The URL can be used to link to this page

Home My Public Portal About6032 KAUFFMAN AVE_Building__ APPLICATION.-FOR, BUILDING PERMIT °3 COUNTY OF LOS ANGELES, BUILDING AND.SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN' BUILDI//IIyyG ADDRESS UILDIN A R BE � Cf O�� v I hereby affirm that I have a certificate of consent to self insure, _\ or a certificate of Workers' Compensation Insurance,or a certified t4EA^) copy thereof (Sec.3800,Lab.C.) ` ZIP 1�JI/I�� CI Ty LOCALITY Policy No. Company SIZE LCT NO BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. r � O�v NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. G R 4 / mac. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE n/^ PARCEL Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ER .meq_ TEL NO. COMPENSATION INSURANCE �fYI)t 1 U%7 Z8 7 Go WITHIN 1000 FT.OF,SCHOOL? YES No LARCHITECT!OR lD Z® (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) 3 �- I certify that in the performance of the work for which this permitMph ni j �� is issued, I shall not employ any erson in any manner so as to ENGINEER TEL NO.becom subjeectt to the Worker mpensation Laws. � STATISTICAL CLASSIJFICATION APT CONDO Date 3"( Applicant Z`�` CLASS NO. 42/ 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 NO. SET BACK YARD HWY PROP LINE. WIDTH Compensation provisions of the Labor Code, you must forthwith A/ 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 underprovisions of Chapter 9 SEWER MAP �= (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE I NO.OF STORIES NO.OF FAMILIEStl Professions Code,and my license is in full force and effect. — NEW BK � PG J 3_¢, s ,� V License Number Lia Class S I ION F WORK ADD ❑ vA TION •(?�;�_�F =:- ,-� ,- Contractor Date ALTER 1:1 �I a+s� O 1J2- IA77 lo,A�A[�c� _ ` REPAIR ❑ f ❑ I am exempt under Sec. $ % I „Fi),jt_11 W 6.8P.C. for this reason DEMOL ❑ LDMA P/C# Date: %O ISTING DG. "i -N URM ❑ iH�(1 n;i's Z Signature j r T �• APPLICANT(PRINT) TEL NO. LDMA Perm# ,,t. ❑ �r�I, as owner of the property, or my employees with wages as Z� ;=_= _: their sole compensation, will do the work and the structure is ADDRESS ,rEr' :_;#�ES^ { (��_ not intended or offered for sale (Section 7044, Business and FINAL DATE _ �Gj Q •e "y �.^- ` Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ,} klicensed OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE S ESL r'-I, aS Owner of the property, am exclusively contracting with AMOUNTS SPE IE ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY r _ —4 'contractors to construct the project (Section 7044, ves❑ Nooy �. }-.: Business and Professions Code.) -- - - = WILL THE INT NDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING '" •••.�,;_;:••v-_ - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ,} h "' ', f._ t �- r"�• CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR /! U GUIDELI ES. I hereby affirm that there is a construction lending agency for YESW No❑ a the performance of the work for which this permit is issued(Sec. . rn (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST. NDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, (V _ I Ohl �� TITLE 2, H TER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS �.y(� "' 'f 3 Lender's Name TSO",VVV MATERI / REPO ING AND FOR OBTAINI A P RMIT FROM THE SCAOMD , I• L° f yl^i °- o Lender's Address OWNE ORA E o . o I certify that I have read this application and state under penalty _ o of perjur that the above information is correct.I agree to comply P.C.FEE / C/ PERMIT FEE - o with county ordinances and State laws relating to building m CO tr tion, and hereby authorize representatives of this Countys (®/ ISSUANCE FEE A�. a to r upo the above- Toned propert r inspec' n LIn < /J INVESTIGATION FEE• TOTAL FE +` m � ' m r m oa�e 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 BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, B LDINOG ADDRESS �` or a certificate of Workers' Compensation Insurance,or a certified C Tv_ y m AA copy thereof (Sec.3800,Lab.C.) r r-_,w A PLS Cp 7fA Z 1 -7 80 LOCALIT Policy No. Company SIZE OF LOT Ir ` ` I NO.,JF BLDGS.NOW ON LOTtel/ ElCertified copy is hereby furnished. NEAREST CROSS ST 11Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE. PARCEL C Date Applicant �� D ) �i SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ER A� ves No ,�� p 7 TEL NO. v A( COMPENSATION INSURANCE `r WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred DA`RES$y V� /4,x DISTRICT GROUP TYPE CONST, FIRE ZONE PROCESSED BY � dollars($100)or less.) 1- � I certify that in the performance of the work for which this per It I�Nj Z is issued, I shall not/employ a*era�kilg any manner so as to �� `�� J ✓ �L2-� -i becom U e e Workerion Laws. ARC CT OR ENGINEER TEL NO. STATISTICAL CLASSIFI ATION 11.0 Iy1 APT CONDO Date Applicant ADDRESS CLASS NO: �� DWELL UNITS NOTICE TO APPLICANT.' If,. this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject to the Workers' CONTRACTOR �t TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 0".,Yt ' FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL 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.FZSIZE NO.OFSTRIES NO.OF FAMILIES d Professions Code,and my license is in full force and effect. ✓•L NEW SK PG O License Number Lic.Class D CRIPTION O WORK ADD VALUATION [ ® O ContractorDateD I ALTER $ J .2 I LD IN REPAIR ❑ a e N ❑ I am exempt under Sec. $ BAP.C.for this reason DEMOL ❑ - - LDMA P/C# - - Dat OF I TING BLDG. URM ❑ ---- -x- Signature i _ . ..._ .. .. AP �r TAANTL TEL NO. LDMA Perm# ,�_..•�,_. ...... ❑.I,:as owner of th roperty, or my employees with wages as :��7 Z their sole comp ation, will do the work and the structure is ADDRESS 0 -fit- not intended or offered for sale (Section 7044, Business and FINAL DATE E a -'=1'-' professions Code.) -�/ `fw WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J _ 1 f�i!•_ I, 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 THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY I/' > `I'f I ; 'R ' S. licensed contractors to construct the project (Section 7044, = -�R••= 2 °7 Business and Professions Code.) VES❑ O_ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - 'E-''�)•'• 1-'I n i i OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANP�M1�ENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. ,Y.~x-'J/ I hereby affirm that there is a construction lending agency for 'YES ElN ...... ...... the performance of the wo k for which this permit is issued(Sec. _ p1 IHAVE READ HE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING e — 3097,Civ.C.) 65; CHECKLIST. RST ND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. ;:(it f I - TITLE 2,C 2. SECTIONS 20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIA AND TA ING A PERMIT FROM THE SCAQMD. 51 - I - o Lender's Address OdNNE .R AGENT o 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 J Q e�O PERMIT FEE N with all county ordinances and State laws relating to building / G � co struc on hereby authorize representatives of this County ISSUANCE FEE 26 O M to e o h above-mentioned property for inspection purposes. INVESTIGATION FEE TOTAL FEE to r S' —f OKant Agent a,e SEE REVERSE FOR EXPLANATORY LANGUAGE