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Home My Public Portal About10616 OLIVE ST_Building__ TEMPLE CITY Iun"06#8082/00 APPLICATION FOR BIDIL..DING PERMIT 1 COUNTY OF LOS ANGELES' BUILDING DEPARTMENT OF COUNTY ENGINM ADDRESS yew BUILDING AND SAFETY DIVISION LOCALI �+ JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. i 'S"s"- DIST CT N . GROUP TYPE P OCESSED BY FOR APPLICANT TO FILL IN (j CONST. BUILDING STATISTICAL C SIFICATION SEWER MAP ADDRESS ff K CLASS.NO. DWELL.UNIT LOT NO: BLOCK NUMBER HAT YES NO - TRACT USE^ZONE SPECIAL �+,/� `r1 NO:OF BLDGS. CONDITIONS SIZE OF LOT J(% V I NOW ON LOT /`t ' USE OF. BLDG i BUILDING 1EXIST. YARD HWY STREET NAME TE SETBACK IDTH OWNER NO. �3?i POINT 91 ADDRESS SIDE ARCHITECT OR �—' TEL. P.L. ENGINEER _ NO. INSPECTION,,�ECC��{j� ADDRESS 1 O _ a TF-16, 1. 0 A v CONTRACTOR NO1 s v O ADDRESS , DESCRIPTION. OF WORK. LTER REPAIR DEMOLISH E+ NEW � ADD A �f• ' ,� jf SQLVAANLUATION FT NO.OF NO.OF STORIE FAMILIES C� n2 FFj"r1 J OF T APPROVALS DATE INSPECTOR'S SIGNATURE �. FOUNDATION:LOCATION V FEE '$ FEE.$ V.vis+ FORMS,MATERIALS FRAME:FIRESTOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- BRACING BOLTS `� 5 AV44.,g PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE:.LOCATION. AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'S COMPENSATION LAWS OF CAL ORNIA. LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE— RECT AND POSTED ADDRESS FINAL .G CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cr. M.O. CASH V. �'.�► vo�'' ' 3 si GCT j ��_ " 1 D .t7 J' ®p TrEPLIk CIT APPLICATION FOR BUILDING PERMIT 1 COUNTY- OF LOS ANGELES BUILDING / a DEPARTYIENNT OF COUNTY'ENGNEER ADDRESS BUWING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRICT7, GROUPTYpE PR BY `�S f CONST. C,� . BUILDING STATISTICAL.C SIFICATION.. SEVER MAP ADDRESS BK PG CLASS.NO.f MAP _____DWELL.UNIT ' LOT NO. ' BLOCK NUMBER TAT-HWYE YES NO TRACT . ` USE ZON SPECIAL NO.OF BLDGS. 1 CONDITIONS SIZE OF LOT I NOW ON LOT USE OF , EXISTING BLDG. $UILDING YARD HWY STREET NAME EXIST. TEL SETBACK W DTH OWNE NO. ONT ADDRESS 7 -SIDE 2 0 ' ' ARCHITECT O E ' P.L. ENGINEER INSPECTION RECORD • � a ADDRESS � �. TEL (J 1`� Ci- CONTRACTOR - NO. O ADDRESS - DESCRIPTION OF WORK- NEW ADD ALTER REPAIR -DEMOLISH V SQ.FT. NO.OF NO.OF eN ,7 Ln t--ga S Awi./FN.,nlT SIZE STORIES FAMILIES STRUCTURE I • C'9t7 <� ��Q.__ .�. rA Vlow r So AD SIGNATURE OF .Sf i 121., !A/.. e1 C'J-CQ L.#0A fr;P APPLICANT ' V VALUATION$ olov I APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION FEE $ FEE,5_3, 47-V FORMS MATERIALS 10 FRAME:FIRE STOPS. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- BRACING,BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE:LOCATION. AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND .GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. I .CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'S C .MPENSATION(ZS OF LIFORNIA. - _LATH,EXT. SIGNATUREF � �1 HOUSE NUMBER COR- PERMITTE /l/:yO'� RECT AND POSTED ADDRES FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CIL M.O. CASH PERMIT VALIDATION CK. M.O. CASR /BA686A 085-2 2-58 FOR BUILDING PERMIT 1 _ NO -1DIVISION OF BUILDING AND SAFETY ADDEUILD'Ss G G� '� " C9,C !//� Department of County Engineer County of Los.Angeles LOCALITY ,= C_ !Tr WM.J.FOX.-COUNTY ENGINEER NEAREST �Af CASSATT D.GRIFFIN,.SUPT OF BUILDING CROSS ST. Iez �v1V DDISTRICT NO. GP I SEWER MAP TYPE PG FOR TO FALL IN 1/" CONST. I BUILDINGbSTATE OWADDESS NUMBER Oy / & jWY YES NO LOT NO. HLCCK � USE ZONE SPECIAL ` 14._/ CONDITIONS TRACT T�.1 0 /�� •If'-0O V NO.OF BLDSIZE OF LOT -J D J � S NOW ON L:OTS� SET AICK YARD HWY NG STREET NAME WIDTH USE OF FRONT qq.� A / O EXISTING BLDG: P.L. OWNER �A� J O lS OIC/ SIDE P.L. MAIL ADDRESS J�9 ) 3 fG j1,6;7 1,?A_;Z O TRACT DWELL. I UNIT Vt/ - 5 INDUSTRIAL ^� TEL. DWELL. I UNIT CITY L� 1�E/),A NO. 6. PUBLIC BLDG, ARCHITECT OR TEL. _ 2 DUPLEX I UNIT 7 ADDN..ALT.. ETC. ENGINEER -NO. - 3..APT. UNITS 8 MISCEL. _ADDRESS 4 COMMERCIAL CONTRACTOR T N077 s 1 i9 �f INSPECTION RECORD / 4 RANO • !3 i z ADDRESS ;)-3 �3�v,�R�y ,vy, }"v69,4 P v��,4, f/ end DESCRIPTION OF WORK , � ! �/ r NEW , ADD ALTER REPAIR DEMOLISH SQ: FT. NO.OF ! NO.OF I SIZE I, 0 STORIES L FAMILIES /, �� f U T USE OF STRUCRE A n r' �'� r qa SIGNATURE OF / APPLICANT 7 APPROVALS ;_la f�4 )/1l��Ye•C" Lt ADDRESS �J //� , 'DATE INSPECTORS SL ATU E FOUNDATION:LOCATION P.C. FORMS.MATERIALS �zggjc' FEE FRAME:FIRE STOPS, f n VALVA ffi ,tee BRACING.BOLTS REE FURNACE:LOCATION, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT,DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH.EXT. r. SIGNATURE OF /� HOUSE NUMBER COR- PERMITTEE 914d Al RECT AND POSTED ADDRESS FINAL �� ✓-�i+� N ' WM.J.FOX,COUNTY ENGINEER VALIDATION C.N.DIRLAM.CHIEF'BLDG. INSPECTOR ico 3 3 6 APR X 3 1 6 1 2.0 0' 5 4 5 0 APR 2 6 1 2 6,0 0 4 WORKERS'COMPENSATION DECLARATION ' hereby affirm that I have a certificate of consen} to self APPLICATION FOR U I L D I N G PERMIT. nsure,or a certificate of Workers'Compenstion Insurance,or cer i i c�p;r•,t1�711$ec. 3800, Lab. C�. � COUNTY OF LOS ANGELES BUILDING AND SAFETY 'olicy o. G7� aCompany ] Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING CAD 40 �y� Certified copy is filed with the co my b '[ding inspec- � BUILDING ti departmenT. ADDRESS 0 �� ^. OL.I,r�. LOCALITY -re*-%, Date IMP Applicant L CITY t ZIP -i��0 C OSSST. GL #YDMTWI ERT KATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE, SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL ;This section need not be completed if the permit is for one TRACT BLOCK LOT NO. USE ZONE MAP �?+� iundred dollars ($100)or less.) C/ ? ^w ,� TEL. 'l SPECIAL CL certify that in the performance of the work for which this OWNER OL-IFO aL�A p NO.4g2, J61 NDITIONS O permit is issued, I shall not employ any person in any mannerDISTRICT GROUP TYPE FIRE PROCESSED BY V so as to become subject to the Workers'Compensation Laws. t ADDRESS I(7 ( dLl 1/G CONST. ZONE 19 t CITY I i4 Ir t ZIP q.1-1 Date Applicant STATISTICAL CLAS SJfICA(ONONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. LU ENGINEER NO. CLASS NO. DWELL.UNITS Exemption, you should become subject to the Workers' r-'-- NJ Zompensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. o r CONTRACTOR POR-SIA `gyp Iaj NO.TEL'Z405-=4 BK. PG, VALIDATION a1 LICENSED CONTRACTORS DECLARATION �r r-+ LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS pt0 �+w'$ V�•S` NO. ��X02 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. + Professions Code, and my license is in full force and effect. CITY Gab CLASS 5 3 $ ' /�/� ` 1414510#2— SIZ FT. STO IE FA OF CHECK V�/�J License Nu�mber� P609-4— .�� iLic.Class �7 SIZE STORIES FAMILIES ONE , A��G- \ops^ 7 ��Z.� NEW $ �onfracto Date DESCRIPTION OF WORK 71m1 am exempt frothe licensing requirements as I am a )JewPoo1 �JP+� a ply., ADD , licensed architect or a registered professional engineer .----7 ALTER FINAL acting in my professional, capacity (Section %7051, REPAIR DATE Business and Professions Code): USE OFr. � FINAL EXISTING BLDG. KJ�1C'e� DEMOL ❑.. By Lic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT NO.Z� I hereby affirm that I am exempt from the Contractor's LicenseQ 5 0 Q 7 R Law for the following reason (Section 7031.5, Business and• ADDRESS �D 16 cv G14ir t�� Professions Code): PRESS � 2 1 , ❑ -BUILDING - I, as owner of the property, or my employees with ADDRESS 2 ° ° 6 Q,6 8 wages as their sole compensation,will do the work and the structure is not intended or offered'for sale(Section LOCALITY 0 0 . 64,6 8 5 7044, Business and Professions Code). MOVING TEL. 1, as owner of the property, am exclusively contracting CONTRACTOR NO. 07, 1 6-82 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS - 5 0.0,8 R REQUIRED L SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAL LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 0 0 0 0 0 1 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE 2 ° 1 2 S,0 0 ' O�1Vv P L o ° 1 G.r�..0 0 U Lender's Name �-� Lender's Address P.C. Fee$ Permit Fee ��.yycJ 0'], 1 6-82 1 certify that I have read this application and state that the Issuance Fee A/. above information is correct. I agree to comply with all County Investigation Fee &I �^ - ordinances and State laws relating to building construction, Total Fee C� and here y authorize re esentatives of this County to enter upon t above- do ed property for inspectifi Pu poses. 1 b Z! SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applica t dry Agent D to ®s i WORKERS'COMPENSATION DECLARATION hereby affirm that I have r certificate of consent to self I APPLICATION FOR BUILDING PERMIT e insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) I COUNTY OF LOS ANGELES BUILDING AND SAFETY p❑ol'icyNa.IV84-22{�pany Fremont Indemnit JA G Certified copy is hereby furnished. FOR APPLICANT TO FILL INS Certified copy is filed with the county building inspec- BUILDINGET • tion department. ADDRESS 10 Y Temple City T Date 7�]9/84 Applicant Virgin Rnn•F Co. CITY P Y ZIPT. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. R COMPENSATION INSURANCE SIZE OF LOT NOW ON LOTOK PAGE PARCEL (This section need not be completed if the permit is for one E MAP hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. Aldaco TEL. SPECIAL �•• CL I certify that in the performance of the work for which this OWNE�2r• J• NO. CONDITIONS 0 permit is issued, I shall not employ an person in an manner 10 616 E. Olive ICT GROUP TYPE FIRE PROCESSED BY P p y Y p y CONST. ZONE U so as to become subject to the Workers'Compensation Laws. ADDRESS � � Date Applicant CITi ZIP STATISTICAL CLASSIFICATION APT. ONDO. V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. DWELL UNITS Exemption, you should become subject to the Workers' � � Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR Vir in Roof Co NO 87-0507 BK �• VALIDATION LICENSED CONTRACTORS DECLARATION p Q $OX J LIC' C39 J I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ' NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and g 1, 91778 LIC. $ 1,3 0 0.Q Q Professions Code, and my license is in full force and effect. CITYX� clAssl6 0 6 5 0 , 160650 C39 SIQZE� STORIESNO. FAMIOLIEs' CONE License Number Lic.Cldss Contractor Virgin Roof Cow, 7/19/84 DESCRIPTION OF WORK Reroof back NEW ❑' portion of house with ADD ❑ ❑ I am exempt under Sec. ALTERFINAL B.BP.C. for this reason `medium Shakes ❑REPAIR DATE ❑ Date: USE OF FINAL DEMOL EXISTING BLDG. ❑ Signature APPLICANT TEL. By ��` OWNER-BUILDER DECLARATION (PRINT)VirginNO I hereby affirm that I am exempt from the Contractor's License C $OX J San Gabriel Low for the following reason (Section 7031.5, Business and ADDRESSP. Professions Code): 'PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and - 3002A the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. F' ❑ CONTRACTOR NO. I' ° 0 0 0'o I, as owner of the property,am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS ( ° ° 5 tion 7044, Business and Professions Code). + REQUIRED TOTAL SETBACK FROM EXIST. i CONSTRUGTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ° 3 b 7 5 r- I hereby affirm that there is a construction lending agency for FRONT e the performance of the work for which this permit is issued P.L. ( 7 ?'6—F 4 tSec. 3097,.Civ. C.). SIDE 'o :P.L... ' `a Lender's.Name . P.C.Fee$ Permit Fee $26,25 r Lender's Address rI certify that I have read this application and state that the Issuance Fee Q-50 ' above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee $36.75 and hereby authorize representatives of this County to enter upo the above-mentioned property or inspection purposes. i SEE REVERSE FOR EXPLANATORY LANGUAGE Signature cyApplicant or Agent Date I ®s I vDi9r. . SATION DECLARATION hereby affirm ° I have a certificate of-consent to self r APPLICATION FOR U I L D I N G PER l _ insure, c 5 ate of Workers'Compehsation Insurance, or a cerci copy thereof'(Sec. 3800, Lab. C.) r COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO F 11-4 ILL IN ADDRESS '7LLICA ❑ Certified copy is filed with the county building inspec- I BUILDING tion department. I ADDRESS )Cj �; II Date Applicant CITY ZIP/ LO+IALITY , CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BII,DGS. NE1,REST COMPENSATION INSURANCE SIZE OF LOT `�c NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one - '"r LOT... ASSESSOR hundred dollars($100)or less.) TRACT BLOCK MAp BOOK PAGE PARCEL TEL.' USS ZONE, MAP I certify that in the performance of the work for which this OWNER NO. NO. } permit is issued,�I shall not employ any person in any manner `� . + SPECIAL d so'as to become subject to the Workers'Compensation Laws. ADDRESS \' G \ CONDITIONS O _ , I U Date Applicant CITY IL ZIP ARCHITECT OR TEL.' DSTRICT GROUP TYPE FIRE ESSED BY o NOTICE-TO APPLICANT: If, after making this Certificate of ENGINEER - PRO U Exemption, you should become subject to the Workers' _^ /j ZONE CONST. Compensation provisions of the Labor Code, you must forth- ADDRESS _ t Q^+ K 3 with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFIC TION APT. ND. z deemed revoked. CONTRACTOR NO. I LICENSED CONTRACTORS DECLARATION LIC, CLASS NO.. DWELL.UNITS I 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 and LIC. 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 ALUIATION Contractor Date SCRIPTION OF WORK NEW ❑ s ADD ��ALTER I am exempt under Sec. ;21 8 4 5 A ❑ ❑ I , B.BP.C. for this reason REPAIR E] IS - # o o-0 0 0 1 Date: USE OF DEMOL ❑ 1o 2 0 9.2 5 EXISTING BLDG. � Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT y^ +' NO_ DATE ° ° 209.255 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL 04, 1 5_$5 Professions Code): PRESENT By E] 1, I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCP`LITY 7044, Business and Professions Code). MOVING TE CONTRACTOR N . I, as owner of the property,am exclusively contracting I with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING'AGENCY SETT BACK YARD HWY TOTAL SETBACK LIINEFRO WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE a' P.L. I e7. Lender's Name P.C.Fee$ Permit Fee LDMA Ref.'# Lender's Address I certify that I have read this application and state that the Issuance Fee IDMA P/C# ' above information is correct. I agree to comply with all County Investigation Fee or ces and S ws relating to building construction, Total Fee ' U a h h rize re resentatives of this County to enter 25 LDMA Perm. # u above- ntion property for inspecti n pu• oses. SEE REVERSE FOR EXPLANATORY LANGUAGE ' i ure o pelican or Agent Date APPLICATION FOR BUILDING PERMI COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL INTNNC BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION FOWNER ADDRESS _ I hereby affirm that I have a certificate of consent to self insure, l or a certificate of Workers'Compensation Insurance,or a certified ZIP copy thereof(Sec.3800,Lab.C.) LOCAL4TY Policy No. Company T NO.OF BLDGS. ❑ Certified copy is hereby furnished. NEAREST CROSS ST. BLOCK LOTCertified Copy iS filed with the County building inspection USEZONE MAP NO. department. MAP BOOK PAGE Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' TEL.NO. YES NO COMPENSATION INSURANCE ADDRESS WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP - certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate Of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' 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. ADDRESS LIC.NO. PL Cl- SIDE � LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL WLLI I hereby affirm that I am licensed under provisions of Chapter 9SEWER MAP —� (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES NO.OF FAMILIES U. Professions Code,and my license is in full force and effect. r` NEW ❑ BK PG cc DESCRIPTION OF WORK License Number Lic.Class ADD ❑ VALUATION , Contractor Date ALTER Ela REPAIR ❑ LU El am exempt under Sec. 1 B.&P.C.for this reason DEMOL ❑ LDMA P/C If Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm It 2 ❑ I, as owner of the property, or my employees with wages as N0 their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL Q d�'r'► Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLER HAZARDOUS MATERIAL J ❑ I, as owner Of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THANITI 60 Q Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY L 1116 licensed contractors to construct the project (Section 7044, YES El NO El ' t(, � ' Business and Professions Code.) 1 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING }My, A�,; OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 77 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST •� 1{, FOR GUIDELINES. sT1I1fP r' hereby affirm that there is a construction lending agency for YES❑ No❑ the performance Of the Work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES i COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 220.140 CONCERNING ` 3 Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. a Lender's Address — a � OWNER OR AGENT 0 1 certify that I have read this application and state that the above S information is correct. I agree to comply with all county P.C.FEE PERMIT FEE N ordinances and State laws relating to building construction,and a hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. i INVESTIGATION FEE TOTAL FEE Signelure of App—It of Ag nl Dete �! • SEE REVERSE FOR EXPLANATORY LANGUAGE