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HomeMy Public PortalAbout4929 HALLOWELL AVE_Building__ DJ5•3 (1-45 88M SETS APPLICATION FDR PERMIT DEPARTMENT OF BUILDING AND .SAFETY / COUNTY OF LOS ANGELES �� �� WM. J. FOX, CHIEF ENGINEER NO.OF /fir BLDG. � ORD.NO. ' DISTRICT NO. PLAN CK. NO. ���PyyyERMIT NO. PLANS / SETBACK LINE \ r FIRE APPROVED J 67 ZONE / BY \ DATE\ RECEIVED 13Y DATE OF4APPL. DATE ISSUED USE ZONE 1 BYPROVED DATE \ `� !' / 2 J ')"' 21 4e 4 APPLICANT FILL IN HEAVILY; OUTLINED PORTION ONLY ,y ,� a BUILDING 9 NAME ADDRESS 17, L �s 7 R 4,9ff� � Z ADDRESS \ LOCALITY L D ?I I- O NEAREST Pi L W +'► ►^ � / •y U CITY CROSS ST. o �t�G . � ,/� 6,7 Q STATE TEL-.�,� NAME I LICENSE NO. NO. Z MAIL 6 NAME _ 3 ADDRESS (� I�►� u�/ O CITY Q ADDRESS A� NO. f - f 0 CITY !� �� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS U APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ZZ .LOT NOPAR; 2 SIZE OF LOT i��)( /7r SIGNATURE OF OWNER �gQ/] , C d NO. OF BLDG8. AUTHORIZED AGTr BLOCK NOW ON LOT bj .J TRACT �� / CORRECTIONS D UBE OF BLDGS. �/ ' NOW ON LOT /y�_j.1f( � CrARRG�. �EN �}�OfJf�C_�Z,- "o /" 71 Age -OF'WORK /)l��(i� 1/1 a , PU USE OF ,BUILDING l7 O[S/ER P'RoW-r PQ RC 14 1""nll�l ,III f rr�ll.n.r r• �, 1�DD S6R✓lCF_ oRCH G-�X 2� 1 Gi lq i4,,,..--�4 4 II – v a a nn a s -�• v ` c r 'nn av ba in violation.of War Production Bc-urd ord3rs. You are O PrccluelionT3ca-c1Cf='.»b�for�romrn�anc`r � 67;77777)77) in this n(.rmt . z NEW TYPE Yom. GROUP r NO.OFNO.OF ALTERATION ROOMS I FAMILIES �� ADDITION SIZE� bD 710 Rig a« d,.rV 22 REPAIR STORIES RO°�FRo1✓T IBJ Zc�f MOVING WALL COVERING DEMOLISH ROOF COVERING G6 D• P.C.$ FINAL APPROVAL FEE p � 7—* I INSPECTOR'S" VALUATION . FEE �' /J DATEj' NAME f WORKERS%COMPFNSATION DECLARATION >."' ^ •_ }: ; ..r _ _t';, _ rsure, or a certificate of Workers' Compensation Insurance, __ _ APPLICATION F O R �BaU;I -DING PER 11.hereb affirm.that I have;a.certificate.of consent to,self or.a ceitified'copy thereof•(Sec. 3800, Lab.'C.)` COUNTY OF LOS ANGELES- ,BUILDING.AND SAFETY Policy No Company• - F t Certified copy is hereby,furnished '• tr FOR APPLICANT TO FILL IN ' BUILDING` (� i - ADDRESS Certified copy'is filed with the county'bwlding'mspec- BUILDING 1 hon department ' ADDRESS T��/ �V• �1L��1��L.�/�'V�' t i / Date '` Applicant % CITY ��+� ZIP (/ LOCALITY' - - CERTIFICATE OF EXEMPTION FROMWORKERS''•`"" "' NO OF BLDGS' _ NEAREST:.. 'COMPENSATION INSURANCE,: SIZE OF LOT NOW ON LOT I CROSS ST.., (This section-need not be completed-if the'permrt:is for'.one - - - ASSESSOR.. _ .•...:� �i' I_• - ' -hundred dollars ($100)or less.) TRACT' BLOCK LOT NO MAP BOOK - r PAGEi- PARCEL OW r * +; ? - NER':' ! SE ZONE MAP 1 certify,that in the performcince,df the wo�k,for which this• NO I :Y permit is issued, I shall not"employ'any person in'any.manner / I';--SPECIAL-- permit a ADDRESS WELL �4� CONDITIONS r 1 ;V so as to become subject to the Workers'- ompensation La - /'�-y1 • i.-` IT.Y_ ��M�Gc.._67/ ZIP._ Date _ `� Applicant' ARCHITECT OR TEL NOTICE.:TO'"APPLICANT'+If, diter making'this"Certificate of _ DIST CT _ G UP"TYPE FIRE PR CESSED.BY.,.- O ' ENGINEER NO `� CONST' ONE 1 Exemption, ou 'should become subject -to'the Workers' - t P Y I i Compensation provisions of the'Labor Code, you must forth- ADDRESS / - -- -- — - - _t N with comply with-,such provisions or_this; permit,shall be' —- - - --- - TEL -~ _. 1 STATISTICAL CLASSIFICATION",,: M. APT ' NDO ' CA deemed revoked, ;, a• i.a CONTRACTOR NO :.. LICENSED CONTRACTORS DECLARATION - •• -- —• - --t- — CLIC. LICE CLASS'NO DWELL UNITS hereby affirm that I am licensed under•provisions of-Chapter 9 ADDRESS NO (commericing with Section 7000)of Division 3'of t.Ke'Business and SEWER MAP ' LIG - Professions Code, and my license is,m full'fo_rce'and effect CITY. CLASS '"BK "" VALIDATION ,_1 z�. > , SQ Ff: _ NO OF NO OF _ CHECK rrr'•: t` 61•`' ` • SIZE STORIES FAMILIES ONE P. ;r- License Number Lic.Class ~ .VALUATION.. _ _ NEW.,_ ' •+ :t. •a;tl - DESCRIPTION OF WORK Contractor Date ADD $ SCJ I am exempt under Sec. ALTER B.BP.C. for this reason I� / REPAIR_ El Date: _ - USE t, EXISTING BLDG. ' DEMOL ❑ _ -.... ,_ , Signature APPLICANT- - /�r' -7- TEL �/��� FINAL PRINT J>C?GCl/O/�NO.1 _ OWNER-BUILDER DECLARATION DAT - t I hereb affirm.that.l am-exem t from,the Contractor's License �� 4' 6'Pi 7.A Law for the following reason (Section 7031.5, Business and A D D R E FI rofessions"Code): PRESENT BUILDING B as owner'of the'property, or my employees with ADDRESS 9 8'8�'.' wages ds their sole compensation;will do the work"and, 'o+o �a the structure is not intended or offered for sale(Section LOCALITY :7044, Business and Professions'Code). "' MOVING "" - "TEL` -' ,' i^' 'I r •o• s 9.$8.6: . CONTRACTOR NO %i, as owner of the property, am exclusively contracting _ _•._ _._._ . _... i _ 4, 1 _`8 7:-Y : •with licensed'contractors to construct the prolect'(Sec- ADDRESS i -tion 7044, Busmess.and Professions Code). REQU I RED.,. _: L SETBACK _ " `CONSTRUCTION'LENDING AGENCY '~ SET BACK YARD' ;HwY' .TOTAPROP LINE WIDTHI _ ;i •I.hereby affirm that there is a construction lending agency for FRONT the performance of the work for which,this permit-is-issued -PL-• (Sec. 3097, Civ. C.). SIDE r PL iLender's Name LDMA Ref ..�_ .. •` - - •Fee$--.., , ..... -•... .1Permit Fee 1 kt'P/6,0 Lender's Addresst I certify that I:have read this application and state_that the _ . __. ____ Issuance•Fee-•r -•.-•a '+ e - i-• - a above.information is correct. I agree to comply with all County Investigation Fee } * _ t ��y i• t,1\ g ordinances and State laws•relating to.building construction, - ._..._ Total Fee - t LDMA.Perm and hereby authorize representatives of this County to enter f upon the above-mention d property`for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicdnt or Agent "•'-•-^ -Date _- -- -•- __...__. .. _ . -._ _ ._ _ ._...._, ".�__.�, .-. _ _ __._._.. ._ __ - . • • � i , • • ' .. P^U CAM /• F O R -O•U L D ` S ,PR VIT , COUNTY OF LOS"ANGELES ,- BUILDINGAND SAFETY V'✓ORkER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN,_ '� BUILDING ADDRESS I hereby affirmrthat I have a certificate of consent to self,insure, BUILDIN DDJRESS z l �1L�-UlIV�GL or a certficate of Workers' Compensation Insurance„or a certified *4LL � "' � S Ayr 7' Utt, .G t'�/ copy thereof (Sec 3800, Lab.C)" CITY. r zIP (.�/''7 ' G!T !/ / LOCALITY Poky No „Company SIZE OF LO NO OF BLDGS`NOW ON LOT - NEAREST El Certified copy Is Hereby furnished ,t •OX "y/%(7 � _ CROSS ST ❑ Certified copy,is filed with the county;building Inspection TRACT BLOCK- LOT NO department USE ZONE MAP NO Applicant ASSESSOR'MAP'BOOK PAGE PARCEL Date �� r SPECIAL CONDITIONS OWNER -- TEL NO - YES NO CERTIFICATE'OF EXEMPTION FROM WORKERS' S/MG�I LuY wITHw 1000 FT OF SCHOOL - COMP,ENSATION INSURANCE, ' _ 2C'S ZZ'7 2TIe Thlslsection need•not be completed If the ermit Is for'one hundred ?DDRES 'w, (1 P P + z ��4DWL ©Ve DISTRICT GROUP 'TYPE CONST FIRE�ZONE' ,PROCESSED,BY dollars',($100)or less•).', CITY ZIP ,•, Q I certify,that-m the performance of the work for which this permit T” L•� G� -(/��� IS Issued, I-shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL NO S become,subject,to the Workers'Compensation Laws , - / r>" STATISTICAL AS I_FI AT — / APT- 'CONDO ' Date' Applicant ADDRESS - CLASS NO LL UNITS / ZOa c3�x.1aCZln%6 eta `^`NOTICE'. TO"TAPPLICAINT. If,`after '-making ,this Certificate Of REQUIRED TOTAL SETBACK+FROM EXIST "Exemption; you, should 'become Subject to the WorkersCONTRACTOR TEL NO 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 NO PL , LICENSED,CONTRACTORS DECLARATION PILE ; - � CITY LIC CLASS •P L , I'hereby affirm that I am licensed uhderprovisions of Chapter 9 'SEWER MAP, • .(commencing with Sectlon•7000)of Division 3 of the Business and- SQ FT,SI�E NO OF S`To�IES ,-NO. •FAMILIES - -- ' Professions Code,and my license Is,m full force and effect. NEW ❑ BK L- Pd License°Number - Llc Class DESCRIPTION OF WORK - ADD ❑ VALUATION D•~. O Contractor' Date bMO xis ALTER El $ ' I .(am exempt under Sec. ,REPAIR ❑" ,$ F- -B&PC.for this reason ` C�eriG.iQ�Orr DEMOL e•LDMA P/C# W - Date USE OF E;ISTING BLDG ' ^ URM• yt' ❑` - - s a WNW iJ0 !.!.° BIVitG05� Y=; Z ,;Signature - APR ANT(PRIN ) _ S TEL NO ,-LDMA Perm# - i,y P �'�'�'t' - 'AI as owner of the property, or my employees with wages as - " ' their sole compensation, will do the work,and the,structure Is ADD ESS `I/ ,�QL� o -' FINAL DATE - ^ . • not Intended or offered for sale (Section 7044, Business and. �a ZIA/j � _ o ,:�.a,1 f - 1 5.90 Professions Code) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS'MATERIAL "ITEMS OR A MIXTURE CONTAINING,A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1 1 t G1 iJ , ❑,1, 'as.owner'of the'property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?. Q FINAL-BY, _ > - licensed contractors to construct the 'project ,(Section 7044, ves❑ No❑ �!I i ° ' Business and Professions Code.) �� :';• - = WILL'THE INTENDED USE OF THE BUIDI-AG BY THE APPLICANT OR FU,TUR_E,BUILDING ` {,J['J' �•'* i 1 - - .. _ '. '• OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _- .'i -. •'ir-�+ I-J o 7' .. '� CONSTRUCTION,LENDING AGENCY' COAST AIWQUAUTY,MANAGEMENT DISTRICT(SCAQMD);SEE PERMITTING CHEGKUST�FOR rt _ GUIDELINES r - 1•'•,'�� E - i - I herebyaffirm that there Is a construction lending agency for .9 9 Y YES❑ NO❑ w the performance.of the work,for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMO PERMITTING. " 3097,:Civ C)' CHECKLIST I UNDERSTAND'MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY,CODE, N TITLE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING'HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD - o Lender's Address 9329 ° "1 AN 9-'130 0- .. - OWNER OR AGENT O o - I certlfy`that I have.read this application and state under penalty of perjury that the above Information Is correct, I agree to comply PC FEE PERMIT FEE o with all county ordinances and State laws relating to building m construction, and hereby au e representatives of this County ISSUANCE FEE M to ent the above" ned property for in purposes a •� q INVESTIGATION FEE - TOTAL FEE S"tum w AP AU"' - SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY,OF LOS ANGELES,. BUILDING AND SAFETY. WORKER'S COMPENSATION DECLARATION ' FOR APPLICANT.TO FILL IN: BUILDINGA DRESS _ I hereby affirm'that I have a certificate of consent to self Insure, BUILDING ADDRESS' or a certificate of,'Workers' Compensation Insurance,or a certified 4-929 u�'�'Ow�"� aY� _ copy thereof(Sec 3800,Lab.C.) CITY ZIP �/� LC .Ci�1♦ �� , LOCALITY. . . _ Policy No' Company- SIZE OF LOT �j � /6' NO OF BLDGS NOW ON LOT El Certified copy is hereby furnished .51.0 x �'1!.Ip1 . -Two. i. NEAREST CROSS•ST El Certified copy Is'filed with the county building,inspection TRACT BLOCK LOT NO ` department USE ZONE MAP NO ASSESSOR MAP 00 PAGE PARCEL SPECIAL CONDITIONS IITTIIONS Date •' Applicant - S �, DO '/• •• , CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO' COMPENSATION INSURANCE ' =" 913- 127,9K,66 WITHIN 1000 FT OF SCHOOL'?'- ADDRESS CHOOL'- YES No (This section need'not be completed ifathe permit Is for one hundred ADDRESS + - q_ 2_0J,_,-tJAU,0 i ,YQY�►A__- - - DISTRICT' GROUP TYPE CONST. FIRE ZONE PROCESSED•BY dollars($100) or less.) 'CITY ZIP 2 I certify that In the performance of the work for which this permit:• C. _ .91 � 'J IS Issued, I Shall not employ any person in any.manner s0 as,to ARC ITECT OR ENGINE.ER TEL NO become subject to the Workers'Compensation LawsSTATISTICAL CL�ATION • ,= < Pq4 CONDO Date •Applicant ADDRESS _CLASS NO DWELL:UNITS _''?4 07 1335.6101 -tl-q20 NOTICE TO •APPLICANT.- .If, after making'this Certificate' of REQUIRED TOTAL SETBACK JRC3fuF•C EXIST Exemption, you Should become' subject to' the Workers' CONTRACTOR rte' TEL NO SET BACK YARD HWY PROP LINE ITEMS G 7 WIDTH Compensation'provisions of,the Labor Code, you,must forthwith -O.W" -- ---P+ — -- - FRONT TOTAL 1y�, jl� comply with such provisions-or this permit shall be,deemed revoked. ADDRESS LIC NO PL c. LICENSED.CONTRACTORS DECLARATION CITY. uc CLASS FIDE ��• ,6(l I hereby affirm that I am licensed underprovislons•of=Chapter 9' SEWER MAP (commencing with Section 7000)'Of DwISIOn 3 of the Business and SO'-FT,SIZE NO OF STORIES NO OF FAMILIES, - - - - Professions Code,and my,llcense,is Iii full force and effect. /(og7 Oka C7U4je NEW El BK � PG , DESCRIPTION OF WORK Li6enseNumber LIC. Class ADD ;VALUATION Contractor Date hep ry eX/S �wM4 Aoll LVF—;00 1 2/.;15-/9,75-/y O ALTER U369 1 tM 9:56,Ix ElI am exempt under Sec. REPAIR El $ F_ B&f'C.for this reason v1A/�iLC./h1G �_•. y +;y �'• �.l ,'DEMOL—'El' U . . Date. - - US EXISTI G BLDG'•' `- • .+ { V ,UJiM ,'❑ - f1 / . �Y- (1) Signature APPLICANT PRINT ->-. TEL No LDMA Parm# - �,�`'.•, ': ' ';� _ Z y 1 ❑ I,-as owner of the property;or my 'employees with wages as t 2 f _ I + • O • +. . ■1r: ' their sole compensation, will.do•the work and the structure Is ADDRESS _ Z tt CT a not Intended or offered for sale (Section 7044, Business and as FiNA1..LATE �f Q 3307 - 1617,'K 'PfOfeSSIORS Code) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ALJ ✓ / J 1 1•TEM:� ❑ I, as owner of the roped , am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL.TO OR GREATER.THAN.THE P Y Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDEI a licensed contractors to construct the project.(Sectlon .7044, "FINAL BY >• Business and Professions Code) ves❑ No❑ ;. TOTAL 1611.4 WILL-THE INTENDED USE OF'THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING • e;�C OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH :�' - �:HEi:{ - 1617..-1 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT,(SCAOMD)SEE PERMITTING CHECKLIST FOR �.(,�/��,�:•�C r+� GUIDELINES .' 4fiANE •o th l I hereby affirm that there is a,constructlon lending agency for YES❑ No❑ w_ •w the'performance Of the work for,which this permit Is'ISSued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING " •••+. O 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 13000-130131 . - 4%t"i•i/Qs 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT.FROM THE SCAOMD -+•�t�,', L o Lender's Address 93]V 1 AM .91 00 O OWNER OR AGENT. _. .1 o I,certify that I have read this.application and.state,under penalty o - of perjury-that the above information is correct I agree t0 comply PC FEE / PERMIT FEE o with all county ordinances-and State laws relating to building v O �d ; construction, and hereby authorize representatives'of,this County ISSUANCE FEE OD m to enter upon the*above'mentioned property for inspection purposes INVESTIGATION FEE TOTAL FEE ' r� syr­ue a Aoa+—n«Ag�I owe - SEE REVERSE FOR EXPLANATORY LANGUAGE V ARPLDCATI N FOR BULDING 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 A,4 0Wf-- 2 L or'a certificate of Workers' Compensation Insurance,ora certified 92 f.►� �G p copy thereof (Sec.3800,Lab C), CITf► L G�T•7 TY ZIP LOCALITY Policy NO. CompanySIZE OF LOT ' NO OF BLDGS',NOW ON LOT" ❑ Certified copy Is hereby furnished. 7 X 1177. 46 1 /-r NEAREST CROSS El Certified copy is,filed with the county building inspection TRACT BLOCK LOT NO department USE ZONE MAP A/ 75 A Date• Applicant ASSESSOR WQPFSi� PAGE PARC L p(/ �JY SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO COMPENSATION INSURANCE - 51 M4u "LVy &+ WITHIN 1000 FT OF SCHOOLS 'YES NO ' (This section need not-be completed if the permit is for one hundred ADDRESS dollars'($100)or lessDISTRICT GROUP TYPE CONST. FIRE ZONE . PROCESSED BY ) G� CITY ZIP I certify that in the performance of the work for which this permit M M G y► C1 17 L100 �D p Is Issued, I shall not employ any person In any manner so as to v become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO 1_ P y _ 1.. '?1i5L� STATIS L LAS APT CONDO Date Applicant ADDRESS CLA DWELL UNITS _ NOTICE TO APPLICANT If, 'after making this Certificate Of. �+ W�'� O REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the Workers' CONTRACTOR�f / TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation 'provisions of the Labor Code, you must forthwith '5 IA447�.j C.WY 4491 'FRONT comply wlth'such provisions or this permit shall be deemed revoked ADDRESj LIC NO, P L LICENSED CONTRACTORS DECLARATION Ddu©� Q SIDE, _ CITY �may, LIC CLASS •_,P L I"hereby affirm that I am licensed underprovisions of Chapter 9 e ` SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZE NO OF STORIES NO OF FAMILIES Professions Code,and my license Is In full force and effect 4 ON �+ NEW BK PG 1' DESCRIPTION OF WORK VALUATION . License Number Llc Class ADD ❑ pQ � 377, U Contractor' Date ALTER El0 ❑ I am exempt under Sec REPAIR ❑ B&PC for this reason DEMOL ❑ LDMA P/C# W Date. USE OF EXISTING BLDG URM ❑ " l- 2�3 y, CO / )nature APPLICANT(PRINT) T L N LDMA Perm# 1 Z Od I, as•owner of-the property, or my,employees with wages as ��M4� �Vy �• `, Z Ht_�i ea their sole compensation, will do the work and the structure Is ADDRESS f O _,� 50.50 FINAL DATE P •' `elm' not intended or offered for sale (Section 7044, Business and Professions Code) •, WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of the property, OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE { - p p y, am exclusively contracting with' AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL-.BY• > j licensed contractors•to-construct the project (Section 7044, VES❑ NO❑ - Business and Professions Code) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING _33133 6'J3.27' i -. OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH•- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ITEMS .- - GUIDELINES - S I hereby-affirm that there Is a construction lending agency for YES[:] No❑ a 77 the performance of the work for which this permit Is issued(Sec TOTAL -. + m rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING _ ,3097,CIV C) CHECKLIST I UNDERSTAND MV REQUIREMENTS U THE LOS ANGELES COUNTY CODE, —CHECK ( �'� ' TITLE 2.CHAPTER 2 20 SECTIONS 2 20 100 TH GH 2 20 1.CONCERNING HAZARDOUS {•NE E1 11•J a 3 - Lender's Name' MATERIALS REPORTIN FOR OBTAINI ERMIT FROM THE SCAOMD—� o Lender's Address i_HAt+3E .000 . O OWNER OR AGENT o, I certify that I have read this application and state under penalty o PC FEE PERMIT FEE of perjury that the above information is'correct I agree to comply -�-� ��' �' G GOOCI-0001 6r/ a - with all county ordinances and State laws relating to building - W construction, and hereby authorize representatives of this County ISSUANCE FEEIGS t � -"i c � nt to ep =( 1 r,e`on the abov mentioned property for Inspection purposes. l0 f L" - � INVESTIGATION FEE TOTAL FEE room,a A�t _ l/V/ SEE REVERSE FOR EXPLANATORY LANGUAGE