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Home My Public Portal About9924 OLIVE ST_Building__ 1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A RESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) [SIZE !LQT. I ZIP dl 90 1 LOCALITY Policy No. Company NO.OF BLDGS.N ON LOTi ��; 13Certified copy is hereby furnished. )( �0 NEAREST CROSS ❑ Certified copy is filed with the county building inspection TRACTBLOCK LOT NO. department. 6 7S6-' USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE _ PARCEL 69 1SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERT L O. COMPENSATION INSURANCE N / .�3 ( WITHIN 1000 FT.OF SCHOOL? ves No I (This section need not be completed if the permit is for one hundred l Ue �E, DISTRICT GROUP TYPEVONST. FIR E PROCESSED BY dollars($100)or less.) ADDRE Q` cl zip 4 1lf�� tro I certify that in the performance of the work for which this permit if Q �J, 3 is issued, I shall not employ any person in any manner so as to ARC CT R ENGI O`[ become subject to the Workers'Compensation Laws. L NO s�-?137 STATISTICAL CL S FICATION APT CONDO Date Applicant A p 6- 1 /� CLASS NO. DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate Of I'� I�N,1 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR 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. ADDRESS LIC.NO. FF PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9SEWER MAP a (commencing with Section 7000)of Division 3 Of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW 11BK PG , V License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUA ON 00 Contractor Date ALTER ❑ �' C 0� O ❑ I am exempt under Sec. REPAIR ❑ V B.BP.C.for this reason DEMOL ❑ W LDMA P/C# C Date: USE OF EXISTING BLDG. URM ❑ U) ,:J z Signature APPLICANT(PRINT) TEL NO. LDMA Perm# I, as owner of the property, or my employees with wages as •Z :,ter c-• s- their sole compensation, will do the work and the structure is ADDRESS O ,�••r :r ltt = not intended or offered for sale (Section 7044, Business and FINAL DATE a ; Professions Code.) D y WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ��J�s� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE v ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, � { �f u-i.[ >: I�`.� 12 Business and Professions Code.) VES❑ NON L_ - WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH L T�j CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR — I hereby affirm that there is a construction lending agency for YES ElNO L9I 7.G j AL 17 1 m S—� a the performance of the work for which this permit is issued(Sec. CHECK � 171.o.- 3097, i CIV.C.) IH VE CHECKLIST I HE UNDERSTAND MMATERI EMENT UNDER GUIDE AND ANGELHE ES COUNTMD Y ITTING (�. CM CHECKLIST I UNDERSTAND MY RE IREMENTS UNDER THE LOS ANGELES COUNTY CODE, _ TITLE 2, HAPTER 2 20 SE TIO 2.20.100 THROUGH 2.20 140 CONCERNING HAZARDOUS ''+, ! ! Lender's Name MATERI REPO G !L�1 !I,.i INING'A PERMIT FROM THE SCAOMD. `,.•t-ty�!'�t7C C3 Lender's Address c WNER OR T o I certify that I have read this application and state under penalty - 4 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE - N with all county ordinances and State laws relating to building Q, 9T 70 X.39construction, 7,4-6 construction, and hereauthorize representatives of this County ISSUANCE FEE 'L Qoto ter up th b -mentioned property for inspetion urposa�) INVEST IT V IGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE