Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0309A 0310A
i, � � ' � � �i I� j WORKERS COMPENSATION DEClAR,4TION � �.�. ,�,e„ � � ' � I �� ; I.hereby affum fhaf 1 have�a certrfimte of consenf lo self��� ;.. ,��j p���. �,���.�;�T�IQN .�OR UILDING::PERMIT �.. �. ; �,, -insure,or a certificate of Workers Compensauon Insuran � i , , .� . � •. �or a cerfi ied topy thereof(Sea 3800,Lqb.C.)� - . - c�.�'` �� ��'J" � � � SAFETY � - � ��� , !'l,�� �^G i.�,�,��. . ... :f.,.f t.i;:,. F����, � .'�F`,t �t�. � �P � UNTY OF LOS ANGELES � �.{ . ..6UILDING AND . Polity Nd Campany �. '�. ` . . '/ ,�_ � . . � ❑ -Certified copY.0 hereby furnished. " �� } '�,Y.,"'`' � FOR APPLICANT TO FILL W � ¢ss y��F f�7(_E'" �'"CEI�� •C L � -, ❑ Cerlified copy is filed with Ihe �Idin ins c- ep��dN .. ,.� �� � �� � �f-.� .. �� � �tion department. .. -� �� _„9. '�..�� abDRE55 ,�..�. ��E�A 1TL cT� ' , r �n 1 i��';r. `f -k�� �,�,r./.1 �.�.��y-.rss--.�-."��tt.C. CITY�'..-t,'.' ..T'^ i:_�-1 '. -21P . . LIiV � - ,� ,I.' ` , . . i �.�. Date��APPIim 0 ���..-, � , .. �. .NO.�OF BLDGS. � - I,� } . �� •[ERTIFICATE OF EXENtPTIONFROM"CORKEf� � � SIZE OF LOi �� � . NOw ON tOt � �� u551. � � ��.�-G•`� �'^"'��� C� �� ' � � ��� COMPENSATION INSURANCE � �- :SSOR ' ��vaeCEL }- ,. (This section need no�be completed if the permii is for one �� TRACf�.� � BtOCR t07 NO. •gppK`� � -�vnGE�� � �hondred dollars(EI00)br Iess.). . ..� � � . � - - � � iei,�,. . - . � � i�' � ' ' OWNER �J1.\I,l.(r=�C '�.�1� NQ.J.'-:�i/!-/=C ZONE . �P . ' �. / ' . j I cer�ify fhat in the performance of fhe�work for which this �.. . � �/ � - . . �, N�� - - � �, permit is issued,1 sholl nof�employ any person in ony manner � � ADDRESS~%7:� �+''41 �-"ti'�7 S� �� -".�(J(1. ' � CONDI710NS� � � / � :��O . .so as to become subiect to the Workers'Compensation laws.�. � --�. � / �ir � . , .i � . � � .. , . .� . . . . . . . . . CIN � fo�.�r-:rl ^r;� � - �ZIP. � - , I . . J � � �Date � �` Applicanf �� �-�� � � ARCHREROR • TEL� � � FIRE � �PROCE55EDBY . ISTRICT GROUP TYPE j � . NOTICE TO APPUCANT: If, oker,making this Certificate of�' ENGINEER I,I.JI-:� G T/a� 1 l }�e NJ.'^G�'���'r� . �pNST,� :ZONE �� �u.. � ;�� � �Euempfion,.you.should become sub�ect to Ihe�Workers' � � � � r- �� � a � : ).y� . � � >' I '�. � Compensa�ion provisions of fhe labar Code,you must foAh-- nooRe55. � :9�. � ���� L�� � ♦1���L.,.r' ,,��7 �� �,r'�="--"'S�. �� .� I ' .�' with tomply�with such,provis ons or this permit shall be �� . � - �-�t• �. � tEL � � iiSTiCAI ClnSS�PICn7�ON v I ��, APt. �PN�•� '� �� deemed revoked.� � '. ' .� .-. ' � COMaAC�Oa 3=v � i-;����'r.�,r t�No%�/5 =l F�. S..�r c � .� � -` � � p �. ������' � �LICENSED COMRACTORS DECLARATION- � � , �� ��C � . .nss NO. "�� DweLL.UNrtS :�o. � ' nooaess//'/'..� ) ,,�`- .r�i rro. /=!: � � ���here6y affvm that I am Lcensed under provieions of Chapler 9 � - _ ��� � �EwEg�,6qp ., i� . � ...� . . ; (tommennng with-Section 7000}of�rvision'3 of tha Busmess���� Citt ,t - '.(�-tc`- ��r: � -� Cv55-C'- �� � ' � � VALIDATION i� � ' 4 . and Professions Code,and my licende is fn full force�and effett. � -gg, .p� . . . . � � .��,.� ' / . � SC�.FT. . NO.OF NO.OF . CHECK Ucense Number�r� ��"� --Lic.Class �� ��� . SIZE - � � STORIES�� � FAMILIES 'ONE -� , . . � � � �, � ':�, Y . `� VAWATION i � . � . . . ... i � Contratfar� �.�I� ����.�r�'��ate� _�^' =/ DESGRIPTIONOFWORK �' NEW ❑ S,. �,'_r'.,� , .I: • /� / . - : . ., _'J�I•='/I%I � � .�.1 • �t 1 `'. .�C II S \� �:� .(J� ADD ❑ . �t�►+la��Jw . i � ', . '❑I am ezempt onder Set. � - �� ► i� t i � �.' �. i , � .- � a«a � � � �, ���.��,.2a� i �8.8P.C.�forthisreason �� . . j— : �'� �..-.�. ._.�Gs�/ .r•rr S � y �/� � � � USE O" -.�-r . �-er- REPAIR❑ ` � � I .��� `' . f L�i i�!�U M�� . i - . . �. . Ddfe: EXISTINGBLDG.-...1— 't��..s1�R 1' � DEMOL❑ a � f y'' � .� � I'.$ignafure � ' ._ . . . ARPIICP.N��.— ... TEl/ � . .. . '.r:ii�"t ll :��l . . � . . . INAL ��� � ��F• �(PRINT)-t -_;r•�I ...-�I �� _ �c Nor?/�t7:•�� lT � ' - �� OWNER•BUILDER DECIARATION � � �" �ATE �' � � ' � �� �''�' � I ' '�I hereby affirm thar I am axempt from the Contractor's license - . � ��� ` ' .r ��� � , �,� � �� � ����U����•��.� ' - .. low for Ihe following reason�(Section 703I.5,�Business and . Ao�Re55 I��5�� /)��� _ -.�e �'7 C.' �� / 'FINAI . � � � � ProfessionsCode): '��...� . ' � . .�� . �.'. PRESENT � - . . . � jBy �• � -' � . � . � ' , .. .. � BUIIDING . . . �- . I ,�❑ I,�as owner of the property,ormy employees with ADDRE55 i � � � . wages os theirsole compenmtion,will do�be work and �� � t � �� . � , ��the structure is not Intended or affered for sale Secfion � ��'��TY � � s � ' I � � c� ��. 70d4,Business�and Professions Code.) � . " ( . � MOviNG . . . . �. 7E�. � r , � . I .. .-w Q 1�?i}i Q� ' .. . - . � . COMRACTOR � . ' NO. � . . . �.1 r 1•� � ,r��.. 1 . ❑ �I,os owner of the property,am eicclosively controcting � � , , . � , . ' - �'i�+,. .•,lt ' . wi�h licensed controcrors fo constrvct the projett(Seo- �� qpoRE55 ' � � � �� � I � � � ��.tion 7044,Business and Professions Code.�. � � -� � � I � � { ' . . ''�a� . � � I .�. 2EqUIRED . iOTAL SETBAIX F60M � EXIST.� - F' '����� � � CONSTRUCTION LENDING AGENCY � �" � -sei encK '�YAR� HWY pROP.LWE W�D H � � � I hereby aifirm tha��here is a construction lendin9 ogency for � � FRONT � � � . . � i .���'+��,��1,�� � � the performance of�he wark for which this permit fs issued.� �P��� � ' - � ' � � � �� ' � � � � � � - (Sec.3097.Civ:C.). � . . SIDE.. - . . . � . � '��' 7.a�(j . . i. : .. � � � . �-P.L � . � t �� 1 l���r� � - LendersName.-. . J � - �' - � � - � • � � �� ,i .. , . .�... . . . . .., . . . . . . .(. DMA Ref.�M i I ' . . Lenders Address� � � - � � . P.C.Fee S � I. � G m t F . :l.S�� •. � . , � � I certify that 1 have reod fhis application.and sfare fhat the� . � issuo�ce Fee� �/��.f J� lonna V/C M� � � � I��'. �' . . . . � . � ; above Iniormatiodismrretl.-I agree lo comply with all Counry invesiigm an fee. �.�. � �- : . . � �! , � �� ordinonces�and State.laws relating ro�building construction, �� ' Taiol Fee� � �"'''� L�MA Pe.m.p ' a �and hereby author ze representat ves'of th s County to enter �� �- • . � � . �pon.7he.above�ment 9Aed property foF inspectmn p/u5pose .�. �� .�. .� .- _ , . . � I �. � ' � � :� � 'Y�r't�`—' I �/'--� l " SEE REVFRSE FOR EXPLANATORY LANGOAGE� � � / . �-'�.-S�g�,notura of Applmanl or Agent . � .ipatai � � . - � ' . ' . � ' � ,. ' . . � �� , � � � . /� ` 1 _ . i.. . . . . . .., ..,_. .. . . . . . . . I; , . . . � ,. . . , ` . � + .. . ' - .1 � � . — � - — _ F —_ . . � /� . . =r . L401TF.S.k1�30N01'�2fi4'.10�'2>iAnO`:/ � tlS��^�+�r'�a F' r . �F R[ �1t. �!�'� �°" C:� ����"��� �f'��(ea y E ���",�`p"�� � r�-n }I9a ot tn�zno�10 e•o�litie�o e�n�1 I Icri�mi�l�o Yd�i��! t � � ���E/Y��L4.� �t �'�4� 1,�l��1��Fe�.4' ♦ n�. 1: � L'�;•v,K {'u 4J � ,�,�. ��-�. )" �j.�� _n iuznl no.tc.•nsamoJ'x.orio�V io n!��i'�ii3�o io.s�utni � f � �) ' ? t� �'�r�� (.�.d:�J,006E.�aBJ loe•err Yqo�bo�l!�o�c io , YTBik:OC;A.?19;�JfU[3 ' 2713a,SA 261 G�YTYU03 � � ` . . � n _.. .�. •^�-�•a.., . _. . t � -�._� ` � . . �noq^no� ��-� � • ' .tiVl K�il�o5 . q - ^r._ �.�;3I .. _ ._ ._-NI 111�OT T�A71J99A FO� � heriz��,�l � �ri zl v o�ba:l i��7 7:A � �.. Y,:ii_ 4 � , �• �� - :,\ � 27; �4, ����;1�i�n�bLu..•�r,00�arit dt w bvll z'y�e�boi�ihe7 � . i � �, .tnamtroqsu noit � �. " ' Y� f�: aS � ' ..., " YTL'3-' � " �� � , � , _ d,,��•," e::.�..9c G'�v� �.} _ _ ..1ro�I<.qA���� etod i _ _^ � � �� 70,N�i tVOv: � TOJ'C T.�. ca�da�l:'h.J4.1�.�!TtiM3,.7 90�TA7�91TA3� � . � ' T�i�;'.:_ ��� � 7 371qA'r.U2.N;L10;T0.26139.'.10J I y..��: �- . 137vA9__ 7J�9 ?JGv.+k.. .C.�,'01 JIJJJS T]4A:C. Fno ipl zi timi�a f�ri�1i b��oiqmo�od 1^�i b�o•�r.oil�:-z z�r�7) 'i I i Y%'�`1�":t:U;�i�. �'; � . �:: (.tz;,!+o(C012i z�nliob 63�6nurl � � + Jr.i�i It / _ � /�}�,'� tl�l ri�i o1�Iio�.v brlt}���r.0 r�ioim:l sAt n�ic:1t�lihe�I � �' 2HG!i1CN0� � ' � - �9�.^.�f� - ren�om yi o rl nezioq�n:�,��clqmc ton Iloix I.b�uzz'x�fim�•:q � � CJ � . �, �`�, .. ay.cJ r d1,,.�eqmo�'zisvicV.`�,�!t of b��du�emc�oa ot eo o: '. ', " j; 9.S .. . � _, y.rlJ 6:_ � , � . _ Y21 Q_23J0,l�i 3+1i 1 -k� �1i A�TJ7 I op I�D�I !1 o'�f1 i _ :NOS - 3iYl 9UJ'nJ I�'�;; �� : ..:. 14 :2r10� � '.G:� � \ . Pll I �t 61 to e.m�� e tirit �ni+fom io•lo �1 TLt V N9A 01 3�1TQi7 ^: . �� 'r,oAio\! s�'t o t _�d z ^no 3 bl cd. uo� ,no�tqmer.3 �� .GONC� S�IA ' ., .--��� �] Jn r.' .�'���j t.u�uo�r;�c J iod�J^dl�� o,.iv�iq ncitoz��yrroJ ..1- .HO�TA�7� 4n J i!',.6 13' � y-, sd (lod Lmi�q zi� o z�oi-i��G�dwz r��w �:qmw d•�w 7 , F ^ � t�.C��t s Y�t 7 t0��-.{ � .b4:l�.�i bor�s_b •••�.-. ««-,.....,.._�r.-...�cfn U 113� � C c i •,1 l�'O:TAFAJJ:O 2AODA9R"OJ a9d'✓13�U _: • - . .... .�:�,r ,.[tt � i 2�5�_.'I. �. P�s!qod�ioz^.oizlvviui�hnub�:�e�ilmolf�.d�rm;9lcyri_n�er11 , �„ . � � .�,'' .'`� 'Nryl7AqiJAV ^ `� �� . . aro�ie�El vri�lo E-no�z�v io(WJ�no�U�? .t L i��=�nmc�) . � .N�� . . _, L'.�1J ' - YTf }; . .Uy'la r,r•o 3�io',Li��r�zi�n��il pm L�io,9k.o7 zno z.'ci�1 b�^ 1 AJ3 �� �r' O i �O O.1 `�j L. 3 �• ^'�•_,- 7�.� 3b17 '2�.1.R�..9 � '.-0�;: ]��2. _ ' xzol7.�iJ � � iedrciul4 yany��J . �' ' NOriAWf -' � . .:7�, �ti �'k t� :n� allo,v�i�e��a a j ; - _ - .1 ❑ aa,� �•aa__-� � u;bo,!no� C� u;s r�r-r� , . . . � e � � '" _••.�'1 L! P3Un . / —" . .---�"".�9 , , o..�. _2m�tqmssm rtio In , ... ,. {�.r'. . _' . ' .. . � . ' � i��L�I-t F.A53'I .. �. �o?oo�z;rl•io�.�.9$.8 . � . .• ,_�.}� L1JGb+37 � _ A:!.9Jlui3ix3 � :�;�� . ., ! ..i y e n .y,_" ....._.,.... . � . li' � . IYt J� �\ , � y�utnn�iZ � JAb:� p \ 'Cl1 , . . ITN�. 6�„iTF�AA.1�74 A 7JIU8 S.d.qfcU C . � '! ':1� 37'I Y ----�� � � . � �' . �� �; . JRN!'� .,.-�.. � ...;..._._ � _�',-^ a 1.:,'_; bno�z✓:2���Fic,Z le s�in�ueE)rnt;»MGri..oll�T�l�'I�t iol�waJ " . . .�.:_. ....._.:_. .,..•..,. . ....,` � . ; �� � -.. . "'....• -7� �..i! . ' � :(nSo�tnmzzeioiS � _ �4�. 22,c7�A�,�, . dtiw z�s�clqrno Ym io ,rneyoiq �rl�lc i�nwo eo .I � . , i . �.L:' . bno�I•ow sit c611;v✓ nei�c�nsGmo:olo:ii�dt zo zeF,ow . � ,� ..7' YT�i 1 , no.u�2)�loz,ol b�+•�i'o ie tab���n�lo�s i�ivboitz:.r�t � � . . . . �: I " NT F J�t � (.sSo7 e�o!caloi9 bnn zzenizJ9,W.pC . � � Cv� A� nA » �-; . !. .I . . . ' �.�.. . , ' . �.,:u�i m�I vi;�bv�mo,�'ie�niG cd�ic ianwo zq.I l.J . � � �. -�e2j 1� �o q at Uuifzny ot e�G�mino�b�iz�o>!di w p � ^ .--S, y ' - .� (�b.�u�o�usloi9 nno z�^nim�,AGGC ncil . � - �. . � . t '?i� 7.J.'i r�r-i�l�.J!:: j.f,i � � � Ht�,_ ,:�u c.�9'� Yf�N� �O,AY rJt a 7 �i�� � Y�L1i0F c"1.514.1?1 NO�TJIJA'Zv10� � , TN..;11 fq " a�Y�ne�,o nribns�no buitzno�o ei e��it 1cAt mill?o�{deierl I ; . .. . • . .1.9 €�� b��uzzi zi Iini�oG zirii d�rtl.v iol;liow orit lo e�nortnoli3q or!1 �� :i . "r., ) � ' 3r.IL .(7.v�7.CP�C.�sZ) I J9 �: ''� . .. . z.}^._T_'.._:"'^'^"^�I .�..._. ..... 'y"'�, ' nm.^,I�x'isfir:ol I ���.` k .!'J.''� E I . $. �.11m 9` � 2_�3 "1v}. � • �C�P:i ,w.�� zee,bbP.x',�bnsJ � � - t'�� k �c n:� �� • a 7 ....i u �� •�,.{t icr� .tt.z bnn nolmJq�o z��!I bn��evorl I toit�1�•ie�I � � � . �no . �tnuo�Ilo r iw�iq o�o. o�I t� c�z�rai�nr•�ln saado '. � � ' �......,.i _...9l,�i� ._._. .._.,...._`.... j ..'�._,_...._,........ ..... .......�e, ,rio�uvifzno�gn 6! d ot p(u�n z l��04 lrn�zs�^on�cio b ��:':J �."� . . . ,e.a....-.�''�-.._+ , �JI�v ct�r uoi zr.l lo.. v ot . u. �i at o�,j_�9�i bno \ - . '.z�to9�q nGiU4u�ii ioT yt_�qo y F �n� J G�t:.noqu.. � ../� ' . - ' 3JAUJLiAI YP.OTANAJ9%3 A01 3243V3N 73: ' . . " � n:nC� ina:.�A n�tri„�ilq;A lo���tcrp�Z `\