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Home My Public Portal About10419 LOWER AZUSA RD_Building__ 78A8313A'CE 809 11 57, AP`PL.ICA`�'['C 111 O Ru.ILD61 C PERMl`T r COUNTY OF LOS=ANGEI;ES Bui,LDINc ' " ADDRESS �/' / ;DEPARTMENT`OF:COUNTY ENGINEER B(MING AND E AFETY.DNISEON,: LOCALITY :' JOHN- ER NEAREST ...-- .. 'CASSA-TT D..GRIFFIN,SUPT OF BuiLDING - CROSS ST. - ROUP SEWER MAP DISTRICT NO. :G•a.►+ ,! YPE. -c PG - -FOR.APPLICANT,,TA FILL.IN ' BK/ , J CONST. L.. --,. BUILDING ADDRESS / (/ '7'� ti. ,��,.y�.� r STATISTICAL.CLASSIFICATION • CLASS NO. WELL.•UNiT:S - LOTiNO / ' 1�/J�i'1, C.6%. BLOCK' STATE++:��. NUMBER; -O`D �:� - kiWY - - r YES, USE ZO E' '"` SPECIAL -�-' NO OF'BLDGS. - C _ ONDITIONS , SIZE OF LOT NOW ON LOTS a USE OF - :-- EXISTiNGrBLDG. B DING EXIST, _ .. ETBAC S K VNIDTH' YARD -HWY STREET NAIVE' OWNER,.. �� - �� ', FRONT s L, -MAIL. Z rel .-.. N . ADDRESS. . CITY :'.. �GL...tE�t,.a:r(� LdIJ TELNO. _ ARCHITECT OR- ENGINEER INSPECTION' RECORD ENGINEER .ADDRESS, ., - _ - M' �(.. TEL : ✓). p ', /�^AM d/ t---. CONTRACTOR NO " d� ' v 7 ADDRESS': DESCRIPTION OF MORK' NEW ADD! `ALTER REPAIR DEMOLISH ' 1 ESQ.FT - �' jj NO.OF J- ., NO.OF: 'r rl/Cs'L"� '- S�r�C.,iGt. :,.i'L,ry^► :. SIZE _(�.'' 'V' .STORIES /,. 'FAMILIES. USE OF STRUCTURE f ✓`ry �i�".ji/ SIGNATURE OF - - APPROVALS _:.APPLICANT - ' DATE'. I SIGNATURE 4DDRESS .'.: FOUNDATION: LOCATION ,_�,•. :®-'Q '., P.C.� S_ RAMS: FREMATERIALS STOPS.E -FEE, ', ... FBRACING.,BOLTS 1.r^'4, a � - y r VALUATION t N. $ FURNACE:.LOCATIO • '. FEE .` _GAS VENT,DUCTSlal�ar - - �1'HEREBY ACKNOWLEDGE•THAT"1 HAVE READ THIS AP- LATH,:1 NT.' - PLICATIONANp"STATETHAT,THEABOVE.IS'CORRECT.AND AGREE TO COMPLY"WITH ALL COUNTY ORDINANCES AND i'- -' , STATE, LAWS,REGULATING BUI ING CONST UCTION:, LATH,`EXT,' - SIGNATURE OF OUSE NUMBER COR:.. ` PERMITTE !1 RECT AND POSTED / ADDRESS !:•'�... F,![/J5.: �7X./7A �,�1•...�� ;FINAL':..•. ' rs� N. DIRLAM, PRINCIP•ALSTRUCT:U.RAL R'- 'PW CHECK VALIDATION ' CK. M.0; CASH' PERMIT;VALIDATION cK:, M b('- CA$ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS / ]-hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS �,/ 0 7 . or a certificate of Workers' Compensation Insurance,or a certified �� ` � «� o-er A&l �Q"`"' copy thereof(Sec.3800,Lab.C.) CITY J ZIP LOCALITY Policy No. Company 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. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER /`J, / � � TEL NO. COMPENSATION INSURANCE ��v �`�� n WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS Ito% V&1. DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) F� CITY ZIP I certify that in the performance of the work for which this permit 62-r." is issued, I shall not employ any person in any manner so as to ARCHITECT OR SNEER T�NO. Q become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION 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 t0 the Workers' CONTRACTOR 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. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions Of Chapter 9 SEWER MAP >_ (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.of STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG Com.) License Number Lic.CIBSS DESCRIPTION OF WORK ADD ❑ VALUATION Contractor Date G 4 ALTER El $ a 0" 44e REPAIR ❑ `OO ❑ 1 am exempt under Sec. $ BAP.C.for this reason bullQ1Z � C h7 DEMOL ❑ LDMA P/C# Date: USE OF EXISTITle,BLDG. URM ❑ /gnature APPLICANT(PRINT) 11 TEL NO. LDMA Perm# �(•-•-s owner of the property, or my employees with wages as %q Z i-tt_::; .g their sole compensation, will do the work and the structure is ADDRESS 4 -r--1 ` -:- FINAL DATE not intended or offered for sale (Section 7044, Business and /Q CI G Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS ATERIAL q OR A MIXTURE OR A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _J i ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL licensed contractors to construct the project (Section 7044, Business and Professions Code.) VES❑ NO El WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH � •"-•`"` CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ��h( \\ - .--• :- GUIDELINES. V ` y; t @%j'1•',�: hereby affirm that there is a construction lending agency for VES❑ NO❑ the performance Of the WOfk for Wt11Ch this permit IS ISSUed(SOC. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING f.�� 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ,,,r1 <i_ 4"' inl-i TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS ' ,//� jvt')•._3_F 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. "/ _ 0- Lender's Address i�HF's�'s`GE a__ 0 OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comp) P.C.FEE PERMIT FEE sin P l Y 9 Y /� V "3 Li J✓ a with all county ordinances and State laws relating to building i� m construction, and hereby authorize representatives of this County ISSUANCE FEE f C: Ar Cl) to enter upon the above-mentioned property for inspection purposes. p` 7 0 �I s i$'I A` 7 (D\`' �,,. �� INVESTIGATION FEE TOTAL FEE ' ;LD sgrol�re.of ApdKan Agan 7 SEE REVERSE FOR EXPLANATORY LANGUAGE _ vim /�, 1��.�r aq q�p� ■p p�e� pp�� qqq IgI p1 ppp g/�►, pp�,7@�., /q�gp . AS 78A838A CE7#803.x'8;3,74./'��Y 1.�� ,T®�10, ', O . ,B�H.L"®ING. Y_ ER V9IT ,_ - . :COUNTY OF_LOS;ANGELES" BUILDI,N�` DEPARTMENT OF COUNTY ENGINEER 'ADDRESS BUILDING AND SAFETY:DIVISION. LOCALITY; " r JQHN'T LAMBIE GOUNTY,ENGINEER=. NEAREST. ,CASSATT D, IR FIN,SUP•.T 0F,BuICDING -CROSS ST, - a= - • - '" DISTRICT NO. GROUP I�.� - ""®" SEWER MAP ' _FOR APPLICANT'TO FILI:IN r- [TYPE BK PG � `: .w:•. � " BUILDING - STATISTICAL CLASSIFICATION DDRESS A _ a ' CLASS.NO. :DWELL.UNITS I LOT NO" _=` _ .BLOCK„ - / MAP - STATE -YE5 O TRACT �CP' - NUMBER :"HWY - USEZONE "SPECIAL - +'• • - NO.OF.BLDGS'. ' •` '° `CONDITIONS- - - � • -'SIZEOF,LOT. (t7J .NOW ON'LOT' ,USE OF .. _ - 9%1'.`.f-' EXISTING BLDG: `• ' BUILDING .`EXIST.,,"," YARD FiV1lY TREET N ME= - SETBACK _ :' .WIDTH... OWNER •. - FRONT • MALL ADDRESS SIDE - EL _ P.L.• ,� .' moi' .CILIITY 'ARCH.ITECT OR, `INSPECTION,,RECOc '- ENGINEER,. .' -`..':. .-, ,NO .. ADDRESS.e: 7 L .. - �".. ' TEL CONTRACTO ADDRESS DESCRIPTION' OF WOR$ v v �� l:a Fc.,.tl '1,/l f K -NEW 'ADD ALTER_ ;REPAIR ` ; DEMOLISHI• 99 ,�•"� r • ,r}' / { S OR ES 9 NO."OF SQ. FT / , . SIZE` - J �J� vFAMILIE yUSEOFSTRUCTURE - - .•�U.'f"'/" :.. Vit), t PI _ ! .le!// (firrf - APPROVALS; SIGNATURE OF P, `APPLICANT -- -, _ ADDRESS �.� / - "DATE INSPECTOR'.S.SIGNATUR1 -- FOUNDATION: LOCATION / / - FORMS.„MATERIALS 17'/J/, -,,��/ '"fa'`- �✓`T P:C: $ _i �F,) FRAME FIRE-STOPS ' FEE BRACING BOLTS /f/=7�” lPlfsf�ArVt�2:G/vl�+�..� VALUATION' : $ -, p 4 - 'FURNACE LOCATION, - �-FEE ',/••" GAS VENT:DUCTS-,.. -/ ./ -. �!ltl.e+PrL�I ✓� s..* -" ,e I HEREBY ACKNOWLEDGE THAT'1 HAVE READ,THISrAP--.- ^t i - PLICATION"AND STATE THAT-THE ABOVE]S CORRECT AND- AGREE AGREE TO COMPLY WITH ALL-COUNTY ORDINANCES AND'" STATE LAWS ;REGUL,9 NG,' B ILDING-`CONS RU CTI L TH,EXT.. G.J ".!/'�. '�d%J` i7%f n "• SIGNATURE OF ' °;� ' OUSE NUMBER COR- PERMITTE 4C RECT AND POSTED, ADDRESS FINAL JOHN A. LAMBM'tO.UNTY-EN'G'INEER: if ✓ CLYDE N.DIRL'P M.PRINCIPAL STRUCTURAL ENGINEER. PLAN CHECK VALIDATION;, a l :O.',' cAsH.. PERMIT VALIDATION aK: `'� & 0 `1 : �� :4 8::6 6 z1 1}' r WORKERS'COMPENSATION DECLARATION ' I hereby'affirm that I have a certificate'of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATIONF O R BU I LDING- PERMIT 4 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 ❑ Certified'copy is filed with the county building inspec- BUILDING tion department. ADDRESS ►/41 Date Applicant CITY ,le ZIP LOCALITY - CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT (0 X NOW ON LOT CROSS ST. (This `section need not be completed if the permit is for one ASSESSOR N ' hundred dollars ($100)or less.) TRACT BLOCK LOT O. MAP BOOK PAGE, PARCEL ,! /y TEL. �,� USE ZONE MAP I certify that in*the performance of the work for which this OWNER `Z �- �/ NO: ZS`fsS NO. permit is issued, I shall not employ any person in.any manner ��n (I /) -- SPECIAL d so as to become subject to the Wor rs Compensation Laws. ADDRESS c+�l '�yy,v(/t'�xg �`' Z �� CONDITIONS V �: a(/j� CITY Cr/'�.'" GfJ ZIP Date Applicant '�lr ARCHITECT OR TEL. o NOTICE TO PLICANT: If, •afte making•this Certificat' of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCE E_D BY 0 Exemption, you should become subject to the "Workers' _ CONST'. ZONE W Compensation provisions of the Labor Code, you must forth- ADDRESS <</� - I/-" - - d" CA with comply .with-such provisions or This permit.shall be \ TEL. STATIST AA CLASSIFICATION APT. CO O. Z deemed.revoked. CONTRACTOR 6 u NO. L� ��s LICENSED CONTRACTORS DECLARATION - LIC. CLASS . �� bWELL. UNITS'" I hereby affirm that am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and _ UC- , Professions Code, and my license is"in full foFce and effect. CITY CLASS BK PG. VALIDATION SQ. FT. NO.OF NO,OF CHECK LicenseNum Lic.Class SIZE STORIES FAMILIES ONE • .. u , . ❑ VALUATION DESCRIPTION OF WORK NEW Contractor ` Date ,� ADD E] $ ❑ I am exempt under Sec. f '-" _ -�• ALTER. ❑ , ` B,&P.C. for this reason REPAIR E] S USE OFOL A DEM EXISTING BLDG. Z..7.5_A Dare: .. :.-•- APPLICANT TEL. FINAL Signature �r o o ° o ° OWNER-BUILDER DECLARATION (PRINT) NO. DATEAll i I hereby affirm that I am exempt.fr.om the Contractor's License Law for the following'reason (Section 703 1.5, Business and ADDRESS /1 �'° ° b(} 5 0 Professions Code): PRESENT B/; ° 6 Q5 0 BUILDING o o _ I, as owner of-the property, or my employees with ADDRESS � / wages as their sole compensation,-will do the work and /`�O. fjJf/(, ��5 S 0321-86 , - " the structure is not intended or offered for sale(Section LOCALITY , /. 7044,-Business and Professions Code).- - MOVING TEL. ❑ I, as owner of theproperty, am exclusively contracting CONTRACTOR NO. ✓!v b with licensed'contractors-to-construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED YARD HWY TOTAL SETBACK FROM -EXIST. _ CONSTRUCTION LENDING AGENCY" SET BACK 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. (Sec. 3097, Civ. C.). SIDE m P.L. a' Lender's Name /' ''-1 LDMA Ref:# m _ - _- -• - P.C. Fee$ .. .. .. Permit Fee (,JtV ._. .. _ Lender's Address _d I certify that I have read.this application and state that the _ Issuance Fee- -- ! [l �`�- kLD P/C# - a above information is correct. I agree to comply with all County Investigation Fee 10 ordinances and State laws relating To building construction, Total Fee t`J""(J LDMA Perm: # - and hereby authorize representatives of this County to enter a upon the abci -mentioned property for inspection purposes a �rJ// 7ajZy(. SEE REVERSE FOR EXPLANATORY LANGUAGE / v- -Signature of Applicant or Agent - Date •' "' ' - ~/ WORKERS'COMPENSATION DECLARATION y ,l sr,y, athat I have certificate of consent to self jnur6,' or a'certificateof Workers' Compensation Insurance, A P P L I CATION F O R IB U I L D I N G PERMIT or a certified'copy thereof (Sec. 3800, Lab. C.) ` COUNTY OF LOS ANGELES BUILDING:AND SAFETY Policy No.. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL INarc ADBuaDING _ DRESS Certified copy is filed with the:county building inspec- BUILDING�O ,. 1 /1� tion department ADDRESS W V Date ApplicanT.r, CITY ZIP . LOCALITYUlu, _ I CERTIFICATE OF EXEMPTION'FROM WORKERS' NO OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT (G 4 NOW ON LOT CROSS ST. (This section need,not be completed if the permit is for one - - - ASSESSOR : ' c.',. hundred dollars ($100)or,less.) _ TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL 9 TEL. '/ MAP— I certify that in the performance of th'e work for which.this OWNER` TEL! NO.7 � USE ZONE NO. permit is issued, I'shall'not employ any person iii any manner �� SPECIAL - ®- so as to become subject to the Wor ers'Compensation Laws: ADDRESS tin / CONDITIONS V . �'�¢ A licant 7 CITY `[,r V/ICY_. t(_ ZIP .. ./ .�. _ 09 Date pp ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR ESSED BY NOTICE TO A PLICANT: If;'after making this 'Certificate s, ENGINEER NO!' V Exemption, you should become subject to `the Workers' �j� r�Y CONST. ZONE LU Compensation provisions of,the Labor Code, you-must forth- ADDRESS `� `�0 �J d with comply with- such provisions or this permit shall be I ... - TEL- STATISTICAL CLASSIFICATION APT. ONDO. Z deemed revoked. CONTRACTOR NO. _ LICENSED CONTRACTORS DECLARATION, LIC. CLASS NO. DWELL.UNITS I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS NO. ' (commencing with Section 7000)of Division 3 of The Business and LIC. SEWER MAP Prof essions'Code, and my license'is in full force and effect. CITY CLASS BK PG - VALIDATION SQ. FT. NO. OF NO. OF CHECK Lj 7.4 ri License Number Lic.Class SIZE STORIES FAMILIES ONE NEW VALUATION U'Q DESCRIPTION OF WORK Q `, ✓ # o 0 0'e 2 3 Contractor � Date - :-��,•/,1,(� ADD $ I am exempt under Sec. -tU�49 � ALTER , A—- 1 2 1.:1k`3 B.&P.C. for this reason �".rr • L REPAIR a $ ° ®.1 2 1. 1 3 v Date:. US OF lQ�yt �8 1�'I EX TING BLDG. DEMOL 0 3 2 1 -86 Signature APPLICANT'NT . NO. FINAL OWNER-BUILDER DECLARATION (PRI _ DATE I hereby.offirm That I am exempt from the Contractor's.License " Law for The following'reason (Section 7031.5, Business and ADDRESS FIN ' `Professions Code):' PRESENT BY " BUILDING I as owner of the property, or my employees with ADDRESS 'wages a•s 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 - - ❑ CONTRACTOR NO. _ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM. _ IST. CONSTRUCTION LENDING AGENCY. SET BACK YARD HWY PROP. LINE WIDTH 4'�a 7 A 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 m P.L. Lender's Name �t - 15300 a ] LDMA Ref. # P.C: Fee$ /1 Permit Fee C77 \ m m,1 5 3 0 O,M Lender's Address I,-certify.-that I.have read This application and state that the Issuance Fee �V LDMA P/C# ' 0 rJ-2-'7�-8(� '- - 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 authorize representatives of this County to enter upon the abo -mentioried property for inspection purposes. arc �- Q SEE REVERSE FOR EXPLANATORY LANGUAGE - Signature of Applicant or Agent .• ate WORKERS' COMPENSATION DECLARATION insure, or afcertif certificate of Workers' Compensat on irm that I have a certificate of coent Insurancto.se, APPLICATION FOR BUILDING PERMIT or a certified.copy thereof (Sec:'3800, Laf&C-) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElBUILDING Certified copy is hereby furnished. y' FOR APPLICANT TO FILL IN ADDRESS er CertiF'ed copy is file with t co ty building inspec- BUILDINGADDRESS ! I �� part nt. CITY" ZIP 7�,f� LOCALITY D 1 plic n NO. OF BLDGS. / ER IF ATE O EXEMPT N ROM WORKERS' SIZE OF LOT G3 U NOW ON LOT NEAREST CROSS ST. COMPENSATIO 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.) TEL OWNER - NO 0/ USE USE ZONE OP I certify that in the performance of the work for which this / �n e /'0 SPECIAL d permit is issued, l shall not employ any person in any manner. ADD ESS /� 02 l {.� CONDITIONS so as to become subject.to the Workers' ompensation Laws. O ^ 1 CITY YiC �r`w"�Ci ZIP U Date/ Applicant. ( ARCHITECT OR TEL. . NOTICE fb If, after maki g this Certific6 a of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE Exemption, you should become 'subject to the Workers' �� U Compensation'provisions of the Labor Code,'you must forth- ADDRESS a with comply with.such provisions or This permit shall be TEL. STATISTICAL CLASSIFICA N APT. CONDO- N deemed revoked.. CONTRACTOR ! NO. Z LICENSED CONTRACTORS DECLARATION LIC. 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 N�QP nd Professions Code,and my license is in full force and effect. CITY CLASS VALIDATION SQ..FT. - NOB . OF NO. OF CHECK K ' J License Number Lic. Class SIZE I STORIES FAMILIES ONE (� El VALUATION —Contractor Date DESCRIPTION OF WORK NEW $ ADD. ❑ / ❑I am exempt under Sec. ❑ ALTER B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTIN BL'D "v DEMOL ❑ Signature APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT).` ;D J@6 NO. FINAL I hereby affirm that I am exempt from the Contractor's License //, e �,�,�, DATE T f� Law for the following reason (Section 7031.5, Business and ADDRESS r �� GJC FINAL` �� 3�07 . ' 28 Professions Code): PRESENT _- By 7TC� ❑ I, as owner of the ro ert or m em to ees with BUILDING 1- iiGtES P P Y, Y P Y ADDRESS wa es as their sole compensation will do the work'and A� j/�J/ y Y the structure is not.intended or offered for sale(Sectio n LOCALITY ' �qt�7-� +ll[� TOTAL AL 28..+rx�-50 7044, Business and Professions Code.) MOVING TEL. \ C� �1HE4t La CONTRACTOR NO. 510 I, as owner of the property, am exclusively contracting >• _ ., with.licensed contractors to construct the project (Sec- rADDR C � .011 tion 7044, Business and Professions Code.) D TOTAL SETBACK FROM EXIST.. - CONSTRUCTION LENDING AGENCY K YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for 0000-13001 u/ 8/89 the performance of the work for which this permit is issued P.L.- (Sec. (Sec. 3097, Civ. G). 495° 1 AM -9:42 Lender's NameLDMA Ref. # Permit FeeLender's Address I certify that I have read this application and slate that the Issuance FeeLDMA•P/Cabove information is correct. 1agree to comply with all County n.Fee 8 ordinances and State laws relating to building construction, Total Fee LDMA Perm.# a and hereby authorize representatives of this County to enter upon tgob -rr)entioned prop��ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE of Applicant or Date a�