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HomeMy WebLinkAbout1247A 1 f , . . ... .._ _ __ ... ._. .... � .. .._... . .. .. . . . . .. r . . - � �' . , �,� 'a WORKERS'COMPENSAiIONDECLARATfON� ���^�APPLIC�TI�N �VnR �MUILD�NG PERMIT �, � .� � �hereb affvmP�ct I hov(a[ertifiwt�e of'consem to aeif COUNTY OF l05 ANGELES BWLDING IAND SAFETY , � �. insure;or o cerfifico�a of Workeri Com ensa,ion Insuranca, or a cert�fied co �hereot Sec:3800,Lab:�C. �-� -� � ��� � ' g Y . . ., . .., � � �� � - �. f Pa�Y cerofied copr i:nerebyP umisned. . FOR APPLICANT TO fILL 1N ' nuoo�eP.N55G J ,/ . C.�D'a.r'C2/ K-�-.fv �• li t � -{errified mpy�la�filed with�he couny buJding Inapec- ��� BURnuvG� -'�- �(� �] -- � �- �� � - /� � '-� � - g -�Ilondepanmenl. - ... ., . ..., ..- ADDRESS� .. Y C�.. GI. K _ � �/.7� .'� �,� � �ale:���. .� . �� � Appliconl � : . ,- ., � ___. Cltt_... �. .^J .'p.. tIP�, . � ...fj�.�..J. LOCAUTY. , . . . . ..... • . f ... : - �3 a. . ...,.... �, �.. ��CERTIFICATE OF EXEMPTION FROM WORKERS'-��� � � ����- � �� �,���� NO.Of.BlDGS., � r. ...... NEAREST , , , j � ���-COMPENSAT�ON 1NSURANCE� - SIZE OF t0T � NOW ON lOT CRO55 5T. � �-�' �� " � (This tection.eeed uot be comple�ed if the permi��ia for one _ ��1 . _ t� .. ��� ... . . . ....� . ... � i �hundred doliars(S�EK1)or less.) :- . . , - TRACT pf � �BLOCK � �� � LOT NO. �'7 �� Mqp gppK�'�� � PAGE PAR�L . .. . ., .. �-. .. � .� 7E1.?� ' .' USE 7QNE N✓+F . . .� so os!�o becomethe�I eriormdnPca�f�e�work�for�hicfi this � ' �Ea (1!�E,[„ -� � �O� �NO. '� I ��� .�p�p.. �� 'f�-.�,3 . -� permA is faaued;1 shall oot em to a rson in on manner �,t,, � � ; ��' y.. SPECIAL . .. . _. � �+ ; sub'ecF10 ihe WodceTa Com naatiOn lawb. �� � ADDRE55�'TT -� :-L~. 6CK.... CONDITIONS � � U j Daie� .�� 8!Q Applimnt� �a�"�""' clrr Q N � tlr �{��o �J' _ . � , -N O i I �T O P%.I C A N T:J f;o ft e r��m a k m �i h i s C C r h f i C a t e O f � �1RCHIiER OR , ��� . ,p15TRICT GRQUP iYPE FIRE PROCE55E�BY � � 9 NGINEER �� � - - � � fxemption;�,you should`6ecome subjen.ro .fMe�Warkars' -� /'�� - ��T. ; � ZONE � . �� ��' j ii ! Campensa�ion pro4isions.of�the Labor.Code,you m�at forth- � . � A��� � � < ' • wuh comply wilh wch provisions ar this parml�ahall be �E� sunSnU�aaSsiFicnn N �vT. oNoo. N i deemad revoked. �..,.. � ,,, . � �pNTgp,C7pR �. . Np. p� ; ,'� � LICENSED CONTRACTORS DECIARATION.-. . '.�..... ._ ....�� ...... . . ... . ...._lIG -CLA55 NO.�_nSQ_DWELL.IYNITS � ��':� � : I hereby affi�m tFw1 I am licensed under provisiOns of Chapter 9 . ADDRE55 � NO. �� �R�P , . ( (commencing with Settion 70W)of Divlaion 3 Of tha Business dnd , . , . .LIC. � ..., � . ..� . . Professfons Code,and my Ikense b in fuil force oed effed. � �FT. .qc��f....NO.OF, NO.OF C� 'CN ...��BK... .. ..�..� .. . . . VAl10ATION I LicenseNumber���� UC.�Ctos• '� � SRE� af.Jo� STORIES ���� �� FAMIl1E5 � ' ONE � , � l�i�}Ttd COVE2i r;Ew d v�u.uanoN � � DESCRIPTIONOF WORK� n.,�� ' � � � aItCttor ..:. . , � Dote;. . . . . p , �� . ADD . .j � _v.fJ . . : , .... _.� , 1 om ezempl under Sec. -� ALTER�` � . . �. �8.8P.C.for ihis roason . . . . . . � . � REPAIR : . . . . .. . .. �. . . . .'� . . ��, � .. : .. .._ . . . .__. .. Dole: - .. :....,. E%STNGBLOG. � . . . . � . DEMQL ... ' .�. �- -Siqnature�.. �. . _ . _ � ... ..,- .. � .�..�... nvP�KANi _.... . ._ ., _ .TE�. � �. �.'� FINAL .,..� . .. . . �PRIM � �� NO. ��. . ... . �� Z A.RI;R � � OWNER-BUILDER OKIARATION . DATE . . , . ...., . .. �!hereby affirm that.l am ezempt from the Contrectoi'�License.'. -.. ��._... __.�._....... . . .... _ . .., , , :.. � ' Law for the following roason(Section 703L5,Business and � n�DueSS fINAL ��. � ���-:�� ��-'. #•:���••��,� ,��'I o n o�wner of 1he prop, �.... .. .. „ ., . _.. vRE EN --. ., .__ . . . ..._ � , . . �:sY ,. ..._ . � � +�3�i 7�.��. � ew�oir� erty,.or my employees with ADDRE55 wagea oa thelr aole compensation,wl lt do the work and � �- � �'� �' � �' •• •�3'�7 J cz.,� the etrucwro is not�ntandad or ofiered for sale(Section ��'��TY �' � : i ... .7044,�8uainesaondWofessionaCode�. .. . _._ . _ .. Mpv�rlG- _-_ . . ._ .. . . .. if1. ... �... ,._ . . ... . .. . . . '_0$,.�p-.$,g ,. � I,es owner of the property,om exclunively tontracting �T�A�T� NO � � �,. .. .. .witb Ifcenaed contraatoro�io�conatroct the project(Seo-.- -.. .. ..... - ..... .... . . . . . . ...-- .. . . . .- . . . ..-. � ..^..... � ��ion 7044,Buainesa and%ofesslona Code). � � ADDRE55� � �� - �� � , ;. , . ...: ...:CONSTRUCTION LENDING'AGENCY _........ �.��_. .._ .RSET�6ACK...�...YAR�._HWY. � I4TA`SEfBACK . . �, � . . . .- . .. .. . ' � SE PROV.IINE 'WI�iH '� �" ' " � 1 herobyaffirm tha�ihere is a constroetion lending a9���Y� � fkONT � . - �� . . '; � ��.�;-��- . ._.lhe performance of the.work for.wMch.thia permli l:.issued� ,. � P.t.. . ... � .. .. .. .. ... . . . . .... : ... . ..(Sec.3097.Civ.C.). � � SIDE . . � � . .. . _ . P.L.� . , . . , . � Lende✓�Name _.... ... .. ... . � .. . .� t�Mh Ref..•. .... .�. . � . . . .. . � - . . �.�_. . .. . . . _. ... P.C.F��S � ..Pormil fee . . ,. .. . . � � Lender's Addresa �yy � � . I c�rlify_that 1 have r�ad ihis appilmtion and slafe Ihat the .,,_ , . Itsuonce Fse I��V`! LpMq p2#� � - . " . � B above information Ls eorretl.1 opree lo eomp ly wNh oll Couny � � tnwariqauon F�e � . :2,�'iy�.. . . $ ordinonces and SWte law�rela�ing to bulldlnq consh�cib�. ..� . . Tatal F�e_. .�t'C� Y �� tOMa v�rm..N ... ,., . ' ' R and hareby amhaize reprnenfctives of thfs County to enror" ` ' � �pon the obovs-ment�io��ned�pro�p/eJrry for In�pection purposes � . .. �'"�� . ° . � )(�Clf'dl��O����f.yGC2.L'CiJ ��.......� 'd� . ... . _. „. ._. _ . . _.,,.. . . .. ` . .. . �. .M1 �O � �EE REVERSE FOR E](P4INATORY UNGUAGE .. . -.Siqnotun of Apphwnt w Apent ., ..po'te. .� �. . .. . . . . . � . . - .-... .. I // .. .. . . .. . ..... ... ; ,. �t _ --_ . _ _ . _ _ _ ___. ._ __ _ _ . _ -- , . - _ . _ ...� .,... . . � QN�MIiN-UG111.DfN,�D6E:i.ARA1'ION •- i _ � PLANS TO AAPLICANT INSPEQO@'S NOTFS� � �hereby qff m�ha�1 pm exempr lrom the Coniracror's " I _. To: . .� � � . kaluined � � . ,_ . ., . , � _ ��.�.4�tense,Lpw, for ihe�foilowing re<isqn;�,(Sec`'7037.5) � . , � �AProvad , � .Bnsinasx artJ PmJB511(lpS C!fJC Any#ItV i r��ustY u bk6 .� No. Date ' No. �" ` 'Do1e ,' � '" ' °'� '� ' requrres a pernrit(n cnnsfrud ultrr,:mpr re,de noGsb, � �� :,. > , . � .' �, r -, " .. . ... _- arrrfarrany�eructrrrc,�`rnnrf>sts�i.�� �xce,alx�rir.�jmir�s , ., �,,,��.a', ":..., ,.......� ......"u ..�� '.. �.,� � , i'.. a;:..`../...:.� � ��: .. . • � ; L he a Q/i licun t,/nY tut h f r e r xor!t d�f f le'a�si�na J32a3emen t ! . _ ... __ .__ . _. . _... , ..'.'_� „_ ___. _.. _.._ ._ � .... . ��,,� C �� � .;.-�2b�t�1,+e.islitensedyarsu.rnitorbeprnrnsinrs:n(_tbeGon• ._. _ _.. . . . �� '�... _._... . _�`.i-1�:.)r� _:��Q!{ ...:; �.,�'�... �3Y1��.,�: . �,� . tmctnr'sl.ieens.rl.nm(Chufiter9//nrmro�enrii�g.u�th.lec% � tlnn?OOOJ njDirisinn 3 q !be Buainess and!'rn/ession.G , , ` s . � � ��1.�,�. _ `._: . -�{.I<.:.__�5�n���hr7S��-" „ ___.fiodeJorlbutheia.erem¢ttGerefi»mttrtdihehnsi.s/vrthi �� . :..... ..... . ...... ......____ ...._ ._..�.. . . .. ..__. � . , . � . . � ' ' ' qtleqPd�exem finK:�M+ty�aiolatiop�6fSecflnn�.7U31.SQv � .... __._R� ulr�d . . 4 f a .... . ' . � urs a bcant.nr'a' eineit tub erls tha u !i�'an!M o ciril ......._. ...,_.. _ .._... .. ___.. . . .:.,. i A rovols 'q �-Oala N�cfived . � -, �' � Y rr � f ! hA . PP ... ��_"/oi No � or Apgroved� ', ` . �_.j ,, �•..:� � •;'.�prna(Ly b/noXmme-tban Jku buRdreJ dotlars/3500i:J:. __.. .._ . . __ � .___._-._. _ _........ . _ . . . �., .. . .... .. . ..... ._... . _,. ... . .. . � � ' y�r ' �� ,, r�,r� �, � ;:. (_) 1,as owner of hhe property,or my employees�wlih � . ; . ;.. ,. �. �,, ' . . . _. , . �.,� �Yoten.CertiEicote�. ^ ' ::.." � ' .>. .� .. .,. . � :`,`; _:- ... .--- � .. . .: .:�.�.... .-�- _.-�.. ._.. ,„..��.wage,s 95 ihen.gqle mm ensatiqn.�vill.do)he work.pnd . ' ' '� ,i, (�� ..r,; �...�L; ,�.ly,F�- �,.IhestrociNre�isnatin.rendedoroffered�orsa�e_(Sec.70A4) f '� � Healrh�Departmen� -�._._ ._...... ..: ..•, . .- - �.- -..-. .. ._..�.. .. . , .�p sinrss nad Pm%uinns Cade:�Tlse Contruct.�r's Licexse ' ' � ' � r .. S.1 �1¢u dt084fi0t O ! 'Yo an nu�aer r� r .. ; ...."" L ',Si�� - � � �.: �tYt ,,x�x�.�� ' . s � � ���� 9r�9 P4'4ti.�u� �r,duiids ` Eire��DePortment � - - �- - -.- ._ . ,.,� . , . , �}=.}�`�m}hrove�thareaie;'lndu•badoessSi tkwk.hi elfm , ._�.- ...�. �� .,�•..•.��. ,. .� . . ' !.. �. ,lGrnd,qb`his i.nunf"em(�1a.yees.ficduided,�6uF:suib Tvrc- � � �rqd�ng ...;..t. . ., . . � , ...- ��. ' •,.. ,'. �� . �� _.__ ...._.. . .-.hr�t�emebis'�e�•n'�se i�eteeuled or.n/Jered�for.salr.�lj, �.� . � I. � c:�- . • .c-,� ....... ._._ _ '.�:�_ . .._.� _.,,^ bnu•i� ,�tfi n:ldlkgii m/n»uer.ienta atdu�ithinnpe � Geolog tnl � - �� � � .. � ` C��... �' ............... _� .._��'.�._ ._...__._ .4, . � bardenf n��rovs�ql[hubbr did xo�l b�d�r�tmprnoe tbe . . ' � � � .�. fnr __- ` ;tbe u / ... - Redes�r an Protecrioe . . . , � D *P,,;.. . . (Fencei(�noPY}� . �:, F ...""� "�:�.d.."-' �;� i osownetof�he.property,ome.d�sivelY�toqirtic�. , ...: . �^.:. . `�� ;: .. . � ..(ing.wifh ficensed cOntrpctors to construct 1he praject.(S�c. ....._. _.. . . .. . '_!_�. . ' _",.. . ... �.. . .��; Special Inspedion�� 7044)Business arod PrnJesseons�Cade:'1'he Contraotnr's , .... . . � .. � ,-. , .. � {Gont.)�Mdsonry)IWelding) ^..�. . . ". �� .._ ....,._._., . -...._ ... . � '.� ...._.(.itenaeLam,dnes.,�niufi(ilY,toanouineru�J,rnp¢rtyulrn ,�, � . _ .-.:.- .: ..._ .. .., ... ._ ..... . , � ;�� r._,..;t r-� . �f_�'� . bailds or iinprones tAereon,and ur{�n rnnfracts fe>r such .. Lot Droinoge � . � "�:. 4 : ,`� ; . . . -�.�.. . ._..... . . _ .�.. ._....:. ..__.. . . ..,. �rqects astb a rnn actir/sj licensed pana4Rt[o tbe ' tr . . . -,., .� . , �„ t .. "' .� _�C rstract `sLrcenser,au) --.. _ � .�.-; . . �1..) ....�..€. - \P"-.0 (,� � - •;.., . �..,- : � ' � Parking . . � . . . .. . _ .. . ._..__. .„__..._ ¢._.... , . . . � . L. I am exem t under Sec. .$.&P.t.for tMis ;. . � ..,.....�., __._.__._._- ...�.:�,:, �; - .i.��� �-- � . . . . _ . _. ... _.._..... . . _.. ._ .. . ' , � . � � reason � . � .,.,. . .. _- ._. _ . _ . _ . .. _.._. . _. � . '_._�,..._ .. . ..._.e_.___ . � . . . . ... ..... .. ..�.. . .�.:. - Oare Owner . . . . - .:- .., . , .'. ,��, .�s ,. .. . . ��,'. ;;, _.._.. ..__..__._. .. ..._ ...._..__ .-� . . . . ,. � ....... _ ._....... ......W. .___ __._ _ . � �''� . _._. ._. . .... ._..___ � .. . . ,.,,� ', 'APProv61s'�''� Oota ' _ : InspveToi�Signptun ; a ' '..� �..., � ..� ,... .„ . _.... . F�-�.. % t... IN5PEC70R'S NOTES. . � ..c.� .I LO[blion.-:. v.�. 1� � .... _.. .__...__,.....� .....�... . . � : . . � (SetbaCk.BYords�. � " .._.._.. . . ..._... _.. . .._ �-� ,:,. :. r,�,=. � :., �. .... . . ... ..., . .,.{� :. �"��t � . �, . - . .� . ..:. .,. ', Foundalions . ' �'' � ' ,7.�:- .�,,, .. '�.. , .,'.: , ... �is . :�;.: ; � . � Slob � _ � ...,- , . . . , , . , . .,. ' -. � . . --....__ .__.__s. __._.-_.___....__-__ ._....::'.:___. _ .. :i, :.,....� , ,� _ . „ , i. � :.. . -�-, . . � frame � . . . . . . .�.. , .. . _ . , . ....�...,., �.�;:_` ;, . . .. , , . _ ,... .�i. �>�::.� S ,, � .��.. . . , � . _ ... .. , . . .. �. . �.:-_... . . ;..:. .__.,._,.. t ._......_ __i._..:, . _"� ,..... ..-.-. .. ,_ ', Energy Insulation . . . . . � - , '�.'-_. f . _ ... . � K F.. tath/Drywall- � .�...._._.... __._ , ...�....:__f . : ._. .._.. .. . .. _ ..__._._ ;.�� ..� � _ ..., ., ; . -! . Ineerior � � � � j � � . � � lafi-E.tenor : . . . . . . ..... .. ._.: . . ..,,. ���,.� ... ...,.. . _.. _.._.___.. _....__ . .._._.. .. . , . .,.. .. ,.� r . ,,:... _�. , .. . .. � .. . .� ( __. , _..�.. ,__'_'.... . r, . NouseNumbar._ .� � �. .`... .._... ::.:.�_�_._._ ._..�. ..__'_.__' "� . ,�. . .. torrect 8 Pos�ed � � - ... . . .�� �', 1. I ,.� .,_ ._ ..._. ___ __ , . ., . ,_. . ._.i. . .....� Flnal- . . - .�. . . ._. . . _ . .. .__.... . _.. .�. . ,... , �. £nter on Fron� - � . . � . :. .... . \ �� i l.,'. .. ., ., � . � . ',.:.:.,, .. .. . .. ,..: .. � ' � . .. . . . �� ... .' . ,.. , . ;..�:,Y ..., �.l'� ` � �`l i-� 5� i��+ f '..1.. -.,1.;^SC .