The URL can be used to link to this page

Home My Public Portal About6202 KAUFFMAN AVE_Building__ D8-3 9-43 SM SETS I APPLICATION FOR PERMIT. DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES UIL I I wm. J. FOX, CHIEF ENGINEER NO"'OF j?_. BLDG. ORD.,NO. DISTRICT NO. PLAN CK. NO. PERMIT NO., PLANS SETBACK LINE FIRE '\ APPROVED ' ZONE BY DATE RECEIVED BY DATE OF ADPL. DATE ISSUED E APPROVED ZON �/ff� f l�r�. ®,� �+. •e BY -DATE 'f F ♦ sjJ" APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY BUILDING e b O NAME ADDRESS tr ' W ADDRESS LOCALITY F W wZ U' NEAREST c' U W CITY CROSS ST. - !r Q STATE TEL. LICENSE NO. NO. NAME_ MAIL It NAME ADDRESS ` O O TEL. U 'ADDRESS J{/,�+`�� CITY NO. Q ' K. - ~, I HEREBY ACKNOWLEDGE •THAT' I HAVE READ THIS Z , CITY +�- O APPLICATION AND STATE THAT THE ABOVE IS CORRECT U STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. -AND STATE LAWS REGULATING-BUILDING CONSTRUCTION. Z SIGNATURE OF y, O LQT NO. � Si OF LOT . OWNER < a NO. OF BLDGS.' 'f AUTHORIZED AGT. W ¢ BLOCK / �J NOW ON.LOT 2- J W TRACT Lem P/ /��/R I/' ' C ECTIONS D USE OF SLOGS. NOW ON LOT DES RIPTION OF WORK USE OF BUILDING P1,ThIS '1. WARNINGI non may Be in violation of - War Production Rn�rrl rrlA _] cautioned to-consult with your local War,. z' 1 i & ' _ •mmenc t 2 ' ing the ,work authorized in this ,n tt 0 O NEW ,TYPE GROUP NO.OF NO.OF / ALTERATION ROOMS / /'�► FAMILIES' ADDITION ,n-,SIZE t r REPAIR �� STORIES MOVING WALL COVERING. /�j/I'•y / DEMOLISH ROOF COVERING $ P.C. FEE -FINAL APPROVAL � INSPECTOR'S 'VALUATION /�� FEE �� 4 G ' I' DATE v� I I NAME ' W - KERS'COMPENSATION DECLARATION hereby'affirm that I have a certificate of consent to self _APPLICATION FOR. BUILDING PERMIT insure, or a certificate of Workers' Compensation-Insurance, or a'certified,copy thereof (Sec. 3800;Lab. C.);, COUNTY OF LOS ANGELESBUILDING AND SAFETY PPolicy`No. - Company Certified co is hereby furnished. BUILDING PY Y 'FOR'APPLICANT.TO•FILLJN-' - ADDRESS ;a Certified copy is filed with the county building inspec- BUILDING/ /J !� y�J'/ tion department. ADDRESS C LOCALITY _ v ° _ p ^f O NEAREST• J Date Applicant " CITY (� ZIP 7 /66 CROSS ST.' CERTIFICATE OF EXEMPTION FROM WORKERS' f NO..OF'BLDGS ASSESSOR' COMPENSATION INSURANCE SIZE OF LOT ,�U'7� /JVD NOW ON LOT MAP BOOK' f PAGE sf PARCEL This section need'not be corn leied if the.permit is,for-one USE ZONE MAP hundred-dollars($100)or less.,) P TRACT � BLOCK' LOT NO NO t' _ TEL r n SPECIAL } - " I cerci ih'atein the performance of the.:work•.forrwhich.ihia OWNER I O .� �. S'NO. •'� CONDITIONS, d P „ DISTRICT GROUP.' TYPE :.`FIRE PROCE ED BY O: permit is,issued,,I shall not employ any-person in any manner ADDRESS/"2;,,jCONST ZONE _•V so,as to_become,sublect to-the Wor Compensatio Laws: x gyp , fes Ix CITY'./CJY� `L�` 1.� ZIP r/1/DQ r� J O �• Date J� •Applicant w STATISTICAL CLASSIFI TION APT. CON 1-� NOTICE•TO APPLICANT:-,If, after akin' this Certificate of ARCHITECT^O. , TEL.. �1 6 9 // -NO.-oC��Y1 CLASS NO i DWELL UNITS - z` W Exemption,. you. should become', subject; to 'the Workers ENGINEER Q'_ Compensatiori'provisions of.,th'e,Labor-Code,-you muse'forth- ADDRESS i4lt.FF�?�t9yt/ivy.^ - - SEWER MAP- y with comply with 'such, provisions.,dr,this permit' shall; be ;, TEL., l� a deemed_revoked. CONTRALTO T "c(��O BK PG," ' VALIDATION m LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I dm licensed'un"dei provisions of Chapter 9- ADDRESS NO. VALUATION (comrnencing with'Section-7000)of Drvigl:06 3 of the Business and - y LIC Professio_ns.Cod6,-and`my;license is in full force and effect _ CITY CLASS $ (�Q• a - t. 9 - - SQ FT" NOsOF' • NO OF '; CHECK r License Number ibc.,Class SIZE STORIES FAMILIES ONE' / Iloilo _ f e' Contractor 'Dote' DESCRIPTION OF WORK NEW •, $ — J#L ) "• 11. ADD . _Q 2,2 3.6-6.A I;am exempt under-Sec. "i S Ta �E.L ALTER .FINAL �p .DATE •�' -'# •B.&P.C. for th_is-reason, REPAIR 0 f _ Date:- USE OF DEMOL_ EXISTING BLDG O BIN , 1 .;e 4 9,88 Si nature APPLICAN TEL p- 9 OWNER-BUILDER DECLARATION ` ;., PRINT V•' /f° 1 NOS, , �9 a o_e 4 9,8 8"v I hereby affirm thatT`omm,exempt from the Contractor's License " 0'a 7,� =$ " Law for The.following reason (Section„7031:5; Business and ADDRE _ ► ^' ``' - r, , Professions Code):- PRESENT ' BUILDING I, ,as•'owner_of the-property, or m em to ees with• ADDRESS wages as th"eir solecompensation,will do,the.work and• , thestructure is�not'intended or offered for sale-(Section'. LOCALITY - 7044, Business and Professions Code): MOVING' TEL ❑ CONTRACTOR - I, as owner,of-the property,'am exclusive,ly'contracting•,` with licensed contractors to'construct,the,pro,ject (Sec-'- ? a Tion'7044, Business•and P,rofessions•Code). ADDRESS r 4t- CONSTRUCTION LENDING AGENCY , i'REQUIREDLYARDHWYTOTAL SETBACK FROM' EXIST:.;' Z 4 SET BACK PROP LINF- --WIDTH' hereby aff,;irm•that there iss-a construction,lending agency for, FRONT - -- _ the performance of the work for'v'hich this permit,is,issued P L (Sec. 3097, Civ..C.): SIDE y - P L. e Lender's Name Lender s Address P.C.,Eee$ Permit Fee certify th'at'l have read this application and-state that'the Issuance'Fee a 'above information is correct. I agree to comply with all County Investigation'Fee o'rd'n C4 and State laws relating-,to building construction, Total Fee ' a he eby authorize representatives of this County to enter.' P on , u�r0pv,o�sesSEE -REV-ERS�=E;FO;•R EXPLANATORYLANGUAGE _ ®sSiDate i WORKERS'-COMPENSATION,DECLARATION!� - ` I hereby affirm-that'I have a certificate'of"consent to self ; r r rttfj at>'`of Workers'`Compensation -insurance,._ ensue„o"a,ce c e APPLICATION FOR RIJILDING PERIIAIT , or a certfied copy thereof.(Sec. 3800, Lab:C.) " T,YOF LOS`ANGELES _ 'BUILDING°AND SAFETY COUN PolicyNo.' w. `;' Company:_ F7 ,;Certified'copy is hereby furriished, FOR,AFFLICANT TO.FILL IN` BUILDING �� •, �A-' ADDRESS !«�+ `i y Ce�tified,copy is filed with the'county building inspec- BUILDING ❑ - ✓. tidn.department. ` ADDRESS ' .A0F -' r4NJ. \JEAJUE, LOCALITY „•., .l.• NEAREST Date Applicant° CITY: ��L G� 'ZIP - CROSSST nn ASSESSOR +,CERTIFICATE OF EXEMPTION FROM.WORKERS'• SIZE OF LOT:�� f /' NO OON LOT•'/V MAP BOOK PAGEi'','.s*' PARCEL COMPEN5ATION,4NSURANCE, ti, `?' USE ZONE' MAP (This section''neeNO d:not be'completed.if the peer itJs'for one hundredjdolld�'s ($100)'6e. r BLOCK,TRACT BLOCK LOT NO SPECIAL _ - „ E 2l !.... v'CONDITIONS p . T o2 ., OWNER .�r 1c.J�.r+5 ,r , Y_ - N t"z�•'x J d I certify,That•in;the performance of the work-for which this DI TRIC? GR• TYPE, FIRE PROCESSED BY O permit is,issued,.l shall not.'employ any person in.gny-manner CONST ' ,ZONE; ;-` ,' a' P,, V ,•,. so-as to'becorrie subject,toAeuWorkers'''Com Compensation,Laws. ADDRESS �-6L'��`�� a VF • &'c. T �-�� e:a ZIP9t � .:, �==� o . . CI Y' bjJ ;Date Applican STATISTICAL C SSIFICATION APT. f CONDO NOTICE TO,APPLICANT:-.If, after:making;this Certificate of ' . ARCHITECT,OR'. :TEL -. JAI (� '- ENGINEER' NO. - CLASS NO BWELL UNITS LU Exemption, t,you, should' become, subject'• toIihe Workers',; 0. Corripensation-provisions,of,'the'Labor Code,-you.must forth- -ADDRESS.•'” F ;".' " -SEWER MAP j� , °, i with; comply_with'-such.'piavisions or;this,- shall;be ! s TEL', �J VALIDATION deemed revoked. ` CONTRACTOR z NO. BK PG, LICENSED CONTRACTORS:DECLARATION '- UC,- Iheieby`ofl ih6iI'd mlicensed-uriderprovisionsof,Chapter 9` ADDRESS; NO. VALUATION (commencing wish Section 7000)of;Division 3 of'ihe Business and C LIC ' Profe`sstons Code, a,nd'my'licen is'in-full force-and'effect.z,,, CITY,'•' CLASS,' a SQ."FT, NO. OF NO 'OF CHECK ,; License Number'-- t Lic.Class SIZE . STORIES' FAMILIES ONE DESCRIPTION OF WORK'CWSTPW 'C�IJ J. NEW Contractor= Dow,— ADD* ' .= , . - >�IIJ��.�i.ii Z,C�t�. 1� ADD I am'exempt under Sec. W I FINAL _ ALTER• B.BP.C. for.this reason `U �0U AW�V� ' �V1U�.2^7.� REPAIR" DATE N ' Date:'. - USE OF ' ' DEMOL FINAL' (� EJ EXISTING BLDG ,,1 -G.frtml�d ~Signature APPLICANT TEL p� By l� PRINT-1ZICFFt�� P'! H4eP- NO OWNER-BUILDER DECLARATION nn ., I:hereby affirm that,am exenipt`from.the Contractor's License.• ADDRESS 'V/�Z (�WMKAAJ kQ ,-rt;KN Irl_ Law for the-follovo ng-reason (Sect i6n'7031.5,,Business and Professib'ns Code) ',.t BUILDING, - I, as-op46er.,of 'the property; or my employees with' ADDRESS" rs ' wages a's then sole compensation,will do the work and. ;, 'x, ,.•the structure is not intended or'offered foe.sale(Section LOCALITY = '7044,;'Busine'ss and'Piofessions Code); MOVING, TEL ,, s CONTRACTOR' NO. as.ownei-of the-pfoperty, am'exclusively contracting with licensed-contiactors'to'construct the-project (Sec ADDRESS tion;7044,,,Busine`ss and Professions.Code). , a1 REQUIRED TOTAL SETBACK FROM." EXIST tCONSTRUCTION LENDING AGENCY. SET BACK YARD HWY pROP.•LINE WIDTH r I+hereby affdm that there is a construction lending dgency'for FRONT • ' t The'perfofmance'of^thwwork for which this permit'Js issued. `P L ® '' ,5 2X15 A'• (Sec.;3d47:`:Civ. C ). : SIDE: o =Lende'r's Name ,. - - - '2'a`•�,,� 5,}5,Q . P'C^Fee$ t.',Permit Fee U'3 Lender•'s.Address I,certify iFiat`I have re6d this application and'state that,Ike : _ Issuance Fee' y. . above information is'coirect I'a ree to cam 1' with"oII Coun r:-r �•9 5'.-8.3' ¢' 9 PY ry'•� Inv'eshgahori'Fee'"°".• _ i, ;`• •- -ordinances and Siate.laws relating to building construction;' " �:': " df. .--,-and hereby authorize,representatives of this-County!a'enter Total Fee :.upon the above-mentioned.property for inspection purposes. +',•. 1�R3• = :,,-,�'. rt,�, SEE REVERSE FOR'EXPLANATORY Sigiiafure of App t or•Agent Date :, ®s \A/OR ❑ S,,COMPENSATION DECLARATION ��s��e�ot-a,- ate o°woke s�'compe6s;o�Insurance, APPLICA'TIO�N FOR r BUILDING' PERMIT� or a eertrfied'c py thereof (Sec:3B00;•.Lab.'C.)'' - ' - '" ' of r: 40UNTY'OF'LOS ANGELES- BUILDING'AND SAFETY Policy No. • ' - Company Certified copy-is hereby furnished. FOR`,APPLICANT-.TO=FILL IN • - i- ADDRESS 20.E ,. aCertified,copy is filed with'the county building inspec-• BUILDING , c iron department:,' ADDRESS. �vV LOCALITY "` NEAREST Date - Applicant CITY Lr"C ZIP � CROSS ST. CERTIFICATE OF,EXE(VIPTION FROM WORKERS' ��'/� NO-OF BLDGS 1 t ASSESSOR .' COMPENSATION INSURANCE' . n � - SIZEOF LOT w7GJ ..LbD-, NOW ON•LOT.'A Z J- t. MAP,BOOK PAGE PARCEL This section need not-be completed if the ermrt'is for one; USE ZONE +? hundred dollars($100)or less:.) F TRACT ° BLOCK LOT NO v i NO I^' ^:^ -:TEL 1l SPECIAL ' >- L certify that m the performance.of-ihe 'work.for which this' OWNER��` •'K� � NO • ^ 10 CONDITIONS: IL er it is issued, I shall not em to an arson in an manner DISTRICT GROUP TYPE - FIRE gPE§SED BY 0 - P P Y Y P Y - •f' + CONST ZON U so as.to become'subject to"the.Workers'Comp sation,Laws. ADDRESS F r r ,A• - : .,• �•- .�';;- CITY- ZIP .� Date "ZApplica STATISTICAL CLASSIFICATION APT NDO• NOTICE TO_APPL'ICANTc If;-after, makin rs'Certificate of ARCHITECT OR TEL. p' W g ENGINEER NO CLA55 NO. ��- DWELL UNITS Exemption, .you•should become subject'to the Workers a Compensation provisions of the-Labor Code, you:must forth- _ ADDRESS' = r SEWER MAP with comply with such provisions or.this,permit- shall-be µ� �1 TEL. Z deemed revoked NO• 7"eP BK PG;' VALIDATION . CONTRACTOR = {Z LICENSED CONTRACTORS DECLARATION ^- LqC I hereby,affirm''thaT I,am licensed'urid&-provrsions'of Chapter 9 ADDRESS w�i70 w (.� '� NO q � VALUATION `? ` (commencing with Section 7000)of*Divisron.3 of the Business and LIC Professions-Code, and-my license-is',in full force and effect:; CITY _ CLASS - 'e' SQ.,F. NO:OF NO:OF CHECK: License Number .4 "Lic.Class SIZE STORIES% FAMILIES ONE Contractor Date DESCRIPTION OF WORK l�T NEW g ADD.-- ;0 0 02378.0 I arrt exempt under Sec. FINAL �7 M ALTER Q 0 ,/7 2;4,i•8.5 B.BP.C.�for this reason DATE !� REPAIR Date:' USE OF ' ` DEMOL ,❑ FIN EXISTING BLDG. + / BY - APPLICANT TEL ' Signature , '-; '•' '�_ -• ,'-? _ _ ..... . - H' - - - :,-, •, ,i PRINT- z �i NO SO o-- OWNER-BUILDER DECLARATION' r I hereby affirm that I am,exempt,from the Contractor's License Law•for the-following reason (Section 7031.5,-Busgiess and ADDRESS �i' L-bL+�u� - Professions Code)i; , _ RE 3P BUILDING 2 6 1-6`A' •�,,fit, -. .'!":as owner of the property, 'or my employees with ADDRESS wages as their sole compensation,will do'thetivork and # • e o e 'e.� the struct' e'is not intended or offered for sale(Section tOCAL'I7Y t 044, Business and Professions,Code). , M_OVING TEL I, as owner of The property, am exclusively contracting NTRACTOR - NO 1• `M with licensed contractors to.construct the project_(Sec- •''• + ADDRESS• tion 7044, Business and Professions Code).' ' _ REQUIRED:- TOTAL SETBACK FROM EXIST. r CONSTRUCTION LENDING AGENCY, :-SET BACK YARD HWY'a PROP LIN WIDTH . •; I'Fiereby,affirrn that there is a construction lending agency'for FRONT - " ' k== .5•;: x w.*� �y �'' e.o•G ,, the'performance of th'e work for which- this permit is issued'•• P L M� a +; - (Sec: 3097, Civ.'C.): SIDE'. 'P.L.FD o'a iS' 8-5 (Sec: Lender's Name 2 , '+*'• .w a P.C'Pee$ CJI Permit Feet�- L°ender's Address -, I certify that,1 haveread this application and state-that the Issuance Fee ftti ` a above information is correct. I agree to comply with,all County• Investigation Fee-• �,=y 4 ordinances and State-laws relating To building construction;, Total-Fee,'. /, /2 Y Y� and hereby authorize representatives.of-this County-to enter, �;+ rr .- up�thentioned'property for inspection purposes. +' . � SEE REVERSE FOR-EXPLANATORY LANGUAGE "+ Applicant or Agent ^- Date il o \i. �S'-COMPENSATION DECLARATION - - - �'I hereAPPLICATIONFOR BUILDING PERMIT insure, or a certificatificat e of Workers' Compensation Insurance, or a cs;tified'copy'thereof (Sec:3800, Lab. C. - . i . . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. - .Company - " Certified copy is hereby.furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the`county building inspec- BUILRESS , ,' `u tion department. ADDESS1f�j�►i Date Applicant CITY LOCALITY CERTIFICATE DF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST - COMPENSATION INSURANCE, SIZE OF LOT NOW ON LOT CROSS ST._ (This secfion,need not be completed if the permit is for oneASSESSOR' ""'. hundred dollars ($100)or less.,) TRACT BLOCK LOT NO. MAP BOOK' PAGE, PARCEL TEL USE ZONE MAP I certify that in the,performance of the work for which this OWNER NO:permit is issuedj sh'all not employ.any person in any manner ,�//�� i' 1 SPECIAL - sous to become'subject to the Workers'Compensati Laws. ADDRESS 7 CONDITIONS V DateZ��O� CITY/A �`/�. ZIP 09 Applican ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR ESSED BY.. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST.` ZONE U Exemption; .you 'should become subject to'the''Workers' 'fLU Compensation provisions of.the Labor Code, you must forth- ADDRESS �• v126 with comply, with .suchc provisions or,,'this',permit.shall be STATISTICAL CLASSIFICATION APT. ONDO. deemed revoked. •: CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION, -LIC. - CLASS NO. 2 DWELL. UNITS i I hereby affirm that I am licensed under,proyisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC, SEWER MAP Professions,Code,and my license is in'full force and'effect. CITY CLASS i BK VALIDATION ' ... ' SQ. F NO. OF. NO. OF1. CHECK _ License'Numbei 1. Lic.Class SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK CH AM411&^� . NEW Contractor .,,Date.* ADD am exempt under Sec. LV ALTER ' B.&P.C. for this reason Is WLX9 k I REPAIR_E] $ ;2 2.1 1. rJ A USE OF DEMOL -.-. Date: EXISTING BLDG y �# 0 0 0 0 0 Signature APPLICANT TEL. FINAL 7 OWNER-BUILDER DECLARATION (PRINT)"{��`}PI�l��i SdIO DATE 1 o'0 4 9.8 8 I hereby affirm that'I am exempt from.the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 7r FI L, Profes 'ons Code): PRESENT 0 0 0 49.8 8 c=i BUILDING I, as owner of the property, or my employees with ADDRESS5 ?8 8 5z wages as their sole compensation,will do the work and O the structure is not intended or offered for sale(Section LOCALITY , 7044;'Busihess'and Professions-Code). MOVING -TEL.' I, as owner of the property, am exclusively contracting CONTRACTOR NO. with-licensed contractors-to-construct the-project (Sec- ADDRESS tion 7044, Business and Professions Code). _REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY " SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT -the performance-of the-work-for which this permit is issued - P.L. - (Sec. 3097, Civ. C.). SIDE n P.L. Lender's Name ' o ? LDMA Ref. # ..-. ..• P.C. Fee$ Permit Fee Lender's Address I.certify.that.l have read this application and.state that the Issuance Fee SO LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee m ordinances and State laws relating to building construction, v Total Fee LDMA Perm. and hereby authorize repre entatives of this County to enter uponNhe above-mentioned roperty for inspection purposes. L a � t �►�., '� SEE REVERSE FOR EXPLANATORY LANGUAGE � 'Signature of A aMror Agent - Date O ' APPLICATION FOR. BUILDING PERMIT � COUNTY OF LOS ANGELES- BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION" FOR APPLICANT TO FILL IN B D GAD ESS. ,n'^I I hereby affirm that I have a certificate of consent to self insu8U IN DDR re, or a certificate of Workers'Compensation Insurance,or a certified CI .�—+ copy thereo/fJ�3800,Lab.C,) �7Y �y l�LI�.L7 L—Com /�+`/ �`(� V LOCALITY Policy No. pan; IZE OF LOT NO.OF B DGS.NO ON LOT rtifieNEAREST CROST.d copy is hereby furnished. • ❑ Certified copy is filed wijnncount buil inspection TRACT BLOCK LOT NO. - y USE ZONE MAP NO. departmen. . j /� ASSESSOR MAP BOOK PAGE PARCEL Date,/J' Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTI WORKERS'. o NO YES No COMPENSATION INSURANCE WITHIN toxo FT of SCHOOL')• A RE (This section•need not be completed if the permit is for one hundredIU r�� N DISTRICT GROUP TYPE CONST:' FIRE ZONE PROCESSED BY dollars($100)or less.) CI 3 I certify that,in the performance of the work for which this permit G/ t0 is issued, I shell not employ any person in any manner sos to ARCHITECT OR ENGINEER TEL NO. p C T +a-e0C become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION tl APT CONDO Date "Applicant ADDRESS CLASS NO. m:2-1 DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of p pp REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the •Workers' C/jT/ % �./� �� q Q, --0// SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith (�If ,l ,' OC / Vbb FRONT comply with such provisions or this permit shall be deemed revoked. AD KESS PL SIDE >_ LICENSED CONTRACTORS DECLARATION CI �� LIC.CLA�ss- PL 'Commencing affirm that I am licensed under-provisions,of Chapter 9 SEWER MAP FT IZE NO:OF STORES NO.OF FAMILIES (commencing with Section 7000)•of Division 3 of the Business and .� D NEW ❑ BK PG ® C Professions Code,a d m license is in full force and effffeect. v License Number ' 17 Lic.Class C--7 o ION OFLVAMi? WORKWORK- �Na� ADD ❑ VALUATION D p j, wL Contractor w/��% /��2� Q n ALTER ❑ $ z_ 4NLNI o J /"L EPAIR ❑ I am exempt under Sec. B.BP.C.for this re n :3 19/in DEMOL LDMA P/C# Date: USE OIJFEXISTING BLDG. URM Signature [CANT(PRI TEL Q/� LDMA Perm# - -" "•_ C a El 1, as owner of the rFw ly, or my employees with wages as 0 their sole com n n, will do the work and the structure is ADD ESS �� 1-,� not Intended or offered for sale (Section 7044, Business and �� o tv FINAL DATE Q 3307 9' 63 Professions Code.) iC� WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE MATERIAL ❑ I, as owner of ther0 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN _ p party, em exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL i 3 licensed contractors to construct the project (Section 7044, YES❑ NO El Business Business and Professions Code.) + (' � WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK � 7 nV o 6 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH i c CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST, a _ aJhi 1C e 1 FOR GUIDELINES. �P71'1I'f C 'I hereby affirm that there is a construction lending agency for YES❑' No❑ the ,Civ.mance Of the WOfk for Which this permit IS 133Ued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD- _ q ) 3097,CIV.C.). PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES•yc 0000-13001 11/113 '2 COUNTY CODE,TITLE 2,CHAPTER 2 20 SECTIONS 2 2010D THROUGH 2 20140 CONCERNING6' _ �f• Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD.. }•1'S7 1 11 {1f I ALender's Address OMER OR AGENT 0 1 certify that I have read this application and state that the above $; InfORTla' Correct. I r t0 Comply with 811 County P. FEE PERMIT FEE /J� p �J 2SG ordin ces an State laws latin to building construction,and her y autho a represen Iv of this County to enter upon ISSUANCE FEE n ova ntioned propert r inspection rposes. INVESTIGATION FEE TOTAL FEE sgn.wn kue« D.b000, (p• SEE REVERSETOR EXPLANATORY LANGUAGE