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HomeMy WebLinkAbout1382A 4063A �--- ___ . _. ___ . , :_ _ I WORKERS'COMPENSATION DECLARA710N . . . . : : . . �� � I hereby affirm�hct I have a cerfificote of.mnsenl to 5e�f . � .� APPLIC:AT�ON� FOR BUILDING� PERMIT � � � .�insure,or a certifimie oi Workers'Compenslion Insurance,or � . aFe fied co th reof(Sec.3800,L b.C.) � . . � - . � � - � ' ' � t�j�l.;tNP,�'qFi ,/ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company�.��'�r N•��Vt�H"� . - � .CerYfied copy is hereby furnished. , L FOR APPUCANT TO FILL IN ADORE55 0�3�'J�� ��� U.CL�d ' � 'Ceriified copy is filed with the counry buildin9 inspet- gUILDING23Cn51a FAt.�af.s Viey,! f�'ziVE � � , tion deporlmenl. . ADDRESS LOCALITV Geiir..i,/a�1L �'f�/ � � � � . . . . � . . .y NEAREST n- ? . . �Dafe� � Appliconr � � CiT C�E � ZiP I � - CRo555r. �r _ C.iLli _ `CER7IFICATE OF EXEMPTION FROM WORKERS' � NO.OF B�DGS.• f n5SES50R . � . " � �COMPENSATION INSURANCE . . . SIZE OF l0T . -NOW ON LOT G MAO BOpK � PAGE PARCEL � -(This section-need not be completed if ihe permit is for one r�/ U5E ZONE , n�na ��. /l hundrad dollars($100J or less.) . , TRACT��7 i� BLOCK lOT NO.�' /�i NO. ��J 3�l J � ��_ - ..( TEL '/�,�,n� SFECIAL } 0. I cerlify that in Ihe performance of ihe work for which this , OwNE C NO. � Y' � cONoiTiONS `L.rr i..�-e!� !u-�f�- . � permil is iss�ed,I shall not employ any person in any manner 2n oiSiRic� GROUP TVPE FIRE PROCESSED BY V, ADORE55 �Jy � ' V ' CONS� ZON so os to become eubjett to}he Workers'Campensation Laws. ��� � LY,l� cin AGiE iC� zia ��'74'S '�^� ��.z�tJ O' Dale � Applicpnl � - - �� - STATISiICAL CLASSIFICATiON � - � APT. CONDO. V� ARCHI7FCl OR 1E1. NOTICE TO APPUCANT: If, ofrer making�ihis Cerfficafe of '"��� ��N Ll7 NO. A� � W �Exem IiOn, � ' ENGINEER CL455 NO.�DWELL UNITS� N p yo� sho�ld become sub'ecf to ihe Workers' Compensation provisions of the labor Code,you mvst forth- � qDDRE55 � '1f �t(.[ SEWER MAP �. 2 with comply wi�h such�provisions or th�s permit xhall be � deemed�evoked. � ' . � gy—p��� VAIIpATION ( • �ONTRACTOH [JUC�C NO.- � �LICENSED CONTRACTORS DECLARATION UC. .. . I hereby aifirm�hot I am licensed under provisions of Chopter 9.. .. ADORE55 . NO. � � yq�UATION � (commencing with Section 7000)of Division 3 of the Business and UG � � �p� �f � ��?� 3 8,2 A Professions Code,ond my�license is in fu�l force and effecA CITY C1n55 � E d�U �✓ � � 50.F NO.OF /� NO.Of 7 CHECK ' ' � "#� � � �'�3 LlCense Number Li[.Class � 512E TORIES L FAMILIES 1 pNE . ' - r� Co��roctor � po�y - I �ESCRIGTION OF WORK� 'NEW $ ' ' ���8�a�� � � ;� � I am exempt from�he litensing requiremen�s cs I am o S�NC'�G� (�„ � ADD � � • �b`2�.Q Q�.� i Iicensed archlrect ar a regtstered professional enginear . A t7Ea � FINAI - � .. octing In my professional coPociry (SeUion 7051. W/-� ���j� �...,f��,'� � DATE � �� � { �0�.2 9�$Q - ,. �Business and Professions Code). u5E OF �{ E7aiR � ' � � E%ISTINGBIDG.NONE � � DEMpI ❑ F�NA� ,�r„J � BY Lic.or Reg.No. � Dafe i APPfPR 71 Ln W NO. ._ . . ... . - '� OWNER•BUILDER DECLARATION I hereby affirm fhot I am�ezempt from the CoMra[ror's license +'}�9� ►1 �Q..-�v�j�; /J2 .. ;c� , � . . . _ . _..Law for�he follawing reason(Settion 7031.5, Business ond /+�oRess 1 1� +.�R� w -1 v � Professions Cade): , - � �� PeE[rv . �'V � � �- � " - �� . ❑ . . .. _ . . . . .. BUILDING . . . . . �u .; . . . . i I, as owner of the property, or my employees with nODRE55 �- wages as their sole compensation,will do the work and � ��/� �� � . � � - � �'the strutlure is not Intended or offered for sole(Section � �«A��T� � � y � . �U�(a 3 A , . I 7044,Business and Pro(essions Code). MONNG TEL � � ' CONTRACTOR - NO. �'1� � � a � I,os owner of the properry,om exdusively toniraning ' J � . . �• ..• . . � � wirh licensed contractors to construd the projec�(Sec- aoDe[55 � � �4�� � N , -- - tion 7044,Business and Professions Code). - , � G � ��•9 2 G� 3 - kEOUIRED TOTAL SETBACK FROM E%I$i. � k\ '- • . � CONSTRUQION LENDING AGENCY Sei BaCK �ARD HWY 7ROG.LWE WioTN �y '� � I hereby aflirm iho�fhere is a mnsrruction lending agency for FaONT . U V C��. r .° ^9 2 2�1 3� the performance of the work for which this permit is issued P� - ' .l f t �.'1 � � ' ' � '� " (Sec.3097.G�.C.). . . .. . . Sioe . a •� ��:J e ' . D 9.1 6—S 2- . , v.i. � ^x o �.� . . . . - Lender's Nome _ /�.� —�ft� ,� ' .. .. .. .. - . '! 3 - � . P.G Fee E '�`�`��� Permil fee •� . ��� � . �. _ �ender's Address �y I t��.o h� . � , . . . .. � : I cernfy that I have reod ihis applimr�on ond stare tho�rhe � d"y� �'� bso�oce Fee ,.��U M � � iahove informohon is mrretl 1 ogree fo tomply wilh all Counfy ���estigation Fee - -� ` - ! - � ��� �v � i � ordinonces and Stare laws relating to 6uildmg mnsiroction, ioial Fee f�,/ �� �� � � , � and hereby aulhorize represenlauves of Ihis Coonry to enter _ _ . . , , . _ .. � e ` upo he above-menr ned roperry for inspection purposes. - � � M ' . ; i � � - � 9�' � - � � � SEE REVERSE fOR E%PlANA70RY LANGUAGE i � ��^ ���v . ' -�'� � Signa� e , pliconr or Agent . . . Dare. . . . .. . .. . , . .. . , . . �� . . . .. �� .+ ` _'/ , — - - � •PlANS 70 APPIICANT � � �.INSPECTOR'S NOTES . OWNER-BUILDER DGCLARATION � � I heroby affirm that I om exempt from tho Controctor's '� So: � l:oturnmd � �Z✓c�.� �O ��:_�ti /��S�L�L�]"" Utense Law for�iho following roason:�(Soc. 7031.5) � ' Approved _ � n�J BusirsessandProfessionsCoJc:MyrityorrountytuGicb � No. -- Data � � No. - Dme - ���Ij b��j0 . ' regaires a pern�it lo construct,alter,innprove,demol'uG, ., , , � . , orrepairanystructure,priortoihissuance,alsorequires �� - �- -�- �- � _ � - - � . tLe applrcant Jar sucG perniit to jile a signed ataten�ent � . _ , „ , , ',`,' : _, ,, ., '�,��� tGat be is licensed pursuant to tbe provisions oJtbc Con- . � - - - -� �- `,;�, - � � � tractor'sLicenseLaw(Cbapter9J(commencingwitGSer . _ , ._... . . ; . , tion 7000J ojDivieion 3 of 1he Businesr and ProJeuiora -�' � - � � � �� " . �� - � CodcJort/�atbrrsexrnrpttGesrJrornandebebasisjortbc � ' _ . a!leged cxemption.Any viofation oJ Sertion 7031.5 by - _ Rsqulred, DetaP.ecaived � ��1��7. ' � . m�yapplicaneforapern.itsabjeclstGeapplicantLoativi! . . Approvpls �� - or Approvod Qenaley oJrot n�a�e tbaw fiuc band�ed dollars(SSOOJ.J: �Ycz No . , , . . . . ' j��j,- ; �.�,.;•� � ❑ I,as owner of tha property,or my employees with VJater Cerlificale � � I , . , wages as Iheir sole compensofion,will do ihe work,and :;;;_.'J.%, �s-:� i�I1 i I -. , 1he strucNre is nat iNended or offered for salo(SecJ044) � Business andPro essroxs Code:TBe Controctor's License Health Depariment - • � � .:�c�•.:�-• . — ; fi� � � �: _ .-� .�'i}: _:;,r. .. ..1��,_::�..^�•,''�� �.. Lawdoesnotapp�ytoanou,n¢rofpropertywbobalGls FireDe anment � - . . - . orimprovestbercon,andwbodo¢ssutbu�orkbimseljor P . � .��,' -. '. ��"' `'`j:'"''..'�; _ " rhrougb bis own employeee,provided tbat aach im- � . Grading � �„�__,.�, . ��,_„�r : :_, ,_, ,j�� .,��, � provements arc not ixtended or oJjer¢d for sale. Tj, � ' � boa�ever,tbebuildingorin:pros�enrentissoldwitbinone ' .� Geological � � . . .._. _ � . . _ year oj tompletiott, 16c owner•burlder wif!bave tbe . , burde»'of¢roving lbaf be did not build or improue for Pedesirian Protection ' _. _ . , tbe parpase ojaaleJ. � - (Fence)(Cariopy) ,�� � ❑ I,as owner of fhe property,om exclusively contrac- , , . ting wi�h licensed cantractors ro consirud ihe project(Sec. !� Speciol�lnspection . � � � � `"�� 7044)Dusineaa and Projessrons Code:T6e Contrattor's � (Cone.)�(Masonry)(Welding) . .,�� ' �LvrenseLamdo¢snotapplyto�anourrcrojyropertyu•ho ' " - . . !j � builds or ineproccs tGcrcon,and u�bo contraets for suel� ' � Lot�rainage� - + - ' ' . � � � _ . _ . - projects witb a contractor(sJ licensed pursuant to tbe ' ... .. l�1� "_ , T'1�"�`�� � '-... . � Contraclor's Licensc LauJ. ' . .� �� � Parkfng-�-. . .. , �� � . '_ .-,. .- .. . . . , , . ' ❑� IomezemptunderSec. � ,6.8P.C.forthls � , . .. . . � r i..y-^, . - . . reason ' . � , . .. _ . -. . _. . . Ddte � - Ownor i , . . _ Approvels Dcto � InspoNor s Sfgnature � y.... . . " . INSPECTOR'S NOTES � Lo<ation— � . , � , . (Setback&Yard:) � }' , , . . , � � � Foundorions `Q � .. . . . . . . �� �� I SIa6 � �,�/c�-/ 1� � . � . . . . , . . , Frame �, h[ g ,.. " . . , „ _ . . I Energylneulation ' �% �' � � , .. � .. . � . . � ,af.,� � latfi/Drywall— � . IMerior ��� .�'ti� � � . � . ,, Lmh—Exterior C���� /� �- . .. � . � � ., � House Number— . . � . . . .. . .. i Carrect 8 Posted '�. (. � ' � - ' Final— . - _ , . . Enter on Front � � � � ' ' ' - � 1� � �'1-fy- /�� �3 �✓ ��.� �3 e�,,..�-e CL ' � . . . ., :. '�\ L Y 4: � � iLrt✓� . C -- � , ,., � '��.._-�_ ' � . . � __ ,'