HomeMy WebLinkAbout1370 VALLEY VISTA (11) � S�'R i uo
WORKERS'COMPENSATION DECLARATION �-7
I hereby affirm tMt I have vi certificate of consen��o self APPLICATION FOR BUILDING PERAl11T
insure,or a cei�iiicate ot Workers'Compenwtion Insurance, L�
or�a)cer�i4ied copy thereof/�(Sec.380p,lob C.) . r� � COUNTY OF LOS ANGELES BUILDING AND SAFETY
Poficy��� 7b �CbfriPo�r /� .
� Ceriifed copy rs hereby furnisbed. FOR APPI! ANT TO FILL IN B11°'"� -,3 (�
AOORE55
� Certified copy is filed with�he county building inspeo- BUa�iNG .4L, �
tion depprhnmf. � � A�DRE55 '�1'
Dare �___�-1,_��npplican��r ��brt/'1 w!��JrrL{�JhtiS nrr zir �p�.ury
CERTIFICA7E�OF EXEMV7JON FROM W— ORKER� P/O.OF BlDGS. NFAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON t07 CRO55 ST.
(7his section need not be completed if the permit is fw one ASSESSOR
hundrad dollars($700)or lass.) TRAR L K LOT NO. /J�qp gppK DAGE PAR�L
a TE use zor� n�ar / y
I cenify thaf in the perfo�manca of ihe work for which this �W� � NO. �(�J.33
permit is issued,I shaH not employ ony person in any monner { O ��� SPECIAi �
to w to 6ecome au6iect to thr Wwkwi Compenation Lows. ��RI ry� COt�IT10N5 0
ciTr f�. nv t.lJ V
Du�e Applimnt ARCHITECT a
(� 7TICE TO APPLICANT: If, aftx making this Cerlificala of DISTRICT GROUP TYPE fIRE PROCESSED BY O
NGINEER
l .empfion, you shouW bawmo w6jacr to tho Wakers' r COKS U
�Compensation provisions oi the Labor Code,yau m�at forth- ADD r� � � W
wifh comply wi�h such provi�ioni or Mie permit sholt be TE� p�
deemad ravaked. CONTRACTOR OQ�,G/� �ft( NQ'� ,'.t7J SiATISTiCAL C1A5�51F1'C�AjTfON . CpNpp, (n
G IXA55 NO.�_ z
UCENSED CONTRACTORS DECLARATIQN p�, DWEkE.UNITS
1 hareby affirm ehat 1 am licensed undx prorisiom of Choptar 9 qppRE55 p��.SSpYlf�$C( �,�I►7• ryp. D� �'�
(cOmmenting wilh Set�ion 700D)of Division 3 of iho 9usino�s ond ��" Sf WER MAP - " "-. . . .. ...... 'I
ofessions Code,and my license is in full force ond effect. Ctiv h Bv,V �IC q55 I
• �$ ---� - � . .�... ..y� _... . vALIDATIOH
� ' _ i
/� C S0.FT NO.OF CHECK � �
li[anse Numbar -r�`��� �i�,Clpy{� SIZE STORIES p�
iW��F�.�.t�.�5iri� Dare VAt wTlOi�►
Comrac�or �.�+f9 (0 p oescRianohoF K NEw ; r �• i
� � � J � �19Q1 f7 i
� ❑I am exempt under$et. ��R �
B.&P.C.for Ihis reoson &Epq�R � s �.'� � � �l`^,
{ �me: Eu7(gTNG BLDG. �'� � 1 •2 3&�G G
� Slqnature APMI�.4NT . E. PINAL
OWNER-BUILDER DECIARAiION FRINT �� DATE _ ,�s/ e.���:G(��
I hereby affirm�hat I am ozamp�from tha Contmcfor's License �y/� r^ ��Q n, - -
law for the followi�g.reaaon(Section 7031.5,8usiness and ADDR�oS`a�G If�YW� �� 'v NAL Q�i,L�-b�
t Professions Code): gy
� � BUILDING
iI, a:owner of ihe property, or my employaes with qppRE55
. woges as their sole compensotion,witl do the work and �
fhe skuc��re ia not inlended or offered for sale(Section ����TY
7011,Bucineu ond Profassions Code). MOv�NG ieL.
� I,a3 owner of Ihe property,am azclusively conlracfing CONTRACTOR NO.
� witb licensed conhocfors to construcf fha projecf(Sec- qDDRESS
tion 7Qd1,8usineu ond Profeuions Code).
E�UIRED T pl BA K
- CONSTRUCTION IENDING AGENCY sei BaCK YARD HWY PROY.LINE w�oTH
I hereby affirm ihal ihere is a conatruction lending agency for FROM
rhe performance of ihe work for which fhis permit is issued P.i.
ISec.3097,Civ.C.)• SIDE
a2929i:
P.l.
' lendai s Name
2�� innaa R.r.x #,• • • • �
� Lendei a Addrecs P.[.Fea S Vermi�Fee ' � 6���r C
� I certity that I have read fhis appiication and stme�hqt the Inuanca F�� ��'� LDAAA p/C N
9 obow information i�correct I agroe to comply with all Couny Inveulpatlon Fes e •r�(:��?��•i
$ ordinonc�s and Statr law�relo�ing to 6�ilding construction, ioral Fae �)��� �pMq pe�m.M V
R and heroby authorl:o raproionlotivai of Thit County ro enror � �.C j_�;.
� upen fh. 6ovs•mann� propsny for inapaclion purpoa�s. � �
g l/ � ; .�j�� e s
� �`- �'*�C.. i�$g fii�iViRii FOR F7RLANAiORY UNGYAGf
Sigrwtur c4 Appliwnt w Ap�nt ppt�
� ... . .. '
.�. . , .
- ,� ,.�� � � xcze ..,� s. � v� �� � z�` oy `'..;5 � .r
v �;,i�,�!� � fi,..n ' i, '4 y 3 0 o e � -� ` �in : � �
~ .x^ �-�c : s °.r a � ,_ � ;• ; o
•%i c � a c � �,�._ �:. �, � o
_ ^ �,y y: �r "^. �� e+ O �� f y +�w Q i V fU �' y\�, V , . .
'' V �'n c ..;^ cx-��`.�` � �. _% j `='�`'� : =� E m � F 4�;. r a .
^ li a -7'y � y -r., � � i ci v � �� 5�...�'� > a J i. �_M � '
,i �,, . . = � � ��' �.o �� �. .c c ^ � .. � � a � �� � r� �
� r L w �' :r. Z �� '.��. - a; � .n " i� N 's`c, •`• V .. 7 .c�^�\�. � .
.� � c % �' H 3 �, G"� >-a 0 � 4..�b '' � e.ti N -" +. o•�`" p
y' � : � � �`'' G? E = i. ���r� � � c� � -�' u�i
< "' � � C �.� ��`� � z �L� � � .. � E� c'� � fi p I -
v ` fi 1 ^�, ` a c � N z •�i: = � � � ;`O c a .`� '`� a 2
�^�` ` 4 y T. C ;.. L 1 ,. i. r ` l' .
r `� � � � ,'�„" U+�.-C G. O O� �� _� i k� � p �,� y..� OC
3 v. � � � ; � „ _ _ � o o _ �.: =^3 +.a� a d i p
x r ° ,:; �•,� r��. = �`: "' � ,�~ a a�i�V ° � 1.�.e c � ca �'V �.c T Y �n �- -
. � ` � G W �i
r�,� r � ����" 7`M � ''i ° s £c t � c C� -C., " c a i = � v a 'c a
_ _ y � � � l . � � � �' .�. O N.� � Q ra � OC „„ .'- ' C. ^ .�'.. "�' C 1 y� �
i' A � Si f u' � � • j �+ 4 .. � p.,, �' .C„ ' Z l
� ; . : � � a��,�.T � a � �� `� � r`� � eC'w � � t F C + c a' � k �
,7..,�, �� �'" `.3 l . ' � .. .�'. � C � � ;� i.f' G .�. � '..fi' � C F1 � .G. ^ C.� F l I
!Y- �.�`., ._ e ��;"" r�„C y�� 3 - m'�`� 1.-..�. � �� C i� 3 c c"y q"a '^' a i j
o I
^� 3 C ' � e.' n r = e . -L �'� u� .�.� c �� � z ' ��" y E i
r � c �"'^�� J �� c - 5 Y = _ '' � �^ ^ ° - � .: ;`� � o
� v �" =:�'i^ ='� C - ° � c", � �k r `: e ; _ s � � ` �,� _ �1 ,�.
a� ^�� _ r�•~� ` '� .. , �,i'� , i �
c :. u�� = v a �n : � �' � '� : � : � �.� C;� ; � � o
o�" .. , .. . � "�x g i
, .i u �,� � � a'y+ �' c ... 0 y � � �. �' � ^ e a � �o•� � '� .. '-- o � I
-� � e: ..�Y r a J 3 v 4 '!'�Cl�.: ^� G.�1 .-,-0� = n r-C C V �: O 4 I �'".
r `
�" 't_...
y� .F, �-• rf' � :j '�T''�C
i � � f�- � •,,� _ �- ';�
.•:�, % '
,�
l."'` T,. ___ -'� fY j � '�, ,"`; 'v»
,�l __ . __- _. . �' - r, ^�-
..� �I,"y ~� � r •� ,,G�.
W -y r-- � 3 — f�� �E � ,
O +� �, ..3 _ __ C,�.� __ :»
� �'"Y ' �'' �Y� _ r, •`•''� l �,___ -,.'�,. "
° .�;, : � .� . .; �.: �,` :: .
W i .w'.� � - - , y` 7
a - E. �s; T^ ���
T -'' 'r ';, � � c,�'
- � ',_; � �: .� .. E ' �.�.
�ti ' ~ ». � � r
I � - i:.. ��.;,"��'�. �:` ' � k 1 V�I + •
► �.: � ,: ,;:��:� �:... . , j -,:. � �
.� ( � �, �' �
�� .�. �. �..-��� ..�; I
'� i i � �--,%- I:� �- � � �
� �� , � -
� i ��.� � ���- ��� < I " i I
� � � � -- =, , �� �
d � � ., `�' ,�' � �
o , >m -,� �� I � ' �
• s + a � I �
a I .
a � m m �,�~ C I � I
d °ca ' �.' a I I
� � — a o i ,M�` Y -'' o � � j I I
, , ..;.a �� � � I � � � i
r,.,•� �� — - — F a ' � I � �.
� � + 4,' � �� • c � �j I �
a G O(' I � z - � ��---- ---' I I
� � �,'j I ' •� '�-i-- -� �� �f
� �
� �' `}LL. � > I �� ! � w�� '^d t ^U
� Z� '� � �__ " � 1 � _I � m ,� � � � �� ��, _ � ,� I
� �
� � —:---�---+—t---- ----�— a � ;
4 i T. -�---- ; ; , � --�— �i C �� I � N� j i � (
�. �� :�j, � ..x..� I _� � ; il � � � �I � �.
I r � � I ; ' � i ! ._•,__. `
�'� � �, ` � � � j � � � �
I Y M i � f
! �� .,) -.�I �/ ; il�•�a 1 `' i , � Q o.T : �I M ��, I � o ,� i �
�O n � � �I � Lt i ��I� � O p ' � � C � Ly� � � c - 3' n� -
� � ;�; ' `I C" { �- I [: � E �.! I o: � [;�, � � i � �` � � � � I � � F a I LL� �
1/' � ��f+ i I 4 �t � ��. �' u� a c U -- ' � ^ �i c i t c � y,° �!� .
i� u Q, 7 C � , p. � � E d 'ux� Z
��� '� : i? � S .i: � c •f a, .�V ! � ci : d. c ^� � I • � � > (O � � e� +I . 5 (�
--��--�----{- �? - I _i �� � -./ -�; U c ; � � � -r I � - '� � � � t i a� 1 r- :: v �''e c t�
_ , _
. .. � ,I �.+ r. c; � ' I+ ' ii p LL � \
n � �(� I � >' ' 1 �I C� .� n� �n .) i � �ci. � '� L�LL� —ZC .., .
= �'� „ 4. `` I ' .
G . �. �
i � �' i V
:. ~.l_._,�__.1__..;-- ---.._.;L--�----�-"---.`_'; --_ �-- -� -- — -------�----- .. �...� '� -- -"' � �- - -- " -