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HomeMy Public PortalAbout8708 WENDON ST_Building__ WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILD 1 N G P E RM I T Insure, or a certificate of Workers'Compensation Insurance, or a certified o•y thereof jSec. 3800, La . C/) COUNTY OF LOS ANGELES i a BUILDING AND SAFETY Policy No � �t0 Company � uN O�CBUILD ertified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRIESS Z3/j,� f ❑ Certified copy is filed with the coup u' in ins ec- BUILDING J i VtiZ�t,niient. ADDRESS 0 Lr"/u -r�- �01- CITYe6r+ �l ZIP Date Applicant 4 NO.OF BLDGS. / NEAREST ERTI ICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK PAGE I PARCEL hundred dollars ($100)or less.) TEL. 0 NE lk fj x NO. -Q73-37 USE ZONE MAP I certify that in the performance of the work for which this NO. SPECIAL >- permit is issued, I shall not employ any person in any manner ADDRESS LS o CONDITIONS O rs' so as to become subject to the WorkeCompensation Laws. n 2I I 0 CIN ZIP G✓ Date Applicant ARCHIT CT OR TEL. 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY Q Exemption, you should become subject to the Workers' p� 0-,3 CONST. Z E Compensation provisions of the Labor Code, you must forth- ADDRESS .100 a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR 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 Division 3 of the Business LIC. i SEWER MAP and Professions Co�nd my license is in full force and effect. CITY n NO. OF CHECK CLASS i BK VALIDATION SQ. FT. NO. OF License Number , ic. Class SIZE II STORIES FAMILIES ONE VALUATI Contractor QS Dat DESCRIPTION OF WORK � C" NEW ❑ .e r $ ©a ► ADD LJ ❑I am exempt under Sec. 1 yALTER 1:1 BAP.C. for this reason ��� -7'0� $ REPAIR ❑ Date: USE OF EXISTING BLDG. DEMO. ❑ Signature APPLICANT TEL. (PRINT) NOFINAL ,p OWNER-BUILDER DECLARATION . DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL () Professions Code): PRESENT B G• r ❑ I, as owner of the roe or m employees with BUILDING Y Vit!:(F°4 property,rtY� YADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , 3307 70.36` 7044, Business and Professions Code.) MOVING TEL. 4 1 1 i EMJ ❑ I,as owner of the property,am exclusively contracting ' CONTRACTOR NO. , with licensed contractors to construct the project (Sec- TOTAL 3*8 70 m tion 7044, Business and Professions Code.) ADDRESS CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROPA INE FROM WIDTH CHECK !0.1-13 I hereby affirm that there is a construction lending agency for FRONT CHAINGE the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. I.30II3O-0001 4/ 21/' 1 Lender's Name C/ iLDMA Ref. # 3 P.C. Fee$ Permit Fee d ° '4, Lender's Address , � ' i a�:�°i'= I certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee �' LDMA Perm. # and hereby outh raze representatives of this Co ty to enter tffh ab`` - entio ed property for inspect, pu poses. o J SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ApAlicant or Agent It D to 7BA638ACE48038+64 APPLICATION FOR-BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING �J DEPARTMENT OF COUNTY ENGINEER ADDRESS / SUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE•. COUNTY ENGINEER NEAREST COLEMAN W. JENKINSSUP'T,OF BUILDING CROSS ST. -DISTRICT NO. GR TYPE• PROC SS Y le FOR APPLICANT TO FILL IN 's CONST. BUILDING STATISTICASSIFICATION SE MAP ADDRESS f�08WcS'T.(�'.�FT BK PG CLASS NO. DWELL UNITS LOT NO. BLOCK USE ZONE MAP �• lF NO. (J TRACT SPECIAL ��••• Inc -NO OF BLOCS. CONDITIONS SIZE OF LOT �7O*l �QO NOW ON LOT USE OF J EXISTING��JJ c.5r/yS��G��,1pG� BLDG. SETBACK FROM OWNER f �i/v�•c�S NOL FRONT PROP. LINE OF (STREET) f'. e;0 HIGHWAY W sT� _ TYPE OF E%ISTINO SETBACK HIGHWAY YARD = TOTAL ADDRESS a ®8i��ily �Y � M C.L. CITY ARCHITECT OR 0 TEL. BLDG. SETBACK FROM ENGINEER NO. SIDE PROP. LINE OF (STREET)' TYPE'OF EXISTING SETBACK HIGHWAY + YARD = TOTAL >. ADDRESS �� �•u - HIGHWAY WIDTH FROM C.L. D. CONTRA CTTOIdA .40 L ���d + u ADDRESSp�.Ts�v� ! p CORNER CUTOFF YES NO 0 CITY C c10 `� SEE REVERSE SIDE FOR SPECIAL APPROVALS W CL DESCRIPTION OF WORK �• �5, � 4 Z NEW D' ALTE REPAIR DEMOLISH SO.FT. ry NO. OF / NO. OF ��fl fi.L'✓t �C•w.?i" Y� /�i ✓l SIZE O STORIES / FAMILIES 1f' USE OF STRUCTUREv/7?P� SIGNATURE OF I /!/(• / Gs �%G'ILIR G(,T. '� �( (� APPLICANT �_� VALUATION$ ��Qv APPROVALS' DATE INSPECTOR'S81c„NATURE� P.C. PMT. +�•� ' FOUNDATION, LOCATION FEE$ FEE$ IV (/ FORMS.,-.MATERIALS FRAME; FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE 'LAWS REGULATING GAS.VENT. DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK AUTHOR IZED.;HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR COOL OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMENION'S Cn SATRy LATH. EXT. SIGNATURE O �v— HOUSE NUMBER'COR- PERMITTEE REC . AND POSTED I. ADDRESS '� .fd��• ® FINAL JOHN.F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M:O. CASH PERMIT VALIDATION CK. M.O. CASH Lt 0 7 5 5 6.:1 JAN 15 1 A S.5 0- cv