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Home My Public Portal About5533 NOEL DR_Building__ 76ABSBA CE#BDS B BS APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION Loc JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DIS�j{IGT TYPE P D FOR APPLICANT TO FILL IN Q CONST BUILDIN � STATISTICAL CLCATION WEIR M P ADDRES � CLASS NO DWELL UNITS BK PG LOT NO BL CK WATER CERTIFICATE NOT REQUIRED RECEIVED ❑ TRACT MAPJ� HIGHWAY STATE MAJOR SECOND LOCAL NO OF LDGS NO `, (CIRCLE) SIZE OF LO NOW O LOT USE ZONE SPECIAL USE OF / CONDITIONS E X I S T I N .7 E Ira OWNE BUILDING YARD HWY STREET NAME EXIST SETBACK WIDTH ADDRESS/ FRONT ARCHITECT OR TL P L ENGINEER N SIDE P L AqdRESS �y C T R T QC/ V ADDRESVe cpl-w OC DESCRIPTION OF WORK '' '•^ 01-- NEW NEW ADD ALTER REPAIR DEMOLISH y SQ FT NO OF NO OF Z SIZE ST RIES FAM I IES USE OF STIR SIG TURE OF A PLICANT VALUATION $ �.O APPROVALS DATE INSPECTOR S SIGNATURE PC PMT FOUNDATION LOCATION FEE $ �r FEE FORMS MATERIALS FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS — AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION I _ WITHALL COUNTY ORDINANCES AND STATE LAWS REGULAT AS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE ORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN V OLA LAT INT TION OF THE G D �STATEF CALIFORNIALAT ING TO WO MEN 5 COMPEN � CE LA EXT SIGNAT OF ol USE NUMBER COR PERMITTEE RECT AND POSTED r ADDRESS IN L ) PLAN CHECK VALIDATION CK Mo CASH JOHN F LEWIS PRINCIPAL ST URAL ENGINEER PERMIT VALIDATION cK M D CASH L&O 0 7 7 211-0 SEP 2 i D 1 7 5~ `� 76AG38A CE '8031 62 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADDRESS ING / DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DIST IC N G TYPE / BY FOR APPLICANT TO FILL IN '� CONST BUILDING ` STATISTICAL CL8SjTFICATION E MAP ADDRESS .`� S 3 • d� r BK &PCLASS NO DWELL UNITS LOT NO BLOCK WATER CERTIFICATE NOT REQUIRED RECEIVED TRACT cS".ScS' MAP HIGHWAY STATE MAJOR SEGO LOCAL NO OF BLDGS NO (CIRCLE) SIZE OF LOT ,f /Z0 �.. NOW ON LOT USE ZONE SPECIAL USE OFnn / CONDITIONS EXISTING BLDG I[1 Sa // TEL �2.GI OWNER y1 W Ak,^)P_4 0 BLAIL61NG YARD HWYSTREET NAME EXIST SETBACK WIDTH ADDRESS 3 3-?-? FRONT /r� /1 ARCHITECT OR TEL P L 0 ENGINEER N SIDE P ADDRESS / 0 /'Y/i17L Lis? /off TEL1, �� V C6NTRACTOR p N[O`YV7/� (,/ s-7L 'I // ADDRESS 90J G. Ls.S=I'K h+� JJn/I) ,J., DESCRIPTION OF WORK NEW D ALTER REPAIR DEMOLISH I SQ FT NO OF NO OF SIZE Qf STORIES FAMILIES USE OF STRUCTURE -,q,,07'4 SIGNATURE OF APPLICANT VALUATION $ �„ r APPROVALS 16ATE /j INSPECTOR S SIGNATURE PC PMT FOUNDATION LOCATION f FORMS MATERIALS //� ✓ ��r �}.� FEE $ FEE $ (/ v/ FRAME FIRE STOPS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS /� /I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS 4 BUILDINGCONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA `�f /1.� //.J �,.� �• Y TION OF THE /� LATH INT %r RLABOR CODC OF THE STATE Or CALIFORNIA RELAT ING TO WOKM / COMPENSATION INSURANCE LATH EXT PERMITTEE O NOUSE UMBER AND POSTEDR / ff ADDRESS �'O L FINAL IIF .�0/// PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRI CIPAL STRUCTURAL ENG ER PERMIT VALIDATION CK mo CASH HALO 4 7 5 6 Qal SEP 2 5 1 D 8.0 Q- q •r A I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERM COUNTY OF LOS ANGELES BUILDING 1 WWI J FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN SENSE FOR OFFICE USE ONLY BUILDING � DISTRIFNO PLAN CK NO PERMIT NO ADDRESS S J 3 3,s`/ 3 d P:2 IL 9 4- LOCALITY • " RECEIVED BY DATE OF APPL DATE ISSUED n NEAREST , #-/ ` -.r/ s-/ s -5-, ,lCROSSBT BUILDING ^� ADDRESS V YY�� OWNER n d LOCALITY ` 7/ ADDRESS 7 v �O S, G NEAREST TEL CROSS ST o et p W.4 CITY NO A FIRE NO OF fYPK ( / GROUP ARCHITECT OR TEL ZONE PLANS v ENGINEER NO SBLDGET ACK LINE O P L �Y RD NO ADDRESS APPROVED r BY DATE CONTRACTOR 1 6!e NO USE ,/ rAPPROVED ZONE DATE /f( ADDRESS qq HOUSE NUMBERING LEGAL- DESCRIPTION LOT NO BLOCK MAP NUMBERL 0 O C FIELD CHECK BY 4 r TRACT 5� �`�I` NO ASSIGNED 13Y---EAT slzs of LOT 5 7 NO OF NOW ON LOTS CORRECTIONS USE OF NO OF EXISTING BLDG FAMIusB---' i DESCRIPTION OF WORK _ NEW I ALTERATION I ADDITION REPAIR I I DEMOLITION Q S ZE ROOMS �f STORIES Y EXT WALLROOF 1 f• COVERING--COVERING USE OF BTR CTURE 1! f a p X APPROV INSPECT 8 SIGNATI B DATE I HEREBY PLICATION AND STATELEDGE THAT THE INFORMATION GII HAVE READiVENA 8 FOUNDATION THAT MATER LOC CORRECT I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAW, REGULATING ILDING CONS CTION FURNACE LOCATION. SIGNATURE OF GAS VENT, DUCTS PERMITTB ` f � ,� � �. /1 LATH, INT ADDR l LATH, ®iT -' AUTHORIZED AOT O O PLASTER, INT 76AMBA 01094 19-80 8 FSB • I3 r b ® PLASTER, EXT VALUATION 6 i O FEE FINAL . _ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES g=pg` z i -�1BUILDING AND Ave - SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING�'v J� - I hereby affirm that I have a certificate of consent to self Insure BUILDING ADDRESS _ .�` or a certificate of Workers Compensation Insurance or a certified aal ` L' ' -E copy thereof(Sec 388800 Lab C) CITY ZIP Policy No ��/ Company �// -713%bLOCALITY SIZE OF LOTS 6�C NO OF EIL S NOW ON LOT 11 Certified copy is hereby furnished �� 1 4V' NEAREST CROSS ST ❑ Certified copy Is filed with the co R y building In ection TRACT BLOCK LOT NO depart nt USE ZONE LSPECNIAL ASSESSOR MAP BOOK PAGE PARCEL✓Date Applicant CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS d TEL NO COMPENSATION INSURANCE �4cYI JErr �l 0��e WITHIN 1000 FT OF SCHOOLS YES NO (This section need not be completed If the permit Is for one hundred ADDRESS dollars($100)or less) 1 AALZ DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that the performance of the work for which this permit CITYi V_ r �� ZIP q l b Issued I shall not employ any person I an manner So as to ENGINEE TEL NO 2 become subject to the Workers Compensation ARCHITECT ion Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO a/ DWELL UNITS NOTICE 70 APPLICANT If after making this Certificate of REQUIRED TOTAL S FOM EXIST Exemption you should become subject t0 the Workers CONTRACTO TEL NO SET BACK VARD HWY PEI 1F•r WIDTH Compensation provisions of the Labor Code you must forthwith 6 - � � • FRONTn� �f comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL 3303 262 41 LICENSED CONTRACTORS DECLARATION ' ;?.p �� SIDE CITY /J//O LIC C S PL I hereby affirm that I am licensed underprovisions Of Chapter 9 « 7 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ F4SI7E NO OF:ARIES NO O FAMILIES NEW BK PG CHECK �b�•41 >_Professions Code and my license is In Lull force and effect �. C�IANGE ■00 D- License Number Lic Class DESCRIPTION OF WORK ADD VALUATION 00- Contracto Date ��6 i � q_' ALTER ❑ I am exempt under Sec W ; `�� '' too REPAIR ❑ 0000-0001 9/21/950 B&PC for this reason DEMOL ❑ LDMA P/C# 2413 1 AM11:38 b Date USE OF EXISTING BLDG` /)�, URM ❑ 1 a- �-fi Signature APPLICA NT) �� TEL NO �� LDMA Perm# ACCT '` Z El as owner of the property or my employees with wages as 3 a •* their sole compensation will do the work and the structure is ADDRESS F 3 8• 2 Ti not Intended or offered for sale (Section 7044 Business and l��` �� '� ,�!'� 'v FINAL DATE Q 03 1 Professions Code) `�/ �/ 1 ITEMS WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 'I 1 (0 _ ORA MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY r 9 TOTAL 338® 12 I as owner of the property am exclusively contracting Wlttl AMOUNTS SP IFIED THE HAZARDOUS MATERIALS INFORMATION GUIDES Q licensed contractors to construct the project (Section 7044 ves❑ No Business and Professions Code) CHECK 338.12 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 QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR -CHANGE .00 GUIDELINES I hereby affirm that there Is a construction lending agency for YES 1:1No� CM the performance of the work for which this permit Is Issued(Sec 0000"0001 1/17/91 W 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING cli3097 CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER 7 E LOS ANGELES COUNTY CODE TITLE 2 CHAPTER 2 20 SECTIOX3, 20 100 THROUG 0 140 CONCERNING HAZARDOUS C p p p Lenders Name MATERIALS REPO O R ROM THE SCAQMD 4309 1 �"M 12.27 o Lenders Address Q OWNER O oI certify that I have read this application and state under penalty of perjury that the above Information Is correct I agree to comply PC FEEPERMIT FEE b, N with all county ordinances and State laws relating to building construction and hereby authorize representatives of this County ISSUANCE FEE �D ato ant % o ntioned property for in�pec n purposes rn '—` INVESTIGATION FEE TOTAL FEE 56 uture of Apply t a Age t FDM SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS COMPENSATION DECLARATION 77 e-01 1 hereby affirm that I have a certificate of consent toself APPLICATION FOR BUILDING PERMIT insure or a certificate of Workers Compenstion Insurance or a certifie copy thereof�(Sec 3800 Lab�Cf�-_- PolicN�` �/ ��`� Company „�/liCyi -�i:[,,,,.� COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished BUILDING ❑ y FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec BUILDING r �j hon de artment ADDRESS v 6—T 3 A/0�4/ �� LOCALITY i�l �r✓� � NEAREST Datq/ � /� Applicant /^ CITY T4C� 40" G ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS O OF BLDGS ASSESSOR COMPENSATION INSURANCE I 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 y NO O�4c�La� NO p 7�� SPECIAL IL I certify that in the performance of the work for which this OWNER CONDITIONS O // DISTRICT GROUP TYPE FIRE PR ESSED BY permit is issued I shall not employ any person in any manner r ADDRESS&S"3 EL `� �S CONS ZONE + O so as to become subject to the Workers Compensation Laws (r /V�s pC Date Applicant CITY b' ! ZIP STATISTICAL CLASSIFICATION • APT CONDO ~ NOTICE TO APPLICANT If after making this Certificate of ARCHITECT O TEL W Exemption you should become subject to the Workers ENGINEER NO CLASS NO �( DWELL UNITS rA Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP with comply with such provisions or this permit shall be TELq //A / VALIDATION 1 deemed revoked CONTRACTOR i� jV�' T— BK PG (P LICENSED CONTRACTORS DECLARATION LIC 2'- 3 1,0 0 0 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS?/0 j U�/V �7 N '�� VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC �• 3 1 0 0 0 6 Professions Code and my licensee is in full force and effect CITY S6� g15;;074CLASS $ 7 License Numbet�a� �" Lic Class O / SIZEFT Sip NO OF F MILLIIES CHECK / 0 2 1 2—8 2 ��//'' / !� Date DESCRIPTION OF W �� /ate NEW $ Contractoii/"�— ,! p L ADD ❑ I am exempt from the licensing requirements as I am a 09 licensed architect or a registered professional engineer _/ TER ❑ FINAL ��/ � acting in my professional capacity (Section 7051 /✓ �� SC r��« REPAIR DATE Business and Professions Code) USE OF I EXISTING BLDG �S/ �s 0--42P DEMOL ❑ FINALB Lic or Reg No Date APPLICANT L �t� TEL "? d a y OWNER BUILDER DECLARATION PRIN ,6 !T / rx+ I hereby affirm that I am exempt from the Contractor s License ! y �t� Law for the following reason (Section 7031 5 Business and ADDRESS /00-1-!//✓� N �0 r P 2 q(G 1 A Professions Code) FKtbtNi ❑ I as owner of the property or my employees with ADDRESS # • • • • 2 3 wages as their sole compensation will do the work and the structure is not intended or offered for sale(Section LOCALITY 2 - - 36.00 3 6.0 0 7044 Business and Professions Code) MOVING , TEL �/f�0 ❑ I as owner of the property am exclusively contracting CONTRACTOR NO • • 3 6 0 0 cii with licensed contractors to construct the project (Sec- ADDRESS tion 7044 Business and Professions Code) 0 2 1 2-82 CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST4, n SET BACK PROP LINE WIDTH- 'h 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 7�2— A (Sec 3097 Civ C ) SIDE — s i/ PL #Lender s NamePC Fee$ Q�/`' PermitFee D O 0 lender sAddress I certify that I have read this application and state that the ( D Issuance Fee ,S(J c�iabove information is correct I agree to comply with all County Investigation Feeordinances and State laws relating to building construction Total Fee d 6 d 0 and hereby authorize re resentatives of this County to enter upon the ve m it, ed property for inspection purposes /02 SEE REVERSE FOR EXPLANATORY LANGUAGE Sign tura of-Applicant or Agent Dote J ®s APPLICATION FOR BUILDING PERMIT i • i COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN - BUILDING ADDRESS d Ihn I hereby BUILDaffirm that I have a certificate of consent to self Insure SS or a certificate of Workers Compensation Insurance or a certified CITY zip b Copy thereof�s 3800 G� S ^ T F-ti,��`�. C� LOCALITY Policy NO COmpeny rV SIZE OF LOT NO OF SLOGS NOW ON LOT 15'Certifx'd copy is hereby furnished NEAREST CROSS ST ❑ Certified copy is filed with the my building Inspection TRACT BLOCK LOT NO departmr�ent USE ZONE MAP NO Date a Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS OWNERL NO COMPENSATION INSURANCE w� n! O V &J; TEWITHIN 1000 FT OF SCHOOLS vEs No (This section need not be completed If the permit is for one hundred ADDRESS t 1 , dollars($100)Or less) J 33^ N8 ca L. 9A-. DISTRICT GROUP TYP CONST FIRE ZONE PROCESSED BY CITY ZIP I certify that Mn the performance of the work for which this permit 'T (.4e C.r(,'r is Issued I Shall riot employ arty person in any manner so as to ARCHITECT OR ENGINEER TEL NO become subject to the Workers Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO X01 DWELL UNITS NOTICE TO APPLICANT If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject tothe Workers TRACTOR TEL NO SET BILK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith .,P_,R-0 OR 1 N G 2.13 ']:Ll —OQZO FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL >- LICENSED CONTRACTORS DECLARATION !O Z S `�� per' 3 S l 14 SIDE o TY LIC,CLASS PL 0 I hereby affirm that I am licensed underprovisions of Chapter 9 Ce �"r� C- SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT IZE NO OF STORIES NO OF FAMILIES Professions Code and it license is in full face and effect NEW UY BK PG 00 3 I L U C-3 DESCRIPTION OF WORK ADD ❑ VALUATION , w License Nu2t�r Lic Class Contractor 6,M- ROOP'I�+t Date 7 A ' Wee ALTER ❑ $ 0 O O Of 00 ❑ 1 am exempt under Sec SkIRAM", A T6 NQAJ M a' C• REPAIR ❑ $ Z 88PC for this reason d A~S DEMOL 13 LDMA P/C M Date USE F EXISTING BLDG URM ❑ ACCT Signature— APPLICANT(PRINT) TEL NO LDMA Perm• ACC 1 .T ❑ 1 as owner of the property or my ealoyees with wages as 2 7 8 their sole compensation will do the work and the structure is ADDRESS O 3303 2*2.V not intended or offered for sale (Section 7044 Business and FINAL DATE AJ o 1 ITEMS Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1 as owner of theOR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE TOTAL 242-335property am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY � —C licensed contractors to construct the project (Section 7044 YES❑ No❑ CHECK ��'�-�= Business and Professions Code) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHANGE .00 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ OOQQ-0001 2/ 8/96 the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUM AND THE SCAQMD PERMITTWG 3097 CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE i t i /Uy j tZ e C L TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS +� V 1 1'O 1 a.V 'i' Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD a Lenders Address OWNER OR AGENT 3d I certify that I have read this application and state under penalty PC FEE PERMIT FEE O of perjury that the above Information is correct I agree to comply L✓ W with all county ordinances and State laws relating to building , construction and hereby authorize representatives of this County ISSUANCE FEE t0 n the above-mentioned property for Inspection purposes Q q� 11'' INVESTIGATION FEE TOTAL FEE p L� r gIntm of Aoph a s Apt i GOWA a O r7 SEE REVERSE FOR EXPLANATORY LANGUAGE 4WORKERS COMPENSATION DECLARATION y as that I have a certificate of consent self APPLICATION FOR BUILDING PERMIT cU msur or a certificate of Workers Compensation Insurance or a ce'ttified copy thereof(Sec 31300 Lob C ) / �T� �u/�/�✓ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No - Company — Certified copy is hereby furnished BUILDING ❑ y FOR APPLICANT TO FILL IN ADDRESS �[ Certified copy is filed with the county building mspec BUILDING �f tion /partmen,' /yf,�� ADDRESS a0 �� Date � AApplicant "0 D`- CITY /6 ZIP LOCALITY CEIWIFICATE OF EXEMPTION FROM WORKERS O OF BLDGS NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST (This section need not be completed if the permit is for one LOT NO ASSESSOR hundred dollars($100)or less ) TRACT BLOCK MAP BOOK AGE PARCEL OWNER , e--LOi� 1c-' TEL USE ZONE MAP c4/I I certify that m the performance of the work for which this NO K!0 � permit is issued I shall not employ any person in any manner > SPECIAL d so as to b co a subject to the Workers ompensation Laws ADDRESS�yj�7•_+ Q l CONDITIONS O ficCITY / G ZIP V Date Applicant09 NOTI E T6 APPLICANT If after making this Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption you should become subject to the Workers ENGINEER NO y CONST ZONE G Compensation provisions of the Labor Code you must forth ADDRESS 5 �� v g d with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT COus revoked CONTRACTOR - NO NDO Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS.7/rJG e5 Oj 0,7,2 (commencing with Section 7000)of Division 3 of the Business and �/-' LIC SEWER MAP Professions Code and my license is in full force and effect CITY CLASS BK PG g fo VALIDATION SQ FTNO OF NO OF CHECK License Number'p� Lic Class_ SIZE STORIES � FAMILIES ONE n NEW VALUATION � Contractor�l' v -/'/`S �� Date DESCRIPTION OF WORK ❑ �O/1� ❑ I 'OFD $ (J ,I am exempt under Sec �"�'��V� L�� s� ALD7ER ;E 5 0 0 9 A B&P C for this reason �� G REPAIR ❑ $ # • • • • e Date USE OF EXISTING BLDG E�� +� DEMO[ ❑ tt * 19050 Signature APS ��/��" N�p FINAL OWNER BUILDER DECLARATION DATEEP • * 1905030, I hereby affirm that I am exempt from the Contractor s License ADDRESS 7 ✓�Gi''� �� Law for the following reason (Section 7031 5 Business and FIN 7 f 1 —86 Professions Code) By ❑ BUILDING I as owner of the property or my employees with ADDRESS wages as their sole compensation will clothe 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 with licensed contractors to construct the project (Sec ADDRESS tion 7044 Business and Professions Code) REQUIRED TOTAL SETBACKST FROM EXI CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued PL (Sec 3097 Civ C ) SIDE 2 PL e Lender s Name $ LDMA Ref # Lender s Address P C Fee$ Permit Fee 0,6/, lop.m I certify that I have read this application and state that the Issuance Fee 10S6 LDMA P/C# above information is correct I agree to comply with all County Investigation Fee a I ordinances and State laws relating to building construction Total Fee // S LDMA perm # U and hereby authorize representatives of this County to enter upon t a ove- boned property for inspection urpo, �s R .2 /ZK 6 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Uate OO 9 PP