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Home My Public Portal About5720 OAK AVE_Building_1/28/1985_J COMPENSATION DECLARATION at I have a dartifieolte•of consent to self insure, or cerl'ficate of Workers' Compensation Insurance, ora crtified copy thereof (Sec. 3800, Lob. C.) Policy N- Company 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 withsuch 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. Lipense Number Lia Class Contractor Date I am exempt under Ser B.BP.C. for this reason nate: 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): ❑ 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.). a� //��. Lender's Nam- / 1' /' / Lender's Address 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, Aeby authorize repr sentatives of this County to enter ab ve-mention pr for inspection purpo es. nature of Pplicant or Agent 'Dale APPLICATION FOR BUILDING PE COUNTY OF LOS ANGELES BUILDING AND SAFETY F-/yORR APPLICANT TO/,FILL t IN ' / BUILDING S/ Q0 N• V//K �✓�' ADDRES�S(� ///�S /qS / ry CITY / (�i�ii�/I �1e /j61 ZIP `/ f /%�a SIZE OF /LOT c'vj/.�J0 7C �7 V NOW ONLOT/�" /y TRACT t0 �CO7y/yam II BLOCK I LOT NO..f[�/yr�,// ry�y TEL OWNER /�//'//,/E////I�/,V/ �•�f NO`.4/(�O�/f'��J`9T�/dS" ADDRESS /(�p:01 `/I`'^ AZ Ykl/l6/ A 157r%OJ_377/ CITY S/?N L�/7/JVCIGL-• ZIP q/ /; ARCHITECT OR TEL. ENGINEER NO. ADDRESS BUILDING 5 / C v /T 77 ADDRESS / �/� LOCALITY TG////'-��C C/7 7 NEAREST OSSSST.ASSESSOR ��vGo/77C MAP BOOK 9E6(J/ /y IPAGE 0/40 U6 ZONE IMAP NO SPEC. IAL CONDITIONS DISTRICT I GROUP I TYPE FIRE ,§E U K 19-51 T _5 CONST. _ / ZONE �S TEL. STATISTICAL CLASSIFICATION V CONTRACTOR LIC CLASS NO. �f—.DWELL.UNITS— �� LIC ADDRESS NO. LIC. CITY CLASS _ SQ. FT. INO. OF / INO. OF / SIZE STORIES FAMIILLIIEESj�r� CHECK ONE n J DESCRIPTION I�Ei!(lOUCp/-!�[IFG7J/EiJ. NEW ryOFF/WORK ADD ryYlYi/.7W� �4 Adm. F1. mow, `TL( %w.�,L-e' ALTER REPAIR J tl USE OF A �s T'' M I' M EXISTING BLDG.�/ftyl-I,Q/�Cl��jr(1r111!N +W.v�F��/DE1v10(L7 APP(PRINhT)/H�1r1^/ L=y�1%II'Ti'l1 j /'O �'jN�O).r�Cd ADDRESS 4 /tW N - lJ�/7C PVA6 .�,- PRESENT BUILDING ADDRESS SEWER MAP BK. PG. VALUATION $ �Z 05oW, FINAL DATE�� FI LOCALITY ' 'MOVING TEL. CONTRACTOR NO. ADDRESS REQUIRED I YARD HWY TOTAL SETBACK FROM EXIST. SETBACK PROP. LINE WIDTH FRONT P.L. SIDE P.L. r{/ �'/ �Tr �T [y "7 P.C..F.e{e'$ `( 3 7% 5 O Permit Fee / 1/ ,_57 • f [ ! 1 k Isseonce Fee �/ r Investigation Fee ^ LLL6 Total fee '.}1. p SEE REVERSE FOR EXPLANATORY LANGUAGE LDMA R.I. It •MA P/C R ii LDMA Perm. R • Nb -1, `p`�^+ • (� a N PARCEL PROI L APT VALIDATION 142.0A #..ee•1 I.29Q25 ••29825= 01,28-85 916SIA 1 •237.80 • •.237.80 U�07 � #<1 90.1 A- PLANS TO APPLICANT Returned Approved a}e No. Date Required I Date Received Yes No I pprovels I or Approved do"a. Protection t ence)(Canopy) Speciol Inspection (Cone.) (Masonry) (Welding) Lot Drainage Parking I Approvals Location— (Setback 8 Yards) Foundations Slab I Frame Data Energy Insulation Lath/Drywall— Interior Lath—Exterior House Number— Correct 8 Posted Final-- �� Enter on Front Inspector's Signature INSPECTOR'S NOTES r OWNER -BUILDER DECLA I hereby affirm that I am exempt fro, License Law fo—fhe following reas.. . pec Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, deblolish, or repair any structure, prior to its issuance, also requires the 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 Sec- tion 7000) of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basisfor the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars t$500).).- 0 $500).):❑ 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 (Sec.7044) Business and Professions Code: The Contractor's Licause Law does not apply to an owner of property be builds or improves thereon, and who does such work himself or through his own employees, provided that such im- provements are not intended or offered for sale. If, however, the building or improvement is sold witbin one ,year of completion, the owner -builder will have the burden cf proving that he did not build or improve for the purpose of sale). ❑ I, as owner of the property, am exclusively contrac- ting with licensed contractors to construct the project (Sec. 7044) Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law). ❑ I am exempt under Sec. , B.BP.C. for this reason Date Owner INSPECTOR'S NOTES