HomeMy WebLinkAbout1625 BEARS DEN RD (5)• YgORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
,sure ,
sure, o— certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company
Certified copy is hereby furnished.
Certified copy is filed with the county building inspec-
tion deportment.
Date Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
hundred dollars ($100) or less.)
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws.
Yiiate 2.62.87 Applicant
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be
deemed revoked.
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Number Lic. Class
Contractor Date
1 am exempt under Sec.
B.&P.C. for this reason _
Date:
Signature
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and
Professions Code):
IVI, as owner of the property, or my employees with
wages as their sole compensation, will do the work and
the structure is not intended or offered for sale (Section
7044, Business and Professions Code).
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec -
lion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the
above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
upon the above -mentioned property for inspection purposes.
TIAfcl-W 2. /2 IF
Signature of Applicant or Agent Dot.
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR
APPLICANT TO FILL IN
BUILDING
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SEE REVERSE FOR EXPLANATORY LANGUAGE
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PLANS TO APPLICANT
INSPECTOR'S NOTES
To:
Returrrad
Approved
-
No.
Date
No.
Data
Approvals
Required
Date Received
or Approved
Y.
No
Water Certificate
Health Department
-
Fire Deportment
Grading
Geological
Palle icm 5rt lien
(Fence)(Canopy)
-
Special inspection
(Conc.) (Masonry) (Welding)
Lot Drainage
Parking
- ..
Approvals
Date
Inspectors
Signature
s
Location—
(Setback & Yards)
/
Foundations
Slab
Frame:
-
Energy Insulation
-
Lath/Drywall —
Interior
q•,�
/5'
Lath —Exterior
House Number—
Correct & Posted
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-
Final —
Enter on Front
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OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's
License Law for the following reason. (Sec. 7031.5)
Business and Professions Code: Any city or county which
requires a permit to construct, alter, improve, demolish,
or repair any structure, prior to its issuance, also requires
the applicant for such permit to file a signed statement
that be is licensed pursuant to the pr viciams of the Con-
tractor's License Law (Chapter 9) (commencing with Sec-
tion 7000) of Division 3 of the Business and Professions
Code) or that he is exempt therefrom and the basis for the
alleged exemption. Any violation of Section 7031.5 by
any applicant> r a permit subjects the applicant to a civil
penalty o/ not more than five brandied dollars ($500).):
J I, as owner of the property, or my employees with
wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044)
Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds
or improves thereon, and who does such Mork himself or
througb his own employees, provided that such im-
prnvements are not intended or offered for sale, if,
however, the building or improvement is sold within one
year of completion, the owner- builder will have the
burden of proving That be did not build or improve for
the purpose of sale).
❑ I, as owner of the property, am exclusively coniroc-
ting with licensed contractors to construct the project (Sec.
7044) Business and Professions Code: The Contractor's
License Law, does not apply to an owner of property who
builds or improves lbemon, and who contracts for such
projects with a contractor(s) licensed pursuant to the
Contractors License Law).
❑ I am exempt under Sec. , B.&P.C. for this
Dare Owner
INSPECTOR'S NOTES