Loading...
HomeMy WebLinkAbout1184 DIAMOND BAR BLVD (3) �. WORKERS'COMPENSATION DECIARATION . -� � �� ��� � �- � � -- - �II � I hereby affirm Ihal I have a certificote of�o�,e�„o self, -. � ��pp��CATIQN� FOR BUILDING PERMIT 's � � insure,or a certifimte of Workeis'Compenstion ns ronp e�,or j- � o certified copy iherep—i�pye�.3800,tab.C) 4�LG'ij� , _ . . - COUNTY OF LO$ANGELES BUILDING AND SAPETY �cyNoy � -�lOmpony � BUILDING /! ' Certified copy is hereby furnished. FOR APPLICANT TO FILL IN nooaess '7 � � Certified copy is filed with the county b�ilding inspec- BUILDING ' ❑o�department. AD�RE55 �,J LOCALITY � /� NEAREST Date�� pplimnt � / Q G7Y �. �� , Ziv � CROSSSL �" ' C RTIFICATE OF EXEMPTION kOM WORKE 5" NO.OF BLDGS. ASSESSOR � - COMPENSATION I URANCE � SIZE Of LOT . . NOW ON l0T . MAP BOOK PAGE PARCEt �(ihis sec�ion need not be completed ii the permit is for one use zONe nu+W � 2_/ � TRACT - BIOCK LOT NO. NO. .� hundred dollors(SI00)or less.) . � - - � �' � TEL. SPECIAL . G. I certif that in the erformance of ihe work for which this OWNER �l '� NO. J cONolilONS � - Q Y P D�STRICI GROUP TVPE FIRE PROCESSED BY U permit is issued,I shall not employ ony person in ony manner qDDRE55 ''�'� � CONS� , � y� so as to become subjetl�o ihe Workers'Compensa�ion Laws. '. Dote : .. . . .qPPlicant . . . � . CITY � u�^ iP . - � O STATISTICAI CLASSIFICATION AP. CONDO. NOTICE�TO APPIICANT: If, aiter making ihis�Cerlificete of � ARCHITECT OR '/ i� � . w EzempliOn,'y0u 5hould become Subje[t fo fhe WOrkers' ' ENGINEFR � � � "7 QASS NO. �WELL.UNIT$ N Cempersc!icn prcvi:icns cf thc Lebcr Ced^,yeu mu<i ferih- ` noo�ess � n ��' '� �l sew:a rr�no . ? with comply with such provisians or Ihis permif sholl be � 1E1. C � - � � deemed revoked. � . , CONTRACTOR �Y'� N � •� gK. PG, VAIIDATION " �LICENSED CONTRACTOR$DECLARATION� /' UC, ' � , I hereby a(firm that I am licenzed under provisions o1 Chop�er 9 ._.. ADDeE55 � NO. � VAIUATION . � (commencing wiih Sectfon 7000)o(Division 3 of the Business ond ���, S � Professions Code,and my license-is in full force ond effeU. CITY � . C1A55 - �c���,��� . LjZi/ 5�.FT. NO.OF . NO.OF, CHECK � ���� LicenSe Number_�i��lit.Clas� SIZE STORIES FAMI IES ONE . . 1�� S � ��jl�'/V/. DESCRIFTION OF WORK f . � NEW � . . COnIrOCtOf- � � Dale 1 ' ADD � . . . � 1 am ecempt from the �tensing requirements as I om a FINAL �g . - � � licensed architett or a registered professional engineer _. _ . . .. . ._. .. A�TER . ❑ /a ./ � , octing In my prafessianal capatity (Section 7051, REPAIR � �ATE 7 � Business and Professions Code). USE OF . � FINAL � - � � -- E%1511NG BLDG. � f . DEMOI B � �. . . LIG.of REg.N0. DatB APFUCANT TEI. � Y - � � - _ � �� - OWNER-BUIIDER DECLARATION � � - -� � (PRtNT) „ i� NO. I hereby affirm thot I am ezemp�irom the Coniracto/s License � qDDRESS � � / .Law for the following reoson(Section 7031.5,Business and , . � � . Proiesslons Code); . '�ESENi , ❑ . � . . BUILDING . . . . . I, as owner of Ihe p�operly, or my employees with nDDRE55 � woges os their sole compensoiion,will do ihe wo�k and � �OGnLiTv � - the strucfure is not Intended or of(ered for sale(Secrion � � �8 9 2� a 7044,Business and Professions Code). MOVING TE�� . . � � � I,os owner of the property,am exclusively contrac�ing CONTRACTOR N�. ' ' #.�.i •.•�• � wifh licensed tontrodors ro cons7rucf the projecl(Sec- . qDDRESS - - tion 7044,Business ond Professions Code). - ��;' '2 J�.5.0 . REOUIRED iOTAL SETBACK FROM EXIST. , CONSTRIJCTION IENDING AGENCY SE7 BACK YARp HwY PROP.LINE WIDTH . � •�2�Jr O U I hereby aHirm that there iz a constroction lending agency for � pROrvi � � �'� • � ' the performance oi the work for which Ihis permit is issued P.L 0 7,•�3�8� ' (Sec.3097,Civ.C.). . . . .. - �SOE -- . - - � � � • e�. Lender's Nome _ _, . . . .. (�, • � � -� � � � � � ' � G.C.Fee S . Permi�Fee ` .��+ Lender's Address _, ,. . . � � � I cerlify Ihal I hove read this opplicotion and slate that the Issuance Fee , , obove informotion is mrrect.I ogree to mmply with oll County .. _ Invesega��on fee - �� � � , ' � � " ordinances and Siate laws reloting io building construction, iaiai Fee ��0 . . and here6y authorize representaiives of this County lo enler . . . . .. . . - .. upon th above-meNioned property for inspedion purposes. � � . � . . � �`A���/ . _. SEE REYERSE FOR EIfPIANATORY IANGUAGE - � . . . . .. . . ./v. . . .. . ... . . . . . .. _. . . /_. i�narure of ��- nt or A�ent Do�e � ..� . �g g z _ '" `�z a . ;�n� C�� O� i0 fl t�� , � '. � ," C�v �, ¢ o a v '- n'. • a ° o o �N o o � 'a m y , � p. ✓� �n, ra. o c _ v O � r F � �O n �U•. :', tf • . � . . � v, o po � o � , o - 3 9 n o Q m- ,� fl c1 P n r a .c�o� �C t{ a o o T' � � o'ti � ^� � •� m p 7 T O� T 1 t0 ['J� . • 4 �� .bp� Q �m �� '.7� ~� r' �a � � �O ""�� . ` o�` w� o � p ytD.^.. 3' O I �� � �-L 7� �� . • � .G � „'t_.7 O . . V� � �� ; o f;.��t � . G o „ � � 0 0� o o , o � a � � � + ;�, ti �o a '° c, a� o •C p m -a a� � o o • � '" p � n a � ' �' ° p y n � a o ,o, .,� o � Z °' Q 0 0 0 j ' �,A 9 'U 'a JJ 9 tl O 0 � w � • � m� 4 N G.C� w ' � ttt O - U C p _ 1 . ' - v' . . •' � � '�: , ' m ,\ � � . � .' . . , A - ' � ' i � . . O . � , . • , r � � � �� � h � � . ,n s+ ,,,,('�a p M h w��'' N N � ���C �� A tlr v'1 � p b 'l� m O � . , v �bir��� � � ❑A..A�`�--.�,�,ab,w.�N ,,,-�cQ . � " !!`� p p `� � .� N '� G.O �v p Q (1 1 � . .'�l"` . C�"� p O x, w �C� �t O T n'n A A G 0 o �.p�'� ❑ro� o o � 3�v�a��.^.�' ��..n�' t.,�•�rina,k� c"`� '7. PO 3�'jp. £ X �Y v.�= ip C'O N Ta .�.�S N 3 �•"• eA•�-�+•�N�..,,�� Q � 3 � � � N � =1 � v' n t'..S."'4 O r, x iT N � �� tD O ��`O C'�+n a � F "a'i S C7 p Q in O F O`'�O �.Tn C�' w w -: �L .. O •� A.i., w P� , ' � ' � fl p ��:p"x�mo o ��a^� � A�voo � ; i ° � � �•� � � c''ic ° m ���" i , 3 .�...•�E � N .� �....r, �� aE �'tr M" cip^ m� 9�.s �7` �' = '�" o,aC3 c- t+. � - o ? 'c�ri �.• 3 t� , m n P c :; n a"^ ;o W a � ,c.e ?� o a a y A�`t v«,`�'¢s 7 p'� � � � � 3 � n N a c�.Q ° �„ pq � a ° � �n„� ° - «'e ti°.,�cr n -� � �� m t7 v_ � �� »�= � «.c-,°. x o c.� ha�o�� ' �e-=i ° "o��,�'0 3 n . � � c ��,Q�a o o m �„a m ti g o 4 p m .D n.?:�n,°° �C C� 3 �O r � � f3Y h a b e=�° a e � p„� a'� m-. p a c"ei°, o ti��6/`'':'" .ea,`,t�C� �^r^. . � � ��,...c c't �^.N'O 0.�� �'^ �ey � �,i � A .. O N o'� h � M_�_fl O 7.7 o � H`� 3 m cn �,= o � A-� c bo s�' a��-°.,` �a � Aa =`t � 9 ' . a �n �s a� �`< �Q.» � o N��..'"' p.£.o P.a nv'p..'�"'"�ee ��9a'�b � �0 . . � ^t`'a o 7 fl .c�•��°�i.n o °o n.K �-b,�^ Q ��� � c � `n m v� � � � u,= 3 � c,,••Anc'b�, ,� oa °.�oma.� w�'=' � ^ ox � ' x :e c x `•: � � �� x'�.c'-5� a o �-3 a n = w yav°,w o �� � `�i � • . 'es�.,��� '9► �•aa°�'� �°,_u+�� inew�,`�"�,"�»'���° o-`�'..'v N � Q' � � o �� tD �e-�-He �ot�^ �� q� 'v.� o•�oRMc��� � � .'.�'v ��.p�-�i �o eA xa�Ax�onf '`._«,,{�h `� ' Cl 10 O �M p �tp.ai O'7� � , � �t�t ti i-? '^�C.3 �7 Q � F �X'.� t � a T P�i �O N � N