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HomeMy WebLinkAbout1281A 1282A �. . �.__��� _ �� �:.. �.�,�„�,mm..��.�..�.�.��:.,� �_,. .�,... � ��_ ,.� �,:: � WORKERS'CO�MPEPYSATION'bECL`$.RA710N .-�� ,. , , . . `^'_ -`-•.-�---����;' � .,: .. . .., . . ....� �. � . .:, " . ...,.- ,, e _ , I hereb i hqt I have,a Gertfwte of consent to sel �,�, ��'...-�-t�� ��������/��"'��'�"""�'�"�'�`�`"��;"ry�""�i�'��`�'t--�y-�=-='--u ' 7�� . � 'nsur �or a ce i i te of Workers Compensarion Iniuran V L V �\i� f� M� � - ...J _ ._.___«, ,_....._,,. ..�...,V�.. ..r.�� . .� > �4�;,. �'� or a ertif e py t ereof(Sec�'�80iS Lab.C.) �' , !ES BUILDING AI�D SAFETY. ` �` --__._ _.. , .,,. . ,. _ , Pol cy No Company _ COUNTY OF LOS ANGE _._: _ _.._.;._._ ....>. . ,...:.,..__. .__--- _. ert coPy�s hereby fornished t FOR APPUCANT 7�FCLL IN ` Bu�[o�rvG ,,,,� � �-� .�. � ADDRE55 too'1edartmY s filed�wifX the coun}y bmidmg inspeo- . . BUILDING �..: .� -.. _' '-� ' .':�.. `.," " @nt . . . . AD�RE55 V`;;,JC...- t.. .�'�Ctt::�.: . . ,. ,. . .,.. _..... _. _. . ... �.�. ..._....... �.... ., , ... ._,._:.: - �. Date�� PPlicani �:.�. . . . CITY � '; " ZIP LOCALITY ' .� ... �.. . ' . , .. ER7IFfCAT-� F EXEMPTI'ON FROM WOkKERS'.....: . . . .. ... .... - .......-. NO.OF B10G5 -. ��'� NEAREST-. ....,..__ . ..__...,_,.,., . ... ' � -MPENSATIONINSURANCE �-� - S¢E OF Loi NOW Oni�07 � - cROss ST.,.. � This-secton�need�not be com�le(ed if the� ermii is-for one � � . �, ( " p P � :._ . .� . . _. �;.. _._ ' . . ASSESSOR. . . : . .., . �hundred doliars($100)or less.} � TRACT"� BLOCK �- - � LOT NO. � M,o;p gpp� ` � -�PAGE PARCEL . .. .� ' - •--- . � TEL �.. .... . � . „.. . , ._.. OWNE �� .._. . . . � E MAP I certify-that n ihe�performance gf the work foi which this � � '�' -�N�� f - . Np. � �— � .... permit;is issued,1 sfipll not empl�oy any person n ony manner � � PECIA� � � ADDRE55� t . .t='^� .,t` . �� �-.COG�.. P .,. . � so as to betome subject to the WorkeYs'Compenwtion Lows � � - ONDITIONS� � Date ,... ' _: APPI cant � .�. . ..;... ' CRv��Vl .�' ._... . �... _ �...,_21P� fC....C/�... _ .G.� . . __..... _. _....�..'_. .�0: �OTfCETC$�API�LIC�N7. �f, after making 1his�Cert'ficate of - �� ARCHI7EC70 w TEI,.x {,� � �� DISTRICS..... GRgUP 1YPE.� � FIRE PR SSE�.BY. o - ENG�NEER Br� NO.s�..r$� '.,y'.J� � � F.. „. ert5ption, y�ou should become�sub�ect�-lo �he�Workers' '� "' � CONSL Z E .bmpeh5aiion pravisions ofihe Labor Code,you must.forth- qDDRESS�Z� � � �y,),�- '� �., - � � � with comply with."soch provisions or ihis.perm�i shall be ...�- ..._ .._. ..._._ `., .. . ...,. .. ._.. ." . . deemed revokgd „ .: ., , _., '_.NO .. STATISTICAL CLaSSIF ON �� qpi'. CONDO.�� $ ' � . � - CONTRACTOR '' �..� � UCENSED�CONTRACTOkS 6ECLARATION � � �.,i �`-� -� ji �hereby affirm if1a1 I.gm�iCense(1 Vntler pr9`/tsiorls Of Chppfer 9 � ADDRESS ' �- NO '� CLASS NQ LL UNITS (commennng with Secr on 7OODf"o'f`ISiws on"3 ofthe Business and � � �� ��� � SEWER MAP��. � ., ..__ .__....._.._.. ._._,.._. . ......._..._. . Professions Code,an8 my license is foli force and effect CITV CtA55 � � � -��""� YALIDATION� . .. . - . .... . .n�., . .,.;, _. � BK. � ._ _ , .,, SQ.FT. -NO.OF NO.OF CHECK �� I.icense�.Number � � ��� ��Lic.Closs �� �� - SIZE �� �� � ��STORIES�-- FAMILIES��������� - ONE'���� � . -. . _ .�. �. ,. : . � . .,yALUATIGN ,_ - . . , . -�� -'_� `" ' ' "- ` "" DESCRIPTION dF WORK ' �'�-�• NEW� �"' ' � Contracfor Date �- � � ADD � S �� � � , .. ., ._ . .__ _ .__... �I am exempt under Sec. � . , ..... - � � � ; AL7ER ' � ... ,�,2 S.7� . .-.. �B.BP.C.for this reason . .. s , .� s.,. . - --- � REPAIR _ .... .. .... ._, .. . '4s USE OF �� . ..._ ._ _. , ._ ��{.' °°�'Z,'�J DEMOL � " '� � D te: � EXISTING B��G. , , ❑ ` �" -Si nature� rLyl P.PPUCAIVT ... . "... �.� , Tei ., i �596:70 . 9 �---� �L .v i PRINT) V`il2,1 ��l''' NO'd�'�..� FINAL . , . OWNER BUIIDER DECL ATION DATE ,- � ,-_ ...-::a ���.7 �. I hereby�affirm thot I om exempf from the Conlractor s License "-� � � ^� �- �������' "'" � �fj�'""' t7 low for ihe followin reason� Section 7031.5 Business and A�DRE55�.'�.y � �f..�^^..y�✓' ' s_._� .;, ,. ,..,��,� � 9 ( . ° ...�� FINAL�_"� _ , . Professions Code: �� - ����^ ��--'- . .. . . a � .. :, m, : By v�,��� .,-!2 i 2-26 ...<.a� BUIIDING - � � - _ � , r�� �� I, os owner of ihe prope ty or my employees with ADDRE55 � _._.,_.�M__ :�_,�_. µ. , � �T�, ,, �L i. �� .. ._ ..�. . ..-.� wages as iheir sole compensahon,wiq do the work and � ���� " �' ._�,„ -� � }he structure is not intended or offered for sole(Section LOCALI7Y - � � � �� . .�044,Business�andProfessionsCode}. ...... . .. MOVING '. .�.. _ ..-•-7EL. � ,. .... . -.. ., . a e'� � � . .:_. -.-.-� . � I�,as owner of ihe praperty,am exc�usively cantracting CONTRACTOR . .Np -.� w .��^� � � � z 11 9�G � �� with licensed��contrac�ors ta constrDct the project(Ser. - - . �. .� .:.- --.------, .-----.- -,...::..-.--�.,:.- . -. .. . .. _._.. _ ,._.w.....__ ._._... _ _...�.„_, ;..; . lion 7044,Business and Professions Code) ADDRESS �-... ,..._..,��...-.. �� �- s � G J�(�i�c2,� -. -. - .. .�_:_..„ ..REQVIRED. ..TOTAtSETBACKPROM ..___ _. _....:._.... _. .. . .. .. ..___ ._.., � ���CONSTRUCTfON�CEF161NG�AC"iE'N'CY'���"��'�"' - �YARD�"��HWv� � - �� SET BACK� PROP.LINE WIDTH ' ' �,2 2_'�� I hereby affirm ihat there is a constructionJendmg agency for � FRONT� � - Ihe performance of ihe work for which fhis permif irissued -. P.L� -- _ . . .-_.. .._,. . . _ __.. ...,T.....,�_.._.._...�-,....„..�.._. .,ir................. .. .�..... ,..�. (Sec.3097,�Civ.C.).� � � ����� SiDE " � �� � � � �' � � �.. . ......_.. .._,.....__.._..._ ..,._,... _...,._._. _......:.,.. ' ", ..,.,.. : Lender's Name . P.l.. . ._. ,__..._.,....,._.__._._. . .._. ___._. .._ . .,.r.. � . . . . . ,..... ... S . . .., . � . - LDMA Ref.# . .. ... :..'. � . .. ....._. ,..:.. . ...:.__ .._.r-, .,. P.C.Fee$ �-,.. PermirFee... ....�. ._. � . ._ - Lender's Address � �jy � - � # � � ' � Y/V � I certify that I hav.e.read this applicaLod and slate lhot ihe Issuance�Fee� - , � - ��LDMA P(G#-! , � _ . . . ._ ._ ...�.. _._ ¢ above in4o mafion is correct I agree to mmply with oll Counfy , � on ee ��-�"� f� � ��� . � ordinances,and_Srqte laws.relo)ing to building construction, �,�..-��.. Toral.Fee-� �� . -�LDMA Perm:�# .. . _..,. .___ ..�.. . ...; '" �and hereby aulhorize representahves of tFis County to eroer � "� u - � upon e above-m i� ed prope ty for inspechon purposes. - ���- -_.7�6�� - � � � ...... _ . __ . ...__, ,....,..��C� ... .. . _.,. ` �� ��/ lZ-(j�-�'� �. _. _ . t4 � � � SEE IIEVERSE FpR p��TORY LANGUAGE ' '� � � Signature of p cant orAgent �- pate� ..- - ..-- - �l ��I.�,/ -... .... . . ....._....„„ . .. . ' _ ., . n ,- .. . ... .��........ ....K. . ..... ..< , ./.�.: .:'�.., . . ..-, PlANS TO APPLICANT - INSPECTOR'S NOTES ' -- �'�- n1�'�1ER-BUILDER DECLARATdON � �„ ,. . . . , ,,., � „., r_. ,v: .. I here6y affirm ihaf I am exempf from fFe Confractor's . .;,..... . ... . . . .. � . . To: � �" Refurned . � �.; � ' �License�-Low for the'followin � reosan"��(Sec. 7031.51 No. �..Date No. ...� Date-� Approved �..� � �.....�.. ...� "� '��guires a perntit to construd�.•tny city or county x�fiicl�� - . - � � � � � � ter,improve,demolrs/, . .-� � _...._..,...,� .„„,.,..,..,�,. .a.y, ,,,,,�,�„ .,, ocrepafranyslructure;prdortoitsissuaxce,nkoreqadres . . .. � .. . . •�M , : .. � .,. ... . .. , �„ . . ...'�. ,.,.. . �..:` � '.; tbe appficant jnr such permia zo�ja'le a ssgned statement _ - - _ _ that he is I¢tens,ed,pursm¢nq to Lhe pro,ztS'zoves of tbe Con- � tractor's License Law(Cbapter�9J(rommencdng witb Sec- . .�. ,-��� " , . . . . :.,;. Eion 7000J of Division 3 of tbe Susin¢ss and Professions - � � � . .CodeJ nr tbal 5e is exempt Iberefrom and[he basisfor tbe . . . . . ._ . . . . , . .. ...._ . .. .. . ... ' . . . _ . . .., ,. .. alZeged,exemfitfon.Any uooladian of Section�703 Z.5 b�� " Reqqired o�fpPP�oved � � ��� � �� �... . : •.. ...,-. . pen��ydofnotmore han.fiv�6uxdre�PPlicanfM¢civil APProvnls.. . . � d dollars.($SOOJ.f:. ...::� Ves No ,.. ,:: - . . . E � -- . .. . �� � ' - - � �_ ❑ I,os owner of ihe property,�or my employees with Water Cerfificate �� �� ,., , ' �• -� ��� � � :.��. �.-�� :..wages as the r sole compensation,w II do ihe wo k,aod . ..�.. . .....,��. -- � ' ���he strocfure�is not nte`nded gr offe{ed,for sole�Sec 70;4_h) �: .. $usiness andPro essioxs Code:T$�'ConF aclu,r'r xcerase HeaNh Deppriment _._ .. . . . - . . . .��.:.. _ ✓,':_.: .. ..,... . 5,. ,. f.� . . ..... ,�' -_ �Law does noL appdy ta an owner of pr periy who builds F.i�e Department.__. . ..�. .-.- ...._..._ .. ....,.._. ..,_....._,�. ............p .....or ivnproves thereon,und yubo does such work bimselJor . � , , . ibove en� own,.empdoyees, pcovided ahuE suc5 f�v,is�._ B Gradin " � � � �v �� � � ���� � ✓� �� ��� � p. ts are,not intenderl�r.offered for-sudw � 9 `" � � . � however,the b+cifding ar improcement.issodd within=oi. a. " � � � � � �- -� ` `--`-- -`-����' �-��" <-year oj mmplet4on,�the�owner�huilL�er wi11 bnve�the � Geoioqical� - .� ... .... � �' . . burden of proving CSat Fie did not build or improl�e for .. , � ,... ._._.. . , Pedestr an Protec)wn � � � ��, ;.' -- the pu pose of saleJ. ��� . .. , .. (Fence)(Canopy) � � � � - - � -��- --�� . " ❑ �I,as owner of ihe property,dm exclus�dely contrac- � (Conc.)(Masonry)�(Welding) . _ ., ..... . . . � -,..- - :':;: ' _. . ." � ..._.Eu¢�1JsBLaw��oamd tPa����n.+Codn��ntr�tsl f tr srz�s S ecial Ins eclion e Tbe Cont actor' jA P� y � � ��� an�t u�h h Lot Drainage ' � projects wdtb a contractor(sJ licensed pursuant Lo 1be - .a : ,., .�- �. � � � �� .. Cnntractor's Liren.ee I awJ. � . � . ..... � Parking . , .:: � � � ._.._. .. _ .._ . . .. . � .- ....:. .. ... ...._. ._.....:... ...:.-.� .., .:. . . � �y'�'� a. - ��' �� � �l am exempt unde Sec ,B.&P.C.for ihis � (��9.r�ra�'- .. _� �� � __ _._. _ �. `� reason � . � �� :�I�. �lJr..,i .. _ ._ ;�. . .. :�. ..:.,. :�..._ . -, .,_, .ner .. ,- ... " ' : �:r v - . . �.�._... � ._.. . .,.,;", Date ,..i :... ._. ...:., Ow Approvals� V. Date � Inspe[}or's5�gnbtfrre, . . . :. ,. . ,:.� :.�..�� .:��. .��.�.. ��::�.. , '� . .� ........ . . .... . .�;,.,.= ....�_ � . .. %- INSPECTOR'S NOTES . � � �.. ._._ ._ - . .�'�, Lor,dtion— -. .,., . .,...:,,, . . .. .. . . . . . �. . ._ ....._ . .._. . .. ,:., ,... �� (Setback&Yards) � � � � -"-"- .._.. .......,. .._...._. ......... ..... __ . . , ... . �. .; .. Foundotions � ��`� ��-� ._ ����' -, r•� � �. , _ . ....: .. ,. . _ -�.,.. �. , ,.. 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