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HomeMy Public PortalAbout9834 HALLWOOD DR_Building__ i is.9Y69. rr i p ihoi I-hdve a certificate of consent to self n_5,- or c_riifi ore�f Workers' Compensation Insurance, � �� ��%JIM UK DU ING PERMIT . t r a certified•.opy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. ,_Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING Certified copy is filed with the county building inspec- BUILDING / ADDRESS tion department. ADDRESS. �� 14A4It (:vt�UT Dk Dote Applicant CITY i�PLe C fl- ZIP - ��"�=" ` �•y LOCALITY .r••-fh t •. .,,., CERTIFICATECOMPENSATION INSURANCE ORKERS' SIZE OF LOTS&tit Y 13 NOW ON LOT I CROSSNO.OF BLDGS. SST. R, (This section need not be completed if the permit is for one j `{ ASSESSOR hundred dollars (5100)or less.) TRACT j it ABLOCK], LOT NO. MAP BOOK PAGE PARCEL h Gli t dJ(w,J•r ! TEL._, LZ I certify that in the performance of the work for whit this OWNER ��` TO.;Z 5-tZC b USE Z�N� NOP �- permit is issued, I shall not employ any person in any manner ! �y NA L� V� ry�p� / SPECIAL O so as to become subject to the Workers'Compensation L ws. ADDRESS �+ V'` CONDITIONS V • Date `�� Applicant CITY i�MrlG. (f ZIP 9 %0 O NOTICE TO APPLICANT: If, after m ARCHITECT OR TEL. this Certificate of D.STRICT ENGINEER NO. GROUP TYPE FIRE PROCE D BY Exemption, you should become subject to the Workers' ) � CONST. ZQNE �•, Compensation provisions of the Labor Code, you must forth- ADDRESS U with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR TEL. CLASSIFICATION APT. C0;M. _ LICENSED CONTRACTORS DECLARATION LIC CLASS NO. 2 DWELL. UNITS r V I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division3.of the Business and LIC SEWER MAP Mfessions Code, and my license is in full"force and effect. CITY j �� CLASS VALIDATION SQ. FT NO.OF ' NO.OF CHECK BK. PG. License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK c�Z?i}. �, NEW / t r� ADD S I am exempt under Sec._ ° `Tih�rt� �:XJ�` ; r'tnQC C. 1s e w200N, ALTER } / . &&P.C, for this reason /ai n 5�{J +4�n L'T`�rt rI auE""' S Date: USE Of: REPAIR ' EXISTI,4G BLDG. Lif f�' ? ` )J�CE DEMOL t Signotu;e APPLICA14 // TEL. FINAL s OWNER-BUILDER DECLARATION PRiNT)6X_ NO.285'IzV& GATE I hereby affirm that I am exempt front she Contractor's License (+,Gt 3 1 I A 4 4�� � Low for the following reason (Section 7031.5, Business and ADDRESS `! 4 ►1 �� FINAL Professions Code): PRESENT By n r- t BUILDING ,n� A i, as owner of the property, or my emplovees with ADDRESS w:9es as their sale compensation,will do tie work and ine structure is not intended or offered for sole Section kADDR Y ° ( 704•;, Business and Professions Code). G TEL ' t, as owner of the property, am exclusively contracting CTOR NO. with licensed contractors to construct the project (Sec- S r tion 704e,,Business and Professions Code), RED TOTAL SETBACK FR r,h CONSTRUCTION 'ENDING AGENCY CK YARD HAY PROP. LINE WIDTH ,3 11•.e:eby affirm that there is o construction lending agency for T �e performance of t�,e work for which this permit is issued . (Sec. 3097,Civ. C.). Lender's Nome LDMA Ref. # 4 J f t Permit FeeLender's Ad-fress ritFeeI certif thot I have read this o !icotionand state that theY PP Issuance fee t,; � LDt.AA P/C!tabove information is correct. ;agree to comply with ai!County ation Fee ordinances and tote a%ks relating to building construction, ff S ! iTobl Fee � . .� LDMA Perm. and hereby�uthoriZe representatives of this County to enter '. u on the oboes-menti nec property for inspectic•n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �, rwwre of Appli cnt or Ager,+ T G—otee WORKERS'COMPENSATION DECLARATION F` 1 hereby affirm that I hovecertificate of consent to self ?' "PLICA"'I" insure, or o certificate of Workers' Compensation Insurance, " �( or o certified copy thereof (Sec. 3800, Lab. C. -COUNTY OF LOS ANGELES x BUILDING AND SAFETY- Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING d ADDRESS Certified co is filed with the count building inspec- J r{ PY Y 9 P `�'. FADDRESS G Q n � .� i tion department. SS 1 � ' t1�� {N �%�j (✓ i ��1`rn i'L C tr- ZIP ` f Date Applicant f t' LOCALITY V CERTIFICATE OF EXEMPTION FROM WORKERS' f" /-'j y ti NO. OF BLDGS. NEAREST COMPENSATION INSURANCE f. LOT lY (J NOW ON LOT CROSS ST. ?. (This section need not be completed if the permit is for one ," a ASSESSOR ,hundred dollars 1$100)or less.) BLOCK LOT NO. T: MAP BOOK PAGE PARCEL d TEI. - .- `" / j r: F y.. ( irj USE ZONE MAPO 1 certify that in the performonce.9f the work for which this `��� NO , NO permit is issued, I shall not employany person in any manner: ^+2, r 1SPECIALW SS l �q ",/�(:1.v �,� %4 ` � -so os to become subject to the Workers'Compensotion Laws. a CONDITIONS/_. L1 ' / APP �.;. I�`if j l. , ! ZIP £t Date licant ECT OR TEL.NOTICE TO APPLICANT: If, after m this Certificate of DISTRICT GROUP TYPE FIRE PROCESSED BY Q ER NO. Exemption, you should become subject to the Workers';` _. y CONST. ZONE Compensation provisions of the Labor Code, you must forth ADDRESS ' ),! jf with comply with such provisions or this permit shall be �' d deemed revoked. �-' TEL STATISTICAL CLASSIFICATION APT. CONDO. CONTRACTOR NO. W LICENSED CONTRACTORS DECLARATION3 UC CLASS NO. DWELL. UNITS F- I hereby affirm that I am licensed under provisions of Chapter 9, ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and �} LIC. SEWER MAP Y Professions Code, and my license is in full force ond'effect. CITY :C.' CLASS VALIDATION SQ. FT NO. OF + NO. OF CHECK 8K. PG. ,.License Number Lic.Class SIZE STORIES FAMILIES ONE rr--tt VALUATION Contractor Date a DESCRIPTION OF WORK D Lli ,6 NEW _ ADD J 1 I am exempt under Sec. i'rTl� t- Sz.4jcJu yt�:L `rA ( f ALTER 8.8P.C. for this reason ' (�+�: A i t_: fir tI"';. �l k"V<'fi ' $ REPAIR %,?- USE OF I Dote: EXISTING BLDG. tl':.FT'>�! DEMOL Q II! APPLICANT j FINAL Signature �t N TEL. u OWNER-BUILDER DECLARATION 0 PRINT t NO.Zc !�f% DATE I hereby affirm that I am exempt from the Contractor's License 9 Low for the following reason (Section 7031.5, 9usiness and ADDRESS _} �'1 ! ir✓OCI� I` FINAL Professions Code): '"• k R By t- lLp�l( BUILDING 7,t,7r i 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 for sale(Section LOCALITY 7044, Business and Professions Code). ; LADDR TEL. r�.� � + •� '�' , 1, as owner of the property,am exclusively contracting CTOR NO. with licensed contractors to construct the ro'ect Sec- ;l.°li c r tion 7044, Business and Professions Code). - 's o A K 7'r� ED TOTAL SETBACK �'µ' '�r CONSTRUCTION LENDING AGENCY.,;. CK YARD HWY PROP. LINE WIDTH r ` n 4. , I hereby affirm that there is a construction lending agencyor T v !' A' the performance of the work for which this permit is issutte, d (Sac. 3097, Civ. C.). r' f a s Lender's NameMENEM * LDMA Ref. 0 Lendei's Address c S _ Permit FeeI certify !hat ! have read this applicatia and state that the Issuance fee J LDMAP/C H above informot on is correct. I agree to comply with olI County tion Fee t ordinances and State laws relating to building cons!ruction, r-i _•_ - ` and hereby authorize representatives of'his County !o enter Total Fee i LJMA,Peim. # •pon the above-menti ned property for inspection purpoies. - c %✓�;ti ( �` �,., 1 7' SEE REVERSE FOR EXPLANATORY LANGUAGE aPPUC AMON: FOGS PU L UNG PEROT COUNTY OF LOS ANGELES BUILDING AND. SAFETY WORKER'S COMPENSAMON'DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS B 1 ADDRESS ® � ' I hereby affirm that I have a certificate of consent to self insure, _ � uz�d or a certificate of Workers' Compensation Insurance,or a certified copy thereo ((S c.3800,Lab.C.) CITY �( Polic Company �"�J�� /A LOCALITY -� OF LOT NO.OF BLDG&NOW ON LOT Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the unty build inspection. TRACT BLOCK" LOT NO. - de artment. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL - SPECIAL CONDITIONS OWNER T L O. `� �� 1✓ / CERTIFICATE OF EXEMP N FROM WORKERS' p WITHIN 1000 FT.OF SCHOOL? YES NO COMPENSATIO INSURANCE In J (This section need not be completed if the permit is for one hundred ARE _ DISTRICT GROUP TYP ONST. FIRE ZONE ROC SED BY dollars ($100)or less.) ' I certify that in the performance of the work for which this permit '^7 ;t is issued, I shall not employ any person in any manner so as t0 CT R ENG( EER EL NO. d !/ 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' CONTRACTOR TEL W 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. ADDRES LIC.NO. ^7 P L LICENSED CONTRACTORS DECLARATION 7Z 6 VP , 7/ SIDE CITY - LIC.CLASj,�Sf�' P L I hereby affirm that I am'licensed underprovisions of Chapter 9 C C�� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ. T. IZElp I NO.OF STORIES . NO.OF FAMILIES Professions Code,and m�y7llicense is in full force and effect. / NEW BK PG d ❑ License Number -7/ ��7 Lic. Class'e3 - IPTION OF WORK /ADD ❑ VALUATION D 0 Contractor Date ® ©�. ALTER El � d d� �-S REPAIR B.&P.C.for this reason EJ I am exempt under Sec. .B�MOL ❑ L W 7 J DMA P/C# W Da /7 "I STING BLDG. ,� URM ❑ i - (' •Signature APPLICANT(PRINT) TEL NO. LDMA Perm# 1 Z ACCT. . ❑ I,.as owner of roperty, or my employees with wages as Z 1�8o9Q their sole co e cation, will do the work and the structure is ADDRESS 3303 1 0 7 not intended offered for sale (Section 7044, Business and FINAL DATE' Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL O'er to�- S i ITEMS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 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 ElNO El Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUA /` {�LITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR CHANGE. .00 -GUIDELINES. - I hereby affirm that there is a construction lending agency for YES❑ NO❑ w the performance of the work for which this permit is issued(Sec. �IRJ—Q�Q 1 g���1� m (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING - tJtJ 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 95 MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. � 2487' 1 AM11:01 o Lender's Address O OWNER OR AGENT - I certify that I have read this application and state under penalty O Of 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 constr tion, and hereby authorize representatives of this County ISSUANCE FEE 10 to ent r pon the abov entioned prop y for inspection purposes. a � (p INVESTIGATION FEE TOTAL FEE /O )'J Sg„awre of Aoar�m o� t O SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'`itOMPENSATION bECLARATION .�' .,eby affirm that I have a'certificate ,of consent,to self /� D q Q Folk, O� M O n� �( insure, or a certificate of Workers' Compensation'Insurance', LrV �� �„� M U �®'�ll:V �LI V U�-U- or a certified copy thereof (Sec: 3800, Lab.it. : COUNTY OFL0$ ANGELES AND Policy No. _ Company BUILDING ;SAFETY Certjfied.copy:is, 'hereby, FOR APPLICANT TO FILL IN BUILDING, - ADDRESS " Certified copy is filed with'the county building inspec BUILDING'e�J C1 ,.,.Certified department.•, ADDRESS /CJ 1J '��ry�,�T�4v U'�� C1y�J ` Date' Applicant-` +` LITY� rn��j e l ZIP 1721 LOCALITY -'CERTIFICATE OF'EXEMPTION'FROM.WORKERS' f NO.OF BLDGS. NEAREST COMPENSATION,INSURANCE- SIZE OF LOT5(pk ` 13! NOW ON LOT o CROSS ST. (This section.need not be',completed:jf.,the permit is'.for;one ASSESSOR, hundred dollars ($100),or less.) -, TRACT _/ BLOCK LOT NO., A AP'BOOK`." PAGE PARCEL r TEL.. w USE NE' MAP �1 OWNER6 E L r' TEL. Z>�� -, .p tin the performance of the 'work for which`.this NO. so m t i becued; I'sholl not ern•to an arson in an manner SPECIAL �` I certify tFi'o QQ permit is res P Y. Y P. Y ADDRESS /Q`3 Q��-� �. oma subject to the Workers''Compensation Lows. CONDITIONS 0 ii CIT; •.1�Lr1. ZIP c6d Q �2f.? Date r 0 Applicant, U ARCHITECT OR TEL. NOTICE TO'APPLICANT: If afterm this Certificate of DISTRICT G OUP TYPE .. FIRE. ,PRO Ss BY Q' Exemption you should=become subject to the Workers,' ENGINEER NO. ZONE" Compensation,provisions of the.Labor Code, you,must forth: ADDRESS' �' NE LU with comply,with .such provisions or this permit shall'.be . _.. TICAL CONST ' deemed,revoked - TEL.``, .. N , STATIS CLASSIFICATION APT. CO CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION " _ Lj CLASS No. c _'DWELL'. UNITS Z C. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS, NO. (commencing with Section 7000)of Division 3 of the Business and _ LIC SEWER MAP r.. Professions Code, and my license is1. m full force and effect. CITY CLASS VALiDATIOfd' SQ. FT NO. OF ! NO. OF 'CHECK BK. PG. License Number' Lic..Class SIZE' STORIES ! FAMILIES ONE / _ V NEW ❑ VALUATION ,Contractor Date DES N O WOR �'I am exempt under Sec: mYY1lC ADD s V X13., • � ALTER. .'❑ � T1 35 s� 7 B:BP C. for this reason /CJs) SWI 444 L.TfIC fj` [Z Ivy REPAIR USE OF Date DEMOL'. EXISTING BLDG.- w 1 N � ❑ `.Signature '.. ;,. FIA Ev. !� APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT 7f�L NO.Zc�S�mo , I-herebyaffirm thdt`I am exempt.from the Contractor's License �( a d o �j D ADDRESS O] �'11Q1���eb. .�I< Professions Code): ( sand BY, P '. gy z.7'` Law,for the following:reason' Section 7031.5, Business � BUILDING I, as owner of the property, or my employees with ADDRESS . _wages as their sole compensation,will do the work and >. 972 A thestructure•is not intended or offered for sale(Section LOCALITY ` 7044, Business-and Professions Code).` - MOVING. dEC: I, as owner of the ro ert CONTRACTOR NO. ' P P y,'am exclusively contracting _„ " with licensed contractors-to'con struc-the project (Sec- ADDRESS o";o _ tion-7044, and.Prof essions'Code). '' 40'575, REQUIRED; TOTAL SETBACK FROM CONSTRUCTION'LENDING AGENCY ,; SET BACK YARD-_ HWY PROP. LINE WIDTH O'Q_2 2'k.8;7 I hereby affirm that there is a construction lending agency for FRONT the perforrrionce..of the work for whick this permit is issued P.L. '(Sec. 3097;•Civ. C.). SIDE Lender's Name. P.L. w P:C.'Fee$ Permit.Fee L Lender's Address 3S. S LDMA Ref. # $ I certify that l have read this application and state that,the. Issuance Fee R l�(J LDMA P/C# �. above information is correct I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building'construction, Total Fee .� LDMA Perm. # and hereby authorize representatives of this County to-enter. - m upon the above-menti ned property for.inspection purposes. ` ' a SEE REVERSE FOR EXPLANATORY LANGUAGE 77� nature of APPIi ant or Agent 1r Date.