Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0828A 0829A
l y WORKERS'COMPENSATION DECLARATION , .. .___.J.�___-.� . ... , . . ... ._ ..._... .__.... _ .._._..�.._.._'_'' .... . _ �.,_;_ ..'._'__._.... -' .i Z Z� c insorebor�aicerlifta'�eofWorkes'�Compensahonlnsvro�a'� -���—���-��--��-�APPL(CATION��FOR.�BUILDIN�G� P�ERMIT��-�� �' � oi a certified copy thercof(Sec.3800.Lab.C.), '•' �- - ---.;..---` �- --.-. .- .... . . .. .- . . . - .. �- � COUNTY OF LOS ANGELES : BUILUING.AND SAFETY ,� � ;. • i . ,. O�vNo.61WETX7993om��YHartfp�^d Grouo _.._. - � • -• • .Certified c6py is hereby/urnished..� � FOR APPUCANT TO FILL IN bUIIDING � . �.�. ..:. AD�RESS O �� �Certified coPy is�filed with 1He tounly;6uilding�inspeo- �"-�-- BUILDiNG ,/, � , IiondeportmenL �' � ADDRESS 1036 SOU h L n v� W g ` . .. . . __. ._._._._..._."__. . ____ ._. _.__. _. . . ..... , Dote� ��j-ZS"-�iApplicanr � i GTY � ZIP LOCALITY . , ' • CERTIFICATE OF EXEMPTION FROM WORKERS'� - ""�"� �" ''' """� --�"'--� ----"� NO.OF BLDGS. � -��� � -- -�� NEAREST _.. � "--___..�_ .. . .--- --�-----_._._._.�_. _. " - � ' - COMPENSATION INSURANCE - � ��, 51ZE OF LOi i NOW ON LOT CRO55 ST., (ihis�se�lion'need not be comple�ed if the permit is forona ---- �-�--- -- � --���-�--�--� -- --� �- �:/ a55E550R ---� � , �� -• '�- ": hundred dollan(SI00)or less.) „ . . tRAR 4256P! '� g�ocK LOT NO. 72 /.�,4P 800K�� �� � PAGE. PARCEL •. � . . ... .,.,.....� . �.. .. '_" OWNER . . . _'__."NO = _- �P III! 1/�....7� _ ._ . . . US ZONE 1 certify tha�in�he performance of the woik.for wKich this - p� � 7�3 r L permit is Issued,I shail nol employ any person in any manner . � - SPECIAL�'-'-.--.. . -_ .."' ' '- -�-�- -�a I so as to become subject to the Workers'Compensofion laws. - �- AD�RE55- 1 1- 1 T�W V . -$ 1 t8 N ---'-����'�' CONDITIONS '. ; -- ., . •�, , 'v Dat. . � . . . . . � ...,.. . .�,�, ' _. .__ ..�. -.-. . __.._._ ... . ._ ---- a ; .�. � -._. ar . ---Costa Meda ..CA. z�P_92626 -- -- __ m e � ��� Appliconl� ARCHITECTOR TEL. �� �� I . �TICE�TO APPUCANT:�If oftei'makmg�ihi3 Cerhficole of _ _DISiRICT . GROUP-oN� . ZR� .PROCESSEDBY. ,,V m ti6n, ov should become�sobed'to�the Workers' ENGINEER NO.]52-i8 R componsotion piovisions of the labor Cede;you must ferlh• qpORE55 �� ��`J - - ---- �� wifh mmply.with such provisions or lhis permit shall be --� . T • . __. __ .. . _ ... .. . . deemed revoked.� � �..� i� �� • E�� STATISTICAL CL4SSIFICATION ; : APT. CONDO.�-� �Z • � � •� coNreacroa f. No.$50-1001 . ; .. _ . LICENSED CONTRACTORS�EQARATION•.� • --�---� � ------ � �------ �---------- -��C:- ------� CLA55 NO. ��"/Et4 UNITS 1 hereby affirm thal I am licensed under provisions of Chop�er 9 AD�rtE55 NO. (commencing wiih Section 7000)of Division 3 of tha Bosine:s ond _..._. ' �iC � �R'�P � �'-.�� � " � -'---..__._...._.. -'--.. ._._... ....._. ....._ . Rofessions Code,and my license is in full force ond effect. CITY t Meda CA. ctnSS B � "��"BK." �-�-";-"� . �-� `-- -"VALIDATION�-� � 'i . . . , .. . ,`._ . .. ., , ., SQ.Fi. � , . NO.OF _•_. ND..OF CHECK_..�. . � License Num6er -4n9�iln � �'� Llc Closs� R '' SRE STORIES - FAMILIES- ONE � �� � � • � .VALUATION. ^ �� � ��Z co��ro�;o, Bramal ea Cd�l f�Date ` , . ' '-- - o¢sctEivrioN r woe�`�`" 24BR .% _ � - -� (� �j(�- .- � NEW- . ... . . .. ADD � S I�// k' • . .2�' . �I am e:empt onder Sec. - --� 111 1 e-Fami.l . Res.idence _.__ _.. � � ,. . .: . .. .... ..... . .. . . AtTER � , . ,, . ...I °J 4 l�J P : � �� New Construction � s- � 8.8P.G�or fhis�eoson ._ ...__ REPAIR-- " ' "'-'._. ...�...._ ..• �.� - --� ' 4--i�;G=': � � '�•' USEOF � J ` _ _.-'._ _. _ _.. . .._. .._.. . : -�Dote�� _ E%ISTINGBIDG. I1O112 �Ma ❑ ' . --- - -- . ' . . ..Sfgnatura � APvuGaNT TEi. FINAL J / 7 .': G g 1 9-8 6�I O ER-BUIIDER DECLARATION PR�M ... . ._ _ . .�' � _' .. DATE-- -L � . ..._.--"__. ._...... _..._....�..._ . � I hereby afiirm tVat 1 om e*empt from tha Contrador's License - v , , _ , Law for the(ollowing reoson�(Section 7031.5,Business ond AooRE55 3151 Ai rwa aV@. N COStd M2S7�� FINAL ��' ' � - � '� � ��" '� --" - . - 'Pro(essions Code):.._ ._._. .... ..._. .....__.._ ..- --... PeeseNr . - By - -. - -- ...... . . - .. � B���o��� � �e��g i� : I, as owner o(the properfy,-or my employees with ADDRE55 �' . : .� �wuges az�heir sbie mmpensaiion,will do the work and �� �� ` � � � `\ � � tha slructure is not tntended or aifered for sole($ection ��'��ry � � I �� •�••���`� - � - 7044,Buzinessand ProfessiansCoda).-� --�----�' -'--- MOVtNG........-_..__. . . . .. ._..-_-.--TEC:.-._-_. _. . - .._ _.. ... i_. , —.. QCONTRACTOR NO. ', , - �'����G O� I,os owner of the property,am ezclusively con�racting , ��,,.� �)� _"�� wRh licensed wntractars�o consfruct the ro ect�Sec-.. - � --��---._._._...-. - .----.. ,--__ •-_--'-.___.. .. -.-- -.--.--- . - .-.. - --. fion 7044,8usiness and%ofessions Code�P I ( ADDRESS . . ° ^Jr�:i.�O�i '�� ... . ..REQUIRED � YAFU' HWY. .._�OIALSETBACKFROM.._ I .. "'_""""'_ ......_.._ � �.'�___,.:�-:�__:._.... _.. ��" - �CONSTRUCTIOPf LENDING AGENCY"-�-�--�"� - � SEi BACK PROP.UNE Wi�iH - � �� � � 1 hereby affirm that there is a cons�roNion lending agency for iRONi - , . � O II.1-"��8 6 , •. � -` ^'...:.,, --the-performance of�he�work for whith this permif is issued ----- -P.l:........ . . ..._..-..-. -_.. .-----...-' -- - � ------_ .--.- . ._.�.,_ -_... ....., -.._ . ... . I (Sec.3097,Civ.C.). , , sioE - �' � � � �. � � — —Toronto Domi m on.Bank.- --- ---..- r.�----- - - ------ ' _ . ..._._ . ._ _ . _ __ Lender's Name • � . ' . '` / IDMA Ref.N .. � � � .. . . . .. ._. ._ . . . . .__... P.C:fee 3_'�7�•(O�."' Permit Pee......�7' -�. _. . � JLcerdt fysthadiec�da reFad�lhis opplimlioC•A^a 94104,�,h0 ----- h._7s•�. ._. bwonee Fer-- C�J-��- ' IDMA P/C p.....-._:..•..�.i. '--....-� .. . ._..._..�'. �.� ,��.. - obave in(ormalion is corretL I agree to mmp�y wilh all Caunty Mves�iga�ion Fea ` ' . ordinances and S�ote.laws ielating to building construction. ..._--- _'-'....--'---_._.,_.. ... iorol Fee�-�p��...-_ � � .... `", .__. .....-- . IDMAPerm.N-.— ._- . . ._ . _._ . ._ . ond hereby au�horize representafives of this Co�nty to enter - �pon f above-mentioned pro rty or inspec�ion pv�poses. �,/�� ?,l� • _ - _ .. ... . . ...' ... . ... -. ._ _ . . .__ .._ . ....__._ .._" . «. ✓J . __._ . .. . . _ _ _- SEE REVERSE FOR E%PLANATORY LANGVAGE . . ..-. �gnmvre of Appl mnt or A9em ......_.._��.'�.._." "'. �... ' ._'_ . _.___ __'._._.__. '.�_.____ . "'_'._'" '.. . ... ,�.... . .._.._ .. . O � \ _.. .. '1� r s i . • :� • . . ;, m�n (1 2 r m � V1 T r 'O � N. T�._ ..�. _�.. .,T. __.. . _ _ ' _"_ 'j '..� . ^ > > O O O O 7 � 0 O �O O .O . .C1D � fD � ....ry_ .i 0 . O O l' !�. S 7 � � Q� 7r � � 7,a O I 0 � O i ' � �J ' � �� I �� � Q °� a p ° � v r,', o �"^ °� � o s �'� ; ' � (� p m � �C p n o D , ip � � � rp. •tp � � a,Z x �'�c � r�'' � � o �'� `O o o '�p DI I �, T �3 �^ o o � « � I ° , '�° o v L ° v � � �- T+, ' 0 0 - -< s m �'� 3 o a 9 � � � ° � o 0 0 �: o•o . -' m �� -- - � a� I � � " •'�c �� .��`....� :.� � � �� o ° � '" � '• ,? - - « o , � ::. � '� � , r 1) � n. - . _, ' ^ � � r� � � � N � , o � ; � � v � �^ � n• ^�. � . '. ', � �Y � 'A o • O �a- c �) C` � o y • , a - �o � � �' ; _ .. , � , o a �_.. Q� ;e_ s � M, - . . , e �o' -Zi I ! o' � � '� , . , I ' 4 w• . . . � 0 .. . . I �n . . � -�- - - ye ' �. � � _ v oa D _ ; � o� ,_ • - � o � 9 !'i . � , i :�! , , no �: ; _ . _. i � , a � ' � ' i .. I: : , : � -, _ - � I � � .� - - � . ; '1 ' . � , I � ` i ' . _ � ' . ... _ � : _ � ; .. . . t , , � � • , ._ . . , . , ; .... •., ; i _ .� � � � � i i -, r � � .: t ` .. �� .... _. __ . .. , i I . . ; ' � � � ' ' ' ' II i � . . ' . . � • . .. � i, ; �_ � I ; � . � , _ iC , " ��I I - I ._ i � 1' ! . 1 , � _ '� ; ._ ,_ � � , � t ; � � . I. ' - I� . �! _ .. . � , i I i � • I ' C-.. , . i �� �- � � j . :_ � � I - . '' � 2 -- ---' - � I ' � - _ �` • ` -..- � . , .,. � ; -- ' . �. � � � _ - __ � , � A ' � --1 � - ; ' r 1 I ' , - ^ i - ', ' �-'- -, .''- O . � ; I ' ,_ _ ' _ . � I i.� � 'T^ � '.� i �� _ . 1 _ . , __ ;.. \ i . �� i :, __.' ..1 _ �. -f i � ' j;; -. ;, , � ; ` , �� ; f. . � ; + - _ _ t.. i- ir. ;�� , � ; ; � - 1 i i �, . ' �� 1. �. ; I• I I � ' � _ i � : _ y- - IO� i j ry^.saP�= a� C-b• �c ���sf b � F .,ri�- ^�,ce-c-n �.r- '� :� - �� • ;'.,,_ : p i � � • ` .o�_. :� pe m c � �c�� ��� �.o m a �o.o a w � �,,� e..n : . 0 c n a,o � � n F o c•.,•�-.�. � � �a`e n c.a ,n,� •, __co s �� ,'� � � � i .'�, a a-'- �4 ^`� � e e' `a�.� m p°m `�o �4�•�.3'..:N m.- � � � i �f�' _ e p e: � Oe.� �� H 4 ♦ o� � n ro�-co c�.. � _ _ 'i � - � ` �'� ��-- b ��'ti `m C�� ��N �.o -�4"!L� o�.N'�:�.a h.• o- . - � o� ' _ �; _o o`,n a c '^ c �. o �n�' or L a � n '.o`�_O i`i � �- - . - _ �. � i 3: h-�•` EA�m:o. �e ° �,^ 'NM ^_��.�o � s.� ao �'�'�c�.� c' E'.°'� ' - 'ti, � -t �� ra� �� � �.H S.�x� °j�° b�''' � c��m b� �o�.�:�:Q 3.Z �� = � " � 3' " .� � '�^ a a� �� ".: �;;5��0 o A � ti `c'�Z. • '�� c,,;� x I., _ _ ' � v_ �.� �.a �.a o•`�° °a �o �'a ;e'N:' '^ o. °.s.� si z•E e n � ° ti T_'C Z c� � � ...�..- �, e �� . N ti ., o• �y C ' - ' - � ' 71 r'..'t.�Z � .S .,�� � w �C � ��'�.�� T C� .1.� `.1 � �� O �. _ � = r�n m a_� -,� oo � . �,°� a`'�'= G.h"a3m � �`�w�%+ncbbM " �'.0 - - - - = . � . � �� `:o o T'N o v. . �.� �4 0.a.n�y� .o � �:.y o c� i � .� (� °� C; a'e o c3a „ Fo�oo-� o �'+� o•�,�� : sc'co_o " _ . c .' 0 , W 1 '�-� •v�'O � � "J C.��e:L`�� O �' C �.'� � 0. N"x '' - _ . oo ^: ;��'o a°:o m �:a � '^_� a,n�.o� ��,c�� n' � •• o� `•° £,m C � 0.' �� '� ' - ` ., � �. ���•Ca � ^;� � � ` b�ci .j��� �.n'o':���c ��'a��:C) �,..: _ ZO -"'.� o o� o : � c � o M`,��° o G.N ��� � �y`TL� ,�'�'�e � r `� � � I- -. � - .. . m . �'n p.� m c�3 .� _�,�3.`.0 C b� �-�� '� N~�a ��� 1 p "" = � �9 w ` . i•�^ � ' n x ...? �� � o o =3� Aa'�.,a N � `c � `s'�� p �`x � : • ..._ . _ : ..O' . �� � y-.n C• M � 0.�4 � � a< �b »�0. �.�;°i s� c:.� 3•� . _ � � F . ; ks`�sN H � ' �e � � u'.om �� �°`a'c� �,^� �:ti T` - - � � ..w, -.� � A .i.K o c` c c o 3 .o., ��^_a � ,�.� . ; _ - � , - �m � oo i � �� cjv � ... �.:r��a�„`�:� ���v N z�a;Q,��•o 0.�,'e.C.�nz ' c . - _ : �:v: � �`� o o-_ "F ;i �E;�in£-°c 1 ��,'.ti �,M o �a .� o . . :.� _ � s .,c 'G L`' • �i^ C`N'�p :O c � : - � . �1 ,� ' n • n ��z.e'a'c �.,n � � �cw'�'��:.C��` • �c v � . . .. .. . . I O� C c '�'N .j�-H �\�D tp �p 'J�" ' '�� .� ��'�.in� � � O -i�ti.�.�i��•:O O �t `.�. �^1 `p'�p j C.r.,'ti,.L1��p . j - � . . ,. .. - , . . N... , �C`v'N`�� O l A R t�i h R ..a.aS��:�GPR M :.Si w�h CC'�a