Loading...
HomeMy WebLinkAbout10_30_1986 - 21073 PATHFINDER RD (2) . . i_ — ---- _ . .. .. __. .. - -- --- . . _�...___._... .. ... .._ . _ ._--�- �----- . ..._ . . , . _. . „ ... , . , . . . P ....- - � ---. . . . . .. . _ . .. WORKERS'COlJIPENSATION DECLARATION I he�eby affirm that I have a certifim�e of conseM lo self , qpp��-CATION�-FOR-,�UILDING�PERMIT�-- ��� insvre,or a certificata of Workeri Com ensation Insurance, I � . . , .__.- ._ � . . . - . � .'-'----�--'-- or'a'certified topy thereof(Sec.3800,Lob.C.) I COUNTY OF LOS ANGELES BUILDING AND SAFETY � , , _._....__. ._. . _.. �.:'. PoII�yNo.-' Compony • � BUILDING Q Certified copy is hereby f�rnished:• . .. , - . I FOR APPLICANT TO FILL IN nooaess 2�b7.3 ���F�'��� 2�• ' �' Cerlified copy is filed�with the county building inspec- -' gUitDiNG '�flon depariment..� . , - . , . ADDRE55 10 73 GAT�/F/���� . ; �/�"�a�p �.�� � � Dofe . .. APPlicom . � •-,1.. . ' CiT�'!�s'A/�YJQtiO �� La tOfAlitt �: .. ,._ , .:,�� � � �` 'CERTIFICATE OF E%EMPTION FROM WOkKERS'� '� "' � " " � � ��n��- NO.OF atDGS.-- � -�� N�r,aesi-� - ���� �- � � �` � -�COMPENSATION INSURANCE ` � � � SiZE OF LOT �Ir���c� NOW ON lOT � CROSS 5T. ' , (Thii section rieed nol 6e�completed if�he'permi��is for one - - - - � - -- - �--- � --- ---�� ASSESSOR . �- �'-- - -� �'��"�� �� ' hundred dollars(5100�or less.�; � . . . . , , � tRnCT BLOCK LOT NO. Mpp gppK '� ' • VAGE' PARCEL� . .. --+ TEL. Pcbrrif thot in tha performent of i � w ��h�s � OWNER �/,cJ -- - �4 - �rup.' USE!ZONE �P } �ermit�s issued,I'shall nof em I o erson in nner {y /� //J ����, '�I �— - SFECIAL -�� - � ��� --� - P Y P . 1' _' A�DRE55�/P�L"-��/I� b �!! . . . . :V — :o as to become subject�o�he k rs'Comp " n`lows. � CONDiTIONS , ... .,.. ,. . ., ; . . . ' arr.�Z�2✓i�vE_ -- -.._ ._.ziP_92y�{--. -� - -- � - -.. ... _. .. '� Dme 10^ � Appliconl � ARCHIiECTOR,,( ,/ rrc. 7 I � � . .Q �}JOTICE TO'APPIICANTi If,�affer mo cing this Certifitate Of , ENGiNEER H S/t �/ N NO. aSTRICT _ GROUF�TYPE. FIRE _ P� ED BY - -'F /E'xemption,�yoo�should bemme�subject�ro"the Workers' "�' �I � CONST� z�qY{J , . � Compensa�ion�provisions�of ihe tobonCod'e,you must forth- ADDRESS"L�� �1A�j �'1A.��.� - - -��-��� ��/ - - -��' wHh compfy wHh'such�provisions or�this�permil shall 6e �-��� • '^ TEL. STATISTICALClAS51FICATiON � APT. CONDO:.'� �2 deemed�evoked:��• � � • ��� 'i • -:.�..��� CONTRACTOR DI,/.Ji.��� NO. .. . :. : �. : � . _ �". ...._ _ .. .. _._ LICENSED CONTRACTORS DEClARATION.�. •� -� -- ���� -�-- �- ----- � - � ���, �� - � M55 NO. DWEII.UNITS I hereby affirm that I am licensed under provisions of Chopter 9 ADDRE55 No. � (commencing wiih Section 7000)of Division 3 of the Bosiness ond _,.._. �i� � �R�P ' " � -� ----- -- . . . .._ . . _, .-'- . . Professions Code,and my license is in tuq force and eitect. Citt ttA55 �"' -�BK.--" � �- �- " "VAIIDATION���- � ...,..,.,,, � .. .- . . .� �. .. .. � -- - . .. $Q.FT NO.OF___, .. . NO.OF . .CHECK � " ' LicenseNumbe� �� �� � Lic.Class�' � SIZE STORIES FAMItlES� ONE , , �' � � . �� .. . . . ... . . . . � ..VALUATION. - - --. . .-- -- - - - . -- � �� . :;. :�..� � , , ,,,, ,,, , ;, ,, .. ._ : Contracfor �' � ' � Dote �� � �� DESCRIPTION OF WORK � �p� � '" � � . . �• ADD ❑1 am exempt under Sec. .... _. ... . �� . . .. -. .^ -- - `- •-. .. , . .. . .....,. .. ALTER �C � , � � � �' ... 8F75A B.BP.C.for this reoson _; ._. S�Tv2� � /� � - . ' .. .#_• • • •2 3�, � REPAIR-.❑ �'�/e�'�D , , __.__._ .. ._�.�.____.._._ ' ' � �O1e' I E%ST�INGBLDG. OFF�LE SPI�C� DEMOL ❑ ' • , .. . . _. ..i. i u a.5 0 — _" ' _ . . �'' ""'""'""" , :�� , .-- APRICANT - TEL `�1 . SignotUre ._ ... . . � PRINT •p�/✓{��I�`.JCI\ NO. � p FINAL/ p ; • • 1 44.50= OWNER-BUILDERDECLARATION ___ . _ _ � _ �-dATE z'��I�G� ___-.. . .,___,... .__.. _ __.. -I hereby a(firm ihat I om exempt from the Contractor's Licensa ADDRE55� Y Z �M ITCFFELC.�i�7 tT�1t�Ll�UI� FINAL �� ' �� � `�� ��ft 6 � Law for the following teason(Section 7031.5,Business and � . '-.._._. - - - Pr fe35ions Code): ... .... . ...... ._... __ . � - PRE NI BY � � � �.., . , BUILDING � . . � � _I, as owner af the property, or_my employees with � ADDRE55 _ ;, ., . _ , . . _ � ' '- � wages os their sole compensation,will do the work ond � ='9 3 6 3 A � �he strutlure(s not intended or offered fo�sole(Sectlon ����TY , ' �'• V' . � �� '� �7044;Buslness and Professlons Coda). -- --- � --' MOVING-'" � --- -� - - � "- � �TEt: -' � - - � ' `- ' - � ' ' --- -- � -� � I,as owner of the propeny,am exclusively contracring � caNTRnCfOR NO. . . .. ' � •...�.' �--- - - -- � �,�,�2 3�: , . • with li[ansed contmclors to conslru[t the projeU-(Seo- � ADDRESS '. . ... � . - . .. . .. ' � � �.•'�7 q.tI�8--'"' flon 70Ed,Business and Proiessionz Code). � �, - � �, .�, �•��,•�.' � � �7 II�� ' ___.. . . REOIlIREO- .IOTAlSEiBACKFROM kl . _ _ __-_ .. . - . 9 G'. . . . �- CONSTRUCTION IENDING AGENCY--" � - " �'�'- sei enCK � YARD Hwv pROv.uNE wiDTH � � ' I hereby affirm thot thera is a constructian lending ogency/or � fRONT � � I G.3 0�—n�6� -i the performance af iha work�or whith this petmit is issued •---- P.L ---- --- - - - �------ - - - ' � -� - - -�-�' - - � - - --� (Sec.3097,Civ.C.�. � SiDE I �9 3(�!i A '. __.'_'. _. . ._' .___ _.... __. . .._.... .' .'_ .P.L- . ' ". . ... " _.. . ._ _ - . . ._. . '� . . � • • rs . .. .. . . . � �... �Lender's Name 1 � . ' � � -i- r sa a�3� 5 �Ref.N . : �I�O� ----- � i •2� 9 9 P Y9 Y �nves+� ..r�on Fee � ._.. . _ _.. _ ._-.-- .- 1-certif that.l have read this a lica�ion ond stofe that tha 1 - Y Issoance Fee � �D' , � � �2 7 h.Q�� - ' ' '— ' . .. P. ' ee f"-' ermi�F 'i' lender's Address ' /j !,/ - Y PP ' ' "-/��. . Y� � � AL4 P/C A... ._.._ _ � - . . . '.... �. � o ve iniormation is correct.I o ree to tom I with all Count � ya J � Q j Q-a 6 or inantey4nd Stata aws relotin to bulldin conslrvction, . ..__.____.. - �- To hl F e e Q� L�MA Pe r m:8- �� - � a d h eby out riz presentatives of this County to enler ' �r • � n he abo i ed prope�ty fo�inspection purposes. . � `�,�� � ` \� � . . .. _.. . .... . .. ... i.. .--. . - .-'. '- - - � - ---'--- -�---- - � - - ., � --. _. _ . --- - - — ^I/� � � SEE REVERSE FOR EXPIANATORY LANGUAGE � � ' � � \ . LL� '_. _ .. ignature A icon�orAgem "" Date . .___._ ._.. ""' ...._' "' � _ _ __. __ .._ .'__... _._.. .. _ ._.__.._Q ( _ . _ .. _. _. _ _ ... _. .. .. r 1 2 0 � 0 .�, ,2 'p ._1,�y , .o G�. `o' �+ n ��^ `, :� ' �,,,ro ��g, O' n' ��O O �1 N � i O ,� . � � o c+ n:`� ,°p,_ � o .p �;; \ � ° O �o .`tD�a o � ° `a'; ` � i �° x A :. . �,� i� .�a 3 i� � ���: � `' �� : q -� iro � o '�N �'O � '' ? • `''r s-'- Z \ ' 0 � O � �m= p4_. -; ;,,�. , „ .• a '^ o � G-' Y� co o �, �.m �� � ' r^ o � � o `o .0 1 . �,, t ' Z � = 1 3 ° ".� '^ -4�" ° , ,, �• .;; Q .' y.o . �..�(�o ? � � W o , 4�� .�e ��" . � ` - . ,� ' j - �' !e ; �o m°io ic T �°,� � '�" o M " � _. ' 1 .A - � ' � n � � ; � � a- a ,m, �. . :o- 'Y �� w� � ' ° % o � ,5q �. o o. a � �t 'O� �D � O � .. ' ; \ ' � � . � a - O N� y 't fl' '� .,, � t9� �t ' a 1 O , ° '.i `, �'`: . � \ �.r ! �'� . � � , Q , v � �" � , �` ' �. �o` , a; � „� :t . i. �'. ,� � _ �.. !?-. �, M +. V p� , p' ` 1,� , o�o- � N '� ''` . � � � , ' ' f , ' . � ' � • ' � w y ` • ,� i "m 'f � .��� ; � ' ' � , `` + �• ' ` = m '` t'' �� . • � O , . � � � � t �1 , 'r� �. ' N `�: �. ri •� y , � - � . , Y � �'. . , _ ' \' �\ ,i 4 ' �,. ' • \�+. :� li� ,� � N . , i ' . '.` ',v .. � . ' : 'f �� ':: ' - '. , '.'y: , "t.. . . , , �_ '.': .� . L .,, , _ . �� �ti. � A ' �.� �,� � �,� , it`, '�4� ` . � . �ti: , ,�,` �. , , . .- .� v , . �'.i �; .! , , .. �\ � _ t� �1 , \.� .1, \ � `\ , 4_. .(f �S , ,��) � - . ../- �i� �1� � - � , \ ' . . � t .:.ti ''. � . ` t ✓ . �� �� 1� \. • ��� �,: � . _ , . � 'i r. � �. '� •�.�• ,. ' ;�� � . � �� �'��� �� . t�', t:.r + . o �..�c�:��M`° � �."s � m _ i� ��•.y\ . � , . ',\, . ,` .. ,i �5 ff �,t y, �..'�y m�4 p F O p O Q«.�' C' � in n �L . 1 '., � ' ' .l C� � Y.�� �% w `'�?.��o;...y�•":M�t c' ... � C7 `' , ` ' : ... , ` �A ° [ o•" c.�.� a :' c ..''` o ^�, o ,� Y � o� r' "i' .�e "t '�'"� �O�er'bR c ,�„ ���n 0 �c' y t M.-..N 3�p K ...,o,� ..,?C.'+ . .� t � , t�`�a^'n`�° (���:"c° � � �"�=m@o °.«.-.�:�d`° �N=cH,W,o.G � '� ._.4 -. :' �,_�A �.�,..� f oa . �.� c � „ o � t' . ,. ` O' p,` � y ^ ,,, � G?�o'�,^ ^C�,�n f^�y c�ro a O-�. 0 i' `�. 'X O�� V,L"', 1° 3 H p O .�i �, t� O , n m � C"'�, `;� �°�'�o b'p-a C m b�tiC-.�.t9 p�r'� r�� � C�t m� �i p O tp � o� Q � mo, o � A ��� H-� � �a � wc-a � ocwf * G . . �\ o. ° � ='� H � 4 H� `^. •'�� »`� � mo T�s�. '"�`v - �_.. ' -. ��,.� �o.�.. , ' 3� H�? o'^ mro ��'c�:o �.- .g � 3cc �s -: e `"' nc ^ o' � 3 C� o a. � ? � 3 p �,H m m v ��e �'�'c��,,,a Q..� .% < c � O-""'' b C.- �t7 4 7 O o cr G-+ r, r, c m . . � ��., n L' � '^ �D. C 'x `� 3 , � ws,�� e,�c �A�^� A.., � '� � �s� ° c a '^"e t°� -'��`Q ��� = 0 3�' 1 -�p �, » �,'L+ ? . ...A •i°q.��.fi„ 4 fD L'N� ' N e„"'i!O �a • v� � ` ' � i� n ~� �' O� G.�'b m ��C"1 "1<p�� C,.S�.p N O'N.N 3`U y ,"� ♦ � • C1 � O �u y,9 . �.`S O T"� C L';.. O R N N� u. in �Oc n O•ei N O + � � " �; � ? ..c � � � � � p'a`='� O-£' 3 C"b.,e»�a'�N m 4 p L n O x - . � ' .�p i u+ �+�w = ?,� .:c o a�� o "� n ''.� t..�^:�� s..H �-•,.� . . " � � � N! 4 �e � �'� O O- C p',�a La.^~S�O C �" , � \ ^ \ -s„a n� o a.«.����,'-�b ��No 3 �Q.a Q.,��...,� ��ti o0 . . - � p .'� � \� � ° c.:��� ►.rt"a�'•� t"� ^�+ � °S'fl. in �."t�i' ���:'t';,,c o L..'io - �p . N � t. .G'�' . y �" � p t,� N'W 0 O u��w•p y � . - u* �, � c �io ^...i. 0. o C';� .O i- f.c in O ,�'w'.."'�^ C'C'��,=i&': .ir u� . x ,, a. � �, .��� y� z..�^�.�.N � ° � o s� �,'�+ ^���, °'��`�J . O ' � � '„'� ��.e�',.m �.'a .3'�"�,'`'r �•°��•`�..,'-�f �r:a'��: , , , �, O'�. - ` �� N o� n�°'m ' .''. �c.?."a„;, �c � >> >.';:,;`L . . • �;•. ��•. �. � %p ^••°v m'�a �� ��P- `=•N�"?o- . � � i^ ,Q '�..�y � � 7 m C '-� .�.� . p ��, ..,,,,t•���".� - . . , �i C1` � '+`.< N p y �o �' ' - . ,� ��� K �� n n 'i . , , , s �Q�� N _ N.. . � ' ��: " � '�' . �.