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HomeMy WebLinkAboutNo Permit Number (216) WORKERS'COMPENSATION DECLARATION . '^ I hereby off��m,ho�� ha�e a�e,�,f,�a,a of�o�=e�,,a=e�f � . APPLICATION FOR� BUILDING PERMIT s Insure,or a certificote of Workers'Compensation Insuronce, � or a cerfified copy thereof(Sec.3800,Lab.C.J . . �"�� . � O�yNaRCS 09 26 21Company ROYAL INSURANCE C0. COUNTY OF LOS ANGELES ._ BUILDING AND S ETY Cerlified copy is hereby furnished. FOR APPLICANT TO FILL IN BuitowG D � ADDRESS � Cerlified copy is filed with the county building inspec- BUIIDING 1024 SOUTH BREA CYN. ROAD ' tion dapaftment. . AODRE55 IOCALITV lil_7 3-6-84 ALLAN d. HART NE^REST • Da�e Applicanr arr WALNUT zia ceosssT. 01� ./J S r2ini S CERTIFICATE OF EXEMPTION FROM WORKERS' ` � $EE PLAN$ NO.OF BLDGS. 3 nS5E5SOR COMPENSATION INSURANCE SIZE OF LOi NOw oN l07 MA7 BOOK PAGE GARCEL (This section need nof be tompleted if the permit is for ona PM-4739 ---- 1 USE ZONE �P -333 TRACT 6LOCK lOT NO. NO. hundred dollars(E�00)or less.) � . 7EL. ��'2 SPECIAL }� owNea MOBIL OIL CORP. No 683-5957 -E. CONDITIONS G. I certiiy tha�in ihe performance of tha work for which this DISTRI�T .GROUP ivve FIRE P E D Bv O permit is issued,I shall not employ any person in any manner � qo�RESS 612 $OUTH FLOWER STREET CONSt. ZONE so as to become su6ject�o�he Workers'Compensation Lows. � .a � � O N/A N/A aTr LOS ANGELES, CALIFORNIA ZiP 900ll ` Date Appli[anf STAIISTICAICLASSIFI TION . APT. CONDO. � NOTICE TO APPLICANT: If, after making Ihis Certiticate of . ARCHIiECTOR TEL. � �Exemption, you ahould be[ome Subje[t to Ifle WO�kers' ENGINEER N.J. SONNEGA � No.246-2388� cu�ss No. a DWEIL.UNITS a Compensafion provisions of Ihe Labor Cade,you must forfh• qDDRESS 2682 KENNINGTON DR. GLENDALE. CA.�91206 SEWER MAP � with comply with such provisions or this peimit shall be TE� �' �„ deemed revoked. � CONTRACTOR SPERCER & JONES Np,818-369-1611 � BK. PG. VALIDATION LICENSE�CONTRACTORS DECLARATION � IIC. I hereby affirm that I am litensed under provisions of Chap�er 9 nDDRESS 247 NORTH COVINA LANE Np 184669 yALUATION (commencing with Sxtion 7000)of Divisfon 3 of the B�siness and ��� Professions Code,and my license is in full force and effect. ciTv CITY OF INDUSTRY, CALIFORNIAcwss B E SQ.FT. NO.OF NO.OF CHECK Ucense Number 184669 Lic.Closs B Size S70RIE5 FAMItIES ONE ' :_ � fj C�J'� S Controc�or SPENCER & JONES DO1e 3-6-84 DESCRIPTION OF WORK ,risT/,t/� NEw ❑ {t, . . , , � ❑I am exempt under Sec. N/A S _U/ - T;��` C G'. ADDR ❑ FINAI .,/ � � 'O Q 5� 6.8P.C.far this reason � 3 S J'C O� . . REPAIR � D TE >���/ • , u(;(i�(1� USE OF DEMOI. Data: FINAL � � EXISTING BLDG. - � � eY C S.O�EJ—�j Ll 5t9narore APPIP la NiT ALLAN J. HART No 818-330-6009 X OWNER-BIIILDER DEIXARATION , . I hareby affirm thot I am ezempt from 1he Contractor's License ADDRESS 15964 LOS ALTOS DR. HANCINDA HTS. CA. Law for Ihe following reason(Settion 7Q31.5,Business and - � Prafessions Code): N � � � ❑ BUIIDING � .. I, as owner of ihe praperty, or my employees wilh qDDRE55 wagez as iheir sola compensation,will do the work and " ihe structure is not Intended or offered for sale(Section - ����TY � � � 7044,Business and Professions Code). MOViNG TEL. � I,as owner of Ihe prapeny,am exclusively controcting . C NiRACTOR � NO. with licensed contrattors to construct the project(Sec- qDDRESS tion 7044,Business and Professions Code). _, _ _ . _ . REOUIRED TOTAL SETBAIX FROM EXIST. CONSTRUCTION LEN�ING AGENCY � SET BACK YARO HWY PROP.lIN WIDTH ► . I hereby affirm that Ihere is a construction lending agency for �faONT - - -- - - � �� - the performance of the work for which this permit is issued P.i. t$BC.3097,Civ.C.J. - SIDE 9 Lender's Name NONE v.�. _ � - P.0 Fee S Permir Fee '�I O � lender'a Address I cenify thaf I hova read�his application and ata�e that the � iss�a ce vee ��'�� � Z abova information is corretl.I agree to comply with all County Investiga�ion Fee � / S � ordinantes and State laws rblaiing to bvilding tonstruttion, - Tmol Fea Cp0' Y and hareby authorize represenlofivas of fhis Counfy to entar S upon the above- an' ned property for inspaction purposas. � - � � � i / �� � 3�6��.¢ , _ SEE REVERSE FOR EX►UNATORY IANGUAGE , ,, o „ 5� ato e of Applica�t or Agent � - pme �� ��� . . . . . . ... . . . . . � '_ ' ___ "'""'._... .' " .. _ .......... ... '� i, , „ � � ' '�flANS TO APfiLICANT. � � �� � - � �INSPECTO�'S NOTES � ,i ��.. ��O�i'KLELBUIT.PLr DLCI.ARA170�., . � �I hercby aifirm ihaf I,pm ezempl irom iho Conirac�or's To: • .F.etornad , , .. . _ � � License Lcw foi Ihc'folloWin� reason. (Saa�7031:5) - � �AGProv�d �.;Er!slr.esxcndProfertinr.zCndc�Ar.y�Fi'yorroarrly�oGic,i+ No: ..._...__Da}c—i_ __- No. _.�Dafa-�, -_ __ .. ._ . . .. . . ... . .., .. • '___reguirrsap ,�rtmcnr.tr rt,a.+ter �rrpmro�J .rolril�, — nr refair any st ruch:�e;rrior iti rts issa�n ce,a:sn reguires . . . '. . _-._ _. -_:_. . ._ ._. .• ...._:. ....._ .___ _ .._ . . _ _ . ___ , . • . . - tl e vprficant Jnr racb Aenxrt!n J:le e signrd ststenrcii! , .__.....__ __.__ _'_ .� � . .. ., .... . _ �; ,` .'_:'.':� . .." ''.�.�'. .:���' �� 11 at Gc is liccnscd prrrsr+ant to tbe/�ror•isrorss of tbc Con. . -�,� . � �- ��� �-� ..--- - traclnr'sLimnsnla�r(CGaptcr9J/roninrrneirsgyrillrSec- - .. .-�ion-7000J<JUi��isir�i��3 tf tbe Uusiness ani!Pmfersions , .. . .. � - � .. . , _.. . CadcJor[huflnisv.rr'r.ift�tlerefronrandll�L<tshforN�e ' - a!le,;ed crenrrttn�.Abr i•iolatrorr nf Scetion 7031.5,6y ' C¢quirod �- ' � -..-- . . :�.`,... . , ' �' arst•a/y�Iicar.tfnrapnrr.it<vbjrc.stbctrfplitantto�atiril I—'--Ap^rovda . ' Dat�K�crlvod , � . . � � Yos No -. .or Approwd ' .-. . .. , . . : � �----. �.:� . fena111�f not v�orr tbc+i j'i+e 1 cr..rrd do!lers(3500f.): . .. .�. .. .. .. _._ ._. . ' ' • . ' .._..,..'� � � . [.�. I,as owner of fhe prcFarly,or my employees with Woter Certif�cate � �. �� � ' � �.Y � , .�; .. � �wages as 1h�ir sole compensation;wlll:�do ihe work;and � --- -- �� - �-� - -��� - ' � the struc�ore is not iniended or cfiered far sale(Sec.7044) � ' � � '' ' -�- � " --.- Uasrmvrs c�+d Prn/cssior.s Cndr:Tl c Contrnctnr's Li�ensc Hedlth DePartment ' '_'_'_. " .. . ...-_ . . "... . `.' �..-:'. • .�.".�, :. . ._._.l.au�dncs rint np/:Iv tn en�osor.cr of/�rn/�cr1}•a�l n buildr Fire Deportment ' _ __��. _. . � . ... . .. _ . .��r i if r �rs lherrnrr,c��s I o dots s�ech t.•ark-f inrs�/jor ' . , ., _...._. ., _ . _.. . �U rou,ql bi.i orev( rnrr4iy ecs, fmrided�tTiat'aue! -im- Grading ' � .._ . .___ _. . . . . _ ... ..�_ . __ . . .��;��pro<�a�:cr:ls��dre not ii :r,d��J�or offc�rcd�or�salc.�lf, .. _ ��� fiou•ercr,!Lc bi�ildrn,q nr id�/��»re�ncnt ii xold tnil5in onr Geoloqical - - . - ,yecr nf cnm.plctior., t.f�c c�e•rrer•Lr:ildcr s.^i(1 bace-!be � . .. � .. ., - "... ,.. �� . . hurd.•r.-njprniirr„(L:t r"i1'r.oth�r':Inrii:�pmrefr � Pedesirian Protection � - - � ,.,,-tL•c pu�osc of sJ1cJ. � �� � ' �: (Fence)(CanoPY) . � . . .. .. , . - . ...� ❑'.I,as owneraf thrprope.ty,a xduaive�yconirao- . . �ing with licenaed controctors ta mns!{ucl ihe project(Sec. SpeCial inspection .. .....- ----� -- � � -. --._._. ..-_.'____ ' -70141�Uasin�s:ana PrqlEssior.s Cn!c:IZ+dConfrecfnr:r � (Conc.)(Mosonry)(Welding) ' - , , I.iccnrr Lau�does-n1 af�plvin uo�ou�nor nJJ�m(�cr(y xrbn .i __....- )..� . ..:... -- . . '.' -.. - .-'._.: : �._ __._ . Fr:ildr nr rnrfmrr.v_tbrrenr,;ar,il�r�Gn rnrctrncts for�racl, Lot Drainage t ', . . .. . .- `��z.1�. �...,.'`.:.,.._�,;� .. •'_:_ .. __�l�c�e e��i�fr nt'art raJ liceri. d pr�r.u�arrt to(ILv . -- - -- - , ,�urrrrors .,...,�-,�.,? �.: Parking : .. . . . �.� ' _ � _ .. _ .'.. . .. .:....... :.,.� ,. ... . ,. ,_ ._ _____ _ _.___. _ .. � � � - � - -.- --- -...---� . Q -Iamexemp�under�Sec. .B.f�P.C.foHhis � • _ . /' ' ' _.._. .. .____ , .___ _ __..._ __-__ _". �' J.�T . _ . ._ .. _._._ . . . . n ,.. .f-� � - _ ' .. __ _. . . . �y , . . ,. .., ,_ . , . . .. �-. ,. : . --�-- - -.. _._ , . ... .�. ... . _ . Dete 'Owner . , -, . .. _ , .. I Apprcvd: Deta Imp�et�r'�Slgnatur• . . . . . _ ��. .� . .. � - � I^1_P�C70^'.l:OT�S -- Location- '— — . . �� �� � � (Setback E YardsJ . . � . �. ._. . ...--' - � . .. � . � �. . . . .._• Fo��daro�s .. �.- Slab . � � , . . . , � . _. . , � . .._. Framc , . ; . .. . . �... .. _. . : . , , , i Energy Insulation � . .. � '... . :: . , . ,: � � : :�i��. ._.r., .. ,;�,, 1` ... � . Lath/Drywall- • . ' . . - . � Inlerior . .�. �: . � '..�. '. . '� La�h-Exterior ' .• �� ; . . " . �., ' � ....._. . .� . . __ .. _.. _. _. _ ... .__. �_. . � � � House Nomber- �- . . . ------�-�-----.. .-��--... ....... ... . �. . Corrcct 8 Posted - ._ __�..''_. ._..__. � _. ..__.._. ...._. .___.. �,.,. .r.:. ,�t . , ;. .. . : , . � :-� . :. � Final- . __ , . . .. . . .. . � Enter on Fronr . . . � . .. ..-.. � � . , ' � ' ' '