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Home My Public Portal About6164 SULTANA AVE_Building__ 4 ' � WORKERS'COMPENSATION DECLARATION rebo affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compensation Insurance, or a certified copy theo.3of-(Sec:*3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified qropy is h3reby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Gnye.. Date Applicant CITY1 �� ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. S 95 (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT yy� BLOCK �y LOT NO. MAP BOOK PAGE PARCEL O1 ' 1 G n L/ NO. USE ZONE MAP J I certify that in the performance of the work for which t ' OWNER NO. / permit is issued,I shall mp oy any in an nners SPECIAL so as to become subj a Workers'Comp i ADDRESS CONDITIONS V Date Applicant CITY ZIP NOTICE TO APPLICANT: If, after making'this Ceitificate of ARCHITECT ORTEL. DISTRICT G59UP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. IK/'J CONS7. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS V`V 0 W Al with comply with such provisions or this permit shall be O. deemed revoked.. CONTRACTOR TEL.NOj )"t STATISTICAL CLASSIFICATION APT. NDO. N � LICENSED CONTRACTORS DECLARATION LIC..21CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSQI+D ,,fl) r N O SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and ffect. CITY �}6—► CLASS BK �' VALIDATION SQ.FT., NO,OF NO,OF CHECK Licens u Lic.Class SIZE STORIES FAMILIES I ONE �. VALUA�T^7ION / Contractor ate DESCRIPTION OF WORK ADD NEW $ / � C) ❑ I am exempt under Sec. ❑ 0111.ALTER B.&P.C. for this reason REPAIR ❑ $ USE OF Date: EXISTING BLDG. I . DEMOL ❑ ;E7454 APPLICAN TEL. // J .1 o l 6 2 3 Signature FINAL G OWNER-BUILDER DECLARATION PRINT O. DATE o a 1 6 2 3 8 53 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS e _ _1. FIN .0. 13-87 Professions Code): PRESENTI By ❑ BUILDING I, 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 0111.7044, Business and Professions Code). MOVING TEL. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM EXIS CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097,Civ. C.). I SIDE P.L. Lender's Name I� LDMA Ref. # Lender's Address P.C.Fee$ Permit Fee 1 certify that I have read this application and state that the Issuance Fee V LDMA P/G# above information is correct. I agree to comply with all County Investigation Fee 9 ordinances a to laws relating to building construction, ; Total Fee 6 LDMA Perm.# I N and hereb ri repro ative f his County to enter upon the v1 51 tions oper f nspection purposes. a t � . „ SEE REVERSE FOR EXPLANATORY LANGUAGE 4 NIF-Signature of A icant r Agent Date I 1 WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of cnta s elf - APPLICATION F O I' BUILDING PERMIT LI IS insure, or a certificate of Workers'Compensationion insurance, or a certified copy thereof(Sec. 3800, Lab. C.) � COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUIL Ess to r Certified copy is filed with the county building inspec- BUILDING / tion department. ADDRESS !� { LOCALITY Date Applicant CITY i4 ZIPq a p NEAREST C O CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' �/ NO.OF.BLDGS. 3 ASSESSOR COMPENSATION INSURANCE SIZE OF LO �� 7� NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZO E MAP hundred dollars($100)or less.) TRACT BLOCK LOT NO. 7 NO. TEL. ^^�j/ SPECIAL y- I certify that in the performance of the work for which.this OWNER NO.Or Dv 77�� CONDITIONS 9.. permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE I FIRE PRO SSED BY O so as to became subject to the Workers'Compensation Laws. ADDRESS — CONST. ZONE U Date " � Applicant CITY ZIP Cd �� ;STATISTICAL C SIF CATION!•// J APT. CONDO. � NOTICE TO APPLICANT: If, after ma ing this Certificate of ARCHITECT R TEL. UJ Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. -� DWELL. UNITS L Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP464 with comply with such provisions or this permit shall be deemed revoked. TEL' CONTRACTOR NO. BK. FG,J VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. ` VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC, d� Professions Code,and my license is in full force and effect. CIN CLASS $ ,��Q ► SQ. FT, NO.OF NO.OF CHECK License Number Lic.Class SIZ STORIES FAMILIES ONE DNEW IDE WORK 13 $ Contractor Date i6! ADD 1 am exempt under Sec. Id X ALTER..:. LTER. FINAL ,/' B.BP.C. for this reason REPAIR DATE (� USE OF FINAL /' Date: EXISTING BLDG. DEMOL ❑ By ( �p Signature APPLICANT jj 'T EL_ I OWNER-BUILDER DECLARATION PRINT Z0 f S i XintNO. -7y J I hereby affirm that I am exempt from the Contractor's License nn Law for the following reason (Section 7031.5, Business and ADDRESS L Sk GYh !G (:i ® F r 0 6 A Professions Code): PRESET -BUILDING f I, as owner of the property, or my employees'with ADDRESS wages as their sole compensation,will do the work and LOCALITY ° ° 3.() the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. _ C y x I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 0 c f —° 4 tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. tSec. 3097, Civ. C.). SIDE a P.L. o Lender's Name Lender's Address P.C.Fee$ Permit Fee r 1 certify that I have read this application and state that the Issuance Fee /b �0 = above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, 33 Total Fee and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 1 a- 1s '' Q�/A/��j� I 1EE REVERSE FOR EXPLANATORY LANGUAGE DIJ� ll Si ature o Applicant or Agent Date ! 0 es >E APPLICATION FOR, BUILDING PERMIT COUNTY OF LOS ANGELES - BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR A PLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING A RES or a certificate of Workers'Compensation Insurance,or a certified CIT ZIP LOCALITY f' copy thereof(Sec.3800,Lab.C.) / [ 78O Policy No. Company SIZE OF NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. U NEAREST CR SS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL E' SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OW — - TEL NO. ,�/ COMPENSATION INSURANCE .CJ �(g �C Jry-Z 7 UP WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred D SS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) C _ ZIPof .y�O I certify that in the performance of the work f which this permit // C�/�f is issued, I shall not employ any person in an manner so as to / V ` become subject to the Workers'Compensation Laws. ARC ITECT RENGINEER TEL NO. - STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS 40. DWELL UNITS NOTICE TO APPLICANT• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FRONT PY P P ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CIN LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 1 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIE NO.OF ORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. (Q U NEW ❑ BK PG , a License Number Lic.Class DESCR ON OF WOR J ADD ❑ VALUATION O Contractor Date ALTER ❑ $ C U REPAIR ❑ ❑ 1 am exempt under Sec. $ 0 B.BP.C.for this reason DEMOL ❑ W Date: USE OF EXISTING BLDG. URM ❑ LDMA P/C# 01 IL nature APPL NT(PRINT) TEL TEL NO. LDMA Perm# ACCTtt g z I, as owner of the property, or my employees with wages as Lro tr e V 1 G 'a 14 Z 3303"r 108.90 � '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 a ITEMS Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY TOTAL -108-910 licensed contractors to construct the project (Section 7044, YES❑ NO❑ CHECK 108090 Business and Professions Code.) 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 .00 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there Is a constriction lending agency for YES❑ NO❑ y((�� (� ((��(�((�� i iA the performance of the work for which this permit is Issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 0000-0001 9/ •,95 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, n TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 2201 1 RM 5°s 10 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. i 0 Lender's Address C OWNER OR AGENT c I certify that I have read this application and state under penalty c of perjury that the above Information 13 correct.I agree to comply P.C.FEE PERMIT FEE p' (� N with all count ordinances and State laws relating to building e:J , V constr ction, d hereby a h ntatives of this County ISSUANCE FEE m to a Upo above-m ed party .inspection purposes. m INVESTIGATION FEE TOTAL FEE (/ SEE REVERSE FOR EXPLANATORY LANGUAGE 8A688A CE*so-a-Io.98 APPLICATION FOR _ U I ®I N Ca PER IT - •�.� BUILDING AND SAFETY DIVISION BUILDING Department Of County Engineer ADDRESS County of Los Angeles LOCALITY JOHN A.LAMBIE. COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST. DISTRICT NCa. GROUP . 0NS,T, SEWER MAP FOR APPLICANT TO FILL IN �Jf/ `-'-/L °� CONST BUILDING ADDRESS ' 616'2A NO Sultana STATISTICAL CfSSIFICATION CLASS. NO: L DWELL. UNITS LOT NO. A-2.!2 BLOCK MAP � 2�^' STATE• �Y/� NUMBER ck,3 HWY. YES /NO TRACT �ran-n- eK USE ZONE SPECIAL Q� q NO.OF HLDGS, iya� CONDITIONS SIZE OF LOT Q® 93 A I NOW ON LOT USE OF I EXISTING BLDG BUILDING / EXIST. YARD HWY STREET NAME SETBACK WIDTH OWNER G. A. Wall FRONT / MAILC. P. L. ADDRESS Same as ab a SIDE TEL: P. L. CITY Teme l e i t v No. INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO. ADDRESS CONTRACTOR Virgin Roof Cm1Eo'AT705 7 . ADDRESS 600 S.San Gab ri e 1 Bl.,S.G DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH Q.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF TRUCTUR e- . WI ti WOOCl SYl $ Z. y APPROVALS SIGNATURE OF APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS 600 .S'. San G riel Bl. S.G FOUNDATION:LOCATION FORMS. MATERIALS $ 572.00 P.C. S FRAME: FIRE STOPS. FEE BRACING.BOLTS VALUATION FEB $ 5.00 FURNACE: VENT D CTSN. 1 HEREBY ACKNOW EDGE TI-14+ 1 HAVE READ THIS AP- LATH. INT. PLICATION AND STA ATT ABOVE 13 CORRECT AND AGREE TO COMPLY L OUNTY ORDINANCES AND - LATH. EXT. STATE LAWS RE UILDING COP($TRUCTION. SIGNATURE O HOUSE NUMBER COR- }I PERMITTE RECT AND POSTED ��A ADDRES 600 S•San G ie1 Bl. �S.G• FINAL '� �Y ¢• r '-'�`� OHN A.LAMBIE.COUNTY EN INEER. CLYDE N.DIRLAM. PRINCIPAL STR U AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PEHMIT VALIDATION CK. Im.o. CASH Lp. ,01 5 5 7 16 1 0 - 5.00