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HomeMy WebLinkAbout1424A 1486A ._ _ � _ . _ WGRKERS'COM�ENSATION DECtARATION �. �� . � . � . � � I,hereby_offirm that I have a certificafe of tonsent lo self � � insure,o�acertificateofWorkcriCompensotion��,�,a��e. � �� �� APPLICATION� FOR BU.ILDING�� PERMIT � . � � o�o terr0edmpy thereof(Sec.3eo0,tab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Polity No. Company � _. � Ce�fified copy�s he�e6y furnished. , • FOR APPLICANT TO FILL IN . eu�ID�NG.^� 4� (`� ADORESS O ` � �Certified copy is filed with ihe couMy 6uilding�(nspeo- "" - gURDiNG''')�' p�G� -� p ' � - ` tiondepartment � ADDRE55 LC)A�J �rt.V Dale ' Applitant CITY l�(A kU� �•t ZIP l 7�S IOCAIITY ♦ - CERTIFICATE OP EXEMPTION FROM WORKERS' -� ' � - - � NO.OF BlOGS. .. / NE4RE5T ,_, _ _ . _ __ � � � COMPENSATION INSURANCE � � 5¢E OF l�01� � NOw ON LOT 1 CROSS ST. � -`�-� � � ���� (Thla section nead not be completed if Ihe permit Is for one � - �Y3�F3 S � BIOCK- �- l0T NO.:2� � �SSOR � ��- - � hundred dollars(E100)or less.) . TRACf MAP BOOK� - PAGE PARGEI TE�' ; USE ZONE MA I certify thct in the performance of the work for whlcH Ihia - NO. � OWNER W �� � � NO. � '� permit Is issued,�t ehall nof emp�oy any person In ony manner ADORESS- '��S �� SA V" � � ���A� � � � CONDITIONS so as io beeome subj/ct to the Wo kera'Compen ,smio(n'�la�.w(� �- -� � U /+Date' �'����'Applicant�.�`G ._ �. I.. �,oX_�. . CRY� ^ ZIP � ... .. .. . . . - � ARCHITECi O� iE�. DISTRICT GROUP. NPE FIRE PROCESSED BY O NOT�CE TO APPIICANT: If, afler`makinglhls Certificate af NGINEER ,KL.� �I ttlVO. o�- � N5. 20NE" (� F- Eaemption,'you'ahovld become sub�ect to �he Workers' -' �� � � TTV�fJ f�\\ V Compensafion provlsians of Ihe labor Coda,you must(orth- ADDRE55 �-�-�1 G�✓�a 6C� '� ��S^ � � � "�-'� W wi�h comply with such provisions ar.ihis.permit shall be . . . . � � LL' deemed revoked. �, � . � �� . . - „ T��• , STATISTICAL CLASSIFICATION APT. CONDO. tq CON7RAROR NO. c� ,'� LICENSED CONTRACTORS DECLARATION . �--- - � � � � - � � - UG-��� � � CA55 NO.��T"CWEl6 UNITS � � � I hereby affirm�hot I am liconsed under provfsions of Chapter 9 ADDRE55 NO. ' (commencing with Section 7000)of Division 3 of the Bwinex and _ ., _ . ��� � ' `��R�P . . - Profesnions Code,�and my licanee h in full force ond effec�. CITY � � - GtA55 � � �� BK � - � - - - � VAIIDATION � � � � - � �� 50.fT. NO.OF NO.OF CNECK � � . LICenSeNVmFlel � '�LIC.CIass SRE � STORIES FAMIUES ONE � , . � � . � . VALUATION DESCRIVTION OF WORK � N� � t��1 �� Confmctor . �. Dafa ~^ . ADD ; '^�p � ❑I am ezempt under Sec. � ��� � �� w L L �, - � � ALTER B.BP.C.for this reason . ' REPAIR S . . . .- ... �� �1 2,�l A USE OF � � - � � Dafe: � E%ISTiNG BIDG. � DEMa ..--� APPLICANT TEL ( ... #� � • •2 J Signotvre �� � � � � � FINAL OWNER-BUIIDER DECIARATION rawr ,$� J No. o-_ �' DATE/j/ � - I heraby affirm Ihal I am exempt(rom Ihe Contractor's Licansa - ��' ������� La for rhe tollowing reaion(Section 7031.5, Business and AD�RE55 �"t�: lR5 � FINAL � � _ Pmi sions Code): . . ... .. .. . . ... . � SY. . . . • `2 5'Q�°' BUII�ING ' r• I, cs owner of the property, or my employees wifh ADDRE55 -' ' � .O 9,O 7'II H ��wages as Iheir sole compensation,will do tha work'and i����T� � - - - � � -� - � - � , the atroaure is not inianded or offered for sale(Saction 704a,Business and Professions Code). � �� �nowNG � - � TE�.- �. �� �- � — � <1 4 8.b A �❑ I,os ownar oi the properly,am excl�sively contracling CONTRACTOR NO. ' • • . wNh Ilcensed coMroctors to consfroct the projed(Seo- � qDORE55 � ' � �� � � tton 7044,Business ond Professions Coda�. . � CONSTRUCTION LENDING AGENCY � 5[�BaC� �YARD�- hiwv T�TApROTG UNE wiorA � - I •�•3 6 7 5 I hereby offirm that Ihere is a consuuction lending agency(or FRONT - ��the periormance oi ihe work for which Ihis permit is issued - F.L, � +� • •J�7 J�F� (Sec.3097,Civ.C.J. SiDE - P.�. 09.09-88 Lendar's Name (�,(�� LDMA Ref.M m - � � - P.C.Fee S� S 1JV Ve�mit Fee .ZS � � � � tender's Address � . I cer�ify that I.have.reod this application and siate that�he iawa�ce Fse ���'f� IDMA P/C N - � obove informotion is mrrect.I agree to comply wilh oll Couny ���mrfgation Fee � � ' ordinances and Store lows relating to building conarrvction, . ,. . taai Fee �� �G-• � IDMq aerm.N � R oQ areby au�horize�epresentatives of this Coun�y�o enter - - � upI n ihe obove-me�_tioned pr perty�for inspe[tian purposes. . - ��' -` ''� � � •-- ^ `J, �� T � � ��j,�— ���� �SFE�RjEVERSE FOR E%�LANATORY LANGUAGE 7C✓�Signmur�¢f Appli<anr ar Agenf � �pate . . .\\\\\r� �lC _.L t�t).'7�a-'t353 . _ . '?So-YJ[f.� FLANS TO APPIICANT INSPECTOR'S NOTES .�.-O�l'Nlilt-13lqLUfiR llIiC;I.AHA7'l0\ � I here6y afhrm:hat I 6m-cnemp�Irom�F�e Cono-unnr's ' To: -,� ;. ". .'L;�� ...:�. Returned � .. , , .. .., < . . ��, ��' ��' � ���Lice,se Low' for �ihc �oliowing r a on (S!•c� 7031.5) .. � APProvad � � �- �� ' ��-�f)us�ueaan�(ruJ�scu,n.a(.nd�.:An,yrrtrnrN,unha•/gd, No. Date � No. . `•:Datr�.. .. , ,.. ... . , ' •-, '" . • _ � rryuirr�arrr.nit(u mnsfru�l.ultrr.im/.rnrr.dromliJ>, .. . . . --rr.rufnirany.clruetur.•,'rrinrTnitsiau.�uce.aL�iroquircc ' . � ... ; :. : :. � - ' .. : .� ,i .. �. :•�,.. � �L� l� i l' , . !/c N��J�/iinnt f r sv:h p mi�tn�Jife usi.qn��d atutrmrnl / �` � . . --- - - - -� �� -' . 1!�t l c is[i<enscd/nnsumi e tu!1 rPn�rs s�J the C.m. . , . „ . . �. . . �('�.__ �., J �,�}�`��:� C.�. i- tru.lor's l.ironcr J.�ie/(:!,¢�l��r J/(�nur i�n<'�n,q u�ilh Sr�• ( , . --- - -- --� --- - _ _ —� - — - = u /t� 3 ! u ' dr 1 � � tir�n 700 1 n iric�on n !!r uerrte�s un rn rss�ans �. . ;' �.' - � ?f�' : • . .,. ,. :' :�� 1 :-' ' �� C�- ��i 1 � ,-nJ�Jnrtbat(�risexcn�flelerrfrnmanJlbrFnsr��rufl�e , � . ,:. � ., ,� .� _._.•___ �_.._..—. .._ .., .�_--__-. - '_ - -�- --�--.. ._--=- . ._. __.__....--._..c. --� ;__.._. ____..'_._'_ ___ _'.Roquirod ._ . -"' � �' __..__�._.__.. �_ -�'.... _.•...,� _ anf�upphcn[/nrafcrnntsahjccfsf!afpLrunt(tra:r r7 --Data R c Ivod-.. . . �.:.'' ^�'� A provals . . � - ' ' ' � u!(v n/not ninrc ehua Lundrrd Jnllars/SSbOJ. ; v' �.. '�Yos No . or Approvod;,. - . . . . , "�.fen /irc J. -. , . � . r . � . " � . .. . ... _ ... . ...._. . � _ . ..._...__ .._'_.. . ..._ ...-..... __ . _ . .. __ _.. '_.___ . ��� I,as owner of ihe propeny,or my empioyees w-�ih ..... __. � � . , Wa+er Cr..tihca�e __._.._- . .�� • .... . �. _.__�.___._.�_ . .__._.._.. ..� .._ . .. tr._�.._._ ._ �+'ages ompen as�he�r sole t sof�on,wilt do ihe work,ond -� " - �- - �� � � d or oifered for sale�Se�,��7044) .. .�: -. , . .. . _., . ,.,,the sfruUure is nor intende Heal�h OePanmem-.---��-- .�- .. ----...-._.__._ ... _.. . ._. _ . .-..,_ . .. U+uinnrs und Prutcssinns C�Jrr'I7>c C ntrdr(er's I.i�cnse __.._'__ _ ._. ..__ -__-_ ��._...__ .._ . _ . � .Luu�Jnrs not apJ�lv In an nu•nrr of/�roperh'�rl�n Rui1,1�� ` ,.. . � �: . � �.nr im rnres thrrcun.and u L dr er t�a�6 u� k!�i ! Fi.e.OePariment-._-,.__. ._ . -_ ..._ _ _..__.. _.. .__.._... ,�. . - /' . _ ->� • . ' ..� - - .1Lr u,�L•.l,is nu �crnpL�r s p rrd.! pl l�su! �nn-�' . . Grad�nq �. - �- , - '�� , �I , � - r /rr�t�rrnen�s a r� .nt rrtJended. .u//c ed f r t�l� IJ, � � �.� � '' '� ' ' -,- r ,.� i.(�.:,.� .,,�I . (' '.,:'_ ��-�.Gnuerrr,�.eGebruldia,qnrnnfrnvcmnnlnsuld�ri!$innne .. ._ __�____ ..__.. . .. . , _.._-., .. . ..,_._--._....__ ._.._ _____ . : . �� - _ nmpfetion, � Geologkal ; .. .. .. �- - ,:: Year n/'t :tfir-nu�eerbuiWer.u iX�/>ar�• tGr � �' _.---...__. . '- ' �� hurJrn nf j�.nri»A U,ut l,e did nw builJ or irnp.nrr f r '� _ . _..._...._.__..._._ .._--._�. .... :.• . , _ .. t!c/�erpnir n/.iulel�-. . " .... . ,.... Pedeslrian Prolechon �. ..'. - '� � •.�� • , . . � �[! I.'as owner of the. et'" �� '� '.. . . � �Fence)ICanoPY) �.� .., . ___...__ '__'1.,�,� _��__.._........_. ...____.._... .___. '-�� . . P P �Y.bmeds�vely�ronvac,: �Jing w�th licensed co�iractors to constr c1 the pro�ect(Sec. . . �. � . .'.:'_.._:"._'_.�._:_ _..____".__._;_._ ,.__.__ ._ � llasinnss and Prn/c�irnnr�C�idr:"!'/�•-Cnrilrart.rr's _ _ Speual Inspecllon i ..,,. ..- .' --- � .� . I . , � .:. � 7044 ' � � l.icvnve I.neodnrs nnl s I 104d 04`AP�!f erfi u•!n (Conc)IMasonrY)(Welding) � j �. : � � �� . �� ....:�.... �,�..._ . ....:.._.. .. . _.__._ . .� hh 1 .P�'f . . . � � buifJs�nr irnJ>rnrrs Il rrenn,dud u•Lrr rnnfracfs Jur such i _-. _ � . I .-..• � . ' �, .__._ • . pr jrcts udth a aunfrortnr(a)liren�rd prusaunt !o fGr '_' lo�Dro�nage .. . I'; - . ,___. _ _.._. .. ._. ' _ _'_.__.:._'.� . __ t ( . .__... .. _ ;. :. . _.. -' �� ' . '�.` � ; -.--.' Cnn ra�n.i�l.i�rnse lauJ.'- ...- ... ,:.,, Park�ng � :� � , .. _� ._....__ _ ___ ._ __.__. _ �_ .._' - . . .__._ . _ ' ' . .. _.._ i � -� , ❑ I om exempt under Sec. _,�.BP.G.for`�his . , _._._________'_______-.__ �,,,.,. . . . ' �� � . reoson i .., . ... . ,.. ' . . ., . . . .. . ,�.�. .. -.- .-.- _--. . . .__.-__ _.. .. _ _.._..'-- ....----.' � � ' . „ - Daie O er � ' . , �. . -. - . . , , . , . �.,. _ . __ f .,, � _'__ ..._. .._ _ _ . . _ _... ',:_Z • '__-_ `..;' __ ..1... l � '. :- _ _ � .._ _.__.._. . ` .... . .. .;fti :_;:'-.� ; .._ :.�.- >.., . :INSPECiOR' � .• .. Approvals bato Inspectar's'Signafure ", . . . . � . . , . 5 NOTES ' c I lomhon._ .// _ ' � . � ... , .. .. f5etbock 8 Yotdsl /( '�--���'- ; � .;. �� � : �. . � . , � .: - Foundai�ons � , v;:�. . . . . , ,, , : � .�. . . ,. . . ,.,._ � Slab. � � . ` � , . ,_,.. � : , J - . . , ; ..___ __...'_:_ . _._...__'.__.."'.__._ ._"_.__.:�..... . � . ,�, �- �., ..� ,..,..�.... , �� Frame. ,.�. . �.�. . , .. . .. .. . . Ener9Y Insula�ion � . ' . '__ . _'_�_ .�'.'_..__._; .. . .. . ., . ... ..., . . . , . ,� . � . .__. _ . .__. _ _ . . _..., . , . � Lath/Drywoll- r -.__ . ._.._._.___.,.__....__ :._._ .. _._______. . . � ., . Inlerior � � � .__...._'___—____.. .._.� ' , . -� �.', . -', "� � larh-Eare��or { �, . . .. �... .. � . � . .. , . __ .. - �. .____._..._._.._ '..___. • ' � .' , . HouseNomber_ __._._'._ ..________._._ _ _�_.-_ , . CorreuBPosted � ' � ' �.._. ; \ .- _-_ . -__ ___.._ '__' . __ ._._ ..____ __._'_." �. . . ... ,. .. ._ . . . . , . . Finai_ . - .. _ i _._._ _.:_.�_.__.. ... .__:_ _ ..___._ . _ _._'___ . . ,,_ .. ... En�e.n�Front ' . � � , ..._. ' . .'. . . , i . . .. . .. , �� _ " . ' r . �. . .,... G,�-�- /.�r-� __ _ . . - ., ;_ r . .. . ,. � � .... � . . �:.. _ �, , , .� _. � . . . . .. . . . .. . .. .. . . . . ,.� -, r' .�... . �,i� .. - . ._...__..._-...- --.'._c -__.:.._.� __:__-'_ ... ,�' - � . . .'�'1����-_.'-ti_ � . , . ..