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Home My Public Portal About4851 ARDEN DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILD`�IN�J�' D s I hereby.affirm that I have a certificate of consent to self insure, BUILDING ADDRESS >� "7`� /� - or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sects.3800,Lab.C.) CITY, ZIP Policy No. n 6, r-U Company LOCALITY SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS Tr. LOCK LOT NO. El Certified copy is filed with the county building inspection TRACT B department. USE ZONE MAP NO. - Date�- -Glx ApplicantASSESSOR MAP BOOK PAGE PARCEL �- X_aJ Q��j SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O ER / TEL/NO.�' COMPENSATION INSURANCE C 07 WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred A DRESS v( y DISTRICT GROUP T E CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) ' �p I certify that in the performance of the work for which this permit CITY ZIP is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date� -` y Applicant /f � J 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' COMOR / /� TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith //Qa�tR q y� "lam Con?i� 7 / �� FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY /J /� LIC ��S PL I hereby affirm that I am licensed underprovisions of Chapter 9 [�•c >_ (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP a Professions Code,and my license is in full force and effect. NEW 13 BK PG v License Number Class �` DESCRIPTION OF WORK ADD ❑ VALUATION 0 Contractor �/ f L Date /-Z 71 ALTER ❑ $ W CL � - ❑ I am exempt under Sec. REPAIR El Cl) $ Z B.&P.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature AP N TELNO. LDMA Perm# ` ❑.I„,as owner of the property, or my employees with wages as gDDR SS � �'�� O ACCT -a their sole compensation, will do the work and the structure isL,f k�_ ;I i not intended or offered for 'sale (Section 7044, Business and FINAL DATE /^y G _ --- Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 1 _q. j L' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE VVVV ❑ I, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q y ? licensed contractors to construct the project (Section 7044, FINAL BY > -E jT Business and Professions Code.) ves El No 11 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 'CHEM i�5 c.,i 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 for YES❑ NO❑ �� a the performance of the work for which this permit is issued(Sec. rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SGAQMD PERMITTING _ 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, f t'I t-;'Is I"I li A i;'r`,`� TITLE I CHAPTER TING SECTIONS OBTAINING THROUGH 2.FROM CONCERNING HAZARDOUS �,� J_.... .. Z � Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SGAQMD. o Lender's Address /�/Z3/y3 - �•- + -1'�- O OWNER OR AGENT Z) 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 I- 6 with all county ordinances and State laws relating to building �� 7 CO < construction, and hereby authorize representatives of this County ISSUANCE FEE CID co to enter upon the above-mentioned property for inspection purposes. a 10 INVESTIGATION FEE TOTAL FEE 2 :ol �m Agent Ddle SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT • COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN ' BUILLw ADDF)PS _ I hereby "affirm that I have a certificate of consent to self insure, BUILDIN DES y�l �( �p 1� �� or a certificate of Workers' Compensation Insurance, or a certified `•+ -, )• -NRDIEN, YR copy thereof(Sec.3800,Lab.C.) CITY ZIP T t� C,Y �8o LOCALITYO Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. T71 NQ NEAREST CROSS ST. ❑ Certified Copy is filed with the county building inspection TRACT LOCK LOT 1\10�6 department. t 1,t - USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL -amCCp� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER EL $ COMPENSATION INSURANCE ` N Unn.sbjbWITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS Ii2 M / fjnt � TRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) I certify that in the performance of the work for which this permit CITY 141 jar/Y� ZIP q��,,Q -o f TEL NO . is issued, I shall not employ any person in any manner so as to o�u1T=nT no=I SNEER �t �J become subject to the Workers'Compensation Laws. \ U . STATISTICAL CLASSIFIC�QTION APT CONDO AES fruA F� 8 " 2-� ` G �- Date Applicant ADDRESS IL CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of AJ w /+ • REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' CON RA TOR r TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwit Q �C FRONT comply with such provisions or this permit shall be deemed revoke ADDRESS. # P L LICENSED CONTRACTORS DECLARATION PILE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.$IZ NO.OF STORIES NO.O�AMILIES Professions Code,and my license is in full force and effect. �j NEW BK PG a } CL License Number Lic.Class DESCRIPTIO OF WORK ADD ❑ VALUATION , AC C--T.3 O r ti: Contractor Date C ALTER ❑ `� %3 0 330 1J�1aAt El am exempt under Sec. REPAIR El1 TT� O O $ T� TOTAL 13 9 ! a 4 v B.&P.C.for this reason DEMOL ❑ �__ LDMA P/C# W Date: USE OF EXISTING BLDG. URM _ o CHANGE � �� 1301.94 � Signature APPLICANT TEL T) e T®NO. _` LDMA Perm# Z CHANGE .00 Z ❑ I, as owner of the property, or my employees with wages as --FAT- HnqEdl t AD S •� -* C)' their sole compensation, will do the work and the structure is - - -�`t=::,i:" �.t • not intended or offered for sale Section 7044, Business and i 4 1 Z— 1 FINAL DATE 0 r 5/25/93 C -+ ( !'x- 701 :1/25/93 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDIN CCUPANT HANDLE A HAZARDOUS MATERIAL ,� - J q f` [��I as owner Of the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE '•' 1 1`FV�4. J property, am exclusively contracting Wlth AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY tensed contractors to construct the project (Section 7044, YES❑ NO❑ "T Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING i e_€THL OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR I + - GUIDELINES. � P ''HE,:rt�1hereby affirm that there is a construction lending agency for YES ElNo El 0j � f_Tlsjtl91I3i - 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 '�� UU. 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. yt. o Lender's Address C, Il.� i-_t 3�E 1 IL-I O OWNER OR AGENT f 9 'S M1tv a i'� L a41 o I certify that I have read this application and state under penalty z hftii+_ .i 0 of perjury that the above information is correct.I agree to comply P.C.FEE /�Q PERMIT FEE N with all county ordinances and State laws relating to building V m construction, and hereby authorize representatives of this County ISSUANCE FE�y/ to enter on the b ve-mention fJ property for inspection purposes. �J!p'7 a _ rGl C.�� —C INVESTIGATION FEE TO AL A f` c .ai mpR s orw nt Date V• o7 0 SEE REVERSE FOR EXPLANATORY LANGUAGE