HomeMy WebLinkAbout1667A 1668A (10) ._ .. . _. . . . . ... .. .....
. .. _.... ... . ......
_.... .
WORKERS'COh5REN5ATI0N DECLARATION �. '• �• .'�"-� � � _ ' • '
I hereby a11�rm tha�1 havc o ce��ificate oi tonsenl io self
. .. ....._ . . . _ . . . .
insurc,oracertif�cnicoFWorkeri Compensa��o���,��e�«, APPLICATION���FOR.��BUILDING PERMIT�
or a cr,�uF�r.d copy�hernof(Sec.3800,lali.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY •
Pol�cyN�'(: R60-755(b,.�padatd�G n 1 mn y
� Cer��tied copy�s hereby(�rnished. FOR APPLICANT TO FILL IN su'IDiNG z J �[ /}�
ADDRCSS / J • +'��4/ �iti •
� Cr.rtificd copy is filed wii i e ounfy i i in e AUiLDiNG ,
r� ndeppnmenl: ADDRESS 24447 St. Ives Ct. ,�.f3•
DatB� J Appli[Onl CIiY • ZIP IOGALITY
ERTIFI ATE OF EXEMPilO FROM RK RS' "�""
' NO.OF BLDGS. ' ' NFARCSi ... . . . . ._ . ,. . . ... . .._.. ,... ,.. .
COMPENSATION INSURAN � SIZE OF LOT NOw ON lOT CRO55 ST. �
(This sr.ction need not be comple�ed i(the permir is(or'onr. - -- 4LS66 � 1H n55E550R . , '
h�nd�ed dollars(SI00)or less.� . irtncr � niocK � �Oi7�b4 MAP BOOK OAGE PARCEL
o,,,M�alif Cor�munities, Inc ti�i62-3700 us��NE �P �I_��
1 reHify ihat in ihe perlormoncc of�hc work for which this S � .}
pv,rmil is issued,I shall not employ any prrson in ony manner ,.._. ADDRESS 318� A �1YW1 � - � S�'ECIAL � d �
so as lo be.came subjr.cl to 1he Workers Compensation Lows. COhDIT10N5 �
V
Dafe Applicanl . CITY. . CC7R a :fe�a ._. z�P 92626 - - .. . .. . ... - . .m
'�TICE TO AP%.ICANT:�If, offer ma4ing thi5 Certificate of ARCHITECT O4 . TE�. ,.DISiRICT. GROUP IYpE fIRE PkOCt55ED 9Y . ,� I
� ENG'NFER — Cp,yST ZONE V
,�ption, yo� should 6ecome s�bjr.N to the Workers' ' � �� •
�ompensation pro��s�ons o(rhe lobor Codr.,you m�sr fonh- F�p;[u 3990 F?e,teTl' Pl ;:�1]0 N.B. 92660. IO �� � . � a
wi�h comply w�th such provlsions or �his permii shall be �
TEL. STIITISTICAL QASSIFICATION APT. �ONDO. '�
deemed revoked.� � � � •,� CONTRACTOR NO. ' ,y�
IICENSED CONTRACTORS DECIARATION � • � �� � � � �� � �i�. Q�SS NO. �7 DRtIL.UNITS_L_
1 hereby offirm�hot I om licensed under provisions of Cheptcr 9 AD�RC55 h�.393701
([ommencing with Section 7000)of Division 3 of�he Business and . _ . ._ _.. . . , . ��� SEWFR MAP �
Professions Codn,and my license is in full lorcr.ond e(fett. CI C1A55 B 1 �BK:- ���: � ' " VALIDATION
� . 5 . ` NO.OF NO.OF, CHECK . •
L�cense Number "1997f11 � Lic.Closs � si sTo2ies � Farn�ues 1 ONE •
VALUATION.
eo�r.a���.���.� . Daie� OESCR�DTION OF Yro�K-- �� � :;1 G�.7 A -.
SPD — Plan 2 ADD � s
❑I am e*emp�under Sec. � � ,, ,. • • •2�
�LTCR
B.BP.C. or�hi reason ....s ... . . . . � c L
� � REPAIR � I ^�l v 7,��l:
pa� : USEOF CF:'OL � �
' EXISTING PIDG. ❑ ' �
� Signatore� . nvPUCANT fEt FINAL ' -° e:i�C!,�''�;�:
OWNER-B �ER DECLARATION IFRINT� �l�f Nc662-3700 DATE- `` ... .. . . ,= r
-I hereby aifirm that I am empl from ihe Conrroctor's license S�"!I`u7 1 _ . �'J—^� � .
Law for the following reoson�SeUion 7031.5,Business and ADoaE55 A A' A C.�`i. ?�Zfi FINAL ' �
- ProfesS�onsCodr.):.. .. . _ ' .... .. � FkE�n� BY � � �ti�, �
^-� BUILDING ,
\ I, as owner of�he properly, or my rmployecs wilh aDDQESS
1 wages as�hcir sol^campr.nsnlion,will do the work and . .., G���
ihe shucfure is not iniended or offered for sale(Seciion IOCnLitt ' �� � ,
- � 704a,Busin�ss ond Profeuions Code). �� � � hlOV!NG - - � ' TEt. � �� � �
� I,OS oWnef O�IhC properly,am eaclusively contracling CONTRACTCQ NO. "' ',-� ' .��,_ � �:�• • • • e � . '
wi�h licensed con�rac�ors to construcr the projecr�Sec• � �� qooaE55 � '
�ion 70Ad,Business and Pro(essions Code). , , . ,� • ��-t`1 d�
� � CONSiRUCiIONIENDINGAGENCY' �� ' ` WE�gq�K YARD HWY �V�AFROP IINEfkUM �� '�yIDTH ��
�-� • ° /j.;C��QC
I herrby n(lirm tho��here is a tonstruclion Ir,nding ogency for f NUNI ;'t�\,'���; ;4.•`.�-� �
fhc periormancc of Iha work far which Ihis permit is issued G L - �� � � � � - � ' . � ����U J_S V :�
(Sr.c.3Q97.Civ.C.). SioE . . '
. .. . . . . . P.L. .. _ . . . -. .. .
Lr.nder i Name .
� l0:'A Ref.M '
� � � � P.C.fee S . Perrii�Fee �
Lender i Address d,� q , � �
. I cerlify Ihat I ho .ad this appliwtion and stofe thal Ihr. O�s��-��}- /S�Cl� � Issunn<e Fee ���'� IDMA P/C M ' � -
above informati n is ro t.I aqrer.lo comply with oll Co�nty Invnsn�o��on Fcr. , �
ordi nces an �cq ro building constroc�ion, .._ � - Toiol rce '�� � iD:!n Perm.N
nd h rcby ai orizc repr sen iive�of ihis County lo enfer ,
p n I e bov -menlionc p�oA «Y ���spPctlo puip es. . . � '
� - '�1f 3-.� ;. . .. . .
, � � SEE REVERSE FOR EXPLANATORY LANGUAGE
.. Siqnn�,e ol pplicant or A�em . . .poie . . ... .. .. . _ . . . . . ... . . . .. 7�
� o 0
�
T � C .
� � � m
��o � G Q '? C� y o .
o c+ v v
�-N O C- 7 'O c� ; . O m
� C1'O 7 G �
� O �p
'C 0 U n f�'S� �' O � � �O
� p n o �c o 3 � o� • �
3 �
. " � ? z N. o? � � �' . Z�
� �'% G �� y Q O� <� . � O
• r j O Q G, O 7 '�O .7.y[p 'i O 0 y,e
p n � O 7C � O 'i� ? 'O r
-n C��' O ? � Q p ?' c i'� •
?; �O S 1 7 1 � . � .0 �0 f� � �
� ` '� N ° ~ ` \• o � 9
"'\�^� °i � a�' � o. a '" y� � a p. Z
�l c`r � , C�? ro � o Q � `� � � a
� y .
N �j? o'�� � \ � Z, � 2
\ c
0
i-- o-� A � . . .
� ..--- o
` ♦ ` 'o y
`'� l� /'..� % �� �a 9
O
.- C, U . C'+. f' O
�; � �J cS`� o� ,`�j � � c� o,
....., . C. �'� � ' � o o.
� C^'�' -J � Q , d e
� '� . .
n Q
�� J � c N . .
^ � � , � ( , � .
� ' .
�
.:
O
� . A
, ' �
. �
p
�
24�
. N
t
r. .
, , ,
. ,
. � � �. �
, . c � N � s
� �.-t.c. 7 �
' ' �' 't L t' � r'.'S �' tG
� ' L �p� � 4' � v. � f•` i+,
�7 L.
`!7 �.. _.µ r � e/
' � f �'<70 �:� .-.� y 4 C p %
�.��Km ° ����.,�'c�_F�'? �� - I'
� rJ '�C :� .� r.J� N V. i+� w ,n i��� N 1 1 �� Ir
,,, lT C .". � i ., "'' � =
—= s. K c=��"�,� �- .-.,c. ,; `�c�,..�� �,-r^ ::,� o�G
� C � �"3r � � � ° �� c^'r. � �, _ ` z
a" � y
. ,., ', c� n�C K :�n � ,• a � n p �„� � . � � . e� �i
' f;: « : �4 ^ ? �N N ? c.. � .: 4 : q e' L.H.},—� � w i
a � O�^'::N' �%�-^,`,y _� ' � ^; a � � �?.' ^•� Nc.• Nr o3..`S_s
C C �
. • � �r �G f. ' �, �, i:^s ., n ,�.y C r. �,"--..� f. p^^ X i � '� Cl F"� =�Vy C� a o �
� 6 O . w'^' `-� � " „ �b c � F "_- f � 2 wc' '� � t � 4 r {s
7 , '� � f! � ..%,r �a K. 3 C,'i � p +� c '1 r �' � w ' j ry �'
� v'�-- s..M '^ � c y: �c.� � c - � � � f " ._�.��'c " o L >`� v<
� ^, y c � �.. .. � N 4-�C .O � � �" .. �7
y �.t' � � Q 0, -' �' �.� `c.�� C�O-7 0��'.:'. �ea r,r.�i' O�O r
' ' (� = L � ^• C .. G �' 'D t, y C+` v� .
.9 � '"~ -- , -- , c'" '_".. �� C-° ° o —�� ^_ t .�,-o e O 3 'Y.
' • . b '' w'r4 ^ C � v: .. ^L-� ^ _ �.". O O ..L » » .. � �� " N s- " C � S ..%
� C` ..� �>�=-�9 e: �r- r � C.^'�=..F � N .'� '� � �fl O
� �- � " �v�,m� t:? e;�~?, �,:..� c `c,� �F'�s.:" �I=�s '� - � e,in!
_ � ��' � O � � y ': y w�„ r G-i L •� �-. N r. G "= � !' 7
c.-�^.c • N H
_ _ • � n ...�p V'nnO'C :�� � `� ^ 3 � p (C — 7 C•r�c^ y�''r. p O
n t+ 7 O c� '�,�r. L'7 � �n ,,, 7 y 4 „ � .�t'.. � _ �: •V
'� . � . . n r ' � � 3 C,s.. ,y C_. .� � O-'.p N � �.t�. �„ � j.c.~�� I O
. . � � � �- v� y v f. N �w-. ' � n ...�'�'
- O . � � r. � f• t^,,t �, C p � !J�N
R „ �' ^ ri � �-c fi �- 4.� v+ .. ..t, n" ;, .�
C. � ^ � �^S- ?:'y.' � f6 V� � �.•Vt^
. N 1 L+r '1 r � '1 .L.... �" �.�N n �N '`.L' V�� ,�
. O '►" 3`^.,n <' i "..y =� � � �G �^. .C..� Q'y ' �
� � "Q �'�O (";O < y` —F ...� �ro O O 4 . ::y es
'r 4 �9 `�'t ..-' s` n : � V' ^.�� J a?...
c �
' n„ �O .:.`�:.' �? i Cv , y v�
'n'• �" ^�'o �;, R
o .''c�: � ':
� . .. N
� �