HomeMy Public PortalAbout6346 BARELA AVE_Building__ ` -WORKERS'COMPENSATION•DECLARATION
y affirm that , have a certificate of consent to.self PPL�C�T�ON. AOR BU,IE��.NG PEMIT
Incur or a teatlflcate of Workers' Compensation InsUronce, .
ora certified copy Cher Sec. 3800, Lab. ) COUNTY OF lC�S ANG�LE� BUILDING AND SA E1jY
Policy No. G _ mponY BUILDING
Certlfled copy Is hereby-furnigmd. R APPUCM4T TO FILL IN ADDRESS
�1 Csrttfled copy Is flledLvlth the tounty'bulldlog Inspec- BUILDING
1J tion de ent. ADORESS
date � Applicant
t� r p{f�u � CITY ZIP mXALRy.
" `��
CERTIFICATE OF'�YJMOK FROM WORKERS' NO OF BLDGS.'
COMPENSATION INSURANCE SIZE or LCQ (0 -NOWLOT ST.- u
(Thismdlon need ngt•bv cam letbd,if the prrmlt.t;fqr ono.,--. TR �O« ' LOTNO:
hundred dollars ($IOQ)gr less - MAP ARc�
MAP
OY04ER � TE3 . 115E COPE
I-OWIfy'that"In'the per4ormohce of flip work for which;this. NO.
perrhlt is Iss�led, I shall not employ any peraorl In dny mann6r _ ADDRESS_
so as tb beto e-wuNeat.to the Workers.C.ompensatlon Law&-,
c� tii� Orl i7 17'7 ..
Date AppllEdnt ARCHITECT OR TEL_. DISTRICT GROUP F3 BY
NOTK:E ArPPLICANT: ff, .after rrlakln9 this Cettfficdte'of NO
Exemptlorr;.you should become sublect.to, fhe. Workers
Compensation.proviCans of the.Labor Code,,you must forth- ADDRESS
with.compFy:with 4Uch.provisions or this.,permit shall bb
ddemed nvokced. 7 T> STI�TISTICAI TION CONDO
to
UCENSED CONTRACTORS ATION, ;: D 10 KfF QASS tJ0 UNTFS
I herby affirm that,lam licensed under provisions of Chapter 9 SES MAP'
'(oomnA4 dng wMfi Sectlon 7000)of Dlv%+c�'3`of the Businsw and. l}C
Profe"loro Code ond'my II Is In full fora and effect. CITY CLASS _, VAL )ATFON
a SQ.-F r. NO.'OF tJO:OF _•CHECK
Llcer�se jVumber LIc.CI STORES Off�E
—� VALUA
40
EW
Sd-r WORK r
GoniroctbrGiM[f N Date _
.ADO
0 1 am!exempt under Sec. • ' TER
B.6P.C_ for this reason REPAIR
USE OF
Slgrtature- »ars r TEL
oCMo1 IRNAL �.0 8 9.0 A r .
.awe .,-, �
-BU I Tl ON �v- DAIS _
1.hereby 4rfflrm that,I am exempt from th6 Cor3troctpxs License #;q o o • r
Law for the follbwinq rason (Section 70QI.3, Buslness and ADDRESS PI
Piofession.Cod.): hr 16 2 9 Q 2 5
I, as owner of the P overs BUILDING"
property, .or my .m I with }1DpRESS _ e • 2 9 0,2
"5
o,� s
wes c their sale oompsnsatian,will do the work and
the sinuc-ure Is not Intended or gffered fot"rale(Section j
70",-Business and Professions fade). MCS VINO TET.'
1, as owner of the property, am.exclusively cbntractina l NO }'
with licensed goottactots tq construct the,project (Seo-
ADDRESS
tion 9.'O , Buslnew and Profe=lons Code).
AL SETBACK
CbNSTRLICTION LENDING AC;ENCY YARD HWY PROP. UNE '
I herebfafflrm thpt there Is a construction lending apehcy for FRONT.
the perfoun incw of the work for which this permit Is Issued
(Sec. 3097, Clv. C. SIPS
P.L.
L.ende(s Nome
LDMA Ref.
$ Lehdert Addreits P G Fee i M Fpr "
I_certify that I hgye regd this-appligatlon and state.that the lssirance rel �. LDMA'P/C
o. Above Infotmatlgn Is correct.f ogre&to corn piy wlth'aII County
ordinances and-Siete laws relating,to building odrutructlon, n rolal Fee t��. LDMA-P«m_
and h w
aufhoirize reprentatives of this Count) to enter
upoh tioned pnirtyfor 1 pedlon
111111111WIM PM oG4A#LAT0+n UWOUAoa. . �... L.
loam or Agent
.DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES T
NVM. J. FOX. CHIEF ENGINEER BUILDING
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING Q A V DISTRICT NO. PLAN CK.NO. PERMIT NO.
ADDRESSr `„ /�� 1, yL (0 3 r�
LOCALITY /`r/�j��/� / EIVED BY DATE OF AIPPL. DATE IBSUED
> r
NEAREST r:"�s�� ��>'•, �� V {,!' 1 �'•
CROSS BT.
BUILDING w'J l � A
_OWNER /J✓/ ADDRESS IV fR
MAIL - / LOCALITY
C
ADDRESS .
TEL.
NEAREST U
CITY NO. Q
CROSS ST. 7
FIRE NO.OF TP GR
ARCHITECT OR TEL. ZONE PLANS
_ENGINEER NO.
BLDG. ORD.NO.
ADDRESS SETBACK LINE
APPROVED
CONTRACTOR _ ryp.- BY DATE
7 ' USEA _ APPR ](�EID
ADDRESS ^ ZONE 4 BY t'�, '�� DATE
LEGAL CORRECTIONS
DESCRIPTION LOT NO. BLOCK
TRACT (. V
NO.OF SLOGS.
SIZE OF LOT I NOW ON LOT
USE OF - NO.OFNO.OF
EXISTING BLDG. I FAMILIES I ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION 13
A
REPAIR MOVING DEMOLISH
Sq.FT. NO.OF '��- Z
SIZE ROOMS STORIES D
WALL {^ ROOF r
COVERING ..,-,� Ia � I COVERING Ki
USE OF NEW
BUILDING
V " a A Met,i o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION,: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: FIRE STOPS,
SIGNATURE OF /r ,/�/` -�•/•, BRACING,BOLTS
PERMITTEE (/, O LATH, INT.
AUTHORIZED AOT 'fir ' ✓�
LATH, EXT. '�' I 1�LL� 7. ' '• ,5.5
76A63BA-3 7-49 Tj� too P.C.S j PLASTER,I NT.
V "10 r/ FEE �=•. PLASTER,EXT.
VALUATION
0 0 FEE � s FINAL - ► 'J