HomeMy Public PortalAbout5502 PARMERTON AVE_Building__ APPLICATION FOR BUILDING PERMIT ,
' COUNTY OF LOS-ANGELES BUILDINGrAND SAFETY
WORKER S COMPENSATION DECLARATION ((�� FOR APPLICANT TO FILL IN Bul Q ADDRESS
hereby affirm that I have a certrflgte of consent to self Insure Q BUILDING ADDRESS O� ex�2%' .
e w a certificate of,Workers Compensation Insurance or a certified 2 rm'e 'i:b n
copy thereof (Sec 3800 Lab C) I. It G"~ 'emp le Cl t-y
ZIP / n �O• L
OGAILITY
Policy No ' .Company 3 SIZE OF LOT
( 1,
NO OF R� O NOW QV LOT
' El Certfled copy Is hereby furnished � ' ' ` 1 G2' x I DO _ 1 NEAREST CROSS ST
El Certified copy Is filed with the county building inspection ``v` TRACT BLOCK ' LOT NO - -
department r} USE ZONE MAP NO ^ _
Date ApplicantASSESSO ` l� PAA7 PARCEL/ 1
J �j SPECIAL CONCTPONS, �—
CERTIFICATE OF EXEMPTION FROM WORKERS OWNER Te n^ t Hoe�j&e ELN°{_56,70 wln{IN 1000 FT OF SCHOOL2 YES NO
COMPENSATION INSURANCE tt �N al '
(This sector need not be completed If the permit is for one hundred ADDRESS
SSa2 Pa.r m erto►q DSA GROUP YPE CONST FlRE ZONE PROCESSED BY
'dollars ($100) or less) i ' 'r
I certify that In the performance of the work for which this perrmt 'Y-
rem Ie � '� ZIP •�D� "
Is Issued shall riot empty arty,person m any manner so as to-
ARCHITECT OR ENGINEER TEL NO V
become suhtect to the Workers Compensation Lavrs ' O e. STATISTICAL C�L}AS�SIRCAMON APT CONDO'
Date Applicant - t ADDRESS . - - CLASS NOCS-L— DWELL UNfTS
r NOTICE TO APPLICANT If after making this Certificate' of REQUIRED TOTAL SETBACK FROM EAST
Exemption you should become subject to the ,ftrker5 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 P L H
LICENSED CONTRACTORS DECLARATIONSIDE
CRY LIC CLASS P L _
I hereby affirm that I amlicensed underprovisions of Chapter 9, SEWER MAP /
(commencing with Sechor 7000)of DI 3 of the Busmess and5a FT SISIZnE NO OF STORIES NO OF FAMIL ES
Piofessions Code and my license Is In full force and effectM NEW ❑ BK Po
License Number LIC Class DESCRIPTION OF WORK .� .. ADD VALUATI�jN O
Contractor ' Date of ALTER $ IPL( OLIO
IIIr
El am exempt under Sec Ile @N't G 10--011 T �X l S tl h REPAIR ❑
BSPC for thereason - W
eut) 4 N/IRdil -7D—WPIC
DEMOL ❑ $
♦ ,
"
USE f EXISTING a � , LU
Date �
Signature ' APPLICANT(P T) TEL NO LDMA Perm♦ �ti�. _ ' ,.J, '= 11 'IAGGT.i Z-
�] I as owner of the property or my employees with wages Re, „��/T
their sole compensation wt11'do the worn and the structure IS ADDRESS i1 F r113 efr;V_
rot Intended M offered fa sale (Section 7044 Business and FINAL DATE -+• i . Q _ -�._
_ Professans Code) r WILL THE r RJCArrT on FUTURE❑ �pN3 OCCU +T Hu+a e A HnznHDOUS rwTERUE � `,{'�7'dr /1 y',�1 as owner of the property am exclusively with OR A MIXTURE CONWIbVa A 142MppLB MATERIAL EQUAL TO OR GREATER THAN THE � n a ( A A,
N.IOlNTS scECIDED ON THE 1 i0019 A TERINLS IWOR Wi GUIDE, - FlNAL BY ! AG C T.T 1.
licensed contractors to construct the project (Section 7044 _ _ _
YES❑ No❑
Business and Professions Code) _ -' 3303' JO 1.19
WLL THE REOURD USE CE THE CONSTRUCTION
BY THE A1010 OR FUTURE aJS SOUTH
_ r i , 1 ITE116
OOAST I REGURE A Pi FOR CSTRICT CTpN Ori ME PER qN G CH THE SOUTH
CONSTRUCTION LENDING AGENCY OUST A3i ouwrY NAIYflEMENT dsnacT IscADMOI SEE PERMnnaG,cHECKLIST FOR '>� T
I hereby affirm that there is a construction lending agerwy for ❑ sNp❑ 0 _ / •''��� x� 11 l (TOTAL 3151 _ 69
m the performance of the work for which this permit lS Issued Sec oIHAYE REAbTIE WSAfiWD91MTERNL9 YfQMgTgNGUOE ANOTHESU➢no PERI.frnNo HE(Y L
3097 Cry C) • CHECxLIST t UIDERSPNO W REQUIREMENTS UNDER THE UOS ANGELES COUNTY CODE _ 35 1.V9
• TR-E 2 CHAPTER 220 SECTIONS 2 20100 THROUGH 2 20 140 CONCERNING HAZARDOUS • T GHAHGE •00
Lenders Name MATERIALS REPOP TNG AND FOR CBNININO A PERWT FROM THE eLAOMD '
Larders Address
o avnan oR.aoP
I certify that I have read this appltcatlon and stte under penalty
S of perjury that the above Information a correct 'agree to Com PC FEE PERM'T FEE r
py ,sa X73 �y coon-cool 7/,13�5-
$
with all county ordinances and State laws relating to building
' construction and hereby authorize representatives of this County ISSUANCE FEE ,�O 0 1310 ' ' ], AN 9.2 i
to enter upon the absolve-me coned property for Irepe�cltany
[ '
�,Murporyses
�"'I S INVESTIGATION FEE TOTAL FEE
mr \%
h SEE REVERSE FOR EXPLANATORY LANGUAGE