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1060A 1061A
_....__.._....._._._ __.� ._.__.�_ _.._----_.___.�_. .._. ...----._...._-------.__...____--._._.... _._--. .__._.__.__.. WORKERS'COMPENSATION�ECLARATION •' -•�� � �•� � � •,:-�,�,�;� -. . . . . . . ._ . .. �� �.:� . � . .;., ,. . . , .__._. � . . _. ... - �., : _ ...._.� ....-'--.'" .. --- ' . . . . _ . . : `I.fierel3y affirm ihat I have a certificole of tonsenl to self APPLICATI�C�N��F�OR�:�BUILDING� PERMIT� � insure,or a certificale of Workeri Compensoiion Insurance, 'or a ceirf�ed copy,�he:eof(Sec.se00;tob.C:� ' "' -"- � COUNTY OF LOS ANGELES BUILDING•AND SAFETY - ---- -. ,.. � ..�.:; , ..-: aoiin�005=279�����y Natiomaide 60/E (3 Car) ,-- - , - - - -' ' - Certified copy is hereby fumished.��:��,�'�^. � � BUnDiNG 0, FOR APPLICANT TO FILL IN AODRESS 849 N. FeatheYtaood DYive Certified copy is filed with the coVnly building inspeO "�--"- gURDING ' - � �'-tion'depar(rrienti � � �•• � •• � • qDDRE55 - ' ,. • . . . .� ,. .. � �r: ..,...' ,. �..� ..�,_ . .. s. .. ��.� . . . . . t : . . .. . _. ' I . , � .. . ..__' _ __ _ ._ _ .._" � � Dota�n 6-19-86 ��naa���a��'�E AbIDEN..Gf3�UP CiiY Dl"lI1DI]CZ Bc1L' 21p ' LOCAItTY D1clISb1XI Bc�L' ' , - ��' � �CERTIFICATEOPEXEA4PTIONFROMWORKERS' �� '• --- �-�---�--��-----���-------- NO:OFetDGS.- ---�� ---�����-- nIEAREST_._ 1CJ ��'•'� � -'`�''COMPENSATION INSURANCE � '� SIZE OF LOT NOW ON LOi CROSS 5T. . ' - � ���� � ' (This'sec�ion nead nat be tompie�ed if the permit is for one �-- -� � �------ � --� - ---- �--.-- _ .._.... ______ a55E550R --- - . -- a:,�- hundred dollars(5100)or.less.) , TRACT BLOCK LOT NO. ! MAP BOOK`�' '� PAGE. ' PARCFL , ' � , . •. . .• � . . ... . . .�-�. '. . OWNER-_- �IHF AIVDIN GF�.JUP ' '.{.A� USE 7,QN� MAP , _ 1 I certify�hat in th�e performance of Ihe work for which Ihis � -� jr� n10. ' � permil is issued,1 shall not employany person in ony manner P.�.Box 3329 : -[�Y�� so�ani --- . �- �- � ---�-.�-... - - .�a � • . . .. ADDRESS.. - _-____'..'_ __.__ _ '___"• ZD1'?� CONDITIONS � I I so as to 6ecome svbjett to the Workers Compensalion laws. ,Q 'TICE�TO APPL�CANT: �If,liafter Pnoking this Certificale of .� cirr - - ------ -21P �9445�4073� ��STRiCT---GROUP•ttPE_, . ..r ..� .. - • ...•.....:.... ;� . . .. •: . . __ �'AV11Y'i PP � ARCHI7ECT OR TE ENGINEER DaVA S �IA FIRE _ _ .PROCESSED BV.._ '0�- I mprion, you should become subject�to'iha Workers' '-��- CONS • � -Z Compensalion provisions of tha Labor''Code,yoo musf fo�th• � ADDUESS 314 N. First� Arcadia.9 006 , �� �'L � �/ -. /n.�-- � ,tVy wilh comply with svch provisions or this ermit shall be _ .AS V@ ---- �� ��LIC:-� - � -��! `, / �a deemed revoked.;,.� • ,_ , STATISTICAL CU1551FICATION ! � APT. CONDO.� � i Z IICENSEDCONTRACTOR50ECtARAT10N,�.�� CONTRnaOR �tA55ni0.--���� DwELL� �� � -� � - - - � - .... �I4�. �`II�ELV CiI�UP No. ___ _ _ ____ .UNITS� I hereby offirm that 1 am licensed under provislons of Chopfer 9 A�DRESS NO. 371SHO � (commencing with Section 7000)of Division J of the Business and _..__ ��� B SEWER MAP � . � �� ., .,�.�,�,; . . -_ . .----- ,-'. .- � ------�- : . . Professions Code,and my limnse is in full force and eHett. CITY nqu -�-� --�-.-----.,-__._.._ _____' _ T� _____._ . � . . : ,, �, � . ...BK. PG. ; � ; DA ON � lice�'seNumlie�'371580 . ��a ClassB '" ' ' s°eFr. 2375-s ou°s -- - - F MIL�IES 1 - - CONE-: � .. ....'.... �.� O,�O A ' � � ..� :. `II�.' ANDIN�CI�UP �. f I9-HF) .....-. DESCRIPTIONOFWORKS� 12�f�ml� _'.._.__. NEyy_ � ._VAlUAT10N.._:._._�_.___;_ __._. ,_.. .__. _�.�..• •i'� �-; . . . . ADD s , , i ,' ,..�.., �' �: Co���o�ro, p .. Dotb. - _ _._._.._C-3L'dC32 F774 SF___'.._.""'__ REPAIR_❑ ' e<r3 A b � - 87 680 - : , --- ` 9 _.� I am exem t under Set. I- 3 3 G.S 9� , . 8.8P.C.for this reason s..---.--- --"- ''-_-� - • • � ' "' USE OF ' ' � � _._"'...,.. ._..._ _.._ _ _ .. Dafe: .__ � ERISTING BLDG. DENIOL O � I � '_._.'_Signalure "� ..._'... _.. .. . .� _�: : � _" AP7tPRl T7 `�� ��� � NO. FINAL �1 _'_ '.__'._ �i�'.Z 2 8 6 - OWNER.BWtDERDECIARATION � -- -.-�Jq.� . ...-'_�. ....__..1..._.'-'......_..-.".__" . . .__. _- � @ -. . ...........- --.-. '.- DATE .:� �-I he�e6y aifirm that I am exempt from�he Contmcror's Ucensa � �� - . , � . law for the foliowing reason(Seclion 7031.5,Business and A�DRE55 p�Nq����; r�.- � .::r.=••;•-', , �fessions CodeJ: .. . .. _.. .. �.-- �- �---�-• -- -- rae eN --�y' � --- �---` - - � , .,-- BUILDING t;;_ � 1, as owner af ihe property, or my employees with q�oRESS �-,� '��"�•-��• �-�'�!'• -�• - +•� • - i .' he structu eeis no1 n�endedor�offere�Ifor�sale(S cuon.._ _ `�Ra R-� - --�-- '----��--�--' - ---'�� - ' '-_-_, _��-��---��-�--- -- --� - �- - �-- T a.' ! _ ,.. 9 P �. � � -�"� nt�� � ,., --�---7044,8vsinessandProfessionsCode.�- MOVtNG��- TEL�.--- --- -------'.�-- - ---�- -�*-�-• ti�•.'��-�-+ � I,as owner of fha property,om ezclusrvely contract�ng CO RO NO. � , . .'.._ __'__ _.__._`._.__' ._'_'.........._.__....._._.... '_'_._'_.______'__ ._ ...._"'_'._ . . . I •4d9,00_. _ with licensed contracfors to construcl the•project(Sec-�"� " qDDeE55 ' ' ' tion 7044,Business and Professlons Code). �. „ � � � „ -. .. _ ._ REQIlIREO__ ..iOiALSE18ACK FROM.. XI T., _.._. O O v -'.___"'_'_"_..�.: . �CONSTRUCTION LEN�INCs AC>ENCY "- ' �� � SET BACK �YARD- HWY PROP.UNE WIDTH � `� -�-� ---" -'���-- ' I here6y oFfirm that the�e is a construction lending ogenty for FRONT ` � ' ��''����� ` °�G C 9. ,'--�,;. .�,t i;;s..;,.:.{t � 08.2�-8'b - �ha performance o(the work(or which this permif is issued � -- p.6: ---� --- - -- -- �- - --.---.-.. ..'-" �------�--'-- - - � ._....._. . _"_ -- - (Sec.3097,Civ.C.)• SiDE . � ���` ` , , . .. . ... ."_' _ ._._ .. ,.. .,'__...._'.__'.__-. -.'--. P.L r--•���.• , �.� ;��.y�•.\� ! Lender's Name C'nnti ttPni-BZ Ill]S1D'� . . . _ . _.....__.. .._��.�^..1 � . _"_._.. _._ ....'.__.. � . , -... .., , LDMA Ref.Tf + J : ...� �.'. .��: . , ' Pcmi1 Fee- ' Lender's Address 231 S• I'�Sd�'le�CYllClgO IL-- � P.C.-Fee s � - • 478.50----_-_ ' ��•`��.__:._.._ ._ . _ _ . I tertify.that I have.reod.lhis applicotion ond state thot�h 0693 .,_._.._. ._. ����o�Ce 10.rj�.__-. �._. . � ,-�: ;, - ,' Fee•- - L�MA P/C N- -�-- - ._,. ...._ .. obove informmion is correct.I agrea lo comply wi�h all County Invevigation Fee �� � � : � ..ordinances and te laws relating lo_buildinq consfruction, Tmal Fee-- �89.00-----: IDMA�Perm.M...---- -.-—�.__.-... .., _ '__ .._ __... . _ _. „'__._ __.'.. ' '- �; and hereby ize represenlatives of ihis Co�nty lo enter -"- - upon the o m 'oned properly for inspectio u�poses. , ' � -- - --------- e -_ __..__I�.._ _.. .-- $75 5 -.- -_ $3 __. -- -_ _- --- 6 (�� __. _-_ SEE REVERSE FOR EXPLANATORY LANGUAGF i � . j � . .SignalvreWApplicenlorAgenl -.._ . . 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