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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 � � � � 1���. -� 5� re f I� A .' . pa�e ... _. 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