Loading...
HomeMy WebLinkAbout1161A 1162A ... , .. . ._.. . - -- __ _�_.�....---_...._ .�_.�.�._..__. .___._. . _ _.._ ._----- .___ ._. WORKERS'COMPENSATION DECLARATION � '' � .•` �� "� - ��•-'��'� �'� ��� -' , . . .. . ,P . .._ , .._- - - _ . _ . " _ '--`� . �h`,�,eorafcertifca�ieofWorkersr}Comenso�onlneuronce, APPLICATION �OR;;BUILDING PERMIT or a certilied coPY thereof(Sea 3800:Lab.G).., •'. ".. `. ...-' -' ._..- . ._ .. . .. �-... .. . ____ ... .. . . _ . _.. _ .- Pon�yNo7�n�5-2�,„�4 :Natioriiaide __ . _ 60 (2 Car) COUNTY Of LOS ANGELES BUIIDING,AND SAFETY . ' � BUIIDING . �;>Certit�ed copy is hereby furnished.'�'.• �: � FOR APPLICANT TO Flll IN AppRES$ 7S9 N. Feathexro�od Drive . � Cer�ified mpy is filed wiih tha county bui�ding-inspeo `�- - BUtiOWG �59 N. Feathexzaood Drive � � � . '�lion departmenf. '�,. ` � � . " �'� ADDRE55 � ' - ' ' "' : 6-19=86 "' ':�. THE ADIDEN GRCXJP - Diarrb Bar - -. _ � ' � Dote ' Appl�mnt CIN 21P IOCALIiY Dl�b� � . ' i .. .. �, �. ,. �. . . �."���'CERTIFIGATEOFEXEMPTIONFROMWORKERS'.•:'.�. ' -� -�---�-`... .... . .. . . .NO.OFB�DGS.-'---�--.-.. .. .. NFAREST.-..H1C3Y1�K3'10}�-&-GO P11-Sj�'lIKJS �-._._: . _' � '�' ''� COMPENSATION INSURANCE �, '� . � SIZE OF LOT NOW ON l�i ' CRO55 ST._ � . � (ihis se�lion need nof be comple�ed if the peimit is forona -��- � ASSESSOR_,. ,� -- --, '-� � �� hundred dollars(5100)or Iess.J . . � tRACT_.v,-3S7E)�- BIOCK LOT NO 72 hIAF BOOK � PAGE� PARCFL . .. � TEC:�••Y1°a . M4P : ,�... .. '_ OWNER .... _. __N 67-9541.: u oNe r,o ; 2 _�35G II � so oyi'o thot in the�performance of the work fo�which this .- � �� pe�mit is issued,1 shall not employ any person In ony manner . _ p,Q.�QX.3�Z9 . ' -��-- SPECIAL�r -- - �--�^- -�-��- '- -- ---� a become�subject to Ihe Workers'Compensotion lows. AODkE55�- � '-- �� ----�-�- ; tIY`D CONDiT10N5 ' ;V • .. .. . . • � . ' �� .: . . .� ._ . _ dTY . C�11�... _ _.__. ZIP_9�.722._.' . ' __." '..._."'_" '__ , _ ._. i ' . ._ ._,_ . i� le'"��" Applicanl � ' �. . ARCHITECT OR TEI. - ,, ,.. � I TICE TO APPLICANT: If,�o1fe1 making this Cerlificole of �3Ve SZ�Y1y A� N� D�STRICT__ ,GROVP CON57� F' NE -�-PROCFSSED BY ,I V mption,' you should become subject to'the Workers' - ENGiNEER , �ompensation provisions of the labar Code,�'you musf forth- ADDRESS 314 N. F]YSt� Arcaelia 91006 __,��__ �-J'_. __� �_ �. , �' _ _ __ _ �y wilh mmply with su[h provisioos or lhis perm0 sholl be - �- TEL STATISTiCAI QASSIPICATION AP7 CONDO. • deemed revoked. . . .� .... ... ... ...... . . .: COMRACTOR NO. ' __. _ _p� _ _-� _ ._... __ - � LICENSED CONTRACTORS DECIARAT�ON•� � ��• - ��- -�-� � ---��--� -- -��--- ��---- --LiC. -���-� ' '- . �u NO._,.��DWEtC UNITS� �x I hereby affirm fhol I om licensed onder provisiens o(Chapter9 A�DRESS No3Z1580 � ' � (commencing with Section 7000)of Divisian 3 of the Bvsiness and __... ___._ ._.__...----.- ---..-- ."-- .. .., lIG-, . . _ ��R�P .� � �. . ' Professions Code,ond my Iicense is in full force and effect Cltt CU155 B ' �"�"--BK:"-�-`"�'" �-- '"�� - i"'-"- - VALIDATION' - ""�"; . ....._ . .. „ ... - ,.� . . �3�371580-�,�cioS;B , , . .`_ sze`� 2375 sroa�s F MILOIES�. _ CHECK� ; ; � _"_ ' L�tenseNumber 1 �� ONE � . . " _ VALUATION---�--��- ._ ., . �;� `� 'I b.� /}.�. . . . Single_fami].Y__.. New...- - . �� � `� �� DESCRIPTION OF WORK-� ' � Comrac�or`i4� F1NI�IIV'GFdOUP Date 6-19-86 , S $6��U : i � ' ', Garage 510 SF � , `° • • • noo '- - -----��- - 2-t -- ------- - I am ezempl under See. �--"' ---'-�-""' � � AUER � I ; "� ...• . . � .,.. � � � �:)v�,�� �_._ B.BP.C.for this reason __. REPAIR ❑ ---�s--� "- -- . ._ ...-..-- ' ---'-�'-'-----"-� - - - � i ---- - - .na�e:- use oF o�M.o� D ' -`--'3� L 1 2? ' EX�S7ING BLOG. .. ,_ _.._ - "_�. . -...Signature ,. -. . . - . _. _�. . .-'-.-.- '... . . . A7RicnNT te� , FINAI S i : Q 8 2��8 6 4iIE ANDIIJ GF�UP OWNER.BUILDERDECLARATION ---"' . (PrtiM . - - - NO. '- .._ . . _' -_DATE- - � � -�-_ . ._ ._...._.__-._......-._.."-..... .. , -1 hareby oTfirm tha�I am exempt from Iha CoMractor's Licanse �� ��� e� , �� aoozess � flNAI . ..,, � ., .. . _Law for the foliowing reason��(Secrlon 7031.5,Business and _ _ � _ . � �IfS510ns CDdBJ: ...... _ -._., . _.... .- ...' ' .' PRE ENT . 6y. . _" _."' ' ' '_ I I . . BUILDiNG � '.+ .�;�;� ."..'�, � .�I � l,as owner of the propeny, ar my employees wiih __ nD�RESS � � � ���1 L ii . wagesds�heir sole compensation,will do ihe work and ���TM ",-� �� , - � �he strucfore(s nor inleaded or ofie�ed for sale(Seclion ��' '� ` ` "�'`'��� • � � � - � r - -- 7044,Business and Professions CodeJ.-- _......... ---- MOViNG....... . . . .. . .. :. ..��TEL.•- ."" -..-. - . -'.-'.-.. -- -.. . .---" , - -• s-o_�-�.__i � 1,as awner oi the property,am exclusively conrratfing CONTRACTOR NO. i , � _ _ __:_ ' (!g��O-� -wifh licensed contracton lo construct the p�oject(Set- . -....----.--. __ _............ .._ ._--'...'- ' - '.- - . e � I ADDRESS , ": (�:.� C\ . , ,.� tlOn 704E,8usiness and Professions CodaJ. �.�.1. � � ' _REOUiRED. . -TUTAt SEiBACK M.._ . Xi i.. . . . _.. � .("' _ i _•.^L�C.S O G �-� - � - CONSTRUCiION LENDING AGENCY ' - �' -'��� SEi f7nCK YARD- HWY� p�p ��NE WIDTH' �-- C\ l�- . I hereby aFfirm Ihat�here ts a tonstiuction lending ogency 11r FRpNT _ _ i _� d '� (�<< _�}`:��� � I..��'2 2-8 6 _ � ---� -�he performonta of the work for which�his pe�mii iz issued ���-- P.4:�--��� ------ ------ -�- - -�"-' ' "� - ,) i,` , . I (Set.3097,Civ.C.). SIDE � ' . - --.'.. CAII�ri� Illll'7015.. ... _ _ v.1. _ _.__ ' ---' - ,•" �5�'-'1 i j-, -•t� 11` Lenders Name � � , . • __ r.e:F«s33I.12 - - ve,m�.F��- 474.�0 ' I�MARef.�M! �\:' .� � �i; chicaqo a . .__ _. _.._._. _. lender n Address 231'"S: LdSEi112. i ' � � ; -I cerlify.thm I.hove reod this appi{cmion ond stote�fiai�693_. . .------._.._.. _.._.--.--,,,�e��a F«..._1U.50__ ___:. ipr.w vic x _..------- -. .. .. -. .... .' _ ��_ - - above in(o�ma�io orretl.I ogrea to comply wilh all County Invesugarion Fee � . � ordinances an t e laws relaling fo b�ud��9 to�5r�„�ro�, .-----_-- ,o„�F«_.. 484.rJO__'.__! -LDMA Perm:M-'-' � . -- - -. . _..- - �---- ------ -� _._ ._ and hereby 1 i represeMalives o(fhis Counly to enfer � � opon the o en' ed property for inspeUion pu poses. I�.,� $-J5 __ _ ,- $3�- ' - ---- - �-�- -- - --�- ��� -- � ��� .__ - ... . . ___ � �IO_ ".. _' '_ . _ -....._ _. ..- . . . SEE REVERSE FOR EXPLANATORY IANGUAGE i ' � _... SignaNre o4 App¢om or Agent _."- .pme . ". �.... _. . ...'."'.__'_'._'_. '-' " ._. �_-_. _ _._.__.._ _ . �._._._._ � ._ ...__._.. __.C�i r . _ Z ,-+ ' _ _ o ;o , � ... ��.�. � . . • � ._��- Q '1 ..:r�- "�' '� � O .�p ' . a o nv� �';a. o�, a o T 'n 1 � ^. n �, O 3 .,p p '� a' .. -n 1l�p F � �O' �^, �' � Q _. I O ' � � O m n . � O � ' P O O � , p 0 .. r Q � O p- j tS�. � 7 ��r Q� � 'n ',p 'p�� ` �: m . �=� p= ? 7 � � p p j VD . t�0 O m� �0 .7 � 'N � „ ._. �c -, l �� ✓' I �V � O w` p � 7=. �.� ' � w F 1 r o I ^�, % "-< N N � � �?, _ , , . ..1 , y � �C � �Q � 9 N 7 1 �.:� .I � T � i � ; °� ° I o� = � . 1r' � o . o a� o a � " t ' b ,� ' 'c �0 70 v + ° ° C G c 5.: fl � D � ta Ci' o • 1 = p, e o. Z� g . • a � � '� ' : ',, � ;� _ � . , � � •1 . 1�1�� ' O p � � ,1 ' p, i . I ' 'O 7C 9 .�'; �.y . . !1 , _! ^ � q . ,I 1� i^'� � . ' ^''i 1� 1 ' m q ''�> . p, � N � ! .1� .� . 0.a. �. � f= ��- " ' _ � ,1 � . . . ! ,.� � . � . i . 1 1 � , ^,C i� ;1 .l �'A�� - � . �. 1 ' ' i: '� `' ',s ,i�'. , `, . 1 • ; ' ��'' =1 '•1 . ''. ' '. . ' '•1'f ;I :- - i�` _ • ,,i � �1�� ',.` �� (_ _ .. �� ,� _-1 '`� � � ���•' � ' . . . � �. ,1 j` `t ' '', ',,' :'r t('- i . � ��,.) . . n �.'' _ 11; . � , �. �' `.I .'11 l � .� �� (Y ' N ,1` 1 O � ��' I � 1� 1 ' � t z . ' ',i ,'t ,� � � ��S.t �1 . . { ,� _ � � ',, '�i . � . i'' � 1 . _ . � , � I` .,1• ',v ,' '�I' � � �� 1 - I~ � �, ; �1� ,� ; .` ,t.` .' • �1' � 1, '1 J , � t . � ��. . � . � . . _ . . � ' r : '� "1 • � - � , . �i- _ 1 1 . � , i 1' • ` • , . :1 "!:7.1 1'1 _ ':,^ 'y• , ,'�` � 1 � . • . r. � . �j . '� . . . . , . f. ' � ^ � � , �1 � , . 1 � • . , i �: .� A ^'.C��L1��»n 1'� � ro c' w�. � . � � t ` ' ^ � �.tt e-? B-� c x.��o ❑A �A''�+-Ci n4 U h 'p^ �.�.O _ _ _ • ` � ' � � n'V K r O 7 h t n � C,C1:� � 3�.-.�._yNi �^C"; p�n�w'^y L G p�-! . . ., • - • �, O �i9 1 0 •,^o n� �b �~ e 3 p=: c h�.^.-� `,n+. C����a�� c" � �.2 ,y . • . ;W :o ; p ����--£� � bo3� �:�,Nm }:�`�o.s° � � _ .«�-.`"� ?,`'.:^ b °3�r. + '.' _ �'7� ^ „ ;� r,� �O M'_„� �N N'; ��N�?.� .�.o�aCn a ^ci «N� S�d ��. ' � C ...G• .n.N R4 �+ 10 � ' �� .N '1 `'' � D ...�� � .. M.�Q.� .-�• � ' . p' .� �,� g � mo, o vo-. � m� 000 � oa ? ;, ^'�� n � � c m � , /_f ' _ � �! , �. �.��' o� �c�o � fi�::�.w.F_'c�h� �c Y�a >� a^� ��' a � op G ; • " A' �.no � ua.� �xc�-o �:x :�eo c.= � = v,�a�ioe " n 3w /�i. ` , ' ' . . � D�. a � M-F O.' O�.�'«? x �.'0 3 F u�i fl-"30 m 7 :'C 1^��..�y^= � �C,.'f y ~ - .. �..-.� v ' ' �� ' � ` �- ��-T � c� _ ='t-a'c1 a m v -,� ��. A � „ _ -a t•; , - " � " . � ;, � '.�.�ti°-�o, �� a3A�� � 6o �"'v° A��� �` � `.�,a'° rof� x m' � '�` c� Noo' ��° 'e ,�-, � o� !°- o,� `= �-^'o�C�`�'='^ �5=e �.-^> • m t N `°�a``',':��• . €;� o � z-� y �'� a � ° s� o? �M� =• ° o'x •1 ' ' . f� c9 `p.O.N O.-. m C b N � �,..c� � C..�..�' �'� C N� �'� O:'3 :Y ..1 _ .- : . O n .. , . arm .n� ^Q,� '�+ o. �-,"_� £ � � �'' tn�.l°, = �• �-� e � �, �1 . ' _ 1%N „ '� A �;O C� 3_, T�.3�G..C.e�i� Q p p.K`C�y ,^,��L s C� A, � e+ r`_f1 m 0 �2' • . . 1.. . � � � '�,h. C 3 10.C:m. � �.�w.; G.� lE ^ N:� A M�Q���w.N �p,� F n O � y „ ;.x o.�. a � E � c o 73 c o � a..��°,h c zz S3 '�' � - O `by�CSN� �'-�i-�_�..,�oi�e'� o � � O � "O�•��„F.•'�.�p � ��O'� v' ' O , • - , t � m ...=. o.^ � �in� i�^� � e� c c� ;� . � � ' , f � ;.M �b �� � � --� -, �;c-�� o m v�s o M �na ' �,c-��.o :` . r.. , ' � ,.A '' "� •. iFb ° �•"� ? t�. Cc .Ki•a �t.." JFa `n •n~ �no3•� �-C-��d^ �r . M � � w `��� ^��' . ' - .:n�. :�h � n-O � n � n�io �o O O �. ` �C'W��„ �: � � ,,% ,% �� -� � a . o �..�.`;`G� Aa a's, ':`� :' , - � v X L..�'^t.(� O_ 1 A p�� p✓ . I - ,,��` N. _ �\�j . N .O ,� � _ ' �' - \.. . i ; .. . .- ., .... ' - . . �