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05_30_1986 - 21015 PATHFINDER RD
I�hereb aifOirRmE hat lOhav.. . .• J�• . �... .._• ._�. __ .__. ......... , _. . . � . . ,. - . ., . �.- . . . _ . ....._. ._ ... _-. . ..._. _-----. _...--'---- � NSATION DECIARATION :.�." �� •� :• •.�-.-: � �� . � �, � _ .._ ._ _... _. � . _ . _ , � ,. y e a certifimte of consenl to self ' msure oracerLficoieofWorkers'Compenspfi0n��,�,a��e, . APPLICATION�FOR��;BUILDING� �PERMIT ��- - �-��. . . _- - - _ . or d cerlified copy thereof(Set.3800 1a6:C:): �' - COUNTY OF LOS ANGELES � � BUILDING�AND SAFETY � � - �- ; . : . „� �. „ _ - Polity,No.� .�.- Campany . ... . .. - -- . . . _ _ .. .. ..- -� - - - �-- - - �. � Certified mpy is hereby fum�shed. ` � �: FOR APPLICANT TO FILL IN euuoiNc , nooa�ss Z/O ✓'r a �i' crpr I �' ,Certi{ied copy i3 filed wilh lhe couMy 6U Id'ng,�inspec- -- �- BURoiNG�J �C ��'I /1/7 � �, �tiondepartment.�� ADDRESS(/��/J N/N��N�ST/ /�-l�/- � Data .� .. . ,:Applicant '�. .,",•� . � CITY � ZIP . .. LOCALITY �, . .: . �.`CERTIFICATE OF EXEMPTION FRO/v1 WORKERS�.. "! --�- �--..'.. .. .. . .�.....-�- �-�---NO.OF eloGS.---2.-. .. -� NEAREST ...._..,._.." --'._ -'....._. . ___..._ .... � ' ��`�'�"�'COMPENSATION INSURANCE�"��� . SRE OF LOT NOw ON LO7 J CROSS ST.�.. � , (ihii'3ectlon'need not be'completed if�he'perinit�ii'for ona �-- ----.... - .--- - - . ._--. ..-. .. - ------ -� � A55eS50R ,.. � " ��. � ��,• . � �'. hundred dollors(5100)or less.), � .� ,,.,;,�„ � � � iRAR BLOCK LOT NO. MAp BOOK''- �� � ��'� � PAGE i PARGEL� ' I cerfif �that�n-the�erformonce of�he worP for whic6�fhis _."'_ ODDRESS� � �� '� '_'� No(�IJ-- U�� �P ITIONS OJ 3 3 � � } permrt�s rssued I shall not employ ony person io any manner CITY pV�N�____. .. ___ ._..ZIP ._ 7: .. -_..� - �-'- SPKint - -._.. . _ ..._ .:�O - so as to become sub'ect to fhe Wo kers Com ensat on Laws. ro� ' �V /1p� DISTRICT.. .GROUP� . . .��.� . . �. . . � . . ,� .____' __ �� APPIiCoM ' � ARCHITECT OR TEL . TYPE_. ._._ �fIRE__ .....PROCESSFA BY __ _�� Co ensati APPLICANT: If,'after moking this�Certi(icote af ENGINEER r�V,.)���• NO.� CONST.� �ZONE �x;�mcoRn;i'you�shouid become-subjed'�fd'the'�Workers' -` � i NOTICE`TO' P , t7 �.���. ,W p � on p�ovisions of the Labo+Code,�yov most forth- qDDRESS � 2LSiQ. • r�D��� � '� . , ..___--� ---- -__. . . � .... ---_ _... . � p y wilh�.sath provisians or this permif�.shall 6e �-- �H TEL - �1,� � STATISTICAL QASSIFICATION � APT. CONDO:� '�Z deemed revoked)�,� :.. ��� ' � ., ...•� _,� .,..; CONTRACTOR • (,JQ/YaIVf No. "Q37✓ - LICENSEDCONTRACTORSDEttARATION . .�.'.. _..-_.-.. -._ . - _ -.- ....-..-. ----- -.. ....-.. &n55N0. .zZ. .bwEu.UNiTS �. -. ... .. ... . ._.. .. _ -- uc. _ I hereby affirm thar I om�icensed under provisions of Chopter 9 qoD2E55� (l£i't.d� NO. (commencing with Section 7D00)ol Division 3 of the Business and __. _. _ � G, �..._..._ .. pC. --__. - �__ - ���R MAP _. ... �, . , , : Professions Code,and my license is in full force and eff'eU. Ciry np,�,5 � -�-�--�---���� - - -' � � -- - � . . �.. �.,. . , . . • . ., ,.. ,. . ., �.�..`. SQ._FT._...._.... NO.OF . NO.Of _ __CHECK. � .. __. gK. p�. ; VAL�DATION� . .,� .. . ., . . .---. . . .... licenseNumber ' � ������ Lic.Closs �� ��- SIZE STORIES ���� � FAMIUES ONE �'>�- �:� � ,!.'1 - ,.;. � � con . _vawanoN.___�__. '__- 2 3 4 Q 1 A_ , . ` .�.� � .,� . .... ,.•�..� -._." DESCRIPTION OF WORK' __ __ _ . - .._._ . _.' _ -_._ NEW . -❑ /}/��j. . fractor .. .. ` Uate '�.�. ADD � s ""`--'1� ' � #• •7�J � � O B.&P.C.empl onder Set. , . . ---.._ . .�/�J'�j .. pL .�'"i M. ._ .__O .._ ._ _.. I om ex . . . .: .. .... .i ALTER . . . � • •��z Jr .. ior ihis reason _ �(J�k' ' .��� REPAiR� � - S.._._..__.. .---- -. . �_ ---- . . , _.;. -- � � _.-- -- _.... __.�ofe: __ ;, _ use oF �/ o�a � � • • •3 8 2_5 z ; . E%IST�NGBtDG. (�a ❑ . ._. . -.. . , .. � :. ... __ ___. , _ .Signdfure - �--..___..---.._.._.___. _ . : AVPI�CANT TEI. . FlNAL ' ' � PRINT) �i gTM1. NO. ��� ' � ... ._....... _. 0_5�,.,0-8 6 � ., . OWNER-BUiIDERDECIARATION � /� --DATE--�--- -�--�•-�� __.... y . . . .._.._.... _... -I hereby offirm thol I am exempt from the CoMractor's Lirense qDDRE55 N� � �✓�� I.II q� � � Law for iha followmg�redson(Seition 7031.5,Business and ! � FtNAC-'� - -.��' ' � . .._..___ . _ _ ../- -�PrbfeiSfbns Code) --�"'�"-"-� '-�" "' ""��- -���-- pRESENT ��By - � - - BURDING � - � � _I, as owner of�he property, o�my employees with _ qooRE55 � � � . _ . .. wdgei as their dole compensmion,will do the work and � �/� ! -- �-' - the slrutlore is nol infended or offered for sale(Section ����N � ' ! __.. _. �� -- , �-�7044,Business ond ProfessionsCode): �'- - `— n�OviN��'-� ��--'- - -- ----� -iet.- -)(�/ �- - -- - - � 1,as owner o(the property,am ezclusively contraciing CONTRACTOR NO. �/ t ► /}� � .❑-�with licensed contractors lo cons�roct ihe project(Seo- .__. .. . ._ _ _.. .__ _. ...-._-- -.-_ -_--_ --. -.y/�� _�A� _.- �� . - ---. - . l/' ; aooaess tlan 7044,Business and Professio�s Coda). V ____.... REOUIFE� TOTALSETBACKfROM _. . ___. _/�_r�__ �1 - � CONSTRUCTION IENDING�AGENCY�"'�-�--- ��-�- SEi eACK YAeD -HWY p�p ii� WiDTH }' ,/ � "� � � ' -�- �� - - '� 1 hereby oNirm�hat there is a tonsiroction lending agency for FkONT %I f,J �. � ' � � ' � '�, � -ihe performance of thework for whkh this perm8 Is-issued -�-- -�Ptr�'-- -- -- --.. .- --- --�----' - ---- - - b --. : ... - . .. . . . .: (Sec 3097,Civ.C.). SI�E � �'� ' - � � � . ......� � _...____ P.L•______ __._._ _'_ _. ._... ...___'.__ . ___ .'__..__ __. _._.. ._.___ ___ _. .. . _. �.._._ .__...' _ ._.__ '..___. ___. . __ _.. . . ____ ._ . _ . Lender's Name � p i � ... .. _. . ..._. ._... . . ____ ._ ._ . P:G:ieeS.-'.� D L�_ . LDA1ARe1.M � . . . - _ .. . "" i '' Permit Fee......__. _ ._ _. tender's Address � - ��� �- :� �� I.certify thal I have read.ihis applitation ond stale fhat the _.._. __.___._.__._.____ - . leeuonce F<e-�- �-�---�� ��1�M,4 P/C N - � � � above information is mrcett.I agree to tomply with ail County Investigaiion Fee � - ' � ..ordinantes ond Sfofe laws re�ming-to boilding.tonsfrocfion. --_ -� Toml Fee---------.-..----- LDMA Perm:M- - -- .- . . . _- ':. .... .. .,.: ` ..�, i and hereby aufhorize representotives of this County to enler � , upon 1he abave-mentloned property for fnspeclion purposes. � - _ _ "" ' ' _. _. .. _"_ _.._. ...._. . _ .. .. _ _ ..__ . _ "_ _�.. _... ..... ..__...__. ._. .._. ' SEE REVERSE FOR EXPIANATORY LANGUAGE , . �'__ ' SlgnotureolApplimntorAgent- _. .__ ___.Oate... .-_.._.__.'__' __._'____ _.. .__ .__ _.. ___...._. _ ... ..' .. ...__ ._._.. _ _._._ _. __.._...... . _ _...__._...�_.�Q.i i �" n= o Q � '^ �" o in o 0 o nv -:'m- -G). _G� ,"_ _.x- r-o- �- -- -- o '�o.: 5' 00 � 'o o � rn � o � � � —T- , m'o � N s � � 3 � � �o . n' v � n �;m � °a, ,io ;o i� � �" � � � ' v •c fD o ° o D , � o o' � , �' � �c '- 1 � I �Z x �� � _ �� 9 : � .� ._c � `° ,0 10 '.� . � c� of ° w� 0 3N n� o � � _ D 0 0 3 o c H � � , . :� o� � v ,3 0 �, 'a i� - ' �fD � I � ° � � � ^-" v°;°. - �� ;3 io o�, p a� � a v o'"- � � - � I a' '` o° o .._ ��. - 3 - �o . __ � �i'? i M � �': a - - ' � 1�� �. � G � � ' � r� Z � �p ' , --- �. - 2 .N.� _ � o• , ,. O > � IA 1! O . , _ _ I " ° D - � . . � � ' � 70 � i i i 'o ..� kn � . = a p ,� _ � _ D - o , i c a ' i i � � M'' �'. � . � 1 I � � � � H ' b.. + _ _� ' :�� � O� '. , � ' ', � i _ ' . - / � �' J, , � � I Do � �. ' �I .. .. 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