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Home My Public Portal About9362 LOWER AZUSA RD_Building__ / ,78A838A CE#803 8-84 APPLICAVOWFOR BUILDI G PERMI'L'_` .If - -CbUNTY OF LOS ANGELES BUILDING / (� DEPARTMENT OF COUNTY ENGINEER ADDRESS , BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE-. COUNTY ENGINEER NEAREST COLEMAN W. JENKINSAUP•T.OF BUILDING CROSS ST. DIST T NO 00 OUP TYPE: F; BY - ,FO8 APPLICANT TO FILL IN CONST. IZ BUILDING �n STATISTICAL�,L�A�SSIFIC TION. SEWE MAP / ADDRESS L Vint u - /'0/• BK/ PG f� CLASS NO. DWELL UNITS LOT NO. LOCK USE ZONE I MAP TRACT SPECIAL NO. OF BLDOS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM ' /� TEL. FRONT PROP. LINE OF STREET) OWNER fi4O O• TYPE OF EXISTING SETB CK HIGHWAY_ YARD .TOTAL ADDRES w (J_ HIGHWAY WIDT �F OM C.L. _ CITY L tT BLDG..SETBACK,FROM ENGINEER OR ~ 6 NO-L6 3 z7-1 SIDE PROP. LINE OF (STREET) /� TYPE OF EXISTING SETBACK HIGHWAY + YARD- — TOTAL' ADDRESS AO Iss LD AUtl HIGHWAY WIDTH FROM C.L. a CONTRACTOR (j0 NOL j U.37j J + — 0 ADDRESS ( ,j fNO / 442.0 CORNER CUTOFF YES NO Q CITY L-ItA(4 A c� S ;SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK AND PARKWAY TREE REQUIRED h NEW ADD ALTER REPAIR DEMOLISH ? SQ.FT. w IVO. OF NO. OF 1' __� !• It. SIZE c7 S� STORIES /� FAMILIES ' USE OF • e stallations should be taken out at the L. A. Co. [load Dept., Altade G STRUCTURE 1EL0j#J cs 0 P Fo 9— Office, or T. C. Co. Engineers Office Immo ,atoly In order to av 1d LAPPLICANT L&FE, — ^ ' ^ 1' i not s#art d F Until Permit has boon issued. Apply for parkway tree pormit is 1 Hall. Q ,APPROVALS ATE- INSPECTOR'S SIGNA7URE . . PMT. _ Gnr FOUNDATION, LOCATION Q•' l_I C . !'. FEE$ i C/V FEE$ a.�-. FORMS,.MATERIALS __ (� f'j' �/'affljL,,✓ ' FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT,V /� t'frtri' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS yam` f •^ 'BUILDING CONSTRUCTION. 1 CERTIFY THAT. IN DOING THE WORK AUTHORIZED HEREBY•I WILL NOT EMPLOY ANY PERSON IN VIOLA, LATH. INT. II TION OF THE LABOR COD- OF THE STATE OF CALIFORNIA RELAT. r \ INC TO WORKMEN'S CO S TION INSU E. LATH. EXT. SIGNATURE OF HOUSE NUMBER COR-- PERMITTEE RE .T.AND POSTED ADDRESS Pr 7 70d71 SSto it/ &Q FI NAL JOHN F. LEWIS. PRIN IPAL STRUCTURAL ENGINEER 'PLAN CHECK VALIDATION CK. M.O. CASH PERIVIIT VALIDATION CK.. M.O. CASH LACO 3 7 9 3 JUL 19 -2 3 1 8.0 0 A �;160 4 1 9 5 ,!UL 3 0 1 D 3 6.G 0, c FGA585A Ce*808 B_eg APPLICATION FOR BUILDING PERM COUNTY OFLOS ANGELES BUILDING r I� DEPARTMENT OF COUNTY ENGINEER ADDRESS ? BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. •'�� DIS T GROUP TYPE R ESSED BY FOR APPLICANT TO FILL IN f �f CONST. BUILDING STATISTICAL C SIFICATION WER M ADDRESS 3 &.f- O V CLASS, NO. DWELL.UNITS B PG LOT NO. e BLOCK WATER �`QAMCISQNi10 CERTIFICATE: NOT REQUIRED RECEIVED TRACT MAP HIGHWAY NO.OF BLDGS. •[ N (CIRCLE) STATE MAJO ECOND LOCAL SIZE OF LOT NOW ON LOT 1 USE ZONE - SPECIAL USE OFCONDITIONS EXISTING BLDG. /�I TEL. ��F i OWNER �{ s NO. BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS u FRONT AAGii4T.6i'sTOR TEL ENGINEER NO.] V 37-773SIDE P. L. ADDRESS TEL. CONTRACTOR(�(,¢�vAJ (j NO. V ADDRESS S IN DESCRIPTION OF'WORK O . v W d NEW ADD ALTER REPAIR DEMOLISH t!!Z SQ.FT. NO.OF SIZE 3 4' STORIES FAMILIES USE OF STRUCTURE WA1LIF-i+0u C n im it te,r— J SIGNATURE OF APPL I CANT VALUATION $ '� 3°d d APPROVALS DATE INSPECTOR'S SIGNATURE P. EC. Q PMT. �6lf FOUNDATION: LOCATION FES FEE FORMS. MATERIALS f FRAME: FIRE STOPS, j I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS / 'C/ _ .✓J� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS. \ BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK / AUTHORIZED HEREBY I WILL NOT. EMPLOY ANY RSO IN VIOLA- LATH, INT. TION OF THE LABOR C THE STATE O G IF IA RELAT- 1 `` INC TO WORKMEN'S N TION'INSURAN E. 'LATH.EXT. \ \' SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED. n / ADDRESS L j FINAL JOHN F. LEWIS. PIi1,f4CiPAL ST TURAL'ENGIISEER PLAN CHECK VALIDATION C). MID. CASH PERMIT VALIDATION CCK. . M.O. CASH LAW 6 2 2 2 NOV 2 7 2 3 D 7.5 0 v U i.iAbo 6 2 2 3 NOV 2 7 1 D 15.00- r J. WORKERS'COMPENSATION DECLARATION ( ,( hereby affirm that I have a certificate of consent to selfAPPLICATION FOR BUILDING ' PERMIT insure, or a certificate of Workers'Compenstion Insurance, or, a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND'SAFETY Policy Na. Company I Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN ADDRESS � �- Certified copy-is filed with the county building inspec BUILDING �J tion department. ADDRESS 2049 cl ADDRESS / /! NEAREST" / Date Applicant CITY /� Ci i ZIP CROSS ST, CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. As'�S ESSOR COMPENSATION INSURANCE SIZE OF LOT .T1�' G. NOW ON LOT MFP BOOK PAGE PARCEL (This section need not be completed if the permit is for on USE ZONE , MAPTRACT BLOCK LOT NO. NO. � / /J hundred dollars($100)or less.) I v I a' � TEL. � SPd SPECIAL I certify that in the performance of the work for which t{,is OWNER J d .5 NO - 107 CONDITIONS 1 DISTRICT GROUP TYPE FIRE PROCESSED BY U permit is issued, I shall not employ any person in any manner ADDRESS 9��a LOGtJ?� Z 51 I C .�3y CONST. ZONE so as to become subject to the Workers'Compensation Laves. -v d 5( O Date Applicant I CITY /� / ZIP ��0 STATISTICAL CLASSIFICATION APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate!of ARCHITECT O / TEL. IL ENGINEER // / NO. I CLASS NO. —2 UNITS Exemption, you .should'become subject to the,Workers' /� tail Compensation provisions of-the Labor Code, you must forth- ADDRESS�i�( /r/. ,[J��f SEWER MAP with comply with such provisions or this permit shall ,be TEL j r deemed revoked. CONTRACTOR NO. I BK. f--PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am.licensed under provisions of Chapter 9• ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. n2(( � C,R Professions Code, and my license is in full force and effect. CITY CLASS $ pC 5 9J to 4 SQ. FT. NO.OF. / NO.OF CHECK ° ° ° ° 23- License-Number Lic.Class I SIZE 6 STORIES ! FAMILIES• ONE Contractor Date DESCRIPTION OF WORK /� NEW $ Z 1,061.45 I am exempt from•the licensing requirements as I am a / ADD ° 1,0 6 1,4.5 ❑' licensediarchitect or a registered professional eng1heer ALTER FINAL , acting in my professional capacity (Section 7051, REPAIR Ei DATE 0•b 0 2—8 3 Business and Professions Code). j USE OF EXISTING BLDG. a DE/u101 FINAL Lic.or Reg.No. —Date APPLICANT ( // TEL. By OWNER-BUILDER DECLARATION - (PRINT) /�/Cn NO. — I hereby affirm that I am exempt from the Contractor's Lii:ense / Law for the.following reason (Section 7031.5, Business and ADDRESS �6J! A • 'Professions Code): PRESENT / BUILDING 36 OuJt� GlS4 ) I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and Q the structure is not intended or offered for sale(Section LOCALITY D, 7044, Business and Professions Code). I MOVING TEL. 1 u I, as owner of the property, am exclusively contfacting CONTRACTOR NO. 7 with licensed contractors to construct the project (Sec- FADDRE 1� tion 7044, Business and Professions Code). ✓( TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET YARD HWY PROP. LINE' WIDTH I hereby affirm that there is a construction lending agency for the performange of the work for which this permit is issued I r (Sec. 3097, Civ. C.). Lender's Namev Permit FeeLender's Address I certify that I have read this application and state,that the Issuance Feeabove information is correct. I agree to comply with a(I County n Fee ordinances and State laws relating to building construction, �r y and hereby authorize representatives of this County to enter Total Fee upo heabove- entioned prop inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ° Si li ant or Agent i ate ®s ' WORKERS'COMPENSATION DECLARATION hereby affirm that I have,a certificate of consent'to self I'I'L I CAT I' N F B l!I N G �P•E RM I T insure,or a certificate of,Workers'Compenstion Insurance,or it A D a cert'f//�e copy thereof(Sec. 3800, dab. C.)�l COUNTY OF LOS ANGE 5 ��' BUILDING AND SAFETY , t ;folic No.��/'ul- "Oompany,� S^'F30. Ulm �� 5' BUILDING Q Certified copy is-here by furnished. FOR APPLICANT TO FILL IN ADDRESs- Certified copy is filed with a ounty building inspec- BUILDING d tion department. ADDRESS ` SL�; LOCALITY, , Date•'•' Applicant CITY /'4 ZIP NEAREST CROSS ST: ) 'C TIFICATE OF EXEMPTION OM W R ,S O:OF BLDGS. ASSESSOR s I ;= --COMPENSATION.INSURANCE SIZE OF LOT NOW ON LOT: 3• MAP BOOK •PAGE RCEL (This..section need not be completed if the permit is for one USE ZONE MAP / ' hundred dollars($100)or-less.) TRACT BLOCK LOT NO: NO. ®/ c TEL. i SPECIAL I certify that in,the performance of the work for which this, ER OWNrr O. <. CONDITIONS JTYSTPE -.i,� ` I •DISTRICT GROUP FIRE PROCESSED BY y Upermitis issued;I shall riot employ any'person in any manner ADDRESS , /JZ v � N / E ompensatioraws.so as Vbecome subject fo the Workers'Cf L - 'O. ZIP (� Date- Applicant; STATISTICAL-CLASSIFICATION PT; ]CONDO. 1 i LJ NOTICE TO'APPLI'CANT:',If,1after making thistCertificate of ARCHITECT R T164;11&/ % �, LU i Exemption,'you should becorrisubject to, the Workers' ENGINEER Q /75 tb1-. CLASS NO. y DWELL.UNITS" • i Com ensation �ovisions of-the Code,'you must forth- f` t z` P P _ Y ADDRESS' � �^ /LO/I,[�Q,� �(/ � _SEW ��••� � with comply with.such provision's-or this permit shall Be en a. --TEL.' , HSJSG! j �VALIDATION deemed revoked.. CONTRACTOR NO: B ERR • LICENSED CONTRACTORS�DECLARATION-. LIC, I hereby affirm that I am licensed.uncle",provisions of Chapter 9, ADDRESS " ...NO. 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 $ t SQ.Fri q / NO:OF NO.OF CHECK " License Number Lic.Cidss SIZE(p a/C7 STORIES FAMILIES ONE $ z06Q'5'A , Contractor. Dare, DESCRIPTION OF WORK NEW �f�p , i 'r- ADD I#'o o;o 0 23 ❑ ,I am exempt from the licensing requirements•as'I am.a / Ilcensed architect or a registered'profess!a no I engineer ALTER" FINAL o 0 1 . DATE' � ?�. `z r� 8 Q•O acting in, my professional capacity,(Section 7051, REPAI , R Business and Professions Code): USE.OF -EXISTING BLDG. :' DEMOI. FINAL c� t Lic.'otReg.No. Date APPLICANT ;TEL. BY OWNER-BUILDER DECLARATION V PRINT�r _ 'F�D�><$ NO. I hereby affirm that I am exempt from the Contractor's License ADDRES 3 �(�'� ��;`, /- Law for the following'reason (Settlor( 7031.5, Business and s!J'Q- n 1� Pr fessions Code); PRESENT * i BUILDING 1 ' 1, as'owner of the property, or my employees with ADDRESS /J Jaz GJ 0;6 Q 6 A wages as-their sole compensation,will do the work-artd '` , , eC/' / • ' the structure'is not intended-or offered'for sale(Section LOCALITY o,0 0 0.0 , t 7044, Business and P"ofessions Code). MOVING', TEL. /� `� f3 , "o -F71 1, as owner of the property, am exclusively contracting _ ' CONTRACTOR NO. f O with'licensed contractors'to•construct the project (Sec- ADDRESS t ` tion 7044;Business and Professions Code). REQUIREDTOTAL SETBACK FROM EXIST. b r' CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH" I hereby affirm that there is a,construction lending agency for FRONT _ the perfotmance of the work for which this permit i3 issued• 'P.L. _(Sec. 3097, Civ..C.). SIDE P.L. Lender's Name��F� / r Y .' P.C-.Fee$ � �� r SU ^ ��' Lenders Address. Per Fee I certify that I have read this,application and state that the / Issuance Fee- above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee / J I and h reby'authorize representatives of,this County to enter 1 c up t e,above-mentioned ertyfor inspection purposes. - r 'c •I, / SEE REVERSE FOR EXPLANATORY LANGUAGE Dote Sigpdture,of Appl.icanf• ent ®s � WORKERS'COMPENSATION DECLARATION 77 { ' hereby affirm that I have a certificate of consent to self �. APPLICATION FOR BUILDING PERMIT'. insure,or a certificate of Workers'.Compenstion Insurance,or a certifiesa copy-thereof;Sec. 3800, lab. C. COUNTY OF LOS ANGELES' BUILDING AND SAFETY NI-7121`II` �j -rIiS CU., Of OW UP+ P❑olicyNo: ompany_ ' BUILDING ! Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS fvo2 Certified copy is filed with thVVunty building 'pspec-.LLBUILDING . /J f— ' tis dR rtment. ADDRESS 6(2�/L� , \\,�' LOCALITYNEAREn " f� Date 3 Applicant CITY J /" ��( ZIP 1�v CROSS ST. CERTIFICATE.OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR - , COMPENSATION INSURANCE SIZE OF LOT NOW'ON LOT MAP BOOK PAGE PARCEL'. (This section need not be completed if the permit is for one USE ZONE MAP ,hundred dollars($100)or less.) TRACT BLOCK.. LOT NO. NO. U �{► TEL. i SPECIAL ®, I certify•that in'the'performance of the work for which this` OWNER 1649 • 4,7 NO. CONDITIONS ' - O perrriif is issued', I shall not employ any person in'any manner G C�,� /�� DISTRICT GROUP TYPE FIRE PR CESSEErBY V ADDRESS 7 G. h(�7�7/q 'U s� r CONST. ZONE 09 t so as to become subject to the Workers'Comperisation•Laws. /� Q RO ` CITY /95 ✓�NrT' CPF •'ZIP 7'11.UC� ,�; '/� Y' , : O Date Applicant STATISTICAL CLASSIFICATION, PT. ]CONDO. U ARCHITECT OR pC+r - N N1(yrn{. TEL. . GG NOTICE'TO APPLICANT: If, after'making this Certificate-of 76�46 3 CLASS NO. 7_ DWELL.UNITS Exemption, you should 'become -subject to the Workers; ENGINEER �NLLI ( NO. esZ .'Compensation ptovisions of the Labor Code, you must forth- ADDRESS SEWER.MAP �- with comply,with such provisions 'or this permit shall, be TEL j �� , VALIDATION deemed revoked.,, •- • - BK. PG, ON CONTRACTOR , NO: LICENSED CONTRACTORS DECLARATION LI + I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NS. VALUATION (commencing with'Section 7000)of Division 3 of-the Business and LIC. Professions Code, and my license is in full force and effect.. CITY. CLASS- x$,• '7 li V�! SQ.FT. NO.OF,. } NO.OF CHECK License Number- .Lic.Class SIZE / STORIES ` FAMILIES OISE Contractor Date DESCRIPTION OF WORK NEW ❑ $' nnf. . ADD ❑ I am exempt from the licensing requirements as I am a R0. I�I• 1 Yl 4 licensed architect or a registered professional engineer ALTER FINpjL ...� 20603, ' acting -in my professional capacity (Section 705,11 O(e 5A.e REPAIR ❑ DATE , Business and•Professions Code): USE 6F0 o;o a 2.3' t EXISTING BLDG. DEMOL' [3By' Lic.or Reg.No. Date APPLICANT ,� TEL. ' I -' 2 0 1' 2 9,6 0 OWNER-BUILDER DECLARATION (PRINT NO. I /� a • I hereby affitm`that I am exempt from the Contractors License" (1 a 1 29,60 ' Law for_the following reason (Section 7031.5, Business and ADDRESS' Profe slbr)s Code).. • - PRESENT / J�_ f Q ' 0 a.0 3'8 1 BUILDING •q3 6 L Z4 WEA :zIIIt� �il, as,owner of the property, .or my employees with ADDRESS wages as their sole-compensation,will do the work and t the structure is not intended or offered for sale,(Section. _ LOCALITY 7044, Business and Professions Code). MOVING TEL. :❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO; .�0 6 Q 4 A with licensed contractors to construct the project•(Sec-. i tion 7044, Business and Professions Code). ADDRESS t # 0 0 0 o e;1 REQUIRED TOTAL SETBACK FROM EXIST. t CONSTRUCTION LENDING AGENCY i SET BACK YARD HWY PROP. LINE WIDTH 2 a 1 6 9.00 , I hereby affirm that there is a construction lending agency for FRONT the'performonce of the work for which this,permit is issued P.L. s �'1 'br9 0 0 cz� (Sec. 3097, Civ. G.). SIDE P.L. ' Lender's Narne T G - . ' I P.C. Fee$ 6/ Permit Fee Lender';.Address I certif thaf,I have read this application and state that the - Y, PP � Issuance Fee �� • above information is correct. I agree to comply with all County,. Investigation Fee old ` or ' nces anho d State laws relating to buildin construction, Total Fee a , ,h reby autrize representatives of this L�ounty to enter pon 1he aiwhtione op ty for inspectio purposes. ( 's -7 Ik4 o. S '( SEE REVERSE'FOR EXPLANATORY LANGUAGE Signature of A•plica or Agent Dote I ®f• t I I. WORKERS'COMPENSATION DECLARATION > 1' hereby affirm'-that 1 have a.certificate of consent to self eI APPLICATION FOR BUILDING PERMIT , ' insure, or 'cedtificaficate of Workers'Compensation'Insurance, or a.certified cop thereof ec. 380,0, La . C.) �/• L I COUNTY•OF LOS,ANGELES, 3 ILDING AND SAFETY •. ;Policy N Ar El. Certified'copy is hi.reby'furnished. FOR APPLICANT TO FILL BUILoiNG j ADDRESS K. Certified copy is filed with the county building inspec- BUILDI.N tion department.- ADDRESS. ff L i Date'! Applicant CITY ZIP LOCALITY f CERTIFICATE OF EXEMPTION FROM WORKERS' NO..OF BLDGS.' NEAREST �A COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section'need.not be completed if the permit is for one TRACT BLOCK, LOT NO. ASSESSOR hundred dollars($1'00)or less.) MAP BOOK PAGE j PARCEL' OWNE ✓ TEL. ' USE ZONE MAP 1 certify'that in the performance of the work for which this NO. permit is-issued.I shall not employ.,any person in any manner l SPECIAL. so as td become,•subjeet to the Workers'Compehsation'Laws. ADDRESS CONDITIONS ' Date Applicant, CITY ri.I�– ZIP •' 0 ,' NOTICE'TO APPLICANT: If, after makin this Certificate of ARCHITECT'OR,' EL. g DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER NO. _ CONST., ZONE Exemption, ,you should become' subject to the'Workers' Compensation provisions of,the Labor Code;you must forth-: ADDRESS i with comply with 'iuch.`pr,.oyisions.or this permit shall be ,• TEL, �,/ STATISTICAL CLASSIFI ATION. _I APT. DO. ' deemed revoked. : CONTRACT '+L_ NO. �• 2:1 • ' LICENSED CONTRACTORS DECLARATION LIC.'. CLASS NO. DWELL..UNI75 I hereby affirm that I am licensed under provisions'of Chapter 9 ADDRESS `' NOW, i (commencing with Section'7000)of Division 3 of the Business and LIC, SEWER•MAP Professions.Code,and my license'is 1 it force-and effect.; CITY' CLASS BK �ij .VALIDATION SO.FT. ' NO.•OF. O.OF CHECK' Q' License Number•' Lic.Class SIZE STORIES ' FAMILIES e.. ONE` ,my VALUATION DESCRIPTIOEW_ N OF WORK !/ N '❑ ConiractorA.1 Date ADD ❑ ❑l am exempt'unde'r•Sec. ❑ ' ALTER B:BP.C..for this feason REPAIR ❑ $ ' USE OF Date: EXISTING BLDG. _ [- DEMOL — Signoture APPLICANT �"r; /TEL. ?.. FINAL OWNER-BUILDER DECLARATION` PRINT .1'J_!LJ NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason.(Section7031.5, ,Business and ADDRESS`' .7 Professions Code): PRE EN B BUILDING , I,'asowner 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 far sale(Section LOCALITY { ; 7044, Business and Professions Code).. MOVING TEL. ❑ I, as owner of t66 property,am exclusively'contracting CONTRACTOR. -NO; ACCT-Ir- with ,h a 4r4 a 3•- with Iicensed•,.contractors to construct the-project (Sec-• " ' tion 7044, Business and-Professions Code). ADDRESS 3307 , 50 REQUIRED YARD FIWY TOTAL SETBACK F �J ITEMS' CONSTRUCTION LENDING-AGENCY'. SET BACK PROP.LINE WIDTH•• :I hereby affirm th6rthere is a cbnstriliction'.lending agency for FRONT the•performance of the work,for which this permit is issued P.L. " TOTAL' ,0 ' :50 (Sec. 3097,-Civ.C.)..' SIDE I P,.L:'. (HECK :'60. n50 . Lender's Name LDMA Ref.M CHANGE o �• Lender's Address P.C.Fee'$• Permit Fee' //�/t '� U I certif that I e th a Ii tion and state that-the Issuance Fee I v ��= LDMA P/C p obove inform i correc I agr a to comply with all Countylavestigation Fee ordinances tate la ' relating to-, " ilding,construction, I Total Fee t LDMA Perm.fl ' 0_ and her eb thorize r resentatives of this County to enter �^ ;" upon t e o e-merit' ned roperty for inspection purposes. / •2 o I SEE REVERSE FOR EXPLANATORY.LANGUAGE Signaturepliccnt or Agent Da��te (V `r,"' / „... WORKERS'COMPENSATION DECLARATION 1,hereby affirm that I have a certificate of consent to self APPLICATION FOR B U I L D I N G PERMIT insure,or a certificate of Workers'Cornpenstion Insurance,or a,certified copy thereof..;Sec. 3800, Lab. C ) / s-- 10 A� COUNTY OF LOS ANGELES BUILDING AND SAATY Policy No. ompany BUILDING, Certified copy is hereby furnished; FOR APPLICANT-TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING z/ tion department.. ADDRESS /O'Z viGc/ r/S� LOCALITY NEAREST - Date Z Applicant CITY y /� ZIP �� CROSS ST. I ERTIFICATE OF EXEMPTION FROM WOS' y NO.dF BLDGS. ASSESSOR COMPENSATION INSURANCE I SIZE OF LOT NOW ON LOT MAP BOOK ]PAGE PARCEL - 5 (This section need not be.completed if.the permit is for one• I USE ZONE MAP ; I TRACT BLOCK LOT NO. NO. �0'f, hundred dollars ($100)br less.) + / 'L /�� SPECIAL r d I certify that In' the performance of the work•for which this I OWNER i'CS 'G /o�`fs NO. T �L g /”" ' CONDITIONS permit is issued, I shall not'employ any-person in any manner � DISTRICT GROUP JTYPEST.,/ FIRE PRO SSED BY ; U ADDRESS Sli�+i i CONZONE /` ad so.as io become'sublect to the Workers'Compensation Laws: rJ i0 clTv fizip _ i F- Date Applicant • STATISTICAL CLASSIFICATION, APT. CONDO. U. NOTICE'TO APPLICANT: If, after making this Certificate'of ARCHITECT OR TEL. � , w ENGINEER O t7 NO. / CLASS NO. DWEkL. UNITS r IL Exemption, you should become subject to the Workers' _ / y Compensation provisions of the Labor Code, you must forth= _ ADDRESS ZJ •�„sZ d - �' SEWER MAP z - with.comply with such provisions or this permit shall be ' deemed-revoked, i i f' /,��7EL' �///3 BK. �pG / „ VALIDATION CONTRACTOR Qty-a,r CT NO. J++� LICENSED CONTRACTORS DECLARATION // // ' LIC. /, �•-7 I hereby affirm that I-am licensed under provisions of Chapter 9 ADDRESS 603 GGr `L�- NO.�`T�� / VALUATION r j' (commencing with Section 7000)of Division 3 of the Business and LIC. y� �-- �t r Professions Code, and my,license is in fyll force and effect. CITY. ' CLASS (/ $ :9'J—ed SQ.F , NO.OF NO.OF CHECK License Number �j�ad /6`7 Lic.Class_ SIZE r STORIES FAMILIES. ONE. Contractor f'div«r�G vr� t;s Date ZZ-f DESCRIPTION OF WORK NEW ❑ I am exempt from the licensing-requirements as I am a. - �C ADD licensed architect or a registered professional engineer ALTER ❑ FINAL acting in my, professional capacity (Section 7051,; DATE REPAIR Business and Professions Code). USE'OF FINAL EXISTING BLDG. DEMOL ❑ By Lic:or-Reg.No. Date APPL'iCANT TEL. OWNER-BUILDER'DECLARATION (PRINT) 4",_ : C NO. I hereby affirm that I am exempt from the Contractor's LicenseADDRESS 4 9 2 1 A' ' Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT # o o a o23, ❑ BUILDING I, as owner of the'property, or my employees with ADDRESS 2 ° c 2 8 0� 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. ° ° °'2-8 8 QIv ❑ I; as owner of the property,am exclusively contracting CONTRACTOR NO. 0 2 2 4—8 1! with'licensed contractors to construct the project (Sec- ADDRESS •'I Sec- tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. • ` • ;24 9 2 2 A' 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.L. ' # 0 8 0 0 0 11 (Sec. 3097, Civ. C.). SIDE 2 0 0 4300 Lender's Name _ �/ 0 o43oCIc=� '3 P.C. Fee$' �� Permit Fee (r •o Lender's Address L I certify that I have.read this application and state that theIssuance Fee I i 0 2 2.4—8-1: xabove information is correct..I agree to comply with all County Investigation Fee ordinances and State laws.relating to building construction, Total Fee f and hereby authorise represe.tatives of this County to enter x upon the above-me 'o pr rty for inspection purp es. I Q � l °¢ N t Y SEE REVERSE FOR EXPLANATORY LANGUAGE ` Signature Applicant or Agent Dote �i