Loading...
HomeMy WebLinkAbout1099A 1100A � � . WORke..,, , .....fION f� I hereby af(irm ihal I hovr�a««��;�aP�o��0�5��,�o,��F APPLICATION FOR BUILDING PERMIT '� niure,��a cr.nificale oit•Jor4ers'Com ensation Insurancr., or a ccrn�ed c^py ihe�.bf(Sec.3800,Lob.C.� Y �n�� ��p Y — COUNTY OF LOS ANGELES BUILDING AND SAFETY Polic No��}�� an BU:IDiNG � C'1 � � \�h_ I�l n Cerr�lied cop�;4 hereby Iurnished FOR APPLICANi TO FILL IN �S- AD�2ESS c.�. A1CertHied cepy is fited wii .he c u �b ii ng in eo- BURD'N � � lion departmen�. ADCRE55 �a�e�Applic .1 CiTY Z�P J LOCAIITY \Q�Ct��'�j �� CERTIFICATE OF EXE�l. O FRO � RK NO.OF BlDGS. NEAREST � � COMPENSATION INSURANCE SIZE OF LOT NOW CN LOT � �RC55 ST. �This s^t��en nead nol be complc�ed if ihe perm�l is for one "• a55ESSC? h�ndred dollars(5100�or iess.) . TRaCTZ � BIOCK LOT NO. flAV @OOK PAGE PARCEI ,E�. �5E ZQN: �P to s 3 5 I cert�fy iha�in�hr.per(ormance oF ihe work fo�wh�ch ihis OwhF� No �� � } prrmit is issur.d,I sholl nol employ any persC�in any menner � � �.` SPECIAL (y so ns lo become subjecl lo thr.Worke�s'Compensalion laws. AODR.SS � � ��J CCNDITIONS I �Q 0 Dare Appliconr CITY IC L ZIP )i � NOTICE TO APPLICANT: If, nfler making Ihis Cer�ificale of FNG N�FFRi C 7� N� .. Di51RiCf GROU� tt7E Fi4E F¢OCESSED ev O Ecemption, you should beceme s�blect �o iho Workere' ro���`1 ,��� U Compensaiion p�ovisions of ihe Labor Codr.,you musf lonh- �C^R�:S �' .v� �" �� W wiih comply wiih such provisions or ihis permit shall be ` H � �� � - a dr.emed rCVOked. CONTRACTOR � ,� STATISTICAL QA/SS�IiICATION ACi. CONDO. f/� LICENSED CONTRACTORS DECLARATION �i� � CLAS$NO. v� DwEtt.UhiiS� � � I hereby nffirm Ihot I om licensed undcr provisions of Choprcr 9 AD�RESS NO (commendng wi!h$ec�ion 7000)of D�vision 3 of the 8usinessand �1 i�� SEWER MAP Pre(essions Codn,nnd my license is in(ull force and effr.ct. CIN Q ,! � CLA aK � VALIDATION r SO.FT `IfZ NO.CF NO.OF J CNECK Litense Numbe � •� lic.Clnsf��J SiZE STCRiES FAMIIIfS OkE � VAIUATION Conhocl� ��Dale.�� OESCRI7TION OF WO,'K I:E1V S O O O O�I� A�� � ��am e.acmpt under Se[. O Y � AITER � :�� C'�.r'ii B.BP.C.for�his reason � vEPniR ❑ s (+ . USE Of � � � ��� Da�e: EXISTiNG°LDG. CE.M.Ct ❑ � . $ignot�re �PRICANT TEL. FINAL(i /• � •�C;:.�'(� OWNFR-�UILDFR DECIARATION ��iNT� No. DATE t l ��q e i.C:'"' ^�`: I hereby offirm�hof I om erempl from Ihn Cantracfor's License '""'� "� law for the lollowing reason(Seclion 7071.5, Business and ADC7ESS FINA���� Profnseions Code): a4eaE�:� 6Y / �r��'�� ` ❑ 9VIlCING , , I, as ownPr of Iho properly, or my employees wilh AD�RE55 / ;_�� � j:i�,,. wages as thrir snlr.compcnsation,will da ihe wrrk and � the sMuciure is no�iniended cr offcred for saie(Seaion ����TY , I � �' o e � u . � 704<,Rvsinese end Professions Code). n'.Cv:NG 7Et. ' � CONTRA�TpQ Np. I,os owner ef the propr.rty,am exclusively Conlracling � •2� ��;I? with licensed conlranors to construct tha pro�ecl(Sec- ADDRE55 ' tion 70<4,Businees and Drofessions Code). • •G I :..��,'�- CONSTRIICTION IENDING AGENCV SEt�BACK YARD HlW ���ApROa,Lin� WiDiH V I he�eby alfirm fhat ihere is o cons�ructian lending agency for �2CryT . G F,�`.(_�:�U ti Ihe performance of the work for which ihis permil is i�s�ed P.l. (Sec.�097,Civ.C.). SiCE P.L. Lender's Name � ' /� tD'7A Ref.M P.[.Fee S Permi�Fee �V lender's Address I ' I rrily thm I hava reod this o im�io ond 51ate Iho1 1he � Nwonce Fee � � �D.X4 P/C M � ove informotion is corret a .eo�o c mply wiih all Covnry inves•�povon Fee � rdinarlF s and lafa I s fing fo ' ing co�slruC�ion, Tc�ol Fee ID.MA Perm.M O and her by a oriz epr niarivee .is Counry�o en+er Iu n� e m_tion praperty ' spr.ctlon purpases. �� � � ��•ao , ��� � SEF REVERSE FOR E7f�LANATONY LANGVAGE �9natu�e ol A licnn e�f Dc�n ' \\ ' � (1� `� r^ T� (!• ', in: i : � ':: �'n� ^ �� �' n . �O O ' " , _ O 7 U O ' • _ (1 . , _ —" . ^ ��' .^,. ' '; .^. r G C - n (_ �- ' - � � � � � . c _ .. � ? p � � � M . �., .. r. . � r'"-, I ��, ;� t� :: �: U D ' C ��.� :_.= a��`. • � . I� 'c` i � �: - . c: ^ �" a:? � ��$ � o '�-�I, v , a _ no _ . :i T _ I� D , i ' ��'" _ c � M � � i: � - -- :; :i = �I o : I� - - u a ° li ° � ` � c `' - i: ,` o . j�o ' U G ^ `p � "' I r, ' �� p . I� J I � 7 ' ' I I M I � "'/ � ��I ' . .. II .I D I p � • � Z � ( y� � ° — II Z �n v I-1; �� I � � � c� � 1_� � �i ' -. � __�;: o —�1— II_I o �- - —{� I . i� � . i �� a ._,�; I ,- — -�'I' � � � -• �� II _ G .,. I� � n I �r.--� � — --— o I o ' Z i .� G � ./ -71 ,o ' ' � I I , I ' i O . . - I II M • � � . N �� '° ' I v o I '' I � ` . •- I, 9 o a �^, � � � � i� I o . � Q ' , I� 0. � � � a . � 1 � � , � t^' f� `r l ;�`"' l , . : � .� "�� ,� � �o, r•f /� � ' �� � ; �,;�.•, u• i,� Cr, , �. ,, � .�.� r • ' � J , P� !/, �' .' ///���r CY•J . _ _ _ _ ' � •�_(J.i i�+ „i J/ � \ ,�+ � . . - .,,~�;-�� ��� ,i f �` c" � � � ;,:� . �; � . � 1 i ,J d .-,^ -� �`" �. Z � C i✓Y/J �Y! v � ) � ; ✓ v' V l T � /�' • y7/� L I� V �=" (1 • , r �� �1 �' 'if �•• � f ' f�/ �^J, 0 :.� �� � � ; ,, f . � � „ , t , � f�� � � l�� % !�r l.. u� . ' . +'.� i �i f'�r �', � � !'� 'r✓ t� � i� ,J � ?j /� m � •� � f f • � .� � � / v' �' •'i :. i i •i,' S/' � �� �: l � -. . �� . •� � � ✓ :' .�' { ' � � . , `� �„ � ' � � :�� � ��,� j' ,// . . r y/ �l � r ( f . Y ' �'�^ . , � , �,v � f ' �i I^�,� r/ . C ^� �.�.ti � ` �^ �� �� �4�_ f __� � ^ �.C.' ��j r�` _ _ eCi J R iilc L.� � 1 ^ � � <: C . ��'` ���`L� ^•!� ^ / ' �% ( �_ 3 � ,_� r�� ` 1 ti[ ` ==�' '_ r` ` � ' ' l � � �} T � L''�i ✓ �� i.�i °�� F .+c � . � `� L � � �� ��..`i� n� �� Y-, � _ ;i: {}�.i- _ - � � �=� % �_ � - ' -�f ;i�= '%;� '��q%� ' . .^. I C •� ��� • •� _N �1� � � C � � .^. � �I� �.�.��� Y�C � ` ,v� C y_� {'^ � f w 1 = �n M .� ' f - O � _L' L..^!� `r =� '� t �� ' f: p � n` ' L.. f, � JY� � A C �j�~ [`'^ J 1 A=' = • .. •• ��' - = `1'��`• `'_ \ v ' - � •��� 7 v = `' 1 rT .`. \�'-(i O .^. .1. ��Yi- L�/` ��' � �. / � ' " � ` � _ ' � � �_ = C � �` f i C�� � .:/`^� T = w " p ` a ^ . r � n �, '� � � e .•, r �r�. /� � S ���a^ _y _ _ _'��_.; � ' ; ; � �_ s�=.� � ,�� , � - _ - � m � ^ (: y.�'�'�..' .' •�' � : "`° � �. ': i' ` ^ �-/�-ls: K N -� G /� ^ �ti/ .�r� o : _ � _ ^Fi'; � �r :�`1 = _ '•� ` � ( � ' p � ^I" V '_ "c` C ^ ' C � � ^ `' �� "�'" . . ' - � z ti a �r�^ is � ` � � �. � ;; e ,� a' ''-��il` .: s � � 1 i 'c° ,� ¢ ��...`^ �.::.�: �, � ~ c - �� - � .. ..`.�„ ? . a � _ • � ^s� " �/ � � .r,���; 3 � ' , � ''�' � � � � �1 i► ? � 'I � � m F af:'� = w� � • �;`' _ - : %: ��� _ _ 'x%?� ` � �n i�� •i�. ° �.< � , ` � - � ��. =�"�4 � � �: . � • f n ;r._�( - t�i � L' � : � �'�-c �+. �� � � �.��I • � _ i C , . �r�� �C-._ - ` �^ _ ^ ^ _ _ � �,y - ' �' y„/i ' .- }���' �j �� C: ~� . �. � � � � �' + ., ' � M��� a � F',�-„J= �tn: .. ! ' pc ��1w^' � •, � � _ .�,. _ = �' — r` 3 ���=_ `N _ �, �� /. ' z ..' :� L �, ^ o .. �.i �� ` Q/��,: ? ,/ n �'�`w �� � ' _ .r,: � r �" c' j� - ` ' ✓ � ` � ". � ^ " ' • ' �� ._ . " =� ���r � �i _ c �- �� � i � C �` ` =� ti�= ^ , �- a ; `-4 f � 1 ,,., � � ; _ . ` �. I � �, ' � � �` � •� !i/