The URL can be used to link to this page

Home My Public Portal About6415 LIVIA AVE_Building__ WORKERS'COMPENSATION DECLARATION '^' '� AL '71311r herey affirm that I have a certificate of coent to ipsurebor o certificate of Workers' Compensat on insuran elf H FOR R p n n�n O��n G F E R �U or a certified copy thereof (Sec 3800, Lab C �� [7=�� (J�J v �L (J J (J`/�J p� _COUNTY OF LOS ANGELES. BUILDING AND SAFETY- Policy No��3y company Certified copy is hereby furnished FOR APPLICAN TO FILL IN - 'ADDRESS Certified copy is filed with the county building inspec- BUILDING, tion department ADDRESS LOCALITY NEAREST Date Applicant CITY ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT N ON LOT MAP BOOK' PAGE PARCEL .(This section need not be completed if the permit is for oneUSE ONE" MAP• hundred dollars ($100)or less,) TRACT BLOCK_ LOT NO 1 ( NO TEL �1' SPECIAL I certify that in the performance of the work for which this OWNER NO 3 CONDITIONS ffE permit is issued, I shall not employ any person in any manner ADDRESS - �, •. ' DISTRICT GROUP TYPE FIRE PROCESSED BY CONSTCI `` / _ / V so as to become subject to the Workers'Compensation Laws. U(/J V � - c Date ApplicantCITY > ZIP-_ STATISTICAL CLASSIFICATION APT rNDO Q ARCHITECT OR TEL NOTICE TO APPLICANT If, after making this Certificate'of ENGINEER - -NO , •`" _ t'V Exemption, you should become subject to the Workers' CLASS NO DWELL UNITS ILL Compensation provisions of the Labor Code,-you must forth- ADDRESS ' - SEWER MAP rA with comply with such provisions or this permit shall be ' TE '! Z deemed revoked CONTRACTOR ( t.. _ NO T �i�D BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION t- LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS7 NO VALUATION ' (commencing with Section 7000)of Division 3 of the Business and LIC f 0 Professions Code, and my license is in full force and effect CITY CLASS E '� D SQ FT NO OF O OF CHECK License Number Lc Class SIZE STORIES FAMILIES ONE' n Contractor�iw_.JLM'�-•��^ Date��ry DESCRIPTION OF WORK NEW $ADD - I am exempt under Sec �{ ALTER E] FINAL .� B&P C for this reasoREPAIR n - - DATE _�G ' USE OF _ DEMOL Date: �YZ— 17 "WY F/� EXISTING BLDG -- � Y Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRINT _NO I hereby affirm that I am exempt from the Contractor's License D Law for the following reason (Section 7031 5, Business and ADDRESS Professions Code) 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 0 I� 7044, Business and Professions Code) MOVING - TEL I o 0 I, as owner of the property, am exclusively contracting CONTRACTOR NO _ 0 0 0 4 Q 5 0 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) ; CONSTRUCTION LENDING AGENCY REQUIRED SET BACK YARD HWY TOTAPOTP LINE WIDTH WID H .1218-86 I hereby'affirm that there is a construction lending agency for FRONT D the performance of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE m PL Q Lender's Name $ Lender's Address PC Fee$ Permit Fee �) ` 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 /1 ordinances and State jaws relating to building construction, Total Fee (/ d and he eby authorize representatives of this County to enter upon t r above- entioned property for inspection purposes o /�_17—,K SEE REVERSE FOR EXPLANATORY LANGUAGE n - - Signature of Applicant or Agent Date ®_ ..,r MEN OF`BUILDING AND SAF CATION= IT COUNTY OF LOS ANGELES (�1p,Aye` ,'•G BUILDING WM. J. FOX, CHIEF ENGINEER LV` FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY l� BUILDING J'� / `' DISTRICT ND. PLAN CCK. NO. ,( PERMIT NO. L ADDRESS ✓ /1"O 7_ - /6, LOCALITY � /(A f y -u/ 2- D B DATE rOF AP/PLL..1 D`'fA'-T(E'ISSUED NEAREST , CROSS ST. , Ad BUILDING S�Li OWNER y u ADDRESSMAIL ADDRESS /o G f S/►�T �/� /fie I^ LOCALITY TEL, / 7 NEAREST, CITY /6 /✓�r �L/% C./S NO (�. /jf, CROSS ST. ARCHITECT OR : TELFIRE NO.OF I TYPE oma}+ i GROUP ENGINEER . ZONE __I PLANS A NO. BLDG. ORD. NO. ADDRESS SETBACK LINE TEL. APPROVED , CONTRACTOR NO.. BY DATE USE _ APPROVED Ai/7 _ ADDRESS ZONE BY •J DA/TC LEGAL DESCRIPTION I LOT NO. I BLL.O�C-K'`�' - CORRECTIONS TRACT SIZE OF LOT D �I NO. OF SLOGS. n NOW ON'LOT USE OF NO.OF' NO. OF EXISTING BLDG. FgM1LIS9 I' ROOMS DESCRIP N OFWORK- NEW ALTERATION ADDITION - D A REPAIR O / DEMOLISH p SIZE (p STORIES D r WALL �/p+�-�w I ROOF , COVERING ��f1 � COVERING BUILDING USE OF NEW ` A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS V AfPPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, II SPECTOR DATE/ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FDRMB, MATERIALS 1I A A .! �_4 y AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, Al��/��6 _ SIGNATUREO'F///�/I� BRACING, BOLTS OWNER .: •C/ , LATH, INTi AUTHORIZED AO LATH;-EXT.: P, C. $ d,10 PLASTER, INT. FEE �'� PLASTER, EXT. VALUATION-37 ,20 ' FEED FINAL �oBS-3 ZSM T OF BUILDING AND SAFETY APPLICATION FOR PERMIT _DRn_r __ JTY OF LOS ANGELES BUILDING UILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL.IN FOR OFFICE USE ONLY BUILDING ' DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS .� ..7 / V )•�j �.. J 2 •� LOCALITYRECEhV(/E�D� Y DATE OF APPL.1 6,DATE ISSUED` NEAREST ` I V �, ( �� (7 ✓�� !T CROSS ST. , xn BUILDING OWNER •.(.J N S J ADDRESS MAIL ADDRESS 5A/, ) A L /y1�� /y- LOCALITY O G I T ) C, /Jy� ,a) /(. p NEAREST CITY b ' AC f NO. 7 CROSS BT. N/r • FIRE NO.OF: % TYPE �i OROUP T ARCHITECT OR TEL. ZONE �-�- 1 PLANS ENGINEER NO. BLDG. ORD. NO. ADDRESS SETBACK LINE TEL. APPROVED CONTRACTOR V NO, BY DATE ` USEAPPROVED ADDRESS ZONES/BY DATE GAL DESCRIPTION I LOT NO. • ,Z I BLOCK - CORRECTIONS AC TRT / seL� SIZE OF LOT "� 1�J I NOWOONO N LOT USE OF NO.OF __I-NO.-or EXISTING BLDG. I FAMILIES I ROOMS DESCRIPTION OF'WORK NEW ALTERATION - ADDITION O REPAIR MOVING DEMOLISH O SQ. FT. NO.OF / - D SIZE `t7 ROOMS. STORIES ♦ r WALL ROOF COVERING p, I COVERING USE OF NEW - BUILDING p , t.li'I' _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS - - APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, •/INSPpE ACTOR DATE�]�yC MATERIALS • AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, lool NII�� 1 -V -AND STATE LAWS REGULATING BUILDING CONSTRUCTION. I FRAME: FIRE STOPS, �- • SIGNATURE OF BRACING, BOLTS OWNER1 �� _LATH, INT.: i f�I AUTHORIZED ADT LATH, EXT.: P. C.!8, PLASTER, INT. I _ Bel- FEE PLASTER, EXT. /I VALUATION 0 FEE FINAL ��.,/ JL- !— I-