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HomeMy WebLinkAbout1119A 1120A (5) ..__... .._. ......._...__.._.._._ ... .. . _...__...._....._. _. _ �.. ....�..Y,.. hovNSATION DEC[ARATION �-��.,��. � �, .. ; ... _ _ ... ':_..:�__. _.__;,,":.,...._._ . --•_ -._.......i or o�cert71i I d co he MPE " I.hereb Aifirm thvt I .. .- � . ...�._ ..._ .. . � _ , WORKERS'CO . _ e a`e�"``�°;a.°`�°°SQ°„°Se" qppLICATION� FOR ;BUILDING PERMIT ��� �msure,or a certilica�e of fWorkersa'oCoompensation Ins�ronte, aoucyNo.�����-��cos���y �Nationwide 10/B COUNTY OF LOS ANCELES ; BUILDING AND SAFETY _ ...._ . Q„Cer��fied copy is hereby furnished:.'.••�.. •,�,•. �•. FOR APPLICANT TO FILL IN qDDRE55 730 F2d �� Ceriified topy is filed wiih�he munty 6uilding in'spet- � BWlo�rlG'73O:N. k'eathe.n+Aod Drive � �'tion deparfrtient.� � � � �� - � ADORESS � � j ' ,,. . ,. , . ,- , .. ., , �., , Diaimlxi Bar ._... --- - Ddte ':(_19-R(,��APPlicom' E ATiI�FT/ C:SN1fTP c�rr ziP 91765 ' i��n.DiaTro� Bar . � . "� '•�CERTIFICATE OF EXEMPTION FROM WORKERS'� '- ' � ' -- ---� -- -NO.OF BLDGS. ---- ���-- - NFARESi._ , � ...- . . . . .. ..........'- -.._�_ ._ -COMPENSATION INSURANCE'�'� ' " SIZE OF LOT NOW ON lOi CROSS ST.Hl tl KT]D}J�& GOZCZP,Il L' S � .... ,,,., .., .. .. (Thii'secHon need not be tompleled if fhe'permil is for one -- - 3S7F1�.-�� `- ' �- -"' '� � �� �Z�I- � �ESSOR "� "' �- -� • � TRACf BLOCK LOT /yWP Bppl( � ' - PAGE' PARCEL hundred dollars(SI00)or less.) _.. „. . - � � _.� . �. °, -- owr�a 7i� P�IDEN GId�IJP �----- 'nio. 967-9541 riav USE ONE h Ihis _ �. • ,} whicanner . /.._.. SVEC t .�--- . _.--.-` _- ._- - .. . .' ' � . AWRES$-P. . ._..._ ... "" ' " ' ' CONDITIONS �U ermu is issued,I shall nat em lo on erson in o y LaWs _ - ; ' Pcartify�hal in ihe�'perAorii nPt'�f f�Pwork foroion.... -. . C�ir C'�V�'1.� ..._.. ZlP 91722 ..... - ,, _.'.. . .... ..... . . ... ',�. so as lo become subject lo the Warkers'Compenso � � pTICE TO_APP(ICANT:Pf, oRer makin Ihis Cerlifi[ote of ARCHITECT �R TEL DISTRICf_ GROUP�iYPE ;_ _ FIRE _PROCESSE�BY. . _,O � 9 ENGINEER�Ve S � r,o. 445-4Q73 /� � �N Z� u emp�ion, yoo'should bemme subjed�to-�he Workers' 314 N. F]YSt ATCdC�ld 91006 l v /t�?j ��,� � ' Compehwlibn provisionz of the Lobor Code,you musf forlh- qDDREu � �,;W wifh COmply with SU[h•prO�i5fOn3 or IhiS'permit shall be - - TEL. STATISTICAI QASSJFIC�ATION APT.�N�O. ' .? deemed�evoked., : ,,.. �. ., � ..�. . ....�'�-.'� COMRAROR����IN C'� NO. - - -tr - - - LICENSED CONTRACTORS DECLARATION.� � � �-��� -- � �-� pC. M55 NO. -�r� � OWELL'UNITS ' I hereby afFirm thol I om licensed under provisions of Chapfer9� ADDRE55 AS�. 3t70Ve No. 371580 , , (tommencing with Se[Iion 7000)of Division 3 of ihe 8osinesseod __ _ _ _��� SEWER MAP � �� �� �- . _.. ,.' ' ._'. ._ B__�_._ . . Professions Code,.and my license is in full force ond effect. CiTv C�n55 � �-��-BK:- �� � -� ' '----��-.` ---VALIDATION- -�� � � . . � . . . .. 5C7.fT.�.�I46_ NO.OF _ NO.OF ,1 . CHEIX � . licensaNum6er��37�SgO "� ` Lit.Closs �B' " �� SiZE STORIES� FAMiLIES ONE , . � . .. . ,. � � . .� �. ... . . . . . __,VALUATION ' � � � DESCR�PTION OF WORK S� 12 famil -� �-� N� -- 54���0 .�. ' . .._. � �. _..". �..-_ _ .. Comr'ndor`IHE ANDEC�i�G1�LTP Date 6=19=86'' f . - .. � Garage 470 SE' noo ❑ , 1 1 1.9 A i om exempt under Sec. - - .- ..- . .__._. .___.- - ---'❑ ----'-- -t- .. -- . . . , „� . ,.., . . ALTER . , . __ ' . B.BP.C.fo�thisreoson REPAIR_.O -.s..-.- . .'- "- -'"'" "-'. ...'— ��•,• •-•2'.�._.._ � ._.. . .__..__.. _ _...Dofel.._.'.- . •, .. . USE OF DEMOL ❑ ' ' ' ---:-_- -_ 1 •2�1..1 6 _. ' ,,.. .. _ EX�STING BIDG. � Signature �.- '. - '. ..-....._. _'_.._... _. . '' APPIICANT rj� �� C�� TEL. �'�FINAL . � OWNER-BUILDER DECLARATION PRiNT No. ..pATE� Z��"�j� �� ' '���'� 6�' � .. _.._...--. _. . . .. . . I hereby af(irm fhat I am exempt from the CoNrocfor's License ADDRE55 � a�Ve � �� FINA( � O��2��S'6 ' -�aw for Ihe following�reason(Section 7031.5,Business and " ofe5510nSCOl�e�: .. . . . _, .. ." `.. . PRESENT `AY �(�- �- ""- . . . . - ..�. _ ... . � ,... . I, az owner of the ro er y P Y BUIIDING � , . . 'i p p ty, or m em lo ees with aD�RESS ' � � �-wcges os their sole compensation,will do Ihe work and �� , � � the strvUore is no1 intended or offered for sole(Sedion _ ����TY � '�� � ?,Q({' -.- - -7044;Business and Professions Code).�-- �------- MOVING-... .- . . . ---TEL.- - �- - - . .-.... . __ __ �.._ _ . _ � __... ._ � I,as owner of the property,am exclusively controcting CONiRAROR NO. . . :, �• s • • 1 . . -with licensed mmractors to construct the pro�ect(Sec- - qooae55 � tion 7044,Business and Professions Coda). ' ' � °j'�(z p Q. ' � REQUIRED.. .YAR� HWY . TOTAL SEiBACK FR M . . . . ._'_ _.. .:. -_ _ ' ___ " - _' � �"- ""'� CONSTRUCTION LENDING AGENCY'����" " - - � SET eACK PROP.LINE W�OiH ' ' I hereby a(firm tha�thera is a mnsfrudion lending agancy for fRONi �J����'_ �' �the performance oi�he wo�k for whitb this peimi�is issued - - -p.L.- --�� - �-- - --- - --- �- - -�� � - -��� � -- - �`� � �----� e -- � � (Se[.3097,Civ.C.). SIDE ; �^_..� � ��.2�"�i 6 ... .,. P.L . . ...... _ ...• ''- . :. ,, , �.' .. _.._ - ---- —- Continental.-I1limis � lender's Name �pMA Rei.M � ,.. :'•.\':_.�',j� � '. ---. -. - • v.e.Fe�s 231.16 P��mnFee---325.50 lender's Address 2�1 S La;al�e CtLcago II, � ' . I cerfify thal.l hava read fhis applicotion and state thot tl(l�693_ . .. ._._ ..' __ -_ Issoonce Fee - - - LDMA�iC M -- ,. . - �-' '- . .. obova iniormat is correcL I agree�o mmpiy wilh all Counly Investigarion Fee � .' ordinances tata�aws relating fo building tonsirucfion, � Totol Fee � �- � � LDM.4 Perm.N � _ _..... _.____.__ _ . _. . _ .. _ . � and hereb au rize representatives of�his County lo enter �� . ' upon h • ioned properfy for inspaction purposes. _ � . � � ._. . . .'.' .___... . __. .. _ ' .. . _._ . . . �� SEE REVERSE FOR EXPLANATORY LANGUAGE .' _"_Slgrmlvreof pplimnforAgeni --. . .. ._ le ._ _"" . . _ . _. � ___' . _. .._n '" _ "' .. . _ . ._ ... ' __ '_.__ ._... r 1 - - ..."-�. � _ ' � -, `_ . ` • -' ".__...� . ,.� ..�i1- `T- '�' `O' -"�"' .:'... "' O ��O _._.-- " " . �• . ' ' � • v .� ' � . • ., . 'O � (1V � � �. p m fl 1� ' o a o a. . . r O O fG 7 �p O r m T N Q �O 7r O � P �^ �: � '� 10 ,t�D D l mT C1S O � ^ � C' � �O . 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