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HomeMy Public PortalAbout6243 IVAR AVE_Building__ WORKERS'COMPENSATION DECLARATION �e insure+, oraafcemif cote'of Workersrt6ornpensat on Insurance, ' �'�l1� LI O O O M LM ] PC G3Gw�1 ood'certified copy'thereof.(Sec. 3800`Lab. C.) Policy No: Company 1' COUNTY OF LOS ANGELES- BUILDING ea ND SAFETY Certified copy is:hereby:furnished.' FOR APPLICANT TO FILL IN aooRess ..Certrfied copy is filed with the county building#,inspec- ' BUILDING y1 Tion department., ADDRESS' ;� �TJ Uri - LOCALITY �/ NEAREST .Date Applicant CITY 1� �� C—/'T f ZIP 0 CROSS ST. CERTIFICATE OF'EXEMPTION,FROM WORKERS' ��Q X �0 NO. OF BLDGS., i ASSESSOR COMPENSATION INSURANCE' i ,SIZE OF LOT NOW ON LOT / MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one G �/ USE ZONE MAP hundred dollars ($)00)'or less.) - TRACTS 10 —t /yBLOCK � �0 LOT NO /� n NO. © OWNER Q. V. �R I? CJ NO.r f4� / SPECIAL - 13 7d1�' CONDITIO ' 11 . I certify that in'the performance of the work for which this P permit is issued;1 shall•not employ any person-in any manner TYPE. FIRE _ DISTRICT [GROUP PRO SED BY O so as twbeco'Me.subjectao the Workers'"Compens ion Laws. ADDREi(Glnrt�cy��13)_/Y y�Y /�- TrV y� � CONST., ZONE CITY Evnt��-4- j1 Y ZIP' r�4J [/ - j 3. �- ® . Date Applican STATISTICAL CLASSIFICATION PL CONDO. U .NOTICE'TO APPLICANT: If, after making this'Certificate of ARCHITECT OR TEL. / 9 ENGINEER NO. CLASS NO. / DWELL. UNITS W Exemption, you _should become•subject to the Workers'' Compensation provisions.of the-Labor.Code, you must forth- - ADDRESS . SEWER MAP with.comply'with such provisions or this-permit be deemed revoked. TEL. BK. i/1 PG, VALIDATION CONTRACTOR NO. l LICENSED CONTRACTORS DECLARATION tit LIC. I hereby affirm"that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of'Divisiom3 of the Business and LIC. Professions Code, and my license'-is in full.force and'effect. CITY. CLASS. $ - SQ: FL NO.OF NO. OF CHECK 'License Number Lic.Class SIZE STORIES FAMILIES - c ONE i DESCRIPTION OF WORK /Y�0S J I. U3 NEW" ❑ $ Contractor Date vv J 11 ❑ I am exempt under Sec :,;) I\!7T 6- kc H !7S Lt V N G ADD ❑ B.&P•.C. for-this reason ot'Jrn 1.7-i`611) ,: EPAI ALTER ❑ FINAL _ R R ❑ DATE USE OF Date: DEMOL FINAL EXISTING BLDG. ❑ BY .� � APPLICANT.n r Q p v o 1 TEL. p Signature PRINT Tt 1. � +J r'h- _C NO. O,O6 7-7113 . OWNER-BUILDER DECLARATION�;, I hereby affirm.that I am exempt from the Contractor's License. ADDRESS 173 .Q Es, I G .PL Gtr Law for-the following reason (Section 7031.5, Business and Professions Code): PRESENT O. BUILDING 0 2 7,G �i 1, as owner,of the property, or my employees with 'ADDRESS' wages as their sole compensation,will do the work and ffr o o the,siructure is not intended or offered for sale(Section LOCALITY e 7044, Business and Professions Code). o MOVING TEL. 2 00 (( Q. Q' I, as owner of the property, am.excjusively.contracting CONTRACTOR NO. r j m o,o C _ with licensed contractors to construct iFie project (Sec- �-I-�,'�0 CT)-- tion tion 7044, Business and Professions Code). ADDRESS' 9 REQUIRED TOTAL SETBACK FROM EXIST. O 4.O°5—H G• CONSTRUCTION LENDING AGENCY SET BACK YARD Hwv PROP. LINE WIDTH I hereby affirm that there is a construction lending agency'Tar FRONT the performance of the work for.which this permit is issued P:L: (Sec. 3097, Civ. C.).' SIDE o ' Lender's Name P.C.:Fee$ Permit Fee 30 Lender's Address _ - • > I certify that I have read this application and"state'thot the Issuance Fee above information is correct. I agree to comply with•all County Investigation Fee r1 g ordinances and State laws-relating to building construction, Total.Fee V S I&u and hereby authorize representatives of this County to.enter " m upon the above-mentio ed p�aerty for-inspection purposes. 3 a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature 6 f pplimnt or Agent Date l' WORKERS'COMPENSATION DECLARATION aWorkers' a certificate 6f _ nn 1.+insure, orafceerrt fi ate of Wconsent f orke s' Compensation InsuranceL�1 �� Ll��'lJ O 0 O.0 DH.S. '� RLI V LI or o'certified copy thereof (Sec.3800, Lab. C.) IC0�1fS C Com �p 'COUNTY OF LOS ANGELES BUILDING AND.SAFETY y ' P olicNo. pang `/l BUILDING a Certified copy is hereby.furnished; FOR APPLICANT TO FILL IN ADDRESS.' " G : Certified,copy is filed with',the county building inspec- BUILDINGPf tion department..: t t/ ADDRESS '_ LOCALITY J ._ v" NEAREST Date. pplicont, r CITY. i�. ' �� ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM=WORKERS' NO.OF BLDGS,; ASSESSOR COMPENSATION INSURANCE SIZE OF.LOT NOW ON LOT "MAP BOOK PAGE• PARCEL (This section need.not be completed if,the permit is for one n USE Ne. MAP hundred dollars ($.1.00).or les's;)' TRACT �' BLOCK ' LOT NO. NO. C• /� TEL. a ISPECIAL y =I certify that in the performance of the wotk for which this OWNER _?• �K (C5N0. CONDITIONS,_ 9L permit is issued, f sADDRESS �hall not employ any person in any manner 3 /7 DISTRICT GROUP -CON TYPE' FIRE PROCESSED-BY • O 'so as to become'subject to the Workers'Compensation Laws. ST/, ZONE ; -fes Cr rt [[►► � V r 13.' Date- Applicant CITY' +° ZIP STATISTICAL CLASSIFICATION APT C DO• t9RCHITECT OR TEL (� NOTICE:TO APPLICANT: If, after making this Certificate of ENGINEER ' ( ' (� NO. CLASS NO. DWELL. UNITS W Exemption,, you should become;subject 'To the'WorkersIIL Compensation;;provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with' such provisions "or. this permit shall,beF deemed revoked. TEL. ' BK. PG, CONTRACTOR (JjTO/� r. .,NO.Y VALIDATION. LICENSED CONTRACTORS DECLARATION LIC Thereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �'TQ�-tea NO. 1 / .LZ VA ATIOP! (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my License is in full force and effect. CITY (tel C( 'l-_ CLASS $ (/ �'� . SQ. FT: NO. OF NO:OF V ..CHECK License`Number �� Lic.Class / SIZE STORIES FAMILIES ONE 7.0 8=4 A 1 . �/ ���„ n NEW $ Contractor -7t�/_G(l.(,C"b ate S.�-01 DESCRIPTION OFWORKlv\ nn. >> ® # oto 0 o-23 Ilam exempt.under Sec ® IJQ IT( .� 1� ADD ALTER FINAL 2 6 5 8 5 B'.BP.C. for this reason �(�: !>�f (_ E ,. . R USE OF PA o o'2 IR ❑ 85� 'DATE FI ' 6 Date, DEM !. EXISTING BLDG. ,- •`:': - B n ' Signature _. El APPLICANT TEL. 0 Q�.�, 8 8.. OWNER-BUILDER D LARA IO PRINT-) NO. I hereby affirm that I,am exempt from the Contractor's License Law for the following reason (Sect ion'7031..5„Bus iness and ADDRESS 'Professions Code): PRESENT El I, as owner of the property, o. rny.employees with ; BUILDING SS 3 -� wages as their sole compensation,will do the work and` qq a-•'' the structure is not intended or offered for sale(Section LOCALITY. Q► J �' r 7044; Business and Professions Code): MOVING TEL`:' 7 5 Q,9 A CONTRACTOR NO. I.as owner of.`the property, am exclusively contracting with licensed contractors to con'stru'ct the proleci.(Sec= tion 7044, Business-and Professions Code). ADDRESS I ®'` �j 2 = REQUIRED, TOTAL SETBACK FROM EXIST: ”'`- G c.Y CONSTRUCTIONlENDING AGENCY SET_BACK '_ _YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency FRONT - 7,2 2 8 7 the performance of the work for which this'permit is issued 0.L, D (Sec. 3097, Civ. C.). SIDE t m 'P.L. _ v Lender's Name - - Lender's Address P.C.•Fee$ PermiYFee OF— I certify that I have read this application and state that the Issuance Fee above information is correct:I agree to,comply with.all County' Investigation Fee g .ordinances and State laws relating to building construction, Total Fee' " u ' and hereby authorize representatives of this County to enter upo bove-rn d property spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Signature of Applic nt or Agent .Date ®s WORKERS' COMPENSATION DECLARATION lrhereb affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, A P IP U C AU O M FOR [O U L D N' P IERM T or a certified copy thereof (Sec. 3800, Lab..C.) j ' COUNTY,OF LOS ANGELES ` "_> -_BUILDING'AND SAFETY.,, .•�, `. Policy No. Company BUILDING ` F-11Certified copy is hereby furnished. . FOR APPLICANT TO FILL IN ADDRESS �p r2l(3• . . ❑ Certified copy is filed with the county building inspec- BUILDING / /� tion department. ADDRESS ({�� /vim �/fTIL _' �, Q♦,M11 �'`e CI CVl. V Date Applicant CITY � ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ! NEAREST COMPENSATION INSURANCE SIZE OF LOT x Go NOW ON LOT CROSS ST. O (This section need not be`completed if the permit is for one510 ASSESSOR hundred dollars ($100)or less.) - TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL TEL. p USE E MAP / I certify that in the performance of the work for which this OWNER9_8NO. O 7 NO. ��Z (� IF I permit is issued, I shall not-employ any person in any manner )� LJrnSPECIAL t, so as to become subject to the Workers' ompen ati n Laws. ADDRESS av � t- �T� '� CONDITIONS Q` Q p CITY �� (_ R ZIP V UV Date V v Applicant ARCHITECT OR TEL. Q NOTICE TOAPPLICANT: If, after making this Certificate ENGINEER NO. of. DISTRICT GROUP TYPE FIRE PROCESSED BY JL ' CONSTt J. ZO V Exemption, ,you should become subject to the Workers' U I/ Compensation provisions of the Labor Code, you must forth- ADDRESS t �n with comply with such.provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CON DO. deemed revoked. CONTRACTOR NO. 2<1 Z' LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 111 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 BK VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE NEW VALUATION DESCRIPTION OF WORK U Contractor Date - � $ f�2A1 c'O C O LI of� ADD ❑ I am'exempt under Sec. ALTER ❑ B.BP.C. for this reason I REPAIR ❑ $. Date: USE OF DEMOL EXISTING BLDG. BLDG. 7 Signature_ APPLICANT TEL. FINAL . G OWNER-BUILDER DECLARATION PRINT NO. DATE � ^ 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5; Business,and ADDRESS FIN Professions Code): PRESENT B �y I`e1�AL I, as owner of the property, or my employees with BUILDINGADDRESS' wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY r D 7044, Business and Professions Code) N MOVING TEL. A 0 211 A ❑ I,.as owner of the property, am exclusively contracting CONTRACTOR O. ` with licensed'contractors to construct.the project (Sec- #;o o' 0 0 0 ADDRESS tion 7044, Business and Professions Code). O REQUIRED TOTAL SETBACKFRi i .°: 8 °.4 9,8 CONSTRUCTION LENDING AGENCY. SET BACK YARD HWY PROP. LINE WIDTH' I hereby affirm that there is a construction lending agency forFRONT o`,o,o = the.performance of the work'for which this permit is issued P.L. --4.9'8 (Sec: 3097, Civ: C.). SIDE P.L. 07, 1 .888. Lender's Name m P.C. Fee$ Permit Fee 3 LDMA Ref. q Lender's Address oI certify that I have,readthis application and state that the Issuance Fee .�V LDMA P/C fl above information is correct. I agree to comply with all County Investigation Fee o ordinances and State laws relating to building construction, Total Fee LDMA Perm. q and hereby authorize representatives of this County to enter m upon the ab e-mentio d p perty for inspection purposes. aaA4U—) `SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A plicant or Agent Dat t�At7�A ns.t n•a� ._. - :� , �:�:.�'a#:.4Yr���:�:�:; ..•'fi'i'.il�;+.l�'-^ .- APPLICATION FOR .BUILDING PERMIT . . -, 1 DIVISION OF BUILDING AND SAFETY tvrLDr+w N gR[as ' -:• Depratmrnl el County Lngtarer County of Los Anq.lss .'; WM.J. FOX.COUNTY CNOIN[[R ' e` eAssATT O.ORlrrl N.suw?or eumolR• NEAREST'^'..J.. ., , ROSS yr, v s FOR APPLICANT TO FILL IN DItTRIc oRou► !cw[+a w �� TY►i �.• t 'w i ADoncf! !J�7. 1- �lr� wA► STAT[ �+, �•r vwedt .200 1AMWY LOT No,y76c,ry t�n��f_,�,?' DIOCK v: -s►eelAL- N IT Cts ,M• TRACT �J-7e F Ol1f ,rte, 91I[OT-� Fy� NOW�ILQJ� 1VILDfMO YARD MWY iTMR NAM[ 0T E •''�"' Us[Vr [T�AcIc WIDTH ' [%ISTIN'O eLDO. rAOIfr ... ` O R MAIL R ADOR .- • - l I �� TEL 1 [YNtT ` 'S T.'?0VSTRIAL ��•Ht CRY NO. Ttt' 2 t-f0-LL'It. UNIT 6 —''LIC PLO-7 - w" ARCMIT'[tT T[L .. [NOINCLR' NO. ' A/T '�'h}IITe 7 AVON..ALT.. •;C+�+— ADDRESS -tA" t� ,( COrunfCIAL 8 LISCEL '.y. CONTR �� /`} 2 / _ TCL rlt �* - :.=-:INSPECTION RECORD ; ADDRESS S F-7 7—It OF WORK NCW AO AVER REPAIR DEMOLISH off it NO. r / FAO4 p�[ii �„''•y _ or..M fly/%i FTORIO . Us[OF aTRUCTV R[ ','y� SIONATURt Or `�'• •"" .. mac: AM— is NT DDR[!O _ ': yrA + _ _ -.,A= i _ OAT[ IRIILC,—S Olde 4TLRt '�0 t." s j`••_, L! ;•-?:ai+C :' P.c_ S o0 Mr r XKK16 WAtfTZRIALST N nsb .: - {-.,.1 I'��/�a .O• VALUATION -'- FEE ,OANACoWCAT10N. • - •�.+ 1 N&ALCY ' 'KffO%VL==r THARo T I MAVR r. TM._ APPLICATION AND STATS THAT TM[ AS01•[ It CORR[CT _ �� -ro AND AOR[[TO COMrLY WITH ALL COUNTY ORDINANCES 7>i � AND STAT[ V S ALGULATINa SUILDINA CON.TRUO. TION. .. TN 7['! svoli.: G••. �• .. •.L OIQNATVR[O �,, NO:Je[!R'Y9[R COR• ►tAwlTrtt ct'r AIfD►psTLD F1Nf:� i4`a ter. '� �'( n.: 'ti*"� . : •'�a+►� . VaL A f= couK r Kb''*Sp"= VALM :IOH _- - _ . - W/Y r A •a sAMIN :5;,�,r :. .• ..�. ..... ."' 't^;+;: .--.t`51- 1 - i.+w.��y�.w.�Y= 1.M•if �•! .... IlE' 1 Q.QG3"�!1,.1..t2!'i'lIG4Y9`'a"a 1 2 O Nr•+.\) L- ,gyp F is 't _ �'i.:?sf'DLrvT�p I rS i • Y ^OVr�'"' nr +cMr'..•a!_.... i A�,� �:. Z.�N- � �.%. . it �`Et�S�[-`l.^-.'g.:" M y O7r I' '..�i'�,.r•.A "'�"� �,�vr•'+yt', � --• +�wr.,+:L.+rTU*F+sT� a- �i:. sctl .s »,+.•z�3C'' �eoelS+._.'k' a �wY••- _ .a_ DEM. r