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HomeMy Public PortalAbout10425 OLIVE ST_Building__ DEPARTMENT, OF BUILDING AND'SAFETT AWN1 A va6 rLif midi COUNTY OF LOS ANGELES ® � WM. J. FOX, CHIEF ENGwINEER e FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT O. PLAN CK.NO. PERMIT NO. ADDRESS x I S I A_l:lA A d9 IN LOCALITY V-e,.a,1"4n! op R VED BY DATE OF APPL.. DATE ISSUED ,ROSSSST. l I 66 y ---- BUILDING OWNER{ :'� 1-b'i �fl. 1`— ADDRESS MAIL /► LOCALITY T�'•yo c_c ADDRESS,�,ya't1 /! ((1= LJ:t NEAREST Gy�---- .r r} CROBS ST. CITY ! n . ,-I• 11.01 t".It I NOL . .L.-�ns. Vic: �P��. �q r y FIRE NO.OF TY GROUP ARCHITECT O TEL. ZONE PLANS ENGINEER NO. OLDS. ,�rree•d� SETBACK LINE V /Zel- NO. ADDRESS , y TEL. APPROVED CONTRACTOR 11. NO. BY DATE USE APPROVED - ADDRESS ' ZONE ` BY DATE LEGAL �] a- r CORRECTIONS DESCRIPTION I LOT NO.j� I BLOCKAl TRACT I NO. SLOGS _ vo s _ v rR 11SIZE OFLOT,ttA 9 4fl' NOW 13N LOT � � .-/) USE DF v NO.OF NO.OF EXISTING BLDG. �eJy�� I INxJ( I ROOMS J Y DESCRIPTION OF WORK Pe., A_.r 1 rl. tr! a.)A NEW ALTERATION ADDITION �r � REPAIR a MOVING DEMOLISH S or ZE T.r/ �I /� ROOMS I STORIES D WALLROOF f1 - r COVERING �;Ir , .16; I COVERING (':+p.��l,¢A._L y USE OF NEW BUILDING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY'WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE TOPB, SIGNATURE OF BRACING,BOLTS I.OWNER LATH,INT.: AUTHORIZED AG�. . / =1 Cdl �� �fI /I L f:`ri LATH,EXT.: I DBS-3 23M SETS 1-47 $ P.C.IB PLASTER.INT. FEE- rr PLASTER,EXT. / r ` VALUATION FEE a�-m.�— FINAL "OB9�9-YSM-B0.,•8 B-45 I -••__ s DEPARTMENT-OF IIUILDING AND SAFETY j APPLICATION FOR PERMIT --_CObfty OF LOS ANGELES L F - •�. WM. J. FOX. CHIEF ENGINEER DI NG FOR APPLICANT TO FILL IN FOR OFFICE. USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT.NO. BUILDING, �i � ADDRESS. 28-51- Olive S't®. j LOCALITY Temple City RECEIVED BY DATE OFPPL. DATE,196(JED 1 I f �. NEAREST CROBS ST. V_`� array E. r ght Constr. ` r`' g��t OWNE Co, ADDRESS �_ {� MAIL 31O e Continental Bld LOCALITYNEAREST A DDRESS . TEL. ORDS13 ST. A10 /1/ a /- CITY. LOS Angeles. 13 ND. TR 6362 FIRE I No.or � TYPE 1 GROUP, Qx ARCHITECT OR TEL. 'ZONE ;.,� PLANS ENGINEER NO.. BLDG. \ �J ORD. NO. hk ADDRESS SETBACK LINE arry Si WrIgritone4BL. APPROVED a CONTRACTOR NO. BY DATE �Y 0 Continental 1 go , Los An U5E T APPROVED f0,/ ADDRESS ZONE, / BY DATE ' F LEGAL DESCRIPTION� LOT NO. y, I BLOCK CORRECTIONS TRACT See attached� 1� �. . �yaar� ' ,� ✓I r� No..OF SLDGB. rT j SIZE OF LOT„ 53 S 139 I NOW ON LOT 0 ` .� I� _ 5 �j �A�V"�•� USE OF; No.ILIEXISTING BLDG. FAMIS I ROOMS t I v DESCRIPTION OF WORK nl_ '6I I ,liw•11 ; NEW X ALTERATION ADDITION REPAIR MOVING DEMOLISH Lf' �.11 JA.sn(.r�(.J•'. 1 ✓1 fl.43. ,-�✓( tf I p ` / .S ZEFT" 1150 ROOMS Ej° STORIES 1 l ,L•, .: r>ik � !L�/.' 1"T . I d �;• ' - .-WALL 4f COVERING Plaster I ROOF Sn le f ! COVERING h$1. g USE OF NEW `' V BUILDING Dwelling . ti3 I HEREBY ACKNOWLEDGE THAT 1• HAVE READ THIS APPROVALS APPLICATION AND.STATE THAT THE ABOVE 18 CORRECT FOUNDATION: LOCATION; INSPECTOR DATE AND AGREE TO COMPLY.WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING 13131,15TRUCTION. FRAME: FIRE STOPS, • SIGNATURE OF BRACING, BOLTS � � - OWNER LATH,- INT.7 " AUTHORIZED AGLATH, EXT.: I o J t©/oo P: C.$ b D .PLASTER, INT., nJ FEE C PLASTER, EXT. , VALUATION FINAL. ,/�t 7,FEE r )i►\�'. .t J `Yi—g-3 89M SETB'6-46 Cif —'�=`= `-=._e,,,�,_ — ���-• Z_ '---• Jwq �pEPARTMENT OF BUILDING AND SAFETY APPLICATION XORSVMMIT lI COUNTY'OF LOS ANGELES p U ' C ® I N G WP4. J. FOX, CHIEF ENGINEER FOR APPLICANT__TO._FILL_ IN - - FOR OFFICE USE ONLY �y 'DISTRICT NO. PLAN CK. NO. •PERMIT NO., BUILDING ►�'f I / ADDRESS s �� _ 1, .t`i . t r; N LOCALITY ! ,,r,I,��j�p: p�Z(�f,//-_/_l "el.�!+ RECEIVED Y DA,T�EOor APPL,.. /+DATE ISSU�EDD NEAREST CROSS ST.r•+,. lvkj{ jlf�.�! T r• F7 j �.Q1�:�IQr /• BUILDING. � - OWNERr 4�y l �r)\��/�i�rl r! .�.+fri:/t ) i .4/ k ADDRESSMAIL �o ADDRESS :J �- �( p . xLOCALITY /_y�'^ "^' /�/ J/(�� ' 1 v r`�,7 NEAREST1;4 / �_fI �b ( :. /' TEL. 4+'/"I,�_ ./ 'CR098'ST. x CITY A.f.ti r f �A 1 NO. " FIRE NO.OF' - TYPE / GRGUP yENGINEER T O I NTEL.O �`+' ZONE I PLANS I I V `BLDG. ORD. NO. ADDRESS SETBACK LINE ' TEL. I APPROVED CONTRACTOR •NO.' '�� BY DATE �'/J USE APPROVED ADDRESS ESS . 3t / ( / 0J It���o\1�1 ZONE ` "1 BY DATE r }� = CORRECTIONS DESCRIPTION, LOT NO.,{ : � BL LEGAL OCK ��y� �� TRACT r! /(-_LJ ��_r�- 'L•4.'�,•'_ 7 •-. f.r Y ) ,,�•• ANO. OF BLDGS. J SIZE OF LOT / + L�I NOW ON LOT / USE OFa /17 Nmmr NO. O EXISTING OLD G.r�1 t...p�.p ..A,f., FAMILIrzf3 IF- I ROOMS DESCR_IPTION OF•WOEX J .NEW 1 ALTERATION ADDITION O REPAIR MOVING DEMOLISH G ior 8 ZEFT` � 6 . ROOMS STORIES-,' WALL. ' aROOF COVERING USE SOF NEW BUILDING' 71— APPROVALS I..HEREBY ACKNOWLEDGE THAT 1:*.HAVE'READ"THIS f.NSPBCTO_Ri DATE APPLICATION-AND. STATE THAT THE ABOVE IS-CORRECT FOUNDATI,ON:'LOCATION,• AND, AGREE TO COMPLY WITH ALL.-COUNTY ORDINANCES FORMS, MATERIALS T AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME:' 'FIRE. STOPS, _ BRACING, BOLTS -SIGNATURE OF: � • OWNER _ /��'' LpTH, INT.: AUTHORIZED, AGT� A �%" %► LATHi EXT.:' _ a .. .. 4 P.,•C.!!� PLASTER, INT: ' FEE- PLASTER, EXT. s VALUATION FEE FINAL 1 1 • • RKERS�;OMPENSATION DECLARATION /i that I wave a certificate of consent to self APPLICATION FOR BUILDING PERMIT C1 W., . ertificate of Workers'Compensation Insurance, of a certifif.d copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicybNcM Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS `3z-5 01 'l//L7 Date Applicant CITY 6n ' CA ^/C! ZIP ` � �0 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' 2 NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT- •3lr r 3 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 TEL'OWNER Y - r SCS USE ZONE MAP I certify that in the performance of the work for which this ce-,- o.J �S NO. permit is issued, I shall not employ any person in any manner c�+ _ SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS t7 CONDITIONS 0 Date Applicant CITY ZIP O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRO SSED BY G Exemption, you should become subject to the Workers' �yu ENGINEERjc� NO. CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS /Q Ao with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR NO. 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 and LIC. SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. CO .OF NO.OF CHECK License Number Lic.Class SIZE 3 �S STORIES 1 FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW Contractor Date $ I am exempt under Sec. Plu CJ0,5C eiliv ADD ❑ ❑ , ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF /� r� EXISTING BLDG. `+ �- I 0 DEMOL ❑ APPLICANT TEL. Signature FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DAT I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINA Pe sions Code): PRESENT BY BUILDING 1, 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. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. v 7 2 7 A with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). # 0 0 0 0 0 REQUIRED TOTAL SETBACK FRM' I CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 10 0 4 0 F A the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE o 0 o1 s' P.L. C.fJ. Q Lender's Name LDMA Ref. # 1-230-85 a Lender's Address P.C. Fee$ Permit Fee - ' xI 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 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter $ uppft a above-mentione party for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE \ Signature of Applicant or Agent Date t ),OWORKERS'COWENSATION DECLARATION �J I�herelay affirm that I have certificate of consent to self P P L I CAT I N I`O f BUILDING PERMIT �l ' iFsure, or a certificate of Workers'Compensation Insurance, P`�e% 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 IN BUILDING ADDRESS j o`1 Z ❑ Certified copy is filed with the county building inspec- [. ADDRESS ILDING Q I J tion department. f nnDate Applicant TY �� ZIP LOCALITY (.. PLL' C../rq CERTIFICATE OF EXEMPTION FROM WORKERS' Z> O.OF BLDGS. NEAREST r 1 C COMPENSATION INSURANCE SIZE OF LOT O NOW ON LOT CROSS ST. l� (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 TEL. NE MAP I certify that in the performance of the work for which this 'OWNER NO. USE NO. permit is issued, I shall not employ any person in any mannerSPECIAL 9L so as to become subject to the Workers'Compensation Laws. ADDRESS �� -I CONDITIONS O CV Date Applicant C ®�S CITY ZIP 99 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRIcro GROUP, TYPE FIRE P ED BY Exemption, you should become subject to the Workers' ENGINEER NO. 1-0— 2 CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS VtO -3 3 @� with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR � � NO.TEL. STATISTICAL CLASSIFICATION APT. CONDO. Q 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 and LIC. SEWER MAP Professions Code,and my license is in full force and effect. CITY CLASS BK 'V PG.7 VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE -: STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ; 1 s� ADD ❑. pill. F ❑ I am exempt under Sec. e. N. ❑ ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL EXISTING BLDG. a. S� ❑ . Signature ; APPLICANT TEL. FINAL PRINT ` OWNER-BUILDER DECLARATION Y� NO. DAT < (�[G'j, I hereby affirm t I am exempt from the Contractor's License : ADDRESS 7i O `( �/ (/ o a C Law for th owing reason (Section 7031.5, Business and FI o 0 Profes s Code): PRE ENT o o o 2$ rj 0 5 BU I, as owner of the property, or my employees with ADDRESS 02, 06-87 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. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FRO I CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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. (Sec. 3097, Civ. C.). tlnvestigatio!nFee E 3 . Lender's Name LDMARef. # Lender's Address Fee$ PermitFee I certify that I have read this application and state that theIssuance Fee LDMA P/C# above information is correct. I agree to comply with all County d p--� ordinances and State laws relating to building construction, Total Fee <] - LDMA Perm.# i and hereby authorize representatives of this County to enter above-mentione proper for inspection purposes. ap SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date t 7 - WORKERS"COMPENSATION DECLARATION her t'" of coent to self insyre, or affirrh certif certificate of Wo ke s'that I have atificate Compensat on Insurance, APPLICATION F®R 13 U I L®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 IN BUILDING ADDRESS (( ❑ Certified copy is filed with the county building inspec- FADDRE �}� // Tion department. C / L v r 9 Date Applicant /G / ZIP GA LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS. -y NEARESTCOMPENSATION INSURANCE 3`� /3 J NOW ON LOT J� CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) BLOCK LOT NO. MAPBOOK PAGE PARCEL EL�-eS C,04 J NO. �S-20 USE ZO MAP I certify that in the performance of the work for which thisNO. permit is issued, I shall not employ any person in any manner SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS —� CONDITIONS Oct CITY ZIP ad Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROC SSED BY Exemption, you should become subject to the Workers' ENGINEER (/1�.d� NO. '`y p CONST. i/ ZONE Compensatin provisions of the Labor Code, you must forth- ADDRESS Sr v0 I� b J with comply with such provisions or this permit shall be TEL. STATISTICAL CLASS TION APT. I CO O. deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (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 BK PG VALIDATION SQ. FT. p NO.OF NO.OF CHECK License Number Lic.Class SIZE A STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK , NEW ❑ $ ADD ❑ I am exempt under Sec. ! G1E] ® 2-11 5 3.7 A. _ ALTER B.&P.C. for this reason $ REPAIR ❑., # 0 0 0 o a t Date: USE OF EXISTING BLDG. DEMOL ❑: . ( o 0 7 8 v 7 Signature APPLICANTTEL. FINAL OWNER-BUILDER DECLARATION PRINT) C,145 5,0(SPINO. J�7.�?✓67�.t, DATE �^ o o o 7 8 0 C I hereby affirm that I am exempt from the Contractor's License Fl, r the following reason (Section 7031.5, Business and ADDRESS 0 2� (C, �� T-t C- g FINAL )�211 o Z 1 5—8 5 ions Code): t PRESENT By BUILDING 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. ❑ 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). CREQUIRED YARD HWY TOTAL SETBACK FROM SET BACK PROP. LINE WH CONSTRUCTION LENDING AGENCY IDT , 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 �O LDMA Ref. # Lender's Address "P.C.Fee$ Permit Fee r, I certify that I have read this application and state that the Issuance Fee 10, " LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm.# i and hereby authorize representatives of this County to enter o the above-me tinned property for inspection purposes. i�� � JftS SEE REVERSE FOR EXPLANATORY LANGUAGE o Signature of Applicant or Agent Date ©i `-WORKERS'COMPENSATION DECLARATION he�'�Dq of rrrt that I have r certificate of consent to self APPLICATION FOR BUILDING PERMIT c r 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 A /)/� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS (�•7 d ❑ Certified copy is filed with the county building inspec- BUILDING I tion department. ADDRESS t•V e Date Applicant CITY [Ci Ct zip �7 t7 S LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST / COMPENSATION INSURANCE SIZE OF LOT 156 y( 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 TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER C)/50^J NO.X7.5' + `1'l NO. } permit is issued, I shall not employ any person in any manner SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS ?.iS f O CONDITIONS CITY T-,C ZIP Date Applicant ARCHITECT OR ,s TEL. NOTICE TO APPLICANT: If, offer making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE I PRO SSED BY Exemption, you should become subject to the Workers' (/ CONST. ZONE Compensation provisions of the Labor Code, you must forth- U® ( 3 ADDRESS 6' with comply with such provisions or this permit shall be e` TEL. STATISTICAL CLASSIFICATION APT. C deemed revoked. CONTRACTOR �C/1� eJ�i/� NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (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 BK PG VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ ,p ❑ 6 dNv I am exempt under Sec. V ti>R ' 1�� ADD El❑ ALTER B.BP.C. for this reason REPAIR E] $ Date: USE OF DEMOL E] 2 1 53.6A EXISTING BLDG. Signature APPLICANT TEL. FINAL # 0 0 0 0 0 1 OWNER-BUILDER DECLARATION PRINT) �2� NO. DAT I hereby affirm that I am exempt from the Contractor's License ( 0 - 49.88 Law for the following reason (Section 7031.5, Business and ADDRESS FI Profes ` ns Code): a PRE ENT B o o 0 4 9$8� BUILDING I, os owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 0 215-95 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I,as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETCK FR M CONSTRUCTION LENDING AGENCY SET BACK YARD HWY BAPROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT + the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name 0 LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee 1 "'Q I certify that I have read this application and state that the Issuance Fee S_ LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee �( ordinances and State laws relating to building construction, Total Fee U LDMA Perm. # and hereby authorize representatives of this County to enter n he above-mentioned property for inspection purposes. u % alf 15-19S SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date O° WORKERS'COMPENSATION DECLARATION fl jI hereby affirm that I have a certificate of consent to self I � � uU AU I L " I N G PERMIT insure, or a certificate of Workers'Compensation Insurance, i';I' �'" ora tiI�d co y thereof(Sec. 3800, Lab. C.) � 3 � � �. COUNTY OF LOS ANGELES BUOLDING AND SAFETY Policy No. Company �AY�� ..�l��.oY. a Certified copy is hereby furnished. j FOR APPLICANT TO FILL IN BUILDING Certified copy is filed the county building inspe BUILDING I J tion department. ADDRESS L /� 1 `" LOCALITY 10 `- ,,/" Cc c Date S Applica CITY ` ! ° NEAREST ZIP CROSS ST. /ef VO- CERTIFICATE OF EXEM ON FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATI N 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.) TRA I BLOCK I LOT NO. ; NO. .72 OLV TEL. ' SPECIAL > I certify that in the performance of the work for which this ~� OWNER D ��. NO. CONDITIONS a_ permit is issued, I shall not employ any person in any manner ADDRESS DISTRICT GROUP TYPE FIRE PROC ED BC ESS �< � CONST. ZONE so as to become subject to the Workers'Compensation Laws. f� .v A 3 Date Applicant CITY ZIP STATISTICAL CLASSIFICA APT. CONDO. NOTICE TO'APPLICANT: If, after making 'this Certificate of ARCHITECT OR TEL. Exemption, you should become•subject to the Workers' ENGINEER NO. CLASS NO. - l DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS tE with comply with such provisions or this permit shall be -/ deemed revoked. I ONTRACTOR -/ �. �C TEL. PG, 3 VALIDATION LICENSED CONTRACTORS DECLARATION I O Rw/Com— ��—/ LIC. I hereby affirm that I am licensed under provisions of Chapter 9 AD ESS r f" Rj CT. NO.(commencing with Section 7000)of Division 3 of the Business and LIC. �Professions Code, andmy license is in full force and effect. CITY Gbf?��L CLASS l.SQ. FT. NO.OF NO.OF CHECK Li nse mber J Lic.Class / SIZE STORIES FAMILIES ONE � � IPTIONOFWORK ..�(k4` � x 1=WContractor e I am exam n SeADD ❑ nALTER dr ❑B.&P.C. for this reason r — � EPAIR ❑ { Date: USE O DEMOL FINAL EXISTING BLDG. ❑ By! Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS. :. Professions Code): PRESEIK , BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and :I 0 h the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. i I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- 'tion 7044, Business and Professions Code). ADDRESS •REQUIRED TOTAL SETBACK FROM EXIST. i;• - r CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH IL 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 o P.L. Lender's Name $ P.C.Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee a ,.T above information is correct. I agree to comply with,all County Investigation Fee y ordinances and State laws relating to building construction, Total Fee t�„3 and hereby authorize represerdgtLves of this County to enter J-1 $ u abov menti ne roperty inspection pur ose o {1 SEE REVERSE FOR EXPLANATORY LANGUAGE V ®s Signature of App nt or Agent atgf `j