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0960A 0961A
� . , .. . _.__._---�-------._._. _..___._.. .. _._._..... _ �._._._..____ .. _ _.__. yZ. , WORKEBS�COMPENSATION DECLARATION : -r� -,-: -��.• � -._, . ';"'-"'" ' � v""-�---'•-^ . .... , . . , .... �� . .. . � .. . . �, _.._. ._ , ....__ .. . . . . . � .. . . , . _._ . •I�hereby affirm thot I ha e a ce�tificate:of.tonsenl to.self APPLICATIQ�N� FOR��::BUILDING��PERMIT ��� insure;or a certiiicate of Workers'Compensa�ion Insurance or a certified cop'y thereof(Sed 3800,Lab.C.) „ '�;.., ."... ..-._- .-. . ._. . -- . .. ....-. -.� - . . . . ' '` •� � • COUNTY OF LOS ANGELES BUILDING AND SAFETY � . . __.. _ -: PolityNo61WE�TX7G9�-omPa�y.Hartfnrrl�f'rnnn � - ' �' '�� , -- - _._ .- - � Certified copy is he�eby fvmSshed. . . . �•. FOR APPLICANT TO FILL IN BUILDING , � ADDRESS /a o,z ,�_ �.,-.� ��,Certified'top"y is f led ,ith tfie�counry building�ins eo -� � BUiLDiNG fion depaA nt: -��•`. ' � � ADDRE55 ' : / � . . ,� . . : , ... . . .. . . _-___.._ � � : Dat ,6"/I�APP�cant� � 1 � Cltt ' ZiP__. ... .. ---� LOCktITY I �' t.'CERTIFICATE OF'EXEMPTION FROM WORKERS'. ., '---- - -- -- ..._... -. . -- ---NO:OF BlDGS. - ----'- �-. niFAREST..'-".. __�_" . - ,_c"-'-;....-._.__ , � i - SIZE OF LOT / NOW ON LOT ' CRO55 ST.., � � �' � hTundred1dollors S 00)or lesm;le edRf haEpermit is for ona �� TRACT-� �JZ56H��/ BIOCK' '"'....- LOT NO. 3Z�� MAP 900K��-�� . .-...- PAGE' � PARCEL '�. .... . . .. � ,. , ... __.. OWNER-- y� M4P . . . TEL. _ . " ._._NO. I cer�ify thm in the performance of�he work for which this - ��� � �� p�p � �,3 permit is issued,I shall not employ any person in ony manner � . � . '� � � SPECinI...----/`- ...- " - ... -. . _. _ �O I- ��-�-- ADDRE55- - �- - �-----� e..ODOQ CONDITIONS : ` so as to betome subject to the Workers Compensat'on Laws. � Dote :�', .,. �. . •APPlicant-'- �.. ��,.: . ..,, _.. GN . _ .------- -ZIP ... __ - - � ' -. --'-'.. _..... . ._ . _ . .. . ..----- ,O ;_ _DISTRICT__,GROUP TYPE,, ___._ '_FIRE .. _ �OCESSED BY._ ARCHITER OR � TEL. � '" ' `�ICE TO APPIICANT: If�ofter makmg 1his�Certifitote of I �4npflon;'you should betome su6ject to the Wofkefs' "'- ENGWEER � NO. . CpN$ ZONE 'G Compensalian provtsions of the Labar Code,you must forih- qDORE55 • 1p �..3 � �.,„. �"' -- -- _ _ __ . .. .i a wifh comply with such provisions or Ihis permit shall he -.-- . � - daemed revoked...� �.. - . � . TEI. � STATISTI�P.�CLA$`$�F�CATION APf.� CONDp. � . � . . . '. .�•.' CONTRACfOR Np_ _ , IICENSED CONTRACTORS DECLARATION� } -----� --�v-=- --'-- -- ... .' '""- - -�'-"--" C1ASS NO. DWELL.UNITS� .. . .� ,... _ __. .._. _ . ._ . .' ._".__.'' .'IIC. ._ . I hneby affirm that I om licensed under provisions of Chapter 9 qD�RE55 NO. (commenting wilh Settion 7000)of Division 3 of the Business ond . , . � � SEWER MAP - � Professions Code,and my license'is in full(orce�and effect. � � ��7y - --- ��� �� � -� �LA -� -��--- _.___ ___ . ____ �O 9 G.G A � .� . . . ... .. , . .. _ � , . ' - ---- _` -_. . 5�.FT. NO.Of NO.OF : CHECK � . BK. �' , VAIIDATIO�1 � license Number a(19Fi1 fl (tc Class B S�ZE �HH4 STORIES� 2 FAMILIES� � ONE ' - � - . . , . ., .� ..:. ..,. � . . . , � �. , , oesce�P oN oF woRK - PLAN-23 :1_ _ __ - - --� - I e J 2 O�� �' Contrallor_'Rramaloa f�1 if �' � � � '7��1 � � Date � .. .._ N�yy - VA UATION - ' ' � ADD S IOI� /"!/ �I om exempf onder Sec �- - - .... • . • _ • _. . ._-. -._---� � . .•.n.J- �Q t1�� � , � . . .. ALTER Q , , 'I . Q t9.C b--.E�G�"'�..�; B.BP.C.for fhis reoson �:� . . -. - • REPAIR � ..`s__. ___._ ._..,... ... - __._'_ __ _. - ' , . .. ..__ ... _...._ . ..Dote: --' uSE , ' � � : EXISTING BLDG. N n DEMOL ❑ ' ' ' � � '....Signature .. ._ . ' -_. AaPI�PaINiT Ge r d 11 No. �, FiNa� � ._ _........ _ .._. . . , � O NER- UIIDERDECLARATION - --DATE--�_ �� .�� ._._ . � - '-..__._. ....._._._. .,._.....-��------..__.. ._..,.._:. .I ere yaffirmihotlame:emptlromtheContracroriLicensa aooaess3151 AiY'wa Ave. N Costa Mesa ' + ;; :-G9G. Law for the following reoson�Setllon 7031.5,Business and FiNAi-� < . .• 1-.A -�------- -- - - --- - - _.. �Professlons Code):'- - ��� � - � prtE nli � 8 --� � -- -- - �- BUILDING � y l � r• •��� �- � I, as owner of 1he properry, or my employees with q0oaE55 � � . - - wages az tBeir sole compensation,will do 1he work and ; -- ,- � - . -r - the srroc�ure is not imended or o(fered for sale(Settion ��"��ry ., � J�` �� . � -' - �7044,Business and Protessions Code�. . . . '- - � � MOVING�- ---- -.-..--—'�--"'----TFL:-' '-�--- ..„ '-- - --'. . .._ - '..r � � 9, .l�.Tti�l � ^J LI C. J. � � I,os owner af rhe propeny,am exclusively comracting COMRACTOR No. � .. : ..;___.___I \; �n- . ... . . ;. . .�. 'with licensed contrac�ors to constrvct the project(Sec- - . ..'�-'---__.'_. .._.--.--.._._._. _..__.-__.----"---.. ... ._........'_- --_ - -..__...._ .. ..... ' ' � A��RE55 � D�t�C�l".fi..Fi. �. tion 704d,Business and Professions Code). • -. - -- REOUIRED.. _ . iOIALSE7BACK M... XI . ____.__ .____._ . . �.__ �: �.. � _ _. . -�-CONSTRUCTION LENDING�AGENCY� ��' ' -�- SET BACK �ARD HWV- PROP.LINE WIDTH -"'' � -" 1 hereby affi�m thot there is a construction lending agancy for FROnii • . � . �- ' �rhe performance of the work for which this permi�is issued _._ .. .-p.l.-.._.. '--- ---- -. .. . ... .._ _.- .-. . ..--.---.- . ---'-;�,. `:. ._......___:;'' (Sec.3097,Civ.C.J. ..._ SiDE , ,. ': . , . .__.___ _.. . . _.... .. .. . _'_._'__ ' ___ - P.L . •..�. :C�.- .. lender's Nama ' ' �� • .. . ,.,. ` ,. ^' ' ....': .._. � � ..,... .:...�. -- - 144 Sansome-�5t:� S111 tQ /OO P.C.Fee 5-�LO.� -- �,m„Fe, ��d'.,.j"'O__; LDMA Ref.M ' _ ` ' � _.... lender's Address r-.C� �I� ;�� �d II�iS�p�ic�ri9rt a st the lS'�!}{'- _7�:.6'7� ��..v_ti � �.� i � � .��• I terti(y thaf I hav � -- Iseuon<e Fee�-- �-- - � LDAM P/C M�- �"�� '_.__ ._... ._. ... _ . a6ove informotion is correct.I agree to comply with oll GooMy �mesngmion Fee p �� - - � � � _.ordinances and Srota laws relating to building[onstruUion, --____ 7oia1 Fee--S -�*�� � LDM4 Perm,M��� �-- � � � -__.. . __....__...._ _____. _.._. .. ...... ......-.-_ _ .' .. -. . . and hereby authoriza r prese tatives o this County fo eMer _ . � �, i , p t ned p rt fo inspection purpases. �� �{ _ 5'9 . P .. _ _ �r�. � _. _.- .__'... . _..._ .. _... , ..-. --_ .--'. . . .• _ - . SEE REVFRSE FOR EXPLANATORY IANGUAGE , ` ` U on B a eof^I�canror gent . ...... .Uate._ ' �_ _ __ _ . ' _. __.__. '__.___'__._._._ ... _'..' .�'\ . � �-1. .T.' . � c —'_' .___ ..__. . ._ .. . _.__ ' _- .OO :: - � ;o-. _ . . J,,. .,., 0 . � � ,o. _ _�,. -c�- o o ;� .�... �. o '. +-. � �u+� ��p_ o. o- v 7 ',N 7', � �� - �O O O� �f+,'w O' t�0 4 O � �' �� ` }... O 7 �'- /D .. �� � •U .:. . . O . _ ` .F � ✓Q �,O p. � �'� `� .. � � o n� 'm g �� o .o cn o m� m � �c o..a i;' 3 �o �, •'' '- T .T. p G 6�, 9 � ��: O�'O"� � . ',• Z r � O tT a O O O ' �p O � .9G,ly l ., ..�. � tP � o c� 3 o F° o ; ...� _ -� • ,,,.� t�Z ° ? �p m 1 0 -c� ; "o . , ^• Z, ,;� p �� �� s ?.d { � � ` .�- . � r f ° 9' � ����+m m �.:c N N o M � .. � 14 7e . v � C o , Z x o`� � �- a .^ :c ,p !'_ � � , z � F�c � ° o :". i.;' ,,_` m. m �- n � a o�� ° 1 � � a ', _ ~ c G i Z � ' c^ � + y � O-�, i� � p. � �• O p ,'� � � � i� a .. � , � � �c �` �^� � o .T . 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