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1115A 1116A (5)
. , . .. .. . ::.. _._..-------_..._., _ _. _..__..,�..___.__. ._...._.._._... _....._ . . ..._ _ .___------- WORNER$'COMPENSATION DECLARATION . . ��' ��"�_',.'='��� ; ' �� � • '•.- � �'�� -:�..� .,. � . . � _..-.___.. ......... . . .. �� ^. _� , .� . ,. ' I.hereby attirm-ihat I have o certiiicate of conseM�fo�self , insure,oracertifimteofWorkers'Compensation��,�.o��e, APPLICATION:_FOR..BU.ILDIN�G PERMIT--� �- ��; or a�ertified coPY ihereof�Sec:3800.Lob.�C.) '" � --��-"---._.�. . .- -- . . . . . __..__._---- , . ` 73WiC005-27�0004°`Natiortwide�� 10/A COUNTY OF LOS ANGELES � BUILDING AND SAFETY ; Polity No. - ompony- • . .. . _. ._ . _,._. .... _ a Certified topy is hereby furnished. .. POR APPLICANT TO FILL IN eui�o�NG : ADDRE55 678 N. Eeathezw�'�od Drive � � �Certified�mpy is filed wiih�i6e'county_6uild�n'g inspeo- �-- gunoiN�(�$ j�], F�{��iz,� Drive � • . tion deporfinenf: • Ao0RES5 . . ,. , . . �. �. .. � .,�.,. ... � . . '"' . . ___ D'ote E-Z9�HE)� -..APPlicant`�IE.ANDIN,G�UP an DiamolxY Bar �nn 91765_.. i iov+urv Diamol�d Bar : , '� �'"CERTIFICATE OF EXEMPTION FROM WORKERS"��'" � �"'"'""'`"--" -'�-""`--"" �-'-NO.OF BloGS. �---- ---- . NFAReSi. •� , �,,,,. SRE OF LOT NOW ON LOT '� Q2055 ST.,, g P � ''�'���- '' • 'COMPENSATION INSURANCE' • -�-Hl h-�Kmb�& Golden S ri S �� �� (This sedlon�need na1 be mmpleted if the permit is For one -- - --- ' ASSESSOR.� '- `� ' � ' - hund�ed dollars(SI00)or less.) . . , . TanR-- -3576�" tO�K LOL ---NO 2� /�WP BppK' . , � • PAGE: PARCEL , so s�rosbeco e sub'elCt�olhe Wo TEL. 967-9�1' , r .,. .., '_...__ OWNER"' TE�F'�1I�IDEN GFb�UP _ _Ntl' N MAP � P mdnte of ihe work for which Ihis i U O �CIA �� - �'-- � - ---" ...-- - -�a I ,` . , .p y any per5on in any mann¢r ADDRESS��'-P.O.Box-3329-- ------�--��--------' ��/1rrV OENDI710N5 � �U .__.... v rkers'Compensatlan Law3. 3 I cerfif thal in the 1 erfor. ., . . . :. . .,.1 ! . . ..-' ' ' - "". . .... .Y P � . . . . . ,. . uTr....._. Covilla----._._ . �zia_91722 �---- - - ;.. _ o e � �ApplicaM� - ARCHITECTpq TE��445-4073 �: _o�sre�cT _ �aouP NPE_ ..... _ FlRE._ ..�ROCESSED BY_.. _;� I TICE TO APPIICANT:�If, after moking fhls Certificafe of _ ENGMEER LdVe S2dT1IT AII1 . Np, CO�yST. ZO E emption,�you should b6come' subjeU to�the Workers' '-� 3 N. F].Z'S � 71Y'C 18. /�j 3 �/ � � �++ Compensation provisians of the labo�Code,you mvzt fonh- aoDRESS - 4 - �-1�' ��� � - �� � --- ��- with comply�wilh'svch provisions or this permit shail be ------ �� �D� � TE� . � daemed revoked..... . . ,•, : . �: � ..�;: � � ' COniTRACTOe No. -- - -- ----'� �- - - -- - --- . . - . : STATISTICAL CL4SSIFICATION APT CONOO CLA55 NO. �� DWELL UNITS UCENSED CONTRACTORS DECIARATION�� � �• -�--�- � �-- �--- -�- � � �------�- - ---- -uC.� - ' �'Z I hereby offirm thot I am litensed under provislons of Chapter 9 AD�RE55 AS t'it?OV@ No371580 (commencing with Section 7000)of Oivision 3 of the Business and ---... -__.- -. . .--_..-. -_- --- .---'-UC..-$---- � `"��R�p � . � �� Professions Code,and my license is In full force and effece GTV CwsS -'---'BK �"��: �'-� - -"- --VALIDAT�ON -���-� ', . , . . :. . . , . . ,_. ,....: .. 3Z158Q ..,. : .. . � B :.,, _ so._F,....1446 NO.OF_ . .__. NO.OP__� ... _CHECK._ ' i . Licensa Number L�c.Clasi� SIZE STORIES FAMILIES' ONE . ' � '�� �`1 1 1 tJ/t � . . , _ ... �---VALUATION -- .._.. . ��. . ri � �:,����' I�IDII��G�XIP. �. �� 6 14-SF) . _. �ESCRIPTIONOFWORK"-Sl le�famil New-- . . . � _._ . . .-- --- - . .-- - -.-_- Contracror Date G�'3 e 470 SF y pDo a S $4���� ; �.� • e �2� 't �1 om exempt under$ec. -.. ._. _ -_'__ ___. g _._._."."—'.". '.'. ALTER � ' ' I •2.�.�,� 6�.�� . . . . ""..._ - " � ' -B.8P.C.(or Ihis reason . _.- -- ��- REaA�R ❑ �..s._ ..--' . - -'.- . '.- - .._..- .------ - - ; ; d ��31,1_b�-_� �.. .- --� -- - � ----. ._ .. �� �SE�F a � Date: EXIS7ING BIDG. DEMa � � ''- ' . p , � AFRICANT TEL. ' � , : , Q E 2 2�V C� ' I --�-�Signaiure ... . —. �.. .-�.. . .. � FINAL OWNER-8U4DER DECtARATION PRiNT NO.� -DATE-�Z`�-Z�`� - ��•• �-- --� - --- -�� � i • I hereby allirm that I am e�emp�from the Comractor's license AD�aE55 � �e FlNAL � �� � ��"����'� I �nw for the following reasod•(Section 7031.5,Busineu and � � _ __ _ ' '--.._ - ^ � �fessidns Code):' - ' --.. . . -_.. _.. _. ._ vaeSENT � BY _._._. __._..__._... - ' -� '--- - � � ' BUIL�ING ���-�,�ry. I, es owner of the prope�ty, or my employees wifh qo�RESS ! - ---------- - -� �woges as th?ir sole compensotion,will do the work and � . � � � r e � � a �. , . _ the slructure is nof intended or offered tor sale(Settion ��`��T� ' � I �' � � ' . ..-- - 7044,Business ond Proleuions Code):� - . .. ..- .._._. nnoviNG-�- -------- -._.....------ tEt:----...--- - � -- - - ------ . _ . ._ .� .-- I,as owner of the property,am excl�sively tontrocling ��N7RACTOR NO. ' " � � � •3�6 0 G: � -❑-�-�wiih licensed tonrrocrors to construct�he project(Sec- ------ ---.... .....----.._..-�-"`- ----"- "----�---`-' �` - ----' - �- ------ - -- --------. --� --' -- - - - -� . tion 7044,Business and Professionz Code�. ADDRESS ' .,;, �� ,, __ �I � e j,j(,Q Q��i .._ . REOUIRED - IOiAL SETBACK FR M ` '" ' � -- - -- ------ ._..__ . YAR� HVJV _. . Xi . _.._'._....__._ ._. . . _. • _ . CONSTRUCTION LENDING AGENCY-'-��-"-"� sei enCK PROP.LINE wiorH � � �� 0 8.�2-8 6 - � I hereby effirm thal lhere is a construc�ion lending ogency for FaONi %,�i � '"--�+ ' � ' ,�. , , _- „�..,. . the performanm of tha work for which this permil is issued -- -.. a.�.-.-.- -- . -. ..-'--"-'--------� - ----.. ._._--'-- --. .. _� ....:_ -. - _-' -.... ..... ........, �(Sec.3097,Civ.C.). SiDE ' _ � , � . ._. .. ._...... . . . ... . _ .____..... . _ ._ __ P.L . . ____. _____ _. ".. "'.__ ... ._.._.. , � . _ __'_.. __ .__.__ I - --. ._..._..--�---- -. .., _IDMARef.M ��-��_ ` lender's Name �Q]yti noni-al Tl l i 710i c , . .• � .. .. ._ ., �...__. ___ .. . .2.3�. S.-�Ix�3Sd�.�.E)CtL7CdCJO..IL �. . _ P.C.Feef �.�- . "-_ PermitFee 325.rJ� -___". .-_ ' ' . _ 11 � , f. ,� ' lender's Address . ' � .� • � _.1 cerfify.ihat I hove reod.this opplication and slate lhat e693. ' ---..- "-.---"'--� Neuence Fae�-10•50' ' '- lOMA P/C M- . ._ . . - , � -�.. ', above Informa�ion is conect.I ogree to comply with all Counh in�ev�qoron Fee 336.� ' �. �. _ordinances an ole.laws,reloting fo boilding.construction, ___. .__..._.__. _____.___.._._ Taal Fee-�---�-- - -� -- � LDh1A Perm.M------ � � I and hereby i ri e represenfalives of this Counry to enfer � ' vpon ih e ' ned propery for inspetlio p iposes. ; � . .._._. . . . .- - - �- -�--.'.--.."----� . ._—'_-. ..--� �-�-' --� -•-----�--- - '�� _ ___....... _. . � �� f -...---_- I --- ' Signature of Appliconl ar Agenl� -- -�-�- -�}a - _ SEE REVERSE FOR E%PLANATORY LANGUAGE �.. i O I / ..___._..'.' " _ __ '.. � l � , � ,o.. � ,. ' � .- - ' o . � T � 9 '� N '^N N O � O .� l .o ± fnv m.a o n. v s �n , Q �� n:� °; � -�p O �t� q +' � r F' .O n �.. �., � 'O . � .� .tl� p fN0� 7 O -�� O n: 'O �:. t7. ' p . , r .p '7 O Q j ��, tfl a j�. 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