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Home My Public Portal About4847 ARDEN DR_Building__ APPLICATION FOR BUILDING PERMIT �] COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING yRESS , BUILDING ADDRESS A O I hereby affirm that I have a certificate of consent to self insure, /7' or a certificate of Workers' Compensation Insurance,or a certified copy thereof Sec.3800,Lab.C.) CITY ZIP LOCALITY Policy No. F f' Company SIZE OF LO NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Date/-zgF_2 Applicant 'I ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION F OM WORKERS' OW TEL NO,_ �C YES NO COMPENSATION INSURANCE e r WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADORES DISTRICT GROUPT E CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) - -- CITY -Lt� ZIP .{ I certify that in the performance of the work for which this permit ��Q yD� ✓ f ��, is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. a become subject t0 the Workers' io STATISTICAL CLASSIFICATION APT CONDO Date -ZJ F-9Y Applicant ADDRESS CLASS NO.- DWELL UNITS NOTICE TO APPLICANT If, after makin ale" Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers TOR / TEL NO. c� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ,ten r, 1. /-,-- (.on-4i /6 d F FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L r3 C(/c. t/' LICENSED CONTRACTORS DECLARATION 222-77 J y SIDECITY / LIC LASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 fj�/ (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP 0- Professions Code,and my license is in full force and effect. NEW BK PG O License Number u•r Lic.Class 4f` DESCRIPTION OF WORK ADD ❑ VALUATION O F- Contractor ��. C_ Date -Z�-9�' � 44-- . ALTER El $ BBB W ❑ I am exempt under Sec. 'r "4- REPAIR CJ ALTER z BAP.C. for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ _ Signature A RI T) TEL NO. LDMA Perm# 'T OHO 11'_• f t ❑.I,:as owner of the property, or my employees with wages as Q 4 rRC 1 A` Z _ _ "_ _.. their sole compensation, will do the work and the structure is ADDR SSutil! not intended or offered for sale (Section 7044, Business and FINAL DATE Q ---�- A 0 - ' Professions Code.) r6 t= WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALEl _ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE YYY J j . 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY ; IMP!_ u•�...,_3 � _s 0 licensed contractors to construct the project (Section 7044, r VES❑ NO❑ •�'�g"•i:' ^;}C yy .Business and Professions Code.) !_r�L:.�.:f•. %•?_•=:) WILL THE INTENDED USE'OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH f:{-.r, i••ji_��_ i i(I CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR s" GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ No❑ N the performance of the work for which this permit is issued(Sec. ' -- -•r:i s-_ti [HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20 140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. k 5?:i LL t i o Lender's Address /V-51 OR AGENT /`�3�� 0 o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE /� PERMIT FEE �0 !v N with all county ordinances and State laws relating to building CO construction, and hereby authorize representatives of this County lrSSUANCE FEE ��0 a e eels o hOYeanleationed property for inspection purp^oses. / INVESTIGATION FEE TOTAL FEE .So� Y .,tur of ApOlicanl or Agent /0.,'—4-10 JY�I Date ,\ r SEE REVERSE FOR EXPLANATORY LANGUAGE :.r�. APPLICATION FOR-BUILDING PERMIT COUNTY OF LOS AN GELD" ' ' ' i3UILDING AND SAFETY BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL INS I hereby, affirm that I have a certificate of consent to self insure, BU DING ADDRESS w or a certificate of Workers' Compensation Insurance,or a certified CITY ' �� ZIP `Q O E a C Z N J J " copy thereof(Sec.3800,Lab.C.) LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. Z �� NEAR ST CROSS ST. ST. �. �JA RD ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. J department. USE ZONE MAP NO. Date Applicant ASS OR MAP BOOK JC PAGE - PARCEL �� D SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ` \ NO( ��1� /\ YES NO COMPENSATION INSURANCE IJ't JS y( WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit Is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONEPROCESSED BY dollars ($100)or less.) _ I certify that in the performance of the work for which this permit\ CITY - N� zIP �- is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER a become subject to the Workers'Compensation Laws. H�969 /7 STATISTICAL CLAS$IFTION O APT CONDO o�� /.....:... .......... Date Applicant A DRESS Z ` CLASS NO. 1�.- DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED � � TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers CONTRACTOR TEL NO. SET BACK YARD HWY PRS?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. P Litt,f o v LICENSED CONTRACTORS DECLARATION SIDE - - -- --- - L+,:+� 1- - •{{ CITY LIC.CLASS P L .. . .. 30 J 94 I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP 1 1 i FM1 (commencing with Section 7000)of Division 3 of the Business and .,� SQ.FT.SIZ NO.OF STORIES NO.OF FAMILIES ``, NEW BK.. ............_..PG Professions Code,and my license is in full force and effect. I} , �)-T A;_ il{;j a j`4 Q DESCRIPTION OF WORK ADD ❑-- -VALUATION. (.l�j ,. Q License Number Lic.Class1X C d�i i� r- Contractor Date ALTER ❑ CHECK CH •HA SGL a CIS! 0C REPAIR ❑_. ... - O El am exempt under Sec. .$ U BAP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM Q �I 57 25/93 O I�tI1�-I�I I I W Signature APPLICANT(PRINT) 5 f I •TE NO.- s LDMA Perm,# -- - s`• j q - f•1 FL•e+•VY 1L .4`+yJ 3• �• Am lo:11.6 Z z 1�1._•t o g a ❑ I, as owner of the property, or my employees with wages as HO, >,?�,? their sole compensation, will do the work and the structure is DRESS -) - -not intended or offered for 'sale (Section 7044, Business and LC 4q, FINAL DAT Q T j i`m` P fessions Code.) WILL THE APPLICANT OR•FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A•HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE' ' - •`•""•'° ''�- v as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON.THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL +' '}-1`I fL i"'• u`�1 en Ed contractors to construct the project (Section 7044, k VES❑ NO❑- - \� I_a-}Pf-�•' • '�_ -c' ;:i B 'Hess and Professions Code.) - WILL THE INTENDED USE OF THE•aUIDUNG BY THE APPLICANT OR FUTURE BUILDING �{ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH — I_y�Hf.�13L s i_4 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. - the affirm that there is a construction lending'agency for VES❑ No❑ . I Ll O/+� -14 N the performance Of the Work for which this permit IS ISSUed(Sec. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING G ", V ':.It f'i!`•— i iLi S +!i+•=-• - rn 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ,/y►/�� _ N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS —/' ri'I�-'' !�!�f'I ii'+• 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. i•f•i••" rlf'•L'� -r IL Lender's Address OWNER OR AGENT O 0 1 certify that I have read this application and state under penalty O of perjury that the above information is correct. I agree to comply P.C.FEE /�/ PERMIT FE� /• �� CV 0 with all county ordinances and State laws relating to building r/ construction, and hereby authorize representatives of this County ISSUANCE FEEa� m 'S/ r toon the ab ve-mentioned r perty for inspection purpos a e prr INVESTIGATION FEE TOTAL FE //��• /�yy.��) Sg.1u.of Applicant.AWl Oate r V _ SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FQR`BUILDING PERMIT COUNTY OF LOS ANGELES, " BUILDING AND SAFETY BUILDI FOR APPLICANT TO FILL IN N R SS WORKER'S COMPENSATION DECLARATION I FAIZ I hereby affirm that I have a certificate of consent to self insure, BUILDING QDDRJESS or a certificate of Workers' Compensation Insurance,or a certified F� Y A-ROEAJ DR 7 /1 G /7�� copy thereof(Sec.3800,Lab.C.) CITY /T �T ZIP ��O LOCALITY` ' G Policy No. Company SIZE OF I-(&LL C..3 NO.OF BLD S.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. I USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ,C TEL o.LL� yj COMPENSATION INSURANCE k1 H r C 0 IS WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS dollars ($'100)or less.) - '�h, C y: 1'�4 DISTRICT,/p� GROUP T E O�J�� IRE ZONE PROCESSED BY CITY�� v,j�. I p /�/OV �0 I certify that in the performance of the work for which this permit V•V71 .aa//✓ _ or ARCHITECT is issued, I Shall not employ any person in any manner SO as t0 ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTORTEL NO, 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. P L LICENSED CONTRACTORS DECLARATIONSIDE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP >- (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZ NO.OF STO!!!j NO,OF FAMILIES a Professions Code,and my license is in full force and effect. NEW BK PG , O DESCRIPTIO OF WORK VALUATION '{ V License Number Lic.Class kAJAL� j ADD ❑ � y Contractor Date LJ ALTER ❑ nn�� Itly L000 REPAIR ❑ i ,,c•H ❑ I am exempt under Sec. $ i B.BP.C.for this reason DEMOL ❑ W Date: USE OF EXISTING BLDG. LDMA P/C# ITE�jt a URM• ❑ +:-:TA-1 ;�• N Signature APPLICANT(PRINT) /' ,J TEL NO. LDMA Perm# t, � � >a S �q Z ❑ I, as owner of the property, or my employees with wages as N C�/� r• tH �I !� Z .�HE. 1 a�...I their sole compensation, will do the work and the structure is ADD:21e12 . lS /y J��r /�� /J/j/ / D! L. +W W/�L"y'• C� 7AL DATEnot intended or offered for sale (Section 7044, Business and �rofessions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUoil- S MATERIAL � J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL"TO OR GREATER THAN THE _ I, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY t`i t--1 _' t fes-'' licensed contractors to construct the project (Section 7044, t'•_,.'�= :a I`!i -1 I 1 . YES❑ NO❑ _ Business and Professions Code.) r �•�.};.-., : - WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �`=°.=•'- - .. ,.f,L;n`'I'f-! OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for VES❑ NO❑ w the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,Civ.C.) N CHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTIN FOR OBTAI N A PERMIT FROM THE S24 o Lender's Address OOWN OR AGENT ' 0 1 certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE o with all county ordinances and State laws relating to building !1 < construction, and hereby authorize representatives of this County ISSUANCE FEE / (0 /tp erlj� en the above mentioned grope�t�r inspection purposes. p741/1 11/10 / � INVESTIGATION FEE TOTAL FEE / ✓ m fV/ � gnat a Appirant or A nt ate y SEE REVERSE FOR EXPLANATORY LANGUAGE