Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0769A 0856A
� I�hereb WORKERS COMPENSATION DECLARATION . � . � . - � � - � . .. �--�.. �� Y aff,�m rha, � hn�e a certificate of�o�8e��ra sa�� APPLICAT10�11-FOI� BUILDING-PERMIT insure,or a certificate of Workers'�ompensYian Insurpnce,or _ . a certif�ed copy)hereof(Sec.3600,Lab.C:) COUNTY OF LOS ANGELES BUILDING AND SAFETY v��yNo. o�,p.�q45ompany����wnrTm -rnmFnrtivlTY- — -- -- Cerufiad copy is Fereby furrrtshed. FOR A'PPLICANT TO FILL IN Fl�oeess���` ���r.a� �� 7�1_,Cerlified copy is filed wBh the a6v`nYy build g inspec 6UILDING �_ . � -� �-� tion dgparfine�eat "� ��-' - .^` . nooeess I K OOD�RD. �ocaurv , � ` � � � � ��r�� ,(� :�" ... �� NEAREST . . Daie. �� Appl�i,c��it - CITv - zIP - cROSS si - � � � � CERTIFICATE OF EXEIC{PTI N FROM WORKERS' -� � � NO OF BLDGS. � ASSESSOR � - � � COMPENSATIQN INSURANCE -- --- - SIZE OF lOT ' NOW ON�LOT ' � MAP BOOK PAGE �PARCEL (This section need not�6e completed.if�fihe permit is�:for one � �/� . use zoNe nnnP s�ry TRACT 6�+'�- y `Y BLOIX LOT NO. - NO. `,°;3�9 / . � hundred dollars($100)or less.) � �� . . �f �- TEL. � SVECIAL � . � - �, owNeR PAULIS No.594-4247 �' ��r coNoirioNs ��. _ I cerfify that in ihe performance of the wo k for which thls . . . - � � permit is iss�ed,I sfiall nof employ qny person n any manner DISTRICT GROUI� TYPE FIRE PROCESSED BV - ADDRF.55-3�..�I 7 HAWKWOOD � CONST. ZONE so as ta bemme�siib�ect tq ihe-Workers'�Campensati6n-Laws.� . , �� ,/,j �� � � '� __ . - CITY ZIP 1789 �L.� &� � Dqte - - Applicani - qRCHITECTOR - � . 7EL STA�ISTICALCLASSIfICATION . P,Pl-. ' CON�O. �� NOTICE TO APPLICANT lf,�ofter-mqking�ihis Certificate of-� � � �' . � � � Exemption; 'you�should �become�sutijecf to fhe�:Workers' ENGINEER � N _ CLA55 NO.�� � DWELL UNITS_ �� - Compensation provisions dF ihe LaBor Gode;-you.musl forih� � AD�RCSS �]136 HAJnK�.'�.LL ' SEWER M�P � � � with�comply-with-such provisions.or�this permi( shall 6e � � � � deemed.revoked. � - - � , TE�� gK. PG, VALIDATION . � - � � CONTRACTOR N . � � � - � �LICENSEDCONTRACTORSDEC4ARATI�N-�--- � � IIC.� . . I�hereby attirm that I a n�li<ensed.nder provivons of Chapter 9_ . -��oDRE55_.. . . . -�- . - � VAWATION � . _ (commenc ng wiih S ct an 7000) f Division 3 ot th B siness qnd � � ��C. � � �Q ]��R . Protessions Code,�and my license is in full torce and effect. � CITY�TALNUT �� CLASS 53 $ � � ' s-f ,& - � _,�'`� SGl.FT. NO.OF' NO.OF . CHECK #�ro c m�e`�.�. � CicenseNumber,�f��/f0. Lic.Cla9s SIZE � STORIES � FAMILIES UNE � � - - . �}tjg�,f ��-� � �,� - � e q3"� DESCRIPTION QF WORK NEW $ + e ���'`�� � � �-�Ci�iroctdi'�/7lf����"��,�t' .Dafe���8,,.� . . � -.I am exempt from the licensing raqu remenis as I arn a _ � . � ADD � �, ��,�j�� * licensed architect or a registered professional engineer , _ ALTER O - FINAL� � acting in my prafesslonal capBcity (Sectian 7051, � . REPAIR � �ATE�'���� � 1'��`��g �� � � .8usiness and Professions Code). USE Of- - . - EXISTING BLDG. � DEMOL. � FINAL . . . - . . __ 6y. . Lic.or Reg.No.___ Ddie � APPLICANt � TEL � , . . OVJNER-BUILDER DECLARATION - � � PRINT) NUT POOLS� Ncb95-7547 - ry ��� � I hereby affirm that I am exemp�from the CaMractor's Llcense - �,g� G��j � Law for ihe following reasoo.(Section 70�1'.5,.Bosiness a�d. AD�RESS- ����""*'� ��� . Professions Code}: . �-. - _ . PRESENT - . ' �' -•- ,+' '� . ❑ . ...- . - . � � BUILDING � ���rt'nr,.f9iLsu.,-C_./�-�r�L,./ � . �I, as owner of ihe property, or my emplayees with qDDRESS- � wages as their sole compensatibn,wil I do the work and - � the-structure is not intended o�offered�for sole(Section � LOCALITY - - � .✓,_c�6_G'�.. � 8 � 70AQ�8usiness and Profassians Code). MOVING � TEL .. �'� � �.r,,O���� � I,as owner�ot the property,am exdusively coniracting �CONTRACTOR- NO. - �� . . . � with licensed contractore ro construd the project(Sec- - �\, � �'k.m�o�,m a �'� � � �tion 7044,Business and P�ofes;ions Code). AODRE55 _ .. . _ ._ _ __ �REQUIRED TOTAt SETBACK FROM' EXIST. " . a � �9.5� . - CONSTRUCTION LEN�ING AGFNCY . SET-BACK YAR�' HWV -pROP.LINE - 'WIDTH� . � � �. I hereby affirm that Vhere is ci mnsiruction lending agency for � FRCNi r � ' ' .the performnn�e of ihe work foe which this permit Is Issued p.L � � - . � � �4�5 Ci�$ (Sec.3097,Civ.C.;. .. � .- .- .. . .._ � . SIDE �f . - . -. - . . , , . � a v.� , I c,0 1 -°8 1 Lender's Name . � ` . - -.. � - . __ __ . _�^ ___ ..._.. . /,��_�_ . . . . . � � _ ' PL.Fee$ ' �-o t,;�� Pnrmii Faa �.� , �^"�'� � . Lender's Address � . � - . I ceriify�ihat I have,reod this applimtion and slate that the e Fee �-� � � � � � - - � � aba�e i fo mation-s correci I agree to conply wiih all County invesriqation Fee issuan: M ord-nances artd�tate laws Ic�t ng to bu�lding consfruction, .s°�j���� � , ond ha by,.'ayrhon�e repre,y$`�ntat ves of 1hls County to enlar io�al Fee _ u up i ihe�'abeve-me twneb�pwperty�ar inspedion pur oses. � . � � � � , . , � , . . s � � _ � Q �!."���,�,t,t,,,y,J� � ,�''�,,,,.- ����j�� � SEE REVERSE FOR EXPLANATORY LANGUAGE � � . - . - - *^ w��5ignotura o{qPPI oni or Agent f Dote . � � - . � .. . � -- � OOs � � �Lei',` . . . , . _ .. _ _ . . . .. � o.� V�� oxi�_c .� a w"��?�'� �v �� � �"'o��, .. a m a� �-W -� � � . u c^s s�.. � 6J�'"�•" a.� �'O 3 O c� ��� � y,..� � � J � Do a ° o,c�i�d�w 'y"� oti c10 y�.t� cn„9��,�s-�.�-m � -c� � � �„.� ° 'c^ a,y a�. �'� `+°;�y m c"A� � ci"� v �� a o - ° u � o . � - ,N y� Q W�.$ Ul �- � 19 a� `�y �i lR S. � � d sa �4l N � ,�i � e�l � ` T v+� +a ' ?� ?.'—k'" . �c�y o���c���°� d � a.�� *y° �°� � ° ��°� � Q� o'U � ,� ' �� " an; � �.c�� mON-� E-=o � ��'��03 '" �� � c� a„� a c� � � i� � :. m.qo° �:�u';>' � o o " ; � � � w Q . �s,��� � c ; Q E @ w�� �n.� �'� � Q'� �.-a� � '�,�+°'y �H o�°n� ;z f"' w ° A, ' , � a � � � � �.� s, �h �'e� �= o � �, m`�,"„,'�' �, ` mv'� � �sa I �.�= o v"'..«, y a°, � � ��,�' � � • -a'U .q �`�c�� � � ...� ��o,� � � � I a � a,��ti �,�'«, � c�� � 3 � � �� � n �� � (> g.�. �ti.�`°�o�` '� o � y � ��.�S�� � � ��4. � � o c a o �-� . � , � � . W E �� �.°� C����o � � �pwE�e a, o.�a;o � � � � oU �'�» - � � e +a w, m m"�: ea� o ea`� ti �3 � � m3 '� � a.'� '� a' *��o�~a owo°� ��° �'� � � o-L° � �` � � I 0 9 �o w, .�,w.y ea• ,� e:.� O p m � � o y s s. V � � Ao.� � °� � � � r� o ,sa „`'' �m �a � �,�.„ o o ��.�ao°o � i �- o � o ci-L+ �.�..�;'� ��� � E� � ����a o�� s ° � �o�°i ��, � � � i ,� �.� y v � cs � �.� k`�+ o� w- V °'$ '� � ,� � � `c p,a ��'� ,.a � °o� . � � „ p � �. w -Q,cu o. s, � �� o•„ � 1 0 -0 9O � °D � �. �. qs� � y4�, � m -- w»a�o m � V'� � y o � ! v � �.��,� � p �`;�'.� �w m.G �` �- k � I C� � o'� �� � a� m o o`��� � • wn a� � a�-a � � a oa � C �i W E o s. �:��� ���'.y,,�o � c : s,� �� o a,m� � " c �; �, e � � �` a� p(� I 1 � ','^ �' � " ,a � n�i`'�'w �** o o a� �'�,'�� � aa �,�C o - a�a'� �*�'� � N � J �� � a x '���'w��-nv,��.�on � � an�,.�D.� � �„b � a'�a � °�'� �� �•m���� � j . . , V 9 >..� � p�- e2 G y"a o k'K 6 �.,,, a� e; � � $° '�'g o�.8�= '� o � ,a i �, . � �, ,,,.w::•».�y p q� oa�. �n C � d a: Q -r ��] a _ . n � � � aa � �aa"r.o:c'c3 '`�� � a � o"a o �'� �`� � • �.1 d ? � � �' s ucs � � a��i � ,� o �°� �p � � rn°'y� � o a °' �� 4 3 �°� a, n� o i — u �'��,�„+�n, � o'o y �a,� a � � �•�� % s°, o � � °i � �'o m � t°. D � ° �s � J. � � � o �U � d �., 3s�� a: a,� aa5� � �..1�ais,CJ � � ! � � _ I ,.. ; d � I . � � em � Fe � � � � , I �� � , � � i � � � � �, � � - , � ; _ � _. r,, : � � - =�: � .�r � � � . � � � � � � _ � a� � � � � � � � � ; � � � (�p � � � � _� � 6 � . . � S � � .f r �. '�� � R � � �pq �_ j � �� � � �, . � .. . �p'A 9 ! ik � � ry � 3 I . � � � �� � - . -� i- � '4 � � � � � I � "� i � �,1 �� � � � �� ii � � � � � � � � � 9 � . �� ,I � �Q � � � ,� � � i ➢ !; ! � 5 �.' � ."�� � ' , �� ( j yi I � �. R � � ' . �� � I �, � .. . . i { �'4 . q� � � � � �I . I � - } � . � ' ' � j �r� � � s � j � � f ��..{- �, - 'o � �� � � � � � � � � o p 4 � a Q3 B3. .�1 A ..C� ^' . � n� � � � I �' Q_ C m T� O I � � � � o � , � I.' � o o � o � a j � o �� c �: �^ o ? � ' � � sa.Q � � >- �n � . o p � � � a°"i ' o � s v �� a � � � o � �3.°� � �� u-'.� I a p `� 6�- � L �c ' p A� x I � � .. 'U i � li� � � �� _U �3 u d$ '� � o O � � '�4J� � �� C� � �1 � O.z'`� � i � ..� (ve � �_C V s .o � d$011 �_. � .� �—e i , 7 - C �.� b �3 � � BD �, a8 � .a �, �` �O� � O ° � �� p , � �' �O � O O C C �" � � . - .� � � '�-en=. Ch C'D io_�.. u:U � � a J`�� � ��va cs: � � r :C C1 'u.��