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HomeMy WebLinkAbout1663A 1664A _ . . --- - . .._ .. .__..... ... ......_._ . __. _ _.. .. . ... ..._ .. . ..-- - - . . _ . _. �� WORKERS'CO!AF'ENSATIDN DECLARATION '�' ' '�'` '' �'�' � � ' I hcreby affirm thnf I hove a cerlifitale o(mnsent to self ;�,���,o�oc��i�r�o��orwo�ke�:•Compensafion��=�.o�«, � � �-��--�APPLICATIDN��FOR BUILDING PERMIT �, or a ceri�ried copy ihereor(sec:3800,tab.C.) �OUNTY OF LOS ANGELES BUILDING AND SAFETY roi��yN��',�860-7556ompaF.rldu5 I�1lecdnitv Co. � � 1 �• Ce.t'rfied copy is hereby iur ished. ' FOR APPLICANT 70 FILL IN ADD7ES5 02 ��y J• �¢i • _ � Certiiied mpy is(iled with fh county iny pec- BURDiNG . n �aoA rtmenl. �DORF55 Z4432 St. Ives Ct. ��• Date� llppliCOM -- CITY ZIP lp('1�LITY ' C RTIFIC�TE OF EXEMPTION FROM R FR$'� "��' " � � � " " ���-" � � NO.OF OlDGS. � NEAREST .. . ... .. . . _.. . . . . . _ � '� ' OM.PENSATION INSURANC � . Si2E CF lOi NOW ON lOi CROSS 5T. (This sr.clion need not he complMed i(1ho pr.rmil is for one n55E5S0R _. � "" __ . . . . .... .. . .. . ... . . hvndred dollors(51�0)or�C55.) TRACT ���4256b BLOCK LQT N . 25 �aAP DOOK PAGE PARCEL . own ��. . - . No. usE zone rM,Ao� I(-3�{ I terli(y Ihot in fhe prrlormonce of the work fer which Ihis . � — R�� �" I permit is issved,I sholl nol employ any perso�in any monner . AOCVE55 3187 A Airw;� Avenue � ..... . - sPeani � a. so os�o becomr subjeci to the Workers'Compensarion lows. a2`7z�O COhDITIONS ,v _. . nTr . .Costa Dfesa z�P 92626 m Datc Applicont pRCM1TECT OR TE�. _DIS1RiCT. GROUP TYfE. FIRE 'rROCE55F�BV � I �ICE TO APPLICANT: li;afle.r moking�his Ceriiiimle o( ENG!nEFR s N — f0�� ZONE V npiion, you should become sublett to'�he Wo.ke�i � ' /� Lompensa�ion provisions of the ta6or Code,yoo must iorih- �coc[:39�0 `dc:;tCrl .PZ ii1�0� 1V.33. 92660 . lv ✓`"� �/ � � y wilh comply wiih such provisions or this permi� SFIaII bP. ��� TEL. STATISTICALCLASSiFI�ATION � APT. COY�O. deemed�evo�ed. • � � ' C04TRACTOR NO. /�� . ? LICENSED CONTRACTORS DFClARA710N .- ' -�� � � � - liC:� ""•' � - Ctn55 NO.�_l�D'hTLL UNIT$ � 1 hr.reby nlGrm iho�I am Ilcensed under provisions of Chopler 9 ACDRESS NO. SEKiR l;Av (commencin9 wieh Sec��on 70W)of Division J oF ihe Businnssand .__ , _._ ._. . . .__. �i�. ' Profess�ons Cafe,ond my Itcensr.is in full torce end rffect. CiTV C�n55 $1 BK �� � �' � ��YALIDATION S � _2 NO.OF NO.OF CHECK ' ' License Number lic.Clas � 5 STORiES � iA�•.iliES 1 O"�`- � . ' � •� , ■ � hFw.. • ..VAlUAT10N _ . . . ., � " DESCRivTiO!�l OF V.'ORK ' - � �� 1]H,900.00 � Conrracr r a/` • � Do�e 0 S r �� i .... SFD — PLAN 2 ADD � . . .�1.6 6.3 i1 �.. �I om e.empl under Se.c. - " � � , . lil7ER — t �.• • . •C� 6.8P.0 for is reaiC , REPAIR��❑ � - �� ' � � o�e�� E%S1�iNG BLDG. DE/fAl _ �.•:�7,8 6 Si nalure — ' APpuGaNf fEL. FINAI � • •(l��."'G' � PR'NT� 714�:0.662-3700 '� �L � OWNFR- UILDER DECIARATION . . _ . � DATE�-•S�Z{-�fi'7� � � -�—� 1 hereby affirm�hat I a eaemp�from the CoNractor i Limnse . ,. . ... • �A��—L� low for�he follow�ng reoson(Section 7091.5,b�s�ness and ADoaE FINAI � - PlofeSsions Code�: ' ' - "��� � N4E kN 0Y �L2.-i�� .—, cunoi�c ` I, os owner oi thc property, or my employees witb ADDR[55 . ..�� ', /f wages as their snin mmpPnsn�ion,will do fhs w�rk cr.d � .;. � •.�.. � . .. � the strvcture is not imended ar oilered for sale(Section lOfAIR� ��-' � -' � 7044,Business and Professio�s Code). "'' ��'� Y.AViXG � TFt.- � ' -��- � ' '� ` " e0� �'�4��' ' CONTRhC70R �O. � � I,as awnrr o11he property,cm exdusively contracting , ..., a �. . ,. � • e . • r � . wiih licensed coNrauors to conslrucl�he p�oject(Sr.n . . _ . ._ . . _. ... _ .. . _ . .. .... .. .. . . .._.-� : fion 704a,B�siness nnd Proicssions Code). ADDRE55 � � r , � CONSTRUCTION IENDING�GENCY ' � � �� SEi BnCK vnRo NWY '�V�apHOP.iinEF�U'�� wiorti � - • � � ��a O G . I hereby affirm Ihot�herc is a cons�ruction lending o�enCy�or �kUNi ' � . ' � ,'i',lA n�%`u �Iha performonte of Ihe work for whith this permit is issued - �7.l � ---- � � � ' - � ���� " "' -�� ' " •'�' � (Snc.3097,Civ.C.). SIDE � G�,�j?`�,(� � .. . . . _.. r.t. . •�P . ._ ...'(o ` . . . .---... . . . .� Lender's Nomn IDYA Re(.p � � .� � . . . . .. . . P.C.Fee S Pnrmil Fcc ''� ' . Lender's Address �` , �� 1 certify�hot I ha rr.od ihis oppli�oiion ond siate ihol the _.. ..p�{ 7�(/j�. is+m�ce Fer.-�� �-��.V�'- IDMA P/C M �� above informa�i n is I a7ree lo comply with all Co�n1y �nvest��o��on Fne ord�n ces an .ate la 'n 10 bvilding constrodion, . . . . .._. �- ToMI Fre� �/�� LD!dA Perm:M � �� - - - - � hc by out oriz ep sema�n. of this County�o enier � � u 1h a v lfone praprrry ior inspetli purp es. 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