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HomeMy WebLinkAbout1788A 1789A (10) . � WORKERS'COMPENSATION DECLARATION . . ._ . . . . � , - . � . I hereby affirm thot�I have a certificote of consent to self ,�:�,e,o�otenifica�eafWorkers'�omPe�S,�a���5��o��e,e, APPLICATION F�R BUILDING PERMIT a cer�i topy t rreof L5 �g��lab.C.) - . . Policy�o.� �� Bct�ompariy �IId,C!/1'�.G(� COUNTY OF LOS ANGELES BUILDING AND SAFETY Certiiied co is hereb fufniShed. BUILDING av' v FOR APPLICANT TO FILL IN 44 A2 nooeess ,3.3 Z � Cerfified mpy is filed wilh 1he tounty bullding inspec- BUILDING _ ' � v . . - � tion deparfinent. � � ADDRE55 '�33( G�Z�1 " LOCAUTV / � l�' Date �APPlimnt-� � CITv Walnut�� z�a � -91789 ceossssr. �(yL,�tll/BiP08 - . � CERTIFICATE OF EXEMPTION FROM WORKERS' � SIZE OF LOT 117'x64' NO'N�ON�LO7 MAP BOOK � � 7AGE CARCEI �� � �COMPENSATION INSURANCE � ' .�This seUion need not 6e completed if the permit is for one ' . uSE:�N MnP / �3�. hundred dollors�(5100)or less.) , ,.. TRncc�3ZS�I B�OCK lOT NO. �32 NO. � } " TEL. ' /�� SPECIAL ' , � a, OWNER � NO. — f! CONDITIONS I certify thai�in the performonce of the work tor which this , . _ � pCrmif 15 issued,I Shpll not employ qny person in any manner . ISTRICT GR 1P TVPE FIRE PR ESSED BY V nooaess 655 Brea Ca11 On Rc)dd /� ��, coNsr zo�e so os to become su6jec�lo the Workers'Compensation lows. 05 ,7 . O CITY [1Tc1].Illlt CA I�P Date � APPIicaN � 91799 STATISTICAL CUSSIFICATION -� APT. ONDO. V ARCHITECT OR � - � � � TEL. W -NOTICE TO'APPLICANT: If, affer making this Certi4icale of � ENGINEER� NO. CLASS NO.�DWELL.UNITS� � O. Ezemplion,�yov should become su6jecl�lo the Workers' ' y Compensalion provisians ai ihe labar Code,you must forth- ' qD�RE55 � 'SEWER MAP. . . � Z with tomply with such provisions or ihis permi� shall be TE� .. ' deemed revaked. � . -� CONTRACTOR ,S'r]I[Ie 3S QNR1fS� NO. ' " BK- 7G. _ �VALIDATION � � LICENSED CONTRACTORS DECLARATION � � � LiC. . . . . - I here6y affirm that I am licensed under provisions of Chopter 9. .. . ADORE55 . .NO. VAL�J,gTION � . - (commencing wi�h Seclion 7000)of Division 3 oi Ihe Bosiness and ���. � qf 9 pO 0 . , Professions Code,and my license is in full iorce ond effect. . Ci7Y �' tta55 B-1 E CY.-7i � . � B , SQ.F NO.OF NO.OF CHECK License Number.���a 7g - Lic.Class �� SIZE�2 457 STORIES 2 FAMILIES 1 ONE - '� � , � �.lJ� .O'NN1W� al �� _ S . Contractor � Date DESCRIDTIONOFWORK �W H� NEW . '.� � I om exempl from Ihe Iicensing requiremenl5 as I om o ADD � � _ . s'� 7&R,�A licensed architect or a regisfered professionol engineer . _. ._. . .. , ALTER � FINAL ,��_ � �� `- � octing in my professional mpacily (Section 7051, RE7AIR � �ATE �' • •••�G� 8usiness and Professions Code). - u5E OF DEMOL� � � ExiS71NG BIDG. � ❑ gy A� j� .P��L J�G Lic.or Reg.No. Da1e ACPUCANT TEL � ' . - � � OWNER-BUILDER DECLARATION'�` � _._.. VRINT . . . .. .� . .. ND. . . .' . N��GZF�� I hereby affirm Ihot I am ezempi from ihe Controctor's license qDDRE55 ' - ' ' � Q�J,2 rI�H� , Law for ihe following reason(Section 7031.5,Business and , Professions Code): . . 4RE EN7 � � � . .F� ]a 9�. O . - � . . .,. BUIIDING . . .. . . . �' • ' . I, as awner of�the propeny, or my employees with AODRE55 � '=S.#'� � � �� wages as their sole tompensation,will do ihe work and �p�q�ITY ��� � � ' ��- � � � _ the strodure is not intended or offered for sale(Section� � � � � � �� � 70a4,Bosiness and Professions Code). � MOVING TEi. �� .�� p�L�L Ei�� ' � I,as ownet of the property,am exclusively conlrocting fONTRACTOR NO. � - � � _ with licensed controctors b canstroct ihe projeU(Sec- . a w El 2��.%�c: . � .tion 7044,Business and Professions Code).�� -- � _. . . _ ADDRESS _ . . . . , . . . � � REQUIRED lOTAL SETBACK FROM E%IST. � � , £LI.2 fI"H�� CONSTRUCTION LENDING AGENCY SET BACK VARD HWY pgOo.LwE WIDTH . � I hereby affirm ihot there is o construction lending agency for . - FeONf � � ' � � � � � � the�performance of the work for which this permii is issued '� P t � ' � (Sec.3097,Civ.C.). . .. .. - . ... _ . SiDE - . . . - � . . j.. . . . i P.L. . . � . . . � lender's Name � d �� � . . �. � lender's Address � � P.[.Fee 5 � Permii fee �d dd �� �� - , � 1 . m ,l./i . W I certi(y thpl I have read this applicqtion and state Ihat the � Issuonce Fee ��� � �� J . � obove information is cortect.I agree to comply wilh all CouNy . ... Irnesi�goi�on Fee � �� � � (� . � - � $ , ordinances ond Staie laws reloting to building construction, � To�oi Fee � �, � � . and here6y au�horize representatives of this Caunry to en�er . � . ... � . , , __ , .. . � . . 0 � upon Ihe ove-menlioned property for-insPeclion purposes. ' , . � - ' a �����, �/��j-r �.'t7—�� � - SEE REYERSE FOR EXP�ANATORY LANGUAGE - � ' ' � . � � Signoture o7 App�canl o�Agent Do�e � . � � ' .�s �� - ^ 'PLANS TO APPIICANT � - ' WSPECTOR'S NOTES 04T'NLF•BUILDER DECLARATION � I hereby affirm thot I am exempt from tbo Conlroctor's To: � Rofurnod - � Ucansa Law�for Ihe following redson. (Sec. 7031.5) � � Approvod . . , ,. IIusinessandPrn�essin,nsCqde?Any[ifyormknfywbicfi � No. �- -��� Date - � --. No. -_ �Da}e -��. _ . .. ." . . , . .regl�Jr�s d�e`fa�it`to t'onsirucl,aker,inrprovc,demolisb, ar repairarsy struclure,prior to its isruance,aJso reguires �- � � � - ` ' �� - ' �- � � ' - – - � tGe applicant Jar sucG pernrit to frle a srgnedttatement , iGat Ge islicensed punuant to tbeprauisions oJtbe Com • � � . .,_ ..._ _._ � -- - --�- �-- � � , � . ' � �- �' - .tractoriLirer.:eLaw(Cbapter9J(aommencingwithSen . , � tiax 7000J of Dic�ision 3 oJ tGe I3usiness and Projessions � - ' - � � � , . CodeJ or 16at Ge is ezenafrt there,�rom and tbe basis forlGc _ . a!leged exrrn/�tion.Any violatrott a�Seclion 703I.5 by . •� Requirod � -DeteRccoived '�' �� �� anyapplicantJorafreroaitsubjettsfSeaQplicanito¢civil --- AfiP������ - - - or Approved � �� penplty oJnot morc lban fivc bundred dollars(SSODJ.J: Yos No . � - - . ❑ I,as owner of tho properfy,or my employeos with Wafer Cenificme � � . .. , wages as fheir sole compensation,will do tha work,and . -- . �� - - � .. . �� �. Ihe structure is not intended or offered(or sale(Sec.7044j Health Dep6rtiiient . - � � ., _ Buaimeir and Profcssions Code:Tbe Contractor'sLitensc . �.. . � ' , ..� � Law does not apply to an owncr ojproperry mbo buildc � Firo Dapartment � t � � or improc�ea tbereon,and tebo does sucb work bimseljor - � - � - - � � tbrough bis oa�n employees,f�roeided tbat sacb im- Gradinp � " - provements nrn�naJ inlended or oJfered for sole. Ij, - - - � � ' - bowevcr,1be buildingorimArovernrnt istold witbin orse Geolagical ��� -' , . � - _ - , . - .. . , _ _ , year oJ tompletion, tfie ownerbailder utill Laue tGe - � berdcrs uJproving tbat bc did not beild ar imyrocro for �� Pedestrian Pro�eclion ' � � . ... . . . . - tbe purpaac of roleJ. � � � � (Fence)(Canopy) " �. , �� ❑ ,I,as owner oi the piopeny,am ezclusively conlrac- ' ' _ , . ting wiih licensed mntractors to construu ihe projen(Sec. Spetial Inspedion � 70q4���usiness¢nd Pro�esiions,�od:T5c Contmttor'r (Conc.)(Masonry)(Welding) . � I.rccxsc Laa�docs no!af�ply to nn ou�nfr o/property u•Go � _ ' � '� \'�F��,+�Qs�p;tin�rovcs[G¢�c,ga,rpnd a f o�onegeu for tueG Lot Droinaga. . . �projects'o.•itb a eontraotor{sJ licensed�iursuant So tbe � i . . - .-. Conlractor's Licensc LawJ. . . � Parkin9, � r . � �i 'ti � _. . � . . � . • ❑ I am oxemptunder5ec. ,B.BP.C.forthis � ' , , • i � '�.., _�\ � _ - - _ . . . . . .. reason ' � . � . � ' � . . . . . . . . . Date � . . . - - -- -Owner � . , ApAraveis � Dato 1 pmcto .Sfgne}ura . . . . . , INSPEROR'S NOTES Location— , � . . . .. . � . . . . � � ... (Seibock 8'YardS)`• �� - � � Foondations��� � � - .. . . . . . . � - ' Slob .,. - . /` _ . . _ . _ . . .- . � . - . . ._ - . - Frame ` � • . � �. . .. . . . . . , 'rw�:.e--r' Energy Imulation � ' � : � .. - . Lath/Orywall— C� � � . ,� . . . Intcrior / � � � • � � . Lath—Exteriar ... .. �i� . �-� . � . House Number— . -� � � . Correcf 8 Posted � �' - - � Final— .. .. . � .. Enfer on Front ' � ' � -