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Home My Public Portal About6341 TEMPLE CITY BLVD_Building__ Pea ger.¢ a DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELESBUILDING WM J FOX. CHIEF ENGINEER NO OF BLDG ORD NO DISTRICT NO PLAH GK NO PERMIT NO PLANE SETBACK LINE I. APPROVED ZONE p/ i�tBY DATE (,[,(!RECEIVED BY DATE9OP APFL DATTE ISSUED U59ZON /, APPROVED Y'/Ir'ZT7 ✓� /` d _- //_"1 4'— /s� APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY H BUILDING ow NAME ADDRBSS Gd d Z ADDRESS LOCALITY ,yY. = Z NEAREST UH U CT' CROSS BT /7 /7 < STATE TEL LICENSE NO H NAME d Z MAIL � NAME ; ADDRESS NO U O TEL L < ADDRESS CITY ZCITY 1 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS O APPLICATION AND STATE THAT THE ABOVE IS CORRECT U STATE THL AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO N I AND STATE LAWS REGULATING BUILDING CONSTRUCTION Z LOT N�G~ `� /ZE OF LOT a SIGNATURE OF O OWNER j 1- q NO OF SLOGS < L BLOCK ✓ NOW ON LOT AUTHORIZED AST yo ¢ J m TRACT V 1,3 CORRECTIONS O USE OF BLD66 �C/ • �-- �y�Q NOW ON IA �- • � , DESCRIPTION OF WORK USE OF BUILDING _ p XL O 7 O 2 T� r NEW (/ TYPE GROUP J NO OF NO OF ALTERATION ROOMS FAMILIES ADDITION SIZE x a-v REPAIR STORIES MOVING WALL COVERING DEMOLIS ROOF COVERING S O—b P C s FINAL APPROVAL / U FEES DATE INSPECTOR' „A VALUATION d � 96 NAME w 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 BUILDING ` T DISTRICT NO PLAN CK NO ^PERMIT NO ADDRESS TQ ,J ?l•J D� LOCALITY / 1. RECEIVED BY DAT[Of APPL DAT[ISSUED NEAREST / D I DR 4 BUILDING OWM[R (�� ADDR<BS � MAIL //• e 1 LOOALm / ADDRESS A `/ O O C' CITY TEL. _ 8R 2T I rlRc N rras Om ENGIINEER OA e. NO ZONE PLANS I BLDG D Oy ADDRESS SETBACK LINE — tJ APPROVED CONTRACTOR NTEL BY DAT[ T6 UB[ APPROVED APOAPOREM ZONE BY DATE LEGAL -3-170 DESCRIPTION LOTNO. BLOCK a I CORRECTIONS TRACT I Z& Y &I� NO OFL ON V SIZE OF LOT NOW ON LOT 1� EXISTING TI NO M' NO OT LO pj DESCRIPTION OF WORK Q41Lp ALTERATION ADDITION p REPAIR MOVING DEMOLISH p SO PT NO OF Z SIZE ROOMS STORIES 1 WALL RDOr � OOVLRINO�j�l -„i/ QDVERIND S/11MeL2<_ USE OT NEW Doc/ BL.E. BUILDING T IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IB CORR[OT FOUNDATION LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANOEB FORM4 MATERIALS AND STAT[ LAWS REOULA� INC CO ION FRAM[i ►IR[STOPS. SIGNATURE OF / - BRACING,SOLTB PERMITTL 40! (/ LATH.INT.1 AUTHORIZED OT LATH.LKT.1 oeB a MIM BETE I." ® P C • PLASTER.INT. RE �T PLASTER.EXT. VALUATION D ME S R FINAL DEPARTMENT OF BUILDING AND SAF$TY APPLICATION FOR PERBUT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHI[I ENGINEER FOR APPLICANT TO FELL IN FOR OFFICE USE ONLY DISTRICT NO PLAN Cr-NO- -- PCRMITNO eY1LDIDRtSYNG r ADe V LOCALITY RM=IVZJD PY I DATE or APPL DATE ISSUED NEAREST �, , Gj ly Ije OR r. BUILDING tf Of OWNER J O 5 C ` ADDRESS MAIL `1 / [ ADDR[HB '�/ 'IC ( !p C f��Q Y-', LOCALITY c RcmS T �CITY Z /9 /7 Q T[L �� FST Lf FIRER[ARCHITECT [ oR P ENGINEER DA -Q. . NO TEL. ZONE ' PLANS ! BLDB .. R NO DD SETBACK LIN[ ' APPROVED CONTRACTOR N4 BY DAT[ USE APPROVED ADD 1' ZONE BY DAT[ N6 BLOCK LEGAL 0N CORRECTIONS D[BCgIPT1 ^LCT � TRACT / (AMC";) 1 812E OF LOT Q � NO OF BLDOB avt NOW ON LOT US[OF I / M�,l NO Of r NOO OF DESCRIPTION OF WORK NEW / ALTERATION ADDITION REPAIR / MOVING DEMOLISH f p B ZC comair a STORIES / WALL i� RO r CA �.`.�/ !! '7 �. COVERING P C COVERING US[Of NEW au1LDInD .f'• ��Pi� � /elvedo a �- O 1HERESY ACKNOWLEDGE THAT 1 HAVE READ THIR APPROVALS APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT FOUNDATION.LOCATION INSPECTOR DAT[ AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES MRM4 MATERIALS AND STAT[ LAMS REGULATING BUILDING CONSTRUCTION FRAMER rIRESTOPe, RIGNATUR[Or BRACING,BOLTS PERM ITTC LATH,INTI AUTNORIZED LATH.ERCT 1 neB a eon acre Iw P C S PLASTER.INT. FEE PLASTER.O[T. /l VALUATION R[ FINAL DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING� ' L D I WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY I `l - ,I �j DISTRICT NO PLAN CK NO PERMITHO BUILDING ADDRESS 731/7,1 , �7 31� , SI✓VVI "/•r� IC � I� LOCALITY / . RECEIVED BY DATE OF APPL DATE IBBUEED DNEAREBT Gi 1, -r- M9BUILDING s- OWNER ,✓�'��I/I.G ,� ��1 T ADDRCIN Is BB MAILn ADDRESS 1 LOCALITY iIM / G O NEAREST, TELCITY CROSS ST �' L FIRE NO OF TYPE GROUP -r OR TEL ZONE 1 PLANE L ENGINEER NO BLDG I / _ ORD NO ADDRESS BETBACKILINE I N L APPROVED '- CONTRACTOR — Yp BY I I.DATE USE I_ APPROVED ADDRESSIQ ZONE BY CORRECTIONS DATE LEGAL ` DESCRIPTION LOT NO BLOCK �� TRACT 1 26 -2 - - NO OF BLDDB SIZE OF LOT 4 73 NOW ON LCT L USE OFNO OF NO OF I -LII I B DO u DESCRIPTION OF WORK NEW ALTERATION ADDITION y yD REPAIR MOVING x, DEMOLISH G BG FT NO OF , if SIZE ROONB STORIES _Z WALL ROOF I 71 COVERING COV[RINS BUI DI N!W BUILDING E - 19 1 AD HEREBY ACKNOWLEDGE THAT 1 HAVE RETHIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATION- LOCATIO IN CCTOR TE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMAT MATERIALS -ti AND STATE LAWS REGULATING BUILDING CONSTRUCTION / ' pq FRAME FIRERTOP6, SIGNATURE OF .O A� A.� q P BRACING.BOLTS PERMITTED //� ,r Vl-` / LATH, INT AUTHORIZED ABT LATH. [XT Y6YLA oea•a �m 1BRe f0 aC P C ! PLASTER,INT Q FEE PER, ! P� FINAL FEE DIVISION OF BUILDING AND SAFETY 1-L ® I N G Department of OoDnty Engineer Coanty of Los Angeles WM J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDINGBB / t// DIBTA N0. PUN�RR[O NO T �1�1T ADDRC (/ A IYI R V BY DATE Or APPL T. , [Q LOCALITY 7 -W,.rz NZAR[BT CROBROT OYILOING ADDS OWNER �2^ MAIL LOCALITY 1..� ADDS®B 3y/ n NEAREST ArW CROSS ST T[ CITY FTSE N0.DF ARCHITECT OR TEL ZONE PLANA ENGINEER NO. BLOB WB ETBACK LIN[ ADDRESS UBE APPROVED ZONE BY DAT[ CONTRACTOR • O // HOUR[ NUMBERING ADDR[®' MAP NUMOEIZ NO ASSIGNED BY - LEGAL CORRECTIONS DESCRIPTIOLOT NO. BLOCK TRACT / 613 BIZ[ OF LOT Now NO a pLDOO. NOW ON LOT UBE OF - / N0.OF E%IBTING BLD `f ►AM U" DESCB=ON OFWORK GB c NEW ALTERATIOM ADDITION D T REPAIR DEMOLITION SG.FT NO OF SIZE ROOMS STORIES EXf WALL I ROOF COVERING COVERING UBE BTRyC R[ INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR•SSIGNATUR E DAT[ FOUNOATICN• LOCATION FORME. MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STAT[ THAT THE INFORMATION OIV[N IB FRAME. FIRESTOPB. CORRECT GRADING.2OLT8 1 ASR[[ TO COMPLY WITH ALL COUNTY 13ROINAM13EB FURNACE LOCATION, AND STAT[ LAWS REGULATING BUILDING CONSTRUCTION GAS VENT DUCTS SIGNATURE OF , �'►e LATH, INT PERMITTM URE ` LATH. [XT ADDRESS PLASTER. INT. AUTH ORIZ[O AOT PLASTER. EXT S P D • FEE HOUSE NUMBER 6OR- ^ RECT AND POSTED VALUATION O t\ • Frs FINAL � I ' DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OFLOS ANGELES U I L D I N G WM J. FOX. CHIEF ENGINEER FOR APPLICANT SO FILL IN FOR OFFICE USE ONLY BUILDING , DISTRICT NO PLAN CK NO PERMIT NO ADDRESS 3 • 4 V 100 LOCALITY Rg9J4VIED,BY DATE -O>F APPL DATE ISSUED NEARESTO / CROSS ST - ownER �., O 5 e sa� p ADDRESS (o S MAIL / ` LOCALITY C.r ADDRESS NEAREST A TEL CROSS BT CITY NO FIRE NO OF TYPE GROUP ARCHITECTOR TEL ZONE PLANS ENGINEER Q NO BLDG ORD NO SETBACK LIN[ ZO • 4 ADDRESS APPROVED �q /� BY DATE CONTRACTOR �/ NO G USE APPROVED ZONE BY DATE ADDRESS HOUR[ NUMBERING LEGAL r DESCRIPTION LOT NO BLOCK O J MAP NUMBER FIELD CHECK BY TRACT Al Z Y NO ASSIGNED BY ^AT 7 NO OFBLDGS If SIZE OF LOT ff& lNOW ON LOT [KISTINO BLDG P—.-- DESCRIPTION OF WORK NEW I ALTERATION I ADDITION I / Z / 1�_V D REPAIR DEMOLITION D p SNo or Z[ Q ROOMS STORIES O ��lj� BXT WALL ROOF �� / / r COV611N0 COVERING `�. N Ue[OF STRU RE - e OO) /V APPROVALS INSPECTOR B SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION LOCATIONCA PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS C��J CORRECT I AGR[[ TO COMPLY WITH Tl�E CORRECTIONS LISTED FRAME FIRESTOPS. HERY OON AND WITH ALL COUNTRDINANCES AND STAT[ BRACING, BOLTS LAWS REGULATING BUILDING CO STRUCTIONy FURNACE LOCATION, SIGNATURE OF µC -/I��yj/`/�- GAS VENT, DUCTS PERMITT V LATH, INT I ADDR ( AUTHORIZED AGT LATH, EXT PLASTER, INT 1 >MOEA Stq I w s P C t �_ FES PLASTER, EXT VALUATION FEE is �� FINAL DIVISIOF OF SIIII.DIN(i AFD SAFETY COURW OF MM ANG= BUILDING WILLIAM J. FOX. CouNTY ENGINEER APPLICATION CABBATT D GRIFFIN. SUPT OF BUILDING FOS APPLICANT TO Fla IN FOR OFFICE USE ONLY BUILDING DISTRICT NO PUN CK GE Rio No PERMIT NO ADDRESS 3 Z 5-6 y LOCALITY • RHCHIV BY 0 DATE OF APPL DATE 188 8D N8ARQ8T Z- S3 C BUILDING OWNstt ADORES" / MAIL LOCALITY ADDR NHARHHTRE I) C CoeB et /V ENGINEER p PIRG NO OF TYPB_�� ORGUP.ti..• ENGIN TEL ZONE PLANE �� _:r ADDRESS BLDG G D N SETBACK LINGZZ.- USE t CONTRA TEL USE APPRoVBD ZONEoa/ BYE DATE Z 14 ADDRESS HOUSE NUM NO LEGAL MAP NUMB O ASSIGNED BY DESCRIPTION LOTNO , % TRA COBB=ONS NO OF BLDGS SIZE OF LAT9-2 NOW ON LOTI USE OP STING B I DESCRIPTION OFOB8 F- 11ARMS Y l r.r D - NEW ALTERATION DD - O REPAIR DEMOLITION MFT NO or H ROOMS STORIES HZT W I ROOF COVERING COVER N l UGH OPS U Re ) S Ov RPPROVALS I PECMROSIGNATURE DATE FOUNDATION LOCATION FORME MATERIALS /A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRBSTOPS PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACIN BOLTS CORRECT 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION AND STATIC LAWS REGULATING BUILDING CONSTRUCTION GAS VENT, DUCTS SIGNATURE OF LATH. INT P®tM 1 0 LATM EXT ADDR N PLASTER. INT AUTHORIZID AGT PLASTER. WIT Pes HOUSE NO POSTENUM RBHRCORD - QCT A VALUATION Pee � FINAL J jt � `d is 7&A43" Qj �E CE O/0.1(REV 6n81 �I1S APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES /BUILDING AND SAFETY yl t4 FOR APPLICANT TO FILL IN AUDDRIESS 3 BUILDING ADDRESS 3 `\ ZYE.m • C\�� •d'0 LOCALITY NEAREST p CITY \ ZIP ti- O CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT X NOW ON LOT 3 MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ESSED BY TRACT 7.ID BLOCK LOT NO CONST ZONE OWNER �., NO -TEL '/-URI �Y SiATISTICALCLASSIFI TION SEWER P ADDRESS 3 Cz Abd CLASS NODWELL UNITS BK PG CITY Tt.mzip g1Z80- TEL ENGIN ER OR\.� \N NO pQ VALUAT16N ADDRESS ��C.. BLDG SETBACK FROM TEL FRONTPROP LINEOF ISTREETI CONTRACTOR ✓ fRO HIGHWAY + YARD TOTAL BACKFROM TYPEOF EXISTING LIC FRONT PROP LINE HIG4jWAYj WIDTH ADDRESS NO LIC + U f CITY CLASS BLDG SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH SIDE PROP LINE OF (STREET( HIGHWAY + YARD TOTAL SETBACK FROM TVPEOF 1EXISTING 0 ADDRESS CITY SIDE PROP LINE HIGHWAYI WIDTH O SFT NO OF NO OF ^ CHECK + = V SIZE STORIES FAMILIES of ONE - Q DESCRIPTION OF WORK TY1• NEW PC Fee S I pC W a0 PermR Fee / 'VIiV ADD Q 60V\�L /0 Cl Issuance Fee /y Om ALTER 'f—�•L �`/ REPAIR D v v Total Fee , USE OF DEMOL G EXISTING BLDG yQ AP6 0 3 A PLICANT EL Q� �12 IPRINTiT � NO o1 V.J-0.q`(y oZ.3 C 5 2J6�-� rt7 • • • • 23 BY(SIGNATURE) y a Oz (j J 2 - - 3000 1 HEREBY ACKNOWLEDGE READ 1 APPLICATION AND STATE f.^ THAT THE ABOVE IS CORV E TO OJ WITH ALL ORDINANCES 6-k - 7 5 ,�O O O U AND TAWUL S REGULATING BUILDING CON5TRLX:TION I CERTIFY THAT IN DOING THE • • • " WORK AUTHORIZED HEREBY I Will NOT EMPLOY ANY PERSON IN VIOLATION OF n" THE LABOR INSURANCE TNESTATEOf CALIFORNIA IN RELATING TO WORKMEN SCOM j_ ^• OB08-79 THEPENSATIONR INSURANCE / 1 SIGNATURE OF1 3 6 0 3 4 A PERMITTEE ` ADDRESS �V ^ ,,,///''' # • rDATEL �t-MQ•h l _\�Y NO - �• 2 • 301 O ONE MAP C:;le ^ ' J • • 3 O 4,O O mu NO C7�YJ JU —'� 5PKIAL CONDITIONS BY !1 WORKERS' COMPENSATION DECLARATION • insureaffirm that have a certificate of consent ,elf insure, APPS(, CATION FOR BUILbING PERMIT re,, oqa certificate of Workers Compensation Insurance or a ce41 ied copy thereof (Sec 3BOO, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY -Policy No Company ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy Is filed with the county building truspec- BUILDItdG �. tion department OTY //,ZfP LOCALITY Date ApplicantCITY OF BLDGS NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT a X.E NOW ON LOT CROSS ST c COMPENSATION INSURANCE +� (This section need not be completed if the permit is for one TRACr / BLOCX LOT NO J MAP BOOK � PAGE Q&1-1- PARCELIAZ hundred dollars (E1o0)or less ) TEL n q p USE ZONE MAP Ss OWNER NO 98'Z-'S/� I certify that in the performance of the work for which this permit is trued, I shall not employ any person in any manner ADDRESS W / SPECCONDITIONS O_ sa as to become subject to the Workers Compensation Laws 0 CITY /y/ Z ZIP - Date Applicant ARCHITECT OR TEL NOTICE TO APPLICANT If, after making this Certificate of ENGINEER S NO _ DISrRICr GROUP COPEE IRE ZONE c PROCESSED BY rO Exemption, you should become subject to the Workers ,,.. � (� ,( y/' LJ Compensation provisions of the Labor Code, you must forth ADDRESS .i W! S : ,f�0 - J L�L a- with comply with such provisions or this permit shall beTEL STATISTICAL CLASSIFICATION APT CONDO Z deemed revoked CONTRACTOR CLASS NO ' DWELL UNITS_ LICENSED CONTRACTORS DECLARATION ADDRESS tic'NO I hereby affirm that I am licensed under provisions of Chapter 9 LIC SEWER MAP IT (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect CITY NO NO OF CLASS CHECK SK E- PG oZ�s oil VALIDATION License Number Lic Class SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW ❑ Contractor Dote ADD El /_/q��d pool.❑ am exempt under Sec r / L ALTER 10 B 8P C for this reason C � -� �Av IR ❑ E Date USE OF BUSTING BLDG DFIIAL ❑ Signature AWIICAt'IT L FINAL OWNER-BUILDER DECLARATION (PRINT) DATE I hereby affirm that I am exempt from the Contractor s License / f/ Law for the following reason (Section 7031 5 Business and ADDRESS `-� �_ FINAL 1 cions Code) IN By I, as owner of the property, or my employees with BADDRESSSS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , 1� ��Lh y I•�� 7094 Business and Professions Code ) MOVING TEL ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO -1_i�� with licensed contractors to construct the project (Sec- - O tion 7044, Business and Professions Code ) ADDRESS j``I f{L ,3 10 vG RR!MI ED TOTAL SETBACK FROM EXIST 3 CONSTRUCTION LENDING AGENCY BA rARD frwy PROP LINE WIDTH 1 hereby affirm that there iso construction lending agency for FRONT 1 the performance of the work for which this permit is issued PL CHANGE .U:I (Sec 3047, Civ C ) SIDE PL Lenders Name .1 s TDMA Ref I �` 1 C10-13-01101n]L!n 1-�� n Lender s Address PC Fee S Permit Fee , ;j(15? 1 rP 1 I $ I certify that I have read this application and state that the Issuance Fee LDMA P/C above information is cwrect I agree to comply with all County Invnipmion Fee _ ordinances and Stole laws relating to building construction, Total Fee • LDMA Perm # ein ` and herebyputhon epr e ives of this County to enter J 1YQ upon is 3or do rty for inspection purpo s EEE REVERSE FOR EXPLANATORY LANGUAGE _ I � S,prwlare of cant ar ent Dat APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COOMWAUTION DECLARATION FOR APPLICANT TO FILL IN I hereby affirm that I fneHe a oenlflcam of mxxsam ro sen brows M a CWMkaro d Workae Compemetlan Irnruan ce,w a mxKtltbdLLADORESS ooPY owed(See 3800,Lab C),70 crtv O X 2- 6 T�,,/,L � LOCALITY Policy No /nn/19 ComI,IR� SIZE OF LOT No SLOGS Now' LOT ❑ Certified Copy b hereby furdstsd G' '/ 2 �cess ST girwalled departmenteorpyC/fe' filed with the Courcy building IED e�aron T . - > BLO" LOT� 3 OZONE MAP rp S Dal.�-I-�Apw{CBIIt P e ASSESSOR MAP BOOK FAW,p RIRCCEL n � ON CERTI�TMO� INSURANCEON FROM 11111FORIMRS' OWN� F4AQ gI-C.17' TEL w 2 / 100D Fr of SCHOOL? NO need not be completed if the permit is for one hundred vc'A,*z I� y L DISTRICT I�GROUP TYPE FIRE ZONE PROCESSED BY dollars($100)or less) I certify that In the performance of of the work for which this permit Z P q/ 7 ( 7 ,�0 „-3 L; Is Im—I I shall not employ Cry Person in any manner so as to ARCHITECT OR ENGINEER Q baeomne W*ct to the Workers' Mperuatbn LoweSTXMrtWSTr1CAL MAW AOORE38 ,G CLASS NO UNITS APf CONDO DOBApplicant NOTICE TO APPLICANT if, after makln0 this Certificate of ' REOUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the Workers' OR TEL-NO BET BACK YARD I Hwy PROP LPIE WIDTH Carrnpanaetlon proYlsiorro of the Labor Cods,You moat tortlne0th FRONT oomply with Much prwWons or this permit"I be deemed revokedADDRESS LIC NO PL LICENSED CONTRACTORS DECLARATION LCc Ctwss U P ce H I hereby affirm that I am Ileanaad under provlelona d Chapter 8 4 333 LIAP (commenrsng with section 7000)of Mision 3 of the nUrress and BO FT Big NO OF STORESLOES N ❑ o professions Code,and my Ircennae b In full force andIaL No License Number Cltme—J.� DEBCAIPnoN OF woRK p MUATWN W Contractor �.�—/ qL�( ad Gln. ALTER S SOD. z 111 am waw under sec REM 11 $ B SPC for tint reason O D ❑ LDMA P/C a Defls _ 17 IfLOSE OF BLDG - ❑ Signature APPLI (PRI TELNo Perms 1 ❑ Lae orTnar d Me proP�Yor my employees with wages as 7 C A--(T their sole compensation will do the work and the ermctira is tRl1AL OATS t ' not infix or offered for Cab (section 7014, Business and ` 7:yq•,1I_, ProbeaHons Cods) wuLne SIR euaoro OcrAvewr AnwaoOnnMKIvi" ❑ 1, eM owner of tie ro mx+A mrrnse na nuZAnoas uA,es,c To OR GRFATer THAN 1 ITEM: p petty, am ethe pray (Section with fie NMOUNnM oN waArooue ,Rraema,aHowm eaLA1.SIT Ikxnsed contractors to construct the project (semdiorn 70/4 ,.®❑ No❑ TfITALm. 2,34 OCS Bmshneat eM Professions;Coda) waL Tit¢mNnaoeo uME SIF Tice euanemo ar A,TUUJIT a nmae ernDnal C HES_K 4.l i� CONSTRUCTION LENDING AGENCY T Ane 9WAOMD)sax PwaurrNOta¢>ti¢i8r Fon ouOe�Nm C H4Nut .0'. I hereby afflrn that them is a comtruclbn lending agency for vrd❑ w❑ the performance of the work for which this permit Is Issued(sec i Nwre reAn Tice�• A,w nnaanrArlarn oumc Ano Tee erworm 3007.CN C) nLmarnno mseaamr I w maam,nns mnoLn Tee mite AWF1E8 I]I]L�)-t�JU 1 c�i 1 CoUNrvmooeTmaL eearnonsLra,aoTmanomoHTmuMCoRrEna�a LaMefe Name nwrAnoonroMATNaAmn AZO wnaensomvmoAPEwaT naMT,eeaonn q` 477 1 AN 9:U=� Lrider's Address / I ovdly,that I hens read this applkabon and state that the abon vc FEE PEtwrt FEE � .D � \� Information b correct I spree to comply with all Courcy ordinances and State laws relating o building amabuetlon,and ISSUANCE FEE /3 — <g Vthie above me property ford dna Iu�s�upon INVESTIGATION FEE TOTAL FEE Q / (O SEE RE1 EPM FOR EXPLANATORY LANOUAIIE