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HomeMy Public PortalAbout9024 PENTLAND ST_Building__ 76A638A CE 9803 12/69 APPLICATION FOR, BUILDING- P IRMI`T_` U fl COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGEPARCEL- ' BUILDING AND SAFETY DIVISION BUILDING ' JOHN A LAMB]E, COUNTY ENGINEER ADDRESS D N"r•i COLEMAN W JENKINS, SUP T OF BUILDING LOCALITY f FOR APPLICANT TO FILL IN NEAREST I T h' Print or tvDe onl CROSS ST ITYPESF BUILDING q DISTRICTON GRO P CONST PR Sr�D B I ADDRESS 9 L E a d ./ L'--� STATISTICAL CLASSIFICATIONI SEWER MAP LOT NO BLOCK ( CLASS NO _DWELL UNIITS_ 'BK PG TRACT f USE ZONE MAP 0 NO OF SLOGS NO 1 SIZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING NBLDG LI 1 OWNER. -Elmer L. 89 - . ell No - - pBLDG SETBACK FROM ' ADDRESS} PFRONTPROP LINE OF _ ISTREET T` NTYPE OF EXISTING SETBACK I HIGHWAY } YARD = TOTAL CITU rKy . (HIGHWAY WIDTH FROM C L ARCHITECT OR , TEL } _ ENGINEER t Y NO (BLDG KFROM ADDRESS SIDE PROP LIN (STREET) TEL TYPE A EXISTING SETBACK WAY }. 'YARD = TOTAL CONTRACTOR NO _ HIGHWAY WIDTH FROM C L ADDRESS 52 9 E Valley No 18 _ + _ " O LIC U CITY � CLASS r._I q CORNER CUTOFF YES ❑ NO ❑ � CONSTRUCTION LENDER O NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS W ADDRESS y SO FT- NO OF NO OF El ? SIZE STORIES FAMILIES NEW USE OF ADD ❑ STRUCTURE Re-roof (larage I ALTER ❑ _ " 11 9 SIGNATURE OF REPAIR`,© , APPLICANT DEMOL /❑ VALUATIONS 448 . 00 r APPROVALS DATE INSPECTOR' sISHATURE PC PMT FOUNDATION LOCATION FEE SFEES FORMS-MATERIALS FRAME FIRE STOPS HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS SANG !TATE THAT THE ABOVE 13 CORRECT AND AGREE,TO COMPLY FURNACE LOCATION WITH ALL ORDINANCE! AND LAWS REGULATING BUILDING CON- GAS VENT DUCTS STRUCTIOH I CERTIFY THAT IN DOIN HE WORK AUTHORIZED ' HEREBY I WILL NOT EMPLOY AH P !ON 111 VIOLATION OF THE LATH INT LABOR CODE OF TME ♦ F ALIF RrN♦ RELATING TO WORKMEN 9 COUPE NBA O IN A C! 'f-f(YA/i//Y/I-NY////J LATH EXT E SIGNATURE F I HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS—5 9 T_e7 Q l ...I ! !` 4. -��E:V� �l v d S di�a-av FINAL Ll 7 p JOHN F LEWIS PRINCIPAL M O ST C AL ENGINEER MIT PLAN CHECK VALIDATION CK M O DASH _ PERVALIDATION CK CASH • 1 u1Go "s 5'7, NOV 4 1 D 9 00— v Iv 1 _ iaweaeA Oes a la w APPLICATION FOR" BUILDING PERMIT 1 DIVISION OF BUILDING AND SAFETY BUIiDINa��� J Dep�tmeat of Couatp Eaglaoer ADDRESS AagYtYB LOCALITYI�/�/W�/J_/moi WM `J FOX COUNTY ENGINEER h� CASSATT D'GRIFFIN SUP T Or oulLowa NEARESTCROSS �i(.Q_/L FOR APPLICANT TO FILL IN DIS TRI TNO GRQup nPg C71SEWER MAP /� U'OJ' BK PG ADD EBUILDISS %V �( 7 C jM// Gjlh �C CONST '��; MAP STATE - ♦ r NUMBER HWY LOT NO I BLOCK` USE ZONE SP CIAL - TRACT,-/ - CONDITIONS c� 3 10' NO OF SLOGS y 000 SIZE OF LOTS✓ O- NOW ON'LOT -fes BUILDING ygRD HWY STREET NAME EXIST USE OF r SETBACK _ WIDTH EXISTING BLDG v-. A d FRONT P L OWNER` I U 9 v (SIDE MAIL IP IP L ADDRESS Yvyl , TEL _ h %� ARCHITECT O;R t DWELL 1 UNIT 5 INDUSTRIAL CIT TE !/ V 2 DUPLEX=UNIT TEL 6 PUBLIC BLDG ENGINEER NO g !APT'- UNITS 7 ADDN SALT ETC ADDRESS i 4 COMMERCIAL e 8 MISCEL' TEL �e CONTRACTOR �/ . NO INSPECTION RECORD ADDRESS- DESCRIPTION OF WORK t ' NEW .ADD 00 ALTER REPAIR `DEMOLISH' 'I' - GOFT !7 O!\ NO OF , / NO OF SIZE `/-A O STORIES FAMILIES _ USE OF STRUCTURE /J ....J_ � CJJ/ILO'C/LLrO�J.FSAN YI. ®�.r7 n.,.� 1 /y�-L:/L^,'✓h!w'f�{/ /y,7n�1�2.w/ SIGNATURE fi�F L _ APPROVALS ADORESS DATE INSPECTOR S SIGNATURE ' FOUNDATION LOCATION r ��� � " I C _� FORMS MATERIALS 3 c�.�ST 1111 r� ` rt� FEE - 1 tl ' FRAME BOLTS S ve VALUATION -FEE FURNACE LOCATION' ' I HEREBY ACKNOWLEDGE THAT 1 HAVE REAb THIS GAS VENT DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT ' AND AGREE TO COMPLY WITH-ALL COUNTY ORDINANCES ' LATH INT 5 15 i TAND ION STATE, LAWS REGULATING. BUILDING CONSTRUC- LATH EXT SIGNATURE HOUSE NUMBER COR- V (" PERMITTEE v`'r �� ERECT AND POSTED f 'ADDRESS r FINAL Wlk- J. FOX: CGUN E6GZN a VALIDATION , 4 BY '&IY3�0 2r, "MAR 9 1 8 fl 0 in IDEPUTY+J. - - DEPUTY By A By ` a _ ; f lam- _ ✓� �- ® 4 k DEPUTY' 'Y _ DEPUTY ( '.Temple lclty + 7�'',.! AE.+Ac,e,Xz,,-APPLICATION FOR BUILDING, PERMIT T• °' + ..� COUNTY OF LOS4ANGELES =4 , BUILDING - DEPARTMENT OFICOUNTY ENGINEER. ' • fi ADDRESS }° 'R•+_~BUILDING AND SAFETY DIVISION' f LOCALITY, ' �T , `.JOHN An LAMBIE COUNTY ENOIH'c ERp a�, t NEAREST \' .WILLIAM A JENSEN SUP T OF BUILDING \ CROSS'ST S ' s c , ^'DISTRICT N TYPE ,i ;;FOR,'APPLICANTJ,TOJFII FaX IN coNsr 4 µ _ ADDRESS' I .U� �� '�`L'ra ' l� + •r' STATISTICALCATION Panilarid _ SEWER MAP _ ' r ' '» ,CLASS NO DWELL UNITSi 1 - `' BK S• PG LOT NOK '1"1' t '.F . ?•.J _ v BLOCK I WATERJ l f • r - L_ ;"� ,xn •b. { t¢,I� , L •.A' }} CERTIFICATE `v NOT,REOUIRED �i It. RECEIVED t Y k J TRACT• = v .Y''\" -K Ir,MO r0 'F'•? "' ` _Xe IMAPtf 'HIGHWAY STATE MAJOR SECON D LOCAL FBLDGS SIZE OF�LOT?'L',', - -�IND NOW ON'LOTZ T NO O / ICIRCLE)• . _ , �' USE ZONE SPECIAL ,S- USE OF r r ^'- .` - ' . q h '.j' ' ` nCONDITIONS, EXISTING BLDG' .+{'r . vfl'a,�. J1 �/ r i v r 'i v e , ,r JT_ " TP i' y'p/ it al`s 1 a. r _1•1 ,J i" ~ r,x OWNERr NO BUILDING - ( EXIST , YARD HWY♦ STREET NAME ` '• - SETBACK ,WIDTH ADDRESS ` '• ,L J' FRONT ' ARCHITECT OR \_ EL t r , P L �k 'NJ I 'r• p' ENGINEER'I ' r. f~ ,NO" 1 ySIDE+ L ADDRESS - }r L T _ • _ L CONTRACTOR i \ T_ TEL U JADDRESS , ' ValleyO -.,-'DESCRIPTION OF WORK- NEW ORK NEW ADDI I ' ALTER ' REPAIR` _DEMOLISH ' - a N Z SO FT "Y NO OF, NO OF ' I; '" =A •� / C SIZE >a' + A ' '•:STORIES ' FAMILIES _. J` ♦ - USE OF ! V ' A [ _ STRUCTURE Yr I , SIGNATURE O A 2 .FAPPLIICA i ,VALUATION 5,91 OO L• - r,`- •• i y - . - :, r •APPROVAL'S DATe INSFECTOR S SIGNATURE PC - .PMT ♦ 1FOUNDATION LOCATION FEE $ �'•- -r ''1 'FEE E t0O --FORMS MATERIALS FRAME FIRE STOPS- ( - (' I HEREBY ACKNOWLEDGE THAT") HAVE READ THI6'APPLICATION 1 1 BRACING BOLTS' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION t{ l WITH ALL COUNTY ORDINANCES 'ANO STATE LAWS REGULATING ' p GAS VENT'DUCTS, ,BUILDING CONSTRUCTION 1 CERTIFY THAT I • DING THE WORK ' • L ' AUTHORIZED HERESY WILL�NOT EMPLOY Y RBON IN VIOLA TION"OF THE LABOR CO CIO TH TE FIC LIFORNIA RELAT 'LATH INT y j JI li S • , .y ' �ING TO WORKMEN SCO EN TIO I C • { LATH ,EXT t' f SIGNATUR F HOUSE NUMBER COR _ PERMITTEE , I RECT AND POSTED _ ' }=p DD RE Ss29 E. TfAllbi Blvd, p .S dIIG FINAL- A, r '( n 'c� a° r.s' ' • ­ ' t v JOHN'F LEW} PRIIN IPAL TRU RAL ENGINEER N I• c. PLAN CHECK VALIDATIO ' CK ' M o EAB.' Y { PERMIT/VALIDATION ` cK M o ^ DASH` +�Lt y �•' ~r. ,Iz"`�y ="•r�, .,` V: La:�.<'-.9�;0'5' iSEP27',�;1 -Dr '.I r6;OQ^'' Z-la ''h '' TIS� �' ( f ♦ _ I , �• \(J JT ♦ 1 _ L 'f4 WORKERS COMPENSATION DE[LARATIGI ' r cer fica have o cartihcote of consent to selfAPPLICATION FOR BUILDING PERMIT cerehcate of Workers Compensation Insurance d opy Thereof (Sec 3800 L�T f(/AP COUNTY OF LOS ANGELES "i BUILDING AND SAFETY4 &o77 CompanyBUILDING ified copy is hereby furnished - FOR APPLICANT TO FILL,IN �t ADDRESS 0 Certified copy is filed with The county building inspec� BUILDING p tion department u ADDRESS 02 CL! ' tt Data IG t1 Applicant ✓�n5 (�/YrA�C.. (�G Clir ` 1 � T ZIP LOULITY " CE 11FICATE OF EXEMPTION FROM WORKERS NO OF BLDGS NEAREST - ^ COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST �. (This section need not be completedilf the permitis for one k ASSESSOR 1 i hundred dollars IS 100)or less )' t TRACT . BLOCK LOT NO MAP BOOK PAGE PARCEL .F TEL b USE$ONE T ' I certify that In the performance oi,the work for which this r OWNER A41 IM NO �7 O r/l/ NO ' permit is issued I shall not employ any person m any manner 7 SPECIAL so as to become subject to the Workers Compensation Laws} >n AOORE55 !l ' I CONDITIONS i q �y Date Applicant CITY ZIP NOTICE TO APPLI •ANT If after making this Certificate of ' ARCHITECT OR TEL DISTRICT GROUPTYPE FIRE ' SSED'BY Exemption you should become subject to the Workers NGINEER' NO �s— CONIST , Compensation provisions of the Labor Code you must forth' ADDRESS 21(/W� gj • with comply with such provisions art this permit shall'be, TEL STATISTICAL CLA551 (CATION > ,. /%t: AFT CONDO deemed revoked - CONTRACTOR ANO LICENSED CONTRACTORS DECLARATION ' v LIC CLASS NO "IDWESL UNITS— ` 1 hereby affirm that I am licensed under provisions of Chapter 9 - ADDRESS IfiO WVG NO'S f5' ' (commencing with Section 7000)of Division 3 of the Business and u LIC SEWER MAP Prof-eIs;Ions Code fond my license Is in full force and effect CITY CLASS � BK ., VALIDATION 7. B` p_ q, SO N t40 OF O OF CHECK d L¢estSe Num er is _ ass y_ . SIZE STORIES F IDES - F� ONE I O n ., �. _ ' t 'VALUATION ' U Contractor Dates ��� DESCRIPTION OF WORK NEW 3 '6,D ttU Ov am exempt under$ec' ALTER,s B 8P C for this reason r _ - EPAIR f t 7� Is C ^ USE OF L Ln Date EXISTING BLDG �M« ACCT.r Z 4- -c ) APPLICANT TEL Signature PRIM " ' FINAL NO aa07 ii� `5 7 p9 r , ' - '1' OWNER BUILDER DECLARATION DATE ��� vtt ,' I hereby offirrrt that I am exempt from the Contractors License ,;,-♦` .L ,,. 11� - 1 ITEMS rLow for the followmg reason (Section 7031 5 Business and , ADDRESS ` FINAL V Professions Code) PRESENT !� / _ BY 1CIl ALt a vc BUILDING 12 14A /L7 W�N S(� � r �s I as owner of the property ori my,employees with ,r ADDRESS �y _ ♦ CHEGk LyJ 1.�S wages as their sole compensation will do the work and 4 t r:' w t the structure is not mtended or offered for sale(Section - LOCALITv (] /0 Y t' , CHANat 00 7044 Business and Professions Coda) I I MOVING s TFL %io CONTRACTOR NO / I I as owner of the property am exclusively connecting r + with licensed contractors To construct the project (Sec -7a5 ui =1, i r t .7 non 7044 Busmessiand Professions Code)' ' ADORE �7 �•' " ,I - 1 ,ri cN D 0000 Vila1 ,7/ 144] REQUI + TOTAL SET .�> y CONSTRUCTION LENDING AGENCY SETBACK YARD HWY ; PROP LINE _ WIDTH t _ _j tp'� ` 12JC 1 'I'L 111;1�� I hereby affirm that there Is a construction lending agency for FRONT C _ s \s the performance of the work for which this permit is issued P L . (Sec 3097 Gv C ) ' - SIDE - r_ -r L1 c I r.l 3"'. P L . ' "` A,' , i FS ST j Lender s Name �, .[.1t ' ? } _ LDMA Ref Nz�t I x N r R t r P C Fee f Permit Fee J•I a�' 7� C TT't> - ~ y1"• "t ` Lender s Address t C7 -- ' certif that I hove read this application and state that the , , y pp Issuance Fee DMA P/C Y above information a correct'I ogre to comply with all County Investigation Fee qq ""-` c ` Y✓. '� - ordinances and State laws rata to building construction (' Total Fee Z �"�/ TDMA Perm IT 1 t and hereby authorize represent es of this County to enter S upon the abs e-mentioned r y for inspection purposes f..... 4* 77vy ms's 3 3 r.t ^ OA E = i ' L fE!RlVBtSE FON iXPLANAl Y AGE /_ Z u 3�- •-0 �� C T .v 1 /7, /O SS ure of App Lcont or ant Date < t o / z t �kty],_ j , 1 > i LVGOMPENSATION DEClARA710Ne of WorkenrtComeensotoo�nsurdne'f APPLICATION "FOR BUILDING PERMIT ereof (Sac 3800 Lab'C ) r" vCOUNTY OF LOS ANGELES BUILDING AND SAFETY Company t Cerhfiedlcopy is,hereby furnished - t FOR APPLICANT TO'FILL IN BUILDING ' Oa s ADDRESS Certified copy a filed with the county bmlding.mspec' 's� BUILDING - hon department ` ' ADDRESS N y Date . `1' • r Applicant ., CI ZIP LOCALITY t� '`CERTIFICATE OF EXEMPTION,FROM WORKERS '--� - s - NO OF�BLDGS +. s NEAREST , COMPENSATION INSURANCE r SIZE OF LOT NOW ON LOT CROSS ST- ASSESSOR T- , (This'sechon need not be completed rfkthe permnru for ane -• TRACT BLOCK LOT NO ,qp BOp(,s 1 PAS , PARCEL f.n� hundred dollars ($100)or less ) - , EL NO I'cerhfy'that in the performance of this work for which this OWNER - 4 L O USE ZONE - permit is issued, shall not,employ any perrwnfln any manner +f Q SPECIAL solos to become sublect to,the Workers Compensation Lows ADDRESS 5 ,�0l3 - CONDITIONS e,-, Date CITY s _ ZIP OJ 1 C APPII ARCHITECT OR / TEL _ DISTRICT GROUP TYPE FIRE r SED BY c O NOTICE TO APPLICANT If of ma ng this Cerhf ate of ENGINFER f N� �t Exemption you should become bled to the, crkera CONST - ZONE F Compensation provisions of the�Labor Code, you must forth ADDRESS W �/' _3 r r with comply with such provisions or this,peimlt shall be _ s• _ r D_s deemed revoked s , TEL STATISTICAL CLASSIFICATION APT CONDO ,N CONTRACTOR NO Z ! LICENSED,CONTRACTORS DECLARATION ._---LIC�, a CLASS NO DWELL UNITS_ I hereby affirm that I om licensed under provisions of Chapter 9 ADDRESS ._SS NO _ (commencing with Sectiori 7000)of Division 3 of the Business and I I I LIC ,_ SEWER MAP Professions Code, and my license Is In full force and effect CITY CLASS -...BK PG r vY VALIDATN s, �_ FO SO*FT NO OF NO OF' CHECK 'License Number Lic Clan} r VALU s SIZE �� l STORIES FAMILIES ONE ATION ? , ° + DESCRIPTION NEW + Contractor Dote WORK .1 1 111 v ' ❑ I am exempt under Sec r ` TER B&P C for fhbw �rean h I REPAIR v ] 1 ` Date U OF E7YL $L R'T71'ROO/h, _ ° Signature "• APPlIG4NT "LN TEL PIHAL pq t �"f�•}L( Os' , 7 OWNER-BUILDER DECLARATION ' PRIM I -` NO DATI �'�r)_U'/, r ' I herebyaffirm that I am exempt from the Contractor's License % t is Law fothe following reasoni((Sectidn 7031 3, Businiss'und - ADDRESS Fi " FINAL �yy/ ,,-✓ .". 2,1 fl 6.3 0 , Professions Code) _ ,•,,; - - - -s~; - - By, �',w� .,- ,jo,9 2,2 $$ s BUILD n I, as owner of fhe.properry, or my employees with, ADDRESS 'twages as their sole compensotlon,will do the work and { ' the structure Is not intended or offered for saleSection CITY *7044, Business and Professions Code) sale( ` MOVING' ' - -• - >• TEL :- "' ��,.Y . �~ • . _ 1'_ 1, as,owner of the property, am exclusively contracting TR^ NO s with licensed'controctordto construct the project (SecI s r tion 7044 Business and Professions Code), , ADDRESS ` I REQUIRE CONSTRUCTION LENDING AGENCYSET BACK ARD✓ Hwy 'AL OP LINE IDTH I hereby off mi that there is a constructlon,lending agency for, FRONT she performance of the work.fouwhich this permit Is Issued ,r'" -P L'-� (Sec.3097 Gv C ) s SIDE Lender s Name --e - �J p `CDMA Ref=X ' Lender s Address P C Fee Perm ` - infee t I certify that I have recd this apphcahon and stole+that the, _ lauonce Fee "V LDMA P/C X ; 'v oil, t + _ above information ,s correct 1 agree to comply with all County Invev,ga onFee y K 'ordinances and State laws relating to building construction, I , R 'ordinances outhonxe re'presentatwes of this County to enter 'w` Total Fee LDMA Perm Y upon the above mentioned property for Inspechon purposes • ' r +y. 4s s.,` ri p, ..: `',Jr .:J ''•, !v . 'to -�+(��R s •+a`�1, ^�I�C� l / C,�j J r•' +SEE REVERSE FOR IXPLANATOIIY LANGUAGE ,Sg/olre of,Appl,com or Ag t . 'f—,''ate— Z,,L ' i X14. j 'WORKERS COMPENSATION DECLARATION ,�_r -.-- - tert,that haver cenCome ns consent to self APPLICATION-FOR- 13 UIL®ING PERMIT 'aa.certflc_te of•Workers,Compansahon Insurance d copy°thereof (Sec 3800 Lab.C ) 40/� v - w c m „ •. _ q- +. COUNTY OF LOS ANGELES- — - -BUILDING AND SAFETY _ RPol, ^ a s, t `Com n .S •, t P'f y y� Certlfiedjcopy Is haraby'furnished �� y ,? I FOR APPLICANT TO FILL IN ADDRESS - �(j�(_ Certified copy is filed with the county,building lnspec- BUILDING.' tea} rtion department - n. « ADDRESS ILL U/a'/ /^�•"' �t ,+ Date t. 'L" 'l icanf �'' �' ' W t- c La C14, G _ `ZIP . - LOCALITY• / - �.- _. ..,.,,xr f 'APP , a_ _ NEAREST, _ ' CERTIFICATE'OF EXEMPTION FROM WORKERS SIZE OF LOT` NOW ON LOTS " r T -"' CROSS ST t - 1^ COMPENSATION INSURANCEASSESSOR (This section need not be completed ,f'ihefperm It°u for.one TRACT BLOCK - LOT NO -- - ' MAPROOK hundred dollars ($100) orders )`10 " t TEL « - v ,` OWNER r- o _ mUSE =� MAP _ .T-•v " a ' el certify thaton'the performance of the work for which this ♦, c c z SPECIAL- = - } Permit Is issued, I shall not employ any person m any'manner ADDRESS--+ Q•'L G i - CONDITIONS µ t ~ �� a Iso as to becoriWsublect'twthe,Workers Compensation Laws c O s ' '. �` 3 _ "s ' s •- CITU _ _ L -.ZIP _ r `°•- , _ .\ ,,,, } U " *Date -Applicant a a r, ARCHITECT OR . TEL I \-- i ' e K NOTICE TO APPLICANT If, after makinglth,s+Cemfnate of - ENGINEER , - O _ D TBVCf GROUP_ TYPE FIRE s D BV. O (Of C �[pNE , U Exemption yow should become'subject ' 1he3Workers - _ rg . r iS Va " Compensation provisions of,',ihetLabor Code you must forth= ADDRESS �f W ,with comply,wlth'such prov,sco s or,this permit shall be r • N (l��U S 0 79�� STATISTICAL C CATION CONDO deemed'revoked n v , t , r CONTRACTOR 6 '' •a te -., O � s z w. o. LICENSED CONTRACTORS DECLARATION q� LIC CLASSWO 'DWELL UNITS_ _ ,1 aW I hereby affirm that I am licensed under Provisions of Chapter 9 ADDRESS v � L �/UVL NCO _n SEWER MAP (commencing with Section 7000),of Division 3 of the Business f LIC ,and Professwns Code and my,llcense Is In full force and effect _ _ CIN ^"' ' CLASS BK PIS ' VALIDATION'~' ' t �'�.z ' r _ SO-FT O OF , O OF CHECK , • License Number ILS 7 L,c Class SIZE- STORIES FAMILIES. ONE f, at �+...�r ,� _ - _— VAL TIO �1 a ''' � . ✓ -Contractor U) S_ rte// Data `� ; DESCRI ON Of WORK « ❑ ❑I am'exempt under Sec ALTER ❑ '. _ + .i r, .f -,r B&P C for thrs reason` c - 1 REPAIR ❑ $ USCG •. _-'_ -. ,_, l EXISTING BLDG v ..-' - s DEMOL ❑ h t', S, nature' FDECLA�RfATNtr 3 e APPLICANT ^TEL G g OWN"-BUILDE , (PRINT) ` {T/ � l NO' I�IO-/�1,j O FINAl hereby affirm��t}�at lansexemor's Ucense h,�Low'for 1h edUl lowing region usmen and ADDRESS O iV•- 6'E /IY� .FAL�-Pz' ...•°J�\ 1 ' Profeulons Code) • "" _ ESEFTf , - - .n _ F By BUILDING Y_ t _ '� , ^•�= - y- - ❑ ), as owner of the property or my employees"with ,+ ADDRESS ` �„�. j , f jl 't pCCT.T •"'a' " wages as their sole compensation,will do the work and'` -" - -- r- - _ --•• - e } ` p the structure is not intended or offered for sole(Section r +�' i77,' , 'b,u.GJ 7044, Business and Professions Code ) - ., - _1'- MOVING _ _ ., TEL .._. .�•_ , ._T.-_"i . r, (• 1-ITEM ❑ I, as owner of the property am exclusively contracting CONTRACTOR � _ ' O J . " e e -' With licensed contractors to construct the project (Sec` ' ADDRESS - - "" .}-- - " - - -'� !p-".��. . TATA,_ `�-6u '_ 63 . tion 7044, Business and Professions Cade) •' a , "y y >`>< n .'? .4� - REQUIRED TOTAL SETBACK FROM + IST. ``rJ+}'� LT'.tis4 \L1 \ tea' lrTGlic`,,.. `bv°:b: CONSTRUCTION LENDING AGENCY SET YARD" _HwY - PROP LINE WIDTH' y� •` s• I hereby off rim tk6t there mo construction lending agency for FRONT _ r �,f��t `\ ,q` r_� } 'y` C-H� `' I _' 00 the`performonce of the work for which this permit ,s Issued PL 1+- - - - '-t - �r -•`-f' \'- , - 1— - •. (Sec 3097, Civ C ) y _ _ ; SIDE \` � `+t: `` _`. °`�"• Lenders Name IIs, '� �� s < < 00�'t-0001; ,�5/ih/39 ""' LDMA Ref H`1'�c.. l�'f.1�:s 1 ,, ,'a4 \ /aT.' k /,y p 2 Lander s Address P C Fee$ Permit Fee ✓ , \` • • - �-5" ,S,3y-j •'i,.e', f111,c]:14• o fI certify that haveread th,s,apphmtion and state that the Issuance Fee -.- LDMA P/C p , \ '• r� , 8 above Information Is correct_I agree to c ply with all County Invest tion Fee _ * - _ ' ° ,,•, If $ ordinances and State laws relating to u ding construction - Total Fee C� LDMA Perm-R ' `j ."\ ,t y } gg and hereby outhorize representative ,of Is County to enter _ _ k ,3. upon the'abov'e-m phone C?er ns ct,on ur ores 'N' "• -v « / " ' 33 - P v Pr _J Pe P P ,^"i �• e � i;' l/ _ _SEE REVERSE FOR EXPLANATORY LANGUAGE natu hcanf or Agent Date �s , - > ¢a: - l 1♦ _ , • ',• , x w 1_ r I • Y WORKERS COMPENSATION DECLARATION _ hereby offvm that have a certificate of consent to self . APPLICATION - FOR BUILDING PERMIT ' insure or a certificate of Workers Compenstian Insurance or ` a certified copy thereof (Sec 3800 Lob C ) __ __ _ T COUNTY OF LOS(ANGELES BUILDING AND SAFETY Pol,fycNo20-412-1OCt�n]pany Argonaut" Ins. Certified copy is hereby furnished' I `•• — - FOR APPLICANT TO'FILL-IN- - ADLO DRESS ® Certified copy is filed with the'county building mspec BUILDING - lion department ADDRESS- LOCALITY Date 11-1-83 ApphcontHoward L. Randol Co. CITY .Te le Cit -ZIP->91780 . - - CROSSSST ' CERTIFICATE OF EXEMPTION FROM WORKERS ' NO OF BLDGS ASSESSOR ` COMPENSATION INSURANCE SIZE OF LOT _ -NOW ON LOT MAP BOOK PAGE PARCEL r (This section need not be completed if the permit is for oneUSE ZONE+ MAP S _ hundred dollars ($100)or less ) TRACT BLOCK Lor NO NO �-- T f iEL 'SPECIAL Il I certify Ihot in the performance of the work for which this _ OWNER Leta Hiel No286-8900 + - CONDITIONS O permit is issued I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY V so as to become subject to the Workers Compensation Laws ADDRESS a d _ / CONS 3E , O Date 12-29-82 ApplicomHGward L. Randol Co. CITY ZIP STATISTICAL C 4551FICATION / AP CONDO V ARCHITECT OR - - _ TEL NOTICE TO APPLICANT If, after making this the W Workers of -- ENGINEER - NO 'CLASS NO o1 W Exemption you should become subject to the WorkersDWELL UNITS_ Compensation provisions of the Labor Code you must forth gDDRE55 � - - � SEWER P � , Z with,comply with such provisions or this permit shall be _ r?S{ _ �r deemed revoked CONTRACTO TEL _ - • BK PG / iJ - VALIDATION , LICENSED CONTRACTORS DECLARATION ' LIC I hereby affirm that 1 am licensed under provisions of Chapter 9_ ADDRESS _ 529 E- Valle _Bl. n1O186086• VALUATION (commencing with Section 7000)of Division 3 of the Business and _ LIC S _ Professions Code and my license is in full force and effect CITY San Gabriel CLASS C-39 T 662100 SO FT NO OF NO OF CHECK ' SIZE STORIES FAMILIES ONE Lmense Number ],$60.$� Uc Class C-3f� t ' ' 1'- NEW Ren liar Dft iDO S n ConlractorHnW2TA L .--�-a—�9Q2' --- DESCRIPTION OF WORK - - 1 am exempt from the licensing requirements as I am a _ yroofhouse -witb EnADD- licensed architect or a registered professional engineer - i _ ALTER Q FINAL acting in my professional capacity (Section 705 - shingle I2%l8.-' -•" r ' REPAIR ® DATE 'Business and Professions Code) _ USE OF EXISTING BLDG DEMO By ' —'" DEMBT NAL( ' _ Lic or Reg No Dale ^ APPLICANT TEL ►'-^+-� - + OWNER BUILDER DECLARATION (PRINT) flni 'T.- -R;FTn,`lo1—CoM)-988-40 n, 1 hereby affirm that I am exempt from the Contractor s License , 1� Law for the following reason (Section 7031 5 Busmess,ond - v ADDRESS- - ,r�T�.r Professions Code) - PRESENT • I as owner of the property or my employees with ' ADDLDING-RESS - �' - 818 31A wages as their sole compensotion will do the work and i I the structure is not intended or offered for sale(Section - LOCALITY - - - - 7044 Business and Professions Code) MOVING A TEL s .. 00 as owner; the property ram exclusively contracting ng " CONTRACTOR - NO 2r• 2.a with license d�Tontractors to construct the project (Sec- t ta'� `�8 0 0 M tion 7044 Business and Professions Code) - .� ADDRESS _ _ _ - REWIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY L PROP LINE WIDTH 0 11' 0 6-83 -• hereby affirm that there is a construction lending agency for - FRONT '+ the performance of,.the work for which this permit is issued PIT (Sec 3097 C,v C ) - -SIDE---- PL f Lender s Name $ 19.50 Lender s Address P C Fee 5 - Parmn Fee r w I certify that I have read this application and state that the Isswn<e Fee _ above information is correct+l agree to comply with all County- Invesogonon Fee ordinances and State laws relating to budding construction Total F, r a and hereby authorize representatives of this County to enter T Q upon the above-mentioned property for mspedtion purposes• ' ' , 1 ' `yL•d '��� �r�i - /'AYE. -SEE REVERSE FOR EXPLANATORY LANGUAGE J=/Signomre of App¢ant or Ageni Dole