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HomeMy WebLinkAbout1324A 1325A �;- ._ _v . - " ��;ERS'C-0MPENSATION DECIARATION � � -� ! � .��"^ lhm I have a rnrtificate oF�o�,��„a,e�f q�PPLICATI4N. FOR BUILDING PERMIT �"; '�cote of Workeri Compensation Insuronce, thereof(Sec.3800,Lab.C.) �OUNTY OF LOS ANGELES BUIIDING AND SAFETY ,� a� Compo�.; �h�eby fom+shed. FOR APPLICANT TO FILL IN ADDRESS ..2 ZZZ �. µ��� of py is filed with ihe coonty building inspec� 6UilDtNG 222 h.� W�� Q�+��. epartment. ADDRE55 'V �� ��Oate ApplicoM � � CITY �1��"�' 'P�. 21v ' b.7 LOCAIITv � CERTIFICATE OF EXEMPTION FROM WORKERS' � / NO.OF BLDGS. NEARE57 A. COMPENSATION INSURANCE � SIZE OF tOi NOw ON LOT CRO55 5T. --Kr�/ (This aettion need nol be complefad if fha permit is for one 1RAR� BIOCK � LOT O. �ESSOR hundred dollars(5100)ar less.) `'. L MN.F BOOIC PAGE PARCEL rvapY� D' ! U TEt USE ZQNE �P I rer�ify thot in rhe performonce o/�he work for which this OwNER NO. - t�l�� NO. r/��„C�i' permit is issued,I sholl nof employ ony person in ony manner pDORE55 ZZZ �/�"0� ��p ��1Cv �17 SPECIAI � so as to beCome subject to ihe Workers'Compensation laws. �Cdv CONDITIONS 0 Q-g-8Z Tj.�,.S�.�g,�� arv DtIt4�Ot��P Fi ziv �? Date Applicont nRCHiTEC10R 7E1. � OTICE TO APPLICAN7: If, afle� m king�lhis Cerlificate of ENGMEER NO. DiSTRKT GROUP TYPE FlRE GROCESSEDBY Exemption, you sho�ld become subjeU io the Workers' f CONS. ZONE � Compensation provisions of the Labor Code,you mus�forth- qDOrtE55 /� � W wirh tomply with such provisions or tbis permil shall be - � p„� OWu� iEL STATISiICALClA551F1 ATION APT. CONDO. �/7 deemed revoked. . CONTRACiDa Np. Z IICENSED CONTRACTORS DECLARATION S,w,��a�, - � ���. - QASS NO. DWEtL.UNi75 I hereby offirm thot I am licensed under provisions of Chapfer9 nooRE55 vl^"^� MO. (commencing with Section 7000)of Division 3 of the Business and _ _ �i�, �`�R�P� Prolessions Code,and my license is in full force ond effec�. aiv C1A55 gK � VALIDA710N � Sp.FT. NO.OF NO.OF CHECK License Numbef � LiC.CIo55 SIZE - STORIES FAMIUES ONE D VALUATION DES[RIPTION Of WORK NEW .t� ' ' Contra[ror Date !�J Y ' ❑I am exempf under Sec. /Gci�� vp(�j � �'(D AD� S V•�� , � `�M'G!\ I�w� S vit�� AITER � S #Y���p II B.BP.C.for this reoson REPAIR � 'G� Date: � 115E OF DEMOL /' EXISTING BIDG. � � o �yy J���j Signature APPLICANT tEL. FINAI' ii.�, O[=i OWNER-BUIL�ER DECLARATION 7RINT No. . DATE, �� 0 9,D 3-8 7 � I hereby pffirm Ibat 1 am erempt from the Confmctor's License Low for the following reoson(Section 7031.5,8usiness and ADORE55 FINAL� . '�feszionz Coda): - - - 8y -"�" _ BUILDMG 1, as owner of the propeny, or my employees wi�h ADDRE55 woges as their sole compensofion,will do Ihe work and �p�p,��TY ' the structure is not Intended or offered for sale(Seuion �l 3 2 5 A 7044,Business and Professions CodeJ. ' - MOVING � TEL. � � � I,os awner of fhe property,om ex[lusively coMrotling CONTRACtOR NO. #J • • • with licensed mntractars to consiruct the projecl(Sea qDORe55 . � � �Ci�J.D����� . Iion 70d4,Businesa and Professions Code). " ��---�- � , REQUIRED TOiAI SEiBA K - CONSTRUCTION IENOING AGENCY SET BA[K YARD HwY vROP.uNE WIDTH ' qr �^p� 1 heraby offirm tho�thera is a consrrocrion lending ogency for FRON7 � I 6 �he performance of�he work(or which ihis permir is issued a.i. . . ($ec.3097,Civ.C.). SIDE - P.L. lender's Name .S`/�n N . LDMA ReL N " Lender's Addtess � P.C.Fee 5 � Vermii fee ��J �v - I tertify�hat I hove reod�his application ond state Ihof the iesuonce Fee ��'s� LDMA P/C M , Obava informofion is correct.1 Ggree fo mmply wilh oll Counry ��velN9ofion Fee �J ordinances and S�ale lown reloting ro building construction, 7ao1 fee ��J� lpµq pe.m.p . " ond hareby outhorize representafives of rhis Co�nty to enter upon ihe obove-men�io'ned`property for inspeciion purposes. V� �` �.1-�W�- ��� SEE REVERSE FOR El(PMNATOMY IANGUAGE � � S�gnature of Applimnt or Agen� Doie . . . .._ PlhNS TO APPIICA��T � tNSPECTOR'S NOTES . Utt'NIiK.UI�]I.U1�:R Olf(�I.AFt:ll�t0? . . . , . I hc rk-,y a" .�,o�.�l�nm c�c...p�t•c.���l,..�n. To: ' . . . , � Relarned �� . . . � � . - � �Li en5 �La� f� if c ..oll .j r.n�i f i�t.' . . �APPravad I7 . c inJlr��eunns( d::1n�:�tt unt��„ tJo. Dote No. . ..Da1c::� ' , . . . . . . • '•.•. -- reyui�rr�a prrmi7 h�rn•,:7v�f.✓hor.irn�,.,�rr,drinr,r. __.__'____ ' __ ______ �--- �rii,r I�.i . . ., . ... . ... .- -r.�fuir.�n1'xfructvr.'./ l.�i.�u1rs�.�.�L��rr.�r�i . . � � . �I- .� . l�I�('JJ�pI�iJn(1�rY S�(.i�p[ .t_�ti���l4 p slr)tt�.I tl,.la•�t��fn� �1 � ,. �. , . .' ; .. . -.. , � � _ i. i„ ._ '.t e.u.r`,�'.�l,�rnc��•!�,�I�<I��re .Nl/pr� n. /���N�1 . ._ _ ...- �---- . _ '�'._ ._.....__ ._. ._..._ I-__ i'.. . _ r . � , � ... .� .. ...�.. nun?U!1!U„lAri�;in 3 1�! It .tn .� !ln,J.. �n. .., . ' . � i,': f •.; ` ,',� _�� . CJrJ,�rrl�a�! n�prdxrr/r,�wudd�6:�vs/o�th.� ;. ._ . .. - -- ._. __. .... _. . _.. ...- '--.. __ .. _ _.: .... • , _ �.. _. . __ � . _ _ .� ��. . . - -� — �-- -�--, -- �utt,erd�crempnnn .4n� i�ntari„n.�/) .n.in..i�j1.5 h�. '. __ _ . ..___ ____ __Roquired�::__ DateRaceived __.______.__ ' -._•. _ .._._ _.. .. .__.__ .. �n1a(�ph.antJnra)�e�rn�urcuF�v:fcfl,� )r!-:n�rnu.�id Approval� Yes No or Approved . n-prnultv n(nnt mnre�tl,,�n/rr� l�unJnJ.Jdlun/cSUUJ.y �' . ___ ' . ...- �___..,__�� . . �; �._ ._ ..__ . �. �:%._ _ _ .._._' �. I.m ow-ncr ol rho n•op^.�y.�r m r ,p �w�d•. .� — . ... �,. � .: . . �.� r ' _ _ VJ�'..C.�ilra'n .. . �. . . . ' . . '' . ,. � . ._ .__ ..__ _ ... .. de ,, ._.. ._ . .. ..__ . - .. . wc a.s s�he� o�e co �o v.�II d � ����,am • . . _. ...._ . ".. .. .. .. ...... , ' . .. - - . 'lf���i ucl�e cr in�en .d o effrred�o Saie�(Se 70s»� . . . , .. . , .. M�al:h�ePcrtmen�_ .. . .__._ . �'.' .. ... � '.-' ._.._ _ " _._ .. ... .. �_ _ ._.. ._._.. _ � . _ ... _. ..- _. .. � . _ . !l s .undP . �ic( J !!� < fd�t.re! �� se / . � I ,,�.. _ . ., �., i ._-�. .Ix. J c aot fp! -ioia�� � r u/�� �e h vl�� !uf�lr � P��u Dnpo�ima�v..___,_... . ._ ._ - - , . . _ _._ _. . . . . �. ..nr� �) �nr.c r! r�nri,und i!r J,ar rr<!� �hrm 1lnr . - . .. .. lhroueL A,is�nu•n enifln��ei . pr:n•iJ ! d�.�1�-au! . � G-od��q � � . � , :� prnr.<•r�,enn �re not iArr.,d�l �.� ��l/ �1! � shf<-. }!, . � . ^..,G:nrorrr.�tbeGuild�nxvrrmj�rnnemrr�lrcn.lduiebueanc �. - ._-. __ ._._._ _. .. __'. _ ._ . __ _ � Gec.Inp�ml �, " - � - �' � . .�. ' , . .- - '-' I���ar n/rnmplrtlon.�tbr ��u nrr-hwid . !! 1 a:.r.tbo '� � ' �� hurJ�n n� ' rGm hr Jrd n.�t h�ulJ� �mnmrr(nr � . . � , _-�`. . � prorn�� � � .___-- --. . ___ ._ _ .':� ..�. . _. _ rr p p„t�.,l.�uro). PeAestnanPro�ecnon �� � ..�. -�:�� ... . -•'�. �., ,. � L�ns�o�xnrrcirt�c� � t..'-�mc d�s�.�c (vc�:�•1 tcannPrl. . . . ..., , __-----:_ .�_ . . ___._ ._ . ._ ___.- �-� . n F < r,,r. .��. , �ill g �dl,,I��ensed co��+�actors ta<c.�zrucr th��p�o�e��(Sec. S���clol I�{pe<i�on- �- - - � - - - -- �. ..- - ��-��-- � . -- �- 704a1�N�esines�av�!1'rnl�.�� +c'(. fe' 'lb��(.dnlydrfnr's �r � ICenc.l(Aha:onrY1(Weldm9l : . . � � . ._� .. � __ . ___ _ . , u dppfl �lru'f rr (. lai Jesnn! f ¢i��avu�� r� 1� . . ___._. _.. .__..._..._.. - - __F�-�tJ;�nr--,rn ILu�,n, !ii`L,��„nr ��eu:A . p.,. : J��� re c � {rtoro�r,.,�c �-' � -� '.� . � ..�'� . pr�y��t�� artl�.:.ontrJ�i���'�fl�,.�rrc��d p�rrsr<,r.,t n, lh�� � . �.�� .._. . __.. . , . . .. E � . �'----- : : „ ,, .. �,. �,"�.:�� : � .�,, . --Cnnrra�r„r'c t.i.rnse l,aul� .. �. Pa�41nq . � . , . __. ' _ . .. _ .. _ _ n _ . . . . . [! I a c e p!undcr Sec. B dP.C.1o1in�; ' . � .: ���� , _- .. - i .,� �� � , , . _ . , . , . , � . � . .. .. _ ____.. ..__._.. _ _.__ .� _. _. . . . , � � � reoson- i . � . . . � ` i -..,. ' ,. , _._ ___ _._. .._. _._ . _ _.. _ . _._..___ � � Dn� O�«n. Approvuls pulo � Inspector's Signaturo . . .. . . . . .. . . . - .INSPECTOR'S M1tOTES , , � lrtolian- / � ... .. ' . � ___.�.__... -. .. . � . �5?ibo<k&Ya�dsl �j � �-����� __. . �� - .., . j�. . Fo�,�;i���ov. ' . �......� ...�r . . . . . Slob � . . � - � � . . � � � ._ _ . _.__ _ _._ .. .__. ..... . ..: . ....�_ . F.�� -f��E-� _ - �� . . , E�,e;��,�,S�ia�,�., _ ._. _ , � ._. _ , .--, - , , ��•�.:n�Yw�u.. -- __ ._. . --- -- '`. _ ._. __ , _ _ __--- - , �n�rr�o, �---� . � . - . . ' ' ____._..__. ._.___. _. ....._.__. . r ln�h._C �r.for , . - ` `. . . . . ... . ._ .. . . _ _ _.. _. _. . . � , . H::ev.M1�.mhrr.. , . _ ....._.� . . __ ._. __. ._._ . .. . . . . . c<,,,,,:�e r,:5,,.s . . ---- --- -- -- - �, c,�� - -- - . _ _ .__. ._- _ --- e„ ,o,�F,� , � . . - „ . � .. .,. . ... � . ' . . . . .. - .., . . .. .... �� .... . . .,- . .. .� . ., , . ,. . . . . . . . ' .. ' .,. � . ��' . ._ . . ' _ __ ". . __ ........_ .._ _... .._. ._. .._ ..� .. .. � �