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HomeMy WebLinkAbout1214A 3138A - - -- -.______._ __._^ - � J._.,.--,., �--.--_._._.^ . , .. . .. . . _. _. _. __ . , . =• -' WORKERS'COMPFNSATION DECLARATION � � - � � - � ` :_. _ _____ � � - APPLICATlON FOR BUILDING PERMIT � I hereby atfirm that I hove a terfificote of mntent to self -���- �\ / insure,or a cerlifiEale of Worken'Compensaiion Insuionce, . or a certilied copy'thereoi($ec.�3800,'Lab.C.) � � -- � - ' ' � - " '- " � - ' - , .. :+� ,. COUNTY OF LOS ANGELES BUILD�NG AND SAFETY Ocy No. � . .. Company � .. . .. _ , � Certified copy is hereby fumished: FOR APPLICANT TO FILL IN BUILOING n Q � (� ' AD�RESS 0 C,.G��J�R�.. /S��'�1.� W� � �Cerlified copy is filed with the wumy huilding inspeo � - BURDMG � tion depO�imeM. '' ` ADDRESS � � .'„- ,. • � �„'���\. , �. .. _ __ .... .. . .._ ...... .. . _ . �(� . /} . Date Applimnt Ct7Y ZIP ��O LOCALITY h�C_Ct�..,^_ Qy�CY N`�- �. '�� ��CERTIFICATE OF EXEMPTION FROM WORKERS''� ���� SiZE OF lOi 7 � � NOW ON�LOTS OSSSST. _ ' _"r�_.._._. ... __.. .__.'___"'......" -.. � � ' �COMPENSAT�ON INSURANCE- ' (This section�need not be mmpleted if ihe permit Is For one -�-- - - - � - �ESSOR . - � - � � , hundred dollars(5100)or leis.) TRACf � OLOCK LOT NO. MAP BOpK PAGE PARCEL � ` TEL _ � t' 1 terlify'Ihat in Ihe,performance of fhe work for which Ihis OWNER r�0. ' w ; ��, 7 ... . . ' .. .} � � USEZONE N✓F � . NO. permif Is Issued,I shall not employ any person in'Sny m ner AODRE55- � � O , ���I �EC�AI - .�- --- - - --�-- - ---- - d so as to became subject 10 Ihe Workers'ComPe aY n aws. L' CONDITIONS ,V . �/ %. �je-�•''��3 d/nPPlica ' ` Ci7Y A ON ZIP .. .'_' ... _ . __. .. ._ ._. __. _ .-- - OC NOiICE'TO APPLICANT: If, aft r making this ertificale of ARCHITECTOR iEL , ',� ENGINEFR NO. 015T21CT GROUP_ iVPE .,__ FIRE _ PROCESSEDBY _ ,_� Exemption, you should 6ecome'subjett to 4he Workers' � ,,7 CON�ST./'' i ZONE� i W Compensaiion provisions of the La6or.Code,yoo must iorih- ADDRE55 D ��L / � .�� �.7 .r --- (� -��- wilh comply wilh such provisions or this�permit shall, be -.. .- � , �� �TEI. /4 STATISTICAL CIASSIFICATION � APT. CONDp. � Z deemed revoked. ' . .� . .. - . COMRAROR NO. � ' .__ ,. ___ ., '- � " _..... ._ _� LICENSED CONTRACTOR$DECLARATION�.- � -�- � � ���--- - -- -���� -�-� ��•LIC. - - Q�ss NO.-�� � DWell:UNITS ,�. I hereby affirm that I am licensed under provisions of Chopler9 ADDRE55 � L, NO. ' (commencing wilh Seclion 7000)of Division 3 of the Business ond ,_ _ ��� , SEWER AU1P � . . � . . _ _-' _ _ _' .... _. ,. __ . , Proiessions Code,'and my litense is in full force and effect. CIN �C SS ��� � - - -�-�-i� - �� �� yq��DAT10N" �. � __. ' ' � . . . . . � , ... . 5�.F. O NO.OF CHECK BK. PG. LicenSeNumber � 'Lic.ClasS' � $IZE STORIES �iAh11UE5 ONE � . . , -- ' � � � � �� . � . � VAWAT�ON .,, . DESCRIPfION OF WORK ' NEW . . . . .'" "-.�'. . .. - Contro[tor. ., . '� Date �� .. � -� .-� ...-- � �� ApD s � O� ❑I om exempt under Set. ,�!---. •.�� 2�.4��.�...'� . __ .._ . ...� ❑ . .. , . . ALTER . �° �,Z.S ; B.BP.C.fo�ihis reason � .. . _ REPAiR . -s �--... .._ . . -- . . -. . �_-- --___. oa+e: - use oF oennoi I • •7 0 1 3 EXISTING BLDG. � . . . . _. _ .. . �- Signafure � '. - .. .. ..-. .. .._ _. . .- ....... APPLICANT . TEL FINAL ' • • e�] . - PRINT � NO. � �� �� O.� �J c=i OWNER-BUIIDER DECLARAT�ON OATE V Z` ..�--.,- .�-- �--�- -�- - �.I hereby offirm that I am eaempt from the Contracror's license - � � � � - -� � - � � - � � ��� . . � � law for the followin9 reason(Sec�ion 7031.5,6usiness and e.00aE55 C / HNAL ' � ��-� �.. • O H�� -.H�I `Pro essions CodeJ:--_ . .. .. ._..._ ..__.. .. ---- Re N -!y .• � . . _ . � . �' . . , - ,�. . euuow� � �� � �_ I, as owner ot Ihe property, or my employees wilh qDDRE55 ' ___ _ . � wages as their sole compen=otion,wifl8o the work and �� � �p�Alrtv � ' � , � ' - � the structure is not inlended or offered for saie(Section , . � � ' ' � � ' - '� . --7044,Business and Professions Code). - ...--�-- � h�OviNG - -- ..__ .. _ -, .. . iEi. _. .. .._ _.... . .. �.� -.__- . -._ ._ _ . ,.. �� I,as owner of Ihe propeny,am exdosively contracting �aN7eqCi0a NO. ' .�� . �.; . - -'with licensed contraaors ro construct Ihe project(Sec- . .- . - -.. . .. . . . ... . . . . . . . ... --' -- .-...----- �-' tion 7044,Basinass ond Professions Code). no�Re55 - _. _ � � . . _ . i REQVIRE� . iOTAI SETBACK ���''' ' "�-"- "-"�--"-CONSTRURION IENDING AGENCY� -"-" - "- SET gq�K �YARD HWY � pROP.tirlE WiDTH' � � - ���- � ��� �� � � - -��- - � I hereby affirm that there is a construtlion lending ogency for FRONr - �� . . <0.7.3.8 A �...; -�ha performonce of the work for which Ihis permi�is issved - -� �F.L - � - - � �� -- -- --� -- - ---- �-� • �� - ���-�� y � � � - N• ! � (Sec 3097,Civ.C.). SIDE �-. �' m _. .. r.i. : I 9�.0 ` . ... _.._.. . .- �- - --.. .. _. . . . _ . _. . .. . --- �- e-o - .. + Lender's Name � LDMA Ref.N � �� 'O � ' _ '. ' _ _ ' ' _ _... . ._ _..__.. . P.C.Fee S � � O�� � - -- Permn Fee - �S�.�. ' . _'�• ♦S��O C 2_ ' ^ lendersAddress -� � -� ' �� � > �'� ffi .I certify 7hat I have read Ihis application and state ihat the . '. '. '_'_ ..'_". ...... �ssuanca fee - (5 r .. iDMA P/G N -.- . - '- - � : :: ..�Q C F-Q�7 a above information is wrreU.1 a9ree to comply wiih all Couny Imesrgar�o�Fea T� " �� � ordinances ond Stme la ting to build�ng constru[tion, _.. ._ _. .To�al Fee --- -�� � ��V t�MA Perm.N � _._. ._.._. . ._ . ., _ . _. ��.'_. � ond here6y oWhorixe repre la�ives of ihis Counly to eMer �� �- � � � � E � upon Ihe above•meptio a,�e,rty'�fo'r�inspecfion purposes. . �. ' a --- �p� .�d�au� ��}_�.�� __ _ ._ _ _ _ — _. __.� - -- - - - . _.. a � SEE REYERSE FOR E%PLANATORY LANGUAGE ^ � .._"" _�._ __ .'_ � ' - -Signawre of APPI'on�or Agen�-. . . ..--�pa�e .. . . _. . _ .. . . .. . _._ _ .. . r� I .""_ .. _ _'.. . .. . -- ' - - — � - t�. � PLANS TO APPtICANT INSPECTOR'S NOTES . O�YNY:R•IIUILDfR nICLARAT10:�1 �� I here6y affirm that I am exempt from ihe Con�ractor i To: � , R�turn�d , ' ". � � . � - � �License Low for �he following reazon:���Sec. 7W1.5) � ' Approvad � Quslnett and Professronr Code:Any crty or rounty whicb No, . Dota � No. - - Data'-'� � ' ' � �- �� � � reguirrs a J+crnrrt tn construct,after,improve::leno(isG; . -- or refarranyslruc0ure,f�riar to i!t issuance,also reguires . ' . ,.�.'� > :,.1'� i, '. -, . ., . ' � . , , tl�c applirant jnr suoh permit to file a sigrted sentemen! ���� . . • . .!.� ..�- ��� � .. j .': -�:h',J �fi.'� i:i� <J3•_;� ___ _ lrartor'sLirensel.au(C4a�rer9J(cpomnrencin�utLSeo - -- �- - - --- �� - � -� e' 000 f D ' 3 tG B . J f . , . ._ .• --- ,_,;.� ; , . .' . � ��� �: tz:�. . , . . - � mn 7 /o irirmn o e usinesa on ro ettmni ,_>-� _ ��. ' . , __. � �. ����.���_�_ CodcJortGafleisexempllGcrefromonJlGebnsiefortGc ... -- _�..� _ _ ._ • ._ ' ---....-.. _. -... . -- - . ..... . 1! d ' A '1 t' S t' 7031 5 6 ' "- a e � n ou no e[i n egr rx m�+t on. y t�i ro o � � . �.�:. ._., . i ...._.. 9u _ __o'tAPPf _._ � . .. � . ... �... .� ... _. •-. ' un1'aPplirant/nrapernritsvAjeclstl�eapplicanttnaciri! Rc ired olv.d � i Approvals ov�d � � �/�rna!!y o/nol rnnre than j'��e hundreJ dollars(SSOOJ.J:. i 'Yss No .�� __ �-: . .' ._. ... .__.;._. :` ':!; . . � . ,. . . --�-�-�- ❑ I,os owner of the propeny,or my employees wifh� Wo�er Certifim�a �' `� � _ I' i � ,� �. '� , .,..,. .. ,. � � ,� i woges as iheir sole com�pensation,will do the work,and �..,.r.;.' ..:-�:: ...:,,•, �,�� � '_'_" . . �.. .; .. . .. . .:. .. _ . . .. . . � -- -- �- - � ��- ' � � � Ihe strocture is not inien ed or of(eied fo�sole�(Set.7044) �.' .... . .•.- � '" ' - T ;�'�,d' .,�..�,; '��"�� ,- '. �;, . � Dutiness and Prn estions Code:Tbe Contractori�Lkente Health DePaitmen�._ ... - -- - -----. . � �� . _ . . _,,.,.. .:.'--.�. .._ . � . . . _. J, ' -,, _,S� �,�.^. ��,.,,� _�� l.aw does no!af�ply Yn,an ou�ner of frof�erty u�Go burldn , ' ��� ����' � ar im rorci 1Lcrron,dnJ wEo dner such a.ork 1 imsel o Fire DepartmeM .__._. _ __ .__. . . _. .,. _ ' . . . , , , h __._ .. . I r • - � � . lGmugL'Lis own e>nployers,prorided�-tbat ruc%-im- , Groding � � � ! " � � ! . ' , �prnarments are aot intended or offered jor sale. If, • ' '..� ?. �, i! �r'....� . .-- � � _ , .: '_�i-.-� ' �..�;. , ' -��lmrc•et�er,tbe buifdin,Q or irn/�roveracnl utofd v,ylLin onc . � . .�.�\•..� Geologiwl � � � � ,..,�� � year of rnmf+fetron, tle nu�ner-builder ud!!baon tLe ,. i ' ' , .. . <. ' • -_-��3''(.'!' __�� �. bwdrn ofQrorrng tbu[Ge Jid not build or improve jnr 1 .-. .__. ._ _ .. _ __ . Pedestrian Proleclion ''.. .. . �". � " . .- " . .. � tLe urf�ose o/tafeJ. � . (Fence)(Canopy) ' . - - - - - - ��' �'�' '�' �� � '���- � , ❑.�I,os owner oi the�property,am ezdusively controc= . . iing with licensed contractois to construci 16e projeci(Sec. . . ._ . . ..`.: i�,.: .,. � ,., Special inspecfion� � -"-- �--l--� � - � ^�. ��� -- i�� ' � � � Ousinets arcd Pr fettinns Code: TGe Contractor's ( )� Y)1 9) �, .' .� ,...�... , ,. � ._ . . '._. , .__ ... �.�.._r.,� �. , _ Lic��te�nr/inisnf�a ! t�ana�ner� rn erlyu•Go Cona Masonr Weldin hh3' /P h � -bui s or �es �errnn,onJ a� o inrttrarts�Jor rurG Lol Drainage �� -� �` � , ' � r jects u•i!1 a rnntracMr{sf Gcensed f�ursuartt en !be .. ,, . . , . __. .._ _ .. _.._ .__ .__-. _ ._- -_ - P . ' � � . Confraclnri Liccnsr I.au�f. _ . , _, .. � . ._-, :, �. ,� .. . . ' Parking � .._... ... . , ... _ '._ ' _._ " _ -.__. .. � . ,.. . '�: , . � ' ❑ I am exempt under Sec. ,8.8P.C.for ihis ' . � eason . .. _.- _.. _ . . , � . . � . . � - . _- . . � Date . _ � .. ' ._. Owner�___- Approvals Date ImpeNor's5 aWro. - ,. I,.:� ' . • . . � � � � • INSPECTOR'S NOTES � �� � location— . .. (Ser6ack 8 Yards) ._. .-�_. - -- .-..�� , .'��:,.�� . �, . ._ . . . . . �. - . Foundations . . . _ l ,�f i . . ._. �`. . .... ....���i._. . . . ,_ ' . . ' . . $lab � - . ... ._. , _. __. Frame ' . �Z� . . . . , . . , . . .� . . - _. . � � . Energy Insulation • �� '....�.-. _._ � . ._.. ,. .._... _.._. . . . , . , � Lath/Drywall— `i. .. .-..... _._. . __...._. . . ._.'_`_ __ . . __ � � .. Interior J � . .- .... , � .� . ... Lath—Exterior � ' . . �_ . . . . . .. .. _.___. . . _ . __ __�� . �.'.� .. , HouseNumber— � . ` T-�-- � ___ _ ._.._._...____. _ . ..._� __. _ . . . ' .. . _ .: ____.... � Correc�8 Pasted — v _ � . ,- -�' ��" �� � � ��' �� Finol— _ __ ____ . _... . '_'. ' .'_'. ' . , - . . �-- .� . . __ . . .._ __..._" _.___._...'_."'__ ,'. ENer on Fron1 . . I ..� � . � . . . . .. � , - . ." , . _ . � ��� .. - - � i. � _. . . ' . .