Loading...
HomeMy WebLinkAbout1370 VALLEY VISTA DR (6) 1 � WORKERS'COMPENSATION DECL4RA710N S�� 'I hereby offirm that 1 have o«<,;f,�a,e of consent to self APPLICATIQN FOR BUILDiNG PERMiT � insure,or a certificate of Workers'Compensotion Insurance, ar o certified cop thereof�ec.38�,loG C.). COUNTY OF LOS ANGELES BUILpING AND SAFETY W C c►�oe�a�d�e3 No¢�+a�tti.00�G Policy No. Company B��yyG -` ❑ Certified copy is hereby furnished. . - FOR APPLICANT TO F0.L IN - qooeess ,��G�ii�'�-`''r.�4 1 S"C �, Certifiad c ia fSled with the coun buildin ms o- ����' +� `+ � �( -^� �PY �Y 9 Pe ADDRESS,?rI'Q �1'A`\7S^) V►ST<i�� Yvv�F-�.i, �?�� tion department. Dafe��`�..�_�d A IicaM���``����"a dn ��`ZIP COCALITV PP NO.OF BL�GS. NFqREST � CERTlHG4TE OF EXEMPr10N FROM WORKERS' S¢e oF l0T riow oN�Or CRO55 S1. COMPENSATION INSURANCE qSSESSpR (This section need not be coMplated i{the permi�is fo�one TRAQ BLOCK LO7 NO- lAAP B�OOY PAGE PARCEL hundred dolla�s(S100)or{ees.) �t..e;�.�'��� t75E ZONE /�P � OwNE cz^ Ltl�'�'+..c NO. Y cerlify tha�ir+ihe performante of ihe work for whith this gpEq,q� a p6rmil is issued,I shall n0/Cmploy any peraon irt arry manner ADDRESS� �o ��{id1.µ�.�'�-++O'�'p CONDITIONS � so as to hecome subjact ro the Workers'Compensation laws. �p� p .- .-..-- ----- -- � U . CIN Hti `Ji�j ZIP Z O��� _ � �nta ApplicaM ARCHIIECT OR �L. �ISTRICT GRWP TVaE FIRE aRO�SSED BY O NQACE TO APPUCANL lf, ofrar nwking�tfiis Ca�ificate of ENG�n�ti NO. CONS ZOtu� � Exemption, you ahould bacane svbiect to the.Workers' � U Pe P Y �� � l N Com nsation rovisions of the lnbor Code, ou must forth- ��u wifh comply wifh such prov)sions or ihia perm�i-shall be �pNT ROR -� No. Q STATISTIG0.l C1A551FICA710N nPr. coNoo. Z deemed revaked. . - � LICENSED CONTRACTORS OECIARATION UC w CLASS NO. DWELI..UNITS ADDRESS 3�� � �S ��Vd,7��` i hereby affirm rhat i am licansed under provisions of Chopter 9 ��� - $EWER MAP (commencing with Secfiort 7W0)of Divi�ian 3 of the Business ` VAL{DAT{ON and P�o4essions Code,and mpy licer�s.e is in fv11 force and effect. �Fr �� � �•� �� ��E� aK. PG. License N�mber��,��o� Lic CIp55 �^�� SIZE`�ad �ORIES FAMILIES ONE �+ VALUATION ConfrociOr���i��"Zr.-D?te �p��,�O • �ESCRIFRIqJ OF WORK r\�� �Q�-� N� � .s. ��S �`T� �, � ADD ❑1 am exemp�under Sec. �� ��R ❑ .•.. -- - - - � 3 7 Q�,9 A B.&P.C.for this reaaon REPAIR 0 s � •f�y,� USE OF ��' � r Date: EXISTING BI�G. DEMOL❑ 2�O O Signolure �pRC NST NO. " Q. 2 y r � � FINAL� OWNER-BUIIDER DECLARATION ( � �'p � DATE � �r y Z�O O� I hereby affirm that I am exempt from the Contractor's License qppRE55 �3�j '�+�i• s[�LUS� ��� F�F{h� , Law for the followinq reason{Section 7031.5,Business and ��,��/ 0�D 9"8 9 Profeilions Code): � PFESENT . . - -- - By---- ��"� - BUK�ING ❑ I, as owner of ihe property, or my employees with ADDRE55 wages as their wle compensotian,witl do the work and �aAun � the strutlure is not intended or offered for sale tSection 7044,Bwines�and Profeuions Code.) MOH�NG TEI. ❑ i,as owner of the property,om excfusively conMacting �MRACTOR NO• with licensed conlroctors to Consir�ct the proiect(Se[- qDDRE55 �7, �7 A tion 704a,Bosiness and Rafessions Code.} _ � RE(aU RED YAR� HWY OTAt SEfBACK FROM EX15T.. #�t� i�� CONSTRUCTION IENDING AGENCY 5E7 BACK P P. INE I here6y affirm thot there is a wnatrntlion lending agency for fRpNT 2�r 3 0,5 0 ihe performonce of the work for which this permit is issued P��� (Sec.3Q4T,Civ.G). 51�E •! •3 n�J G= P.l, V Lenders Name ���p Z 6.+p 4� l�AAA Ref.N 0 51 1 -8 9 ; � P.0 Fee E Z r� Permir Fea Lenders Address � I certify that I have read this application and state that the Iss�a�ce Fee ���s� ��P2 N ' above information is correct.I ogree to comply with all County Invesiigar�on Fee �j gordinances and State laws relating�o boilding corrstroction, io�oi Fee 7 0��� IDMA Ve.m.# � and reby rize represe tives of fhis County fo enter ihe ve- ti rty for inspedion purpases. � �'S9 SFF REVERSE FOR ElIP1.ANATORY LANGUAGE I~ Signature oF App�imnl or Agan Da�e � � �.�ti{ �.GCiOa ��a'a^�C^a�i� ��� CaCir�n � �V � � � . . ' '� C �1 C O $,�.��,�EVvi��h�$; 16� m�ecdc�' °, � oC�q.`��..,y o I :•�•' ���� QM�� mo°`� mo�'-' o � aa,� QQ @Ltiao �2 (j ' F'; c v:¢ .o r. y a, y t- �n � � m .� � c � ��o aw o � ` o �+.t i .. 3 ,�� e Z, . p y � o O w c ro y 3 .. o � � o a . ZUc�� ai�ayc�to �� pLg,o �ia`..by � � 2ap�.� oe ` ON. � o4i� OCCb0� 0 �",� �� ��aONC XM(gC C ft 0t � ,� H r c�o n?•y m a c y �a >.'o o c $c is �� �+r m �, o % �c,`� 3 _ . 2E�u°,•�� � ��y� wEo � m Ez'' o . ���� `3Q �EY�.° w� i O . � ' gwaL6i �^�°' � a•oco �ta o3��a°'> om � c ��o,;`' I � ' V�,..� C„m„!�;� y`•��Oqj C tOqQ �- Eb� � C `�O ' O .. �.% oEFhi '��°��'m ��oa��� o� �,�ooQ� �ap ���:�i� .� �Q m � ��i D t]y.�.��� G7 .�..��Q� G y p� ; Q y m � ti+�. � C��W"'� (A (g . om°V� `o �`e ��Cc+'. � a�amV � � �mE �a ao �m ' � y m � . J F o0 y bJ'i m 713 0 � � @ T7 % �b p ` _ Y y p LJ m � V . - .� � O O C`Q� � N Q _�r � C � C C.�rC. O � � V'O�L' Q� �% � L•! ,- �,._ t .�33 xc � ogaoe� mc ..vm � a �`°'=:m.�°.� � a � �' O.c.`'� �Gh �,cm`o ��v o�,c� mE � a a, '' . iipp � y Z��O� �ON�� d � O � C � � � Na� � m �Ot � �mw �N` m . � .. � E a � � Qrm� 3 � aa ,co `aam 3-^c� o � x :`. � m°�.. � � x o c._-a `a c� m gm m G,�� e �rUo',�,C�o�� �+ m� � c �b��;rE� �«�°� F� E tC � � �._ p �0 �y'i W q �1` C�' `w, _3 J ��Q� !0 ' � ��y h����� O a C�~ � � h m t� � �� �T p O Z��C(J � +� . � c� Q 4,C^ ti�m �� �a O_3�� R o �,m� �N;� �j a � � � m .-�-� L �� m�ttp« °r � m❑ � % `6E � `� ° m'�`0�.�:� a°Q ❑ � m , ""�m .. o«,..:. U ma 3..�,ro�a.r �.00 , m p 4 ` � . ...Y� � • . . ` . � . . i ' i � ' ` / r:Y ;� . . ; 1 1 ` ' � 1 ] - � f , !}, ., �, � , , N � , �� ` . f � . i , t 'o• � . M ' , CC ` , - y , W ` �., 6, i � _�,i ' � .� r'� . � � •1 . � � y � � ,I . e � � , / � � � � � t � `/ . � , �� �. i � � � a � - ,. ''e � t _ � � ¢ a �� � 4 i � i O � '~L � « � � � 2 t� � ` ` a ' w p C U � Q � Z , 3 , n. m '• � . a oc . a e a • � - i i O q � • ' ~ _ '� � � I � w , � _ ; �, o � , � �� ` 3 .. , � i i .o _ � ` s C� I j > � £ c !�a �c ' � a I m 1 � ' I d �0 16I .iy � � p VJ C i e � � y O� v O F i g a � a� , �a � o,� � o } c � � ' �a o � � d �m O Q � � � �V c� i c � . � Y o c 3'a X Z otS � � I j � � � -_ � � � z.. W � i � o � _ �o �m a � � �`� c { a ° m, v a� � oc � d` I °i � a� 'v m � ' 'u c ' � ` 'a� c a E t- c �' `m � �� - � � � I m � o v � m o � I ! I�m� � m w d �y tC o'`o �" .� • F '�E I � 2 LL I (7 � U' -d� �U I J i d J N t�L in IL W _I J 2 U LL W 1—