HomeMy WebLinkAbout1150A r _,.. . ----- ______ --...._ .._.____. _..... .._.. _ _ ____._... ._. ._ ..___ _ __�.. ... .... :..... .__.___ --- --.._.._ . ..�
; WORKERS'COMPENSATIONDECLARATION ��wsav �
�hereby aftUm that � h�.� a certificate o��o��„t to��< «.,�,=.e, APPLICATION FOR PLUMBING PERMIT n
h �sure,or e ttrtific�re ol Worken'Compenmtion Incurance,or � � I I
� �cenified copy thereof(Sec.3800,Lab.CJ U
r � �y� w�Q ?�� Ft�ND COUNTY OF lOS AN�ELES BUILOING AND SAFETY
' 'olicy Na7ZL'�`�rCompany-� '
i �Certified copy is hercby fLrnished. FOR APPLiCANT TO FILI IN(PRINT OR TVPE) BUILDINO �/�� �
ADDRES$ `l`
I�Certifed copy is filed with cou y ildinY�e ection N4JMBER iIXTURE OR ITEW • FEE
�q,� ° WATEH CLOSET, LOCAUTV l (�,•t D
, bete ADPiic�nt N A T �
.;� . BATM TUB CROSS ST.
;�� CERTIFICATE OF EXEMPTION FROM WOR CERS'
� � COMPENSATIONINSURANCE SHOWER OWNEH Z
I MAIL �/
IJ(ThIS 6MtlOn rteed not be COrtIp lEted i�the wOtk illvoh'2d LAVATORY ADORESS "!` � 6}L
'^by �Ile plfMlf 1] loi one hundIlQ QO1l�Ta($10�M 1lS8.) SINK CITV � TEL.NO O
. 1 ceHify[hat in the performance ot the work for which this DISHWASHER , � O
�I, p rmit is isaued,1 ehall nol emD�oy any peroon in any manner CONTRACTOR
'!so�as to become subject lo the Workenrompensation Laws. � CLOTHES WASHEq ADORESS ~
U
��,�,Daie �! ApylicaM SWIMMING POOL RECEPTOR I a
I'�-NOTICE TO APYLICANT:If.eHer makin¢this Certiflcate of CI7V TEL NO y
'�-Exemption,.you should become su6ject to the Workero' � LAWNSPFINKIEH VSTEM STATE 2 O//� LIC. ,p ,! �
����Compenaation proviaiona of the Lebor Code,you muat forth• O IICENSE N07Z� 8 T CLASSU`^ �"�
•wilh comDly with 9uCh p�ovisiom or this permit sAetl be �✓ATER HEATE
�,.deemed revoked. GAS SVSTEM OVTlET9 DISTR�CT NO. . P ESSED BY
� � �O �`(�
LICEN9EO CONTRACTORS�ECLARATION OUTLETS OVER `' � d�'
�:I 1 hereby afYirm that I am ticenaed under provisiom of Cheprer 5 PER SVSTEM �
�i 9 (commencing with SecUon 7000)of Division 3 ot the eus�- F1Ni4� VALIDATION �
_�, ness and Pro[essiom Code,end my licenee is in full force and oaTE r—a�_�Z
'I�.effecL FINAL
(� f� \
��:License N�umber�7Z �7 bLic.CClau v�� ��� BY $� � J�.�A
� ContractdrRl+.STY� ��"'Dsl�' �Z'���O� #� � • •���j ..
� ,� 1 am exempl from the licenaing roquirements aa I am a Plan check fee �
� licensed architect or a regirtered profeasionel mY�neer pLUM81NG PERMIT ISSUINO GEE S � � ' '� Z 5� •
�� acting in my profeasional cepacity (Section 7051, Bus- • �1 Z Jr O�
��!' iness and Profeaaiona Code). TOTAL FEE !� •
Lic,or Re'�.No, Date Plen ch�ck spplicant � Z 2 9—8.�
' HOME OWNER-BUILDER DECLARATION N�me �� ''` L �((� � �
I hereby afYvm thrt I em exempt from the Conhacfor'a Addrau �7� �' ' ']' � 5 . �,� ,� ,�f
'� License Law for the following resaon (Section 7031.5,Bwi- City �� �, T�1.No. , � . '
ness and Profcsions Code): � �'� � �5
� � I,as owner of the propefty,am eaclusively contneting
with licenaed eon[racton to comirucl the project � • � 2,5� �
' (Section 7044,Bu+inesa and Profesaions Code).
• • � 12SOU
�. CONSTRUC7ION LENDING AGENCY � �2 2 3�pu�
�. I hereby aff'vm that there ia a wnstruction Irnding age�cy
for t6e perfrnmance of the work for whieh thl+ permit is . �
� isaued(Sec.3097.Cir.C.). �u�� ' .
' Lender's Name
� �Lender'sAddreas
- I certify Ihot 1 have reod this applicetion and atate t6at the
above inPormation Is correct.[apae to comply with all County SfiE REV ERSE POR EXPLANATORY LANCUAGE
' ordinances end State lawe re�ulatiny Ylumbing, and hereby ,
�� author' repr nt ives of thia County to enter upan the .
r abor ntio d p perty for i pectian purposea.
/.2�23-8'
`. ignetu of ermittee Dete
L
APPFOVALS . DATE IN:PECfORSSIGNATURE �NSPECTOR'SNOTES ' � ; OWNER-BU[LDERDECLARATION � �.
UNDEFSLA6�VORK � � � � �� -� �
ROUGH PLUMBING � � I herCby affiim Uiat 1 am esempt f[om the Conlract0i 5
. Li:ensc La�v for thc folluuing resson(Section 7031.3,
� cns aiaiNc •� -� ��� �� � - - � - � '� � ' ' � ' �- ' Bustness mid Professions Codef: An}� city or cowtty
cA5 vENT - . . . - -- �� -� whrcli requirer a pennit to construct. a7ter, improve,
riOrivATea HEn7eR � ..� der7�olisli,or repair any smecture,prror to irs issua�uc,'
- ' � . � " alro requires thc apPficant fa� auch pe�mit to Jilr a
PLU�LiBMG FIXTURES- � - " � - � �
. .. signcd�statnne�r!'ther�He is licenred ptdsumu to die
� cnS'iEs7 � �� �� �� � provisioru oJ tlte Cant�actor's I.iceiue Law(Gropter 9
UTILI7Y CO.NOTIFIEO•� � . (cornmencing wid+ Section 7000J of Di�•ision 3 aJ t/ie
_ , , � _ . . .. . . . . _ Business and Professrons CadeJ or that he is exempf
� . therefrorn mid rke bnsis jor 8ie alleged exemptio�c Arry
FtNAC. � � �'n.J,�/c'p�t'�hpKL � - � � . - . . . � , rrolationojSection7031.5bYan)'aPP7icerrtjorapenni�
�- . . . ,� � � � sub%ecfs fhe applicnnt to a civi(pennity ojnot mo�e JLan
�� . . � five hundred dollars(SSOOJ.: �
IN�US7RIAL - � ' ' � �' �
waST[APaRbVa��" � ' � ' ��� ' � O I.as owncr of thc propecty�sill do Uic work,and
, � . � .. � - �[he stmch�re is not intendeJ or offe�ed for sale.
� _ . , - � (Sec. 7041, Busiire.rs m�d Professions Code: Tke y..�on-
� � , .. . . . � . � . ��. . . , rracror's Liccr�sc law does nor apply ta an owncr oj,
. . . � . � � ' . � � � • � .. � „ . yroperty avfto bt�i(ds or i�rsproves tlierem+,ar+d wlro�does'
� - . ��- '. � �- - � � -- � strch �vork hinrrclf prorided that sudr irriprorerttents
. _ ' : _.,� '.. --' ... �
- .'... . . .. .. . . . -� - � � , nre not.rruended nr oJfe�ed for sale. If. 1row�ercr,�the
� � �� . � �- � � , � � ' buildin; or improre�neru ir sald withLt one pear of
', � � ,- . � � cmripletion, fhe oivner-btdlJer wr!! Irarc lFre burdei��.
, . _ � .. .. . � . . - , of proring thrrt he did not bi+ifd or irnproee for �l�e
, � - , � pwpaae of sale.J . : � - �
I am exempt tmder Sec. ' ,
��)� � i . , . E3 R P.C.for this reason �
_
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llatc
Oti�'ner
rt;-�:, : i _ __
. INSPECTOR'S NOTES � . . � , . . � �� . � � . � .� � . '
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�� 21660 EAST COPLEY DRIVE•SUITE 100
I ' DIAMOND BAR,CA 91765-4177
714-860-2489•FAX 714-861-3117
_�, yr .
\(N[RIR�jt, ` I
�98`3
December 10, 1991 '
Carl H. 5un
21464 E. Broken Arrow Drive
Diamond Bar, CA 91765
Subject: Request for Street Address Number Chanqe- 21464 E. Broken
Arrow Drive
Dear Mr. Sun:
This communication is in response to your request dated November
12, 1991 to change the address of subject property. The City of
. Diamond Bar is currently evaluating a number of options pertaining
to the matter. Upon completion of the evaluation, a policy or a
standard procedure will be established for the City of Diamond Bar.
It is anticipated that the abovementioned policy/procedure will be
finalized in February of 1992. Thank you for your patience and
should you have any questions, please contac� Mr. David G. Liu at
(714) 396-5672.
Sincerely,
.
.
Sid J. Mousavi, P.E.
City Engineer/Director of Public Works �
SJM:DGL »
cc: James DeStefano, Community Development Airector
Dennis Tarango, Huilding and Safety Manager
;
JOHN A.FORBING JAY C.KIM PHYLLIS E.PAPEN DONALD C.NARDELLA GARY H.WERNER ROBERT L.VAN NORT
Mayor Mayor Pro Tem Councilmember Councilmember . Counciimember Ciry Manager
RECYCLED PAPFR