The URL can be used to link to this page

Home My Public Portal About10403 LA ROSA DR_Building__ 1 WORKERS'COMPENSATION DECLARATION ' qi hereby that fkconsent insure, a certificate Wores'Compensation Insurance,Insurance, APPLICATION FOR ' BUILDING PERMIT ISI or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING A SAFETY Policy /z!? y2/ Company / ' entified copy is hereby furnished. A p FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING,/6g_D r— / tion department. ADDRESSt— LOCALITY (�! �.�' NEAREST Dote "� Applicant � A N� CITY G ZIP CROSS Si. CERTIFICATE OF EXEMPTION FROM RKER NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT �� NOW ON LOT /e MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one — USE ZONE MAP q�/ hundred dollars ($100)or less.) TRACT3. BLOCK LOT NO. NO. Oc TEL _ / SPECIAL I certify that in the performance of the work for which this OWNS ��71 NO. CONDITIONS d permit is issued, I shall not employ any person in any manner �✓J DISTRICT - .GROUP TYPE FIRE PROC SED BY O so as to become subject to the Workers'Compensation Laws. ADDRE l�z=� .a-;U CONST. ZONE V �J' rP c/ 3 Date Applicant - CITY /LIiG` ZIP TE/Q®La ' STATISTICAL CLAS51FICATION APT. CONDO. O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO.�DWELL. UNITS_ W 4 Compensation provisions of the Lobar Code, you must forth- ADDRESS SEWER MAP � with comply with-such provisions or this permit shall be Z deemed revoked.' COwg"w _ NlY/ BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. p I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NCR`y VALUATION (commencing with Section 7000)of Division 3 of the Business and 14 LIC. //�� Professions Code, and my licensee is in full force and effect. CITY CLASS !/r $ , Gf� �`( /„7 SIOZEFT / STORIIE1 NoES F MIOLIES I CHECK EK License Number Lic Class/ // t7 Con} y—` to -y� $ VQ _ DESCRIPTIO ¢w.ri� NEW / ADD ❑ 13 1 am ex mpt u9 er ec ALTER 0 FINAL u q 1;%'i L1 B.BP.C. for this reason _ REPAIR ❑ DATE !/� �� iT3d:.+.ii i...... _�.9 ';!'_,r;;;,'+M�;�/3 Date: USE OF DEMOL FINAL /' ! Fliltll. GRADMID AP(+Pi�`cMA/iif� EXISTING BLDG. ❑ B BVI rB'�•b•.V.+ Signature APPLICA TELt T '284,1 A OWNER-BUILDER DECLARATION PR 6 /NIEG/f/� NO. W215I /1 1 hereby affirm that I am exempt from the Contractor's License , �G- / $j. a o e - 2-3 Law for the following reason (Section 7031.5, Business and ADDRESS ' Professions Code): PRE EN `..13 1 0 0 631 -2 I, as owner of the property, or my employees with BUILDING ADDRESS- Q o�c o 6 x 2 Z v wages as their sole compensation,will do the work and 17y /i �✓ the structure is not intended or offered for sale(Section LOCALITY - _ •0 6 1 5—8 3 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). "2 8 2 A REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWV 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.I. ' (Sec. 3097, Civ. C.). SIDE _ 12,- 66 Q'75 IPA. Lender's Name /! pp 0P.C. FeePermit Fee 0 6 6 0,7 5 $ 'S �i t0V ,50,2S ., Lender's Address 0.6 1 5-8-3 1 certify that I have read this application and state that the Z Issuance Fee /D. 50 above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee o, d and hereby authorize representatives of this County to enter upon the bove-menti_one roperty fopection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of ppl' m or Agent Date es WORKERS'COMPENSATION'DECLARATION'* _ -~ -- _ P1„ ' r��. -- -•- __ - • - -. �. i.6r - • firm that I have a certificate of consent,to self - - — -- gP,P_LICATIO.�'FOR BUILDING certificate of Workers' Compensation Insurance, or d certified-copy thereof (Sec. 3800, lab. C.) ” ' - '-- -`- - - - . .COUNTY OF LOS t'�NGELES '.}} 'dn BUILDING AND SAFETY-, Policy.No._ - Company � ' ,. OF- r '�. 'Certified copy.Is hereby furnished: FOR APPLICANT TO'FILL-IN' DINU DRESS ❑ Certified copy is filed with the county building inspec- - BUILDING - c tion department" ADDRESS {'.J '(J(Ls Date ' Applicant - CITY - C� ZIP r� V LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' - ` "" - -- -N .OF BLDG . - NEAREST - COMPENSATION INSURANCE SIZE OF LOTS NOW ON LOT CROSS ST. es (This section need not be completed if the permitis for,one - - - - - ----- - - ASSESSOR, n.- hundred dollars ($100)or less.) TRACT B OCK LOT NO.TEL. /.� /�(J MAP-BOOK PAGEI PARCEL 'OWNER"` _� -' NO. SCO / O. I• /Z . USE ZONE I certify that, n the performance of the work for which this' � � - ;> permit Is issued, I shall not employ any person in ny,manner _ q/�//fir - SPECIAL -• - - - -- - - - -• 6 sobs to become subject to the Workers'Co p ns tial Law . 'ADDRESS -- )(/ - _ /`•• CONDITIONS O /'y.(��/ CITY _ _ _ ZIP. Da tel�pl da nt ARCHITECT OR TEL. - V NOTICE TO APPLICANT. If, after making this Certificate of _ ENGINEER NO. DISTRICT GROUP, TYPE- _ FIRE PR C ED.BY Exemption;' you should become' subject:to the Workers' CONST.. / ZONE Compensotion provisions of the Labor Code, you mush forth- ADDRESS _ ... 11// _e •. 6 with comply with such provisions or this permit shall be __. .. H / TEL STATISTICAL CtA551F1CATION A Z deemed revoked. • n, CONTRACTOR L NO. LICENSED CONTRACTORS DECLARATION - - - - ,---- - -- - ---- - - - -- —uC. -- -• CLgSS NO.' DWELL. UNITS 1 02 2 r.8 7, I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER P (commencing with,5ection 7000)of Division 3 of the Business and _. _ . _. . -_ _ -.__ _ __ . .LIG - -» - Professions Code, and my license is in full force and effect. CITY / CLASS BK -PG -'-' t - VALIDATION - SQ. F NO. OF __ NO.OF _ CHECK rte•-7, ,:� License Number Lic.Class' SIZE STORIES - FAMILIES . ONE - •.'.; - "' ' - VALUATION .. . .. __ _. -'? - ""--- '-'- —' NEW Contractor Date DESCRIPTION OF WORK $ ` ❑ I am exempt under Sec. - - —`d= ' w -C-- ADS- ❑ - ;?6 2 3.3 A` // (( ALTER ❑ , B.BP.C. for this reason C pu "LL7"7'/ S- Ti .REPAIR. ❑' $ a/ O -- - -. # e s-• 2-3. , -' - Date:" USE FDEMOL ❑ / 1 •:1 4 5.0 4. EXISTING BLDG. ` Signature APPLICANT .' TEL. FINAL o e O NER-BUIL ER DECLARATION PRINT 1 4SO43. -DATE -I-hereby affirm that I.am exempt from the Contractor's Licenser FINA f 1 2 31 _86 - I ADDRESS � - Law for the following reason (Section 7031.5, Business and _ Professions Code): - _ - PRESENT - "By " I, as owner of the property, or my employees with BUILDING ADDRESS .wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section 7044, Business and Professions Code). '-- -' MOVING "'- '� - - _ _ "' TEL. -' -- - - - -T ❑- I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the'project (Sec- gDDRESs- , j !f -••{- i -T �1 tion 7044, Business and Professions Code). -' __ .REQUIRED __ _ - TOTAL SETBACK FROM EXIST. -' - CONSTRUCTION LENDING AGENCY '- - YARD- HWY --' - - - - '4 5-6 SET BACK PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT , ✓ - --the performance of-the work for which this permit is issued -- �- - P:L- -- � - - —� - - � -- -E - - �+ - -';- #'...'e v • lA (Sec. 3097, Civ. C.). SIDE X1,16 _ PA Lender's - - — — _. _ 738 lender's Name LDMA.Ref. # �^ 1 - 23 s P.C. Fee$'- - ✓t 0 -- Permit Fee_ _ _ 6 _ _ _ _ -, 2'3 7.3 S U _ Lender's Address 0 2.0 2-8.7 wyq 7 .I certify that I have read this application and state that the _.. p UL--. Issuance Feer - -:�'V -4 �-LDMA�P/C# above information is correct. I agree to comply with all County Invemigmion Fee $ ordinances in_ances and State laws relating to building construction, _. _.. . Total Feeand hereby authorize repreZenl Lives of this County to enter upon the above-mention toerty for spection purposes. a 2 - o^ SEE REVERSE FOR EXPLANATORY LANGUAGE i ¢ant o - -Dore_- "' ___ .. -_ _ .. -+Si nature-of APP - --' _-- '-" _ - - WORKERS'COMPENSATIONDECLARATION - - ' .' 'S.; " ' '• _'.. i:: .. }- _ �.heSeby"offirm that have o.certificate of consent to. - -- 'APPLICATION FOR .BU.ILDING PERMIT' -- i W re, or a certificate of Workers' Compensation Insurance, ,or a certified copy thereof (Sec. 3800, Lab. C.J - - '_ ` ' _ _ ,.... _ ' COUNTY OF-LOS ANGELES BUILDING:AND SAFETY Policy No. '�� ' Company- - - - - - ,�• Certified copy isRereby4umished. FOR APPLICANT TO FILL IN BUILDING Certified copy is filed o ADDRESS with the county building inspe - - BUILDING - - - - - - ton department. ADDRESS i d/ D SA Qf ✓'E I ii Q__ r_ Dole Applicant CITY L CrT ZIP 1 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' ' - '" -- - Or OF BLDGS. NEAREST .• ._ _ - `COMPENSATION INSURANCE SIZE OF LOT OW ON LOT CROSS ST. W� (This section need not be completed if the permit is4or'one TRACT BLOCK LOT NO. • ASSESSOR;,. --- • ' - ' hundred dollars.($100)or less.) _ �., • l!im�eeyy� MAP BOOK PAGE' PARCEL • OWNER /�')'� -U' NO��U/r-'� USE NE MAP I certify that in the performance of the work for which,this NO. permit is issued, I shall not employ any person in an manner }�� _ O -n p SPECIAL - - 6� so'as to becorre subject to the Workers'Co pe at rf Law - ADDRESS/,C7--%n> --/�j�i-Y. K 1- CONDITIONS _ r/ _ OC Data" Applicant ARCHITECT OR L. C NOTICE TO APPLICANT"If, after making this Certificate of ENGINEER DISTRICT, GROUP' TYPE_. FIRE PR ESSED BV Exemption,' you should become subject to the Workers' Gt% L C^/�{y CONST ZONE (~j Compensation provisions of the Labor Code,•you must forth- ADDRESS / J V 8 -. , / - -'6 with comply with'such, provisions or this permit shall be - - --. __ - - -. - .... - /\ V_ 'H deemed revoked , .• {.;P - TEL. STATISTICAL CLASSIHiATION APT. NDO. I CONTRACTOR NO. -++CL LICENSED CONTRACTORS DECLARATION - — -- - __ - _. LIC. - CLASS NO. t• •DWELL. UNITS r 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. - - _ Prof.. ns Code, and my license is in full force and effect. CITY CLASSBK - - ' VALIDATION�- SQ. _ NO.OF INC. OF / CHECK_ License Number Lic Class SIZ STORIES FAMILIES ( ONE - ^ • VALUATION Contractor � � Date • DESCRIPTION OF WORK' >gh�L'�'-CQW �- NEW 0 f /j /t ))� l/dd J I am exempt under Sec. _ T�� , ADD - ALTER B.BP.C. for this reason _ _ - .REPAIR �' $- o - USE OF , EXISTING BLDG. DEMOL Signature - _ APPLICANT TEL. FINAL 7 ,CYT WI,ER-BU LDER DECLARATION - -PRINT .--- - _ - NO. DATE 2Y.�y_ --- _ -. •- -.- -I hereby affirm that I am exempt from the Contractor's License r _ Law for the following'reasoo'(Section 7031.5, Business and ADDRESS FINAL (7, -Professions Code): - - PRESENT ' By lNf✓!-e - ' ;9671 BUILDING 9679.JCA , - BUILDING I, as owner of the property, ormy employees with _ ADDRESS- .._ ._- _ _ _ - _ :. # e'e e. 0'0.1 , wages as their sole compensation, will do the work and ' the structure is not intended or offered for sale(Section LOCALITY �' `( o 1 1 55.0. 7044, Business andProfessionsCode). -' - MOVING - "' '- - ' - TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. - o e 1 1 5 5 0 s'' ❑"--with licensed contractors to construct the'project (Sec- tion Seo- ADDRESS - - -` ' --' - - '- - - ' - - - , 1 tion 7044, Business and Professions Code). 1 \ 7 � G,O'J`8 7. _ REQUIRED TOTAL SETBACK FROM _ q . - CONSTRUCTION LENDING SET BACK YARD -' HWY PROP. LINE WIDTH t `rk_1 t i1 t' 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,G). SIDE t Lender's Name m - -' -- P:C Fee S ' - "" - Permit Fee �:' Lender's Address w . .I certify that I have read this application and state that the ... _ .. - Issuance Fee � cJ � �LDMA P/G.# - n I a above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating Jo building construction, .._ _ _ _ - Total fee ,- S"� -LDMA Perm. # - - \ - - it and hereby authorize representatives of this County to enter ' ' m upon the above-rge ,7.�;r',�,� rope y for inspection purposes. ' a r SEEREVERSE FOR EXPLANATORY LANGUAGE - n , "- Signature of Applicant or Agent Data - - - - - - - - - --- - - - -- - - '