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1131A 1132A
�WORKERS'COMPENSATION' .. �. , ._._.. ..�-'.......__�._....__.�.__�_..._..._�....__�..."'- u .,_ ..__ . . . ___�_._.._ ����e:er offirmP�ot I hav�o�e,,,f°E``"R"T'°" qpp�-jCAT10N—FO�R�-BU,ILDI�NG- PE� . _ . ._ - . icate of,Con�enf ro self -'"�� insure,or a certiticate of Workers'Compensafion Insurance, - � �or a ceitified co Ihereof Set:3800.La6.G -'._ .-.- ....---- ----. _ ._ . �. ._.. _._._' . ..'. • . � RMIT � ,.:,.. . .., _ . -�--- - .._: `��C0�5-279-0A0 4o�Nationwi.de 35/A COUNTY OP LOS ANGELES � BUILDING AND SAFETY -• Poli . . . .---. ! ..._._ . . _ . _ _ : . . .___ . . � Certified copy is hareby furnished. , � FOR APPIICANT TO FILL IN i BURDING � ADDRE55 865 N. Feather4Aod Drive erfified'topy is filed wi�hlhe county butlding Mspeo- ' "" gUiLDiNG � ..Rondeportmenli.� ' ' ���"��.� . . '� .:�� ADDRESS 865 N. FeatherTn�Ocl DriVe � � ' i � ' � �., �..� .._ . ,; � . . ,.:�.,.. � . � � . '. . ' " _' _' '_'_ _" ._". .__.__. _ _ � oore 6-19-86 qPP��cant•�� AbIDII�1 GRDUP arv ' zia i�,iin. DiclmDnd BaL' , ; '� CER7IFICATE OF EXEMPiION FROM WORKERS'� � -" - --- -- --- - �-� --- �NO.�OF BLDGS:�- �---�---- NEpRESi. � _ � � �� "' • COMPENSATION INSURANCE-��•`�'•;, • �• SRE OF l0T NOW ON LOT , CROSS ST.Hl Il KTIOF�YSo GOIC12I1 SPrlIX�S ' - (This iection need no�be mmple�ed if Ihe permit is for ona - - - ���- �-��-3S']6]."- -------- --- -- �- . ---5]r. � ASSESSOR._7 ,� �-�� --.-� ��-- I� . � .hundred dollars(5100)or less.) , , . . TRA - Bi«K I�T- - MAp BOOK' � � �il � PAGE PARCEI � .... , � .. .... . .. iEL. : ___. . owNea-'Ii-IE ADIDIN GRDLTP-- n,o.967-9541 u�ON� MAP I certify thal tn iha periormonte of ihe work�for which�this MO. ; ���` � � permi�is issued,I shall nof employ ony person in ony manner P.D.BOX 3329 � - � � SVECiaL - ---�------ _. . . .. _� } so'as"�o become subject to tha Workers'Compensation Laws. - -� - --�"-- -"-' � ' � a .....�. , . , �_., - .,. , . . A� � ;0 RE55 -... .. .. ... CONDITI NS � . ., � ; — Covina z�P.91722 - - ; ---' �v :_._ _. � �e� � - � .qPPlicanl' ... . � .. ._ . CiTY -.-_' . - - .- .. . �: IOC , TICE TO APPUCANT; If, ofler makin fhis�Certifitote of ARCHITECT OR TE�• '�, OISTRICT,_,GROUP, TVPE ._ f FIRE PROCESSED BY �� � 9 ENGINEER Dave S AIA r,o.445-4073 � - emptlon, you should become sub�ecf fo the Workers' -- . CO . � �Z ' ' Compensation provisions of tha labor Code,you most forth• ADDRE55 �3�"4 N. F]SSt� Arcaciia.91006 i �� `-� q� ' �,W . ..____.... .. rl../V..._ . .__ . ..._ . d with tomply-with'suth provlsions or Ihis permil shall be" �y deamed revoked:.•. . • � CON7RACfOR �� ��� � NEQ STATISTICAL QASSiFICATION AVT. CONDO. �- Z . , , �.... � i , LICENSED CONTRACTORS DECLARATION�- ��� ���� ' -��--` -� --�----` - � - -- ' -�� -� -- � -._ " '-" - '- �-" � - --'- liC: - .. . MSS NO. �WEIL.UNITS 1 hereby affirm Iha1 I om licensed under provisions of Chaprer 9 ADDaESS As above No.371580 ' (cnmmencing with$etlion 7000)of Divisio0 3 of 1he 8utiness and SEWER MAP � i ., . � . _'. Professions Code,ond my Ikense is in foll force ond effect. CIiY ��� � � ��� � Q�.455 B -- — ----�--- -- �� ..•.� . . . .,. , .. .,.,. . ' . � BK. PG, j� �i 'VAUOATION" l�tens'e Nuinber 37�.$HO '".`- �Lic Class B• ' SOFFT.1S3I_'-STORI�E$ ._..-..__ F MI�ES--1__. __�O EK__ i : ,. . . ._ , ., . . vawanort... ; . , , ... ,. , �TAE �1DIDEDI'G�IE� `' 6�-9-HF) ----- DESCRIPTIONOF WORK-Sl le-faQRil -��--- NE'�'-.� ' "" � � � - � `-r� Coniiocior Date s 56,560 . ._ �,1-A--' . . . . ., Garage_441 SF noo � , 1 1 , =- - - I am eaempf vnder Sea ---- ----'-'� • -- -- -- -- - . ---.. ❑ ' �o • : •���_ - , •.� ' . ,., ....,:�., ALTER . - . B.&P.C.for this reason � ' '� ..._" REPA�R.❑ .s__. .. : __'_.�` ..__.1._._..__� �2�9.1 9� '"; _ .._ .__. _..__ - _ _- ...Dofe: . �.._ . „� USEOF , E%ISTING BLDG. � ❑ . . ._.... _- __. __ • DEMO _ . .Signalore '.•'__'______..._ ..-.- .. � . APPLFRI TTZHE AI�IDIN GR�TJP NO. FINAL 1 h J ,� c� OWNER-BUILDER DECIARATION _- ,, 'DATE..1��-�i�--.._.i, _..-.'-.---•.-Q�:.�- - �a79=' , � IherebyafFirmthallomexemptfromtheConlractor'sLicansa � � -�� � � � � e- --" ----�-�- '� """"�"-'� . -2 �6'---- . .Law for iha following'reaso�"(Secllon 7031.5,Bu5ine55 and ADDRE55 FINAL�� �t"�' � � • ' � ' �fessiOnS COdB�. .._._...."" ' """'_"""' ..." " PRESENT . ' ' '_ .. .. ,.... ' . _9Y 1 BUILDING - 'l,;, �- . �... . �-, ,. . I, as owner of the property, or my employees wilh aDDRE55 "�'• •'''• • -�-�'r�'�-• � , IOCAIITV 1 . �, . _'".___ '.____. ._... .. .. _'_. ._ ' s'' '. 044!Bosiness an PPrPf��°s coa0a a°`�°�e S tti n MOViNG....-.-'-.-_�. �r• . ...-�TEL.��. , ••:li ; 1 ' - -�. . '{',�,'2_�" ! -..- � .�- ._.__ ��._ .. _.. . . . -. '_'_.. .. ---- ..... ...:....----. .--� - - - -...._ . _ � I,os owner of fhe ro erl om exclusively[onfracting CONTRACTOR NO, i � �j. 1 • � �'�, ,:'j - with Iicensed tonMactors ro mnstrvct the project(Seo- -- -- ---- � --'-- - -- ------- --------� --'- ��, ---- ----- -� - ' "' - _.. tion 7044,Business ond Pro(essions Code). ADDRESS . ! _� � �.'`,4 9.5 0 ,. �--- � REQUIRED . ._.TOTAI SETBACK FROM %I _i .___ . . - �-� � -CONSTRUCTIONLENDINGAGENCY � - - " --- '� -�ienCK -� -YARD HWY- PROP.UNE WiDTM -�' -`-'--.... -. `.". : �-'-"-.^ . _^..T." �hereb affirm fhat there is a tonsiroction lendin a en for �""�w""- ," �,.°J l�`��J Q i3.' Y 9 9 �Y fRONT ''1��� -..... _�,�, I ' .. �i " ,'�1 �'S`:� . � � iha performance of the work for which this permit is issued -- --� -P,l.---� -- �- - .._-. .- _______.._ _ _._..� _. ___ _ . (_ _ �, � � (Sec.3097.Civ.C.)� PIDE ' _.._. .,, . y�'.,-- .•;�"�".'-� I n����G.".�G - i . .-COAtlri2T1� I�.I.lI]OlS � - ` -- ------ -'.--.._ . --� � J _��, - --- --- -- ---- � � ,.,i � _.n:y lender's Name _ ..;,``, -- --. _ _. . ' ' . 0� CdCjO I LDMA Rei.N�,. - . . _ _ . .. . P.C.FeeE...23g.�.9 _._.._. PermirPee ._._'__ ' _�_.' ' --Lender's Address- ... Gl1�93 -339.�0 .. . ____ _.. .-__`-i I.terti that I have read this a Iicatton and slote thot.the '� fY PP '..'_'_.' .___'_._'"_.'..._�. .__�Issvance Fee-IO.50-- iorou we�._.._ . above information i rceU.I agree to comply wHh all Counry invesuganon Fee 349,5� ' ' � ,ordinances and at lows relating to building construction, � ' � • � '_." " _. __ "."'__..____�— . TorolFee ._. . _'_ ..'_ .. __'_ tDMAPerm.M--.._......_.__.....' _'._......... ......_.... ..'. �-' and hereby or'e represenro�ives of�his Couny to enter � � -- �; �pon the ve e ' ned property for inspection posef. '_ _ ._ '_ .. ._'. _ .__ . .-__.. _._— ' (/� , �`'J _..... C . . Q �_"' . SE�FIR VEkBE FORTX�ANAiORY IANGl1AGE Y35 . . �.._''__.'___..._ . _ '' _.'. _._ ..... ._ _ ._.. .--. . -.......-SigewturoelAppicon�orAgent - ' � • _ __ " '___'_"__'_ "___' '_'Q� _..._...__ Da�e'.' ""'.__'.'__'___ '-"._'__. _ .. � � � , .. . _ _, , � o ...• �+ S. .'L.. �` "V v_ ._L�- -Gl- m o � N -i+(p N. p m O lp � fD r � o � n n � O'. � '� S n � m � N o �� � � ^ O �..�-•� �o �O � � '� Y .. C 9� ,.�T n x o ? ; ° °v � p°. y - � �� y�� �� q 3 a •� ,°' o =� °c T : �n m o ^� '9 � ov_ � :.° `' m o "� ' ,�1 0 .. n �p n � T A� � O Qc� 0 (D O tNi v0 , i � � � - M . j ' Z x �f v� ��.+ -C �p � r�- .'�.i�! � ? � 'C S+iO C N Q p c p �j � r � �6 � � � a ~ �L �• � ' ' �.t' ' .. Z � fD O � ••', N .. a j � 0. . � r Z -i �o ..` li ,,- ,� � > Y � o � _ , ! '" .°o a° � .`�,� N � ° . . . I x a � ,o a Z , C C - a .�, e '� , , , . ' � � ' �' ~� � • ' � �� - ` , �.: o�. s• `,: � Y . ' °', . , � . I J o� o. � N i . . ' i 1 �i . �e i' � " � m, . : �¢, • a � - .�. 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