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HomeMy WebLinkAbout1147A 1148A (5) ,. , . __. ......_._...... �.__..___.. ..__ .. . _---_. .____.. ...___....----.,_..._...- - -... _ _ ._. ------- � WORKERS'COMPENSATION�DECLARATION � ���""�' '- "�'':'"" � ��'��" :� :•���� � I hereby offirm fhat I have o.�e�,�f��a{e�of<o�,e����,o.se�F ------- � ---APPLICATION FOR-:BUILDrNG �PERMIT ����� • insure,or a certificate of Workerz'Compensation Insuronce, � , . --. _..---- - - � -- or a ceilified copy thereof(Sec:3600,lob.C.) � '��:' � - - - _....'-.--- ._.._.. ... . ;..- COUNTY OP LOS ANGELES i eUiLDING AND SAFETY � � •-� ' '73WCOQ5-27�4=0004 Natiomaide� 60/E (2 Car) , .. . .. . , PolicyNo. ompany� . ._ _ . _ .. . . �-� ❑ vr v • - • FOR APPUCANT TO FIIL IN BUItDING 675 N. Feathen�vod Drive � 'Certified co is hereb furnished.• � ADDRE55 ��,�,Certified'copy is filed;J.iih ihe coonty'boilding'inspec- � gU4DiNG 675 N. �2c"i�l@TVACY� DT1V2 , tion departmenl:�� • ADDRE55 ,:. , . .l,- ,,, � . . � .� ...',. . '__." _ _ '_ __''__ ' Date�'6�19-H6 'Applicont Z�..�� C'�� Giri LP � IOCAtItt ' �• ' COMPENSATION INSURANCE- '���' �' -- -NO.OP sLDGS. ---- - - NEnRESi�- - � � �� CERTIFICATE OF EXEMPTION FROM WORKERS"'� 52E OF LOT NOw ON LOT cRoss sr.�9h Kt�ob &':Golden�5prings�-` ��` This sedion need nor be com leied if fhe ermit is fo n55E550R.„, ,.. '� � ' �'- - ' �� '• �' . . rone .._ . _ _._� . .__ _. ...----- -----._....._ .. . ,. hundred dollars(E100)or.less.) , . ��P . TRAR BIOCK lOT NO. rj�] � MAP BOOK ' GAGE' PARCEL . ;.Y , P ,, '. . ......: .. . . . '- P.O.BOX T - - SPECIAt. i OWNER TI-,�� -GF�UP----�-No:96 - �- u ZONE MAa permiso as!fo be�coma ub'ect to he CQ of 1he wo�k for,which Ihis ' I �� � � ' 3� . � - I!� I t is Issued;I shall no�employ ony person.in any monner ._ � �-� � ��-�'�' ���----�--�- - � �� Workers'Compensalidn Lows. - ADDRESS- .. . _. � .-�- ----�-""'" -� -'-"'-"--`" CONDITIONS ! ' " � � �!, . �V ,,.._. . . . .. .. .. . :: ... . . .. ... . _.._ ...-._. . .__-__.___.-___ ___ .... __ _ . , . � � . . �..�.��,.�...., -"_' CIN' _ ' ' '__'___ "'__'__'21P. ' __.-'_ e. �,, : . ... APPlicanY:..• - ARCHItECT OR TEL : � . . ,. ..,`•' �O �TICE TO APPLI[ANi: If, ofler moking�this Certificota af Dave S AIA 445-4073 � o�srR�cr..__caouP NPE_�._____ ..FIRE__ __PROCESSEDeY.. -.0 I emption, you should become subjett"-�o'the Wo�kers' �- ENGWEER z"any NO. J� Zj�j Compensatlon provisions af the Labor Code,yoo must for�h- AOORE55 N. 1�'S � �Cd ia 2� GZ 3 �N)/, � ] V _ �a with comply with.such provisions or•this permit shall be - -� j, � •Z TEL STATISTICAL MSSIFIGATION APT. CONDO.'= � deemed revoked., , � . ,` . ' . . •'• ,,..�.' CONTRAROR _ NO. � � .i ._. .____.___ � , ' LICENSEDCONTRACTORSDECLARATION•�. �• �- � -� - � -��� - - �� -- � -�-- _ MSSNO. �' DwEtLUNiTS �f , 1 hereby aNirm that I om licensed under provisions of Chapter 9 nDORESS AS d}J OVe No;3 7 1 5 8� � (commencin wiih Setlion 7000 of Division 3 of the Business and __ _��R�P � ' " ' ' 9 � - ------.- _'-... -- --- ".' ----LIC.. g._._,._... Proiessions Code,ond my license is in full(orce and effett. dTY cw55 � BK�--��-� . � -' '; ' ` - ���-�VALIDATION LitenseNumber37158Q� '� ',�ii�.ciass �•B '-.� '.-. - �EFT, .. TORI�ES F MIL�IES. .. ..CONEK� , . : _ ' - _:�!{��1NDEN G�a. .. ..G-19-SFi VALUATION_._.. __!. ... .��.1 1 4,7�1----: N� " �ESCRIPf10NOF WORK" S1Y1CJ�.0 f�iill�.17-.___ NEW � 86 080 ; � . _.� _._ ._� .2.1 Coniroctor te AOp S •y e . i �I om exempl under Sea --. - -__._. e._rj]_�.�_'_.'_._____.... _.._. '- '-""-'" " . . , , ai,�R�--❑ - I �3 3 1,7 2 ' � - - ' - .._ -- ; ._ B.BP.C.forthisreoson _.__. . RE7AIR- �� _ -' - �-��.-�-"� ��-- -- . _-_'___'_ .._.� ..... USE OF ❑ e s O J�.� 2 cs..�. j � '___ .- DatB: E%ISTING BIOG. DEMOL ..._. .__.. _ _._ . .__..'_ _ . _" - ' '_ _ . '"_'. ._.. _. . . . '' APPlIG4NT TEt. ' $Ignalure FINAL �/ �9 � . O�.2�"FS 6 • OWNER-BUIIDERDECIARATION PRiM NO. _ • �DATE�Z ZY�A�- �--� • ---- , i .. ....,.. --."'.--.'- _. � I heraby affirm ihat I am exempl from Ihe Con�roc�or's license �'a�70Vg . � . . � �ow for the follo ing reasoo-(Setfion 70.31.5,Business and A�DRE55 FINAL" � �� , _ _ � w .._.. � ,`' . `.`[ , . . , Dfessions Code):_. , . .. .. ��. . . . "'-" PRE ENi = � _BY ..."— - - - - ' - ' � h BUIIDING 4Z .1.S`-.�. :.i� \�....`1 ' iJ I, as owner of the property,or my employees with _ LOfALTV •-,(.-� `�. .•, �. �JJ , �� � �"� � �.�{� "' wages os their sole compensahon,will do the work and ' _.� ' -. '- ,-'N7 a�.. ____'_ -�S r . t • � ^ • • �:c' ihe strvcture is nol intended or ofiered for sola(Sec�ion i ' � -- 7044,Buslness and Professions Code). "'��' MOViNG - -- �- TEI. - � -� ' ' � I,as owner of ihe �a ert am excl�sivel conlroCfin COMRAROR NO. � 1 �" P P Y, Y 9 f'�., i�,'s' ^�, . .with licensed�mntrocton��o tonsrrutl Iha projetf(Ser -. ... ..._.. --. --- . ._.. ..---.---'- ---._. ._.. . . --'- ' - ' . ... . . . . lion 7044.Bosfness and Professions Coda). , ' �YARD �FIVJ'f' '... � �• "-�-'"'-�' ~`4,'� y-1 ., '-r^ ' � � I 4 f�$.�l�_, � ADDRESS �� ��. _ _i , • � .. REOUiRED. TOTAlSEiBACK R M %I i.. - CONSTRUCTION IENDING AGENCY � � � SET BACK PROP.LME WIOTM a o(��„`j — . I here6y affirm rhat thera is a construction lending ogency for feoNr �,1 --�:' � ' ""� � .-tha performance of fhe work-for whith this permit is is5ued ---'� -P.L""' . ... �-�- - �'---_. _... .. .._ _..... ... -._.._ . . ___- ' ;---:' .��� --- ` D u 2 .��(...- - �Sec.3097,Civ.C.). SIDE � � � i � G� , � , . _._ . __ _ .. .._. ..... ' _ ..,. .. P.L_ . ' � ._ � .. .. -. _ __ ._ .. __ � .,_ . .,._.. ____.._.' . . ____. _. __: .._ __ '. tender's Nama C'nnf-i npil al Tl 1 i Y1n�c . . . � . � � - ' ' � LDMA Ref.N �. • . : . .. � •�. ...,�. . -- 231 S: LaSa1le,Chicago IL ---- r.c.c�as 331.12 - - r�.m��Fe� 474.00._ . • • :___.__.__. ___........_. tende/s Add�ess ' � � � �-�� ' •.:,.. -I cenify thaf 1 have read ihis applimtion and stole ihaLt e 93. ._ __ .._.._'._ --. -- Issuance Fer..1-0•50 � ' IDMA P/C K - --- �' -- - --'- ,.--..- � --'..�.. ' ' a6ove informatio is covect.I ag�ee to tomply witb all Counry Invesiigmwn Fea � '� �, � .ordinances a ta�a laws relafing to building consiruc�ion, ____ _ _. __ _ ,_._._._ .___._._ ..L}S[�.rjQ._. . � " "'� " �� and hereby rize reprcsentotives of this County to enter To�ol Fee �-- ���Mq Perm.R---�- - --- � -� --�� ----- -��•-- '�- ��-� upon the • ioned property fo�inspection rposes. • _ _. .. --- --- --.. - -I�7A $75-. .. . $35 � --- -- -- -- --- ------ _. .....__..............---. SEE REVERSE FOR EXPLANATORY IANGUAGE � ' � ' ..... SlgnaNre ol APPlicont or Agen�._ ._'.' - D e. _.' -._. ..._'� - "_.'_. __ .. . ._... . - - __.. : ' __. ._'__.____..._ "_" _".. . ..._._ . _.i_ "'__'__. ...._.. ' :Qi _ � , -- o 'o . r_ - , ` .T- ;� '�o � . �' _�. -L�_' � p 1� � � V� T� �. O- O .T 1n 1 (9 O . Q � O�tDn 7 N O 7 ,b �O ��,N 9 � C � O �O ..�i'�. tn � O 'O ... 'O .vr � '$ � �3 0 0 ` ; ♦ .u+ o u'n s O, � !� . ' ^. N �O � 7(, p , t0 . 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