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HomeMy WebLinkAbout1641A (9) .... �.ucCIARATION . .. . . . . . , . � . . °�y°'"'m'h°„h°°e """"°'�°``°°'e°"°"" APPLICATlON F4I� BUILDING P'ERM1T inzure,or o ce���+�ca+e of Workers'CompensaKon Insora�ce, or o cenffied<opy�hereof(Sec.3800,lab.C.} � . COUNTY OF LOS ANGELES BUILDING ANO SAFETY �� QcyNo. Company � 8UILOING Cenif;ed copy�s berebyYum�shed. FOR APPLICANT TO fill IN aooRe55 ►�a 5 S,- Q� � � Certlf�ed copy is filed with the county bu��d�ng inspec- BUUDiNG'�f�C.��� �AY #3 . � iiOn deportment. , , ADDRESS W'(J J Oare ApplicoM GTv � ���� H�+ ZiP 7 S �pCqt�Tr t�`v`dV� CERTIFICATE Of EXEMOTION FROM WORKERS � 92E OF lOT NOW ON`lOis CRO555ST.�� COMPENSATION INSURANCE +�y (This seGtion need nof be compleied if the permit it for one TRAfT BiOfK t0t NO. +!3 '�ESSOR' � hundred dallors(5100J or less.� � MNP BOOK PAGE PARCFt TE�' '�l USE ZONE /+�A7 1 certify ihm in rhe pe+formonce of Ihe work fo�which Ihis OWNER N NO �"��'t'T NO. � permit is issued,I sholl nm emp�oy an pe son in any manner S•5��� W^1r �3 SPEGAt _ ( 5o as 10 beCome Subjetl lo�he W s' am alion lqws. ADDRE55 ' CONDITIONS ( f�f� p Dare Appli<onf, �G�2' �"�P t7 �A ��P 7bS � NOTICE TO AGPIICANi: If, a�ier moking ihZ Cenificare of ARCHItEC ++�� �/A Nto Q`^�3r4,4, DiSteiCT �, GROUa TYVE Fi�tE PROCESSFD BY Exem rion, you should become sub'ec� to 7he Woders' �R ���� C11ov' /y �j {�(� Campansation provisions o��he lobo�Code,you musr ior�h- qpDRE55 S.DD w/�Y l�3 lQ {\ � ��� Vu 2� S\\Q� � wi�h comply wilh su<h provis7ons o+ ihis pe�mif zholl be .tEL C S7A�ISTICAI CIHSSIFICATION APT. COf:00. Z deemed revoked. CONiRACTOR Q�,tJ NOG.7+!B Z UCENSED CONTRACTOR$DECLARATION ���, M55 ND. '��� DwElt.UnITS_ I hereby oHirm fhot 1 om licensed under provisions ol Chopter 9 � A�oRESS AgOV fi Np. ��R�P (commencing wi�h Se<fion 7000j of Divi:ian 3 of 7he Busineu ond �i�, Profeu�ons Code,ond my licenxe is in tull force pnd effect � p1Y �-- � � Ctn55 � BK ,� YA[IDATIQN � � 5�.FT. NO.OF NO.OF CMECK LiCen58 Numf�er lit.CIOss 52E SiORIFS FAMIIIES � ONE . ' VAII/ATION CoMroclor Oate � - DESCRIPTION Of WORK ADD f L '^�� ' ❑ PAr�o Gov�R ' " � I om ezempt under Sec. ALTER' 8.8V.C.ior Ihis reason �� X1 � �-� ��G REPAiR S dO1e; USEOF -l1Cs'/ZtI�GE DEMOL E%ISi1NG BL�G.��L �"v�7 Signoture .. nvP1�CAnrt . . .. . . tEl. - FIN OWNER-BVILOER DECIARATION aRW7 NO. DA 2� I hereby affinrl�hot t om exempt from the Controcrw i license � � � � - . law for the fallowing reaton t5ection 703I,5,8usiness and AOORESS FINA � Pryfessions Code): �: _ � . . . _. _, By '�1 6��� �i . �r{ BUILDING �• • � /�� 1,as owner of fhe p�operry, or my employees wi�h A�DRE55 � -e � /�"'� oges os Iheir sole compansorion,will da rhe work ond , � • °��7� � the strucfure is nm in�ended or offered for sale(Section ��`��T� ,�� S x � 704d,Business ond Profeuions Code). MOViNG iEt. b 7" ' 1 Q 1,as awner oF Ihe properf om exclusivel conbpctin CON7RACfOR � NO. r. r g p919-8E \ wirh licensed connaUon�o consnuc�Ihe pro�ea(Seo- qDDREsS tion IOAd,Businezs and 7rotessions Code�. CONSTRUCTION LENDING AGENCY �SE�eAG� YARO HWr 1�TAL�OP UNE w�otN � � I hereby oitirm ihm there is a consrruaion lendfng agen<y for FaoNT . � the performance o/ihe work for which�hi:permit is iasued V.L . . (Sec.3097,Civ.C). SiDE - P.L lender's Name �- �p�Q��� tender's Addreu � . . P.C.f�e S Pe�ma Fee . , ' 1 cerfiiy ihat I hove read fhiz opplica�ion and srate Ihai the neoa�ce iea �V.JU �Drna G/c N � �. obo�e informmeon is corcecl.1 agree Io comply with all Caunty m.evigauon F<e � o�d�nances and Sime lows relarir,g to bvildmg consrruaion, m�ol i« � LDM4 Pvm.M ' . ond �eb omhori reseMafives of rhis Gounly to enfer -����-� �p e - mio d rry for inspec�fio//r�yy�purp/Q�ses� . � ���� SEE REVERSE FOII E%►LANATO�Y UNGUAGE Signowre oF Applimnt or AgeN . �e. . .. . . .. . PlAMS TO APPUCANT INSPECiOR'S NOTES O1Vhd�.�a•u.�....- 1 �. I.h�.chy o�(rrm il�p!1 am e einpi f��m ir To: 1: � . . �Raf�rnad�. . . . . . . . .C se l lo� if e�WI o.a�nq r�iso�+:.,(St ...7031., ApProved � . . �/li�sinrs � J('rn����si�rrcs(,'nd�'.4rt1�trltu..�iu tt�<l�i�l� No. �_D te No. Oate - � - . . . .. . . .. reyxrr u/�<rnut��,�n.rctruaL ahrr.inr).o� J !.I __. _ `. — - nf+�� 1�� 1 rt �J f C . �! y : I , ''i � � � � rh�•up�d J r/ �r 1 p� n�r t,J'� ¢ d sr�,r �i . � . --- - _ Y y µ _. tlatle�s7�.rn�rdp�n.ruantt,rG�p .r Jr4,�,�n• � . ..:]� , .. � e�'� b�un.i f iu•nn•l.�u Yf3�ep�rr/l(�n �� ��n�u�irh 4rc- .., . , , �'._. ._._. ._ ... _.__. ....�_ _ -. . . . . - � ' �iun?pU01nJU«urnn3o/theUueirirxrunJPr.�/rs.i��nn� �_��J i i � ��.Y- •. f.! .. r r;l i 1" .. •-:. .�• 'rl� ':•,•t �:-�'.. -CnJrlortbatFrn��x.+nptrferrJrnninndr7�vbo.LJ.,rlLr .._ _ _-_'_'__ ._.. _. .. _... _.. _ a11r,QeJ ernnrp�inn.vinv rinlalinn nf S'ea�lion 9(131.5 b�� --' -� Fe9uirod � D-fe�R�c�iv�d � - �.. . . . . .. �nyJPpLc [J Tp t b�..ct�r! ppl�� r i . ... � � _ �� � `,: r�nuln ( t � ..th �I �!d J dJll��ar(SSb011.! I I .nPP _ �Y>s No APFror�d . . . .. . -_.. ,. -. . � �. .h n� � t' I o(ri p P.�y y ..�i y sw h �}.�t�C��I�t,a.c- ' _- .- . - -.-._-- . "'—'—�.~ woqns o.'�4 soie u P satwn II d iHA o ai�d � � { ?�f!.1• � t:t�� �1Me strucwre ie nui iniended or of�ered 4m sab(Sec 70<�i ,^ ; , . .. � . ... D�enneisa JP�nfiisw�nrCnle:7'h�Cnnt.a�lor5l.rrrnsr H.oI�F C/rAa..r.'e�1 _._"...... ...... . ...'__' ..... .. � ,.P t. ;.� �:, '.r:)' �'r'� . `��l.uii(d�5s (aph��nunounrr�Jprop�•hiri�,�buiJds .. .S� �, at til: .. F,c.D«porrmem.___�__. ._ _ ... .. . . 1 ...... � . Y .. . � . � nupr �t n 1 ! J x i u k I !l r . � � - ,, ��i '.1 r.� .t �. ! ^�r �-.. �1!rn yl 1 u u r p(�. .� .J J t/ r s F n. -prn me u�a � t nt d J ryl J J �s� �//, .._ _._ . . - , .._ �' ;i� � `I�C � I , ~i'f � �, . .. � .. _.a_,. �..__. hnu r,d r F,mlding� mpro � t i.c�sotd�lithm one ' _ � ... "'. ; �.:� . , � �..+ . _ , _.. .. . .. . rrr r ieria -... G oloa�cal�! �� � . .. �. � ... . . , . ..,�r3,r��; .. i�ear nl a��p!iinn, Uc aumrr-biaildar i��if7./ .t)e ,. , _., ,a`- ___ .' � -.- - hurd<n.f prn�rAX tl,ae Lc Aid nnr kuiJJ or u.rpror�Jnr P"d.��i �on P.o�ecGon ._.._. _ �. �.. .._.. . _. .. .. - _ v.:,..:.... . . .tbe/�ur(�nreo/ta(rJ. " �. :.. ... .. .. Fencel{CanoPY) .. . _._._ . .... .... .... .._ . . .._..._.. � � ��❑ Las owne�of the prope�ly,nm e.clvsively comwc � ....,....... . ...t1og w��h I�censed<onirocrors�o cons��u<�lho�proiecf ISec. _.. .__ ...._ . _.__. _._.... ._... . - 5�.�•:oi impe:i�o� . � . �.� " � - - � � � ' � 70odj livaineaa anJ Prn/essions Cnde: 7�he Cuntr�rtnsi� iCo�,c.iR�tmnn.vl(We�dng) . ... -�� �, . ,. . .- �.-. -. - . . . . . - . . -- .l.iren:el.anJoesnntapphruanaunernfpr��prrhubn _ � �� , � FoifJs o.i.npmoe:dre•enn,and vI r,���Rrru.es/��.sr«h tc�Oromogr . . �. . � � .�,* -prnjeres.u�itb u-tnntrucenr(il fi.ense�l.pr�rsuurcf fn7be r " : j . . , . . . . : c . ' . Cnrctro t rl r nsrla 1� . . �''� ,... .`..` �: i ':'q - > . . � (co,k�ne, ' ' � . .. �.: ` ' 4.' 4 1, ,i ... (_� 1 om e•empl der Sec. . :'8.8P.C.For lhis , . , .. ; ... . ._""'_. . . . . . ' '��y!.t t.�t . ':R ' ...reb5on .. . . ti. . ... .. ___ -:_. . _ .. ___�_... .. ..__ . ... Dme Ow�e APProvalt ... Do7e Inspoctei s Siynatur� . .. . .. . . .. . .- . ,.. INSFECTOR'S NOTES;' . loca��on- . _. . ,_.. . . .._ .. ' . . . . `./ lSei6ack R vardz) __ __._. ..__ . . ._,____' _ ._... . . . .,.._: .._ � ., . � , . ,' ','� Fovndahom . �� ..__ ._. . _ .. : . ,� .i � ........ � , . , , �,- ..: .. Slcb � .___' ._..-__._... _ _ ___. .... ..__�.: � ..._... - . . �; . ... ........„ �� . '� Frame . . . . .. ._ .. � , . r .., , . . . . '_'__ __ .._.."_ '.._.. , . .,;�: Enerqy�nsulor�on ' .. _� . .. , �. �� �.. . . . . . i Lo�h:Drywall- _ ". .__... ._. _ � . ' .. . . Inlerior ..� .. . . . taih_E.�e.mr ,� . + .� . . ..._ __.._.. . —._._ _- ___.'_ . . HouSe Numl��- ." . . .� .. .. - . -. ........ Correc�8 Posied - ,`��' � �� ' � f�n - . . . . . � .. . Enter on from ,I. . . . ... . ' : . � ' .. ' . ` . . . . - . . . . ... . , ' .. < .1 � ;�, . �� . .. .,..... , ._. . ... . t' . ,-, .,. . , .._... � .. .-. .. ., . i '� . .. . . \ . � _ .. . _ .. . . ..