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HomeMy WebLinkAbout1755A 7550A (10) �_ _ _ _ _ __ " __ _ _ r_ _-- � _ ___ —..._ - --. . .__. r:. . . .: ... _ .:_. �` � � ( � - WORKERS'COMPENSATION DECLARATION �� _� � - . : � . �.��'�J -�I X��ul � /CJ�/1�/- , . , � I hereby affirm thot I have a�ceruficare�oF conaen t I( � , � insure,arecertificafeofWorkeriGompensotion���.q� ..��APPLICAT�IO,N,;�FOR���BU.ILDIN `��PER IT���`° .���� - � or o certif'ied topy�thereof(Sec.3800,'Lab.C.)�..-.'.`�,p����� .�..' . .: . , �'� . . ` . � ' - ' � .. _ � . �.? OUNTY.OF LOS,ANGELES ,� BUILDING ANO SAFETY" � Pohcy CtZ.C_��4�.Compony 1 -. . �', . ,. . . ' . � � . �,•Certified eopy is hareby furnishe LICANT TO FILL IN BWLDWG ' ta_ I . S� . �' Ceriified copy is filed'with the co n� i B iNG -- c � �• AD�RE55 � _ . .. .. . � .. .. .. , �. . . ��`Iion�deparlmeM. • . A�DRESS �� ��� J�yS �SG- i.,... , , . ., _ . ,;. . . ..;.�,,� ..,.. , .._: .... . ' -� • . i ¢Q .. _. .. ._. ._ .. ....._ 1 ... ._ ..._ . � . ... .._. _. .._._._ .. .. Do�e�Q�ApplicaN . . . C�tY�� 2�F �.� 1 . �t�= �� �ppq�RV� /, fj � � � � '���CERTIFICATE OF EXEMPTION FROM WORKERS'�x��" ���� -�- � `--��-- � ' "'"�'�•OF BLOGS. . ' ' . . N¢,4RE5T � i � - � ..:_ �;. 52E Of LOT � � E �'�.NOW ON l0T� �.� '�. ..-..r CROSS ST.'..D OJIL� � . ..�jL✓�.. ......__...�.. . ��� ��``�COMPENSAiION INSURANCE . . . . � (ThisseUlonneed not be�completed if IhepermitJsforone� -...•J`� � '" .'`.� . �'.' ��'-.`•' .�'' ''.' n55E5SOR �' - - �---. ..... . .. . . �'��. `_�:. .. . .. ...� . .. hundreddollars(E100)orless.) , • .......�.. TRAQ.. ...._.... 6LOCK .� ��.. " lOTNO.�� � � � /�qP8001C"�'' � ��. I �. .� PAGE�� PARCEL . .. ... ..,..: • ' � � OWNER��MF.F +�I�Yi Wr.�I1.V TNO.� USEZONE �� MAP:. _ . . . � . I�,certify Ihct�in�the��performance of�ha work�fo��which thls � � �� ' � � � � � � � � . . permit is issued,l sholl no�employ ony person in ony manner _� ADDRESS� 6 b��OL.J7 RU/f�- - --� . ��57ECIAl... - .�� � _.�.i 1 . a �y ao as to become subject�to the Workers'Compensotion Laws. --� � ' CONDITIONS I �'� . O „' , ,...•-^ :..y..� ,� n�. ,:�.. ', � . - . ,j ' . . . . ., i ....._.. ...:.... ..... ..._.. -, _ . ... � �7 U .,._�. _ . �'Date-' ���.:, - Appli�ant �.-. ,,,,.� � GRv� . Zlv / . I . ..-.-� . , fr � ' NOTICE'TO�APPLICANL�If,ofler making�1his Cerlificala of � . ENGMEER �R � rjp, � � . DISTRIC7 GROUP TYpE i FIRE PROCESSE�BY � � Exe P tion,"you'sho�ld become`sub(ect��lo��tha�,Workers ��---- � � � '�- � CONS "� ��" ZONE --- P .' ��Com ensation rovisiom�of the Labor Code oo muv forth - (J p i '���0 � . � � � � �` " W � .�' with�wmply.with;avch provisiona or this,pe�mit.shall be :.^ __ . _.. . . ' --" . . ' .... ` .. n-' deemDd revoked.�,,., � . . ., � CpNTRqCTOR � NO' � STATISTICAL CL45SIFI TION � � ., APi CONDO - � _ __ Z P Y ADDRESS � LICENSED CONTRACTORS DECIARATION � � .. O O��,.. ._ .._.���, .. ._.._..___.;, ttA55 NO.�DWELL.UNrtS�� � '- " �� � I heraby�affirm thot I am licensad under provisions of Chapter 9 - � ADDRESS ' � NO. _(commencing wilh Sec�ion 7000)of Divisfon 3 of the Businass and � � � . ��� � ., SEWFR MAP ��_, �; - �� . ProfessionsCode, dm Iitenseisinfullforce ��d�effetl � -- �E�� � STOR�S -'2 ' Fe.�i.,�u�S��N ��� 'CONE� } � � �.�,,. - �. ,. .�� . . ' � BK.� �PG ' . ..VALIDATION- . Litense�Numjbe1r� �LIc.�Class - . . . ' . oniroeter�♦ �1✓ UL�1 Y,Date ' -...' OESCRIPTION OF WORK . ..: -..... ....�A D sA` . � ' .. _... .. ,. . UATION . „ . ,,._.,.. �. , . 1 cm exempt under Sea ��-- :.. /Ql9J-�^ � �1U� . . . ...-- . _ _.. . rIi� � ,. . . . , . ..:. ..�. , ._ - ..C'. ✓ING .. . �LL E � � ., ALTER �❑ ..S �!"1'd��,-I � �� �I�J�A � � 8.6PC for.thisreoson � � REPAIR.. � 1 . . . .. - .... . - �...�. . . . . . .,,' �..."-. USF OF . . �'.. . ' . I .. �'• i • •`L�J - . . ._._...._ :__..�._ __......._._..Date: . - . � . . � EXIS7ING BIDG. - DE/'Aa. , . .., Signoture'���� __..... . . ..._ .�._.:. ...�-_ ��- -._-.. . nP7uCANT_ . �/V/ -�. .TEI. � - ..FINAI �. I � ��9��.Q.� .�. � OWNER•BUILDER DECLARATION � .� . � DRiM � NO. - ��_DATE �.. . __._ �... I�. � � -.I herob�afiirm that I om axem t fram the Contmeror'a Llcense -;� -' � '--���� - p �QI, � � - _. .. . , . - x_. ADDRES$ V OLnl�VN - ��..D-S - ' r professlons Code: _ _,__ �•5,Business and . . • FINAL ''' ' ' � � �' � �� �� . Law f I,'as�oJ+neriof_theso 0(ee'rioor7m3.,_..._.._ .... ._........ ,.,6y. ..� �. .,�:� ���- 0 9 2� 8 8' . Y P J c� �� . ' BVILDING � .� � . ' . . � p p y, y employees with ADDRE55 � � � I � � . . ��wcgea os iheir aole compeniation,will do the work and � ...".. . . ... .. ... '- -. .'._ ... ._ _ ... ..._. . _. _ { .. .. _ . . � � Iha atr�cture is not In�ended ar offerod for sale(Secfion � ����TY ' ' � � � �� �}� r,�.�r f �. � � �. -- 7044;Business ond Profesifons Code) ------ ��--- MOwNG � � - :� � ��- - TE�. �� � �� � �-�- -'� ��- � . � �. 1,os owner of the property�Gm exCluSrvely CanitaUing . COM1RRAROR � . NO � � � t:,) � � ' � with licensed confroctors fo cons�roct the pro�ed(Sec �•�-- �� � �� ^ � -- -- .- ---�� - � � . �� � � . � lion 70«,Business and Professions Code). . � ADDRESS � � ' ' - � , �I S�O A �RE�UIRED. iOTAI SET&4 K .. "-'- �i�' � ' . ._....._.' ..CONSTRUCTIONLENDINGAGENCY...`'. � -...'... 'seteACK ��YARD�. .HWY� ��.� OROP.IiNE � .` .WiD7N . . .. . . ; '.'- '....# • .'" •'� . . 1 hereby affirm ihar ihere is o cons�roction lending agenty for ' faoNi � � . . ' � ' �� � --the performance of iho work for which fhis permit is Issued ��:.....: _p.l,._. � �-... '- - . . .', ; . ___ _. _ _ ,..,_ �_. __ . . p266533.:. �.(Sec..3097.Civ.C.). . . . ,9oe � . � � . � _ .._ . . . _• . ....: _... .__._ .... "� P.L.� . � � � . . . .. . . tendar's Name - f - � �2 6 6 5 3 3 :n : . .: 1 LDM4 Re/.M � .. � � : v': m ..._. � , .. ...� _ __ .._ . _.. __._.. P.C.FeeS � O � PemhFee -- 10S�. . . .,. . ��26-a9 ' . i � Lender's Address �� - ,. '� � . , . 2 , . .. . - . ., _ , . . , 1 � :. � , , , i g ..1 Certi(y.thaf I have read this appllcatian and itata thaf Ihe ....... '._._n_ . :... �....!. Issuance Fee. -'. L LDMA V/C M � � � . �-...�_ � ' above informatio Is coneu.I ogree to tomply with all Caunry m�es�igau fee � � . - ' $� ordinun�and tale laws relafing lo building tonStruClipn, � ��� ,-„ ..�„� Torol Fee_ . �.. LDMA Perm.N � I� � � � ��� -'M - . . ._. .... . . . _... lG7l) R and Fereby no orize represenmt�es of this County��o eNer - � � � � - - " �� -� �- `-. ���.r a� _upon h bo nho property for inspection urpo3es � � ��- ,`_� �'�� f j'J� ' .. � � - : �' �`n� 1 D�M�A`aS,� m . .._. _ _ W 00; . � ,� � t '<>,�... � ` 9�G� - �, n . � SEF REVFRSE FOR EXPLAN�TORY � � . ��,y 7 3� � �. :.� > � ignatur of JCpp mn�or Agem .--_.... ___ te ' ' . � • -- . __. _... .�'_ ._. ...�. ._ . .._ .. �� .. � , . . . . . . .. . .• _. .i. S% ' � � . . . �, . . � � - . .. - J�;_, . ,_ , ___ _ .. .. . _ _ _ . _ > -:., ,�... ,. :, : '' � �., ,oF+',tii k-n �u.o�H ot c,i.nKnrio� _ � .��) PLANS TO APF'LICANT � INSPFCTOR 5�NOTES ��j. ���Y � 4� - � � . � . A he eby ofEi m lhol I am e c pt�ro n Ihe CoM aaor's ! � ��..s �1;:'� i" - �M s �:; r � ��.��s� w��. C .. P '+ +� � i License La� lo fhe�(ollo n � caso �SeY�'Y071 5 � ,i To: i r . Rsluined e ' . �i , :. , � 1♦ ^'�}; . 1, .-. � .� 1 � , r ., .. . <,. . 90 ; �',.� ,. 1 . ... . ApproJed �� �'�� �;li�eainrosanJ 1 r�J tcmns(nJi Anvcltl ir r u1+h u 1�mb � �� No. � _ Data :,� �Na v`n'Oofc• • i �' � '�.;�� .�'• ,�rl .�`� y�F � -•y . .. rla !1 �nsf t ult �J r ,c a.*r ��s/, , � �e. W 4SL9r � �(9t PS' . , � r:'fy f",^ .K� . 1 �< , , _ � l� .. �' . � :. � ' �� '�+' .:: } . _� �. � ��I d I,.il i-:nt � ..il���< < �. �s� ( �;lfrr��f�u.�f}asuth�peimrerl�%il�nsi,qii Jstaten'en1'� . � � ! � �. .. ,� V F�`)..--t ' \ � ---------- - .i ., � c_Z.tbat�e ia f4rns�?!-pursuawr tn rLre prm i�iuns of�71 r(:rm , � 1 � � �__.EJ _��_1h4la � �_A� _ + �,.��� Z�f71�L}.y.. �.-��� k`_<�-1 f _ � l�acHtal.�rrnacJav�/,La/�fer')I(to�nn�rncinq.u�ifb.len . i " - - "' �, '\ \ �ii�n�4r�n1��'U t nu �i of tbr Bas cas an^�Pro/t�iuns , 1 . --'--- -. S F e_.C\I �'�.. i ��.n.' l �1 �S .1..� � �'� _ � �:Codc s'b�t�e�i�s m t tGerm m�i n�l lbc•`asi5 r fbe; � _.� _ :, `� -� _ 9� a1��1- �(4cs;.._-,9.�(��,. �� __ �' 1'f�.t } �,r � � t- 7� ,. . . . � -.- . all<;qrd exen�pt nn,ylnv'viulutinn�/Seceran:]Q3!5 hp 't.-�_�-�'- '�_ '� Roqdirod ���'DalaRecdvad� '- �J�(H �jceQ„�-�. �-u".v�PAlicdnt/r�arcrniilsuhjec73Nrrapplicant�nu �rif � i � vP : _ __. __. :" ' .. _No .._::._or App�oved-. , _'_�p] ,I,:.'4��` p � r [] VI,as owner oi rhe prope.ty.�or J J dlars(SSUOI�h; � , A oval� ,. , , � �� ^. '. i . -. Yes.. � �...._ ____ V . . . eneld o nn!ntnre�lbun n e bundr my e�npfoyees with . .-. . . { `l. �. • � .. �' . . .. ._.. . ' �1M1�Ir.r Ce t f2aie_._ . . . � . '., . " . �. . - - ...... • . .. '. - _ t woges os,lhert sole com ensat onf will do ihe wo k an�' . � : �� - -�— .�- - � � , �.� � 1�,� � s�„he slructure is nol in(ended or offered far sale(Sec 7044 � , � I ' �� �Heahh-0e'parlme'ni a � � ''�� � t :�'I . � .,..-_ _�-_ . �_'...__ . . __ ,..Rusmes<undPrn/eisior�i,Crde !le�Cmaarf_rs�Liccrise- . _._� . .....-� __._.___ .. _._-_ . . � '-- -- �� � t�. � ���r� .. !au d ea ntit afhl�'In an���ner tJ(.riperh u bo hurld.c � .� ' Fire-0ePa�menr." �--�..;-��. . .�r� �,-�,�iT �� .' .'�rC\r1���,'-��f 1�'l�':\} �.j�Y��!JM�. `:1 o.a�!/r�ru ���l,is�un�rn�fr{}res�ornr•�'dedulbat s'uthli:nr r, . ' .:-�.. I ..-, , � .�-•-'.' � � •' �� -rc.ro0rrnenta>ore:not:nJendeJ or„�f�� eJ;Jnr.iafv._IJ, . . �Grod�n � . �� �` - . �'. ; .9 �. .' .. ; .�:('.� -`�" . 'c�•��'1� Gi.�� �cr, �1�i1,�1��`) � 3 � .� ��� �'.f��[,nurrer.�fbetiaiktingbrirnpmnemextui<ldt�Jebinone � .\ . c.. _\_'31 �. Geolo cdl�-..--�� -- I-- -- 'J iA,�-...� � � 7 "=,Yrar nj;inrripleh n; �tbe�f wn¢f•bulldPr u�illihmr'tbe� . �, _ 9� � I 1 � S�'j?�[ � .. „��i:!)L.�(_)�1�t_ r . , hurJen nf fm�m�lhul bc diJ nol bi tld or'imf+�rore�nr , � � � ._ . :.. ... '._ th riJsatcJ t n:� � Pedestrian ProleUion..,'..-. • � '�." ._a .:;., .�:. :,. . � , .... �_.�� ( . c u'(�ose'.; t .�� .... �. .... � A .: � � (Fence)(Eanopy) . .. . . � - -- -- �"---"-"---�'--- F,,.��.❑ ,6aiowneroflhepropepy am'e cl s� elycomrao ' - �� � ?�ng with 1¢ensed coniraUors to<onsfiuU Ihe projeu(Sec:� � . _ _..._.._ -. .. � �-- -- --- - 704 � ' anJ � �C� C i ti ' 5 �_ _ ��� _ i . �8dsrneu Pmftsrtn s��. nde��lc nn ra nrs � peciollnspeUioo t � C� � � � . � ( ( , Y)I 9) S ��� �"` ,.-�� = . - . -" - .�,�, .iCerta�au;Joar nnl�pll t un��e�u{Prnpertl ulin; Conc.) Masonr Weldin _ L � �_- ! .. _ �; - ' F� I - � � , buil��n�-r�esllc-�nn uiJu•! iunl -r�f rs t(� �j . . � - C " � + .. . __ _..__ __�. _ ���injerK. !t/a m�t Ct r�e/�,�, £f/y fnt!n eb�l , lot Dra no9e, . . . � tiz,.\�"' � I f ... � -r"J�=-.,`.7 �� . . . . s. ...... \. .�._. t �'� JJ� f,�i�tt( ��t � - .� onrat i slicrnv !�¢ . �. � Gorkin -._,��- . , . . .... . . . � __ ... __. � i _. n I � iti �a � �� � � �.I}r -.�r t,. )�- ' � �I � ..C���I am exempt under Sec 6 BP,C io�Ih�s �t � `13��3.'� c',L�V'.,� � __._ .....,.� ,�_�•_: ���� � �: .' .` , , ' ':,� f�.� " � .' . .. � ��..�::_� �1�\� �reoson� � - . . • ._ . , .__.. . _ .. . . _. ._. .__.r" ' " � � i `�� .j " � � � ' i.. ... _♦ . .. � . 7/ . ` � -Date � O e ,, . . : _ . z�.c.� .�a'z_:�..._.. �u�� =t4��t�w_��____.: —__ _.,�.� _ -- � . . ,.. __... ; ,..;.,..,, .. . , . i .�.�APPro ols:;: �. : Doto ,,.-.�Intpeclor's Stgnpfur��. _c� �� ���•� ���l��/t C� �) ia l`�r jC.., h:,;��, .� . 2.�_���;qNSPECTOR'S NOTES _ .�;1�, .. . . . .,. . .:..r:. � ..... �. . ...• _�r; _ . � to2otion- � _ _ � � .. . _ . .... . ! f5etbockg�Yards) . �-�.-..'..-._ �. . . . , �.,.�r. . '�r^�- .��n..,�, � -,:•i � �� � . Foundations ' . { 0 I .�. __._�._ . _-"'_._..�._.�"".." _".---'".� F.... �. .- ._n>. _ . . . c�« ,v: k� _i,�t,�: . . ., . .. .._ . , .. . � + ' . �,. � �;::. . � . ��, i -.�;..• _ . ....... . . . _ . . Slab �o � ^ � �5 6 ° __..�.-- ---- --._.�— �----- � , ,, � , ^� ,. ..� , � Frame . Y � .. � - . ..(- , ,. .....�.-� �.,o t.. .�., .tL...,..... � . .� . O Energylnsulafion�" �.� ..,..: � �,.�.��� .. . .� , . h,._. _--�- -.'-:�_...: :. ._._.-L�-;- �.j--= - �•�ct•;�. �c:.� . - - - .r,•�H:,.�a,..�..=i ;:a Lmh<Dr � all��r. • . � . . . -.-_- ".----- - -_._�___.._�..',_ . ._. _ . . Y+^' -_- ___ ' ___ . -i . . .i�,..� - , >^;-,; -Inrerior. � � ��.i� - � �� � � ,�'t, .. . � . . . . . . _ � . ....�... ..... ...��.. ...._,..: _ ..,� .,. ._, . ..,.. � ,�.I .�.._...�_'__"�___._..-'._"_ �., 'La�h-Exierior � � � 'c'� ('. .�� � � _� �x. Ch I.l"�� 1 � . r �:�1 .. � . , _ ,. , ___'��_._. __._ : . 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