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HomeMy WebLinkAbout1370 VALLEY VISTA DR (2) � WORKERS'COMPENSATION DECLARATION � I hereby affirm,�,,��e o�e,,;,;�a,B o,consent to self APPLICATION FOR BUILDING PERMIT �nsure,or a tertificate of Workers'Compensation Insurance, or�ertifOed cOo y thareof(Sec.3800,Lab.C.) � 6 �3(,4 �Q� �,Q COUPITY OF LOS ANGELES BUfLDING AND SAFETY Policy o. Company ��7�� Certified co is hereb fyrnished. BUILDING � PY Y �¢� FOR APPIICANT TO FILL IN ADDRE55 :� KA Cerlified capy is filed with tha wunry building impec- BUIIDING / �'} yCJ ��on.depa ant. ADDRE55 /� /Q VA�Y ISTA DR �p(q��Ty DateQCY� � A litpn ��Ty �A�J� ►]f'!R NE4RE5T PP ziP � cao55 si. CER7IFICA7E OF EXEMPTION FRO ORKERS' NO.OF BLDGS. qS5E55pR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PAR�L (This sedion need noi 6e completed if the parmit is for one T�tt BLOCK �OT NO.CJ� 1 USE 20NE M,4P � ` � hund�ed dnllors(S10Dj or lau.) ni0. I ceni rha��n rhe OWNER roR Es r'�,o. y� 1"1� ���A� r �y parformance of the wwk for which this CONDITIONS eL permit i3 i66�ad,I shall not employ any pe�son in any manner A DISTRICf GROUP TYFE FIRE PROCFSSED BY � so os to 6ecOme Subjact to Yha Wor s'Com enwtion Lpwa. ADDRE55 (� �I1�lLS1�1/C�v pl.yO, �` CONSt � ZONE U �JOo�'7. � � Dat T �� APPlicanf CITY L�S ZIP APT. CO . � -`�OTICF TO A ICqNT: If,�oher moki his Cerl"rfimre of ARCHITEROR ��,'7�� $7ATISTICAlCLA551FICA � ENGINEER 1LL Np, �� U npfion, you chould betome subject to �he Wwkeri CLA55 NO. OWEu.tl�wi5_ �u ipanso�ion provisiona of the labor Code,yo�musl forih- ppp�� jb815 v N ART JE, of SEWER n�wP � with comply with such proviaions or this permit shall be �N Z deemad revoked. � tEL. • � COrvlanCiat -p NO. eK. rG, VALIDATION LICENSE�CONTRACTORS DECLARATION ���.16�''�Z 1 hereby affirm tlwt I am licensed under proviaiona of Chapter 9 ADDRESS 3 T NO. VAlUA710N (commencirg wilh Section 7000)of Division 3 of rha Business and uC. / Profescions Codo,ord my license ia in fufl force ond affect. Citv � • CLASS�b. E ''2� S�p !Gn—g2 �.�. �.� /� Na.� .. _�E� licanss Num6er �;�,el�u C��_ size sroaies G fAMIUES oHe z 2 4 t�0 A Canirnclor�LLHe.) IyV'l�V . pp�a . T 'R , DESCRIPTION OF WORK 7L�L� NEW � S � '�3 � • • � • ❑I am exampt under Sac. • —C�IRTIC � � �N Aoo � � K ALTER � FINAL � •�O 5,7 8 6.8P.C.for this reawn s 'T—�n'+ V REPAiR � �ATE /���c��� � a �7 r,s U�� ,` G:] Dote: EXISTING BLDG. p�„�pL � FINAL �s 1- Signatufe APPlIG4NT TEL. Br I u 4' /"�7 OWNER-BUILDER DECIARATION ��NT TI NO. Oa 1 hereby offirm thae!am exempf from the Controctor's License p � Law for ths folkowing reoson(Saction 7031.5, Businesa ond ADoaE55 3 � T(��A,ti$E S j . U�[(�. Profession3 Code): pR - � 1, as owner of fhe o BIIILDING pr perry, or my employeee with ,4��RE55 � wogas as their�ole tompanaation,will do 1ha work and the structure Is not Intended w offered for wle{Sestion ���m' 7044,Businass and Professione Code�. MOviNG te�. � �,as owner of the property,cm ezclusively cOntra[ting NTRACfOR NO. with licansed conimdors to constrocf ehe project(Sec- Ao�E� •.�3 Z 5,3 A tion 7044,Businass and Rofessions Code). REQUIRED TOTAL SETBACK FROM EXIST. ?fi� ��� � � CDNSTRUCTION LENDING AGENCY gT�� YARD HWV pRpp ��NE WIDTH � I hereby offirm that there is o construclion lending agency for FROtd7 � •�c 8 2.O O fhe performance of�ha work for whieh Il�is permit is issued p.�. tSec.3097,Civ.C.). SIPE � � s %.�.C.r�t�cYi P.L. ` W Lender's Name ' .���`8,7 � lender'a Address P.C.fee S 4 O S �8 Permit Fee � / .Sv � 1 cartify Ihm I have read thi�appliwtion and smre that ibe Issuance Fee �V'�v � above information is cwract.I agree to comply with all Co�nry �����9a��on Fea p�Q O ordirwnces and Stme laws relaling to building construction, Toial Fee �� lY ond hereby aulhorize represenwtivea of fhis Co�nty to entar � u a obo�-ment�ropany for Inspecti�� � SEE kfVFYSf FOp E7(PLAHATORY LAMGUAGE Si rure of Applicom a Agen� - -- Dote �� .. �. ,�\ y m�j " 0� �' i .0 V.N O-Q G � +4 l� �n Ol 7''�^L ,��^C < b�3 ' � +�^a�i O N �"� .� +�.. ' t N�� �'� y, Z�O m � r�.i"�-G,� � v R � O �7 ? ro . O f9"'�'�''.i �V y•in L d1•U'O ; � V� y 4i i�. 4 4 � C v ?;{. w v�- pO .,�, � O+ oi N ."�.. �n O,,.� C O a�[ �^ � � " .� p O u � � , n � m +.�. ,�"�M o h g o ��:7 0'E y'� e �, � d c�•. V . c w7' y s. es 3 � O ��. T 3 N'�'a� '^ �'�"4 'C, �' o c �l'.. a a . 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