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Home My Public Portal About5029 SERENO DR_Building__ TEMPLE CITY T9A6]EA CEk 0G 263 APPLICATION FOR BUILDING PERMff COUNTY OF LOS ANGELES BUILDING ADDRESS /+ DEPARTMENT OF COUNTY ENGINEER BUII.DING,AND SAFETY DIVISION LOCALITY JOHN A' LAMBIE COUNTY ENGINEER NEAREST / WILLIAM A JENSEN SUP T OF BUILDING CROSS ST TYPE FOR APPLICANT TO FILL IN DISTRICT NO GROUP CONST SSED BY BUILDING 'HeSTATISTICAL C1A581 CATION ST ER MAP ADDRESS �y 7 OG CLASS NO__y'L.__DWELL UNITS K LO WATER NOT REQUIRED154 RECEIVED CERTI F qIICJA�TE TRACT �,/ NO OF SLOGS NO p/� IICCRCLEI STATE MAJOR SECOND L CAL SIZE OF LOT 6/ -j NOW ON LOT USE ZO11IyyyE SPECIAL USE OF A ( CONDITIONS EXISTING BLDG �A, OWNER NO A ,v BUILDINGEXIST Eno C SETBACK YARD HWY. BEET NAME WIDTH ADDRESS FRONT ARCHITECT OR TEL P L ENGINEER NO SIDE r P L y ADDRESS Q TEL F V CONTRACTOR NO ADDRESS O DJ061CRIPTION OF WORK LLrVI a H rNE ADO ALTE REPAIR DEMOLISH • Z NO OFNO OFSTORIES FAMILIES OF CTURE ATURE OF ' APPLICANT VALUATION S PC PIAT FOUNDATION OI APTOVALS DATE INBPQ- Q�IGNAT.RE FEE S FEE E FORMSMATERIALS ON 22�/ FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ' GAS VENT DUCTS BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT INO TO WORKMEN $COMPENSATION INSURANCE I LATH EXT SIGNATOROF HOUSE NUMBER COR PERMITTE / RECT AND POSTED ADOR E58 FINAL tR.JOHN F LEWIS PRINCIPAL TRU CTURAI PLAN CHECKVALIDATION CK M O DABH PERMIT VALIDATION �,p 1 5 7 3 E OCT 17 1 D 6.0 0'" Q TEMPLE CRTf'` 7MaMQa.H.1 APPLICATION FOR BUILDING PE IT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDREee o� BIIIIAING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE. CouNTY ENoINr[R NEAREST W M JEN UPTo No CROSS ST FOR APPLICANT TO FILL 1N DISTRIC,TI N G TYPE P ED BY v CONST �.l ABUILDING IDDRESS C/✓A OFII/ STATISTICAL CLASSIFICATION SE ER MAPCO CLASS NO WELL UNIT (/ LOT IN BLOC WATER CERTIFICATE NOT REQUIRED RECEIVED TRACT MAP ,p HIGHWAY a NO OF SLOGS NO...f L/ / ICIRCLE, STATE MAJOR SECOND OCA SIZE OF LOT ASo X NOW ON LOT USE ZONE//�JL, SPECIAL US OF A / CONDIT NS EXI8ON/ BLDG Oril�i/�° OWNER OA /t' NOL.llrd(VOY7BUILDING YARD HWY RHET NAME EXIST - ADDRESS O el-/✓O L[ SETBACK WIDTH FRONT \ ARCHITECT OR TEL P L _ ENGINEER NO SIDE P L } ADDRESS TEL INSPECTION RECORD O CONTRACTOR 74E NO V ` L' 0�, O ✓ O ADDRESS 6 I DESCRIPTION OF WOMB 12h R j�1%f ✓ AwCom` NEW Y ADD ALTER REPAIR DEMOLISH I toed /�� /✓ VL' ��' y tFT NO OF NO OF STORIES FAMILIHS USE OF STRUCTURE SIGNATURE OF ✓ APPLICANT VALUATION S f APPROVALS DATE' INSPECTOR/�S SIGNATUREPC PMT I ` FEE FEE FOUNDATION MATERIALS LOCATION I I//�/��` ~ - FRAME FIRE STOPS I HERSEY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE A.OV[ IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL COUNTY O"i NANC" AND STAT[ LAWS REGULATING GAS VHNT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT OF THE LABOR CODE OF TH[ STATE OF CALIFORNIA RELAT INO TO WORKMENp C P^[ wA�ATIL ON YJLATH EXT SIGNATURE OF ' HOUGH NUMBER COR- 'IRM"' AND POSTED ADDRESS f 9� FINAL CLYDE N DIRLAM P INCIPAL STRUCTURAL EN � FLAN CHECK VALIDATION a r o cApx PERM V ATION GR No (e 037 "17 Ti; I 1 1 D C, 11 a..a'.a1 i�� , .,,I✓I Doe a .5m erre B-a[ II 7 L'PA$TMENT OF BUII.DING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING ,�Ye I L ® I N G Wm. J. rox. OHIEr ENGINEER ®® FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING 96V S� DISTRICT NO PLAN CK NO PERMIT NO. / Yy ADDRESS (j �+ l / LOCALITY Gib( J RED IVIED SY DAT[ or APPL DAT[ IBSUIE D NEAREST rROSEI EFT OWNER G/� /� ,l � I - (?`��} ADDRESS ADDRE88 /1/'y7 �/ /'1/ �.�G�W9 \ LOCALITY TC BB NEAREST /n CROBT v Ki CITY No TE � I /�� rIRE NO Or TYPE GROUP ARCHITECT OR TEL ZONEPLANS ENGINEER NO -I BLOC ORD NO ADDRESS SETBACK LINE APPROVED CONTRACTOR NOL BY AA-�d'+�'-Ji DAT[ UBE APPROVED OGRESS ZONE BY DAT[ LEGAL CORRECTIONS DESCRIPTION LOT NO (? BLOCK TRADr 6f &—(� —/ ->✓ -:Z-� Size or Lor �/ ' 3 NO or SLOGS NOW ON LOT USE or /n NO Or / I No or I EXISTING ELDO dib rAKIUM ROOMS�1 DESCRIPTION OF WORK NEW I ALTERATION ADDITION O a REPAIR MOVINGNo or D[MOLIBX p B12e� / 6 ROOMS STORIES WALLI OGr � _COVERING Ae� r// COVERING USEr NEW BUILDING rN 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IB CORRECT FOUNDATIONS LOCATION. INSPECTOR [ AND ACRE[ TO COMPLY WIT ALL COUNTY ORDINANCES rORMS. MATERIALS AND STATE LAWS REGULAT BUILDI CONSTRUCTION FRAM[ rine STOPS. SIGNATURE or BRACING. BOLTS OWNER LATH, INTI AUTHORIZED AOT" LATH. [XT• H Fv /11S P 0.0 PLABTERi INT O d rE[ PLASTER. EXT � O VALUATION ree ;W1 FINAL •.E.A ARTI ENT OF BUILDING AND SAFETY UIPPLICATION FOR PERMIT COUNTY OF LOS ANGELES 1 `BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DIBTAIOTNO PL^"^ uO PERMITNO ■UILDIND ADDRESS I LOCALITY R [I B DAT[OF APPL. DAT[ISSUED NASIEf CROSS 13 s/ 'Z - 7 e WILDING OWNER ADDRESB C /O MAIL LOCALITY =/•V7 G' ADDRESS NR B TEL. CROBB R CITY N FIR[ NO OF TYPE GROUP AQT[ HIQT QR TEL. PLANS R ENSINCER NO eLDO '\ ORD NO ADOR[BB BETSADKLIN[ U �^ L APPROVED TEL By DAT[ CONTRACTOR NO USE APPROVED OD iON _ BY DAT[ LroA1 CORRECTIONS D[BCRIPTIO�NN LOT / •B7LOCK R (/` �^ TRACT /� z (r7 ` � G �!/4♦ [i T /' r -5--6a t i rP BIZ[OF LOT '3 A NDW ON LNo or OT I _ 6, US[OF 5 NO OF /I NO O► << r EKIeTING BLDG .�FANIu[S ROOMS) - DESCRIPTION OF WORK NEW ALT[RwT1ON ADDITION �.�/ /A G a r r�l q •/ G G v ^�✓ — D REPAIR MOVINS DEMOLISHSY %.i Y ♦CY B8IZ[ � ROOMS \/ STORIES WALL 7 ..}.� ROC► r COV[RIND -C.L(iCiM/ I COVa1M0 use or NEW -- BUILDINOa-Z tea 1 HEREBY ACKMOWLEDSE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT FOUNDATION LOCATION INSPECTOR DATE AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STAT[ LAWS RMULA NB BUILDING CONSTRUCTION . FRAME. FIRE STOP% SIGNATURE or BRACIND,BOLTS PERMITTICE LATH,INT.1 AUTHORIZED AOT " LATH.EXT Dm-a IixIm E[TB I- $ P -PLASTER,INT. PLASTER.Orr. VALUATION `-� O RE �� FINAL t r 76.530. CE-803565 APPLICATION FOR BUILDING RMIT COUNTY OF LOS ANGELES ewLo1NG DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS SUI T DF BUILDING CROSS ST Av DISTRICT NO GROUP TYPE PROC SED BY FOR APPLICANT TO FILL IN/AAA _p CONST ADDRESS E,X 0.� J4 STATISTICAL CLASSIFICATION WER MAP l� B CLASS NODWELL UNITS P LOT -,ullf/ 611 if ,Z,fO CrZf USE ZONE I MAP nD NO >" TRACT G — — _ I SPECIAL �--/� NO OI BLDB! / O 1 ION 91ZE OF LOT 1/ HOw ON LOT L USE OF pA/� Ic/Yls 3LO0 SETBACK FROM TEL FRONT PROP LINE OF (STREET) OWNER ? / NO'S dv TYPE OF EXISTING S.KTBACK HIGHWAY YARD = TOTAL ADDRE54 Q� L.`O (/ HIGHWAY FROM C L clrr F eA'� _ d D + o?q = ARCHITECT OR TEL BL RPROM ENGINEER NO lI DEE PROOPP LLINCN OF (STREET) TYPE 01 EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM CL TEL + _ CONTRACTOR NO O LIC CORNER CUTOFF YES NO u ADDRESS NO qe Y LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK NEW ✓ fy AD�/D 1 ALTER REPAIR DEMOLISH SIZE T YX11 F /O RISO ES FAMIINo O IFS USE STR UOCTURE G(f ��— �Ll SIGNATURE OF APPLICANT VALUATIONS / APPROVALS D TE INSP¢C SIGNATURE ' C PMT FOUNDATION LOCATION ev FEES FEE FORMS MATERIALS FRAME FIRE STOPS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIB A C ON BRACING SOLT (O AND STATE THAT THE ABOVE IS CORRECT AND AGREE COMILY FURNACE LOCATION WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING GAS VENT DUCTS "WILDING CONSTRUCTION I CCRFI FY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ]NO TO WORKMEN 5 COMPENSATION INSURANCE LATH EXT SIGNATURE OF HOUSENUMBER COR PERMITTEE RECT AND POST - /J ADDRESS FINAL JOHN F LEWIS PRINCIPAL STR1.5 AL ENGINEER PLAN CHECK VALIDATION cH M o CASH _ PERMIT VALIDATION CKM G CASH A.04 9 5 3� SEP 26 1 D 0M 76AGUA CE#aC3360 APPLICATION FOR BUILDING PERMIT . COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 5029 Sereno Dr. BUILDING AND SAFETY DIVLSION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST I WILLIAM A JENSEN CUP T OF BUILDING CROSS ST DISTRIOCT yQl TVPE PR V FOR APPLICANT TO FILL IN ROU`•/( OV cONST "' BUILDING STATISTICALC SSIFICATION EW MAP ADDRESS 029 Sereno Dr. K P CLASS NO DWELL UNITS 0 LOT NO BLOCK WATER / ) CERTIFICATE NOT REQUIRED ❑ RECEIVED TRACT /� / MAP HIGHWAY NO OF BLDGS NO ICIRCLEI STATE MAJOR SECOND LOCAL SIZE OF LOT NOW ON LOT USE ZONE PECIAL USE OF A CONDITIONS EXISTING BLDG I L OWNER BUILDING EXIST SETBACK YARD HWY STREET NAME WI H ADDRESS FRONT ARCHITECT OR TEL P L ENGINEER NO SIDE P L ADDRESS q 1 TEL 0 CONTRACTOR ADDRESS 5871 Firestone Blvd. So. G_te �� 0 , r CRIPTION OF WORK , ALTER REPAIR DEMOLISH �7 7f J /.� / NO OF NO OFC(I STORIES FAMILIES / n 1 0802 _ ee 1-2 VALUATION T500.00 I APPROVALS DATA HB OR BaIGNwiuRE P C PMT �L FOUNDATION LOCATION L /( FEE S FEE S / (�(/ FORMS MATERIALS 7 FRAME FIRE STOPS 1 HER EIY AC KNOWL[OGE THAT I HAV[ READ THIS APPLICATION BRACING BOLTS AND STAT[ THAT THE ABOVE 16 CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE L/.BOR COD DI THE ST' CALIBORNIA RELAT ING TO WORKMEN B O. NBATION IN CE LATH EXT SIGNATURE HOUSE NUMBER COR , PERMITTEE RECT AND POSTED ADDRESS FINAL PLAN CHECK VALIDATION cK Mo CASH JOHN F LEWIS V RIA 1PALTIO ST��OT( RAL EN INFER PERMIT VALIDATION //C`fK ///, M O CASH U" 0744—� SEP2623D, , 3.75 • Q [ '0 7 4 5� SEP 26 1 D 1 5.00- 7 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES +' BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION . FOR APPLICANT TO FILL IN ButUIAD^DRESS I hereby affirm that I have a Certificate of Consent to self insure BUILDING ADDRESS _ O� or a certificate of Workers Compensation Insurance or a certified Aill COPY thereof(Sec 3800 Lab C) T 5 _ O zm 911e U LOCALITY PcIrc:y No Company SIZE OF LQ NO OF BLDGS NO LOT ElCertfed copy Is hereby'furnahad 1 NEAREST CROSS ST ❑ Certified copy is filed with the County building InspectionpT�RACT BLOCK LOT NO department 1 �CCtC lli 5,,`4 -2% USE ZONE MAP NO _ _ - Date Applicant ASSESSOR MAP BOOK PAGE PARCEL 1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS OWNIER TEL NOp COMPENSATION INSURANCE O �Y WITHIN 1000 Fr of SCHOOLS YES NO (This s need not be coADDRESS dDISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY 1$10 completed if permit for one hundred O �J Odollars ($100) or less) r I certify that In the performancerty of,the work for which this permit on C v ^ ZIP / O �' Is Issued I shall not employ apersIn any manner so as to ARgi CT EN NEER U T L 3 become aubfect to the Nbrkers COmpensallon Laws STATISTICAL CLASSIFICATION APT CONDO Data Applicant [ CLASS NO CASU UNITS NOTICE TO APPLICANT If after making this Cerbflcate of 0 REQUIRED TOTAL SETBACK FROM EXIST EXampton you should become subject to the WOrkefs CONTRACTOR TEL NO SET BACK YARD HWY PROP UNE WIDTH Conwrlsaton provlsons of the Labor Code You must forthvAM RONT comply with such pmvlsons or this permit shall be deemed revoked ADDRESS UC NO pP l- LICENSED CONTRACTORS DECLARATIONSIDE ' CITY LIC CLASS PL I hereby affirm that I am licensed underpmvlscrls of Chapter 9 SEWER Mop (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE 6;AJ NO OF STORIES NO OF FAMILIES Professions Code and my license Is In full force and effect d3yo NEW ❑ BK PG , d DSRIK ADD ' AA )NLicense Number LD Class O Contractor DateALTER ❑ $ cc ❑ I am exempt under Sec REPAIR ❑ $ 0 BBPC for this reason DEMOL ❑ - U LOW P/C Y UI Date USE OF EXISTING BLDG URM ❑ 2J ` 7 a Signature APPLICANT(�T) TEL NO LDMA Perm. '•i ACCT.T Z ❑ as owner of the property or my employees with wages as -1111 ZO 43.7 their Sole Compensation will d0 the work and the structure 5 ADDRESS F a'',07 rot Intended or Offered for sale (Section 7044 Business and FINAL DATE _ A Q P}pfesslOnB("ode) WILL THE MPLa' W OR FUTURE SURDING OCC~11MULE A RAZARDOUS MATERIAL 4 6 7 1 C1a3 Goutier Of the property ar11 eXC USNeIY C0r11naCting with CITED A MIX UPE CONWN NG A HAZARDOUS MATERNL EQUAL TO OR GREATER THAN THE Q /�(� _ L PMnUN15 SPECITED ON THE HAZARDOUS MATERAIS INFCR TIXJ OUOE? FlNAL BY It4CT.T �rL�L licensed contractors to construct the project (Section 7044 TEs❑ No❑ A a7 602,18 Business and Professions Code) ' WILL THE INTENDED DOE OF THE eUMUNG BY THE ARi1CAAT OR FUTURE OCOIFANT REOWRE A PERAYF FOR CCIISTRUmION OR MODIFICATION FROM THE SIXTR1 CONSTRUCTION LENDING AGENCY GO MMRs UAUFY MANAGEMENT asTRIK7(SC oMo)SEE PElumwG CHECKLIST FOR II \ I�� p _2 ITEMS DELII hereby affirm that there Is a Construction lending agency la YES ND❑ - � "} (T 14 geTOTAL 650.93 n the performance of the work for which this permit Is Issued(Sec m HAVEREAO THE HAZXroous MATERIAIs wFORMAnaN CJOE ANO TRE scAar m FFRMITTING 3097 Civ C) CHECKLISTti_ --„\ 1�,�I 1 H 1y I JNDERSTND MY REOJrEMENTS UNDER THE LOS ANGELES COUNTY CODE 1 4rIGWA 650.93 CON TI LE 2 CINPTER 220 SECTIONS 2 20 1W THROUGH 220 140 CERMI HAZARD'US Lenders Name WTERI S REPOmINA A FOR QEWNPD A PERMIT FRJL1 THE SC D '�L 1 I .r `', r, .00 Lenders Address 0 omcR w Aoeirt I certify that I have read this apploadXH and state under penally PC FEE I'4 PERMIT FEE nnnn�rrv'L 7 N with perjury that the above s and ton Is contact agree to GDmpty O I�DCr1,pAQ1 3/29/9✓ N vnih all county ordlrlarXXts and State laws relating to budding ppr�[ DSL ,construction and hereby authorize fepresentatrve8 of this County ISSUANCE FEE t/ J CIT ICT 1 f i 112:16 to tlx:ab/o�ve-rtg/Rho property for Inspection purposes n K 7 J INVESTIGATION FEE TOTAL FEE ' �. M R� .b. SEE REVERSE FOR EXPLANATORY LANGUAGE 4-, WORKERS'COMPENSATION DECLARATION r ;.r Ix�, or a cm that I hoW a certificate of aeon Int to self - APPLICATION FOR �BOILDI NG PERMIT _ _CU censure, or o cenifRote of Workers Compensation Insurance or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY '- Policy No Company. - - - - - - Codified co a hereby furnished „ &1KLDING Q ❑ y FOR APPLICANT TO FILL IN ADDRESS �Q 2 ❑ ' Ceni6ed`copy Ii filed with the'county building mipec BUILDING 5U _i "tion deportment ADDRESS Data, Applicantn - CITY ZIP in So I LOCALITY ' r CERTIFICATE OF EXEMPTION FROM WORKERS -- - n7 NO OF ELLDGS - n - NEAREST •"� COMPENSATION INSURANCE1 SIZE OF LOT L NOW ON LOT 4 CROSS ST ' (Thu section need not be'completed rf the perms m for one - -- - -- - - ASSESSOR hundred dollars ($100)or less ) 1. TRACT &OIX LOT NO MAP BOOK( PAGE PARCEL ME - NO 28 �5 USE ZONE MAP I codify that m the performance of the work for which this OWNER NO y Perim is issued I shall not employ any person in any manner D2 /�• - n r_• I� I L z SPECIAL JIL so,as to become subject to the Workers Compensation Laws ADDRESS RI -7215 y CONDITIONS I 18 Date hcant CITY `L1Pie Y ZIP 1 / NOTICE TO APPLICANT�If,'cher mak this i i to of ARCHITECT Meru O 5" 2 DISTRICT GROUP TYPE I _ FIRE $fED BY-_ O INTER V Exemption"you should become mbj o the Workers '- O w CONST ZONE 13. Compensation provisions of the Labor Code, you must forth- N A0 �' " W with comply with such provisions or this permit shall be - 's'DD��_ _ - - sI� deemed revoked s hO Z t✓-Z STATISTICAL CLASSIFICATION r APT C Z CONiRAROR p _'N'S 1 LICENSED CONTRACTORS DECLARATION _ -- _ S�L/NO o ON - doss No�( " DWint ITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS- (commencing with Section 700D)of Dwrsion 3 of the Business and i- //TT LIC SEWER MAP Professions Code and my license ink n full force and effect GTY C 112t- - CLASS BK PG VALIDATION SO FT _ NO OF NO OF. CHEOc LKenie Number _ 'v v Lic Class T SIZE STORIES / FAMILIES ONE VALUATION COnboctar• - ' ' Date - DESCRIPTION OF WORK EW f ❑ m exempt under Sec - _ I a - - ADO t ALTER , �0873A B 8P C for this reoson - REPAIR $-_ 1 Date FUJISEOFGIUDG LIVE .N DEMOL # • • • • • 1 __ Signature _ __ _ _ _ _ APPL�IC NO 2 G.. /Xf FINAL 'I • `5 Q OWNER BUILDER DECLARATIONAtctlA L J L7 -1 hereby affirm that I am exempt from the Contractor's License - - - - - DATE ---1 • 1 1 5506 -� Law for the following reason'(Section 7031 5 Business and ADDRESS +�F" y� FINAL " S -+ I 'Pro ons Code) ---" - - -- - - By- '" _ I Q � 2-1284 - ' j as owner of the property, 0 .r p perry, or my employees with BUADO�RES$ � _ G _ _ wage as then sole compensation,will do the work and LOCALITY r the structure a not Intended or offered for sole(Section 7044,-Business and Professions Code) - - MOVING i - -- -- TEL - -- ❑ 1, as owner of the property am exclusively contracting gQNTRACrOR NO ' with licensed contractors to construct the project (Sec- ADDRESS - - tion 70" Business and Professions Code) L \ r 5ETIBACK FROM MST - CONSTRUCTION LENDING AGENCY- -- - " SET BREQUACK -YARD HWY TOTAL PROP LINE ,WIDTH 1 hereby affirm that there is a construction lending agency for --FRO-NT -the performance of the work for which this permit is issued - - P L (Sec 3097 Civ C ) PIL Lend er Is Name f7 !s IDMA Ref M Lender$Address Fe•f - Perms Fee I_cenlfy that I have read this application and store that the _ _ ' above Information is correct I agree to comply with all County Invntlganon Fee Nuance Fee - TDMA P/C ordinances and State laws relating to budding construction, G and hereby authorize representatives of this County" to enter Toto)Fee-' -- - LDn1A Perm upon the a -v�entioned property for inspection purposes1 ��/�� y SO ItEVMU FOR EXPLANATORY LANGUAGE -Signature of Apphcant or nt- - - Date 7 r,� WORKERS COMPENSATION DECLARATION �1 hereby affirm that I certificate certificate of consent to self APPLICATION ,FOR 'BUILDING PERMIT ILIO insure, or a cete of Workers' Com kers'Compensation Insurance, � ' or a certified copy thereof (Sec 3800, Lab C ) r ` COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUIIDING Certified copy Is hereby furnished FOR APPLICANT TO FILL IN ADDRESS60-Z5! IV Certified copy Is filed with the county building inspec BUILDING tion department ADDRESS LOCALITY - NEAREST JC.. Data Applicant CITY ZIP CROSS ST Z ITS r'1 CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF&DGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK( PAGE PARCEL (Thu section need not be completed if the permit a for one UTELISE ONE MAP hundred dollars ($100)or less ) TRACT BLOCK - LOT NO i NO I certify that In the performance of the work for which this OWNER14 ZHO 38 6i _2 CONDSPECIITIONS IL permit is Issued I shall not employ an person m any manner - -- -- DISTRICT GROUP TYPE FIRE BY 0 W as to become subject to the Wo Compen Laws ADDRESS CONS? / ZONE CITY Date J-I �Appllca - ARCHITECT OR ZIP TEL STATISTICAL CLASSIFICATION V ✓i A� u NOTICE TO APPLICANT If, e m mg this Certificate - - rIDY - Exemption, you should become subject to the Workers N t�R NO CLASS NO DWELL UNrtS_ 6 Compensation provisions of the Labor Code, you must forth ADDRESS "'�� - - - - SEWER MAP Z with comply with such provisions or this permit shall be _ �7JL deemed revoked CONTRACTOR NO /Z- [ BKA PG 76 VALIDATION LICENSED CONTRACTORS DECLARATION IC 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS VALUATION (commenting with Section 7000)of Division 3 of the Business and LIC i— Professions Code, and my license Is in full force and effect CITY JQC_'C $ S-700 , SO FT NO OF- -- NO OF CHECK License Number. Lic Clash SIZE STORIES FAMILIES ONE T f Contractor pate�_ Lt DESCRIPTION OF N171P ,yam "�'`' ❑ S � Q 1 1 4 A I am exempt under Sac t7� / AM11 ALTER E] FINAL / # • • ° 01 , B 8P C for this reason Op r E - ❑ DATE REPAIR 1 -,- 6863 U TI ❑ DateEXISTING BIDG / � '�- - DEMOL FINAL Signal �f&&:d/ APPLICANT _ TEL By _ . . • 6 8 6 3 5 1 -BUILDER DEG ION PRIM - NO _ z [9 I hereby offum that I am exempt from the Cont ctor's License �� h `S.� G 11.21 -84 Low far the following reason (Section 7031 5, Business and - Profeasions Code) ❑ BUILDING 1, as owner of the property, or my employees with ADDRESS wages as their sale compensation,will do the work and ` the structure is not intended or offered for sale(Section LOCALITY - - 7044, Business and Professioru Code) A40VINGTEL�� NO 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS - hon 7041, Busrniess and Professions Code) CONSTRUCTION LENDING AGENCY - REQUIRED YARD HWY TOTAL SETBACK FROM EXIST 1 hereby affum that there a a construction lending agency SET BACK PROP LIN WIDTH for FROM +- the performance of the work for which this permit Is Issued P L (Sec 3097, Civ C ) SIDE PL Lender s Name 6 Lender's Address PC Fees Per..,Fee �y I certify that I have read this application and two that the Issuance Fee , S above Information Is correct 1 agree to comply with all County ordinances and State lows relating to building tnveaigarwn F•• - Ba dding construction, and hereby au raze representatives of this County to enter Totol Fee / zsy{ upon t -menti property for Inspection purposes ^ -F-/_-2/ S L/ WE WVME FOR EXPLANATORY LANGUAGE -Sfuriifiris of imnt ar^56ritiq Data