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1107A 1108A (5)
. .. ,:, , ., . ------......_. ...__.. . . .... -�-----�-� -------- __,----..._... - - -_ _-- ...----- , __.. .. . . .... .. _._ _.�... .__._ . . . i�WORKERS'COMPENSATION DECLARATION ,, " ��• ��� �' '�'�' �" � �''` ' '�" ''��' . � � ..��,. , ., . ...,.._._..._.._... .. .. . . . .insure6oraaicerlif�ateofWorkes''Compenatonlnsurancelf APPLICATION___FOR���.BUILDING PERMIT - �, or a certified topy thereof(See.3800;lob.C.) ' � " . ' � � �� � - - 7�005-274—�?004 �� Na.tionwide 10/A. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy o. � ompony �� - �- BU�LDING � � Certified copy is hereby furnished. • • FOR APPLICANT TO FILL IN ADDRE55 725 N. Feathe.n�od Drive _ �� Certi(ied topy is iiled�with the eouniy building inspec- �'� � BUiLDiNG 725 N. Feathetwood Drive . tion dep6rtmenC� ' � '� ' � �' �'• ADDRE55 � 6-19-86. . � . ., __._._ D�.amo Bar Dote �-•.. -� • Applifoni �.ArIDIN Gf3�UP an ziv iovaiTv Dia¢TqT1d Bas � � ,. � CERTIFICATE OF EXEMPTION FROM WORKERS' •' - ""� "" - '" "--- -- -"----�•OP BlDGS.----------�- ; r,enREST-Hlgh-Krio �&- en T1r�gS .-- � �• '• • �� COMFENSATION INSURANCE^ � �' � � �� S2E OF LOi NOw ON tOi CROSS ST...�. - ' � (This section need not be completed if the permit�is for one -- - -- � - - -- �- -� ASSESSOR. � ,. ,'- "-',' '"' ' ' ' I hundred dollors(SI00)or less.) _ ,., TRnCT- �� 3S7F)�. � etoCic tOT � MqP BOpK•�'` PAGE� PARCEL� - �. �-'.�� TFL. zp E MAp . . -� owr,eR- ____r,o. 67-9541- "�j� N ryp �� -�'} 1 certify thof in Ihe performance of the work.for which,lhis p��) ' � } I permi�is i:sued,I shall not employ any person;in any manner ___ _ p,Q,gox.3329....-.- � �/j �- - sPec�n� �� � ;a ' ADORE55 -'— -"'-�"- -- "�-� � 7 aYV CONDIT10N5 ' � � �� ' � � ^- 'O so as ro 6ecome subject to tha Wo�kers'Compensarlon laws. .V . .... .. . � „ ,....: �. ... , � ---. . - .'_-- . . ..... . . - - � .. _. . atv__ . Covina ._ ...._..._._. z�r_.91722 ----- . :a I �. PP ,.. e A licant� . ARCHIffCT�Ve SZd ATA TEL � OISTRICT... GROUP NPE_ ; -__._. .FlkE __ _PROCESSEDBY- _ �� TICE�TO APPLICANT:If, ofter'moking this�Cerlifi�ale of 1'�' No.445-4073 � mptipn, you should 6emme iubject to fh9 Workeri �- -- ENGINEER • CONST.' ZON � , �V , �r•C • W -Compensmion provisions of tha Labor Coda,you musf forth- ADDRE55 314 N. �].Y'St.� �Cd�]r1 91006 � __ 1C7 __ ��t� ..... _--. - . --- - d wilh comply wilh such provis�onz o� this permit sholl be -� �— TEL. STATISTICALCLPSSIFI TION � AP7. CONDO. �'Z daemed revOked. .� �. :��..' . � ' � '�� ' �.' COMRACTOR �� �IN � NO. ' � - �- . .. . � . , . . .___ ._ _ . .. LICENSEDCONTRAGTORSDECLARATION� � �.'� ----- --- -����a��Ve---- -- ---LiC:--'-"� ��--���- QA55 NO. DWEIL UNITS I he�e6y affirm�hat I om licensed under provisions of Chapier 9 ADDRESS NO. . (commenting with$ection 7000)of Division 3 of the Business and '--._- .- -- __'.'-"-'-.. .__.....'.--. --__-.��C.-..B .- ""-•I. �'�'FR hW.P . . . . Professions Code,and my license is in full force and etfect. Ci7v QA55 " '�" " �eK:-����p�-�:-"�-- '-�� � � `��VAIIDATION�� � � , u� ' 37158Q. , .. ,. . , . . __... sa.FT..14 NO.OF._. ..... NO.OF_.__. CHECK. ense Num6er ��� Lic.Closs � '�� SIZE STORIES FAMILtES ONE ��" �"'� ���-��Q 7 A � � ... . �, ... _..VALUATION. ' ' . .. . . ..�_ . _ . .... _ � ����IDIN C�IP . .•+F)I9�BE __ __ DESCRIPiIONOFV✓ORK. -. • • ...._ NEW-�--� 54,000 � , r e • e •2 t� �.. Contraclor Defe . App a s' ._._...Garage_470_SE_ . - --- I 231,1.6 � : �I am exempt vnder Sec. �-"- ALTER � . .. . .. . __. . - . . . , B.BP.C.for this reason . .. _ ----- �- - � .. . .. --- c�,.. .. REPAIR'-❑ �- -� � • e 2 J��� (�= . . .....'_'_ ._. _ '...Ddle: -" � USE OF DFMOL ❑ � � � , . . .._. exisruvic eio�. -- 0$[2'�8 b _._-�Stgnatura � '.--.. .._ . .. - .- nv7uV.Ni iet. FINAL ' � ' . PRINT)��+ �IN GRCXIP NO. OWNER-BUILDER DEQARATION _ _ DATE��Z•�ZQ-� �� -� --- -�--�--� - - -- �1 hereby aFtirm that I am exempt from the Con�racror's Litense AS �OVA � .. ..� � , law for tha following reesbn(Sec�ion 7031.5,Business and /+DDaE55 FINAL � , .....� . --- .._..___._... ... _ . - , fessions Coda)i" " "� ' "- PRESENi ,, BN BUILDING • _�� � '• ' ' I, as owner of the property, or my empioyees with . . . ADDRE55 .- i .V•�'' .•."'��: , ' . _'•-_. _ ..-_-........ ._ _..._.. _ -,^_� �.Q 8(�i.�. .� wagesastheirsolecompensction.willdolhe(rkand _� G-'`.. !_"i-'- 'r ... ^; • ��1.��\���y �- $F : . -..,� Ihe slruttore is nol intended or offered for sale Section '^� �" ��' � , _ _ . , ' 7044,Business end Professlans Code). -P--.i..._; ��.. " COMenCTOR- - - -- - --"- ----j ...__NO. ,-' 'l--_-1 -�---. �. .._ .` .._.. . . •+ • • 1 . .• .� I,as owner of Iha ro ert om exclusivel mMractin ADDRESS .._-._'..-_�... :C' .,. , ,F � .. ' • � -with licensed conhacrors�o construct Ihe) rd0tl Sec- . REQUiREO �YARO" HWY ' fOTnL 5ET6ACK fR nn -_ i .. __.. _..�.`_'_i.l`'"�-.._. `'��: '.'� 'J��C�Y.�' P P v, r 9 _ ._I 3 3�a.0_�_ _tion 7044,Buslness ond Pmfessions Code. '' CONSTRUCiION LENDING AGENCY ' SET BACK PROP.IINE wIDTH� �� :, ' � e `, I I hereby affirm thal�here Is a constrvction�ending agency for pgONi ..!,,• - ;j �- �-1 Q Q L�`Fi 6 : ,. ..., ..., � 1he perfvrmanca of-Ihe work for which this permit is issoed ....-'' -P.lr"� �'- - -"� ---�''---'--���'-�-"""'..". ....---� �--�--' - :�.�. .�� . �-.. ..-. _. _ . (Sec.3097,Civ.C.). SIDE � ' ' ` '•- � . __.. __ . '__.__. .._..,.."__ "_ '_'...."' ' '_" .P.L."_._ . ...... ... ._..."__'_ ' ' .. --_ -• ' � .. .. .. ._",_' . . . '_ lender's Name C'�n+i nPntal�Ill].YY21s � . . � .,.. .�� } ,..,,, 1 • '.'� � ' LDRIA Rci.N,% ___ ��tT-S_ r:�al lp� 'cago IL - v.e.-ree s 231.16 .._ - P�,m��rea--325.50- — - , - - , Lender's Address ' �• � . I ' •.. ..� • .... -I cenify thm I.have.reod Ihis application and stale ihal.tF�LOE93_ ___.____. '_'._ "' ---- hevance Fee--lO.S�-_._._.: lpMq�P/C N... -- -. ..__..y_ . .. ... .. ....... above informati is torrect.I agree to comply wilh all County imesrigaron Fee 336.00 ' ' ...ordinon[es lale laws relating.fo.bVilding tonstrucfion. ._..._ _... .'_" - '- ' --- To+al Fee--------"----'---� LDMA Perm.�N'--- ._....� -. -_._... . _" . ' � • �.�� and here o orize represeMo�ives o(this Coumy to enter � � upon 1 va ntianed p�operty for Inspecti u� o es. -'----......-, - -_--.. ._ ._. . .--_-.-_ _ - --.- -.- --. ._ . -- �'1�1'��- - _______ _ ___ ._ . _ ._ _ __- -----, - --- --- - - -- -. �__ _. .- - - � SFE REVERSE FOR EXPUNATORY LANGUAGE � 1 � ..,... _$igno�ureoFAppGconrorAqeN .. ... _ " Dote- __ "" ..'.___' .__.___ .. .--'._.__.__. _ ' • . ' :i r i �� Z ..o: -� a •. � _ ' , .r � o �G� �m o � �-u+ �n.� °` °' a p � > o -p � O t9 n N �. � 0 N ., . �O . m �. N .. �., O � jr � � � �,� � �i p �t O { ' • �D r '' O -� '. (�7 . 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