HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (158) --�-- ;- _
�: .�' ' � , .
. ":r.URK �;COMPENSATION DECLARATION � � "
'"" . . _ ... . . :. �...._. . , .. _.
�reS"��ffirm ,�o, I�have a certifimte of�o�se�f,o se�f - � qpp��CAT.ION FOR BUILDIN�G. PERMIT
_r,,.. �SUie;u.o cerrificate of Workers'Compensat�onlnsurance, � �
or o cert f ed copy thereof(Sec 3800,Lab.C) � - " --' -`'""- '" . . . -
volicyNo. Compony COUNTY OP LOS ANGELES BUILDING AND SAFETY_ �� � (a;J�T
� Cerri£ed copy is hereby furnished. FOR APPLICANT TO FIIL IN ' V tj wp,�RE��Iy��� C ' � ° ^s
� Certified co is filed with ihe coun� buiidin ins eo - °' 'qR� �� J�� ��� � � � �
hion department. Y 9 P ADDRE55 ,. �� ti,,,yY. �i'�c�"�
CA Q �:3'_
_.._._..._'2..._..�......_F.�„m�. ..,....
Date Applicant CI?Y J7 ZiP � r LOCALIiY
CERTIFICATE OF EXEMPTION FR6M WORKER$'"' " NO.OF aiDGS. NEAREST rn �� - � - . ,
COMPENSATION INSURANCE� ' � � � 5¢E OF LOT NOw ON�07 CeOSS ST. .� �..r
(This section need not be completed if the permit is for one ' � ` rRACi 6�OIX LOT NO. ASSGSSOR � �---
hundred dollars(5100)or less.) �-7'g',,�F �;-� MAP 800K ' PAGE PARCEI
OWNER^J u11�'3C.�i L 4`uU�✓0�'3 NO..<: �<.- �� USE ZONE MAP '!
I cenify rhoi in the performance of the�work for hich this . , , _ , NO. ��"�Y" �.
permi�is issued,I shali not employ any person in� n manner , . qDDRESS�l�fc` L'-�fi.�.�� Lc' �� CONDITIONS ��Z �� �
so as to b ome�ubject to the Workers:Y; mpe sat on Lpws. ,r� �Q �j/ V
`� l�j CITv !` i�Y/aZ . P.X�7� ZIP � � /Y1 a�./ �
xDa�e � v� APP�i� ARCHITECTOR � "' ' TEL.°'�1 DISTRICT GROUP TVPE FIRE PROCESSEDBY
NOTIC TO PPLICANL If, fter nq s e ificate of .•- ����- NO. '�D/F�. �
ENGINEER
Ezemp ion, you should ec e ub�e to the Workers' 1 ro�yJ$,I�`, �Z�N V
Compensation provisian e L or de,you musi forth- poDRe55 � �j j_ r�,��� -VG 1��1� V. �� �Z' ✓'n� �.Ft�' O�-
wi�h comply witF such provisio this permit shall be � - � - �� - � TE�:, � - �el
deemed revoked. CONTRACTOR ��� ''4�f+: N� r�.�Y�� ^ STATISTICAL CL45�5jJF�IC�ATION � APT. C �O. �
LICENSEDCONTRACTORSDECWRATION �� ���, CLASSNO._24_c[.L__DWFLL.UNITS
I here6y affirm that I am licensed under provisions of Chapter 9 aDORES�� '� ' (.C-: � NO. SEpJER nnAP � ' '' ��-`"-�
(commencing wi�h Section 7000)of Division 3 of the Business and ,.v� rz, q uC.
Professions Code,and my license is in full force ond effect. CITY ild��'�-4�l �M � e' CLA55 BK PG VAL.IOATION
SQ.Ff. NO.OF ` ND.OF CHECK " -
License Num6er Lic.Class SIZE �� STORIES E FAMILIES ONE _ . �
. . ..,.' . .. .. .. .� -,. .:.. VALUATION
' DESCRIPTION OF WORK NF.W E3l`�'�
COnfrqCfof . ..Dafe . ... .. ADD § �
�I am exempt under Sec. M+w �ir '�'�- ❑ .
� ALTER �h`�Q
B.&P.C.for�his reason � � S �
REPAIR i I 1 ,"�,'-.�:fi
Daie: USE OF �. � ' ' +
EXISTING BLDG. �. QC�4� �G�.�%!�+%' DFWAO ❑
Signature . .. APPLICANT^"' _ . . .�TEL q s FINAL . .... .. � 6 c ��
s ,
OWNER-BUILDER DECLARATION�� ' - PkWi)�.I��y7� "�� f4 NO.�p'CLA "� DATE -� i/� � �
_ .. .. ._'_..,___.._' _ . s + � .
I hereby affirm thot 1 am exempi from the Confracior's License ��� � ,r{,f� , ' �'y�'
Low for the following reason(Section 7031.5, Business and ADDRESS.'S /� p�Hq��
Professions Code): ' � ' RE E T � By e ' i i ��,". �.-u
1, as owner of the ro ert or with A��DR 55 " , � � P "
� P P Y, my employees .... .........._........-..._....�,..;„...,e..;..:,,.. .. Q�:��..'-.�b
wages as their sole tompensation,wili do the work and '� �
the siructure is not intended or offered for sale(Section ���f`��TM �e, �
7044,Business and Professions Code). - " MOVING - � ��� 7EC. '� ' ' ' ' -2 7�•"A
� I,os awner of�he property,am exdusively coMracting CONTRACTOR NO. +ti c o c o 2 J
with licensed mntrocfors 1d�consfrucf ihe projed(Ser f'
fion 7044,Business and Professions CadeJ. ADDRE55 I 3 1 h�,„,
CONSTRUCTION LENDING AGENCV - REQUIRFD � YARD HWY TOTAL SETBACK FROM 5T_ . . y
SEf&4CK PROP.LME WIDTH
I hereby affirm Ihat ihere is a construction lending agency for FRON7 d e j �(y.9�] �
the performance of the work for whi<h this permii is issued p.L.
(Sec.3097,Civ,C.). SIDE
� �
���'� P� I G.D6-86
x
� Lender's Nome . ,. .,J _.
{ ,f ,
c ,�1��) P.C.Fee$ ' e ,��Y Parmit Fee � +�7. !. � LDMA Ref.#. _ ...._ ... \: �
- lender's Address d'�¢J�� p{ " �.
'��" I certify thar i have read this opplico�ion and state�that the y- Issoan<e Fee ���'`�� L�MA P/C N ' C7T Ch �.+* �
� obove infarmarion is mrrect.I ogr¢e to comply with all County Investigation Fee +� �� - t —' —' �
g ordinances and Sfote Iows relating to building<onstr�<tion, e[�`, J <p � �� .�p
To�al Pee LDMA Perm.#
�
and hereby authorize repres totives of tfiis County to emer 7, �; � „
� upon ise obor e fm�e one oprApperty far inspection p�rposes. . . .... .... - .�.... .••. .. -u.;. F,nr ��.:,:.-. - -�,o ,E_..�.:� . . . y'�
a 4 ���
SEE REVERSE FOR EXPLANATORY LANGUAGE
gna pp c n � Date - . . _ . ...__'_'__ - . r�i
` �
PlANS TO APPLICANT INSPECiOR'S NOTES 0�4NER-llU1I.n1:l,Z DF,CLAF'��C:"'�
. I hereby dffirm that I�am exempt fru� the con.�.octor's
To: Returned License Law for ihe�following reoson. (Se' 7p31�.5)
Approved ' 'Au.vinc.c.s dnd Prii/cssroni Code:Any citY orcounty'whrcb
No. Dafe No. Defe reyuires a perraet tn cnnstruct,alter,rmprnve,dcmrnlisl,
nr r huir ux��sdrucaure,prear ta ils issuanie,p[�o reguires
t!e applicant fnr sucb permit ta file a.reqned statement
- tl at hc rs licensed purereunt ro thc proodslons nf tbe Core-
� dra��tnr's License I�aw(Chupter 9J(mmmencing u�itb Sec-
tinn?OOOJ njDiaision 3 q�tbe Businesx und Pr fessiuns
. . . , Cnde/nr t6ut F�e as exempt therefram arsJ tbe basis fnr thc
� �IlageJ e.zempt:on.Any obolatinn of Seotiox 703LS by
Required Dafe Received unl'pl'licanl fi�ra permit subjects the app/icnnt!n¢ciri!
Approvals penalty nj nol mnre lhun five hundred dnllarr(55001•/-
Yes No or Appfoved
� J I,o wner of 1he properry,or my employees wiih
Wate�Certi4imte . wages as their sole compensation,will do the work,and
the struclure is�no+�intended or offered for sale(Sec.7044j
Heahh Departmem _ � � � � ����Bus�iness axd Pro%ssions Cnder The Cnniructnr'.c License
Law dnes not�ply to an ou:ner f property u•ho buelds
Fire Depar�ment - - or d�nprnve3 lbcreon,and wbn doex sutb work birnself or
rhroug].his n emplqyees, prnviderl ibut s:<ch im
Grading - � Qrocements are ttnot rntended or offered fnr safe. If.
� hnu�ea�er,the huitdin,�or improoement i.�snld uithin one
Geolog�cal - - ""year nf cnmyleLr6tt, tbe ouxer-buelder miU har�e ebr
, . , burden nf proninq t!u[1 e did nr[build nr rmprnne fnr
Pedestrian Prorechon . t1 e purpose oJs�leJ. �
(Fence)(Conopyl ' � ' - �^' I,ps owner of ihe properry,am exdusively contrar
� � ling with licensed mntroctors to construct the p�oject(Sec.
Special Inspecnon 7044)Busine.cs and Prrfessions Cnde: 7Ae Cnntractnr:e
(Conc.)(Masonry)(Welding) Licen.ve I.au�does nnt u(�ply tn un nu�mer n/f�rnperh�u�ba
buiTde�or inipro:�cs iGercon,aad u�hn conrrartr fnr sad�
Lot Drainage (+r jects with a cantracdor/c/IicensaJ pursuant m dGa
Cnxtrrectnr:s I icense Law1. _.
Porking - �. I om exempt under Sec ,B.&P.C.for this
reason
; . . .... ..._... _ .__..._..___—__...._._. .....,....._.._
- ' Dare Owner
Approvols Dafe Inspettor's Signafure . � INSPECTOR'S NOTES
Location- ��
;Setback 8 Yards) -
Foundations _ , , , .
Slob
frame � •_��' C�'`y'��rL,�� . - �
Energy Insulation , ._
Lath/Drywall-- �
Interior
Laih---Ezterlor �
House Number-- - � �
Correct&Pasted
. . .� ... ..,_.. _.._ ..._ . . . .. '._...� � ...
Final—
Enter on Fron� �