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Home My WebLink About0936A 0937A (5) _. .. �,. ._..., . ..... .... . , WORKERS'COMPENSATION DECLARAiION � � , . ;y;., �.:.. :� .. . � � � ,_.,._.._.,.._-.... ,, , .. . . .. . ...... .- . ... .. _ _ _. .. . .: `.: .. .. ,. _. I hereby aff��m thar I have a certifimte of�o�=e�f�0 5e�, p�p�p��AT101� �O�R� BUl1DING PER�Ml-T � �� insure,or a certificate of Workers'Compensotion Insurance, or a certified ro ihereof(Sec.3800,Lab:C.) ��`- �- "" - " - - , 61W��'X799�3 Hartford Group �� COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. ompany - 3 � � � Certified copy is hereby furnished. FOR APPLICANT TO FILL IN Bu��o�NG �l�s A�• ��i'.�� " � ADDRE55 Certified copy is�filed�with the wunly building inspec- BU�LDING �- 2 fion depariment. ADDRESS 1175 5outh Crestbrook Court o-.c Da�e � �..� Applicant � arv �1dm0Tld BdY' .�.V.... zia .�.... .. iocaurv CERTIFICA7E OF'EXE/J�PTION FROM WORKERS' NO.OF BLDGS. NEAREST . . � COMPENSATION INSURANCE � SiZE OF�OT NOw ON i0i Czoss si.. (This section need not be complefed if the permif is for one TRA�T � , P.`a5E550R� �� hundred dollars($100)or less.) 42 bIOCK LOT NO. M4P BOOK PAGE PARCEL TEI. USE NE MAP I certify that in the performance ot t,he work for which ihis �WNER - NO. _ �� NO. L��- � permif is issued,I shdll not employ pny person in any manner � SPECIAL O so os to become s�bjeci to the Workers'Compensation Laws. AWRE55 Ovd�� CONDITIONS � Date � APPlicam � CITY ZIP .. - . -.� . -....- . . � A2CHITECT OR TEL O !'p ICE TO APPLICAN7: If, after making this�Certificate of DISTRICT GROUP NPE FIRE PROCESSEDBv ENGINEER A m NO. - r .nption, you should become subject to the Workers' � . /.� CONS7�//y� Z�,OIE W Compensation provisions of the Labor Code,you musi forth- ADDRE55 � � A`` �3 / � 6. with wmply wifh such provisions or this permit shall be - -- - - N TEL. STATISTICAL CfASSIFICATION APT. CONDO. deemed revoked. . � CONTRACTOR Bramal ea Cd�l f No. 850-1001 ��p LICENSED CONTRACTORS DECLARATION � - - - ��_ CIASS NO. `U� DWELL.UNITS T � I hereby affirm fhat I om licensed under provisions of Chapfer 9 ADORESS 3151 Ai rwa N No. 409610 (commencing wifh Section 7000)of Division 3 of the Business and . �� SEWER MAP � Professions Code,and my license is in full fo�ce and effecl. CIiV CtASS BK. �. VALIDATION � _ 5C�1.FT. NO.OF NO.OF CHECK Li<ense Numbet_n��_Lic.��lasi �g SIZE STORIES FAMILIES ONE --�O y��.�A VALUATION � Conimctor RratrialP� Cal if pa�e � � �ESCRIPTIO � wosK PLAN 25 �--''� "Ew J -�` � r�° � � s z 1 . ADD � S /�..Y� �GZ! , �I am exempt under Sec. O , (1 . F d ALTER ��' ' i 8.8P.C.For fhis reason . r REPAIR � S � � �, �g,; y,,., USE OF �^ � Oafe: � EXISTING BLDG. N n DEMOL � .;C �✓w�� S�gnoture �� + ` APPLICANT TE�� FINAL WNER-BUILDERDECLARAiIDN PRMT) L. Ab6 No.850-10 1 DATE - - � -�� - .� � I hereby affirm ihpt l am exempt from the Contractor's License J -��''E low for ihe Following reason (Section 7031.5, B�siness and AooaE55 3151 Airwa Ave., N� Costa Mes FINAC Pw{essions Code): ' � pR � By - �y V�(�� I, qs owner oP ihe properfy, or my employees wilh A��DRESS wages as their sole mmpensation,will do the work ond �� . � the struUure is not iMended or offered for sole(Section ��TY , " �. '.o '� . 7044,Business and Professions Code). Iv10VING TEL � I,os owner of ihe properfy,am exclusively confracting CONTRACTOR NO. �? °.�,�i.iJ 11 � � with licensed contractors to consirucl the projetl(Seo- � qDDRESS � - - r``- lion 7044,Business and Professions Codej. . " ` � � ;-�'.;=%. CONSTRUCTION LENDING AGENCY �- " �Qgq�K YnRD HWY 1pTP'pROPpLME WIDTH ��"�`--�� l%�,Lv I hereby affirm ihat there is a construclion lending agency tor FRONT the performance of the work for which ihis permit is issued P.L. ' � - � - �- - - �- � (Sec.3097.Civ.C.). SIDE . �� . � . . P.l. _ .. . .. Lender'sName Tprnntn flnmininn Rank - , 144 Sansome St., Sui te 700 P.0 Fee$ �` / `�"''4 Re' " � Lender's Address n � �i'� Pe.mi+Fea `�' �� ' I certify}hat I have rea�'fhis appricCa�ion�r�d s a e t e J3--<'I/ Issuance Fee �Q`a� LDMA PlC N , above informalion is wrrect.1 pgree to comply with afl Couniy Invesrigarion Pee //„ ordinances and State laws relofing to 6uilding consfrucfion, . To�ol Fee Y`��'O LDMA Perm.p and hereby au�horize representatives of this County to enter upon the o6ove-mentioned proper y for inspection purposes. �� , �`� '�. � _�� SEE REVERSE FOR E7(PIANATORV LANGUAGE � . � ignal�re oF Applicant or Agen� Wre . . . . .. -. . . ' - - �''� ' PLANS TO APPIICANT INSPECTOR'S NDTES OW'�F,R-BliILDER DECI.ARA770N , . , , , . . , . ,_ �, I hereby offirm that I am exempt from ihe Contractar's To: Retumed ��-L'icense Law for the following reoson. (Sec. 7031.Sj Approved IIusrnexs and Professions Code:An,N city or coanty mbicb No. �ate No. Dafe requises a permil tn rnnstrurt,ulter,7mprove,demolisb, .�...� . .•.,.: . .. ._...,,.,:,.,,,._..,.,.....,. . .orrepairan.yseruciurGpriortnitsdssuance,alsorequires , the aJplicant jor suc!(�crmie to(ile a siqned stntcment .tfiaa he islirensedpursuant do tbeprorisions��tbe Con- � . � . - . . . .. . trartnr§I.rcense Lau.•(Chapter 9J(commerscing uidb Sec- tion 7000J nf Dinisinx 3 qf the Business aad Prqfessinns . " . . , CodeJ or lbue he is e.renept therefrom aad the basis fnr eJ e urteRe�exemptiore.Any violaeion nf Section 7031.5 hy Required Dafe Reeeived � ' unl'upplicunt for a j�ermit subjects the uQplrtant to a ciril Approvals o�APP�o�� ,penrelty of ttnt mnre tbun frre hundred dr,llars/SS00/J� Yes No � I,as owner of fhe property,or my employees wiih Wmer Certificate � � � . - �� wages as iheir sole compensation,will do the work,and � ' ' � the st.ucture is not intended or offered for sale(Sec.7044) Healfh Department . . ��-� �� • _ Business and,PToj s.rrons Code:7`fic Contrdc[or's License I,aw does nnt appTy ta an nwner f propertq u•bn b+ailds Fire Deparimenl or improe:es tbereon,unJ u:hn does such u,�ork�imselj�r . . . , � througb bis own empla}�eex, proe�ided tbat such '-- Grading _ , pronement� are not intended nr ljered fur salE � ' . �� . - hou�ever,1be buildinR orimJirnvemene isso/dwitbire oxe Geological ., . � ye¢r o(comyletioa, (be nwner-buildar wi17 bax�e tha . - burden of j roring tl ut be did xnt burld or impmve f m Pedestrian Pro�euion � . .., . •- � tfie purpase o/..��re�. (Fencei(Canopy) �� `❑ I,as owner of 1he p�openy,om exdusively contrao- . _ . ,,, , ting wifh licensed contractors ro construct ihe projecl(Sec. Speciol Inspectiori - � �-�'"" " � � � - 7044)Businee�.c on`l Prnfessions Cnde: Tl e Cotttr¢cenrs (Con<.1(MasonryJ(Welding) � . License l,aw docs not afiply tn un ou�xcr�f properdy u�fin � builds or emproves tbereon,�and whn ronermcts f r sucG Lot Droinoge . _ , ,. . prnje��ts u•ith a nntrnctor(sJ licenscd pursuunL Lo tl e - Cnttiractor's Li�ense Lau�J. � � ' � Parking . . - ., ... . .:: .. ..,..... .. .. �. _..... _ . . . .. , _, I am exempt under�Sec ,B.SP.C.for�his reason � , Date Owner Approvals Dafe � �nspecfor's Slgnalure . � - � �,�� . . � � � � - � INSPECTOR'S NOTES Lo<ation-- " - �5et6ack&Yards) �� c'—L � � Foundations �.� :_�� . . .. ...... . . .. ... . . . � Slab �� //-��+'c�. �, . .. . ... � � .... . .. . .,_. Fmmef. j � ' -- . . . . . . .... ........ ._.....,. . .. �'��`��/ Energy Insulotion ^'1.7.4^� „\ � .�- . . . � . ... . . .'. � . � . . �`/! , . Lath/Drywall�- J ' ' . � . .. . . . -.- .. Interior � �G,/* - ' � Lath�—Exterior � ��. . . � . ..:� :. . ..: .... . ... House Number-- . .. � _ .. .;. . . ... .�... .: . . �.�.'.._ _ . .. '... . . . . Corretl 8 Posted ��L � ' �� - " -� - Final. .� . ' - -, . � .� Enter on Fonf , ...�.�_. ,.� ..� . ..�..,. . � F � j 2�a�= i-s-L 7 ,4�,_ , .. . . ,�. . ,.. .. ��, � �rh� . � y,e�_S� ;�_Y�„_„