HomeMy Public PortalAbout5526 PARMERTON AVE_Building__ r r
� • " APPLICATION"FOR BUILDING PERMIT
'COUNTY OF L'OS ANGELES BUILDINGIAND AFETY
r WORKERS COMPENSATION DEC�ARATION- •7•' -!� '. F APPUCANT LL IN _ GUILDING ADDRE S
PE
BUILDING ADDRESS,A }
hereby affirm that9 have a certificate of consent to sett Insure Z °
or a certificate of Workers Compensahon Insurance or a certified
copy thereof (Sec 3800 Lab C) �1, CNV ZIP
Policy No 'd S-9 ri mparry Idtt Gc��'fCCC '_ _G
SIZE OF LOT NO OF SLOGS NOW ON LOT
'jam❑ CCartrfled_copy 15,bereby furri y f ' ' -- N REST LOOSS ST
dertartmentpy IS bled wRft th county,bu,Uinp,lnspectnn- ` j TACT BLOCK LOT NO ' -- ZONE -MPP NO r ..
p
•Date I1 Z8-QS Applicant i\3�JY'a . , ' ASSESSOR MAP BOOK 1 PAGE - , PARCEL _
\ SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS OWNER „
WITHIN 1000 Fr OF SCHDOL7 VES NO ,
p (This section Reed not be completed If the permit Is for one hundred ADDRESS -
, � r
dollars ($100) or less) DISTFi1LT GROUP TV CONST FIRE ZONE SSED BV
' 1
y ,' t t ' r,• CNV - ZIP
&'I - 1
, I certfy diet�m the performance of the vgdc1 for which this permit
IS issued I shall not employ any person In arty manner so as to `
become subject to the Workers Compensation Laws 3 ARCHITECT OR ENGINEER•'r TEL NO t
STATISTICAL CLAyS{FICf.TIONAPT CONDO
Date - Applicant ADDRESS - _ - ... QASS NO DWELL IINNS
° NOTICE TO,APPLICANT If after .making this Cartificateor,of REQUIRED TOTAL SETBACK FROM JEXI�Exemption *you should become 1 sub [ to the Workers CONTRACTOR ° TEL NO +Jac 1 I SET SACK YARD • HWV PROP LINE Compensation provisions of the Labor Code.you must forthwith mQ.��ON js '3n'3--p '2 comply with such provunons�or this permit shall be deemed revoked PDIXiESS M - UC NO FPRLONTLICENSED CONTRACTORS DECLARATION 'LSIDE '
cr + UCCC3S •PL
hereby affirm that I am licensed�underprovisios,of,Chapter 9 LL sEwER MAP
(Commelcixg with Section 7000)Of Division 3 of the Business and SO FT SIZE.,, NO OF STORIES NO OF FAMILIES ' , \
Professions Code andl N
my license la In'full force and effcect'"" � • �2/-(}- NEW ❑ eK PG , a
License Number. Llc Clase C 3 I \ DESCRIPTION OF VJDRK - ADD ❑ ,VALUATION t + r
i lYJ
Contractor Date f\-Z 8 -'!s•e I \` ALTER ❑ $-
❑ I am exempt under Sec r REPAIR ❑ .$ ,
• B&PC,for this reason !�a z° DEMOL E] 'MWP/C
t W
Date USE OF EXISTING BLOG . URM ❑ F". ' ^ - ' ^ O_
,signatureAPPLICANT(PRINT) TEL NO _ LDMA Perm♦ - - F Z
❑ as owner-of the property'or my employees witli wages as k, - - I ' = i
their sole compensation x611 do the work and the structure Is ADDRESS 1 - • f _ O Y�CT�r i•' ,'T T.-1)
net Intended or offered for sale (Section 7044 Business and ` I+: �•Ia 1 ti FINAL DATE + ` Q .].]W• 142.2
Professions Code) ITEMS
`
1�wli THE APRICAM OR FUTURE BULpNO OOCURWT HA:OLE A HAZARDOUE MATERIAL .7 �'yTGI l,] ' • -•
❑ I as owner of the property am exclusNey contracting with ' OR A MIXTURE COWNININc A HPZMDOUS IMTERIPI EQUAL TO OR GREATER THAN THE L�q[
a
Mg1.Nia eeEclFlpo oN THE HAZMWus MATERNLs INFCRMAnIXJ GUIOE�
licensed contractors to costruct the project,(Section 7044 •rEs❑ No a - - 2
F'l FINAL BY ,> TQTAL 14� :'20 '
Business and Professions Code) - '
F MILL THE INTENDED USE OF THE BUIDLINO 6Y THE APRIGM aR FROM T E SOUTH CREEK '1 142..0
t. rCOAST A REOUPE A PERMIT FOR CONSTRUCTpN OR EE PERMITTING
FROM THE SOUTH ` WILT, 1 L 7V
CONSTRUCTION LENDING.AGENCY GOIDEuNI souwn MAuaEMExr olsmlcT IscAaMol SEE FERMfI'TINp cHECKusr FOR • '
I hereby affirm that there'Is a construction lending agency for a CHE r.�0
YES❑ no�•
ih2 performance of the work for which this permit Is Issued(Sec
HAVE
3097 HAZMCOUSNATERLLL9 uFOPluTary ouoE un TlE scnol.o aERMnnNG (r�1r�r��rT ' e• ,r, r '
• IN i 3097 CN+C) - , CHECKUST I UNDERSTAND MV REWIREMENTS UNDER THE LOS N I_ES GOIINry CODE ' , . . W V1J-LN01, 13/,?8195
TITLE] CHAPTER z s CTgN 2]0 100 THRdJf,H z zo 140 CONCERNwa HAZARDOUS
Lenders Nam AATFRIALs REPOHII FOR oarANINO A PERWT FROM THE SCPf]MD
Lenders Address , 1�.• •_ - - -. r 34491 • •1 QM 936
M
o I certify that I have read this application and state under penalty
of penury that the above Information Is correct I agree to comply PC FEE - - PERMITIFEE /� - •- -'r- - a ,
wtti all county ordinances and State laws relahng to building- / i ' D• +
' construction and hereby.eutlronze representatives of this County ISSUANCE FEE q 30 , t = •. v - ,
to enter upon the a mentioned property for Inspection purposes
•' fO LL 1\'24-q INVESTIGATION FEE TOTAL FEE n ,
+ - SEE REVERSE FOR EXPLANATORY LANGUAGE '