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HomeMy WebLinkAbout1285A 1286A „.� .- , _. //� � rWORK �'�COMP�NSATION DECLARATION '� ' � �� - � - -� t I �Hereby❑ r tFia l have a certficate of_consent tosself f .����,� -Ap������rON �C�R �U(L�D�1VG P�ERI�IIIT � � �� i sure, rtifica of Workars Compe�sahon Insura,nce, .. . r d' ., i .�py'th�reof(Sec.36b0,La6.C'.) . . .. �.�' ”' . `. »`�� .. . �. - COUNTY OF LpS ANGELES $ �, �BUILDING AND SAFETY � - ....�._ �z� z�.� _.>._�,..�.���a_. .,�.�.>,. ._.y ��..,..�s.. olicy No. ._. . Campany _� ...._... � . ._... . .. . . ., .. . . ... ».,-......._. � �.«, BUILQING �J�. / ..�� � Certi co y�s ereby fum�shed. . F012 fiPPCICAI�T TO FILC'IN ' " noorte55 . . �:, ,, __... : / � �Certified cop s filed with'the cqunfy buifd�ng i�speo- � � gUItDING/ . , �1,, �� tion de - ent. � .. . .., ADDRESSCiYt3'"�j , ...�. . ... Date �� :.: A plicant . ��. .. CITV .��. � '.;�. �.-F - .. . ZIP�� LOCALIN ... ..... '. . � + ""�. " ' --�NO 6F BtDGS �-- NEARESL . _ ORKERS v .,._ . . .. _. .-.._ . . ._ :.: . . _.�.-., �:.... P �CERTIFICATE 6F EXEMPYfbN KR6/v1 W_ , , SiZE OF lOT NOW ON LOt CRO55 ST. ctdolla0e$100 o�r less.Ple9ed if the��u 4 [' `� . THis 9e COMPENSATION 1NSURANCE � - �- j � - ,. _ - � :� .. �- - _...; tSSESSOf{ � ' —. ._ - . . ( �permii is forbne - -- - ' � �"' ` hundred TRAQ '�. , BLOCK LOtNO Mqp"860�(�^' � '� `PA E PARCEL . . ) ) .. . � ......7EL`. ' �� Mq ' . , . -,.. ,��. ��,. `�� OWNER:^.., --- � j,•`l,t. . � NO�T� ��� �y/ E p � I certify lhat in the performance of the work for whic�,ih�s . .. F. �� �� �� " ��" pe�mit�is issued,I shalf not empioy any person ih any riitinner .• .(i ' - �SPECYAL' "�'" '-' "'- d 4o ds 10 beCome subjecf to ffte Worker5'�ompen5at�on'Laws �� �� ��RESS�-� +� ' v �� � ` ONDITIONS � --� •-� � .___. ... .�. :, ,.. ..� .� CITY ,. � ` �'"i .... ZIP �'Z ..... .,, . . '�..� 5 . . . ._. � .,.. ,__ _._ Date �� APplicanf� � � ARCHITECT R , -�TE� - .DISTR�CT. . GR041P���. 7YPE � . � FIRE P ED BY � NOTICE'TO APPL(CA,NT if, diter making th�is Cerhfitate of � ENGMEER � N t'� l6"� N��L``����C� CON T Z ~ �emption you should become suh�ect��to the Workers' - � � �--- � �- �����- - w--� �-�� � .Trtpefis'tibon provisions of ihe Labor Code;you must forth- qDDRE55Z.-Z� �C-v #� ..�. ��l � "� �W .vith comply with such ovi,sions or this ermit shall be ---� ��� � � � . P' P .�.... ' �� ' �TEL � _,... � 5TAiISTICAI C YF N �' .. APT. CONDO:- ' Z deemed revoked. . � CONTRACTOR NO � - - � �' � LICENSED CONTRACTORS DECLARATION . ,�'� � --��� -�= `�^� ��OC. �`'� �'-�" CtA55 NO. � ,_WELL UNIT$_� I hereby affirm ihat I am Lcensed y,nder provisions of Chdpter 9 ����' A�oRESS NO .. SEWER MAP - �-��"��� ����� " ��-'��� '�"� (commencing with Section 7(3(TO)of Di ision 3 of the Business and .,_ _ � � � .� .�: '��"' """'"""'' �- � 3(r ._.., ,..._. __. ,_... .,, . �_.:. .uC. - : ,; Professions Code,and my license rs m fuli forte and effecL CITY CLa55 B�G ��- ��� ' -. VALIDATI6N- '` "� " ' " '-�- ' - - SQ.F7. NO._OF � NO OF CHEGK � ...�.� SIZE 5'fORIES ...._ FAMIlIES�.. . � ONE ALUAT.. . . ,.� � license�Number � � Lc C(ass . ... . . �� V ION ..�.T. ._ . . . � � �� " � �' DESCRIPTION OF WORK ��' ���- � - ��NEW {��qj'� , , - Coniracfor �- ` �� �ate� � „_,_ �'� ADD� � S -" � , ?1 ��,��A k �I am exempt�nder Sec. ��-�� �- . .�..�.' �� �" AUER ❑ � ... .., � r � � �_, ,, � �� , � :�o . < e23 ` -B.&P.C.for this reason � ..� , . �� ,.:... . - _ .- REPa.iR ❑ S . "..". . .` - .-- .��.. . _ _ - oare,., use oF _ oeMo� ❑ � ,... . 1 i 3 2 9,_H 3 �, . -EXISTING BIDG �� . . � _: . , ., -._ , ' Si natu�- - APPiI'CANT'T �,g - FINAL � w �.J-��`�i.�J cyi� : � .. I�hereb affirmt PRINT�� Wig'1'3 b;'t42= N�� � � DATE � 9 � OWNER-BUILDER LARATION .. � . . .�-.: . . �... ..�- G_S .. . . .. . . __. 12�2._�t� � � y hat.l am exempt m fhe CoMracror's License 9.7 -'*� � , - . - � Law for the followirig reasbn (Section 7031.5, 8usiness and A��REuZ z ��"f -J'� � "����� FINAjL 9`��"� ""� ` � � . ProfessionsCodeJ;.... � . ..,. . . ... . RE EN _ , . .. . ...: . _BY !i�`�1.� ,.':._ . ....-.�i 7"23..c�'i�n BOILDING� � �. .. �„T 1, as owner of Ihe prope ty or my employees wiih ADDRESS _ „� ,,..,.. ._,._.,_.... ..-. ,.,, . .•.i,+ �.�x§;-p .,..�.{o a e e�• j . � wages oslheir sole compensat on,will do the wark and � �p�ALITY � ' �- . the structure is nol intended or offered for sale(Sectian .,,.TEL .,:.;_ ....< ,_ . ._ .. ,.. ..�, �, � ;;. ,f, _-� �.�'���Q . �-7044,Business and PFofesvons Code)f "- � ' N10VING '�� -�- � � � ., � I,as owner of ihe property,am exclusively tontracting� CONTRACTOR NO - - , '. - . - with licensed coniroctors�to carisiruct ihe projecf(Seo- � . �- ' -�'�'� '��_'�� � � � ���� � ° ^ �'�7�J��J� �- � tion 7044,Business and Profess'ons Code). ADDRESS � . � � '�G`�-��; � � ' .. _ REQUIRED . TOTAL.S BAC M. - ..... �_....... " . . --.;. - � �� CONSTRUCTIaNCENDINGAGENCY `��"`���'-��-� -��""� SETBACK YARD� HWY pROP.LiNE�����" WID?H ' _ - ' I hereby offirm thai.there is a mnstruction lending agency for .�FRONT - � � � � � � - . �Ihe pertorman<e-ot the work for which this permif�is-issued.. ��- P.L. '��"� ��� "� � - -����-�� � ��- ��''��� (Sec.3097,Civ.�C.). - SIDE � �. . . �.��.�....� �•,�: r, , p�. ' ..... . . ..�. o ,.,... ..._... ,...... ..._ .. . . . ... . .. . .. , �� Lender's Name � . ._ .... . . .,.. _ >, _�..,. . .,..,..-,,...w � _ .�.�... . � IDMA Ref.H S . ._.. � ' P.C.Fee$ .. . P mirfee � �. . .......... . .�..__.�_..: ... . � Lender's Address . � .�.._ .. ,. � .,. ..._. .. .. . ..; ..-. � f _ � �certify.that I have read ihis.applimtion�and state that the �� - - � - �-- Issuanca Fee� / ��•�� LDMA P/C k � -� � --�-- <��'� Q above information is correct.I agree to comply wtlh all County Invesr�ga�on Fee� � ���-- /�'` ������- � � , . g ordinonces and Siqte.laws relating to build'ng<onslruction, .._ . � . -. 7omlfee ./�,! �_� -IDMA Perm.#-- � ��� �� - u and�hereby authorize represeniat ves of Ihis Coonty to�"enfer � " , . .._.. , . . . � P . . . .. ._.., ..... ,_.:._.. _ . . ..... u on .e abo�e- -�ntioned property 4or inspecf'on pUrposes. " �� :L"7C�� L��r- ./ ... T St,� .... . 7 .. .. ._ , ._ ...._ _i Q 4.^,.� �(�"'�Q„�!,��/' f�-f .^�y�� SEF REVERSE FOR EXPLANATORY LANGUAGE � a c. ... Signature of A p i<ant or Agen�-- ' ' Oote . . ,._ ,.�..,___ . �_-,. . . ,,..�.. ., ,.,;�..- _-•;:...;^-, • _..,,�k � :_.:. � ... .. .. .. . , . . � . . ., , , . , �i � � �� I here6 ff'rm�ha�ILDER DECLARATION � � PLANS TO APPLICANL INSPECTOR'S NOTES � ...OWVE,R.BU ... . _ , . y a T am exempt-from the�Controctor's To: "� �� Returned, ,.,. ..� ���. � .,� . ` . � '� License Law for �lie.�following. reaso (Sec,- 7631_� � - � � Approved � �$usinessandProfessionsCode Anycrtyorcoicntywl�ic'c No. Date No.� . Dafe -'..'.. .".. ..�.`*.'s�,-. ` ';�..",;, �.`' � .. . �.'- requires a permft to construct,alter,im�±.rove,dermodish; � . �.-..., .. ,_, . . or repair any stracture,pri,nr.Sn sts r.isuarice,addo reqnire,c . . ..,.._ �_� e,�.-::__ . ,,, .,.... . _...., - .. . . tb¢applac¢mt for.such permTt to�file¢sEgneG statement . - ` ������, �. � .,t¢at be,u,lace»;ed pursuant ao tl�e provuions of t!e Con- . ���. � •- � � �� 'tructor i License Lauw(Cb pter 9J/commcnceng wiih Se.r- � �- "��-� `- � tson 7000/jDivision 3 oJtheBusiness�a�idPr fessions .. . -� ', -,'� �.-�� _ . _ . . CodeJ or thaa be rs exempt tberefrom amd dbe basis foi,the . . �.. _.. .. .... .- .. . �� �:.. . . " " . ..alleged exempfeon.tI ny.,viodatian f Section 7031.5 by -. .. . Requi�ed . .Da4e Reeeived - � � �- - --�� - '� -= any applecant for a f�crnzit subjecFs tbe applEcunt ta¢civil Approvafs��� � or Approved., ' ���-.�,pen¢!ty of not more than five bumdred dvllars($500J:/: .- . , Yez No .... . ... .. :�, . - � � � � �� �'� -� - �---��� ❑ I,as owner of the properry,�or my employees with . VJater Cerlifim�e - � � . . .. . : � . .�.'_ . c:._... : .____.: „'y^„ :,;,,,`!gp9es as their sole compensation,w II do ihe work,and � '� -��� �- ����'��� - �the str�cture s not intended or offered for sale�{Sec.�7D64) . .�.�.., .. .- �". B sxness aied P . � .. ,:�„ Heqith Departmeni . ._. . . ' � � - . ..�.... ....-...�� �-.�..-...- .-..-:.....- . `.. .=., .:.. ..:.... f ssmnz�Code:1'he�Contractnr'sL cense � �Law does not apply to�¢oa owaer of property w5o buflds '. Fire.Deparfinen� ..:_..... .. _.. __...._... ::...... ,w,.:�..:.::..... ,.:.' . or improves tbereo�e,and u�ho does sucb work lsrnselJ or '- '� "+'�:- �^�� � � . � throwgb his nwx em�loyees,�.p*onuded t5¢t sucli��ss'ez- � Grading �. � • � . ..� � . . . .. �'-prnuemexts are not intended pr ojjered jor;sale. ZF- . � � ,bowever..tbe bttilding or fmprovememt u sold within.o,' � . .. ` � ` ....."... -. - . . . '"' �" `- '_yea� of rnrrcpletion, tbe ourner-builder�moU.bav¢ �fb.. _ Geological� � . '��� -� � `• � -�-�� � � - hur�lex of frrovixg tbat Ge did nne build nr�dmprove�for ,O, ' ,.: � . ..._ ...-. . . : cbe purpose of sate). . .�.�� .�.,� j Padeslncn ProFechon ,�., . .,. ' � � (Fence)(Canopy) " . � -� ��-� - �� -- - � ❑ �,I,�as owner of the property,_dm excl sively co bac, �� '�"ting with licensed cont�atiors to construct the ' ` t'Sec. ., � . �. ' pro�ec ( �� Special�Inspection � �� - �� � -��� '-"�"�� " �7044)Bariitess un-1 Pru/essions Code T�iv Coxtructor's (Conc.l(Mosonry)(WeldingJ � � �� ' � - � Lacexse Law dqes not apply xo an owner of property wbo - �'!� "-�� � " '-��' -� ""�-"���� ` '���6uiZds or ivuproves themon,und u�ho contructs for such � Lot Drainage - . .,. , � � . ..._.. . . . . .... _. -: projects with a cnntractor(sJ lu�ensed pursriant to tGe ` ' . _ . . .. . - Contracaor's License Law/. - � �'"._ tl Parking . ��..;. . � � . . ._ . . _.._..:.. .._.....: -.___., . .:_. ..,.._�r .-. � 4!� .. � � � . � I am exempt under Sec ,8.&P.0 for 16is A �¢ c+ � . 'i ���v ' � 'f� � . . ._. . __._. _. .... _ _:..... . _:r <s . .. reason ,- �� �`��°UL-. �P,; d � : � .., �.�..._. . Dafe .,. . ._. , ... Owner�.r_ ..... :, .�� ... .. ,.._ �,_ ..�. ':r. , :�. ,. � �� �� Approvala Date Inspecfor's'5ignature, . - . ,,, INSPECTOR'S NOTES �' �� Location—� . ... ..._ , �... ........... - . � .. !: . . .. :....:. _ ' _ .. . .. (Setback&Yards) �� :Foundations � - �� � ` ' Slab ��E��� '�� ._ . . . . . . . . � . . . . . .... , . .. - Frame �� � ` . . ..... . . . .. .. . ' . . .. , .�..:, . - .., .. .. . , Energy Insulation .. _. � .:r. .. .. __....__, .._.....,_' ..�:. '.:`• . � �; . . Lath/Drywall— � _._. __. _ ... .. ..._. .. . .. ._ . .. .. :`,. r.-... .... .`.. ._ .. .-..' :.�. _.: Inierior - �- � - � � ��� ` _ _.. . . .._ ,: Lath—Exterior . . . . . .�..� . ° . ... .. _. . ....._ _. .. . . . . ,.. - House Numbe.._ � . .. . . .. ... .._ . . . . .... .._. ..._. .. _.. _. . _.._.. __,..__ , .. Corre<t&Posied � �� Fina�— -� .. .. .�.� . ... . . _ . . .._ .. .� , . . ..- „ � .. ...._,.... __, ,.'� _ „ . ,. . „ ,,, #.....;, ' Enter on Front :� , .._. �, ,;: . . ,.< <..�.,_ ..: . . ..- ,:. . ..