Loading...
HomeMy WebLinkAbout1324A 6837A (7) _ - - -- -- ---- - _.. -- - - ,� __. . . .. . . . . . _- - ._ . . . ___ _. __ . ----_ __. � � WORKERS'COMPENSATION DEQARATIC�� ' � . .'�," ��, - �� . . . . . . . .• '. ' '__ "_. .. . . -. ... �. . I here6y otfirm thar I have a certificote af consent,� . qpp��CAT10N ��FOR..BUILDING--PERMlT� -- �- �, insure,or a ce.tificote of Workers'Compensalion Insurance, or a Cer>`fied copy'iheieof(Sec.3800,Lab.C.J '' ' ; ' ��� COUNTY OF LOS ANGEI.ES ' BUILDING AND SAFETY - � � PolicyNo. � Company -. Certified co s hereb furnishad. BUILDING ❑ PY' r , FOR APPLICANT TO FILL IN aooaEss �/��/ �-.✓ � Certified copy Is filed with the munry boilding inspea -- gUIIDMG � ^ /' .� , , �io�deporfineM. ' ADDRE55 � /r .�-V(.J Dale ' " ' "�APPlicant � � .. .- � CI7Y ) �1� /4 ZIP LOCAU7V � � GERTIFiCATE OF EXEMPTION PROM WORKERS' -" - �� ' - '�� - �'�-- NO.oF Bi�S.� � NEnREsi --..-_... __ . . .... .. _ _ . _. . ' COMPENSATION INSURANCE . SIZE OF LOT NOW ON tOT CROSS 57. ' (This seclion need not ba tompleled if Ihe permit is for one �-�--- TRACT � BLOCK LO7 NO. "i �ESSOR . - - ' hundred dollars(E100)or less.) • J MAP BOOK � � �PAGE PARCEI OWNER _ /' TEL.��LI (��' USE ZONE M,47 ? I cenify�bot�in the performance of the work�for which rhis � '� ��` 't � No, - NO. �V�"7�' 7 . - ;y permit is issued,I shall nof employ ony person In ony manner -7 - --SPECIAI -- � -- � � -�--�---�-�� ;6. ` so as to become svbject lo Ihe Workeri Compens6' n 5. ADORESSpC � ' '- ' CONDITIONS � 'O `]\YD.ate � 7 AppticaN � ��w'cu�-L CIN ��}/Lt, ._ ZIP �//�i __ - .. . . . . • . . . __ . _ �_ . ,K 'NOTICE T�T:�If, ofter making Ihii C ificole of ARCHITECT OR TEL. 1� DiSTRICT GROUG ttPE _ '_FIRE VROCFSSED BY_.. _O Eaemption, you should become subject to t Wa�kers' - � FNGINEER .'SD NO.C � � CpN T.• ZONE (� Compensation provisians of the la6or Code,you must fonh- ADbRE55 ,C.3 EL /4L �/ /O �. d winc �omply wi�h�such provisions ar ihis permit shall be � - deemed revoked. - - � � 7E�� STAtISiICAL ClA55iFICATION , � qPT, CO �O. -� �Z ' '' � COMRA�TOR NO. /� ., IICENSEDCONTRACTORSDECLARATION , � . �� �� � �- � �� � �� � �-� ._... .. . _._._...._. . _ _ __... .. -_. LIC. ' � CtAS5N0.—�L—�WElLUN1T5 I hareby affirm fho�1 am licensed under provisians of Chapter 9 nD�RESS NO. (tommencing wi�h Section 7000)of Division 3 of ihe Business and .- ._ ......_' _._._ .. ... _._ ... - LiC. . , SEWER MAP � . ... . ..,' Professians Code,and my license is in full force ond eHect. piy ��p,s5 '� --- - �� -- - - -- -� --� � �. . .. . . eK. vc. � YAUDATION , _. Sq.FT.n NO.Of , NO.OF CHECK License Number � Lic.Closs � 52E aC0 STORIES FAMILiES ONE � � - . ., . Contractor . . .� .. .� Date . . . ...� .. __ . ._ __.. �. .__.___ . A DR .s AIUAT ONQ.� . ..-. .. . r� �2 4 A �: � ' "" DESCRIPTIpN OF WORK 9�0 , �1 om ezempt under Sec. --- � - - -];�� • • •�j . ; B.BP.C.for tbis reason . . _. REPAIR-❑ S .._. ._ _ ; _ ._. . __ _ . ..�..o o r2�O 0 . , �� . . . . . .. .Oaie: � - USEOF DEMOL � ' . EXISTING 6LDG. _ � - _ • e.��t',�O� . . Signature - ' � � ' —'-'� APPLtCANT TEL.7fN C� FINAI �' 7� � F � OWNER BULLDER DECLARATION PR��'�T . C O /E NO. G+. DATE r- �(�%`� ���- � �� -O E��"-b�b- �- � -�1 here6y affirm Ihot I om exempt trom Ihe Canimctor a License � � � � � � Law for Ihe following reoson(Section�031.5, BuSinel3 onCJ ADDRES I N C�,9EGk .V d �13•� FINAL ' " " ' � � � ..PrafessionsCade):- . ..-" . . . ... ..-' ". _ g .By - . - .._ = - .� , , ..❑ . _. BUIIDING � ' I, os owner of the property, or my employees wilh ., ADDRESS _ _ .�� _ � _. woges as their sole compensation,will do fhe work and �b 8�L 7-A ' the structure is not intended or offered for sala(Section ����TY , � � , .. ... � -. .-. --. . .... - � � �7044,Bostnais ond Professlonz CodeJ. �-' � -" ''�� � MOVING� '" � - -��� '� � -� TEL - �- � - - . --, � [OMRACTOR NO. �'• • • e • � .,� �I I,as owner of the properfy,om exduzively controc�ing � . . _ . . ._. _._ � ' , _ . ' ___.._, -wifh Iicensed ronlmctors to canstruct tha project(Sec-. .. � AODRESS � ... . . .._ . � �. � • •3 Q Jr Q . lion 7044,Business and Professions Coda). • � � ' �' �- REQU�REO _.TOTAL SETBA K - ' ' CONSTRUGTION LENDING AGENCY� � - - -� -� sEi enCK YARD 'HWY pROP.LINE WIDTH '' � , •♦ a�a 5 O..! �I I here6y affirm thot there is o consrruUion lending ogency for FRONi . '� � � -the perfarmance of iha work for which this permif is issued � - P.L- -� — -� - � - �- - � -� -� ---- -� � --- - ' ---�.' '� (Sec.3097,Civ.C.). SIDE . O�� 7—S'� '� ' . . _... . ._. .. P.L. _ __ _._ . .... .. __ . ' _ ._..`. � � .. �: � lender's Name . . .. � . . - ' �r �D. F'j7 LDMA Ref.M , . ' . . _ . ._ _ . _ .._ _' ' " ' ' '—' P.Cfre5 `�1��.�' ' Permi�Fee -.. .. _._ _. .__ .. __._. . Lender's Address �1 ; � ... .1 cerfify fhaf I have read ibis oppliCation and Sfofe fhaf fhe ..._ . _ .. . _..__ _. ...- -Issuanm Fee ,a� V LDMA P/C N - . - ,. . ... ._"- �� �.. -'- � abova informafion is[orrecf.I agree fo tomply with all Counfy Invezrgoiion Fae �y� � �-�'�,.. . ordinances and Sfate laws relating 10 boilding mnstruction, _ __._ _. .. _ ..___ - � � Tofal Fee. -'��.•v'�.-. LDMA Perm:.N �. -_. . .. . .1__ . . '��__Z:'.. .�. and h Ihorize representotives of ihis Count fo enter , � Upon bo e-menlioned property for inspeGtio pur oses. ^ � . � � � - ..� . _ _._ .. . . . . _...'_.. i __ ._-__ . ' __- _'__'. . _ $/07G/� SEE REVERSE FOR EXPLANATORY LANGUAGE I 1 . . oeure of Applicont or A9ent.- . .- le . . .. .. . "-."'�� �__ -- PLANS TO APPLICANT INSPECTOR'S NOTES '-_OWMiWIIU1LDfiR DIiCLARATION ' ,ereby of(irm ihaf I am exempt from ihe ConfraUor's To• , � RNumid �� � . � - � � ` ticense Low for'the�following ieoson.��(Sec. 7031:5� - � �� �" ' � 'Approved DasinessunJProJesslonsCode:Anyoityorcouniy�oLiaG No. Da�e No: Da�b �� -' � � • . � - . requires a permit to ronstruct,a[ter,impravc,�rnro(isG, . orrepairunystructure,priortoitsistuancr,a(snreqaires .� � � � � - � � ebe a lirant or sutG ermi!to r!e a si ned statement . _. `�." ' PP I P I' R .tl at de is fi�ensed pursuant to t!>cpronisions of 11 c Cnu- (��.�. � , � � traclorYl.rtensel.aui(CAarter9J(rommentrngu�itGSea , - --" , tion 7000J o/Uivisinn 3 of tbe Qusiness¢nd Professions ' �� �' , '� `�.�; � , _ ' . ' � .� , ___CodeJ or 15a1 be is rxentpl lherefrom and tGe basis for t!¢ . . . . _ .. .... . . _. • . ....... . ._ ... . . ._ . � alfrgeJ exemftion.An,y oiolalion nJSection 7031.5 by ( Required_ .DaN Raeoivad . -.. . � � ��-- . . ' �- : ..:. urty applicant fora permit subjects tl e appGcuni m a rivif i Approvolf Yvs No or Approwd � . . . . penally of not more tLa�five I unJred do!lars(r500J.f: ' . - '---.-. ...- _.��-'`-. ` ..- �...�� � �.� ❑ I,as owner of Ihe proPerty,'oi my employees wcth Water Certificote�. � . . „ � " . . .� , wages as Iheir sole compensation,will do the work,'pnd � ���-� -� - -� �� -`' �� ' � - �� � - - � � �� Ihe strvc�ure is no�in�ended or otfered tor sole(Sec.7044) ; HeaNh.DepartmeM_.. .._ . �.� � . .___ . �---- � - '- � � , - � . _- ._ BusinessandYro/essinnsCodedTbe,Contrpctur'sLicense . f.au�dnes nn!aphly to nn ouner of J�rnperty u•Go buiWs . Fire Depor�ment._ . . __ . . � �- . , - � �� � _ _ or improres tl rrcun,pnJ a•bo does sucb uork Grniself,qr.. � , � . � tGrougL Gis o¢�n en+ployees,prorided 1Jalsucb-im- . Groding � � , - � . . �..pmvenaentr arc not intenJed nr,nfferrd fnr aale. IJ, � - " � . . , . , -' Gnu�e<�cr,!1 e building or improvemenl is solJe�itbin one �� Geologiml •� - � � � , . ��ycar n/eonrplc0inn, tGe owner•buildcr utill bnne�tfie � , � burden nJ prnvrng tGat hc did not build nr rm/,rore Jnr --� - �- ` ., ..-- -� tLc purposc oJ sale/• .'.;. PedeslrionProtecfion • -" - � � � � '-� - , �Fence)�(CanoPY) ' .. - .-.- .. - . � . . - .. . . -- - .. ' ��.. ' � ' ❑ I,as owner of the property,am exclusively'controc- , ,ting wifi licensed conrroctors to constroct ihe projetl(Sec: � "- � � �- - �- -- ���- ---�--� -� - �-- )044)Ifusiness und PrnJessinns Code:TGc Cnntractnr's . Special InspeUion � � - - ' - , . -� --�� - . ��� (Canc.)(Masonry)(Weldin9) � � ' � � . -- Lirrnse Lau�Joes not aQQly M an ou•ncr of firo�rerty u�!o ' ' - � -" '� ` �� " ' �" -' -- " "-"�builJs orine/�rorrs tGereon,-and u�Go-eontraals��rsucl� lo�Drainage - - � , . _ .. .-. . ._ ._. Prrjec�s u•iel a mntraclor(sJ liaenseJ punaune ro tl c � . -' � 1 . . . . . � - Cnntrattor's Licensc I.a��J.. ._.-_ . . ... Porking ... . . ' � ._. ___ . . . .. , . . ..... . , . .,._ ..__... _ ._ . __ _ ..._ _ . . . , --❑� I am exempi under Sec ,B.BP.C.iorihis , � � reason ..__. _._. ._. � _ � . . - .. . . � _ . . . '.' ____ ....._...�., ___. ..._._ ___. . ... "-` , ,, , .. Dote Owner ' APProvals Oafe -..Inspaclor's Slgnoturo . � , , � . � � . . .INSPECTOIt'S NOTES � � � . . .... location— � � � - � . (Setback 8 Yards) , ' � --- ..- / . . . .- �' . ... . , .�-' i ; ' Foundations �� V . . , ' � . �, . , .. .� ., Slab • -. . . . . . . .. . Frame � . . . , . . . � � � .- . . . „ . : , . .. . Energy Insulation � . . -.. . _.__ . '.__ � � _. � _..� '., , . .. ., .,� Larh/Drywall-- -- -- - �- - . . :_ __. . .._ - . - . . . Imerior - -- .__. _ - `-- � . . . .. . Lath—Exterior � � . - .. �` .� . . . . . .. . �� ,�^ ' ��. ' Hoose Number— ,� � ---- - �-- --�-- - -- - - - � -- - Correct 8 Posted °�� - � .__ . _ .._..._ .._�_. __. . . . . _. ..._..._..._ ... .._. __ .' . � Finol— - - - - . . . , .., • , EMer on Frant . . - ' ' . . . . .. . .. . .. /�