Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1547A 1905A
\YORKERS'CO•'T.PENSATION CCCLARATION � ��,:nY o��,.m that I ha��o������,�a,P�<<o�,e�„o,P�F APPLICATION FQR BUILDING PERMIT � insurn,or�cnn�ficac o1 Vlorkcrs'Compensaiion Inswonce, or a cerhhnd copy�F�erenf(Sec.3A00.Lab.C.) _ ,�Y�t�Z���a�Y �.^��i�_� COUNTY OF LOS ANGELES BUILDING AND SAFETY U Cend�ed copy�s hereby iurnrshed. FOR APPLICANT TD FILL IN 2u�m!r�,r,� ` C `�� AD�RE55 �G �eri�f�rd copy is flled wiih ihe tounty b�ilding inspec- P.U�iDiNG '.� � o�deportmenl. AODRE55 � � -�{���j��y_7' Date�Applimnl 1_Z��t� `:�7( 1,A�I!� CITv� I� �i� r.� zIP �(� IOCAUTY Q: "V� ,ERTIdICATc OF ExE�1.PTION FRO!.1 WORKERS' NO.OF BlDGS. NEAREST � CO!f�.PENSATION INSURANCE S�2E O�LOT NOW ON LOT CRO55 ST. (This eeuion necd no�be mmpleted il thr.permfi is 1or onr. -7 � n55E55C4 hur+dred doliars�3100)or 1e55.� TRACT � � �B:p[K LOT NO. '� /N.qp y00K PAGE PAR�FI �E�" U�E ZONE r.wv CWN'.R i�^i f ���x.r'�,J�;�1tao.�.'-✓�7- 7 r I certify 1ha1 in the periormance o��he wor4 fo�which this NO. a. permit is issue.d,I sholl nof employ any nerson in ony monner SCEC�AL so os lo become suhjrtct lo the VJCrkers'Compensalion lows. AD�RF55 _ � CCNDiTiONS � Dafe Applimnt CIfY 21P O NOTICE TO APPIICANT: 1I, e(tr.r moking lhis Cerlificatr. of �RCHITECT ORf� �El. , �, DISiRICf GROU7 fYPE f�4E SSED BV F� FN�in!ER FS � NO��Z.> 7 ERempiion, yo� should become subjecl �o �he Y7orkers' � f, C N�,1 ZOIvE �� w Cc.^..p^^:a!icn prcvi:ior.s c1!hc lcbcr Cede.Yeu rusf Ior7h- ACDRE55 � I r � �V � `'~ Q ti- wiih comply w'Ih such provisions or this permil sholl be -� fn deP.mrtd revoked. � �� y�_ �T_E�Q��r � r STATISTIC.4L CIASS�FICATION APi. CO�:DO. Z CONTRACTOR i t� r�0. f^1 — LICENSED CONTRACTORS DECLARATION �� '��� y CLASS NO. 0`1htt.UNITS I herrby affirm ihot I om licensed undrr rrovisions of Ch�pie!r 9 ' AD�RESS��Q ��v NO.-'� (commrncing with Sr.c�ion 7000�of Division 7 of�tie Business and ��� � SEv,4R rrAP Prolessions Cad�,and my license is in lull force and r.ffecf. CITY ��L.� �/\ CLA55 �.-.�� VAIIDATION � SQ.FT. 1 NO.OF NO.CF CMECK BK' �'' licnnse Numbr.r � + Li[.Closs G�� SIZE STOR!ES FA.MIlIFS ONE (�L�� -N�e t77�i.�/�ore 1 U7.1f� ❑ sALUAT�J,� �o���o��a�_ � �� � DESCRIPTIOV OF WC4K NEW � � � � ADO � �I am e.emp�under Sec. J T � _- 1 a�L ALTER � , .--� r,j:,7 f: 6.8P.C.(or ihis reason REPAIR � S v Dole: USE OF DEMIX 1-� .. • • • e i� ExiSTiNG B�DG. U $i nOfUr@ AFi'LICANi I TEL. . 9 OWNER.6UIlDER DECIARATION (F2:NT1 i lr�L F��l�L!� L 1 NO.� �I^I i ( FINAL /'// G �/�� I • •-l.^�) DATE 4.7 L� p/ I hereby aff�rri�hat I am enempt from ihe Contraclor's license � f� • c o�_�;';��? low lor�he faliowing rcason�5ectian 7031.5, 8usinnss and ADCRE55 . ��-� `�.-�f�-�- i��L`C.� FINAL ' Pro(essions Code.�: 4. N BY �� ��.� �-;:�? ❑ P.UILD'NG I, as owner oi ihp property, or my employees wilh nDDRESS woges as ihcir sole compensation,will do rhe wo�k and � � Ihe slrutlure is no7 in7ended cr oiicred for sole(Setrion LOCnLiiv 7044,Business ond Profess�ons Codr.J. MOviNG TEL. � I,os ownP�of Ihr.preperly,am eKclusively conl�ocling CONTRACTO4 NO. wiih licensed contractars�o constr�c�the projeU(Sec- aDD4E55 �ion 7044,Business and Professions Codc�. CCNSTRUCTION LEN�ING AGENCY SEi BnCK YARD Hwv 1O1AOR0�iivE WiDiH I hereby af6rm that fhere is a conshuction Iending agenty for fRCNi %'� Ci G^r the perfo�mancr,of�he work fer which�his permi�is�ss�ed v t. ' (Sr.c.3097,Civ.C.1� � s�oe ,. �. • . • . a j P.L. lender's Name � a ��� n LD!1A Rel,y `'C lender's Address � � P C.F.e S � ,� aerm�i fee _ •�. o�!;:.l:i��: I certify ihar I have reod th�s applicarion and s�oir.�ho�ihn iesue�cw Fee tD.MA a/C M ' a6ove informotion is correct.I agree lo comply wi�h oll County invesi�ganan Fee C 9�=�%-i+� ordinonces ond$talc lows relaling lo building co�structio�, Toeol Fee � Q L��M Perm.M ond hereby aulh re�ep csentaiives af this Counly lo enter upon Ihn ab� me on}d property(or inspeclion purposes. . � ��� ��� SEE REVERSE FOR EIfPIANAtORY LAMGUAGE �ti _������_S/�`]�`� S��nnrure Appl� .nl or Agem � � . ��� \t _�_ ' ,_�.. .•• '�'j ~ �'' '.{JC.Jt O .,�"f. ..j;C� � ?•� i'. 1 ' ' ,,` � _. , r ,_ �.: , ; , ,,.�, ,. , _ — .;_ ,.;- :�, � `. �`� i �. � `.. � b .� ��;°` . '� " ^ � _� .- „ v� v _- - .r'' � - 1 -- � "' in �: '��. 1' o � � • ,,o .�- ..��r t G G •�� �' .� , , . .� �C � :.I� . <. �° ',� r 1 r � r „"� C � � � 'C��,�'.�1, S . 1 ' � ' ,�'. r _ /`'ry , ...t � !'. �,t ' , It` ', � s`1l .1-, '� :7 ` .. i ,+'7 l � � ' ' '+/ 4/_ • o �:� ,�✓ �..r 1��2 0 '^ o ^ ° 1 �� -�^ < e 1 ;J � . ,��� l`, �U� y �r... � � � r �� �, � '� r .. 'o .'� •, � ^ � ;� 4 G ' M � . , , , ;` � � i "" ' `'�G �. = 1 '"' �"[ y , ,' C f'� r'' �+3 0 4 � 1 J � _ '� '°. y, � � � p �T .� �; . t 1 ` � c. ' �10 � Z a p- � �.� ,� ; o —`� � �__1_;�;`� 4 �,� � '' = 1 � . 1 1° 1 _ '� � r--. _ � � - � �='' ° � t =�—y ' _ �1; i �� , ��.,�r, �, � O p , .. ,' q � _�� [-�'�1'� ��� . ') �,O V � / --' _ � \= � �� + � '�9 i �� �. l f 1 + o •. Ij c � p � � iL , � • 1 a� ' ' � o 1 r _ 41 1 � ' � � �'�'e I - : ' i �, , . � � � � � . � ' � n _ . � ' O . R N . � . � , . . Q . , a � ' N , . ' . ��� ' r � :t � � ^ • � .�C`4, � 1� Y: ,.�' ^ } 1� ` t,' ! . ^..> ;=� � L C ^ c' „t� " `' � � 4, �- ^ 1 � ' .. 7�'�„ = �-` �. '- _'� v i> '' � - � .. i,. � _ I v� �� f. ^ : t C.� t. G � .- y :.�^ :�^ � . .. fi> '� '«•v� r 1 �,-� .: k„ ^ ' - �0 _ �, = w c., a — : ^ _ ' :.r'� .� ` P{.7 ."J � ^ � f� M . . Q ` � , `'. .S* £ L� 3 y '3 ' a 3 R jR O �, ^� �^• F,' n _ : C r ' n a � ..'` � � G�.G .=3�� M _ `c� V f:. �'^ ^ �' ' r rr3 f'u �v . . 7 `^ � � '" R o• `-~ T- t ^�M �• .._.� i - � ' - : [ .� t �,r 3 p - "� a� �•� � c „ '� . � . O � n � 4 *=,"- n�, � _ � �, ° .. : '�3 � �,L._^ _ � G' r y "=> t r � _ � .. �.�3 � _ . � � : 4 . s. 3 r < . Y `,s- t G'=. ^7' � � � c. _ � � :� � " ' ' ' _ - � ' �; �,� '_ �n C C." ,'K ~ � G L �'F "•? � � y = a� �', 3 _ � .., t� ^ y� C..7 r, . '� : _ — .. _ � � + L• � :. v . '� S 1 ... � .�. O � :1 r.�.:. .�..� w�. .�, �.. .� � G .�f .�."'`�� „ ��. �` � p .. " S Y��? - ' , � (� i' �� O c :..Y ;i c.." �:.. V '`. 3 _. � = �a t . . � �� � _ s � •y�T. `� t"y _ - ` ^ ^ C` ^",�, �. � ' � � � n �a ` o ^ .n + _ "��� �G 4 - c. : �,y:. � _��r. .; _ � .r'. !� ' z. -` .- ",-, _ � s " ;. .�' - °:: S ^ w ^,`, �� O ' ' c"'x �•� ° _ "'a ;.: - - i: ,. �'..- _? t�� � �c. ,�3 �, p , e F -�� � � �_ �. c,,,=' � p _ i ' ' T r"'�- _ - � . V� .. f O .i �. �. J '� ?',.1 f:' C ^ r.1•'' r,, 't" C,.�`.�.I .. f. ^ �. .. � _ _ _ _ _ V . /�. :..� ... C � L �. V�� f � en'- w.a.l � � ' � t: . . O �+ •'1�' . ^ ✓ - y ^ _ ` � j�' �,n� � � � � Y� p �. 7 ^+1 1' _ ^`� �+` L � � � ' „' /. • .. k 4 s' ` : Q � c' ' f� G � .. �C.'. P� ^' � .�;� , - . � -� i' G" .. ^ . n ' f x' �C ,� '�? '� � F ' . -1.� � � •„ . q �� N '• t