Loading...
HomeMy Public PortalAbout6309 GOLDEN WEST AVE_Building__---- T-- WOkKERS',COMPE �D"IION - `- °a s •c .. _ y;c. } +�I hevoy 4Wp that l have.p ctrttflcate,dfi c,,o t itq self' � - _ Iris+�e, or a ceritftcate of Warlcers' Compbnsatlon Iniurance, f A PP L I CATION W AV-, I LD I N G ■ E . awl�cdhl c copyYhereaf'(Sec 3800, Lob. C) ,' - - . . COUNTY OF LOS ANGELES ! .. dUILD1HG.►N6 SSSAFETY PollcyNo. .. Company.4-1-L: SlA - - Edc.rlfftbd capy�Oweby fuml+�. , 'w FOR APPLICANT TO FILL IN QUILDING . 3��f , ADDRESS Cdrttfred'copy Is fl,l604ilth the courifyy­bvlldtri9lnsQ&c- - BUILDING -1 }Jon'depGrtment. _ ADDRESS Applicant• QTY cl ZJP �'`` 2T1FItATE OF EXEMPTION FROM WORKERS'•' SIZE of LOT - NNOOW ONBL � -- NE SE. LO/►r - t:•t COAAPR4SA'F[ t4-]NSURANCE a (Th ecl ft iloh nebd not be rorNplefbd If.th4'p!lrmlt;.Ii.,fo_r one - & =a6CK LOT NO. ' , PAGE; PARCH�dl 4'yn&ecldglIprs($WQ)or.(�1.- r: 7 - terttfy.—J. in )h� rQrmaAcQ � MAP t}�'e' K,for w l4h thIs �T F ADDRESST 6� �_ �erf�nnH li issued,l sL�dllynof dihploX Thy rfiln dny mgi{ne# '.gs`to bio6ni tbbje :tot W' o Com'" Lor4 Laws. - ` _ i OOdDff10f15 „ C' aty._.. _ -ZIP - - '� 1 A IJOTT�E-?0 bkW..'If, affbr' makl s tbriTfitwe,of NO.. D151R1(T'. -ORDLA TAPE. 4 HW: _ BY _ :! ARCH rrECT ORTfi . Exon ptfon, lyydu7 7-shoufd becbrne- sub(ect•to tfii•'Workera mf•STZOt4E (iompensaHontprovldaru of lthe-Labpr.`Code,.you must;forth- ADDRESS- with, DDRESS with cprholy.•wltlf;tad-�proylslohs pr this �iermlt.shall be -' - - -- - STATISTICAL.CLASSIFK1a _ APT. I deerred.rwokpd=*: .,.. N''.,1,r ',ti ., _, .. CotvTwu r Ae0vV NO. - L1C QDNTRACfORS DEG1ARAllg11, , - - - - - -- -. - �- -- CLASS NQ D1VELi_F Ury rrS I herst}ryafFirtn that ram licensed ynt}erprov�.lo of,ChQpter 9 ADDRESS. NO. - {�,^�� �5edtlph 70M)pf Dlvlilon 3 of tfie Buslnew and _ _ .- - - - _LK - --, AtR t 1 1?ptgslorp� ayi l YrTY NW Ilcdtlse ,Irj.fult force and'effed. crry CLASS I - - - --YALIDJk }cx -. , S 1• ?,r >! _ .'tip., PG. LrG C)" •,1 w. QF NQ.OF I} STORIES LES f ONE 1.1/K I :41 ti ,aa� ht s r�rv''`., a Te 'sY'1!; 2+1 ?. - DESA IPT}ON-OF WORK-- PEyy. ; 00 00 I arrj exempt urK4r Sec A L N 1- _A-0 ALTER B.BP.C_ for this reciion i- - - 112 6.5,-5 A . -- REPAIR. — , - -- - 115E OF. Nat EXISTING BL DC. - - Ta FltA1 I owN�R-BuILDEIr DEaAm-n0+4 _„- -. --- - - - . �1O_ 'DATE-- .f ' - •h' affllrm4hat�arnexem from-theContractor.'i-Ucense Low f6r the followlndkpason Sectlbd 7031.5, Business andADDRESS 'L, . l i O'."4a:5D)A, Pr�5fe�71bt1rTCOdd). - _ .. -_ ♦:: IL as.owner of iheA property, or-rtty employbes wltlr _ ! r p�0 9.�- W0908 as tf»lr sole compensation,will do the.wofk and ' the.strocture Is not Intended or offered.fdr safe(Section LOfluTY ' t - j -” --7041; neer and-Profeaslons'�gde NKMPgG QDNTRACTOR I, ps owner of the property, am exclusively onniIoc na - _With-llcem6e controclorr to cona"ct-thQ Prof (� ADDRESS -k - "on 7044, "Ines and Professlops C'ode), _ CONSTRUCFfON LENDING-AC - aAac YARD HWY PROP. LItE wl �1 hiteby affirm that there 4 a construction 10ndIrig 6i en..y for --the p6rformance`pf the work-for which thirpermlt is Issued P (Sec. 3097, ClJ. C} 5a _g .Londdrs Name_ - � _ � .� ._. _..... P.L. - - - - - `l '• ', - -- - - - * •-. _..-. a-_ , g y r - -- - - LDMA Ref. ! Lenders Addrer{ T -- - - C Fee P.rmit . I c�rttfy.that I hgve read-thlr-applloafloh and-ifatq_that the - - - Issuance Fee , LDMA Pff- -- �•' _ __ _. bbove Infomtatbn b cdrecrt. I,spree to comply with all County 1--tpatlon Fee L •G Total Fee - c LAMA Perm'. 4 - - -' - Qrdlrtaix artd 5 rQlatln 10 b�rl�dfna_can�tty lop, _ anc[kersby outborize idpresentothnn of this County to enter ; u the Tnt1pned.propertyfarl• on.purposes is Date �I'O�DO'LARIATO[Y LAl10UI►W WCIKERS'COMPENSATION DECLARATIONhrey Insurebor a+tcertlflcattelofaWorkers'Compenstl nolnsuranoce o'r -APPLICATION O R BUILDING P E RM I T a certlfledco thereof(Sec. 3800, Lab. c.) COUNTY OF LOS ANGELES BUILDING AND SAFETY' Polls, Company � � .Certified copy Is hereby furnished; FO -APPLICANT TO FILL IN ADDRESS oCarilfied copy Is filed with the county building Inspec- BUILDING tion department. (o3Oc1 OOLbZKNAWw•5 n�/r LOCALITY 6� kP j�E7��4 � C1 rE41�57 Date Applicant CrIY ZIP CROSS ST. CE IFICATE OF FROM WORKERS' f/ NO..OF BLDGS. ASSESSOR COMPENSATION INSURANCE $IZE O LOT C/d _NOW ON LOT MAP BOOK AGE PARCEL (This section need not be cbm leted If the permit Is for one USE ZONE -0 hundred dollars($100)or less.. TRACT BLOCK LOT IJO. f NOSPE. CLAL ROY 50�`FhG ,o. x4` /f Ota I certify that In the performance of the work for which this OWNER . O permlt.ls Issued;I shall-not bmploy any peoon In any manner ��V Z /hVt�• D STRI GROUP TYPE FIRE BY U was to become Yubject to the'Workers'Compensation Laws. ADDRESS .3 r C7� �T jt v _ 3 CC*4yNNE C9 CITY ��''��� Li� 'ZIP !.'o V O Date��Applicant STATIST1 CAL CLASS I DCAT10N APT. CONDO. NOTICE TO. APPIICANT: If, after making this Certificate of RC �� TEL. Exemption, you should become subject -to the Workers' CLASS NOL—D - UN TS Compensation provisions of the Labor Ccdei you must forth- ADDRESS., - SEWER with comply with such provisions or this permit shall be P deemed revoked. CONFRAC.70R R+lfµg0•\"J QQy► ,0.3 a"`0r�r BK.Gl PG, � VALIDATION LICENSED.CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS "Q h)%. `. K3R U VALUATION (commecing with Section 7000)of Dlvlslon 3 of the Business and DG n Professions Code, and my license Is In full force and effect. CITY SQ. FT. NO.OF NO. OF tH[-0c License Number LIc.Class 1,E t7 SIZE STORIES FAMILIES 0 t (L�%4ftc)-v «�-r�� F, a0 DESCRIPTION OF WORK Mr"o or i 7-V• NEW EJ S Contractor Date I am exempt from the 4Jcensing requirements as I'arh a KrTt C I'4. ADD licensed architect or a registered profesRlonal engineer ALTER FINAL= - aciing In my professional capacity (Section 7051, DATE @uslnew and Professlohs'Code). REPAIR EXISTING BLDG. ����-�1 � DEMOL FINAL Llc.-or Reg.No. Date APPLICANT By ' OWNER-BUILDER DECLARATION PRINT I hereby affirm that I am exempt from the Contractor's License -a[.} Law for the following reason (Section 7031.5,'Busineu and ADDRESS _ Profcplons Cod ) •e _ BUILDING © _ I, as owner of the property, or.my employees with ADDRESS Cf wages as their sole compensation,will do the work.and ' the structure Is not Intended or offered for sale(Section LOGALf1Y 3 4-6.9 A 7U44,'Business and Professions Code). MOVItJG' TEL ONTRA(.7OR - _ - NO. / o.e o o o- ' I, as owner of the property,.am exclusively contracting - �#. with licensed contractors to construct the project (Sec, tion 7044, Business and Professions Gode). ADDR pµ S REW I RID TOTAL SETEIAO(FROM DOST. I D I D ^O O U CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH i 1 hereby afflrrn that there las construction lending agency for FST �D U 0 �" r.Z V�8 O , the performance of the work for which this permit it Issued P.L. �rtf (Sec. 3097, Civ, C.), SIDE Lender's Name P.L \ f P.C. Fee S Permit Fee _ Lender's Address _ I certify that I hav& read this applltatlon and state thyt the s hsuoncu Fee above Information.Is correct. I agree to comply with all County- ordinances ounty nvestlpatlon Fse - ordinances and State laws relating to building construction, Two.l Fee and hereby authorize representatives of this County to r In Ion purposes._ enter i t e ve& [ry ntion r perfQoses. i �1( t ' '1. ��►"��:. SEE teRvcvu FOR lXPLAHATORY LANGLIA6! Slgnaturn of Applicant cr Agent Dot• ms