HomeMy WebLinkAbout1778A 1779A (10) . ... _ ,. . �(r��q �
WORKERS'COMPENSATION DECLARATION " ' -� � � „ `1�-7V �,,
. . . . , . . . . . . _... � . . ... ..
P hereby affirm thof I have a certificate of.consent ro self qppL�CATIO�l1� FOR-�eBUIL�DI�N�� -P�ERMIT �
, insure,or a certificate of VJorkers'Compensation Insurance,
or o certified copy thereof(Sec.3800,Lab.C.) � �- ' � �-' "'����-� � �
Poucy N��dCC253824dd6,Pa�y Pac. Emplovers �OUNTY OF LOS ANGELES BUILDING AND SAFE7Y
Certified co s hereb furnished. eUILDING ,n /J
❑ Py' Y FOR APPLICANT TO FILL IIV nooREss I��(c �-{�,Q^�yry.3 P�-t-e.�.
� Certified copy is�filad with the cou ty building i� gULLDIniG , C tl
tion deparfinent. AD�RE55 �^� ,
Date����� ApplimnY w r cirv D' B zic ll iocnurv
CERTIfICATE OF EXEMPTI ROM WO ERS' S1ZE OF LOT NOW ON�TS -O- CR0.5S5ST.
COMPENSATIO SURANCE -
(This secrion need not 6r co Ieted if the permit is for one ��� �- .455ESSOR
6undred dollars($100)or less.) TRAC� � B�OCK LOT NO. MAP e00K � VAGE PARCFL
TEL. U ONE MAP q
owNea�I.J. Brock & Sons NoS29-8170
1 certify that in the performance of the work for.which lhis ��J� NO. 7�'��'/ }
permit is iss�ed,I shall nm employ ony person in pny mqnner P,Q. $OX SrJ� SPECIAL p,
so as to become subject fo�he Workers'Compens6iion tqws. /+ODkE55 �' � ' pZ- fj Q f7 CONDITIONS �
v
Date � Applicant � . . CITY ZIP �
ARCHITECT OR TEI.
�IOTICE TO APPLICANT: If, after making ihis Cenificate of r DISTRICT GROUP 7YpE FIRE PROCESSED BY
ENGINEER L .,. Ma'or YY ASS C.NO. _ F-
mplion,�you should become subjecf to the Workers' / ,(� CONS ZONE V
.mpensation ptovisions of ihe La6or Code,you must forfh- qDDRE55 v� •�3 � �
wilh comply wrth wch provisions or lhis permit shall be � �� � TEL �
deemed revoked. CONiRACTOR Owner $TATISTICAL CLASSIFI TIpN� qPT, CONDO. �
NO. .�L /'
LICENSED CONTRACTORS�ECLARATION ���, - CLA55 NO. DWELL.UNITS.-f—L
I.hereby affirm thoi I am licensed unde�provisions of Chapter 9 ADDRESS NO.
(commencing with Section7000)of Division 3 of the Business and ��� SEWER MAP '
Professions Code,and my license is in full force and effect. Ciiv � VALIDATION
54.FT. NO. NO.OF CHECK BK� �''
,LicenseNumber�4648� u�.aass R� SIZE ST IES FAMILIES ONE
� -�. . . . . VqIUATION
Controctor � pa�e DESCRIPTION OF ORK`�eW S1RolE family A D S ��I r,r.�'Fl
I�7 I A�
❑1 am exempi under Sec. 41t�'1 c1C.t8C �e. � .
. ALTER � f;° � ° �'�C 5
B.&P.C.for this reoson REPAIR S - - � --
� Q�e: USE OF 1 ��J J�,J L
� EXISTING BLOG. �i � DEMOL
Signature ..�� " ..� c � APPLICAN7 iEL FINA J �' �U� ,�.��.x
,OWNER-BUILDER D AftATION PRiNi1M.J. Brock & Sons rvo.529-8170 DATE�-Z� i
I hereby affir ihof 1 am ezempf from fhe Coniracfor's License p,0. Box 350 Br.ea, CE1. 92622 _ u~;:0��—E 5 ,
Law for ih�llowing reason(Section 7031.5,Business and AD�RESS e r FINAL__ '�
Pro4essions CodeJ: PRE ENT gy �� - -
� I, as owner of}he properly, or my employees wiih AD R 55 - - •
wages as iheir sole compensation,will do ihe work and '� �� -� , c � ���P' �
the siructure is not intended or offered for sole(Section LOCALiTY , 4��
7044,6usiness ond Professions Code). - MOViNG - � - TEL r,.s d � o a '��
� I,os owner af the property,am ex[lusivaly[onfra�Ying CONTRAC70R NO. i 4,/:�,��
with licensed coniroctors ro construct fhe project(Seo- qODRE55
tion 7044,Business and Professions Code). , -
REQUIRED TOTAL$ETBACK OM X T. - '` � ^ ��'�rI G�...�
CONSTRUCTION LENDING AGENCY - SET BACK YARD HWV pROP.IINE� WIDTH
I hereby affirm thet�here is a construction lending agency for FRONT �G�����8(�
the performance of the work for which ihis permit is issued P.l.
(Sec.3097,Civ.C.). SiDE �
P.L.
Lender's Nome lVOri2 :T
� �r S� LDMA Ref.N
- Lender's Address �j`.� P.C.Fae§ �7� - Permit Fee 66 � ,
l';� 6'O
I certify that I hove read�his applimtion ond state that ihe � Iss�once Fee O LDMA P/C A � ��
¢ above informotion is correcL I agree io comply with all CouMy Inves�igarion Fee
� ordinan and Stote lo s elof g to building onstruction, To�al Fee LDMA Perm.M
and he by auihoriz repre atives of thi oumy fo enter
� upon e abo��i ��roperry for' ection purpases. � . � �� �
� {/,,, � ^� �5
n ��(/� �j7��..G'..P � G` � SEE REVERSE FOR EXPLANATORY LANGUAGE
� Signalure of Ap icaM or Ageni pate �7^� � - - -.. . . !:�
' �Ol• ..._ ._.. ...
PLANS TO APPLICANT � INSPECTOR'S NOTES OR'NER-BUII.UER DECLARAI'ION "
_ , I here6y affirm fhot I om-exempt from fhe Coniracbr's
To: Retumad license Law for the following reoson. (Sec. 7031.5)
Approved Busixess and Professsona Code:Any ci2y nr county wl�icb
No. Date No. Dale . requr a¢ernrit Ln rnnstruct,alter,¢mpma�e,demnTish,
. or repair an y strueture,prior ao its issuance,¢&a reyuires
� - tbe applicant(or sucb permit do Ja'le a.rigaed saatemant
. that he'svle�ensed pursuant lo tbeprovrsions of the Coa-
. . ,� , , . -, � trortor's Lieerzse Lu�c(Cfiapa�^f 9/(oo»avnexcing witH Sno-
tion 700(IJ nf Dii�irinn 3 0l dfie Busines.r and Prnfessinns
� CndeJ nr ebaa b¢u exempt,tl�erefrom¢nd aho bavis(or the
. al[eged ese»i�>tinn.Aoy vinlation oJ Sedinn 7031.5 hy -
Required Date Received � � uny uppJicant fnra pernrit subjacts the ujrp(icant to a crai!
Approvals Ves No or Approved . � . . Qenulty of not mnre tl¢n five huxJred dallars(S500J.):
-' - � ❑ I,as owner of the property,oi my employees with
Woier Cerlificote � . wages as their sole compensa�ion,wlll do ihe work,nnd
� the siructure is�not intended or offered for sale(Sec 7044}
- Health Department � � � � Busittess and Prajessions Code;Tbe Cqntrutfrir's l.iren;e
Lr�m dnes nnt applg�to un oumer�of property�wl�n builds
Fire Deparimenf . nr improves tber�on,and mbo does surb u�ork 1 imse f vr
through hi� ou•n emplol'�es, prre•irded that sucb im-
Grading �prnrements are not lntended nr offererd�for sole.'"'
bou:e<•er,.the building or improi•ement is snld u�itl�in�.
Geologiml Year qf corxpletion, t!e owner-bvilJer u.•ill bave'dJe
h�erden of prouin,e thut he diJ�vot huild nr imprnx,e for
the purpose Jsale/.
Pedestrion Protection - '
(Fence)(Canopy) �i I,osownerof fhe property,om ezdusivelycontroE-
� 'ing whh!i<ensed contractors 7o construct the projecl(Sec.
Special Inspection � 7044)Busettess and Professions Cnde: Tbe Contruc6nr'r
iConc.)(Masonry)(Weldingl . License l,au�rloes not app7y to an nu�ner of prr�erty u�fin
b��ilds or improi�es t/�ereon,und uJ�o rnntrads jor sucAi
Lot�rainage ' hrojeces u�rll a i�on/rucdor(sJ lrcensed pursuant to tbe
Cnntracmr'.c Li<en'se I;awl.
Porking ' . I om exempl under Sec .B.&P.C.for tnis
reason
`'� " p Daie Owner
c'f�i���Pi�"//�� — '�OG• ,�,r-.,�
Approvols Dote spector's Signmure , , . � . ,
�� INSPECTOR'S NOTES
location--
(Set6ack 8 Yards)(j� /r, /� . _
Foundations �
�
Slab �
Frame i�i�.��n� �-�..--I�. . . . .
Energy Inw�afion ����7� y� � � �
Lath/Drywall-� � - � � � �
Inlerior .��`X��! �` n��.m„r-��• . .
Lmh—Exterior ` r' � �
��-3i� (? ���..�/ . .
House Number-- � � � � - � „
Correct 8 Posted � � - �
Final-- .. . -- . . . .
Enter on Front ' �� ' � �-