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HomeMy WebLinkAbout1772A 1773A _ _ �. __—_ _ .. _ ..�_� . � WORKERS'.COMPENSA110N DECLARA710N .. . . ���, . � � � ' '� � ���, i � ' I hereby affirm Ihot I hove a certifiwre of�o�5e�<<0 5e�f �. . � .. . �APPLICATION �FOR.-BUILDING �PERMIT � ��' insure,or a cerfificole of Workeri Compenslion Insurance,or . , a cerfifia co y ther of(Se`�l C. � . � ' �gO—�O—�/%Y� COUNTY OF LOS ANGELES BUILDING.AND SAFETY i PofityNo, Cpmpany L1LL��� ❑ Cerrfied copy is Fe�eby fu�nished. FOR APPLICANT TO FILL IN BUIIDING � /� 43—B2 AD�RE55 /� � Cerlified,Copy is filed with Ihe�muMy 6uilding inspeo BUII�ING . . ' �tion deportment �. ADDRE55 - �.32�. G1Y'ZOTl IOCAItTY 4 � ome qPPiim�r arv Walnut z�a 91789 c"aossss'.. G46� ' "CERTIFICATE OF EXEMPTION FROM WORKERS'' � NO.OF BiDGS. ASSESSOR ' � , � �COMPENSAiION INSURANCE � �. SRE OF�07.. .7S�XZSZ�� �� NOW ON iOT MAV 000K PAGE PARCEL , � (This section need not 6e compleied if ihe permit is for ane � � u5E � r.uP 3 hundred dollars(5100)or less.) .� . TRnCT 33ZS7 BLO�K LOT NO. 4O No. . . r . � . . TEI. vr Q SPECIAL - � ' y. � - OWNER �p� Hal7ES � � 714 No..-598-1841 � CONDITIONS ' I certify Ihot in the performonce oi the wark for�which this � 0 permit is issued,I shall not employ any person in any manne� � -i DR7RKT GRq�P TYPE � � FIRE PROCESSED BV � (/_ ADDRE55 -��. ' // CONST. ZONE � so as to become subject to the Workeri Compensmion laws. . � �y_j � �. � O � �,TY c��ut cA Z�P 91789 � � � � �ote � �� Applicant STATISTICAL CLASSIFICATION � � APT. CONDO. V ARCHITEC70A � - � TEI. NOTICE TO APPLICANT: I4, afrer making this Ceitificole of � I " � � �+� w ' �Exemplion, you shou(d hecome subje[f lo the Workers' ENGINEER NO. CLASS NO.�DWELL.UNI y . Compensaiion provisions of�he labor Code,you musf 40�16- - ADDRE55 'SEWER MAP . . Z wi�h comply with such provisions or ihis permii shall be , '- deemed revoked. . � .. TE�' , '. eK. PG. � � � � VAL�OATION , � CONTRACT�R �� .dS NO. . � LICENSED CONTRACTORS DECLARATION � LiC.. � . _ . . I hereby ofiirm thai I am licensed under provisiaas of Chaprer 9. nDDRE55 No.� VAIIIALON . , � . (commencing with Section 7000)of Division 3 of�he Business nnd ��� - j A�� ,, -Proiessions Code,ond my license is in full force and effect. ' Ciiv CLa55. B-1 � E 6„ ' � . ' � p� �f - ��/ 50.FT. NO.Of NO.OF CHECK � -' -- . License Number�O�/� Lic.Cltlss SIZE STORIES FAMIlIES ONE � I - �Q /,� t 'ry/)�� E Canlroclor.tJ� AI/�� Oole__�Cf9�¢� �ESCRIPTION OF WORK , NE,N1 HQSC .� NEW � � � , I om e empt from the I�censing requirements cs i.am a . ' Aoo '� . , licensed architect or u regis�ered professional engineer .._ . .. . . , „ , . �� ALTER � FINAL � c/ � � �- � � . � ading in my professional wpacity (Seclion 7051, . � � DATE 0- -p ��, . � ! REPAIR Business and Pro(essions Code). u5E OF i OeMO� fINAI ' �' � � � - � - Ex15tING BLDG. . -� -� ❑ BY � ' LiC,Of RBg.No. Date APPLICANT TEL. .. � �� - � ��� �OWNER-BUILDERDECLARATION -- � .' PRiNt� � � � � � � �� NO. � ' � � � � ' I hereby affirm that I om exempt from the Contrac�or's license AooaeSs - � ' � ' ' -�� 7�.2 A � . Law for�he following reoson(Settion)031.5,Bosiness ond . , Professions Code):' . PRE ENl - . �f� �q�� ..'❑ .. . . BUIlOING . ... . . .. . . � � , . . . .� I, os owner of the property, or my employees wiih ADDRESS wages as their sole compensaiion,wiil do�he work and ' ' � ' � ' � :�2�9 3�. � � � � - �the:tructure is not intended or offered for sale(Seaion -�� tOCaUiv � � � . � ' 7044,Business and Professions Code). MOVING � TEL. ' . . � . � . e'2 3 D,�(j� '�. � I,os owner of�he property,am ezdusively toMrocting fONTRACTOR - NO. � �, � -� � , wilh licensed confractors to construcl the project(Sec• AD�RE55 ' � � � � ��.�7�'�� �� tion 7044,Business ond Professions Code).� � � . � ' � - - REOLIIRE� TOTAL SETBAIX FROM E%IST. \ ' CONStRUCTION LENDING AGENCY SEi enCK vARD HWY PRav,uNe � � -WiDiH' . �; i i � .��� ��.3 F. I hereby affirm thot there is a constrvuion lend�ng ogency for - �� FaoNr . � -" '� ��� ' .' �� ��,,���� � the performance of the wark for which this permit is issued P i ' � - . . _ . . (Sec.3097�Civ.C.I. . .. . . . Sioe � - � - � . . . . . . �� .3 fi 2 5� . P.l. Lender's Name � y �7 >�J �r � . . . P.C.Fee E � i Cerm�t Fee J 7�e J� � _ '�����z F�� _ Lender's Addres3 n�—d � � �. �'.'�4..,2,�-�� � �� I cerfify thot I hove read�hfs application and stote thot the isso ce Fee �l � � �� , a6ove informorioa is torreU.I ogree to tomply wilh oll Counly in�esrgar;on fee -. . � �� --.y� V( � ' � � - � g ordinances ond Sime laws releting io building mnstrocnon, � io�ai fee a� r . � � and hereby ou�harize representatives of this Couniy to enter _ , _ . � . �upbn Ih qbove meNio ed property for inspeclion purposes. �� � . �, � a /�D��...;, ,��----- s�-��- � . �/ � SEE REVERSE FOR EXPIANATORY LANCUAGE ^ Signonre oF Appl�<onr ar Agem Dote . � . . . . ,;/� L�. F( n � nl�Z�,� �Q d'�'�,i�s �y� .� ��,[J/L` �� f-t- .� r v � � � �PLANS TO APPLlCANT � � � � •'INSPECTOR'S NOTES� ' � OWNE•R•BUILDER DGCLAAA7IOIr' -I hereby affirm thm I am�exempt from ihe Conlroctor's To: � � Rolurned - � ' � Lfcendo Law�for the fallowing reaeon. (Sec. 7031.5) Approved Businesa_pnd Projess{nhs Code:Any.cityyrrFdiln ty wGitb � No. - Da}e - No. -f,Date - � � � - � � . � ��Yeqaifei dperruit 7o mnstntd,altcr,impravc,demolisl, , . . or repair any stnscture,prior to i1s issuance,also regaires ... _. . ' ..- -- - '. ..•� ,�. - -�. . . . . :--- � .- .� . . . ... ...� tbe applicant jor sucb permit to/ile a signed stateaient � . tbat Ge it lrcensed pv'suant!o tbe procr.sions of!be Coi+- ' � � � � - � � � � � � �� �� - � -� lractor'sl.icenselnw(CGapler9J(rommencin,qsuitGSen � � ' - ' ��' � . ' �'��"� � � tion7000JojDioision3ojtUe➢urincuandProjesrions . ..... , �.�. . ., .. .._ . ... .. � ... . _ ._. . .. � - _ . . . � . . � - �� _, � CodeJorlGatbeisexrnePltbrrcfronrandEGeb¢cisJortbe _ . _ _._ ,_ . . alleged axemptioe.Any violation of Section 7031.5 by ��, - . �. .. � Roquired -DateRecdved . �;' � .. ...'.... . . . .auya/�plicantJarapermitsubjectstl�eapplicanttoattvi! .___ Approvele .-- - Yos No - or Approvod :-pcnclty oj�ot mare than ji�g bandred dollun(SSOOJ./: " � ,� .. , , .. . ... „ ..._, . . .. . . .-. . . . ;.....' ,... ..: �. :, ❑ I,as owner of tha properfy,or my emploYees wilh � . Woter Cerfifiwte � � . waqes as iheir sole compensotion,will do ihe work,ond ' - the struaure is not Intended or offered for sele�(Sec.7044) Heol�h Departmeni� . '� �� .. -�.. , � Burinesr and Profcrsions Code:Tbc Contractor's Liccrsac i - � ���� •��. � . ' :--�� -�� ' . Law docs not apply to an oumcr ojproperty mbo builds ' � Fire OepartmeN � � �, orimprover tEereon,and wbodo�rtucb a•ork bimrrljor ' � � � � - � � - � � � t5rougb bis o�un eneployces,�provided tbot tucb ine- . Gmdiag � �� �� � � provemerts are not intexded or of/ered for sale,!f, � �' � � - - � - 'boa�evcr,tbe building or improvement fs sold witbin one Geoloc�ica! �--�� '` . - _ � . ... - - _ . � . .. �.. . year oj rompJetion, tGe awncr-builder uil!bavc Lbc � � burden ojproving tba!be did not build ar im¢roe¢jor , Pedeslrian Profedion a - �� ' � .. . - . : tJ e purpose of salef.� � � . � � . (Fence)(Canopy) ,� � � ; ❑ I,qsowneroftheproperty,omexclusivalymMrac- ' . tirg with licensed contrac�ors to construct the project(See , Special Inspection � �� - � � ' 7Q44)'�Qusiness oxd Pro�eseioni?Ca.ile,Tbe Contractor} . � (�onc.)(Masonry)(1Velding) . � . ��. . �Licrnsc Lau�docr not apply to an owner ojproperty a�bo - ` ::; � `...� . � � . �c��bR+j�s,Dr.lnrprones tLe(eQn pnd u�bo cpntrtirlsJorsucG � Lot Drainage . . . � -� �ro�ecit`a�itb a cantractar(s)�Lcenie'd pursoant to tbe . _ . . ,. . . . � Contrdcto'r't Licenae Lau f � � - �� Parking . <-1 . � " , . .� . � � � . .. .. . , . .. , 0 Iamazemp�under5ecr ,B.&P.C.forthis � . . � . _ . .. . � _ - .. reason . ' � - 5 - Dale- - � � ��Owner � /Cpp�ovals , Data Inspaalor's Si .efuro � � ' � ' . � - � .. . .. �- . INSPECTOR'S NOTES � � Lomtian— / .. - . . . . . � . (Setback`BYards) „ � .. . . . ._.. . __. ..- . �� � � . �� . . � Foundations � . . ... . -.. .. . . � . . . . Slob, � , _. . . . . _ . _. � . . � . � Frame ", , � 5/ � ' . ., . � . - . . . . . . , ' . Ene�gy Insu(alion� . . ��. . . . , , � , . _ - � , lmh/Drywcll— i c.� . i . � . .. . . - . ' Interior / • � � � - La7h—Exterior � - " � . �_�c � � _ �. . . � . , .. . . . _.. _ . . .... House Number—� � , � � ` � - , . .. � . . � � Correct 8 Posted ' � � -- - - - � � - � . � Fino1— �� - . . . . . Enter on FroM .. . . � � - ' . . .. . . . . � i , _ -, , '_ . '1 ` - . . ._ .. , - ., ._ . . .. .