Loading...
HomeMy WebLinkAbout1370 VALLEY VISTA (10) WORKER$'COMPENSATION DEQARATION � I hereby affirm thot I have p certificate of consent to self APPLICATION FOR �UILDfNG PERMIT �� insure,or a certificate of Workers'Compenwiion Insurance, or cerrfied copy thereof(Sec..380D,L .C.) � CpuNTY QP LOS ANGElES BINI�{NG AN�SAFETY �j'y�.��/� Pa Y � . Po ic o. Com n BUILDING '1 /�' ❑ Certified copy is hereby furnished. FOR APPLICANT TQ FiLL fN AWRESS ��v (/ v� ^''' ❑ Certified copy is filed with iha c ilding ins - BWlo�nrG 2)O A I I �V \t{CT� /( . tion dapartment. ADott�SS -J � t"titi�V{�,�5, V Ec�t __� /� `'(� CITV lYwf�{,J �P LOCALitt Date�App4iw NO,OF Bl�GS. NEAREST CERTIFICATE OF EXEMPf FROM WORKERS' S11E OF LOT NOW ON l0T CRO55 5T. � COMVENSATI INSUR.4NCE � q55ES50a (This sedion need not ba completed i#the permit is for one TRAR BLOCK LOT NO. AAP.p BOOK - PAGE PARCEL hundred doflarc(5100)ordeu.) N,qp . OWNER G USEZONE NO. � ��3 3 �certify thae in the performance of 1he wor�for wh;ch this � /p �r A' svEcra[ - � a permit is issued,I shail nut employ any person In ony mannar ADDRE55 � - � ��a• t„i+"1 COn1DfTIONS � w as to become wbt�t�o�he Workers'CompBn�ption Laws. �OJ�(�) � (� CI7Y ZIP lJ! I Date Hpplimni ARCHI7EQ OR � TEL _I 1 + OISTR GROUP NPE ZON pROCESSE�BY p NOTICE TO APPLICANT; if, afler makinp thii Certifiwte of ���R � � � � CONS. U Exemptio�, you should become subjecr to the Wakers /}?� N1 �. !(} �J Z �j � � a Compenwtion p�ovisions of�he Lobor Code,you mosl forih- ADoaeSS'b L N TEL. STATtSTICAt CIASSIFICATION APT. CON . with comply with such provisions or this permit ahall 6e .. Z deemed revoked. . . CONitiACTOR ' �� � �j — LlCENSED CONiRAC[ORS DECLARATIQN IIC. CtA55 NO. ..�WELL.UNITS 7.S- 5'0 S-r r�. 6-?ofJ 1 hereby aHi�m that I am 4icensed under provisions o#Ct�apter 9 A ��� SEWER MAV �S' (commencing with Sedion 7000)of Division 3 of the 8osiness CITV 4 ��� � � V�fON.ri and Professions Code,and my Ilcense ia in full farce ond effect. 9K. PG. -7 SC]. NO.OF NO.OF CHECK `�a� Lic.Cloas � � • SIZE ��� STORIES FAMIUES ONE YAlUAT10N i� • r o �.:-' . License Number�s� �" Con1fO[t0 L`��1 �^'Dele ����, DESCRIPTION OF WOftK NEW : q "�1 � � � 1 . . � , �r � ,� r,. ., "`�I om exempl undef SeC. q��q ❑ •" � �� � - � B.&P.C.far ihis reason RFPAlR❑ s ;,'i(��-'�.� USE OF . _ _. .���� - . � EX45T4NG BIDG. � Signo re �PR�T FlNAt x �E-B llDER DECIARATION l 1 � � UATE � � a, I hereby affirm that I am exempt from�he Contrador's License qDDRESS 2 U N I V�25i1Y p�MA�+ � Law for the followiog reasoo{Section 7031.5, Business and �� Professions Codej: � P ESeNT ey (�v' ❑ I, os owner of the property, or my empfoyees wiYh qpp�55 wages as their sola compensation,will do the work and �«A��n, the structure is not intended or offered for wle(Section - -• • 7044,Business and Professions Code.) JJd7V1NG TE� �C..������r-•. CQNTRACTOR N�� ❑ I,as owner of tha property,art ezcl�si�ely contracting . . a . with licensed co�fraciots to Construct fhe projecf(Sec- ADDRESS �y • fion 70d4,Business and Professions Code.) RE IREO TOTAL SETBACI(fROM � F7(�ST.' I ' � �4 ��J CONSTRUCTION LENDING AGENCY SEf BACK YARD HWY pR P LIN WI I hereby affirm thot there is a construction lending agency for FRQNT _ _ . , �. the performance of the wo�k for which this permit is issued -P��� ��1 ! r � "�� (Sec.3097,Civ.C.), sioe _, , v.�: G '• . lende/s Name / S �2 , //�•�r IANA Rei.N V.C.Fee a.� �� Permir Fee (O J � lender's Address e�-� (certify fhaf I hava read fhis applicafion ond slate that the Issuance Fee �� "�� LDhw P/C N ► � a6ove information is correct.I agree to comply with pll County Investigmion fee J/ ordinances and State laws relmin to building construction, Totol Pea � '�""�'S LDmn ve.m 8 and here6y ut or' r r n�at� s of thia County to enter , .. .._ � upon t o i o far Inspection purposes. ' � � r�C� SFE RENEItSF FOR @XPIANATONY UNGUAGF Siqnature af ApplicoM or Agenf Dale . ; � w� � m ��`n.m� � .r''�� .m ,�, H oac4i, m "" , ��,�..+" �� ,�d y�w�` O�a. ��f.t� p Q � , �..i"'" � T N ty C- �,,,....i w O a Z"." a°a �II v, o m,c y. a >i� m ��,°'v, m � ....- v��cp�;X o"_'[?�$ m Y. ci� q�-�v,�'>.�.mc a'�." c''l�c �i' uf -�'r N�'�n,U��' �t�t�a,c'�+� od>�o vit= �o.�y�" ''o i C���� � �W.. y�r� cr� M•� c�no �o��yc�,o,����.Q mo�oa— ' ; .' 0 �,,,�, ., a� m � -a �v ��c� N �o m�m :#� o �o.s„� �a��;�::H- � x. m a'H_ y e Zs O m O y`!? o E p C'r. y� ;'Q `• tn [i'. �^ Ry - Cci � a'� m�c�t� up,'� �9�� Q�'OQ� G' ;;',"w.m .vm �di C QN V�� C p.0�c�j�t.+ �� � 4m> �m£' �OM!��„ LYw-� Cn � �y� a n��+`=�yos@�L c ° c�mH� Q�-v�'a'� �.Y'� y�o� �o a 4��.�'.E��o�,�+ c»c '"� °omGo�vc-��� wo�oQav� � a +�'��m w a.�•- _ tC o'a >,ma,�,y ��,w m �,��o�3.c� cE � �ov,aC'��_S a . Q .,c ta+m.mo-�cs� o ;Ta- ao �cd3E._ � ..i�, ¢w���" �._� o '� c,Lo c c mc pmc � .ay. E ' ,. t] a u,„ o�a�,. > � 0,�p,,b m m �c,._ �,p .n v,..i n v a % . W rG�y C�Q� 0.a'�.�Q.C,_� d �G� p co�w.C r,� �m� 6: rn�� p� . ��p�2oEa�ss�qE¢ ���vcy?^c��c�e o°' �°aC�a� m � � . P��ca°�=� �m o ao mo GQ m�c�'am w a���o�`� � J ca o w o v++" m n,c �u" U m y o �,�d��._. o.�,E c M �,o. � � ,3 �v,��',; J c mmr�au�4"� >..mc¢apow �cca,=c - c�a�^ cN.�s.w�Y � � "c6 . d y Y� O ��,� x c C tA y �� ur r m a,....Y m :+�iJ'C � � � � w" On,�m"` y �y atm m.� °S.wUwo�v�E m° Qy�ao�Q:" ` �j Y't5 r> 4 � Qu C1. d Q m Y �� ��m m m v:^_!q$,o d n=" °' m �,�� ��_�.o� �^ Q`� u, y.qp aw,'�4'a'as T�p����m�o..cs A�jmm Ki0�6'.L.� t�YC p=C' Q, �d ' , y C C'��� 4, m O fJ y O} . � 61 N V; LS .0�_„:'a'� ���w�Y , e � W . " D Z � � O ' � , . � Z ' � , �,�,j � �� � r , . �� � � , ��, � �' . �. �a ` � o� � � '� � , � , a � � ,- � � ,.� � �� o r � � s , ° � ° �'E a u. :� a 7. =o ;n �s � m n oa c d' 6 'm o m �o x Z,. o a 3,� m �� �, ��c, �m w `�g � d o Z o c & �!, o r o� y ��q cc Y � p� '� ,� :• @ `� t " °t„� u.u� y o�a " h v+ S Q {°� c � �a y� �� � _ o �y i !�9 p m " �G m� C 1 U m O N � a . � u � EG <-° �v o� o � � i�`� u. x mm d, 'o� m v� �U o 0 0. a a �� o m` 4 Q �W �u � •• m � � o.-� � m � � � LL � a Z r