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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 ' \ .. . . 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