The URL can be used to link to this page

Home My WebLink AboutNo Permit NumberWORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lob. C.) Policy No. 686145 Company Highland Certified copy is hereby furnished. aCertified copy is filed with the county building inspec- tion department. Dote 5-1-89 Applicant BramaleaX CA , Inc CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not be completed if the permit is for one hundred dollars ($I00) 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. ate Applicant TICE TO APPLICANT: If, after making this Certificate of xempfion, you should become subject to the Workers Compensation provisions of the Lobar 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 40961 n Lic, Class R Contractor Rramaloa Ca T(d.nc 7-31–R9 1 am exempt under Sec. B.&P.C. for this reason JDote: Z3 9 OWNER -BUILDER DECLARATION 1 hereby offirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and Professions Code): I, as owner of the property, or my employees with wages as their sole compensatlon, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- tion 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 Sea 3097, Civ. C.). Toronto Dominion Bank Lender's Name Lender's Address San Francisco, CA I certify that I have read this application and state that the above information is correct. I agree to comply withall County ordinances and State laws relating to building construction, R and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection Purposes. Signer— of Applicant or Agent Dote APPLICATION FOR; WILDING PERMM COUNTY OF LOS ANGELES +0 BUILDING AND SAFETY BUILDING 24137 E. Benfield Pl. ARCHITECT OR Calderon, Nakamug4_ 476-1804ENGINEER DISTRICT ADDRESS TYPECONST. 24137 E. Benfield Pl. Diamond Bar Hills 91765LOCALITY Diamond Bar HillsCITYZIP IV IOWNEOramalea NO. Of SLDGS. NEAREST CONDO. SIZE OF LOT NOW ON LOT CROSS ST. 35576 14 ASSESSOR TRACT BL«K Lor No. MAP BOOK PAGE PARCEL CHECKONE Ca, Inc No 850-1001 USF,,Zgy! In, ZITY ZIP 92626 ARCHITECT OR Calderon, Nakamug4_ 476-1804ENGINEER DISTRICT GROUP TYPECONST. FIREZONE PROCESSED BY ADDREW70 Business Ctr. Dr.Ste.220 Irv. 10 R-3 VN IV TEL STATISTICAL CLASSIFICATION APT, CONDO. CONTRACTOR NO. 22— CLASS NO. DWELL. UNITSLIC. ADDRESS No. 40961C LIC. $ SEWER MAP CITY CLASS BK. PG, VALIDATION 50. FT. NO. OF NO. OF SIZE STORIES FAMILIES CHECKONE VALUATION DESCRIPTION Of WORK NEW 1 1 (_ ooO1'[ SFR w/ att 630 SF Gar. ADD ALTER QPlan4 REPAIR USE TIEXISTING BLDG. DEMOL FINAL J/` jDATE /V J' s APPLICANT TEL. PRINT NO. 850-1001 FINAL p 6Y _C ADDRESS PRESENT TEL. NO. 097-/Z „aaneFee ta, b Investigation Fee pTotalFee r q 00 prnA 60, a tag SEE REVERSE FOR EXPLANATORY LANGUAGE 6 Ref, k I 11- P/C M Opp 0 I.1 ONTF-R-BUILDER DF'(T ARAIION 1 tierrby oft, „ 1 »r. emF.t trr _.. onn'r-rn's sic arse Lav, t , >.e foal _,. 7041 3rr.:inr-rs and t'ruJi-.caio.ws (ndc: r!nvcite nr cr,uneti relueb reyur , dp,rn,it to cr nstrurt, utter, bcp r,. demnlob, r Yup,li unl'.stru c-ture, prier to Itr ic,'n.eni 1, ./tin rc,l rtireF th'. appti—t for s.,b permit to filr a signed sta£er:rrnt tbat be is U" ns. -d par ant t,, the provisions of th, Core- tra.nrr4 Lh"e I,au-(Cbap4r)J( o -7--g uarbtinn7,000) of Dirici,m 1 n% for 11-inrss cud Frr.frsi,.ns Cnd'Jor ibat be rs excacpt tbse ..... and the 1u i., fur the alleged ereneptinn. Any vvd,,ti— of 5,, tdnr. 70 31. i In m<v upplfatnt hrr u f,rrnrit subjects the applka .t to a, ird panatty of not ..rove bion five hssnd.ed d„tion fS500).l: I, as ormo. of ;he property, v, my e,nployees wi,h ges as their sole .mpen .'I da the w -,.k. and the srructure is nor in^ended ar o`fered }o, sola rSe 70Lz1 Busin.as and Prnfssians Code: Tbc Cnntrartor., Lice c Liu, domes not pply to un oa I- of proper..- :,,b,, hands or in:pra s thereon, and u -b,, does—b urork hi,o telt a+ througb his oa n enrployves, provided that -h i prosements are not intanded nr off "d fur sada. y h oueoer, ibe building,r improven,erct is sold .vitt in one jeer of c„nrpletinn, tbr: ou.ner-builder v'itl Piave the burden gfprooin,; tbat be did not build or improv, for for purpose of -'ale). I. os owner of Iha property, am escl.rs rvely rsrntt.c- t ng wrtr licensed conooctors ro co,sirue rhe prule t fSrc. 70-'41 Busine-cs and Profess...... Code: The Cont—t>r`s License Lav doer not appiv to an ,ower , f pin -tv u hn builds or bnp—c- 1b,re—, and ah,.nnera, 1, forsuch prnjrctc wiU+ a rnrrtracd.,r(s) lisraned p to UYe Cnnirortor's Licsnsr I-0. I om eza<n pr ander Sec. , 8.87.C. is INSFICTOWS NOT”