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HomeMy WebLinkAbout1804A 1805A (10) , . . .___._ __ _ __. .. __ . --._ __ _ _ _ __. _ ...- -- --- , ::;5'OO �-- _ . : WORKERS'COMPENSATION�DECLARATION . APPLICATION FOR..BUILDING� �P�E�RMIT � 1 hereby affirm ihat I have a certificate�of.consen�to self � insure,or a cer�ificafe of Workers'Compensation Insuronce, • 'or a cerlified copy thereof(Sec.3800,-lob.C.)'' ' - � - �-� � - , - - .- -� � -.. _ . ... COUNTY OF LOS ANGELES BUILDING AND SAFETY -+ . vo��oyr�oPWCC253824dd6�Pany Pac_ Em lovers - � Cerrified copy is here6y furn�shed. � FOR APPLICANT TO FILL IN qppREu a'���S(p �� �,�„�� (� Certified mpy is filed wiih the tounty build' inspec- gURDING� S t./j L� non depariment:' ' � _ nooaess f��� Data �2' Applicant CITv zIP lOGllliv � . . ' � CERTIFICATE OF EXEMPTION OM WO KERS''`' - --" � - '" - -�� �� � �'NO:�OF BLDGS.- � ��- --� - NEARE57 �--.- - .'._. . .�._ -__._..____- __�. � � COMPENSATION I URANCE � • •� SIZE OF LOT NOW ON LOT �0- CROSS 5T... . ' � ' (This section need not be comple ed if fhe permit is for one ��- �"� TRACT S BLOCK lOT NO. � � ��SOR .• .,, � " � � , � hvndred dollars(5100)or less.)� . . � MAP BOOK VAGE PARCEI TEt,., U ZONE MAP r! I certify ihat in the performonte of the work far which this OWNERM.J.-�Brock�&-Sons - -�NO29-$1��- �0 A �,p. �/�- �y . �� . .. ,} permit is iswed,I shell nof employ any person in ony monner _�.._ ADDRE55 P.O..BOX"35� - �' ��- �� ------�-- ��1� �'���"-l- SPEC�a.I �-�,�-� -- '- - �- � - � G. so os to become su6jetl to Ihe Workers"Compensotion laws. �`i� CONoiTiONS ' 'O . . � . • �� � � .�: � , . -__ __ _ _ . ... '. . . _ � _ ._�__- lJ Date ' � Applicom � . .• • Citt - . _. . _ ___._Z�v__. .__ __. .. . . � ,i+�OTICE TO APPLICANT: If,'after moking'Ihii Cerlifimte of ` ARCHITECT O TE�� .DiSTRIQ . GROUP TYVE_ .. FIRE . PROCESSED eY. . � ¢Ncweea �.C.Ma'ors & Assoc.No_862-8177 ro Z E F- r xnptian, you should become iobjett 10 the Workers' ' / tl� �� W ..ampensation provisions of ihe la6or Code,'yoo must fonh- qooae55 f�- �1 `3� ��- �-- 1.Is ---�f - � G. with tomply with suth provisions or this�permit 5hall be - � � , �� deemed revoked. � •. . � �� coNrancroa Ocaner TE�' �. STATISTICAL QASSIFICATION ' ��, APT. CONDO. ;�, _ ,.., . .._. NO. . . .. ,_ . � . . . __ LICENSEDCONTRACTORSDECIARATION� �'�� �- - -- - - -� ------- -- -- -���.- ------ • MSSNO.�DWEtl.UN1T5 ' I hereby ofiirm thot I am licensed under provisions of Chapter 9 nDDRE55 No. (tommencing wiih Settion 7D00)of Division 3 of the Business ond . __ ... . . ...__ i�� _ �'�R r'ti°'P ' : ' � . . . ._ . .._ .. ._.._...._. , Professions Code,and my license is in full farce and effect. Ciiv CWSS �-�'-�-OK- �-"' ------ � "� � ' VALIOATION ` � � ... . . . . __.._.. SQ.FT. ._NO.OF _' '_'. NO.OF_.._...__. . CHECK . � . :,� License Number SliFilaR� � �ic.Class �Rl' ' Sae 5roaie5 FAMIUES ONE � � � � . . . . . _..YALUATION_.. _ . ..�. . . _._ Contractor pote � � � DESCRIPTION OF WORKNOW sin le famil - NEw s ��� �p �_1 8 Q 4�} . a�o ❑ _ ,� _. _. �I am exempt onder Sec. .. ... h h . .._. ...�......... AL7ER' Q � . ,. �e e . e 2� • . B.BP.C.for ihis reason _._ _ RECAIR ❑ -S . � I-•Q��.Q 6 � � -- --- USE OF ' � ' . . e: � E%ISTING BIDG.� A �EMOI • � `_�.4.£;1.0 v U Signa�ur@ . . .-"�" APPlIU1NT TEI. FINAL '. -�.., NER-BUI DER�ECIARATION __. . PRiN N . - .--DATE��� �,- - �- � Q�.rj S-£j(7 1 hereby affir hat I am exempt fiom iha Conlroctor's License qDDRE55•�• BOX 350 BI'E'8 �',EI 92�J22 �- • � '"- � Law for tbe f Ilowing reason(Setlion 7031.5,Bvsiness and � � FINAt �` � ' • . _... ... ... . ._. ' Prafessions Code): . -. . . ....' .'". . . . " ...- dY - ' - � . �- � .. . BWIDING �..I, os owner of,the property, or my employees wifh _ ADDRESS .. ._ .,. . __ '_� � . . . . . _ woges as Iheir soie compensation,will do the work and , .` ' '� , � the atructure Is not intended or offered for sala(Section ��^��n' � -'�. � ��_��1 8 Q 5 F �� � 7044,Business and Profession:Code). �-� -- - '�- - MOwNG- -�- � � - � � � -- ��"�-"�- -'-TEL - �--�- � � -� - '- �� � '�� - � � CONTRACTOR NO. ' -� ' . ��' • �,. ��,t;• • a � . . I,as owner of the properfy,am exclusively contmUing . • ° .. - with�licensed contracwrs to construct the project(Sec-..-. " . .. . _ .. _ ----. . ._-" . -•-_. - -, ._..._ ._..-. '. -- '- - - . . . . _ Y 9 9 Y aFRONITED'. �YARD HWY ' TOTAL SETBACK - . . ... . �. _..... '� _�. � , r . � 9�O O�' '. tion 7044,Business ond Professions Codej. � •'�S �� � � � CONSTRUCTION IENDING AGENCY � �SE7 BACK PROP.uNE WIDTH 'o'Fi� a,O O c`� ' 1 herab affirm fhat there is a construction lendin a enc for � ' � . . . ' • -the Performance of the work-for which this permit Is issued -- �Re- --- —- - --.. ._.._ .._ __....._._. _ . _.. __.._. ...- .. . .� .- ._ .._..- - - �se�.3ov�,r�.c�. sioe D 9.0 8��6 ^ _ ._._ . . . . .P.L. _ . . . . _ _ _ �. __.. .__ _.___ .. ___ __ m .Lender'a NameNoile � - - - - -.. .. - - - .- 4 . _ 0 .6'U IDhV+Ref.M. ' � . . . . ._. . - . , . __.. .. .. .. . . P.C.FeeS' . ..""._'_ Permit Fee' _' _ ' ._ '.. _.__... ^ Lender'sAddress , ' ���� � "' � I tartify thal I have read this opplitation and stafe that Ihe • �� - - � Issuance Pee- S� tDnnA viC M � - - --- - ��- - --- - a Gbove informofion is torrecl.I ogree to comply with all Counly ���evigo�ion Fee � ��, g ..ordinances and State lawz reloling lo boilding construction, . _ _ .� . . . ...____'_ '. Toral fee.... . .,. --� '' IDMA Perm.'8-..'. . .__... . _.. ._... ..'. ____ . _ -. • and he by au�ho�ize presentaf s of this Counry to enter � � upon e above-m �oned pro ty for Inspection purposes. � � _ �j d - � - -- -(��_['�' --.. ..--- . _ . . _ . .. .--- -....... _. . .._._ _._. . . .._ ._ .. . Q (2"(/�+ SEE REVERSE FOR E%PLANATORY UNGUAGE � ^ � O � Signatura o Pticoni or Agenr-_. . _._ ' Dote . .... ... . .... .. ._ __'" ' " ' _ �/C!.!� ' ' _ _ ' ' ' __.�._. _ ..�.. .._" ... . - . ri ' t PLANS TO APPLICANT ' ' `-'INSPECTOR'S NOTES ,.,.OyVNC•.R-IIUII.DEF DEiCLAHATION I he:eby of(irm�ho�l am exempt from Ihe CoNraUor's To: '' ..' R�fum�d � �� , . . f ' - � License;"L6w for"Ihe;following ieason. (Sec: 70�1.Sj t � � ' ' - ' ' 'Approved� ➢ul�netsandPmfrssioiuCode:Anyriryoreovntyu•bid� _ No. Oata ' No. - ����Oala�'.:=.E . .- ' ' �. . � . . ��... --, reguires a perndt!o eonstrvtl,aller,imhrove,deinolis/i, , . _ or rcpair artyttructarc,frior to its is.cuanrr,also requrres '7 !bc ap/�ficarr!fnr rutG j�crneit to filc a signeJ statenicnt Jbat�!>c is licensed jrursuanl to tbe j�rnnisiont of tLe Cnn- I � . 1)`�- ;:?� c.�- f � ,_� . � r.('�.�.� . . ' �� trac'tor's I.icense Laii�(CGapler 9J(co"nro�encing ruitL Sec- ' `.tiort 7000J nf Dii•ision 3 oJ tbc Businesr anJ Profrssions i. . ,, - ,� . �: :.; . �odeJ or tLot�c is eren pt therefmm and tbdbd rs or be ! ! _ . r ' � J e �--- � � � �� � " �allrged e.rene/�tion.'Art,y ninfnlion of Seclron]031.5 by __ _ . ..._"__..__ __ _ _... _. .. __ . � Req�kad ' '� '.-- :�-._ -- - - - ' - .- '- _- anYapplicantfora/�ernritsabjetts(hcapfrliranttoatinif Data Rxatvad -� �' i APP�����5 � ot Approwd � � - ' .: hrnalfy oJ not rnnrc tban Jirc bandred Jnlfars(SSOOJ.J: . ,. Yos No � 1 _ �, 1' . � �� � �� �- - - ' = ---�-�� -- �-�- �'- � "--- - � ❑ I,as owner of Ihe p�operty,or my employees with Water Cer�Hicate � � � � � . . , .woges as their sole compensation,will do the woik,and � ... _ __ _ ._ �� _: _ �.�.. ._ . !'�• ;� ,' -'�-----' ' -� - � " - ihe struclure�is nof intended or o(fered for iole(Sec.7044) ' Heol�h_Department_ _. _ � '.� ... - � � ••. - . . UusinessundPmfessionsCnde:TGeConlruclortLitrnte �. . . ..-.__'_ "_ . . _._. ___ ._ . . . . - - - � . I.au�Jnes not apply to an ou•ner of proJ�erty wbo bailJs Fire Departmenl _ _ . _. _ ---� -� � � � -- - - - �- - . - - - --�� ar inrrrores thereon,and u�l n dnes suc/mork Gimsrlf or - --- - . , . . . .. lbrou,qG Gis oum�employces, JirorideJ-1Gal��sucb;inr� Grading � � ,,.proren�ents arc no1 inecnded or,nfferrd jonsnle. ..�'� � , . _. -,.l�ou�ener.1l e bailJing or imrrovernent is sold a�ilGin m.. Geological��� ��- , � , _ �- - , �•� year of eonrpletion, tbe�ou�ncr-buikler.util!bavr tLe . . . burdcn oJJ�moing tLal be did not build or im/irone foY ._. _. . .. __._ -_ ___.; . . . .. . . ... tbOurposeoJsaleJ. ' , . � � PedestrionPr0letlion.� � .� .�� . . �. . ..: :.. .� . . � (Fence)(CanoPY) �� � , � � . .__. ...... .. "-- - .- -. ... .-.. .. .--- - � � '� 'I.�asownerbftheproperry:ame.clusivelymntrao- ' iing w�ih licensed coMractors to tonstruc�the project(Sec. . .��. .�•.•,� , :� : � .-----_-' -�'-��-- --�-- - _ . - - -� �� 7044)�Business and Profesaions Code:Tbe Contractori Speciol Inspection- ' � � � -�- ' . ...... ...... . ' (Cont.)(Masonry)�Welding) ' � ������ � - , LrrenteLau�docsnotapply�oanownerofpropertyubo ' � � �� - � --� ----�-'-- -- �- -�� ' - �''buiJds or�i»ipro��es thereon,and'u�bo�contracts Jor rucb lof Drainage . ' . ' . � .'._ '._.. _ .. _. . .. . Qrojects u�itb a cnntratlor(sJ litented purtaant to tbc , . - Cantractor's License LrsaJ. � , Parkin . i -_':�'.�- "- --�-- - � " � �- ❑� I am ezem t�underSec. ,B.BP. ' g - - - � , p C,for Ihis . .-- � _._._ . ___. _ . . _.__ _ .. . . . . ' � - ' 9 ' � f6050� � � • �� _ !• �-t °�..._,..�—"._ , ... , , _..._ . .___— ��4----_. . ..... . _ . . . DOtE �'OWftE!"_� � � _ __" _" .'___'_' . .�., .. Approvnls Oate �Inspoctor'i Sfgn Wro�� ' . ' , - . . . . , . �� - . �INSPECTOR'S NOTES . � . Location- / _--/� -' . . . . . , . �Setback 8 Yards) !� - � � '� faundations � . �'' , . �,.. .� � �� � ���� � � ' . �., .. , ' . .__._._. . Slab ' �� ' . . . . . .. � . � --- ---- -- - -------- � , . . , � Frame Z- 7 . .. .. � �. , ,. ... � ., . ..�. � .: Energy Insulation � � ' � - � ��. . �.-�... . . ., ...�. . � •� .. ... ._ .... ;_ .. ..' ' ___- ' . � i � �._ , � . ., . .. Lath/Drywall- J -7 .. .._. _--- -- ---___.____ � ..--. �_-- --:- _ �' . . - , Interior ^��I -. .. .. � . , . � , �.i. loth-Exterior „ � ' .-�. � ,..,:1,C; � -�i. __. _.____ _. ._ '__._ ._ .�: �� -,r�'. .,�:. ✓ ..- . ....•...✓ ' � -__� •; si � .. �, . . � House Number- .... .. ___. .._. ..__ . . ._..__. . . __._. . _ _.. - _ CorreU 8 Posted �� '�'' , . .� , Final- _ . _.__ ___ ..__._ . _....� ._ ., ._. _ . .___. _- -__ , .. _._.._.. �.,. . , , . ,. . • . Enter on Fronf `�• � � _ � � . ., .. . . ��. �� ..,. . , . . � � . , . ,r- . , . . � , , � . ._ � . . ... � .... . ,..."i ' .i .. ` �'� \�. �,�