Loading...
HomeMy WebLinkAbout1370 VALLEY VISTA (41) WORKERS'COMPENSATION DECLARATION � iI I hereby af(irm thot 1 hove o�e�„f;�o,�of consent ro,e�f qpp��CAT10N FOR BUILDING PERMIT �nsure,or a certifico�e of Workers'Compensation Insumnce, or a certified copy the�eof(Sec.3800,ta6.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Compony � � cen�fied coPy;s hereby fu.��ihed. fpR APPUCANT TO FILL IN swi�iNc /�7 0 ,µ ADDRESS �(.j{,(L � Certified copy is filed wieA�he county building inspec- BUILDING `� lion depprfinent. ADDRE55 v� t Do�e App1;<om crtv zir �ocaurr i CERfIFICATE OF�E?(EMPTION FROM WORKERS' NO.OF BtDGS. NEAREST COMPEN5ATION INSURANCE S�ZE OF lOT Wow OM l0T CRO55 ST. �ihii aettion neod not be completed if the permit Is for one ASSESSOR : hundred dailan�5100)or less.) T��T BLOCK LpT tJO. - �yqp gqq� - PA� PAR�� 7EL. USE ZIXJE j I certify�hwt in the performance af the work for which this �NER b � , permit is issued,1 shalf not employ any person in any monnor ���q� b w as fo become subjetf 10 tha Workerz'Componqtiort Laws. A�RE� 0 CONDITIONS Date Applitont CITY ZIP ,�✓� � NOTICE TO APPIICANT: If, after making this CerTifi�ate of ARCHITER OR {� TEI. � DISiRICT GROUP TVPE FIRE PItOCESSEp gy � ENGINFER 1 NO, OF Examplion, you ahould 6rcome subject to Ihe Workers' / � CON;j�c ZONE Compgnsation prorisiona of Ihe lobor.Code,you muat forth- qDDRE55 v �v 0. with comply wilh wch provisions o� lhis prrmi� chal! be desmed revokbd. CONTRACTOR � N� STATiST1Ut UASSIFKATIpN qpT. . z LICENSED CONTRACTORS�ECLARATION .�y�,� � ClASS n1p. DwEtt.UNITS 1 haraby offirm thol l om litensed�nder provisions of Chapter 9 ADDRESS Q 16N' MB (wmmencing with Section 7000)of Dirision 3 o11he Business and ��� SEWER MAV Pro}essions Cods,and my licensa ie in full fpce ond effect. �iry � ��q� ���AT� SQ.FT. NO.OF NO.OF CHEIX BK. PG. LicenseNumber Cic.Class SIZE STORIES FAMILIES ONE � v�uuanon �ESCRIP710N OF WORK �W Conlr«�or Date ❑ S nDD �I om exempt�nder Sec. A�.�R � �0 6 4 8 A B.BD.C.fw fhis reown REPAIR � _ #• • . •�v Dale: USE OF exisnnic e�oc. °E^AO1 I • •�5 0 0 Signoture APPIICAM TEt. FfNAL OWNER-BUILDER DECIARATION ��NT N�' DATE • • I hweby affirm thu�I am exempf from�he Cantracror's License •2 5,',�;ri' Law for tho following�sason(Soc�ion 7031.5,Business ond ADDRE55 F�� �&��—8� Roieaions Code�: R „ _- . . . 4y � I. os owner o(the property, or my employaes with q��g� wogos as iheir sole tompensa�ion,wilf do the work ond � �he ttruclvre is nol intended o�offered tor sale(Section ����T'� 70A4,Businesa arrd Profeaeions Code). MpViNG 7Et. � 1,as owner of the prapeHy,om axclusively contracting ��NTRAttOR Np. with Ilcensed conhacfors to mnslruct Ihe projett(Sec- qDDRE55 /� � rion 7044,Business and Professions Code). }�/ � CONSTRUQION LENDING AGENCY ��q�K VARU HWY T�Tp'�p��INE WIDTH ��4C.G._. I hereby affirm that Ihere ia a construction lending a9ency for FRONi U the performanw of th�wwk(or which�his permi�is iswed p.�. (Set.3097,Civ.C.J. SIDE P.l. �ender's Nome n�^ Lender's Addross P.C.Fee S d�l•� Psrmit Fm ��ReL X � I cerlify tFq/1 hava read ihia applicotion and state ihot the Iswonce fee L�MA p/C N � � above infwmation is conect.1 oyrea lo comply with all Couny Inveatiqo�ion Fee 8 ordinonees and State laws relating to building wnslruction, Toal Fee IDMA Perm.M ' and heraby Ihorize reprasantat' e of thie County to enter aupon t - en�o e op 1 for inapection pyrpo s. S/� SEE IIFVfpf!fOR iYW�INATORY LANGUAG! Signawr�o{App icoM or Apsnt s � � �. s� =. _— o .1,,; .i.�.C._ � J'.C r.* � `� ,�� �` i . k �" c '� � �o � ~ 'v y � � v S ° .`�a x y� s��.c �i ` � ° �,� " :. `� • O 'y `! . G , n c., �; ' � �y r , . c��' x J.a � ,"�'Y� r z = my F r- � � � ', y � y :� � y '� " 'x * � ' � Y^ V _ � � �, 0.' ct F V'. `3 P' G Ci" r "_.'C3.+ � G � r' 4 t � W � r � � ` � h r � M1 'J ` Y G,. C w I' }i .. 4�+�y � r+ M� L � ^� O �` A' `C' '� � �"' ..�.�. `�'�=,.. r� tiv V '� ..I. - G f" N ^y .'� '+� c� i =' . � ✓, Q �. �U S Q .J�„ c.� �'� v� ,,., G"r .. ' U C, � �Y. y y���� � ='�` ..d.. �[ `^ GS a�^�-� ..— .. O�`+ X`3^. `� W t\ u e�... y,G. *.. "'... `Y.^'t'. � .''.^ C' ..C1tl .`py Y' 4 'Y"' q� ' ^. ` '3 �� d � 1 C. Y.^a "_' :. '� C C `�' if� c t." =s b e " F= � �� f.'= -o�-� �'� :. =. � ` K m � : "' z� ^ n: Z C c �= � . C ^, y �'3 e+ c5 v � m u'=v.. 0. '� �^a 4'^'v� �'„r',� c 3 `� �O ` �U f;. - .. b�.�;w v. C� b.�. p . w ,�, ^ n y ^ .� 6 p �c,y. :y `? , G \ , .. �L 3..-.S`C1 '^ "3 c.� � ,G, Y^.. 7 � ',rsEf�� � �. s�..^<,�?�,. � �� vaad�n�yYd�Y� s�G" `�" ;Js E t '. ��,:. C� �� `•.•My'�.y.^�,��v i�v'.�� o m mV �c a..� cc � . � o= =y ��� � , . t " y... �, Y'.` G- i��U � .. ¢. � '� oC� �y'� v �" M w � \ � r ~ 5 ' ,,, ":'w, .. L" 9) � f- Cp `. a' C y « ��. G d ^3 .c' .,`n � '„J µ4'.. �'�' . i� �'.. .' �.._ ..� wy S 0 07 N � � � , � 7y G it r r`i. ` t5 G+ � 4 � F. 'y �,F.7.�� J C � �,, � y " .�'.. .`_ C O y �•y�F � "' � � b i r+ '; "e1 ` " `. y... � fo- q ,`.,c.w y.i G,y, e, % '� C �' G ° ,�+ " �,.�,-'�; C �.�' 'o-4 O 0 - c.� c o v '� �,°F. o� ? „ = j ��-„ � '�j O z :: .. - C ~ d „ C n '�: ,� y r �%r P �N c o> O �,n,.C`= �. ''_ �=s^ ,i,G w � ; � `� ' „•L u C � �r � .�C.. = � � :� `• = � � �, � � t. 3 Q v � `v .: � - ,�,�,, ..,�-= .�'�•�..,.� o�y d ,� _ .�. � o �n,,,- ff 0- ,c �. - ,`". _ � O � �� w ec y � s. u r- �y 4s.���� ..a' �'� .~..k • � 6� ¢��� C,C" .�� . �'ti� �,, � 'r „ � ��.,�� " � N, �.�k, �.- �, �.Y V� z�-� ?� =, c'ro ,�y e-_ O d �,., c . �T`G ;J � � ���u�~.-i- `ca x 't �,� 3 y . • � �� �. s..-�s� �.. L'� ,�y A. . . . . C ?^� ✓�a ��r . A �J x 4 ' . ` \ ' � � � , : . j � �. .� t � � � �: , � �� `� ` 1 \ � � ::t ���, � `\\ � �,. ,r ,'1 1 y� . . ' .+ . .��� . �� � � � ' w� � , � x ., �o � � , � �._� ' :�u j , ';::. " � + , :r f �.. � i � ` \ �,� � �\ � i � ; i � . � , � � \ � '+t � M� i \ � \ ` � � \ �.����� } 4 � '�.� � ` \ �,\ ¢ ` � Y; � i ` �'� � 1 `< ' � `� � ¢ \ 1 p �.d . � '� � � � �t 6 6 � V \ i 1 � � � � � � \ 1 o . '� w \ /; ` � � °��' C � i � a t . o . o '��n°� u- 1 s y . \ ' � � �� � -, � 6 'p C a 2"C' ° 'G �C � 7 � \ ` '�'D ' '�O �, T 6,\ Y . E; S.�G 0+ 1r O D 6 m \. \ ` � w C d+ d c-} � \\ p Q �=<<i+ 1'`� 'E G ` •� 0�' �7 � � �i' a T b �, .,1 'G }\��.�.> �.�--.r' V 7 t \ '► at .. d: -�� � U Y � a i:_ ---'��� �'` ,s \` \ c o:r C., c'4,° � 9 � c �.�-�' � Q G 6 G C � n � .✓ "d ° -� \ �a � o �, �' o� a , ;n "� O �' � � , �� o c a-` o r.n � r \ � � c�o c� c o�+ �— y \ i S � y � �� � � p`� n�y G y. .s' � O F, E u ; . W a ` ` � ` - � �� ..�. � � �m JV L j , itr � G' ` 0` +1 � c t^' � o d `�r�� c5 O '? � i .�v''' "'`_. ��` ;,� o n�` � � ' L, N ..i�..., � , �� -��� 0 � � Z ...--�`