The URL can be used to link to this page

Home My Public Portal About5445 PARMERTON AVE_Building__ ♦ I WORKERS COMPENSATION DECLARATION + w P APPLICATION F,OR�' BUIL-DING- PERMIT herrby ,ff,,m that I have a certificate of consent to self r Insurl or a ri�rhf¢ole of Workers Com ensation'I^iurance or a cert. Ybpy thereof (Sec 3800 Lab C ): + I a -i �,' _ _ __ COUNTY OF LOS ANGELES BUILDING AND SAF Y" `Policy No Company ` Certified co is hereby furnished r BUILDING ❑, copy y FOR APPLICANT TO FILL IN - ADDRESS �J V•' G71 Certified copy Is filed with the county budding mspec BUILDING Yl1- non deportment , t _ ADDRESS q5` qS PlT;c-M C&404, ' LOCALITY NEAREST Date 1 -2 A Applicant CITY 77aLLQ Q ZIP917Ye'- CROSSST CERTIFICATE OF EXEMPTION FROM WORKERS , OF BLDGS t ASSESSOR 3 COMPENSATION INSURANCE SIZE CIF LOT eq O NOW ON LOT / MAP BOOK PAGE - PARCEL ,(This section need not be completed ,f the permit is for one ' �`, U NE MAP + hundred dollars (5100)or less ) 7 _ TRACT ,,yt,�� ^ BLOCK LOT NO - NO i OWNER Ae .C4� TEL —I CONDISPECIATIONS _ I certify that In the performance of the work for which this, N Z CONDITIONS 4 ' permit Is Issued I shall not employ any person,in any manner r - DISTRICT GROUP TYPE FIRE D BY O _so as to become su blect to the Workers Compensation Laws ADDRESS S 7 TS �m� t �' CONST , ZONE 'V Ael Date + Applicant ' CITU /�'h Lei u-G ZIP STATISTICAL C1A551FICATION APT _ CONDO • O NOTICE TO APPLICANT If' after making this Certificate of ARCHITECT OR TEL - ,V Exemption, you should become subject to the Workers ` ENGINEER NO CLASS NO Z� DWELL UNITS_ Wa Compensation provisions of the Labor.Code, you must forth- ADDRESS t4c, - ' st ; - - SEWER MAP N with comply with such provlslons'or this permit shall be /� Z deemed revoked ! - Tl " NO ��, lr/ 91�T PG - VALIDATION CONTRACTOR f ai t 'LICENSED CONTRACTORS DECLARATION - /)....WyY / n 'LL ,J2 I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 7 T,V /CLQ' •C�/ 3- �7 VALUATION (commencing with Section 7000)of Division 3 of the Business and 'v Q,-, ��r LIC �T Professions Code and'my license is In full force and effect CITY /Tu/Q'^r CLASS !�-/ f (� s-♦,�' qn SO FT / NO OF NO OF ( ♦CHECK �( License Numbb77er� I3 S-V• Z�/ L¢ Class 19 21 SIZE 16 STORIES' ,.rl'�,,�F/AMILIES ' ONE r , Contractor! 'r"'F' "-��QrDate —z �G r DESCRIPTION OF WORK f1 1ar++� ��A1 NEW ❑ $ El1 am exempt under Sec '1'i♦L ADD . ' ALTER FINAL B 8P C for this reason - _ ❑ — DATE/4,;J Date / -�/ REPAIR C1 _` s USE OF 1/ L,[/ - ❑ I t I EXISTING BLDG _ DEMOL 9 N ` Signature ' APPLICANTr TEL T OWNER BUILDER DECLARATION PRIM eSE�7L4L �* GT[dZ.li1B/I*� NO (. •S��-�'J 1 hereby affirm that I am exempt from the Contractors License7 ��r�G �P-//la!!� Q[� �`� lJ� oz / ♦ r Law for the following reason (Secllon 7031 5 Business and ADDRESS , 'Professions Code) , ❑ I BUILDING _ , •� as-owner of the property, or my employees with wages os 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 �.1 t ' �'+ .1 ;95336A t a 1 as owner of the property am exclusively contracting CONTRACTOR t , NO with licensed contractors to construct the project (Sec r{ �, 0,0 ADDRESS bon 70" Business and Professions Code) , 7 REQUIRED _ TOTAL SETBACK FROM EXIST ' ` - I e•1 0 6 1 3 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIN WIDTH } ' I hereby affirm that there,s a construction lending agency for FROM +- _.. - 1 -1 �� • • �. ' the performance of the work for which this permit Is issued P L ,^- 1 \ '� 0 Q 3`� (Sec 3097 Clv'C ) SIDE PI L 0829-86 LenderName s + ` 11•r - •,,tit _ PC Fee S Permit Lender s Address Issuance • Y s 1� ,♦ v 1 • t`s 9 tw certify that I have read this application and state that the _ Issuance Fee ' ,�7 '� +• r - above information Is correct I agree to comply with all County Investigation Fee - - N ordinances and Slate laws relating to building construction Total Fee-�O /� 'v♦ ' tY' and here uthorize representatives of this Coyeq-to enter - upon th a e-men bonedroperty for ms non purposes Q t r - -- > - r , \\ i•• '? a Q Q fO Y op- SEE SEE REVEnE FOR EXPLANATORY LANGUAGE - _ � ti +`.�' ♦may-` ` �- �-T ' Zli. Signature of Applicantor Agent Date i i 1'`'11) P s i •. t•;t` �� f.+ ,t \t, 4"IDs j APPLICATION FOR BUILDING PERMIT COUNTY OF OS ANGELES BUILDING AND SAFETY WORKERS COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A00 I hereby affirm that I have a certificate of consent to self asure BUILpIIO AD _ ' or■certificate of v,Y,rkera Compersetion Insurance,o raPy iflereo (Sec b C) CRY ZIP LOCALITY Pdky NO CKmperry Sig LOT NO OF NOW ON LOT ElCertified copy is hereby mished NEAREST CROSS ST Cerbfl copy o filed will county building inspection TRACT 1 ,��I,� BL LOT NO l L USE ZONE A1AP N0I IL Date Applicant ASSESSOR MAP BOOK PAGE TAR n— / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WOR m /rf/� OWNER COMPENSATION INSURANCE WITHIN IDDD FT OF SCHOOL? rss No ADDRESS '�DB(Tho section need not be completed If the pernd Is for one hundred DISTRICT GROUP TYPE CONST FIRE ZONE dollars($100)or*Ii I CITY ZIP I certify that In the performance of the work for which this perrrlrt 46 y is lashed I shelf not employ any person in any mentor eo as to ARCHITECT OR ENG EWA TEL NO become subject to the Yorkers Coripenaaticn LBWS _ 4M STATISTK,AL KATION APT CONDO Dale Applicant ADDRESS CUSS NO01-7KNELL UNITS NOTICE TO APPLICANT If after making this Certificate of REWIRED TOTAL SETBACK FROM EXIST ' Exemption you should become subject to the Yorkers //S SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith i l FRONT comply with such pno iors or this permit shell be deemed revoked AM g LIC P L I LICENSED CONTRACTORS DECLARATION 0 LIC _ PILE 77 r 1 hereby affirm that 1 am licensed under provisions of Chapter B SER MAP _ S (commWith Section 7000)of DlvWon 3 of the Buslrl end ' FT SIZE NO OF STORES NO OF FA/AI NEW ❑ EW -� r11-i_ I .s p Profeasions Code, d I se b In full force an ffect O I— License NII r Dc Coss DESCRI OF WORN ADD �' VALUATION so (�J 1 Contract Dere l 3 ALTER ❑ S -3 D 1 i ❑ I em exempt under Sec REPAIR 13T� $ B I for this reason v J-t— . DEMOL ❑ EO EXISTING LDMA P/C Date YP I 3 4a Ap URM ❑ 2 !TEN-;, Signaturer INn/,1vf TEL NO LD1IA Perm« = TO-1 AL 141 . 16 ❑ I as owner of the property or my employees with wages ss `^' &Wa=LO their sole compensation Will do the Work and the structure o ADDRESS �� Q C HE'_I• ' i41. 1; not Intended or offered for sale (Section 7044 Business and ////� . professions Code) WILLTHEAPFIIOINSOR rRUIVEBULDaKiKCCLIMNTTANIXEAHAZAR0009 WTFALLL I1+ )-I� ❑ 1, as owner of ther 0a A MIXIL RE CONTAWIND A HAZAROOV9 WTERIAL EO11AL TO On KREATER TNN p operty, am BXCIualvery COfltraCtirlg With TIEAMOINTeON THE HASAI1000a WTO11Al8 NFOIa1ATICr1 fK1TE9 FINAL > licensed contractors to construct the project (Section 7044 s❑ Business and Professions Code) WILL THE usE CF TIE BUllOaq a/THE AP0.1(%Ulfr OR FuiUr1E 9.ILL.OINo I 7`..,i 1 COAST AT RECUWEAPFANRFDHCOISRICT rN )SIDECAnON FROM CHECKLIST 1 CONSTRUCTION LENDING AGENCY FORST AIR OVALm MANA!lEMEurr oLsrRlcr lrAarDl eEE PErmrnNK CHECKLIST FOR DUIKFD ( I hereby affirm that there s a Construction lending agency for Y®❑ ra " - 3D 7 Cjv performance Of the wq�f which fills permit s IB9118d(Sex; I MAYS READ E INIMDW9�WTEAWa INFKRNATKIN AMIDE AND THE 9UOM0 3087 CIV C) P 1`1171Ne I LINDFRBIAND MT REdI1nFJ0lTB THE Lob ANKFLE9 . ' Lenders Wme COUNTY ]CHAPTEnt'ATBECTi �a'A 1m T14KXKIH 1',() No Lenders Address D.xaa.aerr o I certify that I have read this application and state that the above Q }� Information Is correct I agree to compry With all county PC FEE PERI FYE TN Ordinances,and State laws relating to building construction (.J O'and !7 aulflorize representatives of this County to enter upon ISSUANCE FEE the anti property for I puTil yn 3 �1INVESTIGATION FEE TOTAL FEE .3 SEE REVERSE FOR EXPLANATORY LANGUAGE ' V WORKERS COMPENSATION DECLARATION ' . C" - I jereby u off m that I have a certificate of consent to self -APPLICATION�,FOR 'BUILDING PERMIT ' insure, or a certificate of Workers Compensation Insurance ,.., or acertified copy the_eof (Sec 3800, Lab' C ) _ \ -, - . - COUNTY.OF LOS ANGELES -� - -BUILDING AND SAFETY _ J Policy No �' +^" Company �� f0 I ,' ... ❑ Certified mpy isihareby furnished y 7 \ - FOR APPLICANT TO FILL IN - gppDIu ,5 - Herz _ Certified copy is filed with the county building inspec- - sU1LD1NG Sy S /fi72A1ifx�. -.J _ t - - - A 17 ' hon department , ADDRESS_ �� 5-0'T 4 T Date~1L Applicant 'J!'1._ - CITY L 017V,NO OF 1pD �v LOCALITY- C 7 ' ` CERTIFICATE OF EXEMPTION FRO WORKERS` - SIZE OF LOT _ NOW ON LOT' - �SgSST ^ - • r - v r � COMPENSATION INSURANCE �, _ - 9(This'sechon need'not'be,completed if the permit is for one •' TRACT' ` t BLOCK ` LOT NO _ ASSESSORMAP BOO -- PAGE PARCEL L hundred dollars ($100) or less )I . T• - TEL ' v(,'t t ' i OWNER . fLO S7 0A"�?ERC NO /Tli fJ US ZONE MAP P ' I certify that d the performance of the work for which this _ [� , permit is issued"I shall not employ any person m any manner ADDRESS c.,Z ._ {} i(jb.t�_ 4 SPECIAL t , a so as to become subject to the Workers Compensation Laws _ 7G�x CONDITIONS O , r4 w t s.•' . ' — CITY TEm�LE �iT� ZIP u Applicant i°' f - i ' ARCHITECT OR - TEL c DISTRICT GROUP TYPE FIRE PROCESSED BY• O NOTICE TO,APPLICANT If r after making this Certificatekof T _ ENGINEER _ _ NO _ _ (`� CONST'''(' ZONE Exemption, youu should'become subject to the ,Workers s �• d K, I/ Cam nsotion provisions of the Labor Code, you must,forth- _ ADDRESS t (/ c� • with comply with'such 'provisions or,this permit shall be TEL Y J' STATISTICAL C FI TION, AP CONDO N ,deemed revoked \• r _ - CONTRACTOR NO Y•L - - z V \ LICENSED CONTRACTORS DECLARATION LIC � CLASS NO '�DWELL UNITS_ - 'I hereby affirm that I am licensed under provisioiis of Chapter 9 ADDRESS 3 K(Lu A-v NOS _ - (commencing with Section 7000)of Division 3 of the Business ,I I q LIC q E SEwE MAP z . t and Professions Code,and my license is in full force and effect CITY EL- W ovm /� 2 CLASS {�� 1 PG VALIDATION i -\ SO FT I NO OF NO OF 'CHECK r License tJumberMt•S�n 7�4S Lic Class - 39 ` SIZE STORIES FAMILIES ONE - 1 1y1L - - Z VALUATION T Contractor'' '��a'\ � -AT{'na te, I ✓�� DESCRIPTION OF WORK' - r NEW ❑ -3 .t, - 9 / ►Dam exempt urider Sac �C2 3TxN(a' �O ADD-- ❑ ALTER ❑ i B 8P C'for this reason �C'obP' tli,_7 Y �lHP 15 fA9/B REPAIR ❑ $ 4 Z ' USE OF - - , -Date EXISTING BLDG •` • r - i DEMOL ❑ - ~• _ _ �_ S gnah,rw \ 1�1�D.'l - APPLICANT % TEL i .c^�A/ "(PRINT) NO - DATEFINA / U , OWNER B IL R DECLARATION �q DATE / - I hereby affirm that I am exempt from the Contractor's License - ADDRESS °s7 -k�u 1E4v 0'�E C Law for the followatg„rreason (Section 7031 5, Business and FIN 4 c w� T Professions Coda) k. . _ PRESENT BUILDING - _ �= ❑ I Tas owner of the property or-my employees with ADDRESS > ) �. 7 440.50 wages a'their 3616 compensation will do the work and - -- - • -- - -s t - - - - the structure is not intended or offered for sale(Section ' LOCALITY ► i 1 ITEMS- ' r7044 Business and,Professions,Code ) -. MOVING ' _ - _ TEL - - rY-. - - ❑ -1 as owner of the property am exclusively contracting CONTRACTOR NO .- TOTAL 40 _ 50 with licensed contractors to construct the prolect (Sec- + _ _ - _ - - + I I • tion 7044 Business and Professions Code ) ADDRESS 40.50 REQUIRED. TOTAL SETBACK FROM T CONSTRUCTION LENDING AGENCY " ' SET BA YARD HWY PROP LINE ID ° �- JMIE I hereby affirm that there is a construction lending agency for ,FRONT >�- .L he performance of the'work for which this permit is issued ''r ' 'P L (Sec 3097 Civ C ) - S10E ' C _ IPL - - - t 00�-ODOl 11/, 3/89 Lender's'Nome r ,�• TDMA Ref ,6W 1 AM 81:29 P C�Fee S Permit Fee i Lenders Address ' ' o I certify that I hove read this application and state that the t � �•' issuance Fee /O s 5� LDMA PiC N above information is correct I agree to comply with all County Investig ion Fee G_ ordinances and State Iowa relating to building construction, Total Feer' •5 LDMA perm-# and hereby authorize representatives of this County to enter a hi phoned property for inspechon'purPoyseps � 1 SEE REVERSE FOR EXPLANATORY LANGUAGE S,grclhirt,of Applicant or Agent • Date f. '