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Home My Public Portal About10548 LIVE OAK AVE_Building__ 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 Q - Live O \L or a certificate of Workers' Compensation Insurance,,or a certified copy thereof(Sec 3800,Lab C) CITY ZIPa ei r- � 1� C l`� LOCALITY Policy No JZ1��Z` Company �RT� r. '� SIZE OF LOT I NO OF BLDGS NOW ON LOT �L-'M �+ `�►'� ❑ Certified copy is hereby furnished b(OlLi NEAREST CROSS ST ' r� Certified copy is filed with the county budding Inspection TRACT q BLOCK LOT NO M�1v department USE ZONEFA!_a Date Apphcant�t�- 0,PA C-Q P. 0-1 ASSESSOR MAP BOOK PAGE PARCE Z- ` 15L �� ZL CIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ITJEL NO COMPENSATION INSURANCE RAIZ–�S hl 5 WITHIN 1000 FT OF SCHOOL'S YES NO (This section need not be completed if the permit IS for one hundred ADDRESS dollars ($100) or less) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY CITY ' I certify that In the performance of the work for which this permit -5GVA Is issued, I shall not employ any person In any manner so as to 7 O Mc•- beCOme,Sub)ect to the Workers'Compensation Laws ARCHITECT OR ENGINEER TEL NO STATISTICAL CLASSIFICATION TT 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 to the Workers' CONTRACTOR, TE NO SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ' TEN)< ala Yd" o . Z+:}o–COme(o FRONT comply,with such provisions or this permit shall be deemed revoked ADDRESS Ud NO P L LICENSED CONTRACTORS DECLARATION IT�� R c'As? GL' g SIDE CITYSAN v�R L& SEWER PIL I hereby affirm that I am licensed underprovisions of,Chapter 9 �J SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZENO OF STORIES NO OF FAMILIES Professions Code,and my license is in full force and effect O NEW BK Pb a License Number 491 Z1— Lic Class DESCRIPTION OF WORK ADD ❑ VALUATION > O rO Contract8r'Mtz�:r01-4 t!i FrDate 3 1D LOVE ALTER ❑' $ U ❑ I am exempt under Sec REPAIR ❑ $ OO B&PC for this reason DEMOL ❑ LDMA P/C# - W ' Date USE OF EXI G BLDG URM ❑ 9 Signature APPLICANT( INT) TE NO- LDMA Perm# 1 Z ❑ I, as owrier of the property, or my employees with wages as `, their sole compensation, will do the work and the structure is ADDRESS 0 J�11 103.(��' not intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 1 ITEMS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ❑ I, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES a �° licensed contractors to, construct the project (Section 7044, ,� 1 FINAL BY "VITAL JL03 0 05 •Business and Professions Code) ves❑ No byr 103.05't WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHECK 103 a�c �5 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH {{'' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKUST FOR [}AN oll:r GUIDELINES L•f7tit1l7L I hereby affirm that there is a construction lending agency for YES 1:1 NO N the performance of the work for which this permit Is issued(Sec I HAVE READ THE HAZARDO ALS "MAI GU E AND THE SCAQMD PERMITTING _ 3097,CIV C) CHECKLIST I UN.ERST RE IRE NTS UN R E LOS ANGELES COUNTY CODE, I�I �'SI'Y_(ifSP}i 7/21/9 '}�`Ii�` a TITLE 2,CHAPTER 2 S 10 2 100 THR G 20 140 CONCERNING HAZARDOUS UJ VIiV 1 Lender's Name MATERIALS N D F I A P FROM THE SCAOMD Lender's Address 0°x'7 1 AM 11:0 O OHNE /,GENT , o I certify that I have read this application and state under penalty o PC FEE PERMIT FEE of"pepury that the above information Is cor ct I agree to comply with all county man,es and State w relating to building m construction, r by uthorize r res tativeS of this County ISSUANCE FEE 6, -`D to U th a e e e y for mAeonINVESTIGATION FEE TOTAL FEEnoem ' SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES BUILDING AND'•SAFET WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS • I hereby affirm that I have a certificate of consent to self,insure, BIL 11�A Dn / �� or a certificate of Workers' Compensation Insurance,or a certified `j v copy thereof(Sec 3800,Lab C) I,,P JI " zip 1,1(0 LOCALIT Policy No Company SIZE F OT NO OF BLDGS JJOW ON LOT El Certified copy is hereby furnished 1 Y NEAREST CROSS ST ❑ Certified copy is filed with the county building Inspection [ASSSSI'R CBLOCK LOT NO department USE ZONE MAP NO Date Applicant M OOK PAGE PARCEL • 1 i I� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' W E�j�- ,�it�No��Q`r_�_� ` ' + COMPENSATION INSURANCE p�RY�g�/� Yj �I 'aJ'J WITHIN 1000 FT OF SCHOOL? YES ,NO (This section need not be completed If the permit is for one hundred A(hC/)�0� 1 I l DISTRICT GROUP TYPE CONST FIRE ZONE PROC SED BY dollars ($100)or less) : CITY V V F'1 ZIP •`/ I certify that in the performance of the work for which this permit C) b o shall not employ any persona any manner so as to AR�FpTF�(jT o N NE R� ' i� TEI, is is j cyto the Workers' ens n aws IX�I�KV R 1 "� b STATISTICAL CLASSIFICATION A O 0 Date �pllcant � 1 ' ADD S ►(�^\pyo' CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this' Certificate of " N�' �� u'' _' REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' NT TOR yy k TEppL,,NO n SET BACK YARD HWY PROP LINE WIDTH C Compensation provisions of, the Labor Code, you must forthwith l� U�iJ V1I L FRONT comply with such provisions or this permit shall be deemed revokedD S t; p I P L LICENSED CONTRACTORS DECLARATION Iv N1 i A, " -"` ' SIDE CITY' .0 LIC IQLASS P L 1•hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business and NO OF S)PRIES NO OF FA #LIES SEWER MAP Professions Code{' I'�y Ice�11SeIis in full force a eff t :t 7 �, NEW BK PG 0- License Number v — �N is Class 's J DES RI TON F WORK ADD ❑ VALUATION - D Q e-O U Contractor to ❑ ,, 'ALTER _ a CfV REPAIR ❑ � O [11 am exempt under Sec B&PC for this reason DEMOL ❑ LDMA P/C# W Date - USE-OF EXISTING BLDG � URM El _ 1 CO Signature - A P'!G INT)► /_ �; 0 f LDMA Perm# - lil�•1-fog Z ❑ I, as owner of the property, or my employees with wages as l� 1 (�• their sole compensation, will do the work and the structure IS AD AA/ O a� 1; i�7.9[1 FINAL DATE not Intended or offered for sale (Section 7044, Business and V v 1 ITEM'S % Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL lr(� ❑ 1, as owner of the property, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q TOTAL 117 -90 Y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �J iI l licensed contractors to construct the project (Section 7044, YES❑ NO❑ 1?e JIJ Business and Professions Code) �' "'� _ WILL THE INTENDED USE OF,THE BUIDLING By THE APPLICANT OR FUTURE BUILDING CHANGE (r'�'j 1 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH /�Gj ■V CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKU GUIDELINES , I herebyaffirm that there Is a construction lending agency for ' g g Y YES❑ No❑ n N the performance of the work for which this permit Is issued(Secy n� �Si ry 7 � #HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING ..!�`��./ ( 111 l�— � 3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER'THE LOS ANGELES COUNTY CODE N TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS I.� •C S 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD ('1 AM '7:• EL Lender's Address OWNER OR AGENT O o I certify that I have read this application and state under penalty of perjury that the above Information is correct I agree to comply PC FEE PERMIT FEE N with all county ordinances and State laws relating to building' < construction, and er by authorize representatives of this County ISSUANCE FEE m m to enter u ove-menti d property for Inspectio purposes S m - INVESTIGATION FEE TOTAL FEE � e a roWca,l A�t 9,0 SEE REVERSE FOR EXPLANATORY LANGUAGE ��,j�Oj2KERS' COMPENSATION DECLARATION I,su re by C certificate that I have rk certificate of consent to self Qp p�� o,u d O H - Fag,G°3 o M d d D d H CG p C� m 0 u insure, or a cerirficate of Workers' Compensation Insurance, or a certified copy, thereof (Sec 3800,-Lab C.) : COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No12-�-302'fl• Companyg%/.-`Tg r�UNJD „ BUILDING Certified copy is hereby furnished ' _ FOR APPLICANT TO FILL IN ADDRESS 105 'a�K ;9 Certified copy is filed with the county building inspec- BUILDING - LIVE OPK AVE, tion department ADDRESS i OS y Fj C SO Date.17-11149 Z Applicant TEX'Cnµ GO�IS"T CITY Z E M tom: , uZ ZIP 6'l ci0 LOCALITY TEV• U•"'C �I 11 NO OF BLDGS I CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 4�p 4O1 NOW ON LOT 'O NEAREST. CROSS ST COMPENSATION INSURANCE i ASSESSOR (This section need not be completed if the permit is for one TRACT qZ" BLOCK LOT NO MAP BOOK BSg(O IPAGE '1ZPARCEL hundred`dollars ($100) or less ) TEL OWNER ST�a,¢:TS INTI. DfcV arcN0Z13 fLy15S5 USE ZONE . MAP I SO1 '-L-7 NO t'11 I certify,that in the performance of The work for which this - PE IAL permit is issued, I shall not-employ any person in any manner - ADDRESSCpO S I6UI-MoA ��50 _ CONDITIONS a so as to become subject to the Workers'Compensation Laws p' - CITY •LD S' -.&t16l5LZ5' GA. ZIP 9001 F U Date Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY � NOTICE TO APPLICANT If,�after`making this'Certificate of ENGINEER /1.L�ER--C• Al-GO •N071y Iq CONST ZONE 4 O Exemption, you ',should become, -subject,to the Workers' CwN g�Q/Jp�li-b J U LAND sz) 'Z-� , V U Compensation provisions of the Labor Code, you must forth- ADDRESSI-410 Jim vv a with comply with such provisions•or-this permit shall be � TEL STATISTICAL CLASSIFICATION APT` CONDO N deemed revoked CONTRACTOR-rQC til �_-o{J$'t• ' NO 6 _Z� LICENSED,CONTRACTORS DECLARATION - LIC CLASS NO QQ DWELL UNITS I hereby affirm that I cim licensed under provisions of Chapter 9 ADDRESS DS S "SAN 6 A441 6L NO 5"709-79SEWER MAP ' (commencing with Section 7000)of-Division 3 of the Business LIC I - .r AL GAF�Wiiu CLASS . , and Professions Code,and my license is in full force and effect BK N PG �$ �9 '' �,�•Y� A�DATION• SQ FT NO OF NO OF •CHECK License Number �Lic. Class SIZE rj O STORIES FAMILIES ONE�f 1.3113 �l�f 1131 04. ?i, Coniraclor��Ed� GOfaS� Date•17-11� �'� DESCRIPTION OF WORK 5•�•D LAIN NEW L� ITEM j ' - - ADD ❑ ❑1 am exempt under•Sec. IA-P- ❑ i i�) �-= 1i ZF'iy' /O/ Dag B&P C for this reason $ (-HE�K ��It REPAIR ❑ - pp'' �• Date USE•OF EXISTING BLDG DEMOL ❑ i:Hf19L�E of iJ- Signature APPLICANT TEL FINAL' �- g (PRINT)ST/�IzTS' ANTI. O�ed,19 OL13 "9 it-s 6 OWNER-BUILDER'DECLARATION DATEW �y �r� 1-hereby affirm that I am exempt from the Contractor's License ADDRESS O S �6UM�P ciA-46•SO L./�► I trislVU.41D • 12/14P Law for the following•reason (Section'7031'5, Business and FINAL r Professions Code) PRESENT- =t BY El 1, as owner of the property, or rry employees with BUILD F,w, v/ �, wages as their sole compensation,will•do the work and �ocAUTY 4 _ 1�1., the structure is not intended or offered for sale(Section � w �: ',f e 4 7044, Business and Professions Code ) MOVING ` - ` TEL CONTRACTOR NO ��r; t �,.z±J11� +.`.1317. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code-) , � . • '' ITEN03 REQUIRED TOTAL-SETBACK FROM EXIST j'� pp r CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTHt Ti 1TfL i0V7.1J.T i 1. I hereby affirm that there is a construction.lending agency for FRONT � ( �•` r f t - the performance of the work for which this permit is issued OL I f- CHECK- ?'039.0 (Sec 3097, Civ C ) SIDE, _i`• ` S' t P L _ y CHANGE .I:Iil Lender's'Name /a 9 y 4 /9 3 LDMA Ref # ' P C Fee$' / rmi ee / �I!I�I[I-� �1 J` 115' Lender's Address ; 1 certify that I have read this application and state that'the v / a/ Issuance Fee �� • LDMA P/C# 1 1 1 t� 11�'tf� above information is correct I agree to comply with all County Investigation Fee r ordinances and St to to s relating to ilding construction, Total Fee o1O�7 a LDMA Perm # a and hereby out ize resentative of his County to enter ' upon th ab e e propert f inspection ur oses Zr SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date