HomeMy Public PortalAbout9445 1/2 LAS TUNAS DR_Building_3/17/1993_channel neon letter sign for 88 Arcade I
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COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION ('FOR APPLICANT TO.FILL IN BUIL G ADDR
BUILPqADDR
I hereby affirm that I have a certificate of consent,to.self insure,,
or a certificate of Workers' Compensation Ins r ce,ora rtified � �j ;
copy there 'eC. C.) CIT'/' - ZIP t'1 LOCALITY _
• CA
Policy NO: "'Company SIZE OF LOT I�1•/ - • NO:OF BLDGS.NOW ON LOT -
�` NEAREST CROS ST.
❑ Certified copy is hereby rnished. �d' /
�)iCf Certified copy is filed wit the county building inspection TRACT BLOCK LOT NO.
-•d t nt. -•,i _ - USE ZONE -MAP-NO.
rr��11 ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS
Datey 1..JA�Iicant ,
CERTIFICATE OF EXEMPTION FROM WORKERS'. OWNER' (/ YES NO
COMPENSATION INSURANCE N
WITHIN �000 FT.of scr+ooL�
(This section need not be'completed if the permit'is for one hundred ADDRESS
.DISTRICT GROUP TYPE CONST. FIRE ZONE. PROCESSED BY
dollars($100)or less:)
CI - ZIP
I certify that in the performance of the work for which this permit y nn J
is issued, I shall notemploy. any'person'in any'manner-so as'lo `` V � Y !✓ ����� ��
.TEL O.
ARC ITCTR ENGINEER .
become subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFIC ION 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 shouldbecome subject t0 the Workers' CONTACTOR SET BACK YARD HWY PROP LINE WIDTH
Compensation prov -
provisions'of the Labor- you'must forthwith T- FRONT i �. i
comply with such provisions or.this permit shall be deemed revoked. ADD ((// LIC.�Q. P L
&v
_ SIDE. - 00 -.
LICENSED CONTRACTORS DECLARATIONCIT uc. LAs j- P L
I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(commencing.with Section 7000)of Division 3 of the Busin s and'. - DES RIPTI OF RK STORIES NO.OF FAMILIES BK _�ry�i { }� t/9 }
NEW PG J�JJI.I OOG1 f !'�7
SQ.FT.SIZE NO.OF
' Professions Code, nd• r#fc, e is in.full force f � � �
cl - .. ADD- .❑" VALUATION- r !3-7 °15 QU
License Nu ber Lic.Class 8 .3 _ -
ContractO to f ALTER ❑ $
1
f �.. fs cc
�. G tom! REPAIR ❑ 0
❑ I am exempt under,Sec. $ U
B.&P.C.for this reason DEMOL ❑
LDMA P/C# ' • W
Date: - USE o XI I BLDG. -• t( URM ❑ -
-Signature _ APPLICANT.? NT) - - L N0. - LDMA Perm#• - -C R
. —
.. .. .. _. ..
❑ I,'as.owner of the property, or my,employees with wages as Z Z
their.sole compensMion,.:will do the work and the structure.is ADDRESS _ {• �i
not intended or offered for sale (Section 7044, Business and 330 .
FINAL DATE ~
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J
_011,,as:owner of the property, am exclusively contracting-with with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE +
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINA
licensed contractors to.construct the project (Section 7044, VES ElNo 1:1 111f H1CT o JL
Business and Professions'Code.)
WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR'FUTURE BUILDING 3I i1 ,, v�DNI
._ - OCCUPANT REQUIRE A PERMIT FOR.CONSTRUCTION OR.MODIFICATION FROM THE SOUTH /Q�1 _-: ,J V •
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT'(SCAQMD)SEE PERMITTING CHECKLIST.FOR ( ��.�i/ry•fin ' ,��I,� �.
- GUIDEUNES. V/ J J
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. L ITEM
I 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;, ", .
a - TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS TOTAL 277t3.4910r
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. -
atir�
•
o, Lender's Address _ °. r
•. - OWNER OR AGENT
O '
oI certify that I have read this application and state under penalty
0. of-perjury.that the above jnfor anon is correct.I agree t0 Comply P.C.FEE PERMIT FEE
with all county ordinances nd State laws relating to building49,
"' w
< cons u tion, and hereby a Orize representatives of this County ISSUANCE FEECD
to to upon the ab me ed prop for in echo urp s.
(0 INVESTIGATION FEE TOTAL FEE
^ Sg�Wr nor Agent ate �
SEE REVERSE FOR EXPLANATORY LANGUAGE'