Loading...
HomeMy WebLinkAbout0846A ` -�-.�_.. _ . WORKERS'COMPENSarti,.. - �� -"' ��"'�--''�"�'"- -��- I he�eby affvm tbm 1 hove a certiFicafe of consenf to 5g�f`. -. . �APPL�CATI4N� FOR��l�U1LDING P�RlVt1T' � �'� insure,or a cert�f cote of Workeis'Compensfion Insuronce,or o certified copy gIhereof(Sec.3800,Lo6(.yC�.) COUNTY OP LOS ANGELES BUILDiNG AND SAFETY � - Polic N . �u �' �Company WV�� ���n� ' BU�LDING , �Certified copy n hereby f�rnished. FOR APAUCANT TO FILI IN annnsess � Certified copy is iiled with the county bollding inspec BUILDiNG � �u � � iion department. ADDRESS � �[� � F���TY NEAREST oare Applicam CITY ~/ p,7A •G ziv CRlS55 ST �+� v CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLOG. ASSESSOR COMPENSAiION�NSURANCE SIZE OF LOT NpW ON LOT � MAP BOOK . PAGE PARCEL (ihis sectian need not be compleied if the permit is for one u5E zONe MnP f�� f�3 s 3 hundred doilars(E100)or kss.) teacr aiocK �oi No. � seEciat Y I[erlif ihol In Ihe erformance oi Ihe wo�k for which this OwNER TNO.�7Q � COND�TIONS p y P DISTRICT GROUP TYPE -FIRE P ESSE�BY V permif is.issued,I sho��not emplay ony per5on in any monnar qDDRE55 (iR(U CONST. ZONE � so as�o become subjed to the Workers'Compenwtion Laws. �+� � �-� �� i`/ � Oa�e Applican� air �..�[- zio QpY(�jZ O � STAT1571CAL QASSIFICATION APf. CONDO. NODCE TO APPLICANT: If, after moking ihis Cenificafe o1 /+RCNitECT OR TE�� � � ENGINEER NO.'�I� CtA55 N� DWELL.UNITS�_ Ezemption, yau should become su6ject ro the Workers' N Compensotion provisions o4 the Labor Code,you must forth- aDORE55 SEWER MAP ? ith mmply with such provisians or ihia permit sholl be �pi. / BK. �, VALIDATION deemed revoked. �pNTRACTOR L�C NQ. - LICENSED CONTRAQOItS DEQARAT�ON �( d t 1 hereby aSSirm thot 1 am licensed under provisions of Chopter 9 ADDRESS��'J �'�� �O.� f� VALUATiON �/{ • �commencing wilh$edion7l)00)of Division 3 of ihe Business ond IC Q�/ E ���4��� Professions Code,ond my li<ense is in fuU forte pnd effect, Q7Y CLASS F-/ y�tn /�Y1 � $p FT�L NO.OF NO.OF CHECK License Num,b/�er ^�`����v Lic.Class��,L_L_ SiZE V��70 STORiES FAMiUES ONE , �(JA,J ���,�� �� � �ESCRIPTIOfJOF WORK ' NEW � 5 . ConlmctorLl.�JI 9ote ADD � � I am eze�npt from the licensing requiremenls os l am o ALTER F�NAL L� � licensad architea or a regisiered prafessianal engineer DATE `� �/�� octing in my professional mpaciry (Section 7051, REPAIk � . - Business ond Profeesians Code). USE OF FINAI //' Ex�Siit�GB�OG. �/' . o�M�� � � sy., . '��.�'-"�� � Lic.or Reg.No. Date APP�iCAN TEL � � � OWNER-BUILDER DECCARATfON� ��- � � - - .'PRiNi� - o. V I hereby affirm thal I am exempt from tha Contrador'e License _p�� � �' ���.r�?�r �����- � � �� �"fals Law for the following reason(Section)031.5,Business and� / � Professio�s Code): . �_. � vKeser�e- -- -. .-.....--� . . � � � og�,�o�ti� , _ � ,�� , �i, os owner of the propeny. or my employees wifh ADD - i-[� � . F�`�� � wages as their sok mmpensation,will do rhe work and . Ifie structure Is not iniended or ofiered for sole ISectian iOCnUiY w . t TEL. , R 7044,Business and Professions Code). MOVING � � I,os owner of the pioperty,om excVusivafy coniraUing CONiRACTOR NO. � e�.{;:c r wilh lirensed coniracfors fo conslrucl ihe p�oject(Sec- qDDRE55 � tion 7044.B�siness and Professions Code). � , - � -� REQU�RED yqRD HWY T�TAL SEIBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SEt BAC� PROP.unlE WiDTH 1 hereby offirm Ihat there is a construction lending ageocy for FROY7 ..i:i:F'`. � the performonce of the work for which tFiis permil is issued P.�. , (Sec 3097,Civ.C.). SIDE ' P.l. lender's Nome �/ � � g � ' P.0 Fee$ �� Z� Permii Fee ��7' OO - ' . � � Lender's Address �� - � ' W I cerrify that I have read this dppiimtion ond slote that Ihe Isso e Fee �/ " above informaiian is cortecr.I agree to comply wilh all County Invesnga�ion Fee � anc � Q $ ordinonces ond Slale�ows reloting�o building mnstruction, Toral Fee — . and hereby outhori represe otives of fhis Counly to enter mupon above-m lioned erty far inspett,ion!putposes. ._ � y . �T_!-Q � SEE NEVERSE FOR EXPIANATORY UNGUAGE ' _f_�� ^ $ignalure of Appl��wnt or Agem Da+e J Z a o •• G> '� ,� a m tD � � o s n O N �"�o o °` a D F a : � � o� �° � m a � =� a ° a � :. �., � � Q �. � o � � � 3 °. ; n� ° ; o 'W � s� -n N 0 i0 � 'Z.N 4� � N tP O c�� � �� �� a R` .. ° � o'o � � �=• „`��n O O 6 Z r- o � 3 n i�� '� .�� a� ° 9� ^`=' o o s � `�' � � �.c` I i '- s � t? fl (9 �O i� �O � N n^ N O < !0 � �' � � f G� ON O_ M y j\ Q°G � � � O '� � . �• O O� Z o �36 0 `\ o � �" a � � � 2 . -,,� Q\ o 0 � 0 \ �p ''�p0 1 � ~ , •�p 7a e O O � � N o�R #• Y d M }1 i • 0 M � � �� w G � � . 7 '0 � 0 � � ,. ' � . � N i , R pa,s'��� ?6 �ia � m fi.`Y' w LS'`p'V p N u � { Q „�o �� � tp? p ^'$`t � � �t_ r n,;P O O SG O N t9 1�'p...b p„O O N Tn� A y� �L �'2. � a-`�;a+��' � 19 ,,L��e �' o r �'' � " °' � eS' O O O `t G '^ Yt C'...e' e� " m b O �j � � � �� � � W p,"a'ti'' � ` � ° '-^$ � ��,�. � +"�.,-.. n G C� � w � � (y� S�' ei�� Q K�,�„m � 7 p � � p ��e���W P.�n O H W r` O � A f ,i �..y x �,m Y� '�y -: �t c e 'C 4t � � •p" � 'C� � � Q i ^�mWs��'�oa.� �• a.aw+ � o� ° i'� Ko� �,'F, s� � � �3� m � ,. �»� �' �*'� o o�"�°' �m ���'A � n °,."�.`° a '1 w an-�`° �•'� �'a.,�x t� a � �.� � e, � f Nr�. `� "' � s Y`a �.�oo ? trs�'`"�ao� � ., �„ �m c� 3 H�.� oG. m � a� o�o m $ o � � m � '� � mS ;,o �a'O �r p C O� 2 M X � .� pyt O � N4'm'O .r`�.�.' �•��"� O .�R m � A N �O �`S w O .'t� 4+X C�P"7 O� N���� �G C�M Li m`L B O� % � � �'a�n `s° �� ��.�"����°,02 ��� ��o�p��� 3� 9'� y �e, w��oo �� a.'� gw ��3 a �a°».ami�,.H ��°� �-WO , Z N � c �� O� A ��° a� p y N`�"`10 6-�3 R.'�'�n�D�� x L ��� �O x � U+ "V�p ,� � p -4 O �'�"� +t �C g�O'��� p,'V .�..5� .�.w �yF'w' .`t ' .�... � � l^ C 0 e+ M ao ,`�y e� * Q Q ry �.,,��..O t0 A.y�v.'^ � A�L J p p A� ° �,cm �� N+��o�g�m p 't �o�.�£'���c3.. io �' �°� „j=,�. O E ° ._.,c�^��u+o o v+Q �-'�� v�O�� a's-`%�ri Z O p 1T?w '� ...�.� N E'O l.� �" O:t.�" � �0 * b ,-��-..�e f0 '~"'� '� B'� �2 p S y�`d. .ri ! �`�C'.. .�i � �+^ p O £. r..a.� e N +� �� �� � 0 4.'� 6 C��g'��,. �i`tn D O-�•:. ... 'O 7�� n m � it',�� ^ q � �-..�,fa` �� rd �„��� y 7^ C� � ��� c�l�p �m 1° � H � . O w rfi Q ,�n- �' . N � � /� '' .i�� �'�ii /�/'