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Home My Public Portal About5708 OAK AVE_Building_3/4/1983_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 certified copy thereof (Sec. 3800, Lab. C.) Policy No Compamr n Certified copy is hereby furnished. Certified copy is filed with the county building inspec- tion department. Date Applicant CERTIFICATE 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. Date 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 70Da) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number I ic. Cla« Gcntractor Date I am exempt under Ser B.BP.C. for this reason 1 Date: Signatur- . OWNER -BUILDER DECLARATION :' I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and Professions Code): 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 reby affirm that there is a construction lending agency for performance of the work for which this permit is issued c. 3097, Civ. C.). �der's Name er's Address ify that I have read this application and state that the information is correct. I agree to comply with all County nces and State laws relating to building construction, reby authorize representatives of this County to enter a above-mentioned property for inspection purposes. na re of Applicant or Agant D� at 0 3 APPLICATION FOR COUNTY OF LOS ANGELES FOR APPLICANT TO FILL IN BUILDING // �f ADDRESS _'2 7e S !Ivor �K //+Ve_— CITY I Gym/ //Lp� `e, ZIP (1 O Q SIZE OF LOT ' // (J !X / N�OWW ON LOT S /IJV TRACT (/pr J�(p�//+�� t�jK �(/4JLOT NO. �j OWNEfRSY�RIIVr[/ NQC(r! ADDRESS ✓ !Pb/'�/K%,// _ �//jj p�y AiTYRCHITECT ��ALG 6e • ' IP ff?1—1 (/ L. ENGINEER NO. ADDRESS SIIZZE 7>� T r FAMILIES t TEL. CONTRACTOR NO. dOE/d' S!/7E1� d T LIC. ADDRESS NO. ALTER LIC. CITY CLASS I I NO. OF CHECK ISTORIIIEEESpS�� SIIZZE 7>� T r FAMILIES t HWY DESCRIPTION OF WORK1&rA^,S�G%'I� I NEW EXIST. dOE/d' S!/7E1� d T ADD ❑ WIDTH ALTER ❑ REPAIR ❑ USE OF +rl�. �Drp'l� DEMOL EXISTING BL/DG. FF Y/TlgG��,7mv-�c. ❑ ,.y'(� .yp _APP(PRINTTIC -4WROe t- ADDRESS'S4MN I PRESENT ,y rr�rr y� -BUILDING Nc AfC Ale LOCALITY 7�AW;WZ� C! f; e � 1%/ Md MOVING TEL. P.C. Fee $ CONTRACTOR NO. Permit Fee R BUILDING PERMIT BUILDING AND SAFETY ADDRESS LOCALITY NEAREST CROSS ST. .L/w�-� //��•%•Gr ASSESSOR MAP BOOK (PAGE PARCEL_ USE ZONE IOP /1 SPECIAL �J71 CONDITIONS D TRICT ROUP TYPE FIRE PROCESSED BY CON ZO�jE 4 Gf.✓6L/ ST TIST L ��IF�qIJ ION '� (CONDO CLASS NO. I Z, DWELL. UNITS_ ` SEWER MAP BK. PG, VALIDATION yAL km FINAL DATE --i By By � 4 -•a -Cr ADDRESS REQUIREDI YARD HWY TOTALPROPSETBACK FROM EXIST. SET eACK . LINE WIDTH FRONT P. L. I I I SIDE P.L. ry P.C. Fee $ Permit Fee Issuance Fee Investigation Fee Total Fee E SEE REVERSE FOR EXPLANATORY LANGUAGE `.0201A 2 a s 4 0 5 0 ► ('r��04-�3 es I - PLANS TQ APPLICANT Ta. Returned Approved Ne. Date No. Date I J Acprovcl° Required Date Rocelvod er Approved Yes No , Water Certificate Health Department Fire Department Grading Geological I Pedestrian Protection (Force)(Canopy) Special Inspection (Cone.) (Masonry) (Welding) Lot Drainage Parking i Approvals at. laspeefor•s Signeturo Location IS P./ etback &Yards) IFoundations 1� Slab Frame Energy Insulation Lath/Drywall— Interior Lath—Exterior House Number— Correct & Posted Final— Enter on Front I I I INSPECTOR'S NQTES OWNER -BUILDER DLCLARATION - I hereby afiirm that I cm exempt from the Contractor's License Law for the following reason. (Sec. 7031.5) - El-iness—el Prnfessimts Cade:Anycity orcnunty wbicb requires a permit ro construct, atter, improve, d—mlisb, or repair any structure, prior to its issuance, also requires ,be applicant for such permit to file a signed statement - that he is licensed pursuant to the provisions of the Con- tractor's License Law (Chapter 9) (commencing with Seo- - tion 7000) of Division 3 of the Business and Professions Code)or that be is erenrpt therefrom and the basisfor the alleged exemption. Any trlolalion of Section 7031.5 by auy applicant for c permit suhiects the applicant to a civil puna:: y of not r mr, the, five hundred dollars (5500).): JI 1, as owner of the property, or my employees with wages as their sale compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044) Business and Professions Code: The Contractor's License Law= not apply to an ..our of property wbo builds or improves thereon, and tube does .such work himself or through bis own erupinyees, provided that such im- provements are not intended or offered for sale. If, however, the building or inrpro oen.en t rs sold within one year of completion, the ow;;cr-buiffar will have the bard,, of Arovin�ur tohe r.:; an: build or inprone ft r the purpose of sale). ❑ I, as owner of the property, am exclusivelycontrac- ting with licensed contractors to construct the project (Sec. 7044) B -i... and Professions Code: The Contractor's License Law does net apply to an owner of property who builds or improves thereon, and .,be contracts for starh projects with a contracturfs) licensed pursuant to the Co.1— or s l.inrensc Lcu'/. ❑ I am exempt under Sec. ,B.&P.C. forfliis