HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (20) -- _ _ _..
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WORKERS'COMPENSATION DECLARATION - ., � - � �:��• - •:
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I here'by affirm ihot I have a certificate of consent to self Qpp���CATION F�b�R BUICDI�NG P�ERMIT �
" insure,or a certifimt 'of Workers'Compensation Insurance, __t,..L,••
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or a certified co�py,"�repof(Sec.3800, b.C.:� COUNTY OF LOS ANGELES BUILDING AND SAFETY
Poiicy No.�`S?'�7a Company . - . .
� Cenitied mpy is hereby f�rnished. FOR APPLICANT TO FICL IN Bui�o�Nc, { C
❑ , .. AD�RESS l�J� QSW�G'r. C..1
Certified copy is filed wi�h the coonry building inspec- 6UIL�ING � � ���-���'���������������LL��������
rio dep ��ment � ;"� ADDRESS -
paa�e V��l l Applimnt �{�'y� i� aTr h4 z�r �ocautv
� ERTI CATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST
� COMPENSATION INSURANCE SiZE OF LOT NOW ON LOT CROSS 57. �-.S�(\
(This settion need not be completed if the permit is for one ASSESSOR
hundred d011arS($100)or les5.) TRACT BLOCK LOT NO. �/„qp gpq( PAGE PARCEL
TE� ,i�+t USE ZONE MP.P
I certify that in�he performance of the work for which this OWNER NO: �Yo'l NO. ( �( � S y
permit is issued,I shall no�employ any person in any manner ADDRESS Qc V � C--� SPECIAL 45,.
so�as to become subiect to the Workers'�Compensation Lows. CONDITIONS �
V
Date Applkant ... . CiTY ZiP �
NOTICE TO APPLICANT: (f, ofte� makin fhis Certifica�e of ARCHITECT 02 TE��� DISTRICT GROUP TYPE , FIRE PROCESSED BY �
Exemption, you shouid become sobje9l to the Workers' � N� . ^ CONS�i.,y/--/^ .�ZONE' V
Compensotion provisions of fhe Labor Code,you must forih- qDDRE55 ��i ✓ �� f a.
with comply with such provisions or this permit shqll be � . _... _ 2
deemed revoked. .� `,,� �L. �"�,., ��� �..— STATISTICAL CLASSIFICATION APT. C DO.
CON7RACTOR �Y..���a;/Vv�te. NO.
LICENSED CONTRACTORS DECLARAiION � � ���, � CLA55 NO.��WELL UNI75
I hereby affirm thaf I am licensed under provisions of Chppler 9 ADDRESS �- NO. �" SEWER MAP- � '
(rommencing with Secfion 7000)of Division 3 of ihe Business and ,_, uC. �
Professians Code,and my license is in full force and effe<t. OTY CL455 VALIDATION
a-! ` $p.FT O.OF ND.OF CHECK BK. PG.
i ense Number�L�ic Class� SIZ � 1 STORIES FAMILIES ONE �
NEW � VALUATION __� ._ ..v'�
CoMractor Dpfe � DESCRIPTION OF WORK � ' '
�I am exempt under Sec � ADD � _ � ► e ^ _v
ALTER �
8.8P.C.for this reason .,_ � 5 �
REPAIR I ' i C,'i,��j
Dote: � USE OF ^
� � EXISTING BLDG. `�� � DEMOi � FINA £ ` �' !1�:J� y
. . _ _._. _.._.__-'_ '-
5'onoture .� . - !��"`'1� APPLICANT . . . + TEL. L,
OWNER-BUILDER DECLARATION ` PRINT) '� NO. pATef�?/' f� ��'i �`,r�'(� . .
1 hereby affirm thpt I am exempt from the Coniractor's License � � r
Lpw for ihe following reason(Section 7031.5, Business and ADDeE55 �� �.� , FINAL /1 `
Professions Code): � pgE 7 . . . -- . . . .__ ...__......�.,. _ gy /�;i �"�'
❑ BUILDING
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I, as owner of Ihe property, or my employees with ADDRESS _
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woges as t eir so e compensation,will o the work and �aCALITY '
the structure is nof intended or offered for sale(Section ,
� 7044,Business and Professions CodeJ. � MOVING � � TEL.
I,as owner of rhe property,am extl�sively contracfing CONTRACTOR NO.
—�G�.�F
with licensed contrac�ors to consiroci fhe project(Sec- qDDRE55
tion 7044,Business and Professions Code). �, : �, e g � !
CONSTRUCTION LENDING AGENCV - REQUIRED yqRD HWY T�TAL SETBACKFft M '
SEl'BACK PROP.LINE WIDTH
I hereby af4irm ihai there is a construction lending ogenq for FRONT � °L l����)(�
the performance ot the work for which this permit is issued�- P.L - �- -
(Sec.3097,Clv.C.). SioE -
arl;�u`'JU;x
P.L
Lender's Nome (j�,�1�+m�(,i
- c�^�7 �f LDMA Ref.#
-� Lender's Address - P���Fee S �> , Perm�t Fee � / /.V� -- -- ' '
> /
I cenify ihat I have read ihis application and stote ihat ihe Issuance Fee G(7 � �_� IDMA PiC A �
� above information is correct.I ogree to comply with aIl�County I��es�igallon Fee � y�Q ,q�
� ordinonces ond Stpte lows relating fo building consir�ction, Torol Fee ��- tJ �� LDMA Perm.# -� �
u
and here6y ouhhorize represen�atives of ihis Covnty fo en�er �
c � `� ob ve-mentioned property for inspecti n pu poses. � ' � � - � �
s . . .... ........�. . ,_ ._... ..,, ,
upon � ^
i
L SEE REVERSE FOR EXPIANATORY LANGUAGE - r
Signature of Applimnr or Agem te �' - " -
f
0�5'NIiR-BUILDER DECLARATION
PLANS TO APPLICANT INSPECTOR'S NOTES f hereby afflrm ihat I om exempi from the Cont,actor's
To: Returned License�Law for ihe following reasoa (Sec. 703'1.5)
Appro"ved Husiness and Prof¢ssinns Cade:dny ciiy or counfy,u�bicl
No. Date No. Onfe � �� require.c a(�ermit to constract,alier,imnrnve,demolisl+,
. � .. nr iapudranystructure,prior tn it�essuance,also requires
� tha a(ipllcant for such permid tn file n sl,Qned stnaemant
tTiai be is licensed f ursuant tn t!e prouxsions nj the Cnn-
. , , , _„ . . _ � tractnr's I.icense Lau�(Cfiupter 9/(cmnmencing uith Sec-
tion 7p0pf f Diclsrnn 3 aJ lbe Bvsixo.rs and Prnfea-ions
. �. . .,,�, . . . Cndvf nr tLaf he ir exempt tberefrom and tbe basrs fnr tbe
uAeged e.xemption.Any rinlutinn�f Sectinn 70315 hy
Required DaTe Received uny applicant fnr apermi0 subjerts�bv applicaxc tn a rir�i!
Approvals or Approved pena[ty r f nne mnre tbax Jrve Gundred dollur.s(,SS00%/:
Y¢s No
, � I,os owner of rhe properry,or my employees wi�h
Water Ce.tificote � - . � •. ,.. . . . wages as iheir sole compensation,will do ihe work,and
. �he sir�ct�re�s not intended or offered for sale(Sec.7044)
Health Depariment - � � � '�' '�• ��• - � .Businegs¢n 1 Profexsions Cnde:TL�e Cantractor',c l,icense
. l.am doer nnt upyly to urc ou•ner of pmperty xcbo 6uild.��
Fire Department � . or imprnx�cr dhereon,and who does ssscb work 1 rnrself or
��-. � , tlrougl,hrs ou•n emJloyees, provuled thut su.cb im-
Groding provements are nnt lntended nr offered(or sule. Tf•
- bowai�er,th¢bssildlnq or rmpro+�ement is sofd witbix nne
Geoloqicol ,. 7'e¢r oj�complction, SGe otenes-bazslder wi11 have tbe
. -. „, .., - , , . � � hurvters f protrng tbul fie diJ nnt huild nr improve for
" rbe purJ�2ce of suleJ.
Pedestrian Profection [- I,as owner of fhe o ert y
(Fence�(Canopy) � pr p y,am exdusivel <onhoo
Iing with licensed conlranors to construct�he project(Sec.
Speual Inspection 7044)8usixess¢xid Projessinns.Co.le: Tl+e Cnntractor's
(Conc)(Masonry)(Welding) . . - Lfcense I.am rloes not a/�/ily to on nwxer of/>rnJrerty u$o
builds nr imprnves�herco�,and u�1 o cnntracts fnr sucb
. Lot Oroinage prnjects u�i1h a contractor(sJ licensed pr�rsuant to !hc
� Cnxtractnr's l,irense I,awJ.
Parking .. � - ' -
�� I am exempt under Sec. ,B.&P.C.fo�this
. ° • reason. . . .. .- .. .. .
... ^��4 Date Owner
Approvols DaTe Inspec}or's Slgno}ure . . . . , . , - . , �t ��.. . .., . . ...
- �� INSPECTOR'S NOTES
Lomtion—
(Set6ack 8 Yards� -
Foundations � �
Slab
3 � '
Frame E
Energy insulotion �
Lath/Drywall��� � "
Inlerior
LatFi--Exterior
House Num6er--- - � � - .
Correct&Posted . �
final- . , . . ... . . ._. ...,. , .
Enter an Fronf � �