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Home My Public Portal About4853 ARDEN DR_Building__ APPLICATION FOR BUILDING PERMIT i.. COUNTY OF LOS ANGELES BUILDING AND FETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A E I I hereby affirm that I have a certificate of consent to self insure, BUILDI GAD SS ' or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY TEN E c-Ity ZIP Fle0 LOCAL TY - Policy No. Company SIZE LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. ,2 X2.24 "OhmNEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. 1 6 USE ZONE MAP NO. 5 Date Applicant ASSESSOR MAP BOOK ,PAGE PARCELv� //f SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWER TE COMPENSATION INSURANCE �y 0 T D NO. '2 WITHIN 1000 FT.OF SCHOOL? YES NO J 1 (This section need not be completed if the permit is for one hundred ADDF{ESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) I certify that in the performance of the work,for which this permit \ .CIT i p ^^ P4 is issued, I shall not employ any person in any manner so as to ARCHITECT 01*4" E�6IMAM D TEL NO. S�� become subject to the Workers'Compensation Laws. STATISTICAL CL,4$�51c61 J[ON / APT CONDO Date Applicant ADDRESS P CLASS NO. ��✓✓(,�DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate 3� VIA �� 1 A REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Worke CONTR TOR TEL NO.pp SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwit / O� A FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESSr LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY U' LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 ® SEWER MAP r(; (commencing with Section 7000)of Division 3 of the Business and N SO.FT.SIZE NO.OF STORIES NO.OFF MILIES `,�. _ . _ •E °$ Professions Code,and my license is in full force and effect. '0 �.. NEW XJ BK PG ; ;3013 1,; io a DESCRIPTI OF WORK ADD /❑ VALUATION �T� � License Number Lic.Class Q �C - Da pQ L' Q Contractor Date 'v�1J ALTER ❑ $ r TOTAL 130 1.Q4 0c ElI am exempt under Sec. REPAIR ❑ O B.&P.C.for this reason DEMOL El $ CHECK 1`01.94 U LDMA P/C# 1111 Date: USE OF EXISTING BLDG. URM El CHANGE .010 rL Signature APPLICANT(PRINT) .TEL NO LDMA Perm# r w""'T _ Z 7. *UptlIJ�!1, ❑ I, as owner of the property, or my employees with wages as C14r-.Kl a �` ,.--- - Z � their sole compensation, will do the work and the structure is F Z' � a7 not intended or offered for sale (Section 7044, Business and DDR�SOS '� �� a FINAL DATE Y Q --- -i -1 Tofessions Code.) j� L _ i 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 THE FINAL BY Y 7 f'T' � + i Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licd contractors to construct the project (Section 7044, 1y- :•^ usIness and Professions Code.) ves❑ NO 11 enses;' 1. �:a,= _-I� '. 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(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. (\�� . I hereby affirm that there is a construction lending agency for YES❑ No❑ ` V /V\ _ N the performance of the work for which this permit is issued(Sec. {[`, (y /,�` i ?t i 110/115V9a 3097,Civ.C. (HAVE READ ITHE UNDERSTAND MY INFORMATION GUIDE AND ANGELES PERMITTING {- 'V \ ` i?I,jeili—{.I ,a, w ) CHECKLIST. UNDERSTAND TI REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 6 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS /J,'\e^� '4a _ 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD, i 166 J 0112 r o Lender's Address OWNER OR AGENT I O o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE q PERMIT FEE p o o with all county ordinances and State laws relating to building �/ o e con structio and hereby authorize representatives of this County ISSUANCE FEE m Into ent onthe abov -mentioned prop y for inspection purposes. `y 0 a INVESTIGATION FEE C- 7 L F a 'i Sgna� a or Aepliwnl w Agenl —Date L L/ 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 BUILDING AD ESS hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified a copy thereof(Sec.3800,Lab.C.) r`ITv ZIP LOCALITY �'- G� �� /3C3�o.r 4 Policy No. Company SIZE OF OT NO.OF BLDGS.NOW ON LOT �/ NEAREST CROSS T. 41 Lel Certified copy is hereby furnished. 19 LOCK LOT NO. El Certified Copy is filed with the county building inspection TRACT B department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL D/ SPECIAL CONDITIONS Bo CERTIFICATE OF EXEMPTION FROM WORKERS' o / s -�'' TEL NO. .2 YES NO COMPENSATION INSURANCE 14 o 7--'-7.0er WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADD ESS el,,e,r� dollars($100)or less.) ✓. //6 9 DISTRICT GROUP TY CONST. FIRE ZONE PROCESSEaBY cl v I certify that in the performance of the work for which this permit �t/is issued, I shall not employ any person in any manner SO aS t0ARCHITECT OR ENGINEER TEL NO. become subject to the Wor cation La STATISTICAL CLASSIFICATION APT CONDO Date 42F-14/ Applicant a ADDRESS CLASS NO.. DWELL UNITS NOTICE TO APPLICANT.' If, after Is Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CTOR TEL NO. SET BACK YARD HWY PROP LINE' WIDTH Compensation provisions of the Labor Code, you must forthwith 00,01may.Q ;._i L d"p- Vr FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS ✓ LIC.NQ. PL v /�D� SIDE LICENSED CONTRACTORS DECLARATION CITY �J LIC. LAS PL I hereby affirm that I am licensed underprovisions of Chapter 9 �• 7� G SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW El BK PG v License Numb r :6ir'o 79 `Lic.Class r6 DESCRIPTION OF WORK ADD ❑ VALUATION 0 O'O H Contractor Date 2 F y ALTER ❑ $�i �� W REPAIR ❑ i✓ mil!� Z ❑ I am exempt under Sec. $ B.&P.C.for this reason DEMOL ❑ LOMA P/C# Date: USE OF EXISTING BLDG. - URM ❑ Signature AP NT I PRINT) TEL NO. LDMA Perm# . ❑.I,:as owner of the property, or my employees with wages as a p {'sy their sole compensation, will do the work and the structure is ADORES ) ° _ FINAL DATE ~ 'r not intended or offered for sale (Section 7044, Business and `r /� G Y;._.�j_ jet' Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL / I—el y J 't, j EI-11" El OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ,L ) ;g_ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, d C/ s '> C Business and Professions Code.) YES❑ No❑ T I!I i lt'L 10-_ ® 3 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ,} - iI?C OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '•;,HECK S K +...._n•:I CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR 3 GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ m CV the performance Of the work for which this permit Is issued(Sec. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST,I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, Q�� TITLE 2,CHAPTER 2.20 SECTIONS 2.20,100 THROUGH 2.20.140 CONCERNING HAZARDOUS /�Q jWi 6} •—� j�(j '� '' '}-'. Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. AM —" o Lender's Address �C+ V�� -f iF -t OWNER OR AGENT o I certify that I have read this application and state under penalty o P.C.FEE PERMIT FEE of perjury that the above information is correct.I agree to comply G l/O 2 N with all county ordinances and State laws relating to building Q < construction, and hereby authorize representatives of this County ISSUANCE FEECO 0 to enter upon-the_abo -mentioned property for inspection purposes.CID 2 Jc- INVESTIGATION FEE TOTAL FEE �«e.a Acpvam«Apena Dave SEE REVERSE FOR EXPLANATORY LANGUAGE