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Home My Public Portal About5303 LOMA AVE_Building__ APPLICATION EOR BUILDING PERMIT FORiAPPLICANT TO FILL IN Print or type only) BUILDING i COUNTY OF LOS ANGELES ADDRESS ,3 d `1 DEPARTMENT OF COUNTY ENGINEER CITY P BUILDING AND SAFETY DIVISION LV C'� ZIP �} 42 BULDING SIZE OF LOT SE L{.+CSG-NOW NO OON LOTBLOGS /`�• ADIDRESS �3•a TRACT + p�) BLOCK LOT NO LOCALITY NEAREST OWNER 1�ANi•' (Z'�'SC1'i\3 NO 7,37) CROSS ST r ASSESSOR ADDRESS • C, �,()M MAP BOOK PAGE PARCEL DISTRICT GROUPTYPE FIRE P SED BY CITY :E(5 MJ �Lg C ltY ZIP eg CONST ZONE17 ARCHITECT OR '�, TEL c ENGINEER NO y STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO _DWELL UNITS BKPG TEL / CONTRACTOR �l:i*j NO, -- USE ZONE NOP D/ LIC JI ADDRESS NO SPECIA L LIC �61CONDITIONS CITY CLASS ROAD DE P A R T M EN T''A PP ROYAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER AA�� NAME AND BRANCH IV d - BLDG SETBACK FROM,,. FRO T PROP LINE OF` (STREET) ADDRESS CITY HIGH AY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING 'a. SQ NO OF NO OF + CHECK FRONT PROP LINE HIGHWAY WIDTH FT? OU STORIES FAMILIES ` ONE �a, } = LL DESCRIPTION OF WORK <• �(1 NEW El _ '6i DD �( BLDG TRACK FROM, _ Z ScG 1�r - Or )S 1 rV g1c;45 SIDE PRO OF, (STREET) LTER ❑ - TO TBACK FROM TYPE OF EXISTING , � ISTrNa HIGHWAY' -} YARD `_ HIGHWAY WIDTH REPAIR[] SIDE PRO INE USE OF } _ EXISTING BLDG Qu SEEDEMO_L ❑ - APPLICANT ��) TEL CORNER CUTOFF YES ❑ NO (PRINT) )u NO 7 BY (SIGNATURE) • - IN OPEN SPACE YES ❑ NO El Q IN COASTAL ZONE YES ❑ NO ❑ VALUATION Y .3 �CJ CATEGORICAL EXEMPTION YES❑ N ❑ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO COMPLY - IMPACT EXEMPTION DECLARA ION SIGNED ATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTIONI CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PRO SS (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORF MEN'S COMPE NS TION INSURANCE SIGNATURE OF PERMITTEE ADDRESS L i'VI/Q- � Y,717 r T' ��''�, �'—rt.+�►-i�c� NOrtG6 ' jam/ E L,r Q FINAL BY v Q C!r DATE CITYNO.T ��i f P MT Q MAKE CHECKS PAYABLE TO FEE t FEE HARVEY T. BRANDT, COUNTY ENGINEER PLAN CHECK VA� ATION cK M O CASH PERMIT VALIDATION K M O CASH 7 2 4 kP�i� 2 3 D 5 7.6 0 ,&y8. 325�JUN 6 1 96.0OA�8 76A 638A CE#803 7/73 ` f-- „ -- . APPLICATION FOR BUILDING PERMIT FOR PP_LIQANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS �� DEPARTMENT OF COUNTY ENGINEER - CITY" zIP /9 - BUILDING AND SA TY DIVISIONEO -- _ r NO OF BLDGS BUILDING SIZE OF LOT (,� .NOW ON LOT ADDRESS_ TRACTB OC LOT NO LOCALITY � L NEARES ' OWNER-OQ? O CROSS ST ASSESSOR ADDRESS- -MAP BOOK PAGE DISTRICT GROUP TYPE I FIRE ROCESS D BY CITY ZIP CONST ZONE ARCH TEC OR TEL ENGINEER NO STATISTICAL CLASSIFICATION WER MAP ADDRESS CLASS NOC2?!-/ OWELL UNITS SK/a G CONTRACTOR TEL, FI ZONE MAP NO NO LIC ADDRESS - - NO - �/ CrA T- 0' LIC CONDITIONS CITY- CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONS TRUCTI&ITILENDER NAME AND BRANCH BL SETBACK FROM FRONT PROP,LINE OF (STREET) ADDRESS - CITY _ TOTAL SETBACK FROM TYPE OF EXISTING O SQ FT NO OF - NO. OF CHECK HI WAY + YARD - FRONT PROP LINE HIGHWAY WIDTH _ U SIZE STORIES FAMILIES ONE _ DESCRIPTION OF WORK NEW ❑ U Lu ADD BLDG.SETBACK FROM (STREET) C� -SIDE PROP. LINE OF ALTER ❑ HIGHWAY } YARD - _ TOTAL SETBACK FROM OF EXISTING Z REPAIR❑ SIDE PROP LINE HIGH WIDTH 74g =1 USE OF DEMOL ❑ + EXISTING BLDG. APPLICANT CORNER CUTOFF YES ❑ NO ❑ (PRINT) BY (SIGNATURE IN OPEN SPACE YES ❑- NO ❑ Q IN COASTAL ZONE YES ❑ -NO ❑ VALUATION•1' o. CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AHD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION 1 CERTIFY THAT IN _DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF TME LABOR CODE OF THE STATE OF CALIFORNIA IN ELATING T •/f� F -7-40 WORKMEN'S COMPENSATION I S_URAN - _ ��l42 SIGNATURE O PERMITTEE ry ADDRESS r - FINAL BY TEL DATE A16 I /�� CIT NO 1l IRL ("IIL-C S P I},1131"L- 10 FEE EY� [FHRVEY T. BRANDT, COUNTY ENGINEER lj�lJ ' /S '00 PLAN CHECK VALIDATION CK' M O CASH PERMIT VALIDATION CK M O CASH �_�3 5 573 1 D OOg v 26 15 76A638A CE#803 12/72 - 9. 76A�J8A CE ,V§03 4,70 APPLICATION FOR BUILDING PERUTIV � COUNTY OF LOS ANGELES ASSESSOR } DEPARTMENT OF COUNTY ENGINEER MAP BOOK PP/GE PARCEL BUILDING AND SAFETY DIVISION BUILDING _ ADDRESS JOHN A. LA MBI E, COUNTY ENGINEER COLEMAN W. JENKINS, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST f CROSS ST not r t n . ��%�� DISTRICT NO. GROUP TYPE PRO SSED BY BUILDING � �D CONST: ! ADDRESS G7 �L v-___3 - - - - - - -- -STATISTICAL CLASSIFICATION SE ER'MAP LOT NO BLOCK CLASS NO. Z DWELL,UNITS 'r B �PG� TRACT US ZONEFNN P NO.OF BLDGS. 2SIZE OF LOT NOW ON LOTECIAL USE OF NDITIONS EXISTING BLDG. EL OWNER 14 fi&.j)6jVaL_K0. BLDG.SETBWlr..K FROM „ ADDRESS - FRONT PROP.LI (STREET) TYPE OF EXIS SETBACK YARD = TOTAL CITY ♦ HIGHWAY WIDTH I PRSM_C.L. ARCHITECT OR TEL. } - ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY } YARD TOTAL CONTRACTOR NO HIGHWAY WIDTH FROM C.L �, [L ADDRESS NO t = O CD LIC. CITY CLASS ICORNER CUTEOFF �. 'YES +0\\\ ��NO�S,y�♦� CD CONSTRUCTION LENDER NAME AND BRANCH — SEE REVERSE SIDE FOR,SPEC'IAL.APPROV�ALS a ADDRESS e ✓ d t_ r Z SQ FT. NO. OF NO. OF / ~\ '� e 'u-�\/,/Z='-_, SIZE STORIES FAMILIES _ NEW _ .tel\~ ••ti Y USE OF - ADD STRUCTURE = ❑ --,J"' \ LTER �� ^ - REPAIR❑ r;"i �'�b'a-'� � � : :ti•L;a'.6'•+k' .T\C°3. ��`� SIGNATURE OF ICr , APPLICANT DEMOL ❑ VALUATION'$ r. �• .. ,•�,.ewt•�\ APPROVALS DATE INSPECTOR S SIGNATURE z P.0 PMT. FOUNDATION:,LOCATION FEES - FEE $ �� FORMS, MATERIALS''• ,r•:�, �.. v`ti,, `. al FRAME: FIRE STOPS, �� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS .!! 1 AND STATE THAT THE ABOVE IS CORRECT'AND AGREE TO COMPLYi. WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON FURNACE LOCATION, STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED \ GAS VENT, DUCTS I _ t ,H, .' i HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE 'LA.TH; INT:' O - � � � LABOR CODE OF T E STATE OF CALIFORNIA IN RELATING TO 7 y• WORKMEN'S COMPEN ATION INSURANCE �J ` �:• LATH, EXT.1' ' 4 SIGNATURE OFHOUSE NUMBER COR- r; \i PERMITTEE RECT AND POSTED - •� /� ADDRESS FINAL;. JOHNI F LEWIS PRINCIPAL STRU URAL ENGINEER. PLAN CHECK VALIDATION CK 1 0 CASH PERMIT VALIDATIO �K-- M 0 CASH 76A638ACE48033-69 APPLICATION FOR BUILDIN PERMlit COUNTY OF LOS ANGELES ABUILDNG DDREISS ✓(�� • / 7.4 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION /E !� LOCALITY JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS, SUPT OF BUILDING NEARECROSS sT FOR APPLICANT TO FILL IN DIST CT N��(I GR UP TYPE.0 T. PR ED BY (PRINT OR TYPE ONLY) C/ BUILDING . STATISTICAL CLASSIFI- N SEWER MAP ADDRESS CLASS N0. �/ '•D L. UNITS BK PG 4 LOT NO e BLOCK E ZO MAP • _ NO. 2U TRACT sA PECIAL NO OF BLDGS. ((��`" -CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM TEL. FRONT LINE OF (STREET)i OWNERez N0. TYPE OF EXISTING BACK HIGHWAY + YARD = TOTAL HIGHWAY WIDTH FRO ADDRESS CITY ` ARCHITECT OR SIDE BLDG.SETBACK FROM (STREET) ENGINEER N0. SDE PROP. LINE OF TYPE OF EXISTING SETBACK HIGHWAY + ARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. _ TEL. + = r CONTRACTOR N0. CL LIC ADDRESS NO CORNER CUTOFF YES. - -NO -❑ u LIC. CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS CONSTRUCTION LENDER �Q %� /f w NAME CL AND BRANCH7/ �� ,� J/f/ i ADDRESS , l f �"s SQ. FT N0. OF NO OF SIZE STORIES FAMILIES NEW ❑ �� 70 USE OF ADD ❑ STRUCTURE ALTER ba / �_r ,{,(,,. REPAIR (❑" • �; '� - �_ , SIGNATURE CIE DEMOL E]APPLICANT VALUATION $ APPROVALS DATE" INSPECTOR'S 'SIGNATURE P C PMTFOUNDATION LOCATION FEE $ FEE $ j FORMS MATERIALS _.`.� ' tt7 I FRAME FIRE STOPS, IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I ,F'FURNACE LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- y GAS VENT DUCTS ' TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE ; LATH, INT. - OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. LATH, EXT SIGNATURE 0 PERMITTEE HOUSE NUMBER CORRECT AND POSTED �f ADDRESS a FINAL JOHN F LEWIS, PRINCIPAL ST URAL ENGINEER PLAN CHECK VALIDATION CK. M 0. CASH _ PERMIT VALIDATION CN. M.O. CASH I Ap,_, 3 3 1 J iiJ 13 1 D 6.00- I t DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT - COUNTY OF LOS ANGELES BUILDING WM, J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DIST NO. PLAN CK. NO. PERMIT O. BUILDING ADDRESS LOCALITY CEIV DB DATE OF APPL. DATE ISSUED NEAREST CROSS ST. BUILDING ADDRESS ! ✓6J z % A OWNER MAIL LOCALITY L- C / ADDRESS NEAREST TEL. CROSS ST. CITY NO. FIRE NO. OF TYPE�7'^ GROUP ARCHITECT OR TEL. ZONE ��_ PLANS I �JL� I ,pR� ENGINEER C� NO. BLDG. LINE Z� / ` �� //f�O�D�N q. ADDRESS t/ APPROVED `'f-'�,C`��L- TEL. BY DATE CONTRACTOR NO. USEAPPROVED ADDRESS ZONE A BY DATE HOUSE NUMBERING LEGAL DESCRIPTION LOT NO. I BLOCK MAP NUMBERZ- /�T FIELD CHECK BY TRACT NO. ASSIGNED BY r DATE NO. OF BLDGS. CORRECTIONS SIZE OF LOT NOW ON LOT ,_ USE OF NO. OF - EXISTING BLDG. FAMILIES DESCRIPTION OF WORK NEW I/ .. I ALTERATION I I ADDITION REPAIR I I DEMOLITION I I A SQ. FT. NO. OF SIZE ROOMS STORIES Z D EXT. WALL A, ROOF ` r COVERI �//U COVERING �1 I�P� USE OF STRUCTURE C--?AiCnn APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, SIGNATURE OFGAS VENT, DUCTS BY PERMITTE � LATH, INT. ADDRESS LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 76A638A� DBS3 10-50 > P. C. $ a G J di FEE PLASTER, EXT. VALUATION $ FEE - FINAL �''' ;..,,1;- I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES V 1 I J a WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN ' FOR OFFICE USE ONLY ' DISTRICT NO. PLAN CK.NO. PERMIT NO. ANG DDRESH ' �Y fJ � 4' II 51 ��.., 7 ,�♦• RECEIVED BY DATE OFAPPL. DATE199 ED LOCALITY i (...� I � /f� NEAREST e (u . , - /�s/ 7 Glace-74-�' CROSS ST. BUILDING C , �y OWNEMAIL/R/ . }E.f6'E�, p11,--�,,-�C.�aLI �1y 'i9'•_-4'�• ADDRESS J .J c� ep ` ADDI4ESB�.-)T.a im. //[�L�J.R/P{/�f 4-4 LOCALITY T C TEL NEAREST CITY Cl�4 kac/"�"''`e'^ NO. CROSS ST. 1 FIRE NO.OF I .TYPE GROUP ARCHITECTOR TEL ZONE �� PLANS - rI ENGINEER NO. BLDG. ' FP,CORD.NO. ADDRESS SETBACK LINE APPROVED CONTRACTOR NO. BY /L•. DATE USE ` - APPROVED ADDRESS ZONE / BY DATE LEGAL DESCRIPTION / LOCORRECTIONS NO. I I BLOCK �"'"� - TRACT �J Or h/,f, -7- 5XCQ T // SIZE OF LOT J` I NOW ON LOTs UBE OF NO.OF - EXISTING BLDG. L._J FAMILIES I ROOMS - DESCRIPTION'OF WORK NEW ALTERATION ADDITION REPAIR JJ�� p� MOVING NO.OF ^� DEMOLISH .� ,� �- ]�" .� ! L p 84.�. 7 a� Q ROOMS �7 STORIES - D SIZE r WALL ' ROOF h COVERING I COVERING CO In I USE OF NEW - BUILDING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS = APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS OWNER �� LATH,INT.: AUTHORIZED AOT.- \ -444?: r'`gyp LATH,EXT.: ' D82-3 25M SETS 1-47 $ P C. PLASTER. INT. D (J Q FEE PLASTER, EXT. �° VALUATION J FEE �/ Q FINAL �� DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES - •' WM. J. FOX. CHIEF ENGINEER 005 U FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLANCK.NO. PERMIT NO. BUILDING ADDRESS . LOCALITY RECEIVED BY DATE OF APPL. DATE ISBUED NEA CRO R BEBT BUILDNG �-• V ADIRE OWNER � � � n MAIL LOCALITY ADDRESS . t NEAREST TELCROSS ST CITY NG. J . (.. ARCHITECTOR TEL. ZONE PLOANS TYPE G OUP ENGINEER NO. r^ �` S BLDG. ORO.NO. ADDRESS SETBACK LINE APPROVED TE CONTRACTOR , NOL BY DATE USE APPROVED ADDREB ZONE BY DATE LEGAL 7 CORRECTIONS DESCRIPTION LOT NO. BLOCK TRACT le SIZE OF LOT Q DO I NO.OF BL . NOW ON LOOTST USE OF NO.OF NO.OF EXISTING BLDG. F•AMILIEB RDDMS DESCRIPTION C)F WORK NEW ALTERATION ADDITION O REPAIR MOVING DEMOLISH D SO.FT. NO.OF Z SIZE ROOMS STORIES D r WALL ROOF COVERING COVERING USE OF NEW ' BUILDING r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS PERMITTEE LATH, INT. AUTHORIZED AGT LATH, EXT. 76A63SA-3 7-49 $ , P.C. PLASTER, INT. ®'b FEE PLASTER,EXT. VALUATIONoO+�� FEE �� FINAL `�4�'�:'�u�'Til',/�--•-°� ��/ �.,.. PPU C AMOO M FOR BIMLIONG IPER O T COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AQJ�F]€SS _ Jf �•� I hereby affirm that I have a certificate ADDRESS of consent to self Insure, �3 M or a certificate of Workers'Compensation Insurance,or a certified GOP th7f SSec.3800,Lab C) � CI ZIP / ga LOCALITY POI1 o dl0�f —go m an�ht'[ - —11 p y SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished NEAREST CROSS ST Q�Certifled copy is filed with the county building Inspection TRACT BLOCK LOT NO depart ant // USE ZONE EANODate�rAPPlicant 0/1��/NI�!d hJ��i30>-S ASSE R MAP BOOK PAGE PARCEL 88 bb^'7 0-� L CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ow v II TEL NO YES No COMPENSATION INSURANCE ` L Q /1 WITHIN 1000 FT OF SCHOOL? ADDRESS (This section need not be completed If the permit Is for one hundred U M A 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 ' :g I-78b is Issued, I shall not employ any person In any,manner so as to ARCHITECTIOR ENGINEER TEL NO become subject to the Workers'Compensation Laws. STATISTICAL CLLAjSSIIFICATION APT CONDO Date Applicant ADDRESS CLASS NO pL�/DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate ofREQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CO TOR _ TEL.NO p SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith a �` '10 FRONT comply with such provisions or this permit shall be deemed revoked D ESS LIC NO P L LICENSED CONTRACTORS DECLARATION CITY LIC CLASS 8 SIDE Coa.� I hereby affirm that I am licensed under provisions of Chapter 9 L SEWER MAP (commencing with Section 7000)of Division 3 of the Business and S NO OF STORES NO OF Ff1MILIES / 4 CD Professions Code,a d my license Is in full force and effect I/ NEW ❑ BK�/fi� PG (p U Z 83 D CRIPTI N OF WORK ADD ❑ VALUA O License Num r Lic Class _ co Contra ctate 3a Z _ ALTER .❑ 00 CnZ vf" REPAIR ❑ I am exempt under Sec V B&P C for this reason rIUSE _ DEMOL ❑ LDMA P/C M Date EXISTI LDG URM ❑ 't [ �LIAT Signature App6w.ANT(PRINT) LDMA_ TEL NO Perm a ! 3 z 8 ❑ I, as owner of the property, or my employees with wages as O He s;, their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section DATE n 7044, Business and 0 _, i, _ Professions Code) WI LL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALOR A MIXTURE J ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUSINING A TOINFORMATIONN GUAL TO OR IDE? FINAL THAN FINAL BY I L licensed contractors to construct the project (Section 7044, 1T" , Business and Professions Code) YES❑ No❑ ��_ Fig 93 = 63 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING 5, OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH L•I� '�•J j+.:cL+J CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES CHANT I hereby affirm that there Is a construction lending agency for YES E] NO❑ �� the performance of the work for which this permit Is issued(Sec I HAVE READ THE HAZARDOUS MATERIAL INFORMATION GUIDE AND THE SCAOMD { 3097,CIV C). PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,TITLE Z CHAPTER 220 SECTIONS 2 20 100 THROUGH 220140 CONCERNING Lenders Name HAZARDOUS MATERIAL REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD Lenders Address 5123 S 4411i 1"1 0 AGENT 1 certify that I have read this application and state that the above PC FEE PERMIT FEE ��ggg��rtrtrt ation is �rty mply with all county fj L� ordma es a d Sta [ding construction,and v' v hereby uthorize.rCounty to a ter Up ISSUANCE FEE the abo m tic tion purp / a INVESTIGATION FEE TOTAL FEE (d/ SEEREVERSE FOR EXPLANATORY LAN AGE