Loading...
HomeMy WebLinkAbout1109A 1110A (10) ,,... .. . : .. . ... .. . ... _ ..---------..._..__..._._.�._..._......_.._._._... . ___._-___�____ ___ - - - - _...--. . _.._ ._.. �VORKERS'COMPENSATION DECLARATION � ��""�'f�:'^�" ". � „•:...:�� '�" ;-, �' - . ,,�. . . . . . . . . .:, ,._.__..._----- - ' -.. _... . _ . .. _ . � . ._ . . . I.hereby o,�;,� thal,l have a certificate o�.�o�=e�,�0 5e�r � APPLICATION� FOR�.BU�ILDING��PERMIT� � insure,or a certificaie of Workers'Compensmion Insorance, or o cerfified c�o�eY thereoF Sec:3600:Lo6.C.1 , '". ,� . -.,..... ----'� -� --. -. . . . - _ . _ ._ 7.i�c:005-2�9=0004 Nat.ionwi.de 10/B COUNTY OF LOS ANGELES � BUILDING AND$AFETY Y _ �, i PolicyNa.�� Compony- �...� � .�,. . . ... .. ... . .. -. _.-- - -- '------ ---.. _ . .-- -._. . .._ . .. a Certified copy is hereby fumished..•. FOR APPLICANT TO FILL IN BUILDWG �' ' ADDRE55 '715 N. Feathera�ood Drive 0,-Certified�copy Is filed�wiih the county building fnspec- �`��� Bl11lDING ���liondepaifinenf. ' ' '�' ' � �'�' ADDRESS 7V15 N. FedtheitnL'�od DriVe ' � Date�.6-�'4-56, .Applicbn� `I�IE.ANDEN,.GRDUP CITY Dlc"4D77Y7 BdT LP 91765� � � �ov+urr . . ' '� CERTIFICATE OF EXEMPTION FROM WORKERS' �'' "-�-" �"'-� � ""-------'- �-�-�-"�-NO:OF BLDGS.- - - - -- NE4vE5T � � ' � '� �' "''`�' ' COMPENSATION INSURANCE� ��'"� � 5¢E OF LOT nIOW ON�07 � ��sr.High Kmb.,& Golden�Springs-� "' (This seclion need not be completed if Ihe permif is for'one -�---- ---�- � �- --�---- -- �- - � -- ' /�SSESSOR_� ,., ��" � - - , --�:•': hundred dollars(E100)or less.).,...,.... TR CT BtOCK '�---'� LOT NO. /AqP BOqC ' ' PAGE' PARCEL p Y. P P r r a ...,_ � . .... Tf��ANDEN GR�tJP...._. _r .967-954 �, use or,e n,nP OWNER"�� NO. so as1 0 6ecome'wb'ecl t�o he Worke se��onrk�/or.which lhts ��j �O. � °Z'3'3 ��} I ermif is issued,I shall nof em lo on e�son in ony manner . � - SPECIAL -- - � --� • - -- - �� � -- O. . � .... .,.. .., Pensafian Lows. .. . ._ ... U1/1� CON�ITIONS V ADORE55 P.O.BOX'33 9' ' " "" _"'" _ , re � ' �1':paPltcam .� - arr __ COvina -- - -- - nr_91722- --, _ -- - - - � -' -- �� ARCHITECi TE�• .DISiRICf... .GROUP TYPE_.- ._ '_FIRE _PROCESSED BY �� � �TICE'TO APttICANT: If, after�makmg this Certficore of . �ddV2 5 AIA 445-4073 � . ENGINEER �Y NO. � �h- �lemption, you shau�d betome subject lo�-fhe�Workers' "---�-� � � CONST: E � ,V �empensation provisions of fha lo6or Code,you must forth- qODRE55 314 N. F1TSt �Cdd1d 9�.006 � ---------- -�3-- � � 'W with•compiy with such provisions or this permif shall be -��-- � - � � 'y deemed�evoked.;;�•,�. �•. ', . „ . . �.., ,. , ..�. `IHE ANDIN GE�UP TE�' ; STAiISTICAI C1A551F�ION ' ' APT. CONDO: - j,Z' � CONTRACIOR NO. � � ' t _ _ ... _. ._'__..._"'_'_ . . . . . .... LICENSEDCONTRACiORSDECLARATION-•��,�• • �- --- �---------- --- ��----- - � �-���,-- - - - , MSS NO. � DwELL UNITS � I hereby affirm that I om licensed under provisians of Chapter9 ADDeE55 �1S Ei�JOV2 ,,,o,371580 (mmmencing with Settion 7000)of Division 3 of Ihe Business ond .____ . . ���, ..__ ��R�P � ' ' ' ..'______'_.__.._....._�.. Profeisions Code,and my license is in full force and effece CiTY n,q55$ ; -�- - � � - -� ---� �--- ��- . ,.. ,. . .. ,._....� ,..... . .. _ , _ � _ , . ...• • , • �_ . .. -�_.-- - � , _ OF - -- -�HeCx_ LIDATON� ,.`__1 BK. PG. License Nomber 3715HO ' "���.CI6ii"'u ' s°E"'1446 STORI�ES FAMwes""'�-' oNe ' r . . . . . . .. . y-� __VAWA710N '� ' :1. co�rroc4o. � �� G'�bare� 6 19-86 pFSCRIPfIONOFWORK'S�IIC�le"f�U�.Y--"' NEW--'i'J s . . �1 1 Q9/l. . 54 000 ` �Iamexemptunder5ec. ---- -� �-----G a e-470 SF� - � ����+������2-�� ADD _- _._._O , � .. . .. .... ......� ALTER � ..... � . . ...__. . 4 '.. ': B.BP.C.for Ihis reason -_--- . . . __ REPAiR-.� - f-- �-- _ '_ '.-'-'.� . --;.-._ --_ �-•z J��� �J--� . � "'• �� USEOF , � ,,, r ; ..... ._. . ....... ............... . Da�e:" .' . . ..... .,..: _..". E%ISTINGBLDG. ��`'�a -�-�. � - -'��.C_'.7-�,-�-�Ju--� $i9na(ure ' " "'.- .... .' "-- -'-.- ... APPLICANT TEL. F1NAL OWNER-BUIIDERDEQARATION PRiNT �� ' .--DA7E�-�Z-L � y7. � ..-.._..._I..�E,��Z"8_�J._, - I hereby af(irm Ihat I om exempt irom the Contrattor's License ,�$ a�70Ve �y 0 + law for tha following reason(Sed(on 7031.5,Businezs and AODRESS ' FINAI-P, /-y�- '� ' �' � . -.-"._'-.' � ��,y�� ' - . - .. - - fessibns Coda): -.. .._.-....-_'_ ---_.- Fkt Ni _ , '-�8y - � - - --... . ..uh /�• r� . , �� �� i � f'"""- � I, os owner of�he property, or my empiayees with aDDRE55 -+� .• �.1 ' •.,.;..a-I n '1 _ . .-- - -'- - - __ -- 1-- _ - --- ---- - � -._.-" . . • . woges as their sole compenmfion,will do rhe work and ' �� .a. the shucfora is not imended or offered(or sa�e(Secrion LODUTv C` ��'..._.o : . : .��...-�,�: � F� ' � � �^� f �:Q�� �� i '.. ..- 7044,-Bustnessond Professions Code).-'---..__. ._._ .."- MOVING'-�- .• d . •` .•• ... -TEI. '.-`_.. . __ . _._..- ._.._ .__. . . .. . _ _.._.- � .. �. I,os owner of the p.operty,am eaclusively conlracting CONTRACTOR NO. '. , � � r o • • • a � • -❑� with Iicensed tontractors eo construct the) io'ect Sea - - .. . _, r,. e��-... . --_ ' -- -_..... . - . ---�----� �.,u ; V� . . . � �CONSTRUCTION IENDiNG AGENCY --- ��� � �� sEi enCK YARD" HVJY p�p��� WiDTH -- ,- 1 -;1 ,'AI`, ' y`;ti.,•:t'I' I • .;C�O O� , - fion 7044,0usiness and Profession5 Coda. NDDRE55 - -��ti_ .,v P I -- � - - --- •--� - - REOUIRfD- 10TALSEI&4CKfROM_. XI S.= ' . . I hereby offirm thaf there is a construction lending egency for FRONT ��,�` ,1 i '�'•^„�., � , ��C n� + -�-the performance of the workfor-which-this permit�is issued -�- �P.l,------ ---- -- - - �-�- - �--- --- ---� � , �� -:- �� � - y.,�� -� � (Sec.3097,Civ.C.�. sioE . S ..�_ � , 0�.2 L"�i b�•: . . � '���..�.-�' -- ----Continental Illinois...._ .._._._. _r.�_ . _._ - -. . . . __...- � - � _ ,,,.,.. . �s ,_r.;.. . . �': - _- _..;, , ... Lender's Name "-� ` ' � . • ! tDFM Ref.k . � .. . ___.'_-_.__ . .23].-�'J.-LaSa1le�ChlCdc30 IL--- v.c.Fe�s•.231-.�.6 . ___ Vermif Fee- �I .'.' __.._. .._. _ .__. � --—._, �� Lender's Address -.� ' � . 1 cedil thot I have read this a Ilcotlon and-sto�e.that t a 693 1�.50 " ' _ '" " Y PP __ . .' _ '.._'_"..'_.___.___..__. Is�uencefee-. .. .__.-: LDMAP/CR---_.__ ._ . _..'_..,.._ ' _... _ _': obove informa�ion i co�rect.I agree�o comply wi�h all Coumy i���ii9a�ion fee . � .ordinances an e laws iela�ing to.huild�ng cons+roction. .., ... ...------_----..._...__. rowi Fee---- --...- ---" LDnM'verm.M-- � ..�- . and hereby t ize representatives of this CovMy to eMer - � - � ���� � - �� ��- �� �� � upon Ihe o 'oned property(ar inspection urpo es. - . .'. ' _ . ___ _ / .'.._. '_........' ._'__. __ _._'.._... ' __ _._ ' J o ...._ __'_ _ '._._. .____._..._. ..__..._ � � 6 a� SFE REVERSE FOR E%PLANATORY LANGUAGE ` , � . .. ...,.. Signatvreof pplimntorAgenr . _'.. .�.._'_' .__. . ..."_"'.".'—'-__"'._._"_..._ _. ....."_'_'_�..'__........"_."..._.__...'__ . ..._ . _. _ ..._ '_.. .. .Q.i , - Z o_ . � . � -� o �• . ' ' � .n '�� �,a ' �Gl � O t� l, '� �u' �a ° °' Q O �,'� E 1 p • . .p � O N �w �, � p �� � ,.�O � m . . oi a ^° _"o o • 3 0 ° �, o,+.�. � • � , � o. �.`' f+� ; � 'W �_..�: T� �n t�JN O �C D 7�v . j'� - - ,� ' 1 N N "O m p � O�'_ O 0 ' � � ' � .T. O � �`' 9 c9 p �. � m � t" o � � o o ,o � .-�i.;. ,- - .' Z . � O Z o ` ^ m q ^�? O �� : � ,r � 0 9�0 m''• n o 'J `0� ° 9� ` �'�z '. " s� � o « � � p ' � ��+a i� �v � � C • � , ' � 'C A ~: ��' f� � •£ c a- o; . N- • _ � • 'f� O�, a,2 �y � p Q .'"i . � � - G • Z� = 0 36 ° � '° - o o- � o. ° ' � �,� Z ' . a� p , `� o . b m . � � ,�: , , , . � r r N • ', o o e-. • 4 ^ C� � � 9m� a, �p A � . � ' � 0. p, . �, o � �, r�� ;.` , � �1r, ��6 • M . ' N . . � • y �� . . ' '1 . � .O^ ' ;` �5 •i �,` ' _ .` •' . ' .; , 1, �., � ,� . ` ''i .., . ',i . 111 �, .. , .'-��' `� ' � .^ N , � . '� . . - ' ` �,l .' `,� .)� _ '`,' �.4`1. .�' O �l ,�` '' �, ' ,`1 ,,` `,, �� , ' ` `. ! `` ." ' '�. 0 �. `'�� .., ' I 1 1`, t�`., , ,, t , ' �1 `., , • N (�,, ',p`` .'s ,�'11, ,' ' � ��`� , .'r' , ` +� �,� ��- . ':t ' ' �S' ' 1, �' N � . �' ' ' �- `�' ��� \ ` ,.� +�S �- . 1. . .�.. : , ' � ''' �,� � ;'- ,.,'- ,` , / , .'' ',,- %�: ;,, w �: - _ ' ., . `- ';1 `, ; - `�,:. - , i � , �� �'11 ,, �`. , _ . :� ; , _ '�. ,; `� ', ,. � �� � '� � � � �� . � � , _ , , , , . 4 (: � `, �, � ,� � � � � � �-;�, .�c-'�'a p j�o 1� � �t � � ' c r.''n� Q t'.�c � .e �.m �y': . ' ; , ,�, ,.'` . `f ��•�e '�,��,,�..@ ro`N H �i.C � � • `C.S p op o ie �-t ..�'�.p'G. O O G � �. . ' ' ` • � ���y �.�r:N�II '^x �..� CN ._D 3"t..-£-%�? ,. - . � • d.•L 0.� -�•V�.� .. � ���.,.'r,•, C�.�.^tG:ia � . ' ,,� .� �•)1�,` r+�j; ��� � �OCCe��,h,t�+��'G `�-�}S�p,.��� N�p�,^•�;O-,����G . ` . . ,�5` A,�.�.^,^., n iO D� 3°,� �����-A m o °.��'e d 1° c.� �.^.��« S° ► � : �1 Q�',io� ^�.�N.�f, �� c ., � �.�.w. 4 � ?,-,c N N�v= � n o fD-'�- ',°'�'° , 4 �,� c�" �S-p v �= �'F�..,��'-+-`o = ���x'ic 'o� ��'' H�`�3Ct . ,' \t9 �� ', o� 06��� �� � °.e»X'" �',c:n'�-o�" �.��','���++Qi� o'�°c�.�'i.� C � ," < �+ - ' , �', ��-o c..�'o•� c `s o�..:�:�'� o�'3 m a ::r �•,�" ='�` .. � 3 ^ - c c� x o � H •is � c " c. �•.✓�o.,o C , ! x' ro r � � ao '° _x � ,�} Q.� ��v ��.b ��.,. � .� c �`r'` � - ' 9, � 0�� °.�� A` a" "���� c"� p `° e'^ yosnv�;����• o�': '•.,/'.'` � .',1 : � � ��K��o o :. 0.��,;¢M ����e�.� c��-�Q�°•� o a;Q�'? ?. ,� 1 . ' � , - �, Z '-'' ' �� +-� �`o,� .�'� e .c? v.�°—� tD � ° cro'•o•c..�.A ca ='� c'� �C ,t�� , ��' ' � • � "'s s.��'`. �''.��?. � `' a"�c o a-'. ^v^.�c..�� c"--'� � � �� n . t+. �G.� C�� � ' a'"''y�n C`v 3 � � ^ �'.C"Cha r�` y A at J U ,� ' .�� ' p • �' a.� �A� %� �^s � 0.� o ��^ co co O '^ -- ...��-•�• ea �' C �c�%�, ,. ' � � ' '^ 1 � ` �;, � .:" c ' � �.�`�`���' � m o� � ° ~��'.u�'"',m �c•��. , Z �� - � 0 , 1� , � ,e �o �m a. - �� °�'�'.� �..^ f w �„:n L,� .��,3, . �, � m O , N y� ��'i.. R��..��',.:, a,;;a'a � �.-�� A � /°�g :.• ' � - � � j�'` `� ; p�R 3�'n ��3 �' 'y��}. a 4 S:._ i�', "�. ,. , �, .N -�p�'. '3�C+ ^Q j m '�'.`�l n J �� ' � . , '1 �(1" '4� •^�y R fl., . 'o F �m°. � J; , t , , o .,e.�.�. � L � '� —C-O r-;��. � � � � S: .�ta ,t�+�,/,�I' , ,.' . _ , '. �' \.' ' N .J , ,: , . ' �,' . � f . .