Loading...
HomeMy WebLinkAbout1320A 1355A 1353A _. , , , , .._ _ - -- -- .- _% •WORKERS'COMPENSATION DECLARATION � . � � - � � � � � - � ,ora{c1err�iificmelofWorkers'rCompensti�°�=�°a��eso � . APPLICATION FOR BUILDING PERMIT - _���� ti'e y t ere 1(S c.3600,Lob. ) . ay��Q r���q� COUNTY OF LOS ANGELES BUILDING AND SAFE7Y icy No. Company �� // � �' Certi(ied copy is here6y ivmished. FOR APPUCANT TO FIIL IN npoeess 7'� �-�i�zd 2E-.1+`"� i—1 CerfiFied topy is iiled with Ihe counly building inspeo BUIIDING � �J �ion deportmen�. nooRE55 ��J' '��QC�✓ � � .�f�1�.5 toCAUTr �f nA+�c.ntt �� � � DOte. � .Appli[ant CITV fa/�C J R-ZIP '/I7C� NEAREST . CRO55 5T. � � - CERTIFICATE OF EXEMPTION FROM WORKERS' / NO.OF BlDGS. /+SSESSOR � � COMPENSATION WSURANCE StZE OF LOi Ga �I Z-U NOW ON t0T MAP BOOK PAGE GARCEI (This seclion need not be completed if the permit is fOr o�5e USE ONE MAP ,L hundred doilors�(SI00)or less.) TRACT��Z�� BIOCK y—f�l�QT NO. �� �f NO. �7—.3 T� r I�.�/YV �/f�zC�L'�'// Et. `�,. �.-sf SPECIAI . O � I certify thai in the performance of the work fo�whiSh this - OwNER NO.� �.l Ee�+ ��'� '" CONDITIONS ' ermit is issued,I shall nol em �o an ersOn in on mannef '� DISTRICT GROUP TYPE FIRE PROCESSED BY �J P P Y Y P Y ADDRE55 �� ��JE� ��s4l�s CONST� ZONE �� �„ so as fo became subjec��o the Workers'Compensalion Laws. , . �O �3 O DO�e � ' ' qpp�iCanf ' CITV �• Z�P STATISTICALClA551FICAiION APT. CONDO. ~ NOTICE TO APPLICANT: If, oNer making Ihis Cenilicale o� ARCHITEQ OR• TEL. - � n W ENGINEER� NO. CL4S5 NO. �`"/ �WELL UNITS . O. Exemption; you shauld betome s�6jec� to the Workers' in COmpeniotion prO��5�on3 a11hC LObor Code,y0U mUsl(Drih• - qDDRESS SEWER MAP . � with comply with such provisions or Ihis permit shall be 1� � deemedrevaked. . � - � � � - CONTRA ����r�, /F�C'/f N�' �% BK. PG, VAIIQATION LICENSED CONTRACTORS DECLARATION �///1J� liC. I hereby affirm thol I am licensed vnder provisions of Chop�er 9 ADD ESS ,s �[rJD� Na.3yi�y� vnwnnor+ � . �1 3 2 0 A (commenting wiih Secrion 7000)of Division 3 04 the Business and �i�, p . 5 .��ya� !�:`_ �� � � 2 3 ' . Professions Code,and my litense is in full force ond effect. Cliv_�' /�i/f�• C1A55.�J '� % • •:��• �2q SQ.FT. NO.OF /J� NO.OF CHECK � " Li<ense Numhe�l���� LiC.C�a15 � SIZE STORIES f FAMILIE$ ONE �.• •5 2�0 0 � �/;�rnE.�i) C/IEEk��iQS, J� � DESCRIPTION OF WORK NEW ❑ S q��O . . • a � Contrador Dme �/ .� 'J Z��� �� I om�e•emp�from�he licensing requiremen s as I am a � �f,s� y�r'��j�'��C.� ADD ❑ Q� 2 2�$2 Bcensed archi�ect or a reg�siered professional engineer aLiER FINAL J o[ting in my professionol mpocily (Section 7051, " REPAIR � � DATE J p���a— ' Business and P�ofessians Code�. use oc - /� R 1 3 5 5 A � � EXISTING BLDG. � � DEMOL � FINAL . Lic.or Reg.No. Date � APPIICANT iE�. �I BY ����C«n� . #f,• • •��'z 3 - � OWNER-BUILDER DECLARATION � iPRWT� � - � O" NO. �Y' �' /� /,{ �/ZYC� I herebq oifirm that I am exempl from the Contractor's license �� J°t I� /`�u�(� �j �.' "��8� � � _Low for ihe following reoson($ettion 7031.5,Bvsiness ond /DDRESS � � � ProfessionsCode): - recsErv� �Q4t���t�� inJ�1��L ���J,�/'• •.• •..�80� . eUnDinlG � ✓�It a l!l1-d9e✓ � �, os owner�of the properly, or�my employees wilh ADDrE55 U��2']�82 •xe^�s c;fhcir so�a mmpensofion,wiil do tne woik ond � , . ' � . � . the strutlure is not intended or oifered for sole(Section IOCAUTY , � 7044,Business and Pro(essions Code). MOVING . TEL. , ��-� I,as owner of the property,om exclusively comracling CON7aACTOR NO. - with licensed canfroctors lo construcl rhe project(Sec- pDDRESS � - ' " �� 3�3 A . tion 7044,Business and Pro(essions Code). � � . � �, ' REOUIRED TOTAL SETBACK FROM E%IST. . `• � � #,• •�� ���`� CONSTRUCTION LENDING AGENCY SET BACK �ARD HWV . GROP.LINE WiDiH • . , • � I he�eby aHirm thal Ihere is o mnstrodion lending agency ior FRpNi ' ��• •7 9 5 0 • the performonce of ihe work for whith ihis permif is issued P.L. ' (Sec.3097,Civ.C.I. .. . . . . . SiDE.� � - � • • •7 9.5 0� P.L , Lender's Name /�) ' '- � � � P.G Fee S �� L�' Permi�Fee � v V � �� 2 7.�8•2 Lender's Address � �j j1 . . � � � I cerlify 1ho1 I hove read Ihii applimtion ond state Ihot iha � �.Q 0 Issuonre Fee U '�0 ' obove information is correcl.I agree fo camply wiih all County _.. . i��es��gonon Fee - /J�7 -� � � �ordinonces ond Sto�e lows re�ating to bWiding constroction, Toml Fee //•.�B ' and hereby aulhoriza repre5en�atives of this Counly to enfer . . � �� .. . upon th_obove-mentioned roperty for inspec�ion p(o�rQoses. , � . //�.����,�i�-+'�•J`,^,��'�1�— SEE RFVERSE FOR E%PIANATORY LANGVAGE � � � � �� � q i f.� � Sg�oNre of Appliconr or Agent Dote , � � . m�t fl S ^+ r ln � , � r [n ^V �7 � o o. � p ino o p �n G� Gl 2 t - Z a � oo �. _o � �on � . o� AfD o ' m � o 0 � 'P3' -o' o - x- ,� o Q' o � ,�', n � . ?v � m <�' n- ap .A � �' o ^o �.vD a � o s `� � p',Z x• ='-c j� . ::i � 7ni-:� 9� - tO 1 7 " ,,�-�p', �• �O v p (7 r '^ .a� °' o a �.� � �� w i b a � . :�' ,o� � ° � � a . 7 � a �.�' � Q t N p i ( •.M � w O 7 � 3 pr "` b . . '. O ' �O O"' fD n: i O � � a-, - 7 'D 7 � O � O� O d — � v p � '. � � t . 0 L .. I � � _ > O .. O . v O Yi 7 � A r' Q1 � I a t v la � � z s { � . I '� Z � .t o 'r � � .. M Q r � i _ �� ,_ e � � � , � = 1 � r M I� O. a p C� Z � � • v �e -i � � . � o. `. ' '/ , a V, o � , H i , ao : �; �, ° ' � m � , D u . c . ,00 ti . c O �Q < G. O . O. , �. �v � C . . `; �. � . .;" � �' � � ✓ i•� � � . � � � • ' r� S - ' � ' `% f � �I . � - � ` . � � . _ � . �j 1��C, � � %• � .. i• • Z � ��.� � r .,� ,. _ ; T , � `/ ~ �' I{n~� ' I" f // .\..� ,, N ,- . . '^ v 4 ' , � ' ` �\' �t �' : - O � � � � �� i /' % �� ' � t'_ N ' I�r ,� �j�J ` � - . . � � ^, �/ / , f� . � s(�' F\ � , \ ` . �� � � ' . . .��:i � / o � ntr;c.r�-•, c-�e L�t> o �.�;.f b c c n� ` o ;"� ,- : m o [] a .°�:�� a''� ❑� Q.i � a ° y�E �-�iO ❑s�,��0 4 S n « " � � ti m S � i � w'� F � e� � A e:y a.� H �a° m `�o �•�b ;,� � � � � ' w " � , �7-- � x~`�' n L`~ m N � � -�c'p.�{�`i �h`�'�A � » m � ' ' Q 1 F w.A Y'. _O �`.� , i C,C �^ A C � �n F! O r'�n'A•G A '� O �,�,-� 3 . �•n '^ m R} ., t,^...M .�, " x'p S u� Q � ��-,� A �b.- ��p .r O �'�L..,4 E A ? O Q • � r" � Q. .N O O ` �� f�., w`�G C� A. f ....1, . . , � o �'- D�^� m7 N&.�'�� ° ^�� b� � � �o�^ mb� �ofi � � 03 �. 3 A � � �' $ am a a � �'�.`o 0 0 o ti o'N.0 0.ti � +� :U '�a o � ., F � 2 c' c a � o �`� �.�"�s a'c � s� � � n o, mb � k o•�fi .fii fi C �'o G7 � ' '�,� e��i a � T • a °p a $ o`'m' o c,j �: a �H �n�c v� m ' C -� '� �' �,,,°'L a'%�.° o `° o �.�c. & o n ma��° .�, °^•C b`.b � � � n 3 d o y o � � � ' p�v C b4n a-� °�yo � o c•a `o'C� �.•°� � q. ° m r 1 • vA'� �� aN ° �^ �:� 'oq,=' 0.� '.''.-pg.� ��e'° ? ati ° �' o` ;� �'oC ' p � � o o� o « v�� i o � o �m�� � � �o c��\N��a�v n H �.��,�G m ���.��^y o af o �•m�•a �5 o a�•�ti o o� . p n �, n.^ A A m o —3 0.n �ntt h , e q a' o X1 f _ b c o '�1" �,� M'• tL C"'v � °a-c �'o w 0.� � �•M b�e � 3 � � � a..�o T� ° o � � v n `" o a o.4 -C-p a o`'?3�� o i . s�i ' " ' ° � � ,��,bnv �• ' �.�tia°v�e •^. opb �n�a �4.z'�.�A � oinm0 �� . � � � h b�a o f° � "& � n�..� �°t�„ o '' a v� �Oq�°,,H �' � � n z n �`1 i � N n . a A w �n C 'p N (J O D y w O�.p � �^ 1 l�� j a o e �-a n � hn N �„o w � .o- m s`< v 0 ok � omo �,.. ° '� C.�fi � aDf �3.�"' o•tio�s �'c-'w° ' T e�•, �� � „ o c-a �s o � a� • �� ac� � � h �'�:; o . N m C-o a�. � m A�: � �m�n.T ..:�c m � ? � . C-� `