Loading...
HomeMy Public PortalAbout5355 SANTA ANITA AVE_Building__ �.�•�. er- `- /BA838A CE#803 B-63APPLICATION FOR BUIL®IN Com;PERMIT COUNTY OF LOS ANGELES BU I sI N 6-3 ' l C'/2�1 S L !/ DEPARTMENT OF COUNTY ENGINEER /� BUILDING AND SAFETY DIVISION LOCALITY PLLr JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. �.N�_, .�,-a• DISTRICT NO. GROUP TYPE P130CF ED BY FOR APPLICANT TO FILL IN coNsr. BUILDINGSTATISTICAL CLASSIFICATION S WER MAP ADDRESS j ry_ �� �( V F CLASS. NO.-,,gaDWELL.UNITS y- LOT NO. ef., BLOCK WATER NOT REQUIRED REC IVED ❑ CERTIFICATE: TRACT - MAP — HIGHWAY NO.OF BLDGS. NO. t,j (CIRCLE) STATE MAJOR SE ONDLOCAL SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. 1 TEL. / OWNER ��� ry NO. BUILDING EXIST. _ SETBACK YARD HWY STREET NAME WIDTH ADDRESS ,j ILL ��(/� FRONT ' �� ARCHITECT OR TEL. P. L. /�(f C.N/ / ENGINEER NO. SIDE . L. ADDRESS TEL. _j CONTRACT O/JR ! NO. —YG , ti_ (� ADDRESS d S / Q��y L i C� L -GQ 1 :ri. DESCRIPTION OF WORK CURB,GUTTER DRIVEWAY AFFROA a a Lu W ADD ALTER REPAIR DEMOLISH , Q.FT. NO.OF NO. OF Curb. gutter. Sid—BRI M , yrpyDy ti ids SIZE STORIES FAMILIES USE OF F STRUCTURE -[ > a (< ry if:, v. N dl4 r `URI'1�'1"BPRrR 1 SIGNATURE OF G + APPLICANT - VALUATION $ 3 r � APPROV DATE INSPECT R'S IGNATURE P.C. PMT. / FOUNDATION: LOCATION FEE 0 - FEE'S !s FORMS, MATERIALS FRAME: IR STOP I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACI 6. TS ~•at ��L 'C i �.7+�� 5 i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THESTA OF CALIFORNIA RELAT. ING TO WORKMEN'S COMPENSATION INS E. LATH.EXT. SIGNATURE OF HOUSE NUMBER COR. f PERMITTEE / RECT AND POSTED _fjADDRESS ` / V FINAL JOHN F. LEWIS. PRINCIPAL ST T RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH Lh6o U U 6 0' i,A 14 2 1 DAfa�� Lh"o 0 u 6 1 4014 1 c 2 7.7 5~ 75A535ACE#.0031.52 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING Y DEPARTMENT OF COUNTY ENGINEER `�' ' / BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. DIS ICT N GP TYPE P D BY FOR APPLICANT TO FILL IN �� CONST. C BUILDING STATISTICAL CLASSION SEWER MAP ADDRESS CLASS.NO. DWELL.,UNITS LOT NO. BLOCK WATEJRNOT REQUIRED _RJEJ� ECEIVED - CERTIFICATE: TRACT MAP —7] HIGHWAY STATE MAJOR SECO LOCAL NO.OF BLDGS. NO. J� (/ (CIRCLE) SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USEOF 'CONDITIONS EXISTING BLDG. L. OWNE O. / BUILDING YARD HWY STREET NAME EXIST. ADDRES � `/� SETBACK WIDTH. FRONT ARCHITECT OR R TEL. P. L. ENGINEER lr� NO. SIDE ADDRESS C TEL. / PA L CONTRACTOR NO. Via � ADDRESS �' (.• DESCRIPTION OF WORK ' d u , ao/ f_ NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO. OF G�r /A3Rfi�Gi '� /-k`moi• �� e1p-/. e yl_tel �A/� SIZE STORIES FAMILIES USE OF STRUCTUR j (/ -3(6SIGNATURE OF •`<Il'�.ti '. ! "/rie '%irt[":i!'4f^-` ��F`fr/ APPLICANT VALUATION $ pw APPROVALS DATE] INSPECTORS SIGNATURE P.C. PMT. FOUNDATION: LOCATION f�.: �:;•/`•, FEE $ FEE $ / FORMS, MATERIALS 4'��• !I"7 !' ?�'�`' `✓!•'r FRAME: FIRE STOPS, f r.._ 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 J a ..._.r._ BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK /'j� / /�A2 'AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- INT. H r %x,;t A �[ 'Ploo .TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. 'GA41t r� .S- -ING TO WORKMEN'S COMPENS ION INSURAN E. �) .f -••s'i'p d _ LATH,EXT. SIGNATOR * -' � HOUSE NUMBER COR- f r PERMITTE 1' RECT AND POSTED ,fI ADDRES J— rFINAL JOHN F. LEWIS, PR'1NC PAL S7CK- RAL ENGINEER PLAN CHECK VALIDATION' CK. M.O. CASH _ PERMIT VALIDATIONM.O. CASH 4ril,o.0 8 2 7 FEB 1. 3 1 D 1 5.00- I i RPM _.ri%fiT1ViENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 01)27 a55lPEml Ij U 9 LD I N G WM. J. FOX, CHIEF_ENGINEER ' FOR APPLICANT TO FILL IN FOR;.OFFICE USE ONLY BUILDING // DISTRICT NO. .PIANS�CK. NO. �fPERMIT NO. ADDRESS �t�f7 AC/ .C� r..e�61• : C� / Y,3 / LOCALITY F:Ir a C�7-I/, if 7Z RECEIVED ECEIVED BY DATE OF/APPL./ DATE ISSUED NEAREST 7 G ^�i-�/�o� CROSS ST. �./�/�"f �� . BUILDING �r . /� & f� ' / ADDRESS /V Q!l d, L`!T �;,•„ OWNER �TIiNdCN �^ MAIL LOCALITY 7, ADDRESSNEAREST Y.f CROSS ST. :�,�..,�s'�.a /e++/ �,'-'tC CITY �G'.+x/pJ� C/T+ NO. -o j t, y-J FIREI NO. OF �j I TYPE '' — GROUP ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. BLDG. .y + IJ✓ L ORD. NO. SETBACK LINE y' CJ j / g yf ADDRESS APPROVED BY DATE . CONTRACTOR Lfli4 I Nc' l'n 7h�71 NO LI Il 9 USE f APPROVED ZONE jr' I �BY DATE ADDRESS `f' RO eltl Ncl /�✓C'. + N� + �Cj CU U HOUSE NUMBERING LEGAL ^, I s DESCRIPTION LOT NO. BLOCK MAP NUMBER FIELD CHECK BY r TRACT ��� f�% NO. ASSIGNED BY '+ '1''61'2.s HATE NO. OF BLDGS. CO3#ECTIONS b;-'' SIZE OF LOT d� ^x -� ..e I NOW ON LOT USE OF I NO. OF u EXISTING BLDG. -.tea FAMILIES 0 9. - DESCRIPTION OF WORK �c NEW. . "I - I ALTERATION I I ADDITION REPAIR I I DEMOLITION S ZE �+ ROOMS / STORIES i/ �J L Z EXT. WALL ROOF lila d c. P .. �'M ger G 6� tD' COVERING .Sjq CG O I COVERING USE OF STRUCTURE A:e fi !'err c 7 T. i�+C?r, Q ! /I I'`f'•?! !� IC' . �y�r7 D APPROVALS U INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE REA6 THIS AP- FOUNDATION: LOCATION y lZ PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIO S LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES A qD STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, SIGNATURE OF e� �/ GAS VENT, DUCTS PERMITTEE / /t; •/�1 f ... ,_i ADDRESS. ✓J/, + u.. LA1. TH, INT. LATH, EXT. /i Z g+,.ra+ti f.i•�'_.f�r AUTHORIZED AGT. PLASTER, INT. ' 76A88BA•D888 20-80 $ O P. C. $ f..• • ® �-�. FEE fl�,l, �' .PLASTER, EXT. VALUATION $ FEEFINe^`�.�C: c^rl��J�✓ ? / l �. AL 6^' I f g4tA88888 ,, 9e' APPLICATIO-N FOR BUILDING PERMIT DMSION OF BUWMG AND SAFETY ADa EISSS Deportment of County Engineer �r County of Los Angeles LOCALITY 2 JOHN A.LAMBIE,COUNTY ENGINEER NEA REST ' CASSATT D.GRIFFIN,SUPT of BUILDING CROSS ST. !9//✓C-:r eqe FOR APPLICANT TO FILL IN DisTRICT NO. GU Tsps SEWER MAP CONS P! BK �� BUILDING ` MAP q+ �y STATE YES O` ADDRESS A$ NUMBER pt(�� v HWY LOT NO. BLOC USE ZONE SPECIAL CONDITIONS TRACT TRACT �pt� �y NO.OF SLOGS. SIZE OF LOT p�� ,j I NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH USE OF �/ /► EXISTING BLDG. /j�/�vJfi�C,t�/ .� / P.L. 0AwFRONT r/af1iv LO OWNER /C, SIDE L. MAIL _ ADDRESS �• si,5:5�.c% t111 .N �J� O TRACT DWELL. I'U.NIT 5 INDUSTRIAL TEL. I''DWELL. I UNIT CITY r �_+ TE D' U 6 PUBLIC BLDG. ARCHITECT OR TEL. 2 DUPLEX 2 UNITSpDDN..ALT..-ETC. ENGINEER NO. 3 APT. —UNITS 8 ' MISCEL. ADDRESS ""' 4 COMMERCIAL rEL' INSPECTION RECORD CONTRACTOR /IJ.veAe NO, i96d1/d. ADDRESS SJ°Y'J77 '�.I//•�•GG:�c 's, i/G+•A•4�r !. !c ^•e DESCRIPTION OF WORK NEW ADD %ALTER REPAIR DEMOLISH n SO FT. NO.OF NO.OF' ��dilgJl.s%1+��/ /sI R(rG�4✓' �r '!�� . SIZE STORIES / FAMILIES, , USE ��e."uD'r» � �i�..-%�� � I•/ l-'C'(/i +5v% ..f.'�f E •..i.. .�,%' SIGNATURE OF ' APPLICANT - �-'' r ! S" APPROVALS/"/ f ,r• ADDRESS' DATE INSPECTORS S16NATURE FOUNDATION:LOCATION � ���— P.C. $ FORMS.MATERIALS. FEE FRAME: FIRE STOPS. VALUATION BRACING,BOLTS FEE C7'T��yO / _ ss / FURNACE:.LOCATION, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GA8 VENT,DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT z AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 'LATH.INT. !Y '�� ' AND STATE LAWS REGULATING BUILDING CON81 RUC- TION. .y LATH. EXT. 0 �%r SIGNATURE OF HOUSE NUMBER COR ...r PERMITTEE RECT AND POSTED ADDRESS- FINAL ��� IOHN A.LAMBIE.COUNTY ENGINEER VALIDATION CLYDE N.DIRLAM,CHIEF BLDG. INSPECTOR CK MO CASH AP 6Uo. 5'-"Ol JUN i 1000in APPLICATION FOR BUILDING ,PERMIT FORAPPLICANT TO FILL IN (Print or type only)" IJ BUILDING COUNTY OF LOS ANGELES r AD aEss `` 'i., `/3�'�/� i� DEPARTMENT ,OF COUNTY ENGINEER CITY ; ZIP / d BUILDING AND SAFETY DIVISION NO.OF B OT BUILDING SIZE OF LOT' � NOW ON LOT ADDRESS TRACT BLOCK LOT NO. LOCALITY J:!./ ': ' TEL. NEAREST �ir OWNER t)10. /yJd/ CROSS ST. ASSESSOR ADDRES ,,,7 ,� Jfiv%i/' /Y'/Ti7 MAP.-BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY CITY , C • ZIP �^r CONS. ZON ARCHITECT OR TEL. �y•g � ENGINEER ..AF&IZ- NO. Y710 STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 1 C CLASS NO._/_2_- _DWELL.UNITS BK PG CONTRACTOR NO TEL. USE ZONE NOP O �1 ADDRESS �i LIC. - NO. � :SPECIAL R.�- , CONDITIONS CITY LIC. CONSTRUCTION LENDER -CLASS` ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ I NAME AND BRANCH BLDG.SETBACK FROM ' ,y FRONT PROP.LINE OF � . "I STREET) C ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD - 9 SQ. FT., NO.-OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE �� STORIES FAMILIES ONE I� DESCRIPTION OF WORK NEW �L]J + .0 C ADD ❑ BLDG.SETBACK FROM SIDE PROP.LINE OF (STREET) ALTER ❑ HIGHWAY f YARD = TOTAL SETBACK FROM TYPE OF EXISTING REIR❑PA SIDE PROP. LINE HIGHWAY WIDTH USE OF 1 _ EXISTING BLDG. DEMOL.[_] + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) 01 BY (SIGNATOR IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION ti 670 ©� tel— CATEGORICAL EXEMPTION YES❑ NO ❑ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE'IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE). WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED _ IMPACT REPORT PROCESSED (DATE) HEREBY-1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE E OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENS' 10 INSURANCE. ' SIGNATURE O PERMITTEE ADDRESS / Pc✓ ,� FINAL J BY o CITY NO. 4(i f/ ' DATE /����7� 'YfD�•�,C� MAKE CHECKS PAYABLE TO: FEE � FEE HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O.. CASH PERMIT VA TION (!CK.' M.O. CASH GG �/ ` 1 2 8:5 0 76A638A CE9803 7/73 ,`r 3 `Q rV �� _ _ J ,&u APPLICATION FOR-BUILDING PERMIT FORAPPLICANT TO FILL IN (Print or Type only) 7110369 eu�LDING COUNTY OF LOS ANGELES A KESS DEPARTMENT OF COUNTY ENGINEER CITY Temple City ZIP - BUILDING AND SAFETY DIVISION BUILDING �NO.OF BLDGS. SIZE OF LOT �L Q SNOW ON LOT ADDRESS TRACT O BLOCK LOT NO. LOCALITY TEL. NEAREST \ OWNER Mr. Frank Stunden NO, 283-372 CROSS ST. 444-370. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT IGROUPITYPE FIRE SSED BY CITY Temple City,' Ca. zip .yam CONST ZpN t ARCHITECT OR TEL. ✓.V 1 ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS (CLASS N��OWELL.UNITS BKa P� CONTRACTOR Air in Roof Co. NO $ - USE ZONE MAP ADDRESS 600 S. San Gabriel No 160650 SPE AL S ` CITY `San. Gabriel, Vial. LIC. CONDITIONS CONSTRUCTION LENDER RP ND C-39 ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ NAME AND BRANCH B DG.SETBACK FROM RONT PROP.LINE OF (STREET) C ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAYF YARD - C SZ FT. NO. OF NO. OF CHECK _ FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE _ CCCF DESCRIPTION OF WORK NEW ❑ t i Reroof house only using #240 ADD E. SIDEGPROP.LINE OF (STREET) ALTER ® HIGHWAY + YARD _ TOTAL SETBA FROM TYPE OF EXISTING Shing es', Trim, Nosing, Nails, e a REPAIR❑ SIDE PROP. LIN HIGHWAY WIDTH EXISTING BLDG. Residence DEMOL ❑ t APPLICANT TEL CORNER,CUTOFF YES ❑ NO (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ .1230.00 CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHGRIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSA INSURANCE. SIGNATURE OF PERMITTEE ADDRESS FINAL BY CITY NOL' DATE 7-2 .174 . j�C l/ �fJ�L-Y)'?'✓ MAKE CHECKS PAYABLE TO: FEE $ . r FEE PMT.$ HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CK. M:O. CASH PERMIT VA TIONCK. M.O. CASH 76AG38A CEp803 7/73 4•hxsu 10 1, 0 2 1..7 5 ,&-% ' APPLICATION. FOR ;BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) - FIDDREUILDI �:.4 • .✓rte f,2 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER zIPf7j-&4 BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING r NO¢WgON LOT ,9r ADDRESS, 3Zj� 1 �f, TRACT rY BLOCK d! LOT NO. p LOCALITY •� �i ' TEL. NEAREST - OWNER �, .� � NO. CROSS ST. � _ ASSESSOR 6 ADDRES •T Kr+,ryry f MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY CITY ��1 ZIP S C� CONST. ZONE ARCHITECT OA zJ TL•E � S C� _� r NO. ENGINEER Lt1 [ A STATISTICAL CLASSIFICATION - SEWER MAP ADDRESS CLASS NO -DWELL•UNITS BK PG CONTRACTOR r^ NO. USE ZONE MAP LIC. N0. L/ ADDRESS NO, SPE AL CITY I� , LIC. /'`1 CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES[] NO CONSTRUCTION LEWDER NAME AND BRAN&H BLDG.SETBACK FROM FRONT PROP.LI NE OF (STREET) c ADDRESS CITY 1 _ TOTAL SETBACK FROM TYPE OF EXISTING L HIGHWAY + YARD FRONT PROP. LINE SQ. FT; NO. OF NO. OF CHECK - HIGHWAY WIDTH F SIZE X70 STORIES -FAMILIES ONE i _ L DES'CRI'PTION OF WORK NEW, ❑ - .� ADD ❑ BLDG.SETBAC ROM i SIDE PROP.LIN F (STREET) ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY • + YARD\ SIDE PROP. LINE HIGHWAY WIDTH REPAIR[] EXISTING BLDG. DEMOL ®USE OF + APPLICANT TEL CORNER CUTOFF YES NO (PRINT) /% NP, BY (SIGNATURE) �l IN OPEN SPACE , YES r NO ❑ IN COASTAL ZONE YES ON,1- NO ❑ VALUATION c7 � CATEGORICAL EXEMPTION- Y NO I HEREBY ACKNOWLEDGE*THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUSHORIZED IMPACT REPORT PROCESSED \ (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION,-OF THE - LABOR CODE OF THEATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPE I INSURANCE. SIGNATURE 0 PERMITTEE ADDRESS TEL. FINAL Y , CITY NO. DATE_d �_ P ,- 9/P. - MAKE CHECKS PAYABLE- TO: FEE $I FEE 1' HARVEY T. BRANDT, COUNTY ENGINEER410 LC1A i PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VA+ DATIO CK. M.O. CASH 3 0 5t4-'MAY 22 1v l 6.0 0 ,&96 76AGSBA CE0803 7/73 - WORKERS'COMPENSATION DECLARATION .a l hofdby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING s� tion department. ADDRESS /f♦VT /T Date Applicant CITY _ �/� ZIP /7'piLOCALITY $ ) CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT U NOW ON LOT / CROSS ST. l/ (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 ONE MAP 1 certify that in the performance of the work for which this OWNER — NO. NO. 447-H permit is issued, I shall not employ any person in any manner / SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS _ _ ,J,,",q xw,;,�w CONDITIONS Date Applicant CITY E♦t9 C t ZIP �� NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT O TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER a NO. � CONST. ,� J ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS -•S� V r -r 51- 'J �� /y . with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIF CATION APT. J�bNDO. deemed revoked. CONTRACTORt NO. LICENSED CONTRACTORS DECLARATION /, LIC CLASS NO. DWELL. 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 and i LIC SEWER MAP Professions Code,and my license is in full force and effect. CITY' - CLASS t BK D VALIDATION y SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE /)' STORIES FAMILIES ONE O VALUATION U DESCRIPTION OF WORK NEW E] l� C, r rr� Contractor Date ADD ; , ?�E;f -,-'= b I am exempt under Sec. 3 ALTER ❑ i •- r 01 B.BP.C. for this reason REPAIR ❑ $ L 1 USE OF DEMOL ❑ TIN 1 A 5 12 Date: EXISTING BLDG. ♦ .G. i _ � r Signature APPLICANT TEL. •� FINAL *'�=1-CK �yl� �Y PRINT ,t/ NO.3 ) -00 OWNER-BUILDER DECLARATION DATE CHANGE , I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Q FI L Professions Code): PRESENT t Fn FC, i BUILDINGf01901 llJ1 I, as owner of the property, or my employees with ADDRESS � wages as their sole compensation,will do the work and / ' c 1 f� y 1y the structure is not intencled or offered for sale(Section LOCALITY .S ' • � 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). jQ'�II REQUIRED TOTAL SETBACK 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. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ] D LDMA Ref. # I P.C. Fee$ �"55 Permit Fee Lender's Address I I certify that I have read this application and state that theIssuance Fee �•��b LDMA`P/C 1# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee T LDMA Perm. # and hereby authorize representatives of this County to enter o upon the above-mentioned property for inspection purposes. 0 g SEE REVERSE FOR EXPLANATORY LANGUAGE 0 Signature of Applicant or Agent Date . s WORKERS' COMPENSATION DECLARATION 9 he ekiy affirm that 14have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof fir. 3800, La/6Tb—CT' /` COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. �7 r Coomlfpany--= �/�t BUILDING CJ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ BUILDING - Certified copy is filed with the county building inspec- ADDRESS tion department. .J -7d Date Applicant /'���t!'J �!i?� �c CITY � / ZIP V LOCALITY y NO. OF BLD S. . NEAREST CER IFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. C�a COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK PA E PARCEL hundred dollars ($100)or less.) TEL. OWNER - tJ [._/#NO. - ( USE ZONE MAp Z 7 1 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 �� _Z SPECIAL CONDITIONS so as to become subject to the Workers'Compensation Laws. O CITY ZIP U Date Applicant ARCHITECT OR TEL. 7 DISTRICT FIRE ESSED BY GROUP TYPE NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER �j NO. CONST. ZONE Exemption, you should become subject to the Workers' `y' ,� �/� U Compensation provisions of the Labor Code, you must forth- ADDRESS / (/ with comply with such provisions or this permit shall be ? TEL. may,. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR s NO. 3 Z LICENSED CONTRACTORS DECLARATION �7./ LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS U y 2 NO. LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business CITY t!1 li CLASS and Professions Code,and my license is in full force and effect. BK [S PG VALIDATION / SQ. FT. „�/ STONO.RIES IE FA OF ` CHECK I License Number Lir. Class SIZE V/ STORIES FAMILIES / ONE DESCRIPTION OF WORK NEW ❑ VALUATION Contractor G"Date ❑1 am exempt under Sec. a.1 w ��; ADD ,[Ell 7 el-4— �L S B.BP.C. for this reason S ON ALTER $ ys %30^ p, USE OF REPAIR ❑ Date: EXISTING BLDG. r r� �/v 1 DEMOL ❑ Signature APPLICANT TEL. g FINA OWNER-BUILDER DECLARATION (PRINT) 7 �S ,J/,6 NO. / DATEL I hereby affirm that I am exempt from the Contractor's License ADDRESS 010,2 f 7 Law for the following reason (Section 7031.5, Business and FI Professions Code): PRESENT B BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and Poo- 1, r 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.) REQUIRED TOTAL SETBACK'ROM 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. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name 3 6c-23 ? P.C. Fee$ Permit Fee J LDMA Ref. # L Lender's Address , 1 certify that I have read this application and state that the Issuance Fee �,�� LDMA P/C# 3 above information is correct. I agree to comply with all County Investigation Fee �7, ordinances and s relating to building construction, Total Fee JV LDMA Perm. # andMMabo,e-yme .Z y authre fives of this County to enter uR perty for inspection pu poses. o ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicant o Agent ate ViWORKERS'COMPENSATION DECLARATION c, t, insure, afirm ce of cote rf Workers'Compensatioove a certificate of n insuranceent to , APPLICATION FOR BUILDING PERMIT or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAF TY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING l ADDRE G Certified copy is filed with the county building inspec- BUILDING��rr tion department. ADDRESS 7 -S&Na AAIM J&LIC- Date Applicant CITY ZIP q 1160 LOALITY ` CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT L4 NOW ON LOT CRA ST. (This section need not be completed if the permit is for one o N ASSES R hundred dollars($100)or less.) TRACT O BLOCK LOT NO. MAP B OK PAGE P RCEL TEL. I certify that in the performance of the work for which this OWNER T'IJN NO. I US N NO r �� _Z- permit is issued, I shall not employ any person in any manner /J�, SPECIAL so as to become subject to.the Workers'Compensation Laws. ADDRESS IWi L CONDITIONS O Date Applicant CITY fE 'r ZIP &11706 V � NOTICE TO APPLICANT: If, after makin this Certificate of ARCHITECTA. TEL. DISTRICT ROUP TYPE FIRE PRO ESSED BY O g ENGINEER . D AJ NO. Exemption, you should become subject to the Workers' f , CONST ZONE , V Compensation provisions of the Labor Code, you must forth- ADDRESS �i 13, 109 — L+-I with comply with such provisions or this permit shall / 0.7 deemed revoked. / TEL. STATISTICAL CLASSIFI TION APT/ CONDO. tq CONTRALTO Ott9�V�� O. � � LICENSED CONTRACTORS DECLARATION % [C• CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of C apter 9 ADDRESS SEWER MAP (commencing with Section 7000)of D'vis!on 3 of the of and r— / LIC.\ Professions Code,and my license i in full force and a ct. CITY 0 W& T CLASS BK PG VALIDATION SQ.FT. NO.O NO.OF CHECK License Number Lic.Class SIZE 0 STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK ED $ ° I am exempt under Sec. ALTER ❑ / d /5 . �7 3 a 0 A 2"JZ ❑ $ {e�� O�Q # aaaa23 B.13P.C. for this reason REPAI ate: USE OF MOL ❑ ) ° 4 7 2 4 0 EXISTING BLDG. a a 4 7 2 4 0 cs, APPLICANT TEL. 610 Signature PRINT f,N NO. . FINAL c OWNER-BUILDER DECLARA ION DATE0629k-87'j 2 9 $7 1 hereb ffirm that I am exempt from the ontractor's License ADDRESS FIN Law for f following reason (Section 7 1.5, Business and Professions de): RE BY ❑ B ILDING I, as ow r of the property, or m employees with A RESS wages as th ' sole compensation,wil do the work and LOCAL a 7,7 De�O ttS the structure is of intended or offered or sale(Section 7044, Business a Professions Code). MOVING TEL. F_JI, as owner of the p perty,am exclusiv ly contracting CONTRACTOR NO. with licensed contrac rs to construct the roject (Sec- ADDRESS tion 7044, Business an rofessions Code). REQUIRED TOTAL SETBACK F CONSTRUCTION LE [ING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a constr lion lending ency for FRONT the performance of the work for whiff this permit 's issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name \ a TDMA Ref. N m Lender's Address P.C.Fee$ oc�/� � Permit Fee (/ I certify that I have read this application and state that t e T ` it .00 Issuance Fee •M r. TDMA P/C# o above information Is correct. I agree to comply with all County Investigation Fee -3-,65-0 , t , 0 ordinances and tate laws relating to building construction, i Total Fee ,65 LDMA Perm.a $ andjftereby authorize'�represedtativespfthis County to enter , p upon the a ove �itio 1d propert for inspection purposes. a f f' //�• SEE REVERSE FOR EXPLANATORY LANGUAGE r�/' Signature of Applicant or Aaent Date