HomeMy WebLinkAbout1552 0027A (446) �' � WORKERS'COMPENS TIO DE lA TION � � ""�Y �3 �
!, , ,�.aby affirm rhat I hove a ; �a af o���o� a�; � � qpp��CAT10N FOR BUILDING PERMIT
_ � insuro,or a ceriificote of Workeri Com anscAi ' uhanc �
ar a certified cop r f ec B , �
P�l��d � , . CQUNTY OF LOS ANGELES BUILDING AND SAFETY
� cerr�Had�o �e b r �s . r : , . '� - FOR APPIICANT TO PILL IN ADDRESS 32 O n,o�� �.
� Cenified co is filed with the cou buildin � 1 /�n
� PY g inepet' BUItDING 1 ( v/ TA M•` ��.
Non de rlmeM. ADDRE55 �3 �/Cl.{.��G
oote ��^ C� qpplica�t ciTr �IIM�IDNA �f�'L_ zir �,�,Ty
CERTIFICATE OF EXEMPTIDN FROM WORKERS' NO.OF BtDGS. PFAREST
COMPENSATION INSURANCE S12E OF LOT Npw ON LOT CROSS 5T.
(This be[lion need not be tomplafed if the permil ie ipr One TyKT •3 1V BLOCK LOT NO. ��7 '�ESSOR
hundred dollars(E100)or leas.) MAP BOqC pqGE pq��
OWNER � (.l^ CO NO�ZT� � USEZONE_�. MAP /r1-33
1 terlify Ihol in the performance of the work for which this �( ' NO.
permit is iseoed,I shall not employ ony petson in ony manner poDRESS WE� 5�: S.k�,�'.� �O� ,C� ' � �At e �
so as fo become subjxt to the Workara'Compenmtion Laws. CON�ITIIXVS 3p� ,Z,. �.
Daro Applicanr GTv [ ��S C�Z�a qyv� �:
NOTICE TO APCIICANT: If, oher making ihis Cerlificate of ARCHITEC'f 0 . h�• SI� 7�I DISTRICf GROUP TYPE FIRE PROCESSED BY O
Exempfion, you should become eubject to �he Workeri EnIGINEER �fh) O. � U
Compenaation provisio�s of the to6or Code,ynu mus�forlh- q ��,O� ��Z J�1 W
wirh eomply with euch provlalone or this psrmif ahall be ADORESS E� �j� ST. � ��$, /030 Q
deemed revoked. "
t+^.�u_ �'a.S.F����•.„_ STATISTIGUClA551FIG4TION APT, C DO, tn
CONTRACTOR f-o Z
LICENSED CONTRACTORS DECtARATION M� .�y� p T;�_: � anss Poo. ,•r oweu.uN�TS �
I hmeby offirm that I am licensed undn provisions of Choptet 9 ADDRE55 g�p (A�� rt• ' +!. � NO.
(commenting wNh$ection 7000)of Division 3 of tFe Business and ��� SEWER AAAP
Profe�sbro Code,and my licenx is in fult torce and effect. QM� �'.� �/� np,�
. /.�p .e� . . . SO.FT �w NO.OF NO.OF CHECK 8K. PG. VALIDATION
Litense Number 7 /J/SI Lia Clase � S2E � .�VO STORIES Z FAMILIES ONE
(� 'J C VALUATION t-`h
rConfrocto�� `"'lvS'TQ(ltiT��a�s �J��-7(� �ESCRiPTtONOFWORK Q�fC.0 � � ..�: �� ,�`' , � �JJa(�
ADD U v(J
❑I am exempt undar Sec. ALTER D ��
8.8P.C.for fhis reaeon �PA�R ❑ j �S�G,�g
Date: USE OF
EXISTING BIDG. DEMa ❑ - - . . . .
SignalVre APPLIUJTT r� TEL �J FIMAL / Io7-29.8�
OWNER•BUILDER DECLARATION ' DATi (U-3�-4a
1 henby affirm tha�1 am ea�mpt hom the Conrcoctrn'�License App�R�SN'�j,g�/ (�1Uj7#�.�0 (�9r 7(p
Law for the iallowing roason(Section 7031.5,Bveine�s and FINAI
Profeesiont Code): �
� I, as owner of rhe o y p Y BUILDING
pr perty, or m em lo eea wifh �DDRESS .-G G Z�%Ci
wogee a��heir aole compeneotion,will do the work and
fhe ehucture ie noe infended or offered for sole(Section ����TY - � � , �
7pM,Business and Profeasions Coda). Mby11�1G --- ~' TB�, ' �- � ' ` - �;��s,� � i ��
� I,as owner of 1hs proparty,dm exclusively contmcting'�� ° R�G7DR , Np..
with licensed roMratlOn to Conahucf}he projecl(Seo-4, - �s�� °� �r�"��, .`.. - ' -' C Z,v��,��
tion 7(144,Busineu and Professiona Code). '�� n
RE�UIRED iOTAI SETBACK •Z,:i S•i, ' -_
CONSTRUCTION LENDING AGENCY SET BACK �ARD HWY pROP.LINE WI�Tii ��` ��
1 hereby affirm that there is a consvuc�ion lending agency for FRONi � �i C G.,.F�;.
�he perfotmontE of fhe wark for which Ihia permit is iss�ed P.L.
(Set.3097,Clv.C.). Sloe
P.L.
lendar's Nome
'23 33 �nn.v,aet�
m lander's Address P.C.fee i Perm��fee �
� I cerfify thol I have reod Ihis applicafion ond stofe ihat}he lauan<e Fee '? '�� LDMA P/C M
� above informotion ia conecf.I agree to comply with all Counly ���������Fae x�-Q i� /�
8 ordirwn e nd State laws relatin to building tonstruclion, iowl Fx ��7 /.`�'� tpM,q perm.Y Cl Q
� and h e vu�hor'e repreee t'Qs of�his Counry ro enter -
� upo obove- nfioned pro far i ction purposss. � - . -���, _ , .. - _ .. . .
� � SEE REVERSE FOR EXMIINATORY LANGUAG[
SignaNro of Applicanf w Agen p�a
.�
— o °�
� � � ,
�- �; �' o z
c; a
"--'' -'�ca ��° � 4 � r =' �
�
..�--' !1� y CaC y G a .'C V R
"o �� O r c5�^. � � � .�: L f
O ^
CJ � '?. � D � � a ';, � T
?` � ii� ,�'
`�' � ; ti \ a
� � � 7? ;-y 7,, � �`
.i � O N� . � �.C'3 s 9, �j �p .� Q
a m 3 � a" �� c � "�` ° { o \ � '� a ro
< : p �u
: r 9 � p �' � � ,�,�i t r i
� p � � lp Q 4° � �
{\" '"'.., C..� '" 7,Q � .'r '4 4 .. � � � � � j +�. 4 �
�\ ;D u l9 ^, T �y.,L ,��, q ~ Q" \ M jt ` ��� O �i
7-n � Z y4 � 0 p � 6N `,�� �� � o `t p8 6
\ y �".. � ..��` � b \ \ .�
. G p�D � + � � ` � \ .
r ;Y\ .,� O '� ` ` �', `,, � /
� ` ` � , � `
-� 1 ` 4
��. ``?' '\ °� ` ` o
o �
� � �� 1 4 0 � \ m
\ ' , ` 1 p O ` �
1 ,`` ' \ � •:Y, _ Wp„O
t.` � \\ � ' r+ 6
.O
t\r�"", . `{ ';� l j 5}` .�1'
�t 1 � 1 1 � � 1 1 � � y- r l���
1 1 i �'a � � 6'
.�\ ` �� ` j ! y ,� � �,
\ \\ w �
, � � • , ,' ':`" `5'. " ' \
.r �' .� +� ��
,�t\ � ^ F. ,t �' i. �`, �
{4 � �, `�.... �l. ,{'.. '�tl
t ` r� � �i
� u j �y
� , ��,, M. �
,\ , . � { '; ;. �;� y. �:t � \ � �
'�. -;;` � ,• "`; �� '.� ' �
•r (� ; �� '�
i ` ~ � ` �,Yl� r ;Fj 1
�, � �, �,� "4 ` � .� w �� � �%y ,+�. , �t
� -, y: � l' t �� , � a '� � \
� ` "�. '�'' ` `� � �- J;'.' �i' '`. ` �.. , 1\\.
W °� ~ � � r � r ` €
� , !- . . � , .,�;;+(�
��
a , .: �;. ::,, 4�, `�-� ; ,_,.�.....
� � �� �.. � �.� ��. ``}�
^� 1 • •� -;' `A
, ` ? � � r 1 '•, ,'s K "��.
� ;� ' � ;• 4r�`^.� �~ �
� � �' ' �'
� •1 p �.� eL w� ���in'A � M
` � . z ^ ' ^ �T , �
\ t ` � � Q M ��.�' �-c �.
\ . .- _ y�� �a ,,,,;-'`^_v.c� _'x.� � 7
\ ( "`.r C'..A O �.� " � �.....-.+�� x .4.�.a�
4 � � p µ ^ry' �Ff..�`^ �� 1
,,,, �' ^ ��. � � r x.�:"•� �,��
� .. s F p F ^ x s�.io r O '� ?,t, r r„''" ���„�R_�. �3�:r
. 1 �,,. o "t .a � �ryp:._ N � y S 0 ^^M1 K-"tt�c..,� .� •"��
� c. �S.. ,�. �r.,..�.
, � n� �,.^a a 4 ��3 �•y ,�,� �.:n c �-�.'A' � � � ' �-�r��t�c's -�'� r
i � � x ^ ����3Ja � �a �� � �"7J,m �� � x ^ ~ �r� o��
'�"_" p ;C ...1 y �c p in� m 'S F C„ "J' '� 3 r F�j,rt;',�. O �
� m o � G � n `^ ` ^a r ,�, c .�� ti � i � '� s.?r: �+ f f �* �
` � s p ;` �.� � .�,�„j '£ �"�.:.,`�..�� �y ?�.:p � ��_� o S R w.d ^._> " :�►''^�'1°- 9� .
� ��.� �.� N , �g ���-.:.�, = � � @ � � -� ^ �,� �.� .�
� ^ 0 t- �-�^ �o r y 3 y F' c � N'�cP�p `-�X � T'y -.-•�j,f.�Y -� i
i ,�,� , � ��F �c � G O, G^� � � n^�G.� r,O-�, 9 ��.�.�=..�.:.K. —^ �qM.�. ; . '}
��^ � . � ' 3' Y R.^ +�., ' �O G �p '� ��"o "'�" ' �h' ��O : =
� v', � �c'" ti'o �c ..� � � n �3�,Q o -Z � ".,g 3 �_ ' y-'s-''�F- � ^�
� `'p���r`o o �„�?��' �,^ ��� o �'��o .`� M_ r � � N�C
y� � F�c z"' h'`" � . n"p " c"� ��`' p,f s--^i'c : �"'^ ^•N x � r- K �
Fj, �'�I,A-- .o �o .. o ': � -� �,v'-o C`. �-'�c c.c � �c.. ' s,. . sr..� ';
�o m �-� S, ;� -.' - c:. = �o o z ...= � ,,..w r . . .l o c _
� n ..1 s�3 n�''J � ' �.�e �3'� � �'� N� �c _ c ^ � � �, w
c�+ G�� - s. 3 �.� ' c"� + ,.- �.� '�
O ....� �' � s-. �. �„.;..o ��' ry o .;. y�` = �. ;�� :,?'�-
�? e ? " � .. . " � ,`.� .. if+'� � ��' + ». .�.;, �y .,
� �„�- `1 � .1 .�..,_^' q O � S„ Ji � �. ,Y .� � "
N . M � :4 -�v-�.. � �I �,t �.}
-,, O x y"�`t^,.n m a ?Fc Q �,� s r y c `� .. ._� � , .
i�r Q m �'^ _ ��;�� a . ,,,=^� „ o-
.. - � �� �#v� �����°^ ^�����..� y
� o _ —�-, ^ '!�-„``�`
,� \ � i s �"u - � ,.,-.
:`� � j N • /%
��
�t • �
� ' ��^i�''f/
.... ��" rI'�
� i
�
\ .
�..�'��