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Home My Public Portal About5215 FARAGO AVE_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I havea certificate of consent to Self APPLICATION FOR BUILDING PERM-IT ' insure, or a certificate o#,Workers' Compensation Insurance, or a certified copy there (Sec. 3800,plab. COUNTY OF LOS ANGELES BUILDING D SAFETY Policy No` ompany J BUILDING ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS r2 I S �e7 VE ❑. Certified copy is filed with the county building inspec- BUILDING tion department. � ADDRESST"q 1) �c Date / 7J~ RR Applicant ,✓ru"r C=c /�` CITY ` beCPY ZIP LOCALITY �- NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS- SIZE OF LOT ljr} .NOW ON LOT 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.) I TEL. USE ZONE MAP r7 OWNER U 6 NO. I certify that in the.performance of the.work for which this N0 . permit is issued, I shall not employ an erson in an manner ADDRESS //5�� 401,56KA-S A 1/6#/Q-6 -�• SPECIAL B CL P p Y y P y CONDITIONS -°G �" so as to become subject to the Worl�ers' Compensation Laws. ��d� O `��// �\�J/�}p // CITY ZIP Date 1 "f Ap'I"' licant ep � ( � ARCHITECT OR TEL. ty NOTICE TO APPLI ANT: I •after making this Certificate of ENGINEER �WlDISTRICT GROUP CONST. FIRE PROCESSED BY O Exemption, you -should become subject to ,the Workers- ��}} p Compensation provisions of the Labor Code, you must forth- ADDRESS �v! T//l/ �V� "i7- Od_ �U!/ 3 1 N with comply with' such provisions or this permit shall be TEL g STATISTICAL CLASSIFICATION APT. CONDO. Z deemed,revoked. CONTRACTOR �� NO. / ; °Ir _ LICENSED CONTRACTORS DECLARATION LIC. �•- CLASS NO. - DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.J /3 X, LIC. QQ SEWER MAP {{LI®A TTyye+ (commencing with Section 7000)of Division 3 of the Business CIN j /� CLASS /�' Z� VR and Professions Code,and my license is in full force and effect. BK. PG. SQEFT STORIO. OF NO.ES FAMILOIES ONECHECK TOTAL 129.I� License Number l Lic. Class `/ VALUATION l CHECK nn Contractor �P��P Date f Z '! r DESCRIPTION OF WOR Q' f J(6/V � NEW ❑ s V CHECK 129°V7 ❑1 am exempt under Sec. PLAIJ ( Q ADD ❑ ' CHANGE ° � ALTER ❑ B.&P.C. for this reason USE OF �- REPAIR ❑ OLID^ D01 811/29/809�•fp�°v9 Date: EXISTING BLDG. DEMO/L ❑ U w� APPLICANT (PRINT) NO.f�I=� �� - / FINA 1 t7lliC �`ft�. Signature ' OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason"(Section 7031.5, Business andADDRESS FINAL �s Professions Code): PRESENT By . ._ .......i._... .. .. r q G ❑ I, as owner of the property, or my employees with ADDRESS G2-` A&-, VE T°s wages as their sole compensation,will do the work and \" -;- the structure is not intended or offered for sale(Section LOCALITY 33017 1L°ter_ 7044, Business and Professions Code.) MOVING TEL. r El1,I, as owner of the property, am exclusively contracting CONTRACTOR NO. 1 F with licensed contractors to construct the project (Sec- ADDRESS TOTAL 6 m tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. L� r YARD HWY CHECK 16i°it CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby-affirm that there is a construction lending agency for FRONT t•* the performance of the work for which this permit is issued P.L. - {3E .00 (Sec. 3097, Civ. ). n SIDE t i'L I LRI�L�/ C 071o1J P.L. r 0000-000 j�9� �} 'ji /rte � lender's Name. _ LDMA Ref. # � '� +) t•~ t � / /� P.C. Fee$ Permit Fee s i Lender's Address.& `` n • �j c� L� 7432 1 AM 11:2 a I certify that I have read this application and state that the ! Issuance Fee •-/ 0 LDMA P/C# f above information is correct. I agree to comply with all County Investigation Fee 8 ordinances and State laws relating to building construction, lTotal Fee a LDMA Perm. # a and hereby authorize represe 'ves of this County to enter =;�g ntioned erty for inspect] n purpo e a SEE REVERSE FOR EXPLANATORY LANGUAGE pplicant or'Agent - Date WORKERS' COMPENSATION DECLARATION I hereby t insure, oraafcertif care of Worke s' Comtpensation eInsura cent to self* '"APPLICATION FOR BUILDING P E RIlA I T or a certifiedcopy there.F AlSec. 3800,•Lab. C.) COUNTY 'f PolicyNo�D�J ompany T-411 COUNTY OF LOS ANGELES BUILDING AND SAFETY F-1Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS 5-2-115 � Q Ave Certified copy is filed with the county building inspec- BUILDING r. Ave tion department. ADDRESS ,62ICA d Date I / Applicant /� `1 C. �f • /'�f CITY TEh4PLF G7 zip e-A LOCALITY ` CERTIFICA E OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT r:) V50's. . NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT JJ!+JJBLOCK A LOT NO. MAP BOOK PAGE PARCEL TEL.P Q 'p USE ONE MAP 1 certify that in the performance of the work for which this OWNER NOW-4171 2 NO. permit is issued, I shall not employ any person in any manner SPECIAL so as to become subject to the Worjkeers'Compensation Laws. ADDRESS�J2�W. NI,�vN ti ' CONDITIONS r'C�C�✓�- 0 Date Y, Applicant /Jr •�� 1' CITY ALNaMB9A ZIP Sty ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of &B._ DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER ll A.So. NO. �21i$ Exemption, you should become subject to the Workers' CONST ZONE ��v U Compensation provisions of the Labor Code, you must forth- ADDRESS . `GO 0 ANb& with comply with such provisions or this permit shall be TEL. TTI a' deemed revoked. STATISTICAL STICAL CLASSIFICATION APT. DO. Z • CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC CLASS NO. a3� DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS �7_ VALIDATION SQ. FT. NO.OF NO. OF t CHECK BK. C� pC'' f Tir License Number -"+ 7`� Lic.Class' �/ SIZE' x� STORIES FAMILIES 1 x 3 ONE V 4z'r it i VALUATION Contractor 1 t/+-C Date �� DESCRIPTION OF RK NEW S2 II11 ❑ I am exempt under Sec. �-. ��f �N�1_'I bdlvl� ADD ❑ $� ALTER �' B.&P.C. for this reason REPAIR ❑ $ $� . u �' o o ,611 5,8 3 50 Date: USE I QQ��yy DEMOL ❑ EXISTING BLDG. 1" Signature APPLICANT TEL. FINAL 0 •0 1 -88 OWNER-BUILDER DECLARATION (PRINT) hP PESI �}pef�, NO '2 DATE I hereby affirm that I am exempt from the Contractor's License /, p,-� ADDRESS 6i@ 1w� m DZ.4i Ib`—, I �_4 1 A q Law for the following reason (Section 7031.5, Business and '" � FINAL • Professions Code): \VPREbENT By ❑ BUILDING $ ("i A I, as owner of the property, or my employees with ADDRESS ��'�� A AVEav� a wages as their sole compensation,will do the work and 3. ACCT`g the structure is not intended or offered for sale(Section LOCALITY 00 3 3317 ..735.01.1 7044, Business and Professions Code). MOVING TEL. ITEMS. ❑ 1, as owner of the property, am exclusively contracting [AD NTRACTOR NO. t 1 . - with licensed contractors to construct the project (Sec- ADDRESS a/ �/ ��l�a� +�--�° -�� tion 7044, Business and Professions Code). QUIRED TOTAL SETBACK ob ��. 7�5 [I[i CONSTRUCTION LENDING AGENCY T BACK YARD HWY PROP. LINE WIDTH a h M '' I hereby affirm that there is a construction lending agency for RONTARGE aLI� the performance of the work for which this permit is issued .L. ?O T,(Sec. 3097, Civ. C.). ��, _ ,��° y / DE a Ll iLlllG�c�vrE( �G( L. I jLender's Name� ��' �Gt-t. Fee$ V13 Z .� 89 LDMA Ref. # CICI�tI—CtOl1 12111/ 'W Permit Fee ' ' °si7 Lender's Address ® 7 1 AM1I 3 ' g I certify that I have read this application and state that the Issuonce'Fee /, Jr� LDMA P/C# o above information is correct. I agree to comply with all County Investigation Fee o ordinances and State laws relating to building construction, LDMA Perm. # R and hereby authorize reprep tatives of this County to enter Total Fee upon the b ve-mention operty for inspection urposes i // SEE REVERSE FOR EXPLANATORY LANGUAGE C/Signature of Applica' or Agent Date WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT `fl - -insurt7, or a certificate of Workers' Compensation Insurance, or o certified copy ihereofoec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. &Company �10 ^� BUILDINGid (��( Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS a ❑ Certified copy is filed with the county building inspec- BUILDING tion department. n ADDRESS 1 t' E l�`d IAcr�i/� C _ Date 11.� � T'�� Applicant �S� CITY 2 �� c ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one _ ASSESSOR hundred dollars($100)or less.) TRACT / BLOCK LOT. MAP BOOK PAGE PARCEL '( TEL. c USE�NE MAP OWNER l C ti NO. COQ I certify that in the performance of theworkfor which this NO. _ permit is issued, I shall not employ any person in any manner ADDRESS 04� L�G�t,�( '(�c7ti p SPECIAL so as to become subject to the Workers'Compensation Laws. CONDITIONS C1 CITY ,��, wtr�rl.ti10 t4A ZIP 191, � Date Applicant Q' NOTICE TO APPLICANT: If, after making ARCHITECT OR TEL.this Certificate of DISTRICT I OUP I TYPE FIRE PR7— er'),,f BY O ENGINEER NO. Exemption,, you should become subject to the Workers' CONST. NE U Compensation provisions of the Labor Code, you must forth- ADDRESS W with comply with such provisions or, this permit shall be TEL. deemed revoked. p STATISTICAL CLA FICATION APT. LND0_ fn CONTRACTOR 1It lA iCkAr NO. roU / LICENSED CONTRACTORS DECLARATION _ CLASS NO. DWELL. UNITS- C. LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS2i 2 r,5-P& NO. (commencing with Section 7000)of Division 3 of the Business and SEWE P i CoLIC. ^ Professions Code, and my license is in full force and effect. CITY lE41 L�Vf',�1 �� CLASS C-Z� BKOJ�. VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE OV STORIES FAMILIES ONE NEW ❑ VALUATION o0 Contractor Date DESCRIPTION OF WORK $ / �OQ ❑ I am exempt under Sec. Wl p(�^I ADD ❑ , ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL EXISTING BLDG. Signature APPLICANT TEL. q y FINAL OWNER-BUILDER DECLARATION PRINT r - NO. t(J G/O DATE I hereby affirm that I am exempt from the Contractor's License 8 5 9.�1 a Low for the.following reason (Section 7031.5, Business and ADDRESS (Z ,&,SOA WA �/(I,CrNt� P. C(J- FIN Professions Code): PRE ENT By # 0 0 0 0 o t1 ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,.will do the work and 1 0 0 6 Q 5 0 the structure is not intended or offered for sale(Section LOCALITY ' o 0 0 6 p 5 p c�� 7044, Business and Professions Code). MOVING TEL. ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. 121 4-87 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIREDTOTAL SETBACK FROM 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. Lender's Name LOdLDMA Ref. N Le ' ddress P.C. Fee$ Permit Fee J f ' 3 g at 1 have reo thisapplication and state that the Issuance Fee LDMA P/C N o rmotior is car ct. I agree to comply with all County Investigation Fee o; and S to la s relating to building construction, Total Fee ;�� LDMA Perm. # y outh r ze r resentatives of this County to enterave- \do property for inspection purposes. S5^n� J 0� j r�� rhe �JV r /��(,,1/�) SEE REVERSE FOR EXPLANATORY LANGUAGE cel�f Com(/J(/1 Signature of Applican or Agent pole � �-+ �� `Sr__VCC_., WORKERS' COMPENSATION DECLARATION insure, oroafcertif cathat te of Worke s' Comcertificate pensation eInsuran e, APPLICATION FOR BUILDING PERMIT or a certified copy there o (Sec. 3800, 1.2. , C,) �J,, COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No(.O _ Company " rf �„' El Certified coy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS G r Certified copy is filed with the county building inspec- BUILDING I S� Q tion department. ADDRESS vC L Date �2 % Applicant 13ruc� 'Gt N. f CITY U ZIP LOCALITY CERTIFICAT6 OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK A LOT NO. MAP BOOK PAGE. PARCEL USE ZONE MAP I certify that in the performance of the work for which this OWNER E �'�' NO. permit is issued, I shall not employ any person in any manner SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS 1 1-I/TI _� CONDITIONS U T CITYALf ZIP Date / '� Applicant ��' "' ` At "`'" ARCHITE T 0 NOTICE TO APPLICANT: If, after making'this Certificate of DIST ICT GROUP TYPE FIRE PROCESSED BY O ENGINEE CONST. ZONE H Exemption, you should become subject to the Workers' V Compensation provisions of the Labor Code, you must forth- ADDRESSr ` _ _.._. . �, with comply with such provisions or this permit shall be r 'TEL. 71STATISTICAL CLASS( (CATION ,APT. CONDO. t t/3. deemed revoked. CONTRACTOR NO. - / 4 1°� LICENSED CONTRACTORS DECLARATION UC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. j� 240 (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP {{ Professions Code, and my license is in full force and effect. CITY CLASS BK: �/ TOT&IDA 1431.0-3, -0f� SQ. FT. (( NO. OF NO. OF CHECK CH u 4S 1 a CI_, License Number / z� Lic.Class SIZE T STORIES 7/ FAMILIES ONE `'nC r� p w� NEW VALUATION CHANGE °t7i7 etl Date DES RIP ON OF W RK ADD $ z Contractor �j� ( � 1 am exempt under Sec. " -" "" / .0000-0001 1./11/89 ALTER ') 8"� B.BP.C. for this reason REPAIR Q $ 7427 1 AM11:26 Date: USE OF EXISTING BLDG. DEMOL ❑ 1 Signature APPLICANT TEL FINAL g OWNER-BUILDER DECLARATION DATE ACr.T°9' I hereby affirm that I am exempt from the Contractor's License ,x007 514.5 i Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): By 1 ITS Q BUILDING EM I, as owner of the property, or my employees with ADDRESS . -- TOTAL �iii- �� wages as their sole compensation,will do the work and H the structure is not intended or offered for sale(Section [ADDI LITY CHECK 514 r0 7044, Business and Professions Code). ING TEL. -t °-I I, as owner of the property, am exclusively contracting TRACTOR NO. CHANGE "" °01+ . with licensed contractors to construct the project (Sec- Ili II11IG 4� tion 7044, Business and Professions Code). ESS UIRED TOTAL SETBACK 0000-0001 12�11�8 CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP. LINE WIDTH V `3 I hereby affirm that there is a construction lending agency for ONT �1 the performance of the work for which this permit is issued . 7428 1 AM11:26 (Sec. 3097, Civ_ C.). E s7 . Lender's Name Ally �'n ,, ^ }► ,{ m w�jt Q-;D L /I fee$ o Permit Fee �-- k LDMA Ref. # Lender's Addressyn.[i�f V� ri 3 g I certify that I have read this application and state that the '^ V` Zoe 7" Issuance Fee :"✓ r� LDMA P/C# o above information is correct. I agree to comply with all County Investigation Fee a i. o ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter Total Fee s LDMA Perm. # m upon the above-mentioned perty for inspection purposes. m SEE REVERSE FOR EXPLANATORY LANGUAGE n Signature of Applic 't cr Agent Date WORKERS' COMPENSATION DECLARATION -1 hereaffirm tHat I have a certificate ofto insure, or a certif cafe of.-Workers' Compensation consent Insuran elf APPLICATION FOR BUILDING PERMIT or a certified copy there Sec. 3800, Lab. C. / COUNTY OF LOS ANGELES BUILDIN D AFETY 7 tl•� Policy No�Dompany BUILDING El .Certified copy is hereby furnished.• FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING 521 r C, tion department. 1 ADDRESS . 7 r'T'S pAb o �A Y I+ Date f Applicant � `t" "� CITY P� C1� ZIP �A LOCALITY G" pp NO. OF BLDGSi, � �-�•• NEAREST CERTIFIC TE OF EXEMPTION FROM WORKERS'.• SIZE OF LOT'154 5. NOW ON LOT V A(ZAA r CROSS ST. COMPENSATION INSURANCE � ASSESSOR 0 +117 (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. 5 MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. OWNER LN �F� cSf NO. USE ZONE MAP --7 1 certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner ADDRESS � �S ^� CIAL ONDITIONS 4 so as to become subject to*the Workers' Compensation Laws. D 6 0 z/Ye /1 p CITY ZIP / Date 122/17 Applicant �I M� �L, �'�T ARCHITECT TEL. �� DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPL CANT: If, after making this Certificate of ENGINEER �� NO. h CONST. ZONE Exemption, you should become subject to.the Workers' Ci Compensation provisions of the Labor Code, you must forth- ADDRESS ( Q /N r_� (� a v with comply with such provisions or this permit shall be. TEL. �/ STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTORS NO.a LICENSED CONTRACTORS DECLARATION `lI/ LIC. CLASS NO. DWELL. UNITS mmod I hereby affirm that-I am licensed under provisions of Chapter 9 ADDRESS ��. GLV d NOS - S 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 CLASS BK PG I Z—f 1'VALIDATION Q SQ. FT NO. OF NO. OF' CHECK T License Number Lic. Class SIZE I STORIES 2 FAMILIES ONE VA UATION F �" ! °g Contractor / OJC Date r J� DESCRIPTION OF WORK d I F4(A'r10Al Th NEW Els 1� �� 30' 90.TEMS Contractor am exempt under Sec. LPA) C4 tG� 1 � 2 jj ADD 11U Poo. I Il � ALTER 10 B.BP.C. for this reason REPAIR F-1S TOTAL 90 . 36 Date: USE OF CHECK �r �_ EXISTING BLDG. DEMOL ❑ L�Al� 0.'36 Signature APPLICANT TEL. FINAL �•HrN(�E .00 (PRINT) //P/%�(J NO. DATE OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License ADDRESS - Law for the following reason (Section 7031.5, Business and FINAL +- Professions Code): PRESENT By �JUOtI_CI31 1L!1 f/� ` BUILDING 2A F "+ i M i t° CY ❑ I, as owner of the property, or my employees with ADDRESS `F'i 1 Ai 11°2t` wages as<their sole compensation,will do the work and LOCALITY 1' t El1; structure is not intended.or offered for sale(Section ACCT. 7044, Business and Professions Code.) MOVING TEL. tF :1:T a I; as owner of the property, am exclusively contracting CONTRACTOR NO. °T with licensed contractors to construct the project (Sec- 3307 116.V- tion 7044, Business and Professions Code.) ADDRESS {{ ITEMS p� REQUIRED TOTAL SETBACK FROM EXIST.,, 1 LEMS CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT TOTAL 116- 82 the performance of the work for rwhich this permit is issued P.L. (Sec. 3097, Civ:C. � J R SIDE CHECK ii;t.°f.� Lender's Name. Ifi9au(241A P.L. CHANGE !� LDMA Ref. # /��,p �� '• U VV P.C. Fee$ Permit Fee 2 Lender's Addressl�l[a ��yVVV n I certify that I have read thisapplication and state that the Issuance Fee / `' LDMA P/C# , I-t � —, 1 12/11/0.9 o . ' 8 above information is correct. I agree to comply with all County Investigation Fee ' 1 � 11°„t` 0 ordinances and Stategrer lating to building construction, Total Fee LDMA Perm. # °+==` < and hereb authorizentatives of this County to enter upon t ab�ve-me toperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or A nt Date