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1673A 1674A
;. _ _._. .._ .... . ....__..._ ...... . :. ._.... . . ... .... . ..... . . . . . _. , l'JORKERS'C0.41PENSATION DEGIARAiION . �� � .�' ' �' � : :�• '� �� 1 here6y alfirm.thot,l hove o«�,;,;�o,e a<<o�se�„a,e�f �-� � �-�-�--qpp���CATI�ON� FOR.�BUILDING PERMIT ��� � ins�re,or a cerrif�cair.o!Worke�s'Compensarion Insurancr., or n cerriRr.d copy rhereof(Sec.7800,lob.C.) ' � � COUNTY Of LOS ANGELES BUILDING AND SAFETY Poi��YN�C 860-7556om�6�dus Indemnitv Co. � � CernFied copy�s hr.reby furn�shr,d. FOR APPLICANT TO FILL IN OU��DING n�/[! /� . / � ADDRES$ `�`1'T�'�7 �(f�Q/!l I""A CerY(icd copy is(iled wi tF. coun�y .s BURD'NG LJ �� �+e rtmenf. ADDRE55 24438 St. Ives CC. ,�. Date � � ApplimM OiY . .. . ZiP lpCAllTv '� C RTIFI lE OF EXEMPTION FROM RKERS' ' ' ' ' ' " "' NO.OF P,IDGS. ' '-' -- ' NEAREST.. . ..._. . _.�_. . . . . . . _. OMPENSATION INSURANC ' SIZE OF LOT I.OW ON LOi CROSS ST. � ..,... (This seclion nr.e.d not 6n.tampleled if the permil is(or one ASSESSC4 ' " - � � '� - raacT - 42566 eiocK �� i 24 ` .hundred dollars(SI00)or less.) �� . MAF EOOK '� PAGE PARCEL I ceni(y ihat in ihe performance of�the work for which this Otv , • - - •" '" "' '-'"'NO. — ����`� i,�pP ��3. � pe�m�t is issued,I shall not employany pr,rson in ony manncr nooRess� 3187 A Airway Avenue. .-._..... . .. �Q�y,,� �EOAL� � � � O. � . so os to become subjr.d�o thr.Vlorkr.rs'Compensation Laws. COhoIiIDNS � . . . . . . �' .. . � �. �. .t V . .- Dale � ApPliconl . '..:• . . . CITY Costa :fes� .._. . .zir 92626 . . . ._ .. . .... . . � ;� �TICE TO APPLICANT: If, olie.r moking Ihis'Certi(ico�e of �RCHiTECT OR TEI. _ Di51R�Ci. GROUP IYFf F+RE �'ROCESSED BY 0 I mplion, you sho�ld become s�bject 10�Ihe Worke�s' ENGiNFCR ti0. �V CONST. ZONE ..ompensotion provisions of ihr.taber Code,'you musl fo��h• qDDkES��9O :•?esterly Pl '�170 N.B. 92660 � JC"� . ,f�.3 .� p�, wiih comply wiih such previsions or this permit sholl be � �n deemed revoknd. . . , � , . �E�• STAlISTiCAL Cu155iFKATION nPT. CONDO. � . CONTRACTOR Same As Owner N�� � � �p�,ti���,UNITS� � LICENSED CONiRACTORS CECLARATION � -�-� -� �� --�-���� � -�- ����, �- � � QA55 NO. I hemby affirm Ihol I om licensed under provisions of Chopler 9 ADCRESS NO. (commrncin�with Section 7000)of Division 3 of ihe Business and ���.. . ��'�2�P � Professions Code,and my license is in iull forca and eitr,cL Ciiv � Ctn55 �1 � fiK. PG. " ' VALI�ATION - �T.,1 3, NO.OF NO.OF CHCCK License Number Lic.Cla STOR'ES Z � FA�rILIES��1 ONE - . • � _.VAlUAT10N � ._� ��,3 ii ConlrOclo � Dn�r DFSCRIPfIOY CF W07K -._.. .. . . NFW ' , . � � : ADD � s 169 OO.00 r:a • a •?� �I am a�empt under Snc. '-� -'. ._.. .._....---.. ._..... .. . .. .. ,; SPD — PLAN L ALTER ❑ 1 �L•G 1.7� � B.BP.C.fOr. i5 reason . REPAIR � f' "' "' - ' ' ' �I � .. FXIST�ING P,IDG. CEMOL ❑ ' • �:I:I �,�(�)— S�g�O�urc APPLICANT �E� FINAL C`.�,rj.r�i�F:U 'ER- �LDER DECLARATION (P21NT� �1�+ h(.�GZ-3�0O _.DATE �-� ',�i�r 7�� �- - - ��� �-�-- �� � 1 here6y nFflrm�hnt I am �empl(rom Ihe Controctor's License 9,L626 Low for Ihe fallowing reason(Section 7031.5, Business ond ADDRES�IH7 A A1rW1 l�VL�. C..1'�.� FINAL "' ��"' Proiessions Codc): . .. . .. . ......... ' vkf th � 0Y `�ell�i " ... � EiUiLDING I, as ownrr of Ihe propnrly, or my employees wilh ACDPESS \� � woges as their sale compensaiion,will do Ihe wo�k and����� _���� � ihe strucWre is nol in�ended or offerrd fo�sale(SeUion LOChLI1V , • �- :_� G�,li� . � 704a,6usiness ond Pro(essions Codr.). � � - " � ROvwG � �� � - TEi.- � '- �� � � � . � � - � � I,as ownr.r of thr.propeny,am esclusively tontrnt�ing CO�:TRACTCR NO. A , � „ , � • • • + � ..i .. . ., �� wilh licensed controctors to con5lroU the project�Sea � qDDRE55. . . . .. . . . ... . _.... . . .. .. . .. � +%��{�� �ion 7044.Business and Professions Code). , , •^ ItEQUIRE� .fUTA�SEIBACKikU'.1_. XI ' CONSTRUCTION LENDING AGENCY "" �- -'� SEi eaCK Y�RD MYY' p20P.IINE wiDTH �� � � � �� �� � �� �� � ' 1 hrtreb offirm thol�herr.is a consiruc�ion lend�n o rnc for ' �- ' � � � `��"'�'��'' Y g 9- Y ikUNl thn performance of�ha work(or which rhis permit is issued .... .,r.�:... .. ... . . . .. . . ' . -. . - � „ ��.�,�_�;� .. �Sec.3097,Civ.C.). SIDE - � �� ' . . . . P.L. . ._ . ' . ' . . lender's Nomn � _. . , q �7 L�!M ReL M - �� . .. � tendci s Address . . . P.C.Fee S ���•7/ vc�m�r Fcr. / ���- , - � � 1 certify thal i havo read Ihis applitalion and stalc Ihal 1hc - . � ..�r�'U I»�v�ce Fea /�•�7 `� LD.MA P/C M . .. obove informaiion is correct.I ogrev lo mmply wiih oll Co�nty imesegaeon Fn� . � � rdin ces and 5� �elaling to bu�lding[on5truclion, .... ... . � � ToMI Fea �S��G D' LD51.q Pe�m.N - n he 6y ouih r� of this Cou �y�o e ier � � � h.o ove- tioned r.ny or inspeUio pvrpc es. � ' ' � � .... ...-' - — ._.. . .. . . y,n� . ._.. . . . � . � SEE REYERSE FOR E%PLANATORY IANGUAGE �� - � ' �9na�� e aF pp�w�t or�,e�� � � Da�e. � . .. .._..' " ' "' . .. . . .... _.... . . . _. _ . . . . n)i m„ n� '*+ �, �n '^ in o 0 o n"' „� - �G1 G�- '� x �� -- - o o� �'l �v � ?� ao ° � R o o ° r. n � o� � a o' o m o 0 �r.', � mo c 3 c �c p � n „ r. n _ �� _� C. r N -� �c � � , o o � C � � i r, Z � iv � 1D o � � v '° � � �N � '� n n . /� .�„ a�� � o.� � o' �i v o +� f1� o � � � D . � � o 03 ' ' O ` '�^ � < � o'� � �° 3 ° " o . 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