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HomeMy WebLinkAbout0773A (4) _ ._ i _ _ i i _ _._ '� , i - . �WORKERS'COMPENSATION DECLARATION � � ' � �� � �� � �here6y aHirm that t have a`tertificafe of consent To�elf A, pp��Ci�1T(ON��F4Rm BUILDING PERMIT ' Insure,or a�certifim�e of Workera'Compmsation Insumnce, � � . � or o-cerrified copy thereof(Sec.�3800, b.Cyl y�r^_ � ....CCUN7Y.OF IOS.ANGELES .�', :�. ?.�BUILDING"AND SAFETY '� � P_olicyNo��'3ql/ Compcny / L! . . . _..::.. . .. .. . .. . ...' . Y�4 CQ�'fied copy Is beroby fvrnlsbed. � Bui�DinlG , � �`�� ^ LIGANT TO Flll IN . .. ._ nooaess '�'•r`��+'� t.:s_r.fcL . � >�Cerlified.copy fa fi4ed�wilh the!o ny buildin (nsper , BUiI�wG�. � . ; � . � �� . tion.depa.�men�. nooeess, FOR APP_ . . . �^ iocn�m _.. , _ I Dote„�K��.g:��ApplimM 6 U � . ��, Cltt� ZIP � � CRO55 ST. �-,CERTIPICATE OF EXEMPTION FROM.WORKERS"�� � � � � � . NO.OF B�DGS. - � nSSesSOti � � � � �.COMPENSATION INSURANCE� � . . SIZE OF lOT NOW ON LOT� � � MAP BOOK �PAGE PAkCEL � . �This aealon need not be tompleted if the�-permir is for ooe q . � � u5E ONe MnP �� � � .: TRACT or 7S��J BLOCK � LOT NO.���. undied dollars(5100)Or less:) . �. . . �/ �� ��� N0. � ' ���jj 3 . ,, . ... . . .. , , . . . .. . . . . . . ... TEL y �� �� SPECIAL �,-- y . � �1 tertify thqtin ihe performance af fhe woik forwhlch thia ' OwNER NO. 7S�¢ CON�ITION5� � . a. permit Js Iss�ed,�I�hqll nof Gmploy any pe�son in ony maaner � � ��-�� � �'� �� �'' ��-��� �-� � ��-� � • D�STRIQ GROUP TYPE � FlRE PROCESSED 8Y � Q sa as ro�become sub�ect to 1he Workers'Compensafion Laws. AooRe55 � � [ CONSi—�— . 20 � ��.U , . .._ _ �fl �� . �, l I � Dote �`. �. ' Applicont - � . . . CITY � ZIP ',. STA7ISTICAI ClAS51FIGTION� .. .,. . APT. . CON00. O NOFICE TO APPLIUNT:-If,�aher making-this Certificate of ARCHI7ECTOR , ,,,„ , 1EL , __._ _._. � V F.x.amption,: you.should 6ecome�sub�ed�to tk�e.Workers� ENGINEER "NO.�` . CLqSS Np. �T� � pyVEU.UNITS � � d ' Compenwrion provlslons of the Labor Code,yov mvst forih- A���_ .. ._. �....._. .,.__.. . _. .... . .:'� �W�R MAP � with comply with suth provisions or this permit�ahall�be � r ,�� F �, � . '2 deemedievoked..' � . ' . .... _ � 7 y � - . :-� . .. . VALtDATION�� ,. ..- - � . �. -. CONTRACTOR .�. � ' . . „ ...' 8K:-,,_..pG; , �. . � �� . �UCENSED CONTRAGTORS DECLARATION� -' ' - L9 �� `� �'.� �-��YAlUATION �-� ' . . 1 hereby offirm that 1 nm licensed under provisions of Chapter 9 �; ADORE55� `s � �m � 3 . . � � �� - - �� �� � I, . � (commencingwith Section 700D)of Dirision 3 of�he Busiaess and -� �' � � � . � . ._.., .. . , Professlons Code,and my licenae.ia M f�ll force and effect. � �� 50.Fr:� " NO�OF� i No.t7�5� � CriECK .. S��'�. � . .. �, { "tIC. licenie NumbeF:. ���` tit:Closs �.3� � S�2E STORIES � � FAMiU ..� ONE � �..� .. . -.. -- /� .,,�.e.� O �. . . . . , _ _ , _..... _ , . , . , . Conlratfor •G✓E-' I �� te��-k��. ^�a^Pl �i �ESCRIPTION OP WORK.. .. � � NEW '.Q �f .. . :�.� , . .�.�� ,',. .. ��- . .. .. . �_oO�. AOD ..� . . _! . . . _ .. . ❑I am exempt.under Set. � �� _� d.. .� ALTER [� ftNAL / . ... . . . � i : � B.&P.C.for thii reoson� ..` . ' . :� ' L R�PAiR•�� .....�DATE f�� , ' �. . � .. ,... � � � Da1e: � '�.. USE . Ny � __.F{NAL. ' � . .. � . .� EXrSnn�G BtDG...�. ._. .-_.._,. . ...DEMoI. . 6 ` ..., ._ ,,... y � ��Signaturc .. , . .. . . . � ! APPLIUNT TEI. . �OWNER-BUILDER DECIARATIQN �� - -� ��NT .NO... � ' " ���� ', �- - � �� �� � � � 1 hereby affirm that I am exempt from the Comr6ctor'�license ��. �� � � � � . ,� _ , , ��'J 7,�, A . . law f Ir as ownoe ing reason(Seetion 7031.5,B�aineas ond A�u .. � . ...� ...... .. . . . .. . � Prafes5lona Code): . �.- �. � -. :' ` PRE N . . , ����a�;�{� .. O . . ; . ' , BUQDING �. � , .. . ._.,' . , of the ProP�rtY,ar my employees with � nODRESS_ ._ -_.-�.. �-.- .._ ...._. . .s ,��0 0 , wages as iheir sole tompenaafioo,will do the woik and .�; -��� � . , � � � , .,. , �. 1he ntruc�ure is u�lotended or offored for aole(SecHon . .. ' ����T�'� . . . . � .... , .._..... ...... ..._ :.,..... .. ..�.� r�4.�0 d'� - . 7044,Business.and Professions Code)., - � - ; MOVING � . 7Et. � � . . � . � ..I..os owner of the:propeny,am excluslvely eonqacting ...:.:. �� � �"� NO. � ..._. ...._...._.. . __.., ; . . ... .. . �..�'Z l.$+•.€j� .. -�wifh licenaed eonkacfors to construct tbe projacf(Seo- � ADDRE55 � � � � �� �� . . .. _ .Hon 7044.B�sinea5 oed Professions Code). �,� • � -. . � �.� � ...__ ,...._. _.�.... . . .. . . .. � _. .� . . -� � �CONSTRUCTIONLENDINGAGENCY -� - .�B,q�K YARD HWY ��P�FROM F�XIS7.: . . - , .. .lW IDTH ...� . 1 hereby effirm Ihat there Is a construdfon lendinq ayency fo� f ONITE� .. . i07n1 Sei. ...,. _ .........- ...- - -..... .....v......... . . ...... ..... ..... .. ... �� ihe performance of�he work for wMch thla perm8 b iuued P.t. � � . � . t5at.3097,CIJ...C.}.� . . . ¢IDE � � ..,._..:.... .....,_.._.. ...... .... . ..........._........, .... - ..,'�, , . . _ . �P.L. .. � ...-.. ... ...__., , . . 3 Lender'sName . . . - � . . ... .. . . .. .i.� .: � � B . .. . .. . . � . _.. . . . � . . . .�.... ._. .,.. __�,. ........ .. _..... ?.. ,.,�Q . ......, _..._..... .... ... . . . _....... . . .. � , . .- LenderS Addrosa � � 4.C:�Fee S Permll Fee � �,/ . .. . ... . ' . . . . . ..:.._�_. ....: � . ... .__.. ._ .. _. ..__... .... . .. ..��. ... .... _ fY . PP . . . . . ..... . ' laeuonce Fee� � l certi thaf I�hare reod fhis a lifafion�ond siote that the ' !O'�,!'Q.`-.. . .. . . -,� ..' � above Information is cwred.I agree to tomply wlfh.oll Co�nry Inveryation Fes . � . � - � . .. . . ... ... ; . ..._ ... i _�, ...ordirwnees ond$fare laws relating ro bullding�construtlion, . .. . . .` .. . . . -..'........'_..'.......-. 6nd hereby authprize r,presenfofives of Ihls�Couny to enter Toml Fee � .Q� .� � ...epon 1 obove,men �ed/prop rry for inspection porposes. -_. . ..:. .,.., _.,._ ,.. . .:. ..,_... ._.,-_. . .. . .. .... e . Lf''.. �. : I I�iL",�.Z�O�P� .,'� , :.: QEE REIIERSE fOR E%PUNATORY tANGUAGE . .... _..� ._�. _ . _..... ._ � ..._ . � � . . Slqnafun of Applimnf or gem � . DaM ,'. . . � � � .. . .. . � . � .. .... . .� . ..;ms _ _. _ . - � � . � - � .,`.IT??;� D�',U2?:i �3..':i^� '� � `•�i ,� d'=PLANi�TO AfP.IlCAM".•` : „ ,.�.'- '�� ';..' . ��tNSPECTdR�N07E5 � t'�� .�,e:ci t �QW.N$R$BiLDnER,AECL(�,Re�T�,ON. ��. � , , ,�i,-4 heteby�;;pHum qh._ p ex�mpl:from the.Cqntrc4�or's . Toc �. .. . . Raturn�d Lrcense Louc iWJ ibe.<follaWing_�.reason..�Sec .70�1�6) � :. .,.. ., �., ,.... .-- c _, •..<.:: i , .:. .�`APProV�d �' � e��ensCode,A � ' on Yetywbieb ' Ne. ----- . __ _ � # �,R 9winess� �rd;� +�}^�rtq pah � .�-No. ���`Dalo _ - . .� .. .. - �""'�-rrgaises'�p¢rriMtinzoiislrucerrlr�r.i+kpre�v¢,�demotj.cb, . .. ,,.. .. .. . , -- . : � . . . ".��. . ..���: �-. .,,,,. . . . � ar repadr any slructJCre,jd�ior to itS�fati�an�e,aGo 1'eqfFiteY . t_..._....__._____. ,.i .. .:__:._. �_:._�. ...... :�.,.: .__...... .,.. ...�_.,, . .... _ .___ ._... _ _ . �, � .. � .,;`\i . ��.:..:..` ..y.�. _, ..,-.; r��.'.:. , -:a"=�be..�P�trcrsrsnt��sucb�pnimlt:to jile;a.sig»ed atat�en ��,, r.. _.._ .�_____.� ..._. . , �-�'. . . ...:. � _..__..._._ _. ., ._,.... __., . . . , . .. � .� _, . ,. thaf$e is licens d ursuanr to tbe pfovu�oxs o,�tbe Ofl- , � \_.�` �.-_._". ;.� '. � � � r.,C� ..� � .:� ,� .-trnc 'qLicenseZdWrCh¢pter9lfcemmexcin +edtbSer �,... ,.. , . � t, � .. �.,:� __ __ _ ,' , . ' '�,sioK--7000'fbjl7iois�bn-3bft�e'6Jsi�eslo`nd�roJesaioiis '. .-;: _' ' �`'` � � . '., . � .....� :°" 'Codel'e�ikdwibeu�.exei�i�!'tb .. orii�tboSt�isJorsbe . '.. ._ . . .-- ��� Y�s N -_ .r e}TApprovsd �.,~. �:� �� .". ��:}_.`. . �.�._ ,.,.p[leg�e f mYto�p iiy�atJ�r{� PP rf`,b 703I S by �.M._.._Appnvmis � ' � o9ulndp .,`.`�- .. ?. .-.:.. _,.l�t�S.��,ri�i„�.._..�.�.._:,,y... .,'.:I��ae;�,t lop�'own'a ofih proi?9hyr��m�ma IO��OcS'd!1 . 01•) ' - atei�Certi��ofe� � . �' �' ' . ..... . �.��.�-.� � � � . , ��, .. nvages. . . aolp-compen lioni.wlll aodhe work�olnd . - as•�her sa '� � � � ..... . . I .. . _.. �_._._..----- �_.___. .``i.S'S�:�i.E.�-1....._.._._._ _ •�..sRestrortura�isnorfntendsd�braVtarmd�hor�sale�.(Sac.%7044) ` ��� �'�� ` - ` � Businass and Professioas Code:Tbe CoxtrGctor'a I,icense �� ealUiDepaet[nnnt s .--� . - . . �. , ... . ......_. ._.__.... . _. _ ..... �. ' ''.� . � �. :. �.:..� . �:, ..,.._..... -'----._.:. .. .__._.._ .--__-- .--' _—Laaidoesatot ta.aft•a:vaer ro ert �ubabriil&s ��� -I F�reDepartme'nt � a. •, . '�•��.. . ...,:.. .,: .��.� .-�- . ,, sri�proZ �a+a�'�xrt8who' �uthwor.6`lnexseJor � � �'- . 'de es 2�a+a }lo �, � �. ..-.-. .. � - .. ___ .-. .. .----. --- lbrougA�hss $?d+e�p»s�loy2�� provrded 8bal��tutb rM' . . ' . Grading �-. . g. � .. ' . -- ._ ..__..__.._._ . _.._ :` .f,'Qrooe�i�k�s' p�.noi�1nleN e$br-oJ.�ere8'oi k'�ff, �ir �_ sd . \1� ` �..T�� t ' however.1he'bss�l�r'xg:.nr im]Sinuem¢nt�s sQ d yi�l.�isi oi,�e �_:.-.... ` ` .',� . •,'..r� i+va�.1 � L s bssr{!eK o provtx�q tba�d '�d m�h�ld�i`tmbro�e ne ;' Geolopieal �, .„_ .... ._.. �r : . .�� t �I�' ,� r :� f� �e� ty7oearC G ,�. " �Y: \c. �� �� it�ie pur�'e�o{sa�eJ p ,r" '� Pedestnan Protection ' `--.. .^. t ( ��- �� � 1 '�., (Fence)(ConoPY) . `' . •. � '`2.,,,)�.�'�l 4.,.� �'.�l�.3� t�? �_._�,,t, � ..,. �7 .�i:•asowne�of�thepropeny„ornazclusweiymanlmc- j �� .... .� .. - ��� . ,... .�.� �ji�r�gwph licensedcontrofrqrs,to-qonatrycttheproject(Sec. P P ° - ', -.. �1...�, � . ..jQ�aylf�=incA�aasd.Prnl�ssfoNs.9ud.de•T�ic!�6oritrncda�s � ecio)�ns ectirY)( 9) ' ` a � '' � _ _.- r. _--. , . ` Cona Mawn Weldin �,�. � ' . . LacenseLau>doesxop'Lapklytoaa.ownerofpropertyw6o .. � .. ..�.1 { _ .:, � _._ . �.:: � � (:...:1/."uildsq�r,�,i±�1'r3ivp��-:t#uC.eot6Y+?!d�#�o��q�trRctsforsru6 � lof Draina e � `� � � � � rojects witb a cqntracaon'sJ Gcensed,p¢rswant t ('The � " ����..� �e�� � • ; g . ' -\ �i,1_� ]ii _r.�l .f�'? � - --P , _ _,. ..,4� 1 :..,f � , � � _... �f.'antrarzrsw's��tir¢ac�y�) . .._. .: . � . : ' Parking ` ... . . .. � �::; J x���.a c �. �... .i t :3 � :.t� �_ _�_..__ ...�, .: �r,�•, . r,. .,. .., , : „1:.�' ,. .. ._� _�_ ' , - - ' -' �� � ` . . -; �' �� I am exempt un�r$ec. 6 dP.C.for this .�... ... . . . ' J . � .. . . ....�` __......._._....�._._.r. �.v __..__�._ .__...�..__ \ t�-.., ._...__..._ ...._...._.,._. _ .., .'..J�.. .. _ . .,...' ' . �l . _)':�5� �'y'� � " .+I=I._ .,.' . f�030� .. -� : �.._ �e � .. A�.0`7 S � � . . -._.,. .._ . . _ .. . _.. . Dare t, �. F ..s�� Owner . 21 1:'� filrl�' Q "\;f'!...I L .��,.,:a:l,�l ` � . ... �.�...i 'l ' . . ��. . .. .. . . - .i- �:�.L 1 i . .-\nfiil�.3���1 '(.l'��.!)f .,,:�:: ::I ' ' . A ' .. .�... ��, �Apf r6vtl Psa� D�te Inep�Nn i EignrTuro .�` . . " . .. : . . � . . . . . ,.�. � . IMSFECTOP.S NOTES -�� �--; I .._._.__._.._-_ ___.._..._ �- . .. , � - �,�. Locdi • • ......--- __. . _. , � ;.:� i:�;.., ,,,.o;, .. ', ( tb4ck-&Yards) . . . t. 1 c:>I . . . �� , ., , ,...., . ,» . u��„..... . ,��. ... � : �,�. . . ,,�., ...�.,c,: ,,,v� ''�, Foundarions � .- � . . �.. . . , r_.., . a.. i i � ,u ' Slab . i ,�. _..� , , . , ,-_ , ., , h.-_� . . . .. _. _,_.. .__. ...._ ._. _ ._.. � .,.,.. ,e-a,�•_, P � rF:-, �� frame �..� ,..� �,�i _. I � >^ ,,.. . . .}. r � .r r. �;. � v ' I L � .. . ..,."" "__._ __. _._.._..__'" ." .. _ .}�, r -,t:; ,,,,. .: �,� ...�, ..� � � Energy Insulation �,. �: ._....__l ` i {� ..�,.��.;.�z.�..ino:;, f c .:..� . � .� ` } ._.._ _._.,._ , �'.. Lafh/Drywall- � �: �— \� . ..... � ... .., .. . . :� Interbr . .:,., .. '. .- � . .:-,:.. �.�:.:�. -.�uN ��s.e �.. Lath--Exterior � •' ';•.. --'� , < . ....� ,...� _. �, .. �_. ___ ._ � . House Number- . ,..,, .�� . o y.a�� ���� r .;,- .._, �, . - . ._�...... ._--` ---- - ,,r •_�., t �,�rv. . �.,..,'r �l:c. . Correct&Posted ... ...:_ _. . _...�. _ __.. ..:,,,.. .._.. y,.n: � . ��:y'., . - L , Final- '.,�, . . . : � n_�� . ,.. - . I Enfer on front . ., . ,� '. .. . .. .. , .,.., , ... ^ ,_:.,.- �t v �:':;. 1,��:�:it> .,....- ..�;yr- .,.._ ��. � -� � ��� ' � ;: qi, i � Y C r'3�.-.°A . ��\ t ! 4\ . } ��� �.N. � ..�. . .1. �