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HomeMy WebLinkAbout1180 DIAMOND BAR BLVD (22) - . _. .. . .. . .N� '�l!+DECLARATION � � � �� - � �� ,�;�,ebo;•a�...:,�a�e�uwo,ke=-'�omPe�o�o�°°�;�,e�e' � APPLICATION FOR BUILDING PERIlAIT or o tertified copy thereof(Sec.3800,Lab.C.) � ��� � ' ' _ , COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. Company I � CertiHed copy is he.eby fum�shed. FOR APPUCANT TO FILL IN AD RESS �F� lf� � Certified copy is filed with the counly 6uilding inspea BWLoiNG � tion deparfinenl. � ADDRESS v yDare�ZAppl�eanf / 1 C�tt na �ocnun 1.�� �"� � `.Sr Y` �. - CERTIFtCATE OF EXEMPTION FROM WORKERS' , � SIZE Of LOT OW ON LO 5 � � C Ou55T. � - � � COMPENSATION INSURANCE (Thlb Setf�on need nOf be-COmplefed if�he pe�rtfll if fOr One � 7RAR � � - BLOCK �� � � LOT NO. � M4P�BppK ' VAGE PARCEL hundred dallors(E100J or leee.) . . OWNER P Y NO � Q USE ZONE �P I terlify thal Tn the performonce of the work for which lhis �� permit Is Ise�ed,�shall nol employ ony person in any manner / �.Z, SPECIA� � so as to 6emme subjetl fe Ihe Werkers'Compensotion Lawe. ' ADDkE55 C.��✓ CONDIT�ONS � � Date ' Apptltant . CiT ZiP O - � NOTICE TO�APPUCANT: If, aNer making�lhls CertificCte af R TE�' � OISTRICT GROUP TYPE FIRE � PROCESSED BY � ENGINEER NO. �ONST. 20 Er � Exemption, you-shovld become�sub�ect�to the Workers' ^`� .U Compensation provislom of the La6or Code,you musf forfh• qODRE55 Z. �. \� V.� � �W wHh comply wlth such provisions or ihif permil ehall be n'� deemed revoked. � . ! TF�• STATISTICAt CtASSIfICATION APT, CONbO. � - CONiRACTOR � NO. Z LICENSED CONTRACTORS DECIARATION � . . ,` �i�, CL755 NO.�oWEtl,UN�TS - � � I hereby affirm thai I am I Icensed under provislons of Chopter 9 ADDRE55 y No. � (eommencing wi�h Seclion 7000)of Dlvleion 3 of the Bwinev and ��� SEWER MAP : Ptolessiona Code,and my Iicense is in full forca ond effeet. Cltt ' � GL. euss � �� eK �_ � �- � - � ��-� --�---- VAUDATION �. .. . - ������� � , SO.FT. NO.OF NO.OF $� �ONEK - � - License NumberJ��iSL,Z—lfa Class� � - S¢E q STOR!ES I FAMIUES . � c', VALUATION Conlrocfo�+� ��Dofe�-31�89 � DESCRIPTIONOFWORK N� �❑ j ,vlO_,r (.tJ ❑1 am exempt under Sec. - �1 � A TER ❑ � •"2 1 1.b A 0.8P.C.iar thle reason � , . G REPAIR ❑ -s � �° e • •P'J Dote: use oc S g.Z a, � 1 e 7 0 7.6 3 exisrwc aioc -� $ignatura . . . . . . . APPIICANT TEL „ I ' FINAL� /2 . �7 = OWNER•BUILDER DECLARAiION PRinii NO. 5 . DAT 7/ ° � 0 Z 6 3� .. 1 he�eby offirm that I am eMempt irom the CoMratlor's ticensa �� qDDRESSyJ"SZ FL1'r4Ur I��' f�NAI ��.2 4`8 7 Lew for the�ollowing reason(Section 7031.5,Business ond ProfeeslonsCode): � � � - � � - N � �,-u BY � � QBUILDING ,,,�.�r4� I,as owner of fha p�operty, or my employees wi�h aDDRESs � wagesoefheirsolecompensation,willdotheworkand � �---�"-- �� - -----"�""-�"""�� � � �� - the struttore is not intended or offe�ed for sole(Sect(on ����TY 7044,Business ond Professione Code). -��� � MOViNG - � - TEI. � � � , • z J Z 9.9 A � I,-ae owner of the properly,am exclusively conlrocting CONTRACTOR NO. , �, � wiih licensed comrocrors to construct the projea(Sec- . . � , .�'`, •%; `�' �����!� fr• s • • • � ADDRE55 �ion 70a4,Bus�ness ond Protessions Code). ' ^-- '-'�` �.; t � � .�4��� REQUIRED TOTAL SEiBACII M I �-^���,.�'�.�., ��:'�„`�, � CONSTRUCTION LENDING AGENCY � SE7 BACK YARD HWV pRO�.UNE WIOTH � ` a �3 Ij�O O c=i I hereby offirm ihal Ihere is a tonstruction lending agency(or FRONi Ihe performonca of ihe work!or which this permit is issued P.L . �� ,. �Set.3097,Civ.C.). � SIDE ^ � !�.y � � I t,0 4—8 7 P.�. -�;•.ta�sa�� .�L1~�`, / lender's Name Q �pMA Ref.N � %' lender's Address � P.C.Fee E� Pe.mit Fee 1J 3.2•� � ' i�� I ttrlify that I have read ihis applicotion and Slote thet Ihe .. Issuance Fee ��'� LDMA P/C N �. /% ebove informotion i�correct.I ogree fo tomply wiih all Co�nty Investigalion Fee 3 q � ordinances and S�o1e laws relating 10 building conslruction, Toial Fee J�// LDMA Perm.M � - � and here6y authoriza represenfatives af this County to enfer uPon t bove-m ntioned properly for inspection purposes. �^n^ ���� \_ 1��/f, ,� .� n� lJ�(\ . .. .GYJ �('/[_n� SFE REYERSE FOR E%PIAHATORY LANGV GE�� � T \igneru.e of Appl�con�or Agen� . . Dple .. . . . .. . - . . � _ \� Z o o .. � ... `r . ,..� ._ � � ? � � �y _� p ; `', � ` v� �p.- 0 � p" O � �c�- y, . %-;. O ' ti � � �- f�a � A o ': 3 '6' , Q � , .. .G p 0 CR n ✓�. �C., c0 '� 'fl � '� Q O 7 : ... � „ p " p '� �., .. � d �C '�p q'. : .. O .��� , I. �f � ; c — ' n� .'� � m M, �.s , .- .,, 'v,� �� � �?. a ,o - m . , 9 ,Y, 'l' � �' O _ � p 9. 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