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HomeMy WebLinkAboutNo Permit Number (13) ' WORKERS'COMPENSATION DECLARATION {� I hereby affirm that I have a certifimte of tonsent ro self qpp��CATION-�FOR �BUILDING PERMIT �s insure,or a certificate of Workers'Compensaiion Insurance, � � �ar a certified copy thereof(Sec.3800,Lab.C.) � ��IL COUNTY OF LOS ANGELES .. � BUILDING AND SAPETY PoliryNo 83166-8D Compony STATE FUND � Cerlified copy is hereby fvm�ihed. , FOR APPLICANT TO FILL IN- � � aoo ess � �O� . /�s • �� Certified copy is filed wirh the caonty boilding inspec- BUnDiNG lion deparimenL . ADDRE55 1024 SOUTH BREA CYN. ROAD iocnurr-. C � NEAREST " Dare 3-6-84 npplimnr ALLAN d. HART arv zio caosssr. . CERTIFICATE OF EXEMPTION FROM WORlCERS'- SRE OF l0T SEE PLANS NO.OF 6LDG5. ASSESSOR . . � COMPENSATION INSURANCE NOW oN t07 3 rnnc BOOK PnGE RCEI �(This section need noi be completed if Iha permit is for one USE ZONE MAP ' �3 7 hundred dolla�s(�too�o�less.� TRACT PM-4739 6LOCK ---- LOT NO. S �] 2 No. � 'TEI. ` SPECIAL Y �I cer�ify that in the performance of the work for which�his OWNER MOBIL OIL CORP. n�o.683-5957 ��t CONDITIONS a- permit is issued,I shail nor employ any person In any manner � � - -� 6t5tRiCi GROUP TYPE fIRF F SSED BY Q so os fo become sub'ect to the Workers'Com ensation Laws. ADDRE55 CONST.Q ZONE ' P aTv L S ANGELES ALIF RNIA ziP 90017 � �3 .�l.�s v�"'� 'p Dpte Applicont ' STATIST�CAL CLASSIFICAtION, , APi. CONDO. �!- NOTICE TO APPLICANT: If, afrer moking this Certificare Of . ARCHITECT OR iEL ��V ENGINEER NO. CLA55 NO.�DWELL.UNITS � E.emption, you sho�ld become s�ble« <o the Workeri ' c. Compensalion provieions of Ihe Labor Code,you must forih- qpDRE55 SEwER Nwv � �' �with comply with such provisions or this permit shall be �• deemed revoked. 7EL' ��� gg, ��p�, �- � - VALIDATION- ._ CONTRACTOR NO. , IICENSED CONTRACTORS DECLARATION � LiC. I here6y affirm 1ha1 I am licensed under pravisions of Chapler 9 nooaess725 N. CYPRESS No.435616 VALUATION � (commencing wi�h Section 7000)of Divisioh 3 of the Business and � L�C �C n�.�'c Proiessions Code,and my license is in full force and effec�. C�ir ORANGE� CALIFORNII4 CusS G10 S , , , -" 50.iT. NO.OF NO.OF CHECK . . . license Number 435616 lic.elass �-10 sae sToaies FAMILIFS oNe NEW S Controtlor �QNCD � $�NS pa�e 3-6-84 DESCRIPTION OF WORK /J . 2 � ADD � c^��� ���,i A. �1 am exempt under Sec. N1A - �U����� � '� ALTER � FINAL�D� :,��'� � REPAIR � DATE / �^� B.&P.C.for this reason � � USE OF .FINAL.. � . .. �I �� � G�.(:G Date: DEMOL - E%IS71NG BLDG. � � B - Signa�ure APPLICANT TEL Y_ ' ' "C��li�.- OWNER-BUILDER DECLARATION . PRtNi ALLAN J. HART Nc818-330-6009 I hereby affirm fhot I am ezempt from the Conirocror's License , �'"C f�—<'�' Law for�he following reason(Secfion 7031.5,Business and /+DDRESS $ R HAC E DA H � - �� �- ' - � -' � _��� (1;� ! �Prafessions Code): . g�i�o NG ��. . . . . � � I, as owner of iha propeny, o�my employees witM ADORESS � - � - wages as fhcir sale compensafion,wfll do fhe work ond `��Irr I, • _,�. ^� the strucrore Is not in�ended or offered for sale�Section -� � �� � �• ��� . 7044,Business and Professions Code). MOwNG TE�. � � � I,os owner af fhe properfy,am exclusively cantracling . fONrRn[TOR NO. _ • ° ..� . . _ wilh litensed coMraclors to construu the project(Sec• qD�BE55 G 3��5—C�.�i tion 7044,Business and Profesaions Code). . ._. ..- . -� � kE�UIRED TOTAL SETBACK FROM E%IST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROG.UNE WIDTH ► I hereby affirm thot Ihere is a construction lending agency for . FROM � - - � � �- ��- - � � - the perfa�mance of the work for which Ihiz permit is issved P.t. . iSet.3097,Civ.C.). SIDE . . . .. . . . . . . . P.l. : Lender's Name NONE . � � Lender's Address P.0 Fee f �S� Pa.m�i Fea �� � � � � I certify that I have�ead this applicoiion and siate that the is:oanm Fea �Q s above informollon is correct.I agree ro comply with ail Couny tr,,,esrgaron fee s-- � g � ordinances and State laws relaring to building construction, io�al Fee ��� - - � ' �" � . ' C and hereby outhori e represenfafives o4 lhis County to entar • m -upon th`e ah ve� �n�ti�/ operty for inspection purposes. - - ����-� - - - �� �� 4 .,�Z..�/��f f�/ 3� E="�^T` . _ . . .. .. .. . /� SEEREVERSEFOREXPLANATOMY LANGUAGE .. Sig a�ure of Applicam or Agen� Oate ' . . . . . . ... . ..�� ' / � ' �� '.FLANS TO APYUCANT . � � IMSPECTOR'S NOTES ' - ��,.� Q�5'NER-6UILDLR DGCLARA710�.� ; � . , . - . , .I hereby affirm thct I om exempf from tho Controctor's To: ,. ._,...Roturnad . � , � . . ...,. ., _ . ... .. License Law for.1he�followinc��reason. (Sec.�7031.5) � ' ApP�ov�d UuaincsidrtCProfesfronsCodc:Anyri[yoriouniywbicl.+ _ __.___ __._..__'.'__ . _. . ___ _. ._._ _ .. . . .. . _ . . . - ...- reguires a/�rrn:ie ea�rnnsirurt.alter.iniprore,denrolisl, No. Doro Nc.� Dato ' � - - � arreJ�airanyatructurc,f�riarinitsissuancc,alsorc7uires f_ ..__ ....._-._._ .. .__. ... . . .__ _ ___._ _. ... . __._. . . .. _._. .__ ...... . � � � - �'tGe aJ�f�licauL for sucl rerruit!n fi!¢e siqned stafentent ' •.� '... ..,,. ,.i, . .._.�. .., ,._ � ...___ �.�. _.�_ _ . . � . . . _. .. � t5et!r is/icensrd f�un�earsl7o 11 e f+rorisiorss of tbe Con- .._.____ . _.___.._.. . _ .. � � . � - _ . traclor's Licwue I,ou�.(Cl�aptcr 9f(romnrrncing u.�ilG S¢a I '�: '.�. . �� �. : ; ,.;..` �.� " ;. . . . --�� � .. CndeJ�Ouatbe'iscxen�tll�ereJronxandll�basisfortbe _ � , aflGqed rxcrnptinrs.'Any i�iolutian of SrcOinn 7031.5 by ; �- i CoGutred Date R�colved . � "- • � '� -_... . ' .. ,-''. �. - anyaj�/+ficantfnrn/�crmilsuGjectstbeaff�lrcanttoacii�il . �- —��APr^�vals �� Yos No �er ApProvod ,-� -�-,.,�. _. ... -- - .... . ... . pcnalt.>'oJ nni n:nrc f/an f'rc 6undrrd dollars(SSOOJ.J: � - - � � ---- �� � - � . - ,�❑ 1,as owner of fhe properly,or my employees with Waler Cerlrficdie� � ., -, , ��� � � � _ ,.. .'��wages os their sole compens�tion,�wlll do the work,�ond -� --- --� -�-� ��� �- �� �� � ----� ' the structure is nat Intended or of}ered for sale(Sec.7044) � � Depatlmen2 .._�_.-. � �. '� �.r__ .-_:i ' . � �,;;,. �� ;, � � � ,� � �. � . , BusinessandProfrssionsCodcTGrContraclnr'sLicense ' . . .... ." - .- . .- � -. . ,�.-�:�'�� Lau,Jocs not ahpfv to an owncr Jrr„��>ty u�l o burlds Henlfh' � F+re Deportmenl � �-�� �,�� - �� .:� , . �i � , �. �� , or rnr/�mrrr 11 ereon,and ml o�Jors surl�rork 1 rmir Jor -�- '--� . .. _. .. � ...-.. .� _. .., .:�... . . 1Grauh.G�Gi: oi�•n enef�lny'ecs, frori3cd-tbat sueG im- Groding _ . __.___,,.. ,__ , .._:_.. ,_. ..,�_,�....... ....... . .. �� /�soren+ciits are no! inlended or offered for salc, I/, � - --�� •�� ' � bna�er�cr,tlebuildingorimprorenrentissol3u�itGinonc -_'_-__...__ ., . ,._ ;. . . .... Geologiml . '- : -� ---� . �� ycar of mn:pletion, tl e o«�nerb�aildcr u•i/!Lav�c 1i r � � � . bvrdcn nJ/�rooirrg tl ut Ge did nnt bui(d nr imfroreJ r PedestrianProteUion � � - � fGr�purpose.ofsafeJ. . . , ' . ,� (Fence)(ConoPY) � ���...'... .. . �--J � .. �..'. -I� � , �.:'.�„� , ❑ I,as owncr of Ihe propeny,am nztlusively mntrac- � � � � fing with licensed contro[brs lo conslruct the projecf(Sec. Special Inspection � . �- - � � - � � ' -- � �� - . . 70.AJ Erurneas aad Profcrsiun..Co�c:Tlc Contractori ' _. . (Conc.)(Masonry}(Welding) � � ; ; , � :,. . �, .,,,, . Liccntr laic dacs r:ot apply 1n cn oumcr ofr.�r�>:,.u�bo - ?-� ��� - --'� � - ___6uildY�nr lnefmrns(Germn,�dnd u�F.•a enr.lrarls for aacG latDrainagc '. . � . . .�. ' . � �:. . .;. .. . ...r..,.. .,- ;•,.. Qrojrc[s u�itl a cnntracton'sJlirensrdpursvanf to"tic ;.�: -� . i...___. : ._. ; . - .� .. ._ . - ._�nntr✓ctori�Li.:v:sc 2.aar1. ' � Parking �" , . " ' . � . ___ _ .. _ . ..-,. _ � �� , ' � ---'- �- � -�-��--� � "� " � � �� -�- " " - �-� - ❑ IamaxemptundcrSec ,0.8P.C.forthis �, . , . . . _ . ,_. .___. . ._ ._. __ . _ _ . .. . . �: . .__._... _ __._. _ _ . . . . .. . .. . _ _ . _ reason . . .' _p,:.•,:� . , .._�.: i .r .,, _ _. __ _ . . . __ _.. ____ .__- ' ' � �OIO �W�Cf f. I: .1' . . . , . .. . . . . . : Approvc�: Da90 Imp�ctor's Stgnmur• ' � . . �:.� " ��. � . � � � . � � � INSPLCTOF'S NOTES - Localion— -...___ __ . .. .. . . ... . � ISm6a:k E Yards) -�-- � � ' � . Foundotions �� � . - � � . - � i Slab , ' � . . , .. , . , , _. Frame . .� .� � .. . . �.. . .. �� . .. . . . ... �.. � ' Energy Insulation ' . . _._ � _ � . ... I,. .� . .. . . .. ... . ... . ..; .. .. . , la�h/�rywall— i .. . . . ' Interior �. ��. . . . � . . �'. lafh—Ezterior _ _ _ .__ __ _ _ _ - . _ . . . ,. . . , . . _.____. _.__ . ..__. . . . . Nouse Number— � . � � . . . . . � . � .. � . Correct&Posted �� __ . . ..��.' . �_ �.' _ .__ .. _ . . _ ..: , . . .. . Final— � ., .,. , . . ... , . . .� � . . . Enter on Front • . ' . . . ' . . , ' . � . � . .