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HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (27) � - _ -- _______ ,�. ..._„ , , _ ���.,z<�.���..,.,.� _ , __ _ �� 'H _. ___-- - /�p . a� �q j'► WORKERS COM,PENSA*�ION DEC,L�A{RA710N � � -A,PPLI�rl1��ON �OR�C4MD�N�V P�R�I�` � . �.„ .,:.�,.� ' -. .,..... . ..:.. '-�,,I�herel7�af`ym thot I have o ce t f'mte of��consem to salf 76A667A � {�� nsv'�or¢2 rl ficate of Workers Compensaf on Insurante, GE BV(REV.IOi81)� � - ��� � � - � -' � � � � � ��� " � " � � ;y�oi a Ee tified opy thereof Bec 3800 Lab C) . . +y` "Aoli�cy N�o�'���"i'�'Co�a�� ��°"�`��'t�" `y"a x�`'"' "`"`r�°"�<_.„COUNTY OF LOS ANGELES BUlLDING AND SAFETY P Y .. . . . . . .. . ., . . . Cert f ed c py s he eby fum shed � - � � - � -�-•.,-.. � ..w.�..,.h � .,.;�;,,,,. �`�'.%.... .."'.,..`.�"„' „`.,�'...,".''""'"""'''..,..._.""M,.'.""." .'"....",.. " FORAPPIICANTTOFILLW(PRINTORiVPE). .. . ... BU�IDING .. . . �,�,� p h the co�nty buildmg mspec � �-- � � -- •�---� - ADDRESS ` � Cer rfied copy is filed wrt __ � ��� t D de o�ment NUMBER FIX7l1RE6R ITEM � � FEE ���'���r����+#�+��^'���*�S�'�`� f�.� : .ocAurr y Date A I cont wAiERCtOSEi �� n ��`a��x��`L+.�y�.�' y�ptp .���g� �, �,:_ NEAREST 5 �":rr,�`� --����Oh tX��0�1 FR�M�ORK S �� � eA7H Tt16 CRO55 S7. ' i.�, a q._���� a��, COI�APEf�S"AT�bN I�IS'��2AFJ'Z'E� . ... OWNER �1 T h�s sec t ion nee d,nof be comp leted tf fhe work�nvolvad�by S4oWER � �� ,,�e � ��tFe permi}is for one hundred do�llors(5100}or Igss) iaVATORv MAR I`cer�i��iTial"n the performonce�'of rhe work for hich ihis . A�DRESS aj�.,y �qi./�' ~ ' N / '�����rmtt s issued I shol I not employ any person in any monner 'SINK CITY � �"`��so Cf5 io become sub�ect to ihe Worke s Compensqt on Laws � �jV-� ��f � 7EL.ND.�'���^�- x� �_��'T� �,��s+3.r,^�,�uL��Sy,�w,i��`r� �a,,.,� DISHWASHER �y�," �� - a� CONTRACTOfi� � �'%�'��bate�� ��"�L qPp��a t .'RS' $ CLOTHES WASHER � ,�N6YI�'"`f'O i�Pl�(.'AN;f_If, af9e� mqk' g fhis Ce irfi ate of - AC�RE55 ��� �' ,�f���� SWIMMING POOC RECE'rT0 'J - �'�"'� .-"F �,,wExempfon,�you should become sub�ect to the Workers' . Ci7Y ��.'�ryy�� 7EL N0.7���?�- 's��, C'ompensotion provisions of the Labor Code,you must forih- k-'��i%?h comply 'th such provisions or this permif shall 6e �9�'SPR�NKtERSVST � � LIC. ���Sdeeme�revoked �,t s��k STATE ?¢� e���•`�1S�ED�bN�R��OR��D���Cl/+,1i�XIINN�� WATERHEATER `�• LICENSENO. JC.J��� / ?�. YS. !� �wr. �.-*tr� r�-" ` CLASS ���P � ,4.. �e^-m+�,�v mY - •.:,� DISiRICT NO. p�n CESSED BY r�l �he eby a firm t ah f�I am�censed under prov�sions of Chppter 9 � GAS SYSTEM CU TS /1, ��,`\�i; ���rcomme cing�w th Sect on 700p)of Division 3 of ihe Bus ness OU7.ETS OVER, `� `�^-'L� y- �" a'itd Profess ons Code,and my fcense s m full force and effect. 5 PER SYSiEM�� � p � 85. �;�-�,��,.`�a t�,kva�,c�wr a,r ; a.0 , ,.� �, FINAI (_ VALIDATION «� ��s t ce se Nu ber �'��s L c Class � �� � � DATE S� � lf - tJ r � �'. _ .� .. �.. ....e:;�n.r,,:as �L �.....,...,e- � FINAL� SY. � y � �Conlracior�j��IN___ ��fl �Ddte � "��e'""�� ✓��� ' . ` 8Y y � ��� I❑ exempt under Sec k'��a � t-c+e^xqr,�,�.�"2.,_ '�r.�+���'.'�EC�:vs.4,.,� +" .,�aE� t5.-:, ._....._�..�..__... .. ` +d�i .� Sa,�; 8&P C��ar t�s reason �,�r � � �"''���"�' �--�����dare�x�� " '�`^�` Plan heck fee � � i�����xF�''��g a�-a�'''�°'�'��T':K& � '� 'S.'&�'°c. r�z4 .x�� '�, --s , MIT ISSUING FEE$ 1t� � t S y�.,�'� a �, �"ts .�i' a-,�` + s.'Mr+, 7, �- a "��. ��4' ��� �� 3'J*-�., "� �, '� TOTAL FEE � �'(� � �x .�y��t.-,. '���°����'� � �"'���c�"��w�� ^g�°'a�'}�.."��f ..,, '. Plan check applicant � 6 ,�y 4 .j,;, &����INGCE FAM lY .. . _ ._ . . _, '���h���j,,,�^.�.� HO�E� ER$UIL�7ER OEC�LAi�ATION"� , ,, , .�. Name � n� . �he eby aff rm��iar I am exempt from fhe Contracror s License qddress - :'i ri�,4�, � Caw for the foflowing reason (Sec�ion 7037.5, Business ond �,- ,P��essions Code): �ify Tel.No. ., . _ m n W� . slrocture is noi ntended or offl do ihe work pnd ihe . I as o ner of ihe properfy i ���'�'-` �, , . ,ered for sale (Sect on � r � �C S� srys,f'� Y044 Business and Professions Code) ry'�F #��has�`*��r-- 'a � ti '�a ,rw� . 'nn �,,.�,Y..e..�_- -:�o�:.�.,, t k,.<,:..3- ,� t�:�•�_;.;... ..,�:.::.:,' . ;,,�-.,, .. . . .� ,,... . , .._ .._,„ .. ... , ., . ,.. c.i,���� .1�_c�d.� . . . .. > z �'",tsa C�fO L� ING�A�ENC`� ��� I�i.e eby aff rm ihat ihere is a consiruct�on lending agency for � '�� _ '� �..,'&6 ^ 'f�e perfo monce of the o k fo wh ch th s permit s ssued ��,w "�'$e"c 3097 C v C) ' . , . r� �i?'�,� '`�,F�''�'�" A �' �t. �7' h rsr_& '� t---.i a�.�G�7 >,-S �.,+ x. d � y;�:.�az ..'F' �, .. � � E� F x:p�""", 3 1, f .. ,�. �r�S�e.�s.f �Y�vS�"..���'-� d�`�:'��a Su 'a� _s �� �� ��� .�� . i�ss, r �5i-�.�"i Y',. �� �.� �.� ;-�a � ':' �•,"` �� �Ye.nde s Name _ , , z"`3a�:;�'�'m t�s�a��:<���:.�!'�s�.`F.>.� ,...`n'�`'.�,``y 'r.�;i z .�.�tk� .�m.i-"s�4Sj �..-,�.m:.�_,_;,.;e %`. r:�+tr'� . f�.,�� ^"y :-�.E b,,.i:4 7..:?..'? .., .. - lendersA�ess . . . . ...... . ...._... ..._.._ ..... .. _.. ._. ..,.. .... . ... . . ...... _... _ .. _.... .. ,.._..._ ... . �,1 I c'�rhfy tha�I'�o e read ih�s applicaron ond stote Ihat Ih¢ � ^ �. , alio e_ format on s correct I agree to comply with ol)County 1�" �orc�n4 ces and$late Iaws eg lating Pfumbinq,ond hereby y �uthonze representotives of ih 5 County to enfer upon the o e mentioned property fo spection purposes .msy�.'�s ��,��`���'.�y' �"�`•^��,��'� "'_""�' '""^•" SEE REVERSE FOR EXPLANATORY IANGUAGE � � � i ..-a�-ac.el,.a��A�' �'3 ry i — � �S gnptu e of Pe m ite Date '�,,: (ca . r+,�,�h y�a-. s < �:� x . •,� _ i . .a�: �'� .:...?%,�s E .', '���,7 r �s�.. � . . ,(c� _,�:.c' � . $�S, . . . . _ ,��..:.._ ,.,.._ . ,..�._. > , .-. . ..:` ' - . , . . , .. ,...... . ..� : �., .. .� .. ,.. . . �_ .o.:.,.�.�., � ... �.: ..:,...,,��,a:, . .a__. ., ,. . : " �� . ,. -- - II` _ , � � . t S ,�� .£ . . . _ ... - ' ' . . . . .R y i 5{ ..f�,'.4 � +t[ :w,:: . . � ' . ' : .:'.:.- � . '. ' , - �. .." . v.__�__. . . . . . ... . -, ._ . ...�... .: .'.,..-. '_ . -:;::._ �. � � � ""---"""""�-�'+ INSFEGTOR'SNO?ES �� � �' �� �OWN���UILDeRDECL4R,4TION ` APPROVALS Dr.\TE � ' �p CTOR'�SIGNAtURE _ , UNCEP.SiAB WORK V�--'r%'� � here6y affirm ihaf I a .. enpt from tiie Coniracro�'s� ROUGH�PLUM8ING � � " ' ' � - � - License Law {or ihe following reason (Section :Os"1.5, GAS PIPING� � �� � ��"� � ��� �-"-" - ' ' � ' � - ' - ' � � �� �- - - Busi.�ess and Arnfessions CodeJ:Any dfy or counfy whrcn .� �� � �� . ...•-_ . .. ,_,. r ... . ...,..� -� ��� �� � requiras a permit!o r.onsfruct,alteq im�rove,demo�rsn. GAS VENt ' " -� � `' � HOT WATER HEATER � "' '" � �- , or repoir cny sfructure, prior to Rs issuanc�. also re� quires ihe applrcanl for such pe�mi!tro 6ifa o sic�ned s;cfe- PWMBING FIXTURES - � � �-�� ment fho6 he is licensad pursuan4 fo the provisror,s of th� GAS TES" � , � . . ' . .` .,.... ...-�•:-.-.`...:..:...........:...�....:,... .,_. .. Con&�octor's Licer.s2 Low(Chopfar 9(comrnencinq�mah . UTILITYCO.NOTIFIED - � �- ' '" "'"-" � Secf'ron 7000)of Division 3 0!tn�B�sinesg,ond Pr�r`es- . �.` , . � ., , _ . , , � '�' -��' ' � sions Code)or thc4 he is cxempf iFerelrom ond the bos!s _ . ?or�the alfeged exempfion Any viclation of Ser,tio.a . . . -,.._,,......_,... . _— �7 `�"'"" 7031.5 6 an o lrcanf fer a oermit sub;ects ihe a FINnL �� �nfar on _Trnnf . . �.. _ .. ..,. . ,.. _. . .. Y Y PP� i PP%�� . .. . .....:.............. .. ... .._....: __.._. cant ta a civi)penalfy of not more fiian ive nundred .., , ._ . ..._.... .. . ...__. . ...... . _ . . . � - ' ��. .�,.dofld�s(SSOoJ.:... .."". .. . ' � . - . :- . . . ._... ... . . . INDUSTRIAL � � ' ' ���"�� � ' - - . . 0�i,as owner of ihe proper(y cvil;�dc ihe'A•ork,.and , WASTE AP7ROVAL ' -�-"--- � � � � '���"��--'-"--`--'-'--•----�-- ' --��� -� ihe siruciure is not intended or affered for scier - � � � ��� ���'�'�i•^A � �;;� � . . . � -� ,(Se�.7044,8us1nassandPrelessionsCoda: iheCon�rao . ...:.� .,.... ..�� .et� '�n;.�'w� ,.�- "... :, . . . � ���` � "''� ' . � �� �:�aY* �, � r �':; : *� � .:�:� . �" tor's License Law does no(apply to an owner of propesty � , �� � �� - - � ..,,. E �,� - ._.. " ".. -� iids o Im ioves }hereon, ond who does such __ .. .. . 'who bu r p . ,,,.,,, ,`, ,� ;, , �. ,,., , �,- ., , ,.-,,;,, ,,, ,_��� � ' ,.-� � ' - - - himsefF provided thof sach improvements are not . . . . . .;., ..: . . . . . .. ... . ._:.. �.:.s , .. wurlc � . . lntended�or,offered for sale.ff,Fowever,ihe bui;ciing or . . . .. ... -,.. ; .�, �. . :-.� � �� ��. . .�. ;.,:-,. .: : ,-�: � .:. � . - .. ' '..,. ., ...._.�_ '.-. � .,.. ,_..:� ,... . .. ��. . . ,. . � . . , . . �"'� - �°� --- � tmprovemen}�is sold wit6in one year of ccmp(ePiort,thc � . .: . ...... ...�: . .,.�..� :. .. . .. .. . .�. . �:�_..., . . ,- ' -....�.:.._, � .:: . � � a!he did . . ; �-�oiuner=buifder w(11 have fhe burden of prvving th '. �.... ... .�:,; � , ;� . �: �-�3�: . �.,,. :. :..�- - ' ��- .__...... , ve a .:..... .�-_, . � � -"�` '�"� � " '-nof build or imp'ra�i�ar(he�purpese of s�]e.J ..- . .. . . . � �- ', . . . . .. - . '.. ��� -..;, ... � .. . � �.. .. .� . . ,. , ... ,. � �, , r,��^ � � � ' � '� ��i� . 1 am axem t unrler Sec � . . . � . � ..+Ki. a',:rn.'7 v.�J'�.,+Y �,. :. C . p - � : . ' � -.._ .: . ~.� . , .- ... , . . ..... __...- ,_,.._ _'�. -�� �. . . � . . - . ... �y,.eFt� '' .:���e -,��.�'. .,. .. .. . . . . ...' �� g.v . .��� ' . ��" ��4w�S�i • , ..'. .,. ..�_ &P C.fcr this reason . : _.,_.__ _� .. .,. . ¢. . 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