Loading...
HomeMy WebLinkAbout1384A 1629A (7) WORKFRS'GOMPENSATION DECLARATION . . � � �� insure,�or�aFcertifca�teotWoken'�Compensaton��=��o�e" � � APPLICATION FOR BUILDING -PERMIT � �� or a certified copy thereof(Sec.3&70,Lab.C.� COUNTY OF LOS ANGELES BUILDING AND SAFETY �cyNo. Compony � � Ce�tified copy is hereby fvrnishad: FOR APPLICANT TO FILL IN ADORE55 �)��-��a- �l�0. ll � Certifiad topy is filed wilh ihe county building inspec- BUiL01NG /� Q . �ion depoAmenl. ' . A��RE55 / Sai a C/c/4��� irvt" LOCALITY . Da�e � APPlicam cim ) �.ino� ./.vy-.C�. zio l �� NenaEST . CRO55 ST. . .CERTIFICATE OF EXEhIPTION FROM WORKERS' . . NO.OF BlDGS. ASSESSOR � � .COMPENSATION INSURANCE. . . � 5¢e OF tOi � NOw ON i0i MAP BOOK PAGE. vqRCEI � ,(This section need not be�completed if the permit is�(or one� , '� � USE ZONE mwP, � � h�ndred dollars(�100)or less.) . ' � . - ,., . TRACf. � /� , BtOCQK - .�./� LOT N�OJ.'/- ' NO. � � 1 certify Iha�in ihe performance of the work for which this OWNER .0 PL� [/ .SSGE E ./�Y � � - CONDITIONS �� �' C : parmt�is issued,I shall not employ any person in any manner Aoouess��� (�- )"�e U//5 f oisreicr ceouv rrve FIRE P D BY O so os to betome ubje to the WorkPrs'Compens tion laws. � ' CONSY� �1 , ��TY ���.�s�oc= f�- ��P l0 rr r �Do�e_L'��PPlica �� �O C STATISiICALQA551FICATION . . APT. ONDO. . O ��, NOTICE TO APPLICANT: If, afler m king this Ce 'iicate of �1RCHRECTOR ; TEL ��1 , �Ezemption, you ahovld become subject fo fhe Workers' ENG�NEER NO. CLA55 NO.�SL�DWEIt.UNITS � 0. , Compensation provislons of the Lobor Code,you must forth- qooRe55 SEwEe hwv , Z with comply with such provisions or Ihis permit shall be TE� � — deemed revoked. ' � N� �gg, �p�,, - VALIDATION � � COMRACTOR G� �LICENSED CONTRACTORS DECLARATION ' � LIC. I hereby affirm lhot I am licenaed under provisions of Chopter 9 ADDRE55 NQ � VALUATION � � (commencing with Section 700D)af Divisian 3 of the Business and � IIC. '�A^0� � - � Professions Code,and my license is in full forca and effect. Ciiv QqSS S U� . - � �� ' ' � SQ.Ff. NO.OF NO.OF CHECK , . . _ litensa Number � lic.Class SIZE STORIES FAMIUES ONE � ' NEVJ S Contracto� � Date �SCRIPTION OF y,/ORK A�p Q � � �1 3 fl 4 A�� � ❑I em axempt onder Sec. - � /�-N���-�'�'/ r�a v�n���- - . f ` �' AL7ER.' FINAL u $I• e • •L,'j B.&P.C.for fhis reason � � � - REPAIR � DATE l I(o� , , , Date: USE OF 7 --' .� DEMOI..Q FINA - I •-'2�J.O O .. E%ISTING BIDG. PE�S.�p� . Signaiure � . . APPIPRI TT�'7 Q ['` ' ! e� . � , ��_ . .�.° �2�J.O O C ',. OWNER•BUILDER DECLARATION � '� � �� I heraby affirm that I am exempt(rom the Contractor a Licanse • � , � �2�3-8 4 �, Law for the fallowing reason(Settion 7031.5,Business and A�oaE55 � . � - �- - ��� . � ' � � ' Profe fons Code): � - R N ' � BUIIDING I, as owner of the properly, or my employees wiih no�ae55 ' � � � � . � wages as their sole compensation,will do the work and � . _. the strucrore is not intended ar offerad far so�e(Sectian ��`��N � � �, �� � � � �. 7044,Business and Professions CodeJ. MOVING . TEL. . : . � 1,as owner of the property,am exclusively conhacting MRACTOR NO. • , with licensed contractors to construc��he pro�ed(Seo- qDDRe55 ' � �tion 7044,8usiness and Professions Code). , . , ., . .. �� 6 G(�� ' REOUIRED TOTAL SETBACK FROM � F%IST. ' CONSiRUCTION LENDING AGENCY seT BaCK YARD HWY CROP.IINE wiDiH � � � � `�, I hereby aifirm that thera is a construction�ending agency for .. fkONi ► � '�. - - � � i�• • ' " •�� '. � the performance oi�he work for which this permit is issued R�. � � , ,Sac.3097,Civ.C.). � SIDE _ . .. . � � •2 G,,�i Q . . _ . .. . . P.l. �. , �� Lender's Name . , , .� o��.v G Y: . $ � P.C.Fee S Pe�mi�Fee � l � � ` � - Lender's Address � , � �_ �f 2,� 7`Fj[i _ �, � I certify lhat I hove redd fhis applimtion and state that ihe Issu ce Fea .� � � abave information is mrrect.I agree ro tompfy with alf County inves�igation Fea �� � , _ ._ . . . . _ � . ordinances and$ta�e laws relating to building conshuction, To�ol Fee C1 and hereby authorize represenfatives of this County to enter � �, ' . , upan the above•mentioned property for inspection purposes. . - � � - � � , � � � � --� � � � i �/ � SEE REYERSE iOR EXPIANATORY LANGUAGE . -�� ,� ' �• � . _ �3 »..=aiure o�nr or Agem � Dote .. . . . � ' . ` ' . .. . � . ' - :,; � ''�fl.ht75 TO AFS�UCAFtT'' � � � .'�(;SP4C70;:'S Plr)i�> � ?�..�. .... n«'rt 1 .L'UII.DL[t DLCI.ARATI0�1. . ..i ;I hnr 1„c`( ,J.�a?I-�-� excmpt trcno Ihe.COntracfo(s To: � ,� , . Rafurnvd . , � Licc c Lca io. thr (ollavrnfl reoson.-�(Sec..,7031:5} >Approved I . . . !'res irss n.rd f rq4..rr rv Cr,dr:Ar.1'ci(7�nr co��at1'�=•GicG . .. .. .. . . . ir No� ___'.__.DBIe_f._ _._ �So.-.' ...Dato�;.___. . ..._.'._':._. . ... : . " _ ...` - . . .'� _.__.. .. . , ... _rcg:::rrs-cpr -^r-rL�:....r.�cf,r.t.tr�r.rprnrr,dcnenlisb, --- - .. .. . .1 . . . . . . . .. ... . . ..— ..,-- r � �r � 'r�r �' :strir.r e u m c u' ._ .._._.- _. ____. ___.. _ _.__ �.. _ ..._.._ . . ,. .. ._.�.: . _ _. ._ . . .. .----._.... .1 . - ,, -�, , tl+e pplic�rt fo s�t�ch hrrn:itr�u je'!e a�siQncJs[at�nicnt ep rr:r i . , - . � , . . j : .. . . _ �,-_ „ , .. .__�,'�. , , , ,� '�' fLet�c rs lrcenscdra�rsuun.t!n!Gc%froniainns of th.c Con= ,._ .._____._ ._.. ._ _....... .._._.� _ . . _. . . . . . _ . . � . .- \�„ . - . .--.;`,:' 4\.. ,,.`.(,. tr::tor'sl.icersel.:nr(C!_p!er91(comr,:uirrngeri[GSee- . . �--�imo i 0011J�j ITI,�:.,1,,,:i�J t6i•Uu.si�iss.o aud Profe,ssions � � � - ; CndoJortl.+.it! w�ii�nipCtf�errJroinaiia�lbcl,iuisJortbs i . . '�-�`' . - �.-' c11 p � p1> ��1 � e !t�ir-of Sc21mn 7031.5 6}, Rc+��:red � � � -"r �. !'�. r/ , ts�r cts,'t1 �pl'cAnftnacivil �y7y_J �DmoRecvivcd �---� f.^�rcval � ' ��` - � - - -� .l1�n 1 1! rl I�undrel d Ilars'SSOO.: , _ J ve: Ma_I .�..er.Approvad� :,.\� � ` — 1 I�% - f � �� ... . ._ ._ -.-_-- . .-. J. l,cso.norr.f;f,�_propnrty..ormynmployaeswilh •wc;esceth r �.-r.m;>enectio�,will!delhe-wcrk,�and Water Cerfitica!e I .__.- ! ''� ; � I . ,_ .�. � .� �;�•-;.. . . :: . _• . ` : � ,5- �-'` � '-' -�'�� .,�.tho r•a:tu�e a not ..e�r.]cd or otfered forsvl�(Sec:�7044� � Hea111tDoparlment.�..'�-�. `�� ` .. i-�- '.-'� � "���. ��. .. .. ... . ..�.- ... . H ardPrnfresrn�'sCodo:Th.�C�nlractoriLicense �., .. , . . � ...'__ ' ._::.. _ .-.':',_::'_"�. .._ ..`,.-��.'\. .._�,.'�. . .=.. :. : -, _ --_ ✓-:'ocsu�C'upp:t[:i.cr:ocrcr Jpiv/r�dYty.ti.�Gobssilds � ; Fire Department � ':�,•�� �r:�_:.L ��,�. . �, .. __ _,_ ' in/rn c.� ,d mrclror '�. . � v ' :;Il er� � . �f�rr's��:7+�i�nrk'T i� � . _ . _ __.. .. .._....- _. �.' . . ..__ __..._.. ._. . ... �"-fli ,,1 Les d �i �;•I lrrs, f�rot'�drd�t(�aNsutf�'im- � .� .� �. . . . . .... 'I;'Poc�F� � ��c-r>�' � ��� nr fjcres�forsalc.-7f, Grading ,. .. � .. __.._.._. ... . ._ _ . __ .. .. _. ___..._ _. � . .. . , . -- � " Tn:.r:rr,t/,,,7 S!.�r�r .r./ru�v".�nt�rsoldu��tlydonc GeoloSicai� � '' .--- _.._: ._ .. . . . ., '�'. , �.:�'�� yrrr f cn.rplb.�,. t! --h�rl��cr orr!l7iair 1lie . . .� . ' I �ifi� � r.<i �r`o i�.,nr'ir.:prne�c fnr . <,,.. .., , .'. .. . . Pedestrian Fro�ec�ion � � - � d /�urpvtc ot�s 1 f ,:� � , ,' � - ��� (Fence)(CanoPY) � n �(� Y n_�: .� 1�l.l:ns ounr.r.�i ihe P�Ferty�,a:n oaclueivelyconfmc- L .. - . . ,:"�", . , ... .. _ . _. _ . .. . _.._ , , t n�w�il,Iice_ �-+mnrmctnrs lo construci tne project(Sec. � I "..'�� ' �'ii. .��.._. .__ _ .:.. � 70'4J Ur,>fr. �- �.-1 �' 4'n�I�-�_17e.Condrrtctor's Special Inspection ' • . _. '_._ __ _ ._ ... ..�. ' "'_ .r�� . �,r;,_ (Cone.)(Masonry)(Weldinp) ' ' � ,-;,. ,, _ , „ I.icm•ee f.au � q!�l�t n o:r�rr fproperty uJ�n � ' ' - -.-- _. -- _ . hu IJ r �<i xv . LotDrainage -�. � �. -:: ._ ��..: _ V'��("�. ��� . ..a\i\ ,�..,. ��. __ r i .t .. � cfl,` . . , .. ,n1�ltA f._ e tJ �r 1 cn trucia. . � , (+ t d :r.. ���rstiant .i� . 1��..- ,__ . ___. _ .. _ � l(i __ __' -_. "_.(n......tnr. l........�.-_.,.' � --' .� ," _ _'...... .�... ,/ _ . ._ - � � r his � �, �l.F).-i� �,-- --_. -_ t - � c B dP.C.fo t ' Parkin � . cv�'�+� �� 3 '__ _ ""_ 5� l,l .�� � !� � , , ._ r �..t - � � .- r.F ._ ..- '�-h: _..... . -_ . .. . uoce Awncr , , �. _ , , �,, . . .: �` . . . .,.�,�-'i.,..... .,n:o. �...... _ �-.r':- ;�' �.�.�i' ApprovcL• I Co;a J Incpoctar'z Stgocturn � . . . ._ . . . �'. . � I�-- �{:37� '. .. -- __�"�'—_ _ . �. � Locafion- _- _____ _- _._.'_'.'. ____ .__..__'.._� . 'r.— . . _ . . '_'_ (Se�back E YardsJ -- ' ' - ' ' ' ' ' :. _ . , r�� ._ . .. �. .... . .. .... ....� . Foundaiions , . . '.'., .. ,' r!'''�, >.' Slab � . . . � .. .. , . . . .. . .. ,.. . �- , ., '_ : � �) � �� �� �� . Frame �. d �S-U%"`r� �`:. � : ' �. �. , . '. � ... .,.'. . .. _. _ . , �• ' _ " _'_ _ . ._ � . _ Energy Insulalion . , '. ; ' f ��. � • •.;�� . . r�,::.. �,.. .,,'., .� . Lath/Drywall- � �j � ��n , � � . -' ' .. -Interior � � . ..,. , . . .. . .... _ .. ... . - . . . � . . �� . . : . . ��� ', ., . . . _ . " __ "_ __ . .. _ � Lath-Ezterior . ' ' � � " � � . I . _.. ..� •��. • � "' i.. . .._ . . ._. � _., _ . .__.__. _� _ _ ,. . _.__ .'._._. . F . . House Number- � -- -- - .�r:::��;; . , . �. � . , . . , - .a. . �. � . .� '_ " . __ ._ ____.' _, . � Correa E Posred �.. _....:... . ._._: . __.. . _.. . ...___ . __ .. .. � : :>... .,� �.,:-., ,.,., . .;.,..�.. . , �„ Final- . , , . , .. ,,�:._. .—.-'-_.^-. _ .. . .. _ . .. '. Entcr on Frent , . ,,.,`, ... .: �: .-� . . : . ..; .- ., o . -.....',,.:. :: ..�.. ,..: .. „,. .. ��.::��' , . I 1 ' .{� ,.� . , ' � Oc1 ` ':1 1: "`^ � �^�uE � .. .. . .. ..�....._. ._ .,. � _ _ � . ��� ` , L ' � ]i1��i � � . � ..�i,�..� . i l J _.. .. ... . -. i�-