Loading...
HomeMy WebLinkAbout1276A 2437A �:VSATION DECLARATION .. . ... . . � - . .. . ... � ,_ �. � i .. - .-. . .. . . . /� . u ._�,eofwokes-'�omPe�o,o�'��S��o��" � APPLICATION FOR BUILDING PERMIT ' .,�, ...� a cbpy ihereot(Set.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNoPG�$Z¢�`I comca�Y�UBL/G � � ' CertiFied ce Is hereb furnished. BUitOiNG ❑ pY Y FOR APPLICANT TO FILL IN ADDRE55 %Z-S'-1� 1^Q G^�..-p-v-- ha��JS , � CertiFieP�copy is(iled wilh the manty 6uilding inspeo � BURDiNGn Q�`- �,�M��O _ lion de ortmenl. - ADDRE55 /f/ � Date � �l��� APPIimN BRYc�W.P�+����1�1G. CiT�' �f�IYJ�I�Q ZIP . LOGHIITV �lCt�t`i'�P'�"— C��i CERTIFICATE OF EXEMPTION FROM WORKERS' .- NO.OF eL�GS. . NEAREST� � � ' � GOMPENSATION INSURANCE �. � . 52E OF LOT � NOw ON LOi ONFi CROSS ST. - �� � � " �� �'�� (This seUion need nol be mmplefad i�Ihe permi}is for one � TRA�T - - � � BLOCK � LOT NO. ASSESSOR hundred dollon(5�00)or less.) nv+v eoac PAGE PARC�L OWNER q UNOG� . �E�� USE ZONE MAF I certify Ihat in tha performonce of ihe work for which this - � -- N�� �1�.f NO. �0�—^ / permit is tssued,I shall not employ ony person in any manner ,¢J(''Q F2�,•Z� /�J� SPECIAL . . . O� so as l0 6ecame su6jec��o fha Workers'Compensoiion Laws. � ADDRESS CONDITIONS � CIiY c7 ,V�� � ZIP gV U Dale ' '' Appli[oM � ARCHRECT OR ,�i}�.I � NOTICE TO APPLICANT: If, ofter moking�this Certificale of �-^�A��V DISrRiCT GaOUP TYPE fIRE GROCESSEo Bv O ENGINEER X/Kid!�J Exemption, you should betome wbjed �0 1ha Wo�kers' - � � � � CONST' 20NE � U Campenna�ion provisions of the Lobor Code,Yo�m�s�ro.�h- AooREu 11i39-E.Rd.sy.5r 50. Er. MdN� � V }�'.l.-� C �� W with comply with-such provisions or this permit sholl ba (�rf TEI. Q �fn STATiSTIUt QASSIFICATION AFT. CONDO. � deem0d ravoked. . . � CONTRAROR jlF (� , f}Q�,� IVO�p�"�YpO IICENSED CONTRACTORS DECLARATION _ 2 p o MSS N0. x�' DwEu.UNI75- Z I hereby aHtrm tha�t am licensed vnde�prov�sions of Choprer 9 - qDDaE55 �II/l¢'�•�c,US ST �nio.��'¢08273 (commencing with Sectton 7000)of Division�of the Business and L ,I�] ��� SEWFR MAP Professions Code,Qand�my license is in full force and eHec1. . �� Cltt JD•��L i/AJ1L �. ��p,5g� � � � VAUUATION � PI��TJSZ7� 8/ .. SQ.FT. NO.OF 0��, NO.OF CMECK . BK. PG. Llcense NUmbe� Li�.�IOSS SIZE - $TORIES FAMIIIES-� ONE � (� A.��� VALUATION � CoMrodo�✓RYCEkI.Prn�•I�.Y�Dole 9 /-8� DESCRIPTIONOF WORK RA�45� �XlST' . N���� ❑ .s �OOp��� °� 2�Z 6 A � ❑I am exempt under Set. P(fi�N ISLfFNO �i'}-I�OPS/ >j��Q ADD � � �• • � �2 3 , . . . ALTER � B.$P,C.fOf�FIi3 fE030f1 REPAIR � _ - -� � . - � • •3 fl 2 5 � -Date:-- USE OF m,/ � • a • EXIST�NG BIDG.SCR✓•S�TIO� DEMIX ❑ 3 f�2 5 c=i ' Sienaturn • �n"�� APPLICANT TEI. Q�� OWNER-8l1ILDER DECLA TION PRINT Raa�n.r c.�.WiQ���rNO.�W'j¢1r1� DAT� �9��,�a 7 I hereby affirm that I am e�empt from tha Contmctor's License-- - - � � '� law for ihe following reason(Sedion 7031.5,Business and �+DORESS/ 34 E• R�N 5T �D EL�u� FINAL -� g� .'2437A Profese�ons Code): - -�- - � pRE ENi . . . .. - _ � . ❑ BUILD�NG . . 1, 05 owner of Ihe properfy, or my emp�oyee3 wilh ADDRE55 #r��� • • � waaes as Iheir sole compr.nsn�lon,will do�hw wo�k and - � � �- - - � tha structure is not intended or oifered for sole(Section ����T'� � - I •+5 5,5 0 7044,Buslness and Piofessions Code). � � � MOVING - - . . . TEL . . . � � I,as owner 0�1hB proper}y,om e.civfively confracfing CONTRACTOR NO. • • �J S$O� with Ilcensed toMratlors lo construcf 1he project(Sec- - qDDRE55 � - - - ' � �Q�$„$7 �ian 7044,Business ond Professions Code). . � -��.�.'_,• REOUIRED TOTALSEi6ACKFR ..�-�-�•,-�� ."'.= ...•' ��.'-'� �����CONSTRUCTION LENDING AGENCY -� 5ET BnCK YARD HWY �- PROP.LINE WIDTH �-���� I he.ehy aiiirm that�here is o conshut�ion lending agenq for FRONT � . ..Ihe performance o(the work fo�whith ihis parmit is issved P.L. , ($ec.3097,Civ.C.). SIDE - P.L. Lender's Name � � � - � LDMA Ref.M Lender's Address � � � - � P.C.Fee S � � Pe�mN Fee � _ . I cerlify thaf I have read�his opplkation ond stme that the .. hsuance iee (�. LDhw P/C M � obove informotion fs torrect.1 agree to comply with all Counry Inves�igation Fee r ordinonces ond State lows rolating to b�ilding consiruction, Totol Fee ' �C� lpMq Perm.II and haraby authorize repreeeNa�i�es of this Coun�y ro en�er�� � � � � � � � . upon the above•menrioned property for inspection purposes. •C�•(/✓�� /"S SFE RFVERSE FOR E)IPLANATORY UHGUACE . . . Signatu.e ol Appliconl Agenl pp�e - -� . . . . . .. . . • , , • .. . ._ ;�' f�S o o � T N o ino � . � o o na ��. ..�.. ..�_ .,, _�S. -S �-�-- • �_ :' - o 0 . � o o ,� o o � rn o ,� a o' � o � �. m o c T T 3. � � e � ,•p_ � n ' m ° � a - � � o-_ p o : ,'�, " � � 'p � `° o 0 o ry � � `^,o . m � � ' ' � s `. � Z x �� i - r� v � "� . O n , 'n 'V p � • �c � � o. � � 1. o . �S� n� � . ._ :.c � D 0 0 3 - ° o c N � i - � . o'v : ° v , . '3 0 - 9 ' , ,� c o - o 0 0 _ . o ;', oo rt ` ,. �ry = . , a � o. � � � � � �IQ I '% c . ' � - -- v� `p ' � = , �", O � � ' _. � ' I.. . N � ' - V� � . � 1 �r. . .� �i � _O�_. � ` ' . . ' 'r I ' O ,.. � I � ! � � - . M. D � D � '•' �o . • ;i_ � ... q. ' � I ; ' ' � o ' i � n : 1 �' " � � ;— o a 'y „ o o Z 1� � � I, _ � - - • - m a . i � I ; CJ . ' , O o � : . � ' N L, _.. _ . D� ' . j .ic li , � ' � � v . . � ' , a.o � ,oD . , • n �:, ' • oA : c c , • _. i . � o ' _ . . ! °a`m < , a m• • , � �'. 6 :; ' : . � � , ' y .� " ' "' ; i` �• � I I . � , .. • �. , I � ' � i , � ,-i i . :� , G ; _ . . , - - � , . � � , ; . { - � . - - . , �- � , - - - . I � i i L 4'' - � ; . '- .G `" 'S�, ✓✓ i .�' - � . i ' ! : �. � � � r /: � � . � � � I � �-' �r i . •' � �' C/, �.� • � i . � � i ri� ; � i !L� �f ' - . .. . � � ; ' ., � •' � . ; ; K. : - -' _ iJ=' . . . : , ' ' i .• ��J �-- � � � . � ;l= ;�� C ' `✓� , , j� -- .:) ' i � j ! i 1 V J � L ��`�� (�� � . �.. _ - I � , ; i �L ,,. �� �; � ij ; °). , :� 'z ' �. ! �S" / ' (` :�'. "� _�.r.-, �1 � � - - � � I • .I .✓ � ..I ' ' . . i m ' . _ "'_ ___ � I � i G� ;/� ,� ; ' �1.� /,'� I�/ / � �' .j, _ �1 . � j _.__ __ . � � �;.. � �w :f �� � . : � �J/ it ,�i � i •, �' O i "" f � '`: .� 1 , i'.�' :,. j � I . � � '. � I,�( ^ ) < G � �^i `•� _: � !,, :j� - � I ��J r r-' t � � ' j . � , ��l �% � .i �," 'C-.. � �l •'.r. _ _, :yi Z j i 1 �L �` / . ;�,� ��.� r .'! /' O . , -- --; � , � ✓ ': t,� � L v .� �t � ;� � � -• ; j � , .. , � , ,� ��� �,. ,; ��,� ,; T , ' . , ; . 1 �t�, , �L ,�-t��' '" •r : � � , L. . � • �n � � � w ; � � ; �,: �; �:�� i'�J I ; ; ) !� r- I-±-- G• , ; � ' -- I i i � : � _ f ,�-,; i '' � i%. ' I � i i. I I _f , i, f i ;` f � i ' �; '�� . . . . � ' ..� . . r, :� � , _ :L) . �� . . i . .. �; ' ' . . L/ r �- � � ' � _ I i . ^ �oic (�� n,.���o �� � � � -� ti'' ° .�.,�.�� —'s � ��� ° � � -,'� nyT . I I , .. - � O `� "��C�ryi'..r� --� C�1� � C ` �` � ^ N , 'L ]� �;'y^ ��'1``,. >,�' � � � . _ - � . ��� ti r. f .� � � �T_� �.m c' "� C. i R � w � �!� � � � = - I - �. � ' . - �: �'� ��T-.� �1 i � `�', � N � .^� � - .�.o `e.�'^� �•^ � �� .^. '� .. : _.I ��r 3 �•F';�Z � 'n' ° �`� �h N s � �..s° �� : u �z '�`: a � � � ' : - .� r. '^ ' N ° o �e � :� � "' ^��._ � o ' �,� •; ��N 2 C:k ;.S i • � ' � - x . ���.�:, � £ ��_� o�� o �� `'.� ' E \� ^-`w F\ =� = "� j I � ID � .0 fJ 7 C y ., ��t 7� 7 � .h"�.r Z;� � � - � e• 3 s: � " sa� ,�'�� _: ... � ���oo � ; z ] ��'�.�� »:�^ ... . . . � ..- , - • ' . ;� � ,, ,n C�^ T.�}= � L a ^ �F.._�n � �� �`';� � „ .c. - - 1. � - ! . _ � %; � �:�l�,i� �'- ��...k " � ? ? �•n o �- "' �^S` � _ ��'^ � �-�" = C ' � i � N '1 /' 1 � � h��'.��ti. �"' � ' 3 R � �.7"� S �'� .1 2Lw��'~' �. � = N . _ � r� - - - ' i . _. :' "� ' ir�: : n��;�'�°;.ro" ..�f� ��`�` ��.�� � � : ��� � ��?� � o° � n y<_ -.�,� �. �. � _ t ; ., c; 3 � , - � -i N I �- a�";;�O:o' :' o = a - � ''�°-� �e ="����' ^-e � •- �� .0 . . . p � � ' �y.. fit`•'N..ry- � C�; �. C� '.� C � �`�m .^_e: � .i .` 4-f �.:�. p .^ �C a t�• ' '7 O � �.� � " ~ .� �� / . . � � .. y� . .��'�- ^ . r' -C � O -'\'��'�0 � �t^ _ l� i �� � 'iti <- Z `. e` ..V C 1 = ] `G� Y. M � \ `� ti!_l �. _ ' . Z ' ' �.fi�'.-.: �'�-��:C ` a 2 � � '� W ` C w � �� f i.' �, . � t � �� f �� � a �{:: •' - I � .. _. .' O • -r'� �= 3 :a� ' , :„� �,Q_ o. ^ ��,zj* � =��-. •; ' ' ` ,"`„ � ; :�r.;i�!- � � �.^: ^c�. � a =3 C c. " .,� « - c `::.:� Ci �. ' _ _ - _ .�� f.st � c:; �'• c'�5 _ �_oK'�,� ��T: 2 �:;.-:k`�: y' - - - � :,� 'c•���.o� ; - r" � � ^:� - 3 '.= _^rs s.� � % � G , - . ..ry � �rl^ ��'. r� Z � .�E�c` • � ��v_ �^c z '.s;'��' �c . � ` y, 1 +.�, j. � . . . '� _' M^ �:O . � ~ 1 � '`� (/i;5 K.1 \1=1�`u' :. � '�., n - .. 4 �.,,, . �.. � ^.'�n'.: »^ •'� +.L `� ..`,w � � ,� � _'� ` - Q � � i/. _ � . � � �:^ o � �,NG,.,,�M - �� ,r N `� ^\.. = - � _ e d il�� ..�.. � � '] '� �j 7 r [:, �. -^ .`� C • ' � ... ' .. __- `� [`�'O `'"'„ .~�•� p,> �'`,. ��� ^' � � _ ' � "" _'_ . �, .._ � �:.. �n'(� n � . . �:'� ``^. �-G �'� +. . . » . . ti � •