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Home My Public Portal About6029 ALESSANDRO AVE_Building__ �f APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES . BUILDING AND SAFETY BUILDING ADDRESS FOR APPLICANT TO FILL IN WORKER'S COMPENSATION DECLARATION - BUIL IN G ADDR SS �oZ I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CIr� M j� /1, zIP� 8O LOCALITY Policy No. Company SIZE OF LOT C / NO.OF BLD S.NOW ON LOT ❑ Certified copy is hereby furnished. a NEAREST CROSS ST. 07 ❑ Certified copy is filed with the county building inspection TRACT I BLOCK LOT NO. department.' 1 3 USE ZONE MAP NO. Date—Applicant ASSESSOR MAP BOOK PAGE PARCEL PP _ / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O TEL.NO. YES NO COMPENSATION INSURANCE A-A SO 12 WITHIN 1000 FT.OF SCHOOL? DDRES (This section need not be completed if the permit is for one hundred A J di t ve DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit T ha- is is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. 1 Y become LIN t to the Workers'Com nSation Lawa STATISTICAL CLASSIFICATION APT CONDO It Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Ce ificate of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' � �/ SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL SIDE >_ LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL Oa 1 hereby affirm that I am licensed under provisions of Chapter 9 SQFT SIZE NO.OF STORES NO.OF FAMILIES SEWER MAP . (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG Professions Code,and my license is in full force and effect. . v DEC PTION OF WOR ` ADD ❑ VALUATION License Number Lic.Class U' _ N Contractor Date f ALTER ❑ $ r z_ ❑ I am exempt under Sec. 1 REPAIR ❑ $ B.BP.C.for this reason DEMOL ❑ USE OF EXISTING BLDG. ❑ LDMA P/C# Date: URM Signature APPLICANT(PRINT) � , r- _ TEL.O. � LDMA Perm iL+J�7— pl Z 1, as owner of the property, or my employees with wages as O their sole compensation,will do the work and the structure is ADDRESS H not intended or offered for sale (Section 7044, Business and cun alonve-, FINAL DATE G Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - ❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Z� Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Y licensed contractors to construct the project.(Section 7044, y Ww= ? w ._ Business and Professions Code.) YES❑ NO _ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING '- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH ''• s'''""' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST ^V-� FOR GUIDELINES. 's I_I i HL.. r" .".Y v=r•�.r I hereby affirm that there is a construction lending agency for YES❑ NO 5I the performance of the work for which this permit is issued(Sec. 3097,CIV.C. . I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES •= —r '!'} �. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING is Lender's Name H R S MATERIALS R!10; TING DER OBTAINING A PERMIT FROM THE SCAOMD. 1A AID Lender's Address 0*40 oRAa�rr o 1 certify that I have read this application and state that the above yZ information is Correct. I agree to comply with all county P.C.FEE PERMIT FEE r 2ZGz m r ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE I abo a mentioned p ope for ins tion purposes. INVESTIGATION FEE TOTAL FEE Q / Sgnewn of kan2 a oeu SEE REVERSE FOR EXPLANATORY LANGUAGE,