HomeMy Public PortalAbout6252 GOLDEN WEST AVE_Building__ I .
WQRKER$'COMPENSATIQN DECLARAT)ON �a c
1 hereby affirm that l have r certificate of��emt — r -` kppucATION FOR BUILDING PERM_ I T
Idre, or a certiElcate of Worker' Compsnsatlon Insurance,ncece,,
or-a-certified copy theredf (Sec. 3800,Lob. C:) ! COUNTY-OF LOS ANGELES SUILMNG AND SAFETY
Policy No. Cpmpany BUILDI
Ceritfied copy is hsfeby fumlahsd. _ FORA [CANT T4 FILL IN App�3
Certtflsd capy'Is filed wl+ the county building Inspec- BUILDING / - -��3 15
�—+ tion department. ADDRESS LOCALTFIC
NEAREST
Date Applicant ' r440, ZIP 9 CROSS ST.
CII2TtFICATE OF EXEN1pTION FROM WORKERS' S 10T NOW O B ASSESSOR
MAPAAM
COMPENSATION INSURANCE MAP BOOK PAGE ZOO
(This section need not be aom feted If the permit is for one TRACT BLOCK ' LOT NO.
hundred dollar'($100)a less, TF1. SPEClA1 }
I certify that In the perforrtioncs of the work for which this NO. CONDnxvgs 'L
permit Is Issued, I shall not employ any-person Ih am/manner TMI-RICT GROUP I TYPE FIRE ]PROCESSM BY O
' V
so 4s to-become subject to th Work I n ADDRESS CONST. U
000',
Date Applicarft16 A CJl1 '� ZIP JQJNOcx.
O
NOTICE TO APPLI : K,, ARCH 4R _ TE TION
after-makJnq thla'Certtflcate�of ��,
Exqmptlon, you should become subject to tfie Vyoiicers' SEER NO. CUSS NO'. UNITS LU
Compensatl8n provisions of the-Labor COdo, YOU must forth- ADDRESS. �_ MAP
with comply wlth such provisions or this permit"shall be / Z
deemed revoked.' TEL BIC;✓[i�PG, VALDAT"
LICENSED CONTRACTORS DECLAFATION uc
I hereby affirm that I am Ircensed under provlslorn of Chapter 9. ADDRESS NO
VALUATFON
(commefi ing wtth-Section 7000)of Division 3 of the Business and UC
( r—
Professloras Codes and:my llcehas is .In fyll force and affect. CITY QA55 r i � o0o,
SQ FT. INC). J.OF NO.OF EOc
-LJcense Numb-6r " Ljc•Clas+� / SIZE AMILES 1/ ONE ,
Contmattor Dare Dff4ZPTK)rl OF WORK ,,EIA,
ADD
FiI am exempt under Sec.
ALTER Q 1RNAL
l B.BP.C. for this reason ' REPAIR DATE
Dots:
USE
OFBaMNd BLDG: DEMOL_ RIH/1�
Slgnimire APPI}(�1HT w
R UCCIARAZIOW - X338
I hereby affirm that lam sx pf from the Con licens0e � f _ .o o..
Low-for the following reason (Ssttlon 70P1.5, Buslnesx:and
-- I
Profestlons dodo):--- 2.• �'4'3'6
BU I U)4 NG
I, as owner of the property, or my ernployees with AQpRESS. - yon• 1 4�'6 3,5
wages as their sofa compensatlon,.will¢o the work and COCA-LrrY: w
Xhe structure.Is not.Intended or ec offered forials 4, Ion .. _ F1
7044,Business and Profession}Cods). MOVING Ta- 8.1 Q—".8 4 ,
.1, as owner of the.prop", am eXgILWvelycontrocting _ NO
with licensed contractors to consiruct'thq project (Ssic- ADDRESS.,
tion 7044, Business 4nd ProfsssIonA Coded �p
CoKtMUCrlQN LENDING ACENC'Y gF fvAC YARD HWY TOTAL K FRCM WIDTH 1
1 hereby affirm that there Is a corflttrucilon lending gooncy for FRONT
the performance-d the work for whlth this permit Is lapAd -P.L'
JSec. 3097, Civ. C: SIDE
'P.L
Lerubr s Name r
Lenders Address P.0 Fee Permit Fes / t ... .
I csrtlfy that I have read this appllcaflon and state that the lawrvice F«
above Inforroatlon Is co4•eet. t'agree to Comply with all County Im Fee _
otdlwnoes dod $tate laws re ng to byllding conslrucnlon, Total Fes 4- �
and h a I of this County to enter
ent
upon e o for Inspection purposes.
@1/1IIIIit 1!O!K)M A TOfr.l,AWWAG4 es
WoRkERS'connl'ENwioN DECIARAT;oN y
I hereby affirm tf;at h�W r ter.Corrp ns cornIns tff .. APPtICATION- FOR, BUILDING PERMIT .
Irnursi, or a certtfftate.of Workeri Corripensatioo Insurance,or a certtfled copy'theregf(Sec 38pb,{pis. C-} COUNTY OF LOS ANGELES BUILDING AND SAFETY
%IIcyNo,— T�Company
F1 Certlfi!d copy Isk�erebyfumished,. FOR APPLICANT TO FILL-IN S._
Certified copy Is filed_with.the-County,building Iru4w- BJJ[Lp{NG r
tlon d"rtrrient. r- LOCAUTY.
NEAREST
AF Icarlt QTY ZIP Qt055 5T.
CSR RCATE OF DaWTION FRAM NQ.OF BLDG& ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOY AoW 0OOK PAGE PARCEL
Is s40atlon need not be cam ted if the USE ZONE
(Th permit fs for anis TRAGI BLOCK LOT tJO.
hondred,dolkxs{;100)or lesk� W, Zev
TEL .� }
I 'cerilfy,that In the perforttlonceof the work for which this OWNER NO. 0011 IONS d
i:*mit Is baled, I shalL not employ,grty persorr Irl.drty monhiw / J D GROUP TYPE FIRE PPLO BY O
saas to b4tome wbrect to the Workers'Compensatron Laws. ADDRESS Ld T• u
OC
Date CITY
ARQ�rrECl OR (ii T ZIP, TEL ATISTKAL TIOI. - . , G
-f}QT1EE TO. APP�IG4Nf:..Ft, after making this Certificate'of Tip: CLASS NO. DWELL UNITS W
Fxemprtl0n, you .should become subject to the Wprkers, p•
f.,Comper»trtion pPf�ovrsloni of ttie Labor Code, you must forth ADDRESS _._ gyy�MAP sA .
with tompty whWsuch proYliTons' or this pWmlt shall.be Z
db"med.revoked. _ - TH_ BK_- PG, VAL')DATION
CONMACTOR NQ.
L�S�pONTRACTORS UECLARATON _
f hereby affirm that I am Ilc&nmd under proyblbns of Chapter9 NO. VAWATION {
'Jowfirneridng with Sectlay70DD)of p"k)rt 3 of the Business and � LIC c,J
Prof�sslops Code,:4nd my llceas�is Irr,full force;and effect.. QTY G� CLASS
SQ. FT. OF NO.OF CHEU
License NumberL�M�6 , LIq-Class �7/• SIZF STORIES FAMLE5 �—
i
Contrdttor r Date J _ DESMPTION OF WORK — NEW
FII ani exempt under Sec' ADD ❑
ALTER FINADATEL
B.&P.C.,for this reason REPAIR ❑
.r /A�/,'Az)
USE OF A
D(tST1NG BLDG. — DEMOL
Slgnafur•n APPUGANT TEL
-BUILDER -nQN I _ NO.
I hef*4 affirm tfwt l.am exempt fro t *Contractoes License L / `
ADDkM
Law forthe following reasoI.n (Section 7031•.5, Buriniss_and
Professions Code): .
❑ ILDM
I, as owner of the property, or my emplofear'With. BuADOizEss
warms dttheir sole tompensatlon,will do the.work and
the sfiutture Is not Intended or offered for sale(Section
70"; Builness and Profemlbhs Codi MOVM Ta-
1; as owner of this property, am exclusively pontrotting Ta-
NO.
with licensed cohhreors to construct this prd(ect (Sec: ADDRESS • o to 9,2 5 uT
tion 7044,_Busihs."and Professions Code).
7�9 TOTAL MT&.Z( p�7
CONSTRUCTION SENDING AGFN - YARD HWY PROP. U WIDTH 0 9j 7•—8 4-
I hereby affirm ftffhere Is a cc)6Fkx7lcn lendln0 4g�Y.f -- - - -
thQ per For mance of Lha.work"for whldt this permit-is Issued ►,
Sec 3097, Ctv.C;).
C Lendeei Name-
Lenders Addrgs' P.C. Fst Psrmtt Fee
1 certify that I have regd this applicdtlon and state that the bsuanc*Fee O _
abovi information it carred. I agree to Comply witfl.all County InVastiyvtlon FM
ordinances and State laws rek3ting to bUllding conslructlon, 7o4al
-arid hereby a ori �
repcesentativof this County to anter .
upon th b petty for lnspection purposes.
Sig UVN=t'CR D01M1AW
5-41c"hir�oiT04!Y 1.A4MAf or Agent DaM �' .•.A/