HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (87) _. . _ . . .. _ .. .._.... ., _.. _._.:_ ....... . .... . .....
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W:�ICERS'COMPENSATION�ECCARATfON � . , - -
� .- . _ . . . .. .. . ,. ... _ . . ._. .__. _
_ . .. . .._ . .... ..
I here y affirm that I hove a certifimte of consen�fo self ��(y y�.�]1 A/`� '
insure;oracerfifimleofWorkers'Compensation�lnsurdnce, AP�LICA�IO� F�R�,YUILV■�� �ER.�■IT,
or o certified copy rhereof(Sec.3800,Lab.C.j COUNTY OF LOS ANGELES BUILDING AND SAfETY - ,p�,�E:/�
Policy No. Company ._. . .... _.._ .._.. _.. ... ..:..,� :._...:
Certified co is hereb furnished. -� BUILOING /( � �� ��, �s
❑ PY Y FOR APPLICANT TO FILL IN qppRF55 b u�a�
� Certified copy is filed wilh the couMy build�ing inspeo- gURDiNG . ,�
tion department. ADDRESS �(j� � �,
Date Appliconr Q7Y ZIP 1n� LOCALI7V
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OP BLDGS. � NEAREST - - -
COMPENSATION INSUkANCE SIZE OF LOT NOW ON LOT CRO55 ST.
(This section need not be completed if ihe permit is for one � ASSESSOR -
hundred dollors($100)or less.) TRACT 6LOCK LOT NO. MAp BOOK PAGE PARCEL
C TEL. / � USE ZONE �P 1 i/ R_l
OWNER th. NO-�KC'��� a i+ ,�.�
I cerfify ihat in the performance of ihe work far ivh�ich 4his Np. /
permit is issved,I shall not employ any person in any manner 3 SPE��A� . ,� . 3`�g f� o
s�
so as to become subjea to the W ers' ompensaY' � s. P.DDRESS ' � �� CONOITIONS
..y�� �' v
�ate 1/a�-�Applicant CITY ZiP �
ARCHITECT OR TEL.
NOiICE TO APPLICANT: If, affer moking this Cer'tificate DISTRICT GROUP TVPE PIRE PROCESSED BY
Exem tion, ENGINEER _ _ NO. _ f�
p you should become subjeci to the Workers' �� ,(! COf�ST� V
Compensalion provisions of ihe Labor Code,you musi forth- qDDRE55 4'�7�t�" �l � d
wifh <omply with such provisions or this permit shall be
deemed reVoked. . NO STATISTICAL CfAS$IFICATION APT. CONDO. �
CONTRAQOR q �
LICENSED CONTRACTORS DECLARATION � L�C. CLA55 NO. � `v DWELL UNI75
I hereby affirm Ihat I am licensed under provisions of Chopter 9 ADORE55 Np,
(commencing with Section 7000)of Division 3 of the Business and , ��� SEWER MAP '
Professions Code,and my license is in full force dnd effed. CiTY CLASS - VAIIDATION
54.FT. `� NO.OF NO.OF. CHECK BK. PG.
License IVumber Lic.Class SIZE ��J STORIES FAMILIES '�_ ONE
' � NEW VALUATION �
Con}racfor Dafe ' DESCRIPTION OF WORK ' ' s � �
^- I � ADD � ,
�I om exempt under Sec. �� '� L� �G' {�G)6 ll�
� ALTER �
B.&P.C.for this reason REPAiR ❑ S �����,���
Dafe: USE OF `
EXISTING BLDG..JI.S.� (�j)� � DEMOL ❑ ,. a e �, E�v
Signature APPLICAN " ` T . FINAL %�� ll
OWNER-BUILDER DECLARATION PRINT) ( � GTf� NO. �r � DAT .. .✓`' I A °f.�i.G G
I hereby affirm ihat I am exempt from the Conirocror's License !+h�- �. , �_g�� • �
law for the following reason(Section 7031.5, Husiness pnd ADDRE55 L L FT FINA L� = - o;�,,r,p��
Professions Code): PRESENT By �'�/
� euaoin�c�j ,� �L�_.f']�� f+? ! 'I,1 �—8 6
I, os owner of Ihe properfy, or my employees with ADDRESS
wages as their sole compensation,will do the work and �`��y�,,��J,�y �
the strocture is not intended or offered for sale(Section �����TY
7044,B�siness and Professions Code). MOVING 7EL. ' �
� I,os owner of the property,am exdusively con7raUing CONTRACTOR NO.
with licensed contracrors to tonsiruct the projetl(Seo ADORE55 �
tion 7044,Business and Professions Code).
CONSTRUCTION'LEND7WG/1GENCY � �' ' " "--' REQUIRED yqRD HWY TOTAL SETBAIX FROM 7(I T. �� � - �� 'z,j G,�i,.'i P,
SET 6ACK PROP.LINE WIDTH
I hereby affirm thot there is o construaion lending agency for F20N7 .
the performance o4 7he work for which this permit is issued P.L �.e. c o e �
(Sec.3097,Civ.C.). SIDE
� Lender's Name P� I 6 ��2�S�'
- Lender's Address
' - � P.C.Fea$ ��� Permit Fee �� �DMA Ref.# � � s`��F�%�
I certif tho�I have read this a lication and state iho�the t � �,� �`��
� Y PP Issuanve Fee \Q LDMA P/C ri '
� a6ove informotion is corre<t.I agree to comply wilh all County Invesrigo�ion Fee
ordinances and State lows relating�o building constru<tion, Tmal Fee tDMA Perm.N -
" and hereby amhorire representotives of�his Coonfy to enter �
�^+�upon the aboq;-mentioned ro fy for inspetlion purposes.
u (��,`y�, ��Z."�, SEE REVERSE FOR EXPLANATORY LANGUAGE
`� Signa�ure of Applican�or Age Dare � �� � - - � - .,
�
PLANS TO APPLICANT INSPECTOR'S NOTES O4Y:VLR-BUII.DER DECLARATSQN
. _ _ I hereby afti�m thor I a empt from the Coniractor's
To: Re}urned License Law for the following reason. (Sec .t531.51
Approved Awiness undProjessioris Code:Any cit}•or rouxty u�bicb
No. Dafe No. -Data � ' - reguires a permit lo ronstruct,niter,imQm:�e,demolish,
. . . . . .._..,. .. . . . . .or repairanystructure,/.rior ta dts issaaxce,arso reyuires
the applicaat for sucb permrt to file a signed st�tement
,,. , = thnl 6¢is lirensed pursv.ont to tbe prnvisdnns of the Co�
- tractor's Lacense I.uw(Cl�apter 9/(commexein,q with Sec-
- . lrnn 7000f of Division 3 qj the Business and Professinns
, � � � � Code/nr tAut be rs exempt tfierefro»i und lfie 6asrs(or tbe
� . alleRed exemp[ion.Axy a�iolatrox ojSection 70315 Gy'
Re9uired Dnfe Receivod an}'applicaRt for u permil subjects tbe upp(icunt to a civi!
Approvols or Approved penaltv o/rent more.tl un five hundred dnAar..�(.SSOOJ.J:
Yes No
- U I,os owner of the properfy,or my employees with
Woter Certificate ' �.• _.. - . ,, wages os their sole wmpensotfon,will do Ihe work,and
_ � - the struciure is not intended or offered for sale(Sec.7044)
Health Deparfinent� ' _ � ,,�„ � Dus ne und Prr fu�sinns Code:Tbe Cnntrador',s I_icense
LauI�oes not�ply to an nu.��ner oJpropert��wbo baildc
Fire Department � or imprnoes tGereon,¢nd u�ho does such u�ork himseff or
t!rough bis nu�n emylnyees, prnrided that such imr
Grading � � - � - � prui�eneenta are nnt intended or.qffcred jor sale. If,
hnu�ecer,tJ e fiuifding or improvemext is solJ watl�in one
Geological . . vear of compJetion, tbe ou+ner-builder will bave the
burden nf prnern�tbut he did not he<rld or imprn¢�e fot
Pedestrion Proteciion � efie purpnse nf suleJ.
(Fencel(Cdnopy) - � I,as owner of ihe property,om exdusively confrdr
ting wilh licensed controcrors to consiruct ihe projecr'($e<.
Special Inspection - 7044)Business and PrnJessions Code: Tbe Ce�ntrncfnr's
�Conc.j(Masonryj(Welding) - � - Limnse 1 au;rtoca nni a1�P�l'tn an uwner nfprnperty who
builds or impmnes tberenn,and u�!n cnntracts(os such
Lof Drainage . � � _ , . hrojerts u�itl a�nntr¢rto+{sJ licensed¢a�rsuant tn tl e
" Cnntracmrs I,icenrc Lau�J.
Parking ' � � r I om exemp7�nder Sec. ,8.8P.C.for this
��� -� - ' reason
� Da�e Owner
Approvais Dofe Inspector's�Sig�oture , _
� INSPECTOR'S NOTES
Location- �� �- � ��
(Setback&Vards)
Foundations �
Slab . . .-. . �.
Frame . . . . . ,. ... , .
Energy Insulmion �
LalhiDrywall-- . . . . . '. '- . .. � -.
Interior
lath—Ex�erior .
Ho�se Number-- " �� " � " ' •
Correct 8 Posred
Final-� - . . , — .
Enter on Fron� � �