Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1099A 1100A (5)
� � . 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 ' \\ ' � �o 0 /\� •n �, i� ! n �'` n � � ' \. �f p; 'C C' (, (' \\ � �, 1�D �i'�� �f f:� 'tt :, ' \\ '� `G /,� ,%'� !``'� Jn C C ,;� :1� .A ;� C • � � l'3 C :✓ L1�. . . ,\ i � ` - �\ � �: � C �. �` � . �O . , � � C. �a i's •`G': f.� \ '�\.�\ 0 � f= O C i; ,:� � '4 . ?��� • \\ ' o� '. O C f.'� 9 . ✓ '.p� . ' \\� .+i'•� T (1= � ? � O �' �c • � ` �,�\ 0 � =; �'= � � � ; ;� � � � � -. ,- 1�; .� 7p /y '� ^ n � c :,� .^ n � \� '`' m o p D ,`, 1 " : f G G � �~ t � Q n Z �a, u ., c p % ` J � \•, � �\o C- �' ��: i> , o . � . ^ •1 ,�•.".\ � � ... � 1 ' ci - � \ `\ Q / �' \�o � ;� --�"*\ ° �'� ,�• , /' � �� � i � ` w 1 —�-- � cr� - : ', °° � 0 � � � - (b° \ ° � � �� \� � � �,` o y �- �.� � . � � �-�J� . . .. 6 6' � � ! �;� � �`�� � ., , ; � . ��.o�---� �. �, _ � �,o , ,�; / L�/, �� �, �j � � ( V � yy � � �: ,J'� i \ ` �1`�.J;\h;i �Ci` ��' -_�� � f'L' �`� Z , �r � � � ,� ' • '1 ��\ � f !' t � � � �'�'��`` Lr', �� �� /J a � �+��.�s' �\�. M • ��o. ��'�1 � y � �R: r' �r _ � ( i: " J. �• ✓ �� 2 J - r � }; J ,r, lY 'v '� " ' f� ,,� ° C �� r� „ .; !', 1�, 4� ''i v� � t �� lJ.'n+ f� � j � � 7 Vi ' '• !� � /���+ t! �� r,t(.� � i' � ,��t , �� �r� y r .�� . ^>• fJ tl f.� !� . � '� .., � � \ �� �,. � `r��• � V� II /��� � ..i . , . r rr"` j � r ., � . , i� �� � � , �,'� . .. � . .:� .�� �/' : , 14 ,J'i J '1 . - `'7 tl,�': t� y +,� . ��{ �, �;:,, � - , i �,\ / .. _.�?r,� _ �` - Clc�%;�^^•1^�=.n � _, - '- cx•= `'''`1'' r G .. x ;- •: :y y� :. :>'� ;�f'� � !'' �' . _ ��� � - ;,�.r�r=���� �T��L : ' � j ' _." ....'S y� _ C �,r ^t,yt �.�•���r� • ��� Cv }f,,.,� := `•; �1 ` - �-1� �`u. � ':-1�, %;t F .: ; y,.r- � •^; � . T' t� " - � =r" : �c : t s = ' = -'' `�� X '�v� -��r ' ' f`.i31r �: E,`c'' _.��3 �,:y`� - ^, c � o ..:•=r�;�..L�-�� �c. c y ,+ 4 �a V i � �. /- �, � - f r,, it .- n �"-�t� ; � � ^: r .. �- '" .r ' _ C�`f,`j= : - V (^ .� '�.T! 'C..;c �C _ = L' : �, - ^�%�` "^ if � . f G �•�' �'^� - � .',,;.«' � 'G p � �. .�+rl.r��K,..,.-- i�•-.`,- � 'r � � � � O _^ —= ` ' : ... �-?' �" - �' 7. G = �' � ., , � }. "`�.,� " ' G � � � i �' ,. f s. � � q�t•✓L ,� „% i - ., 'f'2't7 4 i � c �^ ^�cM.� _ v ' �. ? �; �, ^ r:�J° _ .. •-,�'�r �� � ��, n � j - ^, i C'�' �� � �' ' t. tl��i:.� F _ �'a ^ ��: �.. - ' ��„ « v� `n� O � �� _ '�� C s. � 'y...r'. ! ' (•l� .'r, ' :. ,.. � � _ f � _. � �'i — ^ � G� = - ��b ' �/:,�� ���` � nC� . G .-,L���t''+� i•' :' ' ' _ G'� i ,.;C=�_` 3' ,:,�x' i J � `J� � 1'� 2 � `��;�`� ��'r^ c:.�^ �' ~?�^•c Y � ���'�'����J' ^ `�J, �!',�1'/� {.� ^� � ` � � = � - ��� r V; ,�,� � t/� ' �" %!^ ^ % y %T'' �r- - C�•C% .�[ t,,,_ �,:�_��,� �-F ' i O v1 n � �L_=1,��c � L:. w'+�' _ ` i: _ -� _ ,��,.i_ _N �"t! �c i:, ♦ �i' � '' ~ ,�1=�� 3 :.,r- � -T : s. �,= � r � -.�^�' -`� 1, c _ �.; �1 � �r '_z3t.-c � t..' _ `y _'� : �' " ° ^y,-='��'� , / � • FF� /^-� � - _�-^ N`� n .n' �r^;r''�'__ — � .,- . / � � Z � �C' u� _ _ " : ^ �. ' _`' '.,, ' �. _ _ '/�� � ' O i 1��c ..;`� = _ '' � = _.'� •� '4 - '" . ^ • . �` ' % , � p ,� �.f _ =w n� _ -_� � .�'c , .. _ ` ��! � C �. _-C���` �(` �.�, n � '� �J� * � . � ^ _ � . �'i.��� ,; �, �'�� ,J � j: �� , (,