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Home My WebLink AboutNo Permit Number (22)WORKERS' 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.BP.C. for this reason J—Dole: J_Z3 A9 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 *O 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 ADDRE`W70 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 10. 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 Plan 4 REPAIR USEEXISTING BLDG. TI DEMOL FINAL J/` jDATE /V J' s APPLICANT TEL. PRINT NO. 85O-lOOl FINAL p 6Y _C ADDRESS PRESENT TEL. NO. 097-/Z „aaneFee ta, b Investigation Fee pTotalFee r q 00 tag SEE REVERSE FOR EXPLANATORY LANGUAGE 6 Ref, k 1T - P/C M 0 I.1 ONTF-R-BUILDER DF'(T ARAIION 1 tieraby oft, „ 1 »r. eml.t ter _.. 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 , to .r nstrurt, alter, bcp........ demnlob, r Yup,li anl'.str., c-tr.re, prier to Itr isr'n.eni 1,./tint grtireF th'. appti—t for s.,b permit to file a signed stat<o:rrnt tbat be is U" ns. -d par ant t,, the provisions of th, Core- tra.nrr4 Lh"e I,au-(Chap4r)J( o -7--g uarbtk,n 7,000) of Dirici,m 1 n% for 11 -mess a d Fr,.frsi,.ns CndaJor that be rs exaacpt tbse ..... and the 1u i., fur the alleged ereneptinn. Any vvd,,ti— of 5,, tdnr. 70 31. i In am' appliasnt for u permit ss.bjeuts the dpplkant 1., a, ird penalty of not nrnre titan five Essnd.ed dotian fS500).l: I, as Demo. 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 Prnfsins Code: Tbo Cnntrartor., Licc-nsv Lain does not uppl, to an oa nee of proper..- :oh„ hands or in:pra s thereon, and u -b,, does sea^b urork himself a+ througb his an employers, lo-Ood that -h r prosements are not mtanded nr "ff "d fur sada. y h oueoer, ibe building,r improven,erct is sold rritl in one jeer of'—pletinn, tbr: ou. nee-brsilder v'itl Piave the bnrden gfprooin,; tbat be did not build or improve for the parpose of -'ale). I. os owner of Iha property, am excl.rs rvely rsrnrr.c- t ng w,tr licensed conooctors ro co,sirue the prule t fSrc. 70-'41 Bnsinr-cs and Profess...... Cod,: The Cont—t>r`s License Lav doer not appiv to an,- -of j r, erfy u hn builds or bnp—c- thereon, and ai,, .nneractr for -,h prnjrctc .401 a rnrrtracd.,r(sf luvned purv.arrt to UYe Cnnirortor's Lics ense I-0. I om eza<n pr ander Sec. , 8.87.C. is INSFICTOWS NOT"