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Home My Public Portal About9218 LIVE OAK AVE_Building__ ` 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, BUI DING ADDF�ESS �� 4��0 OK or a certificate of Workers' Compensation Insurance,or a certified �ZIRLL copy thereof (Sec.3800,Lab.C.) ZIP C1� G!� O LOCALITY Policy No. Company SIZE OF NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS . ❑ Certified copy is filed with the county building inspection TRACTBLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASS SS R MAP BOOK PAGE / PARCE�D� aOJ! SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER EL NO. COMPENSATION INSURANCE 7 I�! l b" GO to ZD WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS L,W DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) VC.. I certify that in the performance of the work for which this permit CITY� e ZIP _ is issued, I shall not employ any person in any manner so as to becomes bje t to the Workers'Compe tion Laws. ARCHIT OR ENGINE TEL NO. J P ,1 STATISTICAL CLASSIFICATION APT CONDO Date 'R Applicant o�lo- 1 ADDRES'Sr1V�nvin/ CLASS NO. DWELL UNITS NOTICE TO APPLICANT.. If, after ma g/to Certif ate of VJw'�/� REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Su ject the Workers' CONT CTOR 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. ADDRES LIC.NO. P L SIDE LICENSED CONTRACTORS DECLARATION 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 NO.OF STEFE7 NO.OF FAMILIES } Professions Code,and my license is in full force and effect. rQ NEW ❑ BK PG 12- License License Number Lic.Class DESCRIPTION OF WORK ADD VALUATION , O Contractor Date 'a D ALTER El � cc ❑ I am exempt under Sec. REPAIR ❑ $ , �p 0 B.&P.C.for this reason DEMOL ❑ LDMAF/C# d Date: USE OF (STING BLD �� URM ❑ T , aK�► E Q,v w i Signature APPLICANT(PRINT) �J TEL cf LDMA Perm# `' Z ❑ 1, as owner of theproperty, or m employees with wages as ��" a 8 �d Z `f their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and DRE / ! INAL DATE Professions Code.) L WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT H DLE A HAZAR US MATERIAL J z EQUAL El 1, as owner of the property, am exclusively contracting with AMOUNTS SECFIIEDTAINING ON HE HAZARDOUS MATERAOR A MIXTURE A HAZARDOUSILSNFFORMATTIIONRGUDE?ER THAN THE FINAL BY licensed contractors to construct the project (Section 7044, �y X i,4 Business and Professions Code.) VES El No El _ _ r- - WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ��j i i ••^ s '�: OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH -•1--s •L�`'�'' �� CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR 1 _z i GUIDEUNES. i 1 i SMC 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. (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING �;ITAi -03 m 95 N 3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, r ,�, ` � TITLE 2,CHAPTER 2.20 SECTIONS 2.20 100 THROUGH 2.20.140 CONCERNING HAZARDOUS i %�"E: Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address OWNER OR AGENT O o I certify that I have read this application and state under penalty o P.C.FEE (� PERMIT FEE of perjury that the above information is correct.I agree to comply �`� 5 _ _ with all county ordinances and State laws relating to building t/ �' /� �� `:_€i 1j-0-1 1_!1 ic, 4 t 7=t w construction, and hereby authorize representatives of this County ISSUANCE FEE to enter above-mentioned roperty for inspection purposes. i Hrl 1_0.52 �� _�i INVESTIGATION FEE TOTAL FEE / a• L/� cO /y J _J SEE REVERSE FOR EXPLANATORY LANGUAGE s 'PORKERS' COMPENSATION DECLARATION re khat I have certificate of consent to self insure, or a cerhticate of Workers' Compensation Insurance, APPLICATION F nR B UH, L D I N G •P E RM I T r a cerci#ted copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELNS BUILDING AND SAFETY Policy No. Company BUILDING / ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS CITYv� ZIP LOCALITY �(iC lil Date Applicant -rteW O. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT �/ NOON LOT CROSS ST. COMPENSATION INSURANCEASSESSOR p�J (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK O Q PAGE �Q� PARCEL hundred dollars ($100) or less.) �O T . OWNERO. USE ZONE MAP I certify that in the performance of the work for which this {`1 SPE permit is issued, I shall not employ any person in any manner �O ADDRESS CONDITIONS O / as to become subject to the Worker ' mpensation Laws. U Do. / 3 pp .�° CITY ZIP 0te/ Ilea ARCHITECT OR �•�• //�� TEL. - DISTRICT GROUP TYPE FIRE PROCESSED BY . NOTICE TO APPLICANT: If, a ter maki th' ertif'cate of ENGINEER �//�j s a�Q1�NO. . 9 CONST. ZONE O Exemption, you should become suble o the' Workers' �C j/ �{ Compensation provisions of the Labor Co you must forth- ADDRESS/ �Q✓ ��O `� ✓ ��l�c a with comply with such provisions or this permit shall be "' TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR (��ry/� NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. o DWELL. UNITS hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business UC. and Professions Code,and my license is in full force and effect. CITY CLASS BK. PG. VALIDATION SQ. FT NO. OF / NO. OF CHECK License Number Lic. Class SIZE (� STORIES ( FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW _ El am exempt under Sec. std ( �/7 ' /�'r ADD ❑ s ALTER ❑ �! � .�U y7, B.&P.C. for this reason REPAIR ❑ $ Date: USE OF az R� EXISTING BLDG. DEMOL ❑ ° Signature APPLICANTTEL• FINAL '.rt °' '64'°`," OWNER-BUILDER DECLARATION �1 (PRINT) NO. Z- 7� DATE a(`�D T 1 ITE ;'4c- I hereby affirm that I am exempt from the Contractor's License b , �� Law for the followingreason Section 7031.5, Business and ADORES ( FINAL TOTAL �.*�i`•:� �"r °L . Professions Code): RESENT BY LDING aLI, as owner of the property, or my employees with ADDRESS _ wages as their sole compensation,will do the work and - the structure is not intended or offered for sale(Section LOCALITY tTT �yt3 7044, Business and Professions Code.) V MOVING TEL. ❑ I, as owner of the property, am exclusively contracting - CONTRACTOR NO. with licensed contractors to construct the project (Sec- DRESS 1/�f. tion 7044, Business and Professions Code.) ` c ?'fig 1 AM :7� l CONSTRUCTION LENDING AGENCY SET BACKK YARD HWY IREDRE TOTAPREOP. 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. 1. (Sec. 3097, Civ. C.). SIDE P.L. ACC 111.4Lender's Name. s/l /j Q° l �y Lender's Address P.C. Fee$ Permit Fee LDMA Ref. # s! 01 2•:)�.I~°•�9 . 1 ITEMS 0 1 certify that I hove read this application and state that the ��•� Issuance Fee 7T kA P/C# , 8 above information is correct. I agree to comply with all County InvestigationFee .n° dj TOTAL ,7S0 °3 , R ordinances and State laws relatingto building construction, TotalFeJO LDMA Perm. # a and hereby authorize representatives of this CC/ounty to enter CHECK L,0}°`9 upon the pve-mentioned property for inspection purposes. j./ CHANGE(^ .00 !_ SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of p leant or Agent Date �Lft CJ 0000-00011, 12! 3/92