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HomeMy WebLinkAbout8435AWORKERS'�COAMIPENSATION `DECLARATION hereby affirm that I have r rs' Come I ofns consent to self APPLICATION FO insure, or a certificate of Workers' Compensation Insurance, or a certified copy `th6reof Sec: 3800, Lab. C) _._._ 73WC(,05-27 ^00.04 Nationwide 30/B. COUNTY OF LOS ANGELES Policy No. Company , 0 Certified,,copy`is.. hereby furnished..`, DCertifed'copy` is filed ;with the county building inspec- tion department. Dow' <.: 5� 19rZ6 Applicant THE. AMEN GROUP CERTIFICATE OF'EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not Lbe 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 I,,; issued,.I shall, not employ any person in any manner so as'to becotne'subiecYto the Workers' Compensation" Ldws. toApplicant .OTICE TOAPPLICANT"•If °diter making this Certificate of Exemption,' you 'should become subject to the, Workers' Compensation provisions of ;the Labor Code, you must .forth- with,comL I with -such --,provisions or this permit shall be deemed.revok"ed LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division'3 of fhe:Business and Professions Code, and my license ism full force and effect. License Number 3715$0 Lac. Class Contractor T[M-' ,,AMI N GROUPbate 51.9-$ 6 I am exempt under Sec. FOR APPLICANT TO FILL IN BUILDING ADDRESS 24329 K. Sylvan Glen Road NO. OF BLDGS... _ SIZE OF LOT NOW ON LOT TRACT 1135754 BLOCK for NO. -----78 OWNER U]Z",lAMEN GROG NO. 967--9543 ADDRESS P:O.BOX.3329 _ CITY.,. Covina.- ZIP_ .91722...___ ARCHITECT OR TEL. 314-N. First, Arcadia _ As.-_ above LIC _ Ess NO. 3715$0 LICB CLASS T. NO. OF NO, OF CHECl( 17$6 STORIES FAMILIES ONE - B.&P.C. for this reason — USE OF Date: --Si nature OWNER -BUILDER E LDmTO iherebyafirmtht IamexemptfrotheContractor's -License ' aw for the following reason (Section 7031.5, Business and pfessions Code). Lj1, 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 Nome Continental. 111imis Lender's Address 231 ' S. _ LaSalle, ChiQd IL 1 certify that l have ..read this application. and state thck"93 above informatio correct. I agree to comply with all County ordinances a St to laws relating to- building construction, and hereby ut rize representatives of this County to enter upon the - ed property for inspection purposes. Signature of Applicant or Agent Date TION OF WORK -SinUle. faMil NEW Garage• .447 SF, ADD ALTER REPAIR.. G BLDG. DEMOL NT) ' AMEN GROUP NO. MOVING _ TEL. ' CONTRACTOR NO. E ZGT aer`-v I- YARD HWY"A2A'ruL.,. oono �in�c %enn.,, r LOCALITY DiaTC nd Bar NEAREST CROSS ST. High Knob & Golden S rin S ~ ASSESSOR MAP BOOK I PAGE; PARCEL UskMAP ll�� 7s NO. J d 4? SPECIAL. CONDITIONS O U DISTRLCTGROUP TYPE FIRE PROCESSED BY % Lid CONST. ZO r%�r_ U � APT. CONDO. ;tom STCLASSCNOCLASSIFICA AL TION . O DWELL. UNITS II ! SEWER MAP vAdWkiAoiq4I A BK. PG. +j 21 VALUATION ; (®`268.&5 65 052 _ - FINAL DATE- /t1k2s t k . .! _..:.._. . FINAL. P ,: t A By _ 0A.3 „1 i _ .9a00,15:.i i 06:058,6 y m IP.C. Fee $Permit Fee Issuance Fee LDMA P/C # 26$..65 3-7:9.50.. . Investigation Fee Total Fee -390.00 LDMA Perm. # . LDMA $109--.. $55- -- SEE REVERSE FOR EXPLANATORY LANGUAGE — _ _- I©t PLANS TO APPLICANT To: Returned Approved Date INSPECTOR'S NOTES Frame Energy Insulation Lath/Drywall— Interior IO'z7- ; ., Lath—Exterior House Number— Correct & Posted Final— Enter on Front OWNER -BUILDER DECLARATION hereby "affirm that am exempt from the Contractor's LicenseLaw 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 suchpermit to file a signed statement that be is licensed pursuant to. the provisions of the (;ori- tractoLicense Law (Chapter 9J (commencing wash Sec= r's tion 7000) of Division 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 any applicantfor a permit subjects the.applicant to a civil penalty of not more than five. hundred dollars ($500%)i ❑ I, as owner of the property, or my employees with wages as their sole compensation,,, will do the work, and the structure isnot intended or offered for sale (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 does such work himself through his „own employees, provided_ that such .i,,_ pro.vements are not intended .or offered for sale, If 1):ihowever, the buildings or improvement is sold within one year of completion, -the owner -builder will: bane the burden of proving that he did not build'deimprove fo`r the purpose of sale). 4 '" ❑' as owner of the property, am exclusively contrde- 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 Z cense' L&W ------ L1 - ---❑ I am exempt under Sec. B.&P.C. for this reason Date Owner INSPECTOR'S= NOTES a SK Y t_ 3 , : t 'i