HomeMy WebLinkAbout1794A 1795A � WORKERS'COMPENSATION DECLARATION . _. . . ... . . � . . ; , - � ;�=�;eba,af�em�f�o;e'afwo,ke5e�ompe�°to���5�;a��e=o� APPLICATION FOR BUILDING PERMIT �` a ceriifi�ed copy thereof(S cg.��3/a�0J0(`�ab.C,.)t COUNTY.OF LOS ANGELES BUILDING ANO SAFETY PolicylSo.������^�ompdn�` L✓�I60ri.tC. / �, cerrfled copy�s hereby forn�shed. FOR APPUCANT TO FILL IN 2�3-j�R aoo ss !o � � � � � Certified copy is iiled wilh the counry building inspec- gWL�ING � . � � ra�deportmenl. ' ADDRESS 131F) C�Y'ZOIl IOCAUTY NEAREST �Dote Applicant � � QTY Walnut � � - z�v �91789 ceoss sr. — !1 � 'CERTIFICATE OF EXEMPTION FROM WORKERS' � � NO.OF BLDGS. as5ES50R . ' ' " COMPENSATION INSURANCE SIZE OF lOT �.�.F) XE)S NOW ON t0T ' O MAP BOOK - ' � PAGE vARCEL � (This seclion need nol be tompleled if the permil js for one � uS OrE Mn7 u7 � hundred dollors(5100)ar less.) TRnCT 33ZS BLOIX LOT NO..2 � NO. � /✓(/� } , � ' iEL B�D SPECIAI � a � OWNER .�123 HQi125 - � 714 r,o. 598-1841 CONDITION$ I cenify that in the�performonce of the work for which this � OISTRICi G OUP. TYPE FIRE PROCESSE�BV � , � permif is issued,I shall not employ any person in any manner � ' V ADDRE55 CO Si. IONE so as to become subjecl to the Workers'Compensation Laws. / �� .y � `4� . �� �� � Dale - � AppliCaM CITY ZIP STATISTICAI C1F�55 ICATION � ' APT. CONDO.�� U � ARCHITEC70R�� --� � �-TEL.- NOTICE'TO APPIICANT:�If,_afrer making this Certifimte of ���" � - � � . , � � Wa Exemplion, you should become subjeet to Ihe Workers' ENGwEER NO. CLq55 NO. DWELL.UNIT�� Compensation provisions of the Labor Code,you must Torih-- qDDRESS SEWER hL4P Z ilh tomply ith suth provisions or this permit shall be TE� � . � � tJeeme[I revoAe[I. � - � � - CONiRACTOR' � 3S O4JIleY' NO. � �- �BK. PG, ' VALIDATION � ' � IICENSED CONTRACTORS DECLARATION � , � p�, , .� I herehy affirm thot I am licensed under provisions of Chopter 9. . ADDRESS. . - NO. VALUATION - � (commencing wi�h Sec7ion 7000)af Division 3 of the Business and ��� �'J q �Pv I ' �� . Professions Code,and my license is in full farce and effect _„ CITY ClASS. $-�. 5 /C.7 � � '� 6 � S FT NO.OF NO.OF CHECK ' ' - � � License Number.�o���� LiC.CIa54 �' � 5� 13� STORIES 2 FAMIlIES 1 ONE ' . yn/I' /(� S � COf1�lOC10I..CJQ�jf /'/��D DOIC��� DESCRIPTIONOFWORK New Hcane NEW �. � � I om e emp�from fhe Ifcensing reqoiremeMs as I am o - A�D � � �J Q,Ll{� '� licensed drehiietl or a re9istered professional engineer. .. . . , AItER ,� 'FINAL ` - - acting in my professional.wpacily (Section 7051, � REPAie � DATE�; rp� �(�. .���2�, . Bosiness and Professions Code). � Use OF � FINAL �/ � ' - � • . � EXiSTING BLDG. - - DEMOI ❑ 8 � �I .��3 4.3 6 Lic.or Reg.No. � Dale APPLICANT TEt. Y � OWNER-BVILDER DECLARATION�� � � " ' �WRiNt� � � - � - - NO. ��-� '� � ;.�•p 3 q,3 6� I hereby affirm ihot I am exempt from Ihe CoNrptlor i litense � i , . ' Law for fhe foliowing reoson(Section 7031.5, Business and- nooae55- � � � � . �, � Q��2']�8� Prafessions Code): - : . . � � vRE�ENi . . . � . �/ p . . ❑ ... . . . . . BUILDING .. . .. ,. " �1 f 9..r]tt I,�as-owner of ihe propeny, or�my employees wiih ADD2E55 . ages as iheir sole wmpensotion,will do Ihe work ond - � � � . - � ��,�.. . •� � the structure Is not Intended or offered for sale(Section �OCALITV . '' ' , , - � �7044,8usinesz ond Professions Code). MOVING TEL , '. � ' � � I,os owner of the propeny,am ezclusively controcting" CONTaqCTOR � NO. . . . . ;� �e�J�2'S Q . wilh licensed confradors ta constru[f the projeU(Sec- ADDRESS ' � i�!�J 8 2�C� � tion 7044,Business and Professions CodeJ. � � - � � � �� �y\�� �, -, � ,_ . REOUIRE� TpTAI SETBACK FROA1 Ex�ST. � �, : , e���2 7�"8� � CONSTRUC710N LENDING AGENCY � Sei snCK YARD HWY pROP.IINE WiDTH ���-__�- �---.. �� � . - , _.. . ._ ,: I hereby affirm Ihoi there is a construcfion lending ogenty for �- FZOtvt � � �� � . ihe performance of the work for which this permit is issued a� ' . � . " (Sec.3097,Civ.C.). . . _ .. SiDE. ... . . . . . ... .. �- . - . , .. . . . ' P.L. - - . lender's Name � d ' , � . Lender's Address � P.C.Fee S ��.� Permit Fee � . � � � � � I certify Ihat I have read ihis applimtian and state thaf the Issuance Fee tJ �� . . - above information is correcl.I agree to comply with all Counly ._ . in�esi�goro�Fee .� ��� � � � � - - -� ' � $ ordinantes ond S�ate laws reloting to building construuion, � - Tofal Fee � � ' and here6y utharize represenialives of this Counry to emer , , , , , � . . � a upon the ove•menlioned properry for�inspeUion purposes. � . � < �.j�� � ��f-�� � � SEE REVERSE FOR E%PIANATORY LANGUAGE ' ' � . � S�gnor�re a/Applican�or A9en� Du�e . ' �� ,',i -. _ --- -- - --. . _ .__ ._ _..--._.. O�PNER-BU]LDER DECLARATION � � � PLANS TO APPLICANT � � � -� INSPECTOR'S NOTES - `I heraby affirm ihat 1 am exempf from ihe CoMractor s � To: Faturnad � � . � - Licenee Law for the fo��owing reason. (Soc. 7031.5) . � ' - Approvad . . . Buairtes.rarrdP j3s7pq.��Cqde:A�•.aiexnrmuntya�bic[� do. -- Dote �-� �- No. -, DC}e� - -�-- � . , � - � .. re}uiirsli pc'rnut to construct,affcq inproue,denmlisG, ��. . .. . . . . ,.. � _ . orre/�aironystructurc,friortoilsiuuancr,alsoreguires � � � - -- --� � �-�- � � -���� -� - - -- � - " - � - � - -�� � �� � � tLe a/�pliCan!for sacG ycrniit fo file a signed sJatcinent � - , . . . tbat Le is licensed pwrsuant to tbe provisions ojtbe Con- i �� .... .. . .. ..-'. �:.'.� . . .' . -_ ..�.: .... ' tractor's Lrtense Law(Cbapter 9)(commencing udtb Ser _ � . tion7000/pfDioi.sion3ojt6eButinessandProfeuians � . _._ .._.... ...._. . . �_. . . � �. . . _ _ _ . . . � . � . �_._ _ � CodeJortGaticrsexenrptlbcrcjromandtGebasufortLc �� _ . . , aJleged exemplion.Any uiolntion of Section 7031.5 by � � � Roquired ,,. . � .._ _... . . � anyppplicarstforaficrnailsubjecltl6eapQlicanitoativiJ ' ..Approvals ' Oetc Rocelved � enalt�o not morc tban iuc buddred dollars SS00.: ' Yrs No � orApprovad ,. ._ �' .1 I I � II , . � ..... .' _ . � ❑ I,as owner of ihe property,or my empioyees wifh 1Vater Certificate � � ' � wages os Iheir sole compensotion,will do}he�work,ond . � � .- � ' . .. the structure is nm intended or offered for sale(Sec.7044) Heahh Deparlmenf; �� . � ' .. . , . , Business and Professioxs Code:Tbe Coneraclor'rLicense -. _ . .. . . - . .. . .. . . �.�� . ,.�� .-.�� '�+- . Law does not appJy to an oaytcr of property wbo builds Firo Oepartmenf , � - � . orimprovcr tbereon,and w6o doee rucb work bimseTjor � � � , - . � tbroug6 bir ouin cmpfoyccs,prooided tbat suc5 im- � Grading � ' . � Qrovements ure not inlended ar offcred for saJe. Jf, � - - �� �- �� . - � �Goa�eucs,tbebuildingorimprovcrnentissoldsuilGinone � Gaological�� � - � . . . __ _ . . _ ._ �� � � - � . - � . year oj completion, tGe owr�ervbuilder�oil!Gae�e tbe � � . burden oJproving tbat bc did not build or improvc for . Pedeslrian Prolection � . .... —.. .. . -. . - .._ Ibe purpose of saleJ. � � �� � � ' (Fence)(Canapy) " ❑ I,atawneroftheproperty,amexdusivelymntrao- ' � � . lirg wiih licensed mntractors to construct the project(Set. Special Inspection . °� . �� 7Qq4)�7lutirsess and PioleQtion.��Code:Tbe Cantreclar's (Cont.)(Masonry)(Welding) I.icenac Lau�doca ttot apf�ly to an oumcr�JJ�rof�erty w/�o , , _. : � �;6¢i(dr orimprones tl erenn„cryd wGo�Fontracts jor sutG tofDrainago� �. � �. � � - � - " f�rqecta�witb a eontraclor{sJ�lic`eniedQursuant to ibe � � . . . __. _ . . . __ Contrsctor's Licrnsc IQaf. ' _. Parkinqn .. . . . . � � � . �� ., _ . ' , . . .. . _. . . . . . . ❑ I am exempf unde�Sec. ,6.8P.C.for Ihts ��. � . ,_ I� � -� . .. . . . reason . . . �� . . � . - . - Dato � -� Owner Approvols ' OCie 'spactor't 5f rtafuro � �� � . � � . �NSPECTOR'S fJO7E5 � Location—� ' � �. . . . . (Setback B.Yards) ��� �� . -. . . . .. . . . . . . �. Foundalions � . . . . . . . ... � � . . . . . -_ i Slab _ . . . . . , . . .. � Frame . � .. �z� . . . .. . . � . . . . . � Energy Insulation � i � ' � �. � � . . � �. . . Lath/Drywall— - - . . . . .. . . IMerior � � - � � • Lath—Exterior •Z/ � - . � � .'C. � . . . House Nomber— - - . - . .. � � ' Corren&Posted ' . .�.. ..:� -. .. . . .- . . . - � � . � . Finol— . . . . . . • .. . . � � . Enrer on Fronl �� � ' . . . . . . �