HomeMy WebLinkAbout1701 CLIFFBRANCH DR (4)WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self
Insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company
Certified copy is hereby furnished.
Certified copy is filed with the county building inspec-
lion department.
Dale Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed If the permit is for one
hundred dollars ($100) or less.)
I certify that In the performance of the work for which this
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Louts.
Date. Applicant :LIE_
NOTICE TO APPLICANT: If, after making this Certificate o
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be
deemed revoked.
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Number /%2 O Z 3 Lic. Class 0' f
Contractor a Dote *14 % S
® I am exempt under Sec.
B.BP.C. for this reason
�/ /yam 0/g/te:
Signature _ r—lY4J�
OWNER -BUILDER DECLARATION If
I hereby affirm that I am exempt from the Contractor's license
Law for the following reason (Section 7031.5, Business and
Professions Code):
I, as owner of the property, or my employees with
wages as their sole compensation, will do the work and
the structure is not intended or offered for sale (Section
7044, Business and Professions Code).
- _ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec-
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued
ZSec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the
above Information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
upon the o ove-ment' d property for inspection pur oses.
a 0
Signature of Applicant or AgenIV Date
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
nooa ss 170 C/iIf r.rnc
BUILDING 1,
ADDRESS -I OI t—U r u C µ
!7
LOCALITY a
CITY D A ►+L09D 011IR CA ZIP
NEAREST ytl
CROSS $T.
NO. OF BLOCS.
SIZE OF LOT70,29 vRewr NOW ON LOT
ASSESSOR
MAP BOOK PAGE PARCEL
TRACT $ JT% BLOCK
LOT NO. 3 1
U^N�
• ` /
Q DD d
9006
NOP Oac
- 3 3 '7
A e j C 1J 6c NO.
OWNER ' at
SPECIAL
CONDITIONS
DISTRICT
GROUP
TYPE
FIRE
PROCESSED BY
ADDRESS S A M F
�-3
CONST.
ZONE
CITY SAME ZIP
L
7 Mr
ARCHITECENGNEERT OR
STATISTICAt CLASSIFICATION
APT.
CONDO.
r-Mir . 15yWyAm
No. q46 8616
CLASS NO.0,1 DWELL. UNITS
I
ADDRESS 9Q7- W 57U PLA u D - CA 91194
SEWER MAP
SK. PG,
VALUATION '—
$ I3/su�1 ,
VALIDATION
�� 8 a. O A
CONTRACTOR AFL HL G NOy7 /C
ADDRESS 16101 CEO C AV S 'Z% NO. ) I C 2
CW
CITY �Ce, fA suG-*m EA CUSS B-'
SQ. FT. O NO. OF NO. OF
CHECK
SIZE STORIES FAMILIES
ONE
a
FINAL
DATE I
F1 L -
,
If • e • • 23
(_e e8306
- -
• • n S �. (j .r) F
O 2.2 1 — 8 5
3 ✓'•.1 F1
DESCRIPTION OF WORK rAM / L- ,,,Om
NEW ❑
TIcAl
ADD ®
ALTER ❑
REPAIR ❑
DEMOL ❑
USE OF 1
EXISTING BLDG. SJ/Vf•LE fAf1lL Ow2CGN6
APPLICANT TEL 'F!w
PRIM ,Q L. LAID
I�LCo
ADDRESS C,p A 511
�AE��
.^
�; s• r. e 2 5
R N
BUILDING
ADDRESS
(e o •JOG -
LOCALITY
m o 0 o J 11 C
MOVING TEL.
CONTRACTOR
NO.
o2.21-05
ADDRESS
-
REQUIRED
SET BACK
YARD
HWY
TOTAL SETBACK FROM
PROP. LINE
EXIST.
WIDTH
FRONT-
PA.
_E907,GA
$i • • • o • 1
PA.
p
��f
P.C. Fee S O !C' r 06
Permit Fee
• .c�T
-
( • 1 1A75
/A.Sz7
Issuance Fee
•- 1 1 1.75r
Invastgation Fee
/• 7 T
Total Fee
J
0 h Il h — R I
SEE REVERSE FOR EXPLANATORY LANGUAGE
N
O
U
W
0
0..
to
Z
es
19
FlAA7S 7O APPLICANT
- INSPECTOR'S NOTES
To:
. returned
Approved
- -
..
No.
- - -Date - -
No..
Dot. -_
t
A- mj•^, _ •. - _
Required
Date Received
or Approved
Yes
Na
Water Certificate -
Health Department .I-. _ _
_._
t
-, t. •. c
Fire Dopartment
Grading
(r •i i
Pedestrian Protection
(Fence) (Canopy)
•�
Special Inspection
(Cone.) (Masonry) (N elding)
_
Lot Dr.r
Parking
APPra'ra' I
Dot.
Inspector's
Signature
—._..
Location—
(S. tback & Yards)
Foundations
k
lye-'
Slab
Frame
Lath/Drywall-
Interior
�' S
-
Lath
House Number—
Correct & Posted
-
Final —
Enter on Front
-
OWNEF ➢UiLDF.R DLCI-AR.ATIOti \
.1 hereby a'firm 0,ct Iamexampi from tha Cootroctor's
License Low fors tho following reason. (Sec. 7031.5)-
Brainrss asd Prfersiu^ c Coda: An}' rr{Y or eonxly u•hicb
-- regnires aperr:r i,, to tors;rrrct, af!rr,Ympra rr, dririnfiil.,
or repair any strecturr, Prior m i(s irsu.v; re; also regriires
the applicant fnr sr:ch pern:it to file a signed starcnicnt
that he is licensed pursuant to the provisiotrs of the Con-
trarfor's Licensr Laa• (U.,apter 9)/contnrcncinr with Src-
--- tlon 7000) of Uiri.in 3 of the Business and Professions
Code) or that heis ex, n+pt tberefrorn and the hdshfortbc
alleged ....-ptian. Any violetea;: of Srctlon 7031.5 by
_r-ay pplica If ra prv:it sr,17'ectstl•c Mplicaul to deiril
p eraltp of not tr:are tnan fire burired dollars ($500).J;
i. as owner of the property, or my employees with
wages — their sale cemponsa:ian, will do the work, and
the structure N not Intended or offered for sale (Sec 7044)
Busineciarnd Prefessi Code: The Cur. tractor's License
r - d:.nh de.� nut CDplp do an ou. cr of yrr7:oeAv U o builds
ur inrprores tf arena+, r. r:.d soho'c'oes sdch uvrrk himself or
tl>rnul,b'bi,' near rrrphiprcs, prerlded that sueb
e
pro veturnts arc 'r. ot-i,a,ndrl or nffcrcd for sale,lf,
hoverer, the hat/din•{ or hnpiarzrrent irsald within'anr
Yrar of cor:.t,LIiorr, the cvr.rr-f ::i(d.r rill bave the
hurdru' fpirorb:g •t,i;a 1: r;rl r: !h r:ild a ,r:hrnfar
�,- the Purpesc of sa1eJ.
'• I.I;asov,ner cf the property, or, a xoluslvety contra
Ling s+j-h licensed contractsnrsto caner—t the project (Sec.
0-:Nn, aad Prg4sslr. r �'risle.• The Conprcctor,
_ 1 is (r t applY to a t e.t nee at property mbu
t\ n t ' u / c1r tracts fnr such
pr 1 ct v tl c t 1 r(J l Wev . p rsuant ro 11,r
1 jti,\le,m of un�er , S.&P.C. for this
.._-Dot t --. O•.�ner
lNZPc CT@R'S NOTES