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HomeMy Public PortalAbout5703 OAK AVE_Building_9/30/1987__cyljRKERS C©MPENSATION DECLARATION I.}Itveby 6616,- that 1 h--.rycertificate of consent to self insure, or o certificate of kers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C. ) Policy No Company ❑ Certified copy is hereby furnished. Fill Certified copy is filed with the county buildinginspec- }'3J tion eportmenL /��W Data Applicant ERTI CATE OF EXEMPTION ROM WO�KERS' 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. Dab, 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 70DO) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Num er 'j/�Lla Gla«�r%� �/ Contracto�V (.Date u//��/ I am exempt under Se, B.BP.C. for this reason note, Signotura 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): 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 sole (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 iso construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Addres< 1 certify that I have ead this application and state that the a4informan ' correct. I agree to comply with all County oto laws relating to building construction, arize representatives of this County to enter ua ti S. S r of Applicant or Agent �D e APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT T9, FILL IN BUILDING ADDRESSX0eOFZBU>GS. CITYSIZE OF LOT NOW ON LOT LOT TRACT I BLOCK I LOT NO. OWNER �il� liCLcD iia L. ADDRESS v CITY ZIP ARCHITECT OR TEL. ENGINEER NO. ADDRESS TEL. CONTRACTy _ N`O. AD �J d1Z..LNO. LIC. Clcuss SQ. SIZE STORIES (FAMILIES DE.(PTI USE OF 7 EXISTING BLDG. APPLICANT TEL. IPRINTI NO. ADDRESS PREbENI BUILDING ADDRrcc ADDRESS V /(/ J VU//LJ LOCALITY .a / NEARECROSS . 6 S CROSS ST. #••ee •.� ASSESSOR NO. MAP BOOK PAGE PARCEL U7E1 I MAT/ NO. REQUIRED SPECIAL HWY CONDITIONS Up STATISTICALC201_ A IONNST� FIRE E �PT. PROCESSED BY F0ND0. CLASS NO. DWELL. UNITS_ SEWER MAP "NECK BK. PG. VALIDATION ONE ❑ VALUATION NEW 0� ADD ALTER L�JL REPAIR ❑ $ DEMOL ❑ LOCALITY MOVING TEL. #••ee •.� CONTRACTOR NO. ADDRESS o a12-87 REQUIRED YARD HWY TOTAL SETBACK FRUM Elll31. SETBACK PROP. LINE WIDTH FRONT P.L. I I SIDE P.L. P.C. Fee E Permit /1J Issuance Fee Investigation Fee / f �p Total Fee ! � // s rl SEE REVERSE FOR EXPLANATORY LANGUAGE FINAL ' DATE 27655A FIN ET B #••ee •.� I•.•4Q50 •••40.505 o a12-87 LDMA Ref. N ,MA P/C If LDMA Perm. R To: No. PLANS TO APPLICANT Returned Date No. Date Required Approvals Yes I No Water i e_'rhtrCUid Health Department Fire Deportment Grnd�ny Geologrcol Pedestrian Protection Fence)(Canooy) Special Inspection iC.onc ) Wasonry) (Welding) Lot Drainage Parking Approvals Location - ;Setback & Yards) Foundations Slob w Frnme Fnerqy Insulation Loth,'Dr'ywall Intortor lC01 Exterior H(,L)-w Nu,rnr�er ( C)rrect & Posted Final Enter on Front INSPECTOR'S NOTES OWNER-BLIKIN1. I)t{('@Ail HON ' hereby affirm that I am exempt frdrn-rhe,' ntruraC�.S "' / License Law for the following renson 7034 '7} Approved i' Business and Profesciuns Code.•:An v citti• or e-ount%, which reyuire� a permit to construct. alter, improve, dernoli.eh, or repair ant,• structure, prior to its issuance, also re•yrsirev � the applicant for such permit to file a signed statement L 7 ��� that be is licensed pursuant to the provisions of the (:on - tractor's license I.atv(0,apter 9) (commencing u-ith Sec-. tion 700()) of Division i of the Business and 11rofesaions Code) or that be is e'xentpl therefrom and the basis for the alleged exemption.: n.v violation of Section 703 1. S In Date Received any applicant fora perincit subjects the applicant to a civil or Approved penalty of not more than fire, .hundred dollars (5500).): I, as owner of the property, or my employees with wages as their sole cornpensotton, will do the work, and the structure is not intended or offered for sole (Sec 7044;: Business and Professions Code: The Contractors License l.aw elves not appy' to an owner of property u4m builds or improves thereon, and who doers such work himself or through his own employees, pruvieleat -that such irn- provements are not intended or offered for sale. If. however, the building or improvement is sold tedthin one Year of completion:, the owner -builder will have the burden of proving that be did not buil) or improve /or the purpose of sale). I, as owner of the property, am exclusively controc ting with licensed contractors to construct the project (Sec. 7044) Business and Professions Coda: The Contractor's license l.au• does not apply to an owner of property who builds or improves thereon, and u•ho contracts for such projects .with a contractor(s) licensed pursuant to the Contractors I.icense haul. _ I am exempt under Sec . B.&P.C. for this reason Date Owner Date I Inspector's Signature INSPECTOR'S NOTES