Loading...
HomeMy WebLinkAbout1122 DIAMOND BAR (7) _ , �. WORKERS'COMPENSATION DECLARATION � � � he,eey aff��m that I have a «�f�f��afe of�o�5e�,fo se�f APPLICATION FOI� BUILDING PERMIT �� insure,or a certificate of Workers'Compenstion Ins�rance,or '. � � a cerrified mpy thereof(Sec.3800,Lab.C.) I COUNTY OF LOS ANGELE$ BUILDING AND SAFETY PolicyNo. � Company ❑ BUILDMG Ce�tified copy�s hcreby fumished. FOR APPLICANT TO FILL IN /�" AD�RESS �� v� � Certified copy is filed with the county building inspec- � gUIL�iNG ���') q ���M'CN� Q�R-�V� �OCAI.ITY {..�++-��,.,. tion departmeni. ADoaess �,� ,sirr TA � /� NEAREST ��Date Applimnt CiTY J 1 r�MDN ,$�7'lC �ZI7 CROSS ST. k�0� � CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSf550R . COMPENSATION INSURANCE SIGE OF LOT _ NOW ON LOT MAP 600K PAGE PARCEL (This section need not be completed if ihe permit is for one USE ZONE MAP `� � - hundred dollars($100)or less.) fRACI BI.00K LO Nn. � W,,. T . �'� SPECIAL ',v,o I certify that in ihe performance of the work for which this nv'/�ER • � ���} _ �A�Cf/ NO. •3 CONDiTIONS � ermit is issued,I shall nol em lo an erson in on anner .f �+ DISTRICT GRUUP IYPE FIRF PROCESSED BY #,,). P P Y Y P Y^� �I CONSi. ZONE so as to bemme subject to the Workers'Compensation Laws. AUDRE55 �j s�40 � � Gt✓ � C�g G✓L/�e �T�• a... ��TY ��P q r r t� � M.c� .c� � Date Applimnt .STA715TICAI CLAS ICA710N •� APT. CONDO. NOTICE TO APPLICANT: If, nfter making this Certificate of � /+RCHITECT OR TEL. �.�t,t Exemption, yoV 5hould beCCme 5ubjeCt fo ihe Workers' tNGINFER NO. CLA55 NO. DWELI..UNITS u' Compensation provisions of ihe Labor Code,you must forth- qppHE55 SEWER MAP , � iih wmply with such provisions or this permit shall be deemed re��ked. . con�Ten�roa- V�� �� Na 4 eK. ac, VALIDATION IICENSED CONTRACTORS DECLARATION ���. I hereby atflrm that I am licensed under provisions of Chapter 9 nDDRE55�v g W° � NO. VALUAQT,IOf� �mmmencing with Sedion 7(%�)of Dlvlsion 3 of Ihe Business and G�L�(�ai..w. 3 CLA55 S q(}{/�s4 4 =9��.2{�, Professions Code,and rny license is in full force ond effect. CITY A — G/�r�'e•�+ 63 . .. Sq.fT. NO.OF NO-OF CHECK LicenseNumber Lic.Class SIIE STORIF.S FAMII.IfS ONE � �w e a.a�J� . s oEscRiPnoN oF woeK NEw '1 �+ � 1 3,6 0 Controclor pote_ �1 /�� � � I om exem t from fhe licensin e uirernenfs as 1 am� ~�N �`Lv M�N�r'—� � ADD � o,� � T , P 9� q 1 3.5C�� - litensed architect or a regisiered professional engineer C�R�. �� �}/ � AITFR � F��`1A� octing in my professional capacity (Section 7051, "� � �^V RFPAIR � DATE O�,.� 5��,,� Business and Profess'ions CodeJ. USE OF ��f�}j�, �1���/�-fR' DEMOL � FINAL EXISTINGBLDG. r��Lj B Lic.or Reg.No. _Date APPLICANf p�� iFl. y , OWNER-HU�LDER DECLARATtON (PRINT)V° STryK� y� � I hereby affirm ihat I am exemp�from ihe Contractor's License /' Law for the following reason(Section 7031.5, Business and ADDRE55� S�' `•7�� {���'� � � t /t1'�J G'�.�L�` �/�,�j�� Profes•sionsCode)� � PR6EN . �"�J � � BUILDING ' n , -- -__-- -----... -- - --�- --- :.� .��..�� .__. U �, .,>�.���e� �� ���� N�.,N�,��, ,., ,,,y �,,,N,,,Y��-., ..,,,, ..��R��� � wages as tfieir sole mmpensa�ion,wi II do the wark and Ihe slruclure is not intended or offered for sale(Sectian LOCALiTY 7D44,8usiness and Professions Code). MOVING � TEI_ � I,ns owner of Ihe property,am exclusively contractiny CONTRACTOR NCI. � � with licensed cantractors to construct the project(Sec- qpDRE55 � tion 7044,Business and Pro(esslons Code). - CONSTRUCTION LENDING AGENCI' RfCZl11RED yARO HWY TOTAI SETBACK FROM EXIST: SET BACK PROP.LINE WI�iH I hereby affirm ihat ihere is a construction lendiny ngency for pRONi � the perforrnonce of Ihe work for which ihis permlt is issued P.L � (Sec.3097,Civ.C.). SIDE - P.L. Londcr's Name � � ' P.C.Fee S �. Permii Fen \� lender's Address__ _.. I certify ihat I hcve read thls application and state that the . Issi co Fee _ � above inforrnat�ron is mrred.I agree to comply with nll County . Inveviga��ion Fee ordinnnces and State laws rel�ting to buildinq construction, iotnl Fee � ond hereby outhorize representntivex of Ihis County to enter -. upon ihe above-menGoned property for inspection p�rposes. � - SEE REVERSE FOH EXPLANATORY LANGUAGE S�ignature uF Applicanl or A{�eni Doie , �s ..--�'�$�� R � r�.Q � l � J ,_ ��.�"'�-^'�� ', i ;C � � � �3� :� � � `� '��� A � � � � � � �r e C'�"NV ,': � ro 9 r � , � ��� �.•Y � � � ��, 4 � � ' ��7�. � o.:��• � ^ � � � � „ ....- �` � ¢� � 4�. ii 4'� ` ....F t �� �� � 4 {� � Q ,� �� � � . R� ._• �, �O � �`3 # n 3 � .n 3 . �+ �� � fD � . P' N O .(D� + �' � � ,j v. .�..y �O . .�.« •i 18� °R. �`,, � - ! m � \ 4 1 � '6a•' 8+ �u, tU Q� �� y � � � � q? q n 6 , a Q j�,�'�} , '� .,7'-* �n � .3 .-��.s, (1'r S� .?e. (p _ '� '� , o � �'t � :b 43 .+a.n,e,...+� 4M�• p 7 f�.-"'; � � �° � t �C ? � ��"'�� � `� � �,�' � ay Q y �l� � N�� � �,�. 5�1 � Rl0 ...,�;D O1 t1'f��SD.C� � � 9 '� i� , (% � � �: �, �! � � ��`, ``�y� ra �°o a� �Q i � �,, � � ,, �� ,a i '. . �, � ��„s � , � �, , ; � � � _ � � y�---'�"� � � . � , i� °�o� " � � � , �.-- � � � tA--�' �J� �'� � �� ^� ti,�� �: � �.� j ,.-a � 't ,� �� � � � �•� , � � . ,..-�_`''...--� �y ; i , � �� � � � , � ,� �c� � � � � . , -� � �`„�`��e "� ���� `1 � `'� a� � � F' t ^a t \ "''� t 1 � � ' � '� �£° � v ----�i ; �j � t i �t �� t � ''� ` ` y � [` j 0 � G+ ,,.�-�-�"' -"'� � i ���., , . 9 1 � �q.' � . . � ` � o� ��:.'f.�f`,���.,�'. � 1� �� � �. ` � ' i ;� , � \ t } � � F � , � � �.� � �: E: � � � � � —t . � , . � � � � � �� � �, 9 ; � 1 � � � . , :�A _ � '; �° � s � �, � � t � � �` .s` � �� , � ,. . , i `s' � - _ ° � _ � � � �_ �� , ��,, � .:�:. , � 1 44 t . : � ` `: �, , -, ' .4 ':. :x: �.'� , Z , , °�� �.. � ��.� y ; , " i-, � �j l �� ��. j�' ?��, y��s � <, ` \ 1 � � � - �:" .�, � .�, ' ' � ! , � ; , i � 1 � ` .�_� � ! �� 1 � . , � }.. � � t � � 1 � ; � � � �. �.,n � � �� , � ^ 5 � A t C��p M�' �� �' N� � ' t � �ru�� e A..� o ""'Aq'�a.N � p S O ' � P Y �P � 4� � i y~ �..'tg ,., ��� � ¢ �.��....+b'�.e"�.,p G m ��"g A � P Q � . G L.�y Q O �p �� '� -° 'n z�.e � ��N"��� S�"�' ^i� � -.a" � :_ µE �� sn.wcQ - o �� a"� � w N'� �3 ;d � �..�a o� '�, � �,�� � - � � � -�,� � ��,� :��,.�:,. � ��y g+. " A� "��� � � Y? �O v� pr .G. N �eY in 9 � .�i p S C.d O O '<�*. � 1L � e`i�^+�..� m G' ..� � N � Q M. �'�•"e.p r'��W �S+'.,�s� h N 5 Q �. C} .'u ��p N•- � "V� q n F$' K� p,R.N ' f, �O, C � .. C�,b, g,,,' E,' b ' C� ,,,✓� � g � �,� � N h �x;"" �'.e`a '^ „' ,.� �, 5 � "'g' � � 't � a C , � � � � rt °. ';"r �° �'`3 � W ¢ o m�� D �c� -°s� � o� .� r'� �� 03 ;-:1 1` � � � � a � � «.� m � S O O� �.`° � p'C8�A�N Oh' � t� `�co e'� �S'o� �4' � r'� � '^�w�' � e� 7 w �} R .'$ � w'1'S' `4 .�. Q � p � � 3 ,�"� J" � � a.'� = °"� � x� ma S' a �'z " ° A "' r -s rt -�s'". � W ;� 2 ��p �� a.o °"— ^"`� � :i�a.� tS c-tDN o��p� "� ' a '"Y o�i a�� i� n � a� � . ` . 'O � � `.:..`" .,�q 3 W .r�'��' � ¢'�'d t + �a^a.� Q N a q O -�t �+`b"' .'4 '.� c4n O "� � � � c ,-+�c �,�.�+,¢ '� � ax a.� a� �' oo � � ��; o� p"�^ � o � 'A � y A P �w"a n'O p £,+�"�-t c� G''4 � � x" 7 3 � �v' 4` i� .^�i 9 rt � � � 4 m �� °'?'^ �,-p �.� ° �`- ' '� S� o A'm`'*p y � �'^ h'� ?� � "� t � es+ :?._ ..o �? ^�s � � : �'.. '.w?�...m tc 4 ea � �.� � ,��,.a�r�'� d � U, O "'q c/� +�.� xi n � -'� �7� � v �":` °� �4 �{ z-°.�. w`"'..S 23 '� � t`�u A e� � Q p� 1 , � ��1 n � o � c� o 0 2 ���� F..y` � l, Y !"A.� G7� fl �e..��-.,�.n 9 � m � a A.� o p A. <; � � c,.�e� 's`eY* N n S er+�3a�..*.'^ m iL �.1 � �.. `�" �' �� a.w 3 X.� .,� �.,� ,w� sa q s�� '� .,a P '� � <.P crc � o n � ti � � tO � k a."= � `O c r. m rn � � o�..,�,�;��'. c � w`a '� � � � '� .� Y°�� �n. "` � �'���`�'�.h_n o� o g �°'��^ m t'����$�u+ ' 1, � *J � '�y �`� v `� � ��• � � q «: ,.,�� N �`L.4v� ? � , - `n � 'q� � � 3 �o .e '+ �a �� :.m `�m t� ¢ �' `::°,"'..•`� `° � � ko 4' �'� �m e+ � e�^� X `.° V,�-+.,..� n p.� � K ro ��-..=t ^i .n.. � Q O � C.,� H"co� i '('� ��,G. e4ai�, O��'"_'^''�s + p �,, 9 m , , p 4.� ��'n l� °+c 5 � � � � N , � ` �