Loading...
HomeMy WebLinkAbout10_30_1986 - 21073 PATHFINDER RD . . 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 i ;� o 0 0 0 � " �' o in o 0 o n�^ �,� G)- -� --" -_- r� �- -� -- •-- z -� . � c�o � c T : � 3 � � �o. � 'r .v �� ��c� o� � o' Q � ;— c .e . ? � 2m � � p � m o ° o D � o'_ •" Q �'; o �' :v s Im � Z x N�[ — T-J � 10 ... �.� 10� � (D ;n j 7 G �3 � � ' � C j ' 0� I Q � �o�'` �7 O � �'�p �� � ] � Q O — �^ { < (D �'O 7 � ' /' .Q '�. 9 . � Q,� � o Q � � �- � �.. _' � 3 �°.'. o � � o •. � � �� " ^ to f c'o i `o � o �� . - • - - - � , V�� � _ I � �.�•, "i, :' ° - � ' - \ a � - � ` � � ' i•' ` . \ o � ' � �• D „'� � ' � . ' � e i ' . Z . ,.N.� `_ , . � � .7O ' I: � .... Q . . . ... . M � S � 9 . 'I , i � o � - � '�' a � I �' '; . ° ,° Z o , • � ,I ! • o •a- ~ � M , it • _ .. p . (` ' ` ,i , _ I . � �. . : • D , \ :.o ' '� .1°, " v , � _ - . - , i o e . � . i, `o. . ' I `o < o'• " . � 6'a `e .�. . " a , ��' , � �: � j _- � ' � I . � . . �; i l �, i . •. i.. . - - i ;i .� . ` ! ; i . ; � ^�`" i ' . ; � _ .. , '' � �1 -� ' • � � . �. � j L � . 1 y: '• i , ' . . � . . � � i I t ' � . �' ' .. • - _ 1' " < 1 i . ' , I _ � � � l'. �� • ' ' � �. ;' " T 1. - /' � , _ .1' v' �' � � ` ��.. : _ . � ' - A . ' , .� � l' �, � � �/` _ -. '�; - _ ' Z : i i �.,�'. i `-• .! ' � i Q � Ir �' � � �� ~ � N • i' / ' i 1! _nj - �� �� ' ./' ' r. I, � i ' , ;� � `. � i ��.� I ,i i • . I �` I � • 1= _, ! �' .�' i i ., , ::�, - ; . .. ; oi � ; , ri� �r�= a� �� - -.csF � �. �'�;.�� o . �.jr 1 . o � e o��' �� mo -se•i"c a ^� �stim � . �' o � � ��'Cs �� �b �'+ nCo.`.•EH-N�n �c`��,�`s ,°n, •�. p �= �,'> >- _ I . � ; � nN f z � oc ��.br.� ' � `�a ° `�+° a"4� i'x c� io ^ " ; ���-- bo~ti � �CN.�^ .�i'N - e?.�,�:• CN`M.4}•� N � � � � � ' � ' � tc� "���•� A � o o�i � n� Z,F ti'C�.�.m o h a `�� a m �'x cc� 0. f �.C . x �.,�b q M f' �. '� a° c�� .b'^ � � `.b a..~a a w ti �.. �2 ' - fD' 'A C 0 N 7 .C. A .�o A �n 7 2 ".� O � 3 - . • ' 3 '�° � A '�^ °aa-� ca'��. �.�b�oo � o '�+ .o .. •mt+�ic �� o3N . � � � - � M o M a q n � ��a `c'0.a o �•� _. cc � p � " Z•p N ^ m .,T - . N - c. A � L'� ,��� ��? �'ti �;:-� � � � �. �U� �'k o.�� � y c.M' �.o C � _ � . , ; �' A R �o C `1 S � � O�O ^��'� " �„`t � : .1 1 0�, �."=0 C O� fp�_ � � ' . - ' � � . � . �� F w A'�O� ' ��1 �F C�,N (D.iO �D � 3.�e 4�'''L'n"c�'o M � o� C j i v+ ��ace H o o `':° ,�•`� na�o :'fi o• `.�-� � a•t.p o 3't- � � i ' - � ' ' �' I � c""v 4 � A� o e �' :.� £ m x � . .. - 70 .i �.q ` Z O � � 4.`.�1 't a �.. c s n �� A�.Q;�� A ti,c w w m. x 7� - , " Z � I ;�•G.a " o� ai � o� O„`I..'�� e?. ��i�`�o �.���'c3:CC-'. . O I � " S � c� o ° a s ,ti ��h c� s '^ a o � �'°`� a v_ C� . . ..r ' i � w C••S ���'3 a� n c H~�=m' f O R�e t _.04 -`Z•i�c l_' ' m • � - � c a ;? �.�� � •�`�•e'� c�a- R �tip a ` o `° � F o 0 9 � m = : C �o +. Q. \,� n���o =3 C a �n a 10 ��F o 3' �C • � . � - t:. �! _ i �� c � y � :� 0.i ti•n �C� a..o a,� �Rr �,R,'" ,� �� ab� _� 3.r� � _ ' � , . � c ���Tc e p � � ti F � ° � ��. .�.a`� o'���.^, � ti -:sri . � � w ; N �� m yF .. io� � oS3 ��.o.� a.� Ns o � � _ - , w. ! c „ o n v � - _.�q�� A,. o �o-m� � a a a 0.�•. �c � c in O � ' : (1- :w o^,4 a.o.`[ 'tr 5,�.��i+`�'�N.�.E � �^�� o�0.`,a � �z.� p 2 - � " - ! y� � �:n � a c,a.n.3�.o-r:'n �� �o w�m�.-e„c �,', ':� V� � - i - . O : o !� n 7 c � a''�.�� C,n•-v, v� pp „'O � C� v"pp��_oa _ . .•- N K � c �a �. c ' '_:��a a o £ `^.�"' ;•n c m�.�-,•&�: =o L"`..� C�• � n O C i��D p C. V � ' �.. C'C"3 ; ,l a��0 C� � , . . _.. _ _ . •.._ � .o e-.o �- _ ti m e� ` .-� ti A a 3- ��e fi b . •��'h :C'� N _ � _` __