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Home My Public Portal About9508 OLIVE ST_Building__ >r1 At'l'LK;ATION FOR BUILDING PERMIT FOR APPLICANT TO FILL,IN (Print or type COUNTY OF LOS ANGELES - DR DEPARTMENT OF COUNTY ENGINEER ITY , r "'�/' _%/,%z I p y/' %' �'" BUILDING AND SAFE DIVISION yNO.OF SLOGS. BUILDING /T ; S'ZE = LOT �� NOW ON LOT 2 ADDRESS RAC 7' BLOCK LOT NO LOCALI Y TEL. NEAREST OWNER -/ iH/�/�/�•+,�!� O. !}�� IY c.� CROSS ST, ASSESSOR ADDRESS 9'lgr _ �� ai MAP BOOK PAGE PARCEL DISTRICT 17P TYPE FIRE ESSED BY CITY y - f-��- ZIP r i1 CONST ZONE �c ARCHITECT OR _ TEL. �, V NGINEER NO. STATISTICAL CLASSIFICATION SEWER-MA p EWE MAP ADDRESS CLASS N04>e-7—/ _OWELL,UNITS BK PG CONTRACTOR �'L f' NO USE ZONEMAP n LIC. /./� NO. G%/ ADDRESS NO. ��- SPECIAL LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLD .SETBACK FROM FRO TPROP.LI NE OF (STREET) AC2RESS CITY < TOTAL SETBACK FROM TYPE OF EXIST'!NG SC NO. OF NO. OF CHECK -GH Y + YARD - HIGHWA' WIOT- 5 � - STORIES FAMILIES ONE FRONT PROP. LINE S ..'ESC RIPTION OF W'JRK•�' NEW G c i ) ADD M BLOG.SETBACK FROM i _ za; 1,.�� `1-' SIDEPROP, I INEOF (STREET' ALTER _ TOTAL SETBACK FROMN. A EXST.NG H IGH WA' t YARC W'CTH - , RE PAIR I� SIDE PROP. LINE USE �`� -_ t EX�ST.NG BLZG. t L EV0,_ 1:1 APPLICANT TELCORNER CUTOFF YES ❑ NO PR!NT) - .. NO. BY :SIGNATURE)-�A+✓ - •`� - IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION 'S G: CAT.EGOR:CAL EXEMPTION YES❑ NO ❑ "EREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ENVIRONMENTAL AND SATE T4AT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- ST R;;C TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROC 55E0 (DATE) -EREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE ^ / 1 LABOR CODE OF THE STATE OF CALIF IN RELATING TO l WORKMEN'S CO MPEN ATON INSL'RANC /'j �I' pl,` r ' r' . SIGNATURE OFyfw.. PERMITTEE ADDRESS L'L=- _ _ .r{ FINAL RY-,- CITY y-y '/✓?i/r /�� NO. �I DATE t 1 } 1I-IKE (:HEC XS Pill'-+1134 70 : P.C. 5 PMT. FEE FEE HARVEY T. BRANDY. COUNTY ENGINEER ' PLAN CHECK VALIDATION CK M O. CASH _ PTt VALIDATION CK M o CASH A_ ti ? 4 .0 DA 76A638A CE4803 12 72 .� APPLICATION FOR BUILDING PERMIT FOR API?LJCANT TO FILL IN (Print or type only) BUILDING r COUNTY OF LOS ANGELES ADDRESS C`yDl v� DEPARTMENT OF COUNTY ENGINEER 'CITY /�sOL �L�/L ZIP f/ �r BUILDIING AND SAFE "DIV®ISION LDING SIZE OF LOT ✓ 7 NOWOON LOTF BLDGS ADDRESS TRACT BLOCK LOT NO. LOCALI Y �J TEL. 7 L �9 NEAREST OWNER F,L/�/F./rL' ' SA%C,NO. iy'O1y1r/L- CROSS ST. I r _ ASSESSOR ' ADDRESS `j-O ` L! vt. MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ESSED BY • y , CONST ZONE CITY y ZIP ARCHITECT OR TEL. �r L� ENGINEER ,`��-y It NO. STATISTICAL CLASSIFICATION SEWE MAP ADDRESS CLASS NO DWELL,UNITS BK PG CONTRACTOR Stili NOL USE ZONE MAP LIC. NO. 46 ADDRESS NO. �- SPECAL LIC. /` CONDITIONS CITY it CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLD .SETBACK FROM FRO TPROP.LINEOF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING Ic C SQ. FT. NO. OF NO. OF CHECK HIGH Y + YARD — FRONT PROP. LINE HIGHWAY WIDTH I SIZE 'STORIES FAMILIES ONE F ,/yy t � DESCRIPTION OF QV�ROK`i � �• G�j�?L NEW ❑ i BLDG.SETBACKFROMP. ADD r SIDE PROP.LINE OF (STREET) =, ALTER HIGHWAY + YARD = TOTAL SETBACK FROM E OF EXISTING REPAIR[:] SIDE PROP. LINE HI AY WIDTH USE OF t DEMOL ❑ + EXISTING BLDG, APPLICANT F1�//•/��-�J 1�J ��•i5r.�fJ01. CORNER CUTOFF YES ❑ NO (PRINT) ❑ BY (SIGNATURE IN OPEN SPACE 'YES ❑ NO ❑ z /ry/hy��J I� IN COASTAL ZONE YES ❑ NO ❑ VALUATION� ' rV ' ev CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- - STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROC SSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIF -Ji IN RELATING TO WORKMEN'S COMPEN A N INSURANC Z SW Of IGNATURE OF ` , yp PERMITTEE ADDRESS 'J p - ��r t;7h [ //�� TEL. j ` / FINAL CITY lP11- 92:122� NO./C l i•: DATE l'�11 f J i T ✓_ L %IAKE C.HEC KS PAYABLE TO: FEE $ FEE-."$ HARVEY T. BRANDT, COUNTY ENGINEER ��' r r PLAN CHECK VALIDATION CK. M.O. CASH ® P IT,VALIDATION CK. M.O. CASH 3 AUG30 1 D 4 2.004 76A638A CE x1803 12/72 1 76A696A CE#6092/60 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST / WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DIST5,4;T N GROUP TYPE P CES IjY FOR APPLICANT TO FILL IN 6 � T__ CONST. . (` BUILDING / STATISTICAL CLASSIFICATION EBWKR MAP G ADDRESS // �' '' CLASS.NO. / DWELL. UNITS -MAP LOT NO. -"� - t�BLOCK NUMBER ST H ATE YES USE ZONE TRACT V SPECIAL ;•� , NO.OF BLDGS. h� �� ONDITIONS �1�L7i SIZE OF LOT �-�._� I NOW ON LOT �V�I ` USE O F EXISTING BLDG. BUt ING EXIST. YARD _wwr STREET NAME qq// F-/ TEL. SETBACK WIDTH OWNERA47J /l1 /'f E /lUlll,j NO. FRONT �/! I r. P. ADDRESS ' ' (_ �� ! (� � SIDE ARCHITECT OR TEL. P.L. ENGINEER NO. INSPECTION RECORD ADDRESS �� J CONTRACTOR/i'll-1 5�� I'/I' I.A. r �� 0 +V�3�'" r� O / ADDRESS �i%7 -2/, �//&" ;;'?7 /L e'l,-, �/"I DESCRIPTION OF WORK O 1� H NEW ADD ALTER REPAIR DEMOLISH W SO.FT. / G NO.OF NO.OF J SIZE / 1 STORIES FAMILIES USE OF STRUCTURE SIGNATURE O APPLICAN'i� VALUATION$ / � �`I�� /'� ) APPROVALS DATE INSPECTOR'S S ATURE 7"/+A+ V^ - pMT 'C'r'G FOUNDATION: LOCATION Z3, �Z FEE $ � __ FORMS, MATERIALS FRAME: FIRE STOPS, 1 HEREBY ACKNOWL DGE THAT I HAVE READ THIS AP- BRACING, BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT, DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH, INT. - - WILL NOTEMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'S COMPENSATION LAWS OF CALIFORNIA. I� r/ LATH,EXT. SIGNATURE HOUSE NUMBER COR- PERM ITT", 'vv %I RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION .J M.O. CASH PERMIT VALIDATION CK. M.O. CASH OF ®s 76A638A , CE#803(REV.6/78) APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDINGANDSAFETY 124 FOR APPLICANT TO FILL IN ADDRESS p BUILDING ADDRESS / JOU Y Jd L c i LQCALITY NEAREST CITY Gyiy�., / ZIP CROSS ST. SIZE OF LOT 3 NO.OF BLDGS.NOW ON LOT ��•!�L ASSESSOR y g MAP BOOK' PAGE PARCEL TRACT / / DISTRICT P TYPE FIRE CESSED BY BLOCK t CONST. ZONE ` OWNER STATISTICAL•CLASSIFICATION SEWER MAP ADDRESS' �d G OL"� CLASS NO. DWELL.UNITS BK PG CITY / Q �,J./7L �i �`� ZIP ARCHITECT OR TEL. VALUATION $ ENGINEER 4 goo ADDRESS 0v BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) CONTRACTOR NO. HIGHWAY• + YARD - TOTAL SETBACK FROM TYPE OF EXISTING LIC. � .- FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. . _ LIC. + CITY CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH SIDE PROP.LINE OF � )STREET) HIGHWAY •+ YARD -_ TOTAL SETBACK FROM TYPE OF I EXISTING ADDRESS CITY. SIDE PROP.LINE HIGHWAY WIDTH 0 SQ.FT. NO.OF NO.OF CHECK + _ SIZE STORIES I FAMILIES ONE IN DESCRIPTION OF WORK NEW ❑ P•C.Fee$ Permit Fee, R ❑ w ADD-- Issuance Fee in ALTER ❑ ZE _ REPAIR ❑ Total Fee f USE OF 0�9!�— DEMOL ❑ EXISTING BLDG. C APPLICANT TEL (PRINT) NO. D J BY(SIGNATURE) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES b AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'SCOM. Z PENSATION INSURANCE. n O n SIGNATURE 0 V !1 PERMITTEE # o 0 0 0 0 ADDRESS �' ZO 2 - 2500 CITY NO. - 2500F1 UNE MAP NO 0928-78 SPECIAL t- CONDITIONS X FINAL v BY oe DATFVO -d 7d WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self ::( •A P P L I�CAT I O N �F O R' BUILDING P E RM.I T .insure, ora certificate of Workers'.Compensation Insurance, 'certified copy there of(Sec. 3800,'Lab:C.)- I l' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.—Co*mpany - 0 ; Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRIESSS PCertified copy is filed'with the county building inipec- BUILDING �?} ` - �� tion department. ADDRESS D 0 LOCALITY NEAREST Date Applicant'� CITY � t�f ZIP 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 A01/_ hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. `T— C SPECIAL I certify that in the performance of-the work for which this OWNER �/)/ /,� NO �� CONDITIONS { STRICT .GROUP TYPE FIRE PROCESSED BY O permit is issued,I shall not employ-any person in any manner ADDRESS t 0 4f.,0L1Ve 1 CONST. ZONE v so-as to be ome ubiect to the Workers'Compensation Laws. h\ Date �y. Applicant ��/V�/�N!//�/P/�/f%X// \ CITY ' P/ �� ZIP ��v STATISTICAL LA IFICATION APT. CONDO. .NOTIC T APPLICANT:. If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject' to the'-Workers'- y Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP z with comply with such provisions- or.this*permit shall be deemed revoked: . CONTRACTOR NO.. BK. ''PG, VALIDATION LICENSED:CONTRACTORS DECLARATION• LIC. 1 hereby affirm that I atn licensed'under provisions of Chapter 9 ADDRESS. NO. VALUATION (commencing with Section=)'of Divisiori 3 of the Business and LIC. !sf Professions.Code, and my license•is'in.full.force and effect.' CITY CLASS $' `ti 0 J SQ.FT. NO:OF ' NO.OF CHECK ,• License Numbe' -- Lic..Class SIZE STORIES I FAMILIES• ONE wl Contractor Date DESCRIPTION OF WORK NEW I am exempt unde'r.SeCL �, LOA ` V ADD ALTER FINAL B.B,P.C. for this reasonREPAIR DATE USE OF- Date:Date: EXISTING BLDG. DEMOL Q By Signature APPLICANT TEL. OWNER-BUILDER.DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License. Law for the following reason.(Section 7031.5, Business and ADDRESS C� 1 9 4.3 A Professions Code): PRESENTBUILDING , ':l, as owner:of the'property, or my employees'with- ADDRESS. wages as their sole compensation,will do the work and .•'' the structure'is not intended.or offered for sale(Section LOCALITY 2. e o U.9.'8-8 7044, Business and Professions Code). MOVING TEL. 1, at.owner of the property;am exclusively contracting CONTRACTOR NO. o . _ " with licensed contractors to construct the project (Sec- ADDRESS oa G.9�s8� tion,7044, Business and Professions Code).;• 051 2-83 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK. YARD HWY PROP. LINE WIDTH I hereby affirm that there is d construction'lending agency for FRONT -. the performance of the work`for which this permit is issued P.L. Sec.3097, Civ. C.). SIDE" .. o P.L. Lender's Name •, ,• �� _ . aP.C.Fee$ . Permit Fee Lender's Address 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 g ordinances and State laws relating to building construction, Total Fee / �• 9 dnd hereby authorize re resentatives of this County to enter upon the bove-me n operty for inspectiori Pur ase . > 1, u SEE REVERSE FOR_EXPLANATORY LANGUAGE gnature of&,cant or Agent'. WORKERS'COMPENSATION DECLARATIONr I hereby affirm that I have certificate of consent to self � r P L I� T� FOR' L�I L®I IN PERMIT insure, or a certificate of Workers'Compensation Insurance, ora certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company „: _ v I copy v FOR APPLICANT TO FILL IN aBooRl=ss off- Certified co is hereby furnished. 50 Certified copy is filed with the county building inspec- BUILDING �j ' r tion department. ADDRESS 9610 53 C)/J V LOCALITY t NEAREST Date Applicant CITY f-e.%,L / C T ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT O yC/ NOW ON LOT MAP BOOK PAGEPARCEL (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. I' TEL. /J SPECIAL 9 I certify that in the performance of the work for which this OWNER {� i�r•n i NO. CONDITIONS d permit is issued, I shall not employ any person in any manner 1 ISTRICT GROUP TYPE FIRE PROCESSED BY U so as to become subject to the Workers'Compensation Laws. ADDRESS U J2 CONST. ZONE ns CIN 7,e-+� t�.T ZIP f O Date Applicant ARCHITECT OR TELSTATISTICAL C SIFT TI APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of . Exemption, you should become subject to the Workers' ENGINEER "07 a.-� NO. CLASS NO. _D ELL. UNITS u! Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR L.�t• Cv 1.NO./Z f3 1'70 17 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION __ nn LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS S 7 y�'&172 /20-- NO.36€3'- S`0 VALUATION (commencing with Section 7000)of Division 3 of the Business and C LIC. c��p Professions Code,and my license is in full force and effect. CITY r G.,ki.ni<I C.; . CLASS1-3-1 $ / h' SQ.FT. NO.OFNO.OF CHECK License Number300 —4 Y' B Li..Class 13 1 SIZE STORIES FAMILIES ONE '�/f o NEW $ Contractor(%/V&Qv.:.,cC �v:�s%r. Date / —1�' 162 DESCRIPTION OF WORK �X%t d I�f ❑ Ell am exempt under Sec. A o a COV rrr- ADD ® ' ALTER ElFINAL ' • ' B.&P.C. for this reason C REPAIR ❑ DATE R. -4 f�'� Dat USE OF FINAL EXISTING BLDG. Si I-st..,r DEMOL ❑ By Signatur APPLICANT TEL. OWNER-BUILDER DECLARA ION PRINT Jcc �!v �+ NO. 7--7c-72 1 hereby affirm that I am exempt from the Contractor's License fjJ. j Low for the following reason (Section 7031.5, Business and ADDRESS nvt r72 Professions Code): PRESENT 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 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 FROM EXIST. 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. tSec. 3097, Civ. C.). SIDE m P.L. v Lender's Name " , Lender's Address P.C. Fee$ Permit Fee ZZ 3 I certify that I have read this application and state that the Issuance Fee n-5v above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee and hereby authorize representa' es of this County to enter upo�above-mentio d pro r y for inspection purposes. f -2-4(e- 0 2 SEE REVERSE FOR EXPLANATORY LANGUAGE Sinnnfure of Aaelieant nr Aaent Date ®S WORKERS'COMPENSATION DECLARATION �I fes! a irm that I have a certificate of consent to self insure,or acertificate of Workers'Compensation Insurance, APPLICATION F BUIL®INC P E RMI T 1, or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ copy y FOR APPLICANT TO FILL IN BUILDING SD Certified ca is hereby furnished. , = ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING �D �L tion department. ADDRESS / 1 C � Date Applicant CITY `(G /// ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST SIZE OF LOT �O X /�10 NOW ON LOT ' CROSS ST. COMPENSATION INSURANCE (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 /yN�/�L /Li1�5//U O. jwy USE ZONE MAP I certify that in the performance of the work for which this _ / NO. �® permit is issued, I shall not employ any person in any manner r r, 7 I/ SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS �J 0! QL/U/ s CONDITIONS �O i Date Applicant CITY f�L /% ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT I GROUP TYPEFIRE PROCESSED BY O ENGINEER NO. CON51 ST. ZONE t; Exemption, you should become subject to the Workers' G _ am Compensation provisions of the Labor Code, you must forth- ADDRESS �V 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. a NO.OF NO.OF CHECK License Number Lic.Class SIZE / STORIES FAMILIES ONE VALUATION DESCRIPTION NEW Contractor Date DESCRIPTION OF WORK '/ �U ADD ❑r. $ ❑ I am exempt under Sec. , ALTER ❑. B.BP.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL EXISTING BLDG. Signature + APPLICANT TEL. FINAL i OWNER-BUILDER DECLARATION PRINT) NO. DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL � / Professions Code): BUILDING /� IINA o ` � TG y/7 I, as owner of the property, or my employees with ADDRESS i wages as their sole compensation,will do the work and O / the structure is not intended or offered for sale(Section [ADDR LITY 7044, Business and Professions Code). NG TEL. ® / ❑ I,as owner of the property,am exclusively contracting RACTOR NO. with licensed contractors to construct the project (Sec- ESS tion 7044, Business and Professions Code). UIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for NT Y the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). E s o Lender's Name ° LDMA Ref. # Lender's Address ee$ Permit Fee //xI certify that I have read this application and state that the Issuance Fee CJLDMA P/C.# above information is correct. I agree to comply with all County igation Fee ordinances and State laws relating to building construction, Total Fee i s-0 LDMA Perm.# and hereby authorize representatives of this County to enter 3 upon the above-me t+ property for inspection p rpo s. o /( , SEE REVERSE FOR EXPLANATORY LANGUAGE Signature a icant or Agent ate