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Home My WebLink About1239 AHTENA DR _ ..� ---�-__ ._ . __ __ _ �._ _ � �- WORKERS'COMPENSATION DECLARATION � . I hereby affirm that I have a certifimte af conseM ro ge�f . . � APPLICATI,OI� ��.{JR BUILDING PERMIT insure,or a certi4iwte of Worke�s'Compenstion Insurance,or � a�e��4�y�e�oyfry5ee.3800,Lab.C.) �: �-±.'c"t`�<'?•.t.r' ">�p�NTY OF'LOS AN�F,S BUILDING AND SAFETY P liyy � Company��R�Y/'��' ❑ ` ` ,a FOK APfiLIeA T TO FILL IN Buaoir�c Certified copy is hereby furoished. ADDRLSS � �/'�� - Certified copy is filed with ihe county building inspeo- -� BUaDiNG� fion depaHmen�. ADDRE55 LOCALITV ' . , . r .. .d . ' .--r � . . NEAREST Date�=��APPlimnt�l�� CFTV� . . ? �.� ' ""�� Z�P � ` �` � CROSS Sr. �L CERiIFICATE OF EXEMPTION FROM WOR .R� � .... SIZE dF fbT-� �. � �....., N01N ON LOT i r. �_. ASSESSOR COMPENSATION INSURANCE � nnno BOOK PAGE PARCEI (7his section need no1 be mmpleted if the perm�.i5 for one s++1 /�� US �E MAP � h�ndred dollars($100)or less.) TRAGT BLOCK LOT NO. LE? NO. } TEL,. SPECIAI I certify that in ihe performance of�ihe work for which Ihis N/NER . �,��NO � �a CONDITIONS O permif is issued,_I shpll not employ any person in any manner � ` � DISTRICT GRDUP TYPE FIRE PROCESSED 8Y V - ADDRE55�� CONST ZO so as ro become subject to the Workers'Compensatian Laws. . . , �� a Date Applicanf ' CITV � Z�P STATISTICAL CLASSIFIG4TION APi. CONDO. O ARCHITECT OR%'�� `� � TEL. NOTICE TO APPLICANT: If, after moking fhis Certificafe of . � � � w Exempfion, yo� sho�ld become subject io the Workers' ENGINEER NO. CLASS NO. DWELL.UNITS y Compensafion provisions o(fhe Labor Code,you must forth- � y AD�RESS JEWER MAP Z with comply with such provisions or �his permit shall be deemed revoked. � TE 1 � VAIIDATION � . CONT ('i/K� N�. � s'�O BK. PG, UCENSED CONTRACTOR$DECLARATION I hereby affirm thol I am licensed under provisions of Chopter 9 ADDRE �/ T't�(' ` '� VALUATION ' (commencing with$ection 7000)of D�vision 3 of the Business and � �1 !� LK. p� � Professions Code,and my license is in full force and effect CI7v a� rT/Gr Y C�qu $�j�.�� "7'� t.,r,��' 54.FT.• ,[/ NO. F -' NO.OF CHECK Li[ense Number��`,� Lic.Class� SIZE 7 Z STORIES FAMIUES � ONE �Conlractor � Date y x8_�eW �ESCRIPTION OF WORK � NEW � � - � � � I om exempt from r e licensing raquirements as I om a- ��(L!✓ �Gr�r�.�� ADo licensed architect or o regislered professional engineer /� J /J/ �J ALTER � FINAL acting �in my professional'mpacify (Sec�ion 7051, U tJ q�L�/ ' REPAIR � DATE Business and Professions Code). USE OF }w FINAL � Ex15TING BIDG. w/�- DEMOL Q B � Li[.or Reg.Na. Date APPLICANT • TEL. Y � � OWNER-BUILDER DEGLARATION PRINi� NO. . I hereby affirm that I am exempl from�he Contranor's License � � � � ,; �.,- �� , Law for the following reason (Section 7031.5, Business ond ADDRESS t?� :`. � i'��.�� r, . Professions Code): PRESEN7 �Q��7 '.��4 ❑ BUILDING - ,!�"' ��r.�� - . ° ° �.' J I, as owner of ihe praperty, or my employees with nDDRE55 �; wagez os iheir sole compensatian,will do�he work ond n , - , the struclure is not intended ar offered for sale(SeUion ��TY �j� 1 r'1 fl�✓F � � 7044,8usiness and Professions Code). � MOVING TEL 7 t�"� < ' . OCONTRACTOR NO. . - � � I,as awner of the properfy,am exdusively coniracling /' �+} t` � 1 � `� with licensed wntraciors to consiruct Ihe project(Sec- ADDRESS " � ` '^�� tion 7044,Business and Professions Code). � � `�� f''p � ' CONSTRUCTION LENDING AGENCY REQUIRED YARD HW TOTAL SETBACK FROM E%15T. �l' . ��..A'� . '� "C'.(.�'', SET BACK PROF.LINE WI TH � I here6y offirm Ihot ihere is a mnstrudion lending ogency for pRONT � ' � _ ., y � the performanca of the work for wh�ch fh�s perm�+�s�ssued p.�, / �' � t,� , �� . < . (Sec.3097,Civ.C.). SiDE � �Ci �i _- I �'!.. P.L s Lender's Name . - P.C.Fee$ O Permit Fee � - � �Lender's Address � � `� � �� ' w I certify ihat I have read this applicotion and state that the . issuonce Fee �� aabo�e information is correcl.I agree fo comply wifh all County Investigmion Fee � . ordinonces and State laws relating to building consiruction, . ��I � and hereby outhorize representa�ives of ihis County to eMer Toiol Fee m upon t eCp�b�eMio., d prope�ty for inspecfipn p�rposes. , � � � a ��L.�.7,�L_°.I� �—�S-�/ SFE REVFRSE FOR EXPLANATORY tANGUAGE � Signa�ure of Appl�can�or Agem � Date � . . �s � . PLANS TO APPiICAN7 � � INSPEETOR'S NOT� OWNER-BUILDER DECLARATION� 1 hereby affirm that i am exampt from the Confractor's To: � Raturnad Licanse Law for ihe following reason. (Sec. 7031.5) � ARF�o��d Busineas and Profess:o�s Code:Any ricy o>mu+,ay wbicb Mo. DaTe No. Date � � `�' reguires d pernti6 to conslruci,alter,improve,den.olisb, -- . . - — or reparr any structure,prior to iu issuance,also reguires Lbe apQlicaxE far ssscb permit to file a sigtted statement . lbot be is licensed pursuant m tbe praoisiorts oj ebe Con- �r,Ci��I lraclor'a Lirens¢Law(Cbapt¢r 9J(commenting v�i1b S¢c- . Non 7000J�of Dioisinn 3 of aA¢Businen�aad Proj¢sssonr � � CodeJ or tbat be is exesn¢t[berefrom asd tbe b¢sisfor Obe a!leged exemption.Any violaiion oJ Section 7031.5�by R�qo3rad petmRec�Ivod ' � � anyapplicantforapermits¢bjectstheaQQlicanttoatir�il Approvais Yos No � ar Approved �+enalty of not more tban five bundred dollars($SOOJ.J: _.�__.__ _.__ . _ .._._, . �+ 1. ..$'Z' ❑ I,as owner of}he property,or my employees with Water Certifimre � - . � wages as their sole compensatlon,will do tha work,and � Iha sirocture is not intended or offered for sole(Sec.7044) Heaith�Departmant � . Business aad Professioros Code:Tbe Contrqctor's License .. - Law does aot apply to an owner oJproPerty wbo builds F�re Depariment . orlmproves tbereon,and whe doessucb work btmae[f or through bis omn employees, proorded thnt aucb im- Groding - Qravements are noi intended or o,Jfered for sale. f) . - � bowever,tbe building or improvement is sald wi6bin one Geologital ' � . � � year oj completion, tbo owtterbuilder wi(1 baue tbe � � burden ojpsovittg tbat be did nat broild or im¢rove for Pedesirian Protection - . 1be purpose of salef. (Fence)(Canopy) . � � � � � � ❑ I,as owner of Ihe properfy,am excluaively tontrac- - ti�with licensed coniractors lo constroa the project�Sec. Sp�cial Inspection � � �. 7044j Busieeu and Professiont Codu Tbe Contrutor'a (Cone.J(Masonry)(Welding) Licersse Law does not aQQly to as owner ojpropesty wbo , . brifds ar improves thereon,,nad wbo coqtracts for sucb � Lot Droinage , [rrojects with a contractorrsJ Iicea.sod pursuant to tJ�e � � � - � � Coxtroctor's License LawJ. . - Parking . . . . , , ❑ I�am exempt under Sec. ,E.BP.C.forihis - � � . reason Date Owner A�provels Safe Inspsfei s Sisnalure � INSPECTOR'S NOTES Location—' � (Setback d Yards) � � � Foundations . - � Slab Frame Enargylnsulmipn � . . � � . � � . � Lath/Drywal I— � � Inferio� � � tath—Exterior� �� . - House Number— � � . Correct 8 Posted � Final— Enter on Fronl � �