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HomeMy WebLinkAbout1829A � WORKERS'COMPENSATIONDEPLA ...,.--'-.._...."--"'-'-----'---��__..._.-.....r..... .� . ..-� ._.. _..._....._.._ . .. . ._ .. ,. . .-- --'--.' '-- ...� . ..., .. � � � RATION � . �.,., .,,i._�.,._,�, ; , ,..., . ; . I hereby offirmlhat 1 have a cerlif¢ale o��o�5e��fo.,e�f � �---�-���aPPLICATION--FQR--BUILDING PERMIT��� --���, � insu�e,or a cerlificate of Workers'Com ensation Insurance, , or a'ce�Nhed�co �hereo( Sea 3800 La6.'C),. . �. :.., _. ._.- -- -- _.. -- . . . . . ._. ... . . _ .. .._..� ._ . �,... � ( . . � �- • •�.� >•� COUNTY OF LOS ANGELES ; BUILDING AND SAFETY PolltyNoVJf��.a�(�Company�/_.LA/�l-j �.bbD P PY Y , . '� - -- FOR APPLICANT TO Flll IN r - - - - PY Y 9 P BU4DiNG A�RE55 N�. �� t� � � � �Certified m ii hereb furnished • �� , � ,Certified co 'is filed with the count�build n ins ec- i : �� tion de a�lmenf.`� � ADDRE55 /) � �� � ; ,. .. .,,.. . �. .� .•.., ���. .. r .��i. •.. ...... .___". _ .. _ __ _ .' ___".. _. .. .. . _ Date.'. .;Applicanl, .... . CIiV ,�} � ZIP LOCAtITY � � i . . .� , ,.. . � .. `-� CERTIFICATfOFEXENIPTIONFROMWORKERS'�- � ---�- � �- ------��---�----......_.No:oFetocs:� �---... . NenaeSi_... __. .._... ...:�... _._�_�.._..__. . . �� �•-�� COMPENSATION INSURANCE�' � . . SIZE OF LOT NOW ON LOi � CRO55 ST.. . (Thfs seclion�need not be tomp�eted if fhe permit is forone -'--.. . _ _.._- -----._ '._'--.__..__..._. .-------- _-.---. ASSE550R -- ' .. .� . . . .•.�.: hundred doliars($100)or less.) � , .... . � TRAR BIOCK LOT NO. MAP BOOK�� �� :-;7 � PAGE�, PARCEL �.. f�7 � .., ... . . . . ...... . � ,.; ... _ . . WJtJER __. . p._.. _NO:6U�-3y6G ZONE MAP USE I.rortify that in the performance of.the work for whith.this ' P10. ' � � - " �} I permil is issued,1 shall not employ ony persOn in ony mann¢r � �-�� �--- � SPECIAL��-- p{"�q� p� � � - --O. .. .'�-- ADDRE55 S�� C1�L'-2i-" .- .._._-.... . ._. CONDITIONS \ \ J� O � �• �u so as fo betoma subject�o the Wo�ke�s Compenzalion Laws. .. . . . ., .. : . . - .,,,... . ., ___' CITY�4N GE __ _'.__'___'ZIP....'...'.'._" ..._.__ . .___. _____ . _ _ ___ . ._. . . Dale .. . , : . ...APP�conl'.�.,. . , � - -- ;.. ; - . ._. ..... �� I NOTICE TO APPLICANT: If, afler'mokmg�lhis Certificafe of ARCMITECTO �u NO ` r ..DISTRICT.. GROUP NPE ' _.... _FIRE ._ .._,PROCESSEOBY�_ �� ENGMEER Exempfion,�you�should bemme subject-lo�Ihe�Workers' � --- CONSl�r ZONE W Compensa�ion provisions of the LoborCode,you must forth- • ` � ADDRESS � �with•comply with such pravisions or�thls�permil shall be �-� . � + ��O ' � � �� �w deemed revoked. .•�,.� � • � � .., ,.,�, . TE�• $TATISTICAI C(ASSI ICATIpN � , APT. CONDO. - Z .. . , . . . CONTRACTOR M{� N0.�1�/ -tF�I : t�. �n - � ..��...._. .. . _ . UCENSED CONTRACTORS�ECIARATION -. -�'�. ----�- �--�--- �---�/ - ---��- � ���, ---� � -� �� ��c1a55 NO.�DWELL UNITS � - I hereby aifiim Ihal I am licensed unde�provisions of Chapier 4 ADDRE55 �' ,5'q IH.qE'L'� NO. � �mmmencin with$ection 7000 of Division 3 of the Busineu and _____, ��R�P ' � �� � �� "� �. 9 ) . ' . . . .. . ._. ' .____.._.._LIC,-..'.__.____--i . : Profedsions Code,and my license is in full force and eHect. � GiT� E�/p-J 111(as CYASS G^�O ---BK--�—�-�— -------yALIDATION��---' ' ' � �{G-7� . ' I SC].FT. NO.OF NO,OF__ _ CHECK . � : � licrose Number`�^�r `�� LiC.CIO53��� C��II �� - SIZE STORIES FAMItIES ONE �� ,. � , . . . . . . . . �� VAIUATION._.. i--- � , . . .. ' ... . .. `. � , �. � � .. ,. G� - . .. OES�RIPTIONOFWOR '._ . NEW-- �O . .' , ... .. . . .. ,. ..._ . ' (414Uo►2 L4tk'di ' S 1 ��� Contractor__Q .,�Date��� ADD �' �I om exemp�under See. � � --� ���� � �-� �-� --- ' ---- ,.. . � . . . . . ..:........ . . .ALTER-� :. .. . : . . _.___ _. ... . . , � �: . B.BP.C.for this reaeon _._..._ A� 2EPAIR.-Q _ S.___'.___.._.._:.....__...__. . .__.___._...._ ...- .._._ ___..�. .""__'.. ..._._... ..._ . ...... . ... .,.. USE OF � ' i . �Date:� � EXISTING Bt � DEMOL ❑ � � i � � .. ....Signature ��--- _. ._. ... . ._.._ .... ...-�: ---��-� nvruCANT iei. FINAL ^ .-._ ... . . ._..-.. .,. OWNER-BUIlOERDFCIARATION PRINT C A t� NO.rLNG`�/,T�I�I .,,DATE-�v �-- ��� � --- �� -- -- -- 5 -_.. _. .- - -- -�I hereby affirm thot 1 om eKempt from the Confrador's license - --- U i u � � M � Law for�he foilowing reason�(SeUion 7031.5, Business and ADDRE55 ��i� l E!f/ L�/� ��' FINAL/'�''/� �J� �- '� � '� �-� . __._. ...._ _. _.. . .. .. '� ' Professions Code): . ...___..._._ - --_-- . -_ _..._.. PRe eni . .-' BY. .�'`�"'��`i . , � . : BUILDING _�_ I, uz owner of tha property, or my employees wilh ADDRE55 � � '�� • wages os iheir sole compensalion,will do the work and �� , --- � �""-�� � " '� , -� � � - the strutture is no1 intended or offered for sole(Section ��`�m ' , �p� '- � ' � ._:. .704a,�Business and Profeuions Code):.. . . . _._....... MrnnNG._._._._.. ._. __-._._.--�--- ��iEc. --.--.-. _-.-� ... --- (��.� � � • •� C u29k CONTRACTOR NO. ]�a O`� �� � - � I,as owner of tha property,am eadusive�y comrocting ' ' � . . __... .. . _.. . _.___ _._...._.. .._-----�--- �- ------�_.�- ----- �--�- �w�rh I�censed connactors to constroct rhe project(Sec- "'-- pDORE55 7� �� '�-��� •3�Q 7-5 -�' tion 7044,Bustness and Professions Code). ' : � �,': _._. . ...._ _ ... . . VARD� HWY� ". . . ....__�.._. . . _...�__►. .3b75.�_: � CONSTRUCTION LENDING AGENCY'- �- --�-- � REOuiRED. - ioini seiencK F nn... i ...__-_... .., _.._.` SET BACK -'... ..- FROP.LINE '— WIDTH' ; "'—_' I . ... . ........ . I here6y affirm tho�there is a tonstruciion lending agency for FRONT - the performance of Ihe work ior which this permit is�iesved ��--� - -RL-����-- -- - ��- ---� � -�Q Q.Q Q-8(�--� (Sec.3097,Civ.C.). � SIDE , � � P.L.___._. _ ___—____.___..___ '. _.__.___.._...._ _.._.__..._ _.. . . . _ _. .�.. :_ . ... . . .._.'___.___'.__'_ .__._'__..._'__ ...._ . __ _____._ _ _.__ ____ Lender's Nome • lDMA Ref.N '� ' ' � ' _. . _ . . ._ .. . .._. . . .__ . .._ _.. _._�' .' - P.C.Fee 5.... ' " _'_ Permil Fee'.._. _.. ; '__.. ____._ . "_ .. : . tender's Address � � , -I cartify.thot I have read this opplicmion and state that-the ... ._ � .__ . . .---':_. _._. hsuance Fee -- .. O.- LDMA P/C N.._.._ ...._.._._ R...- :;.__.._ _ � -_�-�:�. . obova in(ormotion is torrect.I ogrea lo tomply with all County Invesiiga�ion Fee i �� .ordinances and 51ote laws relating.fo building mnstrucHon, _._ ' � �•��� �� �-� ' � _ . . .._......._.'.._.__.'_."`..".'.__ Tmal Fee.._'._'. _._. ..LDMA Perm.N.___ ... ' and hereby authorize represema�ives ot this Covnty to enter �- -� � �� - � � ����� �� � ' upo �he above-mentianed pro erty fo�inspection purposes. � . - - -- - . _ .. . .. . ._.. __. . .. - '.___. - .- - - '- ._ . .. -- " '--' ' --- '-'-- .. . . ._. ... .-.-.. .-- ..-._'- � ` SEE REVERSF FOR EXPLANATORY IANGUAGE __.' igna fApplimnrorAgen�-._. .._.-9/9/� ' .'. "'_'' '__"" '_. ...___'_' _' _. """_'.'... __'_" . .. ._ _ __'. _. ..'.____ ._.. .__ . :QQ� i ._. � . . TT (�S 0 p T T N T NO 'O �U T�_ ..� .'V+_ _T. .___ .—�— -�_..._ __ __- O :O�" � j O O � O O � fD n � � O fD � (D fD .❑ ` I � ° � N S ` � 3 � � �c 'r v � n � m ° a fD ° ;� .. 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