HomeMy WebLinkAbout1701 CLIFFBRANCH DR (8)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 (b100) 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 _N 4J�
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. 31
U^N�
• `
p
9006 d
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 91196
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 l7 F
MOVING TEL.
CONTRACTOR
NO.
o2.21-05
ADDRESS
-
REQUIRED
SET BACK
YARD
HWY
TOTAL SETBACK FROM
PROP. LINE
EXIST.
WIDTH
FRONT-
PA.
907.2A
$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
FIAAJS 7O APPLICANT
- INSPECTOR'S NOTES
To:
. returned
Approved
- -
..
No.
- - -oath - -
No..
Dot. -_
t
A^ rev^ _ . -
r7 s -
Required
Dote Rceiv eed
-.-
or Approval
Ym
Na
_ _
Water Certificate -
Health Department .I-. _ _
_._
r � �
-, r. •. c
Fire Doportinent
Grading
(r •i i
Pedestrian Protection
(Fence) (Canopy)
•�
Special Inspection
(Cone.) (Masonry) (N elding)
_
Lot Dr.r
Parking
Ap"'cr!s I
Dot.
Inspector's
Signature
- -
-._..
Location—
(S. tback & Yards)
Foundations
k
lye-' r_.\
Slab
Frame
WrIl
Lath/Drywall-
Interior
�' S
-
Lath
House Number—
Correct & Posted
-
Final —
Enter on Front
-
OWNEF ➢UiLDF.R DLCI-AR.ATIOti \
.1 hereby a'f,rm 0,ct Iamexampi from tha Cootroctor's
License Low fors tho following reason. (Sec. 7031.5)-
IJnsiness and Prn rerciur. c Cod,: Any city ar eonxly u•hiclr
- -requires apcn:r i; to rmrs!rert, af!rr, Ynrpraue, J"naiib,
ar repair any stet: ca-rr, Prior in i(s irsu.v; re; also regtiires
for appllra>a fnr s::clr permit to f'le a Sigurd statrnicnl
that he is licensed pursuant to the provisiotrs of the Can.
trart or's Lirrnsr Laa• (Cb.tpter 9)(contracneiu q with .iec-
--- Nan 7000) of Dh-;,in 3 ql the 13usiness and Professions
CndrJ nr that by is exempt tberefrorn and the hdshfortbc
alleged ....rnptien. Any tdeletia;: of Srdion 7031.5 by
_r-
ar.vapjli—If-aprv:itsi•(jects tl•e MTlic."t'lo deir41
penalty of not tr:nre tnart 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)
Uusincciarnd Prefc.ssi Code: The Cur. Jrecior's License
r-dl. t, de.snut CITIV domt o u. rr ofpAir"?v 0'o builds
nr inrprurrs tf etrno+, r. r:.d soho'c'oes sr: d, a»rk i•imself or
tl>rnugh'hi,' dwr rmplriyres, proridcd that such r
dIf,
�rorcnavt is arc 'r:nt-i,a,ndrl nr nffcrcd for sale.
lrotverrr, the hat/din•{ or ir-rpi-ar zment irsold within'nnr
Yr,r of cnr.:plct: o:r, 1Lc cvr.rr-f ::i(d.r t. il! L-a ve the
hurdru' f jirorb:g b5;a 1: r;rl is ! h::i11 a rr: hrnt e far
�,- the p—ponc of sa1eJ.
'' I.I;asov,ner of the property, on, a xoluslvety contra
Ling s,j'h licensed contractsnrsto car.st'uct the project (Sec.
aaJ The Cont rcctorr
_ Lice (r ta tiply t:- an o.tner of property mbu
t ' u 1 c1 refracts for sud,
pr 1 ct v tl l -r . p rsuant to the
1jti] le,m of unc4er , S.&P.C. for this
.._-Dot t-O•.�oer
I:NSPc CT@:I'S NOTES