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HomeMy WebLinkAbout12_27_1985 - 1400 MONTEFINO AVE (2) .. � ...._---`----._..._ _ ..__....�..�._...,.._..._,.__._ ...---.��.._ . ._..._-��-'---.. , . ..,:, .,....;., , .' - ,v� C� �� � , WORKER$'COMPENSATION DECWRATION ��� ' � -�' ``—'�d� + � '•� �'•�,� .�. .`,�� .� , . . ., � �--. .....__ .. .. , ... _ . . ._ . _ . -. . . - '---..__ .i � I herehy�aiiirm�hat I have a tertificate of consent m self APPLI� ATIQN FOR ..BUILDING� PERMIT ' insure,or a certificole o(Workers'Compensalion Insurance, � � orat�eiyti�fiye�dropythere�(See.3900,Lob,C.J., ....� ....-- �--�-�-� --- -� -- � --- - -' � Policy� `��r'�pony �'lA1SSlG/-��%b�Cl._�1..''�i� COUNTY OF LOS ANGELES BUILDING AND SAFETY - �•_+ �- Certified mpy id hereby furnished. � � FOR APPLICANT TO FILL IN BUILDING ,}� C-. ADDRESS l�t'VQ �p O I� ��,Certified�copy is filed�wirh�the � nty building'Inspec- -- guRDtNG �} �' - tion department: � � ADORE55 �i'�� ( ��� , � � . . . ' . • �.�'. . :- � . ..._. Do�e 'I2-2'I-S5 Appli�dn ',r.:� ary (. ��AP�iv tocaun 1A �._. 4� i i CERTIFICATE OF EXEMPTI N FROM WORKERS''�' � ""--"' " '""-"" ' � � -"�-"- -NO.OF BL�GS.-� - -��r��- NeaaEST� - --� � ' ' COMPENSATION MSURANCE- � � SIZE OF lOT t NOW ON LOt O^-�G CROSS ST. I 1 {�� �LU p. I (This section�need not'be completed if the permit is for one --- - - �--� � -- �--- �-� --' -- - --- ---� ASSESSOR � -• � hundred doilars(E100)or�IesS.) � , TRAQ � BLOCK LOT NO. µqp gOOK �� � PAGEI PARCEL OWNER __ _ NO. USE ZONE MAP _ ,. , • ,_ i , , — -. q Lcertify�that in the performance of the work for,which this �� ' � L � �} permil is issued,I shall nol emp�oy any perion in ony monner ADDRFSS- ^I "2'�ITL-F '- ���3Y�+ ��3�'- C� 3�$ - a - so os to bewma subjectYo fhe Workers Compensalion Lows. � IONS ��P �J Z •: i V , . . ,.,. , .. ... . : __... . _._.PECIAL . . ""`_ '_ ._.. _' ' ' , .__. anS�Ul►.�E......... .. ... . _ ziv �'i�'"1�4' -- oisreicr_ caouP ' CONDIi � Dale"' APPIicaM . . , .. . • � I NOTICE TO A PPL ICA N T: I f, o f t e r ma k mg t h rs Ce rt i t ic a t e of ARCHITECT OR TEI. 1� 7ypE .FlRE .. ._PROCESSED BY. i o ENGINEER Exemption,�yov ahould become subjact��o the Workeri "- � N�' � CO.�NS�/� 20NE _. V Compenso�ion provisions of the Labor Code,you mvs�fo.th- aooaess - � � -I C'�- �� �a -�-�Y - �-�- � - � -- - �a wilh�comply with wch provisions or this permit shall 6e --� , � deemed revoked.;��. � � ' -, TE�� , STATISTIUL QA$$IFICA110N j AP�. CONDO. � ��� ����� � '' � -�'' CONTRACTOR NO. � . . _ . .... . ..'_'.._�'_... ' '"' "' '"".. ._' ._ � LICENSEDCONTRACTORSOECLARATION���.`, ��+ - � �� - -- --�- �-- ----�---- � -� ---- --�-- QA��O�P DWFLL.UNITS . ., � I hereby aifirm that I am licensed onder provisions of Chap�er 9 (� A�DeE55 - n10. : (commencing�with 5etlion 7000)of Division 3 of the Business and _',�(, _.... _. -���. . -_.___._._. � � Professions Code,ond my license is in full force and effect. xl� pTY cv+SS � �"- BK. �.` '� - - � , VAUDATION�� '-���� � � � � � ..'1 I $Q.fT. NO.OF NO.OF HECK • license Number������ L�iDCa e�ass..�• $RE r iORlES fAMl�lES ONE s . • � , � • . � � , � � .. � ` � �., . .. , � . � �' , � . _�' � ` -� DFSCRIMIONOFWORK- . ��� --'. ...... NFW" � VAIUATION_._ ,-_...._'., . .. , � .. .. . ._.....2. ...._._._ Contraclor r���Ce�a (Z.-7.���}i ' ' ' .� O n�o SC� 0�0 �2 7 4.9 A. _ �I am exempt�nder Set. '� ' '� ,� ' . , . . , ALTER � . i'}� • • •'z 3� . B.BP.0 for lhis reason .... �b • .. RECAIR.O � -s �-- �-�� - �'-'�- -� -"-"' -� � � ''�' . .... . _ . _. ' ' "' USEOF ; ' f 1.47263 ` --Date: EXISTING BLDG. ��%D 5�_L � �+i - -------- --- --' :. . APRICANT TEL � '���'� '�- ' '� i �/ Signdture �`..- -- ---�-�-- `---'���- � �L � FINAL ' � • ��4 7 Z 6 3 c=.� �, OWNER-BUIIDER DECLARATION + PRiNt� F11„ ND. DATE ��� � � �•' _......._.__.. -�1 he�eby affirm Ihal l om eyempt from the CoNracror's Licensa n ppDRE55 I'Z M l'TC.4�'��L�L TP�1�1E�"Z�I{Q��� FINA ' 9•�� � '$5 Low for the tollowin§reoson(Section 7031.5,Business and ' O _ � � I 'Professions Codej:� -'�-"� "'-' -�""' "' ' ---�- veE ry �^ �{-�n � � BY � "�4 ❑ BUILDING � .Jt'7 � �1� 7J[.. •' ' .� . __ '. 7 2.S A___ I, as owner of Ihe prope.fy, or my employees wiih � ADDRESS ' . wages as iheir iole compensation,will do iha work and . � , j �• • • • • � ,_ tha slrucWre is not intended or offered for sole(Setlion ��'��TM�tA � ' ' � -7044,Business and Professions Code):--- " --- , "-- MOVING----`------"-' ---- ------ TEt.--' --- -. . ; ..�_._._._ . ...__.. .... �. ,- --... . +_, 7.4�.O 0... .. � I,as owner of the propeny,am exclusive�y tontraaing CONrenC70R NO. . , �_ /C'� �_� with limnsed contrauorsro construtl ihe�projec�(Ser -� -- qooRe55... ..-- --.-.. __ ......_-- ... _.. .. .; _..... ..__ ._ ...._. .. _ j • Q��. lion 7044,BUsine53 and PfofCS5ion3 CodO�. , .REOUtRED �� YARD'" "NWY ' �UTAI SETBACK FR M. X�,.. ._.�. .. _.._..� � _. ..� ...._. ..,. �.2 2'7-g�5.`�..-. � �� -- CONSTRUCTION LENDING AGENCY' �-'` ��� SET BnCK PROP.LINE wiDTN� I hereby offirm that�here is a construction lending ogency for ieONT ' �� '' ' � � -the performance of 1he-work for which Ihis permit is issued -' -�- � v.L ----'---. . . __... _. , . ._. __.. .- --_. . . _-- .;.. __ ,.. .� .. . . . (Sec.3097,Civ.C.). SIDE � ' � . . ' _ _ - '. _ ' . --'__._. _' ._ _ __... .._. _'_ ._ __ _P.L __._ _ __.__ _.' ____--___.'__-.- _ ..._ .._'..._ . . . _._.. _ __...._'_ _ ___ lender's Name �� � . .. � i� �7 7- LDMA Ref.N j � "__ .._ __ . __.___.. ._ _ ' __... P.C.FeaS_I... . PermltFea�-�/��C•V� ._ _ _ ' . ..__'_ _' ___.' ' Lender's Address ' ' �"'�'•�' � ( ' �..,:.•� -. .�- , .I cenify thot I have read ihis applimtion and sfote that.tha ----- �-- - -----�-���� --- �- Issuonca Fea- Q-• V-U-- �IDMA P/C M -�-�- ,�-----� -- --- - =----� above informa�ion is correU.I agree to comply with all County Invest�goi�on Fee `�J�/ ' _or ina ces Stala re to building constructian. ...,.. .._.._ _., ... ... . ._. __ .3r d � --- - ' .- a reby u hori represeMaliv f this CouMy to mter To+al Fee/-/T �O�'' •IDMA perm:R��--� - - - - -- � - --�- . u o t e ab v ned pr fo inspection p��poses. . _ . . .. _.__ .. ..' ' '.""'-._'." "'.--""' ._..__._..____.._......�. _... _-.i . -..---- �-_. _ . .._---- -..._ _._.. . ."- � - - - � , (� '[,'� g� SEE REVERSE FOR E%PLANA70RY LANGUAGE ; , • " Signo�reofAppicanorA . "" __ 'Da� ' _.. _..._' _ '_"' "' ........—.._..._._._.__.."' ____._...-�_.._...._ ___'_ _._"__' ...'__ ..' "'__'_�_"_'__"_ ""___"' �rt �- ,_._. - ; �` .--N T�'_ '�, ,O --W `p 1-�_ -.��^ ;1 _ f' O N m;Q. 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