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HomeMy WebLinkAbout9982AWORKERS' 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 46AC��: Policy No —�mpany ❑ Certified copy is hereby furnished. ❑,Certified copy is filed with t county buildinginspec- tion department. Dat 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 7000) of Division 3 of the Business and Professions Code, and my license, is in full force and effect. 'gg License NumberI°� l ic: Class ConC. tractor Date I am exempt under Sec. B.&P.C. for this reason Date: Signature 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. ). Lender's Name Lender's Address I certify that 1 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, and hereby authorize representatives of this County to enter rn the abov, e- entioned property for inspections purposes. d 6 Sig ture p licant or Agent Date APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY; FOR APPLICANT TO FILL I . �r ADDRESS \e_ �� r BUILDING 2670 Braided Mane Drive ADDRESS Diamond Bar, Ch 91765 CITY LOCALITY NO. OF BLDGS. SIZE OF LOT variable NOW ON LOT 1 NEAREST CROSS ST. TRACT 30092 BLOCK LOT NO. 19 ASSESSOR MAP BOOK PAGE PARCEL OWNER" Michael Shum Ng714)8619 ZONE MAP NO. 26/0-'Braided Mane Drive SPECIAL ADDRESS CONDITIONS Diamond Bar, CAZI 917 65 CITY ARCHITECT OR TEL-( 81 8) — DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER NO• '�( CON ZONE 1 ADDRESS 142 Turnbull Canyon Rd-E � T ) ' _ CONTRACTOR S. H n e r N87 `+- 7 7 STATISTICAL CLASSIFICATION CLASS NO. DWELL. UNITS APT. CONDO l 7 0 0 E. Lincoln A Vll� ,y ADDRESS` NO. 7 tO 4 SEWER MAP Anahein CA 92805 LIC• CITY CLASS BK.PG VALIDATION SQ. FT. . OF NO. OF CHECK SIZE STONO RIES FAMILIES ONE VALUATION I❑ DESCRIPTION OF WORK NEW ADD ❑ $1 2 retaining walls ALTER ❑ REPAIR ❑ DEMOL ❑ ® 9 9 S A G� v V � ) i 2857 FINAL ` ,; .1 L 9 57 DATE FINAL 07,21 - 8 6 By USE OF EXISTING BLDG. APPLICANT PRINT) David Chung RCE 1-5 873 ADDRESS Cityn _ nOt uS�ty , 91 44 PRESENT BUILDING ADDRESS ' LOCALITY MOVING TEL. CONTRACTOR NO. :P608,9A ADDRESS f ® ° 80,50 REQUIRED SET BACK YARD HWY TOTAL SETBACK FROM PROP. LINE 5 ..CJ. WIDTH FRONT P. L. o6 ® e.080.500. P.L. LDMA Ref. # 0 2 1 9— 8 7 P.C. Fee $ ermit Fee Issuance Fee 0 •- -LDMA P/C # - Investigation Fee Total Fee LDMA Perm. It SEE REVERSE FOR EXPLANATORY LANGUAGE © t PLANS TO APPLICANT INSPECTOR'S NOTES To: Returned Approved No. Date No. Date Approvals Required Date Received or Approved Yes No Water Certificate Health Department Fire Department Grading Geological Pedestrian Protection . (Fence) (Canopy) Special Inspection (Conc.) (Masonry) (Welding) Lot Drainage Parking Approvals Date Inspector's Signature Location — (Setback & Yards) Foundations Slab Frame Energy Insulation - Lath/Drywall— Interior Lath —Exterior House Number — Correct & Posted Final — Enter on Front OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the 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 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 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 (Seca 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 or through his own employees, r provided that such imr 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 he did not build or improve for the purpose of sale), El I, as owner of the property, am exclusively contrac- ting with licensed contracfors to construct the project (Seca 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. for this reason Date Owner INSPECTOR'S NOTES