Loading...
HomeMy WebLinkAbout1370 VALLEY VISTA DR (47) . I _______—_ � WORKERS'COMPENSATION DEGIARATION . - ' '� `' �3 t� .�.�y► i hefeby affi�m that 1 have a cestifimte of�����,o��f � _ APPL1CATION FOR BUILDfNG PERMIT � insure,or a certificate of Wo�kers Compensation Ins�rance, , 'or a certified copy�hereof(Set.3800,lab.C) COUNTY OF LOS ANGELES BUiIDING AND SAFETY '�ir.!-i{1•:� ? ' �i.aT�r. -,�+� � - Po�ity No�� C�irhpany- �:���i- -- 9UILflING J , ' ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN AD�RE55 .!,,: J( ❑ Certified copy is filed with�ihe c nfy 6uil ing i,ispec- BUILDING r�-; � �f"'�,, tion department. f ��// I ADDRESS 1 I� f: ? ; i�r, f j:;.-i-r; �-r�i f �(/rit/ r%(t�-- citr �- ziP �ocnun Dafe�—Applicai5l�:e� NO.OFBL�GS. NEAkEST ' . CERTIFICATE OF EXEMPTION FROM WORKER5' SiZE Of loi NOw ON LOi CROSS 57. � � COMPENSATION INSURANCE qS5E55pR � (This section need not b6 Completed if fhe permit is 4or one TRACt `. BIOCK LOT NO. Mqp 6ppK PqGE PARCEL huodred dollors�3100)or less.) � TEt. � � O�NNER `,-.I_.. '..I- �,� Plp, -I i USE ZONE MAP /,. -x ;; a; Np, i � t certify fhat in tha perfo�mance o4 the work Eor whith this L./ ��{q� . permit is issued,I shall nof employ ony person in any.monner ADDRE55 !%` '�e•r f,�.. °� f�� �� ' f) CONDITIONS a so as to become-aubjee to ihe Worker'Carqggnpatfon Laws. , �� Q � � (' }/////i atr<'.�_ .r , r �;. zia U � Date ���'�I;�-J��-�-APPliconl�'`F•'� L�R/6V�.-1��.�, � ae �hao¢ / _ hi. w NOTICE TO APPIICANT: If, oher mokin this Certificote af ENGINEER / 3 p�p ,s::, r-s 9VSTRICf GROUP NPE PIRE PRG)CESSED BY . 9 CONST, ZO� �y Exemption, you should become sobject to the Worken' f f 7 /} � /'•.�� 1�i �����< r�.� } AD�RE55 �� l.r� n /��.4 I C•.L c.� • Compensation provisiona of the I.abor Code,yau musl forih- � . � wifh tomply with such proviaions or fhis permit sholl be f FEI. . '� S7A71571V,L CIASSIFICATION APT. CON00. Q � deemed revoked. CONTFtACTOR . e ' NO.:�- � - r�� Gt ��� M55 NO. �"�''1 DWEU.UNITS O IICENSED CONTRAC?ORS DECIARAiION r,�p a- ADDRE55 t here6y a4firm that t am liceased under povi�ibns of Choptw 9 � ��� SEWER MAP _ W " (commencing with Settion 700Q)of Division 3 of the Busineu CITY �C" -' .a �� VAUOAilO - ~ and Pmfessiona Code,and my license is in full force and effect. eK. PG. /� Sp.Ff. P NO.OF NO.OF CHECK � l'I[BnS�Nuritber "��•� ��-'�� L'1G CIasS � � SITE: ��� .p STOk1E5 = FAMILIES ONE . �� � VALUATtOH �Conhactor','� �-`� �•�`.�� ..� -'''Dafe '��r, DESCRIPTIONOF WORK �.E _r' N�' ❑ ry � �� � ADD 0 s !���/� .❑I am eaempt under Sec.--"`�}f r/� .r - " d AtTER ��,����� B.&P.C.fw this reason ../.� REPAIR ; ' , Da10: USE OF /, � DEMOL❑ N_o,t���.,�:L.wi . EXVSTfNG IDG. Signature A7FLICANi % . Y TEI. / FINAI �(`( �< '� '. �.,., +a:�J 4t Y: OWNER-BURAER DECLARATION (PRmTI , r / : / tvo..r,r.�.��z' DATE '';� � 7 » � I hereby affirm that I am ezempt from ihe Contractor's License qOD2e55 �'^`���-^'� �1c,. �(/� ••����J�� � law 4or 4he following reoson(Section 7031.5,Business and •��wa� ' ' ' Professions COde�: E EN s •� � �'�����'����� euaom�c „ � ❑ 1, os owner of ihe property, or my employees wiih p,ppR�,S _ � wagea as their sole wmpenwtion,will do the work and ����TM � � ! the strutture is'wt intended or offered for sale(Section a. � 7046.8usiness and Professions Code.} �v� TEL '�;�. GONTRACTOR NO. ,' .. � ❑ 1,asowwer of the property,pm exdusively contrpcting ,�p - with licensed contmcto�s to conshuct the prolecf(Sec- ADDRESS �'� - tion 7044,Business ond Professions Code.) � '"- :�i�{i,�.fi � REqUIRED TOTAL Ff&4IX FROM EXIST. � CONSTRUCTION LENDING AGENCY SE7 BA Y'4RD Hwv pROP.LINE wiorH . �� �'� � I hereby affirm that there is a mnstruciinn lending agency for PRONt r� �'"��'�'''''l�' the performance of ihe work for whith this permit is issu�d P��� �S� '�,'/�' (Sec.3097�Civ.C.). . SIDE � L.!�n F.S�CL.�� P.L Lender's Name � ��!'��',�,C;{"`.�'.1�:' $ � / —g LDMA Ref.M P.0 Fee$ "� Pe�mit Fee �� /. � , � Lender's Addrew �4�,����9 I certify ihot I have read this applicmion and state thal the issua�ce Fee ��% ��� �'� ��+�/+P/�M �g above infv�mW ion is mrrect.I agree to comply with ali County Investigotion fee :� wdinances and State laws r oting 10 6uilding construttion, io+ot Fae t' � � LDMA Perm.D � and hereby a thori rppre�ntatives of this Counry to enter u/p�on the � /��ropersy fw inspetlion porposes. 'g 1 ,� ��,,F„p,��.-ti �•�4-%� SEE REVENSE FOR EXPIANATORY LANGUAGE � �^ Sigrwtwo of Appliwm w Agenl Du+e �. ' - ' j � , '. ' . . , . . . ' � � . , x , �. - . _ . � � . _ . . � . . �... ' •. , ; �- �. ,. . ' . ', , : . + � ��� � . • � �. � . • . . . � . , - • , . � - _ . . .. . , . `� � . ' - �� , , • . . _ . . . , , 1, , . , , ` . , ` •, - � - , ` � _ • . _ . ; � , . , , , , , , . ,• , ,, , • . . . . . ' � .. ' ,; ' . . � , , , . . . � F i' , � ' ' 1 � , �� � . � . , . .' 111 ' . . ; � ' � , ; " . ` , �, ' , ''� �. , . , + ``, .t` •` '' ;.1 , ' ` , , ;� ' �` � 'a �; � ' . , . . � � s �6:,,r ' . .�.� � , .. , . r. .. . , - . ' , .. � ��"' ., , �'� - � . ., ' - � .� � t- i � . • ' i �� � � �"Yu } ... . . . ' . � +'. • (, f , # . ' �^' , �. ' � r • 'a • . . 1 :w� � � .ry1 � . . .