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HomeMy WebLinkAbout1050 GRAND AVE (4) WORKERS'COMPENSATIO . __� .._. ....._... .. _ . "'.. .._.. .._._... .... ..._._...__ ..._.._,.__ .. ...,_.. ._.. _..'".- ' -. insureboroafcertii ca1�e of Wo kers'�N DEClARA710N , . . ' '. ... .. ,. . , �. ,= �. ..:�, � � ... .. . .� or 4 � _...s. .. _. . ,,.. . . � Y `��°'e°`�°°ge°"°°e" APPLICATION FOR BUILDING�PERMIT - —�;' Compensation Insurance, ' a certified capy�iheieof(Sec.3800,�Lab.-C). -'.... ... �. . .. ..... . - . . . /� COUNTY OF LOS ANGELES BUILDING AND SAFETY Po icyNo.3�b���ompany-5��� -��/dl.J .. . �._ ...... _. .. ..__ . .� . . . . � -'�� .. , , Certified<opy is hereby fomished: POR APPLICANT TO FILL IN BU�LDING D �� � / '�Ce tified to is filed with Ihe'covnf bu Idm ms eo " AD�RE55 ,. PY Y _ 9� P BUIIDING .J..�.. A ./� `fion'depa�tment.� ..�.,. . -. . /� , . �. ADDRE55 D CJ . ✓/ � � ��',iJ ' , � Date�Applitont (�f/� /-1�/�L./GZ'N GrtV � � � ,t/ � � �ZIP � LOCAtIN ^� � .� ' � �CERTIFICATEOFEXEMPTION�FROMWORKERS'� � "'"" "� - �� -�"""--" "" "� " � " � NO.OfBLDGS.�--�-- � -�-�-�. NEAREST.-- � - � � � •� �+°COMPENSATION INSURANCE - . S12E OF l07 NOW ON LO7 CRO55 ST. . p.J - � ' � ..� . ..� . . .. (This secrion nead not be comple�ed if the permit is for one -' .. - . . _ ._ .. _-. . - --- . ..__.� ASSESSOR . ,- ._....__ ... _. : _,: ! hundred dollars(E100)or less.) .... , , iRaC7 6LOCK � LOT NO. ' /�qp BOOK�- � PAGE. PARCEL� � ..... �. , ,. �� 7EL. C� ' USE ZONE hWP ., .. _'.__. OWNER _ C _. NO. � NO. : I_ ,I .' } ._ (ceriiiy that in�he performance of the work for which�this � permit is issued,I shall not employ any person in any manner � - � SPECIAL�----�----- -;--�--- - -�� -- - /�� G. so as to becolne dubjecf to the Workers'Compensbtion laws. �� ADORESS- � .�--"tiC: Rl � � - ' � CONDITIONS :V : .� ,.. .;... ,....�. . , .,, ,�..} �/� , . . . CITY l/� 04�i'✓ 21P � . _ .. .._. '_- _._. . ____ ._.._... ...__. -__.. . . a Dme- � .:,,.. APPtimnt . ,.... �. ,y_. .__ _ . .._ : . . . NOTICE TO�APPLICANT. If,�afrer makin �this Certrficale of ARCHITECTOR TEL. � .DIStRICT_ GROUP_ NPE _ _.__ FIRE . __PROCESSEDBY '� �, 9 ENGiNEER NO. CONST.� ZONE � I t) Exemption,��you should become su6jetl ro-the�Warkeri - -- � , . �����- :,W Compensa�ion provisions of the tabor Code,you most fortb- qDDaE55 �� �--1�--�� �� - -- --- � n' � wilh comply with such provisions or lhis permit sholl be ��� ?EL. � STAiISTICAL CLASSIFICATION A7T. CONDO- :�Z deemedravoked. .� •. ,. � � .,�..��, � ,� � ` CONiRACTOR ,:.5"J �',tld ' ' � ._ ' '__ . .. _ -__.. _" .___. __.._ _ . LICENSED CONTRACTORS DECLARATION . � ��. � - � - �`� -liC. �- �CL455 NO. DwELL UNITS - ;, I here6y affirm Ihat I am licensed onder piovisions of Chopter 9 n�DRE55 ,J �J ��7 NO. O a ,� , �� (commenang with Section 7000)of Division 3 af.the Business and ___. . _._- . l�C._ . ._� 3EWER NJ+P, � _ . ' �- �� _ . . . .__. . _ - . _ '_... ... ::.... _ Professions Code,and m license is in full(orce and eftect. CITY ..� iN `J CLASS � ' -" `BK; �� "� --}� -�VALIDATION - Y �� � � ' � � ' � � '��/� ' 50.FT. NO.OF NO.OF CHECK � - - � ' ' ' � � �� � SIZE - - � STORIES � FAMIlIES � ONE � License Number Un�r+y��Lia Classl� � � " � //����/��y�.� � � VALUATION'�, COMfOCtOf�f� •wr•R-VyY.�Ote �II ..- � OESCRIPTION OF WORK. .." . ... '- . . ..- . : NEW�-.� = Q',� �. ... .��. . . . . .. '' -- ' Q= ADD � wc� ❑I am exempt under Sec. . .� .. — �� ., �.� I , ...... . - . . � ' n�rEe p S . � �. � • � <8 1 &3 A • � 1 ,,. , _= : . _ . _ . . . B.BP.C.for this ieason .__.._ REPAIR. �, _� _ .. .. .. . . ..... .._ ..Date:�- . . . uSEOF � • �r DEMOI , �� . . i #� • • • •.� , E%ISTINGBtDG. . ! S � �---- - , "'._Signature� �_ . . _.. ... . .�-. ._ . .. __..... APPLICANT . TEI. _ . _ vRIM N �,',.�n10. �,� FIN�Q . �, . . .� . .3 Q 5 O OWNER-BUILDER DECLARATION _. . ,. , -` ,. -DAW - ---� --- � � � � . . . _... . ... •-I hereby afiirm that I am exampt from the Contradols License � ��q �/ , � �� ' ',`5 , .��_-' � Law for the following reason($ection 7031 5, Business and AODRESS W. f� . W FIN `��"- r � � 'Professions CodeJ: .. . �_._ ._ ..__._ ..__._.____ ....-. vk N : .0Y �. -. . . . _�. �2��9'$J�- �• BUILDING ,, � �. ��-�' I, as owner of�he property, or my employees wifh aookE55 -�-�-wages6i their sole compensation,will do the work and �- � � - �; ; � � the struc�ure is not intended or offered for sale(Sec�ion lOCnliN , ', �'= - -� � ' 7044,Business and Professians CadeJ.. . -.._ ��-- " MOVING .. . ... . , . . _. .7EL. . . . . - -.-. __._._ _ . . i._._ ._ .,_ _.__. : � I,as owner of If1e property,om exclVsively coNraclinq COMRACTOR NO. � . _, � ! ; _ � , - -with litensed contractois to�construcf the pro(ect(Seo- -- -., -.._-...-- - .-... .. ..�.�......... ' .---'.... . . - .. , -. - _..;_ . _. _._ __.__. .� tion 7044,Business and Professions Code). AODRE55 ; „ - I RE�UIRED_. IOTAL SETBACK �,,' -�� � �-� � � YAR�. .HyJY . , ...... _ . ._'. _.' . _._.__ "-�"" "�-'"� CONSTRURIONLENDINGAGENCY-�- - ��- "'-� �--� SETBACK VROV.LINE WIDiH � ' � I hereby affirm that ihere is a tonsfrucfian lending agency for fRONT � , I � Ihe performance of�he work(or which this permit is issued.— - ��RL- . . . .-.-... _.. _.., ....____... .._.___.� .. .'� ---.-'- -. --._--.. -. -� ' (Se[.3097�Civ.C.). SIDE.. _ . ._. . .. ..... . �� ;. , ,. ._ :., ; _;.�..' , m ._...._. _._.___. ...__. .__ __... _._.. , . .._ _'_ P.L . �, . . . .... ._ .. . .__.. .. .. , - __ .._. _ � Lender's Name �' ` . � � ^ ��- IDMA ReF,k ' � -.._ _.. _... . . ..._.. _. . ..._.._. .___-._.. _-._.. P.C.feeS. ... .._......_ PermiFee CZ� . ._� . . . . -_ = lender'a Address �� � � � � -�-- �- - � Issuance Fee I U.'� . ... .LDMA P/C�X ' ' i � I a I certify.lhal�.have.read ihis application ond state fha�.the __._. ._. .__ . ,.._.. .-...-- -� " -' - � . � above information is torretf.I ogree fo comply w(fh oll Counfy Inveai gation Fee �� � •r : g .....�, ,..i g _ordinances and Sro1e laws ralating ro boilding construction, ---_-. _. . ._--..--_...___. ia�o�Fee-.- J.�-'�...-. -I�MA Pe.m.M ,. . .-- .. - -._ ....'I- - . -- �' � . i � �and hereby aufh 'e represenlalives ot this County to enter . . � � � � q up the abov me tione properry for Inspection purposes. � � � _ , , _ Q .__ . _ . . . . _.__. _... _C�� _..... _ ..__.. .._ .. _ _... _ ...'_ . _-_ . - ._...._. ._ _.__ ... ._ '__ , _ , '_'.._ a SEE REVERSE FOR E%PIANATORY LANGUAGE � . , _.-....-- gnonre f Applicanror A9en� .. ----- -Dme- ._._. .. . .. . _ ._ . , . _. . .. . ... __ . . ._.._._... . _ _. _ .__. .._._'_.. . _ .__ � _.. '� .. .t � \ � , . - _ _ __ - __�._ ! . PLANS TO APPLICANT INSPECTOR'S NOTES . OR'NF.R•iIUILDF.R.DECLARATION ���. ��-' '� . _ . , I hereby affirm that I�am e.empt from the Co�fractor's � To��: Rdurn�d �.r � � ` �`: � �. - � - ' � 'License Law�for� �he'�following'reason.���Sec. 70.3I.Sf � ' ` � ' ' '� - � ' ' Approved �QusinessandProfessionxCode:Anyrrtyorroantyu�bicb No. Data 'i No.��� -:'Dafb . . . .,.. .. . ., � . - • . .. '� reguires apennr[10 construct.alter.im/�rove,demolisb. � , .,. , , . , -:-or repairanystratturc,prior to i1s issuance,afro requires ' . -- - .. . . � �. �'�.. . , . ' .. , . t!e af�/.licant for suoG permit to file a srgned statemerst � , , ,.tbat be it licented pursuant to tGe provisions of fbe Con- , ' . , • .."�� ' , • - � ��� . traclor's Licease Lau>(CLap1�r 9J(comn�encing wrlb Sec- . . ... . . . . . , ,. ��., � . .,. .. . � �-'-----.- �,- .�.- .-. -- ... ` ..__ .� .-'-�. . . .... tion 7000J of Devisenn 3 of tbe IIutinets und Professioni ' ',�'. .'_____._.. __ ._ ____ __ _ ..._. .. "�� ___._.__..._. .._. __�_�:.._� . .,._� :,.. '. . _ . _'_ ?Codef or lbat be is rxrmpt tbereJrom and d�e basirfort!e � � a!le�qed exemption.Arsy s�iolation af Sertian 7031.5 by �__�.__�. _`.... �_�:. �. Req�ired`_.,�- " � ,---_-- _.. ... '_ � .�_ . ___. :_._. '.• � ' an.Y af�Qfitant for a fcrniit sabjettt tbe aJ�nlicant to a tici! Approval� Ua»Racsiwd - � �� Yei No ar Appraved � - . ,,� -�/�enalty of nof more�lban fi've bufrdred dollrsrs(JSOOf./:�. . , ..; ' . . , .. . . . .. . , . �' �i �4� . .. _ .�._._"... ._.. ."'__' ._. ._ ... . , � � � ����- ❑ I,as owner of the property,or my employees wilh �. Water Certificafe � �- -� � �� � � ���; __ ..,.. . , � , .I.. , - . wages as their sole wmpensation,will do the work,ond � .. `----- --�� � � � � - -�"�--�-- "- -� ' ' , -. . _ - , 1he 51roUvra is not inlended or affered for idle(Sec.7044) ' ' ' � � �Dusiriess und Pro esiions CoJe:TGe Contrarlor's Lirense .' .�. Heahh.Depaltliient_ . ._ . "__... . .. � '�.�� _�_�. .. ..._, ._._. _____.,�.._ ._ � ... � ._. __ . __. .__ . . .. J .. �, � . � � . I.aw does not ap/ily tn an owner of proj�erty wbo bui(ds � � fire Deparimenl .__,__ ___ _._.�_ _._.__ .__. . ._ ._ .. '� - -- -� � - �� ,- - or im/�mves lGercon,cnd whn does sucb tuork GimselJor - . � � ' , tbrouqb bis.ou�n cnrpJoyces,.prorided��LaL-sacS�rm- , Grading � � "��- - � � �.�prnnen�enta are,not intended or.af/credfor_aale..lf, - . � . -�:bomet�er,!Gc buildixg or imJrrovemen!is told u�ilGin one . �_._9,. _-... - ---� �--� - -- -. _ . .__ �.. _ .� . � . ' Geolo iml � i, .. , .. � . �"',yrar of aompJetion, tl e owneabuilder u•ill Gnve�tbe . ' ' � � �� � .� -- � .• ` �� '.. �. � +.� . . burdem of praning tl�at be drd not bui(d or impmoe jor ��. , , . . .... .. ._ . _ . . _ (edestrian Protecrian ,'�:� . . .:�. ..- . ��,.�. ..�..... . - ., .:... � . he purpose of raleJ..'.� ' .. t Fence Cano . . . .: �.. .. �� ., . :,. ._ �'--- -�-. . -. .'�- -'.. . �. .. . . ... � ling❑wi h I�e ied cofnvacrors IotconstruU ihe P�IY contrac- )( PY) , P� P. Y,am exdusive . ojeU(Sec. � Special InspeUion-- - �- - � - � � - �" � - �" � �044)Qusiness and Pro,�essinna Cnde:Tbe Contractor's � (Conc.)(MasonrY)(Welding) • .'.,�•�. . .. ,�,�. '� .�. �._ � '. :.. .. ..:... ...�.__ __,_._ _._. ..builds oram��es n�t aP/�IY.lo att oa�ncr of property u•Go . ores�tbcrcon,and u�ho eontracts for sut! lot Drainage s�, '- � . ... ,__-. _.._. . .._ ._.. _'. _ ...- .� /�rujects u!itG o contractnr(sJ licensed f�arsuant tn the � . . , � � -��CnnlrpCtor's Licente'Lau�J.� '�� � �' �� � Parking ; � ` �. .. .. . • �. ;. ... . " .-._.: . �, . -�. . . . � ....❑ I om exempt under Sec. � .B.BP.C.for 1h�i� , ' s � � . ., . ' , � - _.... . _ __ _ __ ...._. _.._� _ . , .... ._ . � . � • , reason ,- � : . : ,� , . � .. �. - . -.__ ._._..._..__-_ .,.'------ . .. . ._ . . . � . . Dale Owner�..... _ : .__'_. _. . ._ ... ' - ... '�.. �� .. ... . . . .. . .. � �Approvals Dafe Inspaclor's Signal�ro . ' , .� � ' . INSPECTOR'S NOTES '�� . - Location— � - . .. ' (Setbock 8 Yards) _... . . . �..: . . .. �' . . . . _ . . '. _ _ . . . . � . .�. Foundations .. . . .. � . . . .....,� .� . '..�:. . .. . . . ... Slob � � . - � .. . . . .. . Frame � . „ � .. .. .. _,._.....:.:. . ... ..:,. . ,,�r.-. ..: � � 1 � . ,. . Energy Insulofion -�' � .. . . � � ' � . . ' . . . , _ .____.. . ..._. _. .. .. _ .... ._ . . �� i . � _ , .. . � - . . � .. . . - lath/Orywoll—. - _._ _ .'._.______..__ ..__..._._:__ .�..'__..� . . ... . . ., - -' � Inlerior _..._. __,. .._. ..�, .. : .� . . � Laih—Exlerior '- . .. .. : -.. �:.. - . .. ., . � �- HouSeNumber— . ...._____' �..._._. ..___. .. . � . - ......._.. .�-- - --- -- '� Correct 8 Posfed " � � _. . ...___' . _____. _. .'__... .._ .. � ..: .. . . . � � � � Finai— _ ___.-_-__. . . . .�. . � ,.� ._._... . _......_._. . _'__.. .___ .._..__ _ . _.. . _ _ __.- � Fn�er on Fronf . :''', .��� .... , ' ..,.�.. - � �. � � . . ,. . . .... . , .. . . .. . ., ... .. ��