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HomeMy WebLinkAbout0193A , . . .. .. . . . . ..�_ . ._.. . ._ . . ._. . . -. . �� . . . . WORKERS'COMPENSATION DECLARATION � ,r � � . ' � � � � I hereby offirm Ihaf I have a�e,�,�,�a�e af�o�,e�<<o,e�F � ��� �APPLICATION FOR� BUIL�DING PERMIT � �� ' insure,o�o certificata af Workeri Compensation Insurance, r r fi p of(Sec.3800,Lab.C:) 73�(���—�C1�16 COUNTY Of LOS ANGELES BUILDING ANO SAFETY PoliryNo. Compony Nd�.1�Y1Wlae - . �36 A � Cerrified copy ts hereby furniehed.' FOR APPLICANT TO FILL IN BUILDING 24020 E. .Goldrush Drive ADDRESS � .Certified mpy ie filed with ihe county building in:pec• "� BU�IDING ,� � ; Non deportment. ADDRE55 24OZQ E. Goldrush.�Drive � Date��9=R7 ApplicaM R'FiF-aN[�.C,ROUP Crtr D�'�011� $�r Z„-.91.765 ��l�n, D18Ifq2'1 $dT CERTIFICATE OF EXEMPTION FROM WORKERS' � SiZE Ov LOt NOW ON�LOis � �� CROSSSST. D1aRIp11CI BdC B�.VCZ &.GOI.C�{PSl SpL'].I1Cj5 �COMPENSATION INSURANCE (This section need nof be wmple�ed if fhe permif ia for One � TRACT�}3435� .s�� BLOCN LOT NO.ZS / �SSOR � � - hundred dollars(SIOOJ or less.� � MAP B�OK PAGE PARCEI THE ANLIIIJ GI�UP rF�.467—�J541 us�zoNe tiwv I tettify thaf ln�he performonta of Iha work for whith this OwNeR No. �� NO. permit fs issuad,I shall nol emptoy any parson in any mannm ADORESS �P��:�3329 . ��'"� � �- - �� so os to become subject to�he Workers'Compensation Laws. l0 'C� CONDITIONS � . . . ,. . �. .COj71T13 . -. . . . U ��e � APPlicant . � � tlTY . . La , . � .JTICE TO APPIICANi: If, after moking�Ihts Cartifitale of ARCHITECT OR�Ve SZan p,Ip� �E���445-4Q73 DISTRICT GROUP C P�i. 20NE PROCESSED BY � Eaemption, you nhould become�svb�ect to Ihe Workars' ENGiNeea . y No. � Compensation provisions of the labor Coda,you must for�h• AooREu ..3]_Q-�N. �'irst, �I�rcadia.91Q06 . (,� �3 � P/✓ W wGh camply wi�h such provisions ar this permit shall ba �� O.. deemed revoked. . . TFIE �Y�IDIN GFd.WP TE�� � STA715TICAl CIASSIFIUTION APT. CONDO. (q CONTFACfOF NO. Z UCENSED CONTRACTORS DEQARATION � �� � � �Ve. � � �����.QS6O aA55 NO.�Q_DwELL.UNITS� I hereby effirm ihat I em licensed under provislons of Chopfar 9 nDORE55 NO. (commencing with Section 7000}of Divieion 3 of the Bo7ineu ond .. . . . ���, . `�'�R�P'' Prefesaions Coda,and my license is In full forca and eHed. Ci7Y CLA55 B � BK � � - VALIDAiION Lkense Number Llc.Clase 5O��T' 1658 �•oF 2 No.oF cHecK '� � 51056Q � � SIZE StORlES FAMIIIES� ONE Tf� ADIDFN GId�UP 6 19-87 Sin le famil NEw VALUATION ' COnI�OGtO� Doie � �ESCRIPTION OF WORK g y '� , ❑I am eaempt under Sec. - - Cx�ra e .Q56 $F' Ao0 s , ALTER B.BP.C.forihisreo7on $�$ D�Y . REPAIR - �f $�300 �� Dafe: � USE OF EXISTING BLOG. DEMOI _ Slgnature � .. . APPIICANT TEL. FINAI OWNER•BUILDER DECLARATION PRINT TFIE AN�IN�GF�UP NO. _ DATE "�f/�� � � � . � -�I hereby affirm Ibal I am exempt from 1he Conlroctor'�Licenae jLS �lE , . , �tn for the following remon(Seetlon 7031.5, Buslness and Ao�a¢55 fINAI ( �efeesfons Cade)i . . . _.. . __ .. . 6Y ����"t.s . . . _� 8 W IDING - I, as owne�of the properfy, or my employeas wilh A�DRE55 �. �'�� 9.3 A wages as their sole compenso�ion,will do the work and `�`iY i � , the structure Is not Intended or ofiered fo�sale(SeUlon i ' 7D44,Buainees cnd Professiom Code).- �" - � ' MOVING � ' TEI. � , � #••• • •� � I,as owner of Ihe propany,Om BxCIV71v6Iy ConlfOCfing _ ��MRAGTOR NO. � � , with licensed controctors to construct fhe pro�ett(Seo- �� - , . ' , �'' '8 Q 5� tion 7044,Business ond Professions Code). AODve55 � RE�UIRED YARD HWY TOTAL B . • •��H Q Jr O�, CONSTRURION LENDING AGENCY � �� � Sei aneK PROP.IINE wiorA � � � 1 hereby offtrm�ha�thera is a consrrocrion lend�ng agency for FRpNi � O'���...8� the performance of the work for which this permit Is iasuad P.t. �� �� � � � � (sac.3097,Civ.C.). sioE C3.t.7-Yh917�S. . . . .. . _ P.L. . . . . . Lendar's Nome �� 444'S. �'1p4T�'�:L.A: 9 p.C.Fee S 59.50 ve�m�i►�e JO.00 . �DMA ReL M � Lender's Address . � ' ' � c g I cenify that I have read this applicanon and 6�Ote thal 1he � lafuanro Fee 10.$� - �Dh+A V/C M � ' above informo' n is correct I agree to comply wiih oll Counry Inves��yaiion Fee . ' 7 o�dinances y Sfate laws relating to 6uilding consfruclion, _ Totol Fee $Q.�j� IDMA 7erm.N �� � ond Mere�by a rhoriza representalives of this County�o enter _ upon th o e• 8oned piopany for inspetlion p�rposes. . G � SEE REVERSE FON EX�IANATCRY LANCUAGE ' I S�gnature a appGcan�or Agenr � . . � . I � PlANS TO APPLICANT INSPECTOR'S NOTES ��(��ti���iK•�SC�11.UIfH,lll;(:I.AK:1'170\ I h. 6y oif I oil e c �Fi f il �rn� ..t . '' ' t.' ' � . . . .�.'Liftnse La io +f c. foll� � . � � IS.c'70�1'1 To: ,� � , Returned , � � . . . .. . . �APProvad ��'!)ivn�scrrn:7lroJ���ons(.od�..�ncn�tor.nienfti�hnL No. �ote � No. � ��- Date....��.� :.� :�.'.�. i .. , ..., ......':.'.:.. :•,�.� ri9�.. r rrnrri . _ . .r.. ,. . t tn ,n�r �rr.alr��r ��rr;�dr �li�h.'`- - r�pairnrsr xtructun:/�ri�r t�.rts icv�.�n�i,rbu ru�riir�. � -. ...,_. . ' •.`�."�': .'� G`� _ � � .. _.�, ., . . � . _-fb<•appfi.Jry/r,r ud,pernril fo/�l�.0.s;r,��-J sl.�[<�rr�i•r;t . . . lG�t Ge h L.rn�rJpvrsuant tn fhe J+n . .n/,U ('.a- f - (1'^�' tru�tnril.i�rnsrl,e�r/(:l�rpt�r71(�onmrn<�n,C.ri�rt! 1rr- .. _ _ _.. ._. _... __.__ .__.. '� ._.. 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' __ ..._ ._'_.. _._�. . , ,. . :. .''Yhes�� iu:eis oii�htendedorofferedio 5aie��5et 704a1 � -.,.. . . � . ..,. n �� , NcalthOePanment.___. ._ —_'._ ._._ - ..:__..' _• . �: __'.�_ . _._ _ __._ .. . �. .. �� �,O�uinrss unJ P /�s� �.c Cr le:71�r( �t-,+�/ i 1 ' ._. _ . .._.': . '� -:�:.i. . ._�-- � . �f.uu•�lnvs nr,t appl�h��n.�u ner�,J prnpritti rrl���FuilJ.� :� fireDePartment .__._. -_....___ ._... _.. . ..__ :._. _ - . .. - _ - _ _ _ h '�s vr�n.0 d 1 i. �-�•If,�• : � . � . .,_ :. _�--�. .,. � c ,•, .- ,'.. „ �.. �,TT:. . .�...� ._., ....�i .-.--:,��.� . lfro6,q1�-L'urrni�n,cn�pl,ti� i�J.1-�1��tJs�r1,�. Groding . �. �' . . _.prnormamfs rvr nn� rn�r Jdrr // d/:�.�at.•: q. . � - I .. . r1:'. _ . ... _ . .�' i.�'' , -!bn�t•re rs.fLr brrild�nX u7 r J � n1�s enld�eyt!in nnc , .. ,. , � .� . � � . �. ... Gee!og�cal_. ._i_ � . _,. __ `_: ._'.._ _.,.. . ..:;_. . , , . '}��� ol�rnmhleti�,n� tLr u¢�urr.Faifder.u�p!>r.re !Ae - r . ., . , ',. . `. .- .FurJrn��7rrnrip,q thuf Lr drd n„t huiLi ur imj,rnrr/nr Pedestnan Proteciion �_.�. :�� . .� ;-.. "_.�. . .__. .._.__ . .._._ ._ _' ' !/ �+ �use nI s lel.-. :. � . .,., -�•- . ,� v (FencelKanoPY} . : � , � �.., " � ' _. -. ._ �._. _...._ _.' __'_ .'._ _ __ '. k,-..(.:��I.aso nerofrhepotiertY.�ume dosl��elycen!roc� ting w�ih licensed coniroeb�s la<onsV��rhe proiecr(Sec, SPocial Inipeciian - ;� :.;� •: . . . � . � ��I�''. ...";. i"' ',-..._ _- - >ra/�vrui�c CnJ�` !l ( m�rutd�r's . . -�;:�,: 704a)Uusine:s and�/ �Ce�c 1(MosonrYl lWeld�ng) . . ' � . . .. l.ire rssrl.aie J�+es nn1 df+f�fy fn urt nr<�nrr J�rvperh u•bn , ,• . .�..� . .�...�-�- �- � . . . ��. - . . . . .. -"-hw!d .,iurprorrs fLrreun;unJ trGn e�ntrads fnr r:<.(> ' t . 1". �--�"� ._ , � lotDro�na9e , ' .. ' i____. _ ._'�_ . _1'�_.__ ...,. ..._ . :_ prijrrts`u•ith a rnnlrJrtnr(�/lirrns�r,!J�iirsr�anf tu llrr . . ,� .�;.� ,__. ---• , '- ,.,� � --Gonrra�fnr's l,icensr l.amJ.-�----- - . .. . . . _ . . . .: . .. , �,.- . .... Porking .. . . .. .. �____. __ . . . . . ...__'... -,. . _ . . ..... .. _ .._._ __._ . __._._' P__. __ _ . . � I am e•em t unde�Sec. .B.BP.C.�fo�this i , . . '. . ; "_'_�" "'"".___..._"_ __ . �. , .^ . _. ,., reason .�� , .-. � . , _..___._. ._....__. "___"_.. ._._ . .._... Dntc Own i er . . �..-..r ._ ,.., "` �'.__,.� ,.,:�.� � . .__ .. _ .. . . ., , . �_.. �. .. �: Approvals Oato laspeclor's Signatury "� ' � � ' � , � _ � -- I �� � �- IKSPECTOR'SNOTES-��,-� , locahan- - ,. : � �� ._._:-..__ .._ ._..-.� . ISeiba<k 6 Yards� '/,, n-- - � � . l., . Foondaf,ons . •. .�� ��� �� �. � � .. � Slab p .� � :. . . . . ... . . . .. . .. . . '_. . 0 . ... _ ___ �_.�..______._..__ _._.. . _.. __ .'_ _ � ,-�-�,.,...... �. Frame � .. .. . . . . . .. ' . � .. , . . � ..,.. � .i_ Fner insulaqon ' ... . .__... . __ .. ..__�._' .___l-_:.... . . � ._ , .,. � .' � . _ 9v . _ . . . . . . . . .. _ . � , . . ., _. ....... ....: . Lo�h:Drywall- ___._ ,_. _..._ ___'__.___ _._. ._ � � • -. . �.. ___ "'. ...___. , Inrerior , _-. .___ ___ . _ ___- , ; . . ,,� ..� . ,.- . lnih-Exterior . , � . . . . . . - � __. _ - - . . � . T. _ _ r' .._ �-. .�-. .i , , i Housr Numbe�-- � ���-- . r- `______`___ __ . _ . .___'_ . _ ._.._..._. .�, .. . Correci R Pas�ed ...� . . . .___. ..._.__ -_-_ _._ _._._.__._.___._- .� . . I , F�nol _......."__.._.......... . .. ......__..�..__....._..� ...... _ '__'._._ _..__ . ._._ ' . Enie�en Front . �i � . � . • . . ... . . � . . .� ' . . . . . .. . .. . . . . . . . . ... .. . . , . . .. _.,.... � •�r.:;� .:,. ..._... . �.�. ... .. . �. � . . ;� _..� . , c.�. �.. , ,. � i \ . , , ., -- _ —. . . ,_ __.