR ' 'DEMOLISH SQ.:.FT# NO. OF ^� -NO. OF._ SIZE' STORIES -FAMILIES ' USE OF STR'U, URE SIGNATURE OF { f - - ' 0PPtrer.Ir a 4 I t - APPROVALS 1 t'C 1,4,V A nr�s�F G ADDRESS - -! t 'S�~_''- r n ,,T DATE INSPECTOR'S SIGNATURE . FOUNDATIONS: LOCATION I " Pi Ct FORMS. MATERIALS FEE ' FRAME: FIRE STOPS, $ 'BRACING, BOLTS. . VALUATION _ FEE FURNACE: LOCATION, - 'NI -.EBY ACKNOWLEDGE-THAT •l'-HAVE RTHIS: GAS VENT, DUCTS A P,L°!' ATION AND STATE THAT THE ABOVE IS CORRECT _ • AND``A, REE TO COMPLY WITH.-ALL COUNTY ORDINANCES`; LATH, INT. _ ,AND .`STATE+LAWS REGULATING 'B UiLDING CONSTRUC s jt TION LATH. EXT.. .. SIGNATURE OF q,a!"i { {,� j ( w�, tjr 'HOUSE NUMBER COR - ,"r',PERMITTE -�'""" �' �9'vH.d '` tt" r` C'�` RECT AND.POSTED - 'AD'DRESS "' a t .F FINAL - - ' - it:. (�.:' ,. .": ". WM J. FOX,Cpu14TY �NGINE�R VALIDATION C. N. DIRLAW CHIEF BLDG."INSPECTOR �y lco a, $ At '98A DB9.9 9.58F - APPLICAT'1`ON FOR BUILDING PERMIT DIVISION OF BUILDING AND SAFETY BUILDING i 3' Department of County Engineer ADDRESS ; County of Loa Angeles LOCALITY WM.J. FOX, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN,3UP'T OF BUILDING CROSS ST. DIST RIC NO. GROUP TYPE MA P6 FOR APPLICANT TO FILL IN MAP -7 Its (CONST. SEWERI',."-'"" UILDIN6 , }' (_ �V!VS NUMBER 6..[��. STATE DILDIN j4 ;IV YES NO } OT NO. 1 BLOCK USE ZONE SPECIAL - 1 CONDITIONS I_RACT � �ltz� T�Q/� ��d I NO. OF BLTS. BUILDING FJC13T. SIZE OF LO NOW ON LOOT STREET NAME SETBACK YARD HWY WIDTH USE OF FRONT EXISTING BLDG. P L. OWNER SIDE .L= P.L. MAIL /] ,� • ADDRESS "'( V A � O TRACT DWELL. I UNIT � TEL.. ''}� � I DWELL. `y I UNIT 5 INDUSTRIAL CITY NO. 1 / 6 PUBLIC BLDG. �, 2 DUPLEX I UNIT ENGIARCNEERTEL.(:;OR NO'� fl 3 APT. UNITS 7 ADDN., ALT.. ETC. vii $ MISCEL. ADDRESS vZ 4 COMMERCIAL CONTRACTVR _ TEL.GE b-7 INSPECTION RECORD ' 1 _ ADDRESS 'e`�l \ '2 DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH T t S ZE T �t� STORIES FAMILIES USE OF STRUCTURE r SIGNATURE OF APPLICANT y E `l.Jl-��M` I APPROVALS ADDRESS '7 -"��/ DATE INSPECTORS SIGNATURE FOUNDATION; LOCATION P. C. $ � FORMS, MATERIALS FEE FRAME: FIRE STOPS, VALUATION $ BRACING.BOLTS .,FEE � FURNACE: LOCATION. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT, DUCTS G APPLICATION AND STATE 7THAT THE ABOVE IS 6CORRECT AND AGREE TO COMPLY WITH ALL COUNTY'ORDINANCES LATH. INT. AND STATE LAWS REG ATING UILDIN 7,9 CO UC- TION. tit LATH.EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE - M RECT AND POSTED ,�e�y ADDRESS Z`/ FINAL IO � 1 WM.J.FOX,COUNTY ENGINEER VALIDATION C. N. DIRLAM.CHIEF BLDG. INSPECTOR I To 4 3 9 ME—) JAN 22 1 2.0 0 � DBS i3..25M SETS 8-45 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING U IL ® ' NG 1 WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING ADDRESS_ Y� Q � � ter•^ �j.�,� LOCALITY �/ / RECEIVED BY DATE O'F'APPL. DATE ISSUED NEAREST C"" CROSS STBUILD. /�/j eS� ` - OWNER/[ ' r / (%aEr�Y(/ ADDRESS / v MAIL ADDRESSXa CROSS c NEARELOCALITY CITY �`� j - A NO. t�_ID SST. `� / FIRE I NG90F I TYPE i GROUP ARCHITECT OR / TEL. ZONE PLANS ENGINEER / -NO. BLDG. ORD. NO. ADDRESS SETBACK LINE APPROVED TEL. BY DATE CONTRACTOR _ NO. _ USE APPROVED _ ADDRESS /:' ZONE44 BY DATE LEGAL I 7!J`�I CORRECTIONS DESCRIPTION LOT NO. 7J BLOCK TRACT 'Q ✓ /�,pp�/,/ 7yn/�' I )-cA /A.R.1Ca1 l A11157 SIZE OF LOT lfJo I/� Q V I I NOWOON LOTS USE OF /,� I NO.OF NO. OF -EXISTING BLDG. e V�p FAMILIES ROOMS s DE/S�CRIPTION OF WORK NEW ALTERATION I ADDITION 1 O REPAIR MOVING DEMOLISH O_ SQ. FT. ,/ 1 NO.OF SIZE //�� ROOMS ./ Z ® STORIES / D r WALL ROD F COVERING Vl !�(/+'{/i�l COVERING USE NEW BUILDING ,�,p���//�.'sfZ,� ,, (/L%L4�"✓' 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 BUI DING CONSTRUCTION. FRAME: FIRE STOPS, BRACING, BOLTS SIGNATURE OF^ � ..y OWNERLATH,.INT.: AUTHORIZED LATH, EXT.: P. C. S 1'LA9TER. INT. � FEE PLASTER, EXT. � 1 / VALUATION Tr-FEE - _FINAL t� E r DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT : COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE' USE .ONLY / DISTRICT NO. PLAN CK. NO. 6, PERMIT NO BUILD ADD EISS D 2 !y / /V J i F/^2 z , LOCALITY �~ ® 1J RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST E �.�... I - CROSSST. M• 6 BUILDING �1 ADDRESS V OWNER -L- OCALITY T. C. MAIL ADDRESS a NEAREST /j TEL. CROSS ST. A L L ffr S Q, CITY - - NO. FIRE NO. OF 1 I TYPE I.G.U� ARCHITECT OR ZONE �� PLANS - f/ ENGINEER NO. BLDG:. / O D../10. SETBACK.LINED L- _I q9.F ADDRESS _ APPROVED - - TEL - BY DATE CONTRACTORS NO. t��'T'd_ ', ,USE APPROVED`" ' ZONE BY DATE - ADDRESS A!'-14 t rS � �T�� -HOUSE NUMBERING. Dfi3CRIAL /.I LOT NO. ! V I BLOCK' AAP NUMBER -FIELD CHECK BY TRACT 1 I NO. ASSIGNED BY- DATE /- NO. OF'BLDGS. - CORRECTIONS SIZE OF.LDT tPd x ® I NOW ON LOT 1 - USE OF NO.-OF 'XISTING BLDG,. I FAMILIES DESCRIPTION OF WORN NEW I •_ I ALTERATION I I ADDITION i II OF,c) j o •- REPAIR DEMOLITION - - - _- - '' - -"'- - X SQ. FT. .NO. OF .I Q SIZE - ',ROOMS STORIES Z EXT. WALL _ROOF:._ - A F. COVERING �, -�I:COVERINGd USE OF U UR • L S. —r,-u &J S , - INSPECTOR'S SIGNATURE DATE L HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS AP? FOUNDATION: LOCATION PLICATION AND STATE .THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. - I AGREE TO COMPLY. WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY-ORDINANCES- AND STATE BRACING, BOLTS LAWS REGULATING BUILDGCONSTUC N. FURNACE: LOCATION, SIGNATURE OF GAS VENT, DUCTS PERMITTE - - _ LATH, INT.- ADDRESB l - LATH, EXT. - - AUTHORIZED AGT. - - PLASTER, INT. - 7EA888A• D089 10-80 P. C. $ - - © - FEE l PLASTER, EXT. , A VALUATION $FEE A ��O { FINAL rlvIEX,- or UILDING AND SAFE3Y � APPLICATION FOR PPERMIT � 7B U COUNTY OF`;LOS ANGELES `° f '6 046. WM. J. FOX, CHIEF ENGINEER +< FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK,NO. PER141T NO. BUILDING ADDRESS LOCALITY fNEAREST ;;� //��,i 'f .F [c, 1,@t,,�,�y���'�As' E RECEIVED BY - IDATE JOFAPPL. DATE ISSBUE(DJ. CROSS ST. :;"fF.P..S S �� (`�C..1",1� �' • S .if? 'J✓/�� f G •�1�''�q ,�� �J �•- J 'ADORES Gr�G jS 2-7/-/i,\ 1 11 A A S OWNER T.- 3�.t-) �`��. `�. � EC ��b� �- Jr "''}''' MAIL / /� J , ),,,� LOCALITY % 1, .ADDRESS A G 'J d Cts(-� l�Q cu�!-i ft(`� �V Z NEAREST ✓ ��^ y� ;n�i7/y /� TEL/ti./ f} [' CROSS 5T. CITY '��""/ !'�.& /�'�C.. NO.� 1I_���N / V7 FIRE - NO.OF-- ,ry TYPE GROUP •�, ARCHITECT R / r/ TEL. £,,;,, •M r ( ZONE PLANS ENGINEER Q�,/? 5 � C'O, No.'7'i"! •-->J 3 C� r� B`LDG.- f ORD.NO. ADDRESS I �' 'a r,&+ 6 'I< ?-U-e ,. SETBACK LINE 6 '•! = // APPROVED - CONTRACTOR !' �, /) NOLO BY bSE �j DATE ADDRESS V v ZONE (� BYPROVED DATE LEGAL DESCRIPTION / LOTNO. �',%SrI BLOCK 6— a 7 CORRECTIONS _ TRACT �� LD Q NO.OF BLDGS./tl SIZE OF LOT 18 g I NOW ON LOT - L. USE OF I L� r(� n NO-OF RO EXISTING BLDG. cS� t�� I FAMILIES~_ I ROOMS � S DESCRIPTION OF WORK / NEW / ALTERATIONi 1 ADDITION \ 36- -3K - d 9 J 6.. TZ" Tt,,, A REPAIR1// MOVING DEMOLISH OF S ZE4 - 3 � � ROOMS. .3 STORIES � D SO-WALL �`1 ROOF Fes' t• - COVERING 1 Ll C G O I COVERING C C) i ( _ USE OF NEW � BUILDING 'e�� I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION �(PP5PEcTOR DATE.r:.'% AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES � FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF �p �'����` � BRACING,BOLTS PERMITTEE 4 ///�w(�-•����.•000��'LLL----i��/\\\; LATH,INT.: AUTHORIZED AOT LATH,EXT.: � � / DBS-3 50M SETS 7-47 $ P CPLASTER,INT. ti`.} FEE PLASTER,EXT.41 - VALUATION FEE FINAL Jr n'd -36-ell DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. ADD EISS - V LOCALITY RECEIVED BY !DATE OFA®P�P,L.. DATEISSUED CROBSSST. /� ADD EISS //1! I OWNER / D 0,/� �_ L - MAIL I1 LOCALITY / �/''!f' .� G Z ADDRESS (� � � ®/�/" ,, •v �,! rr NEAREST - CITY TEL. I CROSS ST. NO. Gl FIRE NO.OF TYPEGROUP ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. BLDG. � r/`— ORD.NO. ADDRESS SETBACK LINE APPROVED CONTRACTOR NO. 6 ( `• BY DATE USE APPROVED ADDRESS V S ZONE -�' BY DATE LEGAL CORRECTIONS DESCRIPTION LOT NO. / Z._.S JI BLOCK TRACT �✓r' G .S�X/I�� I NO.OF BLOTS. SIZE OF LOT ?< NOW ON LOT USE OFm I NQ.OF _ I NO.OF EXISTING BLDG.'A'(P JMPP--•-'C FAMILIES ROOMS DESCRIPTION OF. WORK 6,' NEW ALTERATION ADDITION REPAIR - MOVING DEMOLISH Sq.FT. NO.OF Z SIZE ROOMS STORIES WALL ROor COVERINGG I COVERING USED NEW ZOO/" BUILDING T� aka F�tewlvt /z?C y" 3 -X44.SdZ9'W55 f AM, 7y 5T& Alb • ,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 CSTRUCTI N. I FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS PERMITTEE iy- LATH,INT.: AUTHORIZED ADT - LATH,EXT.: Des-a 50M SETS 1-48 $ _ P.C.S I PLASTER,INT. �- FEE �i f PLASTER,EXT. VALUATION FINAL FEE i i �: 76A638A CE�803_�e_S7 APPLICA`T'ION, FOR, �BUILDII� G PERMIT 1•: :+� . CEP COUNTY-OF LOS ANGELES BUILDING 9404 :LAS TUNAS 'Da I VE' DEPARTMENT OF-COUNTY ENGINEER A°°KESS BUILDING AND SAFETY DIVISION LOCALITY T E MP L E" C!T Y ~ JOHN A. LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN;•SUP'T OF BUILo114G CROSS ST. OAK 'A•N:b -.AL E S S A N D R"O " -" JE -DISTRINO. ROUP TYPESEWER 'MAP FOR APPLICANT TO"FILBK PG ��� CONST.BUILDING "STATISTICAL ASSIFICATIONADDRESS L}-04 ' LAS TUNAS GfJ�-.CLASS.NO..� DWELL.UNITSLOT NO: - MAP 'STATE NUMBER - Q" HWY. � YESNOTRACT "USE'ZONE SPECIALCONDITIONS ,NO.OD SIZE OF LOT • NOW /!/ - Z , uSEOF STO_ RES EXISTING BLDG. - BUILDING EXIST.YARD HWY STREETNAIvIESETBACK - '_.WIDTH OWNERMR M PAUL KETTLEFRONrMAIL ��/� - P.L:ADDRESS 644, W E D G E W 0'0 D:„S SIDEc1TY TEMPLE CITY CAL. P.L. ARCHITECT OR TEL. {jam/l IL INSPECTION RECORD- ENGINEER - ..NO. ADDRESS _.. 'TEL. - •. CONTRACTOR B.E.R-LOC MFG a C 0.NO,. QB ADDRESS 13623 CRENSHAW, BL DESCRIPTION OF WORK NEW ADD .ALTER REPAIR DEMOLISH SQ. FT. NO.OF NO.OF - SIZE STORIES FAMILIES” - - USE OF STRUCTURE - I NS'TALL ALUM I N.UI SGNS SIGNATURE OF- - APPROVALS ' C APPLICANT DATE" •INSPECTOR'S.SIGNATURE ' ADDRESS - FOUNDATION:.LOCA.TION _ - ' FORMS,MATERIALS.` A /.7• P. $ FRAME: FIRE STOPS. / �/ 1,4--r FEEE -BRACING.BOLTS —j VALUATION ®Q FURNACE: LOCATION, FEE -GAS VENT.DUCTS -.. �.:_:.�-�, �" ". • 1 HEREBY ACKNOWLEDGE THAT 1 HAVE.READ.THIS AP- LATH, INT: - - - PLICATION AND STATE THAJ THF ABOVE IS.CORRECT AND _ - AGREE TO COMPLY ITH- LL OUNTY ORDINANCES AND STATE. LAWS RE TI G UILDIN CONSTRUCTION_. LATH,EXT: - -- - - SIGNATURE OF. HOUSE NUMBER COR- PERMITTEW AND.POSTED_ / - •A - ADDRESS 1- J�FLINA� JOHN A. LAMBIE,COUNTY ENGINEER." CLYDE N:DIRLAM,PRINCIPAL STRUCTURAL ENGINEER. PLAN.CHECS VALIDATION cx, M.O. - CASH PERMIT VALIDATION cx: M.o. - cAsrl op,..s '� 8 9AY 6, 1 A' ,m ®F> �> WORKERS'COMPENSATION DECLARATION N F ILD G PERMIT I hereby affirm that L have.a :certificate of consent. to self M1 insure, or a certificate of Workers Compensation.Insurance, _ :A P P L I CAT O O R B.0; I N IL: or cicertified copy thereof (5ec.`3800 L'ab.''C.) - COUNTY.'OF LOS ANGELES- j' :BUILDING,AND SAFETY Policy No. . 'Company DIN Certified copy.Is'�hereby furnished. " . FOR APPLICANT TO FILL IN Ao RESS Certified copy is filed with the co-unty,building inspec- BUILDING ti on'departmeni." ADDRESS CITY //4)10V - Com/ ZIP 91720 D Date•• Applicdnt'- LOCALITY CERTIFICATE OF:EXEMPTION FROM WORKERS' NO.-OF BLDGS. - - •+ NEAREST. 1'• -COMPENSATION%INSU.RANCE" SIZE OF LOT NOW ON LOT CROSS,ST. (Th`issection need not be.completed if.the permit is for one -_ _- _•_ ASSESSOR hundredtion ee`&1not br lesmpie TRACT BLOCK LOT NO. MAO BOOK PAGE PARCEL ;._ - �7 (' I certifyXthat m the performance of the work for_,which this OWNER -NO:�[3 !�`i NO, _ US�ONE permit is Issued, l`shall'n'ot em to dn' erson in'dn manner (� /�� -� SPECIAL P _ P Y Y P Y ---• ADDRESS y;,) - �J�//� . ' -. " CONDITIONS _ �r ' 1 V so as-to become subject to'ihe-Work Co'mpensat'lon Laws.. /�J//�r}(/�1 >� /` CITY V,bv�"/-v ZIP 177U_ - - - Date APPllcant ARCHITECT OR TEL. NOTICE TO APPLICANT:'31f, after making`this Certif tate of DISTRICT, GRO-UP TYPE FIRE,_ - _PROCESSED_BY ENGINEER NO. CONST.. . ZONE. •' Ezerriptiont 1•you:`should become subject 16'the. Workers' L•� /��( _. (n/ (f/JUA Compensation provisions of•the Labor, you must forth- ADDRESS ✓`. .vvv $' /s- 3- t/ N with corn f,with such provisions or .this permit shall be - - z P Y P P " ' J TEL.. _ STATISTICAL CLASSIFICATION APT. CON O. deemed revoked.•: , , CONTRACTOR Z' (J�� NO. _ - _ LICENSED CONTRACTORS DECLARATION. . --- - - LIC. CLASS NO. 7l DWELL. UNITS I.hereby Affirm,that lam licensed,under provisions of Chapter 9 ADDRESS NO. (commencing with-Section 7000)of Division.3 of fFie Business and a :., _ :.� _..G ' LIG_. SEWER MAP Professions.Code, and my.ljcense'is in,full.force and effect. CITY !� G/y CLASS , s BK T VALIDATION ' t , x SO. FT. NO. OF NO.OF- _ CHECK , License Number Lic.Class SIZE STORIES FAMILIES ONE _nl/► VALUATION. - - 'DESCRIPTION OF WORK NEW- r 4 Contractor Date �- ADD ~❑ S S ®0, [ � I am exempt under Sec. V ALTER ❑ 395.6A B.&P.C•. for'this reason ;. _ REPAIR --❑ -I S o o o 0 _ Date. USE OF DEMOL ❑ # 3 -' EXISTING BLDG. - _ APPLICANT ` TEL. - FINAy/� ( o,o 3 -Slgndture PRINT A � LJ NO. C�3� I,J� OWNER-BUILDER DECLARATION DAT b,herebyaffirm•thaT Lam exempt from.the Contractor's License s o 0 0 3], c= .t ,j] Law for the following.reason` (Sectio'n 7031.5, Business.and ADDRESS �r/J. �' IN r 'Professions Code)'; �., : ... .. PRESENT 0 1,•3 1-8 6 U F 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: " - ; r. j �.3957A CONTRACTOR. NO. I, as owner of the property, am exclusively contracting o'o_o_0 1 `with-licensed•contractors to construct,•-the project (Sec "" -" -'" - tion 7044, Business and Professions Code). ADDRESS : x _. _. REQUIRED.. - TOTAL SETBACK FROM :.. _ :'� 0.,4 4 9,.8 8 CONSTRUCTION LENDING AGENCY SET BACK YARD. HWY PROP. LINE WIDTH; ` I.herebyoff irm that there is a construction lending agency for rFR o 0 o 4 _' ' -the performance of-the work for-which this permit is issued 8 c�,8(Sec. 3097, Civ. C.). ' :0 1,31 86Lender's Name LDMA Ref:# Lender's Address - r _ 1.certify.that.Lhave read this application and state that the _ Issuance-Fe'e (1r �!1 r LDMA P/C# - - . V Q above Information is correct. I agree to complywith.all County Investigation Fee Q �( ordinances and State laws•relating to building _ _ TotabFee / ,.0 LDMA Perm. u y and hereby represen ti s of this County to enter. 1 u n t :b0p one ,pr y for inspection purposes. - - - - t Q SEE REVERSE FOR EXPLANATORY LANGUAGE f - -. .Signature AppinhorAge i ---_ ------- ��_ Date:.-"•. O I - , P of ica