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Home My Public Portal About6022-6028 KAUFFMAN AVE_Building__ )0,1QUERS'COMPENSATION DECLARATION b ' ,• ' tea,. APPLICATION �FQR BUILDING PER IT I'here_y,affirm that I have. a certificate of consent to self nsurs,aor a certificate of Workers' Compensation Insurance, (- - or a certified copy thereof (Sec. 3800, Lab. C.) j 'COUNTY•OF LOS ANGELES BUILDING AND SAFETY PolicyNo. Company �+__ i.•4 _ ❑ Certified copy s hereby furnished. ' PPLICANTTO FILL I GBUILDING e.2AADDRESS ❑' Certified 'copy is filed with t` ounty uild'n 'n"spe BUILDING Tion department a ADDRESS DdTe Applicant ./ CITY IP LOCALITY CERTIFICATE OF EXEMPTION'FROM ORKERS' OF BLDG,. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not.be completed if the�permit'js for`;one / - Q ASSESSOR -hundred dollars ($100)or less.) TRACT (l// BLOCK ' LOT NO.. o(J MAP BOOK' PAGE PARCEL TEL. USE ZONE MAP OWNER _- NO:L .S NO. I certify that in the performance of the work for.which this � A permit is issued,, I shall not employ any person in n`y manner SPECIAL 126 so'as to become subject To the Workers'Compensation Laws. ADDRESS 2"� (,1� 'l J' Z [CONDITIONS O ' CITY _ ZIP .Q - Date Applicant 1 I t?o'�� -�" � ARCH ITECLAR TEL. DISTRICT GROUP TYPE FIRE ESSED,BY NOTICE TO APPLICANT:` If; after making this Certificate of ENGINEER .] NO. b Exemption, you should become subject to the Workers' " ` ` H CONST ZONE LU Compensation,provisions of the Labor Code, you must forth- ADDRESS 7. G' ` 0. with comply ,with such provisions or this permit shall be - TEL S g deemed revoked. STATI TICAL CLASSIFICATION APT. COND0. ' - CONTRACTOR - NO. - , LICENSED CONTRACTORS DECLARATION LIC'- - CLASS NO. �DWELL. UNITS—�_ • I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. r, ./, 0 A Professions Code;•and my license is in full force and effect. CITY CLASS VA ON SG. FT. NO. OF NO. OF CHECK BK. PG. • License,Number W) Lic.Class SIZE STORIES FAMILIES ONE # '0 0 0 0 2 3 A VALUATION 0 5 G 1.2 5 DESCRIPTION OF WORK NEW ti '. C❑ontroctory-u/L '.1-hit ,Date ADD ❑ $ I S 0 0 , _ I am exempt under Seca ❑ 5. ALTER B.BP.C. for this reasonREPAIR ❑ $ Date - I USE F DEMOL EXISTING BLDG. ❑ (�� _ AAPPLICANT TEL. Signatur FINAL ER-BUILDER CLARATION PRINT) NO. DAT 11, hereby affirm that I•am exempt from the Contractor's License Law for The following reason'(Section 7031.5, Business.and ADDRESS FI L' Professions-Code):' -" PRESENT BUILDING. ❑ 1, as owner of the property, or my employees with ADDRESS wages as tKeii sale compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ) 7044, Business and Professions Code). MOVING- TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY SETBACK YARD "HWY TOTAPROP.SETBpLINE CK FROM WIDTH I hereby affirm that there is a construction lending agency for FRONT 't the performance of the work for which this permit is issued P.L: - z 8-9,6-8":� (Sec. 3097, Civ. C.). SIDE �` .0.oo•o i _ P.L. Lender's Name - 647..25 o y/, LDMA Ref.-,# ' m - P.C. Fee$ -� Permit Fee- Lender's Address 0.0.6 4'7.,2 5 5• I certif that I have read This application and state that the Issuance Fee r v LDMA�P%C# '.. �� O rJ_8 7 a abo in rmotion iWe t comply with all County Investigation Fee i - .Q m or hanc s and Stabuilding construction, - Tota!Fee t TDMA Perm: # u a d her by authoriof This County to enter u on t e above-mefor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ^ ature of Applicant or Agent Date WORKERS' COMPENSATION DECLARATION 'he,O'b�' firm'that•I have.a certificate of consent to self APPLICATION FOR BUILDING PERMIT , ,•'rnsurk,,,or a certificate of Workers' Compensation Insurance, or'a certified copy thereof (Sec. 3800, Lab. C.) Policy No. (�o l Company COUNTY, OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. ; F ' PRLICANT TO FILL IN BUDDING CJ ADDRESS v Certified copy is filed with the county building irisp - BUILDING //^^ tion department. ADDRESS V Date �- 13'�S� -Applica t CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM RKERS' NO. OF BLDGS.- NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT 1 BLOC LOT NO. MAP BOOK PAGE PARCEL TEL. p S USE ONE MAP 1 certify that in the performance of the work for which this OWNER NO. 5 NO. ! y permit is issued, I shall not employ any person'in any'manner c, t[ SPECIAL so as'to become subject to the Workers"Compensation Laws. ADDRESS �'``a Lo ) ✓ CONDITIONS O CITY 0!�--c.c"' ZIP �'t I-Cro-.0. Date Applicant ARCHITECT OR TEL I' /� NOTICE TO APPLICANT: If, after making this Certificate of ENGINEApplicant— ARCHITECT NO.�f�14 7bl�P DISTRICT. - GR P TYPE FIRE PRO SED BY Exem tion; you should become subject to the Workers' "� CONST. ZONE P Y I �j � p �/ Compensation provisions of the Labor Code, you must-forth- ADDRESS �d Anrc• 5,(4 with comply.with such provisions or this permit shall be - deemed.revoked., TEL. STATISTICAL CLASSIFICATION APT. ONDO. CONTRACTOR NO. �� LICENSED CONTRACTORS DECLARATION - LIC. CLASS NO. 06 DWELL. UNITS —i— I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. U SEWER MAP (commencing with Section 7000)of Division 3 of the Business and _ LIC. m22 Professions Code,'and my license is in full force cind effect. CITY CLASS BK PG J ViAWDl11E1QN�3 SO. FT. NO.OF NO. OF CHECK • ' License Number`1 1 1�3 -1 Lic.Class °V SIZE G? STORIES FAMILIES ONE I o374.85 NEW c 0 VALUATI N Contractor 1A�.�1 - �crL Date DESCRIPTION OF WORK ❑ $ 0 0 3.7 4.8 5`0. ADD ❑ I am exempt under Sec. ALTER ❑ , 'I'a 0 7`'87 B.BP.C. for this . as n I REPAIR ❑ $ ate USE OF DEMOL ❑ �8 0 6 7 A ' - EXISTING BLDG. - APPLICANT TEL. Signature FIN # 0 0 0 0,0'� O - UILD .DECLA TI (PRINT) NO. DATE - I hereby affirm that I am exempt from the Contractor's License 1 0 64 050 Law for the following reason (Section 7031.5, Business and ADDRESS FINr Y:� Professions Code):' PRESENT Y _ 0'0 s 64p,50 ❑ BUILDING ` I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and , 1 (1 0 7—87 the structure is not intended or offered for sale(Section LOCALITY 7044,-Business and Professions Code). - MOVING TEL. - I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK AINEFRO 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.). SIDE Lender's Name �• �t moo' }�• LDMA Ref.#, . Lender's Address P.C. Fee$ Permit Fee V I certify that-I have read this application.and state that the Issuance Fee V LDN P/C'#S a above information is correct. I agree to comply with all County Investigation Fee ordinan nd Stat laws relati to building construction, . v and reb t uthorV res t i es of this County To enterTotal Fee LDMA Perm:# up The above-md r r y for inspection purposes. a `, SEE REVERSE FOR EXPLANATORY LANGUAGE of Plicant or Age t Dote �° I, g � cV.16RYVS'COMPENSATION DECLARATION tnsur� or afce�tif carm rte ofaWorkersrTComte of pensat on ensuran nt to self A P P L I CAT I O N �F OR B U I L D I N G P ERM I T or a certified copy thereof (Sec. 3800;lab. C. COUNTY OF LOS ANGELES BUILDING.AND SAFETY Policy No.4;2'A LW\ Company Qw ) - Certified copy is hereby furnished.. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is'filed with t' ount liuildin ins c- BUILDING tion department, < � �� ADDRESS Date`• L3 C46,�[ Applicant / /-- / CITY C-i ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS'% N F BLDGS. NEAREST COMPENSATION INSURANCE • SIZE OF LOT NOW ON LOT CROSS ST. (This section'need not be completed if the permit is for one ASSESSOR -hundred dollars ($100)or.less.) TRACT ps BLOCK LOX NO. It 0'b MAP BOOK 6VIG PARCEL TEL. 88 USE Z E MAP OWNER NO.�y7 �5S D 1 certify that in the performance of,the work for which this SPOECIAL d permit is issued, I shall not employ any person in any manner s 2' so os to become subject to the Workers'Compensatiori'Lows. ADDRESS ( c�uj v CONDITIONS O U Date Applicant CITY _ ZIP { 100(x . Iz ARCHITE TEL. DISTRICT G UP TYPE FIRE PR C SED BY O NOTICE TC-APPLICANT: If, after making this•Certificate of ENGINEER NO� C1lsI� Exemption, you should become subject to the Workers' CONST. ":3 U Compensation provisions of the Labor Code, you must forth- ADDRESS _Z �/` d� W with comply with such provisions or This permit shall be TEL. STATISTICAL CLASSIFICATION APT. YONDO. z deemed revoked. CONTRACTOR NO. (�/J I� LICENSED CONTRACTORS DECLARATION :- -LIC. CLASS NO.�_DWELL. UNITS i I.hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of tFie Business and LIC. !/ Professions Code, and my license is in full force and effect. CITY CLASS BK ��( " -VALIDATION SQ. FT. NO. F NO. OF CHECK ttt/// $ b 9'A License Number 'U�1�el "Lic Class SIZE 'A Cf Z-1 STORIES FAMILIES ONE VALUATION # o 0 0 0,2 3 Contractor i [Uwit c�CC 1, Date DESCRIPTION OF WORK NEW " ❑ a ) - 378.86 ❑ ADD 1:1 I am exempt under Sec. ALTER ❑ o a 3 7 8,8 6' B.&P.C. for this reason REPAIR ❑ $ TO,Q 7—8 7 USE F ❑ te. DEMOL EXISTING BLDG. Signature APPLICANT TEL. 1, FINAL / $ o647,2 6® 7,2 OW /BUILDE DECLARATION (PRINT) ` NO. DATE ` f a I hereby affirm that I am exempt from.The Contr ctor's License M Law for the following reason'(Sectio'n 7031.5, Business and ADDRESS F o a 6 7,2 c�• Professions Code): PRESENT I Q 0 8 ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING ' TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED- . YARD HWY TOTAL SETBACK FROM IST. _ CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE 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.). SIDE m P.L. Lender's Name o / 2 1 LDMA Ref. # m Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application and state that-the - Issuance Fee 11 LDMA•P�%C`#'`;' t-r-•-=._�, '� t , a above information is correct. I agree to comply with all County Investigation Fee a din es nd St to laws relatin 'to building construction, ' c; ereby auth ize rept s ntat es of this County to enter Total Fee LDMA'Perm. #' Pon the above- entio d rop ty for inspection purposes. a 2- SEE REVERSE FOR EXPLANATORY LANGUAGE . ignature of Applicant or Ager - - Date - - - - - _ WORKERS'COMPENSATION DECLARATION 4 ' I•her,�b� (cert That' I have o certificate of consent to self APPLICATION FOR BUILDING PERMIT int Cdr a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C. Policy ) No.S 2q �G Company y COUNTY OF LOS ANGELES BUILDING AND SAFETY >L - - r7j Certified copy is hereby furnished. FO APPLICANT TO FILL IN BUILDING ADDRESS Q � - Certified copy is filed with the county building-insp - BUILDING ^ tion department. ADDRESS r✓ DaTel " `a`r Applica CITY r ZIP LOCALITY � CERTIFICATE OF EXEMPTION FROM ORKERS' .OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR . hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP t�-y, —Z�� I certify that in the performance of the work for which this OWNERti — NO. yy l-OS$8 NO. �✓ / > permit is issued, I shall not employ any person in any manner12� lJ SPECIAL 0 ADDRESS so as to become subject To the Workers'Compensation Laws. CONDITIONS O CITY ZIP.._ �17tJZ0 Rg Date' Applicant ARCHITECT OR TEL. .NOTICE TO APPLICANT: If, after making this'Certificate of ENGINEERS - NO.y 1ILpt(y DISTRICT GROUP TYPE FIRE ESSED BY Exemption, you should become' subject to The Workers' „ CONST. / ZONE Compensation-provisions of the Labor Code, you must.forth- ADDRESS 3 �� ' V �• with comply with such provisions or this permit shall be deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. CONDO. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION - 11C. CLASS NO. 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. F , AE PG. NO. OF NO. OF CHECK License Number h 1�ISLA Lic.Class SIZ STORIES - FAMILIES ONE ° ��A //f� `Q, ,;, NEW VALUATION 0.8'0 b 4 A Contractor a/L -�es�L Date DESCRIPTION OF WORK o 0 0- DD Q o 0 0 U 2 am exempt under Sec. , �' p LTER �� I 0' B.&P.C. for this reason $t7 S 5xv USE REPAIR � # a o o a 2 3 D te: EXISTING BLDG. DEMOL Q Signature APPLICANT TEL. FINAL BUILDE DECLARATIO (PRINT) NO. DAT 535.506 I hereby affirm that I am exempt from the-Con actor's License Law for the following.reason (Section 7031.5, Business and ADDRESS FI O Professions Code): PRESENT B BUILDING I, as owner of The property, or.my employees with ADDRESS wages as their sole compensation,will-do the work and ' The structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). /MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- EADDR tion 7044, Business and Professions Code). H Q 6 . TOTAL SETBACK FROM T. tt CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for ° 647..25 the performance of the work for-which this permit is issued (Sec. 3097,.Civ. C.). ° ° 6 4 7.2 5 5 m Lender's Name � G G 7 8 7 o r � LDMA Ref. #Lender's Address ,� � � PermitteeiII certify that I have read this.application and state.that.the Issuance Fee- LDAk13 C'`#above information is correct. I agree to comply with all County n Fee m o non es and tate a s lating to building construction, Total Fee LDMA Perm:# _ ) t nd hereby au oriz r re ntatives of this County to enter upon the abov - nt ned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �• -- U�Signature of Applicant or Agent Date J _ - - -