The URL can be used to link to this page

Home My Public Portal About4849 ARDEN DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS.ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS ' WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, BUILDI GADD ESS z147 27. or a certificate of Workers' Compensation Insurance,or a certified " copy thereof (Sec.3800,Lab.C.) Cl fek Lf ^= ZIP q1 Mo l ti _/ LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ElCertified copy is hereby furnished. 2 Y 2 2 NEAREST CROSS ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. - 1 USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK_ AGE PARCELp w pV J! 7�1 'aL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' oNER TEL NO. - COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS . /1 / ___- /7►r4'!7� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) � I certify that in the performance of the work for which this permit CITY / �M Y� Z,^ q/7 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER ✓, `- TEL O. dh become subject to the Workers'Compensation Laws. I g i8Z b 3 I STATISTICAL CLAASSSIIFIICVION ,.�.. APT CONDO Date Applicant ADDRESS f1 'rl /i� r if CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate Of ZA / �. / Q� l/LSI � REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers CONTRACTOR »/ TE .�� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 1Lsr! o FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS L(C. O. PL SIDE _...-. ...._. LICENSED CONTRACTORS DECLARATION C�YFT��IZE LIC.£LASS PIL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and S NO.OF STORIES NO.OF FAMILIES /\� ... C'T ®r NEW jJl BK PG .......... t �•4 i n Professions Code,and my license is in full force and effect. _ \ -.- a DESCRIPTI N OF WORK ADD ❑ VALUATION �.A , v{igl�s:F 1301.194 License Number Lic.Class bt PRD �`, V� �_ � Contractor Date ALTER ❑ 3 3 6m- 1 ITEMS - � ❑ I am exempt under Sec. REPAIR El $ TOTAL 1331.94 0 B.&P.C.for this reason DEMOL '❑ CHEC*K 1301.94 W LDMA P/C.# :. _ _ _ Date: USE OF EXISTING BLDG. URM ICHANGE' .00a- U) Signature APPLICANT(PRINT) TEL NO. DMA Perm..#... __. ........ - '•-" a z ❑ I, as owner of the property, or my employees with wages as = U 0 ti their sole compensation, will do the work and the structure is DRESS +. oclol 3 not intended or offered for sale (Section 7044, Business and �-I oil- R ♦ F V(i14 2170 (%T FINAL DATE Q 9nq;___ l;1rJ�O�J Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIA i I_� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ^" 1 --- J ^"—'R' - i-C'-'!'.' si S I as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY !-t t iL licensed contractors to construct the project (Section 7044, ves❑ No❑ Business and Professions Code.) ,•' EL c L': WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ------ "• p CONSTRUCTION LENDING AGENCY COAST AIR QUAL TY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR !'� ;.•I AIN111a- o•s_ GUIDELINES. I V ' I hereby affirm that there is a construction lending agency for ves❑ No❑ N the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING I' 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ,(� _ w TITLE 2,CHAPTER 2.20 SECTIONS 2,20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS / i �p - - ---- :^•. !f Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. { i L'J'3 I AMID n�'- o Lender's AddressrJ\ OWNER OR AGENT O 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 iS ten/ PERMIT FEE/,,, rO N with all county ordinances and State laws relating to building ✓S (f < construction, and hereby authorize representatives of this County ISSUANCE FEE00 m to enter upon the above- entioned prop ty for inspection purposes. R�' a .-•� //•� INVESTIGATION FEE TOTAL FEE /GL! �e� ! 17A1 /C- signature t Appb t or Agent Date SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING DDR S "r WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESSki or a cer=tificate of Workers' Compensation Insurance,or a certified Copy thereof (Sec.3800x,Lab.C.) City i ZIP POI' y No.Ll� O,l�.7 F LOCALITY L Company SIZE LOT NO.OF BLDGS.NOW ON LOT C- Certified copy is hereby furnished. NEAREST CROSS ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department.p USE ZONE MAP NO. Date 2 7 Applicant �l Ic1!n+✓2t F C, ASSESSOR NIAPB OK PAGE PARCEL e�e a SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' oM'216,1 / TEL N COMPENSATION INSURANCE Gl en G� WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP T_YFE CONST, FIRE ZONE PROCESSED BY dollars ($100)or less.) 2 CITY ZIP /�/ J I certify that in the performance of the work for which this permit .ef � is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. 1 P STATISTICAL CLASSIFICATION APT CONDO Date/%T -C l Applicant "- ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, afterthis Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' C TOR � TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith o%e CZ Ar �C1i. �1 ' /1/ FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.f 0� P L LICENSED CONTRACTORS DECLARATION SIDE CITY`, LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 !ter �' (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP M- Professions Code,a my license is in full force andel gj ect. NEW ❑ BK PG ® O License Numb r ��®�,,L Lic.Class y�L�q DESC_I N OF WOR ADD ❑ VALUATION ontractor Date � - ?= 'max _ �r ��n".44— CALTER ❑ $ - W ❑ I am exempt under Sec. REPAIR ❑ $ a z_ BAP.C. for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature A (p 1NI) TEL NO. 6 LDMA Perm# A. ❑.I„:as owner of the property, or my employees with wages aS /�'le �� `o Z their sole compensation, will do the work and the structure is ADDRESS O ,, not intended or offered for sale (Section 7044, Business and FINAL DATE ✓� Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �_ :R{•°e I, as owner Of the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE S� J '• �” property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY =+l licensed contractors to construct the project (Section 7044, YES❑ No❑ .Business and Professions Code.) TOTAL ;_� Imo; WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency forYes❑ No❑ /��S 1__ N the performance Of the Work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING O 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 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. "/� / � 1—J, f7 flljj. .1 o Lender's Address OWNER OR AGENT f{s { uf if t o I 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 FEE N with all county ordinances and State laws relating to building J a m construction, and hereby authorize representatives of this County ISSUANCE FEE co entioned property for inspection purposes. , a i �+ ID f ✓ . INVESTIGATION FEE TOTAL FEE Sy .ol Ap0liwnt or Date SEE REVERSE FOR EXPLANATORY LANGUAGE