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HomeMy Public PortalAbout5018-5026 ROSEMEAD BLVD_Building__ APPLICATION FORCl r BUILDING PERMIT FOR APPLICANT TO FILL IN A�l�aess � BUILDING —ADDRESS �I / LOCALITY le" NEAREST CITY ZIP CROSS ST. 1� NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT 3 MAP BOOK PAGE PARCEL �_ Z DISTRICT GROUP TYPE FIRE PROCESSED BY TELTRACTS.S OCK LOT NO. �7'-" ? j CONST-' ZONE r OWNER 1�C0 NO.v6 7- /i-t/(iC/� �- (� >/�A A ✓ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS-30 0 / (/ GlJ/ CLASS NO.. 2 DWELL.UNITS BK� PG CITY ZIP / / O USE ZONE MAP ARCHITECT OR TEL. NO. ENGINEER NO. —3 SPECIAL CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ TEL. CONTRACTOR NO. BLDG.SETBACK FROM LIC.. FRONT PROP.LINE OF (STREET) ADDRESS NO. TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY '+ YARD - LIC: FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS _ CONSTRUCTION LENDER, + O NAME AND BRANCH BLDG.SETBACK FROM U SIDE PROP.LINE OF (STREET) cl� ADDRESS CITY O SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING U SIZE STORIES FAMILIES ONE SIDE PROP.LINE. HIGHWAY WIDTH N ❑ + Z DESCRIPTIO OF WORK NEW ADD ❑ CORNER CUTOFF YES ❑ NO ❑ ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR ❑ USE OF DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. APPLICANT TEL (PRINT) NO. BY(SIGNATURE) I HEREBY 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. /�Jyn/yi +'meq - SIGNATURE OFAI/ .. FINAL / gY PERMITTEE DATE r ADDRESS TELL 7 P.C. Fee$ Permit Fee CITY NO. Q J Issuance Fee VALUATION$ 7 �j ` Total Fee v PLAN CHECK VALIDATION, CK. M:O__.' CASH PERMIT VALIDATION CK. M.O. CASH 6 8 1� tY i 1 ►�+, v.v 'v Aa ©S. 76A638B CE#803B'6/76 T 76A438A CE #803 1/71Jr/�� �l 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 NEARESTloolr CROSS ST: Print Or tvDe onl �--�(•. BUILDINGDIST.R T NO. GROUPTPE P - SSED BADDRESS SO '-i0 ' �l� CS lvd ( c�O� (ri-?,4NST. STATISTICAL CLA SIFICATION SEWER MAP LOT NO. BLOCK CLASS NO. OWELL•UNITS TRACT .:�- .T .� �• - USE ZONE MAP .may _ - - - NO.OF BLDGS. NO. 70 SIZE OF LOT NOW ON LOT SPECIAL USE OF J CONDITIONS EXISTING BLDG. I-lucjSe I OWNER �.� �LL! 0L'Q a.k- �h I -- BLDG.SETBACK FROM ADDRESS - '2(0 F T PRO_P.LINE OF - - - - (STREET) "'�' e _ TYPE OF E NG SETBACK HIGHWAY } YARD TOTAL CITY � � HIGHWAY WIDT ROM C.L. ARCHITECT ORTEL. } _ ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF - - - (STREET) ,l TEL: TYPE OF EXISTING SETBACK HIGHWAY YARD = - TOTAL d CONTRACTOR ® Ple P NO. HIGHWAY WIDTH FROM C.L. O U ADDRESS LINO.. } - O LIC. F-- CITY CLASS CORNER CUTOFF YES ❑__ - NO _ W CONSTRUCTION LENDER to NAME AND BRANCH N o V, SEE REVERSE SIDE FOR SPECIAL APPROVALS _ ADDRESS SQ. FT ,. NO. OF NO. OF NEW . - SIZE STORIES FAMILIES USE STRUOCTURE /. 16c ADDER Q SIGNATURE OF REPAIR❑ - - APPLICANT Of DEMOL ❑ VALUATION $ QO APPROVALS DATE' -INSP oiv's I �TURE _ r P.C. 7= PMT. FOUNDATION: LOCATION / Y FEE $ FEE$ FORMS, MATERIALS 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 STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATIO OF THE LATH, INT. LABOR CODE OF THE STATE OF CALIFORNIA 11 R ATING TO ---- - -- - -- WORKMEN'S COMPENS TION INSURANCE. LATH, EXT, SIGNATURE OF „`l HOUSE NUMBER COR- PERMITTEE RECT AND POSTED " ADDRESS�Zb ev- e4-.l - fdd FINAL , JOHN F. LEWIS, PRINCIPAL STRUCTURAL EN ER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. E7 0'' x' 23 ' 9.00N APPLICATI N FOR B DING PERMIT FOR APPLICANT TO FILL IN (Print or type only) FRE /�� BUILDING N G /d'�-- / ADDRESS G'� - 6 � ZIP I . .7_4 NO.OF BLOGS. LOCALITY (� d ��� NOW ON LOT 'NEAREST Jj CROSS ST. SSOR TR �.. OCIC` L T N\O. !v MAASSP BOOK PAGE PARCEL OWNER1�Tu-%' .�>�j ,D 'J�jt�EL ` DISTRICT G P YPE FIR PRO ESSED BY- P,�� /� � �y^J Z O E ` <. ADDRESS,I,1-` A/,. �vrL/-�-/�L_ - /^� //�� STATISTICAL CLASSIFICATION' SEWER MAP: CITY C419lVu'''/cdL— ZIP / /.L . CLASS NO "DWELt.UNITS BK PG ARCHITECT OR TEL. ENGINEER - NO. - USE ZONE MAP �� NO. / ADDRESS SPECIAL , L � i' CONDITIONS CONTRACTOR©�q/V N0 4�� ROAD DEPARTMENT APP: REQUIRED YES❑ NO ❑ LIC. ADDRESS NO. BLDG,SETBACK FROM CITY LIC. FRONT PROP.LINEOF ISTREETI CLASS CONSTRUCTION LENDER HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING NAME AND BRANCH FRONT PROP. LINE - HIGHWAY WIDTH ADDRESS CITY SQ. FT. NO. OF NO. OF ^� CHECK BLDG.SETBACK FROM - U SIZE STORIES FAMILIES ONE SIDE PROP. LINE OF (STREET) TOTAL SETBACK FROM .TYPE OF EX-(STING O DESCRIPTION OF WORK. NEW HIGHWAY } YARD = HIGHWAY WIDTH,. ❑ SIDE PROP. LINE - U ADD w ALTER ❑ Z REPAIR❑ CORNER CUTOFF YES ❑ NOUSE ❑ EXISOT NG BLDG, y ij�' DEMOL ❑ IN OPEN SPACE YES ❑ NO ❑ AP PRIN TNT No l ��76-1IN COASTAL ZONE YES ❑ NO ❑. BY (SIGNATURE) ENVIRONMENTAL CATEGORICAL EXEMPTION YES❑ NO. ❑ (% IMPACT EXEMPTION DECLARATION SIGNED (DATE) - VALUATION sQ IMPACT REPORTIPROCESSED (DATE) I HEREBY 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 CON- STRUCTION. 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 COMPENSATION INNSSURANCE. SIGNATURE OFA _y`j FINAL BY lip e PERMITTEE CCC.••660"' DATE ADDRESS P.C. $ PMT.$ TEL. FEE FEE D CITY NO. PLAN CHECK VALIDATION. CK. M.O. CASH PERMIT VALIDATION- 7 ALIDATION 7 6 31"'M t -22 1 u 2 1.7 5 76A638B CE0803A 5/73 '2 _ COUNTY OF LOS ANGELES � � � �� � L V✓M. J. FOX, CHIEF ENGINEER IMIII FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY - BUILD-ADD EISNG SD //� ,., DISTRICT NO. PLAN CK. NO. PERMIT NO. RECEIVED BY [.. ATE OF APPL. DDA/TE IBSUED NEAREST •^ 'ry(/� 6^-�'"�"�� T ' `�� / "7�" CROSS ST. BUILDING OWNER _/TlY" G�d9 ADDRESS MAIL LOCALITY ADDRESS NEAREST TEL CR059 ST- CITY NO. ARCHITECT-13R TEL. ZONE'" I PLANSFIRE NO.OF TYPE '/ II GROUP ENGINEER -`"�'�_ NO. V BLDG. ORD. NO. ADDRESS SETBACK LINE TEL APPROVED CONTRACTOR �=� NO. BY DATE USE / APPROVED ADDRESS ZONE / BY DATE LEGAL DESCRIPTION I �LOT CORRECTIONS NO. l`�(� I BLOCK �� TRACT Uqq//(.tea /g SIZE OF LOT //4?Y J �'� I NOWOON LOTSLOGS /, rr S 6 w- USE OF NO.OF NO. OF q EXISTING BLDG. I FAMILIES / I ROOMS 6' DESCRIPTION OF WORK e� NEW v ' ALTERATION ADDITION O ,9 REPAIR ^MOVING to NO,OF, t DEMOLISH G7 SIZE ���5 �'J ROOMS STORIES / Z D r WALL -'�_ -C ROOF •�'' COVERING tC3�-,/ G COVERING �ra✓a.a4 USE OF NEW BUILDING - t� � 6y 7 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS ! APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, IT NSPECOR DATE'S AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS �IhA � AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OFBRACING, BOLTS �1 OWNER _ / LATH, INT.: r AUTHORIZED AG � LATH, EXT.: P. C. $ / '` PLASTER, INT. MAO AOy PLASTER, EXT. dVALUATION FEE ,10'a FINAL - DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ® � WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY `� DISTRICT O PLAN CK.NO. PERMIT NO. BUILDING H �_ ADDRESS LOCALITY 9`'S FY,?�G.�..� -sQ/+ REC BY DATE F APPL. DA E ISSUED NEAREST .. fA G CROSS ST. ,,yy,,,, BUILDING OWNER'4' Q .,,r c ADDRESS MAIL ADDRESS Q y" -�.G'� y-"� �,r+k. LOCALITY NEAREST .�TEL. CROSS ST. CITY NO. FIRE NO.OF TYPE GROU�P��a ARCHITECT OR TEL. ZONE PLANS a ENGINEER NO. BLDG. �. ORD.NO, ADDRESS SETBACK LINE S APPROVED TEL1 /��`� BY DATE CONTRACTOR+p "S NO. USE APPROVED ADDRESS _ E$ 1 ZONE BY DATE LEGAL I CORRECTIONS SLOTNO DESCRIPTION ( l,.a— y BLOCK /� �+ TRACT I- c /3 .�/� ��- v.t N ) a. A,h't X11 � v � � �� NO.OFBLDGS. � SIZE OF LOT O r� NOW ON LOT USEOF /� I NO.OF ./ I NO.OF . EXISTING BLDG. Imo' FAMILIES f ROOMS I ry DESCRIPTION OF WORK NEW 6•�� ALTERATION ADDITION O REPAIR MOVING DEMOLISH Sq.FT. NO.OF - Z SIZE (p ��(fib ROOMS STORI,EB B D WALL + IT�'"6J:� ^Si/�+. } RODF M.;, r' COVERINGJ/ ..rt„ nl{C,OVERI NGf".�??�i1, �/.r1 USE OF NEW BUILDING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FFORMSOUNDATIONI: LOCATION �% FORMS,MATERIAL6 —vd 4, 0• AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ry , /- FRAME: FIRE STOPS, SIGNATURE OF i. BRACING,BOLTS PERMITTEE " C .. /'?' .. 42`x! ,` LATH, INT. AUTHORIZED AGT V' XT. 76A638A 9-4a C3 C , INT. OBS-3 SOM SETSt*/�9/ �+ P.C, FEE "A ,EXT. - VALUATION FEE IL �.�%hff%'%f'r„i _ 27 D;rARTMENT OF BUILDING AND sAr r,i= -�...s.--•--• •- - -- - �� COUNTY OF LOS ANGELES BU L LID1 N G '•t'- WM. J. F(3X,,E:HIEF ENGINEER �rt7R APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING @' J,Yry c - DISTRICT NO. PLAN CK.NO. PERMIT NO. ADDRESS lJ �� / d" 'A .. LOCALITY ./ a ��- 'd. k RECEIVED BY DATE OF APPL..7 DATE ISSUED NEAREST j�/II/,P PASS CROSS ST. BUILDING OWNERG�C�(�. /fJC p ,//7�p ADDRESSMAIL f{/ ADD RESS-7lO `EYRA� C,011 -qy I�/f� LOCALITY �,i)B[ 60 NEAREST CITY ✓,e,4 0/ ;6 A NO� CROSS ST. FIRE NO.OF TYPE GROUP ARCHITECT OR TEL. ZONE I PLANS. , ENGINEER NO. BLDG. p ORD.NO. ADDRESSBETBACK LINE oevwe"'!� TEL. <:JA�GljJ.C' APPROVED CONTRACTOR JAt-/I /J N�© AlI NO. I-C BY DATE UBE APPROVED ADDRESS r'� A C r wG°P,-, �C�A/ P"L- ZONE BY DATE LEGAL DESCRIPTION I LOT NO. 7 7 I BLOCK CORRECTIONS TRACT Y1/ 5- 's--r- =V //i SI- A �� v T NO.OF SIZE OF LOTS) ^ d f I NOW ON LOTS ��we C USE OF NO.OF _I_ND.DF _ U EXISTING BLDG. " FAMILIES ROOMS /7 O/ Off,-.^r},y�T '(d'7 !i'v4.1i• DESCRIPTION OF WORK .• �� /G �� ��y� ~� �- - ' NEW ALTERATION ADDITION ,D - A REPAIR MOVING DEMOLISH p Sq. FT. ! 1 NO.OF Z IZE ROOMS S / STORIES D r • COVERING�� I COVE USEOF NEW BUILDING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECTINSPECTOR DATE FOUNDATION: LOCATION C AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. v� FRAME: FIRE STOPB, SIGNATURE OF BRACING,BOLTS. OWNERS/[ �s�,J " I LATH,INT.: AUTH O RIZE�T� `" _ e -f 16 ,_ LATH,EXT.: DBS-3 zSM SETS 1-47 $ P C.III PLASTER. INT. FEE PLASTER, EXT. VALUATION FEE FINAL MW� �!ILDING COUNTOF OS ANGELES ' ® � WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN _ FOR OFFICE USE ONLY S'Y� NG g / DISTRICT NO. PLAN CK. NO. PERMIT' NO. ADD EBUILDISS / �_ 1 vr� .��,.' / a // /J LOCALITY _ /� -x/n, ' REC IVED BY DATE OF APPL. DATEISSUED NEAREST' Ll CROSS ST. BUILDING OWNERS ADDRESS MAIL �q �� LOCALITY ADDRESS ,�i�. NEAREST TEL . CITY (//IC.�S. -..A.G�,/ 9-®),s- CROSS 9T. N O. AJJ.m FIRE NO.OFTYPE GROUP ARCHITECT OR ." TEL. ZONE *�'�'IPLANS �� ENGINEER Fy c��ry� ,� NO. BLDG. �/ ; OR,,DD. NO. ADDRESS SETBACK LINE APPROVED T TEL. CONTRACTOR"- _ NO. BY DATE USE /tea APPROVED ADDRESS ZONE/ BY DATE LEGALws►� CORRECTIONS DESCRIPTION I LOT NO. I BLOCK TRACT thr, ,D �^� �-5 I / y SIZE OF LOT 5-7 yl 3 e �I NOW ONNO, OFBLOT/J� wQ !v�l�y 6 2574 e USE OFper• NO O.OF NO. F e EXISTING BLDG./7�.S Ai1T ,G2�4§`.ilFAMILI[i I ROOMS "P" ��- DESCRIPTION OF WORK NEW ALTERATION _ADDITION0 J 7 �/� 8 n r ® A REPAIR MOVING DEMOLISH / W BD. FT. NO.OF SIZE a ® ROOMS STORIES ✓/ /� T/ /�- �^S r WALL ,pp�� ROOF COVERING Q"", I COVERING t r. USE OF NEW q --BUILDING e , all APPROVALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 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 STOPS, rl '�� _ C/�j SIGNATURE OF BRACING, BOLTS (/ to OWNER �A��, / _ LATH, INTO AUTHORIZED AGT_ y141n# • 1A), LATH, EXT.: P. C.• PLASTER, INT. FEE [ PLASTER, EXT. VALUATION 4e 6 FEE / FINAL I .MRARV4ENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR OFFICE USE ONLY r FOR APPLICANT TO FILL IN DISTRICT NO. PLAN CK. No. �jPERMIT NO. ADDRESNG S _�U X- v / O S M P � _l off�S` J LOCALITY Ro Se MRECEIVED BY DATE OF APPL. DATE ISSUED NEAREST D ` // CROSS ST. / -f "7 7 4 /7'l//� BUILDING OWNER /C�/t a✓� / ADDRESS i�!'/✓c1I✓ MAIL a` LOCALITY ADDRESS '5-01 Iv OS'PM 6ti-) NEAREST TEL. CROSS ST. ..0 /7 CITY NO. FIRE NO. OF I TYPE 1 / I GROUP , ARCHITECT OR TEL. ZONE PLANS l/ ENGINEER NO. BLDG, / ORD. NO. SETBACK LINE ADDRESS APPROVED TEL. y BY DATE CONTRACTO((R / [ AveNO.� f/ 1-��� USE I APPROVED j�I 17 W*, A �/��n/1 ZONE/`1�� BY DATE ADDRESS � HOUSE NUMBERING LEGAL ., / DESCRIPTION I LOT NO. BLOCK MAP NUMBER FIELD CHECK BY TRACT NO. ASSIGNED BY ATE NO. OF BLDGS. CORRECTIONS SIZE OF LOT TJX NOW ON LOT '2 USEOF V_EXISTING BLDG. ;?Or �4 r.� y.� I FA OLDIES /DESCRIPTION OF W ORg �If NEW I /� I ALTERATION I I ADDITION REPAIR I I DEMOLITION SO. FT. NO. OF SIZE ROOMS STORIES • i` Z EXT. WALL ROOF r COVERING Z I COVERING -/ N.4-7— USE —USE OF STRUC R[ 4 •e i A-J mac'0%4 APPROVALS INSPECTOR'S SIGNATURE DATE I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION j PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS ` CORRECT. 1 AGRE[ TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, H[REON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATIN eUILDI FURNACE:CO5�� _ GAS V ENT,DCTISN�SIGNATURE OF PERMITTEE LATH, INT. ADDR[88 LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 7ewaseA• Ds/s to-60P. C. 8 t, S j _ 3O FEE PLASTER, EXT. VALUATION S - - FEE '�"` FINAL I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ( 8 � ' � D ' WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT NO. PLAN CK.NO. PERMIT NO. �� " ADDRESS •� 9 --- .- 1.16 , LOCALITY RE C fRs o DATE OF APPL. DATE ISSUED NEAREST CROSS ST. /� I BUILDING ` ,rD OWNER ADDRESS �l /�'( MAIL 121- LOCALITY ADDRESS " TEL. NEAREST CITY NO. CROSS ST. FIRE NO.OF TY GROUP ARCHITECT OR TEL. t ZONE PLANS ENGINEER NO. BLDG. ADDRESS SETBACK LINE li APPROVED TEL. - CONTRACTOR NO. BY DATE USE APPROVED ADDRESS ZON �� BY DATE LEGALCORRECTIONS DESCRIPTION LOT NO. 47 I BLOCK TRA—i�..-� S '." — `-*r) NO.OF BLOBS. SIZE OF LOT ,/� /�t I NOW ON LOT - USE OF NO.OF NO.OF EXISTING BLDG. I FAMILIES ,' I ROOMS I, DESCRIPTION OF WORK NEW ALTERATION ADDITION 0 A REPAIR MOVING DEMOLISH SQ.FT. NO.OF - Z SIZE ROOMS STORIES / D WALL ROOF r COVERING I COVERIN o Fi T USE OF NEW , BUILDING 11 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF�e� BRACING,BOLTS PERMITTEE LATH, INT. AUTHORIZED GT 7,1 LATH, EXT. 76A638A 9-48 / V ��.�(�� laps-3 SETS �f+ p m,Is � PLASTER,INT. FEE PLASTER,EXT. I V LIATION FEE FINAL 9- WORKERS'.COMPENSATION DECLARATI(:(N , sure,*y affirm that L have r certificate of cion Ins to'self APPLICATION F O R� BUILDING 'PERMIT " insufe!"or a certificate df Workers' Compensation Insurance, . >of a certified copy thereof (Sec. 3800, Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. � an " ❑ Certified copy is hereby furnished. . FOR APPLICANUILDING /-- T TO FILL IN ADDRESS ❑ Certified copy is filed,with the county building inspec- ADDRESS tion department. ) Date Applicant CITY T�r'1') �' ZIP LOCALITY PLG-- CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. .NEAREST SIZE OF LOT - NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCKL O. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) OWNER �i�I � � �o T �. SE ZONE MAP I certify that in the performance of the work for which this J SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS���7 /� a �' 2 SPEa- CONDITIONS so as to become subject to the Workers' Compensation Laws. CITY 7� 7 U �541_.a �•1� ZIP ` •3 Date Applicant ARCHITECT OR TEL. DISTRICT G OUP TYPE FIRE OCESSED BY M NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST, V E Compensation o Exemption, you should become subject to the-Workers- X �� IL Com ensation provisions of the Labor Code, you must forth- ADDRESS v (V ✓✓ with comply with such provisions or this permit shall be TEL. STATISTICAL C Y,SIFIfATION APT. CONDO. N deemed revoked. CONTRACTO NO. Z_ LICENSED CONTRACTORS DECLARATION "'7 LIC � ` ,? CLASS NO. DWELL. UNIT I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS"F•� � 7 7 L) ,/ LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business �7il�yJ��� • C_,�/6 and Professions Code,and my license is in full force and effect. CITY �L CLASS BK PG VALIDATION �^ C—�� SO. FT. NO. OF NO. OF CHECK " License Number_:5�?_Z�i/ Lic. Class SIZE I STORIES FAMILIES ONE f VALUATION a , l� ✓ Contract �,i l�� /7. Date/ DESCRIPTION OF WORK S gL5 �✓ EW ❑ ❑I am exempt under Sec. J�rJ s ADD ❑ ► / ALTER ❑ f / B.&P.C. for this reason � REPAIR ❑ $ 7 t USE OF EXISTING BLDG. DEMOL ❑ � V'v Signatur APPLICANT TEL. FINAL OWNER-BUILDE DEC R ON (PRINT) NO' DATE I hereby affirm that I am exembt fr th tractor's'License dd ADDRESS Law.for the followingreason. ction 7031.5, Business and FINAL 4 J ff(�'/JJ G7/IJ Professions Code): PRESENT By BUILDING❑ I, as owner of the property, or my employees with ADDRESS / A.,C I °a wages as their sole'compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY j_e1; ,f90°25 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. �. !TENS with licensed contractors to construct the project (Sec- ADDRESS TOTAL 290 = 25 tion 7044, Business and Professions Code.) REQUIRED YARD HWY TOTAL SETBACK FROM ' EXIST. CHECK 290.25CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH. I hereby affirm that there is a construction lending agency for FRONTA the performance of the work for which this permit is issued P.L. '' � r'i "I'-t (Sec. 3097, Civ. C:). rInvestigationn , L--')/ 'U_ Lender's Name (3000—{ 001 tp�M�� ` LDMA Ref. # tila: Hi i ill a ee$ Permit Fee , 2 Lender's Address L� 1 certify that I have read this application and state that the Issuance Fee ✓ LDMA P/C# 8 above,information is c rect. I agree to comply with all County Fee d ordinances and State ws relating To building construction, Total Fee + LDMA Perm. # a and her auth�rize rpresentatives of this County to enter vetio ed property for inspection purposes. a - �2 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A ant or ent Date f I� WORKERS'COMPENSATION DECLARATION {t r I ., affirm that I have certificate of consent to self �trisurAPPLICATION FOR BUILDING PERMIT I!' 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 rr 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 Date Applicant CITY ZIP 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 d. TEL. USE ZONE MAP U I certify that in the performance of the work for which this OWNER — NO. NO. permit is issued, I shall not employ any person in any manner SPECIAL LJ so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS ( J LL Date Applicant CITY - ZIP }. NOTICE TO APPLICANT: If, after making this Certificateof ARCHITECT OR TEL. DISTRICT GROUP TYPE IF PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER NO. CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS O j with comply with such provisions or this permit shall be d Ih deemed revoked. TEL. STATISTICAL CLASSIFICATIOW�i i i _ APT. CONDO. 2 CONTRACTOR NO. LV LICENSED CONTRACTORS DECLARATION LIC CLASS NO:' 1"+ DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. --- 1111111011111111" (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 VALIDATION SQ. FT. NO. OF NO. OF, , CHECK BK PG. License Number Lic.Class SIZE STORIES FAMILIES``, ONE ❑ VALUATION Contractor Date DESCRIPTION OF WORK NEW ADD j, •" k,� � tL�; 1 am exempt under Sec. , ry ` ALTER G B.BP.C. for this reason REPAIR $ �'F.. L '' Date: USE OF e C EXISTING BLDG. DEMOL E] 1w `+,` `.t'. Signature APPLICANT TEL. FINAL ii, Ti,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): PRESENT By BUILDING I, as owner of the property, or my employees with ADDRESS dr wages as their sole compensation,will do the work and k the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. " NO. I, as owner of the property, am exclusively contracting CONTRACTOR with licensed contractors to construct the project (Sec- rADD tion 7044, Business and Professions Code). TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH J I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). : ` Lender's Name _ ) LDMA Ref. NLender's AddressPermit Fee 01 certify that I have read this application and state that the — — Issuancefee LDMA P/C kg above information is correct. I agree to comply with all Countyn Fee0 ordinances and State laws relating to building construction, Q and hereby authorize representatives of this County to enter Total Fee f LDMA Perm. #i m upon the above-mentioned property for inspection purposes. M a SEE REVERSE FOR EXPLANATORY LANGUAGE n. Signature of Applicant or Agent Date _. F ORKERS' COMPENSATION DECLARATION /Vifereby affirm +haf I have r certificate of consent T6 self APPLICATION FOR BUILDING PERMIT insure, r a'certificate.of Workers' Compensation Insurance, or o cerrttifie8 copy there f tec. 3800, Lab. C.) - ;- \ COUNTY OF LOS ANGELES BUILDING AND SAFETY policy No.�; ompany ST C�TC'i u /)YY) n d BUILDING -� Certified copy is hereby furnished. FOR-APPLICANT TO...FILL,IN ADDRESS O f�" �OSG Certified copy is filed with the •unt buil ing inspec- BUILDING tion�de�p�arrttm�X/ent. ADDRESS �© Date.9' I L2 L!Applicant' CITY77 ` C ZIP Q LOCALITY PIE 4 CERTIFICATE OF EXEM ION FROM WORKERS' SIZE OF LOT 7 NOW ON LOT NO. OF BLDGS NEAREST COMPENSATION INSURANCE CROSS ST. ASSESSOR (This section need not be completed if the permit is for one' TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. 1 1 USE ZONE MAP OWNER e.u NO. NO. 1 CO I certify that in the performance of the work for which This permit is issued, I shall not employ any person in,any man er ADDRESS C>r 3 SPECIAL t t C] a so as to be om su jecT to the Work s' omp mat' n L ws. C CONDITIONS VI J O CITY ZIP 7 U Date 2 Applicant. ARCHITECT OR TELA 1 W NOTICE O PP ICANT: If, %fKer making this.Certificate of ENGINEER !, NO O DISTRICT GROUP TYPE FIRE PROCESSED BY g CONST. ZONE 1�� Exemption, you should become subject to The Workers' AVP, _ -M Sr �� !�' IV i a Compensation'provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be �T . NO.R 1 3 STATISTICAL CLASSIFICATION g) APT. CONDO. Z deemed revoked. CONTRACTOR 1 J — �{ A �P LICENSED CONTRACTORS DECLARATION LIC. �! 1 hereby affirm that I am licensed under provisions of Chapter 9' ADDRESS f A v NO. CLASS NO. DWELL. UNITS S� LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business • and Professions Code and my license is in full force and effect. CITY CLASS BK PG `�, VALIDATION a / 2 SQ. FT. NO. OF '} NO. OF / CHECK License Number �a�O Lic. Class ' 'J SIZE ��� STORIES C>Gi FAMILIES Ci ONE i l R \O J J Qq - IVALUATON Contractor ( . i �l Y 1�L��DoteG ` + c* Ct DE CRI TI NDOF�OR � I NEW a ❑I am exempt under Sec. to gs 1.A fA pl. ^ ADD , I . ALTER ❑ B.&P.C. for this reason U bn t i An REPAIR ❑ $ " Dare: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. 1 FINAL OWNER:BUILDER DECLARATION (PRINT) v NO. 64 R i DATE I herebyaffirm that I am exempt from the Contractor's License I Y 1' / Law fothe following reason(Section 7031 .5, Business and ADDRESS ! , ` FINALI Professions Code): PRESENT By ❑ I, as owner of the ro ert or m employees with BUILDING P P Y� YADDRESS �� ,�`_ AST.T wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 3307 2524.87 7044, Business and Professions Code..) MOVING TEL. ❑ 1, as owner of.the property, am exclusively contracting CONTRACTOR NO. 1 ITEMS with licensed contractors to construct the project(Sec- ADDRESS TOTAL w� tion 7044, Business and Professions Code.) 2524.87 REQUIRED TOTAL SETBACK FROM EXIST_ �' ` CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH �. 254.87 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. """"� .OLl (Sec. 3097, Civ. C.). SIDE / P.L.:.. Lender's Name WOO �f +�/fir / 23 �f4 LDMA Ref. # 6 + 89 1P.C. Fee$ l Permit Fee $ , 3737 1 AM tj ii7 Lender's Address , , 0 1 certify that I have read this application and state that the Issuance Fee .� LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation"Fee d ordinances and Slate laws relating to building construction, Total Fee / J * LDMA Perm. #. a and here y authorize representatives of this Countyto enter auped roperty for•inspection purposes. 9 I g� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of'Applicont or Kgent_ Date WdWdI KERS' COMPENSATION DECLARATION insure or ofcertif care of Workers(}Comtpensat oe of n ensuran ent to lf APPLICATION FOR BUILDING PERMIT or a.certified ropy the of (Sec. 3800, Lab. C.) �� ���.. COUNTY, OF LOS-ANGELES BUILDING AND SAFETY Policy No. w Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county buildin inspec- BUILDING t✓� tion/department. t ADDRESS IV Date/��Applican CITY T. e , ZIP LOCALITY CERTIFICATE OF EXEMPTI FROM WORKERS' OF BLDGS. NEAREST dv COMPENSATION INSURANCE SIZE OF LOT OW 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 / T TEL. �J ,D US ONE [�N� P I certify that in the performance of the work for which this OWNER /C ��J T . � � permit is issued, I shall not employ any per in a y manner �n SPECIAL so as to become subject to the Work rs'C ens ioq Laws. ADDRESS / D ' CONDITIONS CITY ZIP Dat �TO Applican ARCHITECT OR TEL.NOTICAPPLICANT: If, aft r m ng this Certificate of ENGINEER NOTRI�T� GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' /v/ CONST. f ZQNE Compensation provisions of the Labor Code,,you must forth- ADDRESS U I—l•J� with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. C DO. deemed revoked. CONTRACTOR Gp S N LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS � NO SEWE P (commencing with Section 7000)of Division 3 of the Business and / LIC. Professions Code, and my license is in full force and effect. CITY `i CLASS I BK PG—[ VALIDATION .. SQ. FT. NO. NO.OF CHECK D License Numbed�u / Lic.ClassJ0SIZE STORIES FAMILIES -- ONE Q VALUATION �7 ! DESCRIPTION OF WORK (� NEW ❑ Contractor �&— Date ADD ❑ $ , 0 ❑ I am exempt under Sec. ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ A' Date: USE OF DEMOL ❑ 0, 0.7„1 A Z EXISTING BLDG. � # o o e e 0.1 APPLICANT TEL. Signature PRINT) `j N T FINAL/ ( ° ° 6 0,5 0 OWNER-BUILDER DECLARATION DATE G I hereby affirm that I am exempt from the Contractor's License FIN 6�. 5 0 cis Law for the following reason (Section 7031.5, Business and ADDRESS ° m ° Professions Code): PRESENT By EJ 1, 1 1. 04`'88 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). CK F111' CONSTRUCTION LENDING AGENCY SET BACK REQUIRED YARD HWY TOTAPROP.SETBAL NE 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 LDMA Ref. # m Lender's Address P.C. Fee$ Permit Fee 3 g 1 certify that I have read this application and state that the Issuance Fee N LDMA P/C# 9 above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee D LDMA Perm. # and hereby cithorize represents es of this County to enter upon thea e-mentioned prop rty for ' tion purposes. 1 /�SEE REVERSE FOR EXPLANATORY LANGUAGE p i Signature of Applicant or rent Dote ,t(ouS� �• ✓O WORKERS' COMPENSATION DECLARATION Insurto self eboraafirm certifcate of Workes'-ceTificate Compennsatonof coent Insurance, APPLICATION FOR BUILDING PERMIT or 45,certified copy thereof (Sec. 3800, Lab. C.) ' 9Campany�� 1 G-!ti UY COUNTY OF LOS ANGELES BUILDING AND SAFETY [j Policy, e ADI' Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING M)C �f/1 II JI DRESS lJ(J Certified copy is filed with the county building inspec- BUILDING /J tion departm�e/nt. ADDRESS /T�Jt� 1 .. A, Date ��+ Applicant CITY ��/ ZIP e LOCALITY 0i,417A CERTIFICATE OF EXEMPTIO F M WORKERS' O. 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 TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER O NO. permit is issued, I shall not employ any person in any mannerQ SPECIAL so as to become subject to the Workers' mp nsation L ADDRESS /•�r� I \ CONDITIONS "L/ � CITY C/w IP ,� Date l 4 Apf,aft ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER NO. CONST. ZONE �J Exemption, you should become subject to the Workers' � 93 V Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL TATISTICAL CLASSIFICATION APT. deemed revoked. CONTRACTOR �S NO. .� LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. 1 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 / �J l SQ. FT. NO.O NO. OF CHECK License Number���l 7f Lic.Class �/`•• SIZE STORIES FAMILIES ONE _ NEw VALUATION Contractor/��iTi J NDate DESCRIPTION OF WORK $ O A �+ ADD ❑ I am exempt under Sec. f{i ` ALTER B.BP.C: for this reasonREPAIR s 1 07,2A N USE OF z Date: DEMOI }� s R 1 EXISTING BLDG. o or o o Signature APPLICANT /� TEL.NO� FINAL O c PRINT) (rf ,S Gi S Q OWNER-BUILDER DECLARATION DATE _4? O o o o 6 a 5 0 v I hereby affirm that 1 am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS FIN I •�, 4-$8 Professions Code): PRESENT B ❑ BUILDING 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CK FROM EXIST. CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP.SETBpLINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name m P.C. Fee$ Permit Fee 5006 LDMA Ref. # Lender's Address 3 /� g I certify that I have read this application and state that the Issuance Fee' [ (O v LDMA P/C# o above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee O ti' LDMA Perm..# R and hereby uthorize represen fives of th' County to enter a upo th ove-mention d pr erty for i ction purposes. LlSEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Apf icon or gent Dat �5{W ,� I 1 zl ' S o'l, 4yAU m ly ORKERS'COMPENSATION DECLARATION ;re ffirm tica 1 have r certificate of cion Int to raself APPLICATION OR BUILDING PERMIT nuure, or 8,tertificatG of Workers' Compensation Insurance, or a cer;fifiec!.c F there f (Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING ANDSAFETY + (� `Polity`' . Compony5 ' l�iJBUILDING�/�� --- ADDRESS Certified copy is hereby furnished. FOR APPLICANT TO FILL IN O5 ADDRESS Certified copy is filed with the county building inspec- BUILDINGa tion ddeporrttrr/pent. ADDRESS —.i6 OS� Date �11� U/ Applicant CITY e7vff ZIP LOCALITY CER IFICATE OF EXEMPTION FROM WORKERS' 210 ` /�D NO. OF BLDGS. NEARESST. �EivT /� A COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) T,RRA�yCTT,,, }— c+ BLOCK 1 LOT NO. MAP BOOK PAGE PARCEL 11- OWfVE J UNG' NOTEL. S SP USE ZONE OP �� I certify that in the performance of the work for which this i permit is issued, I shall not employ any person in any manner ADDRESS !� �1 �Q� — SPECIAL 1b so as to become subject to the Workers'Compensation Laws. 2 CONDITIONS O Date Applicant CITY Sa,Dr wt� n,a ZIP O lz 7 7 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. /� //__ DISTRICT GROUP TYPE FIRE ESSED BY O ENGINEER (� # NO.2 V 6 7� G ` CONST. ZONE C~> Exemption, you should become subject to the Workers' I Compensation provisions of the Labor Code, you must forth- ADDRESS /A) AVr-66 0 �r GG • ✓Il W with comply with such provisions or this permit shall be It TEL. 3 STATISTICAL CLASSIFICATION APT CONDO. N deemed revoked. CONTRACTOR / Lt/G� /U NO. Z /D A BfdG ( .7 41 / LICENSED CONTRACTORS DECLARATION //��,,�� // �A LIC. CLASS NO. DWELL. Nlrs I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS IdV 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 n 64 L9oi�r CLASS t�S BK G �_ j�/ VALIDATION / i SQ. FT NO.OF /� NO.OF CHECK License Number - Lic.Class 1 SIZE STORIES L FAMILIES ONE q VALUATION. (t)l!yGF�/ ���Yi Date l M6 dy DESCRIPTION OF v �3,� A D ❑ 9 0 69.4.A Contractor ® # a a a a 211 ❑ I am exempt under Sec. ALTER ❑ .:. O QUQ 1220$955 B.BP.C. for this reason FJCl7,'a ❑ , ) REPAIR USE /5 $` Pat EXISTOING BLDG. DEMO' ❑ o ?2 0 8.9,5"0' Signature _ APPLICANT j� L-C) TEL. /_ FINAL 09, 16-88 OWNER-BUILDER DECLARATION NTNO`y' DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ' ADDRESS J ADV INAL Professions Code): PRE NTp y�" By / ❑ BUILDING Z ✓ p�/U./ I, as owner.of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ®LOCALITY �— A Tsa T C/r. ^ the structure is not intended or offered for sale(Section ' 7044, Business and Professions Code). MOVING TEL. _.. � 427 .24 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. TE with licensed contractors to construct the project (Sec- ADDRESS �r tion 7044, Business and Professions Code). T��rU. REQUIRED TOTAL;��EETBACK 4274.24 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT CHECK 4 the performance of the work for which this permit is issued P.L. KME (Sec. 3097, Civ. C.). SIDE p G f "�1 P.L. G {7 c^+ � Lender's Name �� � Ref. # Lender's Address P.C. Fee$./"r�� �; 7 Permit Fej' �/ t /j� ? ' Q "irt►{�1 b /V�f o I certify that I have read this application and state that the .,.a -Issuance i$e �! (1^ LDMA P/C# 02 1 AM10 13 2 above information is correct. I agree to comply with all County In'vestigatio ee.= _ 0 ordinances and State laws relating to building construction, Total Fee;_ / .,. � LDMA Perm. # and hereby authorize representatives of this County to enter v./~ upon th b bcwe-mentionedpr party for inspection purposes. .` a, �b SEE REVERSE FOR EXPLANA0IP4,AANGUAGE:O Signature of Applicant c l5ate s y n jj WORKERS'.COMPENSATION DECLARATIOt4 hereby affirm that I,have a certificate of consent to'self APPLICATION, FOR B tJ t L D I N G PERMIT insure; or a certificate uif Workers' Compensation Insurance, o: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 DDRESS ❑ Certified copy is filed with the county building inspec- BUILDING ADDRESS ?��� .���� �1 i�.v► A�O tion department: Date Applicant CITY - /Z ZIP LOCALITY LE _r NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCEASSESSOR (This section need not be completed if the permit is for one TRACT BLOCKL O. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) --ec OWNER �ef NO. V SE 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 ADDRESS/77 19 a - 2� SPECIAL - C -7 CONDITIONS so as to become subject to th_e Workers Compensation Laws. CITY �igiC -dwr / UO �"'"j' ZIP ` Date Applicant ARCHITECT OR TEL 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER - NO: - DISTRICT" G OU TYPE FIRE OCESSED BY Exemption, you should become subject to the Workers' OK CONSTE /n n U Compensation provisions of the Labor Code, you must forth- ADDRESS ! uJ with comply with such provisions or this permit shall be TEL. STATISTICAL C IFI TION.. APT. CONDO. deemed revoked. CONTRACTOR( NO. 0.3>'� Z_ LICENSED CONTRACTORS DECLARATION (�� tIC, CLASS No. DWELL. UNiTsv I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS"��8. ox- -77 NqS ` (commencing with Section 7000)of Division 3 of the Business LIC. ,+ SEWER MAP and Professions Code,and m license is in full force and effect. CITY �L�A/�����9 CLASS C-16 Y BK. PG. VALIDATION ' �—�� SO. FT. NO. OF NO. OF CHECK License Number,S�2� 22/ Lic. Class SIZE STORIES FAMILIES ONE ' Contract h Pi•/ -Date • DESCRIPTION OF WORK /� s f EW sA "'I_/ !fj 717 ., ElVALUATION V/T/❑I am exempt under Sec." J ADD ❑ 00. ❑ j� 8.8P.C. for this reason ALTER.. REPAIR ❑ $ t USE OF EXISTING BLDG. DEMOL ❑ Signator APPLICANT TEL -" FINAL OWNER-BUILDE DEC O (PRINT) NO_ DATE A I hereby affirm that 1 am exe t fr th tractor's License - - .. I C tp.^ 1 ADDRESS t Law for the following reason, ction 7031.5, Business and FINAL ; 16 Q.� ! Professions Code): PRESENT By J ❑ I, as owner of the property, or m employees with BUILDING T a P P tY� YADDRESS �•'++1•T wages as their sole compensation;will do the work-and ' ' LOCALITY the structure is not intended or offered for sale(Section 3���7 2'T`�I; ` 7044, Business and Professions Code.) MOVING TEL. ," t ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. TOTAL ITS with licensed contractors to construct the project (Sec- ADDRESS LINAC 2'T V 25 i i�� tion 7044, Business and Professions Code.) . REOUIRED TOTAL SETBACK FROM EXIST, t iCK 290.25 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT GE the performance of the work for which this permit is issued P.L "" •-t= (Sec. 3097, Civ. C.). SIDE _. ,.....-. ... . _..- P.L. Lender's Name i�(j Q-I ; ��- 1%_9 LDMA Ref. p -�.�r- �_t,t _ P:C. Fee$ Permit Fee 72002 1 t11111�:1� Lender's Address rR I I certify that I have read this application and state that the Issuance Fee In � LDMA P/C# ,- above information is cLedproperty ree to comply with oil County nve�tigation Fee ordinances and Stateing to building construction, Total Fee r LDMA Perm. q and hereb auth rizet'tives of this County to enter up t ave ntfor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE