Loading...
HomeMy WebLinkAbout1015A (5) I .. . .. _ .. .... _. ... . . _.�,.�..�._ � . ... . . .: . . �'i.. .. ���� VYORKERS'COMPENSATIdN DECLARATION�.- . �.... ... , _... . .�..�., _ --- ��� ��., ..�� ..�...�. . . �.�� . , ... .. �. ,. . .., .�,. ,.. .. reby affirm thal 1 have a cerlificote af eonsenr?o self � -���pp��CAT�i�a►!�i -�OR��:BUtLDING �PERMIT s � � � �re,or a cert�fimte of Workers'Compens�ian�Insurance,or ';'�'^�v-c�rtified c6pyihereof{Sec:3800,Lab.C) .� ��. +. �....� . _ COUNTY Op LOS ANGELES . BUILDING AND SAFETY. ! ,� ,FoliryNo. -� Company ; . . , � �� . . " � ' . . � BUILDING . . . .. .. .�� . � Cenified copY�s hereby furniahed: Y 9 FOR APPLICANT T FfL IN ��� i . . _ , . � , ADDRE55 ' ; � 'Certified�co is filed with the count buCldin Inspec- � 6UaDiNG J� /7 ; . ; .� �.� �.-tion deparfinent. " � `." `. A17DRES5� v �'�,' LOCAUlY-�,p�C-/-'rc�c.� ,�Gt/� ' , , . .. . , .....M1 ..��-, .. . � .. ..... .. � . �..,. .; . . . NEAREST � .- . . � 'Dofe:.- .;. .. ... APPlicanY � .' _.... CtTY. . .ZIP. . :�.... CROSS ST. _ .�. ... � ��.; ., _ �.��.CERTIFICATEOF EXEMPTION-FRpM WORKERS''' - ' ' � � . O:OF&OGS. � .:. ASSESSOR . . ' � . .; - : - - � ' �.COMPENSA710N 1NSURANGE � ���. , -. SqE OF l0T.�. . _ .NOW ON l0T � ��� MAP BOOK � PAGE ���- �PARCEL � . �� ( P , P ir is for one n�7 �� � . USE o E.. , MAF.. . . . � �� �. "�� ,hundred do1lars($lAOj ar I8s5.) .. ., , . . • iRACT+�/�7 � BLOCK tAT NO. � �-��� �NO. ! t TMis eernon need not be�com�letnd if the erm . .. ' . • TEI. � �SPECIAL �:.. � � d I�certify�ha� n lha perfo mqnce of fhe w0 k for which fhis OWNER �N �-.- 7..r4(� GONDITIONS , �- - !� - O , pe�mit�;issued,13hall nof employ any person in ony manner �� � DiSTRICS �GROU SYPE PIRE � PROCESSE�BY .0 i date to become subjecf�PPllea Workers'Compensatr :. .... C'�RE55 ........ ...... ,21P �, sinil iIDCAL�ctAS�SIFI�CAiION 5� iONE.p� /�� ���; O � �. , .. � .� . ANGHNEERTOR .�� �.' CLASSNO....�_,DWELL.UNVTS�__ K � L^, �� � NOTICE r0 APPLICAN7: If,-�afrer makin th�s rnfic e of � -- � �.i,� W �����Exampt�on,�you-�should-become. su6�ect��o'�.ihe Workers . ����y �i '�. � �Compenwfion prpvisfons of the�labor COde,:you musf forth-� � ADDRE55 � - � � � � � � - �� � �� � SEWER MAP � � ' � � r - '�.' '�, wi�h comply-with such provfsions ar�-tFi.is'permit sho�l be' . � � ' � � � '�.. ,,._� *' .� �.deemed revoked... :..� .-, : .,.. . � ..-..: .. coNtenCrort .�_�: . .....,� �...�.r�.._. ._,. .� . � BK.. . aG. . .� .:�. ., ... . . VALIOATION: , . . � '- CICENSED CONiRACTORS DEGLARATION. -�.' . � � . . . ... . . �tIC ���� � ' ' . � � � . �...... ... ... . I hereby affirm�hat i am licensed under provisions of Chapter 9�� ' A�DRE55 - � .-...-�n10.. ���.���- �-� YAIUR�t3�� � . � � � . � (commencing wit6$ection 7000�of Division 3 of ihe Busine55 and�� . . ` . ���, � � � � , i , . ; � ��rofewions Cade.�dnd my license�is in full force and effect � . CITV : . C1A55 � S 1� / � � �' I � I, `., _"'- �� �. � �.. . � . � . 5(].FT. - � NO.OF , NO.OF CHEp( r , .. �. ...,��� � Utense Number ' lic,Cipss � � � SIZE � STORIES FAMfLIES - �ONE � �� � � ��j� . . . . . . ..� . .; . '�� Controctor ��.. . � ..... Date � �ESCRIPTION OF WORK F.IC•P_.� NEW. .-� ,; ��� . . � .� .. ....� ..i ' . 9 P � ...: . ..__ . . . A�p -�.� . - � �, ., �'�.� � � �icensedarchitectoharleesterederofeaslonalesi��ama ....�. ...0 ROOf y� /q�CA��^� � . ��' .... , ._ , i . . . P 9 Q ngineer�. .. . � ...: ... . � AITER ..�] ��PINAL C .. .. � cctin �tn m ofessional �acif Setlion 7051, /�0� pI��� gqtB�F ..ALRyE M--�AIR .DATE � �7�.p��.. � . . , � 9 � Y Pr F P Y ( . ... � _� -Business tnd Prpfessions Code. . � � : � RE�p�. � -plNAl �� ' �� "� " � � . . . . .� ...�.... Exi5i1NG BLDG. .9 ..a .BY � . . . ' � . lic.�orReg.No. ... .... . ':�Dofe . ... . APPIICANT - - .. .. TEL. r,• � . �' ;:... .. . . ..,. � . � �_, _. .. ,.,_�. . ...,... .�.;.,. NO.. ._. '. . ;�: � . I� ., i . !herab affirm�fhat IEam ex�emR fEom the C�ootractor's ��T � y p licenae � � � � - , � ._��0�.�A � - law far Iha following reason.(SeUlon.7031.5,Bosiness and `-' � aD�aE55 ��- � � ��� �� � µ - � Prafessions Code� .�.y . �. � PRESENT , - ' \ � ' . : ;N�i s�f'' ...O� I, os owner o#the�property, or my emP(oyees wilh.�� -�� ADDRESS ..... . ..... � . � ., � .. �� ��;'.� „ .�.�. .,� �2 5�:9 5 d �' . : �wages as theU sole compensation,�will do ths work and - � � � � � . � � . � � . -. ..-��the atrunure is xor tn�ended or offered for 5ale'(Seafon-.`�....'. tOCnti'�v ..�,-.. '�., .._ . ...._ . � .r,. :.. ..:. :. . :. . .. . .. . ��704A,�Business ond Professions Coda). ��. MOVING � ', � tEl.' � � `� � � ..��� �••2 5.9.5 0�.. �' coHTeaooa Na. .. _ _ - �12 1 5, $.1 -�.f;asnwner of the�property;qm exclosiveiy�confra�lmg"'�� ,� with license8 contraUors to conatruct Ihe projecr(Sec- , � ADDRESS ' ' � � �� ' � � . � � ��� �� ���� � . .�.�__ .�. . �-tion 7044,8usinessand Vrofessions Code).�-��-. � -�� � � � � ,� �-.� -, � � � � � REQUIRED "' 7pTA6$ETBACK FROM E%IST'. %'� .�.�� .., " '- � .CONSTRUCTION LENDINGAGENCY� . � SEiBACK YARD HWY � PROP.UNE WIDTH � „-, ..j , !hereby affirm that there is 6 conetrvc(ion lending ogency for -���"�� FRONT � � � '" '�� �'�'� . ��� , .��� �,'� � the performante�of fhe work for which ihit pe�mit is issued . P.L - �� � � � . -,, � � , -�� F � �� � .; � ....(SeC.3097,Civ.�C.). .;,..,- .. . .�. , . ::... �., .. ._. .-SIDE- .. .. ..... . . . '»-. - . � . . . � P.L � � �.... _ f.. A;.. .. . .. _, ..,.. ��� , .._Lender'sName - � ����.... . . ._ ... . . ,qy� ... �... ,.�. ,r�°. a...,....i ..._ � � .. � . _ . . .. •. . - . � P.C.�Fees .... . .. . Yermirfee� �� vV . . rr�'�.. �.�� . C... �. .- „ kender's Address _ , .- ��. „r .' •..�,� } ..�, ,.,, I cer�if that I have read ihie a lica�ion ond atme tha�.ihe � p "�(f.� � � � �' � � �' Y pP . . . ....� Issuance Fae .... .p_ 3 .: , ; . . . - _ above information is torroct.�I ogree to comply wi�h oll Counry . Irnesr�gai�a+Fea .. .� � ,�+ .� � - - � --�- � �- �- � � - � ordinances and Slale laws relming��o building construclion, � - � - io�al Fea � , p d � ' 'i - ond hereby autharize rcprasentotives of this Co�nty to enter _ , . . � , w,,,�,� , .�., �' "upon�ha�.above-mention � erty for inspection'purposes. � �' � � � � � � �� , ,�t ��+ - � .- . - � -� . . .. � �-��7�/�.- � � EEEREVERSEiOREfEPMNATORYLANGUAGE. .-� ,'.. ��.r ' '�.�� " �. �. � ..: r. , i ^ . . _., F . ... .�e� � � � . . "- .'. � r�..•� . -,��. ' - °.�.. ..r.r:nrP'1:.Q9� .,_�+'__ � ... gnotvro o ppl �o gent .pere * .. _...... . . � . .... _..- _�... ,,.w .... . .. . �. ... . . , _....,.. _ ..._.. . - . ,_ .. . ..�.. .. ,...._ ..... ... ..., .. .. ,. `, . ��.i i _. � ,;�PLANS TO APPtICAN7��-= ;t���, -^iNSPECTOR'S NOTES� � OWNER-BNLDER bECLAItATION � �� `� ' � � ' �� � �� ' � '�I hereby affirm that I am exempi'fiom the"Contrdcfor's 40: .-.. ;.:` : . .�.:,. Ref�rrt�d -. .� .�� �.-:. �� �. � :�.� . �;�; :`�. �� ,.' . . .. se taw.'for �the�following.'reason.�{Sec.,7031.5 ilcen ) • *�� Appravad „„._, , , � . , Busixess and ProfesaJons Code:Any eity ormanty wbleb . . ... . � , . , ' Mo•. __._-- �Dats--..:_. ._No. ��----0aN . ..�_.. ._.. ..__ . :.._ � . regukes.a permit to constnrct..al6et.-impwue,de�nolisb. �i ,.,.. .. , �.,. . ..;.. .... __. . . , , ., , ,. ,. . arrepairanyserssctu%Priormitsirasance.b&oraguires �.._ ... . -.:..._. ..... ..:_. ._r.. _ � . �-.� ...,. ... , �-t��. .......-. .�.... _ sbe applrcaxt Jor�svcb permil to fiJe a signed staeeatenl : . •. ��, . . �. .. ;. . . .� , . . . �. . ,. . , .'... ... _. ;. . . ,�..f.� .. ..:_.,.,j.-•�, � . ��sbat be is licensedparruane to�eba provistoas of tbe Con• �: -.,_ .__..._---. .,. �:.._.. . _... .. __ , ... , ,h Y� , .-,... . . � tractor's License Law(Ckspser 91(commendttg wltb Sec- . � . , . �.:J � ._'. . .. ttox 7000/oj D:qrsion 3 of tbo Busiaers a�nd Professioiu � _ � .._ . _ ..... _._.... .... _ .. . ..... . . . . .�... ..,... .__.... . .,, .. . CodeJ or tbai be a esem¢t eberejrym Pad tbe 8atis for tba �, � � � _,..`�' . . . ..::.�' .: � ��"� � � . . alleged�exevrDtion.A�ry violatian�oJ$qctton 7031.5�by i r �- Raquind " � ..' _... .. . ..� . ..�. . .. . .,. an a lscant oca ermitsub�ectst5sn Juaxttoaclui! I____ Approvals . De»R�eeiv�if t� � y pp.as oe more iban � Pp ( � . . Y�s... No .�,��Approwd . ,.'� . ,y ., ...�� , � P Y f Jive baxdr¢d dolkra SSDO).�: � , + , ' exalt o nowner of ihe proparty,or my employaea wlfh ' WmeF Cert�fita�e ; � � '�, ������� '�� �� t � . �. �: � �wog�es,tis Iheir ao(e tompensation,.iwill do 1Fe wprk,and . '� Haolth D� rtmgrit. .. ,� ' ' �... � .,�..: ._ `........ . ...... `;�'`f"'i �. � ' �� �`B�ness uxd Prpf¢utimis Code�Tbe d for sale(SeaJ044) .�'�. , pa '' . ., . � . ,.` � Controctor's L�cerrs¢ � ; . . . ,. _- - ._._ _._.... . . .;;. . ' ��Law'doea eot,ap�ly.la an ownar ef property wbo bssldr� I := fireDepartmen4 ,, ; .: y +,l� ` orimprooeitb�r¢on,a�dWbodoesasscbworkbhnselJor , -. .... ..' . '�.-- �: .-. .-. .. -. ... ..- ....- -. .- -�. . . � .ebro�rgb bis own arnployaas,�pronided tbat aueb,lm- Grdding'. . .... . � � . '`. .. - ' '..:_�: - , .. . � � . . . �� provemants.an wot-:intexded or:offersd for�anle.,-If, . .:.i � � : ....... ... _. _ . . . .. .. _. ._ _. ... .. . . � ..bowero¢r,�ebebiiiTdingorimpravam�ntisroldwitbixone �i Geological 'r.�t:'`. ' � ,_ ���.... .. ` `� ....._ .. __ . ._. ._- ._ _._ _ .... . ._. . year of coasplekoa, tbe owaerbuilder wi(1 bave lba � , '. .,�..: . ...�:. . - �. . � dardem ojprauittg�tbaCbe did eot br�ild or i�nprave far � � Pedezhlan ProtecTion ' r, :,. ;:^-,, � . ...__ ..... ._..._... .._.. .._._. . ...._,.. .... ... . � :.� 'lbeparpase of.taleJ. � .. � : , � ,. . - . . i I � - (Fence)(Canopy) ��. _ � , . �� - ._ ❑.�I,as owner of Ihe property,am exclox�vely mnfroo- � f � � *' � . . . . - �ting with licensed contractorsto consfrucfthe project�Sec. (Conc.)(Masonry)(WE n� � � � � � 7044)Busisess axd Professions Code:Tbe Conhqctor's � I Special laspection . � � � � � 'Lfcease Law does�Kot a� 1 to an otbrler o �ro erd mbo ; Idlag) ' PP9 IP P Y � ',� , ' '^' .j,.�. �.� �� � buflds ar lmprones tbereon,arzd wbo coatracts for,sacb �� lo}Dreinaga. �. � ' . . . - .- '.projects�wish a'contractor(aJ Jicensed pursuanl to t,�e „ ...,,..,. . .. �. .. ., :.. � , ' ., , = , . `Contracmr's License IawJ. ' ' . � Parking . . . . -; �. ':. �: � ; -.. . .� .. _ �.,.. ... ,.. . . ' . • .�... . ,.. '.��.. "� � �� �. .'- `�. . �� (] lamexemptunder3ec. ,B.Ep.C.forthia . _.._ ._.. . . .. . . _. . ... . . .. ., _ . � . . � ... ...� . . .. r � . . , reason . � . . . � . . � �., . . :. -.. � . . . . . i , �� � �, .� . . .. '._ . . .._. . , .�.� f _ __.. _ Date Owner � ; .� e �. .,� .�. _ ,. ' . .. .�,�� INSPECTOR'S NO�... � �� � � �PiPF�p�Q�;" .Dat� Ih�p�cter:5lynqtvn �� � - � . .... � . . � � � . TES � Locq ti,gr�-�. .. . .. . -.. . . ._.. . . . . . _. . . . ... � , (SdtboefE&'-1'aras)�. � � . � . . .. ., , �� ... . , . ! � . , ,� �� , � �Du�dC'+}�fis`:•• ,. ' . . .. . _ . .. . ... .._ ... ._... .. . . �� -. . .. . , . . . . ,. '.. . �, .. ,.. . i '�. I 5�06 a-t, r s� _ _ �-. � Frame � . i�f'� . .. . . . . . . . . . .. . .. , � .. � . _ , . ��� , Energy Insuldtion 'I, Z,� . .� ' �.._ :. _ ,. ;. ...- � . ..�., . � .. ... ....,.`:- ,.. �... ' . , _ . . .... ... . .. LathlDrywall— . � � . ' � , . . ' . , Interior� '� , �.� ..��. � �. �. . .; '�. ,...� . � . . �... . . ��' -Lalh—Exterior . . ' � - i . . '.., • 'i': . . �.�._. . .._....__._ . .__.._._. - � � .� .. �. ..�,�� I , HouseNumber— . . ... �.. . . .... . .. ... . . . � � ..� ..-...� . , .. . Correct&Pos�ed � - .�.... .... .. .... _. . ..._.. . _ � . :. � . .. ...'�.._ � . -�... . . . . . , . � . Final— . . , - � . . . . . � �-. . �. . EnreronkoM � -��� . �..� .� .����.. .. � .�: ..,.. . _....,. . ._ ,. �. - . ., , ..,� , � � S��.cN; IZ-�> - , ,., , I �� Z:�� , : - - - - - ' . __ �