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1068A 1069A (5)
,. . ,. :,. . . __. ___..___.._...._ . _ ___.._.. --- ._.__.....__...._. .__ _._..__.. _._.. . -- -.__. _... ..__._.._ .. ...� .. WORKERS'COMPENSATIONDECLARATION - .':C.i'.:•.'~ .'� .. �;� ........ . .-.��t�.~.�..- -� �.-�..-�. . ,�S�,ebo,°af�e,���o',eofwokes-,�omPe�sa;o�°��s�,o��ef __. ____.__ _- .APPLICATION��FOR.BUILDING� PERMIT__. ..�� � or o cert'rfted copy�hereof(Set:3800,Lab.C.) , ... .. •- �- `--�---". .. - ` -- -- '--�- ., . - _- ---- -. _ - - -- -- - - . . „ � • COUNTY OF LOS ANGELES BUILDING.AND SAFETY � � voii�Yr�3WC005-27��qy Nati.om�iide _..... 30 A '""Q ' °• ' � ,,. :. . _ BUILDING Cer�ified copy is hereby furnished.''. �. + FOR APPLICANT TO FILL IN � ❑ . . ..� .. ... . ADDRESS 837 N. Feathe.n�vod Drive Certiiied co is filed with the coun buildin'ms eo- yU PY� �Y 9� P BURDinIG 'tidn deparfinenl:� '� . ADDRF55 �837.N. Feathe�.00d D]C'iVe . Do�e'.6-19-H6".qpplicont '!��I1NDIN GROUP ` arv- Dyffi[lp -Bdr ' --`zP _ �ocnur 1dT11D - ' � `CERTIFlCATE OF EXEMPTION FROM WORKERS' �''- "-- - --- ' -`-- � - NO,OF BLDGS.----�-�-- --� NEAREST__.__,.._____.._...___.... � _ . ��� �� COMPENSATION INSURANCE�"�� �� '�` S¢E OF LOT NOw ON LOT � CR05S 5T.,Hl h Kmb-&��Golden�S T� S � , .. . . '_- ASSESSOR.�, ., ""_ _ .. _ _. .,.�r��,:'�• is section�ee not e comp ele i t e permif is or�one � ��- ' " -- �-p �p�K � �� �� PAGE, PARCEI � -hundred dallars(;100)or less.) . .. . TRACT.... __. . OCK ..-.. -�- LOT 7$-'-: � ,.. . , ; ._.,.. . . , _ '___ `I'HE_ANDEN GI�UP_.. TE - USE,jpNE N�4a , . ... _ i. I terfify that in Ihe perfoimance of the work(or whicfi this OWNER� NO."- `�/ �. � ; �3'� ,r permil is issued,�shall not employ�any person in any monner P Q.$(]X-33'l9. �' SPEOA4 ------•---�-, --� `--�- �--- d � �'-- ADDRESS... • �--'-... -.- '--- - � • ��`✓» LONDITIONS ; � � .� I so'os to betome subjecl to fhe Warker5'�Compensation Laws. ,v _- �. .. . , , ' CITY.__ CC1V1T1d__ _ _. .ZIP _.9�.�22 _ _ ' ' ____ . � te .. .' � ' �APPlicanl� �� ARCHREC7 OR DdVE S AIA ��•445-4073 o�sTa�a GROUP,TYPE_� FIRE PROCFSSED BY. �0 „ _ � . .__.. .. �TICE TO APPLICANT: If, afler'making this Certificale o( ENGINEER �y NO. - - - �p�� '-'-"ZpNE I mption,�yov should become subjecl �o �he�Warkers' -� - /� ) �� tompensation provisions of the lebor Code,you must fonh- ADDRE55 .314 N. F']Y'St� AY'CdC�]x1 91006 ; .f U /L-3. �_ �fj_ � � -� � a with tomply�wilh such provisions or fhis permit shall be- �----_ �� - � � �u� "''� � � � -�� CONTRACTOR � ANDEN GROLTP i O. ; STATISTICAL ClA551F�TION i AM. CONDO.��� , deemed revoked...; � • � � ,.� � Z LICENSED CONTRAQORS DECLARATION � - ---- � � -� M55 NO. - DCvEiL UNITS� I hereby affirm�hat I am licensed vnder provisions of Chopter9 ADDRE55� aYJOVe� � 371SHO--� � (commencing with Sectian 7000)of Division 3 of the Bosiness and .-' _ l�C. .... , SEWER MAP �� , ... ..�.�..�... , Prolessions Code,ond m litense is in(ull forte and effect. �YFT. n10.OF NO.OF �� CHECK • ' . , .Y -�VAIIDATION"---•'' . ._ .. 8K. PG. . licensaNumber 371580 �;�.eio„ �� s�ze- �1786 STORiES �� �- FAMIUES -1 � ONE � : � . � � �• � co�na��o,TE� AI�IDEN GROUP 6-19— S' le fam;l VALUATION � B� . 86 ... ._' DESCR�P�IONOFWORK" SYKJ Y . "' NEW- � .' '_•- �. . ._ ,�- -._r..� OSFjA'_'� oa,a = 65,320 � - ..,. , ,. ❑I am exempt vnder 5ec. . ------. _-..GdYd�Je 44S SF._ Aoo � ---.-.j�" - '2.1 . --.._. _.. _. .- - - ❑ ; . . Al7ER � i ..-.-_.._�_1.�.6�.6 O_ ,,.1 B.BP.C.for this reoson ��: ,� REpq�g._Q ..--5- --�-- -- ---- ---'-- '.. -- --.. .�. ....._. _ .......... . ''Dale: � ,. . USE OF DEMOL ❑ I ' , � i --- exanrac aioc. _._._-- -_ --'�2 G�6 5�_; -� �-Signature � .__ ._;_._ - ._. . ' ' APPLICANT TEt. FINAL � ' � . PRINT 7.HE P,NDEN GF�WP NO. - , O�2 2"II 6 OWNER-BUILDER DECLARATION '__ . - --. . P ..._ . . . ---DATE �..�_��...__�_ _..._.....-' .'.,---_._ _._._._ -I hereby alfirm�that 1 am e:empt irom�he ContrattoPs license �1S a}70VG' � - � � ' . law for the followidg recSan(Secflon 7031.5,Business and ADDVE55 FINAL`' " ; '' ''' � � �fessionsCoda�:' -. .,. .- -._- ..' - - . . ._. . PeEENT -8y-.-�_-... ------- � --.--- �--.. ._. .�. ... - euaoiric \•�` � :.'t-.�:•::t_,. , .1• ..i::. I, os owner of the property, or my employees with ADORESS � ' � � wages os tFeir�sole compensat�on,wi;l do the work and � - - - --._ •. _ . .....--- _� , --t��:,��' . . ,�-,`�, P P Y, y ( y " �- - -- -----�- - �9.� ... � ihe structure Is not intended or offered for sale Section ����TY ' � �".'� -� 7044,BusinessandProfessionsCode. �� � - MOVING -- -- ---- -- - 7EL:� �- - - --- r�e e e-��----� '., I,as owner of the ro erf am exdusivel coNratlin CONTRAGTOR NO. : ' . % ! � _❑.-�wifh litensed roMractors to mnstruct the pro�e[t($eo-"'--- --�--�-�""" -'�---'......_......_._..__"_.. _...._'."'_� ...`__ _..'.'-__. ______._.____ _.__.•_.r'^V p Q O O__i lion 7044,Business and ProFe:sions Code). aDDRE55 • , - REOUIRED . _IOIAI SEiBACK FR lvt._ XI T.. -:;) ' J,j`-.''.;'J i " -��--��--��--�CONSTRUCTIONIENDING�AGENCY �--�-'-�- �- �SETBACK YARD' HWY- � PROP.LINE WIDTH -�'�-�'-;--�_��-'�-/-� - �-- - ''-�''v��O.QO�.• I here6y atfirm that there is a mnstroction�ending agency for PRONi � � ,�'��ty-�, `� ; �.c'�;,i � ' '�8' ' � , >i -�ha performonce o(�he work for which rhie pe�mit ie-issued --�'-- � P.i.- �-� - -- ' . ._... .. ... _----- '-- -' ._...._..__..- -,_ ._!''_. .� "'_ _..- .-._.�$,G-�-� -(]_�. : ($ec.3097,Civ.C.). SIDE � r „ �'C � ._..'_... _ . P.L. - . ' ' , . : lender's Nome�'OIlt]S1PS1�. u�.lIY)1S _-_. __._'_ \_ '..__ ___ i rY __ .--•- _;— ',.?,j1 �+-� L � ,., _ _-...,� . . . IDMA Ref.N` \ ti' �. ' �� ,-.,. ,,, .,�i - - � 231 S: I�aSa11e:CYL1CdQ0 IL . . P.G.Fee E - -= Permit Fea--379.50._._.... : � w I. ._.... --- ._- -; Lender's Address � ,� '" • � •:, I.certii Ihal�have read fhis a lication and stme�r,a�6�693_ 10.5�__._.__ � � �"�"'� "�' ' � Y PP '__.._' _.._".9�._�_ _..�__.'__...'_ Toro1F eFea'_-_. __'_.__' _IDMAPemNN- _ __ _ . _ .. . . ..... ... . above informalion' cortecf.I a ree lo com I wifh all Coun _.....__. _ _. .. ..�. .. .. ...._.! •:''�'., 9 PY �Y Invavi tionFee _ � ordinances and te laws relating_ro boilding constrvction, � and hereby ize representotives of�his Co�nty to enter opon tha a v e ' ned property for inspetlion p rposes. � • � _._ . _. _ _ . _. .. ' _._ _ . _ .IDP7�1: $75--- �5$35-.,.__ _.. . . -- - --- ._...._...... _._._.. ---- ----- - g � � ` SEE REVER3E FOR E%PLANATORY LANGUAGE i " � . - SignmuraofApplimnlorAgenf. -_ -_. .D�e_ '._._ ,_. . __.._.._. . ._._..___"._...___._" "'_. __.. ....!__'_.'..____'._ ...'._._._ .... __' ... .... .� .'. ' __._..__._._.�pi rn T (")= r r m T f/� T r � � (/� ^�_ "�• ^�' _il' __' '"" _ '"_ ' '_. Z '.,� . > > O O � � � O O � 1D�n � � p� tD� W: �D 'p' � � � �� t tD o � N S �\ � 3 . � 7 �� . � 0 7 n 7�� O� a � O ; . o I � �o � � o � � o � o D m o �o � � m; � �� s �� ! I ' Qu Z K �< j � n"� � '7 : vo n' � T1 'p :(1 � � 0 0 3 � o o � N w I o � ,°o �.'Ho� o.,'o ° � v y � � � H � o o _ o o � o � :. 'o�o -- m ° '- ��,. � e a � o a N 3 � co _ » 3 'O .<�_" o ; . � � v� "'`= - ' _ � �� c� , r. � i• j � ... . ' f _ .�. � i. N �-- °" ' ! ' : � � N O � . ' - ' r • • - - ' ' 2 tv K� ° . � N � �' O 1 1 -' �^'� < ��- I O ' � �" • _ � 'i �\ � A ,. 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