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Home My Public Portal About9933 OLIVE ST_Building__ �^1v(IG wFt11 .• APPLICATION FOR: BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY 'WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL[y-NPs !� 1 hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS _ -� �� !7�� or a certificate of Workers'Compensation Insurance,or a certified er�t ZT Tt^c K 9 cl ;9 0 6 iU 2 C I - copy thereof(Sec.3800,Lab.C.) CITY �^ ZIP Policy No. W 0 $V0 -yS' Company S+AL t FKN v'e `r t /7 W O LOCALITY SIZE OF LOT NO.OF BLDGS.NOW ON LOT 19 Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. 61C?715 1 USE ZONE MAP NO. Date IZ-r�(i-9� s ✓�"v ASSESSOR MAP BOOK PAGE r, PARCEL Applicant 13 5 r6p l D/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. �J COMPENSATION INSURANCE ov s@.sv 6 ry S ��'` b�r+l` y 3'��'��' WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP Y E ONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITYZIP / [ I certify that in the performance of the work for which this permit IF L Ii"oo j• 91 ?,5 1 ` ?7p is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. G� become subject to the Workers'Compensation Laws. e c- yp`i yy _ yy y STATISTICAL CLASSIFICATION APT CONDO Date 12-I rd ed Y Applicant /ek 6, "-&_ ADDRESS /� j� 1 S/► �+ CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of 7(2qo Ps �� '. 0, GN-wm 91766 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP UNE WIDTH Compensation provisions of the Labor Code, you must forthwith IS D FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LI9.NO. PL LICENSED CONTRACTORS DECLARATION 42-75 /u J1j I I.Gi�v i,.. ,9v�- iiLiq 7S$ SIDE CITY L 111 . ��r LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.Fr.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW BK PG } IL License Number q4 7 S Lic.Class rm— DESCRIPTION OF WORK ADD E] VALUATION ® !J Contractor Qy_-*_' (u W 5t- Date 1'Z -1? _91 �`� 1'�iIOCK \.v/�I� ALTER 11 O ElI am exempt under Sec. REPAIR 11 $ Q B.BP.C.for this reason _ DEMOL ❑ LDMA P/C# Date: i Z -I$ -`j S USE OF EXISTING BLDG. URM ❑ W � .� r>��-z z. a .� :r y 1.'i P1,6Z a w1 r. W Signature APPLICANT(PRINT) TEL NO. _ LDMA Perm# r t�4T o 4 Z ❑ I, as owner of the property, or my employees with wages as yw% �� Lev"'� ASO ��'3�S Z their sole compensation, will do the work and the structure is ADDRESS O 3303 360.45 not intended or offered for sale (Section 7044, Business and 7-7`J N AV t. d""NirR FINAL DATE �f Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HAND A HAZARDOUS MATERIAL . 1 ITEMS A MIXTURE CONDONING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE V •••I ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > TOTAL 360 o X} 5 licensed contractors to construct the project (Section 7044, YES❑ NO❑ Business and Professions Code.) CHECK 360045 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHANGE CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR CHA CE .00 GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ (y(} �y �y �}/ /p CM the performance of the work for which this permit is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING �yyr�-•{,1�y1 il/iVf 7 3097,CIV.C.) /� J^^' CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, [M•� a Lender's Name F-r S l4 e.r,L4 AP-v&J JA TITLE 2,CHAPTER 2 20 SECTIONS 2.20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS 383b 1 fel 1 J n 4V O MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address i7�NJ F• V��I�'� �J �1z + "yam-�T•►9 OWNER OR AGENT O o I certify that I have read this application and state under penalty O of perjury that the above information is correct I agree to comply P.C.FEE PERMIT'FEE /G N with all county ordinances and State laws relating to building J J m construction, and hereby authorize representatives of this County ISSUANCE FEE 30 co to enter upon the above-mentioned property for inspection purposes. 7j,� v $ •�Ji INVESTIGATION FEE TOTAL FEE / r• JJ SgMturo m App'.Cnt a AA:m SEE REVERSE FOR EXPLANATORY LANGUAGE �'..4 ,iI APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES — r BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILLFINTBUIL G DDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESSor a certificate of Workers'Compensation Insurance,or a certified diq-'3 OLA ]r AVE copy thereof(Sec.3800,Lab.C.) ITY ZIP Policy Na�� ' � ��ompany '16tMP1� Gl'L Y LOCALITY Cs SIZE OF LOT NO.OF BLDGS,NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. PK Certified copy i filed with the county building inspection TRACT BLOCK LOT NO. department 15 7 S 1..Q T is / USE ZONE MAP NO. Applicant � � � ASSMAP BOOK PAGE PARCEL DateIdol- aS6 1415 Z-i lLtb SPECIAL CONDITIONS �y/��.n/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. G` COMPENSATION INSURANCE DDR a V NIDA -d WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS q Z� �W A DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) 1 certify that in the performance of the work for which this permit CITY5L. _MOOT ZIP C; 1-13' Q® &-3 .f% is issued, I shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER TEL NO. /L -+ r��usz��Cs become subject to the Workers'Compensation Laws. (� GV�7®� STATISTICAL CLASSIFICATION +A-� P� CONDO Date Applicant \t�\(tj ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.- If, after making this Certificate Of p0• Zr0 r0 SLTiQS/4 Ca a�7O2 REQUIRED TOTAL ST LdK FROM EXI 't 59 Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. ET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith &AW oks .9 tNAJ Ii{Z. FRON y comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PC:GT a a LICENSED CONTRACTORS DECLARATIOND CITY LIC.CLASS /P L oc '17 1 hereby affirm that I am licensed underprovisions of Chapter 9 EWER MAP U1.11-10-1I o-] �9tit3= #� (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OF i TORIES NO.OF FAMILIES Professions Code,and m licenseisin full force and effect. 15p� NEW BK PG } License Number a Lic.Class DESCRIPTION OF WORK ppp ❑ VALUATION B� ® 1•i�f NGE 7 Q Date gyyU Contractor �/ y91!, ALTER 11 �~� 0i ❑ 1 am exempt under Sec. II REPAIR ❑ $ �'�� O • f y 8-51 t j Ar 9 e C `9 B.BP.C.for this reason DEMOL ❑ =DMA P/C# W Date: USE OF EXISTING BLDG. URM 11IL Signature APPLICANT(PRINT) TEL NO. LDMA Perm 0 ❑ 1, as owner of the property, or my employees with wages as C SE ��" Z their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL14 -119 J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE S' ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED O/NAME HAZARDOUS MATERIALS INFORMATION GUIDE' FINAL BY licensed contractors to construct the project (Section 7044, YES❑ NO Business and Professions Code.) HALL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR OUAUTV MANAGEM T DISTRICT(SCAQMDI SEE PERMITTING CHECKLIST FOR GUIDELINES I herebyaffirm that there is a construction lending agency for ^ 9 g C( YES❑ NO l' �J ._.`7.j•'J cy the performance Of the Work for which this permit IS ISSUed(SBC. I HAVE READ THE HAZARDOUSMATER INFOR ON GUI E QMD PERMITTING 'V-�J• '�4T_�- 3097,CIV.C.) CHECKLIST I UNDERSTAND MY RE EMENTS DE E AN ES COUNTY CODE, TITLE 2,CHAPTER 2 20 S ON 20 100 G HAZARDOUS _ Lender's Name �� MATERUILS REPORTIN D O A P IT AOMD. o Lender's Address � Iy L' O • OWNER OR KENT •• ?r�i-� o I certify that I have read this application ands to under penalty O of perjury that the above information is correct.I agree to ccmpo P.C.FEE � PERMIT FEE //��J t i'�;' ;, j: N with all county ordinances an ate laws relating to buiml Y construction,and hereby a epresentatives of this Coun / ISSUANCE FEE 3 to enter upon the abo n' roperty for inspection rposes d 3 0 :,:y`�r.- m INVESTIGATION FEE TOTAL FEE/ n w noa'ca««nae u .- _. '•r' . J. SEE REVERSE FOR EXPLANATORY LANGUAGE