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Home My Public Portal About4837 RIO HONDO AVE_Building__ 76A638A CE 71803 12/89 *"11ON' - APPLFORBUILDIN .:'ERMIT fl COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING (� JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY rI FOR APPLICANT TO FILL IN NEAREST Print or tvne onl CROSS ST. nC f BUILDING DIICT GROUP 7 YPE A I� BY ADDRESS f) P Z CONST. STATISTICAL C SSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO. DWELL.UNITS–L— BK PG TRACT V USE ZONE MAP / NO.OF BLDGS. NO. SIZE OF LOT ,f/ NOW ON LOT SPECIAL USE OF '11 EXISTING BLDG. (� �i� OWNER / = \ NOL BLDG.SETBACK FROM ADDRESS FRONT PROP.LI NE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY rZ�� •�. HLPHWAY WIDTH FROM C.L. ARCHITECT OR TEL. + ENGINEER NO. BLDG.SE KFROM ADDRESS SIDE PROP.LI (STREET) TEL. TYPE OF EXISTING SETBACK Y -I- YARD = TOTAL CONTRACTOR NO, HIGHWAY WIDTH FROM C.L. ADDRESS NO' + _ c LIC. C CITY CLASS CORNER CUTOFF YES ❑ NO ❑ CONSTRUCTION LENDER C NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS c u ADDRESS - G SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE A ALTER Q �� ✓ ` REPAIR A-PSI ATURE OF r PLICANT ' DEMOL ❑ VALUATIONS APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE S •FEE$ FORMS, MATERIALS FRAME: FISTOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACIRE NG 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. 1 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 RELATING TO .WORKMEN'S COMPENSATION-INSURANCE. LATH, EXT. i SIGNATURE OF '.� .. HOUSE NUMBER COR- PERMITTEE l RECT AND POSTED ADDRESS FINAL /F .1. .J.. .6a_ e JOHN F. LEWIS. INCIPA STR T' AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH I A�, 1 3 9r OUT 13 1 D 22.5-0- V ADBS-8 11.55 APPLICATION FORBUILDING PERMIT ], 11.89 /"� EISSDIVISION OF BUILDING AND SAFETY ADDtZlQN b D Department of County Engineer County of Los Angeles LOCALITY �1"1 �� Cr C JOHN A.LAMBIE, COUNTY ENGINEER NEAREST t^19 �_C'A .D , CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST. FTS FOR APPLICANT TO FILL IN DISTRNO. GROUP TYPE SEWER MAP T CONST. BUILDING J rl 01 R Q 0 Ra T ADDRESS MAP STATE YES NO NUMBER D HWY IAL LOT NO. BLOCK UNE SPECIALITIONS TRACT NO.OF BLDGS. BUILDING EXIST. SIZE OF LOT I NOW ON LOT YARD HWY STREET NAME USE OF 1 U t SETBACK WIDTH EXISTING BLDG. �f�� FRONT P.L. OWNER .(, SIDE MAIL * P.L. ADDRESS I +CA 6 O TRACT DWELL. 1 UNIT 5 INDUSTRIAL TEL DWELL. J� 1 UNIT CITY NO. -(Q%p // 6 PUBLIC BLDG. ARCHITECT TEL. 2 DUPLE/ (3 'Z UNITS 7 pDDN..ALT.. ETC. ENGINEER 3 APT. `/ -UNITS 8 MISCEL. ADDRESS 4• COMMERCIAL TEL. CONTRACTOR NO. INSPECTION RECORD � ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO. OF SIZE (/ STORIES FAMILIES USE OF STRUCTURE C,!s ' clKV-`� 0a 11�. c f'F i�1i 1v W v SIGNATURE OFi n 'Vl.( V� APPROVALS APPLICANT ADDRESS - i(,O DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION. 7� /A D P.C. S FORMS.MATERIALS (, FEE FRAME: FIRE STOPS, VALUATION REE S I.� BRACING, BOLTS FURNACE: LOCATION, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT. DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT.. AND STATE LAWS REGULATING BUILDING .CONSTRUC- TION. i LATH, EXT. SIGNATURE OF GHOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRES �� FINAL JOHN A.LAMBIE,COUNTY ENGINEER VALIDAT CLYDE N.DIRLAM. CHIEF BLDG. INSPECTOR CK NO CASH LAL81.3 3 8* MT15 1 1 .0 7GA638A CE#BOBS-61 APPLICATION FORBUILDING PERMIlf-_��T COUNTY OF .LOS ANGELES BUILDING O DEPARTMENT OF COUNTY ENGINM ADDRESS BUILDING AND SAFETY DMSION LOCALITY 7 L JOHN A. LAMBIE, COUNTY ENGINEER -NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. 1 FOR APPLICANT TO FTT.L IN DISTRjPT NO. GR UP I Tr'pEPR SED BY CONST. BUILDING n STATISTICAL CLASSIFICATION SE R MAP ADDRESS A!O .rT' P CLASS.NO. DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: TRACT MEl- AP HIGHWAY' STATE MAJOR SECON , LOCA NO.OF BLDGS. NO (CIRCLE) SIZE OF LOT ZX 2 o NOW ON LOT Z' usr-zoiqE SPECIAL USE OF //��AA - CONDITIONS EXISTING BLDG. /AJI OWNER ke IV. BUILDING EXIST. YARD HWY STREET ME nn SETBACK e WIDTH ADDRESS L 0�� FRONT ' ARCHITECTOR TEL. P.L. _561 ENGINEER .NO. SIDE �' P.L. O ADDRESS q TEL. IN CTIOIj/REC RD A CONTRACTORALA,4%115,9A )7)_,V4m/�A.cNO.LiT/8sy� i O ADDRESS �- I/[ / 1,4, n F- DESCRIPTION OF WORK Y!S _ -� � H NEW ADD ALTER REPAIR DEMOLISH ^' SQ.FT. NO.OF NO.OF 1, f C7�/Imo: , /.f�:-sJ-),t it ti L�-- SIZE STORIES FAMILIES �� USE OI: STRUCTURE SIGNATURE OF APPLICANT VALUATION$ I /� APPROVALS DATE INSPECTOR'S SIGNATURE FP C. EE $ FEE PMT. $ FOUNDATION:LOCATION FORMS,MATERIALS FRAME:FIRE STOPS, I 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'COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING'THE WORK AUTHOR IZED,H EREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. ,1 TION OF THE LABOR CODE OF.THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSUR ICE. LATH,EXT. SIGNATURE OF �- PERMITTEE OUSE NUMB HER COR-RECT AND POSTED .Gf !'frA�. ///J>' ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRLY AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION m.o. GASH U;C'3 7 1 8 4 JAN 17 �. 0 3.Q 0 CQ 6A688A CIE kem-7-86 A P P L I O AT I.O 19 I•®'R`.BUIL.®I-N C PERMIT 1' BUILDING AND SAFETY DIVISION BUILDING Department of County Engineer - ADDRESS TN County of Los Angeles LOCALITY JOHN A.LAMBIE. COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST DISTRICT N' O. GROUP TYPE SEWER BK MAPPG FOR APPLICANT TO FILL IN �/ CONS BUILDING �j LI el I }ADDRESS (� qf�/j)_ `�Q�(LI}� �G STATISTICAL CLASSIFICATION Qb¢ b' f v �• !o' 9-0- ! BLOCK CLASS. NO. DWELL. UNITS —1 STATE yES O NUMBER HWY TRACT �'f- USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT 7 � Z 1C I NOW ON LOT •� A— f USE OF EXISTING BLDG. iP /1 l� BUILDINGEXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER Y Q FRONTMAIL to P. L. l7�/ ADDRESS D SIDE TEL- P. L CITY G'J No. INSPECTION RECORD ARCHITECT OIR TEL. ENGINEER NO. ADDRESS J/ TEL. CONTRACTOR p NO. ADDRESS Z7zy� >��' Cc/�• I DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. / NO.OF NO.OF SIZE a%z> STORIES FAMILIES USE OF STRUCTURE /y)X j Z D APPROVALS SIGNATURE OF APPLICANT �- DATE INSPECTOR S SIGNATURE ADDRES -i�i 7Z� ^ q FOUNDATION:LOCATION 11 p} FORMS. MATERIALS $ (/ G P.'C. S FRAME: FIRE STOPS, h �G FEE BRACING.BOLTS VALUATION , $6 ey FURNACE: LOCATION, FEE QAS VENT. DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE If COR ECT AND AGREE TO.COMPLY WITH At C-QjjNTY OJCDIN44CES AND LATH.EXT. \A u STATE LAWS REGULATO aml al CO TRUCTION. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESBd/2,2 ^� ' �'y� FINAL. 90[ '1% `b�`er•r V�✓H'""� 'OHN A.LAMBIE.COUNTY ENGINEER. CLYDE N. DIRLAM. PRINCIPAL STRU.QX.VRAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK M.O. CASH x (;05 0 4 iAR14 1. 6.00 '� ADB6.8 is-BIB APPLICATION FORBUIL®ING PERMIT ], lfBS R ]� DIVISION OF BUILDING AND SAFETY ADDRESS 4 �/ Deportment of County Engineer h (T� County of Los Angeles LOCALITY EM PF C t JOHN A.LAMBIE, COUNTY ENGINEER NEAREST r� JC' f CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST. F FOR APPLICANT TO FILL IN DISTRICT NO.J GROUP I TYPE SEWER MAP BUILDING gog p� Q O`!bo VT• CONST. ADDRESS i"I ,`Q o ,V NUMBER D MAP yyAyy YES NO LOT NO. BLOCK Uy�E NE SPECIAL %E S7,OOCONDITIONS TRACT NO.OF BLDGS. SIZE OF LOT NOW ON LOT BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH USE OF t/` a U C✓�s FRONT EXISTING BLDG. v.`r,- P.L. ' OWNER 1. SIDE MAIL P.L. ADDRESS ! Z 6 / O TRACT DWELL. I UNITTEL 5. INDUSTRIAL CITY Q,/' /1/(J/�,1(,�/ NO. t4-4�6 I DWELL. /J/� 1 UNIT 6 PUBLIC BLDG. ARCHITECT C#1 TEL. 2 DUPLE111-Y 1 UNITS 7 ADDN.,ALT.. ETC. ENGINEER 3 APT. ! UNITS 8 MISCEL. ADDRESS 4,1 COMMERCIAL , .. NO CONTRACTOR NO. INSPECTION RECORD ADDRESS DESCRIPTION OF WORK NEW AD�DD ALTER REPAIR DEMOLISH S ZEFT. (/ STORIES FAMILIES USE OF STRUCTURE „ c- tKtij 8 . SIGNATURE OFy APPLICANT �� R APPROVALS ADDRESS "' j 1 DATE INSPECTORS SIGNATURE FOUNDATION:LOCATION 7� 0 O FEE FORMS,MATERIALS (� '� FRAME: FIRE STOPS. VALUATION FE6 t BRACING, BOLTS FURNACE: LOCATION, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS .GAS VENT.DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION, s LATH, EXT. COR- SIGNATURETTCEF P „e(,( HRECTAND POSTED ADDRES �/ ' FINAL JOHN A.LAMBIE.COUNTY ENGINEER VALIDAT CLYDE N.DIRLAM, CHIEF BLDG. INSPECTOR CK MO CABH of 3 3 ° OCT 15 1 1 .0 0 76A1S38A CE #803 12/59 APPL*TION FOR BUILDIN*ERMIT COUNTY OF t0t ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDINGADDRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUP-T OF BUILDING LOCALITY ,& FOR APPLICANT TO FILL IN NEPAFSTCROSS ST. (Print or-ty-o-e-o-10- DISTFICT W. G YPE E7 BY BUILDING CONST. ADDRESS 7 STATISTICAL C6ASSIFICATION SEWER MAP ,;d BLOCK LOT NO. gn04 In DWELL.UNITS SK AP TRACT USE ZONE MAP DGS. NO. SIZE OF LOT-"/Z/ :)T SPECIAL USE OF I / �f I CONDITIONS EXISTING BLDG. TEL OWNERZ/ W. NO. BLDG.SETBACK FROM (STREET) I'T - FRONT PROP.LINE OF ADDRESS 726OI TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY Q_ HjpHWAy WIDTH FROMC.L. ARCHITECT OR TEL. + ENGINEER NO. BLDG.SE FRLIREO�M .QF (STREET) ADDRESS SIDE PROP.Ll TOTAL TEL' TYPE OF EXISTING SETBACKY + YARD CONTRACTOR NO. HIGHWAYWIDTHFROMC.L. LIC. + >a ADDRESS NO. C LIC. NOE] C. CITY CLASS CORNER CUTOFF YES' [:1 a C CON TRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS SQ. FT. NO. OF NO. OF NEW El] SIZE STORIES FAMILIES USE OF ADD STRUCTUREZ&AA�w:�- ALTER ❑ -g P20Z REPAIR.X St A-TURik OF PLICANT DEMOL 0 VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT,FEES CN.5�10 FOUNDATION: LOCATION FORMS.RMATERIALS FEES FSRE STOPS. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION G BOLTS AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STOPS, S ON TS STRUCTION;.Ll CERTIFY THAT IN 001.6 1 THE WORK AUTHORIZED '3 .El..l I L NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENghTIO ILINS YRANGE. LATH, EXT. SIGNATU OF RE HOUSE NUMBER COR- RECT RECT AND POSTED ADDRESS FINAL LEWIS. INCIPAC STR MY"AL ENGINEER 17 JOHN F. LEWIS. PUN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION CK. M.O. CASH Ar,7 :13 -9?- OCT 13 1 D 2 2.5 ON cv' 1C 6RKERS' COMPENSATION DECLARATION A I Thereby affirm that I have certificate of consent self APPLICATION F®R BUILDING PERMIT insure, or a certificate of Workers' Compensation insurance, AND or a certified copy thereof r(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING pp ❑ Certified copy is hereby furnished. FOR APPLICANT JO FILL IN ADDRESSD� o ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS ,•04z bJI Date Applicant CIN Gm\'n 116 Clij ZIP a o LOCALITY NO.OF BLD NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSORQ (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK g� (� PAGE v 1 PARCEL OZ hundred dollars ($100)or less.) TEL• USE ZONE MAP �f OWNER � O P�} S Q_NO. (.—14L-1 b NO. o� (D I certify that in the performance of the work for which this SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS 4 V5 V.i O DO vt 1q_/ CONDITIONS a so as to become subject to the Workers'Compensation Laws. a CITY ZIP !1090 OU Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY W NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. O Exemption, youshould become subject t the Workers' °± �� CONST 7�QNE n_ Comp � Compensation provisions of the Labor Code, you must forth- ADDRESS `®JC w with comply with such provisions or this permit shall be � TEL. STATISTICAL CLASSIFICATION ' APT. CONDO. N deemed revoked. CONTRACTOR NO. NO. /-I- DWZ LICENSED CONTRACTORS DECLARATION ELL. 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 LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE /� STORIES / FAMILIES ONE ,i VALUATION �O DESCRIPTION OF WORK L( o,t,j NEW $ -� la� Contractor Dote t 0� / f , ❑I am exempt under SecADD 10:1. b G ALTER ❑ B.&P.C. for this reason REPAIR 1:1 $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License n DATE 2 3_ Law for the following reason (Section 7031.5, Business and t ADDRESS FINAL -� Prgfessions Code): PRESENT By ^tr: I, as owner of the property, or my employees with ADDRESBUILDINS s 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- ' oz 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. 'I.1 AL -a.� v o '3 (Sec. 3097, Civ. C.). SIDE _ ni: --�T• Lender's Name _ LDMA Ref. # P.C. Fee$ Permit Fee Lender's Address Ll 1 certify that I have read this application and state that the Issuance Fee a7. 7.5' LDMA P/C# , above information is correct. I agree to comply with all County Investigation Fee p, I j j_j_tj';; ina es and Sta a relatin to building construction, Total Fee s O k. LDMA Perm. # = and her au or e r pr sentati sof this County to enter 54,_4 1 j o g° up n t ov - io proper for inspectionrp es. i o `T SEE REVERSE FOR EXPLANATORY LANGUAGE 'gnature f Applicant or AgentD' ate l i Vffirm WORKERS' COMPENSATION DECLARATION insure, oaof Workers'Compensation Insuran e tttlf raa certificate I A P P L I CATION FOR B U I LD I AI.O P E RM I T or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 1 BUILDING El Certified 7 Certified copy is hereby furnished. 1 FOR APPLICANT TO FILL IN � ADDRESS ElCertified copy is filed with the county building inspec- ADDRIESS 3 R- LPO 14 D O VC' tion department. _r �,� / ,p CITY 1 C P LC �[ ZIP �� 0 LOCALITY Date Applicant I NO.OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT O 9( ( O NOW ON LOT NEAREST CROSS ST. dor COMPENSATION INSURANCE ASSESSOR ?� Q ,y� ((This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK V PAGE O 2 v PARCEL V ltq hundred dollars ($100)or less.) n TEL. 1 OWNER l�pQ Q.. NO. 8�'I b lb ^USE ZONE MAP I certify that in the performance of the work for which this (n NO. permit is issued, I shall not employ any person in any manner ADDRESS r �'O Um O e /� �/ SPECIAL >_ CONDITIONS a so as to become subject to the Workers'Compensation Laws. CO IY A mo_ ZIP � fOO Date Applicant ARCHITECT ORTEL• DISTRICT GROUP TYPE FIRE PROCESSED BY Q NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. I ZQNE Exemption, you should become subject to the Workers' x�� ,3 Compensation provisions of the Labor Code, you must forth- ADDRESS d V CL with comply with such provisions or this you shall be TEL. STATISTICAL CLASSIFICATIONAPT. CONDO. N NTRACTOR NO. Z deemed revoked. — • LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. A DWELL. UNITS A RESS NO. I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP old (commencing with Section 7000)of Division 3 of the Business LIC. •-�� and Professions Code,and my license is in full force and effect. CITY CLASS B VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW 1:1 $ El am exempt under Sec. L. �^ ADD ❑ ► ALTER ❑ BAP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL Signature APPLICANT TEL. FINAL 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 FINA Rrgfessions Code): PRESENT By lfy�l BUILDING r I, as owner of the property, ormy employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY =�j 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 t 0 IAL. :12 1 . 75 5 tion 7044, Business and Professions Code.) (' n, ` REQUIRED TOTAL SETBACK t• t=4j► i t t°!•: CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINEFROM EXIST. WIDTH I hereby affirm that there is a construction lending agency for FRONT t:o-(ANGE the performance of the work for which this permit is issued P.L. 1 (Sec. 3097, Civ. C.). SIDEP.L. Lender's Name i $ LDMA Ref.# P.C. Fee$ Permit Fee yt ,t rl'� ;_. Lender's Address I certify that I have read this application and state that the Issuance Fee O� LDMA P/C# above information is correct�proper I agre to comply with all County Investigation Fee !no es and Stat a elatin io building construction, 1 Total Fee / / LDMA Perm. # a d her b out r' r rentati s of this County to enter i up e a ov - n' n foinspection purposes. o O—6� I SEE REVERSE FOR EXPLANATORY LANGUAGE Ignoture of Applicant or Agent V Date