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Home My Public Portal About9855 FLAHERTY ST_Building__ WORKERS' COMPENSATION DECLARATION of coent to insure, oraafcerti'i cafe of Workers' Comtpennsat on Insurah elf ~; A*P L I CATION . FOR B U I%DING PERMIT -' cr a-certified copy thereof (Sec. 3800, Lab. C.) w COUNTY OF LOS ANGELES* BUILDING AND SAFETY Policy No. /ems Company —❑ /-f/3 FOR APPLICANT TO FILL IN BUILDING Certified copy is hereby furnished. ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS CITY Lk C', r ZIP LOCALITY Date IApplicant VT �-1 � NO. OF BLDGS. CER IFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT" NOWON 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 29-2-5— PARCEL ' 1c1 . hundred dollars ($100) or less.) TEL. OWNER NOW) Z USE ZONE OP !rg/-;1- I certify"that in the performance of the work for.which this SPECIAL permit is issued, I shall not employ any person in any.manner ADDRESS CONDITIONS a so as to become subject to the Workers'Compensation Laws. O T L, CITY ZIP ) d U Date I Applicant {'7"��T�� 'y��Y�� ARCHITECT OR TEL. NOTICE td APPLICANT: If, after making this Certi icate of ENGINEER NO. DISTRICT �ROUP TYPE FIRE PROCESSED BY CONST.' ZONE Exemption, you should'become subject to the•.Workers' v' U Compensation provisions of the Labor Code, you must forth- ADDRESSt;p �/O if a with comply with.such provisions or this permit shall be .1 TEL G STATISTICAL CLASSIFICATION APT. CONDO. ' Z deemed revoked. CONTRACTOR" -.t v �.t N6(8 �F13 _ LICENSED CONTRACTORS DECLARATION LIC. .,r� CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �itJ NO. v� (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and m license is in full force and effect. CITY. �rNl t3R.Pc' CLASS BK. PG. Y J�' VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number �z7z25 Lic. Class �+ �) SIZE STORIES FAMILIES ONE _ - L.�,r ❑ VALUATION Contractor i 'MfV^"�1-� Date r 21) DESCRIPTION OF WORK Lp#J NEW / - -�--� —TI' ADD $ 46 %2100 ❑1 am exempt under Sec. O A� :- ALTER ❑ i B.&P.C.'for this reason vN @ 1'F j Y USE OREPAIR ❑ Date: La �. 0 -,• - EXISTING BLDG. �7 - �, DEMOL 1 Signature APPLICANT _ TEL. Q -�a (PRINT) NO $ s� $!j FINAL I T IM' 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 and ADDRESS FINAL )`.•(h?•zj.. .622 1 Professions Code): PRESENT BY - �•K ;` BUILDING ==t-• t:2 a 45 ❑ 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and , :y;t*I; CIC the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. r { CONTRACTOR NO. ❑ 1, as owner'of the property, am exclusively contracting rt 110100 I E_ ;_(yiI it�j with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code. ADDRESS t ccs--: -- REQUIRED F, r " REQUIRED TOTAL SETB K FROM EXIS: t t t:_ j CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. INE 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.). L'Investigation 4XI Lender's Name, ,; LDAAA -4 Com '/v Permit Fee yf Lender's Address r.•,.! c� �t o I certify that I have read this application and state that the Issuance Fee OS yLDMA P/C# w 1�': ► above information is correct. I agree to comply with all County Fee S ordinances and State laws relating to building construction, Total Fee /!J r LDMA Perm: a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. - ,I EI -<•.I 2 i SEE REVERSE FOR EXPLANATORY LANGUAGE :'! e r I,r Signature of A g licant'or A ent <t 4 w?I T., ...1 4 atT -`�--�_, TMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES_A WM. J. FOX. CHIEF ENGINEER u G 161-9411 U ' L I N G FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY 1 DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING 41 �� t_ T- LA, �S P--T ' �,�, ADDRESS G '1 5- t` /& �'1 � f ,/t y6 LOCALITY _ i^--. `� Y RECEIVED,BY DATE IOFAPP(LL.. DDAAT7E`ISSSUED NEAREST //_' _ �� ✓/'Z - U lq�r/ CROSS ST. BUILDNG C� E A.1 �/ r� `Y •✓ c/�l h-^ �-7 4/d// B 'ADD EISS � 7 L= 1 ///✓'✓�L/ . OWNER L MAIL /a LOCALITY „/'/ •�..."/� ADD RE S5 g NEAREST' TEL. ^ CROSSST. -- CITY W 1✓.� 'Q 1/4 NO. 1Jr0. C..L''. -1 FIRE NO.OF TYPE GROUP/_j ARCHITECT OR _ TEL. ZONE PLANS ENGINEER NO. r BLDG. /lam •�P ADDRESS SETBACK LINE _ APPROVED ` CONTRACTOR i SG d -�-T NOI.• 'pr o•'13�,a E4 BY DATE/ USE APPROVED ADDRESS O C(- L L7 E_vi\AE. -c- ZONE , BY DATE LEGAL DESCRIPTION LOTNO. rj� BLOCK (/ V 7 CORRECTIONS TRACT 4 f ` NO.OF.BLDGSe ` SIZE OF LOT (D Ca` 1�a R1 I NOW ON LOT ��,�,�-, �-,�;�!"r,a, _, _ i „ r l N �r, ,• USE OF _ NO.OF. NO.OF f EXISTING BLDG. FAMILIES ROOMS L (_C C,- IJ.;IF dvca DESCRIPTION OF WORK ^v NEW ALTERATION ADDITION ` p�- 4 14. 1j erl, ;,f. ),•__ ' A REPAIR MOVING DEMOLISH � Sq.FT. NO.OF Z SIZE ROOMS STORIES y WALL •ALAS . I ROOF It t r COVERING S 1 . COVERING 44 1 KAI USE OF NEW BUILDING F l 17 CIA( G / f/0 J � -2 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 REGU T G UILDIN CONSTRUCTION. h/I�W ph 9/9 FRAME: STOPS, SIGNATURE OF BRACING,,BOLTS �`��.. _s`t !/�i /(�Y• PERMITTEE p / LATH, INT. AUTHORIZED AST LATH, EXT. 'C 7 76" 38A 9^48 DBS-3 SOM SETS $ PLASTER, INT. FEE PLASTER,EXT. VALUATION v FEE /�� FINAL / / �,�- 76A638A CE#803 8.63 APPLICATION FOR BUILDING PERMIT,. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DIST T NO. GUPROTYPE - PR C SSED BY FOR APPLICANT TO FILL IN x� CONST. �t BUILDING �— STATISTICAL CLAS FICATION SE ER MAP ADDRESS c� dpi BK ,G CLASS. NO._! DWELL. UNITS t LOT NO. BLOCK WATER ❑ y CERTIFICATE: NOT REQUIRED RECEIVED TRACT �' T NaP "CIRCLE, STATE MAJOR SECOND. OCAS NO. OF BLDGS. o SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLgDG. t TEL OWNER / Sb°j,� BUIL SING EXIST. YARD HWY STREET ,NAME SETBACK f WIDTH ADDRESS - FRONT en".. ARCHITECT OR TEL. ENGINEER NO. SIDE P. L. I ADDRESSd TE SRA®9�® PERMIT It�Q O CONTRAC N Y ®�� U ADDRESS/_3 ,[ jaRADING 0 DESCRIP IO O WORK r) ' W , d NEW ADD ALTER 'REPAIR DEMOLISH SQ. FT. NO. OF- NO. OF Z SIZE STORIES FAMILAES USE OF STRUCTUR W VIOL SIGNA URE OF APPLICANT VALUATION $ v APPROVALS DATE,,--, INSPECTOR'S SIGNUVY RE FOUNDATION: LOCATION d FEE $ '��' FEE $ FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS I (t AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, 'r WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. i CERTIFY THAT IN DOING THE WORK e r AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. 1 /1 ING TO WORKMEN'S COMP ARHTION INS URA LATH. EXT. SIGNATURE O _ HOUSE NUMBER COR- PERMITTEE RECT AND POSTED Y" / tc+ ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STR URALENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.OCASH L,i7922� fPft21 '� D 6.00~ %J-O