HomeMy Public PortalAbout9445 LAS TUNAS DR_Building_3/20/1990_reroof APPLICATION FOR BUILDING PERMIT �
COUNTY OF LOS ANGELES. BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADORE s
TTIA
JBUILDING ADD ESS
I hereby affirm that I have a.certificate of consent to.self insure, �� I
or a certificate of Workers'Compensation Insurance,ora certified TY ZIP
copy thereof(Sec.3800,Lab.C.) TY
PolicyNo.4_L'.3-70 Company&OT01�L—�I CL� LOCALIl?`;--F� 1 C
ZE OF LOT N .OF BLDGS.NOW ON LOT f
❑ Certified copy is hereby furnished.
NEAREST CROSS ST.
_E;:_Qfrtified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department.' USE ZONE MAP NO.
'at department.
plicanG�l, ASSESSOR MAP BOOK PAGE PARCEL
P T K�� —`� SPECIAL CONDITIONS
vAd
CERTIFICATE OF EXEMPTION FROM WORKERS' NER TEL.NO. VES No
COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL?
ADDRESS
(This section need not be completed if the permit is for one hundred DISTRIC GROUP TYPE ONST' FIRE ZONE ROCESSE BY
dollars($100)or less.) CITY
I certify.that in the performance of the work for which this permit
Is Issued, I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL.NO. VVV 111 111
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CO Do
Date Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT: If, after making this Certificate Of NPACTOR ACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' 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 deemedrevoked. ADDRESS LIC.No. PL
LICENSED CONTRACTORS DECLARATION CITY Ic.C ' a PIL o
hereby affirm that I am licensed under provisions of Chapter 9 A-0q r-71Q SIZE NO.OF TORES NO. FAMILIES SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG
Professions Code,and my license is in full force and effect.
✓ DE IPTION OF WORK D ❑ VALUATION W
License Number Lic.Class " `�� rA
r Date 7,b��L2 -' . ALTER ❑' Q0 dam.
Contractor _
❑ I am exempt under Sec. REPAIR
_
B.&P.C.for this reason DEMOL El LDMA P/C#
USE OF EXISTING BLDG.
Date: 1-7 URM. ❑
Signature APPLICANT(PRINT) EL.NO. LDMA Peim# '
❑ I, as owner of the property, or my.employees with wages asp ANT.s
their sole compensation,will do the'work and the structure is ADD SS H5 I
not intended or offered for sale (Section 7044, Business and FINAL -� €�' - `'�'
PfOfeSSlOn3 Code.) WILL THE APPLICANT ORFUTUREBUILDINGOCCUPANT HANDLE AHAZARDOUS MATERIAL 011 64) J .. t !TErI1.
❑ I, as owner of theproperty, am exclusive) contractin with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN '
Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B > f
YES❑ "Y 123
iC
licensed contractors to construct the project.(Section 7044, NO 1 I^1 I AL _ 3
❑ _
Business and Professions Code.) f.(; 99 p c-
�. •
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING 3 i""{t:•K liV o•fLl
OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ ��''}}
CONSTRUCTION LENDING`AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST CHANGE010o
FOR GUIDELINES. - -
I hereby affirm that there is a construction lending agency for YES❑ NO❑
the performance of the Work for Which this permit Is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD _
3097,CIV.C.). _ ,. PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ?�3 f20/9C
0 9
�. COUNTY CODE,TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING 0000' 0001, JI iV/7_I
Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. u
Lenders Address' Q i'`
�a OWNER OR AGENT
o I certify that I have read this application and state that the above P.C.FEE PERMIT FEE /
information is correct. I agree to comply with all. county 1/ Ci 5
ordinances and State laws relating to building construction,and 5/�
hereby authorize representatives of this County to enter upon ISSUANCE FEE
the above-m9iffilpriedopertLfor inspection purposes.
INVESTIGATION FEE TOTAL FEE
Sig—.of Applk .Apron DM
\/ DM
SEE REVERSE FOR EXPLANATORY LANGUAGE