HomeMy WebLinkAbout1103A 1104A I
� WORKERS'COMPENSATION DECLARATION �+
I hereby affirm that I have a certificate of consent�o self APPLICATION FOR BUILDING PERMIT S
insure,or a certificate of Workers'Compensation Insurance,
or a rertiPied copy rhe�eof(Sec.3800,lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
61WBRIz4484 HARTFORD GROUP
P❑olicyNo. Company BWIDING
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRE55 U� �i���L't'a'��/-
� Certified copy is filed with ihe counry building insper BUuoiNG Y /�
ti n depariment. ADDRESS T LOCALITY
�ate �Applicant��,,,�....-.tA. ['-'�^'',`-�y'-`-� CIT`!D �I ZIP CROSSST.
ERTIF CATE OF EXEMPTION FROM WORKERS' ^1 NO.OF BLDGS. _ ASSESSDR
COMPENSATION INSURANCE ��, SIZE Of LOT NOW ON LOT MAP e00K PAGE PARCEL
(This section need not be compleled if Ihe peimit is for one 13 US�rQ�E MAP
hundred dollars($100)or less.) TRACT BLOCK LOT NO. J�1') NO.
TEl SPECIAL ?-
OWNER ' NO. SS —LOO1 dG�� CONDITIONS �
I certify fhat in ihe performance of ihe work for which this DISTRICT GROUP TYPE FiRE PROCESSED 6Y �
permit is issued,I shall not employ any person in any manner 3151 AIRWAY AV�. SUITE N � a:
so as to 6ecome subjecf to fhe Workers'Compensafion Laws. ADDRE55 CONST LO
��J h�-3 �
a,Y coszA r�sa, c�. Z�P 926z6 � �
Date Applicani STA715TICAL CI.ASSIFlCATION AP7. C NDO. f^
NOTICE TO APPLICANi: If, ofler mokin this Certifimte of ARCHITEC70R rE� �'5"�
� g ENGINEER � j(� No. 5 -1864 C�A55 NO. �✓ - OWELL UNITS� "�
�ption, you should become subject to ihe Workers' �„
ipensation provisions of ihe Labor Code,you mus�forth- qDDRe55 39gO WESTG'FLY PL. ��170 NEWPORT B 5ewek rnnP ��
wifh comply with such provisians or this permit shall be �
deemed revoked. coNrRACToa ERAi-111L�A CALIF. No.850-1001 BK. PG, VALIDATION
UCENSED CONTRACTORS DECLARATION S E.uC. - - -
I here6y affirm Ihof I pm licensed under pro�isions of Chopter 9 aooRess 3151 AIRWAY AVE. � ,vo.409610 VA�UAT��N `� � ' ('�"��
(commancing with Section 7000)of Division 3 of the eusiness and COSTEl i�'IF',SA CEf.. 92626 ���� B � n � H �•%�
Professions Code,and my license is in full force and effecL CITY .+ CLA55 � r Q �p , � ���
Sq.FT. NO.OF ND.OF CHECK -
LicenseNumber�nq�in Li[.Class R SIZE 1 $ STORIES 2, FAMILIES 1 ONE � D"C"�)G' '
Confractor RRAN�T.RA CAT.TF_ Dafa� DESCRIPTION OF WORK 23 BR NEVd � g ° `'`�=' ( �. ' �
❑I am exempf under Sec. �� SINCLE FAIIILY RL7SID�NCE A�� � O Z C�-'�F`,:'
ARER � FINAL
B.&P.C.for this reason NEW CONSTRUCTION REPniR � DATE ��� ( �
USE OF
Date: DEMOL FINAL
`� E%ISTING BLDG. NONE gY
Signatu�e�/...�n..-�- �• APPLICANT TEL. � �
OWNER-BUILDER DECLARATION PRINT) BRUCE L. ABBEY Np. —IOOI. _� U A
I hereby affirm thai I am exemptfrom the Cont�acror's cense qD�aeSs 3151 AIRWAY AVE. N. COSTA �S �C � '
Law for ihe following reason(Seclion 7031.5, Business and �'�g � � � ' �
Professions Code): �i �
^ BUILDING � �'h'*r ���
� � I, ❑s owner of 1he properiy, or my employees wifh ADDRESS
� wages as iheir sole wmpansation,will do fhe work and 3 ,, ;��(�.'-,`,�
the structure is not intended or offered for sole(Section LOCALiTv
r-,V 7044,8usiness ond Professions Code). MOVING TEL Q (,�i c—�j�
IV I I,as owner of the property,am excl�sively coniracting CONTRACTOR NO.
4� wifh licensed contractors to construcf Ihe project(Sea qDDRESS
tion 7044,Business and Protessions Code).
CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST
SET BACK �ARD HWY pROP.LINE WIDTH
I here6y affirm that there is a construction lending agency for FRONi ,
ihe performance of ihe work for which ihis permit is issued P.L �
($ec.3D97,Civ.C.). SIDE
Lender's Name ����}} c
TORONTO DOMINION BANK P��
� Lender's Address �� ��I.�COT�CAUI�y41 V4o P�C.Fee$ ���i�� Permir Fee l:J��+�Q
' ��7.�`Z)
I cerlify Ihat I have read ihis appiimtion and state ihat the Issuanre Pee
¢ above information is mrrect.I agree to comply with all County Investi tion Fee t�[ p
� ordinances and State laws relating to building tonsiruction, 9� Totol Fee v/- /' v C
and hereby authorize representatives of this Co�nry to eroer
� upon the above-mentioned property for inspection purposes. �q�A� t,�� ��A(,+.,�
^ � fTC'l•/ T'VJ
Z, SEE REVERSE FOR EXPLANATORY LANGUAGE
Signowre of Applicant or A9ent Do� 8s
� r°'!T�(�Z� l_ f!f �l U. T: �^T .� � J_� __._��� ( ^ T � �Y�� �d
��..__._�_ � I Q � � O �O � 4 � O_ (� n� � I ii: � -�- ' � � '� i
� O O , 3 .�.� _.._._ � - _ _„__'_ Q O
� �wo N � T � `� 3 3 � 3 �.Q n- i � � n � � o I Z � � ° � � f �•
� O � ��� rn � O � 1 � a �n O . '4` (G Q _.fl n' � � � 3 R i S - i � 1
� i � i�Z� r �< 3 � " ��� � � � �— vp' � � , `� a � n � � .E !�
'� .c 3 ! � p� c ' � � � � `n o$ °:�, ° � �, ' �
.,�„ L5' p _ Q �{ II s 1 m y �C -J j Q - I
� �N I � Q � t�a� � � I � ,' a ° � 3' Q I o ! � �js5
� °-' I ' I � i�, � � �� I '� � i ca � o i �
�� i i "�. � �. (c�"v
�. _ . � 1 `�.�._�.,( i;._._ 1 � ,� _ � � � �
" �. � \ I �.�___._.�, � Q �
; � � ��i \ilK�' � 7 ( � I � r�
� �
� �� ,�, ;�.i�:� ' i! � � _.;.J_ _�_ i_ � I__ _� �� - N;
, -�— ,�� �� � i ; � � ► w � ��c �
-�---�—� �--�:----- ! " ,� � 9
_ , . �._�J __ _ C , � �
i ) :R.. � i —'� �" I C r
�Y• I ��
� j A
� � � � I � I ' � � 0 � 1
I` � w � ,,. ! ' !�.
p . �
I s I \ I � 7 ` O v
O
� i i I f w , ��
I � �
� � o , i � � .�
� c � � �
<
�...__�..__.- - — W --- - ---�— ' � a� �
� _ . ;. i , : - _-�-- �----�-__-
! - �:. . ' � �. '_ � ' �
I � , . ; , ! , I . -
� � ' ._-: I � .. . � .. . -i:
� � � .� (
I .�. ; ,
! � ' � � � � � � 1
, i � � � � �
' j � � ' ' :�� � � �
� 1 I oq
1 , � I . � � � ��
. � � ��
I � � i.. _ � N
� I � . ! � �. , � � ... .. o�g
� I � � . � � . N F
. I � ' . i ' I � f . ! I
� I � � i I I
� I � I ; ! II �
i 1 � � � ! i � 1 �I
1 � � � . ( f 1 f I i � { � 1 I � � � i �
� _ � � ...
'�- ( ! ! .b-�^ ,�s c�..r� = �, a•�. a b .. . ..to i F '� ° �n n:`:� ^' � � � •-
I � � • ± � � � .. — ��`' .�.. �c � _ .�e ^a o y �....Q. A � t` ,S "`S'7t —
ry j"c, ❑ y.M- �a ✓'� �_�.J �.' N ^ �p � N � ... h p �?a'��n p' � �� `�' � S
I 3 ,h �S Gc 1+` v C� ��S C.� 'J cJ �y O 5,.�,� '.� :Q'� (J
f: � � . � �� ;j UG N � Y+� F�.O .."�� Q � C �..N N
€ ,i�� � o' �.,. S�� 'b J :t m " O. � �" o ' - ^� • b"`^�..h�e' � s; �
� ' 3 ° � �-.: � =o o �•, i � a c' � ❑ '•� x o�lr^ � a � 4.. C..)
I t !��� � ° -:i� �' � m �a ',� ° •.U � '? � � �u ,_�' � x � �� o �n,�� a. F ° r
' ' F fD ���+y. � O `4 �.e; � � �„ � A.._. (9 p p tJ '^
, ' ' ' � a � �n c �` c+ � ��.�� c�a � m +F. �3 ' £ F ^'` `�,r�r �o i ��o~ :s'1
- , I R .�! '�6� � � F N ��n �'�� o' 4 S � �'o�m° �� :� � � `''�`"�V % �,m' �' S 7tl
1��:'..`,�I . , � I � .I _ �] :S C O `** "' g` � �O x O O J � o � ,� S. X''�+ 3"� '` S��
I i I �'R� � 'u"' ;Ci�. �°, �-M :{ ' C'J O ::e "�ey � � � � (� -' M
� jJ °- � A '�n. ��,n m " �.,a y''!i s p x � 3 � a F�N n c�.`. v .`,�.
' �_ ' I ' F9 ,+9 � - '" c 5' cc Li "'"a w.M..�0.x � �p�3 � S ., le' � � � Y ,; o p �
I 'O O 'o ,< ,� ('� fD L 'd O P
. -.. . ' ' 1 "i� (f) • � `?!.l"-' � z C 9 a f `7 O R 3�n 'Y' y w.\.,'V w � J''4 ^ p� ;�
1.... � � - + 1 �;.., I (t� `�rv...�f O � N ('�p �L i'U f�.b C �i rj'� q�O +�V F:�J l^1"t` ^v n. � .��w t0 � % x
'�_ ' ' . I a :1 = r, o' : �:ti N ;y�= y ro p, . m �„2'� � � � �` � � 3 �
i , �a ,,� „�.�,x :�g � ;� ;.;; o �, o , �; o � � � •,�`a�� .. A � �
I - � n0 a � �.^ .° �, � o `° s ` � ° ^ ^"''4' ;� � =
� .i ,;,,.. ° s ° �',w �a �o �,.� Po a�'' .-`e `2 .o'
I I ' - � ° � � � o y � � � p ��`� .. � h n��� � � �� N �� y N � y,�
� R,:� i� ..,y x .i0. ;���n � o = 3 aL A �=� �.�� F A c2 0 � X
� ��I�� 'C} O � "�3 n A.�e " �c R`�'LT � R`� +�'*J � R�w•� r'n'" :S'v. � 7 � .�,'
E .`S � �=4 �n h 3�'., f0 Y 0 (D C �e�i A`:._...y.�'i. y, � .
� i ' � � ! . w ��., ^� b c� C � � 0 0.y a :. h Q S 3 �.�:�-�x�� � x � p � �..
� !' � � � n o o� � � :��o.. �-� o � � �° y'a � �"b� o �j,h�,V �r; ',�+�_'
�- I � S '4^ t�''� .� o � 'Cr �"` y �3„,.�i`�n S � �`"'��_..�4.: `r,a ro �„ � p
I � I �/—' � j`� V� ^ O O A ''��v' A t1 � V �'n � N ��/t J v�(��C.. •f`"•.r3"ry � � 4_ �
�I � I O O b �. A (n 7 � '� S l�J�� ta � � \I F O.r'..�.i't '' `� ,`g 'w �.::, w �
I �I�' � � I I I N ��1 u� (D Q j�.�a` � � rr�i A 7 �' �.'. �,.ti. O „� O �0 �q �n n. O
1 I � i I ! . c u O `� � . �0 7 - • y'. � 2 S :;`e n x � i �> y - u� u,