HomeMy Public PortalAbout5123 SANTA ANITA AVE_Building__ DIV-=ON OF BURDING
AND SAFETY BUILDING/ori
-. ne orlment of County Dzaa:
-,%?i
Ctwn1V of Los Angeles 1
WM. J. FO COUNTY ENGINEER APPLICATION _
'BUILD
ING
FOR!APPLiCANT TO TILL••IN ADORES9
,�ja3 , j
BUILDING LOCALITY
ADDRESS
NEAREST e
LOCALI {//,1 �• '�,� �' CROSS ST.
DISTRICT NO. PLAN CK.OR REC.No. PERMIT NO.,
GB9ESTT. �_ll � U �� --_- X32
OWNER J}J�ry /� ��JJ (R�/E/CEIV�E/D BY. DATE OF APPL. DATE.ISSUED
MAIL
ADDRESS / +� .L 0-4w-.�*•i�-ee_ ,CC " : R
Us c IwE NO."CF TY GROUP FIRE ZONE
PLANS
CITY /3.:
ARCHITECT OR TEL. I•• �� ZONING DATXD
ENGINEER. ^' NO. APPROVED BY- do-s
BUILDING „..����. Gr ORD.-No.
ADDRESS SETBACK LINE: yC:✓,, ' ' z ..
L• APPROVED DXTs
CONTRACTOR �• NOIl; Sys
���
MOUSE NUMBERING f
ADDRESS . �]
LEGAL ' ) BLOCK MAP NUMBER (J � NO.-ASSIGNED�13 V.
DESCRIPTION LOT NO.
___,� • DATE CORRECTIONS I INSPECTOR
TRACT 4� 4
/ f NO. OF BLOGS. ; p�]/r/ g• �T
SIZE OF LOT% 2-I NOW ON LOT
r USE OF
EXSTNFAMILIES �re
B
D
DESCRIPTION bF WORK , ' c4,n c � �•
I-XI
NEW ALTERATION ADDITION pt
REPAIR DEMOLITION J e-3 (750X
SQ. NO. OF �r
81Zr,(ROOMs STORIES
a _
E)ff. WALL ROOF /(I� pft• L
COVERING I COVERING
US OF STRUCTU E
C'`rt-';�' Ci/l�i �i.�l��/ .►�'' .� r� li"�g1 � i� ��'� eft
` 'l e• N r 1
f
INSIDE OOR' SIGNATURE DATE
FOUNDATION: LOCATION
FORMS, MATERIALS ---Ja-r
-1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-”; FRAME: FIRE STOPS,
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS
COI AGREE TO COMPLY WITH ALL COUNTY ORDINANCESI FURNACE: LOCATION,
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.' GAS VENT, DUCTS
TSIGNAURE OF �. G�•� //i.����� LATH. INT.
PERMITTEE
► q �il
ADD •RESS [ // AL1��C•.t_✓!i��F /�. LATH. EXT.
• PLASTER. INT.
AUTHORIZED AGT-
Q C.7 PLASTER. EXT.
J��/� P• C.>$ ' HOUSE NUMBER COR-
/ `/ FEE $
RECT AND POSTED
u
VALUATION FEE "'^'� FINAL
78A888A DB&S.-8-88
DEPARTMENT OF BUILDING AND SAFETY a APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES I 'I ® �
WM. J. FOX, CHIEF ENGINEER Q
FOR APPLICANT TO FILL IN FOR OFFICE USE'ONLY ti
BUILDING f ,// 1. I DISTRICT NO. .I PLAN CK.NO. PERMIT NO.
ADDRESS :� /�/ 4' �>\� /.f���( /'/t!�tIJ.J.JhC'' f ` :{ .�, "r'F:.`•Y�' t'1 `; A
LOCALITY ' - V -� _.,/a[ .1 e L,,,r RECEIVED BY DATE OF APPL. DATE ISSUED?
NEAREST 7
CROSS ST.
J,67_.i•:at.t-i S `!•1 ( •'G"•J�� may' BUILDINGS �� �J-C�- s �•,! r
OWNERCafe t ADDRESSMAIL
a. �� '.J ;�.y� C,i• l;.
ADDRESS9 . s.�., . —LOCALITY
Y.•�.�,•� -�..
NEAREST
7 /j }p'"' , %f:!' j
CITY TEL. f CROSS ST.
/.�1".�✓7J .r h. �!J✓'4'i NO, / ,/p•_?,_� FIREI 1 NO.OF I TYPE ' GROUP
ARCHITECT OR TEL. ZONE— PLANS-
ENGINEER NO.
BLDG. y� ✓ ORD.NO.
ADDRESS SETBACK LINE.
TEL APPROVED
CONTRACTOR NO. BY DATE
USEAPPROVED
ADDRESS ZONE•-��I BY DATE
LEGAL CORRECTIONS
DESCRIPTION LOT/NO. (/ BLOCK
TliACT
SIRE OF LO T. `X J •j/I NOW ON LOTBJ
USE OF NO.OF / NO.OF
EXISTING BLDG. ""� I FAMILIES I ROOMS
DESCRIPTION OF WORK
NEW X- ALTERATION ADDITION
. O
REPAIR MOVING DEMOLISH
86"FT. /�/ ANO.OF
SIZE �L�( -/WALL \X� ,/*?, ROOMS ,STORIES / y
COVERT G v /) .I Cor
OVERING r
lam , --
USE OF
BUILDING •.�•.•�_.+(„6:31 /) ,p/ _/7 '
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR t3.`7 E
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS , lZ' 4
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ' r �.
-10
FRAME: FIRE STOPS,
SIGNATURE OF BRACING,BOLTS
OWNER LATH,INT.:
J�`l . cn, y
AUTHORIZED AST b /(.ATH,EXT.:
S P.C.6 PLASTER. INT.
FEE
PLASTER,EXT.
VALUATION �—�✓
FEE e' �1� FINAL
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING
WM. J. FOX, CHIEF ENGINEER
ME
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK.NO. PERMIT NO.
BUILDEI
NG
ADDSS
LOCALITY 'alt It Y !^ti 2 ` RECEI D BY DATE OF APPL. DATE ISSUED
NEAREST
CROSS BY.
DDRES9 '
ILDING
/j •
OWNER �� /of p1�
MAIL f r'^ ` • J / LOCALITY
ADDRESS. t "1 i .i �'1 1 �.��i't �!�-Q I
v
NEAREST � f
ee
CITY ,' ,
a 3�•t �2��f G �f l 1.
FIRE_ NO.OF TYP i ROUP
ARCHITECT OR TEL. ZONE PLANS
ENGINEER NO. •
ADDRESS SETBACK LINE
APPROVED
f ] � TEI;'l 1 1,' �• y�.' BY ,;J I,. DATE
CONTRACTOR gr�ra���rYl.L� NO.9.�e�. �' �.
+ USE /LPP�OVED I i
ADDRESS ( '1 t I l r'�P�1 t C 67 I� .� �( ZONEfi( , Y DATE
LEGAL ® i-- ' ORRECTIONS
DESCRIPTION LOT NO. p'♦� BLOCK _
TRACT
O.OF SLOGS
Nr� Cf
SIZE OF LOT 1 l j (J ,1 NOW ON LOT•�C -- I
USE OF INO.OF +1�0OF 0
.EXISTING BLDG. Ip1 I�F ' FAMILIES 01 ROOM '
• rN �V
DESCRIPTION OF WORK
NEW ® ALTERATION ADDITION ry I w
41 A
REPAIR I MOVING I DEMOL,.H ' IN ? p
9 ZE T. ROOMS STORIES '(� r
WALL4 ROOF
COVERING �' •'k'1. COVERING
USE OF NEW f i
1° r
BUILDING
�1-'7 G4�►'7•�-� /1 I JI Jn ®r�' I r a !t L-1 t I
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 LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: FIREfiTOP9,
SIGNATURE O t;;+ .} BRACING,BOLTS gyp+'/+�_✓/' ./�'w/ �. J
PERMITTEE '''� of .lr,• ! 3' I V LATH,INT.: ;f t<-•-,r••'�a /
AUTHORIZED AGT r� OF
v
LATH,EXT.:
DBS-3 SOM SETS 7-47 $ P C, PLASTER,INT.
FEE PLASTER,EXT.
VALUATION FEE `'� FINAL
I
DIVISION OF BUILDING AND SAFETY 11 ® '
NG
Department of County Engineer
County of Los Angeles II APPLICATION
WM. J. FOX, COUNTY ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
,/ , r ^� i DISTRICT NO. PLAN CK.oR REc.No. PERMIT NO.
BUILDING
FAR,r �A �D �B(f b + .Y Q Q -) 76
9
Y MPLa i'd' t6 RECEIVE pp BY DATE OFAPPL. DATE ISSUED
NVAREIn
T. A BUILDING
ADDRESS
OWNER III Ls
AMAILDDREBB X/')-:s Ne' -1b u e J>(L LOCALITY
NEAREST
CHOSE
CITY�� C_ B�T."" '���OF
GROUP
TYPE
JFIRE NO.Na O /42
ARCHITECT OR TEL ZONE PLANE
ENGINEER NO.
BLDG.
SETBACK LINE
ADDREBB
USE APPROVED
TEL ZONE BY DATE
CONTRACTOR NO. HOUSE NUMBERING
ADDREBB MAP NUMBER NO. ASSIGNED BLEY
DESCRIPTION LOT NO. BLOCK CORRECTIONS
/ �sa-3
TRACT /
f I ND. OF BLDOB.
SIZE OF LOT ( .�USEOF // 6 IO rer NOW ON LOT yvu . � �F�� l�a �� �.e�
NIL
EX STING BLDG. iD 1f/lY' I FAMIOLIEB '�"���., .� /'>•'/�C�iy!l��c�9aM1 ,
DESCRIPTION OF WORK `
NEW ALTERATION x ADDITION /a , D
REPAIR DEMOLITION
SO.E•S �O NO.OF
ROOMS STORIES �rdq: -'
EXT.WALLI ROOF
COVERING COVERING �J
USE OF STRUCTURE
.Jdo oars. a „ :S-1b••
INSPECTION FOR APPROVALS
OCCUPANOYAS INBPECTOR'BSIGNATURE DATE
FOUNDATION: LOCATION
FORMS, MATERIALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP--
PLICATION AND STATE THAT THE INFORMATION GIVEN 18 FRAMEI FIREBTOPB,
CORRECT. BRACING,BOLTS
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES, FURNACE: LOCATION,
AND STATE LAWS REGULATING BUILDING CONSTRUCTION., GAS VENT,DUCTS
SIGNATURE OF LATH, INT.
PERMITTEE - L—b-a"- -�
�/ T
ADDRESS'
IZ� /V O LATH, EXT.
PLASTER, INT.
AUTHORIZED AMT.
PLASTER, EXT.
$ 6 FEES N I HOUSE NUMBER COR-
D .o.® U RECTAND POSTED
VALUATION FEE U rI FINAL
7GAS3BA DBS 3 1-52 y
'8AS98A'CE#808-7.36 A.P P L I C AT I O N FOR: BUI L®I N G PERMIT
, 1
BUILDING AND SAFETY DIVISION ADDRESS
/BUILDING l,Z h
Department of County Engineer r
County of Los Angeles LOCALITY
JOHN A.LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST.
DISTRICT N GROU TypE SEWER MAP
FOR APPLICANT TO FILL IN I coNs I �� I
BUILDING I
S �� (,t STATISTICAL SIFICA7ION
ADDRES
LOT NO. f O BLOCK CLASS. NO. WELL. UNITS
NUM EMAPR 01 HWY YES NO
TRACT U E Z E SPECIAL
r NO.OF BLDS. CONDITIONS
SIZE OF LOT (q 7. I NOW ON G
LOT �gQ
USE OF 4 !J
EXISTING BLDG. R BUILDING YARD HWY STREET NAME EXIST.
SETBACK W I DTH
,1
OWNER FAll RONT
MAIL rZ9 V QL 122- b-9, QV'
+JV
ADDRESS 1�y' SIDE
TE 39.i 6 7 b P. L.
CITY No INSPECTION RECORD
ARCHITECT Off TEL.
ENGINEER NO.
ADDRESS r
-
CONTRACTOR
ADDRESS -
DESCR TION OF WORK �/ �� '�'-'�• i l`._
NEW ADD ALTER REPAIR DEMOLISH �V
SQ. FT. v NO.OF NO.OF
SIZE STORIES FAMILIES /
USE OF STRUCTURE
S°iA s E X a S7-,S
APPROVALS
SIGNATURE OF K/
APPLICANT LLCCXX�����r//1111 DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
FORMS, MATERIALS
$ P.C. S FRAME: FIRE STOPS.
FEE BRACING. BOLTS
VALUATION/ $f FURNACE: LOCATION.
FEE —GAS VENT. DUCTS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT.
STATE LAWS REGULATING B ING CONSTRUCTION.
SIGNATURE OF HOUSE NUMBER COR-
PERM I RECT AND POSTED
ADDRESS FINAL
IOHN•A.LAMBIE.COUNTY ENGINEER. CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
►Lo8297E- MAY 17 16 7.00Gm
LP o 9 3 5 1 L .Jul] 17 1 1 4.0 0
FOASSSA CE#8 0311-57 APPLICATION FOUR BUILDING PEfZMIT A
COUNTY OF LOS ANGELES BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGINEER 1
BUILDING AND SAFETY DIVISION LOCALITY y
JOHN A.LAMBIE.COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
DISTRICT NO. GR UP SPE SEWER MAP
FOR APPLICANT TO FILL IN "fes I PG
CONST
BUILDING 5 STATISTICAL CLASSIFICATION
ADDRESS I
CLASS.NO.4DWELL.UNITS 1
LOT NO. BLOCK MAP STATE
NUMBER _ HWY. YES NO
TACT QUSE ZONE SPECIAL
• NO.OF B16GS. CONDITIONS
SIZE OF LOT — S NOW ON LOT
'USE OF
EXISTING BLDG. BUILDING EXIST.
SETBACK YARD HWY STREET NAM£ WIDTH
OWNER G Al FRONT' - %
MAIL 'P.L: �
ADDRESS ,2 SIDE
TEL P.L.
CITY NO - INSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER /✓� NO.
ADDRESS �—
�Q TEL ._ n.1 It ♦c
CONTRACTOR _6 NO.
ADDRESS
DESCRIPTION OF WORKp "�""^'
NEW ADD ALTER• REPAIR DEMOLISH
SQ.FT. NO.OF NO.OF
SIZE STORIES FAMILIES
USE OF STRUCTURE
SIGNATURE OF APPROVALS
APPLICANT
DATE INSPECTOR'S SIGNATURE
ADDRESS U2 ct FOUNDATION: LOCATION /
FORMS,MATERIALS
$ FF�E
$ 0 FRAME: FIRE STOPS,
:BRACING.BOLTS
VALUATION {J Cj�, $� FURNACE: LOCATION,
GAS VENT.DUCTS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT.
PLICATION AND STATE THAT THE ABOVE S CORRECT AND r AGREE TO COMPLY WITH ALL COUNTY DINANCES AND
STATE LAWS R U TING BUILDING ONSTRUGTION. LATH,EXT.
SIGNATURE OF ° HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDRES NAL
CLYDE N.DIRLAM,PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION cK. M.o. CAs PEHMTl VALIDATION 0
M.O. CASH
LAC0 5 0 3 5 OR OCT 2 4 2 3 A 1 0,5 0 A � OF
bluo . 7 4v; OCT 29 1 A 2 1 .00 M-
%
:Bs "d4.P PLI Cp Tf6N�sFO R' .BUILDING PERMIT _ ],
DMSION OF BUILDING AND.SAFETY aoDRESS � f
r Depostraeat of County-Engineer
County of Los.Angeles LOCALITYa82�ct''
'"JOHAIIA.L.AMBIE,COUNTY ENGINEER NEAREST
_,CASSATT D.GRIFFIN,SUPT OMBUILDING CROSS ST.
FOR APPLICANT TO FILL IN D13T ICT NO. GROUP TYPE SEWER -MAP
-7 V CON87�—
BUILDING t'" O�j MAP STATE ..
ADDRESS '�/06LJ NUMBER S Hwy
LOT NO. BLOCK U NE SPECIAL
J pp CONDITIONS-
TRACT
NO OF BLDGS. ^
SIZE OF LOT I NOW ON LOT w4. BUILDING YARD HWY STREET NAME EXIST.
USE OF SETBACK WIDTH
EXISTING BLDG. u g FRONT ads
� /
OWNER vY 1 H 1 PS
R I� SIDE
MAIL •g /]
ADDRESS yl F L:PTEL [�Q O. TRACT DWELL. I UNIT 5 . INDUSTRIAL
CITY �l{ 1]�`Q a4,1 $ NO.-FO-0140 -1 DWELL. I UNIT 6 PUBLIC BLDG'.
ARCHITECT O TEL. 2 DUPLEX 2 UNITS 7 ADDR.,ALT., ETC.
ENGINEER NO. 3 APT. UNIT
M ISCEL.
ADDRESS 41 COMMERCIAL
TEL. INSPECTION RECORD
CONTRACTOR NO.
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. O. OF NO.OF �P�/i� li L �? ,�1/•�
SIZE S RIES FAMILIES
USE OF STRUCTURE
6�.
.-I
SIGNATURE OF
APPLICANT _ �" APPROVALS
ADDRESS DATE INSPECTOR'S SIGNATURE
$ ,/�,py rJfJ ION
P.C. $
FOUNDATION:
MATERIALS
(:/L/ FEE FRAME: FIRE STOPS, l ,� 9v�I ' �
VALUATION $ 4�I BRACING. BOLTS A >
FEE dJ[ FURNACE: LOCATION, f
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT.DUCTS f�(
APPLICATION AND STATE THAT THE ABOVE IS CORRECT '
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT.
AND STATE LAVAS REGULATING BUILDING CONSTRUC-
TION; LATH. EXT. ( � P .,Pt .:,p
SIGNATURE OF A tel.(_ HOUSE NUMBER COR-
PERMITTEE ww __�` RECT AND POSTED /
ADDRES 0c l 2' 3 FINAL
JOHN A.LAMBIE.COUNTY ENGINEER VALIDATION ' CLYDE'N.DIRL.AM. CHIEF BLDG. INSPECTOR
CK Mo CASH ,
..;&7 3.6 5 ,qJN 2 5. 1. 2.0 0
Y
IBA696A DBS-3 8.63
APPLOCATION FOR BUILDING PERMIT
`''DIVISION OF BUILI)MG AND SAFETY ADD EISS dv• •/
Deportment of County Engineer
County of Los Angeles LOCALITY
WM.J.FOX.COUNTY ENGINEER NEAREST ��� I `�
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
DISTRICT GRO TYPE SEWER MAP
PG
FOR APPLICAN TO FILL % • I cower. i I 3
BUILDING
ADD ESS /� Zl +� NUMAP STATE ER V NWY Y -
LOT NO. BLOCK U7� SPECIAL
f � CONDITIONS
TRACT [f' 000
NO.OF. GS.r LD
SIVE OF LOT I NOW ON LOT BUILDING YARD HWY STREET NAME !OUST.
SETBACK WIDTH
USE OF t FRONT �-
EXISTING BLDG. � P.L.
OWNER 1 /'f1 .:V-'f 7 SIDE
/
L P.L.
MAILADDRESS ' (�r' p '� O TRACT DWELL. 1 UNIT
5 INDUSTRIAL
TEL o' 1 DWELL. 1 UNIT
CITY NO _e- 6 PUBLIC BLDG.
ARCHITECT OR' TEL. 2 DUPLEX 1 UNIT ADON..ALT.. ETC.
ENGINEER NO. $ APT. UNI
8 M18CEL.
ADDRE33 4 COMMERCIAL
�� EL. INSPECTION RECORD
CONTRACTOR � O•
ADDRESS �Y� r./U %7�tir�`I',�•y., (,, f�
DESCRIPTION OF WORK
DD ALTER REPAIR DEMOLISH
FT. NO.OF NO.OF —
SIZE STORIES FAMILIES ^ "e_
� U OF S C R . � � ��hoe_10
,
• �f w I A-V? li--�'IM l &T-
Awl.,
it+
GAJ
� • //
SIGNATURE OF i A .41 APPROVALS 1
APPLICANT
ADDRES oti Z DATE INSPECTOR'S SIGNATURE,
FOUNDATION:LOCATION
P.C. $ FORMS.MATERIALS `1' % taif'-r<
QO FEE FRAME: FIRE STOPS. ;/!
D� - 8 v() BRACING,BOLTS / '
VALUATION FEE FURNACE:LOCATION,
1 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. r
AND STATE LAWS REGULATING BUIL G CONSTRUC-
TION. LATH.EXT.
SIGNATURE OF �i HOUSE NUMBER'Coll-
PERMITTEE,
RECT AND POSTED '
ADDRESS FINAL
•WM.J.FOX,COUNTY ENGINEER VALIDATION C.N.DIRLAM.CHIEF BLDG.INSPECTOR `
&6 0 2 7S JUL 2 7 6.0 0 in
{'} WORKERS'COMPENSATION DECLARATION 7`�
affirm
that lhave a certificate iconsent to UILDING PERMIT
insure or acetificateof Workers'Compenston Inane, APPLICATION FOR - 11
a
certifj {cop ec. 3800,-Lab. C.)
Policy o®. �" TCompany STA p��M COUNTY OF LOS ANGELES, BUILDING AND SAFETY
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL INBUILDING s-
ADDRESS
Certified copy is filed with the county bui n c- BUILDING y p
tion de arimenf. ADDRESS o51 Lea &44TA AN$T^ 7A7%1f1rq% LOCALITY
1 NEAREST
Date f' Applicant CITY TIOMME t-0 ZIP CROSS ST.
CERTIFICATE OF EXEMP ON FROM WORKERS' NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT � MAP BOOK PAGE PARCEL-
(This section need not be completed if the permit is for one TRACT 3 3� USE ZONE MAP
b�/
hundred dollars ($100)or less.) BLOCK LOT NO. f C� NO. }
OWNER 6 M TEL. ``QQ ddA� SPECIAL �,
NO.4'0®-4 - CONDITIONS
I certify that in the performance of the work for which this O
permit is issued I shall not mploy a per on i any an r S't�f� DISTRICT GROUP TYPE FIRE PRO SSED BY y
so as to eco s th o s' ADDRESS 66 hh ✓'`s`+� A�s� �d�i �,(V CONST. / ZQNE a
Date Ph' nt TY �� ZIP STATISTICAL CLASSIFICATION APT. CONDO. F_
t s
NOTI T:A PLICANIf, making this Certi !cafe ARCHITECT OR TEL.of ENGINEER �L®tJF. NO. IL
Exemption, you should become subject to the Workers' CLASS NO. DWELL. UNITS
Compensation provisions of the Labor Code, you must forth-
ADDRESS SEWER MAP
with comply with such provisions o'r this permit shall be ��pp�,� pp �
deemed revoked. CONTRACTOR FM99OW bVILI WOL.. � ±' BK. , �J
� VALIDATION
LICENSED CONTRACTORS DECLARATION m1o�w LIC
I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION
(commencing with Section 7000)of Division 3 of the Business and LIC.
Professions Code, and my license is in full force and effect. CITY �d' CLASS $ ��s�' 3 O a 9 A
SQ. FT.�� NO.OF NO.OF' CHECK
License Nummbeer.. ����,�u��y�,ALiic.Class SIZE STORIES FAMILIES ONE 0 0 0 0 0
Contractor KN���rt�A `9 `Pa}e$ �11 #tD® DESCRIPTION OF WORK WALD A 2 11 ADD
D❑ $ 2 0 1 0600 -
❑ I am exempt from the licensing requirements as I am a x ��' �$�R�� hp�
icensed architect or a registered professional engineer ALTER ❑: FINAL
A#4() e a o o Ci u
acting in my professional capacity (Section 7051, y® p�J� �� REPAIR ❑ DATE I �, 1 4-80
Business and Professions Code). USE OF
EXISTING BLDG. V�. 19L I14TP DEMOL ❑ FINAL
By
Lic.or Reg.No. Date APPLICANT .�y��jj�
OWNER-BUILDER DECLARATION (PRINT) EPP♦Itg i• A7VW4J'.'+
I hereby off ifm that I am exempt from the Contractor's License •T'�" '�-
Low for the following reason (Section 7031.5, Business and ADDRESS /J
Professions Code). PRESENT �a
El
BUILDING
I, as owner of the property, or my employees with 'ADDRESS
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY 3 O S A
7044, Business and Professions Code). MOVING TEL.
❑. I, as owner of the property, am exclusively contracting CONTRACTOR' NO. # o bl
��o
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). i. O C
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 01A. 1 -7 O n V
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L. 020 C �- 0 4-80
(Sec. 3097, Civ. C.). SIDE
Lender's Name
PP�s� aJlW1fB°aD1sI.CA P.L.
!
i P.C. Fee$ Permit Fee
Lender's Address
I certify that I have read this application and state that the Issuance Fee
= above information is correct:I agree to comply with all County It Investigation Fee
ordinances and State laws relating to building construction,
th�I ' e�. it County to enter Total Fee
o, upon t e above- ro for 2Aecfionurpos s.
Q i+ S® ' SEE REVERSE FOR EXPLANATORY LANGUAGE
o '
���ApPII_ignature of c nt or Agent Dote ®s