Loading...
HomeMy WebLinkAbout1370 VALLEY VISTA (77) S�'R�iuo / , WORKERS'COMPENSATION DECLARATION � � j 1 hereby affirm tFwt 1 heve a certifimte of�o����,a sa�� qpp��Cq,TION FOR BUILDING PERAl11T ( insure,or a cei�iiicate ot Worke�s'Compenwtion Insurance, or a cer�i4ied copy thereof/(�Sec.3800,lab C.1 . COUNTY OF LOS ANGELES BUILDING AND 5AFETY Oe�(�� 7b 'c�f^var,r /�'L� • aui�on�c Ceriified copy�s hereby furnished. FOR APPt! ANT TO FILL IN qppREu '� � ❑ Certified copy is filed with Ihe county b�ilding inspea BUIIDING .�". � tion depahnM�. / AODRE55 Dare i�'I��Applican�nr ��tit�''1 W(�rJ'fY�{�%hti5 C�tr Zir tocAury T--� NO,OF BlDGS. NFAREST CERT�OF EXEAAV7JON FROM WORKERS'� -� ����oT Npw ON ioi CRO55 Si. COMPENSATION WSURANCE �E�� (711is Section need nof be Comp�eted if fhe permit ie fw One TRAR � K LOT NO. MAp 800K DAGE PARCEL hund�od dollars($100)or Vass.) 7E a ( ��«.� ,�P >/-3 33 I cer�ify that in the perfo�mance af ihe work for whkh ihis �W� �� permit is issued,I shaH not employ ony person in any monner { O �,.� SPECIAi O to W to 6ecome au6iect to thr Wwkw�CAmps�ation Lows. ��R COf�IT10N5 ry� U cirr�. nv t.lJ a Dule Applimnt ARCN{�ECT DISTR{CS GROUP TYPE f4Rf PROCFSSED BY O (� 7TICE TO APPLICANT: If, after makin this Cerlifitala of t .empfion, you should bawmo w6jacr to +ho Wakers' NGINEER � �� � + �� a �Compensation provisions ot the lobor Cade,yau muat_forth- qDD wifh comply wi�h such provi�ionx or Mie permit sholt be TE�. SiAiiSi�Cnt Cta55�FiCATfON � ro�• � daemed�avaked. Coro�RnCTOR OR{Jt,�,{(�, i+�( No.�{J �1`[3 �fj z � • UCENSED CONTRACTORS DECLARATION G c_ p�, IXA55 NO.�owEtc.UwttS ��, 1 hereby affum ehat 1 am lice��d urder prorivan of Chopter 9 nU�RE55 0«S.X��$� W P• rw. DO ...... (commendng wilh Set�ion 700D)of Division 3 of ihe 9us�ne�s o�d UC. Q _.. ��R� - --. . . .. � . ofessions Code,and my license is in full force ond effect. CtTv h BU U CL455 �+� ,_ .�,__ ..p�__... VALIDATION ! A2R $CI.FT NO.OF CHECK � I � `T;J57� �it.C�OSf. .." $IZE STORIES � licanse Numbar VM AS10�! � 1�b�'LF'lWL5��9 (0 p oescRiarion�oF K NEw ; yr� , Comractor � Date�� p,pp y �� � � l �I am exempt undar$et. AITER � �1��1 F} � B.&P.C.for this reason �pq�R ❑ S �• • • •�� � omo. ��icisT°nc e�oc. °E"VO1 i •2 3&�C C � Slqnature APMICANT . �• PIHAI _. va�NT o. T.., OWNER-BUILDER DECIARAiION DATE _ Y.� e a�„�.:_(��_ I hereby offirm�hat I am azampr from tha Contractor's ticense �pR� -��� ����N � Law for the foVlowiog.reaaon(Section 7031.5,$usineu and s fl�'��—��' Professions Code): y t � � BUILDING i I, a:owner of the property, or my employaes with ADDRE55 wages as their sole compensotion,witl do the work and ��q��TY � ihe shuctvre ia not infended or offe�ed for sale(Section � 7041.B�cinest ond Profassions Code). MOVING iEl. ❑ CONTRACTOR �� 1,os owfrer o4 1he prop�wty,am ezclusively conlracting � witb licensed conhocfors to construcf fha projecf(Sec- qDDRES$ tion 7Qd4.8usineu ond Profeuions Code�. E�UIRED YARD HWY T A� �K _ CONSTRUCTION tENDING AGENCY SET BACK PROY.LME w�orH I here6y affirm ihal there ia a conatmction lending agency for FRONT ' rhe performance of ihe work for which this permit is issued P.i. � ISec.3097,Civ.C.). SIDE a 2�/2�7�ri P.l. ' lendai s Name #A� • • � � r� IllMA Raf.M ` Lendei a AddfeK P.[.Fea 5 vermit Fee {�'� , � 6 C p��C � I cerHty that I have read fhis appiication and stme�hqt the Inuanca Fw ��'� ���P/�k �r�(:��?;�:� 9 obov�informafion i�correct.I ogree to comply with oll Couny Inveulpatlon Fes �e��0 � $ ordinoncrs and Statr law�relo�inq to 6uilding construction, ioral Fae 7 �DMA ve�m.M - $ and heroby authorl=o raproi�nlotives of thit Counry ro enror ' �'C �—�?� � upen�h■ 6ov�•m�nf1 s[c{J,properfY fa inspoclion purpoa+s. s �, � ; �1 .�„� (�/$g fii�iViRii FOR F7RLANAiORY UNGtIAGf sfyrwmr ct opc��wn�w Aw�r po�. � ... . .. ' .�. . , . - ,� ,.�� � � 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--�----�-"---.`_'; --_ �-- -� -- — -------�----- .. �...� '� -- -"' � �- - -- " -