Loading...
HomeMy Public PortalAbout5430 ROSEMEAD BLVD_Building__ 76A6313A CE #80312:6APPLICATION FOR BUILDING PERMI ! COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �� O COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. Print or t e only) DISTT5JCT NQS 'GROUP TYPE P O D BY BUILDING 3� Q `����� ✓ © ,(/ �/ CONST. ADDRESS /) (f STATISTICAL CLASSIFICATION SEWER PAP LOT NO. BLOCK � CLASS NO.-g2? BKc —� PG TRACT USE ZONE MAP NO.OF SLOGS. jy NO. U SIZE OF LOT NOW ON LOT /' SPECIAL USE OF l� CONDITIONS EXISTING BLDG. Q� 'hop TEL. OWNER �j „✓, � fJ/f- � .G�j' NO. BLDG.SETBACK FROM ADDRESS FRONT PROP,LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY - HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. + _ ENGINEER NO. BLDG.SETBACK FROM ADDRESS /�� �V '1 (� ` SIDE PROP. LINE OF (STREET) CONTRACTOR t fLG jiJw/ z �iyl_ll OL O t��I1p y�J� HIGHWAY TYPE OF EXISTING FROM C.L.LIC. SETBACK HIGHWAY + D = TOTAL ADDRESS OU' /'_. /�'r-�� NO. / I�J� t� + _ CITY �,/ O✓�✓��� CLcf ASS �f- CORNER CUTOFF.' • AYES ❑ - CD NO ❑' CONSTRUCTION LEN ERJ O NAME AND BRANCH fl�u14 SEE REVERSE'SIDE FOR'SPE AL APPROVALS w ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ ♦y J� 0" • - ESTORIES FAMILIES USEOF ADD ❑ Illi' ��i�t � 01© STRUCTURE CO-0147' S40-wl-ef s ALTER .•Zts. t• REPAIR❑ SIGNATURE. � �` .C' " c�Yi:-1.•� s APPLICANT DEMOL ❑ /; -t c VALUATIONS Z,�j(J(JAPPROVALS- .DATE INSPECTORS'S I GNATU REQ P.C. '` PMT. ,�/h FOUNDATION: LOCATION f FEE $ �G� FEE $ >^l� a.r_,J v 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, . WITHALL 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 VIOLATION. OF THE LATH, INT. LABOR CODE OF THE'STATE OF CALIFORNIA IN RELATING TO WORKMEN'S CO MNO E. LATH, EXT, SIGNATURE PE NS1TION I RAHOUSE NUMBER COR- PERMITTEE RCT AND POSTED /} ADDRESS ®�3 ' FINAL i p.,-- JOHN F. LEWIS. PRINCIPAL..STRU TURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION cK. M.D. CASH L 1t+d 7 ^ 0 5 IDEC -7 2 3 ..D 14.10- LAW 4.10- 76A638A CE #803 4/72 APPLICATION FOR BUILDING PERMIT f] COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING BUILDING AND SAFETY DIVISION ADDRESS MAKE CHECKS PAYABLE TO: _ HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN NEAREST 1( Print ort a T CROSS ST. BUILDING ® CIS T`RICT/ANO. Gj40UP TYPE �PR �ESSEBY ADDRESS �� S'.f .�,�- �✓T � J CJ Ff//^�._'�� / CONST. 1/OD STATISTICAL CLASSIFICATION \ SEWER MAP,/ LOT NO. �3 f/ BLOCK CLASS NO. -L (*R BK (*PG TRACT f USE ZONE MAP ///��� / NO.OF SLOGS. NO. SIZE OF LOT D NOW ON LOT IA SPECIAL ' USE OF /� y / I CONDITIONS EXISTING BLDG. - OWNER l aOf�.�I NOL /,� BLD SETBACK FROM ADDRESSBT ? FRO SETBACK (STREET) TYPE EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY E�(s j iy �jfj. HIGHWA WIDTH FROM C.L. ARCHITECT O TEL. } _ ENGINEER i' NO. BLDG.SETBACK FRO a ADDRESS SIDE PROP.LINE OF IS O �o rTEL. TYPE OF EXISTING SETBACK HIGHWAY } YARD' _ \TOTAL C.7 CONTRACTOR,/, Z 0. HIGHWAY WIDTH FROM C.L. � O ADDRESS 6�I 3rs" y'3'�/>>�'/� LIC.NO + d CITY �.�/1f �� ��/ CLASS CORNER CUTOFF YES ❑ NO ❑ �_ CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES ❑ r USE OF ADD STRUCTURE ��� ALTER ❑ REPAIR❑ SIGNATUReOF T� ❑ APPLICANT � c/ DEMOL VALUATION $� �d:, APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION 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, WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS - STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HERE BY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF TME STATE OF 'CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. LATH, EXT. SIGNATURE OF `�3^` HOUSE NUMBER COR- PERMITTEE - RECT AND P STED ADDRESS FINAL ,S PLAN CHECK VALIDATION CK. M.O. CASH _ `"P L RETORTION CK. M.O. CASH -� 0 0 ? 773 IMAR16 1 D .6.00- ... s.TS 0-4S DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. BUILDING PERMIT NO.•`/ /y' ^ ADDRESS LOCALITY RECEIVED BY DATE OF APPL. DATEISSUED r 3_ NEAREST - CROSS ST. 'r Aegt 7 i BUILDING OWNER0s &1of /G ADDRESS MAIL LOCALITY ADDRESS eNj A //7 �n J TEU� NEAREST CITY Q� NO. D �' _CROSS ST. FIRE NO.OF TYPE GROUP 1; ARCHITECT OR / TO �. ZONE I PLANS ENGINEER I I ! BLDG. ORD. NO. ADDRESS CSI �/ SETBACK LINE APPROVED CONTRACTO y TEL. I BY DATE T / . USE APPROVED ADDRESS n' lip 10"O�✓ s ZONE BY DATE LEGAL p CORRECTIONS DESCRIPTION y t I LOT NO.1.3 ! I BLOCK TRACT ( F NO. OF SLOGS. SIZE OF LOT�4 X /J 0> NOW ON LOT USE OF NO.OF NO. OF EXISTING BLDG. FAMILIES I ROOMS DESCRIPTION OF WORK NEW �' ALTERATION I ADDITION O REPAIR MOVING DEMOLISH p SIFT. / NO.OF f _SIZZ E (� ROOMS STORIES 7 r WALL /r ROOF COVERIN �(�yr/ ICOVERINGUSE - OF NEW �.i �/j,�� BUILDING BUILDING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWSREGULATINGBUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF Jl! �j �{"sr �+y f'r �fl R, /Jt C:v' BRACING, BOLTS - OWNER f r t LATH, INT.: AUTHORIZED AOT- + fXp+s" f. - 'yo — LATH, EXT.: CXm� PLASTER, INT.G v O P. c. � '�` ; FEE I PLASTER, EXT. VALUATION FEE DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ��yy s J DISTRICT_t'Q. PLAN CK. OR REC.No. PERMIT NO. ADDRESS �45 M ' -wG � RE WEED BY DATE OF APPL. DATE ISSUED LOCALITY 7I- !mY" NEAREST RD ST. 'BUILDING + '/ 1 �J'� ADDRESS OWNER /d I� L l e�C e__ /�L , � 15 MAIL A r //�� t LOCALITY ADDRESS (� ,,/ V �L NEAREST /3 ,^J' �" T£L-7'y A�` lA CW088 ST. CITY 1 . t'1 NO. I'�/^'V 6� FIRE NO.OF I TYPE�j GROUP _ ,/ ,�! p � ZONE PLANE .Jllr_- ARCHITECT T ORtz/1 V SDC Al BLDG. ORD. NO. SETBACK LINE ADDRESS // �,./ USE APPROVED CONTRACTOR Le} �t],�`�/7-4 •6a NOL �s�' //��4♦ ZONE BY .,H'ODUSE�..NUMBERING DATE ADDRESS 1' V tY 'kQj "='Z4I MAP NUMBER.,f`� NO. ASSIGNED BY LEGAL CORRECTIONS DESCRIPTION LOT NO. BLOCK TRACT NO. DF BLOGS. SIZE OF LOT I NOW ON.LOT USE OF. I NO.OF EXISTING BLDG. FAMILI98 DESCRIPTION OF WORK / NEW ALTERATION ADDITION Z D REPAIR DEMOLITION r Sid.FT. NO.OF SIZE ROOMS STORIES EXT.WALL I ROOF COVERING COVERING _ USE OF STRUCTURE C2. A-ec2-e'5'— Y INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PL P- FRAME: FIRESTOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS /y / �� / yA3" � A SIGNATUREor / .� �./ r�aP LATH, INT. PERMITTE LATH. EXT. ADDRESS dL_• �.P'<G o\ f5� � 0,1 e /t 'q/_ `,PLASTER, INT. AUTHORIZED ADT. ddd'' C._.. PLASTER, EXT. _ ® 6 P.FECE.S HOUSE NUMBER COR-RECT AND POSTED VALUATION t FEE 110 FINAL / v 76A63BA DBS 3 7-62 APPLICATI N FOR 9UILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRES {{�, DEPARTMENT OF COUNTY ENGINEER CITY ale, ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT O NOW ON LOT ADDRESS TRACT// BLOCK �LOT NO./-:?-�� LOCALITY TEL NEAREST OWNER PO. CROSS ST. ASSESSOR ADDRESS l' GIC MAP BOOK PAGE PARCEL -CITY CGz c ZIP �j DISTRICT GROUP TYPE FIRE ROC SED BY �. CON 53-rr-- ZON� ARCHITECT OR TEL. ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS TEL. CLASS NO. � DWELL.UNITS BK PG CONTRACTOR NO. USE ZONE NOPQ / / �cF LIC. O ' ADDRESS NO. SPECIAL LIC. CONDITIONS _s s- ��- CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YESNO El CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF ISTREETI ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD=TOTAL FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRIPTION OF WORK tjf� .G r #-1NEW ❑ + O BLDG.SETBACK FROM 718 -57 (� ADD ❑�j SIDE PROP.LINE OF (STREET) O ( (} ALTER 'LJ TOTAL SETBACK FROM TYPE OF EXISTING w HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH N USE OF REPAIR ❑ Z EXISTING BLDG. DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES NO ❑ (PRINT) NO. IN OPEN SPACE YES NO BY(SIGNATURE( //����jj'�� /� IN COASTAL PERMIT ZONE YES NO ✓40O V O .. e VALUATION � `�-- ' 1, IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATETHAT THE 15 AND AGREE TITH ALL AND LAWS A EOGULATINGO BUILDING CONS RUCTION.^(C RTIFY THAT IN RDOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE CALIFORNIA IN RELATING TO WORKMEN'S COM. PENSATION INSURANCE. SIGNATURE OF Cl V r PERMITTEE �,` ' eX ADDRESS W v' n FINALr BY CITY�� C f�6 * 1 TEL DATE l'• p�llf�� Y� y NO.' s MAKE CHECKS PAYABLE TO:;. ,F E $ )L/ FET $ UZ� HARVEY T. BRANDT,.COUNTY ENGINEER / T. 40 PLAN CHECK VALIDATION •.k,." CK. M:O. CASH PERMIT VALIDATION CK. M.O. CASH a 6 7 jUL 26 2-3 D 1 �`.4 G �- g 6 8'-JUL 2 8 l 0 2 4.0 0 e�'J J ®s 76A638A CE#803 3-75' - 7 6A638 CE#803 5-65 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING . DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY �G JOHN A. LAMBIE, COUNTY ENGINEER NEAREST �L COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. DISTRICT NO. GRO P TYPE, PROCESSED BY FOR APPLICANT TO FILL IN 4�7p / CONST. "77r7v-7 BUILDING� ...� /'�, STATIST'I'CAL CLASSIFICATION SEWER AP ADDRESS; � � _ I l.✓ CLASS NO. �.�DWEL.L UNITS S pG/ LOT NO. l � � BLOCK USE ZONE MAP' -7�/ NO. CJ TRACT �Z�. SPECIAL N0. OF BLDGS. r'/ CONDITIONS SIZE OF LOT NOW ON LOT USE OF �^ + EXISTING BLDG. (�!�^,'' 4nn) BLDG. SETBACK FROM TE OWNER�U�� Lap Wim/ NOLT '��-?il c;7 FRONT PROP. LINE OF - (STREET) �+ p TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS_ so ROSEM E!� HIGHWAY WIDTH 'FROM C.L. CITY '✓� ��) Y� I© /15-01 + _ ARCHITECT-OR TEL. BLDG. SETBACK FROM ENGINEER � NO. SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESSt 2 'f��// HIGHWAY WIDTH FROM C.L. CONTRACTOR �'(', ��fILI NOL_23'f�j.� + 0 ADDRESS• S� �IAy�D�LG NO MS / CORNER CUTOFF YES NO E V CITY c'L SEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK u W a NEW •HADD ALTER REPAIR DEMOLISH z Z SQ.FT. NO. OF NO. OF SIZE STORIES FAMILIF_S USE OF STRUCTURE r- �_ j--`�"J`r /+; \L9 \1 1. SIGNATURE OF APPLICANT VALUATION$ APPROVALS DATE /t^ INSPEC t OOR'S SIGNATURE FOUNDATION, FEE$ FEE$ /� FORMS, LOCATION ® '' � v �''�'"' j•E�GI! 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 1UILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK - AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR C�DDE OF THE STATE OF L-4 RNIA RELAT- - ING TO WORKMEN' CMPENSATI Id INSURA E. LATH. EXT. SIGNATURE O 4 HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS F I NAL JOHN F. LEWIS. P INCIPAL STR GTURAL ENGINEER' PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VALIDATION cK. M.O CASH 3 ,8 3 t,-G 1 2 3 D 5.75— tt 363e�? A I0 1 D 11 .5 JN r�.+1`M•BETS S-45"_ DEPARTMENT OF BUILpING AND SAFETY I APPLICATION FOR-PERMIT COUNTY OF LOS ;ANGELES - OCT 1 11945 Q U ' WING 1 J. FOX, CHIEF ENGINEER V •FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO.' / BUILDING / , ': Rancho Real a , .S`'w-') � 416 t6`, ADDRESS p LOCALITY Temple C lty p Cali TqPVED BY DATE Of APPL. DATE ISSUED NEAREST CROSS ST. ROs emead Blvd. / •" `�"��s •��� `��""w %!^ ! r rr OWNER Georgie W.0 atter _ADD MAIL Ess ADDRESS 138 NO.Or land O AV e• J, LOCALITYNEARE TEL. 1138. CROSSS T. ��..a-/ ♦ 4. � CITY . Los Angeles 36 WY-1138. TEL ZONE PLANS / PETS GROUP r ENGINEER Jack McDonald, . NO.' Tr-7.547 I I G ORD. NO. ADDRESS Buttress -.,,McClelland Co. SETBACK LINE APPROVED TEL. CONTRACTOR - T.S.Thomsen We-5119 BY DATE 6065 David S t. ,Los Angel USE APPROVE �s' �� ADDRESS LEGALp ZONE BY {- :'.;y�� � DATE G1 �I —DESCRIPTION - rrI LOT NO. 13(X141 BLOCK %An CORRECTIONS TRACT 1123.8].S 15011'3140 I NO. OF BLDGS.NOne, SIZE OF LOT NOW ON LOT USE OF ^ NO.OF(� NO. OF 0 EXISTING BLDG. -O- I FA.M.. '�- I ROOMS DESCRIPTION OF WORK NEW X ALTERATION ADDITION O A REPAIR MOVING DEMOLISH p Sq. FT. n -NO.OF Z SIZE lO 3_ y_ OO ROOMS zz- STORIES - r WALL V1 J. ROOF COVER))JO,n1?3 as COVERINGC Om Os It lO USE OVNEW' BUILDING arage & Oz I lc a type Bldg Leaped to SoXaIiX .Teiephone -- ehouae isastallation and aeryice automobiles APPROVALS 1 HEREBY ACKNOWLEDGE THAT 1 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, BRACING, BOLTS SIGNATURE OF OWNER )� LATH, INT.: AUTHORIZED AOT LATH, EXT.: PLASTER, INT. •' �® FEE PLASTER, EXT. vVALUATION FEE FINAL WORKERS'COMPENSATION DECLARATION hereby affirm that ksrlnf onnua �neoracofte oWoreCompesaIsrn , APPLICATION FOR BUILDING PERMIT' 4 or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company " ❑ Certified copy is-hereby furnished. FOR APPLICANT TO FILL IN BUILDING _ ADDRESS "� t ❑ Certified copy is filed with the county'building inspec- BUILDING tion department: ADDRESS��) /D t r 1� � Date• Applicant CITY ZIP V 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 oneASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO12� MAP BOOK PAGE PARCEL TEL. USE ZONE MAP OWNER I certify that•in the performance of the work for which this NO NO. permit is issued, (shall not employ any person in any manner ,ey /- SPECIAL so as to become `subject to the Work rs'Compensation Laws. ADDRESS-. i CONDITIONS V Date I Appl'icanT n '' h �7l CITY ZIP Q ®C NOTICE TO APPLICANT: If, after making'ihis ertificate of ARCHITECT OR TEL. DISTRICT GX&i�l FIRE PROCESSED BY ENGINEER NO. ZONE V Exemption, you should become subject to -the Workers' ,rG LU Compensation provisions'of the Labor Code, you•must,forth- ADDRESS �t!/0 13- y with comply .with such provisions or. this permit shall be TEL, STATISTICAL CLASSIFICATION APT. C DO. deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION U LIC. CLASS NO. j?=/J DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS BK. VALIDATION _ SQ. FT. NO.OF NO.OF _ CHECK License Number Lic.Cldss SIZE STORIES FAMILIES ONE • VALUATIO • Contractor Date DESCRIPTION OF WORK e NEV ❑ $ ADD ❑ I am exempt under Sec SPAI1 / / 3 L/ ALTER ❑ , 31.6-0 B.&P.C. for this reason ❑ $ REPAIR 3 y S a Date: EXISTING BLDG.USE OF DEMOL' ❑ `�` _U . Signature APPLICANT TEL. FINAL l�/l2I-� ! OWNER-BUILDER DECLARATION (PRINT) NO. _ DATE I I hereby affirm that-I am exempt from the.Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS FINA Professions Code): "' PRESENT By BUILDING S ❑ 1, as owner of the property, or my employees with ADDRESS _ wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section � 21 2 9.$A 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. # o 0 o a o with licensed contractors to construct the project (Sec- ADDRESS a © (G Q rj Q, tion 7044, Business and Professions Code). REQUIRED . TOTAL SETBACK FROM T. CONSTRUCYION LENDING AGENCY - SET BACK YARD HWY PROP. LINE WIDTH a a 4 Q 5 0 C5 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. " Q .0 3_$5 (Sec. 3097, Civ. C.). SIDE P.L. oLender's Name LDMA Ref. # a P.C. Fee$ Permit Fee Lender's Address ( ©��/I certify that I have read this application and state that the Issuance Fee LDMA P/C# a above information is correct. I agree to comply with all County Investigation Fee - 0 ordinances and State laws relating to building construction, Total fee 4 66sO LDMA Perm. # u and hereby authorize representatives of this County to enter m upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE � Ooi -- Signature ol Applicant or Agent• - Date - - - - - - -� -