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HomeMy Public PortalAbout4700 MILLER DR_Building__ WORKERS' COMPENSATION DECLARATION ':,,I hereby affirm that I have a certificate of consent to self . (insure, or a certificate of Workers' Compensation Insurance, APPLICATION. FOR. B U IL D I N G. P E RM I T _ or a•c i copy thereof(Sec. 3800, Lab..,C.) COUNTY OF LOS ANGELES, BUILDING AND SAFETY Policy Company - ❑ Certified copy is hereby furnished:. i 2 �p FOR APPLICANT TO FILL IN' BUILDING (') l �• �� �VFAD DING Certified,copy is filed with the county i ding ins ec- tion d !paVr!tmet. RESS ®�Dat'e r plicant �- k ZIP LOCALITY t �r NO. OF BLDGS. NEAREST I C RTIFICA OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION'INSURANCEASSESSOR (This section'need•nbt be completed if the permit is for one TRACT BLOCK LOT NO. MAR BOOK' PAGE' PARCEL hundred dollars ($100)or fess,) ! TEL. OWNE NQ USE ZCINF7MAP I certify.that in the performance.of.the'work for.which'this NO. -permit is issued,•I shall not employ any person in,any manner 'ADDRESS CONDITIONS IL soas to,become•subject,to the Workers'.Compensation Laws: G� OO CITY• . O , . zip (7 l Date Applicant ARCHITECTOR TEL. ISTRICT. GTYFIRE PROCESSED BY. Q NOTICE TO,APPLICANT: If, after making this,Certificcite of ENGIDROUP TYPE NEER NO. - ST.. ZONE 'Exemption, you%should become subject to, the iWorkers':' Compensation provisions of.the Labor Code, you must forth- ADDRESS with comply.with such, provisions or.this permit shd.11 be TEL. STATISTICAL CLASSIFICATION CONDO.' N deemed revoked. ;• CONTRACTO NO. Z LICENSED CONTRACTORS DECLARATION.' LIC. CLASS NO. DWELL. UNITS �� I,hereby'affirm that I am licensed under.provisions of Chapter 9 ' ADDRESS NO. (commencing with Section 7000).of Diyision 3 of the Business ' LIC. -L P� and Professions Code.and.my:license is in full force nd effect. "CITY• CLASS• 13K c PG �'( VALIDATION . SQ.FT NO NO.NO. OF CHECK License NA9192:!f7, Class'' SIZE it STORIES' FAMILIES ONE VALUATION Contractor Date ® DESCRIPTION OF WORK t " NEW' ADD ❑ ► ❑ 1,am exempt under Sec. �'� _ ALTER ❑ i BA.R.C. for this reason REPAIR 1:1 Date:%. USE OF. _ EXISTING BLDG. _ L DE MOL.❑ Signature APP(PRINT).ICANT '�iJ. NO. L FINAL OWNER-BUILDER'DECLARATION DATE 1-hereby affirm.that I am exempt froth the Contractor's License ' Law for the following reason(Section 703T.5,Busin'e'ss and ADDRESS rs, FINAL: , , Professions Code): PRESENT `' By• ,- -ACCT■a ❑ I;. as owner.of'the property, or my'•employees",with ADDRESS .;�, . -`�? .'4' - ■ 5 'wages as their sole comperisation,will do,the work'bnd1's,�07" LOCALITY :the structure is not intended or offered for sale(Section \ \ �• 1 ITEM ;. 7044, Business and Professions Code.). MOVING TEL. ... >C ►= �..: i l ... ❑ I,as owner of.the property,am exclusively•contracting CONTRACTOR NO: ;'1'bm .59.2'„_s j with•licensed contractors to,constru..ct the project-(Sec- ADDRESS CHE�r`�l ' -25 .tion 7044,,Business and Professions Code:) ■ REQUIRED TOTAL SETBACK FROM EXIST. i CONSTRUCTION LENDING AGENCY SET BACK. . .YARD HwY PROP. LINE WIDTH• 'CHA{d�E ■��" Thereby 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• 0000-0001 ' 10/25/89 P.L. L•ender's Name' t r� tot p ryt I; LDMA Ref..N' 0378 1 Al e' 7 L f0 P.C. Fee$ Permit Fee i :Lender's Ad ess I`certify t I have read this applici3tion and'state that the Issuance Fee 119,150 LDMA P/C'# , 3 above i mati rect. I dgree�to comply with;all County Investigation Fee 3 ordina c a State aws relating-to,building.construction, Total Fee 0 �(� LDMA perm. #on b authoriz rept sentatives of this.County.to enter ; u o ve-m do property for inspection:pu as o -SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur Applicant or Agent ate - - S'COMPENSATION DECLARATION v� l y� Hi `� MOrirm that I have a certificate of consent to,self APPLICATION FOR BUILDING:�'P E RM I T _9r a certificate of'Workers'ComFenscition Insurance, certi i copy thereof (Sec:3800,,,Lab. C.) COUNTY OF LOS ANGELES ''•BUILDING AND SAFETY Company , ' -,Poll P Y•� BUILDING ... , ❑, Certified copy is hereby furnished. FOR APPLICANT TO FILL IN �' V-, ADDRESS , Certified copy is filed with the county building inspec- BUILDING r tion portm�(tADDRESS �+ C� •�� Dat v Applicant CITY C_ ,.ZIP LOCALITY ERTIFICATE OF,EXEMPTION FROM WORKERS' 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 fIrAeFlG ft •• 3f-37r. ASSESSOR hundred dollars($100)or,.less.) TRACT RAN VSQU•ITD BLOCK LOT NO: MAP BOOK PAGE ' PARCEL , TEL. USE ZONE. MAP I certify that in the performance of the work'for which this OWNER IVO. 2MN permit is issued,I-shall not employ any person in any manner �.. + SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS, CITY /+V r Z .01( O Date Applicant, ARCHITECT Offg�.. TEL.•' NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER J, NO•/ r.' DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, you should becorrie subject to the Workers' �j CONST./' ZONE Compensation provisions of the Labor Code,'you must forth- ADDRESS "� with comply with such provisions of-this.permit shall be. TEL. STATISTICAL CLASSIFICATION - _ APT. deemed revoked. CONTRACTO S IVO. �iU LICENSED CONTRACTORS DECLARATION r�` LIC. CLASS NO. DWELL. UNITS - I hereby affirm that I airi.licensed-under provisions of Chapter 9 ADDRESS Gf/ r. NO.¢ SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC, Professions Code,and;my license ienful orce andeffect. CITY ' `�!� CLASS F� BKL� p14LID,�ITJQ�j 3 SQ.�FT�'/' 0 NO.OF NO.OF � CHECK SIZE IOLP(J STORIES•' FAMILIES 'a ONEI 9 5 Q 5-1License Number lass o • � '= � VALUATION Contractor to DESCRIPTION OF WORK ADD NEW $, !J a o 9 5•Q 5;1 5 . O ❑ ADD ❑ I am exempt under Sec. ALTER ❑ •'1,•0'2 8 8 B.BP.C. for this reason REPAIR ❑ S USE OF Date: EXISTING BLDG. DEMOL• ❑ 1 APPLICANT TEL. Signature FINAL OWNER-BUILDER DECLARATION PRINT NO. DATE I hereby offirrrt that I am exempt from the Contractor's License ' Law for the following reason.(Section 7031.5,•Business and ADDRESS FINAL ��dj Professions Code)..' PRE N BY ❑ BUILDING I, as owner of'the propeity,.or my employees with ADDRESS ti 1 wages as their sole comRensation,will do the work and. - the'structure is not intended or offered for sale(Section LOCALITY ACCT■,L 7044, Business and Professions Code). MOVING TEL. ❑ I, as'owner of the property, am exclusively contracting CONTRACTOR NO. 330 T�•TCk! 1128.7. with licensed contractors to construct the project (Sec- ADDRESS ! ITEMS GI IS ' tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK }"TTAL . 1128 7`a CONSTRUCTION' SET BACK YARD HWY PROP:LINE WIDTH �_,•' +' ■ ,I hereby affirm•that there is a construction lending agency for FRONT •- ' .l `"CHECK _1128 75 the performance of the work for which this permit is issued P.L. • r. •�` ■ (Sec. 3097, Civ. C.). SIDE `CHANGE t.. ■CG P.L. Lender's Name j LDMA Ref. e$ q r L m P.C.Feof Permit Fee ./.� 9• �• 0000--0001C71f�7 001 L/rip/8p Lender's Address' O 0 1 certify that I have read`this applicb0ciri'and state that the Issuance Fee- .J © LDMA.P/C N` 4255 1 AM10o o above inl 9q on is I agree to comply with all County Investigation Fee Q 0 ordirionce d d S e law relating'fo building construction, Total Fee /I/�O , LDMA Perm.M N and here ut rize re resentatives of this County to enter upon th a ove menti ed roperty for inspection p 'poses eSEE REVERSE FOR EXPLANATORY LANGV174UAGE Tgnature o plicant or Agent Date.of S'COMPENSATIO D LA ATIO� �� � 67 �/ U� �� � wl� nrm that I have a certificate of'consent t self FM r a certificate of'Workers' Cdlrtp@nsation Insurance, 14 P P L I CATION FOR B U �LD I N G PERMIT ' . ified copy,there (Sec. 3800,.Lab. 7� E :COUNTY OF LOS ANGELES ' BUILDING AND SAFETY Policy Company ' ❑ Certified copy is hereby furnished. FOR'•APPL•ICANT'TQ FILL-IN ,. ' _ ADDRESS 7�(J k Al.Q4 0 BUILDING Certified copy is filed with the county building inspec- BUILDING /J -' . tion d partme ADDRESS D n1� „ ly/0 A111 Date Pplicont (/ / CITY c a.= ZIP ` +_ LOCALITY RTIFIC.T OF EXEMPTION,FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SI E OF L 7 i• NOW ON'LOT CROSS ST. (This section need not be completed if,the permit is for one ' -3 ;Z ASSESSOR, ' hundred dollars($100)or less.) RA t BLOCK 'LOT.NO.. MAP BOOK AGE PARCEL' 'TEL' USE ONE I 'certify that in the performance of the work for which this, OWNER /,.. NO.. 2l� NO. permit is issued,I-shall not employ any person in any manner ` c - —� SPECIAL so as fo become subject to the Workefs'Compensation.Laws. ADDRESS �.);., t r• �/ CONDITIONS DatApplicant CITY. /•✓1(J W. ZIP' L� f0 „ e. • ; - + , NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT DISTRICT G UP TYPE FIRE' PROCESSED BY ENGINEER =C CONST..,, Z E z.'. Exemption, you should become subject to the Workers' , /) :,,/ Compensation provisions of the Labor Code, you must forth- ADDRESS pA/ � LE. �1 c iJ ��// �/ with comply with such provisions or this permit shall be ; deemed revoked. - TEL• STATISTICAL CLASSIFICATION ' APT.. DO.' CONTRACTO � S NO.T . 'LICENSED CONTRACTORS DECLARATION / LIC. CLASS NO. DWELL. UNITS I hereby affirm that lam licensed under.provisions of Chapter 9 ADDRESS 0-1 /"C N84telz (commencing with Section 7000)of Division 3 of the Business and :. + • e • ' _ z; +.LIC,.• t••,,' .,, SEWER,AAA � e• ' Professions Code, and my license is in full force and•effect: a CITY Of✓� "•:.` 'CLASS " ' BK.. PG. VAL D y, SQ.FT NO.OF /1 NO.OF CHECK .A LL . License Numb 13F T Lic.Clas SIZE STORIES /. FAMILIES •ONE 0 - VALUATI N: ff�' # o,o. °.s'2 7J'' V •: NEW :- f/ DESCRIPTION OF WORK ADD ;I,�,.2 8'7.9 6. , p Contractor Date • _ .� ❑ $ I•am,exempt under Sec. D ALTER ❑ pill.. ° '1+28Z96U B.BP.C. for this,reason ! La O � rC� REPAIR •❑ s O: USE OF I � (]2 f"'.8 8. ' Date: DEMOL' ❑ , EXISTING BLDG. _ APPLICANT ��7� J TEL.7 �j Signature APP(PRINT) . ON NO. DATE. 7: 1�/� FINAL... O. OWNER-BUILDER DECLARATION I hereby off irrri that I am exempt from the Contractor's License. ADDRESS Law for the following reason (Section 7031.5; Business and FINAL. Professions Code): PRE ENT BY BUILDING I, as Owner of the property, or my em to ees with AE wages as their-sale compensation;will do the work and, .+ ;' ••+°�A�GT rT the structure Is.not intended or offered for sale(Section LOCALITY nn-f 19�2 7044,•Business and Professions Code). MOVING TEL. ❑ I,'as owner of the ro ert', am exclusive) contracting CONTRACTOR NO. ' P P Y Y g ' 1 ITEMS with licensed contractors to construct the project (Sec- 1 +� t!06'7044, Business and Professions Code). ADDRESS 1 TOTAL w 1,529:'2 ' REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH.. �''' .I hereby affirm that there is a construction lending agency for FRONT :k the performance of the work for which this permit is issued P.L. w' 'r+ C P P CHANGE " r ' (Sec. 3097, Civ. C.). � � SIDE i"' � ` Lender's Name P.L. LDMA Ref..#• O[IQQ—�Q01 6/29/89 i P.C. Fee$ ���. ,Permit Fee Lender's Address ■ I certify tha hav d this application and state that the (� 24 1 AM10■ } i Y PP Issuance Fee /� J LDMA P%C# , , above inf "n is car act. I agree to comply with all County Investigation Fee 11 ordina.n s d State ws relatin to building construction, 9 9 Total Fee LDMA Perm.# 3 and he b uthoriz representati.ves'of this County to ler 3 upon e b ve-m tion property for inspection r ses. gj (� SEE REVERSE FOR EXPLANATORY LANGUAGE Sign atu o Applicant or Agent Date ; 001 S' R7tTIOfV COMPENSATION DECLA �j Q 11A1 I.�7 /f I' PHirrithal I have a certificV, of consent o se ,Qr a certificate of'WorkeSs'Compensation Insurance, I�,P P L I C AT.I O N FOR BUILDING PERMIT o t' ied co y the of (Sec. 3800, L C.) :`�000NTY.OIc,LOS'ANGELES'' BUILDING ANDVSAFETY •Polic�o� Company • �• ~� . Certified c y is hereby furnished. 'tFOf�.APPLICANT TO FILL IN, BUILDING 0A ADDRESS 0 0 Certified copy is filed with the county building inspec- BUILDING /� q9�� )�� tion partm nt. ADDRESS• (/ IL7. L• ., Date pPlicarit CITY ! _ C ZIP,• LOCALITY RTIFIC TE OF EXEMPTION FROM.WORKERS'. NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST: tdWJe4 Y. (This section need not be completed if the permit is for one T a GH•D 9". f' 3I�L ASSESSOR hundred dollars($100)or less.) ` CL ! BLOCK LOT NO: '• MAP BOOK PAGE PARCEL . TEL. n 1/ USE ZONE MAP / OWNE t`'' /r NO. I:certify that in the performance of the work for which this NO. permit is issued,I shall not employ briy person in any manner IAL so as to become subject to the'Workers'Compensation Laws. ADDRESS ' �1/. / NDITIONS CITY' c ZIP'!ld!• !� _ Date Applicant ARCHITECT O o TEV. .7 'NOTICE TO APPLICANT:.If, after rpoking this Certificate of ENGINEER. N (� ! DISTRICT GROUP TYPE FIRE_ PROCESSED BY Exemption, you -should becoine-'subject to the, Workers', CONST. ZONE Compensation provisions of the labor Code, you must forth- ADDRESS �/ ,' ' ✓ [J with comply.with such•provisions or this permit shall be'. . tEC deemed revoked.' CONTRALTO �_ �% NO. 32i_ ' STATISTICAL CLASSIpICATION APi. C LICENSED CONTRACTORS DECLARATION • , t•, '� LLC. CLASS NO..DWELL. UNITS I hereby affirm that I am.licensed,under provisions of Chapter 9• ADDRESS._ i �- INO. �� SEWER P (commencing with,Section 7000)of Division 3 of the Business and "� , ry, LIC. ## qq ,qq J� �,• Professions Code; and my license is•i ull force and effect. . CITY'" CLASS BK � VALI Tf _ SQ:FT NO.OF NO.OF CHECK o I 7-6� SIZE Z, STORIES FAMILIES. ONE Q License Number ' ic.Class VALLI TI N /,r •f 2'�8 8 U � DESCRIPTION OF WORK NEIN ❑ �j 311 / O � Contractor-G Dote ADD. ❑ s p2 CCJJ O DI am exempt under Sec, Grp G• ❑ , ALTER LLF B.BP.C. for this reason• REPAIR ❑ S d: ' USE OF• ,_ Dcte: EXISTING BLDG. TDEMOL ❑ Z. Signature APPLICANT TEL. FINAL (� OWNER-BUILDER DECLARATION PRINT NO. _ DATE 17--) (J I hereby offirM'thbt I am exempt from the Contractor's License ? � N,. FINAL Law for the following reason (Section 7031.5, Business and ADDRESS Professions-Code): PRESENT BY. F1 BUILDING „ I, as owner of the property, or my employees with ADDRESS 0 S . /�/+�+T wages as their sole'compensation,will do the work and A0 f e3 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ! 3307 ITEMS 1533.75 I,as owner of the property,am exclusively contracting CONTRACTOR NO. t 1 i f Et t with licensed contractors to construct the project (Sec- ADDRESS TOTAL. -J Ilan 7044, Business and Professions Code). REQUIRED. TOTAL SETBACK OTML 153,3./5 CONSTRUCTION LENDING AGENCY SET BACK" YARD HWY PROP.LINE WIDTH ' ' R• ; '' ,I hereby affirm that there-is a construction'leridirig agency for FRONT. ;CHECK 1533.752 the performance of the work for which this permit is issued P.L. r'CHANGE .0 (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA,Ref. # D0�0-0001 6/29/0.9 m P.C.Fee S Permit FeeJ. . Lender's Address 1 certify that I ve read this application and.state that the ' d •�d LDM4 P/C'#. ' 256 1 '' AM10.57 R above inform i n is ect. I agree to com I with all-County Issuance Fee g P Y Y Investigation Fee ? ? 'f aq ordinances n to I s relating to building construction; Total'Fee JJ ./ LDMq perm.# $ and hereb orize epr sentatives of this County to enter m upon the a-me ion property for inspection pu poses. W m SEE REVERSE.FOR EXPLANATORY.LANGUAGE y • Signature f .pplicant or Agent' Date pr a certificate ofJAR v1 MPENSATION DECLO �V/� b� EEWIF. 17171have certificate of consent to self 'Workrrs'•Corrf�nsation InsSrance, APPLICATION FOR. BUILDING PERMIT ,or a ceriif'• c o py ,thereof (Sec. 3800, Lab. C.) I 2-77 COUNTY.OF LOS'ANGELES •BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING �r ADDRESS 1 i1� ' LI (moi Certified copy is filed with the county building inspec- BUILDING' �/t L2�J�' tion parfm f^t ADDRESS V A Date O /Applicant CITY All �� ` ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST 1. COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. tgat, uk4a, (This section need not be completed if the permit is for one gnAGltO SRtiI . 1 31-3Z ASSESSOR hundred dollars($100)or'I'ess.) TRACTS ,/ t BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP -�/ (--' I certify that in the performance of the work for which this OWNER �' ' NO. 2 SPE (/J permit is,issued, I shall not employ any person in any manner ADDRES r� . ,ti SPECIAL so as to become subject to the Workers'Compensation Laws. `' I � CONDITIONS Date Applicant CITY !,� ZIP ARCHITECT ORDISTRICT GROUP TYPE FIRE PR SSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER « �� / 102 ` CONST. ZONE Exemption, you_should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS fo with comply with such provisions or -this permit -shall be TEL. STATISTICAL CLASSIFICATION APT. ONDO. deemed revoked. CONTIR NO. LICENSED CONTRACTORS DECLARATION LIC. �/ CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SE ( Z WER M�4P (commencing with Section 7000)of Division 3 of the Business and LIC, /iIOMI� Professions Code, and my license i in full force and effect. CLASS Z7 BK PG VALIDATION SQ. FTT�. � NO.OF NO. CHECK License Num r LIC.:CIOSS SIZED STORIES F IE ONE El VALUATION Al 0 4 A o U Contractor Date DESCRIPTION OF WORK N NEW $ 0 # o 0-0 0 23 O ��e • ADD ❑ (� ► ° 47240 ❑ I am exempt under Sec. /ra/�j ALTER ❑ I -60 � B.BP.C. for this reason G�/l77f / "r C� REPAIR ❑ 9 ° ° 4 7 2 G•C N usE,OF 9,0 2 . 88 Z. Date: EXISTING BLDG. DEMO' ❑ Signature APPLICANT _/ TEL. FINAL OWNER-BUILDER DECLARATION .. NO. // DATEJ J I hereby affirm that I am exempt from the Contractor's License I ADDRESS r t?N' FINAL Law,for the following reason (Section 7031.5, Business and Professions Code): BUILDING By ❑ I, .as owner of the property, or My employees with ADDRESS Wages as,their sole compensation,will do the work and 4 i y' ) .'AC-CIA LOCALITY \' 1 the structure is not intended or offered for sale(Section ? ` ° •� [{[ ;-,1, 7044, Business and Professions Code). I MOVING TEL. ' 3387 0°t'•' ❑ I,as owner of the property;am exclusively contracting CONTRACTOR NO. �, i i ITEMS with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). TOTAL SET -�-si REQUIRED TOTAL SETBACK , CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH " ` ` •\CHECK 566.25 .I hereby affirm that there is a construction lending-agency for FRONT t• °f'U the performance of the work for which this permit is issued P.L: �+'NA( Gt (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name �� LDMA Ref. q 0000-0001 6/29/8? m P.C. Fee S Permit Fee / � { # { °e C Lender's Address � AqJ2qD L ti 1 I certify that I have read this application and state that the „ Issuance Fee , LDMA P/C q above infoFdl o rect. I agree to comply with all County Investigation Fee / 0 ordinanc Stateaws relating to building construction, Total Fee LDMA Perm.q $ and her - uthori repr sentatives of this County to enter upon f ve- ntio d property for inspection urpose 1O SEE REVERSE FOR EXPLANATORY LANGUAGE a ' Signa re of Applicant of Agent' at