Loading...
HomeMy Public PortalAbout5812 MUSCATEL AVE_Building__ APPLICATION F®R; BUILDING PERMIT � ` COUNTY OF LOS ANGELES ' BUILDING AND SAFETY WORKERS COMPENSATION DECLARATION FOR APPLICANT TO FILL IN• BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUIL I DRZ J� 4• or a certificate of Mrkers'Compensation Insurance,or a certified Qu copy thereof(Sec.3800,Lab.C.) CI ZIP beo ' LOCALITY-'Z d�la-G PoIICy NO. Company SIZE OF LOT I NO.OF SLOGS.-NOW ON LOT ❑ Certified copy is hereby.furnished. NEAREST CROSS ST. ❑ Certified. copy is filed with the county building inspection ' BLOCK LOT NO I department.' I• eG� 0• q � ! USE ZONE MAP NO. -/ •' ASSESSOR MAPS K PAGE PARCEL • Data, Applicant �- T1 —� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ' { TEL.NO. a� 0�� YES NO. COMPENSATION INSURANCE Ti°Irv+ ". 441 0 WITHIN 1000 FT..OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred fzj a''' f' r` �01 DISTRICT GROUP TYPE CONST' FIRE ZONE P CESSE Y ., dollars($100)or less.) r� I ceCITY �!rtify.that In-the performance of the work for which this permit �•I-CcLGvt zIP a o �,'�� �3 Is Issued, I shall not employ any peraw in any manner so mo to ARCHITECT OR ENGINEER TEIL NO. Ls becom 11 eC the Workers'C ion (P STATISTICAL C IFICATION APT CONDO P, 4Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTI E O APPL after In .this Certificate o ' E M 9 REQUIRED TOTAL SETBACK FROM EXIST .Exemption, you should become bj@ct to the Works CONTRACTOR TEL NO. SETBACK YARD HWY PROP LINE WIDTH VV Compensation provisions of the Lab r Code;you must forth comply with such provisions or this permit shall be deemed revoked. ADDRESS. LIC.NO. FRONT PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE PL O I hereby',affirm that I am licensed'under provisions of.Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and — FT SIZE 1 NO.OF STORES NO. FAMILIES NEW ❑ BK PG C Professions Code,and my license is in full force and effect. �• DESCRIPTION OF WORK, ADD V DN- P010- OF W License Number Lia Class $Ai� 2r,80 f y Contractor ' Date •ALTER ❑ �`"'44 ©L/ t� f� ❑ I am exempt under Sec. REPAIR El BARC.for this reason DEIMOL 0 LpMp P/C# Date: USE OF OGST I G. URAA. ❑ Signature ARPLI W ( 1 TELNO. El 1.as owner of the property„or my employees with wages is ''� LOMA Perm# ` p 1 ' their sole compensation,will do the work and the structure is ADDRESS not Intended or offered for sale (Section 7044, Business and .7? d✓�d/h" �01 CVs' FlNAt'A Professions Code.) 3307 385.90 WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT LEA HAZARDOUSMATERIAL ,J ❑ I,.as owner of.the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ITEMS Y g THE AMOUNTS SXFIED ON THE HAZARDOUS,MATERIALS INFORMATIONGUIDE?, FINAL BY ; - 1 I t Ei 157 licensed contractors to.construct the project..(Section 7044, YES❑ NO hQ Business.and Professions Code.) r` TOTAL 385-911 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING _ OCCUPANT REOUIREA PERMITFOR CONSTRUanON OR MODIFICATION FROMTHESOUTH CHECK /�t f {}r CONSTRUCTION LENDING AGENCY T AIR QUAMR GUIDEL D MANAGEMENT DISTRICT.TCAOMD)SEE PERMITTING CHECKLIST CHECK I hereby affirm that there is a construction lending agency for yre❑ NO CHANGE =00 the performance of the work for which this permit Is Issued(See. I HAVE READ THE HAZARDOUS MATERIALS INFORMATIO VIDE AND THE SCAOMD DER 3097,CIV.C.). PERMITTING CHE�CIUNDERSTANHAPTER 22IAN 0 I1 DUGH 2.2D.tA0 CONN THE LOS CERNING NG + . ' CgpB, 00001-0001 5/ 7/911 Lender's Name QOLINTY ARDOOS IITERIALSREPORTINGAND ROBTAI GAPERM FROMTHESCAOMDLenders Address cm AGOIT �7 a27 1 AM .42 I certify that I have read this application and state that the above Information Is correct. I agree to comply with all county P.91 FEE PERMIT FEE (.70 f , ordinances and State laws relating to building construction,and 7cxII hereby a orim represent f s County to enter upon ISSUANCE FEE 7t entioned r pection pulp as � (J �• �I��/ • INVESTIGATION FEE TOTAL FEE + A SEE REVERSE FOR EXPLANATORY LANGUAGE,