Loading...
HomeMy WebLinkAbout10_25_1984 - 21015 PATHFINDER RD (2) . . -.,:, . . . .,,, '.. .-------....---------- -- -...___ . . _...--------- -....__._...._:1............ . . _ _. . .._ �'S'COMPENSATION DECLARATION , '� ' ' � � ! —� �,��,.. ,•. ..,...._.� � � �.::., ',�•', ..., . � � , , . � --._...-�- - ' - - -_. �.o�e a ce�tificate of.consenf ro=e�� � -APPLICATION _FOR..BUILDING PERMIT � "brkers'Compensation Insurance,' . �....'"."______. �(Set:3B0jQ.�{ab.C.): :�"����,�'� • •; , •, _COUNTY OF LOS ANGELES•� ! BUILDING AND SAFETY ^ ,-��fJy �� � .�mpanyl!/�41�►`� -• - � � � -. ... .. BUILDING� � � .,•ts hereby fomished '. - � � FOR APPUCANT TO FIIL IN � ' ADORESS 7 .P�7/ ...ed'copy is iiled�with�IFie counly building inspe�� BUIIDiNG��� � 1 , . � ��ion-departmeM: •.'i �„ � . . . . �• �� , ADDRE55 � � . .. .. . ��.� .._ , ,.. _. _ . . �} 1 �1 aie � .. ."-qpplimAf '� � I CITY ZIP LOfAtITY �``� . , .. . �. ,.... ., . � , . ; '�• CERTIFICATEOFEXEN�PTfONFROMWORKERS' � �1 ' - '- ' '�-- - " �"--"N FBLDGS- - -� - - .•---._.._ _ ._....__ ._ . I O.O NFP.REST nA � '�- � � �•�COMPENSATION INSURANCE -'� � � t SIZE OF LOT rL NOW Onl lOi� O CRO55 ST.,. '(.���� � ,' � ��. I ' " .. ASSESSOR...y.. '--'•._ - (Thls secfion�need nof be cdrtipleted if the permit is for onA -�-� - TRACT BLOCK� lOT NO. 2 N,qp gppK " ' VAGE� PARCEI hundred dollars(S700)ar,less,) a��,- . , ,. . I � L-1 � Y. P ' ._,... OWNER Po ''.�NO. IQ`I I r U^ E MAP •. _' � Q" Pcertif that in the erforma�e�f�rYPwork for which.rhi. . , /1 ..,. , „ NO. � . . . ,. ��..y/�� . � ���._ SPECIAL'' '' � " ' ___' _ ' ',y � ermit is issued.I shall not em lo an �erson in any m!y�^]5 .. .. - ADO � �T -I�M`-1 R �..... ..-" - �-�- � sb as to become�sub'eci to the Workers'Compensmion Laws� � ..„�-, .. � .... .....:. . .. .. ... . . . . ' L��1 _- - .'-. . . ... . . . . .... . . . . _ " ' RE55 � �� CONDITIONS v �afe �, ..'. ' APPlicdnt.y „ .�...,..., �.-.. ' . .- CIiY-._� -� � -.._. (.ZIP.'..-1-1.� .. ..._ . NOT�CE TO APPUCANT:`If,�affer makin�'this Certificole o�� ARCHiTECT �p��1 TE� � D�Sii<ICT_ .GROUP ttPE. �_... . _FIRE PR EDBY- - , .. . 9 ENGMEER �. .I�IC. _ ..... !'�-ri. NO�I��7�'1�1 CONST.� ZON� I E■emption, you should 6'ecome subjec('fd'the�Workers' '- � , �p�/1� � /AI/ . Compensation pr6vlslons of ihe Labor Code;'yoU must farth• - ADDRE55 � �L�� V�Y�,V� �'i��- � - ��` � with camply�with'zuch provisions or this�permit sholl be -�---- • TEL. , STATISYICAL CIASSiFI TION . APT. CONDO. deemedrevoked. �' � ,.� ,' ��.� �.. ,�•;•��,:.� �`. ' y �ONTRACTOR NO. . . � �..._._ . .._ . .. . .. LICENSEDCONTRACTORSDECIARATION'�.� -.; � ...--- ----'--._. _._ ...__-.. ...__ ..._. --tIC:.. .- . - QA55N0. - DWFIL.UNITS' � �' _ I hereby affirm that I am licensed under provisions of Chapter 4 noDRE55 ' NO. • (commencing with Section 7000)of Division 9 of ihe Business and __._..- ._._ _ _ ._........_i��. ..._ _ � �P ' � � ' Professions Coda,and my Iicense is in full iorce and effect. CrtY � ' CL455 � " �� • '�--� VALIDATION � ..,,. .. , �] . . , i'_ ._. Sp.FT. .. n NO,OF.� _ 'NO.OF__ _'__ ' CHECK_; ' . _ __ _ SEVJE . .�BK. . I�� . � • liC.Closs � SIZE L�STORIES L'�"-'FAMILIES ONE . .. .. �� ='�.�.�',� 'i License Number � ' �� � Contractor Dar' � _.VALUATION. --.'_.--_.' ---.. .-—- ....... . - ---. " �'Fo��tC'bi257�.... .... . . ... . .... .. _ _ New._ i,i�� �> . . . .��i . . �,� DESCRIPf10N OF WORK �' �L � a � I e AD� � T . "_" .'.. �I am eaempl onder Sea .. - . . `p ALTER � ,' � �.� �:� - -- ' I : ' . ' _'_.. . . ... . . � �� : � ., B.SP.C.for�his�eason ' � � . ❑ S' G�j.�� �--' -"--� �--- �"�,i� ti- - ; ."'-. . . -.. REDAIR - . ___-__' _'____ _ __'._.___'_ _ _'.__., . ; � ( : . � . :. • - Date: - USE OF A I DEMOL Q ) ,� . � ' ` . � � � -.,, ' . E%ISTING BLDG. IU - � - , � _ - � _ .:, ,.... . __' - �j� I � V I . - _ .. "':_r,: :.. I .....Signature . . � .. ' -" _ '""' '_' APRICANT �y NO.GlO�� 7 � FINAL ��/ �Ir � �J . �.... � N OWNER-BUILDER DECLARATION � PR�M ' -- DA�E----- � t �-----� ' i � i hereby affirm�ho�1 am exempt from the Contrat�or's license, qDDRe55 ����� ����� . �� � '�'' '' ' '' � � taw for ihe follawing'reason'jSectfon 7031.5,Business ond � � HNAL ' J� '� � _ '.' ' _.'_.y�_ ._'. __ . _. ' �� '"ProfessionsCode):-. '- . .. "`.'. . _.'-'"- -•"'-�' � " ' 6y f� . --- BUILDING � � _� I, as owner of the property, or_my employees wNh' pDDRE55 �� .� . _ _ . _ _. .. _ .. . - ___._. woges as their sole compensation will do the work and ���TM . ��'(� . ( � the structura is not intended or offered for sole(Section. ' • � � ' � - � -7044,Bustness ond Professions Code). �' -- ..-. . . nnpviNG--'-�--'--- ....._.._... ... - -�-TEC -------- -... . -%, - 1 ; . .-.. . ;._ . ._. . . ..� S , � CONTRAROR NO. . t��L i B/�l� , � �':._ : ': I,os owner of Iha property,am exclusively conhacling' ' • " � � � . � �� ` ..� -wirh licensed conrracrors ro-cons�ruct�he ro�e[t Sec.�----' AREQUSRED- -YARO HWY TOTALSE78ACK{R M xl .� .-..r� -.?G�„"_Vi��i"�(/C-%.�•�'.Z/!T.- 1- .i'``.�,`"I �� P I ( �C/ I tion 7044,Business and Professions Code). , � �"-"'���- �CONSTRUCTION IENDING AGENCY� - ser eaa PROP.IINE wioiH �� �� I ��; ���� � , 1 hereby affirm that there is a conshuction lending agency for� peONT � �� q 9�Y� " �` �� �' � � -the performance of fhe wark for whith this permif is issoed . . -. .-P.L.-"" ' ""-' -"-....' --_._.._ .-_ '____'_ ___.' . '_- '�------�'-`-_---------_--'"- - - i:-j !� I (Sec.3097,Civ.C.). SIDE , " ' . . _..___ ____. _ .. ._. .'."'_'__.. ..... _ '__ __.._.. ._P.L'_.__. .__ _ '.'___._-'_.__ _...'. __ ._'_._. .__�._ .e.... . .-. .._._ __�.__. _.__._ _'_.___._._ ....._._ . lender's Name /� � , .'_.' _'-_ _. .' ._ . .'__. . ' . '. _ � _ .__ P.C:Fee E-� i� •" Perml�Fee--. �3 �J(/ LDMA Ref.M '"._ _ . '. Lender's Address ' �j� n, � '�� ''�• �' �� � -I certify Ihat I hava read lhis applicolion and stale.ihat iha ...-__. _ f/ - , /�� hsuanceiea �/� 1 � ��� � �� � ,� . -7- -'/D �CJ. _.'.'. D�v_- IDMA�P/CM��✓-OIb��'. ,-___ ' _ _ _.__ __ . _ ...__.. . obove informa�ion is correct.1 agree t ly wiih oll County� imev�garion Fee ����1y�� /� � � _+ . ordinonces ond_51a1e.laws reloti f ilding consiroclion, ,. . . __._..... . ...... .._._.____. Torol Pee � v � tDMa Perm.M ' r� - ond h by au�ho' represe ti of�his Coumy to eMer � —' up obov enti n o ' peclion pu�poses. , ' . _ .- - - . . . ._.—'�- -----' ---'---_...._ ._ ' i _.. .. _ . __._._. . i. �//�/�--/f7{/-����J - —---- ---. ._ ._.... ..---'-- � �Q y SEE REVERSE FOR EXPIANATORY LANGUAGE � � ��/� ' SignatureofApplimntorAgenl- ' .._.-" Dota.. .._._ ...'. ______...."_..." '.__'.' '_".'..__. __._._.___._._._ '...'_.'_ _'__ _._. _ ._.._. .___ .__ � . i. � ___ . .. I / • , , ' � .. � '� - � ---- -- Y2 � v. .� -� .�,. _ ,-� ---•— ' o 0 � r N T� �� 1D :p ' r m -n N T N O � � O f�D j a p O W 0 i A � • ♦ 7m T !1 S Q O 7 p p c fD no 7r O �^ n N O � � S � �,. � � � r T tD 3 � � a-- ' o ..�° -".= � �o v o ;m " � �� �, � t0 �p a 0 0 2. fa � n � �p y �,' o I ^�e � �o -� o X� 9 0 33 n� q -o ? v , � Z K < 5 o wl � ov ; � I ' 3 ° �� - � . a Q°c � o f H � o co �c , o - �D 'o o • O O 3 p � � 0 N p D 7 � K� � N N� O R ? �"-,� � o a " ,'�'�� --o. ? - N , n.� � - � � - v m . _ , ' � ' t , r � ;. � . I = 7 ' ' N '� l� ' Z ' � t� O . ' p O , � O � i . ' ' �� N' O ' �,10 'O - 1 . . - Z a :_ Q � D ( N` �i � ,' ' . o , o ,a � � ; o' ; V,� ' - ,. 0 - . , ! � i . • : � . e_ . • y: ' ' ` - . c�i�.. ' - , o e. o' ,, � ; `o � ' . ' - a°o- o. - -' • i ' ' ` _ � � i ,._ - . , ��' �al �, �1 � �� ,J' . . ' l ' ' �' �� `� � �; : ,� � a' � ;�. � ' '' -^ .�. � _ �, � �' ' . ; - °, ; � - i �, ; �'- u a..,. '�� � �' � � =G _ , ,� �` ' . � 1 � °c� b °��� r \ � . : 1 ' ,'. � 1, i •1 („� ��.' '� � N � � : . ' � " !� {. � � �rl. ��. `l�. � 4 � i• � �,� �� t� �, ', �: � �� ; . � � =_ , e � � 1 � o .. 1 . ' . , Q�, �' . �� �a' A ;_ . _ � `�f , I._ �' �:. � f' y�. A. W. � " Z ;, ,' , 1 0 .. � � - , . ; :� � � � � �: �� � " ., � � m .. 1' � . � . � � __ ; ;'_ , � .� � Q,�� t� �. �,. 4-' �__ C�' •� : N . ' �, _. , i � -: _ - ° - �4 ;�� �t _ �- - d"� � t� , ^,:, � - . �,.- � � �' � �' � , � �' - T� ' - - ,� `���� ��^ �. 0 - � � . _ � . ; ,; : -- _ . , .- ;. � - c�� , ', i��;_ ,: , . , i � �. : ,, �� . � ' ; , � ' �'� �' �`; , � � - . . ; • ' ' . , b „�I o r C s� c a ^'n c n �A"'�~'c a r- � � j b a t-•�-. , �fi'� o.,.�� n'c cc o a�t o`.`c.� ^ A � �' � � : . � ` v' f1 0� o � � ro ❑ oe �b �� - � .. _ - ; o • m 1' o o � � >�n �"' � � � � o .�S ._ A �� e `�c L b F.� e��iu �c.. ` ' ', N' M�.. '� n b � r ��r t„� �' y C`� Cti '°4 .N M- �Cs. J��� i, . � � � O � `� ntiN � R � � � �JU� ONnO -��r'lC� � ~ FG ��0 ♦ �1 'L`!` !� �n �i , `, r . . i � ��, r .°� � o �{��T-'O C ; 1O e '^ a c '^ p �,C n,�'��` L ''b � � O�< �' o K �.A " ='Q. �`�o ^ �-e •. � � j.N v � = M q���tK.A 4 �-_ i l�� _ i : _ - - 1 3 N „ ` g �c�c q �i ''�� p �':.°-,�.,��-f '`�`�'� �•~'�^ N c ti;? � o'3 C I` . ' ' • ' . x., C".ub �`�"',. .�i� f ~+i.,�o��m,F tib ^ O O N ` `�i c'� C,-t�'j,N y�^�:� 7Z � � � . tv �.A r M c�p.N C 3 � �. .: a'O�- � ti�C 3.��N.�b K e C �.. S O � 1 _ . � r.= '; I� �' h � w s c.'$ o `� a �o', � `� ,;�o o -« ^ n_�� s �N �"? c � � -C � i ' � � " ' c; �' � ° 'C3 �,c � � � ° a ��3 T �c�. z4�� w(�kb`o w�'^-o� C � , Z ; �• �� m n��.a.� ' c.a `a''o n.ti.av fD a ` y c� i �.t.(� 3 ;r. y' - eroi� ' ' � m �,'.^.A b M^v - C-� `.,��°_R a t")a�p v .=,a��. �..b s o e��-� �c x �:.,e o o n ., ,�-F o.�. � o C �-a a h ...� ?. .�� x- '. 1f� � . • .. .n.� i � �. ..�?�� �.N� ., 4�b �'`e o�-�� o� �`"�.a`. n n e� C c,'-' _� 3 C �;. i - O . �, '�-n q � p c� `c.:a c�0.' �,� o o � �'^'`c'�C�-A r.' v n vA'+ ' l.���",f�o� c a,: �o �ti�@`a �:.~. � `.- » c� 7 :9 : j ' . _ -- Z ,..� � c;_ � o - ^ „ ,. � f � ,�,�,'o a'; p � ��x � .,. . � . ,•a �'q'^ 3 a o t b n a tn a � ?.-� .i��• � . . - � � _ wa L,3 n � . K �,�„�\'+C.n � C. =3 G.C � �N e� ;�! ' ._ . . :r..°'�� ;'� =:� � '° �"b � ° �-'c �F'� � '��. 1% ._ . � ITn - , �' ..7 n �..� ���-A` �e �i m � � ��X',C�� e�i yr _ �, ' ,�ra```�Tu ' � � ° c.'�,° � w ° s3 c ns " z`a' ' � � � ;^, t a '� ,.;E�:�.-,�e , ��a- -, c..y, � �. - � . ; ` m ' ` � +�e �.� f�v.�p ._ _...� o �� N o ^� � i; � .in£-< c F.,�_ � - -. � - � ..V S a� = 0..c � G " � 2 O'�n � � V�i O`�R: .;�� - . I , f1� ^i�e c � � � � �:'L~'0 �n`�F N O n v��.� '/ � ' = , O'" � O M n � Pa . :,,�';...�-AO � ti;•�1' , . ` .. � 7- i�'L"'..,n C-i � � y'ie m=�i-i h m'v a S~^'+. n n • " . . J . N_"'� .ry Z`O N�• r ' ' �;/ ". :. ' ;. '�� . ' __�