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HomeMy WebLinkAbout1770A 1771A � WORKERS'COMPENSATION�ECIARATION _�� _. , �,. - � . . . . , ' . , � �� I hereby affirm rhai I have a ceitificate of consent to self . � app��CATION .�OR BUIL�'DING��PERMIT insure,or o tertificote of Workeis'Compensfion Insuronce,ar - � a ceAified y ihereof(Sec�3gp�l � 1 � � • Policy No.�l�� ��omp�/���,wittsalt.it. COUNTY Of LOS ANGELES BUILDING AND SAFETY � Q �Certified wpy�s hereby fumished � • � � -� �FOR APPLICANT TO FILL IN t}1 Al qooae5s ��"�.�'�� �/Q' 7i � ��_� [ertffied copy�is filed with ihe couniy building inspeo- Bui�DiNG , � ' ��L -fion deparlmenl. ' A�DRESS 1 � IOCAIITY ' NEAREST � i �O� �Dale Applicanl � � - � - Ciiv Wcl�1]llt .. . ZIP 91789 � ceosss..� er - , � � CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF 8LDG5. n55E550R � ; � � COMPENSATION INSURANCE ' � -- SIZE OF LOT : � � NOW ON LOT MAF 800K' ' PAGE 7ARCEl �(This section need not be compleied if rhe permit is tor one u5 O . MAP � / ? �g . . �hundred dollars($100��or less.) , , TR,4CT 332S�I BIOCK lDT NO. � 41 NO. ���7-� . � . 7E1. �Q SGEOAL � � � OWNER Shea�Hares � 714 0.598-1841 Q CONDITIONS �' ' I certify tKat in the performance of fhe work for which�his � - � DIS7RIC7 GROUP TYPE�. FIRE PROCESSED BY � �permit is issued,I sholl no�employ any peno in pny manner . V ADDRF55 � CONST. ZONE sa os fo ber,ome subjecl la the Workeri Compensation lows. n �� . `�-� � F: ` aTv Walnut CA zir 91789 �t O Date " Appliconl � - STATISTICAlCLA551fICATION � � �-APT. ONDO. .. V ARCHIT£CT OR - � � � �-- . TEL. ��NOTICE TO APpLICANL�If, ofler making 1h s Ce tificale ai ' "' . � � �/J' � � W - Exempiion, you should become subject'to the Workers FNGWEER NO. CLn55 NO. OwEtl.UNiTS N .Campensafion pro�isions of Ihe Labor Code,you musl 4orth- " ADDRE55 � � � - � � � SEWER MAP � � . ' with comply with such provisions or 1hls permil shall be � ' �, . . ? deemed revoked.��. � � . � . - TE�' . . gg. � p�, - . �� -VALIDATION ' coNTancroa Same.as Owner r,o. - : LICENSED CONTRACTORS DECLARATION - � tIC. � ., I hereby alfirm that I am licensed under provisions of Chopter 9 . ADDRE55 - - - . NO. VAIUATION ' . . (commencin9 with Sec�lon 7000)of Divisian 3 of rhe Business and . ���, � � � � . � : Professions Code,ond my license is in full force and effect. � UiY C�n55 — - b � ['JQ� ' " /�Q f��/ $p.FT NO.OF NO.OF CHECK ' ' Li[ense Num6er ���+ 7 Lit.C�aSS��� SIZE � 408 STORIES �. FAMILIES�. ONE . , � � p /,/ NEW � 5 Conttattor./J� /�//�lXLD pafe_� �ESCRIGTION OF WORK '. ' , , � I am exempl from Ihe licensing requirements os 1 om a A�� � � licensed orchiiect or a reqislered professional engineer , ._ , . . _. ,. �. . , aITER � - FINAL � � � � � � - �� 7?�O Pi � ocfing in my professional tapatdy (Seuion 7051, ' REPAIR � DATE/� �� - ,���� � ��.2.� . ' Business and Professions Code). u5E OP � DEnnOI FINAI -' � - '-� ' � ' � . . ' � E%IS7ING BLDG.. . . .. . ❑ BY ' � - . lit.or Reg.No. Da�e APPII�P.NT TEL . . . . ..... . . � OWNER-BUR�ER DECLARATION IPRINTI . ... ... . -NO. -- ' , .,I�� �V n� . � I hereby affirm ihat I am exemp�from Ihe Cantracto�'s License . . , . . . . � . .- Law for Ihe following reason.(Section 7031.5,Business and no�ae55 - - � �� . e � C.�i.(',•�'� � - � Professions Code): � �- � � FeEstti . � � ' '� . � � I, as owner of fhe propeny, or my employees wilh AD R 55 � -.,.`.''.. C[�,P`/�-�.� ' wages as their sole compensaiion,will do fhe work pnd - . -� - � , . ..� .. . . . � � Ihe sirvc�ure is not iMended or offered ior sale(Section� �OCnu7Y �- � 7044,Business and Pro(essions Code). ' MOVING TFL. ��7 7'} F' �� ', CONTRACIOR NO. �, �� � I,os owner of the propeny,am end�sively coNrocling . � . ��� � �'��.�,� •'( � with licensed[onlroCfars lo canstruct fhe prolect(Se[• qDDRE55 � ` ' ', � ' . rian 704d,6usiness and Profess�ons Code)., � � � � - � - - - r, � � CONSTRUCTION IENDING AGENCY REoutaeo yqgD Hwv TOTA�S�TgACK FeoM_ Exisi, __.__ � i , �t ^ - '�,I •�Cf i'- O SETBACK FROF.IINE"'� WIDiH � , 1 hereby affirm thof there is a mnstruc�ion lendmg ogency for �� fuoNi � � ` '� ' � � .•i G 9�'-5 Q s ' c the performance o(the work for which this permil is issued p.i. , '�, , . , . (Sec.3097.Civ.C.J. . . . . . SioE . . � . . . . . . �� , - . P.l � ' 0 a,27'�'�� . . Lender's Nome /G p / d„6 � . .� . . tende�s Address - P.e.Fee 5 /OCJ A ' ve�m�i�ee C ''r . . �. 1'cerlify Ihpt I have repd Ihis applicofion and stote lhat the Isso eFee �� � ' . � � �� � above informar�on is correU.I agree fo mmply wirh all Coumy . , i,,,,esn9a��o�Fee. .�. . . ��� ^ '` ! . � ,. '� - .. � . , ordinonces and Srare laws relaring 10 building construclion, Toiol Fee q� �f� � ' and hereby outhorize represen�mives of this Co�nry to en�er ., , , ' , .� . . _- - �i upon Ih obove-meroio/�jed propeFry for inspection purposes. � ��� . . , . . �����.�. ///�f�X» �����f � � � SEE REVERSE FOR EXPIANATORY LANGUAGE � � i � t-— I� i� �K�/ i Signol�ra o�Appliconl or Agent Oo�e . _ 'L.� - �� �� 'PLANS TO APPLICANT � � - � ' INSPECTOR'S NOTES - . � OWNLR-BUILDER DECLARATION . I hereby affirm that I am exempt from ihe Conlractor's .7n: � Refwnvd � �� . - � - � � � � License�law.for Yhe��following rcason. (Sec. 7037.5) ' �, ��•. r �• �-� Approved - ' ' � Busina�ssandPtof�'stiott.r�'ode:,r4ny,criynr�couniyubrcb No. - � �- � Dafo�--- -- No. � Dele � - -�- . � �� � �-� � �-s�'?k'e�dires}�bcrnrittotonttruct,alter,in�prou,�demolisb, . � , . .. orrepairanyatructaro,priortoiRsrssuance,akorequrres , . ;. . .. .,. ,� . �, -�.. : . .. . -.-_ ,.. �.. . . � ..�� ��.- _ _ _ . . . .� - - ,. - � • � � �� . -- -- � �� _ iGe applicant for sacl pernrit to file a sign¢d atatement , � , � �SGat Ge is lirensed parsuanl!o tb¢Qrauurons of tGe Con- � . _... ,, . . � . ._ . . - -- . ... . . . . _ .- .. ... -.. -.. '..�� . . ... � . �- �tractor'sLitenaeLaw(Chapter9l(rommercringa•itGSec- ' '.. _. � . - .......,.. . _�.. - . � tiox 7000J of Division 3 aJtba Business cnd Projessiont ,' , � �-- � �-�� �� �� ; � � �� �� � � - � . - - � � - ;_; � � � � CodeJ nr[Gat Le fs exenr/rt ebcrcJrom and ib¢bcsu/or the . _, , _ . a7leged excmption.Any violation of Sartion 7031.5 by � •.,�'R�qul(ad DetsReeolvea ' ' '� - � - anya�j�licantfosufermitsubjettsN�eapplicanttoarivi! _ . _ACarovals. . -. - or Approvod . '����l � pen¢fty ojnoe morc 1Gan jive bundred dollara(SSOOJ.J:� Yas No � . - . ❑ I,as owner of Ihe proparty,or my omployeos with '� VVater Certifimte � � . � - - � ., woges as their sole mrripensation,will do Ihe work,and � � � - � ..�he structure is not intended or offered for sofe(Sec.7044) �. HealihDepprlment, � ., - � , �.�-� � , - BusinessandProfessionsCode:TbeContractor'sLkense -�- --- � ' ... . : �� ." �. Law does no1 apply to an oa,ner of properry mbo bssildr Fire Departmenf . �or improves eberean,and wbo does svcb mork bimseJf or - � - -� -�- � � � - - -- � tbraugb bis own cmployecs,provided lhst tutb im- � . Grodmg � � � � � � � � -� � provements are not rnteaded or oJJered for sale. Ij, � � ��- � � -� "" � � . � how¢vcr�tbe buiWingorimprovement is:old wit5in one � � Geological � . . � . . . . �� - . . _ . _. . _ year oJ completion, tbc ow�nerbailder'will bave SGc� � � � . � . burden of¢roving tbat bc did noi br�ild or imQrove for Pedestrian Prorection ' � � ..�..�•�.. -. . . . -_....-. . tbe pur/�ose of saJeJ• .. . - . . . (Fence)(Canopy) , .\�� . ❑ .I,os owner of the properly,om exclusive(y controo- , . . �tirg with licensed contratlors to construn the project(Set. ' Special Inspetlion -� � - - 7tL74)��usiness axd PrbX�35ioni!Code:Tbe Corserattori , (Cone)(Masonry)(Weldir+g) } Licer�se La+u does not apply tQ an ownec,oJproQerty who :. ' � . .. � ;� .. ..-� .., �.-� ..6ailds�b��i�reproves 11iSre.n:�and u�h�rohtraels for sueG . . �'i,' . . . . � Co�Orainage, . � � � . f�rojeclS u•iib a tonuactor(sJ�Iicensed pursuant to ibe � � � `. � . .. . ... . .. ... . ... . .. .: ContraUor's License La�vJ. '�' � . . Parkin9+�, - � � . ', " � -' .,.�.`. .. _ ._ . � . �. . - . . . . _ ... . - . .. . � 1 om exempt under5ec.� ,8.8P.C.for this ' reason � � . �� Date -�� �- Owner Appmveli ` Dafo - Insp . .Signetare � . ' � • ' - � � � � . . . � tNSPECTOR'S NOTES� lowtion�� .- + ♦ �� . . . . . _.. . . .. . . - � . (Selbock 8 Yards)' r � � - � � � � Faundations� ' . .- _ . . .. . . . . . . . Sldb` .� . . .. , , . . .._ .. . . . . Frome � � � � . . . ��. �i . - . . . . Energy Insulalion � � . � . ... . . . � � . . Lath/Drywall— �.. . , . . . Interior �� � � � � Lath—Ezterior rV ' . ,. ,. • � ' . , ; ... ... _ . Ho�se Number— . ' �� . . . . .. Corretl 8 Posied ' . .. . . _ . . . _- . . . Final— - . . . .. . � . 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