Loading...
HomeMy WebLinkAbout1560A Y • . '' ." _. _._.-�..-. ._ ,...w. _.._ ...._ '- ". " '_"__. . ._ . , � . _� inSure;�v,dceriPY�a1eOMPENSAiIONDECLARATION � �^7, - ---" � . -j • :t� � � •� WORKERS'C � _ . ----._..__ - DING PERMIT ._ I.bereb affirm thot I hove o ce�fifimte oF tonsenl to�self ; ,. ' of Workeri Compensolion Insurante or o cerlified co thereof(Sec.3800:Lob.C.) � -��-�' - ""- . . - APPLICATION FOR�BUIL � • • COUNTY OF LOS ANGELES I BUILDING AND SAFETY =•;• � =i . . . . . �. .. . .. ..._.._. ... . . . . . ._ . ; ..... Polfcy No.' Company • -� - ❑ PY Y �' FOR APPLICANT TO fILL IN BUIIDING '�Cerlified to is here6 fumizhed.� • � � A�RE�/��({�- G�'��� _ Cerfiiied copy is filed wifh 1he munty building Inspeo- �-��.� gURDING / � �"�fion-departmeM. , ' �. .�•.` . . . ... . ADDRESS o��0 0�, `E Il/ ��•:. �' .. � :. -'�',��.�. � � , . _. __ �_ f�1 __ .. _ . _..__ _......_ _O Dota '� , .,�' APPlicant. . . '.".�- ..�.• - CITV�'V/*G�J(G/...�-. ZiP � a .. . �. LOCAtIN GN � . � ! � `CERTIFICAOMPENSATION'�INSU AN EORKERS' :.' SIZE OF LOT� ,3 7S NOW ON LOTS. � .. �, CROSSSST. . "..:.."-...-_-'_,....._._....___ _, _ - G�OL%tit- -•- [This�sectlon need not be completed ff the permil is for one •--- ��� �/ � -- � ��--- r nS5E5SOR.�• �, ---- -•-�- - -. ���-� -• � hundred dollars(�100)or less.) . _ ,. � TRACT y� 9lOCK LOi NO.�J � MqP BOd('' � PAGE� 7ARGEL so s�to beco e Iwb�ect�othe Warke sPC o�n io onyhmanoer ... �R S a�G -.�._�.�C/�'�d .. N s _ � �IDAO. �pNpiii / '- -- - --, ,�. �• .� :a I _ _ TEL. . ... , ensation Laws. -..---� �5 w�C'�� �Q��� �U ., ,. .,. . . . . .. . Gc . .. . pTY � -�� ---.._.----- -�- -_ ...� .-'-.-- . ..._._ Dafe6��3'O 7�Applicant � . .' .. . ---"---"-ZIP_. .'7 .. ___ . , � � , I . � NOTICE TO APPLICANTi If;pfter making CertifiEate of ARCHITECTOR TEL. : _DISTRICT__ GROUP TYVE.. . .-..FlRE .:o ENGMEER NO. -.P� DBY... Eaemplian,�you should bemme'subject to�the'Workers' '""" D CONST ZONE _._ `V Compensation provisions of 1he labor Code,you m�st forth- ADDRE55 n - - �. :d with mmply wi�h svch�provisions or this,permil shall be �� -� �,� � �� ��� � �vf deemed revoked.. - . � �.. : . .. .. ,,,�. ..�.. • COMRACTO j � Nl. '� (� 5 ATISTICAL CLA N ' _ '_._' . . ... . .. 9 T SSIFIGATIO . A .. CONDO '�Z LICENSED CONTRAGTORS DECLARATION �. �� -� - � ��pC.- ---- � � -G1.455�0��DWELI � �� � � ♦� ''/ .UNITS I hereby affirm Ihot I am licensed under provisions oi Chapter 9 � ADDRE � cC NO. 7 (�S� (commencin9 wilh Seclion 7000)of Division 3 of the Business and . ._ . .. ._ y� l ... ...-f- . . ... ._.. _.UC.-....�+ . � � - _ - � � . Professions Code,and my licensa is in full forte ond effect. CITV /-7 L/l/(.(.,/ QA55 C������ --� '�' - �-��� -� �-� �� -' --- - ---- .. ... � . . BK PG � � �VALIUATI N . . .. �/������� S(].iT. __ NO.Of.�_'_. .. NO.OF_'__ CHECK � � , � .. •. .. . . : • .....-. SIZE STORIES FAMILIES -... -�� ONE - �. '.'.:.,..,'r;.....:1" � , lit6nseNumber5'����s/�� �,�.aa;SSr=SQ,i_ ���� ... .. � . p , . L ._VALUA ION... cor,o-o�r�/-���QiLt__S Date Q �IS'"u 7 ' DESCRIMION Of WORK _'____'_ ._. _ .__' NEW.__ S �rJ.00 `'. _ < 1 r b 0 A noo � � '. ' �1 am exempt under Sec. -�--- - -- - -�'T�- � - - ---- ' ' . . .� � . ., , . . , ALTER � : : � • • • •.� . . ......_ . . _ , , B.BP.C.fOr thi7 reo5on . -. I� G� REPAIR_� -'; --'�--.-_ ..--�� �-' ---� -- -- - -� ` USEOF � ' � � �`S�SO- . __._. .. ._ ._.._ ..._. _ . _ _.._ . . i - �Dafei EXISTINGBLDG. D�a ❑ _ ..___ . • •-�.�j J(��� ."'Si nOtVIB .. APRICANT `�TEL ' ' � � � .... ' �'._.__._..._. _..... ...'__—._.. .. .- . 9 OWNER-BWLDER�ECUIRATION _ PRIM�A�P � 1Q�1C...� N0.�J - SL �DA EL - �--- ,-----�T--�3:_1..3--�-7--'�� _._ _; - 1 hereby affirm that I am erempf from the Contracfor's license '{�. � � Low for the fallowing reason(Seclion 7031.5,Business ond ADDRE � � l. '. FINAL � � ' � ' � ''•� � � 'Professions�Code)i- .. . .._ ..-'--.�_ ... . ... .. .... PaE NT . - By-- � . - � , � -. .. . , .❑ BUILDING/�� � , . . .. . . . _ _... _._ __ . . , I, as owner of the property, or my employees with ADDRE55 ' !___ _ _. _ ,.'__ ._.. .._ ._ . . .. wagesostheirsoletompensotion,willdorheworkand `��TM L �7 ' , � �. the slruclure is nof in�ended or ofiered for sole(Setlion � ' �- � -.-.. ...7044,BuslnessondPfOfesS(On5Cod8).--- - '"` MOVING---"�-`..... .. .._. . '___ �L.'_'...._... .. . ... ..__...__ . . ... _ .. __ , ._ . _ i � 1,as owner of the properly,am eadusively mntracting CONTRAROR �l � N /(� : � �� . .�_. .. ...--- -- - ._... __ ....-- �--'�---. "-- - --....... ._......_ _ .. �..._....._._. 'I �.. ..__. .._. .___; .. , -�wil Icense [oMracfors fo[onsiruU t a projecf(ec- ADDRE55 � ..� � tian 7044,Butiness and Professlons Code). ' � '_"_' ..._._ .REOUIRED._ ..YAR�. .IiWY. ..TOTAI SEiBACK .. I . . _ '_'-"". " __"'_" -___ -'�. '__.. ..'_".._�.: -� --'CONSTRUCTION IENDtNG AGENCY'----�-�'��- sei eacK PROP.IINE wiorn i � I hereby affirm�ha�there is o construction lending agency for FRONt " ' '-�' � � ..iha performance af Ihe�work for which Ihis permit is�issued -. .-' 'P.L-. - - _ . .O.-_..--'.-_-.____..._._ -. . .; . ....__... -'-...._... _ ._._ � ... . ... ._-__.. - __ (Sa[.3097,Civ.C.). SIDE � � � ' , _....___. .._ .. .. ._. .. .. . . ._ __._ ..._.. . .P.L. . „.. ... . _. .. ...__... _... .__.... _._ _ _ _ " . _ . . I ' ' ' ' . . ., __ . . _ . .__ . _._ . Lender's Name v� • �pµq Ref.R ' � ._._._. . _.'__- __ ___ . ..__.._ ._ _....' '_ _._. P.CrFeeS'- - . -'-.'_' PermitFee_'u_�.-'_. '.' i . __ .. ."' " ' "_ ' lender's Address . ' : �, ! I ce.tify thot I hava reod this.opplicmion and stele.thot the . .._ ._._. ._ _... __ .__ ys�a„«f�e---�.(�.-�._' ipMq piCp- _.. ... .. . ,.. . -"� . .'. -..' obove informafion is conect I agree to tomply with all Counry Invesligolion Fee � ' - ! .ordinances and Stata laws relating to 6uilding consirucfion. .__.._ .. _.._.... .'_.__.. ...�_.__ �°' ' _ ._.._............_. .__ (�' ...;,: .,. .,.�: and hereby authorixe representalives of ihis Couny lo enler '.` Tolol Fea ---- --�J�-�-' -LDhM Perm.-�� ---.--_.--. --.---...-. �.; upon the above-mentioned property for inspection p�rposes. , � _ . . ... _. . .._ . ...._. ._ . _. . . - - � - - y p . ._._ . . . _.. __ . ... . . . _. ._. ._ •_ ... ... . .. ..... .. .. .... . (_���Y�� �1i7 Q SEE REVERSE FOR EXPUNATONY IANGUAGE '' . _...- , �Signatv�dfAppY orAgent-..- _. .. Dota._. '_.__ ._"..__.._'-""'_'_. _.. __"" _ _ '_ ..__ �__'_._. .. . . _._._.._ . ..._... . . � ._ .___..___._. � �(�i , : .� Z :-+. , ,'. � __ - - o 0 _� -"- -_ �� � ' � o nv o.Q o', ° m ° ',m ', - r Q O m �i�p a O 7 i r m T f!� _0 V+O �r p � n n.� O' � N (l • r p � W ^ , ^ O �� �O! tp �V � �N D ! m_n Cl= 'P � N � C 7 6�. . t� O �— Q �� .O ,UN. , � `....' ... • 1 p Q � 7. � t0 m p � j 9 � . C �' �� Q . 3 p I.n v^ � i . r l0 � � � D `� . • F '9 t0 �'C7:. � � _ A "O ,t� ' �. O I �,Z x ��c > o Q°� O m O n•. O O_ � 7 � � 'O' O � � � m j T Q°c c� o o � '" o o -- ` � o; •c'� ' � "—� • 0 oQ- o o a M '� y'o :.� _. ' , � � � ��0 1 � ". - � ':' _ ',� � 1 � a I � � � �, ia : ';,, � � i� � � o �. O a Y O � �p 7a A . .o O �. - �.. ?O � � o ' C J� C . ' A ' � � " _. = o. n 0. 2 . � , � � � • �. � . � � ; ' � � � - a � • o0 � �• :� , - . . . p � . ... � . � , - E 70• a - � �'1 .M... : ' . ' . • ' 'S7 4 a ' n ' �,. ' •v;. ' • ,�W. ' , � m - , m c q. �I ,o' ' ' 0.a a , �� � :q- . .. . i . • ' . . . . . _ ' _' ' . I J' 11 � '� • , ' . . , �i� � �i ' • 1� . _..- -� - 1:i/� � ' ,��, �' .• ' . . _._ . . ' - i t { _ � � I . � I � . � � . .� .. �� J -' '' � . . , `' ��I. 1� ,+. 1!, �, '., .. � � . +. ;1� . . ' �•���. _ . '�` '` `- ' � V �I ,1 . '` �,' 1 '�• '!� � • � ` . � . ; . , ; _ 'f`, .a . _ _ .. - .. � .- 't • , i _ N . . ' "i '. . � , y �1 �' '' . , , 'i : • ; ' ;', 1 � . � . � - � � i � i � , _ = j 1t �::1 � ..' �'� _ ' 1s;, '/ � , �i'. �I i , '' �. ` '.1'� - t 1��.. ' , � - 1 . �, • ., :._ ,� � ^�;n~.;:e-=�� �.m s „'•� ...�Sf n � c c c c m ti � .,� � . � ; . � ` � .. c�'.e �b.�.Mc�cceoO��e�.aa .^�. ct, y�_H . - - '' � . p 1' n4 k�p� � m� � g c c .;•�.�.N m ^� '°'�-v i �b �.H �"� �.: : N �i J` .r ❑b � � � R., O r,•„b y �^ •��.(� �. ; .. �' ;t � ... " � . �' p i O ; � � .�a G N� f e ;�� `�`��.p n H n•O :`^•�'�`��V �b.s�.:� p ,/C y �0 C..� O C�� .�.,i ..4 m�C. ' ' c'o , o , �a.N ti. r � � C = n � ' �� �' � �.� 1 � ' ' ' fi O` O � ~.� =.�� �4 3 A~ �~ ���'�f � ��:n C 2 � � '+ $�p.:0 3 x ,l _ 3. N w.3 E M 7 �C O v'b p.� O��jp C �7�'N 7 •�• � �1 N C i�+., w� N � T- 'R,.,' . . ' f� �:ZT (`� ,N L �� M C l0 � '1�Y�'J�O O �D � C.�� �'��? r. C.N T� .cD - n C • m.' �' � ' ' . _ _ , lp j�,A � NCa'� F�CCC3,�,04`_ H'7� .�., na ..1f�J � � MCnC � ' �C' 3, a�^ N .. c.'^ o„: � a.O.e;= �m o �.� a� � ne�ob u '" o°,O . ' � 'g• ° p o -� • a-'. �o � p � ' � 7 c. F�c�w�c n � ...c� 3 r � e� » 'C� w ,e � L:N 0.3 co � • a � � . .� o..o' - ' Z ' �' t'"n `�° e o m ' ...eco '�' a c a.x'f�amv `='"-c�~� = ' .�^.�A�.m:O . . � � - �n CL c � m a h=�'.' m �':'� � �'-o- ,�n � � � n L 'C ^ � � . _ C' �� n .. �. N `O �Ce�^.in'D. ; �`Q y t�n H O � ��:O� ���_,�„`c� `=` ' A'.3�0.�'� �t _ _ '� , ; p °� � n', �-a o M a � _ �� � �,b o�:..a ��i ��h m o e.,;y«h.�� c'+.-•-y � A I � o C:m. � :n. ° o � N _ ` . , n'as np=�. . c 'a.� � o �^`n-.�:f.o ���.�t, �.?:c � e =•,.e 3 .� - � � '� . _ _ _ , . ' � �.o C N o , e„c ie o��� e4 (��- q,a cn� � �.M.tw �y c ��. � , _ - . . . � .1i 1 -. '.m O'3 10 c �o ' �•c-"A�L�4 s ^ O m �b ••��� � s � '� e^ ;u+�,0 ' - ' m c.D � �= _ • c`� G m S � s o' 3 F�°s " c.�� N Q.:°;�: � tl2 . . � N . �' . ' ''.k ���+.��H, i �_�����.^ cD t9� N w,:y����°` p �� -7 � � � w < •" c F'�inf � o °��.r�m a`ry�+ '! f� �. c n o p p �?� 3 _F ~ "N��.�L�h�ID O co��O ��N y� �.c p�E'�t�i : l .:�: ' = "A ��� � �e-�c:n ` C �..n.'F� oa • y '^ nx � 4C"•�o ..�..� o e � o'n�v' o� `^ o cno �e;-i�:; y� . - _ _ •.n• - c 4 ; o � �•m`m a ,�.o o � `� •a «•A �c. N - � � . . ' � ♦�r � 3. n , � : �.`.: •�s..a. � • `����, '; : :w ' . � . • . ^.o K ��/' �+.a •;o A.-A.��0.S . . .. 5.., .C w�N:n�0. �_n �v,�.� . , . � u O r� • ' _. '.. .