Loading...
HomeMy WebLinkAbout1122 DIAMOND BAR (8) � � WORKERS'COMPFNSATION DECLARATION � � � S� , � I hereby offirm,h�f � ha�e a certifimte of�on5enr,a 5e�f -qpp��CATION FOR BUILDING PERMIT � insore,or a certifimle of Workers'Compenstion Insurpnce,or . a ce�rfied copy thereof(sec.3eDo,�ab.c.) �OUNTY OF LOS ANGELES BUILDING A SAFETY Policy No. Company � Cerrified copy is hereby fur�ished, FOR APPLICANT TO FILL IN gUILUING % / .�� ADDRFSS ( a� f�C�` Certified copy is filed wiih thc ty buildinq�inspec- guILDING t �/ !d� tian deparimeM. � ADDRESS � �j�/'W[3ti��,�� LOCALITY l �'V Date {�'�.Applican � CI7Y IP_ NROSS 51. `�•\l�'�� �U� CERTIFlCATE�OF EXEMPTIO OM WORKERS' O.OF BIUGS. ASSESSOR � COMPENSATION INSURANCE 517F.OF lOT .NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be complefed if the permif is for one USE ZONE MAP / �/ hUndfed dallbr5($100)Or Ie55.) TRACT BLOCK LO NO. NO. �/�"'��/'� ,� � C" .M x,,r T L. �,/ �,,,� SPECIAL � I ceriify fhat in thc performance of ihe work for which th'is �WN�R s �1 w,r�'+� 0:.. '�`F�} CONDI710N5 � ermit is issued,I shnll not em I DISTRICT GROUP TVPE FIRE PRO ESSED BV p p y any person in any mqnner qUDRESS -Y� �—�'-� CONST Z � so as to become su6jecl to Ihe orkers'Compensafion Laws. / � J n �. �� .� C;7 N � '^L `� Date A�a t CITV ��^° - ZIP ARCHIIECT OR TE� r� STATISTICAL CLASSIFICATION APT. DO., � . NOTICE i0 APPLICANT: If, af er aking ihis Cerrificate of ��� •� �� Exempiion, you should bec ro subject }o the Workers' - ENGINEER NO. CLA55 NO. DWELL UNITS �, Compensation provisions of t e Lobor Code,you must forih- � with comply with such provisions or Ihis permi} shall bP ADDRE55 SEWER MAP s,. deemed revoked. - ,{�y�:� . �e��^ CONTRACTOR p, �—"��� 8K. PG, VALIDATION LICENSED CONTRACTORS DECLARATION � � I hereby affirm ihat I am lir.ensed under provisions of Chppter 9 ADDRE55 �j�—j4 1 � Np � VALl1ATION (commencing wiih Section 7W0)of�ivlsion 3 of the Buslness and # r uC ��,,� � ..; �j1 Professions Code,and my license is fn full force and effeci. CiTv CIASS �4'1 t+, '`� "`� 5C]-F�. ' NO.OF 1 NO.OF CHECK License Nu �r �!� �� Li<.Class , �i� , SILE STORIES l FAMILIES ONF � � ya-4�2 i � rvtw S Cont�act S pa�y_� - UESCRIFTION OF WORKw_ yd' f � I am exempl from the licensing requirements as I am a ~ ADD � licensed architect or a registered professionol engineer , ALTER � FINAL �� [i . acting in my professional pacily (Sedion 7051, � � � REPAIR � DATE . Business and Professions Co J. u5E OF � FINAL 7 � E%ISTING BLDG. ' DEMOL ❑ / sY" u�c' .�.3 Lic.or Reg.No. a e APPLICANT �+ ,. '9 - 7E�, r . OWNER-BUILDER D CL�R ION �NK�NT� � ►�v�"� � � � I hereby affirm that I am exempt om ihe Conlraclor's Llcense t �� � /) � Law for 7he following reason (Section 7031.5, Business and A�DR[55 �Z—� �"�.+1"`ti-L.�+i.� Profe55ion5 Code�: PRESENi ❑ BUILDING . . I, as owner af ihe property, or my employees with ADDRE55 wapes as their sole comnensation.wlll do the wnrk ond the struciure Is not intended or oftered for sale(Sec�ion tOCALITY _ I044,Business ond Professions Code). MOVING TEt. � I,os owner of ihe property,am exclusively contracting CUNIHACiOR NO. with licensed mniraciors M consiruct ihe projecf(Seo- r 9 9 5,8 R - tion 7044,Business and Professions Code). � ADDRfSS . REQUII2ED TOT�L SETB�IX FROM E%IST e m o • • CONSTRUQION LEtJDING AGENCY SfT f1ACK Y/+RD HWY pNOP.LINE WIUTH �- � � I hereby aHirm rhoi there is a construction Ir,nding agency for �RON7 � . � m�'�2 5.5 Q ihe pertonnance nf the work for whi�h thls pern�iit is issucd � p.�, . . (Sec 3097,Civ.C). t� / si�E � ' N•� P.L. 'e o 0 2 5,5 0-c�'i Lender's Name ' --- a.c reP s Pe.�„��reP ��✓ 1 0,�1 "&.1 Lender's ress {�' � I certi ihal I have read this applimtion and state that Ihe � Issuance Fer. a + .J G? � abov Informaf�on is correct.I ogree ta mmply with�II Counfy Invesitgof�o�Fee � vrd' ances an��5tate lo lating to b�ilding wnsiruction, Toinl Fce ��.�C�* an hereby authoriz epre4enfatives of ihis Counly to enter � u n ihe ove-m ntioned property for inspeciion purposes . �V �"� SEE REVERSE FOR EXPLANATORY LANGUAGE S� nafure of Appllc nt Agent Da�e �s -_ ;� o �-a _�'�--�--yl�___ I � � o n -_m.�i �-��a. ��z . _ I y ..,_. Q � _ J _._.._ - __ � __ � �m� � ' ❑ 7 vJ! Q —'��_l_o_..,---�-3�� m 4 � � ' � .�...� � . �r - � T � = _' � _ . -�p , -_ --�- � ��C''z._._.. I -. ' • - a Q � T� ;'i' s 6 �� 1p O i= N � �'_ �- (D .� ' 'S G � � v � n Y � I fD ❑ �� .� f - � E jm ro � c0�..z tDx Q y . I n � . f - �- f �� . r rn. O �.,. Q � � y^x � Q � �•. � � x ; � . . ,3 i� r. J �_ �. € � O � I� . � � . � � �,,�� � �.. 3,:_ ,;! _. I! ti E � I � �� � n o �. 3 � � � � � i � � �3 �_ c� � µ _ ! 3 � : j, p � � fl-a : ° v � - � '3 = i 'm � � o°, a' a�- t�. � . 1 � F �`' � `� � ro � 3' � �. � , � � �� I I � � � o o �' n I �' J � � 1 � c R I. �•. ! �' ��- �� � i ' �� I � � ` a � j � .�,. i� � �� n � � I �c I, � I �� ,, � i e� I i ... _� _.__�_ ,w..._,J�i � � � — � � s �; � � � s �_ .__._ � p , '._ � Q , f � � i �� I i ; � � �.e, �° � � _ € � � ' � � � i , ��_- -�.__._� �_ � i t I .� i �'� i tn � � i ��N� ; �� I �� � e;� � i � � u y I I E �� � � i i— ��� d � ' R� fa� � -- - — _.'�_.-�w � �� � � �� —�-- � , � � ,� � ;� � ` �� � , I � � ) ! ro � � �� i�; � �_� � �� � � ' � � i� -� ° �--.----►---_-�___!_ _ �_.�._—� I I: �, I � , .. .� � _ -� � t_� 3 � i � � � � � 1 ��� �� � � ' I � � , (. � ! L9 ! f !i y � -f � �I � � ' ' �f� � ' � � � � � � T s I � i � k i � 1 � � � ', � � 6 � 1 � :B I . , ; � �a � i < �': �'r�, � �i__.�_�_..._ _ __ _ __ ___ J_ _ _ _ �.�._..��_._ . �� !_ � _ __ _ Q�_ � � I �i � 3 - � i_ _ � I . � � . � � i . � � � � � . � � � � j , i , ; � � � � � � ; � � i. I ' < • � � � : � � � � ; , � � � � � j a f ' � I � � i �� , � � �� I � � � � � � � .� � � i �� � . � � � � � � �� I � . � � �� ,, � � � . � � � � , I . � , � � ; , � . , � . 3 , , , i ; � � I : I , I � � � I � , I ► � � I � i � v 4 v�+� � a'�t �O � ^•N.s f '� a a n�' �s w�.° � w !-_ 1 9 '9 q.� � ,� j S�� to O ^t 3"p a N Q e .T` �C O R � r,�'p `{�q n ;i ❑ S ,0 .� A« i a '� .�a,. � � O '.�j. :' l0 � �e'. m �.� n � !9 S , i ° E � � � � ❑ A � �mv �' G� � ocCa � �,� �,�„ c " n;z��oo�.��AmH � � , � I � � � � �,�•w �� ° � ,,`r,� o �� ����``o � � � sw `�� nA�an�A �� � ° � � I ( � � � � � "�a a ° � `� ° c � � � " ., � �._. m o � � s ,�m � n� w �+. � .,, x l� v 0.y � � � �. 4„� � �:A °ty°: �' � V,'t ca., ,`.S y�.^„y 4j�. °b -^• i', � � � t m '� � �, m m � w � c%. H.�' C ^�s'a o ' m z -a �'N .�c� � � � � p 3 "rt � I � i � w tl .�, 2 N A �� � ro�.:,,�O O N p ._ ti LS., e� �`, .`d� : . I � "D S � w � m�9 O A.� O n cJ . N � '.� � �A r. <�.. S ` �� ' � . n � �� �'? ° `�: ��c°. R �.� � �. n °. �0� ��k`� o� � �� � `:_ �Q r I � ' 'v1 7 ;�r�q � °'� S � � �C ,� A q C'f J O T S�y� � .. cY -�y�+ �° � A -t" � 1 v a A A �M ^ Q �o u� �c�� t a � ' � a � w��°r. � I! m � M � �., H � ro . � sa �y si° - i ; '1 V' �� �Y'Z H O O 9 9 �'�'1�.1 Tr2 x 0 d N'C w. '�' O.u V.'v a`7.. � O� n p 3 �C"" i O cc y` �"^ o F.�'a 0.� r� i y,o o v � c 1-'r m w� ...� . � � x � q � °� � `� ° � o. i° �,� a A.'' � � `� o m ;,,�•° � q � o �. �,<. m �:o C r" �sa � � � `' c +s �,'°v, a; � � c, o�. `�oN.��� 3 h': I � � � A.x �o � � e� o .� ,�� a;m?� � h � o ��w�p.,� � v C� , f O h ` ' �Y � a�c -� N •`'�,r' m f � �.`o � �.o� w N'� M m ...�y�„ � m I � o � � c �. fi "�" �,R,���`e `7 fl-_ a eo`+,A m `�' � Ya � n: 9 0 0 � w' f7 I aa'� � .^.. x a°`.�� '�S�� � o � �1',�, m S H � � H a ��v o � � �. 3 . � y V,s�"s c o� a A,�C � A `" ° m n�^.`n`.�A � o�`i'� o � ? �=� P s P ,'�„ �e`b `o � '-^. ro � �� ,zt� ° �-3 A� oe� Q,w.,�„ � cn C> • QO A n p n�° c� 7-1:i"o a� ;�'� o � m� � n � �"'�Cy p A�=° � m n Q . � � ro � y� � �.� Cs ��-� �+ �,�y`�F� �" O�..p ��� � �'��.. n � n `�^o � n o a C �A � � � tr.^ � m �° �ti,�n:�� � a `� �+� � o o a �` 4�A,,, � m ° x m V N�ro�•r F'' �� �,� p `T � � w w ��^. ' � h � � a �' c .�,.., oQE �.,.. o'�om -�-= o y � � ti,::, � e..� .a � . �pwa� � � nm " � ., m�o �`n n a m 2:�s ^e '`.�'3'e`o �2's �..:� c� w ="`��•., � � � I � i ! _....