Loading...
HomeMy WebLinkAbout1370 VALLEY VISTA DR (40) WORKERS'COMPENSATION DECLARATION 2�J � APPLlCATiON FOR BUILDING PERlU11T 4 � " I he�eby afiirm Iho�1 hove a certificate of tonse��to self insure,or a certificote of Workers'Compensation Insurance, or a cenified copy thereof(Sec.3eW,lab.E.� COUNTY OP LOS ANGELES BUILDING AND SAFE7Y PolicyNo���r D�� Company SvnG�r�. Nafi,eN,r� � Cenified capy is hereby fumished. FOR APPLICANT TO FILL IN BUILD�NG U � a� ADDRESS �Certified capy is filed witb the county building inspeo- gUqp�� tian departmenl. . qooRE55 U01e �d�I `�'( Applicant n/�'L W 4`S✓�- CIiY ZIP IOCAIITV !+�C ��� CERTIFICATE OF EXEMPFION FROM WORKERS' NO.OF Bl�GS. NFAREST COMPENSATIq�INSURANCE S�ZE OF i0t NOw ON lOT CRO55 ST. (This seclian need not bo completed if the parmit Is for one 7RAC7 / BLOCK LOT NO. � �R hundred dollara(�100�or leu.) MAP BOdC PAGE PARCEI iEl. �ZONE M!W I cenify�ho�(n the performance of fhe work for which Ihis �'NER NO. � � /!� ^3'3 permit ia luued,I sholl nOt Bmploy ony pefson in any monner qDDRE55 �'�� �� SPK�a' O' w os lo bocoma wbject fo the Worke�s'Comp�nfalipn�pws. CANDITIONS CITV ZIP � V: �ate App4itant ARCHITECT OR � TEI. �. � 7TICE TO APPLICANT: If, pF1er moking fhis Cerfificote o} DISTRIR GROUP 7YPE FIRE PROC�SSED BY O emption, yo� nhould b�eoma subjecf to the Workera' ENGinIEER �� �ppyST. 20ME F- Campenwtion provisions of rha Lo6or Coda,you muat forth- q�RE� � S �� /f�� W wllh tomply with �uch provision� a thi�parmil sFwll ba dsamed revoked. ��/ � STATISTIGiL CLASSIFICqTIDN APf. CANOp, N IICENSED CONTRACTORS DECIARATION CONTRACTOR �{L6L1.W �ron^ S.-�,vo.Zl3 63¢•�133 • C �p� p IIC. CU155 NO. DWELL.UNI7$_ ? I hereby affirm rhat 1 am licenmd under pravisiom of Chapter 9 ADDRE55 Z�dtr�.fu¢G�4i�trLf. Np.�3 S/D7� (tommonting with Section�000)of Division 3 of�ha BuNrre�a�d .P L � LIC. 3�'�R NU1P Professlons Code,and my litense Ia in full forta and eNec�. CITV .�1 /�'ribpUni n,q�5 B VAUDATIOH S(i.FT. NO OF Np OF CNECK �. �'. LitanaaNumber �357� IIc.CIo� SIZE � STORIES Zr FAMILIES ONE Contrxtor��W 4���I ata � gJ ��R iOt�O�WORK � VALUATION NEW A� 4 C� l7 �GOb1 A �I am exempt under Sec. ALTER �f� • • �2" 0.8P.C.tor thi�reason REPAIR s pO1e: us�oF � I • 1 1 i.4[:. Fxisr� �p�. ! � �a ❑ Sipnatura '1`P��GM � �NE� � HNAL • • � � %.`"('_ OWNER-BUILDER DECIARATIQN PR�NT OATE �^�'�� 1 hereby offirm that 1 am exe�npt from the Gon�roctw's License pDDRE55 h/� � / i, ��,L 2-U� Low for the following reaaon(Section 7W1.5,8usiness and FINAL Profsasione Code): �-�-- -�� -- -���-�- - 9y j � BUILDING � 1, os owner of the property, or my employees with ADWiESS � woges as thair sole compensaiion,wifl do fhe work and ��y�ITY � the strucWre is no�intended w offered far wle(Saction . 7044,Busineu and Rofessions CodeJ. MOV�NG h�. �L 7[;��F{ � 1,as Owner of the property,om exclus�vely conhatfing NTRP'ROR Np. with Ifcensad contratton to construct tha projeCt(SeC- qDORESS �++ • o e � tion 704I,Business and Professions Code). CONSTRUC110N LENDING AGENCY �Qgq� VARD Hwr TOiwl sETenCK � a � 4 y^`� 7ROP.LINE WIDTH I heraby affirm that there is a conslruclion lending agency fw FROM �u j �;�C.,: the ps 'vmance of the work for which�his permi�is issued p.t. _,. (Ser Civ.C.). SIDE �� V.L I �,O �-Lt� � ^ ` �-+ lOHV1 Ref.M � ' 7.C.fee S � I t Mmit Pee / � �d this applim�ion and state that the luuanc•Fae j0-� tDMA P2 N � \ �ct.I oqree lo tomply wilh all Counry Investipotion Fee �[,(� "felating b building conshuction, iowl Fae ,T/��� IDNW perm.M �nmtivas of�his County to enfer ��perty for inspectlon purposes. � /�_ fE!REYERfi f011 E](�LANATORY LANGUAGE V n � w s �"` ; J..^ .., N,,,,, O , � ti' p � .. '� �.T.w.. L l.,4 "' J :J � �- C `° r.. ' ��.. C N -y „ 0 � z °' . �. t,�:�'" O p e. ��,.0 N�. ,p ► 7•C o C `a � t9 �. i., t'r"c' ^,C 7i 'r' ''z ^�,r _ ^'� � 8' p'�`) �V' t... Q W f n �� ''f r �,,�,'a�, d� '��::, ^ A„��4 � cy �-�.� c„ O _ a`... �;.,? :. a,�. c yy r �,n.'w „„�ue a � � � �.,, .,, u ro' Z,r � '-t' "--,�� ` c 5,.. vi K i� °' " l ;.G .3 z S�« � 4 '=.'r- Y w G s p y" y �'+� „i�� �' �„��"' �• 'p�� 1 , e- ?.• � ��.oc�-.c � M,� E w - c.e m � � � E � � � � a � t -.� ,. .. �.,,,�y .. . C 6 D � �. 'II p C J t«y�_ � ' � � O '.Y^ G�6�r R��.L A+1 T Ti WD C 4 �'�`.� .-t ^ O C � V 1`-' s : ; a Y� s N-� �,a'e: � ` �cr�- ��� c�d � � o� « x�1 �' �o- !t � �" v ,-*�'. �. . i o: e..,.,Y'^ c 3 .- z. C s^� p. .�r• w.� ., :. w � � � � t 1 v r Y.� '' cs .. �� � �x, c�-rc.'a Nm �„�'3 00 '.' o„a. � �s "G Z t ' � ,�',� t. b !rw`,w G-t � � � � i y � � �� •�� R � ��. d p y.`� ii.�' � ` t ! : u a-.m• a' ^'��:.M"� G u� 0 4 � .. .�r,'� y,y_ t �G. ,. " � � �- � , t r .� „ ��c` oa. c'-c� ccKsV ..-s� sec � � _ � � ' ? a,`t'�. � « aW�` �` �L�," °"�% � '����� _'�° i�'�� = ��- `x' 1 .^. K 3 � � = �m�` c.a.�� r o ��` r ' �ro.�« z v ��, ,..-9s �`c,,.��. � 1 � ` � � W o v � .. �� X � � ''" � o y,C .�. c.> � [ .�o c..�`c o �e � � �^=, ° ' � ,y,^, F° c ��� � � = W �r, ^ m �, °. a`.�� ° � c, '� c.,:, o— * ` • u Y o a = - y _ a y c.?'�•r' � �& 3 � _c' =' �. "« y"c ;c„ 's � '' y.� -`. r; o c +' ^�""' c y "� c M..: � � '' "�^" � a� C J O J. ,..,� y c..^..S G. c � � � � r - n c y,`:.--X a �i := u"' c x `w F,i, c � � � � `S G °, d i� y _ ,C,�mc Z w * i.G'y.� 6'o ^,r. �� rC � L !,i' .i. �', 7 "3 �, 3 �, Cy x„T C h w'� ..S �� y... ��* " �,e, N n r x. M `, G _ �"� „ x � u.,:,Y.� c`d, i�'_: p a � q ' r,.-� . .l ,. {S.�•L'Y", : tY T. L L:'�^' `� �' i- 4 y Y� °' •'•'4 Ti r � � :s C �• Qy` •� �1J. ,. 3 F. 6 v ` � �• �,,s-e .. � � � 4 ` • ' J . 4'r , � . 4' ' ` ' � .� ' . �t . � ' , i \t � ' ; � � t � '� i� � � � � ' . . � � � � 4 . ��S � � � . �, � � � . . � ; � � , � � �� � �, w � � � � �� ! �' 1 � - ��.� �,` . �- � � �K � �. . ! . � �, � - ., r ,, � � i � ti. .� , `.` t i � a � � •` ; 1 , '+ �, ' '� � 1 � � � :� l 1 � 1 , � 1� � 4, �� jt \'1 � � � l � 1 �, Q y � , � �,� �� ; ,o � a „��l , � �` ,t �`.- �, o u o, c �1 ; ,! , i i o �� � �� �t � �y �_l� .� . 6 8 lS```t i ` �� � �1 � 1 6 O ��• t i. � �� �++�`i `� - � � p _ � '; � �� ,��� .i � � � � o � .�.--� t � ',1 0 1� t ' ,� C�� ' r` �� , z � � � ' �--t---�; �l, '`-~�}(' i , , -c `1 ? m o ! ; � �e-�'" ��:, t ! '; �t G i J � �,4 ' �� n 1 c M � ��_..,.-� c� I _ , � � � � '°� �� ..t--�'"`� � � 1 � � tj ''"} � � �° �; `n: '� �� ` �- �, -�` � _ 1 x � i a a � 1 � �, ` �:. Cl � �' T'Vc � w v � dt � . ; ��� `i � �' ��' o �, 7 t C " t L` c „��; cG c} CP `L � i � � " O�} � ° ��t��� v t s � `� c u w '� ' o, �c W, 5i ti � -= '� , \y .... ,�, t' t�� �. +, �� , D�p �_G `'i C, i�� t� eS. �l� .. C tit C ;t i LL `� �,,,r�� � . �l '1 �n � � c � h c n Y�,���':,...«... � o ti y �� � '1 � G u � ; 1 �,�', ".�--- o. � _ , '�y ^ - � ' ° !y. � o � '� � � '�1 a ' 1 ; ` � c, � �, ; >;-__�..- d� o' � � o. a' , o l a� , n: o � <: ° � ,�' Q ;`� �� � � ` ` -U ` � G ,ni��s ,f . t.; � �1 0 � �, �: ���, �__ '� o z _ � `t a: [1 'o : �� �� 1 �^�.� � l I ',i i �-� V r--,` +. a Q� r "�