HomeMy WebLinkAbout0926A 0927A (5) __...... -- -.__... _.... . .. .....__... ..._.. ...- - --..__.._.... .. .
. WORKERS'COMPENSATION DECLARATION �-- ' � ���-'-� �� � � � � � � � '-�
,
.. 2�
� I he�eb af{irm tha�I have a rertificate of consent�o self
. . _ . _.. . . . .
insure,orocertificaieolWorkeriCompensafion��,�,a��e, �����- APPLICATION� FOR�BUILDING PERMIT��-
or o cerfiiied copy thereof(Sec.3800,Lab.C.) . . , .. ... .-. . -. . -. . .� . . - - . �� � -. .. . - ,-
Poi;�,,N�.IWETX7993 com��Y Hartford Grouo COUNTY OF LOS ANGELES BUILDING AND SAFETY
� Ce.ti(ied copy is here6y furnrshed. ., FOR APPLICANT TO FILL IN qooRcss -2 � � it.t.�•c(Y'�v f .
.r1 Ceitified capy is filed with the county building i spec- "�� g�iIDING ; �� ,
�W tion�departme r. nooRess 24441 East Thunder Tr '
� . _. . ...' - . -'.. ..._ .. . ._.. .
Dote � ApplimM���1'2��� CITV ' ZIP LOCALITY ' � �
.. . ..' ___ .
� CERTIFICATE F ExEMPTION FROM WORKERS' ' ' ' - -� NO.Of BLDGS. --- � � NEARE51 .
SiZE OF LOT : NOW ON LOT CRO55 ST. .
COMPENSATION MSl1RANCE ' -
(This sed�on need no�be completed if the permi�is for ane �-- iRACi \'BLOCK LOT NO.� AUE550R . .
hundred dollors�S100)or less.) , N✓+P BOOK ' PAGE PARCEI
TFL U ZONE �P �I ..
, _. . .. . .... _ . . .. _
1 cerfify that in the performance of ihe work for which this OwNER • • n10. _ P� �,p. }
permit is issued,I sholl not employ any person in any manner , , � - -�- SVECIAL- - � � � � �n.
so;as to become su6ject ta Ihe Workeri Compensation Laws. AD�RE55� � � � ��Q CONDITIONS � �
. .��... . .. �... .. CITY _ .. ZIP _ ....� .. . .. . . . .. . ... .. .... ..
Date� APPlicanl ' ' � ' .. �
ICE 70 APPLICANT: If, after making�ihis Cerlilicore of nRCHITE f R TE�. 'o I
FNGINEER NO. DISTRICT GROUP NPE., FIRE PROCESSE�BY
� �nption, you should become subjecl to 7he Wo�keri �� - /D /f CONST,I ZONE W
Compensation provisions of�he Lo6or Code,you must forth• qpoQE55 "�-3 � a.
with comply wi�h such p�ovis�ons o� thh permit shall ba • -- � - - � - - �
deemed revoked. � . , . TE�� SiniiSiiCni M55iFIC1�TION � APT. CONDp, Z
CONTRACTOR NO. __ ��� .�.!_
UCENSEU CONTRACTORS DECIARATION -. - -- - ---���, ----- - -- � C1A35 NO. OWEIL.UNIiS
I hereby olfirm ihot I am I�censed under provisions of Chapter9 qDORE55 3151 A' No. .
(commencing with$ection 7000)of Division J of the Business and _ _ _ ___ __���,_ . ._ SEWER M'4� • "
Professions Code,and my lirense is in(ull iorce ond�effect. Cliv �1A55 �"BK.� � ' � ' - �- VALIDATION- -
`I SQ.FT. NO.OF NO.OF CF7EIX ' �
� cense Number rlpg(al�� �u�.aa��- �g��' �� s�ze - 5 STORIE$ �2 FAMILIES �� ONE � � - -- ; �p• , .
{'� �a��Ar�oN :-a 9 z.b a
' ' '" DESCRIP110N OF WORK"-'"pLA ' � N� �yj� 7�' /yl 1 ' '
Contracror Rramalda�CalifDare App � f ,y a�v �,
��• °GI
�I am exempt under Sec. - � � -- ' - - � - �
ALiER
B.BP.C.for rhis reason � N2W Construction REPAiR.❑ f �� -' -- - � - _ � °.�P�.� � _'
. - pa� USE OF DEMOL ❑ • �.���.� U u
/ E%ISTING BIDG. . , ` ^� - -_
'- Si�nnlure / '�/(�� . . ' APPLI('p,NT iEL FINAL p �
O NE -Bl11LDER OECLARATION PRiN7 NO. H�JO-� DATE�d e'LO�g�J-- - ; �`"��.-��_
I hereby affirm thar I om ezempt from Ihe Contraclar's license ._. , . �
Law foi ihe following reoson(Section 7031.5,0usiness and ADDRESS � FINAL�� � � .
'Professions Code): � ' -'- " � - PRESENi BY '«� - - � �.
� BU�LDING
I, os owner of fhe prope�iy, or my empioyees wiih aDDRE55
. _ . _.. � ��. '. . : .
- woges os their sole compensotion,�d✓ill do�he work and � ='C�'.'C,7 I�,
the slrucfure is not infended or offered far sole(Section ����TY � �
� 7044,6osiness ond Professlons Code). �� MOVING --- -� �- �- -- -- -- 7Elr - - � -- , � - �� - • �, +��• a�e � .
I,as owner af the properly,om ezdusively coMrading CONiRACTOR NO. � '� ;
�. i �
- with licensed conlractors to constrvct the project(Sec- - -� qDDRE55 '� � �`��-� � "'� '- I ^��,.C�
tion 7044,Business and Pro�essions Code). ` ' �
' CONSTRURION LENDING AGENCY""" �-� SEQaaCK � �YakD- HWY "T�TO'pgoP LCNEFR WiDiH' �- "--�- �' � � - . ' � ��j� C J T
� I hereby aifirm�hot there is a tonstrutflon lending agency for FRONT �� r '�
-ihe perlormanca of Ihe work for which this permil is issued -- P.L- - - - -- - - � � � � � - �c��2���'�7
(Sec.3097,Civ.C.). 9oE � � �
^ . _, ... . ... . . __ �� _ _ - . . ..
0 Toronto Domininn Rank P�� ��
� lender's Name �j� � ; • �
$ 144 Sansome $t.� Su i te 700 P.c.F«s �cg/•IO � Permir Fee G�C/ �°"'°'R`i.x
- Lender's Address " � , ' �
�
W an �;�"�1�45 �,W_ �„�o�«Fee jo•�b '
� I certify that I have read t app i o� d a st t i ihe . . .- -- - -.-` iDhtA PiC N �. -... . _
¢ obove in(ormation is mrrect.1 agrea to mmply with all Coun�y Inves�igation Fee / � �
� . ordinonces and Siate laws relating�o building tonsfrvtlion, - To�ol Fea -f0'S-J,�d� IDMn Perm.p --- � � � �
._- �- - -�--- .._ . ._ .
u
and heieby auihorize represemotives of this Coumy to enter t�, `,�i �� � rc�� - �
� Upon Ihe o ov -meN ned ro e y for inspection purposes. _ . .. ... .__ , _ _ __ __ '__. .... . `....-- ._..' .' _ _ '_
- .... .. .__. _.____. _
' ' "_ ' .... �S . ,
a ' SEE REVERSE POR EXPLANATONY UNGUAGE � � �
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