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HomeMy WebLinkAbout1129A 1130A 'tNORKER5'COMPENS � ._ _.'-`---_----._.._.._..__...._ _......._._�_.._--'...._ '.'- - insure;or a cert�fica�e of Work TION DECIARATION ... .,. ,...,..,. .. ..... ._. ._...._.. .. _-'..'.._.-_:---...-.'-.. .. _.. ._ .__ . � . . . ,_,� ..� . .. ..- . �.,. .. . . . , . . .. . ....._._,_...... _ . ' I hereby oifirm that I hove a��certif'icate oi consem ro self � � � � """-�" eri Compensation��=�,a��e, - APPLICATION�mF�R�,BUILDING���PERMIT - or a certified co ihereof Sec.7800�Lo6.G).' �.,,, ` ..- ._... . .. . .. . .._-_- .---.. _ .. , . 73F�005-2�9-0004• •Na�.om�nde 10/A COUNTY OF tOS ANGELES � BUILDING AND SAFETY - - �to. � -�company - .... . . . � Cerlified co is hereb furnished.�':s:� �• eVIIDING �� 0 pY Y FOR APPLICANT TO FlLL IN ADDRES$ 876 N. Feathe.n�Uod Drive � � ,Certified'topy�is iiled wi�h 1he county'building inspec- "�"��- BUILDING ; � 'tion depariment. �1 �; � ADDRE55 , � .,. . . . ..:.... . .:.:i�� .., ' • ... ._ . . , .. '. _ _ '. " _'_ Ddte ,.,..E'�.g'HEAPP�icant-,Tf�.ANDEN��GI�?UP arv Diamond Bax' . . . zir91765 �� iocp,urr Diatroxxl Bar -- : '�' �CERTIFICATE OF EXEMPTION FROM WORKERS'�-•��•�- �- � - - � �� - -� � � - NO.OF B�DGS. -- ���� � NEAREST_ 1 � . . . . _ ._ .. . - -:.. .: . �� � � ' � COMPENSATION INSURANCE -� .. SIZE OF LOT NOW ON LOT CRO55 ST. Hl Il K1YJU.Fi�GO�.CIEI3 T� S � (Th'is sec�iom need not be'comple�ed if tha permit f's�for one - TRaCT --35 BLOCK LOT N 2" ' - ASSESSOR . - � • ��--� -�r: ' hondred dollars�E700)or less.) n..i, ,_ , � NWP BOOK i DAGE: FARCEL�� - rE�. . ��,3y9 owNea - TI�AIv'DEN Gld�i.TP- No.967-9541-- u or,e r,wa I certiFy lhat in'1he perFormonce oi Ihe"work for�which lhis �� NO. � } permil is issued,I sholl nol employ any person in 6ny manner SPECIAL � -- �- •��- �. . . _.i 6. so os fo bemme subjed fo 1he Workers'Compensation Laws. �� - ADD - - --- - - CONDITIONS u , TICE�TO'APPLICANT:IfI'a(ter making this Certificafe of CIryRE� ��Ve C�' �l�y ZIP NO.445z4O73 � D15�� GROUP TYPE J FIRE PItOCE55ED BY�� �� � ARCHITECT � � m tion; � .__ FNGINEER ' p yoo should become�svb ech to�tha Workeri f A - CONST.� �`� ' ��ZOnIE W . Compensa�ion provisions oF tha Lobor Code,yoo mus�iortb- qoDRESS ' ' . L!7__. (/�'S_ _ �/�/ � 6. with comply with..sucb provisions or IhiS permil Sholl be -_ .. � � �� TE�, � � -"�� STATISTIV1l CU4551FICAT�ON AP�CONDO. .�Z deemed revoked:.:. ,•, , . � .,•..:.:,���'. COMRACTOR � �`roIN G1�� No. � �- . . . ., ' � , --. LICENSED CONTRACTORS DECLARATION . . �'�. . --. -___. .. _. . _. ... .__._. .__ . .. . ��C(A55-NO.-� DWECi.UNITS� � �� uc.- I hereby atfirm ihal I am licensed under p�ovisions of Chapler 9 ADDRE55 A$ a�{/Q r,o.371580 (commencing with Section 7000)of Division 3 bf ihe B�siness and SEWER MAP ' n �;i ProFessfons Code,end my Gcense fs fn full fo:ce ond effetl. �- - CtTv-... . .. .. �_ ...--�� -- �-��----..._�-Cv.55.. .-. .. - �BK...._� -_,. _- -...- --. ' ' , B ..�. � .. .. . �. .� . . . . ._,., - � " �371SHO.� �'� -�- • � '�- '$.: .__._, 50.FT. NO.OF NO.OF CHECK � �� - � - �� � VALIDATION , u licenseNUm6er " � Lic.Class SIZE--�-446"' $TORIES� ��� -�-� � FAM�llES��' ��� ��� ONE' �. ' �� � �. � ' .. . . . , vawnnoN . . ' _ � _.. I.�z 3 1..1.6 _ �i� ADIDIN GImUP :_-:. 6 19-86 DESCRIPTION OF WORK .S� �.@'fc'lITlll. NEW_..� ___ . Contmtto� Date �age - 470 SF noo � S 54,000 . � � _. _._._ 02��1,.1�6.�.' . �IamezemptunderSea • . ,. . . ---� -------'--- - ' - .. -'-__-..._. _._. ...__....❑ � . . . ..� �. • ,.., . .., AL7ER � , • 0�2�-II b � , B.BP.C.for Ihis reCSon � __. REPAIR � s .. ..--- �-----. -...... ' . . . _. , . ... _ __..._.. .... _ _" Dale: ' .. - , . USE OF ' '. EXISTING BLDG. DEMOI ❑ � . _ .. .... . . .. .. ; „ �� . . _.... APPlIG4NT TEt. ' � Signoture -----__.. . . ---� -- ��-� -- � ��j ('i�� FINAL OWNER-BUILDER DECLARATION PRINT NO. . DATE `�'L�� .-.' . . ! ,_.. .. . � ..._ ._ ___ .___. __ ._. .. . _-��� . - - ---.__ _. . _ 0p.. ._. .I hereby affirm that I am ezempt from tha Con�roctor's License p� �Ve � a . � '�w for Ihe following renson(Section 7031.5,Business ond ADDRE55 FINAL"� "'""" '� ' r,a ' " � . � , ' .. „ • e • o � . DIBSSIOrISCOdB�:.'_ ' ""__. __' "'""'_..._ .... ... .... PRE ENT ' 6y . ..._ '- . ': ' p BUItDING I •.�,.�i�D O� f, I, os owner of 1he property, or my employeea with ADDRE55 � - woges as Iheir sole compensalion,-will do ihe work and � - - � ' ' " � - � tha structure is nof infended or offered for sole(Secfion ��`��TY , , n.e- �_ ' .. 7044:Business and Professions Gode): --- .... . - MOViNG-- -.. ... . .... .. . .TEL.---�� _ . � . .5 J�E C) c�_.. ' - � . .__.. . .._. . - - ---. .. . .. . I,as owner of Iha property,am azdusively coniratting CONiRa.CiOR NO. � • � � ' ��2 2��6 .❑--with licensed contracton to'constract iha project(Sec- -_ .. .._.. ..' -- .- . .- .. ..' ---'-.- --- -- - --.--- -- -- - . .. - -. . . . . ' ' -.- - . . fion 7044,Business and Prafessions Code). ADDRE55 _ ,� , . .._ '�•1:',.1 .. REOUIRED .iO�AL SEi6ACK FkOM XI i. '�• � '.�' � f�� ' ' '" --CONSTRUCTION LEN�ING AGENCY- �-""- " -' -YARD Hwv� � --- � -� -� - � �---� - - -- -- . SET BACK PROP.UNE- W�OiH � I hereby aiiirm thot there is a cons�ruc�ion lending agency(or FRONT � ' '' � "" -Ihe perfonrwnta o(the work�for whith this permil is issued ----- -P.L -- - -.. - - - - � � -'-�-- ' '--- '.. .-..._.._ .. . --. . -'.-: .��_� .. _._. _ ._.....- -- ' (Sec.3097,Civ.C.). SiDe ' ' .. .. , � .--___- CAI1t1T1P11{'r'1�.-II.�.lIXJ1S v.l. '�' � . . ._._ .. .. . .. . '�' ; . ,' Lenders Name -------- ... . _ -, -.. .• , . .... . _. .. . .l .� .�� .� ; . , .,. . , ; - - ----231 S. IaSalle, Chieago IL . . P.c.F�e s 231.16= - �m��Fee--- 325.SO - IDMA Ref.N . . ; •.,. :: , i - Lender's Address - � � --����. ---�- � � �--� ' J cenify tha�I.have read.this opplicotlon and state thvt the 0693 _- _-_- . lesuo�ce Fee '. �� � ' -I.O. LDMA P/C N-.._ . , _.. . , � above inform n is conect.I agree lo tomply wilh all Counry i���siigotion Fee � � , ordinonce n State laws relating to_building mnslruc�ion, 336.00 --- -LDhV1 Perm.M � , � - -- -- - ��- ---__... -.__. .._ Tmo�Fae�--. . -' - .'-� ---'------. . _ . . . . ' � and her y ihor'e repiesenlatives of this Counly to enter s upon i v en�ioned prope.ry for inspection �rposes. � i ` - - --...- --- ---� - --- "--' '---- -. ._ ,.. ---.. . _...._ _ ._. _ .. . , . . . _ _... _ , � , � � SEE REVERSE FOR F)(VIANATORY IANGUAGF � ' _�.. .- ignaturo ol ApplicaM w Agen�_ . - - . a�e . - _ _'- " _- . ' -"_' _^. _ . _.._ "'_ "'_.._. .. ._ . _: . ._.. � .. _ _•C)� . .r _ �. .., ~ . . .�.�. .�.-.-....." . . "'�. . . _ -..�_.-.... _ . �.�... ��..�+...�-^'�.'....-� . �" __�-�-. ._.-.�� . m T n 2 � � 7 �+ N O N O � � '_"f�D _G� G� __^ ..2.. .�. '. �._ _ ' _." 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