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HomeMy WebLinkAbout0914A 0365A 0366A (4) ___ __..__,_._.------.- ___...... _ _.�...--- _..._.,.._._ . .___, .�_ __ ._.__..._ _ ____._--- -..__, WORKERS'COMPENSATION DECLARATION . ',:� � , I I-hereby aff�rm tha�I have�o certificare of�o�5e�,-��o.,e�, --��—� —�—APPLICiATIQ_N���FOR;-BUILDING �PERMIT insure,or o certifica�e oi Workeri Compensotio�Insuronce, .� or a tenified'copy thereof(Sec.3600,lob.C.) "... ..� '- -"-. ..-' - "- � - '�- - . . �7 co���rNo.WC8520419cam��yA.,w . �Hm . ' ��r -Cp,. `�%'oi�e �OUNTY OF LOS ANGELES ; BUILDING AND.SAFETY _ . " , � Cer�ifled copy is hereby furnished� � , ��•. FOR APPLICANi TO FILL IN eun�wc � ADDRESS 21250 Fibre'Court �� Certiiied�copy is�f�ted wi�h tlie eourify buJdmg inspeo- .�-- BUILDING , 1 ' tion deportment. ' " � �� ���� ADORESS 21250 Fibre Court f. � ome 10-30-85.�aPPi��a�rWalritit'I;ifestyle �.- aTv -- zir , iocnuTr 1 ` ' CERTIFICATE OF EXEMPTION FROM INORKERS :.�� '��� ��-- '-'-- - ---'�� ""�NO.OF BloGS:� -- �----- �, t�qREST� •. � ....... ._, ; ... hundred dollars 5100 or less. eimit is fo� srze oF�or 8560 SF NOW oN toi 0 : cRoss sr.WasYungton;.-& Lincolri � �� � , _ OMPENSATION INSURANCE � r one ---�� - ----� -- --- --- - - ��- --- �- � ASSESSOR,„� '" � -� � : TRncr42173 BLOCK LOTNO. � MAPBOOK ].O�JS �� PAGEI 56 PARCEL , TEL - U ZON AMP � . . . .. , _._- OWNER ._ _ . _.• __'. .. . . ..._ .� . � I�.certify that in�ihe pciformon�te�f t�Pwork�for which�this N�� ' ,� �,p, '�. .�,, ��-,� ��� i section nee not� e completed if the p ( � ) ermit is issoed�I shall nol em lo on ersan�in any'manner ,_,.__ • � � SPECIAL��-- � -�• �� �- ----�� --��� � �� � I ADDRESS 950��N. Tust�.n Av: �' so'os to bemme subject to Ih'e Worke�s'Compensatlon Laws. -'--��--�� -����-"�" CONDITIONS , ... .. ,.. � �.. �p .�.... . . �. ,u , , ,., ... i . ! _. .. ........_.... 10-30-85,. . . _... arr_ .._ _ziv_. - - __. __. _ D'ate ' Applicant. . .� ���.. . .-- -' -.... .......! - ��O ARCHITECT QR TEL. � NOTICE TO,APPLICANT: If, atfer making lhis Certiflcale of ! DISTRICT.. .GROUP NPE. FIRE.. 5 D BY_ ENGINEER K.S NO. - Exemption, ybu'-should 6etome�subject td'the�Workers' -' �- - CONSLi � ZONE Compensation provisions of�he lobor Code,you must forlh- qD�RE55 17H9O S }C L']Y. ' � � .�'�� with comply with soth provisions or this parmit shall ba ----- ` ��-- � -�-��'` "� - d deemed ravoked., �.� � � •..�,� � ,: CONTRAGTOR ' N� STATISTICAt ClA I TION � A . CONDO. _ .. .,� . � ... � ' .. .'__ _ . _...._.. _:... _ ._._. . . ... ..... .. .- LICENSED CONTRACTORS DECLARATION :'.+ -�-- ��-� -- - . .. .._��� ..._.., . Ctq55 NO. DWEtc.UNiTS� I hereby offirm thol I am litensed under provisions of Chopler 9 ADDRE55 950 N. Tistin Av. No379873 � 9 � eBvsinessand _...... ..'_ _.. . _ . . ....._._... . SE�qP � .. _. .. .IIC ._ . . � �' commencin with Section 7000 of D v sion 3 oi th ' Profeisions Code,and my license is in full force;and effed. CRv Al]dll@].Itl� Cd CV+SS B-1. � --- � --�-' -� . .. . • � � . _ 50.FT. ___ NO.OF."_ _' NO.OF � � . .�VALIDATION..�... ; Ucense Nuni6er 379873� �" � � �� � B-1" SIZE STORIES FAMILIES CO EK �' B � � Lit.Class , . , , .' _ . . � '., ,. . . ` � ._VAWATION. ._ � �� ' �: D'���p�j'�d1.17Ut L1P2StV12Dafe �.0�30-HS . .' �ES[RIPTION OF WORK. _.. ... ._ .-....�. NEW_..O = _.___.. _.. _G G 1,4 A. �..� . noo exempt under Set. ---�� StllCCO-cViCl� T'UOfS - � � - - -.... ..,_ _--- - �_ • : ' . ,. . . . AITER � �. � • . . _ . . r. , i�� �, , t,� .23 c' 8.8P.C.for this reason � ] �LLF . . REPAIR"a ' S.�j..'7 � .._ .. . . .. _ ._._.. . ... ._. _ __... . ._ . � . ,�, USEOF / , / ...._.�......_ I � ) 4 1� ' E%ISTING BLDG, DEMOL ❑ ' � • ' -.., - , .�..e_`J.i_�^�.�S �$ign01 e � .. . � -' APftICANT TEL. _.�._^.._... .. _..�_._ _ . OWNER-BUILDERDECLARATION PRWT Walnut Lifestyle No632-0134 ! . pA E�-•-����-��• + .�.�L. p J_.:_, .._, .-- ----. . . . . ,_... -I hereby affirm tha�I am exempt fwm Ihe Con rattor's License ADDRE55 950 N. `I'UStl.11 AV. Al'Id}]2]ITl "�� law for ihe following reason��5ection 7037.5,Bw(ness and � FINAL'�� '�" � '- - � �� ���+ � ' - _ .. "-.. . y �_ - __ � .,. _ + .,,�� ' Prof0S5ion4 CadoJ:`-- ' - �� ' PRE ENT -B � �- � � - - � I, os owner of tha properly, or my employees with ADDRE55 � ��i� . _.. . ..... ._. . .. woges as tFeir solc compensation,will do the work and � , � ihe shucfure is not intended or offered for sale(Setlion LOCALIN � v ;` � ,�� �\,� ....- 7044.Business and Professions Code�.'.. .. -.... -. . MpViNG-- - -- ...-. _ .- _........_.- hl:.-. .. -. � � •. °��� _.. .. ..._ ..._.. _ _. . ._. i � I,os owne�of the properly,am ezcluslvely mnt�otling GONTRACTOR Np. � , ^\� � I s � „ ..wiih licensed�contrattors to construct the projed(Sec- " -'" "'---..... .. . —�--- - � -'�--._..__..__ ..._._.._.�. •,l-'- -- ' ' - . .. ._ .. U..� ' "" ,. tion 7044,Busfness ond Professions Code). ADDRESS I � /�\�� �� � � � 8 rl,, �S � -� • -- RE�UIRED .TOtA�SE7BACK FROM.. ...._ ` � CONSTRUCTION LENDING AGENCY-""--� �- � -` --� SEi eACK 'YARD 'HWY� PROP LINE WIDiH� � � �� . __... . ___" _....., I hereby a{firm that there is a tons�rodion lending agency for feONl l, � � ��� 7�-'c°>6�-�' the performonce of the work for whith�this permit is issoed -.. . .v.l.-.....__ .____._- -.--- __..____,..... .__ ._.. . .-_-.' --. ...._... +��• . _. _..... _., ' (Sec.3097,Civ.C.)• SIDE � � ��G 3 6`h A����, _... . . ___ . . . __. . .._... ._... .. .._ .P L.___._ - _ ._ _... . .._.... . .. . __, .' ' '_ . .. _._ ' _._..__. ....'_.'_' _. Lenderi Name t+• • • !'J . //'�'.. .��., LDM4 Ref.# � .., . . ._ . .. . .- .... ._ ._. -._�__ P.G Fee E . _ .' Perm 1 Fee '.'7(. Lender's Address � ,' � '(G fj(��Q � i � y�� ..1 certi(y thof.l.have read this application and slole thot the • . __ ;-��5- Is:uo�ce Fea-- �-+�- -- -� -IDMA P/C X(,(� '---- • .'J�� T � -_ . __.. ..._ � abova Mformation is torrecl.I agree b comply with all County In sr g tion Fee � r � V't� '���� ordinances and Sfafe IawS r0lating fo i ing[onslruction, . . .. .. _..._. . .'-�-'- To1al Pee�— �� ���"�i IDMA Perm:'N --..._ .`- �:]-� ! -���� �. and he�eby aut Nze repre eMa' s of is County to enfer � � • - � upon the ab -mention perty i inspetlio pu�pases � �L� L,y � .� ' - --- . � ... ..__ ._. ._... . . .. ._ _ __''"'_ _..../U • --._.__ ._ _ . .__..._J.S.C.✓" �"' "'..__..__ ....__. .__ _ _ -f��s SEE REVERSE FOR EXPIANATORY LANGUAGE ' � � � � ..- -Signarure of Applicvnr or Age pere �- � - - , i O .. ' .. _' '_... 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