Loading...
HomeMy WebLinkAbout1396A , . .. _._.:_-_----= ------- -- ------ ' WORKERS'COMPENSATION DECL4RATION - . . -� . I hereby affirm that I have a certificote of�o���,�0 5e�f � � � APPLICATiON FQR BUILDING PERNtIT � insure,or a certifica�e of Workeri Compensation Insuronce, � w o certified copy thereof(Sec 3800,lab.Cj•.. .. - . _.. .. ... ...... ... .. ...___._ _-_._-_..__.__._. ._ .-_..._.._ COUNTY OF lOS ANGELES 8 DI AND SAFETY P❑ol�ityNo. Company r`/g�el s �i, Certified.copy rs hereby furnished. FOR APPLICANT TO FILL IN Bl11LDING , `` O /�u� � . , AOORESS � U/ L7 Certified copy is tiled with ihe count bu Idin9 inspec- Buit ING f•,� 'Q� � �` fion�depnrl M.•.. ADDRE55 W 3S Wi vw ppte'. � � V AppliCaM �"� CITV N / 21P IOCAIITV �/y L . ��CERTIFIeA7E OF EXEMPTIO WORKERS' - 5¢E OF LOT O ON8 l0 CRo�ss Si.,��N A,0 �', CQ{.��M/9 � . ..COMPENSATION RANCE-. (7his sec�ion need not be completed if.the permit ia for one � �� - 3 �1� S I /+��R� �' � � � hundred dollars(S1oD�or less,� «�T `� BLOCK ior No. �,y�,p epq� P�¢ PAR�L ' TEI. U 2 E M�P / �iY I certify Ihat in the perfarmonce of the work for which this OwNER ��e� LC NO. � NO. y rmit Is fssued,I shalt nm em la on rson in an manner �,j, - SFEO,aI� - - � 0. so ns to m�e}/ bject to ihe W Y ker PCp nyp On dws. ' AWRESS - ( (�C��L�� �U��� CONDITIONS 0 Dme ` ''' 8 � . .. ; . . .. . w . � V QiY . !;'.. 1 I'y'e ...ZIP__ p� I �P�i��t � ARCHITEQ OR TEL. O NOTICE FO.�.PPLI If,-after ing this Cerfificrna o ENGINEER � DISTRICT GROUP TYPE .FIRE PROCESSEpBY Exemption, you should become ubject�to the Workers' ^ CONS/T.� ZONE �j Eompensation provisionc of the i Cade,yoV must forrh- ADDRESS (% � 4y/y LV � with comply with such-pravisions w-tbis-.permil sk�all be . . .._._. _ ., w �/ � / �}p 4� STATISTIG4L C IFlCATION APT. CONDO. Z deemad revoked. � . . - . CONTRACfOR /y NO. G �/ r � . LI(�NSED CONTRACTORS DECIARATION�--. . . .. � t rt .�� as.SS NO. �� DWELL.UNITS i here6y affir�F{pt I am Ikensed under provisiorn of Cfiapbr 9 AD�RESSQ/a� ��V�L� ,,�.33 Q (wmmencing with Section 7000)of Division 3 04 the Business ond _ � E�Q Q ��C _ �� / Rofeuiom Code,and my license is in fuli force and eifecf. cm Ctnss C"/� ��� ,�,3 VAL�ATION /� SGI.Ff. y� NO.OF Np,pF CHECK License Number�� �" ' lic Class ��� � SiZE STORIES FAMILIES ONE . �/ljV�.G6�/fl. . .. .. � VALUATlOH _ Confracbr �Date DESCRIP,IONOFW�2K � ��' s aaBD D/, �+ �l ❑ t V � �I am exempf under Sac. J� �� • ` '�r��`��R qDER Q � B.BP.C.for this leason qFpp,�R-0 i � ..-... .. . ,.� __,.-Doter._..., -- U5¢oF a . . E%IS71NG&DG. � _ Signalure ...._ ._... . ... .. . -. APPIICANi 7EL FINA� , I OWNER-BUIWER DECIARATION .. . . ..atIN7 . . . No. � � i�I :i .�!;!; �^^'^' _ DATF .�..Ahetabyof£irm�hWlcupeaac+ptfrom.lk+a. �o+:slicanse • e e •� ADORESS .` . ^a Law for fhe following redson�SecFioo 7031.5, Busineu and FINAI �PrOfBsslOnf Code): _. . .............. _, . .. ..,... . PRE _ . . . __ _ . __._.. _ . . .:'g�,_ ' -`'�+� /� ' ' � 4'-. __ / a p , Bunouv� -'`�" Q _I, us ownar of the properfy, or my employees with ADDRE55 _ _ _ _- ___---.__ .. ... . _......_._.._.._.._. .._.._.. . wages os their sole compensation,wilf do ihe woiTc and ---- � � -- �� � + � � ', , � � T �he struclure is not intended or offered 4or wle(Seaion ����TY � i � �� . �- � . . ..7044.�Business and Professians tode).--.. . _.. ... MOViNG.._. .. . . iK. - � G..H i i —n�'� . i,as owner of the property,am exdusively controcting cOrviRaCTOR NO. ��,_ � �-�., .• ..�._. . . :".:-, �. . � wifh iicensed contructors to mnstruct the project�Sec- '- - �--�-- -. ...� . ... �...... . _ . - � tion 7044,Business and Profesaions Code). AOORESS - �� - �CONSTKUCTION IENOING AGENCY�� �-�-- - � ��7ngq�K YARD� MWY TOT pTpBA`WE WIDTH I hereby affirm rhat there is a construction lending agency for iRONi ��he-parformonce of�thewpk for�which thia�permit is issued - ..-- .-p.L ...... . .. ...._ . .. ._. ._.._._ . . .. (Sec.3097,Civ.C.�. SIDE m .... . P.L. _... _ .__ . . _ __ . � Lender's Name �"- J�j � IDMA Ref.A � . .... .. .. . . ... ._... . P.0 Fea S ". .. . ._. . Permk fee..-..._c?O�'. .._ ' _ - lender'a Address �f , . � .i certify thot 1 have read this npplicatinn ond state.lhai_iha _._ _ .hsuonce Fee �L' IDMA P/C M _...- --�--' ---- -' ¢ above informoiion is correct.I ogree to comply wilh all County invasii arion Fas ��Q U � ordinpnces ond State laws.rela�ing�o building construction, � ._. . _.... ... ...' '-__.__ ....._.__... - 7ablfae'_ ' -/- '..._. LOMA Perm.M � ond hereby authwize representafives of this County to enler � u n f abpre-man one perty for inspection purposes. �.\ y.,�,$ a 1/G SEE NEVERSf FOR EXPLANATORY IANGUAGE I � �� Signnn,mvFAppficam,o.�.Age�F. _ .. ......_.p� . . .pi � , r < -'; , . ,' d 's �-. J� 'C x " � �.' � � o O:�� .� M � . 'l.. ,'t �o E:c�`^ `d �o V'+. .�,' t'�� �Y.�r m � °' o `�' �t C."S� °� : G - . � �.�:: p p �y m•� ;�y �6 � T'O D * �. f9 � 3 . N N W''^ '�"A � �i 1� i� 'x^ `� •�� � p•v p•Y'�� Q � yf . O �nr'a�n�L'�j� O * � ' � d w+.�' „ r , � �--.i'.S w x �y�w� 4 �S� �� O N L'�.'i' p `n s..II O : 0 '" `^. " "1� �� s ^°.<n ,�,,� i��i`�Y'"'e.�ye�-'o r� ° '. .u 4..,,-i u.-� Z `o ��o o+;;.�i'''���c " ° d d w ..d M 4� X ` �hs ,� , u`'' $ 3 �.. �" � � "a�— `3 �•.93 w.'2 v. '� .1�,. ec o � �.` 3 � o c � � r.�^d,�..'�-0 E c� '� � � 0 r' �� M o�Cs.'� sQ := � o �;�.ys�+�a,..,K... o` �,j •�s;., O V ? v E w ��=i Y�-L G.� T�.�. a �''N.p � v ,�p p �� �a'� Vp1 y1 U O ? �p'� �� m�'CS E . '4 V � O 4 �j 4 C 'O �^,4, ��� V1 O� �i ii� o o,���'� �x'i°o'=� � c.°Y'EA- d-°�c'o :�� o� •¢. O �3 � � '. Y,d � o y�`� d �o �o � '^ � r °o,dKrm� i�� � °'o°gd�-� � ''. dp v �,`,o,,�'^.°`aYo.e'�'? � o °.° °o 0 3 M�':s s �w oY a� fl- ;,� So o, Y.�:o^ M gcvv ti � o. �� o t �', '+ m � "' ,� d �'�y r t.�� p 7t;,^ �,d N eS� C''_ m[ ' O v� p �w N � CJ E �d .E� °. ;; „�« �« e d E�o�'�d�:o�' � er,°; d-c n y 4 "'..� m � u' °' � '' n° c.r. � s om• �.. ��• � � c � �-er..�✓= E a u o'`� �.°��d.a a. � ��,. u c '�..a. � w �;: ' „-, ; c d g �"" � o +c,.�y,.0�ar d" w � d »-,�- 4'.c a�� b� �4�'C�� o d �/� p.a�- �p v.Q � �.C.v.�•:.Oi y` O C N � G � �,�",� � d �G' m 'n 'r �/+1 �' � N M^ V 4 Y Q.�:i�_w b L' � � �. J��.� v,�j p ia`r-.b i'�W m d G � 0 :�o� � �n d���o.�o o � m� �e o'� �„ �,,,_,° � . .3 ��3.c,K m � �� o��.�.*,a.,���Z,��, �y�., o� ' ��`�}aw d �� �G.co'4':s 'a.V - � E� 4 i N d M O � O j N"'�� `1 9 `.�. '9 �'L1 '~(l 1 1 Q-��.t.`�.�.o. ��, r �, e � � c o d,� .. � y O� 4 ?. Ri � j `sN_.. c,� N �'dtt� K��6L'X+'^� � �5 . � O � � N 1�.�'�f.w C� �"�O� �Q. ; . l^'° 1 � . � � C !��M. M�� M� 4 . . .F j V � Ol � 1 t ' ' , i J � k� �• �. . • � . 1 . �'.` ; �! �♦ ..,-: � ,z . -1� ''�f.~t'• �;. �^� ? '` ` �` . :i/' -�, '(+ .��, :(' �'� v "' �' .r=, t ' . � ..:i . y�' ~ �1': .*' � . �� '%,/ . ;'y "� .�' .C' O ".:'. ` ' Z - ��i C � �• � � o �� _. . ¢ . , : , . w . :� i -� Z . . �, � � �„� �n X' � ' � Y�� O ..`..+` � �' . r ,l � , . • C �...c. O� . M .� M' �^ •tO i .O , . t.:. a 4 O 0 � �G, O o p - �F: � �a �r . " i ` ��' . h'�y p ' " . i; IO � � . � � � � 0 � .��_ � Z , � c � � � � ° Q �- ,� o, 4 1 o E o- �i � O c 4 � _ � q N ° o u �°a o V J ' � T 6� � m >O �i 4�d 1 d O� � �-" ' G � > pp p a, �C L O U �y w 6 �O � � O T 6 G v � � V t J 2 � O 0 � Z .r.. U j. ' � O� O 'O � 8 G J 1� ��• d Cy, �N � � . $ � p � u� 0 0. s � m � o,o �� c o, j� � �n � } n � E m cU_, ° � o. �,, o o E o o � c � p o p `p * N J 61 ••• 6 � � p, � �p N G Q,J � O, G ..�.: Q v � p 'a °u� �°'� N m o � o- � � ` � o = �- 7i O O Z �