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Home My Public Portal About10952 FREER ST_Building__ carrtifatteofworkers'Coo-mpeeof nLo�ionnrsura 'f. APPLICATION FOR BUILDING PERMIT -.rtlfied copy thereof (Sec. 3800. Lab. C.) COUNTY OF LOS ANGELES WILDING ANDFETY No. Company Certified copy Is hereby furrrlshed. FOR APPLICANT TO FILL IN eW. uILD ADDRESS , CertMied copy Is filed with the county bulFding Irupoc- gUILp{NG tion department. ADDRESS 5741 6WTA &ffA Ate Appl lcant CITY ZIP LOCJIUTY CERTIFICATE OF EXEMPTION FROM WORKERS' r No.OF KDGS. COMIO PENSATN INSURANCE SIZE OF LOT NOW ON L ST. section need not be completed if the permit Is for one TRACT ( FJ 3 BLoac Lor NaASSESSOR DOCK PAGE PARCEL dollors ($100)or Fen.) TEL Ify that In the performarxe of the work for whkh thls� OWNER L f,*-J tV0 3-Sd l>SE h10. It is Issued, I shall not employ arty person In any mmr»r ADDRESS [[3 kd to become sublett to the workers'Compensation Laws Akan ARCH ITECT OR TEL CE TO APPLICANT: H, making thh Certificate of IN�a NO Df5TR1C'T TYPE LY mptlon, you should become subject to the Worker' MW vperdcrtion provisions of the Labor Code, you must forth- ADDRESS compFy wked ith duch provWorrs'or this permit shall be An CLASS] Ali. . revoTION CONTRACTOR LICENSED CONTRACTORS DECLARATIONLIC CLASS NO, DYVHL neby affirm that I am Ikprovisions ensed under of Chapter 9 ADDRESS V NO. SEWER rtvw,d g with Section 7000)of Dtvibn 3 of f»Buairws and UC. MAP Code, and my Ikense is In full fora and effect. CITY 3 VALIDATION SO. FIF NO.OF NO.OF CHECK Number Lk (4.: SIZE SIORFS F Ow VALUATION hTpEtor Date I DESCRIPTION OF WORK NEW AS I am exempt under Sec. , ALTER � B.iP.C. for this reason REPAIR : Date: USE OF EXISTING BLDG. 4natur APDL 171 NTJ .! T6 S e OWtER-BUILDER DECLARAMN INT Ir NO �n i eby affirm that I am exempt from the Contractor's License r. AWCAP++ ft for the folloWIng reason (Section 7031.3, Business and ADDRESS ( AVEI essforts.Code): I, as ower of the or om whh 'BUILDING property, my ployees Wages as their sole compensation,will do the work and the strucrixe is not Intended or offered for sale(Section LOC Lm 70", Businen and Professions Code)L MOVING TEL CQNTRAMOR 1, a perty, owner of the pro , am exclusfveFy contracting Na with Ikermd controdors to construct" pro?w{sec-. � .c� tion 7041, Business and Professions Coded 17 CONSTRUCTION LENDING AGENCY M&M YARD HVNY TC PROP 1 1 1 CI t= reby affirm that there is o constnxtion Fending agency for FRONT performance of the work for which this permit is issued P.L. TOTAL 60 - 50 �. 3097,Civ. G SIDE 190.1fj �ses Name LDAM Ref. 0 9.50 I,K,,AddressAddressI P.C. Fee f PVrmN Fee , - 6tify that I have rood thh application and state that thelKxmxe fee 1 1/10/88 to Frrformation b oohed. I agree to comply with dl Caumy Inwsrigotton Fee LDMA P/C� T-L rtes and State Faws relating to budding conMruction, ( Total Fee TDMA Fermi • _,I 1 AM 10:09 hereby outhorize reprosentatkws of this County b order n if,. ed property fpr Irtspectlon purposes- 4 2 3(�► J r f.l`',may /�Ai aF Appltmn,a Agent od. I r3J nT �Ir[JG x- A 6 , � WORKERS'COMPENSATION DECLARATION that I have certificate of cion I nt to self APPLICATION FOR BUILDING PERMIT i fna� ertlficate of Workers' Compensation Insurance, or.o.,grtl ied copy thereof (Sec. 3800;Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nye Compony,_,3TAt7,r= /* C'ertlfled co is hereby furnl�hed. FOR APPLIG4NT TO FILL IN ADDRES&JILDINS' J-- ADDRfSS t�1 Certified copy Is filed with the county building inspec- BUILDING I v �J tion department."` • 1 �q ADDRESS / fr� Date Appllcan r CTTY ZIP LOCILITY CERTIFI OF EXEMPTION FROM WOR ��-� NO. F NEAREST OMPEN,SATION INSURANCE SIZE OF LOTNOW ON LOT (This section need not be completed if the permit Is for one A55a350R hundred dollars ($100)or leas.) TAT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL USE -77 I certify, that in the performance of the work for which this O�MNER NO. permit Is Issued, I shall not employ any person In any manner . p�pInONS so as to become subject to the Workers'Compensation Laws. UTY ZIP Date Applicant fi-3 ARCNTIEC7 OR TEL NOTICE TO APPLICANT: If, after making this Certificateof DISTRICT GROUP TYPE RRf BY Exemption, you should become subject to the Workers NEER NO. T' Compensation provisions of the Labor Code, you must forth- ASS Js with comply with such provisions or this permit Ishall be JEk ( l STATISTICAL CLASSlFICATKxJ APT. deemed revoked. CONTRACT NO -� LICENSED CONTRACTORS DECLARATION CLASS NO. DVAIL UNFTS-±L rbWO.- I hereby affirm that I am licensed under provisions of Chapter 9 /O3 S. (commencing with Section 7000)of Division 3 of the Business and LK_ SEINER MAP Professlona Code, and my license is In full force and effect. CITY 754^/ �da�t/ — CLASS BK F PG VALDATION .3 43 7�i ZE 1, ORIEES S— FaN,MJUES ONES License Number � Llc.Class � 1 0 5.0 A VALUATION # o e o 0 2 3 Conlractar7S� 4 3 / ° IF11ON°F'NO�" E : 1 - 75545 / I am exempt under Sec. ALS , u - 75S45 6 B.BP.C. for this reason S RBAIR = ^ 1 .1.02-88 USE Date: EXISTING BLDG. z$D -'4147 DEMOL a o v 1 z r� r1 Slgrwturo r— � � APPLICJINT T13. RNA t•lti•4.�1 .i OWNER BUILDER PRINT No p,,,n �D p- LSI 1011.T_r I hereby afflmi that I am exempt from the Controctor's LicenseN !TE Law for the following reor}on (Section 7031.5, Business and ADDRESS 1 Z IGttU Professions Code): BUILDING TOTAL 1�►11.r:+ I, as owner of the property, or my employees with ADDRESS I'•••, i' wages as their sole compensation,will do the work and 44LOCALITY � •�,� t it]11.75 the structure Is not Intended or offered for sale(Section • 70 , Business and Professions Code). MOVING - TEL ' I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project ss (Sec- ADDRESS tion 70.", Busineand Professions Code). CONSTRUCTION LENDING AGENCY SETBACK FROM SET BACKYARD I-1wY TOT�PROp LINE ,yID 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 f.. (Sec. 3097, Civ. C.). SIDE r - Lenders Name `• BP.C_ Fee S Permit Fee ^' fir r Lender's Address L I certify that I have read this appliccitlon and state that the .(J issuance Fee O/C i a above Information Is correct. I agree to comply with all County In ion Fee ordinances and State laws relating to bullding construction, Total Fee C/ LDMA perm. / I ' R and hereby authorize representatives of this County to enter fl upon the above-mentioned property for Inspection purposes. o ' O $11 INVEM M*EMANATORY LANGUAGE l�I 'i' Stgnotvre ar Agent D6ft - ".�