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... , _ ----.--- -�.- ---�------�-----�------r__..... .... . . ... _.._ ...,_ . . __ .._ _ ----- r ..,.. � P ....�TION _ _. . „ ,.i . :,•.^ . .. ..� ��- ' WORKERS'COMPENSAitON DECIARA . . insure6ordreertifcateof�Workesr'Comeensoro�5��i�',a�e" � �-���-�-- ��APPLICATION�FO�R�.BUILDING��PERMIT� � ��� or a certified copy thereof(Sec.3800:Lab.C) . . .----. - - _ . .._._. --. . ._.. - -.-_ - -. -- .-. '- - _. , ---_ - - .v..- -.__. 6�WETX�9�, � COUNTY OF LOS ANGELES � BUILDING AND SAFETY Poi�cyNo. mPor,y •Hartfnrd f,rnuP. • � - ❑ Cer�ified mpy is hereby furnished. • FOR APPLICANT T FILI IN Bu�ID�NG ^ P ADDRF55 �/a'I _ � �Certifled copy fs filed_wi�h the tounYy building�inspec- -�--� euaDiNG -� , , � lion department: � "� -" "' '�•- "' '-" ADDRE55 1021 South Lon V1 eW i �: .. . . ,�, . � � ," �___._ ._._.._'_.. __ _'__... ._.. .._ . ___._... ..___._-_-_- . Date '��APPIi[ant QTY ZIP � IOCAIITY � . ' �� CERTIFICATE OF EXEMPTION FROM�WORKERS• . _._.." --......._... _... ._- -.----.-NO.�OF�BlDGS:-.�.---------- NEAREST---... . � '. ` SRE OF l0T , NpW ON LOT CRO55 ST. . .._ ..""'-" "..--... .."'.. .. �. ._..�'.. .. .� � - COMPENSATION INSURANCE�- � � � � ... . __ ,.....,-. . . (This set'tion�need not be completed if fhe permit is for'one - .... ._... .. . . _..._. ..._--...--.-'- --.----._........._. .: ASSESSOR_..:. ._. .— .` ".�-.- . .�. , . ' hund�ed d0�lor5(SIOO)Or I055.J ; ., . � TRACT . BLOCK LOT NO. µqP BppK' ' ' -'� PAGE' PARCEL I rertify ihat in ihe performance �� .. �•.! ., '-.�. _ .... TEL ' U Z NE �P � of rhe work for which�his �NER ' NO. H�JO"�OO�' ��� � , !�3 . � .� � �} I _. .. ...-- ---' - permit is issued,I shall nof employ any person Iri any manner . . n -� � SPEC�AL-,- --- •---� --�• � ��-� --�- -- d f- _._".. ADDRE55..... . " .' __..' .. 0�07's-D ONS � . .. ._�. � IU so os ro betome��subject to the Workers'Compen'sarion Lows. . � �, OateICE TO;APPLICANT:Pf aher mokm �this'Cerfifimte of ARGHITECTOR - '- � --..._.-ZIP-TE`. - DISTRICT �--GROUP -----�•._. ... .__.... .. .. ___ .. . .,..A IicaM._ `.. .,• -- - - � � � .,.._ .., ;0 9 ENGMEER NO. - TYPE_ � FIRE PROCESSED BY._.. .F I � �nption,`you should become iubject'to'�fhe Worke�i -� -� � �O CO .; NE ,. ; ;W �umpensation provisiona ef the Lcbor Code;•jrou�musf forth- • � ' . � wilh tomply�with suth provisions or�this pe�mit sholl be ..._.... ADDRE55 -- ----- . -- --- -� �� -�- - y 3 -. 1 � - �� STATISTICAL C1A551FICATION ' APT. CONDp. � �Z deemed revoked.,,. ...• � .,, ...,,..,��,. �.., [oNTRACTOR Bramal ea Cal i f No. 850-1001� _ __ . . _ � . .. . _ . .. .— UCENSED CONTRACTORS DECIARATION � '•. - ��-----��-� �•- �� -� ��� �-� -� -����-�i�, --� �-�-� � Ein55 ni0. �� ♦ DwEIL UNitS�t/ I hereby offirm that I am licensed under provizions of Chapter 9 ADDRE55 NO. ��R�p . (commencingwithSection7000)ofDivision3oftlieBusinessand ' '_' ...__'___._.'___ __.,__'__._'____"___UC�--------�--= . . . �� . ��� Professions Code,and my license is in�full farte and effe�t. dTY CLA55 -�--�-- - �---'- . --�- -� VALIDATION - , .. _. ._ . _ ... ,. .. . . . . . S�.FT,_ . NO.OF__. _ NO._OF_"' __'_' "CNECK_; BK. PG. , �iten79 NVmbCr 4n9f'1�n ' � Li�.��a55� .R � SIZE STORIES FAMILIE$ oNe ... .. . �0 9 Q 8'A ; .. . ,. ., VAWATION._. '. : � . co�uo�fo� BramaleaCalif oa�e ,, . , • --- oescR���or�o oRK---PLAN-22 �-�--�-- - New-� s � �7� _ - - -�t� . .2.1 ; �I am exempt under See. — l n 1 �-F m'1 - _ ___ Aoo � ►.;. ,_ ",(.'2 8 2,O J . . .' � ' '-'__'❑ . ,. .. .,:.. . . ALTER � � ,.--� � � , 0.8P.C.for this reoson. .. ., . • REPniR--O = ------��--- t- _.' _ .._;_... . .� o i.�'.�2,n��c=i. � � . . . . . . _.... ., ..-. USEOF i � ' __.'.�.7z�-S�J ' . � Date� EXISTING BLOG. DEMOI Q .... � .._ ,� � �Si�nnturw � APPII(JtNT TEL. ' FINAL ��.....' O E1�J R-BUIlOER D CtARATION aaiNr Geor e� Vedel l No. 850-1 1� � ,y .' � '. : � " ,... _ . .._ .. . .. _ _ . . -DATE. f � ---'-'-'--'._.. . -- '-....._ - I hereby offi�m that I am exempt from the Contractor's License � Law for tha following reason(Settian 7031.5,Buvness ond ADDRESS � � � FINAL�/���(J���� " �� I � ' � - -- --�0„".�.✓ .__. _. __. - t ,.._..._�._..""--'. , _. . . _ 'Ro(essions Code): - ' . ..' --� - pRE N By `Q Y Q.9�1 -: � BUILDING , . I,as owner of the property, or my employees wi�h ADDRESS �� ' - - ' � f wages os rheir sole mmpensation,will do the work and �" . . � I . o � the structura ie nol intended or offered for sale(Setlion ����TY � � � . . ._ . . .--'- '.-"..--� - --. .. . ._.... _ _. . -7044;Business and Protessions Code):•-��-�� � �- �� �� MOvwG-�-�-��-�--� ��-- �-� - Teir �. �!, � I,as owner of tha properly,am eztlusively tonlrocting COMRaCTOR NO. '� ' `."_'- , �'� +ll��l,Jr Q'.: . � wilh licensed[ontra[fors to constrvct ihe projett(See- "-.. ... AD�RE55 . . . . . ...- ' . .. _' ; � ` i �° e t i;G,�Q u � tion 7044,Bvsiness and Professions Code). . � � ._ ._. ..._.. ..REQUIRE�.. - "_IOIALSEiBACK .. _ I _.__. . . ._ .: ..-'. ' . ' � 'i � �CONSTRUC710N LENDING'AGENCY-'"'�"�"�"'"- '"' � rARo-' rn�' • � �---" - � � -��- � ��-' SET BACK PROP.IINE WIDTH O . �O—d 6 � , I hereby affirm thal thera i:a constr�ction lending agency for FeoNT � � � ' � - - tha perfoimance of the workfor which�lhis permit is issved -..... -G.L- ._.. .__... ."'-'. .-- ' -.--'--'------ "--".: -.---._.._....._ ... . :._:...;_..... .. .,.. _ . .. ($e[.3097.Civ.C.). SIDE � • .., � ' _ . . _ -- Toronto Dominion Bank--- _ _ P.�. _ ._ ..__.. ___.,-- __----_ .. . ._; . __ _._- -_ — :- -...-- ----. -- -..: Lender's Nome I�� �/ LOMA ReL N ...�: � .- . � �� , , '��. . ._. �44..$dll$01112.$t..� .$Illt2.���_.__. pCFeeE �C•�S-Z--03 ' PermitFec�- �T v'D._ .. lender's Address�attL'1.�CB�-9��— �J ' ,. � �- -I certify thot.l have reod this application and state that the �---- -�_.__.__.._/_��—. issua�<e Fee-'-'��'-'S�—' .iDhW 7/GM----._..._ ._..-- ,-- - --' - � - ,- obove informotion is torrett I agree to comply with all Coonry Investigm+on Fee p�[ � ' � ordinantes and Smte laws relatin to building consnuction. __._. _ � � Tmol Fee ��U��T'��� �--�� �LDMA Perm.k-�� � � �' � - __.. _. - ---_...__.._ .. . . ......,-... . _..,_. ..._. . .. , and hereby au�hoAze reprezenta'es o(�his uMy to eMer � •� - upon he obove- enlion pr erty f i fion rp s . - � . . � ._ . . ._ .. - - -.. . , - _ . . .__ ._ _..-. . --- . _ ._. ._ . . _. ... ...-- - ' - - -" _ . _ ..----� -- �. � - SEE REVERSE FOR EXPIANATORY IANGUAGE � . . i atu�6.o Applic r g i . 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