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Home My Public Portal About5745 RIO HONDO AVE_Building__ 'F r APPLICATION FOR -BULDING PERMIT COUNTY OF LOS ANGELES -Y ' '� • BUILDING AND SAFETY R'S COMS'�,VSATION DECLARATION FOR APPLICANT+TO FILL IN BUILDING ADDRESS ' t ,ave a certificate of consent to self insure, BUILDING ADDRESS ,,��,f y C. of Workers'Compensation Insurance,or a certified 5 , /Z4-;> , e""'6 l C opy thereof(Sec.3800,Lab.C.) CIT r Zlp 6 Qh-h N� may^ r i LOCALITY POIICy No. 7 O'??—_ �I company T N.-_ E. SIZE OF EOT NO.OF BLDGS NOW ON LOT �y,e ❑ Certified copy is hereby furnished. NEAREST CROSS . ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. depa tment. USE ZONE MAP NO. Date) 9 ASSESSOR BODK � PARCEL Applicant !-I�IV'�(f f1ji�/�fCl Off/ SPECIAL CONDITIONS �� Q` CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ° TEL NO. COMPENSATION INSURANCE � •C.,4 `31$ rR WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS n DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED(3Y dollars($100)or less.) 3 S C I certify that in the performance of the work for which this permit CITY � ZIP/j 7 is issued, I shall not employ any person in any manner so as to �O ,! ✓� �. v�LrLc�� become subject to the Workers'Compensation Laws. ARCHITE OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT ' CONDO Date Applicant 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' CONTRACT`O)R- ' TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �j(�[/ ` 0 43) � �-'GJ C FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL } LICENSED CONTRACTORS DECLARATION Ci 13 r Y� LIC`�� SIDE O I hereby affirm that I am licensed underprovisions of Chapter 9 ,• L� C�' SEWER MAP U (commencing with Section 7000)of Division 3 of the Business and SO. T.SIZE f NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. n0 NEW ❑ BK PG O LV License Number'Aa4-TU{ Lia DECRIPTION OF K Class � ADD ER; VALUATION U Contractor P,, 'lf,- i1HEI.r`1Date i�9�(," �H ALTER ❑ $ �� - D C/) ❑ I am exempt under Sec. REPAIR ❑ Z BAP.C.for this reason DEMOL ❑ Date: I:Zf �� USE OF EXISTING BLDG. LDMA P/C# URM ❑ Signature APPLICANT(PPoNT) TEL NO. LDMA Perm# 3 ¢ ❑ I, as owner of the property, or my employees with wages as 2 ACCT.JL their sole compensation, will do the work and the structure is ADDRESS IT not intended or offered for sale (Section 7044, Business and FINAL DATE a 3303 50.510 Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL j 131, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE. FINAL BY licensed contractors to construct the project (Section 7044, YES❑ No ElACCT a� Business and Professions Code.) a �o WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ' .., ,9�1� C OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR L ITEMS S t qHL GUIDELINES 2 Ill I hereby affirm that there is a construction lending agency for YES❑ No❑ the performance of the work for which this permit is issued(Sec. TOTAL 536 - 34 IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING L 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. �Cr�+� }y{}n �• TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS g Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. a ry Lender's Address CHANGE iZ1G OWNER OR AGENT 3 1 certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE D,u� PERMIT FEE f� I�� _�ry � U l%`qtr with all county ordinances and State laws relating to building �J W construction, and hereby authorize representatives of this County ISSUANCE FEE C I-- 6 7 1 AN $:49 to enter upon the above-mentioned property for inspection purposes. 15 O b /Lj:4•yx1 ,d,.(rf2GLGr /2// /. INVESTIGATION FEE TOTAL FEE ` °J/(J N G owi m M AwW l a"I DAI° I J ♦(J ' SEE REVERSE FOR EXPLANATORY LANGUAGE ,r`- WORKERS' COMPENSATION DECLARATION • +K hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of�lorkeW&Compensation Insurance, or a certified copy thereoa.(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 7 -:0 ❑ Certified copy is filed with the county building inspec- BUILDING O tion department. ADDRESS Dare Applicant CITY ZIP v LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT !S 1310 NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCELED hundred dollars ($100)or less.) TEL' rat. _ USE ZONE , MAP OWNER a 0 , NO. NO. , I certify that in the performance of the work for which this �1 SPECIAL >- permit is issued, I shall not employ any person in any manner ADDRESS rrj` 0� "t/ CONDITIONS n- so as to become subject to the Workers'Compensation Laws. p, Q CITY ZIP { 7J Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY 0O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. E 1 13 Exemption, you should become subject to the Workers' ��f/ // v Compensation provisions of the Labor Code, you must forth- ADDRESS a e W with comply with such provisions or this permit shall beSTATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR U LIC. CLASS NO. DWELL. UNITS Z LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of,Division 3 of the Business LIC. SEWER MAP .21 and Professions Code,and my license is in full force and effect. CITY CLASS BK ` PG�� ..VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE _ VALUATION 1:+�j .-- Contractor Date DESCRIPTION OF WORK NEW E] '`' t• ' ❑I am exempt under Sec. kb%11, ADD d i, ALTER ❑ �C I =4 BAP.C. for this reason REPAIR ❑ ; Ijr '?=35e Date' USOF EX IE BLDG. ,5 l 4,5. DEMOL ❑ '- Si nature APPLICANT TEL, g (PRINT) Lac- b O.a FINAL i f t i AL 40" 99- OWNER-BUILDER DECLARATION DATE y — d _ I hereby affirm that I am exempt from the Contractor's License ADDRESS 1 b imp CHECK Law for the following reason (Section 7031.5, Business and FINAL - Professions Code): PRESENT By •HANG:". I� BUILDINGI, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale.(Section LOCALITY , t__;I;(i_I.111 7044, Business and Professions Code.), MOVING TEL. ElCONTRACTOR NO. :1�'`I r v I, as owner of the property,am exclusively contracting 6=' :-. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) ' CONSTRUCTION LENDING AGENCY PRERED YARD HWY TOTAL PROP LINE FROM WIDTFI I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name Permit Fee LDMA Ref.# Lender's Address I certify that I have read this application and state that the Issuance Fee z0 A1 7.< LDMA P/C# above information is correct. I agree to comply with al I County Investigation Fee 3 ordinances and State laws relating to building construction, Total Fee s LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-m ntioned property for inspection purposes. ? s Qk� top SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A (cant or Agent Dale