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Home My Public Portal About6033 GOLDEN WEST AVE_Building__ y9"'�`�`rw APPLICATION FOR BUILDING .PERMIT Y 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, BUI ADDRESS j, + or a certificate of Workers'Compensation Insurance,or a certified , copy thereof(Sec.380x0,Lab.C.) / j �/' ]} CI_/Q_��, /�,� ZIP' Policy No. �'I'I'�''Q�'` —�� Company v��,!/ —` 7/4 �`" �' LOCALITY SIZE OF LOT N0.OF BLDGS.NOW ON LOT 7 ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. ` L/ ASSESSOR MAP BOOK PAGE PARCEL Date Applicant. YY) SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE �� & P h' � WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundr ADDRESS ' i 1 8 L DISTRICT GROUP TYP CONST, FIRE ZONE PROCESSED BY dollars ($•100)or less.) V u CITY ZIP I certify that in the performance of the work for which this permit Z is issued, I shall not employ any person in any manner so as to ARCHITECT OR GIN ER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date - Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of EFRONT EOUIRED TOTAL SETBACK FROM EXIST Exemption, you ShOUId become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE , WIDTH Compensation provisions of the Labor Code, you must forthwith `. i W —r _r comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO.LICENSED CONTRACTORS DECLARATION CITY �y IC. ,LA$ E O 39 0 I hereby affirm that I am licensed underprovisions of Chapter 9 a SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO,OF STORIES I NO:OF FAMILIES - Professions Code,and my license is in full force and effect: NEW ❑ BK PG O License Number Lic..Class DESCRIPTION OF WORK ADD ❑ VALUATION , U Contractor ILL 01f2(_ a>417,Date � _ ALTER ❑ $ / xeoCIL ' ❑ I am exempt under Sea ILL I WC-RSo--� REPAIR ❑ $. Z B.&P.C.for this reason 1qD Nb DEMOL ❑ LDMA PIC# Date: USE OF EXISTING BLDG. URM ❑ Signature 4IGANT(PRINT) EL NO. LDMA Perm# C3 1, A P ' 1, as,owner of the property, omy employees with wages as / 7 Z T G v1 — G9 Z CCT..• their sole compensation, will.do the work and the structure is IADDRE _O ,� not intended or offered for sale (Section 7044, Business and / `� Imo' 3+�;FINAL DATE 3 °25 PIOfeSSIOr1S Code.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL .. l b f O ,L •I.11 E S OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ❑ I, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY °' ''' 2!5- licensed contractors to construct the project (Section 7044, YES❑ NO❑ I LIT( _s Business and Professions Code.) �, .K ;'1 n i'c WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING '• OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT(SCACMD)SEE PERMITTING CHECKLIST FOR CONSTRUCTION LENDING AGENCY CHANGE .001 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 PERMITTING :-Z 3097,Civ.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, _ �J000-0 01 3/12/96 N - - TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS '� >T Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. C+i f j !-� c i m _r 60 i ii F a Lender's Address ' OWNER OR AGENT 3 1 certify that I have read this application and state under penalty p of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE with all county ordinances and State laws relating to building F/f m construction, and hereby authorize representatives of this County ISSUANCE FEE 1y toe ter upon the above-mentioned property for inspection purposes. (/ —� INVESTIGATION FEE TOTAL FEE 6pruNre of Maor i Dace ` v SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION r orhereby aafirm certif carI have a certificate of te of Workers' Compensat on��s��a of APPLICATION FOR BUILDING PERMIT- insure, or a certified copy thereof (Sec: 3800, ob.k C.) Policy No'�I(� •� Company' Vv `U' COUNTY OF LOS ANGELES BUILDING.AND SAFE Y n ❑ Certified copy is hereby furnished, BUILDING FOR APPLICANT TO FILL IN ADDRESS �/ �- yt- Certified copy is filed with'the county building inspec- BUILDING Tion department. ADDRESS y Date,- 1 �- Applicant C CITY ZIP LOCALITY { CERTIFICATE OF.EXEMPTION-FROM W, KERS' NO.OF BLDGS: NEAREST �/1 a COMPENSATION INSURANCE " ' SIZE OF LOT NOW ON LOT CROSS ST. (This section need'not be completed if.the permit is for one - - ASSESSOR , hundred dollars ($100)or•.less.) TRACT BLOCK LOT NO.. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP OWNER NOJ / 1-I V I certify that in the performance of the work for which this ` NO. permit is issued, I shall riot employ any person in any manner ��S' �- SPECIAL CL S6 ds to become subject to the Worker's'Compensation Laws. ADDRESS CONDITIONS CITY ZIP Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PRO ESSED BY 0 Exemption,- you should become subject to the Workers' CONST ZO (; LU Compensation provisions of'the Labor Code, you must forth- ADDRESS ` ' �� IL With comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. PONDO. deemed revoked.., CONTRACTOR-J'J ) NO S LICENSED CONTRACTORS DECLARATION Q LIC. /� CLASS NO. ZDWELL. UNITS — r hereby affirm that I am licensed under provisions.of Chapter 9 ADDRESS �d p S.S2iar� h NO '^' SEWER MAP (commencing with Section 7000)of Division 3 of the Business and .- LIC. Professions Code, and my license is in full force-and effect. CITY f CLASS 0 3_ BK. PG VALIDATION n O� _ Sq. FT. STORIES NO. OF CHE K License Number (% Lic.Class SIZE STORIES FAMILIES ONE Oki / NEW, _..VALUATION Contractor 'v I10 D CRIPTION OF WORK' -' ❑ Date ❑ S � , YY ADD ❑ I am exempt un er Sec. i` Q. ALTER ❑ , B.&P.C. for this reasonREPAIR ❑ S Date: USE OF DEMO" ❑ EXISTING BLDG. -Sigrioture APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT) NO. DATE4 -' j - I hereby affirm that Tam exempt from the Contractor's License / Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT By 6 6.7,.3 A ❑ BUILDING I, as owner of the property, or my employees with ADDRESS l/ / # ° a-0.6: .°i�' wages as their sole compensation,will do the work and LOCALITY ( ' the structure is not intended or offered for sale Section ' ° ° 2 a 5.0 , 7044, Business and Professions Code). MOVING TEL.' CONTRACTOR NO. ° 2 .5 O_ i ❑ I, as owner of the property, am exclusively contracting ® ° c� with licensed contractors-.to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS .0 Z 1 6-8 7. REQUIRED. • -YARD HWY' TOTAL SETBACK FROM.- IST. _ A CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L.- (Sec. .L. - - - (Sec. 3097, Civ. C.). SIDE P.L. _ Lender's Name l LDMA Ref. # Lender's Address P.C- Fee$ Permit'Fee V ; i > _I certify that I have read this application and.state that.the Issuance Fee J V LDMA P/C# - '"-• above information is correct. I agree to comply with all County Investigation Fee m -ordinances and State. laws relating to building construction, Total Fee 'CDMA Perm. # u and hereby authorize representatives of this County to enter m upon the bove- entioned pro rty for inspection purposes. -��a _ SEE REVERSE FOR EXPLANATORY LANGUAGE Signatureo pplicant or Agent - - - Date " '• _' - '- - ' APPLICATION FOR BUILDING PERMIT ° COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION k FOR APPLICANT.TO FILL IN BUILDIIISG ADDR! I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS GF�O�J � . or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec.3800,Lab.C.) r /I7yCITY ZIP LOCALITY / Policy No. - iJ Company 1 (Lr SIZE OF LCT NO.OF BLDGS.NOW ON LOT 7 ❑ Certified copy is hereby.furnished. NEAREST CROSS ST ' ❑ Certified Copy is filed with the County building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. �j f/ 3,V f-!g "A- A _ /� /// ASSESSOR MAP BOOK PAGE PARCEL Date Applicant v �!/sSPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKE OWNER loyTEL NO. COMPENSATION INSURANCE Sf -w (/ WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hun re ADD dollars E S ,r CITY ZIP AE v DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY ($100)or less.) I certify that in the performance of the work for which this permit W �h L is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEE TEL NO. CEJ become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. --5-1 DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the Workers' CONTRACTOR 'I I. TE NO.- SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith V-(-. +mac �-1 FRONT Comply with such provisions or this permit shall be deemed revoked. ADDRESS I /� LCh.�N�WO. / p L � Iq 6Z r�/7 /JL- "/ 1-z SIDE CL LICENSED CONTRACTORS DECLARATION CITY IC.C s P L 0 I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES I NO,OF FAMILIES = Professions Code,and my license is in full force and effect. NEW ❑ BK PG O License Number Lic.Class ADD DESCRIPTION OF WORK VALUATION U - � ❑ Contractor ,.f 27- ( L6r Date ;/[ Z_ W&1 v ALTER ❑ $ CL 0 ❑ 1 am exempt under Sec. T14,/p REPAIR ❑ $ Z BAP.C.for this reason ho 7 f4 d P DEMOL ❑ LDMA P/C# Date: USE OF EXISTING.BLDG. URM ❑ Signature APP ICANT(PRINT) t�� TEL NO. LDMA Perm# 1 ❑ I, as owner of the property, or my employees with wages as N ��I'! U[ — Z ACCTa4 their sole compensation, will do*the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and L• A-313• FINAL DATE Q o, [►; _ Professions Code.) 8J WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL STZZ. J 1 ITEMS El1, as owner of the-property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE. FINAL BY Business and Professions Code.) licensed contractors to construct the project (Section 7044, YES 13 NO ElI TOT i r AL '92 m 25 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHECK 92.25 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR CHANGE tl�)i� GUIDELINES. f I hereby affirm that there is a construction lending agency for VES❑ No❑ the performance of the work for which this permit IS Issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING {� 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, (,i}I Il—I�III I fL TITLE 2,CHAPTER 2.20 SECTIONS 2.20,100 THROUGH 2.20.140 CONCERNING HAZARDOUS 0190 + 3• 12 r 1 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address 520 1 PIM 12-'32 M OWNER OR AGENT 3 1 certify that I have read this application and state under penalty p of.perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE U) with all county ordinances and State laws relating to building m construction, and hereby authorize representatives of this County ISSUANCE FEE tnfer upon the above-mentioned property for inspection purposes. , bm,\ / llNi/cliI'a` INVESTIGATION FEE TOTAL FEE ��✓ m Aa T°' SEE REVERSE FOR EXPLANATORY LANGUAGE