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HomeMy WebLinkAboutNo Permit Number (11) I WORKERS'COMPENSA710N DECIARATION � '_� I hereby affirm Ihor I have a cer�i(icole of conseN b 5e�f . q p�p���CATI O N F O R���B U I L D I N G �P�E RMI T insure,or a certificare of Workeri Compensation Insurante, �� � br o cerlified copy ihereof(Sec.3800,lab.C.) C'� COUNTY OF LOS ANGELES � � BUILDING ANO SAFETY Pol�cy No$3166-SO �omPa�Y STATE FUND '' � Cer�ified mpy is bereby furnished. FOR APPLICANT TO FILL W n�oRess __ � Certified copyis filed wilh the wunty bvilding inspec- BUIIDiNG �ion departmenr, nooaess 1024 SOUTH BREA CYN. ROAD iocnulr. - Dore 3-6-84 qPP���on1 ALLAN J. HART ciTv 21P CROSSST. _ � CERiIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR � COMPENSATION INSURANCE SizE OF tOi SEE PLANS NOW ON LO7 3 MAP BOOK PAGE PARC'EL ,(This seclion need not be compleled if ihe permit is for one __ U5E ZONe MAP hundred dollars($100)or less.) rRncr PM-4739 BLO�K - LOT NO. I �1 _ 2 No. � TEL. SPEC�AL � 1 certify thot in the performance ofi the work for which ihis O`NNER MOBIL OIL CORP. r�o.683-5957 '� CONDITIONS a permh is issued,I shall not employ nny person in any manner '� � DISTkICT .GROUP TYPE FIRE ESSED BY 0 so as fo 6ecome subject la fhe Workers'Compensafion Laws. ADORE55 CONST. 20NE� � aTv LOS ANGELES CALIFORNIA ziP 90017 � ��� � Date ApplicoM STAi15TICAl Cu+551FICATION, APT. �CONDO. O NOTICE TO APPLICANT: If, aifer making this Cerfificale oi �+RCHITECTOR tEL . � V ENGINEER NO. ClASS NO.�DWELL.UNITS �� Exemption, you should 6ecome subject to the Workers' - y Compensaiion provisions of the labor Code,yoo must forth- qDDRESS SEWER Au+v � wilh comply with such provisions or this permit shall be ' .� �deemed revoked, iE�' -- BK. pG, - - VALIDATION . CONTRACTOR NO. LICENSED CONTRACiORS DECLARATION liC. . ,_�'� �,r�, I hereby afTirm Ihat I om litensed under provisions of Chapter 9 nooaess725 N. CYPRESS � No.435616 VAWATION � (mmmencing witb Setlion 7000)of Division 3 of fie Business and LIC. s � , . z� Professions Code,and my license is in full force a�d effecr. e�ir ORAN6E, CALIFORNIA ��qu C-1� E G�� " � � `��-- 435616 50.FT. NO.OF NO.OF eNeeK / ' � a ����� Litense N�mbe� Lic.Class �-1� SiZE STORiES FAMILIES ONE , � �� _ DONCD & SONS 3-6-84 N� E • M1� � r` DESCRIP710N OF WQRK Q� ..l�.UL� N -�Coniractor Dtl1e ADD � �µL�� -��4 ❑I am eaempt under Sec. N/A �� .�'i �'%-� �� :..i � :'�^.F�, AITER � FINAL _ . B.&P.C.for this ieason � kEPAiR � �A7E '�f ��a, , . . . � . .. Dafe: USE OF OEMOL -FINAI � - �;y - E%ISTING BLDG. ❑ By � �� ` ` r:.,. �C $ignofure APPUCANT TEl .. . < < !: t.n,?. OWNER•Bl11LDER DECLARATION PRIM ALLAN J. HART N�18-330-6009 � � _,. . ._ I heroby affirm ihat I am exempt irom Iha CanHatlor's Lkensa pODRE55 i 5964 l05 ALTO$ DR. HACIENDA HTS. A � -�� - - 1��a C b—`'.f�: law for�he following reason(Settion 7031.5,Business and - " - Professions Code�: �� � P N ' � - ❑ BUIL�ING . , . I, os owner o( Ihe property, or my employees with A��RE55 wages as fheir sole compensation,will do fhe work and the slruc�ure is noi intended or offered for sale(Sec�ion � - ���nY � � - - � - � - - 7044,Business and Professions Code). MOVING TEL. � I,os owner of fhe property,am exclusively controcfing CONiRACTOR NO. . with licensed coMroctars to conslrucl Ihe project(Sec- qDDRE55 ' tion 7044,Basiness and Profestions Code). , ._ _ . . . . . . . . . . " REOUIRE� TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDiNG AGENCY SET BACK YARD Hwv pROP.LINE wiorH , I hereby affirm that Ihere is a consfruclion lending agency for FRON7 - � -� - � � the performance of Ihe work for which lhis permil is issued v.i. i5ec.3697,Civ.C.). " SIOE . . ._ ... . . � - . - P.l. � lender's Name NONE � � � P.�.Fee s a.s� Permu Fee /s Lender's Address S � I certify tha�I have reod thls opplicotion and stata that the Issuance Fee �� q above informafion is mrrect.I ogree to comply with oll County lnvesfigation Fee ��� , . _ _ , _ _ . . . � ordinances and Sfate laws relating to building tonstr�ction, Ta�ol Fea G ond hereby authorize representalives of Ihis County ro enter . - � upon ihe a ov entioned prpperty(or inspecfi0�purposes. - � � �� ' -� ' - - ���,� '3—�^��- _ SEE REVERSE FOR EXPLANATORY IANGUAGE _ . _ . . . � �narura of Applicanf or AgeM Dote. . . . . .. mt � , i ' +PLANS TO APPLICANT :' � • � � � " I�LPECiOR'S NOTES - . _ OA'NfR-LIUILDP.P.DECLARAT[O\' ,_ � ��I hereby affirm ihat I am exempt Trom tho CoNtactar's To: � ,,,, .,.Rafurood . � ,-Ucense Law for Ihe following�reeson. (Sac. 7031.5) � ... �.. . ... i :,._.,..... ,., . � � - � � �� - Approved ��-� � Dusinciia+idArofnrsionsCadc:Anyritydreoantyt�!becb Na: "--��—-�-DeTa-,-�-'— No.�.. �� �Date � -�--',:, - -��� � .. . � ',. � . . . .. �� -regaircs a permit!o cnnstrrect.a(ecr,�emJ�rocr.Je�xolisJ. _� . ' � � or repuirany s0ruttwc,f�rior to its issuence,nlso regaires _.. __��._`--._. , �-�- ._... . ..�. . _.... .. . .... . ._. ____._._.. . . _ ___. . .. . ___._ .. .. � ,. , � the appGcortt fot sucG J+ermit to fila a signed statement ��. . ._. , . -� .�,. , , ,��....., � ,... _ _'. ____._.... ... , . _. . . - . . .,. __. _� _. _. . ..__._ ..._ ..'_ . _. .._ _ tGat bc is lrccased yunuant to tGeQrorisioxs oJLbe Con- j � ' .' . ., . . trartor'sl.irensrLau�(Claptcr9J(ronunenciugu�rtl Sco � �� -lion 7000J o,�Uinision 3 of!be B��siness und Profesiions � I i� . � � � �. �. �'.i- .,. CndeJ or tJ at 5c is exen�/�t tbrrcfron+and tJ e basit for thc ' ' � �� � allegcd r..�r��rpt;on.Any oiolat;on of Scction 703f.5 by i �� R¢qulred DaToRu�ivod � -� ,'. ____ . . ;�;�-' ; '- anyapplica�tJoraprrvritsu6jcctsthcaffilicartttoaciril , ...—..Rp�rovcla--�".�.. .-� or Approwd" ...- �. - .- ..- . � . . Qrrsaltl'of not nrore lGan firc J unJrcd do!lars(SS00J.J: � Yos No _ � � , �� . � � ._.. . .. �� -�� � -� - � . .. , �❑ I,as owner of the properly,or my employees witb Water Certifica;e���� � � � - ', ..,. . . wages as fheir sole compensotion,will do tho wark,and � �. � - -.._. �:. . � � �` . � ' � - --- - -��� - '•� • ���'�� ��' - �-4he structure is not Intended or offered for sale(Sec.7044) Heolih Oe',ortmeaf l�._�-.- � � �� '- '`" ' "� �,+ � � � ,�,.�.; '. -� , , , � Dusinrss arsd Prnfessinns CoJe:Tbe Confrnctor's I.ic¢nsc . ..1. - .� . .-- . -� � .. -.— -- . . •� ' . . .. . .I.aw Jocs not upp1Y to an ou•rscr f prn/�crly wbo builds � Fire Departm�nt j___ _ ��� � ��. '. . . �� ��� � or irnpmru tLerron,ar.d u�bo doea ruc!ecork GrmselJor . , ! - ' - ��" -. .....'`•. ., �. . .... � .'.............•..- - . tl rnv,ql Gis ou�n cnrployces. pror�idrd O�at sacb inr. . _ Grading ' �.�•.� . :� .._.. _... ,.._ . ._._.. .. . .. ............. _ ._. . . . froremcoits arc not intcr.ded or offc�cd far safc. If. - � _, Goi<•cirr,lbebuiJJix,q or rrrrpmrrmers!re sold«•ilGin nne ���� ` �� �� ��� ' ycar of tompfetion, t!r oumrr-br+ildcr fvrll Gave tbc _. . __._.._._ �- .. Geological . � � �- � � � _ . . . Gurd�n J�irnviuq tbct Gr rrd unt buifd nr improne%r Pedestrian Pro�ection � - � � � , - rLc purpose of ialcJ. . � . , (Fencc)(Canopy) � � � � ' � •�- �� �� � � � � ❑� I,osowner of the preperty,om ox[lusively mnlmc- � � . ,, . ling with licensed coNractors to consiruct tho project(Sec. Special Inspection � � -�- �--� -�-- � - � - - . 7044)Uusinrss and Professrons�CoJe:T�i�a Controc�or's� (Conc)(Masonry)(Weldin9) . '�' . ., ..� . ,, t :v, .. . . Licenael.au�dorsnotapJ�l1'taanoumernfprn(�crOywGo � ' - I .- - =.- �-. .,,: - ... :. burlds or inrproi�cs tl.+crrnn,and ivL�n rontracis far sucG �. LolDrainage � � . . �i ,��.',. ..- •;.. . .. •. , ,. frojerts u�it/ o rontr✓cror!sl ficensrd parsuant to,'tbe � , ,� '. . ... . . ..- .� • .• ' ..r- � ����:�. . Cnntrdctnr's�Licensr 1.cu�J. '�... �. Porking . . . �__. ' . -.. . __ .. ; . .. . . . . . . _ .... _ __. . . . � .. . '�-- -- � --- �� ❑ I am exempl under Sec. ,8.&P.C.for this ; _ . . , . _ _ ..._ _. . . . . . . .... . . . . _. . .-_. . .. ...... . .. . reason . -� . __.. ..... _ . . . � �...�..;'. -.. .. , .. ��� . ._ . '-.. ,. . , . _ _ .__ .._ _.. � .- Dale � - Owncr . . v ' ..n . , � . � ... , . . . . I.pprova[s Doto Inap�ctoi�5lgnotur� . � � � � � JNSPECTOR'S NOTES Lomtion— .._ _ _.. ... . .__._ . ._ . .. . . . (Setback&Ycrds) � " � � - � � "' ' Foundations . . . . . . '•. "� � . Siab . .. . � _ . . , . . . . . - Frame . . I _ . � . . . � . .. ., . . . � , � Energy Insulation � _ - ' .. - �'� �. �.. �. � . . � . � . .. Lath/Drywali— � . . . . � . . i - . .. :.:,.��. -� INerior � . . - -- .. . . . � Lath—Exterior . ��, �� ' . : •. � .- . . �, House Number— -� � � � � �� �� �� � � � � � � �' � � Correct 8 Posted � � ...__ _..___.__.�.._ _ .:��.__..._ .. . ; __ . . . . .. , . . , , . Finol— . �_ . � . . . � .. . . . . , . Enter on Front � � ' - ' ' .