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HomeMy WebLinkAbout1328A 1329A (7) . __ .... ._ . ----.. __..--- . ..._.. . ... ._.____.._ __ _ _ .---_ -- - - - - - _ __._. _ _- _. . . .. .... ARATION ... . . � :�. . . � _ �.. . .,. oharcerlifedlcopy�thereof(Secc3800cLab�sa;on�^.°se1 � � - �- - qpPLICATION- FOR�.BUILDING PERMIT --- WORKERS'COMPENSATION DECI insure,or a ceriificafe o(Workers'Compe ance, �� � ��"JGK .I-fJS• COUNTY Of LOS ANGELES BUILDING AND SAFETY PolicyNo. � • Company- BUILDING C`� /��, Q ee�rf�ed copy�s hereby fo�n�shed. FOR APPLICANT TO FILL IN nooaess /'T�' CXa,r•✓ � �Cenified copy is(iled with the covmy buiiding inspec- ���" gUiIDiNG � ion department: � �.. ' ADDRESS r � . . . � _'��. Date ApplicaN . . . � CIiY �a ) LP lp�?.LIN � � CERTIPICATE OF EXEMPTION FROM WORKERS' �-' - - �� - -- � -NO.OF BiDGS.' � NeneESi . � . . . ' - -- _. _, . -- ... . ._. ._ .. .. � � COMPENSATION INSURANCE � � . � SRE OF LOT NOW ON lOT I � CROSS ST. � (ihis section�need not 6e compleied if the permit is far one -� - - - - --�� -� -- -- -- -- -� n5Se550R -- ��-� -- •• � hundred dollars(E100)or less.) . TRACT BIOCK LOT NO. �y�p,p gppy, � PAGE PARCEL ^ TEL. USE ONE M4P � �. I certify�hot in the periormance of the work for which ihis �W�R�-- -----I -- -- '-"`NO." �7G � r NO. . �� . - � ;} permit is itsued,I shall nOt employ any person in any manner qDDRE55�- '/�?Z-' -h ! �� - � '- SPECIAI� �- --:-- - -----� �- '-- ;G. _._... _._! _ _ .. ___.. . . . CONDITION$ . .. . 'O so as ta become�subject to the Workers'Compensatian Laws. � . . . .. .._. . . '..._...,. ._..'' '. .'.. . _ . ... . . . . . , ._. . 'OC � .� . . � QTY. __ I,J f� ..-ZIP . Date� � AppliCanf ARCHITECTORA� TEL. �� NOTICE TO APPLICANT:�If,�ofter making Ihis�Certificate of ENGINEER (-0 c[. � 55 � NO.OS� / �� TYPE �.-_._--.. FIRE ..7ROCESSED BY Exemption; you should become subject to�the Workers' " ""- !� 2� I� !_ p DISi� GROU7 CONST.� ZONE . � Compensation pravisions of the Labor Code,you mvsl for�h- qDDRE55 T b ll0 � rtl F� L/� - � ��- � � wilh comply with such�provisions or�this permil shall be --� - TEL. SiATISTICAt ClASSiFI N , �� APi.� C N�O.� �Z deemed revoked. .. . ��, � .'.. ,. CONTRACTOR !}� C NO.IA '4A � -�. •- LICENSED CONTRACTORS DECLARATION��� -' � � -- � �- � ��� � � �-- - - �Cu55 NO. � � � DwEIL�UNiTS � � uc. �1 1 hereby effirm thot I am licensed under provisions of Chopter 9 � AODRE55 ( re�J e n NO.Z�pi'1 S� . (commencing with Section 7000)of Division 3 of the Business and ���, SEYOER MAv , � �� . ��: ...... - ' -. - . .- _. _. Professions Code,and my license is in full force and effect. CiTY o�to p CLn55� C-�v I� ' �' ��� " ��-� � ' - -'-yp��DAT10N -� � BK. PG. �i / 50.Fl. NO.OF NO.OF CHECK � licenseNomber2���� LlcClass L �� I SIZE- - STORIES ���� �� fAMILIES �j� �� ONE . � ' �� � . , /� VAtUATION I om xe pi�der Sec. . .� ._ New -. . -i . _. co���a�ro. � �(�}r�� oa,a��5�' DESCRI7TION OF WORK �'� �, oF s a aoo , - -- - ✓ � I � , : • � n ALTER , � 8.8P.C.fo�fhis reason . � � C �� Z r REPAIR = - -� �' . .. _ . -�__ - . . _ '. p � pO}e:. use oF oerno� ; 1 3 2 8 R E%IS7ING BLDG. -- ��- �- - .� ... Signature . .. -- --� -- - -- � - AP7uCANi /` TEt. FINAL ' �• • • .2�j . OWNER-BUILDER DECLARATtON PRirrt �. Na_GZ3��QSI ._DATE ' � . � - � I hereby affirm lhat I am ezempt from ihe Conlractor's License ,/ � ; �.�.�2��Q . Law for the following reason�SeUion 7031.5, Business and nooaess J��{ C. 6"!� 5�n �7o I� /�` FINAL ' ' � � � � � � _ , 'Professions CodeJ: - � --•- - ..__� _. . - N By - ' _ - -, • • •2 5,�Q�, .. BUIIDING � I, as owner of ihe property, or my employees wi�ft ADDRE55 �w ' .O 7� 2�8 S . _. ... wages as their sole compensation,will do the work and i�ircv . �- g7!] ' ihe slrutture is no1 intended ar offered for sale(Section � . � J/ ; � � ' �' p 7044,Business and Professlons Code)."-"" �"" �� MOVING' � - ��-TE�.��-� - ---- ' ��..i.�<.N�' � -' ❑ CONTRACTOR NO.' ~� ,: , I,os owner o f I he property,om exc lusive ly controcting .�� with licensed mNraclors to consiruct ihe project(Sec• - " " """- "- "� "' " " " �-' "�' �'- '-"- "--' "" /!/t"t - � - - ADDRESS ' R 329 tion 704d,Bosiness and Professions CodeJ. � � ��� �. �o • • • . �� �� . _ __'.._ REOUIRED_ . _TOfAISETBACK ._" _ _ ' '' '_ _�___ ". '"' .-. - CONSTRUCTION IENDING AGENCY " � �"- 5ei encK YAR�' HWY pROP.LME wiorH - 1 hereby a4firm thar there is a consrruction lending agency for FRONT . �" •3 Q J�� ' � �he performance ol the work for which this permit�s issued - - v.t. - � �� ���� � � --��-���� � - � - � - � - � � �- - -� -- -� � -- -- (Sec 3097,Civ.C.). SIDE •3 0.�a�' � � • • m . . _.. . _' ' . _' .___ . P.L �: __' ____ _._ .' _ _ _ . ._. '_ _ _ '. .. � Lender's Nome 'l LDMA Ref.fl 0 7.� G-8.5, � $ - .. .__' _ _ . _ _ _.__. v.C.Fee S �_�'21 ..Perm�t fee ��7J , . _ . _ . . - lender's Address / , � ��.'. : � I certify.tha�I have read this applimtion onds�ate thar the . -.. .-_ .-. ._ - ___. issoance Fee--llO'.S�- i�MA PiC q- --- � --- '- . . . -�- � � � above informarion is correct.1 agree to comply with all County in�esiiganon fee 2 . � �,. � ordinances and Siate lows reiating to building construcfion, _., . - �� Tofal Fee -- ✓�',� �-� �LDMA Perm.X - - u and hereby authorize represenra�ives of this County to eNer , � upon the obove-mentione pro erty for inspection urpos s. / � m _ � � __ . .._ _._ ._. ___ . . ._ ._ .. . _ _ _ . . .. . ._ _. .. ... _ _ _ q ' ^ � , SEEREVERSEFORE%YIANATORYLANGUAGE I � ._ ... ..'._ _. _ _ . . . _ � ._. '' .____ . . _ . �pr� - igna vre af Applicam or Agen� . -. .. .- Dat - .-..�. - - . - . - -. . . PLANS TO APPIICANT INSPECTOR'S NOTES �. �«�NCR-BUILDER UIiCLAKATION I hereby affirm that I am exempt irom the Contrac�or's �To: RNurnod � � .. ,� . � Lkense Law For the iollowing reason. (Sec 7031.5) �� ` - ' ' Approvad pusrnessanJPrnfrssrnrssCoJr:Anytityorcossntytobitb No. Dote No. � � Do1o. � � . . reguiret a permit!o ronttrvcl,aller,improvr,demnlrsl�, .or rc�+airanyslrutLure,Qrior to its issuante,afso requires . . � . 7 .� - . .. , tl e ap(�licant f r aucL pernei!!o fife a srgned statement tGa!be is Jrrensed J�ssrsuartt to!be provisions of tGc Con- _, �. �i� - � • traotor's License l.aw(Cbapter 9J(commenting u�itb Sec� tinn 7000J nf Divuinn 3 of 1fie Dusmess anJ Professiaas . � � �� ; ' Cndef nr 7La!Le is esem/rt!!erefrone and!I e bavisJ r tbe ._ __. _... . . . .. . ...� . . _.. .._. _ . alleged e.xeniplrnn.Any violalion oJSertinn 703f.5 by ' , __ Raqoired DataRx�iv�d - � �� � - an,ya(�pliranfJoraperniitsubjectslbeapplicorstloatiri! Approvals�� Yes No� or Approwd . .fenalty oj nnt more tGan frve bundred dolfars(SSOOJ.f: - ' - �- - � � - - ❑ I,as owner ot the property,or my empioyees with Warer Certiiicaie - -' ' � . � �� . . . .... .. .. . . _. . weges as fheir sole compensmion,will do the work,pnd "� -- - � .--��- �� ' - the structure is not intended or offered for sale(Sec.7044) ' Heahh Deporlmenl_ _._ . ... .. �:.- ' �- -- � � - . .. -.- ... . . Ifusinets artdPrtifestiorts CoJe:Tbe Contractor's Lirense . l.am does no1 apply!o an ouroer oJproperty u�Go buikls Fire Department _.. .__ ._ ._ ., . � - � � � � � nr iinpmees t!ercon,cnd u�Gn does suth u�ork Limtc!/nr - � � � tGrnugb��bis.oum,e»rployces,prnc•ided tbat tucG�irn- - . Groding , � � � _ . � pmvcn�enls are nol inlended or offered for sale. If, ' . � . � , �bntecver,t5ebuilJirsgorimf�rovrmentissoldwrtGinonr _ . _ .� ___ __..... . , , Geologiwl , . �,year of tonrp/etinn, !Ge oumer-bullder mill bave�tbe � burJen nJJ,mring 1Gat bc did not build or improoc for Pedesuian Prmeclion.: ""- . . . . _ -� ' tbc purposr of saleJ. � . . - �Fence)(CanoPY) . : .:. . . �'. ." . . . ----- � � � � � - - . �❑ 'I,asowneroffheproperty,�amexclusivelyconirao ,ting with licensed mmmcrors to convruct the projec��(Sec. Special Inspection -- . - - � � � - � � - ' 7044)Busirtets and Professians Code:TGe Contractor's '�" � � �� � I.itense Laa�docs not a ! ta an ou�ncr o ro erl_ u�Go (Conc.)(Masonry)�We�ding) � - � _ PP.1' JP 0 Y � ' � �� � � � builJs nlimpro��es tLcrcon,and wGo tnntr¢cts fnr such ' Lot�rpinoge �� , � � . . _ . � �� ... _ . _ ._. . . projerts wi!!a roneracmr(sJ licensed pursuant M tGe . Contratlor's l.iccntc l.auJ. " Parking . . . . -. .. .. . _ . _ ._ � . . , . . ❑ I am exempl under Sec. ,B,BP.C.for Ihis ` � . . reason . .� � . ._ .. . • Date .�. . . � . . ...Owner �Approvol� Date Inspecfor's Signaluro � . � . , � . . . - . - �, " INSPECTOR'S NOTES � Lomtion— . � �Setback 8 Yards) � - � � . Foundations � � .. �� . . � Slab . � � � � � . � . , _.._ _ . ___ __ ._. . . . _ _._ . , . - - ( F�ame . .. . .. . . . .. . . . . , -, � . � ., , Energylnsulalion , � �-- -+- =- � - - - _ . , . La1h/Drywall-- . -- '�,- � �----. . � . ' . Inlerior ...._ _ _ .__ � , _ � .. , lath-Exterior� .. .. . � : � � . . . � . . �� " . House Number— ' ..'. ..._---- -.__ . .. . . . __ . ,, Corrett&Posled � � ' -�--- -.. _ .. . .__ __ . . ._ • Final— . . . ._ __ .._... •,.. . _ . . _ � �. Enter on Front ' � ' � �