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HomeMy WebLinkAbout4599A 0801A 0802AWORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lob. C.) Policy No.YPRDD33111 Company A.sa" in_-A•";ty Certified copy is hereby furnished. Certified copy Is filed with the county building inspec- tion department. Date 7/2/84 Applicant Koppel Servicoc Tnr. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not be completed If the permit is for one hundred dollars (EI00) or less,) 1 certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. Date' Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number 287828 Lic. Class Bl Contractor Koppel Services Inc. Date 7/2/84 I am exempt under Sec. B.BP.C. for this reason Signature OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Low for the following reason (Section 7031.5, Business and Professions Code): I, as owner of the property, or my employees with wages os their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). I,as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- Ilon 7044, Business and Professions Code). . CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued Sec. 3097, Civ. C.). Lender's Name— Far Nest Savinas E Loan 4001 Mac Arthur Blvd. Lender's Address Newport Reach, CA I certify that i have read this application and state that the above information is correct. I agree to comply with oil County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the abothtoned property for inspection purposes. 7 O/ Signature of Applicant or Agent Dat APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT -TO FILL IN BUILDINGADDRESS 9 BUILDINGADDRESS Garage Cluster For Bld .119- - LOCALITY QQJJ Cin ZIP 91 7fis NEARESTCROSSST. NO. OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT None MAP BOOK PAGE PARCEL TRACT BLOCK LOT NO. U NZONE NO. TEL. OWNER Far, West Savioup F I NO 0a SPECIAL CONDITIONS DISTRICT GROUP TYPE I FIRE PROCESSED BY ADDRESS to I CONST , J ZONEt5AIJZTCINea- IT ZIPCA ARCHITEC OR TEL. STATISTICAL CLASSIFICATION APT. ONDO. ENGINEER NO. - CLASS NO.ZO DWELL. UNITS ADDREM23 E. 17Eh S - Santa Ana. CA SEWER MAP CONTRACTOR Koppel SerViCes Inc. N0.213 595-4871 BK• PG,- VALIDATION - LIC. ADDRESS NO. VALUATION - OtTy Long Beach, CA CLASS 0-1 t ,3 SO. FT.NO. OF NO. OF CHECK SIZE 1260 STORIES 1 FAMILIES N A ONE DESCRIPTION OF WORK NEW © s O, 4-nd e 4 5 9,..9 A ADD El ALTER 0 FINAL/ 21 REPAIR 0 DATE 2 3 I•• 5 6 -5653 USEEXISTING BLDG. DEMOL FINAL - APPLICANT TEL. By 5653 SEE REVERSE FOR EXPLANATORY LANGUAGE 07,19-84 e_GEC' I A i n" 2 O U 3 h717—E1'. 1 V.. I I 9 .V :., O 7 •. IC ^ u0 l (0 0 C C' C ti .',` w ^ i cD I O' '.: it ,.~ -w •C ~ +. •y-. `.F C N `' O `r R L Q K JJ U I f I li.rU '^ - '.LV C F ••`: O L r_. G.,R,. " O ' < * ... . V+ I - :c'A %.f'G < 1.. Lr ^:, N O O v . ti ` ` ^ C C r••.• y ..y ; L n -_ I .. , •12 O •i w h• o0. e^sac^°cti-^Mc.'..nin':Q: n o n o : o•.•"ice^ 'o , °_N vyi a F.aE'-='' •. O _ C`f 'Y I..' f• _ , t^: q ^' V O L .- N y O` _ W n . ti f; ? fn `• Y _•'.. - M p ° £ O .r1. VI C• CJf O n }. _ •. •^ S n : ^, n ~ i~ 3 o C• A `• Q' rte„' 3 « to :rr _ T T it =r r T T N c top o lU ECCL o 0 T l 00 e o n o 0 027 o D 3 Z X m jr 7 T! Lo 7 v 0 n' •, rp Lp d ItcoD to 31 ate. o 10 ateI r i i is i-. C•• i I r C J N pu V L- V.. I I 9 .V :., O 7 •. IC ^ u0 l (0 0 C C' C ti .',` w ^ i cD I O' '.: it ,.~ -w •C ~ +. •y-. `.F C N `' O `r R L Q K JJ U I f I li.rU '^ - '.LV C F ••`: O L r_. G.,R,. " O ' < * ... . V+ I - :c'A %.f'G < 1.. Lr ^:, N O O v . ti ` ` ^ C C r••.• y ..y ; L n -_ I .. , •12 O •i w h• o0. e^sac^°cti-^Mc.'..nin':Q: n o n o : o•.•"ice^ 'o , °_N vyi a F.aE'-='' •. O _ C`f 'Y I..' f• _ , t^: q ^' V O L .- N y O` _ W n . ti f; ? fn `• Y _•'.. - M p ° £ O .r1. VI C• CJf O n }. _ •. •^ S n : ^, n ~ i~ 3 o C• A `• Q' rte„' 3 « to :rr _