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Home My Public Portal About6345 SULTANA AVE_Building__ a� ' �• APPLICATION FOR B ► ILDING PERMIT �l COUNTY OF LOS ANGELES- I BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING DD r WORKER'S COMPENSATION DECLARATION BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, ;6 541,,/TXNA� AVFFV!/f or a certificate of Workers'Compensation Insurance,or a certified Dopy thereof(sec.3800,Lab.C.) C'oSA Al G.4: zIPCA -91775 Lo n Policy No. Company SIZE F LOT NO.OF SLOGS.NOW ON LOT ❑ Certified copy is hereby famished. J .�j?p may: NEAR RO TZ ❑ Certified copy is filed with the county building Inspection T BLOCK LOT NO. department.' � �� USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Data Applicant s �� l o / 1` SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' N�� Q� + �go1�Fj-7P/ WITHIN taco Fr OF SCHOOL? YES No COMPENSATION INSURANCE DRESS (This section need not be completed If the permit is for one hundred i6,941 -IA7AW�- .'YAWZ1� DISTRI "GROUP TYPE FIRE ZONE ED On dollars($100)or less.) CITY ZIP nn,, n 1 certify that in the performance of the work for which this permit , �TR�I I 9I S OU v is Issued. I shall not employ an reon In any manner so as to AIRCHITECT OR ENGINEER TEL.NO. become subject to the Workers' n on STATISTICAL IFICATION ® APT CONDO Date�Applicant DRESS CLASS NIO. DWELL UNITS NOTICE TO APPLICANT.• If a r making this Certificateof CONTRACTOR TEL NO REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should be ome subject to the Workers' 1 i SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith FRONT comply With such provisions or this permit shall be deemed'revoked. ADDRESS ' LIC.NO. PL I LICENSED CONTRACTORS DECLARATION CITY, i LIC.CLASS SIDE C 1 hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.Q�CZE NO. STORES NO.of FAMILIES Professions Code,and my license Is In full force and effect. a+* NEW ❑ BK PG ems, LIJ License Number LID.Class DESCRI O F WORK/ � ADD VALUAT/ION , Contractor Date I / nC7o f doh $Al0 - t/y IIALTER ❑ z � �� ❑ 1 am exempt under Sec. REPAIR 11CIG . $ y , B.&P.C.for this reason DEMOL' ❑ ..LOMA PIC 0 Data. USE OF EXISTING BLDG. URM, ❑ CjYIB4f. t{ Signature APPLICANT(PRINT) T N LDMA Penn A ( t ❑ I,as owner of the property, or my employees with wages as , �� 0• p a their sole compensation,will do the work and the structure is �� p F AC T°a not Intended or offered for sale (Section 7044, Business and dv�'"T�se Av&/ L �/`77cS FINAL DA G 353-14, Professions Code.) WILLTHEAPPUCANTORFUTUREBUILDING UPANTHANDLEAHAZARDOUSMATERIAL �- { ITEMS❑ 1, as owner of the property, am exclusive) �contractin with I OR A MIXTURE CONTAINING A HAZARDOUS IAL EDUAL To OR GREATER THAN 1' ITEi lam exclusively'contracting ,THE AMOUNTS SPECIFIED ON THE HAZARDO MATERIALS INFORMATION GUIDE? fl 'NMWJ ! .. TOTAL a licensed Contractors to construct the project.(Section 7044, YES❑ NO F Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING N THE APPLICANT OR FUTURE BUILDING OCCUPANT REOUIREA PERMIT FOR CONSTRUTION OR MODIFICATION FROM THESOUTH CHECK 358.1y CONSTRUCTION LENDING AGENCY 1 COAST uAIR Q MANAGEMENT DISTRI (SCAOMD)SEE PERMITTING CHECKLIST FO I hereby affirm that there is a construction lending agency for YES 11 NO 11CHANGE A the performance of the work for which this permit Is Issued(Sec. 1 I HAVE READ THE HAZARDOUS MATERIALS NFORMATION GUIDE AND THE SCAOMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY EQUIREMENTS UNDER THE LOS ANGELES COUNTY COD G YTER ALS POiRT1CHAFrER�8ECT1 S Z2nffE- 0 GAPER PERS FR M THE SCAQMD. 0000-0001 6/ 8/90 �. Lender's Name HAZAR � 1 176 1 AM ;�s�.6 Com-- r ICL Lender's Address : 1 certify that I have read this application and state that the above information is Correct. I agree to comply with all County P.C.FEE EE d ordinances and State laws relating to building construction,and ` r Rth*rl,' aupresentatives of this County to enter upon UANCE FEEve-mnd nspectn purposes. IGATION FEE OTAL EEMP�tanprrt V� SEE REVERSE FOR TORY LANGUAGE, r WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self APPLICATION F OR PUILDING P E RM I T insure,or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(S c. 3,800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. ?c i any��7� /r7 1A ❑ BUILDING Certified copy is hereby furnished. FO,R APPLICANT TO FILL IN ADoulDRESS , Jr m Certified copy is filed with the county building inspec- BUILDING c ' LYJ Tion department. r��_,�)) ADDRESS �J U L- Aj,4. LOCALITY NEAREST Date �.� ��'r Applicant W. . CITY ZIP .� CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR -COMPENSATION INSURANCE SIZE OF LOT / NOW ON LOT 2— MAP'BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE�,NE FSP—EC P �ad hundred dollars ($100)or less.) TRACT BLOCK LOT NO. I .EL. {�// G n IAL 1 certify that in the performance of the work for•which this OWNER r—l'o NO,2 l(J 'p� d NDITIONS o permit is issued, I shall not employ any person in any mannerADDRESS (p// 3 CONST. ZONE DISTRICT GROUP TYPE FIRE PRO SSED BY l3 �( .S(JG. �� r- so as to become subject to the Workers'Compensation Laws. � /J , / 09 Date Applicant •t�'r CITY S N /s ZIP STATISTICAL CLASSIFICATION I APT. CONDO. 1.) NOTICE TO APPLICANT: If; after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER _� NO.2-P�007 CLASS NO. '---I / DWELL. UNITS N Compensation provisions of the Labor Code, you must forth- ADDRESS -6 SEWER MAP with comply with such provisions or this permit-shall be ��E� ' deemed revoked. CONTRACTOR /�eAJZ e4& d7tJ BK.N PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. C I hereby affirm that I am licensed under provisions of,Chapter 9 ADDRESS,S,3 1e1,0d-E NO. (' O VALUATION (commencing with Section 7000)of Division•3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY F-re-e-0 TA CLASS /�� $/ ,00 SQ. T NO.OF NO.OF CHECK License Numbervp' Lic.Class/ SIZE STORIES FAMILIES ONE Contractor_ q ILz ate ( DESCRIPTION OF WORK NEW ❑ $' � '� I am exempt from the licensing requirements as I am a f ADD ❑ ' licensed architect or a registered professional engineer ALTER ® FINAL acting in my professional capacity (Section 7051, U REPAIR ❑ DATE Business and Professions Code). USE OF FINAL tAom,, lnnny ///r I EXISTING BLDG. , QfiL DEMOL ❑R By Lic.or Reg.No. Date v1 APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. e I hereby affirm that I am exempt from the Contractor's License e ` l(k , Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT El BUILDING I, as owner of•the property, or my employees with' ADDRESS wages as their•scile compensation,will do the work and the structure is not intended or offered for sale(Section { kADDRE 2 1 4 9 A •7044, Business and Professions Code). TEL. ❑ I, as owner of the property, am exclusively contracting CTOR NO. ft,o ° 0 0 0 1 with licensed contractors to construct the project (Sec-., . tion 7044, Business and Professions Code). 2'° 1 33.00 ED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY ` CK YARD Hwy PROP. LINE WIDTH _ I hereby affirm that there is a construction lending agency for �° ° 1 3 3,0 0 v the performance of the work for which this permit is issued IZ02-81 (See. 3097, Civ. C.).Lender's Name17 � $ Permit Fee Lender's Address G I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ordinances and.State Ipws relating to building construction, g � s b Total Fee 0 and hereby authorize representatives of this County to enter ' upan the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE o ` Signature of Applica or Age Date I Os 1