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HomeMy WebLinkAbout1624A 1625A (9) .._..,..,.a wmrtNSATION DECLARATION . � J � i here6y alfirm thot i hove a�e,,;,��o�e ot�o�se�„o=e�f -� � APPLICATION F�R BUItDIN� PERMIT � insure,or a cenlfiwte of Warkeri Compensoiion Insuronce, � or o certified rop �heraof $ec.3800,lob.C.) - Pa3WyCN'005-2�9-OOC�mpony NdtiOriWld(� lO/C COUNTY OP LOS ANGELES BUILDING AND SAFETY � Cenffied copy is hereby furnished. FOR APPLICANT TO PILL IN qpppESS 626 Bawcreek Drive � Certi(ied copy is fi�ed wilh Ihe tounty 6uildi�g inspeo- BUILOING lion deporlmenL AOORE55 6 6 C'PaC �V oa+e $'18-87 qpP���a��TEIE ANDBTI GROUP arv Dldmond BaI' ziv 91765 ;�i�ry Dlamond Bdx' CERiIFICATE OF EXEMPiION FROM WORKERS' NO.OF BiDGS. nEAREST COMPENSATION INSURANCE SIZE OF t0T NOW ON l01 CRO55 ST.0 10 & GOLCIPTI S rin S (This seUion need noi be tompletad i(Ihe permit is for one TRnCT 42589 BiOCK LOT NO. 69 �ESSDR hundred dollars(E100J or le:s.) �1P B�OK PAGE PARCEL OWNfR TI�IF+ ANDIN GROUP Na`967-9541 USE ZO E �P t r^'�� I ceAiiy lhot-in the pariormonce of the work lor wbich�hiz R„—� �� � � permit is issued,I shall not empioy ony person in any monner pDORESSp.�.BOX 3329 tr SPECtAI 4 so as to 6ecomc su6ject to the Workers'Compensolion lows. � D� COND�TIONS � pTY ' ZIP U re Applicanf a ARCHITECi OR TEL DISiRICi GRpUP TYPE FiRE OCESSED BY ��TICE TO APPLICANT: !f, afrer making�this Certifimte of ENGitdEfR Dave Szany AIA No445-4073 O .emptlon, yau should betome su6ject Io Ihe Workeri � � � CONST. Z�E � Compensotion provisions of fhe Lobor Code,you must fonh- aooaE55 314 N. First Arcadia 91006 d �.- (� wilh comply wilh suth provisions o� Ihis permit sholl be ?E� ' " 0. deemedre�oked. coN7anCTORT� �NUII3 GR�SSP Np. STATISTIVILCIASSfFICATION APT. CONDO. N IICENSED CONTRACTORS DECLARATION iiC. CIaSS NO.��OWELL UNITS �� z I hereby affi�m that I am licensed vnder provtsions of Chapter 9 aooac55 AS hcaOV@ NoS1�S6� ��R�P (commendng with Section 7000)of Divis�on 3 of ihe BVsiness ond , ���, Professions Code,ond my license is in full fo�ce and eHect. citt C�455 B � � � VAUDATION 510564 B 52EFT�.�I4D S OROi AMI�LIES 1 CONE Licenae Number Lic.Closs YAlUAT10N co���c�ior T� �IN ��e 8-18-87 DESCRIPiION Of WORK 5111 le famil A D � s 67,500 ❑I am exempt under Sec. 2 , �1 6 2 4 A AITER B.BP.C.for fhis reason gEpq�g S �'• •' •2� Dote: E%157�ING BLOG. DEMOL I ��J�,� 6 S�gnamre - /�lic4Ni iFt. FINAt . L OWNER-BUILDER DECLAkAiION �RiM NO. OATE 3 �� "2"'�.� b � I hereby alfirm thot I am exempf from Ihe Contractor's licanse j{S dbOVe tow for the following reason(Secrion 7031.5,6usinees pnd aDDRE55 RNAI �.y�l/�� o 9.1 ]—8 7 �rofessions Coda�r � � � � N �- 47 //"f'o�" JBUILOING I,as owner of Ihe propeny, or my empioyaes with ADORE55 wagesas7hairaoletompenso�ion,willdotheworkand ���q��TY � ihe mrocture h nm imended or offered for sole(Seciion �. 7044,Buefness and Pro�emions Code). � MOVMG � � TEL �� , . � I,as owner of the proper7y,om exclusivaly camracling CONiRACTOR No. , � �1 6 2.5 A wirh li�ensed conrrocrors fo construcl tha projecl(Sec-� qDDRE55 � ' �'•� • • •� fion�044,Business and Pro�essians Code}. ' � REOUIRED TOTAL SETBA K CONSiRURION IENDING AGENCY � SEt anCK YAR� H� PROq lWE wi�iH ' I •-v 9 9.D 0 1 hereby offirm ihot Ihera is a construction lending agenty for fRONT . � . the periormonce ol the wo�k!ar which Ihit permi�is issued e.l. . • . �j(�G G�u ($ec.3097,Civ.C.J. SfDE � P.� 0 9,1 1--8 7 Lender's Nama C1t1}?dI1� � ��. 444 S Flaaer, L.A. 90017 v.c.r�x 231.16 v..mn F.. 388.50 1D''�R°` * lender'a Address � 1 certify ihor 1 have road ihis opplimrion and nta�e tho�the iauoo�e Fse 1d•50 Wr/.n aiC k above Information ts correu.I ogroe lo comply wilh all County Invea+ipo�ion Fe• ordinances and re laws relafing�o buildinp conarruc�ion, Taol i.. 399.00 ipµp,p�,m.M and hereby dze reprosenraiives of Ihh Counry to enfa upon t e o - eNi property for In�pection purpows. � /� pa ` �A $7 3[[ItiVWL fOR IX�IANATORY IANdYA6[ � Sipna u�a of A �cpnl or Aysnl r� . . . . PLAHS TO APPIICAN7 tNSPECiOR'S NOTES ,�. 05i')�I.:K•u�u...,......_ . t he.eby n`f���,d,m t nm o.emp�hor,d�r,Comrocto�s To: . _ . . Returnod� . . . � . . ' 1)ce�. lo��: fnr �he,follo�.�- ,� (S�c.'703i i! �� ... 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