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HomeMy WebLinkAbout1826A 8351A (11) .,. - -_ _ __. - - . . __ _ __ _ • WORKEBS'COMPENSA710N DECtARAT � � � � � � �. �� � ' - � � �- �' �- � I hereby•o�firm that I have a certificate of c sen�io eif -� ;�=��e,o�acertificateofWorkers'Compensati�,,,�.�e� � AP LICATION FQR BUILDING PERMIT � or o certifed capy thereof(Sec.3800,lab.'C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company�-. � �'� Q Certified capy is he�eby furnished.����� ' FOR APPLICANT TO Flll IN BUILDING•'7 a5 � Certified m is filed with 1he,cr�uiity6u�fl�n ms ec- - ADDREu . . . _ py� 9 P - BUILDING ^. �� tiondeparlment. - . . A�DRE55 p E �/nVE < Oate �Applicant CITV IP � � lp(y�LttV � �fr � CERTIFICATE OF EXEMPTION FROM WORKERY. • � SrzE OF lOT D NOw ON�107 � - C O55 ST. � COMPENSATION INSURANCE� � (This section need not be complefed if the permi�is for.one iRAR�� �/' BIOCK "r l0 NO. / �ESSOR . hvndred dollars(5100)or lass.� 1� �P���' PAGE VARCEI OWNER f► AaCr ' . ��Z�E NOP � � I certify fhat fn fhe performance of the work'for which Ihis a„` parmit is issoed,I sholl no�amploy any person in ony manner V SPECiAI . . . � so as to beeome s�bjec�to Ihe Work rs'Com enaatlon ws. ADDRE55 2s LL�71J �1��� �O CONDITIONS � `�� p q� � CITY IP � � � � Dote��.2_II�'4pp�i°"� ''') ARCwrEC70 NOTI:E TO APPIICANT• If, aft making�fhis Cartifi[ate oy ENGiNEER �u� Oi5T21Cf GROUP TYPE FIRE PROCFSSFDBY O �Exemption, you should become sub�ecf�to.-Ihe WorkepS' �� L. !T� f!1.1( � ��� �Z� " V ' Compensafion provisions of the labor Code,you musr forfh qDDRESi Z �✓� �f.1 •��-4� '�+� �'^� J 7�'� W with comply with suCh provision3 or this permit iha11 be . . . . TEL. STATISTICAL CLASSIFICATION AVT. CO DO. N deamed revaked. � GOMRACTOR O. � r� � Z LICENSED CONTRACTORS DECLARATION _. �i�, . , M55 NO.�LDwEII.UNITS I here6y affirm that I am licansed under provisions of Chapler 9 ADDRE55 NO. (commencing wi�h Seclion 7000)of Division 3 of the 8usiness end . ��� SEWER M4P . Professions Coda,and my licanse is in full(arce and effect. C�TV� � � CLA55� . BK � VALIDATION ' � ' � ' � ' ' S�.R NO.OF NO.OF CHECK ' . licrose Number� Lic.Ga33 � -" SIZE � STORIES � � FAMILIES - � � ONE � � DESCRIPTION OF WORK � NEW� VA����ljQ�N . �1 8 2.b A Confracto� � Dafe App � S -� \O�Q ❑1 am exempt under Sec. .. DOD • , �• e • •2 J ALTER � � •,z 5 G,�Q 8.8P.C.for this reOson �'8 ��� REPAIR = � � Dofe: � . . EXISTNG BLDG. / DFNIOL • �P.5�7 O� .. Signature - -.. .- - . � AVPIiCAM i . ^�2/ FiNa� 0 9.2 2-8 8 OWNER-BUILDERDECLARATION � PR�M DATE ��-yd , , , . . . .I bereby affirm�hot 1 am exempt from�he Cantracror's License qDDRESS - FINAL �� � � � Law for fhe(ollowing reaaon(Section 7031.5,Bueiness and �t�" � � � � Pro essions Code):� � � �� � � � - � - �- - � � - � BY� ./f��S, (�•r�c�' - BUILOING 1, as owner of�he property, or my employees with qDDRE55 r - . woges as thair sole compensmion,will do ihe work and �� - � - � � � � Evsrrr-�'/�rn3 �- , � the structure is not intended or offered for sale(Section ����TY �� � � ` ,� 7044,8usiness and Professions Code} � - MOVING - - - �TEL - � � F��ti.� a$ - �,� I,as owner of the property,am exclusively controcting CONTRACTOR NO. �o�.f.' 'n=�,eC IoY T � with litensad contracfors to construct tha proje[t(Sec- qppRE55 /' '�$`3 5'� A tion 7044,Business and Professions Code). REOUIRED 10TA�SETBA K ,�y� - � � CON57RUCTION tENDING AGENCY - �-sei enCK YARD Hwv paOv,uNE wioiH � '� - � � ' � � � I hero6y afiirm�haf�here is a construction lending agency for FRONi � the pertormance oi the work for which lhis permir Is iseued . v.t. ��� . . 2 •4� ��7 ($ec.3097,Civ.C.). SIDE . r.i. tiP41 `�07� � Lender's Name . . . . . . .. . . . . . . - v.c.F.e s `� Q Oermk Fse �'0.'�L, O `o"�'R°f.� 0 Z 0 5-8 9 Lend r's Ad ass � , � � I c tify thot ve re is application and sfale Ihot the .__ luuance Fev ��-« LDhw P/C M , . . - ._ o ve li orrect.I agree fo comply with all Couny In.ee�iqanon Fee �/ $ or in rote lawa rolming fo bulldinq construcllon, Tmal Fu T��J� Q LDMq�erm.M � � R an r prosenrotives of lhis Coumy m�emer � upo� ed property for inspection p rpo i. � M � � SEE REVERSf FOR Ex►IANATOIIY IANGUAG[ �, lico A�nt . • . . . . . . .. . . . . d � �1C%.. �i,.1 s-a�^ � � � PLANS TO APPLICANT - INSPECTOR'S NOTES c•^';�;'4 ljsr � �fc,�����11�kt-IiL111,U1�li�llliCl.At 4710,\ � � ,' , � 1� .by off m ihat.l a pt I o r�+^Conhortor"s . �.. . � . .. � '.. � . ; , ..'. � • ... ' : :.�' �C fT ��OW �b thC,f0��0 �IJ fPry O (SCf. 7��1.5j � � To: '. �. .�.. . : Returncd. . : �: . �.� . .. , .. ,,�: . � . ,. ,, . , ,, APProvod . . liresrn�.n�nJ.l r Jesunns(,aA�r[SnY�+t�nrrnunt�'irhi:L No. Dafe No. ... Dale..... . . , ... _. '• � '. . '. � :7eqaires��.rrn�it J��rnn�tn,�4�ltrr.iwpr��rr.dr�unlich. . ' • '_' r.. �. _ . . . �rra urartt� t si t . ra c� al. . ,� �� `:�. � ,"' ' � , .. � �__(' " , , i 1 `�11.r��/�l�i�ent/�r surG•frrnrrt fnr�d�u cipnrd,strl rr �r�1 .•. � •�.'_ � ..r' _.. . _._ ___� '_ _ ._'. __ - . ; -' , r � � ' . � . 'f'. oi� �l� '.� iI� �-1_S .1a�� ,�\ '� . . ' !�<lfnr'sl.rr.•nsrl,a�r((:la�,frr')/( verxc�nrqru,it/(Iett- _ �.,, , _ __ ,_ - - - - _ . � „ r7r,n:boo//v;r;,r,�n joJel,rUusFn<s.cundl�.o/r , � ;� : . [, , �`a\ �1,. ,�-�1.t1.C� C\ �tT : :1�1 __ . "„_ .� _ .. ...__ _.- . ..._ .. . .__. . ; ___ . _'.^ '.L_-. --_CnJcJnrtb�lGeisi:rcnr/�tlGerrJrnniarsJll�thusis/rr11�i � . �� ! , . • . � ' ':, u!!r rd crrm �iun �An�-i !ah n o leatrnrt 70if 5 I„ . , '. � ._ '.'.'. . _l.'.-.. -eqoired �_ ._-'Deto Roc�ivad �. -..__.._..��__ � �_i._'.'._'..a.�1."�,� _. .. _."_' �>�va/�pG.umt(nrn f�rni�t s h�etfs fl�e,arpl�t�m1 fn�air r! ,., ° .��Ye or Approved ��'fenalll'n(�nn�mnrc lian/i !u rin•JJnllorc/SSll01J: R Approvat :_ .. . � .__. t_. .No. .._ .._ ._ . ____ . -. . .._ ... ...... .. ._�. . ,. . . - . _ . .. . •�����y�,�p „�. � -., (_� I,�s owner of�he p op ly,:o my emplolc••s w�th _ ___ , � � .'' �� '•.V�l • -r .: , :', , `' • , '.-•_ `.�c :. .. .� wages Ps�heir sole tompenso��on,wi,ll do the wo�k.ond Water.CCrIiliCate . � ' ..a____ _ :...I . � � ' .. _ �.. ,�he struGtu.e t not iniended.or ofFered lo�sole(Sec 704.7) � '•�� � ' '� Uusr rrsunJPt��/�asioritGrJe:7�hcCnrrtr�<ror'sl.irensr Heabh Depnnmenr._... .�.___._. .__ __._ __ . �..... . __.._ _ .__.. .. ....___. _ _._._.. �?.i, 1'' � '-S\ ���'} r'.�.�. �.t;-t\1( L'u:v-dui•sn�i�afpli•1n.arsn�rnrro/frnperf�•�rLnFuiLlx FirrDepariment - - - - - �-'- -�i - - - r � �. . j ur improrev t(trc n,.und i.{ Jues i 7 url�luni:ce!/nr . � � �.i h�` 5F'1��� �C- (. e:R �}j'.� . `�' •�brnuql��lis o�an..rnp1�1 + j r�rJJ [!ut au�fi irn- � Grod�ng_ t ,-.� i�J .. '�; \1 1 i... . t l. x .. i...,. ��,;'Tr ien er 1c arr.n t �nf.nrle!�.(r /f reJ/ur aalr.�:!/, I '� �. � _ i: �. . !:�.C\ . .�\`:.. �{��l-'} •%L�..f�.t $,.�,\ . . �' .! ui�er:�t[�edn�ldieXnr ri)�rrn�.rn<ntu:nlJuvll nn.��.� � Geolo ml��. � i ...' ... '� � '�������� - . l rar nj cnnrh!t in, t!- rr.hx�!d� �eri!!1-t� tG�• .. 9� � ; i' �_�'�`11 .,1..'._>\�L2,��1�Y\.,.�.-A � 1__+_ '_.:.:...� �hurdenn/fr i nqdm�leJd ntlieJd rirnpnrrfnr �.._- . . . 1!>e parpuse nJsdlel.�� �. . . ... �.. ._. . .. � ... . . . Pedevrian Proreu�on ' � � _ ' '�-�. . , �...,- � ..� , - ' Fence Cano .. . .._...._. ._ , . : -... . . .,�, I 11 PY) ' '�" . ... � ........... --..-.. ...� ..."-'- �--. ...-� .....- : .�... �-�. �I.osownerofthep peilp,amexJusivr,lyconvpc� ' ;iing wrth licensed controc�ors to consiruU ihe pro�ect ISec. Specinl InsPection ; . �" ��-��----. �. ._ ..-'"�'.;� . .:�� � '.�,-.-'.� ��. ._..-.�. _ ..�: � � Businrsc and Prn/csrrnns CnJr:7%rc Cunfrartnri � 704a) (Conc.)(Masom � 9) ;. . .•. . ::,-,�.. �u�dnes nn�u ! t �nuvevr u ertt,a�l��� Y}�Weldin . � _.. ._'___ '.__'._._ ._�.__._`�_.._ _.. __ ♦ -._.. _1 c. 1 .r'I'.� �h^'P �� . �. ��"�. , � Fu�tdv or unpru�rs fbereon.�nJ u�Ln�unnacts/ur sre�! lo�D.anoge - ..�i �'� . ; � ;.: , . '_-'___. . . ....._ - _ ._._._ . ___ .. .. .,._� /tts u tL a mrslraot r(a/!r'ru� !pr rruant l��,the �. - .. . .'} c'. (�.:��`. �:.�' f t �i's I i errs< (,au� � � �..I . Parking � . ' , . .. . . __.._ . ._ _ . . . - -� �`_ . I�, �. � . . . (,�,(` A.,�'� 3 .�, `.?�`�h ._' [� I am c e pl unde Sea 8.8P.C.for this � �- �. `ti �. . ..reason `��e•-• ��.11'.• � . . .. ' '.�',\ ..�._:. L. �^' � :�� � it � ' __. __- .__-____.'_.' . . ; .. . ._. . . ` .- -_ '�- Dale � � Owner...'__ . r � _ ., . �.. S��`:;`5,��—�——.--:�''�•;�� `� :�_ — -- —— -- — — — — — — App�ovols Dote � � Inspoclois5ignaturo � .. . .�•.. �.•� - . , � � � � - � �- '- ' '� � 'INSPECTOR'S NOTES ' - � �� •�-� lom�ion._ i.�'. _ . . . . . .. . . . . � '_ . :.._ _ _.. ..�.,. ISetback 8 Yardsl '" • i •. .. . . � . . .. �. _ _..___._ - --'— ---.._._ ___._. .. � . I., ... . .,.. Foundarions �., -, .\ '. . � --- ���:�. .. . .._ . . . , . - ' . . . ., . .__ _ �___.____._ _-_.____—_.__'_' '_. : _ . ,t� �._ . . .__._ . .c � f Siob .�., ;,._� � %� . �� ._......_ .__�___:_.___.___'_ _._'__�_.__ —_:......_.._._. - . . . . . .. � ,. - �,: •� .i. '��- �.�i,.� . Frome . - ... . _. . .. _ . . -. � . . . . . , �. . . .�� . .' . . . . . , ..,. .,�. . _. , , . � � �._. _ . � '___ . ._..... __ . , . __ . . . . .. .. ., Energy Insula��on. ._ . . ._ . � . . .. �..ii. ,...i� . ' 1%�_S� d.�,\\:1:5,� �_il l�c.�t^. -.. �.\ . . .. .. .. . . . � .. ,. la�h:Drywall- . .. . . . . . ��.. ... � . INerlor ___________._ � � � �... . lorh-Exterlor .� - � :. I : ... . ; _ .. ... . . .. . . ..,.. _..._.___�_._.... ___._"'.'_'_ ..�.._'___. , , . . '�V (� 1 , . �.--..—"'---_. .-_ -`. . _.. � - House N�m6er- ,..,. � ....__- ._ ____ ..__......._.__.___.' . . __'___ .._.. , �_ ______ __�. _. ____'. � t . -- �. CorreCt$�'o51ed - ' _�\ �� M1 I .,�, � � �. _ \: 1 F�nal.. : � ,, ' . . . - _.. .,.. ,. .:�,7 v:.• t _ t . Emer on Front ; . .., `. . -, ��,. � � � � � ...- . .,.� � ,� ��. �i�:;:.}. � . . ...-. . " . . . .... .. . � .. ... . ' . . ' . . .� :� . , � 1 ��/ � �� � � - r �. . :—:,, .. .. ,.. :,.. . —s.:: .�\t'�, •�— --='Y't�`_�+ '`:1` .�.. -��;. � � , — , . ". ., . _ � _ •- ...��t t.'>yi�: 'i+,::v_:.y�J:,.. . � `'- - �-. �� . .. - . ..