HomeMy Public PortalAbout6133 RENO AVE_Building__ APPLICATION FOR RUIDING PERMIT
L
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WARKER'S COMPENSATION DECLARATION
FOR APPLICANT TO FILL IN BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self insure, BUILDING DDRESS� 3
or a certificate of Workers'Compensation Insurance,or a certified CITY zIP
copy thereof(Sec.
Company(•rSec.3800,Lab.C.)
Policy No.� `�`��� 1 t -79
LOCALITY
SIZE OF LOT NO.OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST.
—PICertified copy is filed with the county building inspection TRACT BLOCK LOT NO.
de ar me t. _
USE ZONE MAP NO.
Date Applicant ? ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS n� Q/
CERTIFICATE OF EXEMPTON FROM WCOMPENSATIONI NSURA CEORKERS' ow a�N -37 l YES f No
WITHIN 1000 FT OF SCHOOL?
(This section nee not be completed if the permit is for one hundred ADD
DISTRICT GROUP O FIRE ZONE PROCESSED BY
dollars($100)or EBB.)
CITY /• _ ZIP / r !,
1 certify that h the a mploynan of the work for which this permit (J
is issued, I shall not mploy any person in any manner so as to
become subject to the orkers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO.
STATISTICAL CL/�SIFICATION APT CONDO
Date App11 ant ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CONT TO TEL NOSET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith S-1 a- 7 7 FRONT
comply with such provisions or this permit shall be deemed revoked. ADD EJ LIC. O! (, PL
LICENSED CONTRACTORS DECLARATION % �/ ! 6 Y SIDE
CIT�y l` LIC.CL S — PL
I hereby affirm that I am licensed underprovisions of Chapter 9 J (� SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES
Professions Code, my lic n e is in full force and effect. NEW 11 BK PG a
an
License Number �� Lic.Class - DESCRIPTION OF WO _ ADD ❑ VALUATION 0� ® V
Contractor Date �" ALTER ❑ $ -�
❑ I am exempt under Sec.
REPAIR $ O
-.j•.-r n U
BAP.C.for this reason DEMOL ❑ LDMA P/C#
Date: ILISE 29EXISTING B G. URM 11 �t_� ' _,c�` ('
y V)
Signature APPLI NT( 1 T �j LDMA Perm# �} ff: z
❑ I, as owner of the property, or my employees with wages as Z TOTAL
,_
their sole compensation, will do the work and the structure is ADDR O I i I nL .1123� �;_1
not intended or offered for sale (Section 7044, Business and FINAL DATE Q _
Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL CA-3N { c`15
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J t��-I-
❑ 1, a3 owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON ARDOUS MATERIALS INFORMATION GUIDE? a 'I
licensed contractors to construct the project (Section 7044, MA2 FINAL BY _ > L•i Ili�C n•_•_
YES❑ Np.LT
Business and Professions Code.)
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT OAST AR QUALITY MANAGEMENTRDISTRICT(SCIAOMD)SEE PERMITTING CHECKLISTON OR MODIFICATION FROM THE OFOR L,I_Iylrl-_i.�_�
CONSTRUCTION LENDING AGENCY GUIDELINES _
I hereby affirm that there is a construction lending agency for YES 11 142/
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
3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,
a TITLE 2•CHAPTER 2 20 SECTIONS 2 20 10 THROUGH 2 20.140 CONCERNING HAZARDOUS
Lender's Name MATERIAL§.8502kTING AND FOR OaTAI A PERMIT FROM THE SCAQMD.
Lender's Address
0 OWNEROAGENT
c I certify that I have read this application and state under penalty
of perjury that the above information i3 correct.I agree to comply P.C.FEE PERMIT FEE
N with all county ordinances and State laws relating to building
M construction, and herebyhorize representatives of this COU ISSUANCE FEE
t�ect`er/upOD�th�e above- ntioned propert for inspec i rpo es. (O o
CO ( �V 1 A-W f Y INVESTIGATION FEE
CO / TOTAL FEE
n
SOV-Y.1 llpp'.Cnt a IIQ 1 0.
SEE REVERSE FOR EXPLANATORY LANGUAGE