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HomeMy WebLinkAbout1332A (7) , _ _. �._ _. ��-�- _ �� � � WORKERY COMPENSATION DEGLARAiION � I hereby affirm 'hat I have,a_certifimte of consent ro self ��5��e,a,a�e.��f��a,eofWa�ke�s�ampe�g,o���s��o�,�e,o, -- A�I�LI'CAl'ION FOR BUILDiNG PERMIT '�.ta certified copy thereof(Sec.3800,Lab.G.). - � � � � � � � �� ����-�� ' �"��' '`" � � - �- � � . � - COUNTY OP LOS ANGELES BUILDING,AND SAFETY P❑oIICVNa � � Company� . . . .. � .:.�BUIIDING �r�-.� �, v ..:} �.� ... .. Cervified copy is hereby furnished. F012,4�PCICA;NT TO KILL IN " qookEss t� �-`t`il l�-�°G.'����Yj'=` ' •L' '�!t' � �� Certified wpy is filed wirh the county building Inspeo guILDING :7 - � ���� � " � - � / � - �^- � - �� � . tlon departmenL ADDRESS @r*8�.� � � �,� f�.��f�, LOCALITY � ':C��/�'`-�L"k � ...Dote ApplicaM. .. �� � � � � CITY - !'-..../ 4 •ZIP �'Yl. .,.. NEAREST j � . f .a ".��/, ..... . j, , '�'�r / CROSS Si. �s-A L.�CV.Y}iS Zd+C> -�-��f1 _.�CERTIFICATE OF EXEMPTION FR6M WpRKERS� � � � NO.OF$CDGS. � ( ' ASSESSOR .,�' � . �"" � � SIZE OF LOT ' NOW ONZOT � / �� MAP BOOK �%,M��J � PAGE L��� PARCEL;}�"' � � CO/v1PENSATION INSURANCE � ` (This section need not be comple(ed if ihe permit is for one =� ,� " . USE ZONE MaP / �[ +� � . kundred dollars($100)or less.) ' � . iRACT��: �",`t� 6LOCK � tOi NQ �!�,"�� . NO. �/�/7.�,3J � � � i� TEL ,�.�- SPECIAL g� . . . OWNER �. PITi1� ,.�.,i f�C�.%1�j'� NO YI� `'✓�� CONDITIONS � I certify that in�ihe performance of the work for which lhis _ � - �K � permit is issued,I ghall nof employ any person in ony manner ✓ ' Y� °' DIS7RICT G UP TVpE,,f FIRE PROCESSED BV V so os�fo beco-me subiecr ic_ihe Wcrkers'�Compensation Lpws. ADDRES� � -� CON�r. �E / � `/ ��" � � e Date - � � Applicant CITY (J Z�P STATISTICAL CLASSIFICATION' �' - � APT. CONDO. � NOTICE TO APPL�CANT It after making ih s Certificafe of AeCMTEC'OR TEL � ' .� W Exemplion, you 'should become� su6�ect to ihe Workers'� ENG�NEER NO. , CLA55 NO.�_DWEII.UNITS, � �Compensation provisions�of the Labor Code,you-musi forih- ADDRE55 ' SEWER h1AP -- ���" � � '� � . w�ih comply with such provisions or this-permit shall be, � � _ ... � deemed revoked.... .� . . . . CONiRACTOR�'�.'�eu"c- �a:�z1���¢a-�.',�O� �e.'��� BK. PG, VALIDATION . � �s' � LICENSED CONTRACTORS DECIARATION � - �" �� � ��-LIC � ��- -� I here6y affirm fhat I om licensed� der provis ons of Chapter 9�� ��-�� A�DRESS � NO VALUATION � (mmmencing wilh Section 7000)of Drv s on 3 of ihe Business and � � -LIC. - � �-�� �" � � �✓ - Professions Code,and my license is in full force and effect , CiTY CLA55 $ � �� ' ' � � � $Q.F7,, NO.OF ry : NO.OF CHECK � License Number Lic.CIpsS SIZE "Z`J�� STORIES .L�� PAhvuES ONE . . . . . .._. . .._., . � :, . .+. .. _ � g .. . Contracttir - � �- � ' Date � � DESCRIaTICNOF WORK " �FJ��.t � l u�li��/;',;- � NENI � - ' � I om exempt from fhe licens ng req'uiremenfs as 1 am a .�;'v E�� "" - � ���� A�� � licensed architect or a reg sfered profess onal eng neer . - � - - ALTER � FINAL 'I ,�S�i� .�� act ng in my professicnal coppcity (Sect on 7051, REPAIR � DATE �fJ��"7 - Bus�ness and Professions Code� � USE OF `� ' � � � . ' :....... . . ..... EXISiING 8 DG � ' �-��//;-', DEMOL � fINAL -� Lic.or Reg.No. � Date APPLICANi ^�' "' 'TEL ' BY �. . . � OWNER-BUILDER�DECLARATION . � (PRINTI �:�.'�� y�:'�j��� ��)ti� NO��f'P°;�""�.`."'�.��7� �� ' � . . I hereby affirm ihat I am exempt from the Contractor's Lice�se � . p� � q � � �.. � � . . Law for ihe fallo ing reason(Secfion 703L5, Business and� � ADDRESS ��`f�' �+-�C�f� ��� �'^- ����� 1 3��A Profe ' �s Code}W � . . . . PRESEN p . -... .� . � . rr�e a� e o�o-.'�� . BUILDING '�/ }' `� �; I, s owner of ihe property, or my employees with ADDRESS ��`� t"~�l"��4�•'����a � � `C � �-a o z,�,��� - � wages as t heir so le compensarion,wi li do t he.wor k an d � . � - . ' 'ihe s}ructure is not intended or offered for sale(Section.. LOCALITY � � - ' ._ R � ,�. � 7044,Business and Professions Codej. � ' MOVING � � � � TEL �� � �-� �� � � �e�°°�� '.J.�'d"' - � I,as owner of ihe property,am exclusively coniracting�.:. .. CON7RACTOR NO. - � � ' � , wi1F(lcensed caniractors t onsirucr the projecl(Sac- ADDRE55 - tion 7044,Business and Professians Code). � � � ��� 4 r 8�. - - -CONSTRUCTION�ENDING AGENCY RE4UIRED�"--- YP.RD HWY TOTAL SE?BACK FROM EXIS'. , SET BAGK PROP.IINE \NIDTH � I hereby affirm lhat ihere is a construction lending agency for FkON7 - �� � the performonce of the woik for w.hicH this permit is issued a.[.� � (Sec.3097,Civ.C.�. - � . � . SiDe � c.�. Lender's Name � - � � . . . . ..,. . ... ..7.,�... . � ' ' P.C.Fee$ Permit Fee r�J��� ��N - � Lender'sAddress � ��_�. _ . � w I certify ihol I hove read this applicotion qnd sfate thal the � Issoonce Fee - � Q b ve info�mafon's ect.I og to<c ply with all CcuMy Irvesiiga��ron Fee �" � � �/�� � - 0 o d�nances and Sta•e laws reiat ng�,o b ilding consirucflon: Totnl Fee � d her by ihor z ep ent t s of tnis Cn nry to enter - � . Q upon t e above memi�o,�n[ed prcperty for inspect on purposes . -��� � � �"� ' -'�"�' `�^"-"- -�"^��•��°�� �-�• - ���� -��-� �.. _ . . . , . a �_ �7r��? ' .�f,.'�U, ;t. � � �� �t�'�,, r{ - . - SEE REVERSE FOR EXPLANATORY LANGUA6E - - - ' � ' Sig�oiure of A�pl 2't or Aqer.t Co�e � � � � .. ' ' � ' � @s �- . , . , _ . . _.„..�...n-+-..- ..�_ . .. . ... � . . . .... . . . .. . . . . . ..,_ ..... . .. . ..�: .i .�.. .. . . . .-�rym..�......--.R�.�._.�.��R6ANS F@3 A.PP7.iCA�."F.� . �� iPdSPECTOR'S PlOi@5 . 4)UmNEIZ-BL7ILY}$Ft 17ECLARATIOIV c.. � . ` � ' •.��' ".�- '_ ��� ��^ a � . a.�w. " 1 hareby effirm thai I am exempt from fhe Coniractor's q�,e � ��pvc��� � �� � ' �� ' License Law for the,foliowinq reason (Sec. 70315� Apgarmvm� Ldusisaess a2d Prrsfo.sslosu Code:Any ciLy or cavant�evbicl� : [�Eo.-� � � DaPe� � � � §do. - Pn4� � � . � ::.. � reguzres ar9erm4t tr,construct,¢Iter,irr.prove,derrealish, - � �� . , .or�ref adr any s2rucAure,prior to$ts issuance,¢Iso require3 '��-...� - .-.- � -� ' . . . . � - .. .. .-. ..� . . ..��- � �� � t5e a¢plicans for such perncis to.jdle a signed stat2meret . . . . � Sbat h¢is lecensed psrassaxa to tbe pmvirions of th¢Coa- � � � . . . . � -� � . � ' '� � . � �-� � aracEor's I,¢cense Law(Chapt¢r 9f(corramexcing witb Sen .. . .:. . .. ` . ,..-�`. -tion 7000f of Dini.sion 3 oJ tfie Business and Professioxs ��. , . � � � �� � � .� . � � - , � Cod j or Ehat be is exsmJit tAerefrom asd the basu for the - . . . . . . . . rsddeged cxec;efitson.Any vio&atean of Section 7031.5 by ' � � � � � 8equir� .... �� � . � . . . . . � - . any appiicanefor n,pessnitsabjects the appllcarot�o ta civ£d ' A r�wo4s �a�i�e�ae�lvad� .�.... �� � .�r Approvud . ¢esselty of�ot more than five kuridred dollors($SOOJ.J: Y�s FS�o , � . . _. � � . �� ��� ❑ I,as owner of 9h¢property,-or my employees with �VJafer Cerfificate . � ' ' � .= - '` � "��`� .. ��� wages as th�s'r sole compensation,will do ihe work,and �� �` ' � Y� � ' ��' • � " ����. .�Lawf dt�es�a�'d nto�ax ourner o ed for,es�le(S�c.�044} Health Departmsnt �' -�'� . . ` ; � '.. ,�.�. ��" Susiseess ax Projessdons Code:Tbe ConEracf.or's Lacesua . ..-... . . .� . � d � PPY .fPs'of' Y wbo builds . - FireDepar9rr�enf . . .. . .. . .� .. "� -��or4mprovestdaareon.�gntdruhodoesxuchworkbd»asedfo-r ' �_._.. -���� �'- _ . . . . . � � Lbrougb bds own employees,�yrat�4ded tbat such im- . G"�:p��fl'` ��- ' '� � �� � -� �-, � --� , � �soven:ents are xot intexderS�or of�red for sa1e. If, � � � . � � �� �� - . -�- bowever,tbebufldfnaeri�rcproaem¢n3issoddwithinone . � Geclogical... .�„ � �� . .. � � , �.. .. . . . . .." . ye�sr�aj cozsspde2i¢w, tbe osusaaa�buzl(ler widl h�ye the , � � bur�en of protaimg ebaa k.x�dad not busld or imgrose for P�desirian Protection � � . . .. . - . . . _. , fhe pv.�ose of s�leJ. � � - �(Fenc�)(Canopy) � -�- ', ` �� �� _ � � � - � ❑ I,asowneroPtheproperty,amezclusivelycontrac- - � , � �.�ting with fi�censed coniractors to construc(ihe projed(Sec. Special Inspection � � � � � 7044)Susdness and d'rofessiaras Cade:The Contracdor's (Conc.)(Masonry)(Weldin�) �. . , , . Ldcessse Law rdoes mot¢pQZy to hss owvaer ofproperty u�ho � � . � � � � � �� � -� ��� �� buifds or improves tbereon,axrl wbo contr¢cts for sucb !ot Drainage , . . ' . � _ � . ' � � �-���f rojects with a contracTarfsJ LitevDsed fiursuaxst.to�the . �_. . . .�� . .. � Cotttrsc4or's L4cense I,Rw/. . Farking - � . � � �� ❑ ]amexemgtund'erSec " ,B,$p.C.forthis . . � - . . �� � � . � � � reason .. . . �, . � .. �� _.-�Ddtz ., _ ... . . .. ... . .. . Owner�,., , � . .�P9�y:�mvalv-.� �R3�4m� � � 8r�sv�s4ma's a'soes�iyrm . . . . . . ,... .... �, ,., . 18d5PEC80R'S NQ7E5 k Loca±ion— . I � � . . _ ' .. .. .. � . . ... , _. . �(Se4back&�Ya�ds): ' I � ' . - . . . . . . . . Pbundations -. � - .. . . . , . . ..._. . .. ._.. . . . . . .. . . � .. . . 5!ab .. . . . . — . . .. . � . . . . . . .. - , ... . . . . -..� . . . , . , � _ . � Frame . . .. . .. .. � , . . . .. � �..... _ _...._.... ' .-..., . . . . . . . . � Energylnsulation . �, � - � � . - � , � � - � � � � . Lath/Drywoil— � . . . . . �. . ' . �. Interior � � ��- �-�� � iath—�xtorior .. , - . .. � . . �House ldumher— . .. . _ . ._._. . . . .. . . . . . .. . . .Correcv&Posted � . . . . :;, . . ...�,-. . �- ; �Final— . . �_ . . . . . . . . EnPer on FronF `� � � � . �