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Home My Public Portal About6314 SULTANA AVE_Building__ i APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUIL ING AND SAFETY WORKER'S COMPENSATION DECLARATION I FOR APPLICANT TO FILL IN BUILDI GLADDRqss �I I hereby affirm that I have a certificate of consent to self insure, BUIL DpR sS -91-11-7—A-144 �G�I _,^ a ' or a certificate of Workers'Compensation Insurance,or a certified (P A-144 1 copy thereof Sec. 0,Lab.C. .� CIS`TY— ®` C`� ZIP Gt�-7� S e/�! If=VJ�/� j9WP,, LOCALRY Policy No. COmpanya —SIZE CROSS ST O 1PT NO.OF BLDG NOW ON LOT i I f # El Certified copy is hereby furnished. � yC C7 , �&-X ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. �J ;99"1 //1� ��Yy SES J USE ZONE MAP NO. r Dat plicant 6"ARE �-r//VS7, ui2 ASSESSOR BOOK PAGE PARCEL 6-3g�f V" dq-,7 9 d_/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' owN�R- w 1 �, 9Q�/� TEL NO. tel• COMPENSATION INSURANCE ,/�, �"f !N C7 WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADD ESS dollars($100)or less.) DISTRICT GROUP TYPE/CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CITY _ ZIP D� �/�f is issued, I shall not employ any person in any manner so as to J ITECT OR�NGINEE�/' EL5 !/ become subject to the Workers'Compensation Laws. 17�I/dw i C7vi/nnJ �3 I. STATISTICAL CLASSIFICATION APT CONDO Date Applicant qt �, �- CLASS NO.�— DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate of J REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CQNTRACTOR ��e T O�� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 7� C�/� 'v l.J• FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L /935 1.4 MLICENSED CONTRACTORS DECLARATION �- � �J/�- SIDE clTl BO LIC.cLASs P L I hereby affirm that I am licensed underprovisions of Chapter 9 (� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ. ZE NO.OF RIES NO.OF�MILIES l/ Professions Code,and my lic se is in full force and effect. Q S�' NEW BK /V PG 6 > DES RIPTION OF WORK / App ❑ VALUATION C D. License Number Lia.Class �^ �0n;Sr, U� E J� $ O� Contractor N Date 4477e? �� `�EI�- [J ALTER ❑ Ix ❑ 1 am exempt under Sec. REPAIR ❑ $ H B.BP.C.for this reason y ,a� DEMOL ❑ LDMA P/C# 11, C URM El CL Signatu G.0"/� APP ICANT(PR/NT� /�M TEL NO. LDMA Perm# Z r•.;. y z ❑ I, as o of the property, or my employe ith wages as ►�2 C w g their compensation, will do the work and the structure is XODYS 0. L} not intended or offered for sale (Section 7044, Business and �rJ FINAL DAT I I 7 5 y�] Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J 3 EME", OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B r0TA.L .6�+3 40 licensed contractors to construct the project (Section 7044, YES❑ No❑ ._ ._ Business and Professions Code.) CHECK " WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING i:)'I�!:F�, t:liL n'i OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR 4 I�)� GUIDELINES {�/(ti '-i-'It17 3� I hereby affirm that there is a construction lending agency for' YES❑ No❑ a the performance of the work for which this permit is issued(Sec. W I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING r 3097,CIV.C.) CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, I")F}}fI If•);I. %/ a TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS i J �L t 1 2 + + Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address jF L 1 HM l i e 56 OWNER OR AGENT cI certify that I have read this application and state under penalty c of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N With all county ordinances and State laws relating to building s r tion, and hereby autho'ze representative of this County' ISSUANCE FEE / �a to ente upon the above men' d property f ction urp s. !s� CD /�(/� Z INVESTIGATION FEE TOTAL FEE / r uta a Apyimnl a At1eR OWB [v 7 SEE REVERSE FOR EXPLANATORY LANGUAGE • J • APPLICAT014 FOR BUIlrDING PERMIT COUNTY OF LOS ANGELES ' ' BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT-TO FILL IN [�JJIL ING 'DRESS BUI DING AD ESS I hereby affirm that I have a certificate of consent to self insure, y� dqq w c �"� or a certificate of Workers'Compensation Insurance,or a certified ;P / / Sa RN�1 AVG , copy thereof(Sec.38_00,Lab.C.) CITY ZIP 0¢6-90— 3 � DAZE Aaaa C T745' LOCALITY Policy No. Company SI OF LFT ` NO.OF BL GS.N WON LOT eldireze ❑��Certified copy is hereby furnished. � � `30 -6pto 0 , NEAREST CROSS 2<rtified copy is filed with the county building inspection TRACT BLOCK LOT NO. depart gent. 12 O & 3 USE ZONE MAP NO Date� Applicant SC Q1VS7,WCM v ASSESSO P BOO R4 PA� �J rd7i. SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWN � , r,/dN� TEL NO. COMPENSATION INSURANCE YID WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred dollars($100)or less.) ADV 4 SDIJEWS�G774'N^ /I, r#£ /'r6 DISTRICT GROUP TYPE CONST. FIRE ZONE PROLES •�/� I certify that in the performance of the work for which this permitIpL /�� ZIP 7/77-57 � is issued, I shall not employ any person in any manner so as to ARCHITECTi =l:^:`��✓^ 1413 EL O become subject to the Workers'Compensation Laws. PAMAW' -SJ S �p Z ��.� STATISTICAL CLASSIF CATION APT CONDO Date Applicant ADDRES #/1V AV I . CLASS NO. DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate of S L�4 64 ' +v F7 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject the Workers' C TRACTOR �I TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith I, s FRONT comply with such provisions or this permit shall be deemed revoked. )DRESS , s �e� �/ LIC.NO. P L LICENSED CONTRACTORS DECLARATION �i �G c SIDE CITY oo LIC.CLASS P L } I hereby affirm that I am licensed underprovisions of Chapter 9 — SEWER MAP (commencing with Section 7000)of Division 3 of the Business and Sq.FT.SIZE NO.o STORIES NO.OFF (LIES p �' Professions Code, and my license is in full force and effe/pt. (j 5FD NEW ❑ BK /t/ PG �O , V License NU er 30,1 Lic.CIas3 • DEE�RIPTION OF WORK ADD " VALUATION Contractor Date % D '0 d y� �j ALTER ❑ EJI am exempt under Sec. /�/1lr1�6 "��"' EPAIR ❑ $ BAP.C.for this reason DEMOL ❑ L lP LU LDMA P/C# d Die: USE OF E TI G BLDG. URM ❑ N �E t" z Signatu APPLICANT(PRINT) TEL LDMA Perm# Z ❑ I. as OW of the property, or my em JY�o Be with wages as their s compensation, will do the w6rlc and the structure is A 0 730,, 5)l=5)' not intended or offered for sale (Section 7044, Business andff (/,4 FINAL BATE Professions Code.) •Z I I S C WILL THE APPLICANT OR FUTURE BUILDING UPANT HANDLE A HAZARDOUS MATERIAL 711 l _ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL 8Y > ' 1�4!• e 3 licensed contractors to construct the project (Section 7044, 3 Business and Professions Code. YES❑ No❑ ,;�,f,�• 508.32' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '`, ITEM CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR i 2 GUIDELINES y,` _ 1 hereby affirm that there is a construction lending agency for YES❑ NO❑ TOTAL Iy-AL 85 a the performance of the work for which this permit is issued(Sec. rn` I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING K r1 C4 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ;t:1�lEiv7t 558. '2 TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. CHANGE .0111 0 Lender's Address p OWNER OR AGENT GI certify that I have read this application and state under penalty c of perjury that the above information is correct.I agree to comply P.C.FEE �/� PERMIT FEE /gyp1+ -I (�� i) r°yL� � N with all county ordinaAel d State laws rela•ng to building �'V r7 vel. � pre coon, and hereze representativ of this County ISSUANCE FEE yl 12-7 1 All i■ m to ant r upon the above- d property f ection urp es. �, '/� a �ft CD �W INVESTIGATION FEE TOTAL FEE IUR of AppOwil«IIpNO17 SEE REVERSE FOR EXPLANATORY LANGUAGE