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HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (106) �� ORKERS COMPENSATION DECLARAiION . -'.— . ...... � 'ti� .�.. � � �az=a����•�������v� -._ ..�._ . .. .-�.. '+,. '-----.-.- ..... -,�sw.-�w�,��u* - , �,� :�� APPL�CA►TlON�OR l�t�lU1��N� P�RNI,IT� � '.A I�here'q��af-`ym il�at i hove o ce t f mte of��conseM to satf 76A667A , „ . . ._ . _� � � � � � {�P�` nsv'�or a C rl ficpre of Workers Compensafion Insurante, GE BV�REV IOi81) _ . _ y,�or a Ee t fied opy thereof Bec 3800 Lab C.) � A,�ry����,��§���$,�.��,,,���� ��y�,� �t_,_ �,;,,.,,rrw,i>,�,<_.,COUNTY OF LOS ANGELES BUlLDING AND SAFETY ol�cY No Co pany .. . . . . . . . .� . . ���❑Y Cert f ed c py s he eby fum shedpry � �-'BUIIDING � � �. -� � --��- + � ��� FORAPPIiCANTTOFILL W(GRINTORiVPE)� �- - �'"'7 Cer fied copy is f�led wdh the co�nty buildmg mspec - ADORESS - � :� �yiJ NUMBER FIX7l1RE6RITEM � '�(,l FEE t o depo imenr .00ALITY r s"i c-. x��:: : .;� �.,,;g�,,��r�������+#�+��'�.&��`�S�'�`� W ATER QOSEi j61,� Date Appl conf NEAREST �#�'�`^�3�,, .z' �. 5�a r x�?t,:s� �� � CRO55 S7. _p,. s }�;�7�i --�r t'C��O�1 FR�M 1�JOR�S , 8nit;Tu6 1�4 - COI(APEf�S`AT�i7N 1��2Af'�1'Z'E�i � OWNER ,�y � �c� 1��� ahi - �� -�, .. �� S40WER �� � {Th�s section need nof be completeA tf fhe work�nvolvad by MAiL F��t6e permif is for one hundr�ed do�llors(5100}or iess.) iavATORv A�DRESS 3�..5 �Elrll�' ^ ' N � "�I`cev�i��iTial�in the performonce'of fhe work for which ihis � � f v��„'�,' �SINK CfSY ` � TEL.ND.�'�s��"�- �v� }S�rmtt s issued I shall not employ any person in any monner �`ier r� V/ � �"� so cfs io become sub�ect to ihe Wo ke s Compensqt on Laws DISHWASHER � z�' ,�'� '' ��`�",`�kut��rr�rc�__ ;.�:, coNtaaaoa . �r�. �� �� 6��G, ��✓.gs" � � CLOTHES WASHER d+�;�'1�7'Jate Appl ca t qC�RE55 �'!( �' y� _, ��,,., .,N6YI�`�O'�i�P�t'.,1�1`7'T;_If, af9e� maki g thls Cert�fi ate o4 SWIMMINGPOOCRECE'rT0 - n 'J _ �Exemp�ion,�you should become subjed to the Wo kers' . C�7Y /�/,L'FH��� 7EL.NO.'7��3yj n '`Compensa�ion provisio�s of the Labor Code,you must fo ih- 4�5pRINKtERSYST ��'����F � k��y?h comply w th such provisions or this permif shall 6e _ STATE ¢� LIC. a`� � ��eemed�revoked �,}.�q� �t�5.�.,�y��,� ..,y�.� /,-W%1TEk HEATER �`�• ` LICENSE NO. 3G��� CLASS �cJ�p '���r��L �NS��bNI�HC.����I,LAK�TICNN� DISiRICTNO. Q\�j\CESSEDBY � . ' � . GAS SYSTEM CU TS /'1 r.\;��, � �he eby a fiim lhat I am I censed unde prov s ons of Chppter 9 ,�, i�,__,t � y. ��"�"� rcomme cing w th Secuo 7000)of�Division 3 of ihe Bus ess OU7.Ei50VER., . - �1. �+ a'itd Profess ons Code,and my fcense s n full force and effect 5 PER SYSiEM� FINAL 1 (�. VALIDATION _ � t .��,�.�.�.�a . " �gk�,cti�t..b.,r.ow:x...t�sU.,�Wa.�voz,�« .., . . . � � DATE S � l ��`$=t cen�Number �' �s L c Class � '�^ � ` —"� ..e:;�n.r,::sn ��L,...-..,:..,�-��. �`� � FINAL� .io �� !�nlrac or�',�:._+�.!°�'����� Ddte � Csr"--�i.F if�l`�. a . gY � ., ��'�' � I am exempt under Sec � ��i�G�^x&r+�`.§"2.,�xs.�+�m �"EC���:s � �" .�aE� ,t._,,, ._.. .._.�..�....._... .. � S-�.. 8&P C ar t�s repso��. _ ��„�� � �� P�(7n heck fee ,/ � �Y a'''�'f.�. `�-y.''�'x��.'fi�fi, 5 .� :�ate i�-r����.°�m.�tY�: ��'�a'�°�� T�.�"" ..� .'� ';e�'"2. �s�. .�=e �..� x � .MIT ISSUING FEE$ ,(� � y���,� "LL�f.,'� o����_.�,,�- �,�Y-s����ia"t a �'nr*,.�"'2 TOTAL FEE �� C-� �'� � r f : i�.'�y��� �vx"� . . ��-�,�c-�`�+,`r"�"a'�`-"g��,"a,'�F;���f�,. ��' Plon check oPPlicant ��;�6�.�,,4� F .INGCE FAM�IY � ...,� . , .�� � HOM�E�'N ER BUICYJER OEC�LA(FATION , Name �,��c�r w�.-..-�,u..,.w_.W.., . . . . . . ... ... .. . .. ._ . `r a 1<4' �. ;9,�,.:3.,,�hereby affirm��ar I am exempt from fhe Contractor's License Address J ���_ ,Ca for the foflowing reason (Sec�ion 7037.5, Business pnd �� p R -'Pro�essions Code) �ity Tel.No. W� '�� �� I as o ner of ihe property,will do ihe work pnd ihe . - � '� � T�C S� `"5"^'�-�` slrocture is�noi inte ded or offered for wle (Secton srys:� �`04A Business qnd Professions Code) � ,,,, ,__ „_, ,, .,, ,_„ ,,..„,., , � c.G.��_' { #��rtar .,�r . ,. �,,.�,�.e. ; - �o�:. �r;c.�<,:.3 ,� t�:���..,... � ... ,,, , ... . .� , . . . ;...,. ._.. -.,�;�_c�,t- '��Fn��+t,c*.� C�fO�L�NG��A2'i NC`�nw. : , . . ... � -- --- � - . . . . _ y - . ���: a .,,�+-;+r..._, .; 7 .;—8 6 e eb y affirm ihat ihere�s a construchon lending agency for '3^ 'f�e performonce of the work for wh ch,t�s permit s ssued .�.- "��ec 3097 C C) S):� v d� ,{�.,„� '`az �' , '. £'��5 E��#S� �F#"x.A�'�;.3v� �.�?- a z.'`'" ��,* ? � . -v r �%'fr& "s' �t Y �.�t 7 5�.- '�,r �� ��° '""3''� . ��ss." _ .. �� �^�,����'�'�^�,��,�.A�� �'a�'�� _`�� 4,. � s , � ,ende s Name ' �,, _ ,,,, . . ... �'€'� r�,�'m�a�����:'���'�!--�s�`.`:-.,.`��. ..`A'k„�.;'. yr x �t�� .�'m.�i:,s�za�wj��.�a �, "._ .,._�.. . .. _,��.�� .....� �..�_ . . ...... . .. . . . . ... ..__. _�.._ _, .. � � b�_ ,�4 r_,' � : � �lender's A r�ress - -� �- - . . � 1 I c�rtify tha�I'�iave read ihi'applicarion and stote Ihat Ih¢ � '�� ,`abave format on s correct I agree to comply w fh a��Cou�ty . � `o c�nq ces and$late Ia _regulatmg Pfumb nq a d hereby �� ;� ,�uthonze,rep esentptives of iha Cou �y fo enfe upon the ove ment oned prope ty fo• spect-on pu�poses �'^ ,� � _ �- . � r��•�--�-' ^•�`^•^ SEE REVERSE FOR EXPLANATORY IANGUAGE � �y`�s �'�,�'��r�i� '���,r� u ,�%.^�'-�3 tv + .S gnatu e of Pe m ite Dme ., - �"'�* 4�,.�„� ���`. ,� " �' �a� ���:�.. r����. yby�- .m < �,�dz� r.., , � .� - : i�_. . , _ .��.:ti'�� . a ; f "�ti .:' .� .,: ` , . ::... .,.,r-... _.:.:.... . ..... , . ,..:�. <.. .�.. ,.•'�� ..,.:. ,.,..�,..a. ,a...,.u-A..� ,. "� � , � � . 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 . : _.,_.__ _� .. .,. . ¢. . ' ,.;. . ... .. .. . . . .` -... . � . : _ : . . . -. _. ... . . , .. .. -�:�.� .� - . Date ..... ... .....� .' . , . . " ' . h .. ..', - . : .. . . .' :.. .. .._......... :. ..,.. . ... ,...:.... ...._:�.:'.. . . , . .. ' .. �" ' �' "... �.�'..... ..�.. '... . . .. .. . . .. . . . . .. ' . : ! . . . .'. .. , : - � . � - -, � . . ..,. . �. , ..�.:"., � _.. .- . . .,C�wner • . . INSPECTOR'S N07ES .. ..'.... ..; ,. ;_ .,., .. . . _ . . .. . . . ._...,.,_ .-... .,.. . .,,.;, _.,..,�ae r ,r'"- � _ . . ., � ., _ .. ,ry..+ ., �,n+'t TNi''A'kiC%vr i�T 3%.+e�. 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