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HomeMy WebLinkAbout1796A 1797A (10) ._ _ ..__ _ _ /c�/� ... _ ..vnntKJ'.COMPENSATION DECIARATiON . •,5w�.�� '-. . -�..'"..... " ......� .'. . ...^__. ____.. __._ ._ r � . . . : _. . .. .._. ._. - - . - � . _ . . ._� . . : . , u i � 1.hereby afinm fhar i have a cenifimre of consenr.to seli qpp�,�CATION FOR.BUILDING PERMIT� - �� insure,or o certificole of Workeri Compensofion Insurpnce, � or o certified mpy thereof(Sec.38Q0,Lab.C.) ""�� - -- --'� � � � . . . . _ "' CpUNTY OF LOS ANGELES BUIIDING AND SAfETY '�� ' � Vo1�cvNcPIdCC954R9Gd61*�Po�Y �Par FQznl^�arg- ", �� : � O Certified copy is hereby furnished. - POR APPLICANT TO F{LL IN sunoiN� ' � - � A�REu .2�z c�x ��..,..,E Certified capy is fi�ed w�ih�he county butld'�g inspec- euuofNG l �fion departmen�. ' ' A�ORE55 �jLX.7 p�J, ' o , _ , Date �Z �Appliconf� cin ziP tOCAlI7Y � . . � CERTIFlCA7E OF EXEMPTION OM WO ERS'. " .. . ��. .- . . ----. .. NO.OF BtocS. . -._.. .. r.�naesT-.. ..:_..__..... .-_.'. _ - '._'_'.'-_'_""'. ..: � ' COMPENSATION 1 RANCE � S¢E OF LOi NOW ON LOT _ . �p$$$7, ' �„ i (This setlion need no�6e tomple�ed if the permit is for ona � �- - �- --- - - � � - - -��-- ASSESSOR,.i ., r-' �- - '- - ��•�'� �� h�ndred doilars(5�00)or Ie55.�. , . , TRA�T 6LOCK l0T NO. hVIP BOOK- � PAGE FA2CEL owNeaM�J: Brock-& Sons NEo�529-8170 -� u o e �P 1 certify Ihat in the periormance of Ihe work for whkh this ' ��� NO. , ' r^ .' � " �-.. i permit is issued.1 sholl not employ any persan in any manner _... ,� SPECIAI'.- -..;_...._.._,_. ._.. .. ._ _.. _. ,a so as f0 6ecome 5ubje[f fo fhe Workers;Compensation lows. ADDRE55 ' """��-- " - ' �D�� �pN01T10N5 . � � . �Q '___ �- ' . � ' ' _. .___'...__.�'_""..... _._ _... . . . __ �me � Applicam - ��.. . - � arv _ _ _ . _..._..__..Lr . __ . . . . , � ARCHI7ER OR TEL. :Q �`''3TICE TO AVPLICANT: If, ofler�mOking Ihis Cerfifimle of ENGWEER • p . D�STRtCf.. GROUP NPE . .FIRE_. ._PROCESSED BY�_ .� t tmplion,�you shovid betoma subjeU to��the Workers' '� " - � CON 20 . �ampensafion provisions oi fhe Labor Code y0u musl forlh- ADDRES;�OH�il S. Paramount Ave. DOWIlE ' � /�--- �3� -- �----._ -, ._- ,.¢W, with tomply wuh.such provisions or th¢permit sholl be��--- �deemed revoked. - . TE�• S7A7157iCAt C1A551FICATiON APt. CONDO. Z � COMRACfOR Owner Na � ' LICENSED CONTRACTORS DEQARATION ' •'� ....--�- - -----' -- -- � - -- �pC:- - .. . QASS NO. '� DWEIL UNi15-i��- -�� �. . ..- . 1 hereby otfirm ihat I am litensed under provisions of Chopfer 9 ADDRE55 NO. (commencing with Seclion 7000)of Division 3 of Ihe Business and ... _. . _. .'__"... .... . ---IIC..- - . ��R MAP � i ., . � I Proiessions Code,and my license is in full force ond effecL CITv «A� CHECK_ gK'� �� � � VAIIDATION� � . . . .. . . ti SO.FT.."'_"' NO.OF. - ._. NO.OF � � � . UcenseNumber 5!i(G$ " Lic,Class BI "' SIZE SiORIES FAMIt1E5 ONE � _ �� . . . . . .-� _VA4UATION_._... . . . _ _ ��:��_� 7 4.17{;..� . oescaivrioNOFwoeKNew-sin le famil - NEw-- '' , Comractor Dale ' " '��� - with.attached A°° s ������ ____ �*•• � •2� �1 am exempi under Sea atH 0.-. - -- - Q ,i ` , . ALTER ' ', .� 4&7�,��` � � 8.&P.C.for Ihis reoson .__ . REPAiR-� -S-._ __. .... : _._.,. .._ . _. _� _. . . . - - - Do�� -r= E�ONG flIDG. � A DEMOL ... . .. '.�""Cl��I,�i G c=.� .. - Signature -._ ... . .�.- APPIPRINTT . N�. HNAL fl C.��"8 6 NE-BUIL ER DEQARATION .... ' --DATE - --� -.�.-� .. .- - -- "'-�--- -1 hereby affir at I am axempf from Ihe Con7rocioi's Licensa AD�RE55 P.O. BOX 350 Brea CiA 42621 � ��' � � Law for the f lowing'reason(Seciion 7037.5,Business and FfNAL�:' " • ' � '� � Prafessions Code): ... . ' .'.� . '. " . ..' ._. _ .Br : - --. :.- . _ .. , / BUILDING t'' / � I,as owner af Ihe property,or my employees with A��RESS ._. _ _ ''_ .._ r_j'J 9 7-A�:.. ' � . . woges as Iheir sole compensation,wili do Ihe work pnd � • � - �� ��•- Ihe atruclure is no�iroanded or olfered for sale(Saction . ����TY '' � =i•� �..�_4� , -�� 704d.Business ond Professions Code). ...- . .._ � MOviNG'._._. - . _ . - . .,....- iet. . -. .. .. -. . � 1ry--.�1 I,os owner of Ihe property,am exclusively mntratting COMRACTOR NO. � ' � �`� � ' �` � . _ . ._._ _. _ . _._.'. �; _..� �. •s� 9.00.:._ �T'i with licens¢d contractors b conslroct fhe project(Sec-" -"�� � -� -- ' � -� , -- � f . - lion 7044,Business and Prafessions Code). A�DRE55 . , , . , rrcouiaeo-- rora�seraacK � ' ° °�1 4.0.0� ' -� � -- CONSTRUCTION LENDING AGENCY � � � � � sei sncK YARD� HWY PROP,uNE -� wioTii � -�� -��� � � �� -� � I hereby af(irm Ihaf Ihere is o mnstrucfion lending agency(or FRONT � �g��5'�b�"' � -the per(ormance of the work for which this permit is issued....---� v.t.--- .- - -- ----._._._ . .__. _._. .... .. __ ._�'__ . :�_ . _ .� _��-._- .._ _ _ -_ . (Sec.3097.Civ.C.). SiDE � '. . . .... . .' __' _"'-_... .. . . .. ..... . .'_.._ P.L_ . . . ._ ' ." ' _ _ ... .'"'. .... ..' '_ ._ ' _ � " � ��' '__" ' " ' ' ' Lender's Name NQnP p O p p S � IDMA Ref.N � ' tender's Address � -�- � -� - P�e Fee E -O � --�� vermu Fee p�CJ - - '�- .--. 6 ' -1 cerufy rhar I have read Ihis opplication and sfare�ihot the �--- -�----� - -- ---�Issuonce Fe� �— -'- �DMA wC N �- ----- . . . . - ..-..- -' --- a6ove Information is mrrect.1 a9ree ta comply with oll Counry Inves��gorion Fee � . ordinances ond State aws relatin o buildin9 construction, _.. . __.. _.,._.._. _.._. . .-- imol Fee-� �- ---� �- IDMA Verm.N���--- - � �� - ' and here y ouihar represent ves of this Counry to enler � upon th abov mloned pery for Inspeaion purposes. !`(� � ; Signatu of APPlican�or Agem "�' -�� _ J _ SfE RQSYF115E FOR EJ{PIAN�TORY LA¢��E�� i '' _ .. ._ ... "'''_.�. .. . '_ �."' ' � ." - '."'�Q.� �j. PLANS TO APPLICANT 7NSPECTOR'S HOTES ...01i'NIiK-Uu��i..:......__ � 1 hereby affi.m ibm I am exempt from the Contracror's T°' � RNurn�d: �. � � . . � . . , „� � �- �iCense lavi for ihe following ieason. (Scc. 7031:5J �� '� � � " ' -"Approvid'� ��BusinessnedProJessiansCode:Anycityorrourtf�,wbitG , Ho. Dafo � No: � '� Dotv�'" ' �.. � .. , ,. _ ,.. . . requires a rernoit tn ronstruc4 aGer,imfrove,den�ol'ul, � �, . . . . . , ._'.�o�irJ�oiruny,t7ruoturc,friur to itt i.rsuance,oGo requiret �'.•.�:, ; � � - . . . t!e applrcant Jor sacL pernrit to Jile a rigrted stalenrent � � tbat!>c is fioertseJ farsuant to!Ge j��or�isiona nf tAe Cnn. � 9�_�'.% J r�.z�.r(��'-1. �t �°.•1_j,S� ' . " trartor'aLicensef.au�(CGapeer9/Iromraencingu�itLSeo. .. . : �_ . . . .. I r J . -�.tinn 7000J r/Uil�isinn 3 oJ tLe Dusiness anJ Pmfrsaions '���� " � '��- �;CoJc/ot!la('Geis`Cxcnr/rtllcreJomrtnddarbasrsJort4e 1- —_ _ __.- _ __' � _.. _ _. _- -- - ' R� airod • � u!leXed exeniplinri,lnny riolaeinn nf Srctinn 70j1.5 by ,.. .. -Approvols-.. .. -" 9 .._ - DaNR�c��wd. . ..:- - . -.. - .-_ .. .. _ anyarflicrtnlJnrafermilaubjecal/icapplicanitoane�i( r Yos No ��APP�ov�d; � penal[y o/nat rrcnrc lban jine GundrrJJoffars(f500J.1: � � ' � � �� �' �� -- ��� -"�' `�� -� - ❑ 1,as owner of Ihe p�openy,or my employees wilh � Water Cert�ficete .� 1'�� ��� -�`; .', . .. , �, _ ,. , woges os their sole mmpensation,wili da ihe wark,and ,.____.____ i __ - . � .... .. . _.___._ .._. ..•.. ._ �.. . � the s7ru��ure is noi iNended or offered(or solc(Sec 7044J HeohhDeparimeM. � - :_, ��� �� - __. __ , ,_ , � DusinesspndPra/essinnsCodc:TbeContraaror'sl.icense . _.._ __._ . ._ . :..._ .._ . . . . _ ._ . .. . . l.au�does nnt apply M an nvrrver oJ property u�hn buildr � Fir¢_p�p�rtment . .- . _ . _ .� _,, _ „ ';_ or rmprnors tlereon,and u�l�o doca sucb u�ork Gimse f nr ___. .'_ ' _. _..'_ ... . .. - � � tGrnugG bis tium rmpJo��rrs,prorided,tGde surL ir� Grading �- � , • � � . �i . , pranemenes arc�rtot intenJed or o/%red Jor salc. , �' . _____ _ _". __�' _.__-._.. ' � •.� . ' . ; :t. � �� . '� ....... bowe�er.t/eburlJrngorimprovemrn�issofdutitGrnvnr Geologi�ol�� ��-�-•� , �.ycar nJ compfetion, t1�e nunrr-builJer u�il1 bare SJe , � :� .. . �'-. . _. . _' .. . . . . ': .�,,', ,.... . . ' , burden nJproe•inR ilat he did not build or improneJnr Pedeslrian Prmeclion. .... ,;. .�.-. ...: . ..:. : -' _ . -- ..... . tl�c purJ�ose of ta(e% , � . ,. . (Fence)(CanoPY) . .. �.. . . . ' '.. ,� ` �� � ` - " .- . ��. .. .......�. . ..--...... �. . . '❑ �I,as owner of the properly,6m exdusively confroc- „�..�. .,... � �� � ting with�icensed conrracfors to cansrruci Ihe rojeci(Sec. SPeciol Inspection��� �.� ."':.. ...._.' . . . ;�.7.:---.. ._. ..-...----- -' J044)Dusiness and Pr feseions Code:T!e Confratlor's (Cona}(Mason.Y)(We)ding) � .- .._. ' . .. .. . . ._ .. _..__. . . l,imxre Luu�Jner nne(�fll'm an oumcr o/j�rn�,crty u�l o • �-" "�� �-� � --- 5uifds or irnprbnes�bereon,and trbn Yonhacts�r sut! Lot Drofnage � .� �...�.� ; � ._ . _.. .:... . .. _:. ... . prnjrcts u•iel c con�ractorfsl lirensed purs�on!tn tGe . . -..:� . _ . ._ . ... � � ----Cnrttrcrtnr's Licensci.aaJ. -� � - - � � , Parking . .� � . � .._... .. .......... .... . ...._ __ .__._.. . _ �. ,. . ' , � � ❑ -(6m ezemp(vnder Sec. ,B.6P.C.for Ihis � C� �� C - . . � - reason � - - __ . � . . . . . . . . _ . � Daie . __ _ ..'i ��Owner ._. � - _._.. _ _. _-._. .. _ � _ . . �: Approvols Dot• � --Insp�cfoi i Si otura � . � •. - ' - � � • � � fMSPECiOR'S NOTES - locarion- • � (Setbock&Yords) --` ' '-�- - , ' � �- - Foundmions !"� � � �� .,: . .. � :� . .. . . Slab .. . � -- ...._. . . . . . ..--_ _.._..� - ..,-�. . �. � � : � . . . ,. .. , _. .._... _.._.._ . . - _. .... . . _. ..... .. Frame .. ..� �. �.� � , ��6 � � � . .,. . . . . . . .. .. �. . . . . . . , . Energylnsulation � !V �' . '.____.:. ...._.._.. --. _-.' . ' .�, . _ . .. . . . ., � , � �� � : ._i �" .. , _ ._ . ,_.. larhiDrywo77- 6- ' .� � . _ . .�.-'---- �-._._.... _.— . ... .._.. � . . . � ., � ., � . In�erior - - -'. - . . � Lath-Exlerio� - . � ... � � � - _ . ......." .. .,.. . . . ..,...:i� '� �,.','., ,� �� : i:: 1 .-• r. '__..___ _ _.__. ._'._.. ._... . . ' � .. - I ),���� House Number- � , -_ �:.. .. Correc�8 Posied � . � '. ..L __'` '; - . ..._ ,.._.._._'_", .�..._ � _.__ r�\ . . "_ ._r_ _' __._ �' .�.� : Finol" '.. ._'.-. _ ....____- __' '_ ' a- . ENe�on FroN _- ... ,_ .___'_ ."_.___.. .___ __ ' . . . . , .. . . _ . . . . . . .. �' _. . , . . - _�.- � .�• . - _ \