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HomeMy WebLinkAbout1066A 1067A (5) . . . .. ..... ..: .. ...... ..:. . ..____ :_------------- - -------....___ _ ._. r . . - --..._ --_...__... _ , WdRKERS'COMPENSATION DECLARATION �.ltC•�.;;,.•';,)':),. � . . . .- _.� _. ._�......�..�-�:;�;'-'.'.�....',`� . ... �� , . . . . . , - � � ...._�__.... ._..."-' _ ' ' _ ' - 1'herebytff�r,pi,ho,I hove-o certifitate of,content to,e�f . qpp����CATION��-F4R �BUI�LDING PERMIT���-�� � insur�,o�o certificate of Workers'Compensation Insurance, � or�a cerlified copy Ihereof(Sec.3800:lob.C.).. •.. . . . . - . .. ... . .__... .._._.._.. _. . . __ . . • ._. _ . ... _. Po'��t�005^279=0(�Oo���3tionwide "`' ' 30/A COUNTY OF LOS ANGELES ', BUILDING AND SAFETY , . ���.;;,; �-.CeNified copy Is hereby fumished.� �� � , , , .i FOR APPUCANT TO FILL IN eunoiN� � � ' �' ' ' � ' ADDRESS 873 N. Feathei��od Drive _; . Cerfified copy is filed.�i�h r6e�ounfy bailding inspeb �'-'"- BUIIDING � '�tiondepartment:' ..- ..� �.��,- . ,.. ADDRESS 873 N. Featheswood Drive j . • .. , ,:..,. �� .. ... . . � � �_ �.. ..,:.�..;.��.,.. , �. ... � , . . . _ ___ . . . ... . � i Date 6-19-86 Applicant��+�DIN G� UTY � 1�p ZIP IOCAIITY Dl�� � I � ! �� ' CERTIFICATE OF EXEMPTION FROM�WORKERS" �� � ---" ------- --��-' � �---- -�'-----N�•OF BL�GS.--�- ------ � NEAREST__H1C) �KllO -&� 2I1- pY'1TKjS-�- �--� -� �' `- • 'COMPENSATION INSURANCE �� � SIZE OF LOT NOw ON LOT CROSS 5T. . (This settion need nbt be compleled if the permit is for ona --- '- -.._..-- 5'�6� - - .--... ...-_ .,.. _. .. z... ._ , ASSESSOR,,., .--. ;. -- . .,, .. . i h�ndred dollars(5100)or less.) , . TRA BLOCK MP,P BOOK•'���' PAGE PARCEL _,r ' ......... - .. iEL � .."_ U ZONE MAP � � Pcertermit is issued,I shall nol em lo an �erso Pin on ma�h15 OWNER'- �� " '-'NO: '' ' NO � �3 ,� ... '} if ihal in Ihe erformanPce�f�t�P work for�hich��er - � SPECIAL� � �- � � - . -�_. _ ._... .� .__._. - y � .Y .� P .. . ._ .__ ADDRE55._. .. . ."'__'... . __"_' ..._. �S'+�,' so as�to become sub'ect to the Workers'Com ensotion Laws. ��� �V . ..... . .. . ...� . .� - .; .,- � ,,... , CONDITIONS � . . , • ,� CITY_.._�vl�__ ___-_____ _ZIP ._.91722 .._. '."' "'._ .. ._ ..__. . . .,.. .._ .... _. _ . e � ' Applicant ' �..,, . .. . . . . ... . _ � '� _.. +OC ARCHITECT OR TFI. O �TICE TO APPIICAN7: If;oifer making ihis Certificate of ENGINEER Dave Szan � NO. �44S4O73 -DISTRICT__ GROUP IYPE fiRE _PROCESSEDBY_. �F I . ._._.. . . tJ Eaemp�ion,�•yoo should become•svbjeU�fo-the Workers' -- - CONS7.: ZON � Gempensatlen previsiens e(�he Lobor Code,you musi fbnh- ADD"ESS 31'4�N. F1.�S't� AY'Cadia.91006 _ f� _ � ' 'a with comply wiih.such provisions or this permit shall 6e -_---- R �� � ' � -�v� deemed revoked. ..� � TE�� : STATISTICAL QASSIFICJlT10N APT, ONOp:� 'Z -., .. .. �: .c�.� .•�: . ..'. CONTRAROR �T�VDEN G� �,�p, � � '� � � . . .._. .._ ..._' ._. �G abo�e LIC. __ _ � � LICENSED CONTRACTORS DECLARATION � ',� -� �� -�� �-�� ��-----�---� � - � � �-��- dA53�N0. DWE�L UNITS� I hereby offirm ihat I am licensed under provisions of Choprer 9 ADDRESS No.371580 i (commencing with Sec�ion 70U0)of Division 3 of ihe Business ond _.. ___._„__���__B SEWER MAP � �-� � � , � ' _ -� -----....... . Professions Code,ond my litensa is in full forte and effett. �iiy � CLqSS -�-•- - -- - - � �— - '� �- �'VALIDATION"�"'" -,., , . . . . . . ... - , ..�. • :� . �. 5p.FT. NO.OF NO._OF_ CHECK ', '. ' _ � BK. PG. LicenseNumber �371SHO � '�� ���:�Closs ' $�� SIZE� ��786-' STORIES�� ���-�FAMILIES �1 � � ONE � � , , - � • . . . . . ...° '. �� . . VALUATION ' � � � - ' ��.'�'� ��'Ci� 6�I9�Hf -_'- DESCRIPTION OF WORK .r71. le fami.l �--.-.. "Ew.... �. . .; . .. , ..... ........� �1 0 Q b p.... .� Conrracior Da�e' f 65,320 � Garage 445 SF ❑ � - t� 21 �1 am exempt under Set. .._ . ___..._._ . ' _._. .. _.._. AD� ❑ � � �� : i . - . n.� ALTFR � � . ' - i � , c: : ,. 8.8P.C.for lhis reason . _ REPAIR..� ..S-`---"-- -"..� .- -.'' ..�'_...'-�..•2 6�6 5 ��- '_' ' "--- :�. .'. USEOF � . .. .. .. __Date:"". .. , . ,-� .-.. _.. EX�STING BLDG. DEMOL _-.-- - .._o r C 6 u 6 S ti-� ... .Sfgnature�� . .__... .._ _ . ._'-_.' _-.. A�PRINi''Ii� AI�IDIN GFd�UP TNO. DA EL 1 OWNER-BUII�ER DECIARATION .-- � ' ---_.._- ' __-_ ..._ . �ig .._ . ._.. . D�2 2-_S 6__:.' ..1 hereby affirm thal I om exempt from the Contractor's License - � Ve'" ��" ' " "-�" � low for ihe following reason�.�5ection 7031.5,Business and aDDRESS FINAL � -- "'�' � ' ' - . ._... ."""__..._ _ _' '_ . _ . .. .. tessions Code): '__" ..'.'___ - -�- � pRe eNr BY - � . - . .. - - . ' � BU4DING , � , , � � , � I, as owner of the property, or my employees with � qooRE55 �- � t � � ' wages ns fheir dole campen'salion,will do Ihe work and "' - . ... . . - - � - - - ��----� ---- � . -- � � �F+7 r�:".. the slrutfure is nof inlended or offered for sole(Seclion ����tt � . � � i - 7044,BosinessandProfessionsCode).-- ' - ��' '�--- MOVING- . .- ..' ' " ' --' '._ ..._. _�l:__... .'_'. .__� .___. . . ._..._... __.__ __'_ . . .. �e• • • • � _ � I,os owner of the prvperly,am exdusivelPconiro;fing _ --- AD QU R DOR yqRD� HWY � 10TA1 SETBACOK M XI i.� � �3 9 a 0�.0 y, - with licensed tomradors ro tonstruct the ro'ect Seo- - -��---�----- -- �-� -- -� � � - tion 7044,Basiness and Professions Code). . � �� - ,• ' ` ' .�, ;•�;,...-'.:Ci � � , �-""'"`� CONSTRUCTIONLENDINGAGENCY SEIBACK PROP.LINE WIDTH --�- � �- -- �-�����- � � � --� � -. I hereby aifirm Ihat thera is a conshuUion lending agency for feONl ''�--- _\�� ' � , .. �..� . --the periormonte of the work for whith this permi�is issued --��-- --p.l.. --.- .---'...... ..'-' - � '-----... .� ..... . --'-..: ._ . '-�'-- .`•:�-...�-:'=�-' -- ---. -- --� -- - - o$2 2 8'b: (Sec.3097,Civ.C.). SIDE ^ - � ___..... . .COrit1T1P11�_ I�.I.1TY�1S_. ...._ _.___ P.L. _"_'. -', :..�.�,.(�:t', "1�. .:�1.' .. _.._ ..._. .. - -- TY lender's Name � ' � � 379.5� LDMA Ref.N ,'• ti !,. ��,• . -- - - 231 S:� LaSa1le,Chicago II, P.c.F«s ••-. 268.65 Perm�1 Fee - - - � • ' , .' _ .:, . Lendei s Address � � . - ��,� I certify ihat I have read this applicolion and stote fhot th 0693 _ _ -.-. Issuance Fea- �-�.5�______ .�p/,Ap p/C M.-� .--.-- � .._. . ..._._. .. ..'_ '_'_"' __.......:... . . ._ __' ' _ obova information' conect.1 agree to comply with all Couny invesfigaiion Fee � _ __ord�nonces on e laws relming to building constrocNon, -.- - Toiol Fee-390.��-----� -ipMq perm:M - -� � -� � - . __�--- -------------- ... .. and hereby t ize represenrotives of this County to enter � � � � �� - � � �� � upon the o e ned property lor inspect!io/n p rposes. . ' _ .... - -d � 6 -IDNII1-' '.$75 - .. . .—$35 --. _ --- -- -- --- -.._...--�- -�- SEE REVERSE FOR EXPLANATORY LANGUAGE � r . �C -Slgna�ureofApplimMorAgent -."--'_ Daie.- -' _'- " .__ '__. "__'_ " '_'_ .___"'_ _ .._"_ '. " '_- _"' . _ ' _ __ ._ __._ . . . ., !Qri ,a � ' ___ o ,o i' -� . . V- r'" . T- -_. .-L... C , . _ � O •^ ' �1 �_�. ^�- [0 O `� � �..'^ m a. o�; o. -o T ',n �� - a o o�io � m p,, � •� p .m Y .. lr' d n O .Ai^ �'� � � C �'• '�,� p •� il�O � P ✓� O p ,� O '� p'. 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