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1083A 1084A
r ..r...,ertifi a1e of Worker. .,...,.,j -._._. .._'._.'__'.'_'_"' ."_.��_'__..___�.... .. .. ._....-_.... _. -L_._......�_...... _ ._ . __,.._.. .._.. .._�. .. ... � ' ,... .. ...,. '__ _ � � �:.JRKERS'COMPENSATION DECLARATION . =�'':�•!.'�,::' :.: "�� � '�." i ��� i . ... � _ _ . . .. -......_._ ...._. _ - _. ._ . _ .._- I hereby offirm�hor I have a terlifitate.of,tonsent�to;self qpp�ICATION FOR��.BUILDING��PERMIT � fnsuPolic No. ��005- 79P 0004 � Na O nsurance, - �,o o c c �om s Com ensa ion I,. ., _ ___. . . _ . .. _ . __ _.. P .-' .._..... or a certifted copy theieof Sec.3800,Lob.C.) � - ��-- •�� � • ' — Y_1 nwide 30/A COUNTY OF LOS ANGELES '. BUILDING AND SAFETY •� �. .,� O� CertiHed copy is hereby furnished. •,'.. • FOR APPLICANi TO FIIL IN BUIIDING 6HS N. F2d�12L�VOOC1 DZ'1V2. , . `'�"� ADDRESS � . Certified copy is filed viith"the toun'ry bvilding inipeo " BUiLDiNG (HH N. Feathexwood Drive � liondeportmenl: ' ��'�'•� ' � ' ADDRE55 Date� 6�19-H6 � A'ppli�canr�T����DIN C'�� CiTY D1ZiTl10IY� BdL' ziP 91765 . i�iin, Diamo�l Bar ; '� - CERTIFICATE OF EXEMPiION fROM WORKERS'�"'' �� - �--� -� - " ' "-- '-"�--"" NO.-OF BLOGS. ��� � . NEAREST- ' � • � • COMPENSATION INSURANCE� - �� �• S�ZE OF LOT NOw ON LOT caoss sr.�4h Knob.�& Golderr Sprirr�s �� - (Thii seUion�need not be completed if ihe permi�is for one -� TRA�- 3rJ761.�� � ���K�-� �� - �aT -��-28---- AUEUOR ,"�� �. -��� � .hundred dollars(SI00)or less.) , . , hl°.P 900K' �� ' 7AGE PARCEL , , .. . . _ .. own,ea TE� PSIDIN C�UP - -- No 967-9541 u ZOJJE M4F ! ry t cenify that in the performance of rhe work for which this p�� NO. ' K��^ � �„ . permil is issued,I shall nof employ any person in ony menner .. ADDRE55 P�.D.�X-3329--'--����'--�----�- --��� - ---� /��v CONDI710N5 Q sa as to become;subjett to the Workeri Compensaiion Laws. ' � V , , . ... .�.. .. . . , -- - te, , ,,.., :.�� ' APPlicant... " -�•�:� � .-.';. ---- CITY . . � - -_ .. .__'-._Z�P ]. 2.. _ . . . .. _ . ._ . .. .. .. .... - - ;CG � .., . . ARCHITECTOR TEL � � ' OISTRICT_. GROUP iYPE__1 FIRE. PRDCESSEDBY - '� TICE TO APPUCANT: If,,afier moking thi's'Certifi�ate of ENGiNEER Dave Szany AI� Np ; �pN5I,� ���r�-�� Zo � I ._. mplion,`you should 6ecome sobject'-to the"Workeri �- - ('/� J�J . '� ,�7 Compensotion provislons of the Lobor Code,ryou must forth- qDDRE55 314 N. F']YSt Arcadia �91006 ' - � ��� ��� --�-J�'--f-�-� � ---- 0. with comply wifh svch provisions or�ihis permil shall be" - -- TEL • N deemed revoked. �. �'.,1, `.'..'�.��1��-,..'. ...; �.,.' �OMRACTOR� � C'�� NQ � ATISTICAL ClA N Ff. . ',Z ..�.�. ._.-- ..'_.. __ ___.' ____ ._.NO. __'_'._.. ST SEWER AIAPIF�T10 �� / A ONDO LICENSED CONTRACTORS DECLARATION�. - �--- QA55 NO. DWELI.UNITS_L . I hareby offirm that I am licensed under provisions of Chopter 9 ADDeE55 ��S a�JOVe 371580�� � (mmmencing wiih Setfion 7000)of Division 3 of t6e Business and ,.. . . . .._. _ ���._ • Professions Code,and m"y li�ense is in WII force ond effecL CiTY [tn55 B -'- '- - �---- --�--�- VALIDATION� �� , .. , , .. ,,...,. ., ... . . . , � . . . • � � 371580,��..,._. .... : ,� �. H .: .. . . sa rT.1786�- r,o oF NO.OF_.,]_.__ ...CHECK, : . .. . ..... ... . . 6K. PG. liCensaNumber ' LicClass SIZE STORIES FAMILIES ONE- , i����•�+�'•;,�� ' . � . . VALUATION...--c-- .-�' - --.__.._._--�� O 5.;3 A�..` ,; � ' �� �I.�, �IN GF�C1P .,,..,F)^.�.9-H6 __--.-. DESCRIPTIONOFWORK-__S1T1C�10-PdMI.�.�1.. .. NEyy_. _ , .� ' ., P Contracror Dare ADD � S 65,320 t� � ---7. •'• •2'1 .'; �I am eaem t under Sec. �-` �- ---'-'... a 0�44rJ-SF-�--'---- ��- `---'O ... _ . _. .. � �.., . . � AITER � . : - � .... ._,._ . . � � � 8.8P.C.for}his reason _. .. REPAIR-Q . 9____._'._. ._.._t__. . . ___'_•..__.__ _�_°_C b$(�Jr�--� - _..., i � � , . .... _ _ __' '_ _ __—_Dofei. .__. .� USEOF DEMOL � . EXIS7ING BLDG. ❑ ' ' -.. . . _..__. • s 2 G'-E G J V ' . .. „� _ '_' ' .,. ._ '_'.. .._._..._...._. . APPLICANT TEL - . , Sig"nature -. .._. .._... FINAI � ' � OWNER-Bl11LDERDECLARATION ' PRiNi NO. ..DATE�IL`�L"P-�-�- ���� �---DEi2_2-86_,... ••I hereby affirm thot I am eKemp�from the Commtlor's License p�g �OVe i ,, • �nw for fhe following reoson(Section 7031.5,Business and ADORE55 � p�Np� ' � " � ' bfessionsCode): ' "-.'___ _--�---- ".-- '-' -- � PaESENt - Br -(�- -� . ... . ... ,.�._..'_� __�.`,.- h eunoiw� � .. �� I,az owner of the property, or my employees with . , nDDRE55 , � ' � -- �- �-- ......---- _. .. wages as Ihei�sole mmpensation,will do tha work and � : � � tha srrocture is not intended or offered for sale(Section toCnuTY • ' i _ �,'Ll��''�'� , -.- � 7044.Business and Professions Code).��-------- �-- -- -- MOVING-------._. ..�...._. �.------ --"TEL.-__... -�---- .�. .... .... . ... .�, -- �-� � - , � --'-� I � I,as owner af tha ro er y � 9 CONTRACfOR NO. ' '� . e�e •e � p p ry,am ezdusivel contractin n ' . ...with licensed conrracrors to-construct tha project(Seo-. . _ __.__-_--•-..-----.__�--_ ....--.-._.__-.._. _..-_-.---. . . . ---.__ ..__._... . � _ . _-tion 7000NSTRUCTION ENDING AGENCY"'�"-.. .-.._ ASET�BACK �� -YARD' HYlY' � IOiAL�P.L�NEFROM- ..WIDTH. ._. .�---._ ..... ..`� ' ;+.�"-..�'`� I :;9 Q G a'U''1 ��i '_ ... I hereby affirm thol there is o construdion lending ogency for feONT -� � 9 �Q T j -the per(ormonte of the work for which this permit�s-issued ---- -a.t:'-�-- - - - -- —'-' '-� - �- --'-- .. .. - -- ------._....-----� - �--"-' - . ... � . (5ec.3097,Civ.C.). sioE '•:'��. .. , 0 8.�2-�b'.."-� __ ------ - - __ . ,._., ...... 268.65__ ._--------.... . -- ---..� --. .... . .. --": ___' _ :,.; . .._ _ P.L . . -.. ,^, .C .._ __ Lender's Name �'r+71 i� n al Tl l i TY] c -�,. ' _ . . - 231 S.-LaSa1le�Chieago-IL. . _- v.erees• ' re,muF��-3 S tDMARef.N ••Cl,i --- --- - ._� . ti•_ Lender'sAddress � � -� • �� - 10.50 :_...:--" . ' �_...,; ..I cerlify that I have reod this appl(catfon and state that.f e 693_ . __.. .__..---.._._-' - _ - --- ��suonce Fer �- '--- �� �onM P2 N� - - - - - �-�--... --'�-'- -- ---'-- ._.. .. . +- obove informol' n is correcl.I agree to comply with all Covnty Invesiigaiion Fee • ' __ordinances S�ate laws relatin to buildin conskottion, 390.0� ' ' '^" '�, _. . 9 9 _ .._. _.._, ._.._""_ __.._..._ Torol Fee_ ....,"__• IDMA Perm:M - . -- � �� and he�e rize represenb�ives of this Counfy lo eMer � upon f - tioned property for inepedion purposes. L��� . $7�j � _ .. __ .. . ._. .....' _ . ..____ - '. ' . _. __ _.... . . .. .. . ... ____'-__ ___�._._. ._ i � /�� . . � SEE REVERSE FOR EXPLAHATORY LANGUAGE � i _"'._...Signot�re o Applimn�or Agen�_'_. ' ' ' �re" '_'__"_..""' ' ""'i" ... _._ _ _. .. . .. .__ !.._.. � _ ._ _ - .Q 1 .� ,. o 0 � .. , � o. �". �t• m `; �� '.W �o `� , �� m� ° o s � r °o �-N N�6� � 7 -�D � t% . .4pw • � p N A N �. 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