Loading...
HomeMy Public PortalAbout9665 LONGDEN AVE_Building__ • T• DIVLBION OF BUILDING AND SAFETY � ' D ' NG Department of County Engineer County of Los Angeles ' WM. J. FOX, COJAN 1.9 f�.05S APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.OR REC.No. PERMIT NO. ADDREBB d A/0 Uati /1�,�, � C CJ RECEIVED BY �q D//YE OF PL DATE ISSUED LOCALITY ��/yl d' l'/ ✓f rf� 'l #' I / I ' !SS// / / J� l� k-Uc CROBBBT. BUILDING q. / ADDR6B8 / 6 r.$ _ o Ai!i!J 6 di OWNER /J MAIL / +5r ADDRESS /��' /P lT'� l^J NEAREST s r n 'J � • ,CROBB BT. 6 L✓�1°�r `�•C�S! CITY r76�� 1'f���i`�/ NO. D,, 7'D � � FIRE NO.Or z TYPE' 6 OUP ARCHITECT OR TEL ZONE PLANS �j ENGINEER NO. BLDG. I Q /�� RD. NO. SETBACK LINE /� ��4^ ADDRESS �^ Ile USE✓E[J' APPROVE�D'� BY ;1 E L 3y7ZON/—()C?CHOUSE NUMBERINGCONTRACTOR NOMAP NO. ASSIGNED BY— ADDRESS BS 417;+)J �G LEGAL / • t' r /-�J7 �e CfO$R CIONS DEBCRIPTION LOTNO.e BLOCK , /CK r;! / ` TRACT /its tV0c14 �/ef7 !:�z2 7 ",(7•,Q G _ 1 a 0 NO. OF BLDG �7rtr? .`=,� 1 SIZE OF L �;�-r�-Y-�-u I NOW ON LOTUSEOF 140.air / EXISTING BLOB. I F M EN I DESCRIPTION OF WORK rz � NEW ! ALTERATION ADDITION .gat O R A ill// I- p CIL C&AI O ID r C le 17WG hd01-E Tb � REPAIR G DEMOLITION J ` /T-(J y2no.FT. JV�t;F, SIZE Q h b ROOMS !`/ STORIES IS L EXT.WALL ,�! ROOF �1 ( do COVERING / G!,C•l++ I COVERING �%'/� v USE OF STRUCTURE d .�c S , c"•':�v^.;r' -I=' cT''�-?� 3 z-J 3 C.d>✓T�D, ��'�--• INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'SSIGNATU DATE FOUNDATION: S ON I �n FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- , PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE BTOPB, CORRECT. BRACING,BOLTS ��OO 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANDES FURNACE: LOCATION.' AND STATE LAWS REGULATING BUILD NO CONSTRUCTION. 7 BAS VENT,DUG79 SIGNATURE OF �r fn J� !/;� ! ,�e LATHwI T. PERMITTEIC .� /) �I /i IL ADDRESS ADDREB �!7 .//; /1 J O/I�i4 l.fi/ ! /'is,./'n! uTN, E". vn PLABTER, INT. AUTHORIZED AST PLASTER, EKT. P.Q• ®® FEE HOUSE NUMBER RECT AND POSTEDED VALUATIONFFEE , o� •� FI AL 7BA638A D883 1-52 DEPARTIVENT OF COUNTY ENGM= DMSION OF BUILD= AND SAFETY BUILDING COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, SUPT OR BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING 7 ! e y -• -I 91 DISTRICT NO. PLAN CK.OR REc.No. PERMIT NO. ADDRESS ' y' ij• ` �- RECEIVED BY DATE OF APPL. DATE ISSUED LOCALITY �•. .:� 1�" � � f NEAREST r CROSSST� II [ d� �r� F!"( S- :' �.� �'+ BUILDING �f Dv-) r,1 '4 t /�. �� .; ... �f: ADDRESS / OWNER r'7 rub' MAILADDRESS r p ►� f n � f 'mss �-- �1.. LOCALITY NEAREST rJ •�,_.{ .:� TEL. I -I K 5 CROS89T. it CITY : f_ r : t� O f7 °�•j•- ARCHITECT OR TETFIRE I NO. 6F I TYPE GROUP ENGINEER NO.. ZONE ""� PLANS \JJ �I/` ADDRESS BLDG. �j O NO. SETBACK LINE CONTRALTO TEL. USE //�� APPROVED ZONE A - �BY DATE ADDRESS ,� HOUSE NUMBERING LEGAL MAP NUMBER � NO. ASSIGNED BY DESCRIPTION I LOT No. BLOCK TRACT 1�e ��dr,� ,g�� CORRECTIONS C" NO OF BLDGS SIZE OF LOT 'PaAC Yl NOW ON LOT USE OF NO. F EXISTING BLDG. FAMILI6 DESCRIPTION OF WORK o - RNEW AIR DEMOLITION ALTERATION ADDITION I S 1 r Q. FT. NO.OF SIZE ROOMS STORIES EXT.WALL ROOF COVERING COVERING USE OF STRUCTURES 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 CORRECT. FURNACE:LOCATION. 1 AGREE TO COMFILYU11TING A COUNTY ORDINANCES GAS VENT, DUCTS AND STATE LAWS � LDIN CONSTRUCTION. SIGNATURE OF LATH, INT. PERMITTE LATH. EXT. ADDRESS PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. $ ] P. C. B HOUSE NUMBER COR- VALUATIONd ._. 0 FEE RECT AND POSTED FEE S/ D FINAL 70weaaA 0823 0-51 TEMPLE CflT_71,� , FGA666A CC#80&1-61 APPLICATION( FOR BUILDING PE'RMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENQINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DISTRI G OU PE P SSED BY FOR APPLICANT TO FILL IN (44CC coNsr. BUILDING STATISTICAL CLASSIFICATION SMWER MAP ADDRESS BK CLASS.N WELL.UNITS—�`r OCK WATER NOT REQUIRED Nai RECEIVED CERTIFICATE: L TRACT MAP HIGHWAY STATE MAJOR SECOND LO AL �/ / NO.OF 13L GS. J NO. (CIRCLE) SIZE-OF LOT /d D /� O NOW ON LOT / USE ZONE SPECIAL USE OF � CONDITIONS EXISTING BLDG. ' • TELAE�T OWNER NO• BUILDING EXIST. SETBACK YAft RD HWY TREET NA E WIDTH ADDRESS cS� J FRONT q� ARCHITECT R TEL R.L. 7L� ENGINEER / NO. SIDE P.L: ADDRESS TEL. INSPECTION RECORD a CONTRACTOR NO. 8 ADDRESS DESC TION OF WORK V W NEW ADD -ALTER REPAIR DEMOLISH N SQ.PT, NO.OF NO.OF Z IZE STORIES FAMILIES USE OF i STRUCTURE SIGNATURE,OF APPLICANT• VALUATION-S APPROVALS DA�T/E F_ -INSPECTOR'S,..SI6NATURE P.C. PMT. ,rte FO FORUNDMS!MATERIIALSON �j1 f/,1``�/ FEE $' FEE $e-. FRAME:FIRE STOPS. 1 HEREBY ACKNOWLEDGE.THAT I HAVE READ THIS APPLICATION BRACING BOLTS r is r i (�i!/ //r� l•��..T AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACEC 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 PERSON IN VIOLA- LATH,INT. TION OF THELABOR CODE OF THE STATE OF CALIF RNIA RELAT- ING TO WORKMEN'S M NSATION 1 RANCE. LATH,EXT.SIGN PERMpITTE TURE OF HOUSE NUMBER RECT D AND POS ED ( 11��, i/�f ADDRESS FINAL I((V/! CLYDE N. DIRLAM, P INCIkJ STRUrTURAL ENG PLAN CHECK VALIDATI c. M.o. cns PERM VAUPATIOk cK. M.c. 0 8 .:3 4 ,, FE-B ! 1 D 3.0 0 APPLICATION FOR B LDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ADDRESS W. BUILDING ADDRESS 9 V(// / Q e LOCALITY �r NEAREST CITY ¢ ZIP CROSSST. . OF BLDGS' ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL Oyu DISTRICT1,71UP TYPE FIRE SSED BY TRAC : BLOCK LOT NO. /L `� CONST. JE—J OWNER ^NO. � ' STATISTICAL CLASSIFICATION SEWERyXP ADDRESS _ I—on 436eltck CLASSNO. DWELL.UNITS BK PG CITYZIP . ARCHITECT OR TEE. VALUATION $ ENGINEER NO. ] , 0 ADDRESS BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) CONTRACTOR /� NO. HIGHWAY t YARD TOTAL SETBACK FROM TYPE OF EXISTING LIC. — FRONT PROP.LINE HIGHWAY WIDTH ADDRESS / NO. LIC. + CITY CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH SIDE PROP.LINE OF � )STREET) HIGHWAY t YARD — TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY — SIDE PROP.LINE HIGHWAY WIDTH SO.FT. / NO.OF NO.OF CHECK + _ SIZE STORIES FAMILIES ONE at DESCRIPTION OF WORK ' • NEW ❑ P.C.Fee$ Permit Fee ADD ❑ Issuance Fee ALTER ❑ REPAIR ❑ Total Fee USE OF DEMOL EXISTING BLDG. Z APPLICANT TEL C (PRINT) NO. Q D BY(SIGNATURE) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES b AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE Z WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF U THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z PENSATION INSURANCE. _ g IL II O 7,oV n A a SIGNATURE OF PERMITTEE # e o 0 0 0 ADDRESS 4 Z 2 - - 2500 TEL. 2 CITY ••''� NO. 2S00'o� 0 0 0 T NO. t?C C� G �I 9-78 SPECIAL ~- CONDITIONS FINAL J i BY f% d DATE _ ` !t✓• r(dt I t bs 760653M CE f{PQ3(RO.11Y 78) APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ADIDRESSLDING LC BUILDING // ' ADDRESS av LOCALITY a aC NEAREST CITY ZIP D CROSSST. (f / NO.OF BLDGS. ASSESSOR SIZE OF LOT d NOW ON LOT MAP BOOK PAGE PARCEL �L '� ! DISTRICT G UP TYPE FIRE PROC SED BY TRACT �j BLOCK LOTNO.. �� Q � CONST.f / IffE TEL. =+ V OWNERp, STATISTICALCLA IF TION /.SEWE�yI ADDRESS CLASS NO.. DWELL.UNITS / r BK�•��,�es CITY ZIP (� ARCHITECTOR f VALUATION $ � ENGINEER NO.TU ©� ADDRESS / BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) CONTRACTOR NO. HIGHWAY + YARDTOTAL SETBACK FROM TYPE OF EXISTING . LIC. - FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. _ LIC. + CITY CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH SIDE PROP.LINE OF (STREET) )l HIGHWAY + YARD = TOTAL SETBACK FROM I TYPE OF EXISTING it. ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH. V SQ.FT. NO.OF NO.OF CHECK + = OC SIZE ISTORIES FAMILIES. ONE qq O [:] USE ZONE NOP V D 9 DESCRIPTION OF WORK NEW� � SPECIAL 1d �/( ADD,g CONDITIONS ub ALTER f / BY �~ f" Z DATE ( t✓ rf t ` ]•7�� ) o__. Gs-'-.r....�•..� _ REPAIR' ❑ 0 i) USE OF l � dI-/ DEMOL ❑ EXISTING BLDG. U / O dI ZC APPLICANT TEL (PRINT( NO. BY(SIGNATURE) 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE uw THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES LJ AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z PENSATION INSURANCE.' 20'58, 1 A SIGNATURE OF 1 0 0 0 0 0 1 PERMITTEE ADDRESS ./ Z 2 0 0 3 IL 0 0 , O CITYNO. G o 0 0 3 IL 0 0� P.C.Fee$ Permit Fee 0602-80 Issuance Fee FE W Total Fee �� d (5s 76A838A y CE 003(REV by 78), L. L. •. � IILII` J% r .� • APPLICATION FOR BUILDING PERMIT -- COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BADDRESS LDING ADDRESS r 6 6.7 Zv+i 0l c�,w LOCALITY �✓�/f , C / ,( E' NEAREST CITZIP CROSS ST. 4 ;, 6) Y �( No.OF BLDGS. ASSESSOR SIZE OF LOT 66 X/a d NOW ON LOT MAP BOOK PAGE I PARCEL 7 DISTRICT GROUP TYPE FIRE PROCESSED BY TR6Q Jt CK LOTNO. CONST.�T ZONE S --ice ✓ip;?-�. O W NER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 9A 6S 4," CLASS NO. DWELL.UNITS----] BK7-1 PG CITY r- C ZIP ARCHITECT ORVALUATION gyp. ENGINEER .S�.4M -t O. P77G �$ ...rrr��� ADDRESS -5,::.-+'r - BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF ;--(STREET) CONTRACTOR SA^n e NO.2 HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING / LIC. FRONT PROP.LINE HIGHW Y WIDTH ADDRESS NO. _ LIC. + CITY CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER NAME AND-BRANCH SIDE�PROP.LINE OF (STREET) s� a __ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD ADDRESS CITY SIDE PROP.LINE • HIGHWAY WIDTH SIIZEFT�2't�b STORIES FAMILIES ONEK + - DESCRIPTION OF WORK 4 e NEW 0 P.C.Fee$ Permit Fee O a0 J'.. e_n gnct F/-v -00 ADD ❑ 1111 Issuance Fee O ALTER Cl REP ❑ Total Fee •� . 00 AIR USE OF DEMOL ❑ EXISTING BLDG, ZO APPLICANT -� �/� TEL (PRINT) V/M til h PN' NO.2 r7 76G BY(SIGNATURE) 2 0 7 6 2 A IHEREBY ACKN LEDGE THAT I HAVE READ THIS APPLICATION AND STATE V . # 0 0 0 0 0 1 THAT THE ABOVE I CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE _ WORK AUTHORIZED HEREBY I WILLNOT EMPLOY ANY PERSON IN VIOLATION OF V 2 0 - 42.00 THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM• Z PENSATION INSURANCE. •0 0 0 4 2 Q Q F • d SIGNATURE OFfl O 1 3-78 PERMITTEE ADDRESS Z 2'- O CITY / NO. z lr 7 7 6 3 ~ D USE ZONE MAP NO. 12-1 SPECIAL CONDITIONS FINALBY n �+ DATE N. APPLICATION FOR BUILDING PE IT COUNTY OF"LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION " FOR APPLICANT TO FILIA IN iir BUIL G ADDRESS u I hereby affirm that I have a certificate of consent to self insure, BUI NG ADDRESS or a certificate of Workers'Compensation Insurance,or a certified,, ® �� ��c t of(Spec.3800,Lab.C.) , J �/ ZIP�/ Cyd �a�D B/ Compa L cS d LOCALITY SIZE OF LOT NO.OF BLDGS,NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS S �• Certified copy is filed.with the county building inspection ' TRACT BLOCK LOT No. /Q�/—�/yG/Ib' , department. USE ZONE MAP NO. Date ApplicantASSESSOR MAP BOOK PAGE PARCEL 11, i SPECIAL CONDITIONS • CERTIFICATE OF EXEMPTION F WORKERS' OWNER TEL N0. d3� COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO '(This section need not be completed if the permit is for one hundred' ADDRESS mak/ DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CITY-7—d-4— /,7/� zIP,�2/ �Q is issued, I shall not employ any person in any manner so.as to ARCHITECT OR GI EE C- TEL NO. /OS become-subject to the Workers'Compensation Laws. STATISTICAL CLASS] CATION APT CONDO Date Applicant 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' CO ��� �-� 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. ADDRE LIC.NO. PL- d2 �' SIDE LICENSED CONTRACTORS DECLARATION CITY LIDt�RA .CLASS PL I hereby affirm bot 1-am licensed underprovisions of Chapter 9 A�� 1 aSEWER MAP (commencing with'Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,anis my license is in full'force and Ct. NEW ❑ BK PGpoll. n License Number LiC.Class DESC ION OF WORK ADD, ❑ VALUATION C Cc ctor T Data 7 aB -1�.3 ALTER ❑ $ ' �p C ❑ I am exempt and ec.`' REPAIR JW $ - BAP.C.for this reason DEMOL ❑ LDMA P/C# LL -Date: USE OF EXISTING BLDG: URM ❑ 1 CL U. II I Signature L� AP J TEL NO LDMA Perm# ❑ I, as owner of the property, or my employees with wages as2 1 G Z ACC T.s their sole compensation, will do the work and the structure is ADD E • O �y not intended or offered for sale (Section 7044, Business and az W U`� U FINAL DATE Q '`, , ! 386■10 • Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ` ` 1 I�EI I•`_� ❑ I, as owner of the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER.THAN THE property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY —' licensed contractors to construct the project (Section 7044, YES 11N �OTAL 3845.'10 Business and Professions Code.) WOCCUPANT11 { ILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHECKI73086.11 REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY I COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING'CHECKUST FOR �j k'r ,y''}0 GUIDELINES CHANGE .0 I hereby affirm that there is a construction lending agency for YES❑ No C11 the performance of the work for which this permit is issued(Sec. SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE.WS ANGELES COUNTY CODE, TITLE 2,CHA 0 CONCERNING HAZARDOUS 0OD0-0001 .7/20/93 Lender's Name ." AND FOR OBTA G ERMIT FROM THE SCAOMD. 0 Lender's Address 0 OWNEN OR AGENT ' c 1 certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE o enter u n o �fioned roperty for inspection purposes. INV ESTIGATION FEE TOTAL FEE uR AppB I DM o !d j SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS"COM'PENSAT'ION DECLARATION • j-4 hpr;�h r firm Ghat I have a certificate of consent to pelf q p p - 1 CATION �F O R B U I L D I N�G �P E RM I T sure,Sr a certificate of Workers'Compensation Insurance, or a certified copy thereof•(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company - BUILDNG ❑ Certified copy is hereby furnished.,` FOR APPLICANT TO FILL IN ADDRIESS Certified copy is filed with the county building'inspec- BUILDING /' J tion department. ADDRESS Date Applicant CITY 61,11, ZIP �(,� LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.-OF BLDGS. NEAREST J COMPENSATION INSURANCE s SIZE OF LOT NOW ON LOT CROSS ST. , / (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 r � USE ZONE MAP I certify that in the performance'of the work,for which this OWNER NO 11 NO. >_ permit is issued, I sholI.not employ any person in any manner /7I SPECIAL• tL so as to be me.subject to the Worker ' ompensation Laws. ADDRESS — 1 CONDITIONS O CITY e ZIP 191 Date S APPlicant ; NOTI TO APPLICANT:`If, 'after making this Certificate of ARCHITECT OR TEL. DISTRICT G OUP° TYPE FIRE PROC ED BY.. O V' ENGINEER NO. �. CONST. ZONE ' Exemption, you -should become subject to the.Workers' , / J) Compensation provisions of the Labor Code, you must forth- ADDRESS �! r�U �3 : V 3 d with comply-with such provisions or this permit shall be'= fA deemed revoked. CONTRACTOR NO. TEL. STATISTICAL CLASSIFICATION APT. C DO. Z '• .- LICENSED CONTRACTORS DECLARATION LIC. - CLASS NO. DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS U NO. (cSEWER MAP (commencing with Section 7000)of Division 3 of the Business and _. LIC. r Professions Code; and my license is in full force and effect. CITY CLASSBK.'_ : VALIDATION SQ.FT. NO.OF / J.NO.OF CHECK License Number Lic.Class = SIZE STORIES / FAMILIES ONE VALUATION Contractor Date• DESCRIPTION OF WORK NEW " ADD El A , , J 1:1I am exempt under Sec. ❑ , ALTER B.BP.C. for this reasonQ t'� REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMO" ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT NO. _.DAT '� z Z 8 9.4 A , herebyaffirm that I am exempt from the Contractor's License # 0 0 a 'o o 1' Law for the following reason (Secti.on 7031.5,•BZupiness and ADDRESS FI Professions Code): PRESE T' BUILDING'em I -1 24,88 JdSJ I, as owner of the'property, or rrly;employees;with ADDRESS • wages as their sole compensollaa will do the work and LOCALITY ' a o 1 2&88( the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. 4. 1 —85- ElI,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 FROM. - EXI CONSTRUCTION LENDING AGENCY SET BACK ' YARD HWY' PROP. LINE WIDTH ,I hereby affirm that there is.9 construction lenciingagencyfbr FRONT the performance of-the work:-,for vithich this permit is:is;ued P.L. - (Sec. 3097, Civ. C.).-,- r SIDE o - - P.L. _ Lender's Name 37 LDMA•Ref.'N:, Lender's Address P.C. Fee$ Permit Fee J r I certify that I have read.this application and state that the Issuance Fee 10 rs-lJ above information is correct. I agree to comply with all County Investigation Fee (+� M ordinances and State laws relating to building construction, _ Total Fee A LDAM perm. H and hereby authorize representatives of this County to enter upon the ove-mentioned pro erty for inspection urposes. 'TSEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant-or Agent to o i,