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HomeMy Public PortalAbout6440 OAK AVE_Building__ *A6BBA'CE#803y1/Lt ro APPLICATION O BUIL PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISIONBUILDING ADDRESS COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY r; FOR APPLICANT TO FILL IN NEAREST Print or tvoe onl CROSS ST. \ DISTRICT IFQ. P CONS BUILDING (0T CESS ADDRESS Y V �, TYPE -F ,045 LOT NO. Z BLOCK STATISTICAL C ASSIFICATION 6R-MAP CLASS NO. OWELL.UNITS BK PG TRACT USE lONEJ MAP NO.OF BLDGS. NO. SIZE OF LOT N W ON LOT �/ I SPECIAL USE OF CONDITIONS EXISTING BLDG. OWNER -- TEL t7 S �t AX- NO. Y 4G.SETBACK FROM ADDRESS �(c( FR ROP.LINE OF (STREET) TYPE OF EX I SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH M G.L. ARCHITECT OR I TEL. } ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINEOF (STREET) TEL. TYPE OF 1EXISTING SETBACK HIGHWAY + = TOTAL d CONTRAC NO, HIGHWAY WIDTH FROM G.L. CC7 ADDRE LIC. + - C LIC. CITYCLASS CORNER CUTOFF YES ❑ NO ❑ y- CONSTRUCTION LEN . NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES NEW USE OF ADD ❑ STRUCTURE ALTER ❑ SIGNATURE OF REPAIR❑ APPLICANT j DEMOL ❑ oa:C3 VALUATION S �sC}( Ell APPROVALS DATE INSPECTOR'S SIGNATURE P.C. 7 PMT. FOUNDATION: LOCATION i FEES FEE$ FORMS. MATERIALS &.1 FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF HE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN.R T G TO WORKMEN'S COMPENSATION INSURA E. LATH. EXT. SIGNATURE OF F HOUSE NUMBER COR- PERMITTEE r RECT AND POSTED ADDRESS FINAL I U449 JOHN F. LEWIS. PRI CAG�TR CTURAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VA A iON CK. M.O. CASH 1.2 9.00- 76A638A..vCE 9603 1/71 yAPPLICATION FOR BUIL ING PERMIT COUNTY OF LOS ANGELES . - ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK �I PAGE PARCEL ' BUILDING AND SAFETY DIVISION ADIDLDING RESS �/ v k4je- COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY '�/L� /{� 0,64 FOR APPLICANT TO FILL IN NEAREST Print or tvoe oni CROSS ST. ��T7j�✓ BUILDING - DISTRICT NO. GROUP TYPE PROCESSED BY ADDRESS 64< so v CONST. LOT NO. BLOCK STATISTICALLASS �LASSIFICATION SEWER MAP � CNO. � DWELLHtr .UNITS ' '� ,C P TRACT ti USE 70NEI MAP 200 NO.OF BLDGS. ] NO. SIZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG. OWNER I OV p ) NOL BLDG.SETBACK FROM ADDRESS 1 A� FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. + ENGINEER NO. BLDG.9EZBACK FROM ADDRESS SIDE PROP. OF (STREET) TEL. TYPE OF EXISTING SETS IGHWAY + YARD' = TOTAL C CONTRACTOR NO, HIGHWAY WIDTH FROM C.L. C7 ADDRESS NO' t = CD O LIC, CITY CLASS CORNER CUTOFF YES ❑ NO y.: CONSTRUCTION LENDER' NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS z ADDRESS SQ. FT. , NO. OF NO. OF NEW SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE ALTER ❑ SIGNATURE OF REPAIR❑ APPLICANT DEMOL ❑ po VALUATION S � APPROVALS �^ DATE INSPE TOR'S SIGNATURE FEES FEES 9,00 rOFORMS!MATERIIALSON FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION BRACING BOLTS AND STATE TNAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN REL - G TO WORKMEN'S COMPENSATION IN SU E. /� LATH, EXT. SIGNATURE.OF M'Ci, LUQ lJ HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ell ADDRESS FINAL JOHN F. LEWIS. PRINCIPXL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH LAGo 6 1. 6 .6;S MAY 19 .1 D 3.I 76AYOSLk CE 0803 1/71 `- - ` -APPLICATION FOR BUILDING PER COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS ` , AzAf f COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY [1�• FOR APPLICANT TO FILL IN NEAREST Print or tvoe onl CROSS ST. BUILDING DISTRICT NO GFTr TYPE P D By ADDRESS CONST. STATISTICAL CLASSIFICATION SEWER MAP LOT NO- v BLOCK CLASS NO,�.�DWELL,UNITS BK9'PG�13 TRACT USE ZONE MAP �� -' NO.OF BLDGS. NO. SIZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG. TEL. OWNER 0 U 5 (� NO. %S �y�� BLDG.SETBACK FROM ADDRESS 7 7• FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY, } YARD = TOTAL CITY a 1M @t� HIGHWAY WIDRTi FROM C.L. ARCHITECT OR e S ,+�! T0. , 3� } — /� ENGINEER LDG.SETBACK FROM ADDRESS d �. 905.elme4d SIDE PROP.LINE OF (STREET) CONTRACTOR L. �G�/2, NOL _� TYPE OF EXISTING SETBACK HIGHW } YARD = TOTALJ. C HIGHWAY WIDTH FROM C.LLIC . ADDRESS O�Sa W® �r�J N } - C CITY IQ)*(_7rl6fb CLASS CORNER CUTOFF YES ❑ NO ❑ a CONSTRUCTION LENDER 0. NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ? ADDRESS SFT,Q. /_ NO. OF NO. OF NEW ED SIZE (Q STORIES FAMILIES If USE OF r STRU TURE m/ ��M ADD ALTER ❑ INX61 REPAIR❑ SIGNATURE OF APPLICANT OEMOL ❑ VALUATIONS A 459-0R APPROVALSATE INS P TOR•s 1CNATURE P.C. ``� PMT• �p FOUNDATION: LOCATION / FEE S a_ O FEE S 02 FORMS, MATERIALS 2 7 L 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, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTI ON, I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSA IN VIOLATION OF THE LATH, INT. (�(,J s LABOR CODE OF THE STATE OF •CAF RNIA IN RELAT WORKMEN'S COMPE NS NS LATH,TH, EXT. 11,1W7-2-, SIGNATURE OF Ly GL HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS4kne-RkFINAL JOHN F. LEWIS. P I L STR RAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VA ON CK. M.O. CASH LJ,o ^ 695; AN 62 49.50A 4 -h .., �J( 6 0 9' 1-R! rpt-17 1 D 8 2.5 ON 4 76J38A.jCE #603 1/71 ,• f` ' ' APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or tvDe onl CROSS ST. DISTRICT NO. GROUP TYPE PROCESSED BY BUILDING CONST, � , ADDRESS 0 ax �G�C�� STATIATiCA, CLASSIFICATION SEWER MAP LOT NO. BLOCK rr��tt CLASS NO. -'?/ BK,6 PG � t TRACT USE ZONE MAPry NO,OF BLDGS. ) NO. ? LTJ SIZE OF LOT NOW ON LOT I / SPECIAL USE OF �~ CONDITIONS EXISTING BLDG. 4 TEL OWNER =_ p_rNO. I BLDG.SETBACK FROM ADDRESSOAK FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY p(p vHIGHWAY WIDTH FROM C.L. ARCHITECT OR.r TEL. ENGINEER - NO. �4 BLDG,SETBACK FROM ADDRESS !Q(U Qj " ) SIDE PROP.LINE OF (STREET) TEL w TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL d CONTRACTO NO. �q HIGHWAY WIDTH FROM C.L. ADDRESS jp] `� NO�/ r_3 + C (� ra QC V/S ( �.. LIC. LL CITY S�Q +� CLASS CC3 CORNER CUTOFF YES ❑ NO CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS SQ. FT. C, NO. OF NO. OF NEW SIZE +� STORIES FAMILIES USE OF ❑ STRUCTURE ' �' r ADD ALTER ❑ r (� SIGNATURE OF REPAIR[:]g. APPLICANT DEMOL ❑ • VALUATIONS O C)0.C) �) APPROVALS DA E INs eroR•s SIGNATURE FOUNDATION: LOCATION P.C.S „l5� FEES FORMS, MATERIALS 75 FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE? LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED J HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT, A LABOR CODE 0 THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S CO NSAINSURANCE. SIGNATURE O LATH, EXT, ,; ,f ,�,N•4,�- PHOUSE NUMBER COR- PERMITTEE RECT AND POSTED r ADDRESS Q FINAL ' JOHN F. LEWIS. PRI CIPAL STR RAL E INEER ; PLAN CHECK VALIDATION c sH _ PERMIT VALIDATION CK. M.O: ASH Ll�W ti 7 ? ',,� i;P 2 3 Dj/ 1.15N Ultuo ,�2 APR 2- 1 D 3 524:15- APPLICATION FOR BUILDING PERMIT ` FOR A �k%ICANT TO FILL IN (Print or type only) BUILroING 71 COUNTY OF LOS ANGELES ADDRESS ,Q,`� . DEPARTMENT OF COUNTY ENGINEER CITYr^ T ZIP // 7 BUILDING AND SAFETY DIVISION 'NO.OF BLDGS2 SIZE OF LOT�O© /B C) NOW ON LOT BUILDING ADDRESS TRACTg !3 BLOCK`, LOT N . ;L LOCALITY NEAREST OWNER T1. .J7G�CJ�¢.e7 r L N / CROSS ST. ASSESSOR ADDRESS o Alt-' MAP BOOK PAGE PARCEL DISTRICT OUP TYPE FIRE PROC D BY -CITY %e C j ZIP 1 79W �� NSTa ZONE�j ARCHITECT OR TEL. l/ `� ENGINEER NO. - STATISTICAL CLASSIFICATION V SEWER MAP ADDRESS / G CLASS NO. / DWELL.UNITS r—BK11;2 4G CONTRACTOR , � � ENE MAP NO. SPECIALADDRESS Q 6( & ¢.S,/-q aO. �/ 7. LIC. g,,Ju 4XONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM ADDRESS CITY FRONT PROP.LINE OF (STREET) HIGHWAY + YARD TOTAL SETBACK FROM TYPEOF EXISTING SQ.FT. STO OF / NO.OF CHECK - FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES / FAMILIES ONE DESCRIPTION OF WORK NEW + O ADD ❑ BLDG.SETBACK FROM SIDE PROP.LINE OF (STREET) O () G S e ALTER ❑ = TOTAL SETBACK FROM TYPE OF EXISTING w L. ;14 HIGHWAY + YARD SIDE PROP.LINE HIGHWAY WIDTH . N USE OF REPAIR Z EXISTING BLDG. r0l�,✓ A&e- DEMOL ❑ + APPLICANT TEL /' CORNER CUTOFF YES ❑ NO ❑ (PRINT) •�, LL�s9'L.. N -�7l,� n IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATUREI ,Q/-�'J���-' ` .[,¢�J� IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ l3 IHEREBY 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 CONSTRUCTION.I 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 COM- PENSATION INSURANCE. SIGNATURE Q PERMITTEE u ADDRESS 2f CITY 7�C-� �/t N .� DATE PM L BY $a.�_ MAKE CHECKS PAYABLE TO: FEE FET HARVEY T.BRANDT.COUNTY ENGINEER 0 . A PLAN CHECK VALIDATION CK M.O. CASH o PERMIT VALIDATION cu. M.O. CASH 75AM 7-8 7. ® 102.75sbld ®s 76A63BA CE#803 3.75' WORKERS'COMPENSATION DECLARATION that I have a certificate of consent to sel insure,or afirm certif certificate of Workers'Compensation Insurance, APPLICATION F®O BUILDING PERMIT c, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli c Nog5giyd I Companyf7� 7,7V-J,4 n Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDR 5S Certified copy is filed with the county building inspec- BUILDING [�vO / �U� tion department. ADDRESS C 1 Date 3 //o Applicant , CITY �11V T ZIP ,LOCALITY CERTIFICATE OF EXEMPTION FROM O RS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT k CROSS ST. hr (This section need not be completed if the permit is for one ASSESSORhundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ONE MAP I certify that in the performance of the work for which this OWNER / / ! NO. NO. IL IL permit is issued, I shall not employ any person in any manner SPECIAL so as to become subject to the Workers Compensation Laws. ADDRESSCONDITIONS 0O Date Applicant CITY ZIP NOTICE TO APPLICANT: If, offer making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIREa:z 0 ENGINEER NO. ^ CONST. „ ZONE Exemption, you should become subject to the Workers' � _� tJ � �J�!// � Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be I� TEL. STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTOR W/�T l/rj//�/1//I� NO. LICENSED CONTRACTORS DECLARATION LIC03 . ? CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 '*ADDRESS d/� li�i s�i �L d�� NO. / SEWER MAP (commencing with Section 7000)of Division 3 of the Business and fJ LIC. y c� Professions Code,and my license is in full force and effect. CITY /�/®pS�i/Y!/�i'/Q CL/ASS Z' / 7 BK O VALIDATION �J /�-� (_—� / HECK SIZE // STORIES FAMIOLIES / CONE License Number /�2-31 ! Lic.Class �;■ _ VALUATION Contractor DateDate I // o DESCRIPTION OF WORK NEIN ❑ $ I am exempt under Sec. �s� �� � �of�-11 ADD ❑ v C/ pill.ALTER ElB.&P.C. for this reason 30 A C O REPAIR $ USE O ❑ Date: EXISTING BLDG. DEMOL pi Signature APPLICANTTEL. FINAL OWNER-BUILDER DECLARATION PRINT NO. DATE ," yr I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and €• ADDRESS FIN Professions Code): PRESENT B ❑ ` 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 intendld or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. ANT 10 with licensed contractors to construct the project (Sec- A z tion 7044, Business and Professions Code). ADDRESS (�7� 768 oLV REQUIRED TOTAL SETBACK FR M I CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT i ITEMS the performance of the work for which this permit is issued P.L. 'I TOTAL 683 o 6 3 (Sec. 3097,Civ. C.). SIDE CHECK 621. 63 Lender's Name ? f t °, P.C. Fee$ Permit Fee /3 LDMA Ref. # H N 3E o Ill] Lender's Address ,�7) r I certify that I have read this application and state that the Issuance Fee ,0• � LDMA P/C# . 000. r above information is correct. I agree to comply with all County Investigation Fee0000-0001 1/ 9 ordinances and State laws relating to building construction, Total Fee / LDMA Perm. # J and hereby authorize representatives of this County to enter 3 `77 1M +a!} ( upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signotu A ant or Agent Date WORKERS'COMPENSATION DECLARATION G /�� C � ✓ nt to self insure oraaffirm cerfif cafe of Workers'Compensation eInsurance, I f�"�1 P T L I L 4� I®N FOR BUILDING RN T or a certified copy thereof (Sec. 3800, Lob. C.) Pat' No 0 4 7 4 2 9-8�8om an State Fund COUNTY OF LOS ANGELES BUILDING AND SAFETY yy�►��, �y Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS: c f�fTft ❑ Certified copy is filed with the county building inspec- BUILDING 6440 N. Oak Avenue tion department. ADDRESS Date 8-23- ' 88 AppliccJt•C.Slaughtrer Co. CITY Temple City, C 91 780 +LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.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 ' ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL Douglas Stewart No 445-1414 usEz E MAP 1 certify that in the performance of the work for which this OWNER NO. permit is issued, I shall not employ any person in any manner 6440 N. Oak Avenue �( SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS V Date Applicant CITY Temple City, CauP 91780 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O ENGINEER NO. CONST. ZONE I"' Exemption, you should become subject to the Workers' ��/ () Compensation provisions of the Labor Code, you must forth- ADDRESS J, O / D a with comply with such provisions or this permit shall be J. C. SLAUGHTEREL. STATISTICAL CLASSIFICATION APT. CONDO. C/)deemed revoked. CONTRACTOR NO 4-0 8 6 8 LICENSED CONTRACTORS DECLARATIONCLASS NO. DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1 3 21 S. 2nd AVeril 5 3 4 0 7 8 (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 Arcadia,Ca. 91 0 0 6 CLASS C -! y VALIDATION 534078 C SQ. FT. NO.OF NO.OF CHECK BK. C. P!''�i./ License Number Lic.Class SIZE STORIES FAMILIES ONE J.C.SlaughterDaQ9. 8-23-88 DESCRIPTION OF WORK Chimneyrepair sEiv VALUATION Contractor p ❑'; $ 2, 400. 00 ❑ earth uake damage. ADD ❑i I am exempt under Sec. ALTER ❑ BAP.C. for this reason REPAIR $ USE OF Date: EXISTING BLDG. DEMOL ❑ Signature APPLICANT 3 TEL. `: FINAL,-7 OWNER-BUILDER DECLARATION PRINT L /�-l'- CaNO. cS _a f DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS �2} �✓ � FIN Law for the following reason (Section 7031.5, Business and Professions Code): BUILDING By MIR ' O I, as owner of the property, or my employees with ADDRESS 51.8 p wages as their sole compensation,will do the work and , G # 0 0 0 0 0 the structure is not intended or offered for sale(Section LOCALITY /j' tl 0 o59,25 7044, Business and Professions Code). MOVING TEL. y ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. l with licensed contractors to construct the project (Sec- (� o 0 0 5 9.2 5 5 tion 7044, Business and Professions Code). ADDRESS REQUIRED L 5ETBACK FTm CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAL PROP.LINE WIDTH Q 8 2 4-t2 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 LDMA Ref. # o P.C. Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee • �(/ kLD P/C N above information is correct. I agree to comply with all County Investigation Fee °o ordinances and State laws relating to building construction, Total Fee , LDMA Perm. q and hereby authorize representatives of this County to enter a upon the above- ntio� property for inspection purposes. $ 8-23-88 SEE REVERSE FOR EXPLANATORY LANGUAGE m Signature of App cant or Agent Date