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Home My Public Portal About6222 RENO AVE_Building__ WORKERS'66AP PNSATIONJDECLARATION. I herdby affirm that I have a certificate of consent to self ERMIT1 insure, or a certificate of Workers'Compensation Insurance, APPLICATION F®R BUILDING P or a certified copy thereof (Sec. 3800, Lab. C.) Policy No � /_ Company T� �L[ COYJNTV OF LOS ANGELES BUILDIN AND SAFETY ❑ Cer ied copy is hereby furnished. FOR APPLICANT TO FILL IN • ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Date pplicant CITY / ZIP LOCALITY ERTIFICEXEMPTION FROM WORKERS' Aq NO.OF BLDGS. NEAREST SIZE OF-LOT NOW ON LOTCROSS ST. COMPENSATION INSURANCE (This section need not be completed if the permit is for one I TRACT' BLOCK LOT NO. MAP BOOOK PAGE PARCEL hundred dollars ($100)or less.) - TEL. USEOI MAP I certify that in the performance of the work for which this OWNER NO. I�/`(J NO. permit is issued, I shall not employ any person in any manner / SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS y»" ®/Tim /a' ' CONDITIONS U Date Applicant CITY /G - ZIP OJ NOTICE TO APPLICANT: If, after making'this Certificate of ARCHITECT TEL. DISTRICT' G UP TYPE FIRE PRO SSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. �� CONST ZONE W Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL, / STATISTICAL CLASSIFICATION APT, ONDO. CO deemed revoked. CONTRACTORd& '/� NO. v Z LICENSED CONTRACTORS DECLARATION LIC. CLASS No. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 2262:: Al -V 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 PG VALIDATION . SQ. FT NO.OF NO.OF CHECK License Number ic.Class _ SIZE Jibij'JS TORIES FAMILIES ONE VAJUATION Contract V Date ;. DESCRIPTION OF WORK ' App NEW $ ADD ❑'I am exempt under Sec. 00 ft—&Z ALTER ❑° B.&P.C. for this reason USE OF REPAIR ❑ $ Date: EXISTING BLDG. DEMOL ❑' f/�{j APPLICANT TEL. Signature PRINT NO. FINAL '[f g o'o o,o o.� OWNER-BUIL ER DECLARATION DATE. 1 hereby affirm that I am exempt from the Contractor's License s; o o'0 0 . Law for the following reason (Section 7031.5, Business and ADDRESS IF # i0,1 Professions Code): PRESENTB v0'106,13 ❑ BUILDING I, as owner of the property, or myemployees with ADDRESS wages as their sole compensation,will do the work and e a 1 Q b 1 •3 c0: the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. —8 7 ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. O 9,3 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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 P.L. Lender's Name . ' T LDMA Ref. # '? P.C.Fee$ Permit Fee V 6 b Lender's Address /�� 1 certify that I have read this application and state that the Issuance Fee V1, LDMA PSC# above information is correct. I agree to comply with all County Investigation Fee i ordinances and State laws relating to building construction, Total Fee 616a LDMA Perm. N and hereby authorize representatives of thtSIC ounty to enter upon theamentioned property for i ection purposes. v g , SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicant or Agent Date Jr WORKERS'COMPENSATION DECLARATION k � •4 hereby affirm that I hay.i a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, APPLICATIN FR B ILDING PERMIT • or a certified copy thereof (Sec:3800,-Lob. C.) COUNTY OF LOS ANGELES ; BUILDING AND SAFETY Policy No. Company FA1 A,14 tr IL ..Certifie 6U IL copy is hereby furnished. I FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING / tion department: ADDRESS y $ ( l el/ ` ZIP LOCALITY i C: Date Applicant. Y CITY CERTI CA OF EXEMPTION F OM WORKERS'' I O.OF BLDGS. / NEAREST COMPENSATION IN RANCE SIZE OF LOT /� NOW ON LOT / CROSS ST. (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK' PAGE PARCEL hundred dollars($100)or less.) TEL/ r (certify that in"the performance.of the work for which this OWNER p E ZONE lop permit is issued, I shall not employ any person'in any'manner A/ JtJc /l'' tSPECIAL , so as to become subject to'the Workers'Compensation Laws. ADDRESS �v / V CONDITIONS I CITY If ZIP Im Date Applicant `ARCHITE OR TEL. • NOTICE TO,APPLICANT: If; after making this Certificafe of ;DISTRICT GROUP TYPE FIRE ��SED.BY ENGINEER NO. CONST. ZONE 1. Exemption,-you should become subject to the Workers' //�� au Compensation provisions of,the Labor Code, you must forth, ADDRESS 54 4-31 . �• with comply. with, such provisions or. this, permit shall beTEL.'L STATISTICAL CLASSIFIC TION APT. [CONDS. $ deemed revoked,;. • CONTRACTOR a. J NO. w 0 LICENSED CONTRACTORS DECLARATION CLASS NO. ti DWELL UNITS LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 12!f1 t NO.4AIC 2,C,7 (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 �r CLASSBK V VALIDATION SQ.FT. NO.OF _ NO.OF' CHECK License Number Lic.Class ] SIZE STORIES FAMILIES ONE VALUATION n DESCRIPTION OF WORK NEW ❑ A Contractor ate �/• I J J ADD $ ❑ I am exe pt under Sec. � '� ❑ .�.� ALTER ❑:c ;2f5 1 b 3,0 B.BP.C. for this reason W Z &F 9W REPAIR ❑ $ USE OF # 0 0 0 0 o Date: EXISTING BLDG. / DEMOL ❑ APPLICANT 1, TEL. yG ( 0 0 4 9 8 8 "' "'Sig"nature FINAL 1. OWNER-BUILDER DECLARATION I PRINT NO. DATE I hereby.affirm that I am exempt from the.Contractor's License 3 0 0 0 4 9.8 8 5 Law for the following reason (Section 7031.5, Business and , ADDRESS FIN Professions Code): PRESENT B 0 3.0 5--8'5 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). I REQUIRED YARD HWY TOTAL SETBACK FROM 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 'o P.L. Lender's Name Q •� LDMA Ref.# Lender's Address 1 P.C. Fee$ Permit Fee rJ r I certify that I have read this application and state that the Issuance Fee O LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee [Tri ordinances and State laws rel ' g to building construction, I Total Fee o LDMA Perm. # and hereby authorize repres tafives of this County to enterSMEIMZ7 mu upone above-nlentione roperty for inspectio purposes. c- Aga > � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicant or Agent Dg 1 M A' WOVERS'•COAAPENSATION DECLARATION 1It,I su&,hereby-affirm that•I mover certificate of consent to self �L I CAT I"M �� Q LIPERMIT R '�° ol y' insure, qr c.certifjcate of Vtiorkers'Compensation Insurance, + �Jj e -or d certified copy t ereof(Sec. 3800 Lab. C.) a F COUNTY O� LOS ANGELES BUILDONG AND SAFETY Policy No. Company—�tdZAI of Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- ;': BUILDING n 1 tion department. ADDRESS rL / + /�C�`(� r7 IJ-�, LOCALITY Date NEAREST AdA IL ti Applicant 'CITY �'Z -� ZIP CROSS ST. CE TIF TE OF EXEMPTION R N1 WORKE N OF BLDGS. ASSESSOR. COMPENSATION INSURANCE [ADDRI F LOT IJ •NOW.ONtOT• MAP BOOK P E PARCEL (This section need not be completed if.the permit is for one USE NE MAP T O BLOCK•� 1 LOT NO. NO. hundred dollars($100)or less.) i� t ,t� ��L/ p i/ SPECIAL ER f gr r6L I A 6� �NO.ft. - CONDITIONS IL I certify that in the performance of the work for which this •� /��,.�` DISTRICT G UP TYPE FIRE PROC ED BY permit is issued, I shall not employ any person in-any manner ADDRESS N. �IVt7 /�� CONST. ZONE kJ 0 I so as to become subject to the Workers'Compensation Laws. - �^`�(r _ / 0: L� '�.�.! ZIP J ® �,`` 1/ Date Applicant STATISTICAL CLASSIFICATION APT. CON 6- NOTICE TO APPLICANT: If, after making this Certificate of ITECT OR TEL. JExemption, you should becomesubject to the Workers' NEER• NO. CLASS NO. IL DWELL.UNITSCompensation provisions of the Labor Code, you must forth- "'`ESS SEWERMAP �with comply with such provisions or this permit shall be rel .1deemed revoked. RACTOR �}# ',l�#44 NO. (� BK. PG, VALIDATIONy LICENSED CONTRACTORS DECpLARATION P Q NC.A2I hereb affirm that I am ficerised under rovisions of Cha ter 9 ESS 6 S ,"'�C�M (Yr. J VALU TION (commencing with Section 7000)of Division 3 of the Business and LIC. �� An Professions Code,and my license is in full force and effect. CITY �(�Ol+�/�f. CLASS $ 00 SD.FT. NO.OF NO.OF CHECK License Num er Lic.Clas SIZE STORIES FAMILIES ONE $ ;21 1 &0 A Ji. ContractorV. Date �- O DESCRIPTION OF WORK NEW ❑ # 0 0 0 0 0 1 am exe pt under ec. G ADD ��11 ALTER E] FINAL I o 1 6238 B..&P.C. for this reason rJ / REPAIR ❑:. DATE �' o o 1 6238F-' USE OF r i Date: EXISTING BLDG. DEMOL ❑ FINAr Signature APPLICANT TEL. By 1 206=84 OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5; Business and ADDRESS Professions Code): PRESENTa 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 TOTAL SETBACK FROM EXIST, CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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. tSec. 3097,Civ. C.).. SIDE ' P.L. `o Lender's Name P.C.Fee$ Permit RawCi V Lender's Address , p I certify that I have read this application and state that the Issuance Fee Z) above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee � a3 and hereby authorize representativ of this County to enter upon the above-mentioned prop y for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of App i&R or Agent Dat ®s