Loading...
HomeMy WebLinkAbout1009A 1010A WORKERS'COM7ENSATION DECL4RATION � I hereby affirm that I have a cenificate of�o�ga�<<o.a�f APPLICATI�N FOR BUILDING P�RMiT insure,or o cer�ificate of Workeri Compensation Insuwnce, w o cer'ified copy rnereof{Sec.3800.�ab.c.� %'CpUNT,Y OF LOS ANGELES BWIDING AND SAFETY Po❑Ifq No. Compony , BUIIDING Certified copy is bereby furnished. FOR APRLICANT TO Fill GRl aooaess o? oZ �% � Certifiad copy is filed wilh ihe couny building inspec• BUiID�NG (�, � _,(3� tion departmanL ADDRE55 7� L LOCAUSY / NEAREST Dote Applicont CITY Q m(h Q CROS551. CERTlFtCATE OF FXEMPTION PROM WORKERS' �'�&'�' ���R COMPENSATION INSURP.NCf SIZE OF lOT NOW ON LOT MAP BOOK PAGE PARCE� (This section nead nat be completed if ihe parmit is for one USE ZONE �P Q p'� � . iRAR BLOCK LOT NO. � NO- hundnd dollan(5�00)or less.) SPEGAI a �` a 2 OWNER ' NO. CON�I710N5 I certify tMt in Ihe performanca of fhe work for whith thie dSTaKT GROUP TYPE ctRE PROCESSED BY � parmif is issued,t ahall not empioy any perspn i�pny manner qDORE55 � CONST. NE so os to 6ecome wbject b tbe Wwkers'Compensotan laws. _ �� � CL CITY ZIP�L. STATR(IG4l CIP.SSIFICATION APi. C DO. O Date ApPlicnnt r�OTICE TO AVPIICANT: Ii, oher making�his CenNicme of NGHNEER � �. � cinss�a. °�-� �wEu.uwn_ W Exemption, you should become subject fo the Warkeri d Compensation provisicro ef the labor Code,you must fa�M qpp�u SE'NER MAP M` with [Omply with such provisions Or ihis permii sha!! be 7�, /�_ Vql1DATION deemed rBvpked. CONSRACTOR NO. � l¢ I� BK. PG. UCENSED CONTRACTORS DECLARATION tIC. I hereby affirm tFrot I om licensed under pro isio'u ef Chaptar 9 nooRe55 � YAlUAT10N (commencirg with Section 7000)of Division 3 of the Buslnass and • tIC. �Gj Professions Code,ond my licenx is in full force ond effect. CIN �wu s i/�� ' $p.F7 , NO.OF q MO.OF CHEIX ticeMe Number Lia Clase SIZE STORIES L�— FAMILIES ONE --- z� C�f.C1� DESCRIPTION OF WORK N� ❑ f �}• •2 J .. Coneraefor Oale ppp � - . ..• �I am exempl�nder Sac. � � ryNp� � ' � � • •v I G 4 ALTER �� � p� � B.&P.C.for thiE raoaon REPAIR � - �A� O � z z?:�G;.;- use oF � fIHAI Qole: EXISTtNG BtDG. �� By t���7`G'r� Si9nolVfB APPIICANT �l. OV+7NER-BUILDER DEQARATION ��M h �� NO- � I here6y affirm that I am exempt from the Controcfor'�License qvo2f55 � Law for tha following reasoo(Saction 7037.5,Bu�inata and Profe � ns Cod�): PRE �� �'�.�� eui�ir� �j 1, os ownor of ihe properry, or my emptoyees wi�h AW0.E55 woges as ihei�sOIE compenaofion,will do the work and H� � � � the str�c�ure is not inlended or offered for wle(Section ��°'��TY 70M.8usiness and%ofessions Coda�. AACriING TEL. � • •4 9,2{ � 1,os ewner of�he poperty,om exclusively contmding NTRACTOR �� . with licensed wntrocrors to construct the project 45ec- • � ti 4 y,c��� tion 704.8usines�and Wofessiona Code). ADDRE55 REWIRED TOTAL SETBACK PROM EX�ST. O G L�J�C Fi CONSTRUCTION LENDING AGENCV SET BACK �ARD HWY pgpp,�� wIDTH ► I hereby affirm that the/e is o construction lending agency for FRON7 the performance of�he work for which this permit is issued P.l. ZSec.3097.Civ.C.). 51� P.L. � Lende/s Nome ,j} �} 7�y �e� S P.C.Fea S JL•/ Permir Fae •�"� �� ` te�dars add.as� �v� � I ceAify tlat 1 have read this appliwtion ond stata that the issuance Fee � above informatlon i�correct.I agree to mmply with all Counry Invaaligalion Fee /�p ordinoncas and Siote lawa reloling to b�ilding conatruction, Total Fee 7 /•Z'� CJ and hereby authwize repreunw�ives of this Counly to enter � upon tfw abov�me�rio�ed proparry f r i�sp ction purposes. �O e��� �"'�� SFi YEVElSF FOR EXHANATORY LANGIIAGE ' � � ����of Applican�w Agent�� Date � . �, N N. N d � r m h i m c, ^ . � ..„� a � . `o`� .II« � :c�, o�n.o���~� � 0 � ��+�..'�~ � �` o N"�� �.^. . r � . p o .! c Cy O�i U„�`vn. O�•d.0 m Y n w�;M,�',�i w u ^ c Q � � c O ' � , m � �, O i� h .. � w tl`i'��.w M,wC�� b p �V +� O � N'F: .l i W rj ,,,�', i..p +. p �X� c ��� i �� � � 3 �'y�,�.r: `,:�. ^. s, >.o z � � U � .. . j,., o +d y � a � " Q N c G U v � �'d G � z a.a � �,s ac �, �, o r.� m'.;�^ V > �U c. � ;, e_ � . . 01 ti X 4� � �•.... C a C +�r e� �1 d � i. 4. . C Ij� • w i �r� � cs .�'. y,� m o 4' ci � � � '-`" e � 3 . a c o.i'�� " U'ro'c -a� >�a o _ t' �' • z �- ' � � � � 4. @ o s, c. � ';, s y �:,;'L E _ � a � �: o ^' , � „ : � y, � C R �ti.:; C �3'C�: r. `��� _ . ; ... I . . . ._+L i� � '�` `^ ... "" . � „1 i, '� ... � ._ ,J .. ., � . I v � .. ^5 : .�� ��..�' - o� r, � - t..' `- ' • � - .7 ' � � � ` ' I I �: E � '` � "•' ,� L i '• ; .� 't . �i . i. � c` � ., f I I x , '' " y. ,-.. z. . 1 ; ^; " : c` , �, m c ' `' g , `� � c ` c �'�', � : � , , R � �c �.: C' ,i .. y '; O. u�� �, „ ` L'• • ' _ . 'e � . - ^ ^ a'• - � �'.r �3•t �_ ! � G . . �a� i ..„- � c - e_.•;: - �. , _, ti _ -� � �-[ - i ', . •- �: .: � ., .. � � r- . ' t � ' (. - � c . _ , s_ iJ • .. . � ' - -- - 'r . c' ' i.: - i � . � � � I,J .;� , ., v . :, ; _ : ��� � �: � I � , � , ' . �; i . ;: f' t. . _ J, _ . _ r . ! � � i ' �. . x . .. . ` ,o' , i,. . ' I �: - �, `.:� . , _ c, r � . , : . ... ; i t r � ' � G ` . `� � `.•. . - ' ` n � - . •. ' � . I � ' I � u ! ' ��.~'�: `_ . - � ...'� � c. 5� .. - _ � . _ ' . f � ,. � I I -c <� �. v . , t �- ' i. C c� -. . _ � . I � , . � "_, �� �� _. . _ � . . . 3 : . - �._. :_ . ,. _ .., _ . � � . C . � � r I � � � i � I I � I I I ...-� � � ! 1 i + � . ' � i , ii I � i � i ' � • ' � � � i � � , , ; I �� ' �: i � ; , L. �; , � , , , I ; , ' � t � ; :�", � , �� i ` �_, � i . , F !. � ; ; � � , � � � � ' � : I i i i � � �'� `'1 , I � , � � I � � �� � I ' ' ' . I ; � , , ;: � � ' ' ; ; ' , ; ; �� �� � I� . � , ' � ; � � � ! . � � ; , � � ; � ' � � 3�� �: � . � , � i: � 'r ; ! ; ' i i X Q� 1 i i � , i .Y� i � ' � � ' i . I ! \ , ' � � � � � , ' � , ' �� h � � � � � � � , i i : . � ; . � � � ' ; � ; w � , , � ; i i ; i I � I - -- �— - � � ._ .... � , .._,� ... _.. .. . . � - - .--- - -- - - -- , ' .I�.. I � � � � I` .rl �' � � „ I � ; I i j ; I ` � � I •r � ; jE i I i" I I i i � lw � f ii � . > � iE � • � ' � . I i i �� � � ,, C� - � E� � I, ! ' � \ �. � ��, ; �; . � � � , � �. 1 — C r�Y !� I .. � k . I I � I ' i ` � � 6pT � s � � �j �, � ' � `., � I � ` I � � . � -- --� i ------I� '- .__ —._.._ -----�--....._....-------�-�._ ':� i i ; i r� r� � I I d� i I ; . a:� Tt', �y �,�� I� ' !" I ' . "Cd i C'i �:: '... f . I I' i � I i �7 « � �'�. �� � i ...---�•-�- —-- — I s I � I ,.. .... ----"----..---- -- � _..- ---.,.. ._... w 4 — �.. ...� � I �� i � � .:_�._—. �,-� ac I 2• � --- --,;--- ---� i � -- ^'; ! _ _ r. �f� , � I i � � { .C] rj �i y.:r` '. ie i . _..._ i` :� �— • � � � { : 1' 1 'r � ' i `, .�,r: _"�._ _'_'__'. __. .__...'"' '_' . ..' __"' '_'_' --'_' —_'__"-'_"'__ ""__ "'� __ ' '-� '__ "_ J . ..i 1 I } I j -U ! � � po I ,I�__._ � �I..__.��.. " : i � ; I-. t__i..._ � I � i�, . i ' p v 3 I I , 1 -.. �, l . I ' � I «.� o `' � c; ; ` � � I V^ � �'_ ` � ,n c � o` U I � _ U ; � � � T : J ' , ` + -`�: O ' � 7'i i ' . `.� � � � ' i � O G � � a � . ' j 7. I 4' , � � I � . . Y. � O S7 � �' � E�, ( �,� •I . £ I I i [ `- C [''` . ' . C OI i _ V 0.[S l'� ; C N O �d j e: ` � ' ' � �c_; c-^ c: I i � i I a;• 0 3 o c� �,a �i� (, I � Z: � u 6• I C j � CY C >`�' x L C � i � v i S o = ; =� i o � � ' c I �I.�-j'Oo 0 0 � �c w '�d ° � — ��� � U O I � '40� � L� (CJ �� Y I Si O� j 1] � y .� t � � m ' O G II N O O O O � Z - - .--.—.I � I LL U� ��U C LL I tn U � d z �I J�� t�i in IL W � � S V LL W L-- J —!--� •-'---