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1089A 1090A (5)
, , .,.: .,. - -- -_. _........ -----�-._. _ .__.. .. _. .. . _ �_ .�__..... _..._._ .. . _.._ _ _. _ . _. . _-- - insure,or a certilimta o1 Workers'Com �RATION ;-.-�^,":.',.�-„�'•� ., ; " " �.�' .� :" .�.� --.... '.-' -"- -�`-� . . , �. ,� ..,�... I,hereb ofORmPYo lO aveNaAcerOrfimEe � '��� .. ._. .' _. . . .. _. . • COUNTY OF LOS ANGELES � BUILDING AND SAFETY Y of conseni ro self ..- -- ' ---- .._ . _. . , P �So,�o���s��e��e, APPLICATION FO_R�-BUILDING PE_RMIT ��- . _____ - -- dr a cerL ie co fhereo ($ec.3800;Lab:C: � - - - - - - ._...,_ � � 73W�C005=?�79-0004 Na�onwide 30/A - PolityNo. � ompony .. . . -- �Certified co u here furnished.�' • .�� BURDiNG � �;' PY� � ,/ FOR APPUCANT TO FILL IN a.00Ress .754 N. Feathezwnod Drive ' ❑ �Cerfified copy ii filed with�he county bvilding inspeo- BuaDiNG - .�fion deparlmenl. '. • . . � �.. .. ADDRESS 754 N. Feathe.Lti�C)pd DriVe �, , Date..;F1-14-HF)..,ApplicontZ'E�E ATVDEN GROUP -. . CITY �Dl�lYl Bc1Y ZIP 91765 LOCALtTY Dlc'IISY�2Y� Br1L' ' � .. "" '�� CERTIFICATE OF EXEMPTION FROM WORKERS'� ���--� - -- -- � NO:OF BLDGS. � �-•�- - , aEqREST_ � ..�. 'COMPENSATION INSURANCE�-�" �. � .. SiZE OF!OT NOW ON LOT ' CRO55 ST. Hl Yl ICT1Ob.S� GO]_C1P1'1 Spr� S (This settion need not be-mmplefed if�he permlt.ii for one ��� 3S7E1. 2].- �-�� /+SSESSOR .,. --�- -- �•�� � h�ndred dollars(E100J or less.) , ,. , � TRACT � BLOCK LOT NO MAP BOOK� ' � PAGE� PARCEL � No.967-9541 . 5 .h .. ' ' OWNER" 4'I'�'11NDEN Gfd�UP " ��N! NOP : �C.3��-`� I certify Ihal in the performanca of tha work for which this ��-���•��._� ��- �} permit is issued,I shal�not employ any person in ony manne� �y.fl- SCEC�nt � �,--�- � �� �� - �-� --��� - d so os fo become subject to ihe Worken.Compensation lows. ao�eess- P:O.Box 3329 ------- - --- coNomoNs ..,:-, u Y ' � CITY.__ ' . _. _..___. _ . • _ _. __ _ . ._ .. _. .. _ZIP ` e. ..., . ,... Appl�c.,.. . . , .�. . - . --- - .._._... , . . � K : ` ��� ARCHITECT OR TEL. � � �� O yTICE TO APPUCANT If after�making-this Certifit6t0 of j�VO-S ATA 445-4Q73 DiSTRICT___ GROUP NFE _. fIRE _ PROCESSED BY .r ENGWEER �nY NO. ' - ,�empfion, ov��should become su6�ect to the�Workers' � '� � r CONS.- �ZO E {� Compensation provisions of ihe Labor Coda,you must forth- • • /�d 3 � (/��' ���� � �.d ADDRESS 3].4 r1. E']rSt Arcaciia 91006 .� . -..-.- -. - �- � wlih�comply with svch provisions orthis permtnsholl be . -- -� - "- �•w deemed revoked:„� . . . +. , �:�.• ,, ,.,.,, ��, ���] G�(JP TE� � STATISTICAL MS FI ATION . APi. NDO. '�Z . CONTRACfOR NO. �� LICENSE�CONTRACTORS DECIARATION; • •'�, - - �..... . ._. .. ._. � ci.qss rv0. � ov�ti:-uNi75 �/ - � - - _� uC 1 hereby affirm ihot I am licensed under provisions of Chopter9 ADDRE55 �1S a}}X�V2 No. 371580 (commencing with Section 7000)of Division 3 of ihe Business and SFWER MaP � ; ---- - -... . ._ . . ._ . . _. . UC. ... ------ -- Professions Code,and my licensa is in Full force and effect. Cltt � CLA55 B -' � - - -- ��- --- - �p � --- � . . . . sK. p�. VAL ATION' .1�.; ..'. . . . . . � . _ ... SQ.FT..�.78G�-NO.OF NO.OF 1 CHECK ' .. tonira[Ormber ���SRn'. . `Da e1d55�..'R��. pESCRIPTtON OFy,r�RORIE5S1.T1C�leFAMILIES - ONE� � • ..,,�' � .. .,,�.. � - ' '" VAIUATION � ��'1 �II 9 p : .�, ._ 74iE•,AI�U�EN.GRf�UP 6-14-86 famil N�-- -- - 2� ❑I am exem t under Sec. ... _ . . _ ._ d /�4 . ADD ' .-__--- - ,.�,e . � S 65 320 ' ' • ., - ... _.. _ .... : ',;, .,P .., . .,. . .. . . ._._ '. ALTER � � �26£ib ,,_ , — - -- B.BP.C.fo�fhis reason REGAtR.� s`""�"" - - � - .' ^ , --- - --��26 '-- -��-�---.'-'- .. .._... . -Date: __.. ..,. USEOf � Ex15T�NG BLDG. DE� ❑ .. �_- 0 �-P 2=8 6 1 he elby a{firm that 1 am axempf fram Iha Conimctor's , APPLICANT �E�� FINAL �' . . ___..._ . ._.. ._. -._' OWNER-BUILOER DECLARATION PaWT NO. DATE-..I Z•� � _ _ c.-8b--. ...,_ . - - —_----..: � License � � '�w for Ihe following'reason(SeUion 7031.5,Business and ADDRE55 � albve F�NAL' '' " ' '��_'',� A ', ,,.. -- --'-- ----.._. .' ---- B - fessions COde):"'�'-' 7RE N ' � BUILDING '� , ' J+1 �(1 O . I, as owner of Ihe property, or my employees wilh ADDRE55 , --v+oges as Iheir sole compensation;wili do the work and � � � � � �ha structure is no1 intended or offered for sale(Section ��C/+utY , � � e a • •� ._ - - - 7044.Business ond Professions Code).--. .-- --� ---- MpwNG �-'-�-'._......- - ---- - TEC. ..-.__ ...._.--._--_.. . _ _•. ..-'--- � #�� r � I,as owner of ihe properfy,om extlusively contracting CONTRAROR NO. � � � �3 9 Q b 0 � � - with licensed contractors to tonstroct ihe project(Sec- -.. .-- - - ��- --- -- - - - ----�-- ---- -_.---. _-.. �--- --"-'.-.. ._.._..--- - - -_.--- . ._ _ . .. Y 9 9 Y fRONi . . . .. ...._ _..._ ' ..-- �-- --�- �� .' ._.._.. .. � tion 704d,Business and Professions Code). ADDRE55 .t^� ,�.,,. ' s ^J 9 C O O�.:i �-.-.--. REOUIRED_ . TOiA�SEi6ACK FR M . XI � �� �- CONSTRUCTION LEN�ING AGENCY� � � � � �SET BACK YARD- HWY PROP.IINE WIDTH ;, ��� ��� �Q� � � __ _ _:�:..� I hareb aHirm thof ihere is a construction lendin a ent for . %,' •- e . +� �• � ��iz2. a.•� _ ;:•; .., � -Ihe performonce of the work for which Ihis permll is issued -.._. P.L--.- ... .... .. _ ...._.. .._ . ..__ _.._._....__._ '_. . . . .. . _ .-. _'. . .. � (Sec.3097.Civ.C.)• SiDE � . . 3 _'__'"' '_. _' . .._... .. _. P.L. � . - . . '___ ' � lender's Name OIl i ZlPn a� Tl�i np�c � � � � � ��� ���� � `�'-` ; Lender's Address 7�1��S TaRal l P P.G.Fee S • • Pc.m�t Fee - - 3J9.SO .. �DMA ReL N _ I �j' icagt� TT� ' - ' � : . � � ! .I cer�ify_tha�I have reod this applfcetion ond stote that.ti�C793... -----.. - _.._- . - iss�anmFee-- ��- lO.SO .LDMA P/CN ' -..-_. �" �" � � � � abova informmion is correct.I agree to mmply with all County imesi�gotion fea � � ; ' _ordinonms a $ate laws relating fo 6uilding conslrucfion, Tarol Fee-- -�� -�390.00. . "" '� - - - ... , . ..._ ._._...._.. ._ .. ""_'"_'.. _ LDMA Perm.N.. . . ' '._. ._._._ . _ . . . � . � and he�e thorize representatives of ihis County to enter . � upon th - tioned properry for inspection p�rpases. LD� _ $75 $35 i ._ .. - - --._ ._.._ � � '-------- . -'. _ . -'-- .. -.--. . _.._. __•. ---- - --- - � SEE REVERSE FOR E%�IANATORY LANGUAGE � � -- "-$igno vre o Applicanl or A9e " '---- --' e . . - " -"' ' '--" - �"' - - . _ . 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