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HomeMy WebLinkAboutNo Permit Number (215) WORKERS'COMPENSATION DECLARATION O•/� � - 1 hereby affirm�hat I have p cerfificate of consent fo:a�f � AP�PLICATION FOR BUILDING PERMIT insura,or a certificate oi Workers'Compensation Insu�ance, - � or a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BWLDING AND 5 fETY PoticyN�CS 09 26 21Compariy_R9YAl INSURANCE C0. ❑ av v FOR APPLICANT TO FILL IN nooaess �07 -4� � Certified co is hereb furnished. � Certified copy is filed with ihe county 6uilding inspet- BUIL�ING tion department. nooREss 1024 SOUTH BREA CYN. R AD ���iTY - �.L� NEAREST ` Date3-6-84 Applicant ALLAN J. HART arv z�r [eoss 5r. � _ � CERiIFICATE OF EXEMPiION PROM WORKERS' NO.OF BlDGS. ASSESSOR � � COMPENSATION INSURANCE SrzE OF LOt SEE PLANS NOW ON l0T 3 MAP BOOK PAGE CEL (This section need nol ba tampleted if the pe�mi�is for one ' .� Use ZONe �� �333 hundred dollars(5100)or less.) 7RAR PM- BIOCK - - l0T NO. /7 _Z NO. TEL. �-• � $PECIAL �- 1 cenify thol in the performanca af the work for which Ihis OWNER MOBIL I C RP NO. - Q- CONDITIONS C. permif is iss�ed,I shall noi employ any person in ony manner �iSiRiCT GROUP TYPE FIRE SSED BV � so as fo 6etome subject to Ihe Workers'Compensation Laws. F.DDRESS � � �2 CONST.' ZONE � V � � Da1e N�a � Appliwnt N1A . arv Z�P STATISTICALCLASSIFICA ON . APT. CONDO. �h NOTICE TO APPUCANT: If, offer moking �his Certifiwte of ARCHISECSOR _ . TEt. �,7 �Eaemp�i0n� y0V 5h0uld beCOme 5ubje[f to ihe Wofkers' ENG�NEER �NO. QA55 NO. � DWELL.UNITS � Compensation provisions of tha La6or Coda,you must forth- pooeESS SeweR n�nP � �' wilh comply with such provisions or Ihis permit ahall ba TE� � deemed revoked. � � CONTRACTOR NO. � BK. �, VAL�DATION - LICENSED CONTRAC70RS�ECIARATION � IIC. I hereby offirm Ihat 1 am litensad under provisions of Chapter 9 ADDRESS NO. VqIUATION j:� a a 2� (commencing wifh Section 7000)of Division 3 of 1he Business and ���, � " Professions Code,and my license is in full force and eHect. CitV Cu55 S �;.• , , . 1 . ' Sq.FT. NO.OF NO.Of CHECK ' ltcense Number 184669 uc.Claas B size sroaies FAMILIES oNe ► �';';����',` DESCRI7TION Of WORK !c S Aa . . N� ❑ S ComranorSPENCER & JONE$ pa�e 3-6-84 D'J.Cl.E—8(1 AD� � �I am exempt under Sea_NJA a/� SY"'.�L[- ALTER � FINAI 8.8P.C.for Ihis reason REPAIR ❑ '� � � � DOfe: - USEOF DEMOL. ' FINALc - � � FXIS7ING BLDG. BY Signofure APPLICANT TEL. . . . OWNER-BUILDERDECLARATION PRIM ALLAN J. HART - No.g18- - I here6y affirm that I am exempt from the Controctor's License � ► law for the following reason(Section 7031.5, Business and /DORE55 - � - � Professions CodeJ: � � � ❑ BUIIDING . I,as owner of the property, or my employees wilh ADDRES$ wages as their sole compensalion,will do the work and . the strudura is not intended or offered for sale(Section ���ITY � 7044,Buslness ond Professions Code). MOVING � 1EL. � I,as owner of the property,am exclusively tonfrptting C MRACTOR - NO. with licensed confractars to co�strvcf fhe projecl(Seo ADDRESS tion 7044,Business and Professions Code). . . . . . . . REQUIREO TOTAL SETBACK FROM E%IST, CONSTRUCiION LENDING AGENCY SET&4CK YARD HwV DROv.LtN WiDTH , 1 hereby offirm thot there is a construction lendfng agency for -.feOM �� � fha pertormance of the work for which ih(s permit is issued P.l. tSeC.3097,Civ.C.). . SIDE .. . . . .. . . . � - P.L. A Lender's Name NQNE a J�_ e Lander's AddreSs P.C.Fee S Permir fee I cenify that I have read this 6pplimiion and a�ata that the - � -�- � issuo�ceFee �� S� i obova fnformation is correct I agrae fo comply with all Couny lo.esugar�on Fee / . . . . � ordinoncas ond$mte laws reloring fo buiiding construcfion, � Toiol Fee C.O�' � / Y and hereby aulhorize representatives of ihis County to entar � � upon Ihe above- entioned properiy(or tnspeclion purposes. . . � � � � � � � - . / / J/ /� � / W s //1N �u���-t�'sSZ '-., SFE REVERSE POR EKPIANATORY IANCUAGE . ,, _, .. . ,/ � . . Siqn re of Applicont or Agent Dale � � \ J ' _"__ "'_. _. . .___ ... . "__�...—' _'—'_..._.__. . . _ _' ."_ '__. . _ .,�1/ - - i^..'":. , . � PLAtu TO APFLICAMT�� ' � - ' � IHSPECSOF'S NOTES � . -. OIVNL&EUl[D T I7LC[.ARA110N ., � , ---1 horoby aff m that I am xempl�from ihc Contractor's To: , .Rc}urnod _. . , License le•.v for the:followinc� reason, (Sac: 7W1.5) . ..� �. � . APProvd - -�..Busin�ss and Pmjcasioxs Codc:An}�,ciry orrouxt���eGicb No. �--- DoTe �- No. -�--�.;Oola ..�-�,---"-�-�" -- � '. .•. . . '"..rrguired a permit to cnr.s�rr�ct,a!!;r,inrpmrr.Jeniolisb, - nr repairnr,ystrirrf�.re,frrorto rtrissr�ancc,also reguirrs �..._ �..� . ._.�.. . _ ._.. . -�... ., �_ . _.. .. . . ..__ ._.. _ . .. .. _ _ . _ ---.-_ -,- ..,t!e appficant fnr sree!perrrrit td file u signrd s1¢ten:ent � ,. _. . , , ... .. .... ... . .._.. .... . ._ ..__.___.____. --_ __ � . . _.- _ . . .. __.. � _. _ .. . _. _._.� fGat be is litcnscd pr�rsuant to fl e(�rorisions of Cbe Cors- . • �. '. trac�or's Liconsr La�.(Cbaptcr 9J(conmrencir.g u�ith Sco- ---tion 7000J f Din' �,n j�nf thc Uusiness and Prnfessiarts j . - � . � CoJcJord+atbrrs�ccrnrpttlierefmrrrandtGebasisforlGc � � allrgcd rxemftr�n.Rr.y i�inlalime�oJSrction 7031.5 by � __...A^..rcvcl:�'.-_.._ �,_Ro ind''. .- er Approwd . .',- '_��-:. .."' - �..'_ ' `, p } t nf r.ot rronm ths f�f G!`vo,arcd do!(a Is(35DO�i�i! G° Dat�RocHwd . p a/nr p" c f Yes � No �� �' � . . . , ��. I,a,owner of 1ho preperly�.or.my emp oyees with � . Watc(Certifimte'... � . � - � � _..,.. ......i.. „; , . . . .. � �.wage3 a:their so!e campensctionk�vlll do Ihe work,and . . . ' �� . - ._... __._. __ _ :....., . :..._.... ....,�__..:- �._ :_ . :.�he siructure is not Intended or oHered for safe(Sec.7044) Heallli Departmonl... �� ' ' � ' � Uueinrrs and Prrycsrions Carlr:7'!^Coxtractnr,'s Licersse �-.. ,.�. . . ._' �.,, ._ . , � _ _. _. - . ._.. . ,..�'�'__ �_ . � . -•.. �.'�.� :. "'... � . .larc dnca not applr tn un�osrr.rr f PropertY u:bobuilds ��.� Fire bepartmcnt ; . .. � :�� _. � . , ,,., . ; . , . ` �nrin:(�ro;,es�ltrcor.,ce��i! � �rrtur/�icnrk�inurlJ'or 1 � - ---' -- . ' --�-- . . . . ... -:fl,mugh Gis oia•n�er;rplqye�r. J�mr•idrd ti�ut�sucl>�im. : Grading .. � ... ........ ..:�.1. _..- ,:;..�, ....... .. .: .�.�p.ni�c»xn�s�arc�nat intc�rced�nr�nJfcr�d Jor salc.'If, - � �" Griu�crcr,tbcbuifJin,qorir,:prorcnicntissold�i�itGlnnnr Geological�- _� � �� ... . . .. . . }•c�r o�cnnrplctinr. L, or .r-5nildcr i<�i17 Ucre tbr , ' ,.._ ... . ' :.�..� .... .., .�. ;.,� .. . . ,. hur<rnn/fro d�tb::tf �-n(�h rl!nrirnf�m�efor PedestrianProteUion . � � : 1F.�r�-.ro��.of afeJ. � � � � . �Fen�e)(Canopy) � + - - - . � : ❑-�I,ax owner of t6c pr p•.rty;om exclmively mnfroc- - - . ting wifh licensed mn!rcctor;to mns!rucl the projetl�Sec. � `-' ' " ' ':-� � ' � _ 7�q�J�t,:�rnrs.c�:�Pr,:�rs:ro�s C�r��:..Tb�Coxtracfor',v etia'`nspeUion . .... .. ..._. �.: ... . .---:_ �. _... .._.. ' P I,uensr f.au�dnes not n !s to an o�rnrr o ert_�a�bn Conc. MasonrY)(Welding) ' ' . � �. . . Ph. Jrc�r 1' �. . .'. ��- �'� .".��'' '� .�-. � hrilds�nsini/�rnrr.vtLer<nn,nndii!. � 'r.lrrtchforrucb - .._ . . . . .... . .... ro;'rc�s u•it! v c rccto firer.crd f arct to'7br Lot Drainag- ' � . � , .. -. - h nrf r(sl , . . . ,.. _._ __ .. � . _ . . . __ _ __C;natracmr4 f i:rr.sr l.s���J.. .. _. � Parking . _ �.. � �> � _ . . . - . ._. .._.P - V . , ,, _,.. � � � �� -�-��- --���.�-� ❑-�lamoxem tund�=r5ec ,B.SP.C.forlhis . __ . . .-_._ .�. ___- .___....... _. _. __. . . _ _'.__. _ ..__ __ ' -___' '_-_ . _.. . . r�nson ...:. _ . . . . .. ,... , �' i.. .� �.,�, '..'. . . .. ..._ __ ..__ _'_'..__.. .._. ._ .. . ,:;� �.�. Datc - 'O�mner l.pprovcls Dcta In�F�clari Slfln�fure . . . . ' . . . . � .� . � ,..�. ,•. .� .. . • . �•,iCP:LT09'SP10T�5 -_ _—_-..__'-' . . Lacalion- _ . . . __. . _. .. __ _ _.___ .. _ . . (Setback 8 Yards) � . , , .. . '� . .. - .. . �. ...- Found❑nons � � ' � - •�- - " �� ' - � r, Slab . . . . _... .._...._. ., .. . i � .. , . , - ' ' r'^ . . ' � Framc ' � ` � . . . .. . �. . .. . . . . .... �_ . ", . ._ - .. . . ., ... . ' Encrgy Insulalion . __. '. _ _. . . . � � i ,,� � �, .. ,.;.. . .. �� .. i �, . . �.,r � ..-. .., ... , . lath/Drywall- '. . . . . , INerior - - �- � � � � � ' Lath-Exterior .�` � �. . ,. ' - ' - .. __ . .-.____._ .. . _..._ .__ ._.__. ._ _'__ ,,� . House Number- ����- � ��.�_ _ ... .. _ ...��� � . ` .. ' - �. ,, .:' . � ..- . ... . ,. . . � ,. i. . Correcf&Posted , - ..__. .-_. .._ _. __ .-_._____...__ _ ._._ . ., , .. . . . Finol- . , _�. .� . � ... ... .� . , . _. ... . , ,n � .. Enter on Front � . . . '- ... " ..- . . . � . .. � .. S.- _