HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (105) _. _
' WORKERS'COMPENSATION DECLARP.fION -'- "' „, -
. v . .. . � .. . . . _ _. ...... �. :. ��
I hr.-eby aff„m thot I hove.a certificate of cansent to self AF�PL�iCA7�O�N���FOR����.��J�IL�I�N�� �PE�RIIIi�T �
insure,or a certificate of Workers'Compensarion Insuronce,
or o certifled copy thereof�Sec.3906,Lab.C.) � .. .
COUNTY OF LOS ANGELES BUILDING AND`SAFETY
,. -_,-___-�___.�.__...:----. ...................
o icy o, ompany
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� Certified mpy is hereby f�rnished. FOR APPLICANT TO�FILL IN gui�owG �t ._ � �,��
� Certified co is filed with the count buildin A�DRE55
py y g inspeo- BURDWG ' -
tion parmen�R.--�-'-'-'—""'--"""""---`.`�...... ADORE55 � ,
/ ra 5 . N� .' ��
Daie � PP � CI7Y � r .Fr��{ ZIP LOCALITY
� ER ICATE OF EXErtAPTION'FROM KERS--�- �'� NO.OF 6LDG5. NEaRE57 '
� ' COMPENSATICSN IN5URANCE �� SIZE OF LO7 NOW ON LOT CRO55 5T. ,�$\
(This secfion need not be campleted if fhe permii is for one 7RAC7 BLOCK LOT NO. ASSESSOR
hundred dollors($100)or Iess.) MAP BOOK PAGE PARCEL
� «/TE�' �,3 USE ZONE �P
I certify�hot in ihe performonce of the work for which this �WNER � ��t7 C "n10.� � NO. }
permif is issued,I shall not employ ony person in any manner qDDkE55 � .J �, /L4�1�]yh27 .Q SPECIAL a
so as to berome su6ject 10 the WorkeYs'Compensation Laws. � CONDI710N5 _ . . �
Dafe "�� �PPlican} � GTY /i'� 'f0�/a �+[ ZIP . .. .., �g
NOTICE TO'APP ICANT: If, after making ihis Cerlificate of ARCHITECTOR TE�� DISTRICT . GROUP TYPE FIRE PROCESSEDBY O
ENGINEER NO.
Exempfion, yo� should became subiect to the Workers' CON� ZONE 'y
Compensation provisions of the Labor Code,you must forth- `
with comply with such provisions or fhis permit shall be ��RE55 TE� p �y �O f , , � y
deemed re�oked. . . � CONTRAC70R/,�J'L=%/�:' �f '�C NO.-11}�'��d STA?!5•TiCAL CLASSIF •TION APT. CON00. Z
LICENSED CONTRACTORS DECLARATION V ���.c, CLA55 NO. DWEu.UNITS
I here6y offirm that I om licensed under provisions of Chapter 9 ADDRESS �����G�S NO-7�(r��a�
(commencing witli Section 7000)of Division 3 of the 8usiness and � ��� �� SEWER MAP
Professions Code,and my license is in full force and effe<t. CIiY�!%L�T�t.��' Ci.455 7 - VALIDA710N �� -
�""��-� SQ.FT. NO,.OF NO.OF CHECK BK� �''
License Nutnber �- ����Lic.Clas���5 SIZE STORIES FAMILIES ONE
� /�\ � �- �p NEW VALUATION �
1 '�'-Z� %� d�' �-�j�" DESCRIPTION OF WORK G� ��/°'-'C
_�Contracror . �. .f + ate �'�"� § �
ff�° A�D ❑ , �.V d l
� ❑I am exempf under Sec � � 'G�'^J � �-� ���7�
ALTER
B.&P.C.for this reason _ - REPaiR [] $ ?`:a e o a.7 3
Da'te: USE OF DEMOL
E%ISTING BLOG. J ❑ � 'O G�J O O
�Si(Jnd�u�2 - APPLICANT �(� ) �/ y/ TEL/)1� FINAL .
OWNER-BUILDER DECLARATION PRIN7) /� K�' /•r NO.���rr onre — � � •� '�,�u G�
I hereby offirm ihoi i am eaempt from the CoMractor's License
Law for the following reasan (Section 7031.5, Business and ADDRESS p�qq � � i ?—��
... ..
Professions Code): , aRE Ni By �---�_�_ .
❑ ' BUILDING II„5"'' si �/�i'�^fY��Q .�'1�C . .
I, os owner of the property, er my employees with ADDRESS
woges as lheir sole co ensaii�in,will do the work and �p�ALITY ►
�he siructure is not inten d or otfered for sole(Section
7044,Busineas and Profes ons CodeJ. MOVING � ret.
� I,os ownar of fhe property m exclusively confrocting CONTRACTOR NO. '
� wilh licensed confrpcfors�o�onstr�ct the�projed(Sec- qDDRESS -
tion 7044,Business ond�rofe sions Codej. � � �� �- �
� � COIVSTRUCTIONLENDI�AGENCY � � �� SETBACK� YAR� HWV T�TApROP.nLCNEFROM WIDTH
I hereby affirm that there i5'd consiru lion lending agency for FRON7
ihe performance of ihe work for whi� this permit is issued p.t.
(Sec.3097,Civ.C.). SIDE - =/.=.i.�a
P.L �_ .
� Lendei s Name
� . �/'� � . r" tDMA ftef.# ip c e a C'a i
- Lender's Address P.G Fee,$� �..,7�J Permii fee � ,
r- � � :.G,�l �:
I rertify that I have read this application and state tha�the issuance Fee � � ,..\� LDMA P/C#
- above informalion is correcL I agree b wmply with all County Inves�igotian Fee !� - � �_ ,,�,�%;:.� .
� ordinonces and ate laws relaling to building construction, To�oi Fee s� �DMn Perm.8
and hereby a orize represent �i s of 7his unty to enfer � /.y i''_&�
§ pon�e a -mentioned pr ty for yA' tion purposes.
u v r
o • �. . _ , . . . . __ . .. .
x � / • , _�
o J Ci� �::'-�='�r ��� '�% /�'�u-� SEE REVERSE FOR EXPLANATORY LANGUAGE
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�.- ./\. ` . _ ... .r
-ignoture of Appli�pnt or Ag %�� Da�e " - ' -�-'�''- � � " '- �
J
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_ �r:
p - 'PLANS TO APPLICANT � INSPECTOR'S NOTES OW VF.R-BUILD�R DLCLARA�['ION
' � . .. ._ , . . . . . _. .,.. _ � I hereby affirm-ihoi I am exempt�from ihe Controc!or's
To: �� Refurned License Law for the following reason. (Sec. 70�1.5)
Approved Busixess¢nd Professions Code:Axy cdty or roun{y�wbich
No. Date No. DoTe reyuires a permif tn rnnstruct,alter,lmproue,demnlub,
. .. ... .......:.. ...:....,.,, .,,,..,., . nrrepairunYxtructure,Priortoitsissuunce,alsnreyuires
, tbe applicunt for sud�permrt to file a sigae�l statement
thai Ge n lrcenaeJ pursuunl to tbe yrorisions of the Com-
-� �� tracmr's Lraense�I,au�(Cbupter 9/(rommencixg wit!Sec•,
, trnn 7000/rJ Uiaision 3 f thc 8¢srness and Projnssiona
, ._ CodeJ or tba[fie ds�exerrspt tberefro�ns and tbe baais for tbe
� � ulleqeJ exemptiun.Aqy riioluaion of Secaion 70315 by
Required pafe Raeeived any ahhli�ant fnr a permit sv.bjerts a$e applicani to u cevi!
Approvols or Approved peruelty nf noz more[ban frve&undred dallurs(SSOOJ.J:
Yes No
� I,as owner of the propeny,or my employees with
Water Cenificate - ' �- � - � - . - wages as their sole compensation,will do the work,and
-� Ihe'slructuie is not intended or offered for sale(Sec 70a4)
Healih�epartment - - - • � � � . 8usi�ess anJ Pmfessinru Code:T6e CqnMacto✓s I,icexse
/.aw Joes not¢pply tn an owner of properqy u�bo huiTds
Fire Deparimeni - � ...._ . nr improries tbereom,axd u•bn does sucb wark bim.eelJar
lhrougb his ou�n empinyeca, provided tbut suc! im-
Grading �� . , prnvementa are not intendeJ or offered�ir aale. If,
_ however,the breilding nr impmveme�at u snld wit!in nne
Geclogiwl� a,.. . _ vear nf cnmpletion, t!e ou�nervbuilder mi!!bane the
' � . � � Aurrlen r>f prnvrxg thaa hv drd not fiuild or improxre for
Pedesirion Protec�ion - - . . tbe purpn.ve of su6e).
(Fence)(Canopy) � � r.' I,os owner of ihe property,am exdusrvely conirac-
ting with licensed contraciors io construc�ihe project(Sec.
Special Inspection � 70a4)Busrmesa ured Professiona.Code:Tbe Cnntrudor's
(Conc.)(MasonryJ(Welding) I.rcense Lau•Joe,�nnt¢pply to un ou.�ner nlpraperty wFio
huilds or imprn��es tberenn,und u�fio cnntrarts for sucl
Lot Droinoge • '- �� � � . � prnjects u�ieb a emetracto�J licensed pursuant to tbe
� Cnntracmr's Litense 1.au�J.
Parking ^ -' C� I am�eaempi under�5ec ,B.&P.C.for rhis
reason
. . . . . . Dote Own-�
Approvals Dofe Inspector's SignaTure INSPECTOR'S NOTES
Location- " . � ... .' ., .... '
(Setback&Yardsl, � . � . �
Founda�ions - � .., " . . . . . . . ... ........�,,.
Slab . . . . . .. , ..... _..,._.
Frame � . .... . . .... . .. .... . , . .. -
Energy Insula�ion , . ... .. -. . ............�. ...�. ...,�.,.-.....�.
Lath/Drywall-- . . . - . � . `.. ' - � .
Inlerior -"'--' - -- �
Loth -Exrerior � � � �
House Number— � -- � - ' � ����� � � � .
Corred 8 Posted
Final_. . . ... . . . ... . . . . . .. . ... . „... .... ,
En7er on Front