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HomeMy WebLinkAbout1137A 1138A „ .. .__..-� — . ._... .. _ _. _. ..._... .._. ._..__...__._.... ... ._. ---- --...__..... .._.._.. . _ ___._..._.. _�-:- WORKFR$'COMPEhISATION DECLARATION � . -. , � � . : . . . . . _._. ..---.-._.. . . .� . . , ..., ,., ... I hereby affirm ih6�I have a�e,,,�,�a,a o���o�5e�„o 5e�f -APPLICATION��FO�R� BUILDING� PERMIT � �- -��1�, � insure,or a ceriifica�e of Workeri'Compensation Insurance, or o cenified co lhereof(Sec.3800,Lob.'G 1-� ”. ' � -� ' ' �- - � - -� - -- - � - -- � ` 73WC8�15-279-OQ04..Nat�.orn�nde• 35�B COUNTY OF LOS ANGELES BUILDING AND SAFETY --- '-��' PolicyNo. - �Company . _ _ _ '� � � O Ce.�ified mpy is hereby fomrshed:,. �,� � FOR APPLICANT TO FILL IN BVILDING , � ADDRES$ 834 N. Feathei.�nvo�d Drive � ' Ce�fified copy'Is flled wifh fhe mun�y building inspec- �- - - gUILDING g34 N, Featheraood Drive tiondepartment.'� � ' -�� AD�RESS . Date�'E IJ-HF) :ApPlicaM Tt��-`ANDEN,GROUP UTY... "Dl�IICKJTX� BdL� Z1P 91765 - - Diarooirl Bar �� � - - -- , . IOCALITY "' - CERTIFICATE OF EXEAAPTION FROM WORKERS' '�•'� - �- -- �-� - �-�--���-- ---- - NO.OF BlDGS. - � - NFAREST.._ � �.���� • SRE OF LOT NOW ON LOT � �`""�"�'"" � ��COMPENSATION INSURANCE�� _� �, ��• CROSSST.Hl h�Kr�ob-•:&�;CiO1C1PS1 $ T� 5 (This sectton need nof be completed if Ihe permif i!for one - �� TRA� --3576�.-� B��K ---- lOT - �SSOR � -— - -�� �� .•,- � hundred dollars(5100)or less.). . � , , MA7 BOOK���� -' ' PAGE� PARCEL� ' Y .. P _ ': TE�. ��o� �P � !�3 -35�9 } �.. . . -;. OWNER �ADIDEN G�UP-- No.967-9541 I terli(� that�in ihe erformance of iFie work for which�this � .. perinil is issued,I sfiall nv�'employ any person`in dny manner .-_1 _ SeECiAt .-..._.. . ._ _ ... .��._ �_ .O � � so as to becofne subjett to fhe Workers'Compensation Lows. � ADORFSS-P.�.'-�1X�3329- - ---- W ✓ CONDITIONS ; � �e .,,, ., ....A . . . .. _ . . CiTY C'OVll]d _ 21P 9�.722 - ,_. . .. _ . _ ' . ..�. ._ __ .__' - -��O .;, - ,�.i.,• PPlimnl�, ... . . .. __. _ _ _._ . . _. . TICE'TO APPLICANT: If, oltef malc�ng"ihis CeflifiCofe of ARCHITECTARVA S AIA TE`'44 DISTRICT GROUP NPE �FIRE PROCESSED BY �! ENGINEER i�a No. 5-4073 mphon, you should 6ecoma sub�ect to Ihe Workeri ��-- CONSI� �ZOyE� �ompenso1ion provisions of the Lobor Code,yoo most fonh- ADDRESS 314 N. �lx'St� �Cd i.a.91006 �v �-� � � �U ��;W with comply wilh soch provisions or this-permiLshall be _.. , h� - - --� � �---� - -�� � - � - �d deemed revoked. , : , , , , ,. . : ��' �ID� G�P � � STATISTIGIL QASSff�CATION APT. CONDO. ;Z . � � . .. CONTRAC70R Np, ��v �/ UCENSED CONTRACTORS DECLARATION._� .. Ctn55 NO. � DwEtL UNiTSLL ' ' �� � '� ' _. _ . .. .. _ ..... _. .. . -uc. _. . - I hereby offirm thot 1 am I�censed under provisions of Chapier 9 AD�RESS AS �70Ve No.3Z1580 � (mmmencing wilh Sedion 7000)o(Division 3 oi ihe Business ard SEwER MAp � , . Professions Code,and�my license is In full force and effect. � ���� �i7y ��� �� �'�- � �- '- . _ _ � � uc. g . ,. . . cU55 �BK.� -pG,� i--� -- � - -�'- AUDATION. ..�..�� , . _.. , 371584�;�. . :., . ,. B ,: so.F NO.OF r,o.oF c�ecK ! ... ..; �icenseNumber � � LiaClais' � � � SIZE�53�- - STORIES- �-�� FAMILIES 1 ONE �,.,..� , �. • .:. - ... �. .:. , , .. , ., . ,., . - �. , ,. ' ' �� �ESC2IPTION OF WORK S' le famil N� Conrmctoi' 447F: ANf1F:N QFl7fTR�me .,6-19-86 __ � - - - - VALUATION � ❑1 om exempt under Sec. � _. _ . .,_. Gc1ti'dg2 441 SF' non � S 56�560 ^� ; 3 7/�,�-` � _ ._... ' '._ � . . . ,- . . ' __-� _. ALTER � , , � #'e • e e 2.� ., � . ...,... . ,. 8.8P.C.for this reason REPAIR.❑ -. j.' --''-- .. . . . ..-_ � ----'-_ - . . -. ...----. ..... .... . . . . - --- �seoF ; I�•239.19 - --`Dafe:�-'- -' EXISTING BLDG. DB�fOL ❑ ' _"Signotu�e __,_.__. _.. _. .. .'__.._ . ... .. ... .. APPlIG4NT�S1�E AAIDEN GROUP TeL. , -- —.. ._ " °2�9.1 9�'-. . FINAL ; OWNER-BUILDER OECLARATION PR�M N�' . DATE..�Z•Z ' -__. � ' .1 hereby affirm that I am exempt from the Contrattor's License � -�- ... �C �Ve - --- . ..-... . . . „ � . ... ._....�(�7 2..�8.6 ... � ' w for the following reason(Section 7031.5,Bosiness and /+oDaE55 F�NAL�� ' �• � I �fesslons CodeJ: - • - � �-�- �� • � - � PkE ENT 'By� � - . . � . . � � � . BUILDING �, � - �--- 1 I, os owner of fha property, or my employees wilh ADDRE55 ; ,„ r _ .._ . wages as t eir ao e mmrensetion,will da the work ond , -- �- - - -���---_--- �� - � the stroctore is no�in�ended or offe�ed for sale(Section �OCnl�iv ; _ --- --- -- --.. _._... _�_ � a 7044;Business and Professions CodeJ.� �� � - MOVING -- -� ---- -----rEt.-- - I - �� � ��5� ._ � I,os owner of the properly,am extl�sively can�racting CONTRACTOR NO. � . -with licensed controctors to construct iha project(Sec- --.- ..... ._..---- -- . _.._..... .-'.-._-_-.--- - . .- _ . _ - ,_ -_ -. .. ---'.'_- _-__--___--._. _. ._ . . {!• • o . • � tion 7044,Buvness and Proiesslons Coda). aooaess � ; , � REOUIRE�_ __.�OTAL SETBACK . . %I i. ; � °v LL 9.S� � � � -- - CONSTRUCTION IENDING AGENCY--"'"-"-� -- SET BACK YARD�- HWY PROP.LINE WIOTH � � � � � � -- "" � � � --' - I hereby offirm Ihaf Ihere is a mnstruction lending agency for feONT ,-•,.; � `,-� - e �u � -Ihe performonce oF the work for which ihis permit is issued ----- p.�, �-�- - - --- --_ .. .... . .___._. . . ._.. . .. ... .... .. .. . .. : ' � ' " � '.[t y,� (Sec.3097,Civ.C.). SIDE � _ a.i. '�� � r��.o b. ' ' 0& ' � Lender's'Nama CAIIt1I1P11�.�. I�.�.lINJ1S - . . .-. . . . . . . --. .._. . _ LDMA Ref.M ' , � �•-: . . � •`� ....i ' -- - . .. 231 S. IaSa11e,..Chieago-I2, - r.c:Fees239.�.9 • ' . P��m�rFes ... 339.00 _ _. --:_... _ lender's Address , -- -� _Lcertify�hm I have read Ihis opp�imtion and sta�e that t e693 Issuon<e Fee --- �.O.SO -- LDMA P/C k� `� � ` �'-"=' ' '_ ._._... . .. '------- '..._ _'_ _.__._....... � above informaiion is correce.I agree to comply with oll Counly Inves�igolion Fee � .ordlnonces an te laws reloting_to 6uild�ng construttion, - roml Fec----� $49.50 �- ��p,qq Perm.M ���� " � ... ... .. .. .. ...._ ._____. --.._ ... ...-- --- -- ..�._ . ."_' and herehy t rize representatives of�his County to enter - upon�he me ' ned property for inspec�ion urposes. LDMA � S75 . S35 ' ' ' - - - -' --- - ------ ' --' -----.. . ! -- ---- . --- , j� SEE REVERSE FOR EXPLANATORY IANGUAGE � ...._..-�$ignafurc of App imm or Agenl-�"" po�a .. . 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