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HomeMy WebLinkAbout1605A ' _ _ - '.__ _.._ ._ _ ._. . ._.. . ._'.�,,. _ _ ' "�_'.. ____,�"._.�__...' � . . iWORKERS'COMPENSATION DECIARATION i� . - ' � ' � �J� �O l�L{.1.�.�,Q ��p? � SS aoc�erlifmtefofWorkeseCo�mpenstioolnsu°a��eso': � APPLICATION F.�R BUILDIN� PERMIT � � ed copy ihereof(Sec.3800,Lab.C.J � 3 COUNTY OF LOS ANGELES BUILDING AND SAFETY , � lo. Compony n r �ertified topy is hereby fumished. FOR APPLICANT TO FILL IN nooaess G /��I¢ �i�',b� d/✓/�17 ' CertifieP mpy is filed with ihe caunly building inspeo- BWIDING .709 �� ,�n � - , . � �NNr , ' �tion de artment. - AODRESS y0n LOG4LITV nPPt��o�r aTv Wa]n't ziv 91789 c"eossssr. �f//�SfF/i1JGY0/✓ � CERTIFICATE OF EXEMPTION FROM WORKERS' � � NO OF BlDGS. ASSESSOR COMPENSATION INSURANCE SiZE Of LOT PdL't Of IAtS NOW ON t0T MAP BOOK ' PAGE PARCEL i section need nol be completed if ihe permil is for one �S=ZiN�Z �P //�f//.�33 � } idred dollors(6100)or less.) �� ie.4Ci C �V� NO. �,, �� rvo. OWNER �� H��$ No`.598-1841 ��� con�ioinoNs � °' erlify tha�in 7he performance of the work for which thls . . Q � �fmit i5 ii5ued,I Shpll nof employ any per5on in pny manner � DISTRICT GROUP TYPE FINE ESSED BY V �as to betome subjecl fo the Workers'Compensation LowS. P.DDRE55� �GSS BTCa �Il Ll.�LY�. � � �� '� CONST� ZQNE / � 3 riL�r+�J.— O late - � Appliconl ' � ��TY ZIP �y,, STATISTICALCLASSIFI�j T�ON APT. CONDO. JOTICE TO APPLICANT: If, afier moking this Certificale of � FNGMEERT OR �s � �Dlelddr 5� o2d � W EKemp��on, yov shoold become wbject�to the�Workers' CLASS NO. DWELI.UNiiS a 'Compensation provisions of Ihe labor Gode,you musl forth- y ADDRE55 e SEWER MAP Z with comply with such provisions or this permit shall 6e r deemed revoked. � � TE�' gg, pG,� VALIDATION - CONTRACTOR NO. - �LICENSED CONTRACTORS DECLARATION/ � ���. � I hereby offirm thot I om licensed under provision�s oi Chapter 9. ADDRESS. ' N032H279 VALUATION B� ' (commencing wi�h Section 7000)of Division 3 of ihe Business and ' . ' ���. /� u�a , Professions Code,ond my license is in full force and e(fect. CrtY ciass E �� . . � - ' � 50.FT. NO.OF NO.OF - CHECN �- ' License Number Li[.Class ' SIZE STORIES 1 FAMIIIES � ONE � ' ' DESCRIPTION OF WORK NEW � b � . � � Camracror Dare - ❑ . . , � I am exempf irom fhe licensing requirements os I om a • . . ADD licensed archilect or a regislered professionol engineer , , Al7ER ❑ DA E`��Z7 C�/ � :_� f>Q.,�� S . acting in my professional copacity (Sec�ion 7051, fOr' SUl'�S �. 2 3' REPAIR � • � Business and Professions Code). . USE OF FINAI �*' ''"• � ' - � - E%IS7ING BIDG. DEMOI ❑ - • Lic.or Reg.No. - . .Dtlfe APPlIG4N7. •TEL. BY Tj•�,�•�•—� � f •.•j'9 5� � - ' � OWNER-BUIIDER DECLARATION—� � � � �� PRiN71 � NO. _ p� bj!J 7f�� ` L'���7�S n s I here6y affirm that I am exempt from the Contracfor's License / O/ � � Law for Ihe fallowing reason(Section 7031.5, Bus�ness and � Aooae55 �—�WdITI a�/�8� �. � �-�i 2�r_8� Professions Code): . � � , ckE ENt - � � - BUII�ING . . . . . - - . - I, as owner of�he properly, or my employees with nDDRE55 ages as their sole compensation;wil I do�he work and � �ocntrtr- � �the strotture is not intended or offered for sale(Section - - � � � � " - � kkk------,,,iii 7044,Business and Rofessions Code). � ntOviNG TE�. � � I,os owner of ihe property,�om exclusively contracling-� CONTRACTOR NO. . . . � with licensed contrac10r5 to Conslruct the prOject($eC- qDDRE55 � �- .tion 7044,Business and Professions Code). -� - - , � � � CONSTRUCTION LENDING AGENCY , REOUIRED YARD HWY TOTAI$ETBACK FROM E%IST. � SET BACK PRO�.L�NE WIOTH � I hereby afFirm Ihal fhere is a mnstruc�ion lending ogency for iRONT -� � � ' � ihe performonce of Ihe work for which this permit is issued r i � - __ (Sec.3097.Civ.C.). . -SiDE . . . . .. . � . . P.L. Lender's Name / ) � Lender'd�Address G.G Fee 5 �l E?�O Pe�mii Fee O I certify thal I have read this applicalion and slate Ihat the Issuonce Fee above informolion is correct.I agree b comply with pll County Invevigarion Fee .� � �T � �� � � ordinances and State laws relating�o buildinq�constroction, Toiol Fee ��/ and here aothorize represenratives at this Covn� to emer � ' � ��upon th bove-mentipned�property( r inspection urpo es. �"� � . . � . . I I b -� - � - - SEE REVERSE FOR E%PLANATORY LANCUAGE� - � g ! e o}Appliconl or Aqen1 Do�e . , ' �i . . . ' PLANS TO APPLICANT � � - -INSPECTOR'S NOTES O1V'NER-IILtILDER DECLARATION � �I here6y affirm Ihat I am exempt from tho Conlrattot To: �� � .�etuinad� � �� License Caw for the following reason. (See. 7031.! � ' � � '� Approvad , Business aad Pmfessions Code:Any erry oreounty wbic. t.o. -- - Dato No. � Dato� � � - � � .._ requires a permil tv eo�rstruct,alter,imprave,den�olrsG , , , . , orrc/�airnnystructurc,priortoilsusuantc,alsar¢guirc. - � ' - - � - � - tGe applicant Jor sucG permit to jile a signed statemem � . .... tbot Ge is liccnscd pnrsaant to!be provisions ojtbe Com � -: , � � ' �� , - - � � - � � ��- -� � � � trac�or'sLicenseLaw(CGnpter9J(tommencingwitbSec- __ . . . . tion 7000J of Dit�ision 3 oJ tJ c IIusiness and Profcssions � � , �- � � � � . �CodeJ or tGat bc is exem/�t lbemfrom and tbe basrsfor tGe .. . . . a!leged ezemplron�Any e�lolation ojSectron 7031:5 by F.equi rod,�, any applicaxt for a perrxit sr�bjetts tbe applicaa l to a civrl . _.Approvols. ._ ' Dato Recclvrd - � � enalt o not more Sban ivc 1 andsed dollan 8500.: Yoa No � or Approvad . . . h Y � I ( )� - - � - - � ❑ I,as owncr of the properry,or my employees with Water Certificate. ' � � . . , wages as their sote compensation,wilf da the work,and � � ' � ��� � �� � � � - � the structure is not intended or offered ior sale(Set.7044) � Health DaparimenN � � � � . � Buainc:s and Professions Codc:The Conlracsor's Licensc � - . . . . , . , . � Lau.�does not apply to an omn¢r ofProperty wbo baildv � - . Fire Departmenf . . . -. . - � �or improves tbereon,dnd wbo doessacb a•ork bimse7Jor � � - � - tbrougl� bis au�x employeer,�pmoided tbat sac5 im- Grading � � � � . ; . ._. . . . . pronrnrentr are�not intrnded or offcred for sale. lf, � � �� - �� - � � bou�ever,tGebuildingorimprovenrentissoldwitGirsane Geologiml ' ' . .. . � . .. .. ._ . year oj romplelion, tGe awnervbuilJcr will Gave tGc . � � � , . burden of proving tGat be did not build or improve for �� Pedesrrion Prmection � � - - . � . - tbe parpose ojraleJ. � - � � (Fence)(Canopy) � �. � , � -❑ I,as owner of the property,am exclusively contrbc- � - � . _ fing wilh litonsed contradon to canstruct the praject(Sec. � Special Inspection - � � �� 7044)Dusiness arsd Professions Code:Tbe Contractor's , � (Conc.)(Mosonry)(Welding) Lrccescl,au�docsnotapplytoanownrrofpropertywho . � brei(ds or in+proves tl creon,and who eontracts for sraeG lot Droinago_ � - � � � _ ��Qrojecls witG a contractor(s):licexsed pursuant to the .. ' .. .. .. .. _..... ... ... . .. Coneracror's Licensc LaaJ. ' . : Paiking� � � .. . ,. _ .. � . � ,. �. - -. . � . . ❑ I am exempt onder Sec. ,6.8P.C.for Ihis . . � . . . . ..-. � - .. . � . - reason - . ' . , � - . . bate. .� .- . . . Owner .. . � AFProvals Dofc Inxpecfor's Signafarn .' , . " .. .. . � � . , - INSPECiOR'S NOTES� � Lotolion— .. . . . . . . . . . (Setback 6 Yards) - �� � . � Foundafions - . . .. . . .. . . ' � . . . Slab . . . . . . . . �. . . . Frame . � . . � � . � .� . . Encrgy Insulation .� . � � . -� - � Loth/Drywall— � . . .. . . . INerior � � - � Lath—Ezterior . . � ��� '. House Number— ' � . - , � Corrett&Posted �-- � � � - � - � � Final— ' � . �� . . . . � Enter on Fronf � � � � �- ' � �