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Home My Public Portal About9321 BLACKLEY ST_Building__ WORKERS' COMPENSATION DECLARATION insure, or a certificate of Workers' Compensation Insurcln elf APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, L}p: C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 12- z& ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING copy y ADDRESS ElBUILDING Certified copy is filed with the county building inspec- .. • Tion department. ADDRESS r j1 CITY 1 _ ZIP LOCALITY Date [ Applicant NO. OF BLDGS. CERTIFICATE OF.EXEMPTION FR WORKERS` SIZE OF•.LOT NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) . TEL. ' OWNER & NO. USE ZONE MAP NO. I certify that in the performance of The work for which this 7 r y SPECIAL >_ permit is issued, I shall not employ any person in any manner ADDRESS l �/-�Y i ` —/ CONDITIONS CL so as to become subject to the Workers'Compensation Laws. -}� f O CITY `may i 1 ZIP Date Applicant ARCHITECT OR I 7EL. DISTRICT OUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making,this Certificate of ENGINEER NO. 3 —� 3 CONST. Z� E 0 Exemption, you should become subject to the Workers' p ) �j'f_,, /_,�� j LU Compensation provisions of the Labor Code, you must forth- ADDRESS S bi T 16 6 ��CkPJ ✓ ��llCCC��"� with comply with such provisions or this permit shall be yyi�1 J TEL. p/ STATISTICAL CLASSIFICATION r ' APT. CONDO. N deemed revoked. CONTRACTOR ID, i�G�jr - Y: NO.(J(�' Q-Wr Z LICENSED CONTRACTORS DECLARATION ,f,, u LIC. _ �i CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 AD4 DRESS `�� NO' O - SEWER MAP (commencing with Section 7000)of Division 3.of the Business LIC: and Professions Code,and my license is in full force and effect. CITY of CLASS 75 BK. PG. VALIDATION SQ. FT., NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES -� FAMILIES ONE VALUATION Contractor Date' DESCRIPTION OF WORK ''11 ADD NEW 5�S I V S ❑ ❑I am exempt under Sec. S ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATf I hereby affirm.that I am exempt from the Contractor's License FINAL ADDRESS Law for the following.reason (Section 7031.5, Business and - 1 Professions Code): PRESENT BUILDING By , f f - - ACCT.'fia ❑ I, as owner-of-the property, or my employees with ADDRESS - wages as their sole compensation,will do the work and 3ri17 U the structure is not intended or offered for sale(Section LOCALITY TT_ t�sr 7044, Business and Professions Code.) MOVING" TEL.. , 1 1)Et O ❑ .I, as owner of the property, am exclusively contracting CONTRACTOR NOf ThITAL B� m 011with licensed contractors to construct the project-(Sec- ADDRESS 4 5 tion 7044, Business and Professions Code.) /� CCHECKv��s) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.).. SIDE / _ P.L. t I ll�l—Ui l�!1 1/?1:'c Lender's Name !! p� { P.C. Fee$ Permit Fee O� LDMA Ref. q ''' 1 i�-f1 t1t L°Laa - ° 3 Lender's Address oI certify that I have read this'application and state that the Issuance Fee I LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee U LDMA Perm. # a and hereby authorize representativesof this County to enter • on thea v -m ed property for inspection purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE Date Sign u o r A nt . WORKERS' COMPENSATIQN DECLARATLON L"1/1slo lo 01°i&i2Mz .PZ fiA-) insure,oraa certif carte of Workers' Compensat on Insurdn elf APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company —� A ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 7 '>V4 �v ❑ Certified copy is filed with the county building inspec- BUILDING f 1 7^ <—rTion department. � Crr/_r L L.G ADDRESS CITY L E CZ it ZIP CA 179-V LOCALITY Date Applicant f NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 60 X , 3S NOW ON LOT t CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) T TEL. ) j OWNER � G� INAN y NO��)8-/ 3/ USE ZONE MAP NO. I certify that in the performance of the work for which thisT SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS d V� ST• CONDITIONS O so as to become subject to the Workers'Compensation Laws. 7' g CITY &'�,1` L& Cy-TyZIP C/'T t'7 U Date Applicant ARCHITECT OR r TE k 13 DISTRI GROUP TYP FIRE CESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER TIN--J�� V Nq �j ��35 CONS Z�jE � Exemption, you should become subject to the Workers' (f pp v U Compensatioprovisions of the Labor Code, you must forth- ' ADDRESS Z$Su>t��r`�""`� G' r��Cri �� d with comply with such provisions or this permit shall be *yam L i /J n ?E STATISTICAL CLA IFICATION T. CONDO. N deemed revoked. CONTRACTOR PJA,'. [, wl cl NU�'�I - '1 ? LICENSED CONTRACTORS DECLARATION I IC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS [G,NO' SEWER MAP {� /� LIC. (commencing with Section 7000)of Division 3 of the Business {�O ein�ea.d, C'fl °lj��v f CITY 1� 1 CLASS L- VALIDATION and Professions Code,and my license is in full force and effect. BK. PG. SQ. F,T NO. OF � NO. OF CHECK License Number Lic. Class - SIZE STORIES FAMILIES ONE VALUATION DESCRIPligPOWFWORKNEW ❑ Contractor Date $ , ADD ► ❑I am exempt under Sec. ALTER B.&P.C. for this reason REPAIR ❑ $ 14 Date: USE OF 1 EXISTING BLDG. DEMOL ❑ Signature APPLICANT ,+{'p yrs �/r1�V TEL ${$ z_ FINAL (PRINT) ,J A y Nr l� 3) v OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License 93� rias S-r,�� ytr– C�Tr Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY 1.'71 BUILDING :1�3.:1'. Ju I, as owner of The property, or my employees with ADDRESS Iry wages as their sole compensation,will do the work and , "'.,� '?F,.�i. the'structure is not intended or offered for sale(Section LOCALITY •`' ''r 7044, Business and Professions Code.) MOVING TEL. 1 HEMS Et CONTRACTOR NO. � ` _ ❑ 1, as owner of the property, am exclusively contracting s Fii —_ ,. with licensed contractors to construct the project (Sec- ADDRESS i t!I E t_ tion 7044,.Business and Professions Code. 5 REQUIRED TOTAL SETBACK FROM EXIST. C'HE_K 7 a_== CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH i I hereby affirm that there is a construction lending agency for FRONT HN'6,E °�t'I the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ..C.). SIDE ��'!! P.L. 1;4)I'V`I)�Ii 'Hill Lender's Name. , P.C..Fee$ 8�� ;J3LDMA Ref. # 9391 ' j'�1 1 -A M :`u,-: Permit Fee Lender's Address , a I certify that I have read this application and state that the Issuance Fee /� . LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee d• LDMA Perm. # and hereby authorize representatives of this County To enter � y pon the above-mentio d property for inspection purposes. " SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of licant or Agent Date WORKERS' COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I her"y offi hdt I'W� ve'o ejrtificote of consent�ta self insure, or a certificate of Workers'-Compensation Insurance, 07or a certified copy thereof (Sec. 3800, Lab. C.) ' 7R p � COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 1/ij�. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Q Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS / x Date -2 — 7P Applicant CITY ZIP LOCALITY 62 CERTIFICATE OF EXEMPTION FRO WO KERS' /^/ O.OF BLDGS. NEAREST r COMPENSATION INSt SIZE OF LOT F� �`141 NOW ON LOT CROSS ST. f 14 (This section need not be completed if The permit is for one ASSESSOR TRACT BLOCK LOT NO. MAP BOOKPAGE 0,P� PARCEL USE ZONE MA hundred dollars ($100)or less.) - 0 OWNER j/�"/� '✓��/ %�`3 14 N P I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any mannerADDRESS 9��7 dL/VfigT• SPECIAL Ot so as to become subject to the Workers'Compensation Laws. y� CONDITIONS CITY / -/y LF ZIP U' Date Applicant ARCHITECT OR TEL/AGI �3 � js ISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER c>!/V�/i'� Yv N CONST. ZONE f—` Exemption, you should become subject to the Workers' ��.7�U a� �� U Compensation provisions of the Labor Code, you must forth- ADDRESS p � �� V � 7 with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. (J) deemed revoked. CONTRACTOR NO. z LICENSED CONTRACTORS DECLARATION LIC. ' CLASS NO.G_',%(f DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC, '}'' Professions Code, and my license is in full force and effect. CITY CLASS BK PG "'�VAALIDAT�ION �/ // SQ. FT.W/ NO.OF 2 NO. OF CHECK License Number ¢ oYI- Lic.Class SIZE STORIES 2 FAMILIES ONE °� �,��p VALUATION 31307 851.07 Contracto,4a 1 92h" Date DESCRIPTION OF WORK y A D $ ITEMS ' 1 am exempt under Sec. / O //��l 1 p ALTER /� ' V U WI i& E 1 „ �?' B.BP.C. for this reason v""`�' REPAIR $ !( 1 �/ ► /z {HE{.Y� tGic1ai Date: USE OF ,Z/!/J �`��)!lJ VW EXISTING BLDG100 "0 DEMOL Q CHANGE ,0 0 APPLICANT TEL FINALSi nature PRINT NO.OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License 64Z4-V,0 Law for the following reason (Section 7031.5, Business and ADDRESS ; FINAL OUCO-0001 8/15/89 Professions Code): PRESENT y 5087 1 ' AM10:37 BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ' 307 210.37 7044,Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. 1 ITEMS with licensed contractors to construct the project (Sec- ADDRESS t tion 7044, Business and Professions Code). TOTAL 2:10- 37 REQUIREDTOTAL SETBACK ROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for kFRONT {•H�':I�i 210..:r the performance of the work for which this permit is issued {a' E e]�iQ(Sec. 3097, Civ. C.). ��Lender's Name 3 -..1 Permit fee ' L Ref. #� H ' 11000-0001 2/ 1/90 Lender's Address --i 1 certify that I have read this application and state that the �j ! �t►Oi� 1 A� 9�tI o y pp' r Issuance Fee - LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee TDMA Perm. # o nd hereby authorize representatives of this County to enter m the above-menti ned property for inspection purposes. O•+ � a � SEE REVERSE FOR EXPLANATORY LANGUAGE a � a Sig tur of Applican g nt Date T