Loading...
HomeMy Public PortalAbout4906 ENCINITA AVE_Building__ a. TEMPLE CITY [f''IIII 78ACf OA C8003 1— 1 u ,� APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS - r BUILDING AND SAFETY DMSION LOCALITY rL� JOHN A LAMBIE, COUNTY ENGINEER NEAREST / WILLIAM A JENSEN SUP T OF BUILDING CROSS ST FOR APPLICANT TO FILL IN , I�N UP ONST C�l D BY a--) BUILDING aINI � ori STATISTICALC�ATION S ER MAP ADDRESS O(o N/ WECLASS UNITS- LOT NITS LOT NO , O 1- 1 BLOCK WATER NOT REQUIRED RECEIVED I ' L CERTIFICATE TRACT I �d MAP HIGHWAY NO OFBLDGS J NO 6YI (CIRCLE) STATE MAJOR SECO LOCAL SIZE OF LOT ��� NOW ON LOT / USE ZON SPECIAL USE OFu CONDITIONS EXISTING BLDG ` 1 c Yn trpp EL OWNER V�-I(,ISSI., NO A-T69a BUILDING YARD HWY STREET NAME EXIST ADDRESS Ll�� O . [_7 f) NI �Cj0 SETBACK WIDTH FRONT ARCHITECT OR TEL P L CICCl ENGINEER NO SIDE P L ADDRESS CL INSPECTION RECORD O CONTRACTOR TEL NO ADDRESS O DESCRIPTION OF WORK G a h NEW ADD ALTER REPAIR DEMOLISH Z SQ FT - NO OF NO OF IZE 3 STORIES FAM �ILIgEjlUSE OF �ION WAUCT,URE A-m i OO Ir \ Qt,. ol W � SIGNATURE OF APPLICANT VALUATION$ �0 ©C APPROVALS DATE INSPECTOR S SIGNATURE PC PMT FOUNDATION LOCATION , FEE $ FEE $ (/(/ FORMS MATERIALS FRAME FIRE STOPS, I HEREBY ACKNJC T I HAVE READ THIS APPLICATION BRACING BOLTS II AND STATE THAT CORRECT AND AGREE TO COMPLY FURNACE LOCATION �. WITH ALL COUNTAND STATE LAWS REGULATING G4S VENT DUCTS �I►n BUILDING CON STRTIFY THAT IN DOING THE WORK '1�- 1� ' AUTHORIZED HEREEMOY ANY PERS N IN�GIOLA- LATH INTI A v �nTION OF THE LABE S TE OF CA IFO NIA RELAT 'ING TOWORKMENO NC LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE ,_ �- RECT AND POSTED /v ADDRESS '`F NAL r CLYDE N DIRLAM, PRINCIPAL ST URAL ENGINEER PLAN CHECK VALIDATION cK ,o cwax PERT VALIDATION cK o - caPERMIT L&O 6 7 4 3 NOV 8 1 D 15-00- 4 APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Pnnt or type only) BUILDING dG / �� ��� COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY Gc C i ZIP ( (� - BUILDING AN SAFETY DIVISION . NO OF BLDGS BUILDING SIZE OF LOT NOW ON LOT ADDRESS TRACT MR (-7" BLOCK f' LO ONO �10 ,// LOCALITYTEL NEAREST ,OWNER D NO CROSS ST Jj _ ASSESSOR 'r , ADORES _ R(J� MAP,BOOK PAGE PAR L �"� DISTRICT GROUP YPE FI PROCE -VD BY CITY C v ZIP '7 V ~ NST ZO E ARCHITECT OR ^ - TEL ENGINEER NO ' _ STATISTICAL CLASSIFICATIONefTAEWER AP ADDRESS CLASS NO � DWELL UNITS BK P CONTRACTOR TEL USEtZONE MAP LI NO 4 LIC 01/6 ADDRESSr - NO SPEC AL LIC CONDITIONS ' CITY t CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER ,�y� ' NAME AND'BRANCH (//ti/ BLDG ETBACK FROM ' FRON PROP LINE OF a -0-� (STREET) ADDRESS r CITY HIGHWA } YARD __ ,TOTAL SETBACK FROM TYPE OF EXISTING SQ 'FT _ NO OF NO OF - CHECK FRONT PROP LINE ,HIGHWAY WIDTH SIZE" STORIES FAMILIES ONE , DESCRIPTION OF WORK NEW ❑ o '// ADD BLDG SETBACK FR U SIDEPROP LINE OF (STREET) /�^ CD LTER ❑ TOTAL 5 CK-FROM TYPE OF EXISTING v 2- ZIZ: -REPAIR HIGHWAY } YARD = SIDE PROP L HIGHWAY WIDTH a USE OF } _ N EXISTING BLDG EMOL ❑ Z ,APPLICANT TEL .� CORNER CUTOFF YES C] NOz El _ ' (PRINT) C NO Xa BY (SIGNATURE IN OPEN S'PACE,, YES1:1 NO ❑ _ ~ IN COASTAL PERMIT ZONE YES-E] • NO `❑ VALUATION�sg &- O s _ 1 HEREBY ACKN WLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1 WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ' STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN LATING TO `{ WORKMEN'S COMPENSATI URANCE 'SIGNATURE O Y 1 PERMITTE ADDRESS G FINAL °• ` BY T TEL CITY NO DATE y/. MAKE CHECKS PAYABLE TO p E �f FEE HARVEY T BRANDT, COUNTY ENGINEER 'PLAN CHECK VALIDATION CK M o 1 CASH PERMIT VALIDATION• CK" M o CASH 78A838A rcE#803 5/74 APPLICATION FOR' BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUI N� DRE I hereby affirm that I have a certificate of consent to self Insure, � / ! or a certificate of Workers'Compensation Insurance,or a certified A)0 /YA copy thereof(Sec 3800,Lab C) CI ` ZIP LOCALI� Policy NO —Company STkW�VAw S Fiv 71 NO OF BLDGSNOW ON LOT 9 ❑ Certified copy Is hereby furnished 1. NEAREST CROSS ST WCertified copy Is filed with the county building Inspection TRAG I BLOCK LOT NO de rt ant USE ZONE MAP NO AS91ESSO MAP�OOK PAG PARCEL Dat Applicant ��_ � ��� ZGJIS�/1 SPECIAL CONDITIONS 0/1 CERTIFICATE OF EXEMPTION FROM WORKERS' ° TEL No WITHIN 1000 FT OF SCHOOL? YES NO COMPENSATION INSURANCE AD R (This section need not be completed If the permit Is for one hundred DISTRICT GROUP TY,,,,PE CONS (This FIRE ZONEISSEDIN dollars($100)or less) C ZIP 5" Y X J _ /' I certify that In the performance of the work for which this permit (gJ1 c / l e //�,- Is issued, I shall not employ any person in any manner so as to ARCHIT TOR ENGINEER TEL NO become subject to the Workers'Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of CONTRACTOR 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 deemed revoked ADDRESS LIC NQ.J PL Agln5 leg-oil SIDE LICENSED CONTRACTORS DECLARATION _ / L C PL o I hereby affirm that I am licensed under provisions of Chapter 9 �l SEWER MAP v (commencing with Section 7000)of Division 3 of the Business andMDESCRIPTION NO OF ORES NO OF FAMILIES C Professions Code,a �hcense in full force and a ct NEW BK PG License NumberLlc Cl OF WORK r % ADD ❑ vALu o Contractor Date — ALTER ❑ $ `O Z_ ❑ I am exempt under Sec REPAIR ❑ B&PC for this reason DEMOL C3LDMA P/C i Date USE OF EXISTING BLDG URM ❑ {{ Signature APDL NT(PRINT TEL NaLDMA Perm k 1 ❑ I, as owner of the property, or my employees with wages as Z AD O YID_i�I e a their sole compensation, will do the work and the structure Is H 3397 , 175.41 not intended or offered for sale (Section 7044, Business and FINALDJTE/ G 3 !? 3 i=u 41 Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J I ITEM ❑ I, as owner of the property, am exclusive) contracting with O A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I Q R I Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, T6TAL :175 - 4 Business and Professions Code) rEs❑ No❑ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING C HEC I1 d 5 e 4 i OCCUPANT REOIRE 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❑ the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD _t(��`� (��ry{ ] 3097,CIV Ci) PERGELES COUMITTING NTYCO ETITLE2TCHAPTERR220SECTIONS2220100THR000HI UNDERSTAND MY REQUIREMENTS 220140THE LCONCOS CEERNNG VOOCI�+�0 11 8I15/90 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD Lender's AddressCL O�OR �'151 0 AGiNT 1 certify that I have read this application and state that the above Information is correct I agree to Comply with all county PC FEE PERMIT FEE ordinances and State laws relating to building construction,and r hereby aut onze representatives of this County to enter upon ISSUANCE FEE the mentlone o rty for Inspection pG � mINVESTIGATION FEE TOTAL FEE 1-3,619 r «pent 0m 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 ADDRESS BUIL I NGADDRESS I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP COPY thereof Sec 3800,Lab C) „� LOCALITt Policy No'7ffll Company�I�Tr +� SIZE OF 07 NO OF BLDGS NOW ON LOT CITY ❑ Certified copy Is hereby furnished It M1, 1z_ NEAREST CROSS ST Certified copy i3 filed with the county building Inspection TRAX 0C BLOCK LOT NO USE ZONE MAP NO department r1 /�71� �!J� �,,,,,,,( Date&-1` Applicant� i ` `JI.T/rOGY a&%1. ASSESS BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' NDDREtS AO S JUW1N YES NO COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? (This section need not be completed If the permit is for one hundred G DISTRICT GROUP TYPECONST FIREZONE P ES}/S-E�/� Ydolls $hat or lesape pe ZIP 5 /I certl that In the rformance of the work for which this rmltq1 Wd Is issued, I shall not employ any person In any manner so a to I ECT OR ENGINEER TEL NO become subject to the Workers'Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of CON CTORA41TEL REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' -oTZ r7 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith II FRONT comply with such provisions or this permit shall be deemed revoked ADD ESS Aqm/ LIC o PL SIDE LICENSED CONTRACTORS DECLARATION CITE' � LI CLA PL CD a I hereby affirm that I am licensed under provisions of Chapter 917� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ F_,IZE NO OF STO ES NO OF FAMILIES O Professions Code,and my license iS n full force and effect NEW ❑ BK PG U License Number LIC Class DESCRIPTION OF WORK ADD V UATIO Contractor r Date 4ewALTER ❑ ��a, z t-1—9100' � REPAIR 13❑ I am exempt under Sec B&P C for this reason DEMOL ❑ LOMA P/C# Date USE OF EXISTING BLDG URM ❑ 1 1 1 Signature AP ICAN (PRINT) TEL NO LDMA Penn# _ ❑ I, as owner of the property, y employees with wages as O A'_ €o a p party, or m their sole compensation, will do the work and the structure Is ADDRESS F - -- y-r not Intended or offered for sale (Section 7044, Business and RNALjjA�TE 4 QG ,:j_LI( Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL L IIENG OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q E] 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B Q licensed Contractors to construct the project (Section 7044, VES❑ -NO❑ ""' > �i.���. 14 9-15_.i Business and Professions Code) �i ' H�j�i_ii..r\ 116,30 t L WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING l �• �t_'a L1. _ OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST (( 1 t FOR GUIDELINES J '1 tl 1 `HANG a=1E I I hereby affirm that there Is a construction lending agency for YES 11NO El the performance of the work for which this permit Is Issued(Sec t j I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,Civ C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,TITLE 2 CHAPTER 220 SECTIONS 220100 THROUGH 220140 CONCERNING L / - Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD ioni,7 i A 5 n i= Lender's Address OR AGMT o I certify that I have read this application and state that the above PC FEE PERMIT FEE Information is correct I agree to comply with all county ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upupon , ISSUANCE FEE , 0 V/� th mention operty for Inspection purposes INVESTIGATION FEE TOTAL FEE /y m b Applad SEE REVERSE FOR EXPLANATORY LANGUAGE • WORKERS' COMPENSATION'DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers Compensation Insurance, APPLICATION,-,F B-UILDING PERMIT or a certified copy thereof (Sec 3800,;Lab C ) COUNTY OF LOS ANGELES BUILDING AND.SAFETY `Policy No Company ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS G �T Date Applicant CITY ZIP LOCALITY PP S I NO OF BLDGS NEAREST CERTIFICATE OF EXEMPTION"FROM WORKERS' SIZE OF LOT Zp NOW ON LOT CROSS ST COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT �?i BLOCK LOT NO 'L MAP BOOK PAGE PARCEL hundred dollars ($100) or less ) TEL OWNER RftNO USE ZONE MAP I certify that in the performance of the work for which this NO SPECIAL - - � permit is issued, I shall not employ any person in any manner ADDRESS QZ CONDITIONS a so as to become subject to the Workers'Compensation Laws �/� OU CITY ZIP4/�• IO Date Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT If, after making this Certificate of ENGINEERMA NO CO Iff E Exemption, you should become subject to the Workers' /� r T� w Compensation provisions of the Labor Code, you must forth- ADDRE7_3 V 5r`-'V �� l as a with comply with,such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO OZ) revoked CONTRACTOR NO - Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO '920 DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NCO SEWER MAP ,=1 (commencing with Section 7000)of Division 3 of the Business _ and Professions Code,and my license is in full force and effect CITY CLASS BK PG { VALIDATION SQ FT //�� NO OF NO OF CHECK _ `" _ License Number Lic Class SIZE 1 'T� STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION" i t C OF WORK NEW ❑ 4 An J 'C D i D s (AJ 740- 97 ► i ts El am exempt under Sec AD ALTER ❑ B&P C for this reason S - S REPAIR ❑ Date USE OF T- _ - EXISTING BLDG DEMOL 00 Signature APPLICANT TEL FINAL (PRINT) ( p ` NO Z� OWNER-BUILDER DECLARATION DATE i I hereby affirm that I am exempt from the Contractor's License ,3,'19 Law for The following reason (Section 7031 5, Business and ADDRESS FINAL; i Professions Code) PRESENT BYOt31 BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ' the structure is not intended or offered_ LOCALITY for sale(Section ,lN \r 7044, Business and Professions Code ) MOVING TEL �,_ , ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO _ with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code ) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH Thereby affirm that there is a construction lending agency for FRONT the performance'of the work for which this permit is issued P L + (Sec 3097, Civ C ) SIDE 4 PL Lender's Name Permit Fee LDMA Ref # P C Fee$ 77m � Lender's Address � � i I certify that I have read this application'and state that the Issuance Fee LDMA P/C# above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee - LDMA Perm # " a and hereby authorize representatives of this County to enter upon'the above-mentioned property for inspection purposes ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDI ADDRESS I hereby affirm that I have a certificate of consent to self Insure, O or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP 790 ( copy thereof(Sec 3600,Lab C) LOCALI Policy No -!e-/1� Company� M S T OF-LOT NO�LDGS NOW ON LOT ❑ Certified copy Is hereby furnished _' f 80 NEAREST CROSS ST Certified copy is filed with the county building Inspection TRACT BLOCK LOT NO USE ZONE MAP NO department 01?Z 9. 2 �J ASSESSOR MAP BOOK PAGE PARCEL Date,Yp:/:/—LQApplicant �rn CLOW� O O Q SPECIAL CONDITIONS 191�510ERTIF CA E OF EXEMPTION FROM WORKERS' OWNTEL NO Y NO COMPENSATION INSURANCE WITHIN 1000 FT of SCHOOL? ADDR (This section need not be completed If the permit is for one hundred DISTRICT GROUP GROUP TYPE CONST' FIRE ZONE PROL�/E} ED BY Bolla $hat orless) pe C - ZIPS ��, \ V1W � / / ' I certifythat In the performance of the work for which this permit LI X-V `-'K/_ 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 0ONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of CONTRACTOR TEL NO REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' ` SET SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwithtsr- -CJ FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC 1�0� PL �r SIDE LICENSED CONTRACTORS DECLARATION CI LIC CLA PL o I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and FT SIZE NO OF TOR NO OF FAMILIESBKO Professions Code,and my Ilcense in full force and effect NEW ElVA U DESCRIPTION OF WORK ❑ VALUATION PG � W License Number ;l LIc CI ADD� a Contractor Date — Z ALTER ❑ Z ❑ I am exempt under Sec REPAIR El,�{� $ B BPC for this reason DEMOL C LDMA P/C# Date USE OF EXISTING BLDG URM ❑.Xk Signature APPLICANT(PRI 4TEL NO LDMA Penn# Z ElLI I, as owner of the property, or my employees with wages as O 1 ITEM" their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and � D 4 TO 11 AL ;B 11-31 ® 00 Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALJ El I, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ; � `�� J1 v l�1, THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY [��{}44 licensed contractors to construct the project (Section 7044, YES 11 NO❑ I_�tF NGE v 00 Business and Professions Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH Vvy-V CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAGMD)SEE PERMITTING CHECKLIST FOR GUIDELINES 0000-000 C Qf I I hereby affirm that there is a construction lending agency for YES E3 No No ��� v 1 the performance of the work for which this permit Is issued(Sec 2i,_,6 1 hM '15:14 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE TITLE CHAPTER 220 SECTIONS 2 20 100 THROUGH 22D 140 CONCERNING JV Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD Lender's AddressOWNOR AGENT o I certify that I have read this application and state that the above PC FEE PERMIT FEE information Is correct I agree to comply with all county ordinances and State laws relating to building construction,and hereqL.%LthQnze representatives of this County to enter upon ISSUANCE FEE J3., O ve mention r rty for Inspection purposes m ,�� INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE