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HomeMy Public PortalAbout5301-5303-5305-5307-5309-5311 VILLAGE CIRCLE DR_Building__ APPLICATION FOR BUIL. ING PERMIT FOR APPLICA T TO FILL IN (Print or type only) BUILDING O11 BUILDING ADDRESS ADDRESS 6 _30/- If CITY lem c, ZIP _LOCALITY NO.OF BLDGS. NEAREST d + SIZE OF LOT NOW ON LOT CROSS ST. TRACT6O LOCK LOT NO. J ASSESSOR ` MAP BOOK -PAGE PARCEL OWNER1 TEL DISTRICT GROUP TYPE FIRE ESSED BY a �h Wm M NO. C NST. ZONE ADDRESS 4pp1% Q, 'T'E'V . `!to n Vsun STATISTICAL CL'ASSSyIFICATION SEWER MAP CITY � WV%W%C, ZIP CLASS NO.�a _DWELL•UNITS BK PG ARCHITECT OR TEL. ENGINEER NO. USE ZONE,MAP NO. ADDRESS � SPECIAL CONTRACTOR S �• II1CT—� CONDITIONS A�epy ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ ADDRESSZ �O Lane. NO.. x.776 a3 BLDG.SETBACK FROM CITY ja Mas'(, LIC' FRONT PROP.LINE OF (STREET).CLASS C-Z. _ TOTAL SETBACK FROM TYPE OF•EXISTING' CONSTRUCTION LENDER HIGHWAY + YARD - HIGHWAY WIDTH NAME AND BRANCH FRONT PROP. LINE RESS CITY + •.Ger F NO. OF NO. OF CHECK BLDG,SETBACKFROM CD SIZE STORIES FAMILIES ONE SIDE PROP..LINE OF (STREET) v NEW HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING 0 DESCRIPTION OFF WORK %nrft6- SIDE PROP. LINE HIGHWAY. WIDTH CD D1QCi YM 41 ADD ❑ + _ w LTER ❑ 00 N (V�� EPAIR❑ CORNER CUTOFF YES ❑ NO ❑ Z � DEMOL USE EXISTING BLDG. ��,/�(����y❑ IN OPEN SPACE YES ❑ NO ❑ AP PRI CAN NT) TQ a* TEL NO V� IN COASTAL ZONE YES ❑ NO ❑ BY (SIGNATURE ENVIRONMENTAL CATEGORICAL EXEMPTION YES❑ NO ❑ eepIMPACT EXEMPTION DECLARATION SIGNED (DATE) VALUATION$ 10 /5a00 IMPACT REPORT PROCESSED (DATE) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND.AGREE TO COMPLY S/ -,burr P S 9r WITH' ALL ORDINANCES AND. LAWS REGULATING BUILDING CON- STR_UCYl'i)W.-I--'CEfi TI'FBe'TwAT IN. DOING THE WORK AUTHORIZED CJS 0- HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE CLABO,yQ•,;:xQODEu.OF. THE STATE OF CALIFORNIA IN RELATING TO J WOItRMEN'S COMP N5 TION INSURANCE. /•- SIGNATURE ` FINAL / I � 9Y PERMITTEE DATE ADDRESS • F $ FEE %CITY- Ws+k ye� NOL p�� O PLAN CHECK VALIDATION K. M.d. 'CASH PERMIT VALIDATIONcK. M.O. CASH 7.4 Oc- EB 10 (j.,,A ,f 8 2.5 0 ,ya 76A636B CENS03A 5/73 , Jv_ APPLICATION FOR BUILDING PERMIT L� FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS - DEPARTMENT OF COUNTY ENGINEER CITY Zip BUILDING AND SAFETY DIVISION NO.OF BLOGS. BUILDING at-- ? SZE OF LOT NOW ON LOT ADDRES JAFJ TRAC' ^�•"' 6c .s f LOT NO LOCALITY `:',,.,-•;a TEL. NEAREST OWNER NO. CROSS ST. f ' ✓ � .�..� ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT 1GROUPITYPE FIRE .PR9CE,SSED BY CITY ZIP CONS T.��- ZON .I ARCHITECT OR TEL. �/ 4� ..� ((� ,/ - •�':%�= ENGINEER NO. ✓ STATISTICAL CLASSIFICATION SEWER.MAP ADDRESS CLASS Ndfl_ _OWE LL.UNITS � BK PG CONTRACTOR NOL USE ZONE MAP NO. / LIC. , ADDRESS SPECIAL LIC. CONDITIONS ' CITY LIC CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ d CONSTRUCTION LENDER CC NAME AND BRANCH BLDG.SETBACK FPOM ISTREETI LL FRONT PROP.LINE OF ADDRESS CITY Li HIGHWAY } YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT, NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE _ Q ❑ + Ix DESCRIPTION OF WORK NEW d ADD ❑ BLDG.SETBACK FROM (STREET'S - SIDE PROP,LINE OF F ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING y HIGHWAY t YARD = SIDE PROP. LINE HIGHWAY WIDTH REPAIR❑ USE OF DEMOL ❑ + EXISTING BLDG. APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. IN OPEN SPACE YES ❑ NO ❑ BY (SIGNATURE) Q, f� IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ �'' V CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED IDA TE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY W'ILl NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO - WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF' PERMfTTEE ADDRESS/.,, �' ^I / Q FINAL BY CITY NO. ATE M.1 KI: (,IILCK I'AY:1/s(_.I: (U: FEE Q, PMT.Q FEE `K FEE `✓ HARVEY T. BRANDT. COUNTY ENGINEER .) ;II PLAN CHECK VALIDATION CK o CASH _ PERMIT VALIDATION CK M O CASH 76A638A CE#803 7/73 yi ids- �.li 1G 1 J APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING .- COUNTY OF LOS ANGELES ADDRESS-6-.5'i�/•�dpi-��=0 7-04-i! DEPARTMENT OF COUNTY ENGINEER CITY � ZIP P BUILDING AND SAFETY .DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT TRACT �� BLOCK LOT NO. LOCALIT L TEL. NEAREST OWN E NO. CROSS ST. ASSESSOR ADDRESS /, MAP BOOK PAGE PARCEL DISTRICT I GROUP TYPE I FIRE CESSED BY CITY ZIP �I/v� (y CONST Z NE ARCHITECT OR TEL. _rd O f ENGINEER NO. STATISTICAL CLASSIFICATION SEW MAP 'ADDRESS CLASS NO. DWELL,UNITS BK PG CONTRACTOR TEOL L-.9Q 'USE ZONE MAP LIC. NO. Q10 ADDRESS , Q NO ',37- PD SPECIAL / LIC. CONDITIONS CITY �� CLASS -/ ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP,LINE OF (STREET) ADDRESS CITY HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING SQ, F NO. OF NO, OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE 3 STORIES p2 FAMILIES'(p ONE DES'C RI PTI ON OF WORK NEW C BLDG.SETBACK FROM C.2 y ADD IN SIDEPROP.LINE OF (STREET) ALTER ❑ HIGHWAY •} YARD = TOTAL SETBACK FROM TYPE OF EXISTING C~.7 REPAIR•❑ SIDE PROP. LINE HIGHWAY WIDTH 1.1 CL USE OF + - Z EXISTING BLDG. DEMOL ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) j PEN SPACE YES ❑ NO ❑ QQ OASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION:$ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMP ` WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZ HE9,EBY 1 T EMPLOY ANY PERSON IN VIOLATION OF T ODE OF T E STPTE •CACI RELATI WORKMEN'S COMPE E IONSTT INANCE ay SIGNATURE OF PERMITTEE ADDRESS FINAL BY TEL �q q CITY !� NO. �-�/B/ DATE MAKE CHECKS PAYABLE TO: FEE FEE-:$ HARVEY T. BRANDT, COUNTY ENGINEER / O PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONCK. M.o. CASH 9 9 8LPtEB �8 1 / 3 5 1.3 0 ®yo 0 76AG38A CB#803 5/74 ,-,,(J; P P L(CAT I O N FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ' BUILDING PERMIT BUILDING MD SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS J'%5�A3�j//J WW41-40,'W41-40,'r P4�1%C C . LOCALITY /Lr/+[/ L Gi` ZIP rQ NEAREST CITY CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT ��TYPE FIRE ESSED BYTRACT BLOCK LOT NO. ZOWNER .a �� TEL. tj i !�l NO. STATISTICAL CLASSIFICATION SEWER P ADDRESS ` & AL CLASS NO._2_-/_DWELL.UNITS BK PG CITY ZIP q!� USE ZONE MA NOP C_�5?0L/ ARCHITECT OR NO. SPECIAL ENGINEER CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ tlyt�/�f. T0. .. (`� BLDG. ETBACK FROM CONTRACTOR 1N` &EEL. •++'�' FRONTPROP.LINE OF (STREET) ADDRESS + t7W('r�C� NO. NIGHW Y + YARD = TOTAL SETBACK FROM TYPE OF EXISTING q FRONT PROP. LINE HIGHWAY WIDTH CITY &,9,6ASS 4-� ,6 CLL _ CONSTRUCTION LENDE + NAME AND BRANCH BLDG.SETBACK F ADDRESS CITY SIDE PROP.LINE OF (STREET) CC.7 SQ. FT. �p NO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM EXISTING Q SIZE // STORIES FAMILIES ONE SIDE PROP. LINE HIGHWA DTH DESCRIPTION OF WORK NEW + h 11S� e'l 7e A? ADD ❑ CORNER CUTOFF YES ❑ NO ❑ Z 07GiALTER ❑ REPAIR❑ IN OPEN SPACE YES ❑ No ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. j� E -Ne[. DEMOL [:1 APPLICANT TEL (PRINT) W CAr.. 0. BY (SIGNATURE) IHEREBY ACKNOWLEDGE THAT I HA READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. 1 CERTIFY THAT IN DOING THEWORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSA SURAPCE. SIGNATURE OF FINAL1� BY PERMITTEE152� DATE �- ADDRIESSS _�J CITY/'T �T NO. .C .Fee$ Permit Fee Z I ,+ Issuance Fee VALUATION$ 1 �� c Total Fee PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 2 9 2 LZVlAY 16 1 0 1 2.0 0 ,&bs 76AG36A CE#803113 12/75 0 APPLICATION FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER [BUILDING PERMIT BUILDING AND SAFETY DIVISION FADDRBUILDING E R APPLICANT TO FILL IN ADDRESS S'3 ,7 !� •.503 I1ICGXIG� ( � AR. LOCALITY � y�IJ�-� �(% NEAREST / �-y ZIP 9/7R� CROSS ST. r' -b�1 NO.OF BLDGS. ASSESSOR NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUPTYPE FIRE P CESSED BY ��O J CONST. ZE 7 BLO LOT NO. Ii't TEL. OWNER /./7j - j% �/ ,6' NO. STATISTICAL CLASSIFICATION I SEWERii QM//A��11P ADDRESS ,j j /� / �••L ,/ +9 CLASS NO._ / DWELL.UN ITS ^� U BK L PG _ 'USE ZONE MAP CITY jY�9G C T! ZIP rf/ �(5 NO. C7IO ARCHITECT OR TEL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTM NT APPROVAL REQUIRED YES❑ NO❑ TEL. BLDG.SETBACK F M CONTRACTOR ��-�I�� oTP�77 ',9 LIC. FRONT PROP.LINE F (STREET) ADDRESS/,<,5P;7 a ��_�lv J� NO.�.Z _ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD HIGHWAY WIDTH CITY /l LIC•G13.p� FRONT PROP. LINE /� CLASS O _ CONSTRUCTION LENDER / + NAME AND BRANCH pk BLDG.SETBACK FROM O ADDRESS CITY SIDE PROP.LINE OF (STREET) c SQ. FT. NO. OF NO. OF CHECK HIGHWAY { YARD = TOTA SETBACK FROM TYPE OF EXISTING SIZE °�� STORIES FAMILIES ONE SIDE ROP. LINE HIGHWAY WIDTH �F�, DESCRIPTION OF WORK NEW ❑ + C ❑ u. �.� ADD CORNER CUTOFF YES NOA. � L T E R ❑ REPAIR[:] IN OPEN SPACE YES ❑ NO E] USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. DEMOL ❑ APPLICANT TEL (PRINT) .�a NO$9r9.77xQ BY (SIGNATURE) I HEREBY ACKNOWLEDGE THAT I HAVE MEAD THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED. HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. / SIGNATURE OF !� FINAL �/ BY PERMITTEE , ( DATE LLL/// vL�_ ADDRESS - t1 G �• TE L. /5- CITY i95F'/d' C�iT lv NO. P.C. Fee$ Permit Fee Issuance Fee VALUATION$ �� � O Total Fee PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 0 4 b ti%9 AY 24 1 U 1 5.17 0 76AG38A C8*8030 12/75 t 6�' APPLICANAO PILdCATIO9' B�J�DING PERMIT FO.. YP Y COUNTY OF LOS ANGELES BUILDING -ADDRESS L ? l _ DEPARTMENT OF COUNTY ENGINEER clrY ZIP i� 6 BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS - L TRACT ] BLOCK LOT NO. LOCALITYNEAREST OWNER ///,( NO. CROSS ST. pp�� ASSESSOR ADDRESS j2 U y[. MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE P ED BY -CITY ZIP �� N CONST. ZOpLj / ARCHITECT CP TEL. ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �w //��Qp^(^� CLASS NO. DWELL.UNITS BK PG CONTRACTOR C Qi LO �'I NOL 312,, USE ZONE MAP ADDRESS j&MW&k NO. �`'`G _ f Z)o I) SPECIAL LIC. CONDITIONS CITY t;,I//��L CLASS�`' ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.Ffi �y� NO.OF NO.OF CHECK HIGHWAY F YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRI ION O W RK NEW ❑ + O d BLDG.SETBACK FROM Cie (STREET( O ADD SIDE PROP.LINE OF N�U ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTIN REPAIR 1:1G W HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH . h USE OF ti Z EXISTING BLDG. tJ DEMOL ❑ + APPLICAN TEL ++�� CORNER CUTOFF YES ❑ NO ❑ IPRINTI NC} DA' IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATU ��y� IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION $ "'[l )l IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATU PERMITTEE ADDRESS 1p �I - ! ��1'l NO. �'� 1 DATE ,✓� -77 CITY BY id P MAKE CHECKS PAYABLE TO: FEE' FEET'$ HARVEY T.BRANDT,COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH P MIT � DATION CK. ' M.O. CASH 9:0 0 s ®s 76A63BA CE#803 3.75' FOR,.APPhICANAoPPLICIATIOor tyeYN FOR BUILDING PERMIT FILL INCOUNTY OF LOS ANGELES ADIDRSS QJAj4,fdtIf Cj DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING d� SIZE OF LOT NOW ON LOT ADDRESS % Q TRACT 6Q v BLOCK LOT NO. LOCALITY ,t TEL. NEAREST OWNER •U r L NO. CROSS ST. r ADDRESS © ` 7 ASSESSOR MAP BOOK PAGE PARCEL DISTRICT GRPUY TYPE FIRE PRO SSED BY -CITY • ZIP p CONST. ZO ARCHITECT OR TEL. o ! d ENGINEER NO. STATISTICAL CLASSIFICATION SEW AP ADDRESS CLASS NO. DWELL.UNITS BK PG CONTRACTOR dt IV& r N TEL O.LI/tv/97- SE ZONE I NOP O/p LIC. ID SPECIAL ADDRESS �f /rl/ NO.� 6 / JJ CONDITIONS CITY 6 CLASS e' CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ NAME AND BRANCH BLDG.S BACK FROM FRONT ROP.LINE OF ISTREETI ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SO.SIZE FT. UB NO.OF NO.OF CHECK HIGH AY + YARD = FRONT PROP.LINE HIGHWAY WIDTH ISTORIES FAMILIES ONE DESCRIPTION OF WORK NEW + O ❑ BLDG.SETBAC M cz S'0 d A �S7 ADD SIDE PROP.LINE OF (STREET) F O Gj ALTER ❑ SETBACK FROM TYPE OF EXISTING w HIGHWAY + YARD = SID HIGHWAY.WIDTH h USE OF REPAIR ❑ Z EXISTING BLDG. DEMOL ❑ } APPLICANT ° TEL ..��ppCORNER CUTOFF YES ❑ NO ❑ (PRINT) NeZ- /& r 6O. lox/OL J ., IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) �J6rZ �� ; � IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ s I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE OF PERMITTEE w� ADDRESS We CITY �i�_ TEL. FINT L e r•J / �-;r� BY MAKE CHECKS PAYABLE TO: FEE F ET HARVEY T.BRANDT.COUNTY ENGINEER / PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.0. CASH 9'3'2t'o-..PJL 12. 1 D- 1. 2.0 0 09f ®6 76A638A CE#803 3.75 VP APPLICATION FOR BUILDING PERMIT FOR,,APPLI.CANTTO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS v/4/L DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS � G� i(• TRA Q 7/ BLOCK LOT NO. LOCALITY .. TEL. NEAREST � OWNER �' L� CAI NO. CROSS ST. ASSESSOR ' ADDRESS p (» MAP BOOK PAGE PARCEL -CITYDISTRICT GROUP TYPE FIRE PRO SSED BY Ll C ZIP CONST. ZONE ARCHITECT OR TEL. 0 ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAK ADDRESS ��rr CLASS NO. y� DWELL.UNITS iJ BK PG CONTRACTOR ffeG'� //1 0. /-7 2 ��jEZONE NO. �b LIC. Q /�� SPECIAL ADDRESS �� rJ1�+ DN(,_ /!/ NO. [ iyLIC. I\ CONDITIONS CITY ASS �� / ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT. NO.OF NO.OF CHECK HIGHWAY t YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE �7 STORIES FAMILIES ONE DESCRIPTION OF WORK NEW + = O �x r ADD BLDG. PROP.LINE OFOM (STREET) O ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING G USE.OF REPAIR ❑ SIDE PROP.LINE HIGHWAY WIDTH . Z EXISTING BLDG. DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) V/Vee- ©,c, 1N NO. f1w IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) Q@ IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE SIGNATURE OF. PERMITTEE ADDRESS ®` CITY /L�-i'7 d� o NO. - DATEFINAL /�--7� B ,-�c�� MAKE CHECKS PAYABLE TO: FEE' w / / FEET' HARVEY T.BRANDT,COUNTY ENGINEER / PLAN CHECK VALIDATION cK M.O. CASH a PERMIT VALIDATION CK. M.O. CASH 1- 2..010A& ®S 76A63BA CE#803 3.75' ,WORKERS'COMPENSATION DECLARATION , 7� -In hereby a cert that I have a certificate of consent to self APPLICATION FORBUILDING PERMIT f� insure,or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. Lab. C.) COUNTY OF LOS ANGELES. BUILDING AND SAFETY Policy No. Companypang Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS /� G G ik v Certified copy is'filed with the county building inspec- fADDI DING tion department. ESS t7 ! (�f ��-`l LOCALITY Date Applicant NEAREST ` ZIP p V CROSSST. G'ZCERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE OF LOT ° NOW ON LOT MAP BOOK PAGE PARCEL (Thissection need not be completed if the permit is for one USE ZONE MAP 7 hundred dollars ($100)or less.) T BLOCK LOT NO. NO. >_ TEL. C ^ SPECIAL p,C .1 GL.1i ^ c�2S �T7 CONDITIONSI certify that in the performance of the work for which this OWNER �,{,0 � �; o t A. DISTRICT GROUP TYPE FIRE PROCESSED BY U gl permit is issued, I shall not employ any person in any manner ? ! CONST. s Z E so as to become subject to the Workers'Com ens ion Laws. ADDRESS,rJ C` L ' �O ty gAJ o Date App lica • r`s ft -`' CITY ZIP U STATISTICAL CLASSIFICATION APT. CONDO. I �� : ARCHITECT OR TEL. t"1 NOTICE TO APPLICANT: If, a er m ting this ertificate of W Exemption, you should become `ubject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- .:ADDRESS ti/ SEWER MAP with comply with such provisions or this permit shall be — deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION 410 _ (commencing with Section 7000)of Division 3 of the Business and LIC. O �� Professions Code, and my license is in full force and effect. CITY CLASS $ a SQ. FT. NO.OF t NO.OF CHECK License Number Lic.Class SIZE STORIES ! FAMILIES ONE $ Contractor Date DESCRIPTI N OF WORK NEW ❑ I am exempt from the licensing requirements as I am a ADD licensed architect or a registered professional engineer ALTER ❑ FINAL acting in my professional capacity (Section 7051, REPAIR ❑: DATE FINAL ( ('} Business and Professions Code). USE OF . EXISTING BLDG. DEMOL ❑. By Lic.or Reg.No. Date :APPLICANT TEL. r OWNER-BUILDER DECLARATION (PRINT) NO. V I hereby affirm that I am exempt from the Contractor's License I Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ❑ 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 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 FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 1' 1 5 3 0 A I hereby affirm that there is a construction lending agency for FRONT 1 the performance of the work for which this permit is issued - P.L. 0 0 0 0 0 1 j (Sec. 3097, Civ. C.). SIDE P.L. 2 0 0 3 0 0 Lender's Name 0 0 034006 ii P.C. Fee$ Permit Fee Lender's Address I Q, 1 3-81 I certif that I have read this application and state that the � Y PP Issuance Fee , above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this County to enter upon the above- ntion property for inspection purposes. 1W Ll SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Ap 'Ent or Agont r L!—Dartte-�=� o as