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Home My Public Portal About9917 LOWER AZUSA RD_BUILDING_6/13/2016_ (2)E9TOZZTOST 8050 'IS avIINH0IS33 M3N SIWa3d ONIa']Ins Vs nz�+ ?01mcll L i bb '1X3 8860-S8Z (9Z9) :SNOHd 08LT6 YJ ASID S7dW3I SVNn1 SV'I TOL6 Soso k ALIO 3'Idw31 INSwdo'I3A3a abm / A133v�q aw ONIa'IIne MOM JlRend 30 LNffiCkVdSC 63'I3nMV-SO'I 30 AINNOJ 8090Se 01 3SaOS T9zada :oI 1Hod3Nl I 1 I I�I �AONddY SN6NSWd3O 33IdII I KOISJ3d SNI a3NIn03N 3o0J OS7IV3 (EI a,I I (j' I S3JIA3a NOIZJ3S3a 3XOWS I NO I 'a3N0OS 30 a3QN3d aNadsn SOS s 6I XUQN (ZI No '3JN3MOJ SON S30a XilOM (T I SOVNIV3a IO'II dI SAW 08T S311IdX3 1IW33d I J 41 II II HIVI HOI33SX3I 1 I =MA3a/H.LV1 3OI33INI I pyI a/ dials asHIV3M/NOISMnSNI I S'ISNyd SVHHSI Q SJ3dSNI 3WVH3 'Sd3Q OQ7Hi 1 ON ON ON 71 1103dsKI 3w as 'Id3a SSIdI L J 6'MHSIvw I33d OOOT :AII7VOO SIv1 OD ONIHSV3H6 30031 6noaNVZVH NIHIIM ZOOHJS I Jb0 53A 5 1 � HSy3HS SOO'Id 'I3A3'I aN2 I I I H.LV3HS NOMA 'I3A3'I SST I I :swizz) IVIS raNOJ/ZdV 'S,LINn ONITI3Ma :ssiaiwyd dO 'OKI I I I I Izo E NOISy'IOSKI So0AssaNni 1:dwJ :SNOZ 33Id '3oyd :Xo0e dvw 33M3S 'ON dvw II SSLEZ I :ON 'JI'I OEOT6 vJ 'VN3ovNd HNoma3O3 Z 3S5 SAV SXvO 3IVd 6Tvl16Tj ONIWVH3 HOO'Id a3SIVHI I i/ %JI` 33aNf1/eV'I6I I SwHo3 H3N33S/NOI.LVONnOdi I -8TBB-66L (9Z9) i :ON '131 NOISSa a=MIS SHOI'I 3JVdSI :S3SNION3 NO IJSIIHJSVI I I 7VAO3ddV 333NION3 S'IIOSI I I OZz5B9 VGLT6 VJ 'XSVd 733SINOWI SXJVSIas aNV NOIIVJORI OZ'E08'b SSSS RVIOI I ON 'JI'I TOZ HIS 'aA'IH JSINV'ISV S 6081 I SSOSy3OI5 SOLJSdsm 31Va STI(AOSddV O8-SZT 09'988'Z WA 00'ZLEZZZ AJMVdnJJO dO 311H3J 801 70SSN3/M Llwdsd ZHI -6966-OLS (9Z9) 'ON " m 'OJ oNla'IOH ONOMOWI :3OTJV3LNOJI I 06'9Z 'MA 00'ZLEZZZ aI93H NOHOW ONOTLLS DVI00,6 1 'MA 00'ZLEZZZ VIS IM O1SSI aSSIn0S3 SHS'IXNI3dS 3SIdl OVVIE 3JNVfSMI SIWS3d3ems vvI OEO16 VN3aveVd HLn06 1 SNOIIIaNOJ DAIJSdSI OL'EVE 4W 0C M %sz 33d NOISN3IX3 Jd T3 ZS SXvO SIV3 6TtoI 1 O8'bLE'T TIA 00'ZLEZZZ N3 /M Od a3VaNVI6 Val-8188-66L (9Z9) INSONIA 'IOSI 3VO M Z a3HJVJZVI:lnOWv :WOn :ASIINVOO :HOI7dISJS3a 3331 :ON 'R3I :,INVJI1ddV1 RUM 'SWOOHHIVH E 'SWOOHa39 b OaKa a3HJv13a .[ S-Z MSNI I XHOM d0 N ISdI s30I alvd saga I T4090BLT6dW3II 3AV SOa3ONV E69SIVH o-' I I 'Sa0J :Ae 'IVNId 3I I di ZLE'ZZZ MOIIVn'IVA 1 :101I NO MON 'SOO791 :ON "ISI NONS ISM1 HamoI SS 9T/ET/901 :As a36SHJ03d :No asnSSI Z-S '3NOZ 350 'INVNS11 IVJ AIIJ SadMI :AlMDO'I SS 'aI30 L6S :3OVd SVWOHI I :33HI0 620-420-6858 :133HIS SSOHJ 1S3HVSN I n S-A T BZb :30vm :11ammN NOI.LymoaNI HOSS366V T60608LT6 vJ dw31 I E-S e-4 Z so ST :sw=n3S6l ae vsnzv 3SMo'I LT66 Idn03O daJJO SdA1 SHIHOLS Id 'a6 ZT :11 8486 :1111 1_ :ssaacav 0NIa7Ine I MSN ISNOJ dO 'ON 1 :aI 'IvwiI E9TOZZTOST 8050 'IS avIINH0IS33 M3N SIWa3d ONIa']Ins Vs nz�+ ?01mcll L i bb '1X3 8860-S8Z (9Z9) :SNOHd 08LT6 YJ ASID S7dW3I SVNn1 SV'I TOL6 Soso k ALIO 3'Idw31 INSwdo'I3A3a abm / A133v�q aw ONIa'IIne MOM JlRend 30 LNffiCkVdSC 63'I3nMV-SO'I 30 AINNOJ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the chackmark(s) I have placed next to the applicable item(s) (Section 7031.5, Business and Professions Code): Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. 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 Contraftor pursuant to the Contractors' State License Law). L)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 cqnnot 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.leqinfo.ca.aov/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. / �^ License Cls License No. 4O J ZZZD Date/// ' / Contractor Signature \ .. Q Co W///ORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER 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 self - 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' compensation insurenc er and poli , mbe are: —rA-�F4EjwoS c� Carrier Policy Number Exp ratio at 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 ((6 S a urs, of Applicant 0Date LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits In Unincorporated Los Angeles County only JOB ADDRESS w, 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 ❑ WIII 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 X2'20 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 Constmction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lenders Name Lender's Address By my signature below, I certify to',each of the following: I an, the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county This is to certify that I, as permit applicant, am familiar with the ordinances and state laws relating to building requirements of Los Angeles County Code Chapter 2.160 at seq., construction. (relating to the Los Angeles County Lobbyist Ordinance) and that I authorize representatives of this county to enter the all persons acting on behalf of myself complied and will continue above -identified property for inspection purposes. to comply therewith through the application proces . p ^ � Si re of , roperty ?Fr or Authorized Agent Applicant (Print N e Applicant IgnXre Company Nanie Date Date 1 ' -b