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Home My Public Portal About10623 DAINES DR_Building_4/30/1981_WORKERS' COMPENSATION DECLARATION 1 hereby ofJjVn that I have a certificate of consent to self' insure, or a certificate of Workers' Co nstion Insurance, or �S_iternf'e op reof S c 3 L ) ri y'F_. f_._0°' .,,a S_ Certified copy is hereby with thehe �(/ Certified copy is filed with the only but Ing inspec- tion crep Ip ent. Date `� I J1�U0 Applicant _ CER+IFIC E OF EXEMP71 WORKERS' COMPENSATION INSURA (This section need not be completed if th permit is for one hundred dollars ($100) or less.) I certify that in the performance of th ork or which this permit is issued, 1 shall not employ a ers in any manner so asto come subject to the Wo er ' m ensar tion Laws. pplican /jLICANT: If, afte 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. LicenseNumber /� Lic Class 6`k Contractor 14.i1..LP'� Date l t BIZI-) am exempt from the licensing requirem nts as I am a licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Business and Professions Code). Lic. or Reg. No. Date 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.). - ).�cles 'Name Adclres� that I h ve r ad this application and state that she ormati n is orrect. I agree to comply with all County an Stat laws relating to building construction, ereby ou hori a representatives of this County to enter the abov -m ntiiooneddpproperttyy for inspect. n pur oses. awre of A licont or Agent VDtet APPLICATION FOW' BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLI NT TO FILL IN ADDRESS _-'J ALL. rr a� BUILDING `_ �s ADDRESS l ObZ3 AI NS.�S LOCALITY CITYT/ ,�� 1—UT- � NEAREST �` `{moi . LOL _L T�'' ZIP CROSS ST. ` x NO. OF SLOGS, ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE (PARCEL TRACT (BLOCK �Z ILOTNO.g3Z•�-7�� UJ[�jE /E INOP C=57,#6 f/ I OWNER(LUJJ l D�l d26s�L NO. ��i'Z .7L"E,� 1'/ �� I SPECIAL /r CONDITIONS f /•� /^' /� �r (+ DIS ICT ROUP TVPF�+� 'ZONE PRO SED BY ADDRESS ,I E/�//�� ,,/---.��..ss1.1 (��.N �l -� n n� �� .`iS ' /. � E �YC!� CITY f ' s$ Cl ' v' ZIP STATISTICAL LASS(FIC,A ION Vv PT. CO O. TEL ENGINEERARCHITECT OR UL�r O,) 1 NO, CLASS NO. 3 / DWELL; UNITS _ ADDRESS l-Je/'%y/��(��-�-L`c.t L �'_I LI7� /�-�-- TEL. CONTRACTOR 1_/Jt �' IIs+ s .1 L� C} ^ NO.LIC ` /� ' t 44 -ADDRESSS15 (A J NO. IIIITQ 4LG sL'_ L Ll) 22 LIC _ CITY L.A�-r I J •^I SQ. FT. ISTORIIEES IFAMOES SET BACK CONEK 'SIZE - PROP. LINE ,,//�� -DESCRIPTION OF WORK rpQ� V Wim=% FRONT NEW ❑ _ s,isl./1 Q 4 J^ vQLD/(/N� ADD E] / ✓�' ^ -�^ P.L. ALTER ❑ REPAIR ❑ _�••f _7�V USE OF EXISTING BLDG. %1 DEMOL ❑ APPLICANT SIDE --ILIA+ /u� t 14 `L ( ��• -ADDRESSl • �+ s"^•�� PRESENT BUILDING ADORES' 7j a O LOCALITY MOVING TEL. CONTRACTOR NO. ADDRESS REQUIRED TOTALTOWk FROM NIST. SET BACK YARD HWV PROP. LINE WIDTH FRONT I P.L. SIDE 'P L. 7j a O /L P.C. Fee $ Permii Fee % 7 Issuance Fee Investigation Fee S1� :alai Fee SEE REVERSE FOR EXPLANATORY LANGUAGE SEWER MAP BK. /�_ P.G, VALUATION $ 5. is o $ FINAL DATE I�f�{" -(� 30 el FINAL B /v� VALI ATION r• r �?2964A #....21 2••27.00 • • • 27.005 11,06-80 -52965A, #.....1 2••5200 •••520010 11.06-80 0 es PLANS TO APPLICANT To: Returned No.I Date No. Date Approved Required i Date Received Approvals Yes I No or Approved - Water Certificate Health Department Fire Department Grading Geological Pedestrian Protection (Fence) (Canopy) Special Inspection (Conc.) (Masonry) (Welding) Lot Drainage Parking Approvals Location— (Setback & Yards) Foundations Slab Frame Energy Insulation Lath/Drywall— Interior Lath --Exterior House Number -- Correct & Posted Final— Enter on Front Date I Inspector's Signature INSPECTOR'S NOTES OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from 4146 Contractor's License Law for the following reason. (Sec. 7031.5) Business and Professions Code: Any city or county which requires a permit• to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement That be 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 be is exempt therefrom and the basis for 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 ($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 License Law does. not apply to an owner of property .wbo 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 within one year of completion, the owner -builder will have the burden of proving that be 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 contractor(s) licensed pursuant to the Contractor's License Law). ❑ I am exempt under Sec. B.&P.C. forth is reason Date Owner INSPECTOR'S NOTES