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HomeMy Public PortalAbout10433 MILOANN ST_Building__ 7®A899A CE#809..,.58 APPLICATION FO R. U I L®I N G -P E R ISI I T BUILDING AND SAFETY DIVISION BUILDING c . Deparb hent of County Engine! ADDRESS County of Los Angeles LOCALITY r JOHN A.LAMBIE. COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST.'$ali ax DISTRICT NO. I GROUP I TYPE SEWER MAP FOR.APPLICANT= WORKERS'COMPENSATION DECLARATION' I hereby affirm'that I have a'certificate of consent'to self- insure, orb certificate of Workers'Compensation Insurance, •f APPLICATION FOR WILDING, P E RM I T or a certified copy thereof''(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES t BUILDING AND SAFETY + ' Policy.No. Company. i ❑ NG Certified copy.-Is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS .3 ❑ Certified copy is filed'with the-county building inspec- BUILDING tion department. ADDRESS ✓1� I,, CITY' ZIP LOCALITY a.C Date Appliaont NO.OF BLDGS. NEAREST' CERTIFICATE OF EXEMPTION-FROM WORKERS' SIZE OF LOT' NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not'be completed if the permit is for one I TRACT' BLOCK LOT NO. MAP-BOOK PAGE PARCEL hundred dollars ($100)'or less.)'... , - I �\ - rEL,5� �� OWNER NO. USE ZONE MAP / 6 I certify that in the.performance of-the work,foT which this I� aa ,, :{' No permit is issued, I shall not employ any person-in.any manner .( ADDRESS t7 `v`�LN'� • SPECIAL t I CONDITIONS O so as I-become subject to the;Woekierss''Compensatiori•Laws. ,I U �,,��. LIrt. '.�Y�TJ� CITY• a. . ZIP / ~.: ... .. ,. '. U Date„2_( �Applicant i ARCHITECiOR TEL. .,DISTRICT-- GROUP TYPE. FIRE SED BY O NOTICE TO APPLICANT:•I.f,. after,making' this Certificate of '' ENGINEER NO..' CONST. ' ZONE :•0 Exemption, you-should become.-subject to fh'e Workers' I 4 T. w Compensation provisions of the Labor.Code, you must forth- I . ADDRESSd p 3 p with .comply, with •such provisions'•or•,this permit.shall be''°•j, TEL STATISTICAL CLASSIFICATION APT. . CONDO. rn deemed revoked: CONTRACTOR O&F-6! N Z LICENSED CONTRACTORS bECLARAT,ION. LIC. CLASS NO. DWELL. UNITS I hereby affirm'that l am licensed unMiI�iilJ-. der provisions of Chapter9 i. ADDRESS NQ' _ SEWER MAP (commencing with Section.7000)C4Division3 of the Business v-� LIC. and Professions Code,and my license is in full force and effect. CITY' CLASS BK PG VALIDATION �� j SQ. FT. NO. OF NO. OF'. CHECK ' License Number DgU' Lic. Classes- / r' SIZE STORIES' FAMILIES ONE ; - ',VALUATION' + Contractor sa'• �� Date• 4 DESCRIPTION OF WORK NEW /��O + ;j ADD $ !' am exempt under Sec. 1 ALTER•❑ 1 B.BP.C. for this reaso ' USE OF REPAIR ❑ $ Date EXISTING BLDG. DEMOL ❑ Signature: i APPLICANT TEL. ;FINAL �L /a OWNER:-BUILDER LARATION i (PRINT); NO. C7 s J I hereby affirm mE that I'am exem the ContractoD r's License AT Law-for-the following 'reason'(Section 7031.5,,Bus1H&ss and ADDRESS FI Professions Code): PESENT, ❑ I,•as owner of,the e:pr ert , or rn em to ees'with BUIL . DING ® P P Y Y p Y ADRESS wages as their;sole'compensatioh-,will do the work and`' ' "' F1:.•: LOCALITY �'� • the structure is not intended or offered for sale(Section •� + - ?�b";"�• ^ - - �v'e 7044; Business-and Professions Code.) MOVING TEL: CONTRACTOR NO. ❑ I,as owner of the property,am exclusively contracting I :! with licensed contractors-to construct:the project (Sec- j` ADDRESS •F " tion 7044;Business and Professions Code:) . E'- Z,9. REQUIRED TOTAL SETBACK FROM EXIST: ' CONSTRUCTION.L'ENDING AGENCY i SET BACK YARD HWY PROP. LINE WIDTH C.`F t•I.' '; jLi I hereby affirm.that there is a construction'lending agency for FRONT the performance of the work for which this'perWt,ii,issued P•L•'. " 'ars'; ;x'10 (Sec. 3097, Civ: C.).• SIDE.- Lender's Name ��-1 +,-� 4' a'r _ r• $ LDMA Ref.•q Llc ., t?__ ,r 7r`8 P:C..'Fee$' Permit Fee �� 01,111 y•r! Lender's Addressr 1 certify'that�l have read this application and state that the l Issuance Fee �'� LDMA P/C N ►'.;�_�- g above°infor ation is correctA agree to comply'with,ail•County •�•, Investigation Fee �• �, • ._ ; ; '�,: 3 ordinances nd State laws relating to 6u'lding construction, 1 Total Fee ! • LDMA Perm.N Q. and here authorize repres ves this County to enter _ m .'upon the Ove-menti ed or inspect' 'pug "se '' ' '-'B /' ' SEE REVERSE FOR EXPLANATORY LANGUAGE lgnature of pp cant or Agen Date `z:` , j WORKERS'COMPENSATION DECLARATION u that I hcertificate of consent to self insure, or a certificate of Workers' opensation Insurance, APPLICATIONF R BUILDING PERMIT or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES ` ' BUILDING AND SAFETY Policy No. Company �+ ❑' Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 3 3 G ❑ Certified copy is filed with the county building inspec- BUILDING I oc7p pl i S1- V - tion department. ADDRESS ^� Date Applicant CITY C ZIP / O LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK I PAGE PARCEL OWNER t 360010 USE TE MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner //�� i SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS V , �/ CONDITIONS U Date _ t Applicant l CITY ZIP I O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR W I(te TEL. "' DISTRICT G UP TYPE FIRE PR ESSED BY O ENGINEER NO. " CONST ZONE V Exemption, you should become subject to the Workers' II4)5Q9-�7 /( l l Jl, Compensation provisions of the Labor Code, you must forth- ADDRESS (�, f - �,l _ V a with comply with such provisions or this permit shall be TEL. . //� STATISTICAL CLASSIFICATION APT. ENDO. fn deemed revoked. CONTRACTOR - NO.13C_60(0/ Z LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �: NO. + (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP 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 e. VALUATIONAA pp((U Contractor Date DESCRIPTION OF WORK NEW ❑ $ �/ �v/ �9 7 9,8 A ❑ . 3 r�, ADD , loll- B.&P.C. # 0 0 o a 23 I am exempt under Sec. UAMALTER ❑ ( 028 for this reason CSP W-f REPAIR ❑ $ 2 8 6.8 8 J Date: EX S7688 USE 01NG BLDG. S I Cv, DEMOL ❑ a 7 a Signature APPLICANT TEL. ® FINAL 413A9 O8 OWNER-BUILDER DECLARATION PRINT iCC NO. DATE 1 hereby affirm that I am exempt from the Contractor's License ADDRESS .�. C Law for the following reason (Section 7031.5, Business and Professions Code): PRE BY ❑ BUILDING I, 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 7044, Business and Professions Code). MOVING TEL. I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). Is REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ©y �c1 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. (Sec. 3097, Civ. C.). SIDE 0 / 8 P.L. + Lender's Name Cal 9-88 y ry LDMA Ref. # Lender's Address P.C.Fee$ r Permit Fee 7 J • `-�� I certify that I have read this application and state that the Issuance Fee � LDMA P/C# / above information is correct. I agree to comply with all County Investigation Fee ao ordinances and State laws relating to building construction, Total Fee 6 LDMA Perm. # and hereby authorize representatives of this County to enter $ upon the above-mentioned property for inspection purposes. s SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date