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1058A 1059A (5)
. - . . , . .._.._.._-�---.._...._.._ .. _. . ._ . .__.. - :.C:pRKERS'COMPENSATION DECLARATION ..:... ... :....:."" - � . .` _ .,__,_. .-... - ..;,:t..... .'. .,.. . .._.."'.. ._, ; . ... . , .. . ... ' � ".. �. I�here6y affirm that I haJe a certificate of�o�5e��,o=e�f — �---��-----����APPLICATION��FOR�.BUILDING�� PERMIT��� --�° insure,or a certificale of Workers'Compensalion Insurance, . or a cer�i{ied co lh ie f Sec 8 ,Lob.C.� • , �' "�- ' �� �" - -" --- - " -�" ' " - � 73WL��0�-�7�-0�0� � Nat�.onwide 60/D(3 Car) COUNTY OF LOS ANGELES BUILDING AND SAFETY� � � PolicyNo: Company -- . � � Cerriied copy is hereby furnished:��•.- • FOR APPLICANT TO FILL IN � ADDRESS 824 N. F2dt'11CY4�170d DY'1V0 � .Cer'tified�copy�is filed wi�h the couMy building�insper -`�" gUiIDiNG . � -. ' Non�deparlment.��-' ADDRESS 824 N. Fe3thezwt7ocl Dz'ive Dale 6-�.9-H6. ...Appliconr ��'.L'u�wEN�GI�.�UP -.._- CITY D1c�HYJIY� Bc� _.. ..ZIP. . . _.. ...... '� IOCAUTY Dlc'H1Y�1K1 BR.r ' .� � � ��CERTIFICATE OF E%EMPTION FROM WORKERS,�'. �` -� S2E OF t0T NOW ON�LOTS f 05555T Hl Yl KTIOb�..&��GOZC12T1 S r� S ��� �! ' •• ' �'COMPENSATIONINSURANCE-•�� • g p u� � ,;, (This settion�need no1 ba�completed if the permit:is(orone -- iRACT - -�3576�' BioCK-- ----- �p - - -�-3----'�' ASSESSOR.. . ---,---- - --, " •-� . hundred doilars($100)or less.). . _ . - �P BOOI� " ' � � PAGE� PARCEL I certiiy that m the performanc Y -, oWNER - ��+�A�IN G�P -- -�NO:-967-9��- P . . � .. ,.,,. . . ... . . -. ,. �L so s�to56eco e Isub ect to the Workehe work for which this ,�� �� " �T � � '} ,. .. . ' e of P P YPersoninanymanner ADDRESS- P•�•�X 33 9 .���- 57ECIAt� ..-'�•- - ,.- -_.-. .. ... y a . � rs'Compensation Laws. -- '-"'-' " ... ... _..._. ..____. . ..."""_ �pNDIT10N5 � . -.. . :v ,.. .�: .. . . ... . . .. .•.'..,,.; ,.. . � '�. .... .��" .__. CIN � .._ ____ .ZIP _. ... '_'.......... . . . _._ ... ,__ _ . . ___ _'__ . __ .�OC e , -. . . "APPIi[anl`. . ARCHITECTOR TEL. � . ., . `� TICE TO APPLICANT: If;'�oNer'making this Certificate of ENGMEER Dave Szany AIA Np 44S-�IO�J3, DISTRICT__ GROUP � .._,__ . ZOEE_ _ PRpCE5SED0Y_. _;v �mptiom,'you shouid bemme�svbject to the Workers' � -- Compensalian provisions of 1he Lobor Code,you must farth- ADDRE55 314 N. F'1S'St. F1Y'CHC�13 91��6 ----��-_- -�'3 . _. . d wiih compN with,such provisions or this permil,shall ba - TEL , STATISTICAL CIASSiFICATION ��� APT. CONDO. : �Z deemed revoked.,. . • . ., ,. ,,; 'l�IE 11l�lDEDI GIaDUP CONTRACTOR NO. • � � UCENSED CONTRACTORS DECLARATION -�,�'•, -- --. --- � ---- � ., anss NO. � � DwEIL UNIiS� �� � - � LIC. I hereby aTfirm fhat I am licensed under provisions of Chapter 9 ADDRE$$ AS 2�70VA No.371580 (commencing with$ection 7000)oi Division 3 of fhe Business and ___ ��� ��R�P �� , �' � � "�' � ' full forte and eifed. CITy ._ � -. . ._.- . -- CLq55 $ - ....- . . . . . . _ _ _ . . �� ........BK_...'.pG .. ., . . . VALIDATION ' ._... L efnse Number a';'71 5Rn nse is m` SQ.FT.23'�CJ NO.OP NO.OF 1 __ CHECK .� � �. � i0.Class ' A� ' � SRE STORIES��� �� � FAMILIES� �ONE �� , �. , � , � � � , �. �.. . , . ... ,.� . �, .._VAIUATION ,._ :_ . ' �'� � ' � ' DESCRIPTION OF WORK Sir�gle famil.y ���--- New----. '- � ��� � �- �� -- � ,. .6-19-86 � Comractor TFTF• AT�Fl�1 C:RnTTR�afe-, . H� 68O ' . �I am exempt under See. GdY'dge 7 $F ADD � s ' :?� Ci�8 A_ ` .._ _. . ._ ._.. : _... .... ...._..._..._ ._.._. . ..._... ❑ - --- � . . . ., .. ALTER �• o • •'2�� �� g.�P.C.{Or fhi5 rea5on REPAIR.� _ s ' -"' _ ' ". .... : .. . '_ ..._ . " _. _. .._ ____._ . -. .__.__ Dole: ."' _�.. .., �._� USEOF DEMOL ❑ � � ..� •33469 EXISTING BLDG. _ . ..._.. ._. .... .. APRtCANT TEL. z . ..Signaturd ' .. .... .. .- -- -._. ..,. _ � `�� ��� Ci�� FINAL " a�5�u�:.6 C/� � OWNER-BUILDER DECLARATION PRiNi . NO. . DATF- ,a�'Z2+g�.-� .__... __.__.... . . . ._ -1 hereby affirm�hat 1 om exempt from the Contmctor's license �G aj7OVe- � -� � - - � - - . ' ��,Q'L�8 6 • ADDRESS �• w for the following reason�(Setfion 7031.5,Business ond � FlNAL' �fesslons Code):'--- „'. .... . - . _.'-''-.._. _... -- PeeSeNT . Y --.. _.._ ... � . .� � i BUILDING � � ' 1, as owner of the properfy, or my employeez wifh AODRE55 � . � � ' ---wages as their sole Eompensation,will do the work-ond - -� � ��" �- � ���- � " `-���" " ' " "�' Ihe slrutture is not intended or offered for sale(Settion ��"��TY � � � '� �' � - - - 7044,Business and Professions Code): -�---- - -"' MOVING . .. - -- ' iEl.--- �-- --- -� ,�- ---- �--� -- --� �--- � '�`1 0 5.Q.A . . . � I,as owner of the property,am ezdosive�y contracting coNrenCtoR NO. , . �.• • . e , . , � - --- ---.. . ..... ... .. ... . - - � ----- - -- --- - - - . .. ._._ � -with-Iicensed conrracrors to construcl Ihe projetl(Sec- " qDORE55 • .. tion 7044.Business and Professions Code). ' .:.'+ �. , ; .t� ' � . . ..----CONSTRUCTION LENDING-AGENCY -� - - -. .. :SET�BAIX YARD HWY iOTAPRO�CNEFROM WIDTH �''..-..-- -.-... ... '' ' • •'� �• � I •4&9 0 0 -. I hereby offirm that there Is a construction lending agency for fRONT .�•' -�' �' ' � �the performante of the work for which this pe�mit ie issued - ._ . ..P.L. ..-_ . : _._ . _ . ..._... --' . ....- -' - -...�._.._ _ . �..,'�. .��-'._-_ ��Q czi... . 048 (Sec.3097,Civ.C.). SiDE _ � , . , , , P.�. •�; :��` -. , 09.22-86 a - - -- - ----- : � � lender's Name Coritiner�tal. Illir�ois tpMA Ref.N ��� ��� .r' . - � 231 S. LaSa1le,Chicago IL . P.c.F«s.334.69. _ 've;m„Fee-..__....478.50 ;Z..,;_�. - Lender'sAddress � � �. ., i .J certify thot I have reod Ihis app�ication and state�hat t e93 _ . Issuanee Fea--- - �.0.SO.. LDMA P/C i - � � - � - _ � r .. . _._ .._. _---''. _ ' -"'-- a obove informa�ion Is correct.I agrea to comply with all Counry imesrigaiion Fee � — '' � g ordinances tate laws reloting to building.mnstrucr�on, _ -__ Toro�Fre--�----�--48J.��-�-� ' ' � ' ' _. . . ... .... __._..._._ .lDA1A Perm.M..'.'."_'_' i and hereb a rize representalives of this CovMy to ente� � -�� �-� -�� � � � � n upon th o - tioned property for inspeclio ur o5es. .LDMA . ' o _ . ..__- - — .+f'�,i�� -_ -_ ' $75-- ----- � $ .. ._ . - - - - - • -.- - - -. . - � /�/ SEE REVERSE FOR EXPLANATORY LANCIIAGE 3 � � ' 0 � .._.._._Signowre a Applimnl o�Agen -- �- � DotlT .__. ._ ..—___. .___.__..__......_..._ .. _.. __ .'_ "_.'__._ . __ ._ _.__ _ ._•�O'� � — � ' , : 7 - - ---�- - - --- .._ .._..__.._ .. . . '.: : .. .:;: � . ,. 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