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Home My Public Portal About5229 FARAGO AVE_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS A�s,GE�:E'S BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN f BUILDING AD�,, BUIL G ADAE$ $ I hereby affirm that I have a certificate of consent to self insure, or a certificate of Wor rs' Compensation Insurance,or a certifi copy therec. ab.C.) CITY ZIP n� LOCALITY Policy No. any SIZE OF LOT NO.OF BLDGS.NOW ON LOT ` ❑ ertif d C s h reby f e NEAREST CROSS ST. Tp YJ ied y is led i he un bu di insp do TRACT BLOCK LOT NO. art ent I USE ZONE MAP NO. �. .i ASSESSOR MAP BOOK PAGE PARCEL Dat Applicant Q�� U"Q�I SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TELLIQ _ COMPENSATION INSURANCE S �� WITHIN 1000 FT OF SCHOOL AD 6!R!; ? YES NO S (This section need not be completed if the permit is for one hundred a� DISTRICT GROUP P FIRE ZONE PROCESSED BY dollars ($100)or less.) CITY ZIP r/ I certify that in the performance of the work for which this permit G' �GG,L�� ,c� is issued, I shall not employ any person in any manner so as to become subject to the Workers"go pensat ARCHITECT OR ENGIN ER TEL NO. STATISTICAL CLv6,$yS/IFFKATION APT CONDO Datel-6 Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certifi to Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CO TOR TEL . SET BACK YARD HWY PROP LINE - WIDTH Compensation provisions of the Labor Code, you must forthwithCog* NI3 FRONT comply with such provisions or this permit shall be deemed revoked. AD R < LIC.NO. P L J9a LICENSED CONTRACTORS DECLARATION 3 SIDE CITY LIC.CLASS P L 1 27 1 I hereby affirm that I am licensed underprovisions of Chapter 9 A SEWER MAP (commencing with Section 7700000)of Division 3 Of the Business and SQ.FT. Z NO.OF STORIES NO.OF FAMILIES "' "•i•T' �• Professions Code,and y`�// e is in full force and effect. NEW ❑ BK PG H=•+_s �s } DESCRIPTION OF WOR �/ , ADD VALUATION ► ?I' ;!,'f_f �- License Num Lic.Class 06 �{ a�� } 0 Contractor Date le-11-11z `r' ALTER ❑ $ of4� U ElI am exempt under Sec. REPAIR ❑ $ a� BAP.C.for this reason orvk _r_� j- U& DEMOL ❑ -f- j±'`, w LDMA P/C# " u Date: U E OF EXISTING BLDG. J URM ❑ i 'y E��'' CL Z Ism Signature APpLIC (P 1 �„/J TEL NO. �" LDMA Perm# � �� -I-!I�� Z ❑ I, as owner of the property, or my employees with wages as �L �/� "" ADDRESS 1 t_ their sole compensation, will do the work and the structure is � CHECK ,�� not intended or offered for sale (Section 7044, Business and FINAL DATE Q �- Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r7 vR 11 tIT•SL s Off A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE IIII ❑ 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, YES El YES Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING r_iI,I_jlj-I.IE[ �• r r_ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH M CONSTRUCTION LENDING AGENCY COAST AIR QUA ITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR I�_'i s }5 -'5-SGUIDELINES. " I hereby affirm that there is a construction lending agency for YES 1:1 NO a the performance of the work for which this permit is issued(Sec. I HAVE READTHE H RDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097, Civ.C.) CHECKLIST.I UN TAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY C TITLE 2,CHAPT SEC IONS 2.20.1 .20.140 CONCERNI OUS 3 Lender's Name MATERIALS R T AND I P IT FRO AO 0 Lender's Address 0 OWNER OR AGENT o I certify that I have read this application and state under penalty 0of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE o with all county ordinances and State laws relating to building D' mconstructs n and hereby uthorize representatives of this County ISSUANCE FEE to enter th bov ioned pr erty for' spe n urposes. (0 INVESTIGATION FEE TOTAL FEE/ Sgoawre of Ao�Iioanl or Ap nt 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 I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS - 2-1 or a certificate of Workers' Compensation Insurance, or a certified. S2,7 copy thereof(Sec.3800, Lab.C.) CITY ZIP 176 �] wL, LOCALITY Policy No.'(`S'7� Company ®�� (� SIZE OF LOT V NO.OF BLDGS.NOW ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS ST. Certified Copy is filed with the C my buil ng i pection TRACT BLOCK LOT NO. depar��tm��enfft^^�� USE ZONE MAP NO. �/ -7 Date�Ldo4- Applicant ASSESSORId�� O)`` PAG PARCEL �' /.� / - �'� T �=J /c\(� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION F O WORKERS' OWNER // , ELN COMPENSATION INSU ANCE tel/ WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCE D BY dollars ($100)or less.) a. 1 CITY ZIP 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 N0. 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 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' NTRACTOR TFL l` SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 1Qf+�T1 . 1 T -�7 - FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION �0 SIDE �y/y�� CITY f�IC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 '� L— (commencing with Section 7000)Of Division 3 Of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP Professions Code,and my license is in full force and effect. NEW BK PG DESCRIPTION OF WORK VALUATION License Number Z50 ylk Lia Class_ 16 ADD - ❑ O Contractor 2�2 Date '3-2- ALTER ❑ $ ��— 0 ❑ I am exempt under Sec. REPAIR ❑ 0 B.&P.C.for this reason 6 DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BL-SQ, URM ❑ D_ Signature A IC NT .RI ) LDMA Perm# 1 z El 1, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS O Ate'f T"Ts not intended or offered for sale (Section 7044, Business and FINAL DATE Q 33:7 107.225 I Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE licensed contractors to construct the project (Section 70444, FINAL BY J El I, as owner of the property, am exclusively contracting 4AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? , - Business and Professions Code.) YES❑ NO❑ TOTAL . . 107 m 25 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �( j^7 6�� OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �^� CHECK f0(e 25 CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. pf�� CHANGE n 011 I hereby affirm that there is a construction lending agency for YES 1:1 NO❑ �o�-�O /y {t a the performance of the work for which this permit is issued(Sec. rn HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING �aOQ . .. ... 3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 3 0. Lender's Name TITLE 2,CHAPTER 2.20 SECTIONS 2,20,100 MATERIALS REPORTING AND FOR OBTAININGTHROUGH A PERMT FROM THE2,20.140 SCAOMD.CONCERNING HAZARDOUS �� 0000-0001 3 x26/9 o lender's Address o tf OWNER OR AGENT �� V J � 1 AM 10:01 0 1 certify that I have read this application and state under penalty o of perjury t �D hat the above information is correct.I agree to comply P.C.FEE PERMIT FEE with all county ordilhances and State laws relating to building m Cons truen,,andPhry authorize representatives of this County ISSUANCE FEEto t pon thentioned property for inspection purposes. ^ZtO vo, INVESTIGATION FEE TOTAL FI s o UAuurcam o.Ag m Dae SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION ificqe of consnt to self insureboraafcertifcatte_ ofWokesrlComtpensatoneInsurance, APPLICATION FOR. BUILDING PERMIT or a ceriif)td copyth reof (SeX00, b. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy nj/pan I'lla,ae/�`�� Y (� BUILDING ❑ Xertified copy is hereby fur n ed. t h FOR APPLICANT TO FILL IN ADDRESS �^ S Certified copy is filed with the co ty build ng inspec- ADDRESS BUILDING �� 7 �`�� ill ti n department. *7/ CITY LTi C.( 1 // 0 LOCALITY / Date Appli ant i �J NO. OF BLDGS. NEAREST ERTIFI ATE OF EXE SIZE OF LOT U+ul G NOW ON LOT CROSS ST. COMPENSATI INSUR ASSESSOR /� (This section need not be completed i the permit is for TRACT BLOCK LOIT(4NO. e- MAP BOOK PAGfOO PAR !J/ hundred dollars ($100) or less.) OWNER S W r NO�$��a 'O USE ZONE. Mf+P NO I certify that in the performance of the work for which this ] A yy/` SPECIAL 7 • permit is issued, I shall not employ any person in any manner ADDRESS ! 's�� f '�� ,` CONDITIONS 4 so as to become subject to the Workers' Compensation Laws. ` •�-- 7 O CITY '+SAA C l ZIP f 7 Date Applicant ARCHITECT�Rf,'t TEL.(( NOTICE TO APPLICANT: 1f, after makingthis Certificate of ENGINEER !� (� fJ � NO` �� DISTRI TYPE IRE PROCESSED BY O CONST. ZONE H Exemption, you should become subject to the Workers' , . 41,17'rj S'-' 1'4"1-�f, *lk?A �� jrl 3v Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. N .deemed revoked. CONTRACTOR NO. z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. �� DWELL. UNITS 71 I hereby affirm that I am licensed under pro visions-of.Chapter 9 DDRESS NO. (commencing with tion 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Co e,c d my license is in full for and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Lic. Class SIZE �� STORIES FAMILIES ONE VALUATION Contracto Date DESCRIPTION OF WORK NEN/ s t � -7v� vwt[ ` SECADD- ❑ ,.., ,�» ❑I am a emp Sec. 1 ALTER E: 10. k j"i." ' - r... Bl for this ea,on REPAIR El $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT. NO. FINAL I€ OWNER-BUILDER DECLARATION DATE �' Z Z '� hereby affirm that I am exempt from the Contractor's License ;=(''E'•_ 1;tt;`A.'!,` Law for the following reason Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY e = - BUILDING��Z�� ;'°� ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY �J at'la.t _ the structure is not intended or offered for sale(Section 1 �f/I # _ t ._a_ ,;. J. 7044, Business and Professions Code.) MOVING TEL.' y/J� _ - _ CONTRACTOR NO. .-t '';' ❑ I, as owner of the property, am exclusively contracting t ;/i __= '= -• with licensed contractors to construct the project (Sec- '�1 ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. 1 4:� •`. --''• CONSTRUCTION LENDING AGENCY SET BACK` YARD HWY PROP. LINE WIDTH a I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit.is issued P.L. W (Sec. 3097, Civ. C.). ' SIDE. P.L. Lender's Name. /Ge LDMA Ref. # 1 P.C. Fee$ Permit Fee ✓ 3 Lender's Address f a I certify that ave read this application and state that the Issuance Fee /' 7.< LDMA P/C# o Y PP 8 above inforniatio is correct. I agree to comply with all County Investigation Fee. - R ordinances and to I relating to building construction, Total Fee LDMA Perm. # a an orize repre tatives of this County to enter upon th tion roperty for inspecti purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of AppIica r-AVeo t Da