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HomeMy WebLinkAbout1690A 3948A 3972A - - _ ...� ------ -- - _ _ � � _ ____ __, WORKERS'COMPENSATION DECLARATION � Q � 1S I hereby affirm ihof I hove a�e„��,�a�a of consenf fo self .- Qpp��CATION FOR �BUILDING �PERMIT insure,or a cerfificate of Workeri Compensation Insurance, � or a tertified topy ihereaf(Sec.3800,lob.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. Company ��'�A - � Certified mpy is hereby furnished. FOR APPLICANT TO FILL IN qopREu '�� ,�,�rC� � Certifiad copy is filed with Ihe tounry building inspec- BUitDiNG,Z Z A1 . '� .? , . flOn fJeparlmeN. . ADDRE$$ [..�� LOCRLITY /s'�.�.+�.�:.. �'J.a�/ NEAREST Date Applicanl an'- t,,.r na ceoss Sr. . CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SiZE OF lOT ZQ, NOw ON toi hav BOOK PAGE vqRCei �This sedion need not be completed if the permit is far one USe 2oNe nti4a hvndred dollars(E100)or less.) TRACt BLOCK LOT NO. �3 �� NO. S� � � - TEL -- - - '/ SVECIAI - � 1 tertify that in tha performance of Ihe work far which this �WNER NO. 'FJ"L 1��(f CONoiiiONS O permit is issued,1 shall no�employ any person in an -- �- �� - oiSieiC7 GROUv TYPE FIRE PROCESSED BY V so ez to 6ecome aubject fo the Workers' ion Laws AD�RE55 2-Z�G`— 1,,,�._ �C�( D CONS� 2�ONE . �-� lC^3 � 11.� � Dafe�"'���� Applimnf �� � � �TY , Z'P STATISTICALQP.SS�fIfJ�TION , , APT. CONDO. O NOTICE TO APPLICANT: If, after making this Certificata of ARCHiTEROR TEi.ZI� {,7 �Eaemption, yoo should become subjecf to Ihe Workeri ENGMEER \, ' '=-•-c ' NO.� QA55 NO. DWELL UNITS a Compansotion provisions of the Lobor Code,yov mu5f forlh- qDDRE55� LZ'ij Q � SEWER MA� � wifh comply with such provisions or ihis permit shall ba .? deemed revaked. � TE�' BK. PG, VALI�ATION CONTRACTOR NO. �LICENSED CONTRACTORS DECLARATION ii�, I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VAIUATiON � (commendng with$ection 7000)of Divisiot�3 of fhe Business ond �,�. �, �� -�1 6 9.0 A Professions Code,and my license is in full force and effect. Ciiv � ttq55 E�'-- � � � : SO.R. �..�71 NO.OF NO.OF CHEIX ► ,�° ° � �2 J License Nvmber Lic.Class - S¢E U�✓ STORiES FAMtLIES ONE . I - s �� � I •2b1.38 � DESCRIDTIONOFWORK L d-- NEW � Conlratfor Date � A�D � - • •2 6 1,3 8 c�� �I am exempt under Sec. � � � (.- � ALTER � fINAI � . O�L 2 2-S Q 8.8P.C.for�this reason REPAIR � �ATE �llS r�S Date: USE OF . DEMOI �-FINAL - � � � EXISTING BLDG. � ❑ B�, �l Si91lO1UlE � APPLICANT ( TEL.�2..1� . OWNER•BUILDERDECLARATION PRvdT \�� ` . .�-� NO.� I hereby affirm ihat I am exempf from the Comracror'a Litense ; /+ �s � Law for the(ollowin9 reoson(Section 7031.5,Business ond i nDORe55 12- 3 S. �s2.I+.K� � � . Professions Code): � � ' . j e � . � � BUIIDING . I, as owner of�he properry, or my employees with� qooRe55- wages as Iheir sole mmpensalion,will do Ihe work and ; � tha strutture is not inlended or ofiered(or sale(Section � ��"�m ���� - � - � 7044,Business ond Professians Code). � MOVING TEL. � � . � � � � . � I,as owner of 1he property,am ex[lusively tontmcting I C MRACiOR NO. ' -. � , , . : s j 9 4,a A with licensed contractors to conshvct Ihe project(Sec- qDDRE55 . �� -� ,! �• • • • • � tion 7044,Bwiness and Professions Coda). . . ,... ... �. .-. REOUIRED TOTAlSETBACK FROM E%IST.'. CONSTRUCTION IENDING AGENCY ' SET BnCK YARD HWY PROP.LIN W�DTH -- , `'� I •4 5 3.0 0 � I hereby aifirm that there is a mnslruction lending cgenry for FRONT - �� - � � � - � the pertormante bf the work for whith Ihis permit is issved ' a.i. � , � � ' •Ll.�i J.�(1 c''_� tsa�.ao��,r�.c.�... . . . P pe ; - . .. � 0 6 1 4=8 4 Lendar's Name � - - �/ � � � ' a � P.G Fee S ��� 1� Permil Fee 7.7��� � � -' '� - lender'a Address - p� e ' • ��� �h�'• , � � I certify ihot I have raod Ihis application and sta�e that tha � �� • �� issu ce Fee ���s� � � � � '"' J • � above informa�ion is correct.I agree to comply with all Covnty Invasiigation Fee �� � � J ' � � ordinances and State Iawe relm�ng fo build�ng consfruc�ion, � �� Taral�Fee� �S�'� � � � ' � 9 dnd hereby authorize repraseMatives of�his County ro enter O� �7 �l N N � upon Ihe o e ne y for.inspection purposes. . - � �� ��� , � � , � R Cn�(n Gl D .. .. � �l (��(ti`��� SEE REVERSF FOR E%RANATORY UNGUAGE � . �-��� CH � T Signoturo of Applimnt or Agent Do�e - - - � • ��s � . . . . . . . - , .:.�, . - .._. . . . . . . - . ' _.._...___.._... _ ... _ _ G _"._-_' ' �I� i� . r __ . _ . � � PL1,K3 TO APFLICwHT � " � � � � INSPECTOR'S NOTES . . �-. 01S tiT•.I;-P7AI.D�I;DF[CI.AT..q7"10ti, , � I hereby affirm�hm I am exempt from the Contro.ic�s To: .Refurrtod , . _ . . License Low for �ho followinc��reason. ($ec.�J031.5) �APProwd Gusir.c.ssnr:dPrn,4ssim:sCndc:Ar:pcitl'�rto¢ntyu�biCl+ No.._... . -..DcTo -.. . No. --Dato.. . ...�---.�. . , . . . . _..-rcguirc;a f.0 ^ifYn co,�trv:f,nit:r,'im/�m��r.dcirroTisG, . nr r rcrrairi'stn:Curr,pririr in i1t isruancq aLro regurrcc ._... . . .-_�_._ . _ _ .___ . ._ ._. . _ _ . . . � ' � , , � . � -�'thr u�fArnrrt f r sucl fnrnrit!n fe'Ie a si,qnrdstatrnicn� _ _ . , , _ _ _. __ _ .7l�nt!�c is liccnrcd persuant 1n fI c pmcisiwu of tl c Con- . _. ___ _.__._ . � � , . 7ractnr:s l,icen.cv ln�o(C1;apt rr 9J(ron:n:entin,�tritl�Sec- . � -tion�7000f nI7)ir�i.cinn 9 oJfbe�Uusrness and Professrorss '� - � �. . . , . . CodrJnrtJvtArrrc��ririfllbrr.JrorirandtbeGa.cisfartic � a!lr,�ed eceni�ti�nr.Ar.q x�in(ltiorrofSection 7031.5 by ', .'R6qulrod Dato/�cdved � . . ' . .. . . � . . �' a i p/1'c¢rtJ�rnprhr �srl�ac1s77.,��rrr,�.�;,froa�,�•r� � --hp;:rove!:- - �- orApptewd. � - - - - - J,onefl.l Jm r unn J�m��Jr<L�.ia�!reJdaf(ars(CSOOJ.J: ._ . _ i Vos Na. _•. .. ' .�.;� -`>_.. ' .'• , . . - ' . � . . ._�.. I,as owr.zr.cf�,IF:e pro�erly,�or.mY employees with ' .._ ._ . ... .., Woter Certificate� ; � � � , ,_ .wo�es oa th-v<o!^c�mpense•-o�,wlll'do the work;and - ' " -. -. -. .. � . . ' .. .. . .. . . � Ih<s'rucJure Is nol nrended or oHzrcd for salc�(See 7044) Health D�portment •- - ._ �' ' - � , .,, Cusirics�an�Prnfrs�;nns Codr.7Ge Contr.aclor's Lrcensc -. _�. .. __. . • :.. , . . . .. . ... . . � �, .. �. . _�'In�i doca nnt cp;,h�3o�arr o�erxr ojprnperly u�Gd h¢ild.v Fire�eparlment I � . , . _ . .. . .._ _. . . . - .. _ . or irir(�rni•cs ther�or.,r,��•.'::I n c�nrs�svrG u�ork 1 inrsrl/or . . - . . - .-tl�rnuq�, /is oeri: c•vr(ot'i'rr, pmerdcd ibat iue!'im- . ' Grading . _. _ .._ . .- : .._ .. •r .. . �/,rorrmrr.;.v��ur� a:n:�.ii:�.�m'eJ or�iffn•eu for sale.'If, . , , Im�i�errr,tf c fiuildir.q'�;r b�rpmrrrnrnt�v sold a�itl br nnc Geologiml.. . .. . � . . . . _ ��ccr al rnnvplcrior.,t,!�c o r.rr-h:rrfdcr �rr'!!Fnrv�tbr u . - �., l�r�rd:n r;/p,-vr e rb::: df11: :'Fr�i1J or in:pr �P f,r Pcdesirian Proteetion � . . , . ..tbr pur�,oseql aalel. �. .. . .. . � . .. (Fcnce)(Canopy). ' • -' i� � � � ... '`1��. I,a�.ormr.rnfrFoprocerty,amexdusivclymntrac- " � ' � , tiMj with Gcens�d con!ractors lo conslroct the project(Sec. Spe:ial Inspecfion : . . . '� ... � . -.-. -� .. ' . . .� . -.- - e�).�«tinrrre..f P,ofrssbr s Codr:Thr Contracmr's . 70 • - e 1 ' (Conc.�(Masonry)�(WeldingJ - _ � � � I,erense7as•daecnntu,^p:�tonr.nr�nrrnfprofert}�n•!n � _ . � � .. .. � • . . � � . ._ F:rtldr.u_'��rpr�.rr:.t±,:•r�ar,.c•rd u•J�o mntrnrts fnr rucb LotDrainage . � , - projeclsrs:�ith u cor,tra:mr(sJ lirensel p«rsaeant to;lle . . . . . ��.. _ � . . . . .-Cnrren:.tnr's I.r�rr•rTl.a:rl. ' � . Parking - . _ - - ' . . . . . . _ _ . _._... . ...__-' -. -��- �: � ..�... ..,.. ;, �- �- - - -- � �- � � --- -- --�-� -� -L�� I am eRempt u�d ., � ,B.dP.C.for this , . ._.__' _.__' _ ...._ ._. .. __.._._ ,. . , • .. ... _ __ ._. .. ... .�. . _ . _.-�reason :. .�.:_ ' ' . _.. ' .._. ..'� � •.� � . "' . . . .... .'" - _'_ . .. . ... . .._, . � � Dotc O�.vner . ` . . . . . . � .. ..� � , �. I t.Fprv�Is I Cota In�pecfor i Si�ndun . . . . . . � . , � . . . . , .�.., . —_�� IC:�F CTO�'�P!OTES Location- I . .. _. _. . . .. . .... ... ____ .._. . . � . .. (Setba;!.E Yards) , I 1,� .. ' � ' . . , , . � h 7-tY J Foundations 1"�W . . . . . . . _ , . . ..... . S � M 0� �!/e cr . Slob . . �� rJ �� �c/a/fV .U�cu.G r....,c. n.L r _lli tC�.,N ' � .. ,. � � �, . . " _ '-. . . . . . ---� frame. . ', � � ., . . . . . .'. _ , ._. .. " . .�� ... - . Enerqylnsulation� ��� . . . . .. . � .. . . .' � .. . .�. ..�. .„ Lofh/Drywall- . � . � Interior ,�j � .[� �� � . .. � . . - , � ___ _____.-_ .__. ..___ ._ _. " . nI � - . .. .'-.� . . . '� . ', . ,.� . Loth�Exterior Jy�'blNG � � ..�� .� ____ ' ( _�I - � . ' . _ - - _.. ._ _ __. . _. . . .. House Number- ' . . . . `. � ��`- - . , .. .. . .. � . . � . .. � � _ . � . . � . Correct&Pasted � . � ,:- '-__. _ ._:'__ ;�. �__�._ :._. .._:. ._ -. .___ ' -' . . . . . . .. , Finoi- � .. . � ' . . . . , . . . Enter on Fronl � . . . . . . . - .• . . .. - . � � .. ... . . , .K.� C.eo �'<FE/G T� `I�5� °dy�, :-�.l ' ' . ,�:� ChE'c cI�"��NEi �a i % ��di '=-c-�.� _ �