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1056A 1057A (5)
� . , . , _.."'-, ..._._..'.. ...._. ....__-.__._---.'_._. .._..-.--'._----_.-.'._.-- "-..._.,_._. .--'.;.,..... -' ' i I,here6'�o ORKERS'COMPENSATION DECLARATION �� .-.., :.. -•.-^�:-' � ...- ,•. r�.-._.-....... .. ...---...-..--- '� � .' . jy . . . .. � ,. .. -. . • . ,.. . ,. .. .___.r_._._._......-. � y ffirm that I have a cerrificme�of consent to self � � � ��� ; �ns�.�,ora2erfificateofWorkers'Compensa�ion��=�,a��e, APPLICATION ��FOR��BUILDING �PERMIT � or o ceitified copy thereof�See:3800,�lab.C.) � ��: . . -..___..__..__ .. . - . - - . -._- . - _-� ._ . .. ---. - -- . . . _. ; Poli No. 7����5- a 04' Nationw].de __ __ 60 3 � �OUNTY OF LOS ANGELES ; BUILDING�AND SAFETY�- .� _..E-: � � � � 'BUILDING ' � � � ��- - ! � Certified mpy is hereby furnished: ,�. � ' � FOR APPLICANT TO FILL IN ADDRE55 I Cerlified copy is filed wifh tha counly building�inspea -�" BURDING Dote�'_G�I.9 HF) .q P . . 1 �., � `, ..;� , _....._ ADDRE55 Dlffifb. g��e�od Dri91765. . .! I � I " � � lion de rlment. . � � p I�canr� ANDEN�GRDUP aTv zir ior>.un Dia[T�pl'1d Bar i '�� CERTIFICATE OF EXEMPTION FROM WORKERS'-' �� - � - � - - -� - -- NO.OF BtDGS:---� ��- ---�--�. NENREST._-H1 h�Krob. & Gold � � • � �COMPENSATION INSURANCE� . - SRE OF l0T NOW ON LOT � CROSS ST. •g_ �-�11KJS --'"` -� (This section need nol be'tompleted if the•permi�Is for one -- - -.._._. �. . . � a5SE550R,.,, --�� �� � --- ��• �- . hundred dollars(E100)o�less.) ,,. , TRACT - BLOCK t0 MAP e00K' � " �'� � PAGE' PARCEL , ' I certify(hat'. .� .�. . �. . . .., . . --� - _---- TEL. Mqp �. .. . . ' _'� U 20NE in the pe�formonce of the work for whith Ihis OWNER�- - NO. _ _/ � �3��j c� , ;r pe�mit is issoed,I shall nm employ any person in any manner .P Q.$pX 3329_._ _ � � s�EaA� - -�� .. - . .. .._. . .. _ � d � - ADDRESS • ' -- - �--- - --� --�- (/V'l7 CONOITIONS ' � � „ O �so os to become sob'ett to tha Workeri Compensotion Laws. G20UP TYPE. I ., � FiRE PROCESSED B , e 'A� licant" ..� � � „. � , TICE i0 APPIICANT:Pf af�e �. ,� . ...• .�� � ' "'. CITY_". COV1Ik�_.__ ... ._ ZIP.J�.7ZZ __ ...-� -'- '.._.. ._. _ .. _ ._.__ j� � r making'Ihis Cerfificafe of ARCHITEROR �Ve Szany AIA TE�•445-4Q73 . o�sTa�cr . . v..: � ENGWEER NO. -� ' mplion; you should bemme sub�ecf-lo-the Workers','���-' ' CONS � �ZONE . . ,; I Compensotlon provisions of�he Labor Code,yov most forlh- poDrtE55 314�N. F]YSt� Ax'CadiB.91006 ' .__�D,___ �j_ �._ � .a : wiih comply with svth provisions or this pe�mit�shall be .— . � ��- -- "� �"�- ' �-' � �✓� ' deemed revoked. .�, „�; � � � �� � TE�� STATISTICAI ClASSIFl�ATION ' APT. CONDO. . Z '� ' �" �� •�• '� COMRACTOR NO. : �� � ��L, . . . .. . .___ -;- UCENSEDCONTRACTORSDECIARATION . •� �- --- -----.-- - - .. . . . _ __._i�� _._. . ClH55N0.� DWelIi�UNITS� ,� • 1 hereby ofiirm fhat I am licensed under provisions of Chapter 9 ADDRE55 NO. ��R�P (rommenting with Section 7000)of Division 3 of Ihe Business and ____ ____._. _,.�� _ _ ' . � • � _ _.. _. . _. .... . ._ . . C.. . � 37d my license is in full force and effect. CITY ' C1A55 B ' -BK - �'�- � - �� -� VAIIDATION ---""-- ' PrafessionsCode,an ;, . SQ FT. NO OF NO.OF _ CHECK , , ' . , �,^� Ltcense Numfier 1580' �' � �'�;�;eio:: � ''"'' � - s¢e 2375�-STORIES�� �---� FAMILIES 1-�-- �-�ONE , •��,..,�,���., ;�� .,.� ! . . � � � � 1''1 VALUAT ON � Co�aocio� �I.� ��NDII�I GF�UPDoIe F1�I.J�S6 __'_ pE5CT2�PfIONOFWORK • ' NEW-- }G S 87,680 ; - _ . � � �1 D 56 A , - , ; ,. ❑I am exempr under Sec. ---_ ._.__._.Gd�dCJ2 674 SF -----._. _. . aDDR_ O ' I - --�� � _°2�� ' � � � . .... . ; :�,. ... � B.BP.C.for fhi5 reosOn . ._. REPAIR_❑ s -- . . ... '. "', - "'; - � -� •3 3 4,6 9 - � � -............. _ . . ._ Dote:..... ��� uSEOP � • I ,. - . .._ EXISTING BLDG. DEMOL ❑ __.. __. _�.e o J 3�4 6 g c=i ' � --�-�Signoture . .-..- ' - - -.. .. .. . .' . APPLICANT TEL. FIN� �; - � r5 , OWNER-BUIL�ER DECLARATION PRINT �� ANDIN GA7UP NO. _. DAS� �� � ,�'.;,I�'_� O L.Z 2`S�__� _ ::. ____ . . . � n,. �-' ' -1 _�I heraby a(firm�hat I om e:empt from�he Contractor's lice.ise -��-�� AS E3YJOV2��-- "'���" �'� � � " � . ,- ..� � 8�ri for Ihe following reason(Section 7031.5,Business and ADDRE55 flNAI'� � - ^ ! � -" � - ; � tesstons Code):.. _ _ .-------.,_..- ----...__-_ �-�- vee Ni OY - - � � - - -- - -- -� - ; BUILDING ' .. .. .. ,� IW as owner of fhe property, or my employees wilh ADDRE55 � �" � . _ . - ogesoslheirsolecompensalion,willdofhewbrknnd � -- - - -- " : - - � � . tha structure is not infended or offered for sale(Section IOCAIiiv ; . , , ' �1057A "- 7044.Business ond Professions Code). .--.. --.-- ----- MOV�NG--- - --'. ..... .-.- .. .......TEL.-.... -... _.. ,�- --..- -. -- . . . - - � -� --- � - ' . . � I,as owner of Iha properfy,am extlusively tontrotting COMRACfOR nlp. � �� � � e � � . . - with licensed contractars to construct the project(Seo- ' ... _.._.� . -.-'--- -� -- - - � ---' - . . ... -------' � -- - �. .-._... �_.._ ... . ---.-_ ' tion 7044,0usiness and Professions Code). ADDRE55 � j � •t�8 9.0 0 -�� _.__ _ REQUIRED.. . IOIAl5E7BAIXFR M_ .. %I i.. .......... ....... ._ . ._ ...7..,. . _ �--—CONSTRUCT�ON-LEND�NG AGENCY----'- --- `" ' �$ET BACK 'YARD �Hv'n- pROP.lWE wIDTM � ' � � '-- �� I hereby afiirm Ihat there is a tonslruttion lending agency for FRONT � ' -;'` '� � � ���9�Q�i''' � -rhe performonca o(Iha work for which Ihis permit is issued ,--' P.L.-----. ..... .-.-------...._.. _ : _..-----'------- ....n�:' ! . . ._ r� - _; , ( Cont�.nental Illirois -— ��;•.,�-`! �b .. Lende"�Nam�e C SIDE •..._ _" _ ___.- ' IDMA Ref.N '= , n,`P \ `(, . O e 2�`. . ...-, ; Lender's Address�231. S. Ld.Sd�.�.2iCk71Cdq0 IL �- v.e:F��s 3�� 69 . . ve�mc�pea --- �� : . �. -. ,;��..�� ; Y PP -. ... . .. ---� -. .. Issuanm Fea--- �' - .L�MA P/C R..-_. . �-...��� � � � .. .- 1 _I.certif that I.hava read this o Ilmtion and state ihat.thLO693 10.5� '_ � � . . __ _ obove informall correct.�agree to comply wilh all Co�nty Investiga�ion Fee ' � � ordinances o la laws relating fo_building mnslruction, . _ _ _,__ _. _ _ _- - Tmol Fee�--- 459.00.._.__� ' ''� � � IDMA Perm.M -- ... .• ' and hereb o rize representa�ives of this Counly�o enrer -�"-� ` -��- ��-""--�-�' �� � "" '"' upon rh -m ' ned propeiry for inspection parposes. _ � , ; � — - - -- __...... .. LDMA_—_ $75 , 35 _ . _ - - ' — ----.. .. . . �� SEE REVERSE POR EXVlANA70RY LANGU�GE : _ _ ___ _ '. _. .--. i __' -_-Signm�re o1 pplimnl or Agen� . . tt_' _'- _'__' '__ ----__'_'_"_'. ...___' .. . . �-... . . ..""'__'"'_'_ _ ._. ...._.i._ . ...__ . _.. . 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