HomeMy WebLinkAbout1653A 1654A (9) . . ...._... . . _._..... .---. . ..__.. . . .. . _ . ... . . .. _._.... . . .__.
L"JORKERS'CO�d.PENSATION DEClARA710N � ' "''.� '�� ' � 2
I hcreby afF�m ihat I have a certifita�e o(consent to self
... ._, . .__ . . . .. . . . . ... . .
insvie,o�ace�iilicatr.ofVlorkr.rs'�om���5o,�0���,�,o�«, APPLICATION FOR, BUILDING� PERMIT�
or a cr.riified copy ihereoF(Sec.3800,tab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY �
PoI��yNfi . S_� 60-755(7ompaTipd�G Iy�l�mnity CO � '
a Ce.ti(ied copy is hcreby furnished. FOR APPLICANT TO FILL IN BU!IDING 2 1 �y(
ADDRESS I ��V
�� Certliie.d copy is filed with t e.county b Id' tsu��DinG
t n depnrtmenf. � A�DRESS 24418 St. Ives Ct. g.
Dote$ ' Applicant ' � UTY ' LP � LOULITY ' '
� C iIFIC TE OF EXEMPTION FROM W kKERS' ' � �� " - ' -- �--NO.OF 91DG5.� NEAREST �
..... .. . . .. ...,_
� COMPENSATION INSURANCE � SIZE OF LOT NOW ON tOi CRO55 ST.,
(ihis section need no�be completed if the permil is for onr. � -�� -� nS5E550F , � � � � �
.hundred dollars(3100)or less.j iRricr�� 42566� e�«K L T ' Z7 �;rP BOC�C PAGE PARCEL
t. usE ^� �.v+N
I certify tho�in Ihc performancc ot Ihc work for which this ��'�� ' ' p�Alt].e NO _ ��� � /����'�.� }
permit is issur.d,I sholl nol employ any person in any mcnner . qC:QE55 3187 A Airway Avenue � . . r�,�.� SVECIaL � �� � 1 �
so'as fo betome subjecl to Ihp Workcr5"Compensalion laws. CON'�ITIONS Q
, V
•--- . . .. arr . .Co a biesa ._ .-. _ ziP 92626 . _ . . . m
Do1e � 'Appli[onl A4CHITECT OR TEL. � I
' 'ZTICE TO APPLICANT: If, offer moking Ihis Cerlificv�e oi ENGi�EER �, � _ DiSiRICi G¢OUP NPE . F14E CkOCtSSED BY .
4nprion, you should hecome subjr.c� �o the Workers' - CO^�5 ZO!:E W
.,dmpensa+ion provisions of�he Lobor Cade,�you must(orlh• ACCREs3990 ?deStCYl••Pl ��170� N.B. 92660 l� �-3' � � �
wi�h comply wirh such provisions or this permil shall be" �� z
deemed re,voked. . . , TE�� S7aTi5TICAL CLASSiFKAiiOv APT. CONDp.
CONTRACfOR NO. c�..� .
IICENSED CONTRACTORS DECIA4ATION �� - � � ���. � � C1.n55�N0. ��/ �wEu.UN:75
I hereby afFirm that I am lice.nsed undr.r pro�isions oF Chopter 9 nDDeE55 k0. ,
(cammencing with Sr.ction 7000)of Division�ol the Dusiness ond . ....._ ... . ._ ���_ SEWER MAv
Professions Code,and my license is in(uil(orco and eifec�. �iTY ctASS B1 eK. � �eG. VALIDATION
� � 5 2 NO.OF NO.OF CNECK
license Number ��Z�1 Lic.Class S SiOR'ES FAI'.'.IL�ES 1 OIvE � �
�j � VALUATION . �� (7;y.�(�
COnlro[IO � � Da1r `� P DESCRIPTIOYOF WORX " '' """' ' " ' ' NEW s ZOZ JOO.00 � �
f
ACD � r.'• • • •2�
�I am ezem�l�nder Sec. � � � -" -�' ` .
ALTER ❑ n
8.8P.0 f Ihi rea�on � SFD - PLAN 4 REPAIR � s ' � � � �.�'G u 7�. .
� USE OF s
FXiSTihG CIDG. CEMOL ❑ . .. �.��!I n,�
Signa�ure � ArMKAni TE� FINAL �7 � �9.G 5��b
.Y�'R-8 L ER�ECLARATION eRiNi� �14h(f762-3�00 ..DATE ,5%Z�'S / -
�I hereby alfirm thal I om e pt Irom Ihe Coniroclor's License . . , , , •
law for ihc following reoson(Secticn 7031.5,Business and nDDRES !� W1 Ave. C.�1. 92fi2fi FINAL'� • �
'Pra(essions Code):'" ' " � '"� '" ' ' '� veESeht 8Y c�. � � � �
^7 �UIIDING '
\ I, as owner oF the properly, or my employer.s wiih AC�RE55 �� ��� �%�+��ii�
. � wc�es es!F.cir:c!^campensa:ion,will do the w�ork and ,
�� thc shutlure is nof intendcd or oifered for snie(Seclion ����T� �'- � ;'� •-0 •�• � 1
� 7044,Business and Prcfess�ons Code). � � MOViNG �- ��' - fEL� ' " ' � '
� I,as owner o!ihe property,am exclusively conhat�ing mvieaCiCR n0� , .•� � s S7 r 2.r O
with licenzed conr�aUors to'constivcr ihe P�ojr.cr(Seo- .. . . .. . . ... . ...._- . . . • . . .. . � y . .'.. - .
fion 7044,B�siness and Proiessions Code). /�DRE55 . � r;J���,-
� � CONSTRUCTION LENDING AGENCY SEI�HACK YARD HWY ��U��pRO�ICNEFR�,� WIDTH ' �
I hereby o1(irm that therr,is a consrruUion lending agency for f RONI , ' �'��5�a� �
Ihe performvnce o(ihe work for which Ihis permit�s issued� rL� -- � ���- - � ����� � � �� � -� • �� � —
(Sea 3097,Civ.C.). SiCe , '
. P.L. . .. . . � . ' .
Lr.nde�'s Nome �� , � � � . . .
���(yJ�/�� 7 LL� !� L�!:A Ref.M
... . . _ .. . ' P.C.FPP.E �+—�•/� PPrmil FP9 " � �
lender's/lddrr.ss y� f' � � �
I cerlify that I have r his applica�ion and srale Ihal the . p�4itiJ�' _../��✓I/ . lasuance Fee ��� � I�MA P/C* �� - - , , ' ,
abo e information i conect. gree fo tomply wilh all Co�nty Invesr�go+�on Fee p �f (� -� � .
o din, ces and S� ir wrre un,A fo building construUion, .. To�al Fee OSoG/O - LDUA Perm M � �
d he by othor e sem i�� tthis Cou ry�o emer , • ' , . � . • �
n Ih b ve-m �oned r r'for spectio purp cs. pf •
. .
. � i _ _ �tC�,�t'T�S' . ... _ _. _
SEE NFVFRSE FOR EXPLANATONY LANGUAGE , . .
�Si,n v f App�[anl or Aqenl � ote . . . . ' . . . . .. . ' � ' � .. � �I
k � >> o o' ° ° � o' o ° m° c o n� „� -G1 Gl- _„ _..- .t ..... _ . 2 �
� rv Ti �a � T T - 3 v ; o : � � ; n. o o' � � d c e
�� � � � y
f o i _m I �o ,�c' r. a �o D � o ^ S ia�=' � � � : I
� � � �Z n n,� � o �� 'O co �. �. - '� � v n
�� o �3 _ ° o c � w I o � �N n° c � � � a ,
n h � � � o _ ° '^ o N ca o� o � � ° -^ � c
^ ' p' e C n
:li �' ci o a - ; - � � � ? o o' v
�, ' � `� _ n c o 0
( '� -�i. � v° ' N °
�
� `'.�y ' ;� , � t;n � � ' � �
f'� � Q �► :n Cv , (v �� v � '
t;1 c `' �. , 1 V C� f� ° ' ' z
� J� �` n^ ".n M � � A. S z �
'' d I e „ ° o
` •+ e D
� 1 \ -� � � `- ° v
� - c
�
�� ' 1 .. Z a o ; �
? �>, � � � m a �
1 � - o .
:; . � I o °
' m ao
e v e a
` ' . � o a
. e a a m
a
�
. � ' , . Z
' � N
. � S
_ • . A
�
O
. • A
. , � N
� 0
y
T
N
. , . ` i
'� O �
� . ' O � �c `r `O,n ^`� c: �c tiC-� � �ci o �,' ���•� ���,�; � r —
- . . ' � . n o � `�'N� � L:� L'� � ^ �.t�� .w�' �s. x �� n � _ �] S
. . � � ^ �£ fi � i�� �•� N �� `v': ^`+`. '-` � r,
� N „ � �,.T_? '`'`; `^ � n _''r ��w `'�„ -�` M : q'_
? } � ' � � =c ' \^ �� c c � N �..,i. .� �'c c �O
� f�1 � �M � � f. e.'I V\� �C � \y � � �
�.. � N,�'�J �e; 7 � �` •; �''' � �� �j p ^ •�• : � �' �t' n`. C f C r
. �, `" C a £ ti- .�,a° � ` +.� � f � � �w � .r ='7
3 � - : �� ��,' .�� � �y�o o � � ��. `m Co '" Y c ' o.. �
, _ � w �nM `� ` �,� - �o ,�= � � .�� ... �� _ "
- ! N j �= � = ,,,�7 �,` ` � ~ M J n ^ ^ ;, �.�. „ X t n T� G
• ' � �� 1 C 4— � y w? r.\ � ` .Qi 7 � � ,� .`t ��~., �n .: . C
. In n � .�. �+. O f) C� � _
� n • ^ .:� ,`�, � C,�i �L F �. �.o m � �`� w w�z b b M � �o
. '+ ' <^ ``� "" ° o ^. � =�' � -�n c; � ^�.� �� •`. � = ' � —3 v
� � n � S � C^� C� :� o o 'e ., - c'c c' p ...
� ' `c � � - : _ � cv e`a��`� � -� n n f m.^'
N � . . � � O � t� C� � •: e -. � n'_ � q � ^ � � � � �
' 2 ' " ^'�� C�O :� ~ C^a �`� �' 7-<' a•^ 'i�:`v' •� ��c 3
p ,.�, � ^ ., p : a� � `�w �n_ sM � � n .. �„ + bf�
-' �': �� 3 r� � � �~ - �f o �.��� �'° � ta" ' ` o -'>
. . . , . H 'C` � � � x � ...�.:`L:, c n =3 �n �'a � � _ q `e � o' ...
. O �: y p '1� _ �� N ^ L C�� .. O C�••� �� w C,�, : e., ^ ,�4 � 3 �
"'1 � N ti,b�,� ,`� :; � �LV� � ^ � ° 3 °.^�.�� y �'��: �.� T :
' - vo , e ,z, = nv R ; 0.ti� r'„'" � ��� H d a �T. M n � �, 2 �,� O
n � '^ na °.�c \ ..�. ' ��h.Nf � �'� �w . ''0`« � �. npL
�� � : � c � �' � � � ;.�n � N ^: w�'\�.�� .~. :`! =
o ? '`' r - � - � c; - •�F o �~M �' :•c � e o0
. ' _ `� �.� �o ;,�=� .`=. oo F ` `"• •�:�1^ e .-�,.'a"
; �'• �. o
' • „ . �`e M-^ . � . � .-� �� °.' aT `r',a�M . � .. ., _`���