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Home My Public Portal About9026 HERMOSA DR_Building__ r : APPLICATION FOR BUILDING PERMIT 'r COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATIONFOR APPLICANT TO,FILL IN eul me�/ADDREss BUILDING ADDRESS I hereby affirm that I have a certificate of'consent to self insure, D /ry OS g or a'certificate of Workers' Compensation Insurance,or a'certified - ' - _ CFio tflefe�oyf(SOC.aaoon, Lib.c.) •y,' jf CITY .� l /-' ZIP Q� A LOGALIT No. DO, �`k,fCysL� SIZE OF LOT G 61 y, NO.OF BLDGS./NOW_ONLLOT ❑ Certified copy is hereby furnished. �� -y I]A 91 Z NEAREST CROS T' ❑ Certified copy is filed with the coup y - i1 'ng inspection TRACT ( _ BLOCK - LOT NO departmenrt.� _ S�O lI USE ZONE MAP NO. Date 4 .Applicant ASSESS MAP BOOK PAGE-- - Pq GEL -7 --- 4.Q/4 Q�Q SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER / TEL 111. y,, _ - f COMPENSATION INSURANCE I AaAo 1 WITHIN 1000 F-L OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADDRES - _ Zp - _ dollars($.100)or less.) -0Z� OAjA- DISTRICT GROUP TYPE CONST, FIRE ZONE PROCESSED By - CH Y /� ZIP ! " I certify that in the performance of the work for which.this permit, `r K- C 0}, DoT /,��J is issued, I shall not employ any person in any,manner so as to �` O O ' D� -J Ybecome subject to.the Workers'Compensation Laws.- - -ARCHITECT OR ENGINEER TEL NO. -- - - f - -- " 'STATISTICAL'CL SSIFI TI '-` - ---- --"-"APT-"`-CON00--_- - - - � t'2T/.cls E 8 �Z' Date Applicant - ADDRES pp ,{ CLASS IN L UNITS NOTICE TO APPLICANT.' If, after making this Certificate of 6 1 WAPAP �/t'•Z 0/44wra IV, REQUIREDT LSETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTR R TEL NO. •7.�/ SET BACK VAR HWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �/�dNl� !"/ 6 FRONT comply with such provisions or this permit shall be deemed revoked.. ADDR SS LIC.NO P L -- LICENSED CONTRACTORS DECLARATION 3 10a �J.3`7r�-.SSIDE +''` ' " CITY �`Qlj�x _ LICCLASS g- PL 17= r_,,. 1 I hereby raffirm that I am licensed underprovisians of Chapter 9 //70,vLd,64, .L(/ lj SEWER MAP ", (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OF STORIES NO.OF FAMILIES } _ v. Professions Code, and my licens his in full force antl eff t. / ..NEW BK PG _!L'r .4_- 768 vz __ D- DESC PTION OF WORK VALUATION I II+'IL 68 Lice 'Be Numb Lia Glass ADD ❑ ®: = O �j�j� _ Dontrac or Date t � ALTER ❑ $ S S IvD• / {r!ENS* ]v._ V ❑ am exempt under Se (Nt�!r- ,I~ 0 REPAIR ❑ $, in 3r .l• 0 e&P.C. for this reas I � � DEMOL, ❑ CDMA PIC z _ LU ate. USE OEEXISTING BLDG. URM ❑ - w�= -Jlhli ci' .?"7„! Signature r -:n; /=c_ Z APPLICANT TCE,L NO. LDMA Perm# 'LL?i_q' 1 f!i t.-!_— '❑ I, as owner of the property, or my employees with wages as' d ALT Hod �o'g �2- . '1 2 p- their sole compensation, will do the work and the structure is ADDRESS q I//� 6 p not intended Or offered for sale (Section 7044, Business and ROAD. 4-G 044yO G� /�70 FINAL DATE lQ - q Professions Code.) -=-f'Ot'=�'= WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS.MATERIAL y�” OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J 4!r•. ❑ a5 owner Of the property, am eXCUBIVBy COn(faCtlpg with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY - j + T!OIL iv licensed contractors to construct the project (Section 7044, ' ! YES 1:1 NO E] - L Business and Professions Code.) !IJ I AI '- -�: ,€. WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTUREBUILDING _ _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR.MODIFlOATION FROM THE SOUTH •�'- -CH 'I' '-i c. CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR '- t-(+i 'e JIla L%1. Gu US FES. I hereby affirm that there is a construction lending agency for YES El No El the performance of the Work for which this permit is issued(Sec. r e• ' ' I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING 3097, CIV.C.) - CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, _ It -•lr TITLE 2.CHAPTER 2.20 SECTIONS 2,20.100 THROUGH 2.20.100 CONCERNING HAZARDOUS' 1I , _�I_ Lenders Name MATEPIALS REPORTING AN FOR OBTAINING A PERMIT FROM THE SCAOMD.. 1 OU P_ i -Ui 4 'i oLender's Address wvrvEx OA�FNT 1� {j�'a,? .1 HMI. ,_�• o I certify that I have read this application and state under penalty ' o P.C.FEE PERMIT FEE Of perjury that the above information is Correct.I agree to comply with all co/4-y"VIrdinances and State ws relating to building m conslructi a d he y authorize rept ntatives of this County ' ISSUANCE FEE / �/ to enter up n boned prop y for inspection purposes. (i •7 a INVESTIGATION FEE TOTAL FEE ynawre.or eaWcan;wMmi SEE REVERSE FOR EXPLANATORY LANGUAGE -WORKERS' COMPENSATION DECLARATION "rl her by o certificate that I have r certificate of consent seff APPLICATION FOR" BUILDING PERMIT insurA -or a certificate of Workers' Compensation Insurance, ' }� or a certified copy thereof{Sec. 3800, Lob.,C.) COIiNTY OF LOS ANGELES BUILDING AND SAFETY Policy No - Company - BUILDING - ❑ Certified copy is hereb'y,furnished. FOR APPLICANT TQ-FILL IN - ADDRESS O ❑ Cenified copy is filed with the county building inspec- - ADDRE G �d26 -/�US _- tion department:' ADDRES-S"7�. /' v - CITY' / `l✓ •ZIP LOCALITY Date Applicant - - _ L ,y� !�' NO..OF_BLDGS." .y NEAREST. ' .-CERTIFICATE OF EXEMPTION FROM WORKERS'; _ SIZE-6F iOT 60^] s✓� NOW ON LOT L— CROSS ST. COMPENSATION INSURANCE __ n ASSESSOR !J p '/ (This section need not be completed if the permit i5'for one - TRACT 6q BL K LOT NO MAP BOOK ,�vL.O - PAGE �T PARCEL hundred dollars ($100) or less.) ' _ - ( - --� _ - . . ' 1 -" ''� OWNER��LAE O. - USE ZONE. 'I certify that in the performance of the ork for w ich this (fir //�y�- HAE; i - - D PEIAL •7 rf 10 } permit is issued, I shall not employ any rson In an anner 'v1 ADDRESSI -/ 1- t A jr, —_ 1 F� I CONDITIONS so as to become,.subject to the Wor ' Co at' "m Laws. / // _ __ O �(y� CITY. /_ q /�/I''6EL CS zip "0 � !_ r .v Dates . Applica `�. ARCHITECT OR �y TEC ( 7 DISTRICT 'GROUP TYPE FIRE PROCESSED BY Q .NOTICE TO APPLICANT If,, aft akin this Certificate of ENGINEER i/ NO. > U 9 r' CONST. ZONE 1-J�� _ Exemption,__yau-should-_become-_subject to_the-.Workers • - -- ---- C-�.- - ,u,,,,,��•• II r. Compensation provisions of the Labor Code, you must forth- with orth , ADDRESS - Q " - ^• D/ 'with comply with such.provisions or,this permit shall be 1E TEL. STATISTICAL CLASSIFICATION - APT CONDO- z deemed.revoked _ - CONTRACTOR NO. € I. Z - LICENSED CONTRACTORS DECLARATION • r - p'pp^ CLASS No.�DWEu. UNIiS ,� i 1 hereby affirm that I am licensed under provisions of Chapter 9 'ADDRESS L LIC. SEWER MAP 1 t t' (cam menciions ith Section 7000)of Division 3 of the Business CITY - CLASS 4I .and Professions Code;and my license is in full force d effect _ - gK, PG VALIDATION, p�.py},� SQ. FT'---�/�/ .. NO. OF NO. OF CHECK License Number �C,n�nLV ic. Class— SIZE `L STORIES � FAMILIES ONE - 2O_� VALUATION - Contractor�'JGd •F-«rl Date ` DESCRIPTION OF WORK - .NEW V"s--xTINO S�^P ADD ❑ C71�i t I ❑ am exempt under Sec. - / /�^^ F.1_ i c p ALTER .❑ y 9C' Q. e e r r! 'r BAP.C. for this reaso - $ _ REPAIR ❑ V1 7 y ' at - USE OF ••�� DEMOI - - EXISTING BLDG. /1F'j`- L'r, �� tu - l APPLICANT LGH H�NO, 2.3 FINAL'S L , '-16W -BUILDER DECLARATION. �L�. .DATE ,S Z I hereby affirm that I am exempt from the Contractor's License 'ADDRESS DVG Law for the following reason (Section'7031S Professions Code): .. .. . PRESENT - - By' f-p BUILDING' _ t' tt ' ❑ - I, as owner of the-property, or•my employees with ADDRESS _ q wages as their sole compensation;will do the work and " '° ALITY the structure is not intended or offered for sale(Section 7044,,Business and Professions'Code.) MOVING - - TEL' ❑ 1,as owner of the ro erty,�am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project.(Sec- '- ' - - - -I-t rAODRSS - _ � � tion 7044,Business and Professions Code.) - - - CONSTRUCTION LENDING AGENCY IRED - TOTAL'SETBACK'FROM' EXIST. YARD. HWY r ACK PROP. LINE WIDTH iU1(;;'} 1 hereby affirm that there is.a construction lending agency for T - 'the performance of the work for,which this Permit is issued \XA .�, ` , at i I_ jtl(Sec. 3097, Civ. C.). _ ._ - IF Lender's Name -LDMA Ref-Ne $ QJ•�0 Perm it Fee r , Lender's Address • p I"certify that I have read this application and state thattheIssuance Fee �y 7� LDMA P/C N/1 8 above information is correct. I agree to comply with all County Investigation Fee . . 9 ordinances and State laws relating to building construction, Total Fee I./ /o LDMA Perm. It a and hereby authorize representatives of this County to enter _ _ " m upon The above-mentioned property for inspection purposes. 'a SEE REVERSE FOR EXPLANATORY LANGUAGE - ,Sign.wre 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 ILDING ADDRE O 2-1, BUILDING ADDORE^5G ` "O� DV hereby affirm that have a certificate of consent to self,insure, < ••r on a certificate of Workers' Compensation Insurance, or a certified r .^A �iI'7 COPY thereof (Sec.3800,Lab:C.) CITY 'iiP Q W� LOCALITY Policy_N0. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the countybuilding inspection TRACTD BLOCK LOT No, - department. 7 USE ZONE MAP NO1 010 . _ Date . .Applicant - - ASSESSOR MAP BOOK. PAGEo/ PARCELL S J2 SPECIAL CONDITIONS 10 99 CERTIFICATE OF EXEMPTION FROM WORKERS' OW>LH t L 4 COMPENSATION INSURANCE 1. L 1�Yh�� -got WITHIN 1000 FT of SCHOOL? s No - (This section need not be completed if the permit is for one hundred ADD ESS I. /) j '1^� A /t'/� DISTRICT GROUP PEC ZONEgPR0CEZSSED:By, dollars ($100) or less.) L F3 ` GI Y ZIP N _ 1 certify that h the performance of the work for which this permit > � 00 2 is issued,A shall not employ any person in any manner so as to become Subject t0 the Workers'Compensation Laws. ARCHITECT OR ENGIN E TEL NO. _ p _ - _ STATISTICAL CLASSIFICATION .. _ - .- APT CONDO Date Applicant ADDRESS . - CLASS N0, DWELL UNITS NOTICE TO .APPLICANT. If, after making this Car tificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject' t0 the Workers CONTRACTOR TEL NO. SETBACK YARD' HWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith - - FRONT comply with Such provisions Or this permit Shall 6e deemed revoked. ADDRESS LIQ NO, PL - LICENSED CONTRACTORS DECLARATIONSIDE - . CITY LIC.CLASS P L- 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 FLGIZE NO.OF TO NO,OF FAMILIES Professions Code,and my license is in full force and effect. I(p liff NEW ❑ BK PG a DES&O F K VLLicense Number Lic.Class , O Contractor Data ❑ $11(Roo 80 ❑ 1 am exempt under Sec. REPAIR ❑ $ Q B.&P.C.to, this reason - - - - DEMOL ❑ LDMA Pic 0 _ W Date', USE OF EXISTING BLDG DRM ❑Tx d Signature APPLICANT(PRINT) TEL NO. � LDMA Perm� - - � Z a5 owner of the property, or my employees with wages as - - - --'" -"- Z 'T ' ' sale compensation, will do the work and the structure is ADDRESS " p O i .. nOf I ended Or Offered for safe (Section 7D44,.BUGIneSE and FINAL DATE „a JJLiJ 86.70 PrOa na COCl th WILL THE APPIJCANT OR FUTURE BUILDING OCCUPANT HANDLE P HAZARDOUS MATERIAL" - ❑ {{ ` OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ l as OW er Of the or am exclusively contracting With AMOUNTS U SPECIFIED ON THE HAZARDOUS MATERIALSIAL EQUAL 70ON GUIDE? FINAL BY_ licensed ontractors to.construct the project (Section 7044, ves❑ No❑ Tu 18L 86 L �0 Business nd Professions Code.) x _' i ELM. _,,'}} �. WALL THE INTENDED USE OF THE BUIDLING BY THE APPIUCANT OR FUTURE BUILDING" !:HEIK '�'L'•�U -- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MAPERMT F oisTRlcT Iscgomol SEE PERMUTING CHECKLIST FOR .. . _.. .. LIr - ' GUIDELINES y}{;��yr3— ,ULI I hereby affirm that there is a construction lending agency for YES❑ No❑ N the performance of the Work for which this permit is issued(Sec. _ 3097,DIV.D. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING - m ) CHECKLIST.2.CH UNDERSTAND TI REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE 10 3/'1 { C!{ TITLE IA-S REPORTING I NG SECTIONS 220.100 THROUGH FROM THE E SCAO NTNG HAZARDOUS T I)I tIJ�-I�IJI_j y :V 19�!J f Lender's Name MATERIALS REPOPTING M'D FOR OBTAINING A PERMIT FROM TME SCAOMO: I- •,_ o Lender's Address - '14 i, AM' - o - rnrNea aR.r ur _ o 1 certify that I have read this application andstate under penalty CG+/ � of perjury that the above information is cormct.I agree f0 comply P.C.FEE PERMIT FEE O with all county ordinances and State laws relating to building - m construction, and hereby authorize representatives of this County ISSUANCE FEE o the above-mention�ed prop�erty For insp�ection pur �oses. ne� ,� � �Q�.f.(.� �.0/9� INVESTIGATION FEE TOTAL FEE R1 6. 170 999 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 BUILD, ADDRESS I hereby affirm that f have,a certificate of consent to self insure, BUILDING RESS� a /��' -0� or a certificate of Workers' Compensation Insurance,or a certified "O / copy thereof (Sec.3800,Lab.C.) - CITY //yJ, ZIP Policy No. Company LOCAUT SIZE OF//LOTANO.OF BLDGS.NOW ON LOT 1 N ❑ Certified copy is hereby furnished.. G� O� 1�_ NEAREST CROSS ST. - ❑ Certified copy is filed with the county building inspection - TRACT O BLOCK LOT NO. / - - r department. USE ZONE MAP NO. ✓ 0 _ Date Applicant ASSESSOR M Bf]O$� PAGE PARCEL q VA(lY Q� (}';l(' __/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OwN TAW-- - YES NO COMPENSATION INSURANCE -�O/J� WITHIN 1000 FT.OF SCHOOL? ' (This section need Trot be completed it the ADDRESS permit is far ane hu0tlred / DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars IS WO) or less.) GITY Zip— I I certify.that in the performance of the work for which.this permit ) �OOo?� �� is issued, I shall not employ any per in any manner so as-to Z'Z r become subject t0 the Workers'any. n5ati0 Laws. ARCHITECT OR ENGINE TEL NO. ^i STATISTICAL CLAA/SS,IFICATION APT CONDO Dale -�7 93Appliwnt ADDRESS ,yM CLASS NO. DWELL UNITS NOTICE TO APPLICANT If, after making this ertif to of ?�/7 i, .REQUIRED TOTAL SETBACK FROM EXIST Exemption,- you .Should become .Subject to f WOrkBiS CON RAGTO ,_,.. TEL.NO: ---= SETBACK ygRD`-'-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. A DE'S LTC.N P L LICENSED CONTRACTORS DECLARATIONA E SIDE CI Y CL P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT.SIZE NO.OF STORIES NO.OF FAMILIES , Professions Code,antl my lice a is in full force and ffect/ NEW ❑ SK PG d License Number tic. / DESCRIPTION OF WORK - � `� ADD ❑ VALUATION , Q Contractor a r�- � p n G ALTER ❑ B£D v �uPP� REPAIR ❑ $ O0 ❑ am exempt under Sec. _ BAP.C. for this reason DEMOL ❑ LDMA P/C• W Date: USE OF EXISTING BLDG. URM ❑ a Cn Signature APPLICANT(PRINT) TEL NO. . LDMA Perm a ❑ I, as owner of the property, or my employees with wages as Z Hil.f.a their sole compensation, will do the work and the structure is' ADDRESS 0 r' Not intended Or offered for sale (Section 7044, Business and FINAL DATE r Q 330, l Professions Code.) n o WLL 1 ITEM THE APPUCAM OR FU URE BUILDING OCCUPANT HANDLE A HAZAROg1B MATERIAL •�� ' /9' J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 0.1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? a i licensed contractors to construct the project (Section 7044, FINAL BY. r,I > + 1�1TAL 86 - 70 Business and Professions Code.) YES 11 No El 1 r -W. 'f OWILLCC THE INTENDED USE OF THE SUOUNG BY THE APPLICANT OR FUTURE BUILDING I.HD3, y e?I! OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION D) MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR OIIAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GumsurvEs (:HMGE I hereby affirm that there is a construction lending agency for YES El No❑ - a the performance of the work for which this permit is issued(Sec. p1 IHAVE READ THE HAZARDOUS MATERIALS INFORMATIONGUIDE AND THE SCAOMD PERMITTING 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. TITLE 2,CHAPTER 210 SECTIONS 2.20.100THROUGH 2 •I.20.140 CONCERNING HAZARDOUS IJI�UU-013Q1 61/17/9.' 3: Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE S. AOMD. o Lender's Address - 114 1 AN 3"v'4 o avn+rn w.,fT o I certify that I have read this application and state under penalty o P.C.FEE PERMIT FEE /D of perjury that the above information is Correct. agree to Comply $ with all county ordinances and State laws relating to building constri7tion, and hereby authorize representatives of this County ISSUANCE FEE toe upon t Ove-mentio property for in ection urp ses. a INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE