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HomeMy WebLinkAbout1072A 1073A (5) " . . .� ..... �..� : . .r� �_._ "_'_ "_�.,__'__. ._'__'__.}j_�.�...��.���..�_.`�._.���..�.._.......__.�_��. . V`-.II�. . ECIARATION ,s���;�.��y,,.,,..: ., ; ..�_,._..._.___...;. ...._,. ,:-.�..---,--'-_--...__�._........, WORKERS'COMPENSATION D , , , ll .� _."._' __'_. �hEreoy aftirrt7 ihat I have a certificote of'consem io self ' - - - insure,oracertifitaleo(Workers'�omPe�sa�,o���5�ro��e, � APPL�ICAfiION-��FQR;BUILDING���PERMIT�---�-�- �� or o certified<o y fh reol c 3800 Lob.C.1.�.•� :". ---'- '.. . .. -�`- --. . . ...-... ....- ---- -.' , : . � --"'-.._..--- ---'-' 73WC00�2'�9-0 �14 Idat�.ornviae ; � 30/C COUNTY OF LOS ANGELES BUILDING.AND SAFETY�� ,• ,.••. PolicyNo.• .. .Company- •--'----- - . .. _ . _ ... .,. ._.. _._. . _ . _ �. . Certified co is hereb furnished.�.•� �'� . . . � eUIIDiNG , � ❑ PY Y " `' FOR APPLICANT TO FILL IN ' aooaeu 753 N. FEc3thel4AOd DTiVe �� Certified capy is filed wilh fhe tounty 6uilding inspeo- �`" g�iLDiNG + `tion depar}ment. � �-•� •�' �- � qpDRE55 �753 N. Feathel'Fx�od Di'ive i . :.... . _�. . .. �.... ...- . .. ; �. : : � 6-19=86 ' ' TI-��ANDIN GR�UP - -- Diamorri Bar -- 91765-" -� Dote ��:Applicont cirv Lr LOCAu7Y D1aITID1Y3 Bdr ' . '�' �CERTIFICATE OFEXEhlPTION FROM WORKERS' ' '� '��' "--- -�---'��� -�"�" �" -� -�-----NO.OF BLDGS:- - - ---� �' NEqREST-� h.KI�b.'&'GO1d2T1.'S S'�"-'-"�" � � ' " "'�•COMPENSATION INSURANCE' ��" . . SIIE OF LOi NOW ON LOT CROSS ST.. 9_ ��'.� This section need nof be[om leied if ' .- -.. -..._..._ .....__ _. ..__.___" ' ,:• . �., - � � i ( �� �p tha permif,is for one -- -�- ASSESSOR. - - - ..�.-.��� . � .hundred dollars(SI00)or less.) ..� .,. ., TRACT BtOCK MAPBOpK' -PAGF PARCEI � soasltobeco , ' , •' . ,. '^ , ov�ru�e .`I'E�.ANDEN-GId7[JP- -- � r,wP . y in Ihe performance of the�work for which thiz Np. z,3!� �• . �permit is Issued,I sholl'not employ any person in any monner --- SveCinl -�- �- __._ .._ ._._ ._ ._ .. No 967 9541 ; u oNe ' ADDRE55 P:�•BOx 3329-.. ; -J.. 'a .__ _ _ . _.__ _ . rrie sobjett lo tfie Woikers'Compensotian.Laws. � - �-� CONDITIONS � , .. , ��:... . . ,.., ::��.,.. .....�. ., CO 11]7 .. ... .....� ,. _ O -- ' � V --� -- ' 1 V te... �� �.,.r.:_ . �Applicant��' �. , •, ....�..� ,., �-� - Cltt. _. ---'--- ---._.----�--�� ---21P. _- .'.-�-- -- ---- - -�---�-�----._.. .-'-" --..__.-;-- -.. -_;_ ;a' ARCMITECT � TEL. � � `�� �� . TICE�TO APPUCANT:�If;after mekirig`Ihis-Certificate o( �V0 SZdIly � 445-4073 : _ o�sTe�cr_. .ceoua; TYFE_�____.._ FIRE.... ...PROCESSEDBY._ �� I ENGINEER NO. , mption,'you �should become subject�to'the�Workers' ��- � - • CONS� nlE . ,p V �Campensatlon provisions of�the Lobar Code,you musl fonh• ADDRESS 314 N. F'].ZSt� Areadia 91006 � lll.3: � +�++ with comply.with�such-provisions or,�his�permil shall be" --.- ""�----- -' --' �- - --- - --�----- - deemed revoked. . �,,. • ' . `II-� AT`IDII�1 GROUP TEi. STATISTICRI CLASSIF�TION � � . '�. . . ....•,• . ., ,...�.. CONiRACTOR NO. ____ • APL CONDO. '. ,�r �2 LICENSED CONTRACTORS DECIARATION�� ��� ev+55 NO. ' Dwet � � � � - � � " - ' " ._. _.__. _....LIG. i L UNIT5�11 � I hereby aifirm thot I am litensed under prov�sions o(Chopter 9 ADDRE55 � aL�OV2 N�3�JZSHO -: (commencm wiih Section 7000)of Division 3 of the Business ond __ ________..._..__. -liC.-- .--- �R�P i � � -'--�---..._. . ._. ., ense is in full farce and effect. CITY Ctn55 B ' -' � ��-�- --�- . ,_,. .... . .. ..... .. .. ........BK.�- -cG. - '--- � I�ATION , " - --�"- "VAL Professions Code,and my lic � COnfracorm6���7�IN ��aClc55 �B 1 DESCRIPTIONOFyyQR RIES FAMIUES N�ONE ' 1 � . SQ.Fi.],78(_. OOF _. .___' NO.Of _CHECK . GADUP 6=19-8b vnwanoN. ;_----.. _ _'_ `^ �2�- � 107 � oa�e - - . . �- o s 65,32 k��_ ;z.� , o , ADD �IamexemptunderSec. .. -...' ' - -' _�X'dC�O_QQ5_..SF- ___'_.'_"'_. ' . .- _ . - . . -" i . .. . . .. . ... ...� AITER Q i ; � � °2 6&6 5..: � 8.8P.C.(Of ihi5 fCOSOn ... .. REPAIR_� '-s _'"--'__" _i"-'_';. ___ ' _ _.... e �L��C J U' , _.... . . ... .. . .. . __Date:�____�..,- . USE OF DEMOL � ` � ., E%ISTING BLDG. ❑ - _ __.. - _._._.5tgnatura -. �. .__ _ .._._.. ...... .' _.' APMICANI TEL. , . __�...-_� CC-$6. . PRINT 4i�. P.NDIN GRUUP NO. FINAL ' ' � OWNER-BUILDER OECIARATION _ � ',z- ' � ' ._-�----�- --- -- --�DATE. _.5-�.�].-- �� ---..___...__._...._._�_----� -1 hereby affirm thal I om exempt from Ihe Confractor's License � -� A$ aj7(,jVe � '�� " " � , .low for the following reoson•�Section 7031.5,Business and ADDRE55 � F�NA�:%:�' ' ..r, v � , ' feSslOns CodeJ:�_.... .. ... . .. ._.. .._._ .._.,... . .. . PRE ENT ... BY._ .._. -. ':'_..._'__ __ _:_- . ;-� .� 9UILDING � � . . __ O �'�. I, as owner o(the properly, or my employees witb A�DRESS • : , n�� wages ns thnir sole tompsns�den,will do the wcrk and - .-.. - - - ----.-_.�... . .._. .__- .__- _- ' ' the struuure is not Intended or offered for sale(Section IOCnUiY �� 1 �.�' �•� .• �:':.�Ir�•,;; ! � : _ . .' "'.- ��-'---._.____. , --_.--- -- � -7044,Bosiness and Professlons Coda).'-� - - - MOVtNG -�- ._-.-... : ---'--'`-TEL: . .. - i ----�- i--��-"-""--'_- �• • • � �� I,as owner of the properly,om exdvsively cantracting CONiRAROR ',. , .NOL � . i: . -� -wiih licensed conhacrors to tonstrucl ihe project(Sec----- - ----- -'-----'--------...'---'��"' -" �'�� ''- '� �-=--.-'---�- - ._. __ � .. .._._.'. _-- --- -- -- - 1 �39QD0 1(on 7044,BVSineS3 and PIO�e5510n5 COdB�. AREOUSRED. IOTAL SETBACK Fk M. I i,. 1 - �_�i.��" �� ��. �3�:' • n CS - CONSTRUCTION IENDING AGENCY���- �""' - �' SET BACK -YARD HWY "� pROP.LiNE WIDTH ��� � � , - }' � ��� � � -� � � ---�--- - �"" - I hereby aHirm thot there is a mnstruc�ion lending agency for pgONf ,�*,;,��,.A s� ,.r�.�;� - 0 Q,� .-� -the performance of Ihe work for whith Ihis permil isissued ----- � P.L- � ' " ' '�--- ��-- �'-- -- - - .. ..'--..i -'---.-_ ..�_ ; _. . _ _ _.. ._'_ c-i _ ___ ____ _ _ _ _ QC • . _�; 2�gb� (Sec.3097.Civ.C.). SiDE , �, j. I '� , , _.'...'...."_" ._ . . P.L. • .. . 1 „ '., : lender's Name-�.'OT1t1I1Q21{'dl. II.I.lIY)1S_�... _. ... - � . ' � +�� 'f � - -.�.. _._--- � . .� .._ .1' :��.. IY ' - -� '� t '�..--- '� ... _ ... .. - -- -- 231 S.�:.I�aSa11e,..Chica4o � - r.c:F��s-- 268.65 o�,mn c�e- 379.5�__._._.: �,�,e.Ree x � .,. �, (---�- . ",. "�, lender's Address 60 , '' - -I certify thot 1 hava read this applitation and.srete.that the _..- ' ._._.--. -- . _ ._. .. issuanro Fee ---.-..-... .-' iDMn aiC M- .-__.._.__ '- � : �� ' ... - abova informatio s correcL I ogree to comply wi�h all County imes+�ganon fee � � � ordinances an te laws relating lo building mnstruttion. � '. ,... .....-',�! - --- - ---- -------... .-- ro�oi Fea- 390.00 --- � -iorna v�,m.x-- -- --- - __- and hereby t rire representafives of this Coonty to enter - � - -�-- � - upan�he m onedpropertyforinspecti rpo s. ---I.�"�. $7rJ� --- - $3rJ.'--..�._.-"-----'-.'-.. - ---- -.,----"'-" ------.. --'-- , ..-- �- � - - �-- - - - -'.___ i . � � SEEREVERSEFOREXPLANATORYLANGUAGE � � ' -.,. Signarure of pplimn�or Agenl . ....-. -D te'_ __ ....' 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