HomeMy Public PortalAbout5702 OAK AVE_Building_12/8/1992_WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance,
or a certifiie��dcopy � thereof (Sec. 3800, Lob. C.)
Policy NJ./���LCompany 'SCT F'
�❑Certified copy is hereby furnished.
`,;R Certified copy is filed with the county building inspec-
/3 tion department. C
)ok!ate 1Z,BtZ QApplicant
CERTI ICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
hundred dollars ($100) or less.)
I certify that in the performance of the work for which this
permit is Issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws,
Dot- Applicant
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be
deemed revoked.
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business
and Professions Code, and my license is in full force and
.,effect.
rr//���IT�Y License Number J i 3 7 7 1c. Class C_ /C_
�X ractor ieets \J0. Q.00�LM I. \L VG\CL "L
J a
QI3DI�❑ I am exempt under Sec.
_I B.&P.C, for this reason
r)nte:
Signatur- -
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and
Professions Code):
E] I, as owner of the property, or my employees with
wages as their sole compensation, will do the work and
the structure is not intended or offered for sale (Section
7044, Business and Professions Code.)
❑ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec-
tion 7044, Business and Professions Code.)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is Issued
(Sec. 3097, Civ. C.).
Lender's Name
Lender's Addr==<
I certify that I have read this application and state that the
above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
upon th bove-mentioned property for Inspection purposes.
Lam. ( 2/P/ r 7
Signature of App icont or Agent i to
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
BUILDING
ADDRESS 6'7 O 2-�j
A) • L� �C
CITY L Le
l..t+NOZIP 917 Rte
-S.
SIZE OF LOT
. OF BLD
NOW ON LOT 2-
TRACT t( S l(� I IBLOCK I LOT NO.
` 1 TEL. p
OWNER J. `Y. V trV NO.IG_..a _2_ -2227
ADDRESS S% 0
IJ (/ 'OL K
�
CITY / ! .t,. D � [+
C1 I Y ZIP
ARCHITEC OR TEL.
ENGINEER NO.
ADDRESS
TEL. rrr`a
CONTRACTOR >~,� QO O t :ua NO.. ^07% (e,
ADDRESS!/1 �j� W t 3PA JNO„J)13.7?
�atJwQ rrfo cuss C _31
5 ZE `S� fl II STORIIEES((''''�� IFAMILOIES I CHECK
DESCRIPTION OF WORK \L,p ^ QZ OO I NEW ❑
ADD ❑
0 V e ALTER gyp❑
fL�C L.a S�'�- + •"� `0 REPAIR`r
SF
EXISTING BLDG. P �Q "C, -0 DEMOL ❑
APPLICANT ll'L/r L�LTTEL.
(NT)LVt. 4
ADDRESS v � 7 •" a Q^ a
PRESENT
BUILDING
ADDRECL
LOCALITY
MOVING TEL.
CONTRACTOR NO.
BUILDING
Cil
ADDRESS
✓
LOCALITYNEAREST
PROP. LINE WIDTH
FRONT
CROSS ST. L,�
aj Q l/ IL
ASSESSOR
I
MAP BOOK
I PAGE PARCEL
USE ZONEIroP
I
NO.
SPECIAL
P.C. Fee $
CONDITIONS
DISTRICT
GROUP PROCESSED BY
b'
I
CONST.
�
ZONE
STATISTICAL
&ASSIFICA
ON
PT,
CONDO.
CLASS NO.
DWELL. UNITS_
I
I
I
SEWER
MAP
ADDRESS
REQUIRED YARD
HWY TOTAL SETBACK FROM EXIST.
SET BACK
PROP. LINE WIDTH
FRONT
P. L.
S10E
P. L.
I I �• �`7
P.C. Fee $
Permit Fee
24,
Issuance Fee
Investigation Fee
/43
Total Fee �P
SEE REVERSE
FOR EXPLANATORY LANGUAGE
BK. PG.
VALUATION
L
S 1700
S
FINAL
DATE
FINAL
By I
t
LOMA Ref. If
ILO P/C If ►
LOMA Perm. It
VALIDATION
ACC .r
X07
a'
a
0
tY
Z
Z
JJ 14.5.6:
1 ITEMS
TOTAL 143 - 63
CHEC , 143.63
CHANGE •C�tl
0000-0001 12,` 8192
6926 1 AM11:U�
! PLANS TO APPLICANT INSPECTOR'S NOTES
OWNER-BUILDER DECLARATION
I hereoy affirm that I am exempt from the Contractor's
To: Retumed
License Law -for the following reason, (Sec. 7031.5)
A roved
pp
Business and Professions Code: Any city or county which
No. ( Date' No. Date,
requires a permit to`construct, alter, Improve, demolish,
or repair any structure,•priorto its Issuance, also requires.
-
the applicant for such permit to f//e a signed statement
•
that he is licensed pursuant to the provisions of the Con-
,
tractor's License Law (Chapter 9) (commencing with Sec-
tion 7000) of Divlslon 3:of the Business and Professions
Code) or that he-is exempt therefrom and the basis for
the, alleged. exemption. Any violation of Section 7031.5 by
Required
Approvers
Date Received :" •
any applicant fora permit subjects the applicant to a civil
Yes No
or Approved
penalty of not more than five hundred dollars ($500).):
I, as owner of the property, or my employees with
Water Certificate _.
wages as their sole compensation, will do the work, and
I
I
the structure Is not intended or'offered for sale (Sec. 7044)
Health Department8
( _
usiness and Professions Code: The Contractor's License
�- - -- - -
Law does not apply to an owner of property who builds
Fire Department I
or improves thereon, and who does such work himself or
through his own employees, provided, that such im-
Grading• -
provements are not" Intended or offered for sale. If,
' -
' j" '
however, the bullding'orImprovement is sold within one
Geological
I -. �
Year of completion, the owner-builder will have the burden
� pletlon,.
1
f
of proving that he did not build or improve for the purpose
Pedestrian Protection
sale).
of ❑ I,
(Fence) (Canopy)
as owner of theproperty, am exclusive) con-
tractirig with licensed conaorto construct the pro-
Special Inspection
ject (Sec. 7044) Buslness'and-Professions Code: The Con-
(Conc.) (Masonry) (Welding)
--
�
tractor's License Law does not apply to an owner of pro-
_ . , , -
_ party vyho.bullds orlmproves,theneon, and who contracts
for•such pr6iects with a contractor(sj licensed pursuadt` `
Lot Drainage
to the Contractor's License Law),: ,
Parking ( I
O 1 am exempt under-Sec. , B.&P.C. for this I
I• ..
reason
Date Owner
Approvals (' Date I Inspector's Signature ,
_
. _ I
INSPECTOR'S NOTES
Location—..
(Setback'& Yards)'
...r- Poundaffiins• •. .. ` -. -
, . -
- Slab
Frame
Energy Insulation
- Lath/Drywall-
Interior
Lath—Exterior
House Number —
Correct & Posted
Final—
Enter on Front