The URL can be used to link to this page

Home My Public Portal About9044 LAS TUNAS DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION BUILDINGADDR � FOR APPLICANT TO FILL IN BUILD G ADDRESS f/, � -R,? ! � I 1 I hereby affirm that I have a certificate of consent to self Insure, 0-' or a certificate4f Workers'Compensation Insurance,or e certified zIP copy#Wwf(Sec 3800,Lab C) Cll LOCALITY TLAP�� I Policy No Company. C/ SIZE OF L NO OF BLDGS NOW ON LOT- ❑ Certified copy Is hereby furnished NEAREST CROSS ST - ❑ Certified copy is filed with the county bulldln In Ion TRACT BLOCK LOT NO - USE ZONE MAP NO department. ASSESSOR MAP BOOK PAGE PARCEL Date - Af 7pplicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTIO FROM WORKERS' OWIV4V A / TEL NO YES NO COMPENSATION INSURANCE �i4�/ WITHIN 1000 FT C�FTIQOW ADPRESS (This section need not be Completed if the permit is for one hundred DISTRICT TYPE CONST' FIRE ZONE P ESSE BY dollars($hat or less.) I certify that In the performance of the work for whlc his permit CITY � J ZIP IS Issued, I shall not employ any In any e r 80 as t0 ARCHITECT OR ENGINEER TEL NO become subject to the Workers' pen on L STATISTICAL CLASSIFICATION APT CONDO Date Applicant DRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT: If, er eking this Certifl of 'ems REQUIRED TOTAL SETBACK FROM EXIST Exemption, you ShOUId bBCO a ubJeCt t0 the WO ers' NTRACTOFF , , r TEL NO SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the La Code,you must fo with V FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PIE 23 I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP A ;(; (commencing with Section 7000)of Division 3 of the Business and FT ZE NO OF S RES NO OF FAMILIES °s O= Professions Code,and my license Is In full force and effect X (� ` NEW ,Z BK PG , —vD `�°1 DESCRIPTION OF WORK ADD ❑ VALUATION 6-J W License Number Llc Class ` 1 ITEMS °� Contractor Date ALTER ❑ �� 5 ❑ I am exempt under Sec REPAIR ❑ $ TOTAL .,�. ,�� B&P C for this reason DEMOL ❑ LDMA P/C N CHECK f Sal°i•! ate d— 1 ID USE OF EXISTING BLDG UR-M ❑ CHANGE .130 Signature A A APPLICANT(PRINT) TEL NO LDMA Penn# ElI, as owner of the props or my employ with wages as p DDDR-DDD 1/WWI their sole compensation, dl, do the work an the structure is ADDRESS F not Intended or offered for sale (Section 7044, Business and FINAL DATE ^J C 13015 1 AIS 10: 36 Professions Code) WILL THEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > licensed contractors to construct the project (Section 7044, YES❑ No❑ Business and Professions Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING `; °F OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST -75 FOR GUIDELINES 3307 C V° 1 hereby affirm that there is a construction lending agency for YES❑ NO❑ r- the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 1 I T FMES 3097,CIV.C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,TITLEZ•CHAPTER220SECTIONS220100THROUGH 220 WCONCERNING TOTAL AL 548' m 75 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD Lender's Address CHECK 58.11 0 OR AG&fr 1 certify that I have read this application and state that the above CHANGE .00 information is Correct I agree to Comply with all County PC FEE /l PERMIT FEE 45, ordinances and Stat aws relating to building construction,and a ' herb onz re ntatives of this County to enter upon ISSUANCE FEE0 . o ? /''� the v anti n roperty for Inspection purposes j 3 r l� uDOD-3�A01 4/10/913 AA _ql6 . INVESTIGATION FEE TOTAL FEE a wAye.� y g s CID 16 1 AM 10-'3 SEE REVERSE FOR EXPLANATORY LANGUAGE•