Loading...
HomeMy WebLinkAbout0916A 0341A 0342A (4) ...Y WORKERS'COMPENSATIO .., ., ...�. .. .. ..._ . ..._._ . ..... .._..... , . .. . . . . . .... .._ . �. _.�- ...... msvre,or a cer�iftmre of Workers'N DECLARATION .:,, .,..,.,..... ....- ... - i_.__._. ......... . .,.1 . �J'J. Z . � � � . , _ . .,._.. - � -- � . ..... .. _ ___. __ ...----� --.. I hereb offvm�lhalJ hove a�e�,,f,�a,e of�o�,e��,o 5e�f , APPLICATION FOR BUIIDING PERMIT ���� ' � � Compensat on Insurance, . or o cer�ified cop'y thereof(Sec:3800 1a6.C.� " ' "' � �� �OUNTY OF LOS ANGELES : BUILDING AND SAFETY � yNo. W('R520dl�ampany.Tumr. Am .Accnr, �Cp .._..:._-__._. ._.- _. . ' '' . ....•.' . Palic Certified copy is hereby furn�shed FOR APPLICANT TO FILL IN Bui�o�NG 21236 Fibre Court ADDRESS �'�Certified copy is(iled.wilh Iha'count'y building�inspec- "�'� BUiLDING I ., , "tion depa�imenl.�� � ADORESS uo�a in_Z� n�r_aS �Applicam' uT�7.,.,+- r;�,;��:,i„ an Walnut zir 91789 . , iocAurv Wainut '• . '. _._ _ . . . . .. .NO.OFBLDGS. ... .. ._.._.....� NEAREST � . ......_..__............._. . CERTIFICATE OF EXEMPTION FROM WORKERS �' � ` ' .._ ... .... � � �� ��GOMPENSATION�INSURANC�'��'�������'.`��� � SIZE OF LOT 69E)O SF NOW ON LOT CROSS SL .WdSil1II Il�S� L111C0 (This�secrion need not be completed if�the permit is for one � � - �� � � � � ��-� ASSESSOR.,9zQ � � , � 1-'] �� � ' - hund�ed dollars(b100)or less) . TRA BIOCK LOT NO. µqp gppR PAGE PARCEL . � - -� � � TEL. - U5�ZON �P � - - own,eQ Walnut Lifes le- - r,o.632-0134 � P Y P P Y YP tiaich Ihis {/_�� �. � � � � ',} so s,tos6ecome Isub'elct�a he Worke seCom ensany manner . . . F' SPECIAI.. . .. ..-... .- . .- .. .O � p nLaws. � ADDRE55-9rjO�N. 5 � " �"�� �- CONDITIONS ..V .... � ��. ..., . -. �... .. .. . .. . . Dote 'r1�-30-85�qPPLcant. .., �. �..,.�. ,. . � ENGINEER • _ . . � ..___..___ . `NNST.� . . ,.. � . r�O . . CITY_. -. . . 21P _ . NOTICE'TO APPIICANT If� after�makm �this Certi(i[a1e Of ARCHITECf TE�. .,.DISTRICT_ GROUP NPE , _ . FIRE . PR ESSED BY .. ; e ' ' �. J. Marvick & As.r,o. 261-0383 zon,e v Ezemptioa,�Yoo should 6ecome+sub�ec� �o�the��Workers' �'- � �7 . / � W Compensalion provisionrof ihe Lobor Code,�you most(orfh- ADDRE55 � -� � ��" wi�h comply�wi�h such provisions or this permit sholl be . . , � ; qpf. CONDO: ,�� �2 � deemea.e�oked.,, ,,;, ,, �..,.. . Walnut iil.fes le 632-0134 .��/ ..'',' CONTRACTOR .. � .LC. , STATISTICALCLASSIF TION� . . . . .. . . ... .. ... LICENSED CONTRACTORS DECLARATION.. -� -�- CIASS NO.�- DWEtLi�UNITS�L � . . ' NO I hereby affirm fhat I am licensed under provisions of Chap�er 9 ADDRESS 9SO N. `rUSt].Tl AV. r,o379873 �R�P ., � � (commencing� dh Sec�ion 700D)of D s'on 3 of�he 8usiness and ..,. . _.__ .. _ - . LiC. - .... . r �. : Professions Code;and my license is in full force ond ei(ett. , CITY j�p�7e� CtnSS - - - "�-VALIDATION " ��-� ,., �. �. ,� ...�. . ,. .; . �VI BK . . � �V . . .. . . . . .�._.. �.�HOO� NO.OF._].. .... NO.OF."..1. .. CHECK � ' . UcenseNumLier �79R7� �iC.Cl6ss R-� SIZE � STORIES FAMILIES ONE � .. . ,. . . . � � .. . . .. ALUATION... ._ � . ._ `- � .. � . � ,C91,( A . .. .. • ...' DESCRIPTIONOFWORK-�WOOCI fTBRIe... .. ...- NEW.. . . .. COnfmCtorWd�i'17 "T.1'FPRI�V�PData '. ..�,.' .. ��r: • • • j . ' 0 s` ' i4 • 2 ❑ . . . ADD ' ,. .. .. . _ .. . ._1, I am eaempt under Sea .. '. . . ... .. - ALTER ❑ ; I •3� �1,�� � ' � - _... .. .. . . s.�.)�� � B.BP.0 for�his reason . � . QEvn�R � C( � "" '' � � � �� ` '� .—� .. USE OF U ���� � • A .� �i `�,'7 czi : . ..__.., ._ . _ .._ ._. ❑ � ' EX�ST�NG BLDG. DEMa ' -�-- "Signafur � � � APRiCAraT � TEL FINAL ' - ..� . ..�..�.l�-�Jr , ' OWNER-BUIIDER DECLARATION � PRiNi NO. - DATE-�-- �� �--�-��--- � - �-� . ___._ ._.. ... -- I hereby otfirm that I am exempt trom the Contrattor's Litense � 9SO N. Tustin Av. �11d17E1IC1 �. . . . , � •• - "� low for tha followirig reason-�Secfion 7031.5,Business and ADDRE55 qNAL- � � � - _. . .. . �. _ ,. ._ ...... ' �Professionz Code):...__ .__..., ........... ..�_- .... .... ... P ENT :,-By- . .. . � -... ❑ BUR�ING � � � � I, as owner of the properry, or my employees with ADDRES$ l�1 t v `. ,_� �j'n wages as their sole mmpensation,wiil do the work and � rL 4 . . �, the stroctore is not intended or offered for sale(Section ����rr , � � �� '�' ti . • � �i j �: ' ...._. .-7044,Bo5inessandP�ofessionsCode)..-.. .. . .. .- � MOVING'..._. . . _- _.. ..' -� TEL . ........ . . �. . '� .. ; . �. .❑ CONTRACTOR . r1�... �. � ' . ... _ ., I,as owner of the property,am exdosively conhacting �P Y '� � ° �n 3� -wnh licensed mntractors�to tonstroct the project(Sec- -� ��� -� ' ���-�- �� �-� � ----- " � ������ �� �/ � � , Iion 7044,Business ond P�ofessions Code). aooRe55 . � 3 � � ��, ��„ r r ;� _, ;; , ..RE�UIREO ...TOTALSEiBACK . � � - � � � � C O N S T R U C T I O N I E N D I N G A G E N C Y�� -' "�- � Ser eneK Y A t t D H w v PROP.LINE wiotti� , � .; O l� /_�b I hereby aifirm that there is a constructlon lending agency for FRONT N � � Ihe performonce of Ihe work for which this permif is iewed ..- .. ..P.l.. . - --. ... . ... _..... �... ..... . -... .. . .._. . .. .� . .- - -�` .. .. -- �n . � (Sec.3097,Civ.C.). . SIDE � .S�1��n�?r� � 'u . . . . . . _ _ .. .. . . P.l. . ... ._. . ... . . _...__ ..__._._. . .. ._ . % Lender's Name . .._ _ ..._.. .. .. .. . � . ' ' ' � � . ^ ^".� LDMA Ref.M � � • , � � .. _._ ._ . ."'". .._ .__. .. _ ... .... _ ._.. - - P.C.Fee E- / .� Permil Fee� � .I�LV ' •�I / `��. - Lender's Address t � � �.y7 i ' �' Q � @ .I.cerlify thaf I.have read this application.and stale Ihat the .�___. ..._._. .7.���.���IsswnceFee"'.....I��.���� �IDMA P/Ck��✓� ,- --i.....� a ),.�.'::7,. . y abova information is correcf.I agrea fo ly wi�h all Covnry Investiga�ion Fee • � � 'J�'� - g _„ordinances_and Stole.lows relati o bu'ding,tonzlrutlion, __..,_ ._.._____ ._.. . �.-. Tolal Fee �Sl� �LOMA Perm:N[,�C..�7 � ' �'� !=��(`- �� ; i and hereby rize rep otives o is County to enter � ' � Upon fha o e-mOMi pfOpef f inspe[li pur OSeS. - SEE REVERSE FOR EXPIANATORY LANGUA� ' � ,y u _ _ _ _ �_,. c , _ . _ _ _.. _ _ /I.� �,�' E , . , , ' . ._Signatura of Appliconl or A ... . .. . Date .. _. ......... _.._. _ ,. - - _. ...__... .. . . ... _. .. . ...... . ._. .. _ _.._. ..... ._.... O . r� ( f„__.,_ _ ' _ ' rr -_ ^a��-. �K - a a.. ... _ �r � . . . I . � ' � � ' . .. " . . � � � O O O O 7 � p � �D n G O (l� ��' '�. ..�' 'T ..�5" ''� " " , ._ O !O' N O � c S S � � � 7 p'-� � O � n �'�p Or `p � �. ,� ' � - O I �� I �� K � � � � O D � O �O W � O I �'_ .� T .! � � �Z x m� � _ F� � � �. ��. �,� � v p '(� I i : � m o E ° ao l 0 3�� n� a fl m '� ! � o� o � ° o .'�^ � i � _ � °��. �:� ; . 3' o �»� 9 i . - �m � -. o 0 0 _, o.o. m ^ jn ,•-� a 'o' a � � �'�o � : � 3 °"' ° . � , ` � o v� , � �o '.'�c� o � o , ��' I.� I .7.. _...M � � . . _ . � � �1� , , i �.' Z 1� 7 ,,�. 1 �1... ��' r t�. v � D '� � . i i I I , �� � � o � O . � � « e y ; ' I i � ' ' j� _ °a, o, � n . I . i M; ��� , 0 i �_�. 0 � .L d. 'Oy ' ', O' h� y t � , � . ' ^i _ , .� . �. i � . . , ` ' y'f i `� f t �l I' ! ��', . l. � O. , � � ' .1 r � � �- ,c� �- D � � � ,o j � ;� , 9 � � �:' � � � c: a , � , � � . � . , � � o � � o.d, �. , I ; a . ; �. .. i .. . , t , � . F . , - I . � I . I�' I�� �` ' � ,,. i . � I i � • :� . , I.7 i�f"� i , , I^ „ 4 i I i ' � I , � � . � i � i�• �. ! i . �, ' I , . . � I ; ' . I I '�I I '� ' ,F � � , ,... ' � .. I� . . , I � � ` � '�. � ' , ; ' ' �1'' � n .. .I, i i . . I, . -� , . I , . N . � I � � i• � . , . , O . i I �1 , ' � i' 1 - I. . . N ,� � . , i� . � . .. . . '' . . � • , � ' �: . �, . ' � , . . � t ' , � I,. ... � . '� , , . , i: , ' !, i , I . ' ,' i i . � I.' , i , . � � � - . . ., „ , . , .., ... .... � ' { i . . . . • � i , � ., . . . . �, r . . ' ' ! o o ' no c^o �' . ?�� a� c° 0 4�.o A °a .°.�„c c-a i i i A � �- ,� , � ��� �fD . w � � .`t�..�ee V� � �.� F C C...•�,� � � 1�� C`.7! � w q �� � fD S A . . _ � , , �� ; � � p n '^�,�„ £. � e � e ��b 0.� « 'C� '°'`,�i �"Zr c �'�.� � . . . �. . , � h ,o' `° �s- 'b �~i A C-� ,°, M �.o -�4��i pN•�4 y,� N � P ! ' � i 3 N,F_w.��.- o �'$ �� �+� �.� � To sQ'�.�o^=:A�a4 � .o.0.0 r ' ' � ' �p, �b � �o � o � � w ' � ° 0. :�u o .o � � �o m ti'�e �`� � f �.C I �� ry'Q O 0 N f9 7 N w.1�� 1~E C.10 p �'7 N � � o~.�m b A �^p Y ^ '1 'p �T � � � • 3 A « aam oa �- • � �t' 000m x � o • '� tiK �•c 3x . I , ' � � �. � '1 �C .`t � i� C' .T'.Rb`..� Op �3.M'C 4M � ^��. � � � '" o A.� o �'a„� a .ti A i�`< � � ^ �. �b k O'� tt n � C w T o•C _ � � e'„ ! • m �� 'ti°�° o o cc' , ^ c� a'b��` a �,''3 s a��e � � nfi'�'� ° � � -r' � n i , ; F A Zr�^-v C�n w e 0.s:`" m� � a ... b `.",�-a �'p �`� o o'C ,,,� N �O O'e�.'�N.o fo ' '�4 n a N'� `�w�,� O C 3 1 .� n 3�Ct: � i , 0 a o c ` a ,� Eoo � • tiZi... h o'a o i '�' �-� v 0. b 0.A n- o o �•e o e� .� cc•x � � I ; �o I„ i ^ `A'o � o m �� o A � o � A �� A.,°:,z�, i i:-i o •� .^. m f x '� �� In ��..�'p N �p �- q�p .p:—• ��o q m , O � •7 ��Ci I ; � • Z � �•0.� o�; ' a ;� A�{ ob`�.o '+ "I �� e ^ o'i C`c-o .�,�� 3 tz: � � . r Q ! . N � � 0 N � , � C 3 ~.O i h��.� � 1n �{O h'��T �M•�0(� ?� r' �, � � A c� m 3 a .� � r;H,p n.f, � 0.i��„� a �'` m � ~ n'o•.> i 1 ' - N ;_cL ' � � co � 0. ti�� '+ O -3 0.Aya10 ��r .a �'�'`' � o7c I > , I - f � b � ►�_ N � � �.'�m � ° o'� o b ?. a'a.'�` � �'� ° '�3 a ' � ~ � �i � - � � � � �� • .� � `,�Se . p C�+ �e�.G �n W a. 'J.O����,C,`f � S,r: . . i�� -�� � : � i .. ��. i � ^a c'v.�� , '.�'�o.°�.',�„`� o�:�`�u��v ;A.�a �-0.'j��� �° ��c m� o : �' . i .v: r� N4 �°.� .� C�.�,.;^,e-..�'M,inf -°< �'�`�p� �0.'�NeC,s ,^ o'�. , , , �' , � < • , �. : � .. m ., � a c H s o :° ° � \y„o w��, i-z r', `°�e ' n ,, ,s- � � ` ' . . . ' _ , i '. O .O 1`� n ' 7 C eCC a�m�`n P,n V��",0 O "'O M a.� ��C O'� �p� . _ i s, . .,�,n �-°�i n o' \., o • .ti= � .aoo £ ��.`^' o•�yo�•i•�a, wo � •- - tt �� � .V, � • ` c e-,� � s a^ ir . _ '_ _ - " . N--.: ' A C-.o M•.^ ^ ti m A` .ti A o_S_., ti�t o ... .�'N ..C- �