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HomeMy WebLinkAbout1588A 1678A (9) ____--.--.___�_. _____.___.,.___�.—_.______,--. _ �.____... __--__ _._ _ __ ,_ _.__--. WORKERS'COMPENSATION DECLARAiION ' � I hmeby nHirm that 1 Fwve a cenificate of c�nxnt!o seit '` �OUNiY OF LOS ANGEL�S BUILDI��� ����I� inaure,�orare(tificoteofWorkero'Compensafionlmurance, - �������'�yA����� ���-�� Y�'�� or a ccrufied copy thereof Sat.3800,lo' ;� NG/iND SAFETY � PolicyN Company � � � ... � . BUtLDING� . . . • �� � ❑ � '. FOR APPLIGANi 70 FILL IN nooReu �,O Certified copy is he�eby f�mished.- . Qfied eopy is�P i ainh the �nty bv�lding inepec- euaoirlG ..��G�. C>1l h'P '�-f�� � an�IA/YJ'oIJD �! zie � D �ocn�m . _ __, ck�,i �.tion deportme 1. � ADDRESS 2� �-�.� � �/9 .� NE4RF5T Dote. � '� �,� CROSSSL� . .. . �. CERTIFICATE OF EXEMPTION FROM WORKERS' � � � � � � � NO:OF BLDGS. � � � ASSEs50R . � COMPENSATION INSURANCE � - . 512E OF t0T � NOW ON LOT � � MAP BOOK PAGE PARCEL (This seaion need not be tompleted if the perm�t is for one - � � �-. �y u5E ZqNE nv.v. . , � - hundred dollan(5100}w less.)- � �� . TRACT� 3 � BtOCK p� LOT NO. �G..1� � -�:NO. �� f roMlfy that In ihe��performanee of 1he wqrk kr which this � OwNER � L /,,.711 �'�� CONDmONS � � � � ��� �6r. . permitis iuued;(ahcll not employ any erson in any menner � - ' � � � � WSTR�CT GROUP NPE fIRE PROCESSEO BY � P AODRESS .2 z O � d�1-�J,�i9�L. .� co� zoNe � v .so as}o become sub�eq ro the Workers Compensotion Lawa. .. - .__ .. . , , . . cirr �A.+�lcn!!� �'ia,�.zia`�r 7G•,� �° --� - 1 � � GCte ���� � App Ifcanf� '� �-- .� '. .. , � ,. STATISTICALCLASSIFICATION AVf. CONDp..� .�1� NOTICE TQ APPLICAN7: If,afier making ihis Certificate of . ARCHLTEC70R ..� ,;���- • � :iN,71 -• �.� � -� . -� . , E INEER NO, V - �Exemption, .you�sbtiuld become �ub�ect��fo 1ha VJorkeri . ���G1X+55N0.--�� -'� OWELL.t)NI75 � ,:0. Compensation provisions Of Ihe Labor Code:You musi forth- . _ AppRESS 1 -�'.... '��. . . ��.:.+ �. SEWER AnAP � � . .Z �with.comply with��uch pravisians ar this:permit thall 6e �- �/�� 1� ( � f � deemedrovoked. C`ONTRACfOR q� �t� �0.1�`l�`�/! �• �� YALIDATION � � . ��� UCENSEDCONTRACTORSQECLARATION ��� . . .. . _ . � �� ./� . . ���iK:-� � � . . I here6y affirm thot I am ticensed u�er proviaions of Chapter 9 ADDR0S5 •1/ � �� � ��ypLUATIpN � �� . �- �� ��� � - �� - � � -��� � (commencing with Setlion 7000)Of Divhion 3 of the Business und � � .- / LIC. .� . � � Professions tode,�ond my license is in�full force an effect. . Cirr t�'�^"� t I j L C1q55� .� s,�Q Q � ���rj�$,$A � - � � . i � I� .s�,f� .. � SQ.R: NO.OF NO.Of � .CNECK.. � .. .. � .. � � . ticanseNumhar LicClasr� - sITE ... .siORIEs fAMILIEs . ..pNE . : . . . . ,#•+•��'�33 �, r� ��.� + '2� �-� � DESGRIPfION OF WORK � � � co�r.�+_ - � oo,e � � �' _Kl � a ! • •2 5 0 0 �I am exempf under Sec. . . . . . ""- �l� �/' 1"L.�. . . AITER � FINAL . ..�;,� �:�2��U fl�S � e.aac.fo��,�..�050„ O�/G D/✓ ... , � REPAIR � DATE � � O♦P���6�S:G� ... . . , .. . �. . . . . USE OF . sY. , . � . �... . , . ... Date: - _. _-: EXISSING BLOG. :.-. � . . DEMOt � . ... :.. . ....... .. FIN � ..$iS}f10tulB � .. . .. . , ' APPLIPRIM{/O{Jf�LG � 7EL. , . .. ..., . , � . �OWNER-BUILDEROECIARATION ' �� -� �' �� 1 hereby affirm tMt 1 am exempt from the CoMroctor't Ucenae � ' �C'� G . . . ' , � „ Law for fbe following roason�Secfion 7031,5.BYEIeeSs ond � ADDRE55 / '� . . . .. .- �. - � . ..�.. .. . ,. -. . . . �.� Profeuiona Code): .. .. . .� �y.. . � . . . . . . . . . i. . , .. BUILDIMG . . I , . ... . � � . . � ., Q�,.:I,�aa owner of thq properry,oe.my empiayeea wi�h ADDRESS. ....- . , �: � $� 6�,�$A � ,.. waqes ds thelr iole compenaation,will do the work and � �� � ; . . ; -_ .__ .the atrucrore is not intended.or offered for wle(Sedioo .. ��`��ry- . . . � � .. � ��� ��:. .. .. ./;�- #,� •.•.•���� .. � � �044,8usineis and Professions Code). �� � ADDRE55 �� . f EL. . . � . _...... ,,.,.-,� ,, , �.,��f"J�'.4 .Yi i 3 li.��Jr�'- . � .. 1,qs owner of tFra property,am exclvsively wnhodinq � _ CavTRA[TOR �NO. � /� , _ , �.�wllh Ifcensed contractonto mostrua the pro�acr(Sec- _ t 3�7.5� - �fion 7044,Business and Professfons Codek ... � .... . .. .._ .. . .. . . .... .� ... .. - . . . � . � REQUIRED .. . . iOTAL SETBACK FROM EXI5f. ►. ... r� . , � - � CONSTRUCTION LEM�ING AGENCY . ' SET BACK Y�� �Y PROP.UN � WIDTH ' � O G Z 2"`B Ll ��. I hereby offym ihat there fs a�tooxiruction lending aqency for paoNr_ � � - � . . . � �� � - �-- � the performance of the waik fo�whlch this permit Is iuved � P.l.�� � �� � � . , -. . t5et.3097,Civ.C.J. � � � . '� . : - . SIDE . � ..... . . . . � . .i _���,. e P.�. lender's Nome ��. .� --...� . B— 07'l..�4'S'� - .. .. .. .. .. . � . . P.G.Fee;' Permit fee . . . ... . . � - Lender'sAddress— - . . .. . . � � . � . � � : � � �1 cehify thet 1 havC read Ihit appl{cCtion anA�slote that�fhe � .... . Iseuaa<e Fse Ia•S� . .... ...... �. .... . . :. . . � above in4ormatiotl is Correcl.1 apree to comply wilh�111 CAunf� ., Inves7lpmion Fse � � .. . �,/ ,_. ... , .. ... � � ordl ncas and Sfate laws relating to bullding consTrudlon, Sowl fee �L� �J '� 6nd ereby authoriu representatiros of thia Couny M eMar � �� � , � � � ,� � ,.upo tfi above-menfioned ro rty for.inapection purposes.� ..�.. ..- . . .- . .: - ....:-�. . . �i .. -... � . :. ..�� .: .�. � � , . " .. ��` , 5EE REYERSE fOR El(PIANATDRY UNGUAGE , ��� , � . .. ... . .. . , . . � . . . Siqnoturo of Applicam or Apen � �� Dote �. � . . .... �� . ef .._� . . ' . . - ...� . , �; �. . . ' ... .. .,. . ..._ ._ . � �_ .... ... ... .. . .... I, �...... _. .... ... . .. . . ... . . � � . _. , ,� - ,_ ' n:'.;r e i.�INSPEfyT4R'f TES�.� � '- - tl.::..r. -AW,I�'ER•D�I,LAL'RDL'C�.AAA.T��QN�. ...rv i � ii .,i- t. ' .: �. :. ; � , �;:� :- . , .., .. ,. . ,� . iTo: � _•. ,.. ..,, .. R furasd . � ..:..., ;, t„ .� :. �. ..,. .. .. �. . ���Lcense�Lm f 4er�het�fallowi�g maaon+�ESe¢n17031 b) , t . °. ��.;a �.r. A rowd � ., .. . ., " " PV �-� ' ` � �`'� " $uslseess ated f"rofes�anns Cnde Any cety er pouxt�whicb N6. __ _.�af� .._�- No. _.D4�o�. ..__ . _..._ .,.' _ ..' ,.. .'.,. . -. . , ,.. .. ,_ .. _��._reqnires-apar�nrtxoro::sfruct ahcr,lmpra-q¢,-deviolisb� _. ....: :... ..:.: : . _x _ . ' _ _. __ _.__ or re ' an ructtlYe. Itio`t to i '31/dnCe.tllSo'fe x'stel __ _. �'�,, � ' ' , ._ ' t c,,�. ....., �,, ��, \' �. �...: :.....Yhe�plicww6 for-.sucb p'ermk-kJ file assi�ned.stdie»!en` , �,_,_� .._-.- - - - -. �.. . . _.._ . ._ ��;<• -. --_.... ...-...- .1`,,,{. ns d u uuns to t '� nlc�i�tar.'s-ajtba - ---- �� . �.�. . ,; , " ' },., v ., _ _ tbpt eisltce e rs be � �, :. ... - p� �� f �� g� � -. . :..' ,'�:.<. ,.: t. , , , ..� .� � ` 1�., k f`, � "twN�-TlIB9/�J-tiieision-$'tl�eh's�B�iaiaeasaMd�Pr aasloris tractor's L�icen e Law Cba ter 9 comenenein witb Sec �'.. i .�-.` .:��. .R� virod �O���Rac�tved�:� . � �'� '�'� '��� ,".shoe&��1lc��trapermfitsub�etls ��fic��toa`tY�, � ' ��� � � � ' � q ' ` , _��- a11�e exe ' e�r �iviy bJ 1 t�ox o Se son 3 by � �_..___xPiravalr_-.-'_ Y�s No �� erApproved �._1 __.. __ C, :._ .�.� n me e u re o � . ,y „ pexaltyoJn t reFfia��f�u 6 si`d� d��71si�3'(�SSD"O�rf:� , ^� : � �. ....__�.->t•���x�. �, t+ C� . 1 >.. us;awnerof� e o er I, � � . . ,.. ( ,.. .,>,,,-:3 : .. - - . ..l - --'- - . .ri-4�� 4c t� M P Ik,.o,r n OYO a w . . n � .. VJaterLmHificate , ..;, i ._ R .�::. � :� t. .�l.i..,(\ c .-.a . >.l �-, . .�neag4sas.IMeir:selecamyiernetion.'.wi.�nkld heWo k;'.ar� �. ��.� . . : .._*:_ .-�_ :. .., _ .;��_•.:w__ .r-,-__ .�.�.J- :.tNe'sirutMe�lanot.:lntendedora#£9fdd.fUt�e'�t�-(6e�9044) � i -..: . ,. , � ... Hpallh.Qepa�tme�f i_....._.._.S_ _r..'-�_._ `' :" '.�_ �.x.;. ��� ,,;, -.-d f +�`�1 �.-�� ssandProfessionsCode:TSeCoetractor'sLic¢nse t ., , ,. . -,: .,, .__ \�.,._ . .._. ._._.. i.au+.do nosapplyloanou�nerofpropezzy o ' - � F�re Departme�t _ ,:;,�.. . ;; � i � . � ���; r�.��tr 1fre�ro�Let dber*eo�c'�and who 1oe's'aucb tUon€�bhiisa� ��.� Gradinq �`�. . • - ._�.. . � ... �� ��' _:.:.. ..__ .� _. -_ -- , '$'rovefixb���s�a n'$m'riiendc�tlka bJfereB f$f��snle�;� • •,•„ �.� : 1 �� ,� } , '. � �7 ou er�nr,�he busl�ing or� �ovemen�ys fo(r�{vs'35�s o�ie ___..._ ..�,.. �. � ., ., t.. .. .. , ,_..... . �... Geologicml - �-,. ._ ' �:.;' � � -� � - ' �� '� �� � - year of�one leeoo�t, lhe owxer¢u�kfer.wil/'bave Ebe ' . . . . - y � ; burden�o,/;Ji�vi»g tl,a1�ie aid uoi bu�tld�otim�rovefor Pedestrian Proteciion ' ' ��� � ! ��� s ��t�;epurQ4se.o,/sa�eJ �:�i,: ���.:;. .,.;,. , _,,`, � (Fencej(CanQPY) ��f G : 1�.+';� �� .', J . .vs[3 nlpmewderoft6e�grreperty;amexdwivelycoMmc-. � ". ~`;� .. .•.... . ,-..'.'.. ._ . � ,-..` .. ..'-.�. ' ti wlTtylica�sedcont ciorytnconstruUthe rojecf(Sec. � Speci611naaettiSn�� �� - � . � � � . P '" , . _ r . _a.... ..�.-. �:,- ___.7094J..FiztsLmsi)aad Ptv}esaiona..Codc:_l de�oritxmtar's ....._ . _._ _._ __.. - (CoFc�)(AhqsonrY)(Welding) ��. � 5 ;'. 1 ._. y,. , --.--� `, . ,:,,� - ..- .,, -License Law does nat apQly to4n owaer of psoperty mbo .. a n __.-: l ,, .;, . .� . . . . . : _-.__._ .._..__.:� __ ._. _:`ge�&{sp'r_insJ�rat�tttfir.rcox,�ndu!,bo�on/raEts�nn�ratb . . . Lot D,rpinqqe� � � �' ��i `t- '��� , � \ �,.v E, ��. `�Jects wi!L.a c ntractos(eJ licensed�ursuant tq r"Lbe C,_n . �.,� ,�, ;.-U..� '. .I ". . -..--,.- -....__ . � ._ _ .._ ._ ._ __ ._._i�� __. anxruaxar'r'i.fcense�Y;aea'l�� : . . _._�.. l,._; PaL7i.�1�_[j �.1 O r ' .-'._ � � ^` `.._ . ._�_ _..._..__ _...___ __ '_..___ . .. �-,..r..,�7at ".R:��. , ,.,., . ,�., . .. .' . . ..._.._'__�_._.., _. _.. ... .... _. �_ p___ .._ .� �-`-�� �[7 I am exem t undar 5ec - ,B.3P.C.for this .. - ; . .;i: . .__ ..__. �___._._. _ — ._,. __ .....� .._ ..._._. __._ _ � -__.____ �,..�..._. ., :..__ C .�''� C 1. - ` ` . ,h �..7 ���� 1�., .- reaso .-r- -,( ;� � r .,� , �" "'_.� .�c,;t,:�: � ' � � _ . _ . Date � r.� . �����; a�., �,�04vner ;3 . i I �i _,y�_L``,`y :E �.i�� .,:a. . A rova7e Cat� Im .�. - � ��. �� � .� �IhS.'��C7Ui5 NO.�,. PF P�cfmr�Signnfun . .., .�- .... .:� ..-:-� --.:, , � . . `''' ..: .. m_ ._ .... ` . 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Interior . . .. �' ' - .. � ._..., :, .� . . ...,... . ._...._.....___.._._._.. .___'__.._.__. ��.�:_�;�r^�.:n;J b Lafh-Exterior �. •-. rv ,�... ..� j.. � .� . ���-�-- - ,., , ,; ��.�,. ._._....._ _ _._._ . ..... ..._...- �. ._-__....�.__- � _ _ : _,;�,•�,9 .�. -,.� . HouseNumber- � �':.. ... . ♦'..` � .. ____ _ __. �___ ..,nH�, ��� , . . ... ,. ..... �.�„ i,:,:��_i i r^:.i i Correct S Posted . __._....... . .._.._.._ . .. � . ,... �.` `. -�--i�-'--_—__.. _ _. _..:,-. _ - v 4._ . . .vyi:. - �._��r r, r.. . . . final- � ._ � . '.. . ... .. . �: Eroer on Fr nt - . . �+-.'-< .;�)a: i -_. . .. � t�.. - .,_ �9 � � - � � , . ... ..C.. . 5 ..:� "` . . �'. . �J : ..5._ — ,� _.��.. , . . . .: ...:.. . , - � � i 4\ . o- '... _.,...... _."...... ., . �i