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HomeMy WebLinkAbout1070A 1071A � � �' r �„ : '` �]. .. .. ..a� ,�. /f . . - -_ - ���� . _ . _ . WORKERS'COMPENSATfON-DECLARATION j� � �� � � � - � a� x - � - � I hereby affirm thot I have a certifimte of con ent lo self � � App`�ICATION�.FOR� BIJ��:�1-�11tG PERNl�T,�, � I��, insure,or a cerr limre of Workers'Compensahon Insu�ance, . � � ; � -.+ � or a certified copy thereof(Sec 3800,-Lab.C.) � �"" � �� ' � � � � : _ , COUNTY OF LOS ANGELES BU�DRNG'RkNl��A 'TY : y� ,� _� _ ,w�s „�' > PO<yNo. LdCP864S0$Ampany Great Attierican . euaoiN� � �' Ce�tified mpy is he�eby furn�shed. FOR APPLICANT TO fILL IN aoortess � ���0� � Certified copy is filed with the coun�y boilding inspec- 6uItDIr�0605 Climber PYY1V2 tion deporfinent.. .. -. . .. . . ADDRES Dote 6Ig/88 Applicant R. CI72S11EY� CITV ��land�Helghts nP iocnur� CERTIFICATE OF EXEMPTION FROM VJORKERS" � NO.OF eto�s .,, .._. .. ... N�eST COMPENSATION INSURANCE � 9ZE OF�OT NOW ON i0T CROSS ST. ihis secfion need no�be compieted if tFie permi�is for one . .3363( ASSESSOR� I TRACT - BLOCK � l01 NO. 30 MAP 00OK � PAGE PARCEL hundred dollars($100)or less.) � . . TEi - / � - USE ZONE MP.P � I certiEy tfiat in the pe�formance of the work fo�which�r,�s�� own,eRPRESLEY OF 50 CAL- No660—Q660� � , SpclA` ��f j� � permit is issued,I shall not employ any persm m any monner �a y'd f� �^�t ;'�'�- sa as to become subject to the Workers'Compensation Laws. ADORESS / CONDiTIONS G�-32�' 0--. Irvine Z1P 92714 �1�L�— c� aTv - � � Dafe App���anf - ARCHITE�qjt TE� DISTRICT GROUP 1YPE FlRE y1tO�ESSEDBY Q NOTICE TO APPLICANT: If, Qfter making�rhis Certificate of ENGiNEfWi�r�25 'Shc1C�E n,oS47-3203 CONST. ZONE / ] � Exemption, you should become s�61ec1 to�tHe Workers' . 61O E.-17}�1 ..St.� �t105 r S�I].td At1a �_ {� � � � W�. Compensation provivo�s of Ihe Labor Code,yoo musl forth- qDDRE55 _ . „��� � . with comply with suCh provi5ians or_this perfnit shall be � 7EL. STATISTICAL CIASSIFICATION ��� APT. CONDO. � deemed revoked. � - CONTRAC70R S� � �� NO. LICENSED CONTRACTORS DECLARATION � �iC.- _ C�n55 NO. �� DWELL.UNITS � I hereby off3rm that I am licensed under provisions of Chapter 9 AD�RESS N�' SEWfR�MAP' -. ��� -. . � (mmmencing wilh Sec��on 7000)of Divisio�3 04 the Business and . uC. _ Professions Code,and my license is in full force ond effect . CIN `2_�Z -CiA55--� BK �: VALIDATION 527293 Bl szeFr� S ORI�ES 2 F MIOES �' CO EK License Number lic.Clau - VALUATION � PRESLEY OF SO C�L 6/9/88 DESCRIPTION OF WORN S1T1 le Fami.l NEW ,� _ ���;(9�J " � t;!.i;jy Controcior � ��e with attached garage ADD � /. � �I am exempt undar Sec. . . ry - AREft ❑ i� G 6 ��� �� B.&P.C.for ihis reason P1dT1�� /7 C REpp�R ❑ 5 . Dafe: USE OF � .. .... . . � DEMOL ❑ � °L;.z�..�`.G �.... .. ' EXISTING BLDG. --.„ pPPLICANT� - TEL ( . . s;g„a,,,,e R. Chenier No 660-0660 FINAL (�( 'y� '�' OWNER-BUILDERDECLARATION IPR�N7) DA7E O\rl�� I hereby offirm thot l am ezempt from�he Co t actor s ucense 179j]_ ,jNltCh@ll SOLltYl� IYV7.II2 FlNA� � � �`�V�-a c`'-�.- �-�- Low fo�the followin g reason(Section 7031 5, Business and_ ADDRE55 --- � , Professions Code1: ... �E E . . . BY ,. -.-� .:�j..�-(-;... . ❑ BUIL0ING . s _ I, as owner of Ihe property, ar my employees with ADDRE55 � /�„ W� wages as their sole compensation,will do the work and ._ t2f s� i the sirocture is not in�ended or��offered tor sole(Section ���'��TY -� � . -`- j d - - 7044,Business ond Professions Codej.- MOVING . N�, � �/Z�J�f4-� E ) s�n(� � ❑ CONTRACTOR j _ I,as owner o4 the property,am exclusively[ontracting . with licensed controctors to construct the proietl(Seo ADDRESS � � V �`�����'1���j tion 7044,Business and Professions Code). � � REQUIRED YARD HWY � TOTAL SETBAC CONSTRUCTlONlEND{NG-AGENGY � - � -- se1BACK � PROP.uNE �� wiDiH I hereby afflrm that ihere is a consrrudion lending agency for FRONi - U�a'!�)r—:��c5 -. - . the performance of 7he work for whi�h ihis permi�.is issued P-�. (Sec.3097,Civ.C.). SIDE - N/A P` lender's Name -- - � . c��n LDMA Ref.N � P.G Fee S � Perm�Fee... �='V��� ' tender's Address . . ....- >� �s ���y ► � I cerlify iho�I have read this application and 51ate thot fhe _ �7 �-/`3� �ssoonce Fee �-�•5� LDMA P/C k ✓ obove informotion Is correcl.1 ogree b comply wilh all CouNy �nvestigation Fee .�$Q - ordinances ond Stote laws relaling�to building consiruc7ion, 7oml Pee'7�4�v(� LDMA Perm.M 'U�7 G/ �. on� hereby autho'ze representalives af ihis Caunfy to enter . . 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