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HomeMy Public PortalAbout10546 LIVE OAK AVE_Building__ APPUCAT�ON FOR BULDNIG P ERNT COUNTY OF L - � OS 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, BUILDING ADDRESS 544 It- 1.,.�VYL nov.- or a certificate of Workers' Compensation Insurance,or a certified �S 4(o VSE p/��L copy-thereof(Sec 380x7r--w q�1 g Q LOCALITY 0,Lab C) CITY ZIP ' Policy No 1Z7. so 2 l CompanySMM 1'!4t-� �4 - _ CA-CSIZE OF LOT NO OF BLDGS NOW ON LOT TC W" Le ❑ Certified copy is-hereby furnished NEAREST CROSS ST Certified copy is filed with the county building Inspection TRACTq BLOCK LCuNO rZ,l_ yVtDNTV. department 4 \3�� L.. USE ZONE MAP NO 1' ^ ASSESSOR MAP BOOK PAGE PARC L ISOO L 1 Dat X93 Applicant t�N fr1JST Z'jam SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER T L NO COMPENSATION INSURANCE S'T S t(4-TL, WITHIN 1000 FT OF SCHOOLS YES NO (This section need not be completed If the permit is for one hundred ADDRESS dollars ($100) or less) $O I SSto" DISTRICT GROUP FIRE ZONE PROCESSED BY CITY ZIP F� I certify that In the performance of the work for which this permit OSE �iyNCPon , � �•QU F-3 Is issued, I Shall not employ any person in any manner SO as t0 ARCHITECT OR ENGINEER TEL NO become subject to the Workers'Compensation Laws' STATISTICAL CLASSIFICA I/pN APT CONDO Date- Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the Workers' CONTRACTOR TE NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must-forthwith 71--_�(zI f4 4-ON ST $ Z I00 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LI NO P L LICENSED CONTRACTORS DECLARATION 10 S P-IJGAF,W ci�� 5-704%_1 SIDE CITY LIC CLASS P L I hereby affirm that I am licensed underprovlsions Of Chapter 9 SA 4'1&w51� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES .Professions Code,and my license Is in full force and effect 5-0 NEW J�X BK PG D d License Number�70`� Llc Class DESCRIPTION OF WORK ADD ❑ VALUATION 0 Contractor�X-T-�. GON4_1 Date VA i l?j• rL ALTER ❑ $ G'�' I am exempt under Sec REPAIR ❑ Q B&PC for this reason DEMOL ❑ 0 LDMA P/C# Date USE OF EXISTING BLDG URM ❑ Signature APPLICANT(PPoNT) TEL NO 'LDMA Perm# z ❑ I, as owner of.the property, or my employees with wages as k"'60N �� Z ACCT.T their sole compensation, will do the work and the structure Is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS ITEM . MATERIAL J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO'OR GREATER THAN THE ❑ I, as owner of the property, am,exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES Q licensed contractors to construct the project (Section 7044, � FINAL BY > _ Tf ITA!L 103 ® 05 Business and Professions Code) YES 1:1 N7 �v WILL THE INTENDED USE MI THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHEt K - i1,�. 1C' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH � CHECK 1V J CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR (�{�ir GUIDELINES !_RANGE .00 I hereby affirm that there is a,construction lending agency for YES❑ No� a the performance of the work for which this permit Is Issued(Sec rn I HAVE READ THE H USM ERIALS INFORMAT UIDE AND THE SCAQMD PERMITTING 3097,Civ C) CHECKLIST I UN T M E UIREMENTS U R THE LOS ANGELES COUNTY CODE, TITLE CHAP 22 E 20 100 T UGH 2 20 140 CONCERNING HAZARDOUS 0000-0091 7!y 1 3 Lender's Name IALS I AINI RMIT FROM THE SCAQMD o Lender's Address j 18431 1 AN 11:07 0 ER OR AGENT , o I certify that I have read this application and state under penalty 0 of perjury that the a ove information Is correc ree t0 Comply PC FEE PERMIT FEE o with all county ances and S to law rela ng to building construc n, d reby uthorl epres tatty of this County ISSUANCE FEE - 7 O 10 to u n t bove- nho o er for pec on p rposes 10 77/7A 1171 INVESTIGATION FEE TOTAL FEE/a 3. d 1 e d APP&6 oa SEE REVERSE FOR EXPLANATORY LANGUAGE .,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, BUILDING ADDRESS; aole lle"G 4ee� C� or a certificate of Workers' Compensation Insurance, or,a certified r S 6 G l c-,r �J�'f - - - copy thereof(Sec 3800:Lab C) CITY' ZIP LOCALITY Policy No Company S . SIZE L T "e ', NO OF BLDGS OW ON LOT ❑ Certified copy is hereby furnished - -41.J1 NEAREST CROSS ST ❑ Certified copy Is filed with the county building'inspection T BLOCK NO ' n p department Y {. �f d!/z USE ZONE FSPEC�IAL'CONDITIONS _ ASSESSOR MAP 8 K "P G 1� PARCEL _ Date I Applicant V , CERTIFICATE OF EXEMPTION FROM WORKERS,, o NE EL o 15�h - COMPENSATION INSURANCE � WITHIN j000 Fr OF scttooL9 YES No (This section need not be completed If the pefmif IS for Oneihundred, Ay/�•/)Uy� 1 !l� ;� / DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars ($100)or less) (// ��// ((// I Y L I certify that In the performance of-the work for which this permit C !11 ZIP` I Is issued, I shall not employ any person'in',any manner so as to �I� beco I t the WOrkerS�Orn ensatlon Laws ,{/ AR IT T O N INEE nT N Q� Date Applicant p / `�' `ADD E �, 1 I l/� STATISTICAL CLASSIFICATION , `C •�1,7�� CLASS NO DWELL UJ/I S O NOTICE TO APPLICANT If, after making this Certificate of ' LD 9A ` ' L'''` 1 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should ,become',subjedt", to the 'Workers' C9 NTR TO T NO 1� •SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith �jo , �- `� FRONT comply with such provisions or this permit shall be deemed revoked APES< �1 �: L - P L LICENSED CONTRACTORS DECLARATION` Iv PILE • CITY LI LAS P LIDA _ rf I hereby_affirm that I am,licensed underprovislons of Chapter 9 SEWER MAP (COmm@ncing with Section 7000)of,Division 3 o the Business and S FT Z I OF ST O IE NO OF F MILIES _ ' Professions Code,an my license,is In full force od eff ct ;- �- r NEW BK PG License Nu ber LIc•Class `•` IDE IPI N F WORK,' ADD •❑ VALUATION D Q / _ t $ � aw ,Contractor � �Qate �' ALTER ,❑ � 0 ❑ I am exempt under Sec " REPAIR ' El $ B&PC for this reason o DEMOL LDMA P/C# V W Da"te USE OF EXISTING BLDG URM » Signature - `' _ APPLI N ( :'- j -LDMA Perm# - qr' T s - Z i ❑ I, as owner of the property, or my employees with wages as, "� ZO A`•f E'° L their sole compensation, will do the'work and*the-structure Is ADD - 117.90 not Intended or.offered for sale (Section 7044, Business and FINAL DAT/E^f / (�A Q }j Professions Code) - WILL THE•APPLICANT OR;FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL i'_• 7 % UEN-3 ❑ I, as owner of theproperty, am exclusively contractingWlth OR A MIXTURE GQNTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q i y AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY licensed contractors to construct the project,(Section 7044, TOTAL . 117 m 9 Business and Professions Code) Yes El No 11 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING -C•�••��r,�ti• 1�? 70 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH,CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR i F[' n Iii i GUIDELINES �• �,4"ANNE JV I hereby affirm that there Is a construction lending agency for YES❑ NO❑ �/�G. a the performance of the work for which this permit Is issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING N 3097,CIV C) CHECKLIST I UNDERSTAND MY REOUIREMENTS UNDER THE LOS ANGELES COUNTY CODE �{I�I+Int Ill i C/1,f/S� TITLE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS , L Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD ! n�� Lender's Address 96 f 1 AN , ° t7 OMER OR AGENT O , o1 dertify that I have read this,application and state under penalty O of perjury that the above Information Is correct I agree to comply PC FEE PERMIT FEE , with all county ordinances and State laws relating to building / a construction, and er authorize representatives of this County ISSUANCE FEE �� m to enter up ove-mentione erty for Inspectlo purposes s ` - _ INVESTIGATION FEE TOTAL FEE 7Y , A9.1 e (J SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION insure, or 6�e* ifi atte of Workers' Compensation ensuran eificate of'consnt to lf °. G°Q' o Ud©� 1 -p QM or a certified copy thereof (Sec 3800, Lab C ) Policy No 1117-3622MCompanyTA"t� �t''D COUNTY OF LOS ANGELES BUILDING AND,SAFETY BUILDING -1Certified copy is hereby furnished FOR APPLICANT TO FILL IN' T ADDRESS I OSg4 - UVC nc-m - &ye Certified copy is filed with the county building inspec- BUILDING ; tion department ADDRESS 1054 Ltvle -+-`f L PP r�-1 T1L'GUPY CO/��T(� Clll C �'1 l�G G T Y zip 1 8 C7 Date i" LOCALITY A lica �rv1 G"C NO OF BLDGS NEAREST CERTIFICATE OF EXEMPTION'FROW WORKERS' SIZE OF LOT 9(o Z NOW ON LOT "D' CROSS ST r_�L2 MON-TS COMPENSATION INSURANCE- ASSESSOR (This section need not be completed-if the permit is for one TRACT2— BLOCK = LOT NO Z- MAP BOOK ���'� PAGE ''L- PARCEL �� Z hundred dollars ($100) or less-) TEL OWNER S7.&CL-rS IWTt_ pE'A• IWe-N02136Z41S55 USE ZONE MAP 50N2'i'3 I certify, that in the performance,of the_work for which this u NO permit is issued, I shall not employ,any.person in any manner ADDRESS �pQ,I S IGU Is�OJs �4C05.0 ( SPECIAL } CONDITIONS so as to become•sublect toa•the Workers'.Compensation Laws L_D S /�►�VC�-ES O - CITY ZIP960111 U Date Applicant ARCHITECT OR TEL DISTRICT GROUP .TYPE FIRE PROCESSED BY � NOTICE TO APPLICANT: If, after making-this Certificate of ENGINEER /J (L'T V. SAITO NO 7 14 q�Igps CONST ZONE 0 Exemption, you'should become, subject to the Workers' 5•Q� . 23 V U Compensation provisions of the Labor Code,,you must forth= ADDRESS L4 l_ SAW se"&R.OINq R'O w with comply,.with such-provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO a LO deemed revoked CONTRACTOR TE)c GoNSTn<JG 1081$ 2 ' I Z LICENSED.•CONTRAGTORS DECLARATION = LIC CLASS NO �O' DWELL UNITS - LICENSED. hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSI(03 S $AIJ GA�(taBl. NO SIOg-f Fa SEWER MAP (commencing.with Section,7000)of Division-3 of the Business LIC and Professions Code,and my license is in full force and effect CITY Q G P$TL+C�'' CLASS BK PG 9 't/ALIDATION ;t SQ FT-• NO OF `` NO OF CHECKS 2�T�-r.'}i License Number SJ0-tl-. Lic Class+� SIZE 2 SOO STORIES C FAMILIES ONE t�I VALUATION H'�l `. i�!i'•' ContractoPTl✓�9ZU+3 CIO NS'T $'Date!7 14 Z•-- DESCRIPTION OF WORK S.F.O. L.�4 NEW El .. ';4DD'� ❑ .^ r , r I am exempt under Sec, t ALTER El DDD •&o B BP.0 for this reason ` ~• Y REPAIR ❑ $ Date USE OF1'� EXISTING BLDG 0 A DEMOL D j APPLICANT TEL �ti•!j( -I i 1�•+-+u Signature (PRINT)S"rAtZTS DEQ!' NO 2]'3"q 15'SS FINAL _ -i}j OWNER-BUILDER DECLARATION DATE 1:si ti l ;_ ! l ( },_. 11!' I hereby affirm that I am exempt from the Contractor's License J , Law for-the following.reoson (Section 7031 5;'Business and ADDRESS&01 S FIGUEL Re,/a }igdo� _A9001� FINAL'••'' MINA Professions Code)•;. PRESENT B 7 - LLtt ❑ I, as owner'of'the property, or m employees with BUILDING ,• ) ' Y { f nt=�t }tiv7.11}' P P Y. YADDRESS ,r �" ' ' (, ., t ' wages as their•sole compensation,will do the work and LOCALITY t S ~ JS�t'Nt� {raE ,i ill the structure is not•intended or offered for sale Section d 7044, Business and Professions Code ) MOVING ; i TEL' ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to-construct the prolect (Sec- ADDRESS V t p r -r_ �I � f7 tion 7044, Business and Professions Code ) : /'' •- ,q ;� �`o +t.,ai t-ll ��'.j`� IRED TOTAL SETBACK FROM EXIST _ CONSTRUCTION LENDING AGENCY [RiQU ET BACK YARD HWY PROP LINE WIDTH ' ^ I hereby affirm that there-is a construction lending agency for RONT �; y r�'1 ! '~ , the performance of the work for which this permit is issued P L' ` yl (Sec 3097, Civ C ). IDE Lender's Name "' - • L• - LDMA Ref } PC Fee$ / / PermFee Lender's Address �f o� o I certify that I have read this application and state that the Z, f / �� Issuance Fee �a LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee / ordinances and S to laws relating building construction, Total Fee / LDMA Perm # a and hereby a ize r 'res to of this County to enter upo a -me oned prop for inspection pur oses .o IZ 1o7 SEE REVERSE FOR EXPLANATORY LANGUAGE ' Signature of Applicant Ag t Date A 40H FOR BULOW3 PERMN' � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS t O s I O 5-5`I (V AF O Ay__ I hereby affirm that I have a Certificate of consent to self Insure, o 5 1 a sy Ll V 1_ or a certificate of Workers'Compensation Insurance,or a certified O -1 EY^'`P LC- r—1-T9 17%'0 copy thereof(Sec 3800,Lab C) Cm ZIP LOCALITY Policy No J223DZ'1-9 I Company 5li' L6' FL0\40 �'� L Gly C11l O -fe711 �( t SIZE OF LOT NO OF BLDGS NOW ON LOT Gl El Certified copy is hereby furnished CC,9O 3h - D NEAREST CROSS ST I Certified copy is filed with the co�ty building i tion TRACTBLOCK LOT NO / L1,91 , PARCEL 3. 6J 1 , $ USE ZONE MAP NO. department ��- (_of't— ����✓L+'�' ASSESSOR MAP BOOK - PAGE Date Applicant SPECIAL CONDITIONS NO CERTIFICATE OF EXEMPTION FROM WORKERS' OMER S I�t�- f7 e V. 1 N G- ZEL (per' 155 WITHIN 1000 FT OF SCHOOL? YES No � COMPENSATION INSURANCE ADDRESS a 1 (This section need not be completed if the permit Is for one hundred &O 1 S F I(,ul IZON, F`-4(05 DISTRICT GROUP TYPE CONST' FIRE ZONE PROCESSED BY dollars($100)or less) CITY zIP I certify that in the performance of the work for which this permit L05 A,4(-eL_V-5 9 OO 1l S• a _ 3 � is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO become subject to the Workers'Compensation Laws. tab LES 5 toe I- g I$ 2.+x-1-(p$)1 STATISTICAL q.ASS�IF}CATION APT CONDO Date Applicant ADDRESS CLASS NO —D I NOTICE TO APPLICANT If, after making this Certificate of (�D u j^. . M 1 N �� �LI;�MnI7� REOUIRED 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 FRONT comply with such provisions,or this permit shall be deemed revoked ADDRESS LIC NO PL LICENSED CONTRACTORS DECLARATION CITY LIC CLASS PILE C U I hereby affirm that I am licensed under provisions of Chapter 9 _SO FTSIZE _ NO OF STORES NO OF FAMILIES SEWER MAP (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG O Professions Code,and my license is in full force and effect v License Number LIC.Class 17� DESCRIPTION OF WORK ADD ❑ VALUATION D t2Eri�u,)"•4 iat 1. Contractor-TRk"r'o"r o" .-Fate ALTER ❑ Z ,5 I .it- aST P.l_ 34SI REPAIR 1:1❑ I am exempt under Sec. i I B BPC.for this reason Z GO7 AT S a u-Ir I P•L-. Zo a DEMOL ❑ LDMA P/C# � USE t--,-,-, 'EXISTING BLDG URM ' ❑ 'L" Date � ,� �w Signature APPLICANT(PRINT) TEL NO t., LDMA Penn# S'YL1 p-T s ►►off L p v El . ►N c 213 l)5SS _ I, as owner of the-property, or my employees with wages as (p'1.z( O their sole compensation, will do the work and the structure is ADDRESS Lgt1- not Intended or offered for sale (Section 7044, Business and t7 FIbLl e_"A, FINAL DATE Q Professions Code) �� �� G WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ❑ I, as owner of theproperty, em eXCIUSIVBI contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 14%,._ 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 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH 'f CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST " FORGUIDELINES I hereby affirm that there Is a construction lending agency for YES ❑ NO❑ �.- the performance of the work for Wh�h this permit is issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD w�,- 3097,CIV C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES i- r t- COUNTY CODE,TITLE Z CHAPTER 220 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING 1•^( Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD Lender's Address av ER ORAGv _0 1 certify that I have read this application and state that the above PC FEE PERMIT FEE ' information is correct I agree to comply with all county G `7� ordinances and State laws relating to building construction,and Q' hereby autho¢e representatives of this County to enter upon ISSUANCE FEE ,;:v A/_ ��t the ab ve ntloned propert or Ins con purposes INVESTIGATION FEE TOTAL FEE / Q J Q' ^ �J O • / O a Aovaart a= 0m 4 / SEE REVERSE FOR EXPLANATORY LANGUAGE I -