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HomeMy WebLinkAbout1790A 1791A - . . . . . . , . i . _ _ � , . '. . _ . . . � . � � WORKERS'COMPENSATION DECLARATION . � . , � ! � �� . insureborofc�ernifimtelofWorkeseCompenstion�ln�°a�°eso: �� � - APPLIC�ATION �FOR BUILDING PERMIT a�erti ed co y thereof Se. Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY �Po�������'-eo-�ssi3��lv�Jauoa,u.. n � CerGfied copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �.3Z� (T/9" `L /!� � Certified copy is filed wilh the couNy building Inspec- BUILDING � , � tiondeportmenl. � ADDRE55 1330 Ga.x'zon iocnutr '� Vi!/�' � � � NEARES7 Date �Apptimnt � � CITY Zlv� CROSSSL � �..�N ' � ��CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BioGS. ' As5E55oR , � � � COMPENSATION INSURANCE � . SIZE OF LOi 118'x66' NO'N ON l0T O MAP BOOK ' � PAGE FARCEL (This section need nm be completed if the permit is for one TRAc,� �33257 B�OCK tOi NO. 31 u ��E OP � �J'3 .hundred dollars(5100)or less.) ' � �BO SPECiAL i� a TEI. OWNER � . JO. - CONDITIONS I ceriify�hat in the performance of the work for which this �� - �' permif is issued,1 shall not employ any person in any manner ' DISTRICT GROUP TYPE i FIRE PROCESSED BY V ADDRESS. F7SS BYC'r1 CclTl OTl R03C1 / so as ro become subjea to the Wo.kers'Compensalion Laws. ' � . /� T CON3fl Z� � CITY j'�3]S]llt �1 21P I� ,9 �� Q Date� " � � Applicant ��� � �� - 91789 S7ATISTICAICLAS5IFICJTION '�i �APT. CONDO. V � ARCHITECT OR � � �TEL. ��� /� NOTICE TO APPLICANT: If, afler making ihis Certificate of ENGiNEER NO. ClASS NO.._C�DWEU.UNITS 7� a Exemption, yoo should 6ecome subiea ro the Workeii � y Compensaiion provisions oi the Labor Code,you musl iorlF- - - pDDRE55 � SEWER MAP Z wilh comply with such provisions or Ihis permit shall be � '� � �TE�. VAIIDATION deemed revoked. . -� � CONTRACTOR $3[[IL 35'.�n�I12T - 'NO. ' ' ' ' BK. � M'• � � LICENSED CONTRACTORS DECLARATION � ,���_ � I hereby of(irm ihot I em licensed under provisians oi Chap�er 9 ADDRE55 :NO. VALUATION 'I (commencing with Section 7000)of Division 3 of Ihe Business and . ,���' �O oO Pro(essions Code,and my license is in full force ond effecl. CiTv �CIn55 � E ' � e n 50.FT NO.OF NO.OF CHECK- ' LiCenSe Number�O�/9 lit.C�aii� SIZE 1 Q�8 $TORIES 1 FAMIIIES 1 ONE . �, i . D�� !/_ ��/n_i NEYJ $ Contracror�(t G /Z�4 Date /6/ DESCRIPTION OF WORK.. NEVJ HCIIS� � , I . � I om ecempl from Ihe licensing reqviremenls os I am o �, ADD � licensed orchi�ect or a regis�ered professiondl engineer _, . , , , , n�7ER � � FINAL Cy� -� � - -� ocfing in my professional capacily (Secfion 7051, �� REPAIR � DATE 7i� 0�� ' � - Business ond Professions Code). � , USE OF � - - � ExISTING BLDG. �EMOI ❑ F�NA� �I� B lic.or Reg.No. Date aaPucnNr ,TEi. � y . ���1 7 9.0 F� �� ' � OWNER-BUILDER DECLARATION ' � (PRIN7� � ' 'NO. . � �, I hereby oi(irm that I om exemp�from the Controctar's License � ' . : '�, , �• •�*2� Law for the following reason(Secfion 703I.5, Business ond � ADORE55 � Professions Code): FRE trv . , ' , �� � - � •1 8 3 a 4 . ❑ . . . ' _ BUILOING . . . � � .. . I, as owner oi the property, or my employees with n�DRE55 p f 1 8�.O�� wages as their sole compensatian,will do the work and � � ; . � � � . . . . the stroc�ure is not Iroended or offered ior sole(Section �oCauiv � � � �, � �, � - � 7044,B�siness and Professians CodeJ. MOVING 'TEL. ! I . - D 4.P 7^'8� � � I,as owner of the property,am exclusively coNracting CON7RaC70R �NO. � � � - � wilh litensed controctors lo construcl the projecl(Sec- qDDRE55 �� � � �� 7 9� F� lian 7044,Business ond Profession5 CodeJ. - � � j� �. REOUIRED TOTAL$ETBACK FROM EX15T, �t, 1" ' ' CONSTRUCTION LENDING AGENCY - SET BACK YARD HWV pgpv.UNE Wi�iH. -- _ * ��f.-� , `' C+ - :,.�• �~'�� ' ' I hereby affirm thot Ihere is p constrvciion lending agency for � FRONT ' �' � � � y� � � the performance of the work for which this permit is issued a L ' ��, � 1� •G 9�5� - ($et.3097,Civ.C.1. . . . � .SiDE . . � � � ��� - � c.�. . 29�F0� Lender's Name ` A ) ' . � . • g Lender's Address P.C.Fee S O ;� Permir Fee �� � a�` �•j • �Q.2 7���t � I certify�hat I have read this applicaiion and siote ihoi the ' � iss� ca Fee p �� � ' . — a6ove intormation is correcf.I agree to comply with all County i�„e�i,ya„o�Fee . . . . . , . . $ � �ordinances and Stare laws relating to boildin9 construciion, imai Fee �. � . � and hereby u�harize represemafives of this County to enrer � mupan ihe ove-meNioned property for inspection purposes. . , . . . , � � � � ���1�— � /f'JL�� ��J- � SEE REVERSE FOR E%PlANA70RY LANGUAGE� ' �. . ' , ^ Siqnorore of APP�cani or Agem pote - � � j . _ �s � ' � � .PLANS TO APPLiCANT � � � INSPECTOR'S NOTES OTS'NER-DUILDER DECLARATION . I hereby aifirm Ihat I am exempt from the Conlrattor's . So: � P.a4umod � . License Law for the following reason. (Set. 7031.5) ' Approved , IJasinessaxd�Projrssidns�dc�Anycjtyor�rountyu�bicb A�o. - - Date - No. - • Dafo - - � � . � - - reguires aperniit to conrtrucl,alter,improve,deinolisb, or reparr any structare,prior to its issuanre,also regutres . - � –- -- - ' � ' ; � '� - - � - � � - - - - . tbe applicant Jor sech pernait to Jile a signed atatement , , tbat be is licensed pussuant to 1Ge provuions of 16e Con- � ' � � - � _ `� �_ � � � - '- -��. � - ' tractor'sLicenseLaw(CGapter9J(commentinguitbSea ; ' , "�,-� ' ' tion 7000J of Divuion 3 oj tbe Business and Piojeurorss ! � �� , ��, � � _, - Codr)or tGnt 1�c is ezenrpt tGerejroni and 1Ge bavisjor i5e -� . , . alfeged exem/�tion.Arsy violalion ojSection 7031.5 by `Raqufnd DeteRetolred � � �� � anyapplicantJorapernrilsubjectstbeapplicanttoacivi[ _ _ApprovCis ' yos No or Approvod , , J�enalty of aot morc tGan j;vc bondred dollars(SSOOJ.J: � " - , - � � . ❑ I,as owner of fhe property,ar my employees with � Water Certeficafe � � � , wages es their sole compensation,wi�l do the work,and ' ' . � .. ' � . � "- .. . .� . ihe strucfvre is not inlended or offered for salo(Sec.7044j HaalthDephrlment � ' � . . , _ BusinessandProjessionsCode:TbaContractor'sLicensc - _ . � • � .. . . � �� . . Law dacs xot apply to an o+cner ojproQerty wbo builds � Firo Departmont �, - . . . , or improves tbereon,and mbo doea sucb uosk bimseljor � � -� �- - - fGrougb bit own employecs,frrovided tfial sach im- Giading � � provcments ore not intended or oJjered Jor sale. If, ' � � - � -� - � - , 6owever,tdebuildingorimprovemewtissolduiitGirsone Geologtcal �- -- . , _ �� � �� . - � . year oJ eomplelion, tGc owncrburlder will bavc !bc barden ofproving ibat bc did not build or im�irove for Pedcstrion Frotection ' � � - � � � � �t5e puspose of saleJ. ��' � � � � (Fence)(Canopy) . - , 'y,�• � � ❑ I,as owner of tha property,am exclusively conlrac- �. �-� tirg wiih licensed comroctors to mnstruct fhe project(Sec. Spetial Inspection , �� � � 7044)�jirasiness and Profesiions'Cp�c;Tbe Contractor's (Conc.)(Mpsonry)(Welding) License Law dnes rtot a(rply 3o an o¢mer nf frroperty who � - . . . �burlds'or'inrp�oves tbereon,.bijd wGo;contracts Jor sutb �''- Lot Droinage � � � � . projccti witb a contractor(sf licerised pursuanl 1a!bc . . . Contractor's Licensc LauJ. . Parking ' �- � � � � - � . .. . . . �❑ I am oxampt under Sec. ,6.8P.C.far this - � , . . reason � � � Dmo Owner _ , . � . _ . _ . __ . . ' Approvab ; Dato In:pecrori SI eturo � � ' � � �� ' INSPECTOP.'S NOTES lotation— '. , (Setback 8 Yards) ��� � � � � � � � - . Foundations-; .' . -.. . . - - - � . . . � Slab� ., , - . ' , , , . , . . Frame. ,. ', 2..'� _ Energy In4ulotioh � � � � . � . , , lath/Drywoli—� !` � . Interior� ��p . .. . - , . Laih—Extedar� ,. . ° ' � .• � ,_ ,f_� House Nomber— , . � �t . , - Correcf&Posled • . - - – � - - - � � Finol— . - � � . Emer on Front � ' • � � .