Loading...
HomeMy WebLinkAbout1370 VALLEY VISTA DR (8) WORKERS'COMPENSATION DECLARATION � � ' I hereby affirm ihat 1 hove o cenifica�e oi consen��o self APPLICATION FO�t BUILDING PERMIT inaura,or a certificote of Workers'Compensation Insuronce, t or a cert�t�ed copy theraof(Sec.3eoo,�ab.C.) , CpUNTY Of L05 ANGELES BUIIDING AND SAFESY c(7-�.h,L�01� PolityNtic�-�r�Cort+pa^YSvP�z►� N�+e�� BWIDING .�r n � Certified copy is hereby iumiehed. FOR APPLICANT TO FILL IN ^ ADDRE55 �� � V v�l CN Nh• QCerlified coBY�s filed with the county b�ilding inspec- BUItDiNG /� rr � tfon deparfinenf. ADDRF55 � U � Dala 1��� Applita�t �k��^^"'l��i CISV ZlP tOC4lITY �Qn..^�+`� �� CERTIFICATE OF EXEMP710N GROM WORKERS' ������ NEAREST COMPENSATfpN tµSURANCE SIZE OF lOT NOW ON LO7 CRO55 Si. (This section nead not be completed it the perrt�ie i�ior one A�'�R hundrad doliwa(t100)or less.) TRACT 3� ' BIOCK l0T NO. ¢� AM1AP BOOK PAGE PAR�I owr�R '�_ use zor� � �i I ce�tify that in the performonce of the work for which thia �� l r���f � � SPECIAL O' permit ia i�a�ed,(ahal)not emplay any person in any monnar A�RE� � g �( �� �DITIONS so os to become wbject fo tha Workers'ComFunwtion[awe. V CI7Y g Z�P �' Dote Applimnt ARCFtITECT OR NO. DISiRICT GROUP NVE FIRE PKOCFSSED BY OO � -'�TICE TO APPIICANT: It, oftar making�this Certifimte of INE R � ZONE emption, you ahould become �u6jett to the Workers' ,i ��l W Lompensalion provisiorn uf tho ia6or Cod�,you must fwth- ADDRE55 `� i, ��� �«I� �u �` � � Q-` wilh tomply wilh such provi6ions or fhii pYrmit ehall ba t L STAT75TICAL CUSSIFICAiIOM APT. � � deamsd ravoked. Cpo-iTRpCtoR Yl.�t Wl r7trx�, `L(3(�34"7�f �n� Z IICENSEO CONTRACTORS DECLARATION �,s' �p�,.,�(��;_ - - Ct.455 N0.�LOWELL.UNITS 1 heroltY affirm thot 4 am licensed under provisions of CFwptx 9 ADDRESS i-b �"��'"'�'�"�'�O. �J�7�� gy�A MAi (camme(uing with Senion 7000)of Divicion 3 of the Bualneas ond �, ��- UC. � Profaaions Gode,and my licenaa is in full fores ond effxL Cttv C�u 8K. pG. y�'�dAT� SO.FT.. NO.Of FMh1�5 CONEK Lieense Num6er ����� ltc.Cfass -� � SIZE 1 STORiES � Q YAWATION � � qo DESCRIPTIONOFWORK "E"` 0 s 2G SOD co��,«�o.A ern-nn�W �svh ��. „oo � �I am e:empt under Sec. �� qLTER ��0�'�A 6.8P.C.far this�wson ��'�•lV�''- REPAIR ; #• • • •L 3 on�•: Ex�sT°Nc s�oc. r l.C. °EA''� I • 1 5�8 5 Sipnoturo �R��i � �t. FINAL PRINT NO. L OWNER-BUILDER DECLARATI�N p DATF -7, ���j •• � �3,;�J� I hereby offi�m that I am exempt from the Contractor's Liti�ss ADDREu Z�Gi(} �� �7 0 4��+.f ,f I)•r�..(/ F1NAL Low for the 4ol{awing rcason(Section 7031.5,Businesa ar+d � ./ ��.�2"'�8 Profeu7ona Code)� euitoiriG � � 1, as owner of�ha propsrty, o�my employees with ADDRE55 wpye�Cs their sole tompanwtion,will do Ihe work and ���Ip, � the structure ia�ot intended a o44ered for sale(Secfioa 7044,Businefs and Professions Cods). - MOVMG TEL. � I,as owner of the preperty,em ezciusively contmcting ��TRACTOR �� with(icensed comracton to construct�he project�Sec- qpDRE55 tion 7044.B�siness and Proiessions Code). , REIXJI D YARD MWY TOTA1 TBA K �, CONSTRUCTION LEN�ING AGENCY SET BACK PROY.LINE wIDTH I hereby affirm�hat�here is a construction lending agency for FRONT �2���� � �he performance of the work fa which thie permit is issued P.L. ($eC.3097,Civ.C.). SIDE �•�� a �7 V.L. Lendar's Nome � .� LphW Ref.M � � � C�'"�' W P.C.Fee S l� Pe�mit Fee � � - :� _. Landar's Addross � 1 '� i �' . .' � I certify ihm�have read this application and slate thot the Issuance Fee ���� ��P/�k obove informo�ion i6 corrett.I ag�ea to comply with all County �n.es��gation Fee / ,` ' �,C%—�.R ardinances and Stote fowa relating to 6uilding construction, Total Fee / �•V � �MA Verm.M R ond hereby authorize representatives of�his Counfy to enter upo�the�+a6orrvo-men on Qroperty for Inspectio purpoaee. M1 , I�/;���M���� !� � SEE RFVEYSE FOt EJ(HANATORY IANGUAGf Y Siprw�Lre of ApPIimN or Aqenl te r � s � _s =' s �1�4,`f` 'N w � • � *µ� Q � w ,.`v� � , � . _ � a `� p �o U `� .�'i cL"u�-- � � G t a � " � , i 'r O ��^ v 4' ta 7i y� � w^ � �� *w�`�,S S �' 4'"� ~ � = � . � � .,"" o s. � a� c- "" . :� .�'�''L �O I y� � z'« ^ r�� ,n C+ y`� d'K (?' Z <, �r �f v *'�..' `f�' a' O ,j'�_ � 3..�`:.''V ;3 c J t-^'"�.%.^� 'f+ ' �'-'.'.�� �c.: :, �...,'. �v;, i-�i � r ��-O w 4 ns y ? 'i. F s. K� � , '1.,;... 75 �, 'i+ .;��•a-�,..:.".^v en � '� � � � 7".�y ��d „�, ,,,� fG C� � � � 1,J 'Z L � t� E �" G...B '+Y �...:C. .0 O V K."3..." .i o� Y.�,��.�.a,��-t e .v."" s. �D � v c � 7 • ° .-x c•,... d `"� ..� v .. �..� v c c r-r� o :. ��.. � ,��' ° � o � .c» `� '�' J' `n � n .i � :i��• �.��y. q''. v�'�v �'% �D J �,�n � 6 � d�, N m �, � � • A' a r�V �, i C ^a Z„°f,.'w� H��.n ', s o 3 y"`� y.� c'tS s.� „q O O y �c��� •�i, +O . C"j y � �� �, � �. � a`...-o . ��?^+ v'� - � a� p,�r-c» e. Y". � � . i _ C � t A`n rF�. .« � � � � O O y �1.S m C ,�' � N � i y � w 4 � � �}. � ...' � ,y•�.„�n s. � �L 9: O O O c � �':: a. �+ '� �� �'� a �, � � � '�� ,,,.:t^y ..�y�n,,. d 6 �' K C ,. O'o � � � r� �� y r •- Yy�^ a �. g-� � � o�mv �c �"' a � ' ° � a ^ � '�',;, o; .; � u' '' ., 5y "" a � � � EG O �'� £ " � � r y Gc� y•� c„r � � � \ :� '� c��� . :. -� y,,-." � n s m•„ � ie'� ... � c � . �- '�. o � � y, _ :: -• v'L o c..�.T..c ° •r. � �. � 3 y �, � 3 :. c �" K 3 i. y S(n T y, w. `� C ` �: v � p G O � . *3 + � `. •* y .� a o y r. ,n .- ,n �� � �GO� _�S^ `''` C m� a c 6i N G P+�S"'' � N S.. �� G.�'.�,C8y � TM� �,i N O _ ^ ^_ y -r � G Y N C' :Y�-'.:•,. C � i �" Y'v y� " c,y''�` ,�.' M �L � ^3 O Ai-g '� F. �' 7i 4 �+' �4 i .- J � .�'.. v. - " c O � N y t ^ _ �C Y. '? ,� �a '3 �J , , y "�"'.� ;'� �`�'`: �'s "s � ^ �.` .. "�`'��", �o "'-= +R a Y c. i �� �.:� M�:_R C � �� � C'_O � v„y�� ^ Cn �« t- p ^i. t v �-.,,,+�,'� }S.• C -� ? � � C+ � 7. 'Yc E, o. * ,r�� � c,��, � s. f � ..� X w x x ``d :'r �� ��o �n' . � a ��,`'= a"' �,+. a' -�-` et, � F' 3 t J "•f�� ,��� i. � s, �Y«``� G y � G: C,W, � �` t."- J � 1 e� ` ` ` , � ..' � � � , ; a� � - � � �� , � � � � , �� � Y � � . � t (� i t � � � � . . ,� ! . o � � . `� � � U ', � � ` � ` � � � � � ° �� �� � '\ � w, � � � � l N . �� `' �'� '� ` i `, � �, � � �;. 'l ` � \ `, i L +. � � �t � q.� � � � � `�! � � @ , ; � � , � o� , -� � E 1. \ �., .a i q �� ` �, !� �a \ m t � t n, � o o � � ��. ��,,:�-=� � � 4 � ao ` '� o � �`��'f/�` Y . �� . t` O � , d ` `, �.� 6 �� �� W � 1 d � 1�- � �.� � 'p`,%b ,� Yp� �d� p W t' �. ` 4 � � 'n t � + 7 � ''l V K �' `i � y� 'Y! � ' � �? ,. '4 � "� `` l �^- ` ? t` '�:� � d' �3C� ` x.a. : ° � a i. t � `�� % f c � . l "� ��: .:�. �,o ,,„s u � � T � : � � � � t ` L��3 ���' ` 'a- � � � �"T � o c v` �o� ` E- ` �: �.�, ..1-.�'•". 4- �- \ ° ° � o.�o o' � � �t ° � "^`-�-.`' ,8� �� \ �a ��N ff ,{( �p �''�� i��,.r. O � �i ` �� p.,j, � � �"`Y J�`, .-,-"" � � G �... � � C � � z� � � 4` � g� . D G U. y � � ` �"p'. \ C ` " � l` V CY _ O��: Z?- G 7 \ � '� \ �O � a C'., L O' ` /�' 14 �.-"' �„^- � ; 6 �'t " � � a c � �P �°� ca 1��� ��.-1..�- a � ~: U m � '� '� ew. D d i.� L G� a „�� �' , y ^� m t� t � - , � ,y a-�' , o y �, \_� o �. y� r