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Home My Public Portal About9909 LOWER AZUSA RD_GRADING_4/20/2016_3dx1. a37I3 SSHOd3U 57IOS CNV JID0703O a 3OUVHDSIa INVIn770d 7VNOIIVN 5 (QI'I) iNawd07SA3a IDVdWI MO7 30 3DNVN3INPiW 3HI ONIaHVO3U IN3WS3UDV UNV INVN3AOJ a S Max Had XUOM 30 NO] ,b` 1I 09'SVL'Z 06'bE :x3 a3aN31X3 :01 aSaN31X3 'd X31 01'EBE'T 01'8ZE'T US 91/0Z/60:1.NnOWV Mx3 cassaDOUd ;NO GMSSI� ,,,,... IIwH3a 3wI1 a3IIwI7 V Si s1xl ...,... I I x1.13 37dW3I :xSI7VJ07 SB :aIUO G65 :3DVd SVWOHS I 4133UIS SSOUJ IS3HV N I60608LT6 VD dwal QU VSa2V U3MO7 ET66 ZOOOSOZOST BOSO UD IIWU3d ONIaVHD V$ mW moi Lb b - bo bb Bosose :oi 31.noH Z9 ZUda :or IHOd3U 37I3 NO VIVO 7V9OI1IQQV . 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NOISJ3dSNI a3UI0D3U 3a0J NIVISO 01 57IV3 (E HO 'a3NOQNVSV UO a3aN3d SaN SI XUOM (Z UO '33N3 OJ ION S3Oa XUOM (T 3I SAVa 081 S3UIdX3 1IkMad 69ZH661 Z -H ON :ON dV :3NO2 ASO :X.T. cTxIc :a37I3 3IVO :xH Q�D3U :ON axOS 96856 :ON 'JI7 -BBSE-E9Z (9Z9) :ON "1131 OZZS89 ON 'DIU -6966-OLS (9Z9) :ON '731 -88SE-E9Z (9Z9) :1X3 8860-SSZ (9Z9) :3NOHd 08LT6 VO ASID 37dW31 SVNILL Mn 1046 8060 k ASID ndW3I xe a�J331 '1ISOd3O HSVJ� :a37I3 31.Va 'xNVdWOJ xI3UQSI $ :aNO3 x13Unsl 90016 VJ 'VIaVJHVI V IINn 'aVOU ONIUO'IOO 618111 'DNI 'S3JVIJOSSV 7D3I 6SLT6 VJ 'XUVd AaH3 NOWJ TOZ 315 'ams JIZNVISV S 6081 "OJ DNIa7OH DNOMJWI 90016 VJ VIaVD3V a3 DNIUMOD 6TBST ONOP 'Xw m :INVJI'IddV OE016 VNSaVSVd HSd10S 3AV SXVO UIV3 6TVT NOUVHS Iam 'N3xMO INVN3I 6ZO-6Z0-6858 '113SKM NOII'.WHO9NI UOSS3SSV ZT :(S)I07 8686 :UI L .LNHNd0'I3A3a aNV7 / x a"S GAV ONIMMU SXUOM DIMMd 30 IN34IUVd30 S373DNV SO7 30 AJ4,10J 5333 7VIOI I ;ON '731. Had SJNVOSSI 11WH3d OZ no 00'OSZZ IIWUSd DNIa O VZ aD 00'O9ZZ SIE - XDSHD MV7d 801 :Won :x I1NVnO 1 :NOIIdIUJS3a 333 -8188-66L (9Z9) ON 731 aIVd 5333 :1X3 8860-SSZ (9Z9) :3NOHd 08LT6 VO ASID 37dW31 SVNILL Mn 1046 8060 k ASID ndW3I xe a�J331 '1ISOd3O HSVJ� :a37I3 31.Va 'xNVdWOJ xI3UQSI $ :aNO3 x13Unsl 90016 VJ 'VIaVJHVI V IINn 'aVOU ONIUO'IOO 618111 'DNI 'S3JVIJOSSV 7D3I 6SLT6 VJ 'XUVd AaH3 NOWJ TOZ 315 'ams JIZNVISV S 6081 "OJ DNIa7OH DNOMJWI 90016 VJ VIaVD3V a3 DNIUMOD 6TBST ONOP 'Xw m :INVJI'IddV OE016 VNSaVSVd HSd10S 3AV SXVO UIV3 6TVT NOUVHS Iam 'N3xMO INVN3I 6ZO-6Z0-6858 '113SKM NOII'.WHO9NI UOSS3SSV ZT :(S)I07 8686 :UI L .LNHNd0'I3A3a aNV7 / x a"S GAV ONIMMU SXUOM DIMMd 30 IN34IUVd30 S373DNV SO7 30 AJ4,10J OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s) (Section 7031.5, Business and Professions Code): Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure 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).): U I, as owner of the property, or my employees with wages as their sole compensation, will do (J) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner - Builder will have the burden of proving that it was not built or improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contra or pursuant -to the Contractors' State License Law). U, I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in whicF I must have resided for at least one year pdorl to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an own If it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: htto:/ANww.leginfo.ca.00v/calaw.htmi. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions 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 Class ;�__ License No. S %/Z0 Date Vdntractor Signature WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My works�insura�olicy be are: Carrier Policy Number Expi tio. Dat Name of Agent Phone Number I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions 5 Applicant Date LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in Unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiar with the requirements of Los Angeles County Code Chapter 2.160 at seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself complied and will continue to comply therewith through the application process. )K A -M fW slim n, S � Company pany Na ` G6 pli ant Si n to Dat JOB ADDRESS LOCALITY r HAZARDOUS MATERIAL DECLARATION Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amount specified on the hazardous materials information guide? Yes ❑ N o ❑ Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter 220' Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAQMD. UV1 ]X.9NT.9.PSifdtrnif9T:1 ❑ Notification letter sent to AQMD and/or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lenders Name Lenders Address By my signature below, I certify to,each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. 1 agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this county to enter the above -identified property for inspection purposes. Signature of Propedyl9wner or Authorize t S—dip . V G Date �� /