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HomeMy WebLinkAbout1155A 1156A , ... . ._.._-----__ ____ _ _ ._.. ._..- --___----------- -.. ............_._.._._-- - __.. .. ...___ --- . .., .,. WORKERS'COMPENSATION DECLARATION � � . - . � , . �.,, .. , , , , . �,?. ' , � . ��s�:ebo�a`�e,�F�a,eoFwokes"�om'Pe�so�o�'��5��a��" �� �-� ��-- — APPLICAT��ON FOR,,BUILDING PERMIT �� -�; �or a ceitified coP'ihereof(Sec:3800,Lab.C.)�- --� -� �- � - " --�----- - - "- � �- - - "' � �3W�Ou�-279�00�4 � Nationwide 60/D (.2 Car)_ COUNTY OF LOS ANGELES I BUILDING AND SAFETY •� � . : Po�icy -' --- --'.. . " � Certified copy is hereby fumished.•. � . FOR APPUCANT TO FILL�N BUILDING �31.N. Feathex�i.vod Drive � ` aooaeu � Certified mpy is filed wi�h'ttie�county building inspec- � �- gUILDiNG ']3],.j�]. Feathez�nvod Drive i �'�tion deparlment.� �' ' � . , , .. . „ . ADDRE55 � ! I � . I , ., . .� . . .... . . . . .. . � . .• ' .__._._ .__ .'.... _ ... ..__. . .. __ oare 6.-19-86 • �.'PDIDEN GF�UP - -- - , � APPlicant�� CITY ZIP LOCALIN I �� CER7IFICATE�OF EXEMPTION FROM WORKERS" " - -- """ '"'"'"-'" ' �� �- ' -"""NO:OF BLDGS.-- --'- -'--+ NEAREST._ . . � � • -'- ' -���COMPENSATION INSURANCE � � 5RE OF lOT NOw ON LOT cRoss sT. �i9h�ICmb�:& Golden�Springs-��"- � - (This eection need nol be completed if Ihe permit'is forone -� � -���� � 3S7G1 - -- --�--�--- - --- �-E)7 � -�= AUESSOR..,:•. . " �,- " � -' � " ' .hundred dollars(E100)or less.) TRaCf�� BLOCK L AMP BOOK' '� � FAGE� PARCEL ; . . , . - - - owN�u .-��ANDEDI G1�1XJP-- -� No.967-9541-' u ZONE �? � �I ceAify that In the performonce of Ifie work for which this � �/ �� ' -� ' � 'y. permit is issued,1 shall not employ any person in any manner _. -- - SPECinI -- - - -� .. .... -;d I so as 10 hecame�subiecl lo the Workers'Comp'ensatiou Laws. �-�- ADDRESS-�P:D.BOX-3329'--'-�`-�---'�-------� �'-�-�• Q'D'11 CONDITIONS : : ,Q . . �, . . , . .. . . .., , � �V i. " _'_ .. -_ ... . . .. . �.; � . . --��-- CITY__.. � _ _21P._ . _..__ _ _ _.. ....___ " __ _ '_ _ _ ' ' ' e �Applicant � �� ' ARCHITECT TEL. � �ISTRICT._ GROUP NPE_. , fIRE PROCESSE�BY. Q �TtCE TO APPLICANTi�If, aRer moking this��Certificara of ENGiNEEa�e-SZ3I'1�7�A No.445-4073 � . coN �- " � � mprion,�yod'should become subject to��he Workers' ---' - G Campensation provisions of the labor Code;•`you m�s�forth- qDDUE55 314 rT. �'1L'St �'CdC113 � 91006 . �`�.-_.-.. 3 .. . �.- - . 'W wifh camply�with�s�ch provisions or fhis permil shall be" --- �- T �vai � deemed revoked..� .,,.;�1. . .:.. ...... .•. • ATISTICAI M N , � . . '2 Fl _ ST SSIfICATlO APT CONDp ��� •� � [ONTRACTOR ' NO. � - LICENSED CONTRACTORS�ECLARATION ,� �, �� � �� � -�--� - - ��-- -�- ����-- �- - M55 NO. � �� DwEtL UNITS� --l�C.- I hereby aifirm thot I om licensed under provisions of Chop�er 9 ADDRF55 As above � No.371580� (commenting with Seqion 7000)of Divisio0 3 of the Business ond _........ . ___ ��R�P � ' � - _-' Professions Code,and my license'is in full Force.and effect. CITY CLn55 B �� -- � �--- - �-- � -� - �� - VqLIDATION �--- � .. , .�,,: . , . � . ti 5° `T:.2375-- "o oF NO,OF_ .. 1__ CHECK...i BK. PG UcenseNumber 37��Rn �,� CI6s�i ' " � sze sroaies -- - - Fnnnmes ` ONe � , TF�':ADIDIId GADUP •. 6-19-86 -- ._ ocscairnoNOFuroeK�-Single family._ . . r+ew--� _ vatunnoN -- '---- . - � �1 1 5.5 A . co�,�a�io, oo,a s 86,08� � '� . . , . . . ADD O ,.1.... . #h'.. • •G�_.: ❑Iameaempronder5ec. -- - -------G3L'd 0-��-SF- ----- --- - - ---❑ :., . . .., ... ., ... ALTER � ' � I .�:3 �j.� ' B.BP.C.for ihls reason REPAIR � s �".- . ' . , .. , _.-... .- ��� ` ! ' �' USE OF � � ' ^ __._ .. . .Date' EXISTING BLDG. DEMOL ❑ °J J�,� C c=i, . , _.'__- ---Signdlure - . _ - .�. .. . .. _.. _. APPIICANT te�. ; FINAL 7 ---�- O H.2 2�B cS . OWNER-BUILDER DECLARATION PR��'�Tl NO. ._.DATE,L'�=�.?..... --- -- .-..'-- . .-- -- �-'--- � I hereby aifirm thot I am exempf from the Contractor's License �� � j�$ �]�pVe � � .- ,� ��w for the following reason.(Section 70.31.5,Business ond AD�RE55 � FINAL � ' _� � . _._._... _ .. �feS510n5 CodaJ: ' .. . . . . .. " -'--- ' PRE ENi BY� ���- . ... ....;. � � .-- . BUILDING I, as owner of the property, or my amployees with ADDRE55 � �w6ges as their�sole compensation,will do ihe work�and �� - �� - � -���' � � - � - ��I I r3 6 N � , the structure is not imended or offered for sale(Section tOCAtITv •.�� •,,. ,, ,, --1��\; r, c, ' � , "� '7044,Business and Professions Code).� ' "-' � - MOVMG'-' ' ''� �' ' ''' �� '• TFL:�' ' • , �--' '-' ' --' - - -�� � �;• e e s e � � � I,as owner of the property,am exdueively cont�atling CONTRACTOR . ,��Na �,�: , J ... � ; � . . ..___,t_.. . , .�_.r:.... - . - � with Iicensed tontracrors ro mnstrutl the projett(Sec---. . ... . ..•.• , , _'._c,.•+ ... _-- .. _ ;- ....I „!�8� -rJ� -.; ' Non 7044,Busroess and Profaszions CodeJ. AooRess � .,,___•.: �;�. , � , ,•+ �`_�.�, � � �- CONSiRUCTION LENDING AGENCY � ' � - � �SFT�BACK �ARD- NW'f- --��OTAPROipB�INE WIOTH , `�`' � • - -��-�4�'4'`�O�� � _-... :. .' `., . I hereby a(firm Ihot there is a construction lending agenry for fRONT �-� �'�- �-1 � � i''' � � --the performance of Ihe work for which this permit is issued"'.._. .P.l.- �----' --- . ...:...- ---�--- -'-�-�--------. .__.. ."' -- ... ... .- � • . .� ' .-''.'....�� - . '22 86 (Set.3097.Civ.C.). SIDE � . . . ... ____... _ . ._._ . .__� _ . - P.l. . .. ._ __" ._ ... ._..___. ")'' .:i__ _ .. `.'.-_._ ' . -. . ., •.. • ___ .' " . �. '. ..r.� ',. •. _��..t Lender's Nome �'nT11't T1Pn{�al T1.1 i rni s - t � � ti, . LDMA Ref.N I � •--- -231 S. La5alle,Clueago-7L- --- v.c.Fee s �. . _ � _ ve.m��Fee 474.00-- - --- - ,,,. . lende:s Address � ., _ , ' - � -_I tertif that I have read this o Iltofion ond slota thot t a 693 331.�.2_ 1�.50 � '.' '. ' � Y PP _ .._- ' _-_'__IauvncePee _ . _ _ __.'. . LDMAP/CM __ '_.._' ._..._ ._. _ . _._...' .. . _ obove informatio -s torrett.I ogrea fo comply with all County Inves�� r�on Fee 484.5� � ._ordinances a �e,laws.rela�ing to building constructlon. _........ --'-9� _ . -- .-.. To�al Fee.. . . .._. .IDMA Pe�m.M- � � . ,�. .. .. ...._.. .- -"--.'-' .. .. ...' . . and hereby v rize represen�atiyes of this County to enter upan the m ioned property for inspectiorypor s s. $75 . $3cJ . _ i � _ ,. .__ _ .. _ . . . _ --- - -' "--- - ' ' --- - - - -._ . . .- - -- - --- Q a SEE�f FOR E7IPLANATORY UNGU�cE � � ".... Signafura of A pliconf or Agent-. _ �... ... .Dote' _" _'" '_'__'—'_' "'"_' "'_ ....._. . ... ..... _"' -"_" ' _' .._._. . .. ._ Q ._....._ _.. _ _.__. . � : .i O �. • . . I -^.... w �� ��, 'y- �o� � � _ ' �, �, , _c,• m ° ��� `� �- � T�c p o- d O `� ,o. O ��n m a � v m , .o� 'o r C�9 3 t9 �. �p p ,fl � ' � � j n. 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