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Home My Public Portal About5708 OAK AVE_Building_8/24/1994_WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self or a certificate of Workers' Compensation Insurance, or a,e copy thereof (Sec. 3800, Lab. C.) Policy No. Compo ❑ Certified copy is hereby form ❑ Certified copy is file the county building inspectior department. Date Applicant /CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the Work for which this permit is issued, I shall not employ any perso, many manner so as to becor`r%��.� I^e7ct to the Workers Coppenstion Laws. Date `' b Applicant Alt� NOD 70 APPLICANT If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed underprovisicns of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number Lia Clas. Contractor Date ❑ I am exempt under Sec. / B.BP.C. for this reason Date: Si tura as owner o e property, or my employees with wages as their sole pensation, will do the work and the structure is not ince ed or offered for sale (Section 7044, Business and Prof Ions Code.) ❑ I s owner of the property, am exclusively contracting with 'Goosed contractors to construct the project (Section 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for m the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) 3 Lender's Name - o Lender's Address 0 o I certify that I have read this (cation and state under penalty of perjury that the above rmation is correct I agree to comply with all county oM' ces and State laws relating to building m construction, a20.4fereby authorize representatives of this County to ante1 Ipowffif, above-mentioned property for map V, purposes. s-rowre Aewnm aWJm� APPLICATION FOR COUNTY OF LOS ANGELES FOR APPLICANT TO FILL IN BUILDII{G ALTSS q A� � . CITY i ' ZIP SIZE Q LIT. Ti NO,,,QF BLDGS. NOW AN LOT TRACT.4 t / I - I� ' OCK � /-, �i LOT NO. ASSES AP B00 I a!DPAGEI PARCELe:�3: OWNERI ' TEC( NO. ADDRESW1�_ O rte' S CIT r X ARCYGINEER TEL NO. ADDRESS BUILDINGPERMIT SAFETY AND PERMIT BUIBUILDII� ADDRESS 1 � i%O LOCAL'f IT NEAREST CROQ�\[$ ST. 1(L� USE ZONE 1 AARP N . - ISPECIAL CONDITIONS e7ll�Y n_ O/ / WITHIN 1000 FT. OF SCHOOL? I YES NO V/ / DISTRICT GROUP TYPE CONST. FIRE ZONE IOCESSED BY STATISTICAL CLA SIFICATION A T CONDO CLASS NO. �21 DWELL UNITS PG APPLICANT (PRINT) r1 TEL NO. LDMA Perm # ADDRESt (� x FINAL DATE ANLL THE APPl1CANT OR F RE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL / OR A MIXTURE CONTAI A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECT ED THE HAZARDOUS MATERIALS INFORMATION GUIDE? FIN BV YES ❑ NO WILL THE INTENDED USE OF THE SUIDUNG BY THE ARROGANT OR FUTURE BUILDING OCCU A,W REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUAUTY GEMENT DISTRICT (SGAQMD) SEE PERMITTNG CHECKLIST FOR GUIDEDNES ES ❑ NO 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE TIRE 2, CHAP 2.20 SECTIONS 2.20. 100 THROUGH 2.20n A0 CONCERNING HAZARDOUS MATEPAfIS RLMPOWING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. ovlhR P.C. FEE u/`� PERMIT FEE ISSUANCE FEE INVESTIGATION FEE TOTAL FEE /NQS (O� Tff�2 SEE REVERSE FOR EXPLANATORY LANGUAGE u j } a TOTAL SETBACK FROM EXIST YARD REQUIRED CONTR&CTOR � d/ WIDTH TEL NO. SET BACK IISSDDCCSS//�'"''.'•��i == W FRONT ADDRE � — O 1 Q LIC. NO: o Nr:f:I .4 P L T --M_: 32 ni:. SIDE CITY UC. CLASS P L SS(OF,'nT.�512,EE NO. OF 37RIES I NO. OF F MILIES NEW ❑ SEWER MAP BK OE9LAlPTI� I O RK // // ADD J?� ,VALUATION $�� pp p crop�`� ALTER REPAIR 11NTI ❑ / t DEMOL ❑ LOMA P/C # USE OF EXISTING BLDG. �r _:I URM ❑ PG APPLICANT (PRINT) r1 TEL NO. LDMA Perm # ADDRESt (� x FINAL DATE ANLL THE APPl1CANT OR F RE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL / OR A MIXTURE CONTAI A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECT ED THE HAZARDOUS MATERIALS INFORMATION GUIDE? FIN BV YES ❑ NO WILL THE INTENDED USE OF THE SUIDUNG BY THE ARROGANT OR FUTURE BUILDING OCCU A,W REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUAUTY GEMENT DISTRICT (SGAQMD) SEE PERMITTNG CHECKLIST FOR GUIDEDNES ES ❑ NO 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE TIRE 2, CHAP 2.20 SECTIONS 2.20. 100 THROUGH 2.20n A0 CONCERNING HAZARDOUS MATEPAfIS RLMPOWING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. ovlhR P.C. FEE u/`� PERMIT FEE ISSUANCE FEE INVESTIGATION FEE TOTAL FEE /NQS (O� Tff�2 SEE REVERSE FOR EXPLANATORY LANGUAGE u j } a TOTAL SETBACK FROM EXIST YARD HWY PROP LINE WIDTH PG APPLICANT (PRINT) r1 TEL NO. LDMA Perm # ADDRESt (� x FINAL DATE ANLL THE APPl1CANT OR F RE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL / OR A MIXTURE CONTAI A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECT ED THE HAZARDOUS MATERIALS INFORMATION GUIDE? FIN BV YES ❑ NO WILL THE INTENDED USE OF THE SUIDUNG BY THE ARROGANT OR FUTURE BUILDING OCCU A,W REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUAUTY GEMENT DISTRICT (SGAQMD) SEE PERMITTNG CHECKLIST FOR GUIDEDNES ES ❑ NO 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE TIRE 2, CHAP 2.20 SECTIONS 2.20. 100 THROUGH 2.20n A0 CONCERNING HAZARDOUS MATEPAfIS RLMPOWING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. ovlhR P.C. FEE u/`� PERMIT FEE ISSUANCE FEE INVESTIGATION FEE TOTAL FEE /NQS (O� Tff�2 SEE REVERSE FOR EXPLANATORY LANGUAGE u j } a O U 0 == W (n Z — O 1 Q o Nr:f:I .4 — Q _ T --M_: 32 ni:. �','4,HIE PLANS TO APPLICANT LN. o:Returned .l Date No. Date Required APProvals Yes No Water Ckrtificale Health Department Fire Department Grading Geological Pedestrian Prolection (rencq(ce000y) Special Inspection IConc.) (Masonry) (N91amq) Lot Drainage Parking INSPECTOR'S NOTES Approved DateReceived or Approved Approvale Date Inspector's Signature Location (S -.O .yards) _ /� / Foundations f-(-},✓f(1{�t . Slab Frame Energy Insulation J 7 "7- fftf Lath/Drywall - Interior Lath - Exterior IP House Number - Correct & Posted Enteron Front _ Certificate of Occupancy Issued OWNER -BUILDER DECLARAT16N ,a I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5) Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement 'hat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9) (commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Sec. 7044) Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one yearof completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044) Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Laws. ❑ I am exempt under Sec. , B.B,P.C. for this reason Date Owner INSPECTOR'S NOTES