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Home My WebLink About1155 SOUTH DIAMOND BAR BLVD (156) _., _ / ' ,. �, _ , . _ _.._.�.�� n.r_� _, ...._ WORKERS'COMPENSATION DECLARATION � ,.-�^� � ' � ^`�—"�"--.--- -' -- %�� -� � � , .:. ..- _`. .. . .. ... . .. ' . . . . I hereby affirm thot I hove o certif�cate of mnsent to self qp�pL��CprtiO�l�� FC)R� Bt,�I�LDIIVG PERMIT insure,or a ceriif cote of Workers'Compen`saf"on�lnsurohce, � or o certifred copy thereof Sec.380D,lab C.) � �� - -'� �� —""--�" "�� - _. ' .�:....,, . ,:_ _,; . C�UNTY OF LOS ANGELES BUILDING AND'SAFETY PolicyNo.7..�Z� o pany 3'%/.��'C`'�� - �.... . ...___.�.. ._v.. ... .... ... .. ..... -. ❑ ' --' '- BUILDING - S� r� . �Q v FOR APPLICANT TO FILL fN ' Certified copy is hereb fornished. �,,,r..,�' ADDRESS I�S�� (/�TqJ � Certi4ied copy�is filed with the county building inspec- gUiIDWG !�- � �� -� l��y - tion department. �- ADDRE55 ,j� o Q .QGi�,Q 1//a . �.�� _�/� .. ._..........._.. ... ...�.....,._.. .. ..._.._............ ..._,�..�._..,._._..._.. Date /.Z."�`� Applimnt��C:.�l/G�� qTY / B � ZIP��.. . ... LOCALItY ... . � . CERTIFICATE OF EXEMPTION FRONC WORKERS' ' � � - NO.OF elD�S: "�� ' NEAREST . . ' '- - . _ . ' ' -�-��<<�•�- ' - ..� � SIZE OF LOT NOW ON LOT CROSS ST. � COMPENSATION INSURANC�� ` (This section need not be completed if the permit is for one TRAC7 BIOCK Lo7 NO. �+55ESSOR- � � - hundred dollars($100)or less.) MAP BOOK PAGE PARCEL � TEL 7/Y USE ZONE MAP . ....."-.-"' -�-�[ OWNER G� J�N Pi�a�O6jc�Y No. 3/-��a } I certify ihat in fhe performonce of fhe wo!k for which ihis Na� ��l" °�t permit is issued,I shali not employ any person in ony manner � �� " "' ��rn SPECIqL � - � 5o as to become sUbjecf to�he Worker5'�Cpmpen5atipn LaWs. ADDRE55�7.T.2.� /=E RKZ�.J� � �Y]NDITIONS u ❑TY 0�/.Sf/0 C B ZIP q�Z�� 9.' Dnte � Applicant ARCHITECT OR � - � �' TEI.7!�/` NOTICE TO APPLICANT� If, aher making this Ceriificate af DISTRICT GROUP CON57. Z�E PR�CESSED BY V Exemption,�you should become subject to ihe Workers' ENGWEER Ld'rJ /!� // NO. 7 /� W Com ensation rovisions of the Labor Code,you must forih- � P P � ADDRESS .T.� D��' ,D� �l/��"Z� � � d with comply with such provisions or ihis permit shall be - �--- ...-,.. - ��y� H deemed revoked. STAT�STICAL CW551 SATION APT. C DO. Z CONTRACTOR GL6'Y/�/J' / NO .� a LICENSED CONTRACTORS DECLARATION - '" �� --' ��: �� - � _�- CLA55 NO. d��DWELL.UNi7S I hereby affirm ihot 1 am licensed under provislons of Chapter 9 AODRE55 9� /�'f�m/Y e NO. ��..a�.� ,.,_,.,,. ., ,, _. .,.... (commencing with Section 7060)of Division 3 of the Busineu and � �� •� -�� - SEWE2 MAP � - • - Professions Code,and my license is in full lorce and-eNect. CiiY / CLA55 G"'��y� BK � VAUDATION ��/�Z� �� $Q.FT. NO.OF ND.OF CHEIX . � �icense Number Lic.Class C^!� SIZE STORIES FAMILIES ONE ._. . .,, , . ` ..-,.. ....°•. VALUATION �Ci�-�i� � . Contractor��-�L�d�G'��Date A��G�� DESCR�PTIONOFWORK NEW O s�d�Pd� � rtE lf� L ADD , '� �I am exempt under Sec . A F, • � � . �f d AITER 8.8P.C.far this reason Ic�O�7T�'' . . . REPAIR � S � ��'�� USE OF � � � � � ' Dale: EXISTINGBLDG. Cd /Y��S/�� EMOL ��t�� .. ......_.___.v..-.:.... . . . .. ...... APPLICANT .'. ' ' � T L. Sigrialure PRINT) . �GC` ( /,�NO. f flNAL OWNER-BUILDER DECLARATION - � '. _ .,_,__„�__, „ ,_„ , _ , DA7E I hereby afFirm that I am exempt from the Contrador's license � � . . low for the following reaaon(Section 7031.5, Business ond ADDRE55 P/�� 7: /Z/L/ I � fINAL Professidns Code):- przESENi � �� -� �� -�� BY . ❑ BUILDiNG �, . .... , . , . . I, as owner of}he property, or my employees with A�DRE55 _ .__'�"_.,-___.. _ .,._,�_,;_'_._. ...'__, wages ps their sole compensation,will da ihe work and -` •� i ihe structure is no�imended or affered for wle(Seciion LOCALITV , � y� 7044,Business and Professions Code). - - '--�� MOVING � � �TEL. - - � I,as owner of ihe properfy,am exclusively controcting CONTRACTOR NO. �� with licensed coMroctors to consfruct ihe project(Sec- ADDRE55 � �j, � � � `�`"��A �ion 7044,Business and Professions Code). .. � CONSTRUCiION LENDING AGENCY REQUIRED 7DiAl SETBACK Fk0 xi y�/� {`{.c m a b_p� _ $ET BACK YARD HWY pROP.LINE N1�DiH y� I hereby of4irm that rhere is a mnstruction lending agency for pRON7 E� . r ,; a i Jr 5 G,� rhe performance of ihe work for which this permit is issoed P.�. ($ec.3097,Civ.C.). SIDE � � _L'^� „z � Lender's Name �0/�G /2.6�'�� P� ��y o . . ...:.,....,.... � - .:x�. ��j. . . / . ��,... LDMA Rei.# I C I �'"FS'�O - Lender's Address - P.0 Fee$ Permrt fee /��a � �� -� ��- ' I certify that I hove read fhis ppplitotion ond state ihat the Issuance Fee r�'`�� LDMA PiC K ¢ obove information is correcL I ogree to comply with all Coumy I�ves�igai�on Fee �r� ordinances and Stpt,e laws relating to building construction, _ iowt Fee � ` `� �MA Perm.# � and hereby authorize representatives of this County fo enter < upon the above-mentioned properfy for inspection purposes. " . ... ...'.""-..,.^,..-...^,,.....��-:...�:•....�i.>:-.a....<-,.,.,-�..-.�..' .. °;... :.�� . ....�...... . .: ...� _,. : � /�r�!„��/' ��,�-�7�f SEE REVERSE FOR EXPLANATORY LANGUAGE ' � u�l � ican�orA f � Dote . . .,._.__.._ .... OO�. Signafure of Appl' gen --�- � �� - �� - � � 1 _. .... PLANS TO APPLICANT INSPECTOR'S NOTES � �u ntiV\Isii-.^,,D!I.DER DFCLARATION - i here6,.:{'::m P�at I art-�exemp:(rnm rhe Conhcrcror's To: Returned � License Iqw iur �he frn��owing reoson. (Sec. 7037.5) Approred Busixes.��and Prr fussion:�Cudu:Grey�ity or rnunty whicn No. DaTe No. Dafe .,^qre�,ulres aQer»sk to cosutruct,uffnr,.improcz,demnlisb, . - r repai dn y 2iructure,priar en its usuance;a)s�n reyk: tbe ujplic¢xit,jor sucl�permlt to file a signed samtemend . that 1 c is]icensed pursuant to tbe pror;isions oj the Con- , ,, � t�., . ` - ' lrac[or's I.icense T.au�(Chapter 9J(o menang u�ith.Sec- tion 7000J of Ur,vision 3 f t6e Bvsiness a�rl Prof�ssinns - � � , .. . . .� .i 1'� , . � '�CndeJ or fhat be ir e'xe�npt t5erefrom avJ'the basis fnr tbe � � - - - ¢llegad exempaion.Any violation of Sectiox 7031.5 by Requlred DaTe Received � any applicant for a permit smbjects the applicant to a rdvi! Approvals or Approved �� ]+enally of not mom than fix�e hundred dollurs(5500f./: Yas No ... ❑ I,as owner of the praperty,or my employees wifh Woter Certificale � �� . , �- � � • � .� wages as their sole compensption,will do ihe work,and the structure is no�intended or offered for sale(Sec.7044) Health Deporiment . ' � � � - �� Bus ne and ProfessJon.r Code:Tbc Caxtractor's License La�e does nnt app(y to an owa¢r of prvperty who huilds Fire Department. � � - nr improcrs tfierenn,and�cho dues suc%work bimselJor _ _ � througb bis nu�n employees, yrnvided tbut such sm- Groding � .. prnr�ements ure noi intexded nr offered fnr sale. If. . . ., .� - . .. - bourver.tbe buildin�orimprox�ement is snld:c•ithire one o .�.� . �....,. ..�. . ., ., . � . . .�. - � �-' �-�- - � -- "'" '--�" "' f compleaion, the ou•ner-buikler u�il!bave tbe Geologlml ., •. 7'ear o � � „ . _ . ' ' � • � . burdcn n/pronang�ha1 fie did not haild or impmne fnr Pedestrian Protection the pa pnse r f ra1eJ. jFencel(Canopy) - ' �"� � � ' ` � �� ' ❑ I,asownerot�heproperty,amexdusivelyconirac- ling with Lcensed ronrronors b construct rhe projecl(Sec. SpeCi ol I nspetiio n - � � "- ' � '� '� 70441 Susrna�s und Pr�fes.vionr Code: 71 e Cnntructor's (Conc.)(Masonry)(Welding) I.icense,Lau�dues nnt¢(/�ly toan ownernjpraperty u�bo builds ar i»xprones GGvreon,end u•bn rontrarts fnr sucL LotDrainaqe � • " �"��rojeots,u.�rtj u rnntrurtar(sJ.lir.ensedpursuunt an tbe - Cnntractnr�l.icenseZuuiJ. � � Parkiny � '. , ... " . � . . �_� I am exempf under Sec ,8.8P.0 for this reason , Da�e Owner Approvals Date InspecTor's SignaTure .� . , . ... , .� . �. � . _ � INSPECTOR'S NOTES Locanon-� � (Serback&Vardsl � - Foundafions Slob Frame Energy Insula�ion " - , . . Loth:Drywoll- inierior Lath—Exterior � ' � � ' . House N�mber- Correcl&Posted ,, Finol-- Enter on Fronf , ,