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Home My Public Portal About9909 LOWER AZUSA RD_BUILDING_6/13/2016_ (2)BSTOZZTOST 8050 7E 7vIINHaIS3H MEN limad 0NIa7InS aS"ZV Amc-101 b066 '.LX3 8860-58Z (9Z9) '3N d 084T6 VO AIIJ 3'IdW3I SVNnI SV7 TOLE 8050 M AlIJ S7dw3 XN3Wdo73A3a aNv7 / AI33VS UNV ONIO7IOS SXHOM 0I7and 30 IN341LUYd3a S37ri0NV 507 30 AINnoo 805058 :OI 3IDON T9znda :aI IHod3H I NOISJ3dSNI a3UI❑O38 3aOJ NIYSHO OS S7iva (E 110 'aalloaxvEv HO a3aNSd5n5 SI XdOM (z HO '3JHENHOD SON SHaa XHOM (T 3I S)LVa 081 S3HIdX3 IIWU3d I W7 I 1 O� V • M Q'"MAO3ddV XN3WSNVd3a 3HIdI 1 1u 1 S3DIA3a NOIIJ3I a 3XOW51 9f I 3OVNIVHa IO71 / I I Hxyl 40IH=3I fit i 1 j i lilro da/HiV'I HOISSIH1 I �� IdIUIS H3Hly9M/NOIXy'I❑SNII �I / % �8, I S73Nyd UV3FI51 IlD3dSNI 9WVU3 'Id3O Da7H 1 / I ID3dSNI SWVUd 'I43a 3HI3/�Vi 1 ON ON ON I 3'MU3IVW X333 0001 :XII'MOO HIv ONIHIVSHS dOOU HXV3HS UOO'I3 7SA37 aNz �lt'1\ ,M' CIV,1"l QvlkAAI y?V,fn i1/Q�{V �/-(j�(�.Q� I �q�l'y I jy4��I J / l(�� 7( I' � �-" it )"' 1 %teaV , JO<J I SnOQHVZVH NIHXIM 7OOHDS I J60 SEE 5 -SSMIJ XVIS :ONOJ/XdY :SXIN❑ ONI773Ma •S3I'IIWVd dO 'ON HIY3HS HOO'I3 73AS7 ISI I —,.-gi wdNZ) I 1 NOIIV7DSMI doo73U3awl 111711'1 S `1,1�p r"08 ��7'�/yW�� 8 Sw w 0 _dWD :3NOZ 3dId :3DVd 'XOOH dVW H3M3S 'ON dVNI - DNIWVHd Hooai CESIVHI SSL£Z OEOT6 VD 'VN3oVSVd HIOOSI 1 1 UOO7d U3oNn /SY761- '! 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Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U I, as owner of the property, or my employees with wages as their sole compensation, will do (✓) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner - Builder will have the burden of proving that it was not built or improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Con"or pursuant,to the Contractors' State License Law). U I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year priorl to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder If it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: htto://www.leginfo.ca.gov/calaw.html. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. p,r— License Class $ License No.6?2 Z�"� I Date (Gontractor Signature tiRS'COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN MPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm, under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to seB- Insure for workers' compensation, Issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My rkers' comp gsulnceca a $nd polc n b errZT6r/� Cartier Policy Number Expl tae Name of Agent Phone Number I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the labor Code, I shall forthwith comply with those provisions C_ -' S 4 ('0 113 �- ghature of Applicant Date LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in Unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiar with the requirements of Los Angeles County Code Chapter 2.160 at seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself complied and will continue to comply therewith through the appli tion p ss. Applicant (Print Na ) Applicant ga ren r HVl�/N� Company Narni I Date r JOB ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amount specified on the hazardous materials information guide? Yes ❑ No ❑ Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ N o ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter 220' Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMD and/or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lenders Address By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners behaff. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this county to enter the above -identified property for inspection purposes. �gnature of roperty er or Authorized Age XVVV (.,9DC� S Date v l