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HomeMy WebLinkAbout1239A 1240A (6) , _ . __ -�--- __�_ .--- - , _ ---- __�.,_.�.-.- _� _- _ ,..�--'-- WORKERS'COMPENSATION DECIARATION - � � � ;�;�,ebo�a`�e��f�o�eofwoke=-'�emPe�=a°o�°��,��a��'f � APPLICAT.ION FOR �BUILDING PERMIT o�a ce�tifed copy thereof(Sec.38W,tab.C.) COUNiY OF LOS ANGELES BUILDING AND SAFETY . P�ol�icyNo.._ Company - � . BUIOMG � ' Certtfied copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRE55 � Certified copy is(iled with ihe coumy building inspec- BV��DING 1 1 iion deporimenf. ADDRE55 Z JO z1'Id(� 1 �IZ tQUUTY ti[�r7 � � NEAREST Date Applimro � Cl�v lclYVld✓L('� 1 ZiP �6� cROSSSt. . �� CERTIFICATE OF EXEMPTION FROM WORKERS' NO.Of 8tOG5. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LO7 A+AP BOOK PAGE DARCEL (This section need not be complated if tha permit is(or one /7 USE ZONE �P .� —3�3 hundred dollars(E100)or less,) TRnCT r BLOCK LOi NO.�� / � NO. I certif fhat in the erformance of fhe work for which this OwNEQTI NO- '� 1'I N ��� CONDITIDNS 2.C�. 5�3��.'4 i��a y Y P +? (^� i ,� . r1� OfSTRICT GFOUP TYPE FIRE PR EO BY O permit is issued,I sha11 not employ any person fn any manner qDDRESS'7Z-30 �y-�1 �[J h1 �P 1� CONST. Z NE V so as la 6ecome s�bject�o ihe Workers'Compensation Laws. ��T� �«���a ➢�a2 z�P j��� Qa o Date � AppliCOnl ARCHIIECT Oa�- TE� STATISTICAI CLASSIFICATION AGT. CONDO. v NOTICE TO APPIICAM: If, afler making this Certificate of ENG�NEFR T�•(W�KZ� NO. '� �7 ctASS NO.�Z' 9wElt.UNI75 W -Exem tion, ou should bacome sub'ect to the Workers' �J a Compensation provisions af fhe Labor Code,you must forth- ADDRE55 3Z3o�all�w "�l SEWER MAP ' . Z wilh comply with suth provisiona or this permit shofl be TE�, �— deamed revoked.' coNTRncroa OW fWJ�� NO.�7)-(�1rj(� '' e PGj � VAlIDA710N LICENSED CONTRACTORS DECLARATION ' uC. I hereby aHirm�hat I am licensed under provisions of Chapter 9 ADDRESS NO. VAWATION�� (commencing with Section 7000)of Division 3 af the Busineuand (7C. , 2 � Professiona Code,and my license is in full(orce and effect. LiTY CV.SS S US/v�� t :1 2 3 9 A � � � SQ.FT. NO.OF NO.OF CHECK � LiCenSB NuTber �ft.C�a35 SIZE STORIES fAMILIES ONE ' $J • • • ♦�� - S CoMrp[for pote DESCRIFTION OF WORK �'N� I � � 9� �.r7 AD7 ...� ❑I om exempt u�der Sec. � I ✓VJS AIttR � PINAL ^�^��_ , • " � r,� `���'- B.&P.C�for fhis reoson � - - �REVA�R � DATE-- . USE OF I' � FINAL. . . � �,U�-�� Date: EXIS7ING BIDG. �T f ��/'��� � By SignatUre � APPIPRIM `' ��71 Z ��INO. 7-���p ... . - ::1 C r C A OWNER•BUILDER DECLARATION �1 (� /� I hareby aftirm tha�I am axempt from tha CoMrotloPa license � qDDRE55 J�'3C�+'� �c�3-�t� ��-• �,�� - ' � ' ' ' � • • • • i Law for the fallowing reason(Sectian 7031.5.Bustness ond Profesaions CodeJ: . � � ' - � � ����'`� - � I,as owner oT the property, or�my employees with � � ADDRE55 � � '' � _. °G.]: :,., wages as�heir�ole compenso�ian,will do the wo�k and ���� • - . tha s�ructure Is not in�ended or offered for sale(Section � - � �� � I Z.G�-�� 704a,Bueiness and P�ofessions Coda). � MOVING TEL. � 1,as owner of ihe properly,am exclusively tontracting . . � MkA�� NO. . ,, ,,_ . . with licensed tontractors lo conslrucl Ihe project(Sec- � qpORE55 ' � tion 7040,Buslness ond Profess;ons Code). � . .-. � . - � - -- -- REQUIRED TOTAL SETBACK FROM E%ISt. CONSTRUCTION LENDING AGENCY ' SeT aACK YARo HWY PRO�.I�NE WioiH � � I he�eby offirm thot IFera Is a tonslroclion lending agenty for FRONt �,� - � b � � -' - �- the parformanca of the work for which this permit is issued a.t. , � tSec.�097,Giv.C.). SroE . ._. . ... .; . .. .- . - . . . � m A )I� 'P.L. . � . . . . . � Lender's Nome 7 V ' � . �. � � 7.C.Fae S��/?-� Permii Fee �ZS`� . . ..-_. . .� .. lender's Address - � I certify�hat I hove read Ihis applica�lon and stote Ihat ihe � � iao ce Fee l0`�� - � � � �� � � S a6ove intormafion is correct.I agrea�o comply with otl Coumy i�,.e��;goi;on fee a� �` _ _ _.. . . , �� ordinances ond Stare lawe relating to buildinq tonsiruction, � Toral Fea � Z.3 S.!J— -•� Ci ond hereby thori e represanfa�ives of this County to emer � -.upan the v -m ntioned propeny for i�spection porposeQa. .- .. . . ._ .- �.. .. . . . . . .. - . �Z.'S"Z/S � SEE iEVERSE FOR EXPLANATONY IANGUAGF ,_ ,_ _ . -. � Slgna�uro pplicanr or AgeM Dore � � � ..�s . C� C311 �'�Zd� . .. . _ . . . . . ' FL�ii75 TP APi'UGANT. ' p ; � ' . . ' INSPECTOR'S tIOTES . . . �?���t^,.12LJILALR D:'CT ARATIOti .� ,-„� t ,. . _ . . , _ _, , ,_�--I hereby atfr i ILci I�c�m�e:�empt frem the Contractoi s To: . Fslumed „ , ., license Law�� torl�I�.c tollowin��reason.•(Sea�,7031.5) ., ... , . . � ... . . `. • . :. ' APProwd � .. .. flavir..�sscrdl .Col A �'cir�.�ormvnEqu•licG No. _._ _--Dofc___ No. �-Cato .. . .,�.'.- '- . :.• ..'. . . .� . .. , . .... �.. _ '_.reyrr esu f< ,7-- ns[T �t�u!l-r,1 /r rr:de olrsh, �r r ,_ -,._:_ .` ,. .: _ _ _ . _ .._ _. . orr�pcirr.rct�strri;Jr-rr,priurtnitsissriarrce,ulso�reg¢irej . . _.. ._. ___,.._ __.... _ ".. _...__ _' "_.. ..._._" __. . 1 . t ' , fl ,,.. ' ; `� , -� tGo�tpflitanRfors+�c1�'pi•rmit�ibf:'la�asr,krscJsldten(en`t + . : . .. �,._��._ . . � t", _`. , ;. -__- ._ _ __ ,__. _ ., _ .- , , __ . _ .__ __ . ^� ._ .. tl nt Ge is liccnrrJpursacnt fo 1Gc f�rorisina's'of rbc Con- � :�'1 I;' . • � �"11.Sf.. ;�:' tructnr'sl.iccasrl.uu(Cl�apter9J(mnurrenrin�u�ilGSec- --tion-1000J f flir'siur.�j qJ fbc�Uxsinrss und Pr fessians ; � , , � . . . Cadr)nrti�etbr'is�t�rnir:tiler�frnn+aia�lle7usufoslhc . � ' • ': CoGuired ' . , , !!, � . . � 1 � ! .,'� Scc'ri 7 31.5 b n c^ca e�r„rQ mr t r t .+t i if bn 0 y -� -Arprorala' - _- DateReedwd _.� i __ .. � .' a>rrd�,;,li:cr�tf�ruj.er� tirllN tlo�/�rlieunt3 anril � � .Yoa'; �Ne. er Apprev�d , � fe:r«!h�o(no!� � t?vn f l:n.cri��l JnTlsrr(SSOOJ.J: ' ' - ' S.'_ � . .�`-- (1..'1' (?�/y, l,'' _- ..�. � I..:, l.as owner b(dhe proporly,.or my employoes wtlh , Water Ccrlificate i . � � ' -��� ,��� `,.�,��� ��.1 _��_ � . ���wcg.�s nt thr.ir sol�compensotion!will'da ihe work;and ;. ' ' ' " . ' _... -_-__ .. . � ) � . _.. � •thestrucrtr�3ls , e�,d:dc e 1-�edforsate Sec.7044 � ' ' �' i- .��. ., ._ t3usirsc�s nr�d Fr f s Cn.?r.TL>c Cnntrnctor's Lirensc ,. P mun... _. .. . . ..__ __.... ..__._. . _ .._. _ . , ,, 4 Hcalth�o art �,� ��rn, Fira De artme� '" '•. r i '.. . . . .a d ec nr t qb(�v���I an ou•n�r of f r erty� b 'dc ,� p n� ; _ __, . ...�. . . ' � �. ,. . ,_.. . , nr7�/snecs�llc�roNrtvdreJ���`r.�ncsar�el��ibar.�hbHsclfor . ._ . . . , '__ . .. _ .. . �. . '.i. .t . __'l . C';___ � 1 r SL lr �i h/rt e rrri:�:J Sbat sceb-rm- � .'..t r . o -rt Gradinq .. _ . _ . . __ ,�],o�nirer.L a�c not t.:t� �.d qr r�f�cd fnr salef,lf, ' ?t'� rl'��' /�-�.,1',;� - � b-n:rcrrr.lhcl l�in,�'nrir;:�srnrrn+arrlisrolJecil/�ix�onc Geolo�icol � .._..-- , _-� � - - 1'P�'r f cnr,ii�:;;r��..tl.�r.e:r;;:r-bei(;lcr�tri!!Ga���c tl�c .. ... . . � . . F r i .�Il'r,u . �! :. Y7 ! r��i�,-�n ,e fr�r Pedestrian Protection I � , , t! pLrf;ase,o� af/ �� _. _ (Fon2e)(CanoPY) ....- -'-� = �.".�. .� -• _ ___ -� {7.�I,asovnnr oi�Fr p o� �ty am exdwrvcly o t ac- _ _. ' . . _.__. _. __ _�. � � � � � h 3 w th liceo:�d con•rocto 1 corstruu Ihe projeU(Sec. Speciol lnspeclion" , ' � ���- - --- � -�- ----- - __...7044).Gesrn.-c:rtr�.11-ru,�cS.aer,s CvJc:ThF.Codtractor's (Cone.)(Ma.onrY)(Woldin9) � . . _ . , .. f.icncel.r.u•dn��r.nta��hlyfnrsaou�rirrr�rrn�crtyu�Go �;, . r � _.._... _ ,_. .,�'`'., J>r.elds nr.(n;/�.-�,cet lb:�r.'✓rr,.r.r.:l trbo eor;trc:7s�nr�sueb n et i .< <,r.tractu l::crised ursaa>:t to'tTii� loro.ainaqe , .._ � .. .��1-'' .. . '_!_ . �-r: .. _ �_.. __ P J n'.,1.. , ,f'.� _ . ,.� - �. , -C.o,�..:.rr,r.-1..�.��L���•L� Parking � . \..��.. .__._.,�- "�� - _ � ' '� _ __ - . . , . _. - '. ' __. ___. _ .._. ._ _ _. _._.. .__. � _ ._ �. .._. ,-,.. .. _.�,.. . . . . - [�j I om o empt undr�Scc ,6.6P.C.for Ihis ..� .� ,.-, i ....�t i :._, .,- •. , _' _ `li� \7• �� �l�__-_ _ 1 r`')t ', ""_r[��5_-.-_ . ._"-_'__"'__ '__"_'.`__ ' . � Da1 — '� __" Owner C � ',I, � i f� . � .. _ � . ,�.. ,i ' ' �-.,_; i. � � , n c..� 'AFprov:le . I Dat� Infp�ctoh Slgndun ; - . ' . ., - . ... - ISlbi"CTO£'S PlDT"t5 � � � � locati6n-� -- - � -� - - � ' . ,.,_, ISatbock E Yards)� , 1�,�.:��:..,:�i;-. _ _ ._ .. .. Foundclions ' . . . � . - . . � � � .. . -. _ ,' Slab ' . .,. _.. . � , .. - _ .� . � �.. ... ._ . 7 , . � i .,,, . . .. _._- -- - - -- � - - �--..:,. . . .,.�,,� ,..�� _, Fromc . ,., .. . .� � . . , .. I , ..- � - . . ... . -,.� . _. , � .. � . . . ... . , . .. .. . _ _ __________._ . :. ____ .__. '__ I Energy Insulation �� � �` .. . '-- � . .. .�,'' . '. ' . '. ' • ' ^ - . . . .. . .. . , �. � . . _. ._ . � ,., i ' _ , __... __ __ _.. .. .._. .'.... , .�i. � ... .. .. _.. .. ._ , . - i i Larh/DrywolilZ Si , - ; . �" . '-` ' -, INerior �7i/3/�" ..- . .. . . . . ..`. \ '�i.. . . � � . . �._ ._. . —_ , .__ lath-Exterior . -�-.`. • ` . � <' , � ` � . .. '' ._.._.__.�-'--- -. _.. .--.' _....-. '--- -' . ..,.�.. � �. , -'_- -�� ....�_��.�I - ____ . _.._ _. . .__'_- ' Hause Number- . � - - • . r � . , _ .. � _ .� ..... _ , ,. �� y,.�., � . _.._._,. ... ...^- - �--- -- - �- �-��� ���� . , �. Co��ecf&Poatod . _ .. __ . ,i-�.�..,I�.,. �. .. . . .. � ... .. �. . ��. . Final- . � - � . i � . � Fnter on Froni � .-. .. ' . ' . ' . . � . . . - - \., - .. , •,�- ,. � - ` .... i.. �f� ,Y,-11 . .