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HomeMy WebLinkAboutNo Permit Number (6) _ _ . _ . _ .... __ _ . ._ ._ __. . . _- ..- -., - _ _. _-- _._.. _ .. _._ . WORKERS'COMPENSATION DECLARATION � '� ' -" i' � ' "` 1 . ' � ,�;��ebo�a`�e,�f�a,eo°woke5-'�omPe�a;o�=��5�'.o��e` - APPLICATION �FOR BUILDING �PERMIT --�1� or a ceriified copy thereof(Sec.3800,Lob.C.) � � �� -- � �� "- � - � -- -- - � COUNTY OF LOS ANGElES BUILDING AND SAFETY P❑ollcy No. - Company .. 1 , � . Cer�ified copy is hereby iurn�shed. FOR APPLICANT TO FILL IN A�REsS ,3�a� �a-tv OCertified copy is filed with Ihe coonry bvilding inspeo- - �-� BUILDING r/ � 'lion deporfinenf. -' '� - ' �'� ADDRE55 � �NY�� � �� �� � Date ' � 'APPlicanl C�7Y.. � / . . ..ZIP � LOCALITY ' . �'� CERTIFICATE OF EXEMPTION FROM WORKERS' �� � - - ��- � - NO.OF BLDGS. � -� � -- - NEnREST .��-. ._. .. _ . __ _._, , ____ _. ._ . . . � ��� COMPENSATIOPJ INSURANCE SiZE OF lOi NOw ON LO7 CROSS 5T. _ � � (This section need not be�mmpleted if�the permit is for one /y�Q�!�, - ---� - � - � ASSESSOR ., I - � � � ���� ' hundred dollars(5100)or less.) . TRACf BIOCK LO7 NO. M4P BOOK DAGE. PARCEL � �� TEL^/' USE ZONE �P '. . ' ' . .'. OWNER /� -� � C.F! . ..._.NO.'rS�1 + NO. � � 3 3 3 .,. I,certify Ihal�in Ihe performance of the work(or which Ihis n Q s ' �i � 'a permif is issued,I sholl no1 employ any person in any manner __. ., qDDRESS �ctJ� !'�� .t7 OENDITIONS U u / d's��-L� �0 so as ta become subject to the Workeri Compensotion Laws. V DateExem tion,� ou shoul � APPlicant . . . . . - Giv .cJe�O.�-� .ZiF Z : ._. .__.._ . . _.:. . .. . ....._' --;- - 6: NOTICE TO APPIICANT: If, ofrer making this Ceriifica�e of ARCHi7ECT0 7E1. '� FNGINEER O/V NO. _DISTFICT GkOUP_ NPE.... .FIRE. .,PRO�ESSED BY.. ,F p y d become'subject fo fhe Workers' - cON57, ZONE V Compensation provisions of the lobor Code,yov must forth- qbDRE55 l�iV �� �_� �e CwT1n� � - -- --a wilh mmply with"such provisions or Ihis permit shall be -- TEL. STAiISTIGLLLASSIFICATIONY`�HC AP7. CONDO. �� deemed re�oked., � � , � •,. . CONTRAROR NO. � . . _ ___ .. __' _ . . ..i_... __ . _ _ . LICENSED CONTRAQORS�ECIARATION� • - � - -- � � - � t�C.- � - - CWSS NO. ' DWELL.UNi1S I here6y affirm fhat I am licensed under provisions of Chopter 9 ADDRE55 NO. , � (commencing with Setlion 7000)of Division 3 of ihe Business ond _ . . . , _ . . . .. p�. .. _ ��R�P . � ' Vrofessions Code.'and my license ts in futt force and effect. CiTY Cta55 � -� BK- - � �-� -- - - -;�- -'VAUDATION " "- . � ���.� � SO.FT '�.1 NO.OF_ NO.OF CHECK � �1 3 1.8 A License Number �- ��Lic.Class SiZE I� �V[l STORIES- - FAMIlIES ONE ' •,��. .,. . . _ . . VALl1ATION. : � . . . DESCRIPTION OF WORK. ' . ._ .-. ..--' NEW a p� ' '. ,. � �. _ . �.�.�. •2 3 . . Conirac�or Date . � � S OL�� � � n �I am exempt under Sec. .. .. . _ ��'-� � I AODR � , � � •8 1 A'/`� ' 1 6.8P.C.for ihis reason . . RE7AIR � S -. - ..... . .' ... ' ..- _ • �£j� Q,�]3��-.. . -. . . Date: E%STOING 6LDG. DEMOL _ . _. O 7�� Z�'S Jr -�� � Signature � , .. . . - ._.. " - APPIICANT TEI. FINAL �. � . OWNER-BUILDER DECLARATION PRWT ND. � DATE - -- --� - �� �-- -- -�- ---� �� � - ��- � � -I hereby ofiirm tha�I am exempt from the Contronor's License . , , , low for the following redson(Seaion 7031.5,Business ond AD�RE55 FINAL " - 'ProfessionsCode):. .. - ... . . . . ...__. _.. .. . R N sr .- - ._ - . .-� . _, 6UILOING � ' �_ I, as owner of Ihe property, or my employees with aooRess . .. � _ � - . . . ._- . _, _._ . . _. .__�. wages as�he�r sole compensmion,will do the work and , � : , . Ihe structure is not intended or offered for sale(Section ��A��T� � � ���-7044.-Business and Professions Code). . .. _.. - /�nOvwG ' � - - - -� - tEL .. . . . . ... - � .. - - - �- . . , I,os owner of�he propeHy,om exclosively tontrocting �ONTRACTOR NO. ��� �, ' �wiih Ikensed contractors to construct the project(Sec- qooaess � tion 7044,Business and Professions CodeJ. �n � 2E�111RED IOTAL5E78ACK i .�`-��._i__-_ .-- . . . . .. � �"-CONSTRURION IENDING AGENCY - -- SET BnCK YARD Hwv CROR LWE WIOTH 'YII�.rM ' I hereby affirm that�here is a construction lending agency for FRONi V�� ' � � ' '� -fhe performance of the work for which this permit is issued --- -P.L - � -- - � - �- •�� � -��� - - - � -�- - (Sec 3097,Civ.C.). SiDE � ' � - m _. . __. . _. . ... _ _ __ . ... . P.L '. . . ' . .. __. _ _ _ . _ ... _ � Lender's Name �DMA Ref.M ' $ �- �- - - - -- -- �-- -. . ._ _ P.GFee: 81 -73 -- Pe,m��Fea � --_ ._ _ . �_ .. � - Le der's Ad ress � ' . � � � '�" ..1 rtify.th 1 have read this applicafion.ond state ihat ihe --...- - -. .-.._. . ._ _.. Issuance Fee �-��- � - -- LDMA P/C M �� '� a a ve inf alion is mrrecl.i ogree b comply with all County Invesrigaiion Fee _, ' � � o dinont and State I s reloting fo building conztmction, _ .. _ - - -To�ol Fee � LDM,4 Perm.X- - � - �- � - - �- - u are authorize r resemafiv his Coumy to enter � � � p the mt d pro y for inspecti��yrpo•�( .Lr� �O � ' o � _ �1� \ _ � , _.__ .. - - — - - - �- — a • [� Y d SEE REVERSE FOR XPIANATORY LANGUAGE ' � � � lure of Appliwn�or gant . . . . ._Data _ ._ ......._ . . . .. ._.... . . .. .. . ..:. .. _... . �Q.i ( " ' . _ .. . _ . . , �" PLANS TO APPLICANT INSPECTOR'S NOTES . .OVYNF.R•DUILDCR DLCLARATIOY , -" I h reby affirm thai I om exempt 6om the CoNractor's To: � R�turoed , � � �. �� - ' � LI se Law lor�the fo�lowing reason. (Sec. 7031.5) �� " � " � Approred � �Qus�xessandProfesrionrCodc:Anycrtyorcounlyu,•Gicb No. Dafe � No: = � Dalo "���' � ��.. � � - �- � •- � �- requirrs a J�emrrt fo construct,aller,im/�rove,deninlrsG, . - or icparranyslruclure,frior to ilt itsuance,a/so requires ' � _ .. �� . . . . , .. , .��i. '. the applicant Jor tu�G pern�rt to file a tigned slatement , dmt 1 e is licrnseJpursuan[to tbe prnvisrnnt of tbe Con- �. ' . � �_ �� ' � � tractor's Licensr Lau�(CGafrter 9J(comrxenting u+ith Sec- i l ' '� ' �J�. ,� . .... � �� �- �-- � -� � �� � -� tion 7000J of Dicision 9 of tbe Uusiness and Profearinns � � _ ._ _ _ __- __.. . ., _ . � CodrJ or tbal!c is cxemp!tGcrefrom anJ 1Ge basitfor tbe i _ . __. _.. _ _. . . _.. _-. -- - _- .�. � afleged exemJrtinn.Any aiolalion of Setlion,7031.5 by � „ 1 __ RaQuired_. ... potenPPrsiv�d�' - - .... .. .-. ��,� � - . .. -- . . an,Yafflicant/nroycrnritsubjeetsthcapplicanttoativi! AP�r���'s� Yes No OV°d � � Qenally oJ nol morc 1l�an Jire burtdred dollart(fS00J.f: ', ,3 �. .' .. . _._. . _.�.i. '. .._ ._ . . . _�._ . . , ❑ 1,as owner o�the property,ar my employees wifh ..� Water Certificote :� � '�� �' � ` �' � . - _�_ . � wages os their sole compensmion,will do the work,ond ..-_ .. _. .__ . . _ . . -- - �- 'ihe structure'is not intended or oifered for sale(Sec.7044� . Healih Department".�___-.' . ` . � ._. .. �- - - - - - - � - � � � �� . . - I7asiness and Professinns Code:Tbe Contraclor's License � l.aw dnes no1 applv to an ou•ncr of properly wbo builds - Fire Deparlment __. ._ . _ . . � - � - � - ar iniproves tGercox,anJ u�l�o dors rucb work hiniself or � , . tlrnugb bis ou•rs crnpinyers,proriJed 15at-ruaJ in . Grading j . . hrnvcmcn[s arr�no� infended or o/fered fnr safe. !f, � '� � �� � , � � � . , . � Goreerer,tbc buildire,q or irnprovement is sofd witbin one �. ___.. ___ _ .. _ . .. ._ _ , '...� _ � Geological, , _--j . _, . . �-. . ��,year of mmQfetion, 1Ge owner-builJer wiff bave tJ>e . . . ... _ ._. _. . . . . _ _ . :�. burdrn of pmring IGat Gc diJ not build or imf�ro��e fnr i �_ . �� � . _ . tGc purpotc�oJtalel.- . .. . ..� PedeslrianPro .� �.�� ... � ,. � leclion�,. . -- . . . .. - • . ' . (Fence)(Canopy) , � � - - � - ��-- � - � -- � � �- - -� � 0_ I,ds owner of the pwperty,am exdosiJely con�roo ,,, ling witb licensed wntroc�ors to conztruct ihe project(Sec. ' � � -�- �-�- � �� ----�� � ��-�� �� �-� - - - � � 7044)Uusirtess ond Projestronr Code:Tl c Controctnr's $pecial InspeUion-- - - � - - � (Conc.)iMasonrY)(Weldin9) � � _.. .... _ . . � . . . _ ._ _. . License/.auJnes nntafply tnan nu�nrrojprope>ty u�bo - -� -- - - - � - -buifJs br inrf,�o�rs�J/erenn,and u�bo contracts fnr tuc! LotDrainaqe '' �� � � � �, _ . _ J�rojecls uvt!a tontractnr(if ficensed fursuont to !Le � ., . � . .. � '__.__ _ _ ' __ _..__ _ . . � � . Conlraclnr's Licrnsc l,au�J. ��- � - . Parking� . , . . . . . �. -. . .__ . . _.._ _. . . .__ � . , � ❑ I am enempt under Sec ,B.BP.C.far this ' . .. , . .. .reoson ... _ �. � ' � � � � ; .. _. _._ .. __ .. .. .. . _ "._... . Date Owner P �'. . . .___ ._....__ ___ _. _ . . . . Approvols DaTe Inspecfor's Slgnatura - . , , . . � � � �� INSPECTOR'S NOTES � Lomlion— . . . .____.... ..... . '. (Setback 8 Yards) , � � Foundations . . . .. . . .. ' ,. . Slob �� � . . . Frome .. . � . . .. . . . � . . .- , . . . . Energylnsulation � . . _ .��. �..:. . -.' '.._ ._ _ .____ _.'.. � .' '. . � �- ,. ,. ... . � �- , . i larh/Drywall— ---___.. —..... ._. _ . ..--- _- --_ . ._- '• . IMerior . .__., __ . _.. ._ . . _.,- _. , _ .. . .. Lo�h—Exterior . � � " � ' : . -... -- - - ", . . Nouse N�mber— - --_._.— - -._ . . .. + _... �� � � Correct 8 Pos�ed ' ` . - .._� �'. �'�-� '-�- -- � � - �- � . . . , � Finol— � - � ,.. .. .. _ __.. _ _ ._. _._._ .._ . .____.__ _ . . . -__..- En�er on Fronf � �I . , . .-. , . - . �� . � . �. ... .