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HomeMy Public PortalAbout5941 IVAR AVE_Building__ APPLICATION F®R 8-UIL®ING PERWT FOR APP-1:ICAMT TO FILL IN (Print or rvoe only) BUILDING] COUNTY OF LOS ANGELES ADDRESS, DEPARTMENT OF COUNTY ENGINEER CITU" - i I% IP. ':�: •� - BUILDING AND SAFETY DIVISION ` //''�� O.OF BL`OGS. BUILDING S.IZE OF L�OT�b./ VOW ON LOT ADDRESS �•- TRA O BLOCK LOT NO LOCALITY' �� - _ TEL • NEAREST OWNER _ L - NO: - CROSS.ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL _ DISTRICT GROUPTYPE IC FIRE RO SED BY Q / CONSTZONE ` Cl TY ZIP - ' - ARCHITECT OR TEL ENGINEER ``; NO. STATISTICAL CC�L�sASJJSIFICAT10N SEWE M P ADDRESS CLASS NO.CL��L--DWE.LL,UNITS BK PG CONTRACTOR , NAL', Z1ONE MAP - •`v�,. - LIC. JJ NO. d .ADDRESS - NO. - - SPECIAL � ) `- LIC. v- CONDITIONS CITY" CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM - y. ' FRONTPROP,LINEOF - -(STREET)_.,. d CC�a O ADDRESS � j ITY HIGHWAY �-, YARD TOTAL SETBACK FROM TYPE OF EXISTING U FRONT PROP.. LINE NO. OF NO. OF � CHECK HIGHWAY WIDTH CC SIZE ®-STORIES FAMILIES. ONE . - C:) } DESCRIPTION OF WORK NEW X LLI [O BLDG,SETBACK FROM DD (STREET) Z SIDE PROP. LINE OF ALTER ❑ HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING tDEMOLE1 EPAIR❑ SIDE 'PROP. LINE HIGHWAY WIDTH -USE.OF EXISTING BLDG. APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) L BY-(SIGNATURE) �^ IN OPEN SPACE YES ❑ NO ❑ ' ,^ !, - IN COASTAL ZONE YES ❑ NO "A ❑ VLo �UATION oo�b� CATEGORICAL EXEMPTION YES NO ❑ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT-AND•AGREE- TO COMPLY IMPACT EXEMPTION DECLARATION SLGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ,. ST RUC TION. I CE RTIFY THAT IN DOING THE WORK' AUTHORIZED IM ACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO . 'iC WORKMEN'S COMP E ATION INSURANCE. SIGNATURE OF f ��/� �i �� ,,•� PERMITTEE- - • /. ADDRESS ' / lol �J &jj FINAL BY TE4/�J h CITY NO NO. 44UYY/ DATE M,-i KE CHLCKS PA):A13LE' 7"O. FEE FEE HARVEY.T. BRANDY, COUNTY ENGINEER , ,5-- 2 `7 .�� PLAN CHECK VALIDATION (c K'. M.o.- CASH o PERMIT VALIDATION cK, CASH n �� C. ( i ,T . S 1 D 23 .GO >1 GOT 15 � 3 7 .35A ✓'� 76g638A CE 9803 12/72 "' r _ &S 76A638A CE#8031REV.-6/78) APFUCATEON. FOR BU OLMNG PERMIT ' COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS ,S q BUILDING .. ADDRESS - �. i LOCALITY NEAREST CITY �jt /L C/j f ZIP CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT 'NOW ON-LOT. MAP BOOK PAGE PARCEL ✓ DISTRICT. GROUP TYPE 'FIRE PROC SED,BY TRACT 0 BLOCK LOT NO. 1G � CO,tT e7 NE . /,, ` TEL. O JJJ����—_--��; OWNERS dG' %ycb4N0. v t .S�L7 ' STATISTICAL CLASSIFICATION VWER MAP ADDRESSS // 9C�T� � CLASS NO. .�` 'p DWELL.UNITS BK? &PG CITYi' /�tL1 �; Vii% ZIP_. ARCHITECT OR TEL. VALUATION $ ! O ENGINEER NO ,ADDRESS Y BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) CONTRACTOR / TOTAL SETBACK FROM TYPE OF EXISTING ��99 LIC. HIGHWAY + YARD = FRONT PROP.LINE 'HIGHWAY WIDTH ADDRESS✓ Jf.7`3' r11 1� NO.j7✓i e LIC. + — CITY d/ /`✓�Ls!j CLASS i .' CONSTRUCTION LENDER BLDG.SETBACK FROM , NAME AND BRANCH SIDE,PROP.LINE OF (STREET) HIGHWAY +, YARD TOTAL SETBACK FROM TYPE�OF EXISTING' = . ®4 ADDRESS CITY SIDEPROR.•LINE HIGHWAY WIDTH ®. SQ.FT. NO.OF NO.OF CHECK 4 SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK } ia . ' NEW ❑ P.C. Fee$ Permit,Fee . fMa ADD a Issuance_'Fee 7 , . ALTER [REPAIR ❑ Total Fee c�, USE OF 7 EXISTING$LDG.d. J,�64.4 m �. DEMOL 0 -71 v�/ „t/��(`? APPLICANT .TEL /-7 (PRINT),C- /a�'iCi /{j l0. E+�3y J�.. � �_ �'� / ( Q . D , r BY(SIGNATURE) I HEREBY ACKNOWLEDGE THAT I'HAVE READ THIS APPLICATION AND.STATE THAT THE ABOVE ISCORRECT AND AGREE TO COMRLY WITH ALL ORDINANCES- W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE - V WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z 2 t O k 7 A - ^' PENSATION INSURANCE. - g SIGNATURE OF �^ ' PERMITTEE 2'o 0 34 0 ADDRESS n ay Q oozo3JILO,0TEL c=i. CITY ! .Z��a�f/.off/ NO IJf�!✓ :��. Q ri V 7 USE ZONE NAAP 0 Q av SPECIAL CONDITIONS- a /� j7� W DATE L.. /i I/V`r dC/ rGA ©5 76A638A ///. • CE N803(RL*.6/78) �� �r/p// APPLICATIO COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS -� - .{ 4 BUIG '"LDINt._ - ' ADDRESS /.',.• v LOCALITY i.- ♦ NEAREST ! 'CITY. ZIP'. CR05S ST. NO,OF BLDGS. ASSESSOR SIZE OF LOT NOW ON lOT ./ MAP BOOK PAGE PARCEL DISTRICT. �FIRAE ,-PR(5JESSED BYTRAGIIBLOCK -LOT NO. - - . TE OWNER �� NOL. �L �/{ , e! STATISTICAL CLASSIFICATION. SEWER M ;ADDRESS� l /Y- f� CLASS NO. DWELL.UNITS r BK PG CITY2:jzn&jr ` ZIP ARCHITECT OR TEL: VALUATION ENGINEER NO ADDRESS V BLDG.SETBACK FROM off y TEL. FRONT PROP.,LINE OF ' (STREET), CONTRALTO / NO. S TOTAL SETBACK,FROM TYPE OF EXISTING LIC HIGHWAY + YARD .= FRONT-PROP..LINE HIGHWAY WIDTH ADDRESS NO - " LIC. CITY ' - CLASS, ..-. CONSTRUCTION LENDER BLDG:SETBACK FROM . NAME AND BRANCH SIDE PROP.LINE OF (STREET) TOTAL SETBACK.FROM TYPE OF EXISTING HIGHWAY + YARD = �. ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH ®, SQ.FT. NO.OF NO.OF CHECK + _ SIZE STORIES FAMILIES _ONE at DESCRIPTION OF WORK NEW P.C. Fee$ Permit Fee t; ADDe ❑ issuance Fee. / ALTER 7. REPAIR ❑ Total Fee USE OF YT g DEMOL ❑ Z .� EXISTING BLDG.. APPLICANT TEL 0 IPRINTI D BY(SIGNATURE) a " I H EREBY-ACKNOWLEDGE"THAT I HAVE READ THIS APPLICATION.AND.STATE` - .- - - THAT THE ABOVE I5CORRECT AND AGREE TO.COMPLY'.WITH ALL ORDINANCES- tVu AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY'THAT IN DOING'rTHE V ' WORK AUTHORIZED HEREBY,(WILL NOT EMPLOY ANY PERSON IN VIOLATION OF - - - THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S'COM- Z PENSATION INSURANCE. [ d SIGNATURE OF PERMITTEE ADDRESS p TEL. r �0g130.A _ CITY NO' �j .. . Q ' Z�U54-ZONE.­J�SPENECjIJAL,' MAP , ti ° - .- # 0 0 0 0 0O ° °'.� 00 COITIONS fINAL ,. APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS my, _ DEPARTMENT OF COUNTY ENGINEER CITY r-^ ZIP - BUILDING AND-SAFE DIVISION OF SLOGS. BUILDING SIZE OF LOT �� .x I:5`V OW ON-LO. -' A00REss---i zo - TRACT_5yav, BLOCK LOT NO. /.(� LOCALITY -�y'Y •� c. ' TEL�ry}�f �Ij NEAREST OWNER C n NOo -:dd/✓ CROSS ST. ✓✓'ls)� `. -... ASSESSOR ..I-� ADDRESS 1 --rod)— MAP BOOK PAGE EL ,:mss ` DISTRICT G TYPE FIRE ROCE SED BY -CITY �/c+' -ZIP - ZL ONST. - ZOyNE t �' ARCHITECT - - TEL. - -- l7� I - =i ENGINEER NO. STATISTICAL C IFICATION SEWER MA, ADDRESS - CLASS NO. jDWELL.UNITS K G CONTRACTOR �; .��/�,�� NEOL•. ;-fA'� - US ZONE MAP NO. - ADDRESS P .f ..NOjL�e ��% SP IA.L _ CITY 'S LIC.. r! .--'r. CONDITIONS . �.� - CLASS -v cT RFR�4T DEPARTMENT APPROVAL REQUIRED YES❑ 'NO ❑ CONSTRUCTION LENDER NAME AND BRANCH ..S.ETBACK FROM - O --- PROP.LINEOF (STREET) t7 ADDRESS , CITY .. HIG WAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING L1t SQ. F"( � NO. OF � NO. OF CHECK., FRONT PROP. LINE HIGHWAY WIDTH O SIZE STORIES FAMILIES - ONE - V DESCRIPTION OF WORK - - - - NEW ADD ❑ BLDG.S SIDE PROP.LINE:OF � (STREET) ALTER ❑ = TOTAL SETBACK TYPE OF EXISTING HIGHWAY } YARD - REPAIR❑ SIDE PRO P. LINE HWAY WIDTH USE OF } EXISTING BLDG. DEMOL El APPLICA TEL CORNER CUTOFF YES C:] NO ❑ (PRINT) NO �� 8Y (S I.GNATURE IN OPEN SPACE YES 1:1NO El - Q IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ �a J CATEGORICALEXEMPTIONYES❑ - - NO ❑ ' i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT. THE ABOVE 15 CORRECT AND,.AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT INDOING HE WORK AUTHORIZED IMPACT REPORT,PROCESSED (DATE) HEREBY I WILL NOT,EMPLOY ANY PER50 IN VIOLATION OF THE - LABOR CODE OF STATE OF CALI RNIA RELA NG 0 �/1 " - r WORKMEN'S COMP ATION INSURANCE. r.�(/ - �i IslAk-, SIGNATURE rlI-v'A btp�a 2711 PERMITTE ✓ - ADDRESS c . FINAL BY TE It IF CITY,-,-a. I - NO�j DATE 7—,�tI � MAKE CIIF-CKS PAYABLE TO: P.C. $ FEE $ HARVEY T. SRANDT. COUNTY ENGINEER 7,59 PLAN CHECK VALIDATION c o.. CASH a PE M T VALIDATION CK. .O. CASH 9:7 31c0lJUV 24.2,l',D 4.&3-6 76A638A CE9803 7/73 - 9;:7"4.IhiJUIY'. � ,, _� 4 8.7 5•,A98 -APPLICATION FOR E.UILDIf G PERMIT FOR APPLICANT TO FILL IN (Print or type only) i BUILDwG � COUNTY OF LOS ANGELES ADDRESS s-9" / /�/ .� � �. DEPARTMENT OF COUNTY ENGINEER CITY—IEY "$- C;Iy ZIP - -`- - BUILDING AND'SAFE DIVISION J. ./�c NO.OF BLDGS. BUILDING ' SIZE OFrrLOT/ � 9�iLy .NOW ON LOT -ADDRESS TRACTv-C,D BLOCK L`OTTt O,& 'LOCALITY - (� . TENEAREST OWNER ..!\Q :.,1 'rnt'-�.1' � -NO•. y,-y CROSS..ST.- --� ADDRESS i MAP BOOK - PAGE PARCEL DISTRICT GROUP TYPE -' {. FIRE SSED BY .CITY J' - -�" ZIP /�/y ' CONST, Z E , �- - ARCHITECTOR ' - TEe-!LL. '" ENGINEER NO. ' _ STATISTICAL CLASSIFICATIONEWER_MA - ADDRESS CLASS NO. -DWELL,UNITS BK G 'CONTRACTOR HEEL• ZONE MAP 0. LIC. NO. (/ .ADDRESS- NO. SPECIAL' LIC. CONDITIONS - CITY CLASS - _ P ROA D'DE PARTM ENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCHBLD .SETBACK FR_GM O [FRO/4T PROP.Ll NE OF (STREET) C ADDRESS - CITY V HIG WAY. + YARD = TOTAL SETBACK FROM TYPE OF EXISTING SQ.- FT ', .- NO. OF NO.-OF CHECK FRONT PROP. LIC NE HIGHWAY -WIDTH - SIZE STORIES FAMILIES J ONE 6~7 + _ W DESCRIPTION OF WORK aE ° r NEW ❑ - N BLDG, K•FROM ADD . ,�• _ ,�•' - .- SIDE PROP.LAN (STREET) ALTER. ❑. TOTAL.S.ETBACK FRO IG Y E OF EXISTING. HIGHWAY + YARD = REPAIR_❑ SIDE PROP. LINE HWIDTH USE OF � +' EXISTING BLDG. - - ��,,D``EMOL E]APip RIN ANT NOL;gyv'-'�' �° _ CORNER CUTOFF, YES C:] NO ❑ .. BY (SIGNATOR-E) �. / IN OPEN SPACE -YES ❑ NO ❑ " IN COASTAL ZONE YES ❑ NOCIO ❑ VALUA-TION$ - - - - - - , CATEGORICAL EXEMPTION YES❑ NO ❑ I .HEREBY ACKNOWLEDGE THAT I HAVE.READ THIS APPLICATION, ENVIRONMENTAL AND STATE THAT THE ABOVEISCORRECT.AND'A-GREE TO COMPLY IMPACT EXEMPTION.DECLARATION SIGNED (DATE) WITH ALL ORDINANCES 'AND LAWS REGULATING BU4ILDING"CON . STRUCTION. I CERTIFY THAT IN-DOING THE WORK AUTHORIZED • - 'IMPACT REPORT PROCESSED (DATE) HEREBY I WILL-NOT EMPLOY ANY PERSON IN VIOLATION OF THE - LABOR CODE OOT STATE OF CALIFORNIA IN RELATING TO , WORKMEN'S COFMPE SAT ON INSU NCE. SIGNATURE OF PERMITTEE , ADDRESS FINAL. p�j� BY. CITY. .. +� y'y ... NO.✓9�'� V DATE, Q MAKE CHECKS PAYABLE TO:. FEE F ✓ _ EE / HARVEY T. BRANDY. COUNTY ENGINEER ,PLAN CHECK VALIDATION CK, M O. CASH, o PERMIT. VALIDATION cK M.O. CASH 2 1 1 5.0 0-A98. 76A638A CE9803 7/73 , APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN' (Print or fYpe_on'I0 BUILDING p+ - COUNTY OF LOS. ANGELES ADDRESS DEPARTMENT. OF COUNTY ENGINEER cI Tr .. r -- z I P BUILDING-AND SAFETY DIVISION O.OF BLOGS. BUILDING SIZE OF LOT ® NOWON LOT - ADDRESS TRACT 10 L BLOCK. `t'O� NC7 /�/ LOCALITY - NEARST OWNER &'o t NE -Y '!-Kl CRO SEST...-- - - - ASSESSOR ADDRESS © � _ MAP BOOK - -- PAGE PARCEL DISTRICT' GROUP TYPEFIRE SSED BY CITY .ZIP .CONST. - ZONE -- -ARCHITECT OR - - TEL. . _ 1 Q - ,•NO. ENGINEER - _STATISTICAL CLASSIFICATION SEWERMAP ADDRESS - YEL. CLASS.NO�3_DWELL•UNITS— _ Bf� _pd% CONTRACTOR - - NO - USE ZONE MAP - .-- - LIC. NO. G - ADDRESS - - - NO. /� ,� SPECIAL LIC. - CONDITIONS CITY - CLASS- - _ ROAD DEPARTMENT APP APPROVAL REQUIRED YES❑ NO,.❑ CONSTRUCTION LENDER NAME AND BRANCH... . BLDG. E"TBACKFROM FRON. PROP.LI NE OF '(STREET) a ADDRESS .; CITY - HIGHW } YARD TOTAL.SETBACK FROM TYPE OF EXISTING CD AY SQ, FT. NO. OF 'NO. OF CHECK - : FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES - .FAMILIES ONE rY CD DESCRIPTION OF WORK - NEWLLI _ U Fj L ADp SIDE FROM - - (STREET) COom ((JJ SIDE PROP. LINE OF ALTER ❑ Z rJ � HIGHWAY •} YARD- = TOTAL SETBACK FROM TYPE - EXISTING UU// VITE ar SIDE PROP. LINE' HIGHWAY WIDTH REPAIRQ. USE OF - •} _ - - EXISTING BLDG, - - .. DEMOL, APPLICANTEL CORNER CUTOFF YES C3 - NO. (PRINT) T 1 0. _. ` IN OP-E.N.SPACE - ,,1_ ....YES ❑ NO 0.. BY (SIGNATURE) ��fj^�J� ���•�'��___�����` IN COASTAL ZONE Y YES ❑ NO ❑ NO VALUA'T�hON$1040 CATEGORICAL EXEMPTION ES[—] ❑ .. . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE'THAT THE ABOVE IS CORRECT AND.AGREETO COMPLY - IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED -IMPACT REPORT PROCESSED - (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE- - LABOR .CODE OF THE STATE OF CALIFORNIA IN RELATING TO - WORKMEN'S COMP SATION f URANCE. SIGNATURE O PERMITTEE ADDRESS FINAL BY CITY + NOL. . DATE F . P,C. -- PMT. _ .. AI,AkE-CIIL�C;ti$ Y,1};1/3LE 70: FEE ✓ FEE ARVEY,T. BRANDY, COUNTY ENGINEER V d PLAN CHECK VALIDATION `.CK. M.O. CASH o PERMITVALIDATI9ON cK. M.o. CASH. f 76A638A CE_#803 12/72 -- .-_ - &1P1PUQ%M R FOR B ULIO M PERMH �1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKSRS CU,"PENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AOD�E BUILDING ADDR I hereby affirm that I have a certificate of consent to self insure, �U or a certificate of Workers'Compensation Insurance,or a certified copy thereof Sec.3800,La'b2.C.) CITY r Zlp�je LOCALITY Policy No. 285— v Company 5' '•� U� SIZE OF LOT G NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. !!!!!!�// �rtified copy is filed With the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department.` t�,r 6_l� AAU- om � (� ASSESSOR MAP BOOK PAGE PARCEL Date �pplicant 4. SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ' q TEL.NO. COMPENSATION INSURANCE � C �J J WITHIN 1000 FT.OF SCHOOL? YES NO ADDREES (This section need not be completed if the permit is for one hundred scft4 M u At UE DISTRICT GROUP CONST. FIREZONEI PROCESSED BY dollars($100)or less.) CITY ^^ ZIP ,l / 1 certify that in,the performance of the work for which this permit E 1, T p f3v is issued, I shall"not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. ✓✓✓ become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.0z_iDWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exem tion, I CO TRACTOR TEL.NO. Exemption, you ShOUId become subject t0 the Workers' SETBACK YARD HWY • PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ;N'5-9'CA1 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. Q PL 6 190— 1113033 8 SIDE LICENSED CONTRACTORS DECLARATION CITY - LIC.CLASS p L n- 1 hereby affirm that I am licensed under provisions of Chapter 9 �� L C"I C�3 SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES 11 NO.OF FAMILIES CD NEW BK PG CD Professions Code;and my license is in full force and effect.d v ed 38 33g G— I DESCRIPTION OF WORK ADD ❑ License Number Lia Class VALUATION oW... Contractor AAla I�LIt'►'I �i Date 10-6-13- ��� SM" ALTER .❑ � ` ' 11 REPAIR ❑1 am exempt under Sec. , B.&'P.C.for this reason WSTAC L ELl1� C�- 5DEMOL ❑ LDMA P/C# USE OF EXISTING BLDG. Date: L'mmp. stns uRM. El Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# �7I'b •19,1 a�= ❑ I, as owner of the property, or my employees with wages as r1,40XVIn I-V Z�% 47-2,011 p + their sole compensation,will do the work and the structure is ADDRESS H I 1 i RE not intendedl or offered for sale (Section 7044, Business and 6��Z AA FINAL DATE C7/ _ Professions Code.) �Z7_`s /3 j I S'j . 35 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ❑ 1, as owner of theproperty, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I 1 •ti_ Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > ?_HE L J i v _I licensed contractors to construct the project.(Section 7044, YES El NO ElBusiness and Professions Code.) (_ (f` ,s'I s WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. hereby affirm that there is a construction lending agency for YES 11 NO❑ - ;I11 ­13f-11-110 6 -_ the performance Of the WOfk for Which this permit IS ISSU@d(.Sec: I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD j 17 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELESy'€ 'a .D. COUNTY CODE,TITLE2,CHAPTER 2.20SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING _ z Lender's Name .HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. - a Lender's Address- owr+ea OR AGENT a o' 1 Certify that I have read this application and State that the above P.C.FEE PERMIT FEE ' information is correct. I agree to comply with all county ordinances and State laws relating to building construction,and hereby autboAzWepresentatives of this County to enter upon ISSUANCE FEE 0 the a men t' �e prop ty for inspection purposes. INVESTIGATION FEE TOTAL FEE /• n , _n AC•M - D.. . SEE REVERSE FOR EXPLANATORY LANGUAGE,