HomeMy WebLinkAbout1151A 1152A (5) .. � , . ......: ... . ._„ ------_____.....__.___ _.-____..._._...._._Y._.._---- -�--._..._.._____ _ ..._.. ___.. _..--- ..._----- - �,: �. WORKERS'-COMPENSATION DECLARATION -:����'''�•'�T'��"''�' ' �"� "" �- `�' �' ' " � �. , . , :..� •".� .,..-__ .. . . _ ,. .. , . ,.._ . . -' .- ' - � . '}herebjONirm fhat I hove a certificefe�of<<o�se�„o=e�E . APPLICATION� FQR BUILDING PERMIT���-�� �� . insure,or a certificote of Workers'Compensotion Insurance, ora terlified fo " lhereof $ec.3800,lob.C.) . ."•:� '__..__"._ _.._-.. _.._ .._ . .. _ _ _. - _-._.. .. , . . _.._ , ... . . �3WC0��-279-b004 �Natiornai.de �• 60/E .(2 CdL') COUNTY OF LOS ANGELES BUILDING AND SAFETY - --� P❑oNcy o. � � Company.. '. . .-----.... . ., . ' -' _ , _ PY v ' ' '� 1�����"� � FOR APPUCANT TO FILL IN ' A�REu 711 N. Fec1t17eYNnOC1 DL'iV2 Certified co is hereb (urnished. BUILDING � Cerlifled copy is filed with tFie county 6uilding'Irispet• - --� aunowG 71,], jQ. Feathez�nn�od Drive , . tion department.`� �"�� AD�RE55 , ,.. . ,. . . ... , . ... _ . . .... . . - . �. Date ��.g-86 , Applicon�'��.�IDIN �P an---'Diam0ixl BSti' . ..Ziv91765 �� � iocaurr D18ISUIY� BaT ' . � ' � CERTIFICATE OF'EXEMPTION FROM WORKERS''� �� ""` � "'- " -- � - --��aF eio�5:--- - - -� Nea.ReS7._ � � � ���'COMPENSATION INSURANCE" '�:, �"�•• SIZE OF LOT NOW ON LO7 ' CROSS ST.H1CJI7 K1Y�b,.St;Golden Spriiigs ���"" �� " (This seclion�need not be mmpleled if rhe Permif"is forone -�- � -' -- - --- -------__' "_".. .._.__ ASSESSOR,,. .,, . .----- - .. ._ ..... ,.,.:. . ( ) �.. ;.. . . . TRAC-...�3 � BLOCK L � AMP BOOK.. . .'. ! GAGE' PARCEI ZT-]E ANDIN�GRWP-- 'E`.967-9541 p mit i51issoed.I shall nat em lo�anhpe sorn�n a yhma,this OWNER-" NO. ... ���_IE p�pP ,Z„3 •3 �C> .. .} I er red o ars SI00 or ess. :. Ic� ... ,� .. � r a � P.O.BOX 3329 . _.. sPEani.. . . _ -- -- Q P Y Y nner . - ADDRE55.... .._ . . - ---- . .. ...__ _._.._. __.._..'- . dYi� CONDITIONS �.- �;� - so as to become�subject�o the Warkeri Compensotion laws. . �..�. . � �,.� . ; . . , , , V .. . � . .. ' . .,,,... . .. _..... CITY.__ � _...__'..__ __ Z�P__ � -.....__.' _ _' . _ ..... ......... .__ __..._.. . . 1e �� ' Applicanl��` ARCHITEQ OR TEL. � � ��G 9 ENGINEER �lY NO. DISTRICT_ GROUP TYPE_.,. _ _ .FIRE._. .PeOCF55ED BY.._ TICE TO APPIICANT: If, a(fer makin� this"Certificore o( DdVO $ AiA 445-4073 � -- coNST. zor,e I mption, you should become subject �o`the�Workers' ""'- �(J ��) �- ' e.ompensalion provisions of the Lobor Code,you must forth- ADDRE55 N� ��S � � � � ��- 0`�3 -�� �fll��-- - � � �-� �� -��- � �d wifh tomply with so�h provisions or thts permit shall 6e - -� , ;Z deemed revoked. � . TE�• STATISTiCnI MSSiFi TION , APT. CONDO.� '� �, . . . •.•... �,.`�:,... CONTRACTOR ' NO. _ .. '. _' _... � . . .'_ __._ ._' __� . .. IICENSEDCONTRACTORS�ECLARATION^����`• �--- � �-- ---� - ��----- - � � ---- � �iC: - -�, MSS�NO. DWEL61lNlT5 . �. 371580 I hereby oifirm thot I om licensed under provisions of Chop�er 9 ADDRESS AS.327CT1e NO. ��R�P i licenie Numbee� '371 58d�se,s inLicf'Class anBd effect. _'__ 5 EFT.2375-�s oR°s-- .. F°i°FS 1 ss .�-co EK �� - - - ----.-�- - - . , , ';,!i commenan wJh Section 7000 01 Drvision 3 of ihe Busmess ond _ ' ' �.BK.. ..`PG I VALIDATION � � .VAlUAT10N.- -•--- - . �i. _ _ ..r,.� � ra� �-.._: • THE AAIDFN GROUP, . 6-19-8fi _.__- �EscaivrioNOFwoeKSingle f�ntily --- Nen' i ._ � .co���a�io� oa�e Garage. SF nov � S 86 080 ' � -n- • • •2 1 - . .� " �1 am e■empt onder Sec. -..__._. -...-_..---'- .- .-_.. - ------�- �---- -----� , . . . •�� .. . . . . AUER � . .. .. . 'T , ^. . B.BP.C.forihis�eason _ '.. . . REPAIR..� 5-----'-�---. . ;..-' -.�. _ .... .._._�_".J..:���-�-G- i .... . ... . . ... ..,. ._ _ . .�. . USEOF '� ' ; ..._.. a �JJ-��� �-� � "� Datr. EXISTINGBtDG. DEMOL ❑ _.. . � SignOfurB ""-'. . .."" ' -_..._" -'" �: .....- APPLICANi � ADIDIN G13�(]P 7[l. � FINAI � . OWNER-BUILDER DECLARATION 7etNT NO. _DATE-Z^�Z,[ q � -�- ' O�.���8 6_ � 1 hereby aifirm�hat 1 om eaempl from the Contmctor's licensa � �pVg T�07� ' , !, „ . law for the following reoson�(Section 7091.5,Business and ADDRESS FINAL' �� - � � ....__,.- -'.._....._..'-- �fes5ions Code): '- .. - � _ PRE Ni ,-., . . ' 8Y - —- - --_- --- --- ' -• . � BUILDING _ ' ' .� ' � .I, as owner of 1he properly, or my employeet.wifh ._ ADDRF55 "'"' '• � .. weges es their ale compensction,will do the wo�k and ' .:� , '-- �,,' `..,.. ,, r� �_�2� , . rhe sfructura is not intended or offered for sale(Section loCAITfY'�• .n .: .. • • '-' �' 7044,8usiness and Profeuions Code). . . -..--- ���� MOVING� "- ' ..- "- " "`• � ""'�7EL " ' ' . ..-- "- -.. .-.. . _� . ..- ..r e e e e��i � � CONTRACTOR ' NO. , � � I,as owner of the property,am exdusively coMracting � _ y __ � _ - . �wifh licensed-mnfracrors to conifruct tha projett(Set- .... .' -'-�- �-� -- �-" ---....._-. .... - '--' " ...' ..- -- _ . C.`; (. ` , �--o�(3�1,�b . " tion 7044,8uslness and Professions Code). ADDRE55 �����:�. ' ` 1 ___ REOUIRED.. . . .iOTAlSETBACN FR . _ XI i.. --^,R� �+1�� � ±:A.�' 4 . � ��- -�CONSTRUCTION LENDING�AGENCY- ����� ' SEi BnCK YaR� kVJ1' PROP.UNE wioiH � � � � r� �, ,°�7 I7 4.7 O� �. I her�eby aHirm ihat there is a construction lenP ing ogency for feoNT....... . . ._. .___.-_---. -. -__... _ ..._ :r. � '��•..• ! `'� ' C V.�.,.. . -the erformance of-rhe work for which this ermit ie�issued •�-�-�-- v.L - � 1`�• -� -����-��(7 . _. _...._ . _ (Sec.3097,Civ.C.). SI�E � �"�;� � ' ', _' . . _ f_ .. . .."' _..". .' '._... P.L__. . . _ .. _.___ ___ _ .. . _ _ .. ... ...• - ' ' ""''" ". . . .. "" :. . , e .. .... . . . .!.�.. Lender i Name ('nni-i an al Tl l�i tY�15 1 �' �' . . , ,._ .. _ ..,;�� . .... �:,. � , _. . .._._._. . 231 S.-LdSd110�Chi.Cago IL -- v.e:Fee s 331:12 .. .-- vermir Fee.474.00 �nren e�f.w. --- -... ---- ----� lender's Address 06g3 � �� ,..I certify.�hot 1 have reod thiz application and state.that the ..__ .. ----_-.-..--.--.... . - Issuance Fee._�-0.50-...-. -; LDAM P/C M-. . . .--- - � ,-- --- '.....�.. '. . �- + obove informo�io is correcf.I agree to comply wi�h all Covnfy Inves�igotion Fee � , ._ordinances an me laws relating to b�na��9�o�:���rno�, .._._- --.------.._-_-._- ro„i f� . 484.5�--_--, �p,Hq Perm.8� ;' , . . ond hereby u orize representatives of this Covnty to en�er �pon tha e- ' ed property for inspecfion urposes. � . � � ' _. .. . . . .. . . . /_ .._ ._'.�_.� �S�] .. ..".'_ ' _.._. ._ _.... . . .. .. .. . . . {O .c ' - - SEE REVERSE FOR E%RANATORY LANGUAGE Y3S , _ .. . .. .-....Signalure of Applimnr or Agen� ----- - re-- -" ��- ' 1 ' . .-_ ..--- - O _. ..__ ..'__- . _._ _._..._- "'_'_ _'_'______ '.__.`_ "__'__ .__... ' ,r� Z '� . o .o , � � _ .� " ; N T� , �' •p N O +�N , 1 � n.o m d o a o 's � n o ° o � �� o � � � : a� v 7r � t�,` p ��-�. n' O 9 '^ ' C ,�.. -n � ...-' Q o a '�� o � ' m .N o m� ° ° �`. 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