HomeMy WebLinkAbout1003A -- ----- -- ._- -_ ___ ------,.----.._ .
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insureUororc1enificale'o�WorkeneCompe�s�tlooln�o��e=o: APPLICATION FOR BUILDING PERMIT �
a cerrified copy�hereof(Sec.3800,lab.C.) �OUNTY OF LO$ANGELES � BUILDING AND SAFETY
Polity No. Compony
Cenified copy is he�eby Surnbhed. FOR APPLICANT TO FILL IN AD R°55 j
❑ 3 C��-� �E1��-N .Q Z
�Certi(ied copy is/iled with�he coun build� g inspet BUIIDING t I G G4�3 a U n� �
tian depor�ment. ADDRE55 � IOCALRY �
NF�w".•
Daie��Appl�can� aTv LI/ f�}-Lk/!3' r— zia ,�' '—.}�' —f!'/�?
CERTIFICAiE OF EXEMPTIO R , ORKERS' � NO.OF BtDGS. �
� COMPENSATION INSURANCE � S�ZE OF LOT N�W ON l07 � _� I. � PAGE PARCEI
(This section need not be compleied if�he permit is for one ' �� r� ''�'u`P
hundred dolla.s(5100)or less.) - tenct �Jr BIOCK ioT No. ��� il No. �� �3c� �,
TEL. T SPECIAL n,
OWNER �✓ ,Cv NO —�� �V� �ONDITIpNS
I certify Ihat in the performonce of the work(or which�his , �
' �pe�mit i1 IssuetJ,1 shall np�empl0y any perion In pny mtlnner DISTRICT G���ppp UP TYFE FIRE PROCESSED BY (J
so as to become subject fo fhe Workers'Compensotian Laws. 1•DDRESS L U h!P � //� CONST.A/ 20}'E a
� S
utr L/v. � ziP �f � .:� r
�Dote Appli�Ont � SiAi15TICAl CLASSIfICATION APi. DO. (J
�NOTICE TO APCLICANT: If, of�er making this Certifica�e of ARCHITEQ OR - � �EL. . �,y
.Exemplion, you should be[ome SubjeCl fo �he WOrlcels' ENGMEER NO. �tAS$NO. DWELL.UN175_ �
� Compe�solion prowisions of ihe La6or Code,you musr fnnh- AODRESS SEwER huP . ?=
with comply�with su<h provisions or ihis permit shall be - /`
� deemed revoked, iE�' ` _ gK. / pC,, � VALIDATION
fONTRACTOR No. - � .
' � �..LKENSED CONTRAGiORS DECLARATION � / p�, �
I hereby offirm thot I am licensed vnder provisions of Chaprer 9 ADDRE55 /� NO. � � VAlUAT10N ��=
(commenring wilh 5e<tion 7000�of Division 3 af 1he Business ond ��� a[ �,p ��
� �Rofessions Code,and my license is in fu�l(orce ond'eHecL CiTY ClA55Z 7`�O L' S Y �
�/ 50.FT.�7' �y NO.OF NO.OF CHECN '
license Number ` 7 { � Lic.Class �� �y SIZE 4�^! 'STORIES fnMiL�ES � ONE '
/ J � fU'Tli+Y,G NEw � 3
Confroct��j�Do�e� DESCRIPTIONOFWORK JU . �
❑ ADD
I am eaempl from ihe licensing requirameMs as I om a � q
� licensed a.thi�ect or a regisrered professionol engineer . nitEa � FINAL .
oc�ing in my professional capacity (Section 7051, � REPA�R � DATE � D� �
� Business and Professions Code�. USE OF � � . �
EX1571NGBlDG. .LD !c�-P4�L DEktOi ❑ FIMAL /�
Li[.or Reg.No. Date APPLKANt iEL 8Y l� .
OWNER-BUILDER DECLARATION PR1Ni) v0. I ^ Gy �
1 hereby ofiirm tho11 am erempf from the Conirocfor's license qDDRESs � ����M�� �'� �
Law for Ihc foliowing reoson(Section 7031.5,8usiness and - � y_� (i[!;t� •
Frofe3sions Code): GRE EM .
-� I,�as owner of the t or m Ip bUIlOiNG. . ' a a o •�
proper y, y p yees wilh AODRE55 �'`
� woges as their sole compensation,will do the work and
�he structure is nat imeoded or affered for sale(Section� �DCnuTv � j .� �i��,rj ;
704G,Business and Prafessions Code). �- MOVING TEL � _
� 1,os owner of ihe property,om exclusively connauing CONTRn[70R � NO. � . o j !1'�,i,. � �
wiih licensed conlrocrors fo consh�c��he projeCt(Sec• qODRE55 � � �"=
tion�Oa4,Business and Professions Code). � � G c'�� G—���� .
CONSiRUCTION LEND�NG AGENC'� REQUIRFD yqRD HWY T01Al5EiBACK FROM EXIST. - � '
$Ei BnCK PROP,tINE W OiN �
I he.e6y afiirm�Fof rhere is o consrrunion iending ogency for FeONr 0 O . � . . �
ibe perfarmance af the work for which this permit is issued v t � � '
. (Sec.3097,Civ.C.). 90E - � -
P.L.
Lender's Name )/� . , -
Lender's Address v.0 Fee 5 �ermir Fee �JD �`r ` � ' . �
1 ceni(y 7hat I have reod this oppiimtion and state thor�he Issu ce Fee ��S� � .
above informorion it m�rect.�agree ro compiy wilh oil County , invev�garon Fee �� /� �
�ordinances a Siare lows reloring�0 6uilding consrructian, 7omi Fee �
and here6y uthorize represe rotives of this County to enter . ,
upon the ove-menr� ied ropeny f inspection purposes. � , ,
� SFE REVERSE FOR EXPLANATORY IANGUAGE
Sign9 of AppliC nl O� genl � Po�e �
� PLANS TO APPIICANT � � INSPECTOH'S NOTES � OR'NER-TiUlLucn.,____
I heteby affirm thdt I am exempt from ihc CoMraao�_
To: � � 6eWrned � � � ' ��license Law for the following rooson. {Sec. 7031.5)
Approwd Business and Profesaions Code:Any city or county u•GicE
Ho. - Defo - � No, pete � � requires a frermit 10 cottstruct,alter,imyrove,demolisb,
or r�airarty ttructurc,Priot to its issucncc,ako requires
- �- - - �� - - � �� � � .Sl c applitamtJorsucbprnnit[o file a signedstatemene
_ , . , , . _. ,� , tbal Gc is ficcucdpursunn0 to[bcpravisions oJtbe Con•
� - � � � � �"� �, tractor'sLicentelaw(C�apter9J(comm¢ncingmitbSeo-
- tion JOOOJ qf Divisinx 3 0/ibe Ruxineu and Profeuiotta
� - ' , CodeJ or[1 at 1 c is cxempt tLenJron�and tbe basis far tbe
.____ efleged excrrrption.Any violatiors of Section�031.5 by
, �Roqulrod DuteRece[v.d . � anyapplitantforopermitsubjrcfstbrapplicartttoarivi!
. Approvale . a�AFP�QYad penalty of not morr tGma fivc Gundred dallars(SSOOJ.J:
Yas No •
� , � . ❑ 1,as owner of the propeny,or my employees with
� Water Cenificate � � , , wages as 7heir solo mmpenso�ion,will do tho work,ond
� . . - , �he strutture is nm iMended or offered for sale(Sec.7044)
Heahh Deparlmani� � , Dasincai nnd ProfCSSfOHS CO[�C.TLC COEff6CfUT5 LfGCfISC
� • ' � . � �Law dars no!affly to an ouncr oJp�oQcrfy wbo builds
Firo Depanment � , o>improner tGereon,and wbo docs�uch work bimse f or
- - . - �� lbrou,qb Gis ou�rt employeea,prnvided!1 at sach inr-
Grading � . proocments are xot intendeJ or offered for sale.Jf, �
Gowever,tJ e buildircg os improv¢men t i.e to(d ruithin ane
Gealogical � - . . , , . .., . ._., , year of eompletion, Jbe ou,�nes-6uilJer wil!Gaoe tbe �
. . busdors vjproving IGat bc did not build or improvc for
� Pedestrion Protecrian � - � , ibe purpose oJaaleJ.
(Fence}(Canopy) � � � � � ❑ �I,asownerofihepraperty,amexclusivelycontrac-
' tirg wiih ticensed comranors ro canstrvct the proieci(Sec.
Special Inspeciion � � � � -. � •- 7044)pusincxs ond Professions�Code.Tbe Contrattori
(Conc.)(Masanry}(Welding) Lice�uc I,au�dnes nntapp/y M an aecner ojproperty w!o
' . � � - . , 6viWs or i proves sbereon,and wGo contratts far sucb
� lot Drainpge � . � projects u�itb a coniractor(s)licensed pursuani to Obe
�� � � ., . Contraclor's Lircrcsc LauJ. �
' Parking ' , . ❑ famexemptunder5ec. ,B.BP.C-forthis
. . . � . . reason
. Uote� - Ownet
Approvels Oafv lnspoctor's Sfgnaturo , � ' ,
INSPECTOR'S NDTES �
Locotion— . . �
�Setback 8 Yards) �
Foundmions . .
Sia6 ,
Frame �y� � � ' �
/'
Energy Insulafion it � l ' . . ' �
1
La�hl6rywa11— .
INerior - � �
La1h—Exlerior � � ,%-�"� � �
House Number— ' .
Corretl&Posted � - � - �� �
Final—
Enter an Front � ��