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Home My WebLink About1155 SOUTH DIAMOND BAR BLVD (51) _ __.. ......._.._._....---- __...--..___ ..._. .._ . ��.,,_�._.. ._�__,_._..._�.., - �. � . _.. ' WORKERS'COMPENSATIO`N 6E�LHRATION � � �.: � .. . ....... . . .:. .. . .. .. . .. . . .... -.. - � .. .. . . . ' . .. ... I he. �ff�rm that i hove,a.,cerffwie of conseni to self �pp��CA�'10��1�� UI�Lh�It�G �'ERNIIT� insure,or o cc�nif�ore oi�Warke�s'Compensarion Insuronce, or a certified copy thereof(Sec.3600,Lab.C.) � �� - � � �- -� -- --�--• � �----�- COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. � �Company ._._. .... __ ... .. . .... ..... .. ... . __,-,_...;.,..,,.., . __.'. _ _ _ ..._'___.. .. ._1 ._....,. __........ ., � Certifled mpy is hereby f�r�ished. POR APPLICANT TO FILL IN_ qopgE� �\�`'j`�£� t�"'��(�,i�s�,` � � Ceriified copy is filed wiih the counry building inspec- BUILDinIG J �`.P�a.ur�l/] j{AGJ Dif/ tion department. ADDRE55 I� >> ��Y"°' 4/ rti'\ CK{' Date APPlicanf . ' � CITY�/�ry� �� ZIP ��6��v LOCALITY - ' �CERTIFICAiE OF EXEMPTION FROM WOIFKERS' �� NO.OF e�DGS. � NEAREST - - COMPENSATION INSU'RAN�E- � � SIZE OF LOT NOW ON t07 CRO55 57. (This section need not be completed if the permit is for one P.SSESSOR � . hundred dollors($100)or Ie35.J TRACT BLQIX LOT NO. MqP BOOK 7AGE PARCEL �j �.q� 7EL.�l �ra)J USE ZONE �P I certify fhat in the performonce of the work for which this OWNER � q�� ✓" NO. � NO. } permit is issued,I shall nof employ any person in any manner ��,�„r �.°'��1��/� �'�� SPECIAL � so as to become subject to ihe Workers'COm ensation LaWs. ADDRESS ,(� �{� '^�j �^ CONDITION$ ; � a,,,�6��'I � CITY �.Q��n�l� 0=�1��\ ZIP a�/iOJ � Date ApplicanY ` ARCHITECTOR �j-,C� �5�� 9 � NOTICE TO�APPL�CANT: If, pfier making this Certificate of ENGINEER !"�J �YG��H�fO. b��-� DISTRICT GROIJP N7E FIRE PROCESSED 8Y F Exemption, you should become subjecf to fhe Workers' CONST ZONE � Campensation provisions of ihe Labo�Code,you must forih- qDDRE55�� -��bS.�X� .�� r� �` ��d y with comply with such provisions or ihls pe�mlf sholl be ' ' 7EL SiAT15TICAL CIASSIFICATiON APT. CONDO. Z deemed revoked. � � CONTRACtOR (��"'WI� NO- �S'� LICENSED CONTRACTORS DECLARATION ��, QA55 NO..�DWELL.UNITS I hereby affirm ihot I am licen5ed under provisions of Chaprer 9 ADDRE55 NO. (commencing wilh Secfion 7000)of Division 3 of the Business and _ �� SEWER MAP Professiong Code,and my license is in full for<e and effect. CITY CLn55 BK � VALIDATI6N ' ' $Q.FT. NO.OF NO.OF CHECK License Numb�r Lic.Class SIZE STORIES FAMILIES ONE . . _ � . . .. VAIUATION DESCRIPTION OF WORK NEW (� �-� � ��7 f�� Conirotlor � Date ��p $ �` t�o�.l �I am exempt under Sec. !�'"��f�G711-1 /f�-''S/l�� }� ADD � ' r A , ��y ALTER � 9 6.&P.C.for this reoson S'�� gEpq�g � S � ° °�:`�'.v C - Date: " USE Of DEMOL , e EXISTING BLDG. � ' � �-��O i.ri T � Si nature ' APPLICANT �j�-7�p /� ��JfEl � 9 . _ . . .. PRINT)!�[�-✓ �'. �!-/�i�'S'�lF1R�N0. �tGI"f��(� FINAL /�� f� I�.� =`C= / OWNER-BUIL�ER DECLARATION -n��-' � �ATE I hereby affirm}haf I am exempt from the Contractar's License qDDRE55�a��' �r'�"�"�p'� �� - Law for the following reason(Section 7031.5, 8usiness and FINAL Professions Code): RE N7 BY ..� I, as owner of the ro erf or Y BUILDING p p y, my emplo ees with ADDaESS woges as fheir sole compensotion,will do the work and �Q�LITV � ihe siructure is not intended or offered for sale(Section 7044,Business and Professions Code). ' MOVING TEL - ' ' ' ' ' � I,as owner of the property,om exclusively cantracting CONTRACTOR NO. with licensed'contracbrs to canstruct ihe praject(Sec- qDDRE55 (� tion 7044,Business ond Professions Cade). - ' ' " REQUIRED yqRD HWV T�TAL SETBACK M IS. - CONSTRUCTION LENDING 11GENCY� �-�� SET BACK PROP.LINE WIDiH I hereby affirm fhot lhere is a consiruciion lending agency for PRONT � the perFormance of�he work for which this permit is issued P.L � �''t`•�G F� (Sec.3097,Civ.C.). SioE . a.�. F=F = 3 . m � Lender's Name � (`�('� LDMA Ref.N � "' ��U,�'G ... . . ..- . .-.. ... ._ .. .. -.. - P.G Fee$ � Permit Fee �..lV`� ' lender's Address ' 9 � __ artify that I have read this applicotion ond sYofe thot the �ssuance Fee 1 � LDMA PiC S `"r��`��' e information is correct.I ogree to comply with ali County InvesNgaron Fee y;�,;�1 C�-.�'� '^xes and Sta�e laws relating to building consfruciipn, Total Fee LDMA Perm.p `�y auihorize representatives ot ihis County to enter hove-menti ne property for inspecfion purposes. �� ---_ z'-6-a'J SEE REVERSE FOR EXPLANATORY LANGUAGE e of Applimm ar Agent Date .... -.. . . . „ PLANS TO APP�ICANT INSPECTOR'S NOTES � n«'��k-RUILDIiR llECLAKA"I�IO\ . , „ ._ .._., ._..._� .M I hereby afflrm�ho+I am exempf from ihe Cr To: ReTurned . � �License law��for 1he foliowing reoson. ' ...i1�5) � Approved Busiaexs anJProjessio�s Code:Anry riiy or county which No. Dafe No. Dofe � reg¢ires a permit to construct,alter,imf�rone,denzolish, .._.... _..u........__..,.._,...__..:......,. -.... or rcpoir uns strurture,Prior ao its usuance,also reyurre.r . the applicant for suc�permit t�fiJe a s�ned at�tement , . , , , tbat Ae�is licensed yursuant to dhe provisiows nf iha Cox- - . tracenr's l.icense Lam(Chap[er 9J(rommencin,�udtG Sec- . , . . , . ... finn 7000)nj Dinuion 3 0/�the Busiqeas und Professions � - � . .. , . Co`te/nr tb¢i bn is excmpt t{erefrom and tbe basis for tbe . „ afleqed exenepiion.Anv vialatiox pJ Section 703I.5 by Required uny upplicartt for a pernxra subjecas ahe appticanr ro a ciail A rovals Date Received PP Yes No or Approved ,, nenalty oj nnt more tAan Jine hundred dollurs/SSOO�.f: � [l! I,as owner of the property,or my employees wi�h Water Certificate '-� - � � - -- � �� + - , --�.--��.'�•< wa9es as their sole compensation,will do the work,and Ihe structure is not intended or offered for sole.(Sec 7044) Health Deparimen! . ^ � � Liusinesx and Pri f•ssions Cnde:The Con{ractnr's I icense , I�u�does nnt upply xo an owner nj prnj ert,y�wHn builds Fire D=partmenr � � � �� -��-----.._. � . -or improves.�bervori,and u•hn dnes'such u»rk bimseljor ihrau�pb hfs nwn empdoyees, prnevdeJ ifiat surb im- Grading - . prnvements ure wnt intended ar nffered fnr sule. If, � hou�e:�er,the building nr improvement is sold witGin one Geologiml . ycar nj cnmpletion, tbe awner-buefder u�if!1�aue t6e , � . �� ., • � �� hur�len nf prne�ing tl at fie did nnt lurld nr dmpro��e fnr Pedestrian Profection '� the purpose�/sule). (Fence)(Conopy) � I,os owner of ihe property,am eadusively contrpo- : ting with licensed ronrractors b<onsiruct the projec+(Sec. Spedal Inspedian 7044)Business anJ Profesxinn.c Codc: Tbe Cnmtractar's �Conc.)(Masonry)(Welding) . License I_au�does nnt apply to an ou�ner ujprnperLy who � builds nr impro»n.a therenn,und a�Jo rnntracts for xucfi Lot Droinage � . � �� projectx u�rth u cox�rurtnr/sJ licenseJ pursuant tn the . Contractor's Lrcenac/awJ. Porking . - � ..- . - . - � �om exempt under Sec. ,B.&P.C.for fhis reason . .._ , Dare Owner Approvals bpte Inspecfor's Signature � . � . INSPECTOR'S NOTES Lo<ofion- . � . . . _..__. .. .,. (Setback&YardsJ Foundations � ",' Slab . . . . . ... . .. . . . .. .... . . Frome ..�� „rC .. - - ... . . � ..,,. , .,�.,..,, ... _�,,...... G Energy Insola�ion � Lath/Drywall-- � ' .. . . . .. . . . ... . .- . �._ ..... . Interior -_._ ,.,....._._...,..,...,W ..._...: Lath—Ezterior ��'" ''- "' � Hau e Number�- � �� ' �� qi -�� -� . �� .� Correct 8 Posted .. Final-- � . �. . . . . . .. . ..._,__ . Enter on Front � �