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HomeMy Public PortalAbout10663 LORA ST_Building__ APP:L.ICA'T''I.OSI..FQR....B•UIL.DING."PE,RMI'7' .. ' . COUNMOF LOS.ANGELES .. :. " BUIMINGAO.SAFETY. �: •. .. ' � ' BUILDING / !� FOR APPLICANT TO FILL IN,. ' ADDRESS>/Q•Li 3•'G ADDRESS (a LOCALITY CITY ZIP ✓7j&y) - GROSSEST. ��yy / d pCl.OE BLDGS. ASSESSOR.. SIZE OF LOT/. s �J NOW ON LOT.` MAP BOOK-" PAGE PARCEL• DISTRICT'`- GROUP TYPE FIRE CESSED BY.- TRACT /`L2C_J' BLOCK LOT NO: OWNER..•..MVi NO. 'D76� `' CONS.•, Z�pl�: ;r �,: r. •''. ���yy/��, oli STATISTICAL CLASSIFICATION �' r ;'SEWER ADDRESS(."-C3 _40 4I ­6,14-i 6,14 •• CLASS NO:""" D.N!ELL.UNITS ' •.� . B PG _ - ZIP ARCHITECTOR- TEL. .ENGINEER :�:/Y®N --,-.NO, VALUATION ADDRESS BLDG:SETBACK'FROM r �y� FRONT PROP.LIN_E'OF TEL: (STREET( CONTRACTOR (,���(�/ � NO. HIGHWAY t YARD TOTALSETBACKFROM TYPEOF• EXISTING LIC... - FRONT PROP.LINE HIGHWAY,' WIDTH ADDRESS NO. ' LIC. + CITY CLASS' CONSTRUCTION LENDER _ ._.._ _ _._ BLDG.SETBACK FROM •.' + NAME AND BRANCH .' SIDE PROP.LINE,OF (STREETP HIGHWAY'.'+ YARD _ 'TOTALSETBACKFRO%N TYPE OF EXISTING. � ADDRESS CITY SIDE PROP.LINE ; HIGHWAY WIDTH: ; SO.FTy.j-tQ NO.OF r NO. OF CHECK 7 SIZE ,,' .'STORIES': FAMILIES - ONE..:" US NE MAP ®` DESCRIPTION OF WORK'- - NEW ❑ NO." SPECIAL #L ADD ❑` J� CO DITIONS ALTER :•❑`FINAL_• BY �TF/� /� ot�/+�� REPAIR ❑`DATE: _ USE OF DEMOL ❑'' EXISTING BLD G../!� ' _ -OZ APPLICAN TEL(PRINT) I op i J/J NO. 'D` �y R I HEREBY ACKNOWLEDGE-THAT I HAVE READ THIS APPLICATION AND STATE U bd 1 { qq THAT THE ABOVE.IS CORRECT AND AGREE TO COMPLY WITH ALL.,ORDINANCES,.`, ':IL ,, c«�.C;.'Cj;•1_ AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY-THAT IN DOING THE. =_ V r. WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF,• .THELABOR CODE OFTHE ST OFCALIFORNIA.INRELATINGTOWOR 'SCOM - .•, -. - Z tr o 0 0 ° ° �'•`•,•" PEIJSATION INSURANCE.: SIGNATURE :F A PERMITTEE �?G,'�J v'c;• ADDRESS W.:. -TEL.'- CITY TEL .CITY NO. � 9 !, .� P.C.Fee S' Permit Fee �.^ > '. r' Issuance Fee . ... -r_ ul ' Total Fee ,� � _ - •• _ - �t.• 'j,�'j APPLICATION F'O R COUNTY OF LOS ANGELES BUILDING PERMIT DEPARTMENT OF COUNTY ENGINEER. BUILDING AND SAFETY DIVISION u BUILDING BUILDING FDDRESS R AP//PLICANT TO FILL IN ADDRESS (,, NG ® �91_0eALOCALITY NEAREST ZIP6! CROSS ST. /rI aBUILDI p O.OF BLDGS. ASSESSOR ,3/ F/// NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT IGROUPITY PE FIRE PROC S ED BY TRACT/ate S BLOCK� �J�LOT NO� U �.�,v� Z CONS ZVE OWNER &0,(5, /�f/�/'T ��alNOL �V STATISTICAL CLASSIFICATION /f l SEWER MAP ADDRESS 90619 3 6 1-9&W' j x'67 , CLASS NO. "2• DWELL.UNITS d_BK dA G CITY Z/- ZIP %/!P® USE ZONE NO. ARCHITECT O /�.�/� HEEL. j SPECIAL ENGINEER /� i�1 CONDITIONS ADDRESS y�fROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ L. CONTRACTOR ®!+ A 61� N0. BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS NO. HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP. LINE HIGHWAY WIDTH CITY CLASS _ CONSTRUCTION LENDER + NAME AND BRANCH BLDG.SETBACK FROM a ADDRESS CITY SIDE PROP.LINE OF (STREET)..- CC.: SQ.EF Ly��ry NO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING Cr SIZ //D p STORIES ® FAMILIES ® ONE SIDE PROP. LINE HIGHWAY WIDTH V DESCRIPTION OF WORK NEW ❑ + h ,vy A� �/ AW/ms ADD CORNER CUTOFF YES El NO ❑ ']/NW ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ �// REPAIR❑ ' USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ `�-- EXISTING BLDG. DEMOL ❑ ? Q' ° �i' �j AP0.4RI � 6NOL � / BY (SIGNA - • I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION � _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1 WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE i1J �• LABOR CODE OF THE STAT OF CALIFORNIA IN RELATING If 11 � i WORKMEN'S COMPENSA ION SURANC E. y SIGNATURE OF 4 A FINAL / PERMITTEE DATE I ADDRESS �y - TEL. CITY NO. P.C.Fee$ V' Pe mit•Fee / (� Q �+ Issuance Fee VALUATION /.',)Total Fee PLAN CHECK VALIDATION CK. M.O. CASH o PERMIT VA p/TION CK. M.O. CASH v U . 4. 2 2 MR 30 1- ®. 116.2 Z=A98 76AG38A CE#6030 I2/75 �' ~ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only)' BUILDING X0 Xp COUNTY OF LOS-ANGELES ADDRESS (� DEPARTMENT OF COUNTY ENGINEER CITY'& �( e_l` ZIP' BUILDING AND SAFETY DIVISION per/ INO OF BLDGS. BUILDING /� F SIZE OF LOT 7V �� NOW ON LOT ADDRESS (O may, TRACT 4,2L24>4—I BLOCK TEL �iJ'(� LOCALITY OWNER ♦ �/ ���4NEAREST 7C(�NOL7'�0 ��d CROSS ST. ADDRESS ASSESSOR I ADDRESS Q ' ��L�'L�f�% MAP BOOK PAGE PARCEL CITY �� �� ZIP��/ O o. DISTRICT GROUP TYPE FIRE P D BY CONST. ZO ARCHITECT OR, TEL. U ENGINEER NO. STATISTICAL CLASS FICATION SEWER MAP ADDRESS CLASS NO. DWELL.UNITS Z_ BK _�PG TEL. CONTRACTOR NO ZONE NOP 0��� ADDRESS LIC. . 0. SPECIAL LIC. CONDITIONS CONSTRUCTION LENDER CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ NAME AND BRANCH BLDG ETBACK FROM FRO PROP.LINE OF (STREET)- ADDRESS CITY NIGH AY •} YARD ITOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE • HIGHWAY WIDTH SIZE STORIES FAMILIES ONE a DESCRIPTION OF WORKliLa+•w W ❑ L ' ADD ❑ BLDG.SETBACK FROM (STREET) a SIDE PROP.LINE OF C: ^� _Q_ LTER TOTAL SETBACK'FROM JW HIGHWAY •F YARD _ It OF EXISTING ~ b..[.GC.ii REPAIR❑ SIDE PROP. LINE HIG AY WIDTH OLL. USE OFco" EXISTING BLDG. DEMOL E] + Z APPLICANT/�)`f`7/� /J/��j1 �EL;J CORNER CUTOFF YES El NO ❑ (PRINT) (�/ BY (SIT R t IN OPEN SPACE YES ❑ NOC.L ❑ /7 IN COASTAL PERMIT ZONE YES ❑ NO ❑ �-.VALUATION,$ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE-ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ' STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED , HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE J ' LABOR CODE OF THE STAT OF -CALIFORNIA IN RELA G TO rj WORKMEN'S COMPENSAT ON URA CE. ('�J SIGNATURE PERMITTEE / 1 ADDRESS �Q r✓46.5 o I 1 1A ` f ! ` NEOLL7� FINAL A TE BY ry �!� f CITY �''� OD + MAKE CHECKS PAYABLE TO: FEE' ' .� FEE HARVEY T. BRANDT. COUNTY ENGINEER PLAN'CHECK VALIDATION CK. M.O. CASH w /fERMIT VALIDATION' cK. o. CASH . 9. 2.2 EP 9.4 p•®c,a 7GA63BA CE 0 603 S/74 s 76A638A - CE#803(REV.11/78) , APPLICA O �- O R RUI " ERMIT. COUNTY OF LOS ANGELES BUILDING.'AND SAFETY.-,_ :.. FOR APPLICANT T.O.FILL IN BUDDING ADDRESS BUILDING // +.? SJ_• LOCALITY- �2 ADDRESS ] (p 1� �J CITY Te Oe?-) /e ZIP �y� / �] NEAREST j CROSS ST. y p # &F BLDGS. gg ASSESSOR SIZE OF LOT/ y///� NOW ON LOT. .G/ MAP BOOK PAGE _ PARCEL, 'DISTRICT 'GROUP TYP�- FIRE PROCESS ED BY TRACT BLOCK LOT NO. CONOWNER' �+V �j. OSC44 NO... �d STATISTICAL CL FICATION SEWER M ADDRESS /0 h 4 (� �T S 1 / ��,/ ^ CLASS N j DWELL.UNITS rG�BK. CITY 7C.�"' A� = ZIP ��� �d' - ARCHITECT OR TEL. VALUATION.' Of��G��. ENGINEER '-NO. lo ADDRESS �` _ BLDG.SETBACK FROM / �7 TEL. FRONT PROP.LINE OF ��-�� ISTREETI CONTRACTOR .. BW 6r TOTAL SETBACK FROM TYPE OF- EXISTING LIG. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. LIC. CITY CLASS CONSTRUCTION LENDER BLDG.SETBACK.FROM NAME AND BRANCH SIDE PROP:LINE OF (STREET) TOTAL.SETBACK FROMTYPE OF EXISTING ADDRESS CITY HIGHWAY +. YARD _ SIDE•PROP.LINE HIGHWAY WIDTH.. 101 SQ.FT. NO.OF NO.OF CHECK + _ SIZE iall STORIES I FAMILIES ONE USE ZONE MAP DESCRIPTION OF-WORK -- /� NEW ❑ NO. - IT061-0 n m ADD CONDITIONS " ALTER ❑ FINAL BY • / ❑ DATA REPAIR USE OF 'DEMOL ❑ EXISTING BLDG. �/ � �1/ Z APPA S[ � . 03( /(D BY ISIGNATURE)' .•.... a> _ IHEREBY ACKNOWLEDG THAT I HAV EAD THIS APPLICATION AND ST E �- 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 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OE THE STATE,OF CALIFORNIA If�l RELAT_ING TO WORKMEN'S COM- Z " PENSATION INSURANCE.' 5 - SIGNATURE OF PERMITTEE _ y ADDRESS 0-1,2' -2. U v Z TEL !J(�� � - - -2 CITY NO. / P.C.Fee$ 1 Permit Fee > . Issuance Fee IL Total Fee. COUNTY OF LOS ANGELES �. APPLICATION FOR DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS 0&& •�, aJ BUILDING ADDRESS 106 (o3 L- 0 r A. d LOCALITY tV NEAREST Q� CITYT� !Z C°. 4 ZIP CROSS ST. �/- � NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT. MAP BOOK PAGE PARCEL DISTRICT I GROUP� a TYPET. FIRE PROC D BY U� NSZpp� TRACT - D J BLOCK LOT NO. 3 Q � TEL . OWNER (� , n NO. _6 d� STATISTICAL CLASSIFICATIONSEWER JP ADDRESS O L() �'�. CLASS NO.41-DWELL.UNITS y BFC 1 PG • 'USE ZONE MAP CITY+► ,g c, '-AV ZIP NO. .20./ 0 ARCHITECT TEL / SPECIAL ENGINEER /� /�-2 LAS' NO.�� -d/�3 CONDITIONS ADDRESS G 10 .5'O IV ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRALTO /7 TEL. BLDG.SETBACK FROM L O6I ld NO ��Z�'r LIC. FRONT PROP.LINE OF (STREET) �1 ADDRESSxL SV (Pp 1r/l O. 3IyaI L HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP. LINE HIGHWAY WIDTH CITY N� CLASS C CONSTRUCTION LENDER + a NAME AND BRANCH BLDG.SETBACK FROM CD ADDRESS CITY SIDE PROP.LINE OF (STREET) CD SQ. FT c NO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING �' SIZE ,3p O STORIES FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH O LLJ DESCRIPTION OF WORK NEW + _ N nr0'4 ADD ❑ CORNER CUTOFF YES ❑ NO ❑ r� ALTER ❑ REPAIR[:] IN OPEN SPACEi YES ❑ NO ❑ USE OFDEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. /', ,/ d APPLICANT A EL''y, _ .A . C o. (PRI NT)w SGl*/ oa CoC/ rRND��ss 1-12_lj BY (SIGNATURE)/ - v ' /fliLGti I HEREBY ACKNOWLEDGE THAT i AAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY L e�- WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION ON- STRUC TION. 1 CERTIFY THAT IN DOING THE 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 COMPENSATION INSURANCE. SIGNATURE OFINAL / I 4 x BY PERMITTEE �•"" �w�-- DATE C/�- �1 ADDRESS e)� v d`p S I It u TEL. P.C. Fee$ _--,)L Permit Fee CITY LLJ F'•}-� M[.1� NO. 5'-/7/S ° Issuance Fee VALUATION$ T(,UV, ; tal Fee �! -- PLAN CHECK VALIDATION CK. M.O. CASH ® PERMIT VALID T N bim.o. CASH 0 4 1 OCT 2y 2 3 D 2 5,2 0 4 2. CCT 2 G.9 D 4 2. 0 ��, 7GA628A CE*809B 12/76 t, DEPARTMENT.OF BUILDING AND SAFETY APPLICATION FOR PERMIT ''COUNTY OF LOS ANGELES WK. J. FOX, CHIEF,ENGINEER _ IL®I � . FOR.APPLICANT TO FILL IN FOR OFFICE. USE ONLY Brl11LDING D18_T.RICT O: PLAN CK,NO. gPERMIT NO /j ADDRESS •. �• �' ,I/� `� .. �4 2,� LOCALITY RECEIVED BY DATE OF APPL. DATE Ize SUED NEAREST CROSS ST,..' "f � BUILDING. OWNER... ADDRESS L MAIL- LOCALITY - ADDRESS,��p�: NEAREST - - - - %�' / TEL -CROSS ST. CITY./ No.:, ` FIRE' .•. NO. OF TYPE GROUP`], `' ARCFIITECT OR TELA ZONE C�I-PLANS �/ I I. _".i1• ENGINEER -NO. - BLDG' / pRD}`�O1 t SETBACK LINE• 2r P•7'"Ni'I/V ADDRESS APPROVED TEL BY DATE CONTRACTOR'':' NO. USE APPROVED.• ' ZONE' �'/ BY DATE,r ADDRESS HOUSE ;NUMBERING•, - LEGAL DESCRIPTION -I LOT NO. BLOCK -- MAP NUMBER �'��® FIELD CHECK BY ' TRACT 'r o,yarfj NO. ASSIGNED'BY nATF O" ' "NO.OF BLDGS. CORRECTIONS. _ SIZE OF LOT • 'aa• ' I NOW ON LOT'USEOF Zj EXISTING BLDG. �U' 13—,A''1g I F0. O AMILIEs X S ` DESCRIPTION OF WORK-: NEW I• ALTERATION'I I ADDITION,,, REPAIR I. .I•DEMOLITION I SQ. FT. - NO. OF 'n SIZE _ ROOMS STORIES i. EXT.WALL ' ROOF o. r COVERING . W.6.0• I COVERING* er I��p.A1 USE OF STRUCTURB {r�.•' _ - APPROVALS INSPECTOR'S SIGNATURE DATE • - 1 HEREBY ACKNOWLEDGE.THAT 1 HAVE READ THIS AP= FOUNDATION--LOCATION PLICATION AND"STATE THAT THE INFORMATION GIVEN 18 FORMS, MATERIALS L CORRECT. _ 1 .AGREE TO COMPLY WITH THE CORRECTIOWS LISTED .FRAME:FIRE STOPS, i HEREON AND WITH'^LL COUNTY ORDINA CES AND STATE "BRACING, BOLTS LAWS REGULATING BUIIhjd G CONS , N FURNACE: LOCATION, SIGNATURE OF / GAS VENT,.DUCTS . PERMITTE T.H-, INT: ADDRESS - _ 'LATH; 9XT. ✓' AUTHORIZED AGT. PLASTER, INT., 7BA888A D888 P. C.-$' •• _ ® _ _ � FEE "., PLASTER, EXT. i VALUATION "`` - FEE ffi FINAL WORKERS'COMPENSATION DECLARATION �f hereby affirm ifica I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or 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 BUILDING �o ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS c,��3 C• G�� i2tt� ❑ Certified copy is filed with the county building inspec- BUILDING c+— tion department. ADDRESS Date Applicant CITY / 7 ZIP h71& LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 73.MY killNOW ON LOT I CROSS ST. COMPENSATION INSURANCE ASSESSOR ��` (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE��� PARCEL �b hundred dollars ($100)or less.) TEL. OWNER � NO. USE ZONE rO. AP .s17 lla75 I certify that in the performance of the work for which this / ry / } permit is issued, I shall not employ any person in any manner ADDRESS ��p Z ha )¢ � PECIAL ONDITIONS O so as to become subject to the Workers'Compensation Laws. Q U CITY OLS -G T ZIP 7 Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZO E Exemption, you should become subject to the Workers' 1 / Compensation provisions of the Labor Code, you must forth- ADDRESS s ��� - V a ;.` N with comply with such provisions or this permit shall be �y� TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR Jl'��� NO. — LICENSED CONTRACTORS DECLARATION LIC. ,y CLASS NO. DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK. PG VALIDATION SO. FT. NO. OF NO.OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK AD � $ ❑I am exempt under Sec. 6 TER ❑ �( , B.&P.C. for this reason REPAIR $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL• FINAL OWNER-BUILDER DECLARATION (PRINT) NO DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL- v-=" �v Professions Code): PRESENT By BUILDING 5d I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY - t the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. h` s with licensed contractors to construct the project (Sec- - ADDRESS L a�� tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY REQUIRED SET YARD HWY TOTAL PSETBACK IE FROM WIDTH I hereby affirm that there is a construction lending agency for FRONT >"1' e 7 33 P.L. 7L. —r t a the performance of the work for which this permit is issued _ _ (Sec. 3097, Civ. C.). SIDE L�t_•ti Z,F o L- P.L. Lender's Name �� s ritYl_t ,•.1_ dLDMA Ref. p P.C. Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee a r LDMA P/C qL_,'ti"_ '- Investi ation Fee above information is correct. I agree to comply with all County g ordinances and State laws relating to building construction, Total Fee �o LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned arra arty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applilq6t or Agent Date WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FORBUILDING P E RM I T insure, or a certificate of Workers'Compensation InsyrancV, 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 0�m�/,-4 ❑ Certified copy is filed with the county building inspec- BUILDING Lt9 T tion department. ADDRESS J Date Applicant CITY G. G/ ZIP / 7/6 LOCALITY NO.OF BLDGSNEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT73,q-� X NOW ON?E� CRSS ST. NMICOMPENSATION INSURANCE ✓ Y ASSESSOR,(Thissection need not be completed if the permit is for one TRACT BLOCK N . MAP BOOK O PAGr(/�� PARCEL�9 hundred dollars ($100)or less.) OWNER IIVC�Z No .SLp�—�2 USE ZONE MAP . I certify that in the performance of the work for which this n SPECIAL NO permit is issued, I shall not employ any person in any manner ADDRESS J ^ / CONDITIONS so as to become subject to the Workers'Compensation Laws. O CITY 4z C rK ZIP 917dol� U Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. Z E Exemption, you should become subject to the Workers' p Compensation provisions of the Labor Code, you must forth- ADDRESS ,AO `� .4- with with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. NDO. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS N DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapteri? ADDRESS NO' SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE I STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ ❑I am exempt under Sec. ADD ❑ , ALTER ❑ B.&P.C. for this reason Z_-- REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL Signature APPLICANT TEL. FINA 3 OWNER-BUILDER DECLARATION (PRINT) NO. DATE C G/ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT LJ property, ING BY BUILDI, as owner of theor mY with ` w r ADDRESS _ "I�•�••• •'7 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. _.. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. s J.,it 1,= with licensed contractors to construct the project (Sec- ADDRESS ' ti+ 00tion 7044, Business and Professions Code.) t� �;�L a.rvc CONSTRUCTION LENDING AGENCY SETBACK YARD HWY TO7APROPALINEFROM WIDTH I hereby affirm that there is a construction lending agency for FRONT 34 the performance of the work for which this permit is issued P.L. ri (Sec. 3097, Civ. C.). SIDE P.L. Lenders Name _I=1�I�_j;)"tla " QU LDMA Ref. # J" �t lii P.C. Fee$ Permit Fee Lenders Address S lilr.iPoo •: I certify that I have read this application and state that the Issuance Fee �� LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee (j rj 0.0 i ordinances and State laws relating to building construction, Total Fee D O z; LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 2 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of pp- t or Agent Date 4 WORKERS' COMPENSATION DECLARATION herdby affirm that I have a certificate of consent to self` I N F BUILDING PERMIT insure, or a certift�te of Workers' Compensation 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 ':rt ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDNG y ADDRIESS 10106 3 F . IVP—A- 5 tion department. p� 1'1� Date ApplicantCITY Qj ZIP l 7 vi. LOCALITY/ / NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 7rX�� NOW ON LOT I .CROSS sr. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) , q L �A� p OWNER �,(/ O, r �QQ-/ USE ZONE MAP I certify that in the performance of the work for which this oo�� 1 �, NO. " O7 permit is issued,I shall not employ any person in.any manner ADDRESS 046 3 r kD� �� SPECIAL so as to become subject to the Workers'Compensation Laws. CONDITIONS O 3q4 ! Wi►U m-G. � =CITY t�,. zip �l 7�� ix xDate Applicant J ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER Q!,(J '— NO. s,' J /, CONST. \ ZO Exemption, you should become subject to the Workers' �; ` , �t[ �� �y'/ '�)�,7 UJ Compensation provisions of the Labor Code you must forth- '=ADDRESS J (©©� with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. = CONTRACTOR w�F`�ty NO. x CLASS NO. DWELL. UNITS LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ''" ADDRESS NO. SEWER MAP S r' (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK \ VALIDATION SQ. FT. NO. OF NO. OF CHECK J License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION ® MW� DDESCRIPTION OF WORK NEW ❑ -. ON Contractorr/(J o Date $ ADD ❑I am exempt under Sec. f S ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ . Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION 5' (PRINT) NO. DATE'57 I hereby affirm that I am exempt from the Contractor's License w for Q the ollowing reason (Section 7031.5, Business and ';ADDRESS FINALd Profes ' Code): "PRESENT ` � r. By G BUILDING ,3 wtryir{� o4 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 3307 68.635 7044, Business and Professions Code.) MOVING ��� TEL. El1,as owner of the property,am exclusively contracting CONTRACTOR NO. 1 IAB with licensed contractors to construct the project (Sec- ADDRESS ` w tion 7044, Business and Professions Code.) o REQUIRED TOTAL SETBACK FROM EXIST. -. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH -` CHECK 68.6.' 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 � p_ i �r��I S LDMA Ref.# P.C. Fee$ Permit Fee Lender's Address 4280 1 AM 3044 I certify that I have read this application and state that the Issuance Fee ® r' LDMA P/C# ® o above information is correct.I agree to comply with all County Investigation Fee / ordinances and State laws relating to building construction,. Total Fee V '. LDMA Perm. # and hereby atAlhorize.representatt s of this County to enter s: upon he a o e m tinned grope for inspection purposes. o lam. 1 —11210—HSEE REVERSE FOR EXPLANATORY LANGUAGE \'J�\ ture Applicant or AgerllDate WORKERS;•ICOMPENSATIONeDECLARFtTION rl 11 i hereby affirm•That I have a certificate of consent to self APPLICATION FOR B� 1S ..insure, I L®I N G PERMIT RIM IT or a certificate of Workers'Compenstion Insurance,or , a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Compahy 4so4,G ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN :;' ADDREss Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS �Q Date Applicant CITY ' ZIP C,I/ /� CROSSSST. .IF -CERTIFICATE OF EXEMPTION FROM WORKERS' T40.OF BLDGS. i COMPENSATION INSURANCE SIZE OF LOT J� /� NOW ON LOT Ic— MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE �SPE�CDIAL P TRACT BLOCK LOT NO. hundred dollars ($100)or less.) � }�� ] > J���� �. +� + I certify that in the performance of the work for which this OWNER4Y ,/�a�l_c( . Qyp. d.�, NITIONS / O permit is issued, I shall not employ any person in any manner �/�'� �'_ DISTRICT GROUP TYPE FIRE PRO SEED BY U to as to become subject to the Worker ' ensation la ADDRES c CO ZONE O ' a ��v CITY �/r` � �f ZIP , "" I.. Date Applicant STATISTICAL CLASSIFIC TION APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificat of 4REFItF OR /,r��t/,�. /� NO. d Exemption, you should 'become subject to 'the Workers' ENGINEER CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- SEWER MAP with comply with such.provisions or this permit shall be TEL. / deemed revoked. s CONTRACTOR `��'�I�c.��J6� NG, BK./_FG%�� VALIDATION LICENSED CONTRACTORS DECLARATION I hereby affirm that I cim licensed under provisions of Chapter 9 ADDRESS VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS $.rO ?� SQ. FT.y NO.OF ,r� NO.OF CHECK License Number Lic.Class SIZE "k=t��` STORIES Gr- FAMILIES ONE Contractor Date DESCRIPTION OF WORK i�/�41 «�'��13�� AD JGIo U ,1 I am exempt from the licensing requirements as I am a ALTER ❑ FINAL { licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, REPAIR ❑ DATE ,ry• �. Business and Professions Code). USE OF FINAL (J EXISTING BLDG. DEMOL ❑ By Lic,or Reg.No. _Date -TELL NOs � 1� ✓ �V / Ii' �' '~ OWNER-BUILDER.DECLARATION /� _ I hereby affirm that I am exempt from the Contractor's License ` Pie.- �` Law for the following reason .(Section 7031.5, Business and, ADDRESSD l-> gAl�d� Professions Code): PRESENT r e r C' 9 p,t' BUILDING I, as owner of the property, or my employees with •' ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. /� �j —� L I, as owner of.the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- i 2 C �- tion 7044, Business and Professions Code). ADDRESS , (J ) REQUIRED TOTAL SETBACK FROM EXIST. ( O'7. 1 2 CONSTRUCTION LENDING AGENCY SET BACK YARD LHWY PROP I WIDTH lam• I hereby affirm that there.is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. U 0,7 A (Sec. 3097, Civ. C.). SIDE - P.L. i �t e v o c 1 Lender's Name 'o P.C. Fee$ � Permit-Fee / " 1j. ? 50 Lender's Address l� I certify that I have read this application and state that the '� V Issuance Fee ` above information incorrect. I agree to comply with�bll County =Investigation Fee 3 ordinances-and State laws relating to building construction, Total Fee �?Z.sa 7' 3 and hereby authorize representatives of this County to enter ;s _ upon the ov -mentioned prgperty for inspection,purposes. >l SEE REVERSE FOR EXPLANATORY LANGUAGE 0 Signature of Applicant or Agent Date I i /