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HomeMy WebLinkAbout1806A 1807A (10) ._--..rr--- �� . _ - -_ " �1� _ . ._ ._.... _, __. -- � _ - - � WORKERS'COMPENSATION DECLARATION .'S�V' ���' � � ' ��' . I-f�ereby offirm thol I hove o certificote af wnsent to se�f _ insure,oracertificateof Worked�amPe�,a�,o���,�,a��e, . APPLICATlON����FOR.BUILDING PERMlT�� � � � . or o cernfied copy ihe�eof(Sec.3860,lob.C.) COUNTY OP LOS ANGELES BUILDING AND SAPETY � PolicyN�WC('754R74a�npony_Par_ Fm�l�vc�r� . gU1lDING � � � Certified copy is here6y furnished.• FOR APPLICANT TO FILL IN qppRESS '2 .ZD�, �_ ����%P��.L+�7/+� (�"'� Certified copy is filed with the couMy buil 'ng inspeo- "�- BUILDING . /.� � g{j� fion deporfinent. ADDRESS Q �� �� �•`�' ��.��� > - - _ _ _ . Da�e ^�t'Q�Applicont � Crtv Diamond Sar Ziv 91765 locr,uTv - ' �- ���CERTIFICATE Of EXEMPTIO OM W RKERS''' ' � - � - -'- � -�--� �'-�� -'-NO.OP BLDGS. �� - - NEAREST • - � COMPENSAiION I URANCE�� � - 52E OF LOT NOW ON LOT '�' CRO55 5T. �' .....-. � .. " _.__..,..' ' '_''_"__ _.._'___.. (This section�need not be compleled if the permit is for one --- / - - - � - -- 0.SSESSOR . - -. - ��� h�ndred dolbrs(S100j or less.) . . , TRnci U BLOCK LOT NO. MAP BOOK � PAGE PARCFL TEL. �t 1 cer�ify that in the performonce of the work for which this �'�FR ' - "NO. - ����E NOP ��'�Y ?., permit is iswed.I shali not employ ony person in any monner . AODIiE55 P.O. �BOX-3SQ-- -�' - ��'dv �EOAL�"-- . . .... . ._.._ _ . .._ _ y ' so as l0 6ecome subiect to the Workers'Compenso�ion laws. � ��- ' CONDITIONS •. - 'v .. .. _..... arr Brea..CA --- _ .__.zir. 5Z9-8170. _ ,. __ _ . Dale '��. ' APPlicant � ARCHITECT Oq . TEt. � r/"qTICE TO APPLICANi: IS;after�making this Certificate of ENGMEER L C,. M3 OI'S & Assoavo.862-8177 ' DISTRICi GROUP ttPE . FIRE PROCESSEDBY � . amption,�you should hecome su6leci Io the WOtItCfS� - -��� / C�� Z� , . � �ompensalion provisions of the la6or Code,yoo must forth• ADDRES�OH�FZ S. Paramount E1V@.� Downe (JD. �=3 _ _� p�. , ilh wmply with xuch provisions or ihis pe�mit ahall be -- ' � �- - vi w TEL. 5TATISTIG4L CIASSIFICATION qM. CONDO. ,Z deemed�`CENSED CONTRACi � CONTRACiOR Owner NO. • �y� ORS DECIARATION, .�. . . �.- _._ _ _ _.__ .. .. .__._. t�C._ ... .. �CYA55 NO. W DWE�L UN�75_!.-L _ . � �hereby affirm Ihot 1 am licensed�nder provisians of Chapter 9 ADORE55 NO. (mmmencirg with Section 7000)of Division 3 of fhe Business ond .. _ _ ���_ . SEWER h4tP • � _ ..__''_"'_'_"... .._. _. _ .. Profezsions Code,ond my�icense is in full force ond effect CITY C1A55 ' -' � BK �� � -� �. - -- �VAl4DAT10N � ' � SO.FT.. NO.OF NO.OF CHECK ' , �icenSeNumbel 54648 li[.Closs' B1 " SIZE ��� STORIES �� FAMIUES ONE � - , � . . . . , VALUATION _ .. . • . ,. .. = � Q b� --� Conhq[tOr Date � �� - � DESCRIVfION OF WORKNBW sin le�famlly � N��� � �� � `1 8 _ _ s fC/zr�� ! u E . .. with attached. ara e. . AD0 �� ���--' . �I am ezempt under Sec. �� � - � ALTER ,. � .. � �.-,.. � , . � ' • �{.CI f] � .. 8.8P.C.for this reason ..._ REPAiR.. -"-S -..- . -. -. -- � -- -- .__ . �.. . . .Dme:. ...� �. USE OF oeMoc � ' ' • ^4�i.0 b i> �, E%ISTING BLDG. � - � �- - � � ����"�Signature� � -� �� � APPpRi 1 M.J. Brock & Sotts Na529-8170 F��� /• y�q �` -- -O�p2-56�. ' O ER-BUIt ER OECLARATION . ____ . _ - _. _._.. _ ._. .. .. _. -__, DATE -!O O '/"" . .��.. .. .. .� ._... _ ... I heraby affirm at I am exempl(rom Ihe Comroctor s llcense AOORE55 P.�. BOX 350 Brea C,P. 92621 � � � Law for the f Ilo ing reoson(Section 7031.5,B�siness and _FINAI,:�,r � � � - � � � ."Proiessions CodeJ: .. . .... .. .-.... . . . Sy� � - ... . . . . . BUItDING �� I,as owner of ihe property,or my employees wnh ADDRESS � , __ _ . ' � wdges as iheir sole tompensalron,will do�he work and � � � '� � . , �� ,•. � the struciure is not imended or ofiered(or sala(Seaion ����TY �� _ :'� �.Q 7{` � 7044,9usiness and Professions Code). .. . . . ..- . MOVING '-_. .-'- � ... _ .. -�TEL: � . ,(.. ,- - . _. � . ' . . , � _� 1�as owner of the f0 er COMRACTOR NO. /� � � � ' P P �Y,om exclusivety conimcting , '._'___.. . ....... ._, r. .... .. .. . {;� . • • •���� with litensed coNracfors lo mnstroct the projecf�Seo- �- qD�RE55 ' � fion 7044,Buslness and Professions Code). � . � - � •'II 1 9.0 0 � '_ . . RE(�UIRED - tOTAI SETBACK . . .. . ..- '- ' � "' �w c � .. � CONSTRUCTION tENDfNG AGENCY � "- � SE7 sncK vnrsD� HWY PROP.UNE 'W�DTH � I�ereby alfirm thot Ihere ts o constmclion lending agency for FROrvT . �. � �� S'���"� the perfo�man<e of Ihe wo�k for whith Ihis pe�mit is iesued �-- -- P.l. -��- �-�-- --�� --� ��� -� � -�� - �� � -- ����- - � - �� ���- - �� � - {Sec 3097,Civ.C.j. SIDE G 9 0 2-8 6 m __ _ _ _ _ . .. - o.i. _. _ .... � Lender's Name None � � - � ' " ` IDMA Rel.N . . .. '. � $ Lender's Address . . _ ._ ..-.- .- . .._.'. 7.C.fee S 1 ��- rm�i Fee .��- ,. ... . .._. . . _ . Po -p , � 1 certify thm 1 have read fhls applicatlon and ata�e tho�the .. . . .. . ._...__ .__ - �awaoro fee - 'S�--�--� iornn aiC N -�� �� - � - �- � -�- � --. a obove information is wrrett.1 ograe to compfy with aii Counry In.ea+�ga��on Fee �, � g ord�nances.ond fra�e I s relating o building conslrutl�on. ._. _ __ ..__ . Ta�al Fee-- . .t�MA Pe�m.M ...- _ . . _.__.._ . _'.`" '. . _, � ond hereb cuthariz epresento'es of this Caunty to enter " � � upon the ove- ioned pr eny for Inspection purposes. �.l�f�.,� .. . ...... ... ..... �_, ___'_ ____ _.:...._ `. ., . . . . . . ... . ..._ _� _. __ _ . ._ . . . ._._ . . � _ 7�� SEE REVERSE FOR E%PUNATORY UNGU/�G �` �/�•� . _ _ _ _ — = - ......��.�nt or Agent . . .._.. .Date . . . . __...�._ '._'_. ... __..._ _ .. . .. . ... _ . _ � _ - _. PLANS TO APPIIfANT t` %GNSPECTOR'S NOTES �. OWNER-BUII,DIiR DF:CLARATION . , . 1 here6y affirm Ihot 1 am e•empt from the Contracto•i 70: RaWm�d• � ��� � � �� + � � l7cense Low foi fhe following reason.-�(Sec. 7031.'S� � � ' �� ` �Approved ' � UusinessandPrf�ssionsCada:Artytit��ormr.ntyu�GicG , No. ppfe No. � Da}�� . ' ......, . ... . .• . � .... requires a pernri[to ronslrud,affcr,tmJ�rot�r,dentolitu, � , ,,. . . ,, ..�.ar reJ�airanyslruUurr,f�rinr tn itl is.ru¢nce,alro requiret � < ' � ' " _ � . tGe applitarc!for rutL pernrit to filc a:rgned:tuten�ext � •. 1Gat 1 n rs lirenred pursuaxt to tbe p�ovi.riona o/U e Con- i . . . . ._r , . i • ' ,-� �;:.._� .�_J"JCt ��`�l � ��)�t�,'-t��' . • ,.. `,tra�tor'rl.icersreLau�(Cbaplrr9l/tomnieneiqqu�ill Ser- - - � , " `�[ion 7000)oj Ur��ision 3 oJ u,c B�st��ra and ProJcas:�n� � _._.. ._. ..-_. � � � ..'�� '. ..�..__.__.__ __�.�.. �' . '�.�. Codlort/iatGe.kezenpellareJromditNtGn;bnsisf stla . . . .. ..._ .... .. . ..__ . _. �_ .. - alleged exen'rption.Any riolation oJSectiors�7031.5 b�� � . Raquired . DuleReceiv�d . ---- -.-._�� ' .�' .� �.. -..--________ _ _ anyapP/icantfnrapernritaubfeatrtbeapplicanttoeciril ' RPProGols�-- - � or Approwd ., .<�j� ... __ ..._._ .. _'-J �'.� . J�¢aa{y of nnt mnre tban Jiuc bund�ed dollars(550DL1: ,, _ 'Yat No . .f_...; ._. �. -�- � ❑ 1,as owner o(the property,or my employees with i . Wate�Certilicate � '•�, ' ;,� � . ,. .-�. . .�_.. . ._.� .. - wages as iheir toie compensaliop,will do the work,and � ._... � .,, __ .....�. .__ .. �__. . i . — � - � --- - ��he struaure is not�iniended orbffered for sale(Sec.'704d) � HeolthDeparfineN_. .__ �.�.__.__�. . � . .-� '�� .... ..' ___ '_ ' ". _'_.'.... ... . _ .. . . ... .. .... . Pr�e,sm . , . Liusiness and "ons Code•7Ge Conlrac7nr's�Lrcensc � , f.¢u�doer nnt ap p to an ouwcr af(�ro(icrty u�!o buildr � � � ��� �' �" or im roees tl ereon,and iebo does surb urork binisef ; Fire Oeparlmem_. . . _ .. . -- -. - --� -�-- � -- -- . _ . ... __ P. . _ . .. . . Jor � �- ��- �- - �� ,fGmvg� Gis ou�n-eniployces,prorided!lnl�sut/in�.,. Groding _ � � � . . proucnrnnu nre aot imlendeJ nr nfJesed for sale.l , � . ,. - ' _ . � � Gou�ercr,tLc builJing or improuenrent ir solJ urtGin on. � , � . . : .,� a .., . � Geologicol . .._ � . . . . ._ _ , ..__ _. . '' .' . . . ,�, ��:ir. r ,year n/rnmf�lelinn, 1/c ou�ner-bvifJcr�ud!!6aec'f!r � � � � � burden of pmurng tLa7 I e Jid nae 6uelJ ar impro��e J r i , �., , . . . . _......._._-. _...._ __ ._:_. �._.. .: '' . � Pedeslrian Pio�ection " � � . 1hc f�urposc of taleJ. - . � . .-., . (Fence)(CanoPY) .. -. _ _ ._._ �'.__. .____.__. ...__.. . . _ . , � �❑ I,asowneroflheproperty.amexd�sivelycontrac- ' fin9 wirh licensed comroc�ors fo conNruct lhe project�Sec. � Speciol Inspectian -- � - - -= �� .��"' -� - - -- - "����"--=�:';� -- " '�: - 70d4}Qasiness anJ Prnferainnt Code:TGe Cnritractor's ' (Conc)(Masonry)(Weldinq) � � � -. l.icrnsr Lau•dors xo1 apply M an ou�nrr of pmpesry u�J o � � ���"� --"- � -� - � �� - . � -"builJs n inrprfires t!crcnre,anJ u�l o tonfracts fo�sucG I Lof Droinoge � � .._ . __.' _ - .. . _. , . _ . projertrru�i[!a tnntrattn�J lirenrrJ p+rnuant!n tbe ' � � . � -�-�Contractnr'sLircnaefnu�J.-- - - � -� � . � Parking ' � ,_.._. _ . _ . . ._ ._.__ . . _ .. .. _ �,.:., .. � � ', . � [�� 1 am e.emp�under Sec. ,B.BP.C.for�his , � _._.__ _.... _.. .__ - . . � , ' . - reoson� " i . ._ , _ . . .... ... _._.. . �., - / Da�e - Owner � , ..' �O� ! � � . � . .. _ . . ____ .. __. ._. .__e_. .. _ _. ' .V.. INSPECTOR'S ' Approval� Dale -'�� Imp�et- s 5lgnofun . � � � � �, - - � NOtES " � � Locarion— . . �I [ _. _. .. __ ' . f5etbock&Yards � � � �� Fo�„da��o�� � � � � Slab Fmme� .. _ . � .. . _ .. . . . Energy Insulolion '� . . � . ' ..- ... . ., �. � � i lath/Drywall� ... . � _ . .� ___ - - - - �---,_. _-. -._ ------�:��- �.. . . , . . . . INerior . . . . � . � . . . . •,. '• lath—Exterior f � . .� � � ..� � '.�,�.. '' "..' :' . , . , ,� "___.......... ...__.. . ... ._. 1.�.l. House Number— ., .'__".. . .. �.. _._ � ...'�. •_'."___.- .._._. _.__... . ' '.' . . Correc�&Pasted ' ' t•�.., i ..__.__�____.._- _ _ ..�. . �-.. � ... i '�Final— .. . . . . . . .. . __ _.____ _. __ . ., ... .. ._....__'_._-_._.__" _._. . Enter on Front . � . . - ' , . • ` .. . .. . � . ' � -. . . . . . _ ' � ' . .. � . . . .��. •.\,. . .i � .. .. . .... .. . .... . . . ` . �\� � _'\ _'"