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HomeMy WebLinkAbout1808A 1809A I . . ; .. ..... ..�._. ... ., r .. ._ ._. . ._.--." ' ... .-.. _ ... ._._ . ._. ._._.. .._.."'.""':. � ,Y ATION DECIARATION , �� � �S O� � . - - � .� � . insure,or aOceKEfica e orf Wos�. .. . .._... .._ . ' ' - � . .. . y hereb 6ffirm that I hove kers'�Compens6lion Insuran e' - APPLICATION� FOR:.BUILDING -PERMIT �--- �� � -- . . _ -- - - - - _ . , .. - c(a certiiied copy thereaf(Sec.3800,Lob.�C.) �� COUN7Y DF LOS ANGELES BUILDING AND SAFETY - �� - - Pou�ynt�WCC253824dd�Po�y Pac. EmDloyers . - � Certified copy is hereby fumished. �_ � �., � •.i FOR APPLICANT TO FILL IN aunow� � ZO p .�' /.,� /j��� � — ADORES$ � �.11h./Y�/G 'Certified copy is filed wi�h the cooNy building ins eo gWtDiNG � 2 f� p '�� � - � ADDRESS O � /:,/ . ; Date V��Z'�q � ' �.. . . ... _ . _. ---__. _ . -tion de artment. pp��canf aTv Diamond Bar z,P91765 ��,,,, ��:' CERTIFICATE OF EXEMPTION OM WORKERS. � ....- -- .- ..._ . . .__ _ ._.. NO.OF BiDGS, . - -.. . . tdEp.RESi. _._... _. . _ ____ --__-.... __ _. ..�. . . � ' COMPENSATION INS RANCE� � � SIZE OF LOT NOw ON lOi -O- CRO55 ST. (ihis seuion�oeed not be compleied if the peimit�is for one -- -- - -- -� - --�.�- �-� � - �-. - - - - -- ..•� � ASSESSOR .hundred dollars(5100�or less.). , . . , • iRACI� BIOCK LOi NO. MAP BOOK� � .DAGE PARCEL OWNERM..I. BCOCIC"S[-SORS '"NCDZ9-H17O - USE ZONE rnn.c f��_ 7 p 1 certify lha�in the performance bf the work for which this ' R�� NO' J l�7 ;r permi�is issued,I shall nat employ any person in any manner r �-`�`-� � SaeGqt �- -� ,--- �- __.,_..__ . _ _ a � �� '-" ' ADDRESS�P.O. BOX-�JSO--���- -� � � ��- �-- pu-yvY [ONOITIONS �. so�ds to become subje�t to the Workeri Compensation Laws. p �._ . ,. an Brea, CA_. _ _. zir 92621__ .._ _.. _ - ' - u Date. . ,., .,APPlicani - : � . .. .. - - . ' . . ' - �O /�`�TICE TO APPIICANT: If, afler making this�Certifimle of ARCHITECT O , TE�. _ D151RICT _ GROUP TYPE FIRE .PROCESSED eY.. FNGINEER � mplion, you should bemme subjec� to the Workers' � Y ; `a �3 CO .I rZONE �� a.ompensotion provisions of fhe Lobor Code,you musl forih- qDDRESS lOH�ll S. Paramount Ave.� DOWRE' rv wifh mmply.with such provisions or ihis�permit sholl 6e�-�� - ' �" - - � - - �y deemed fevoked. . . . 7EL• $TATISTICAI CIASSIFICATION ' � APT. CONDO. ' �Z � � ' '-'�� CONTRACTOR Owner NO. � LICENSED CONTRACTOR$DECLARATION � �� -- --- - - --- - - - - --__ . . _._. - . .. _.. -�-' � 'IL�I -" - "- IIC. QA°S NO. DWEII.UNITS I here6y affirm�hm 1 am licensed under provisions of Chapter 9 ADDRE55 NO. , (tommencing with Settion 7000)of Divisio�3 of Ihe 6usiness and _. .___. _ _ . ��� � SEWER MAV ' . , � '- . - - _ . __ ._ _._ Professions Code,and my license is in full force and effect. CtTv C1n55 ' - ' � - ---- -----� �- �- -- yp�IDATION � ' -� �� 5�.Fi. NO.OF NO.OF CHECK � gK' �'' . �IC9nse Number 54648 � �;�.eia3, Bl " ' SIZE - � STORIES � � FAMIUES ONE �� ' '� - -,�� � ' �A��r9a ._., _ COMroUor �� � � Dp1e �� � - �- DES�RIPTIONOF WORK New sin le-famil NEW- � �� : -� --, - � . . . ADD � s I .. . ❑I am exempt vnder Sec. - - - W1CI1.attdCllECl aYa 2..-_.... - - .. � . . . AITER ❑ � ,� �� F•O E F . . . . RECAIR. . " ' '-__ _ _�. ; _. _ _ B.BP.C.for Ihis reason S� - .- � _. ' '. _ Date: � .. . _" USE OF DEMOL O � _ . #i•• • •.2� � E%ISTING BLDG. N A - .. . �� � APPUCAN7 TEl .. Signarure �� - . .. .. . .. FINAL '� �. I a 4 8 1.0 6 OW R-BUILDER ECLARATION PRIMM.J. Brock & Sons N�Z9-$1�O pATE /�=b7�7 ' . c• �r ' - . . .-_ �_ _..._ . - - - - - - - . .. . .--- -I hereby aifirm th I am ezempt from the CoMractor's License P,Q, $OX 350 BPe3 Cl� 92621 � • °���" 1��b�' . Law for the following'reason(Section 7031.5,Business ond , ADDRESS > > FINAI �� '� � � ' ProfessionsCodeJ:- `.._ _.._.. _... ___._.._........__ _ R N Br .� �� := 09.L��—�b -. /�7 BUILDING ' j � I,as owner of Ihe property, or my employees with ADDRE55 , ,; � , .�, wages as fheir sole compenmtion,will do ihe work and . . . -' •, .- : ihe strocture is not intended or offered for sa�e(Section ����N � � �. � - �- . � �, ^��� � 7044,Business ond Professlons Code). - � ' MOVwG -�'- -- � ' - - �-TEL � -�, , - -- -� - ���- - -�{���Q 9 r1 -' ryv I,as owner of the property,am exclusively controcfing CONTRACfOR � NO. � � ' ',�. � ���a ..with lirensed contraUors la Construct 1he project(Sec----- ..--.. . - --. . . .-.....----.. . . _ - . .. .. . ... ` . . - `�. �'e_a�e.o._.�.. tion 7044,8usiness and Professions Code). ADDRESS � ,�. - - , � ..- - CONSTRUCTION LENDING AGENCY ... .. ... - ' �S�Qg,�K VARD HWY ...TOTAPROP,unKie �wioTH . . . - - -- ..-- .- . I `�� 9�D O_ . 1 Fereby affirm tha�there is a tonstroction lending a9enty for FUONi � . � ` � o'�j y C p� � -fhe performance of the work for which this permit is issued - -- G.t: - - � - � - � �- --- -�- � � � � ' . . - _ ._ ._ ._ . _ . (Sec.3097.Civ.C.)• SIDE ' Q 9.�£_b,� 3 '. _ _ . . _ . . . ._. ._____ P.L . . _ .. . . _ _ -. _� _ . - _ Lender i Name None (� /� � . "..." ." ".._ . . . . .- P.C.Fee S �D "Ob 'Permil Fee �� .�� � LDMA Ref.k .. . . ' • `.. - Lender's Address � � � ; - .�- _ � I certify Ihat.l have read 1his.applimtion and stafe.lhot Ihe ._ ... ...._ ..__. -_ -._ isauance Fee �.6� � '' LDMA ViC il --. '.- - -- - - ¢ abava informalion Is corred.1 aqree lo tomply wilh all Counry Invesiigai�on Fee � ' � g _ordinances and Sta e Iaws relating to building constructian, _ ___.._ - To�ol Fee- � �� '� " .__._ ... _ s - LDMP,Germ.N . . . _... __ . ___ u and hereby auth e represant 'ves of this Counly to enter , � upon 1 ab entioned p perty for inspection purposes. n + . : -... . . �J,�7' . _... .._. {�" ___ __� _._ _ _.. . ._ ... ' ^ v�G.-g� SEE REVERSE FOR EXPLANATORY UNGUAGE � � (� i .i -Signar eolAppliconrorAgen�.� . _ __ . .Do�e . _._.....___._ ._ __ __ _. ._ _._. . b.IG_� . . .. _. . . ' _ _ _. _ . . . . . . . Q 7� PLANS TO APPUCANT _ %INSPEROR'S NOTES ,,�0�5'NEiR•IIUILDER DF.CLARATION I hereby affirm thaf I am exempt fiom Ihe Contractor's To: � R�furn�d ; '� ��' � . �. �'`". ' - . ' License, Law:for tlie'following reason. (Sec.'7031:5) ' ' ` -"� " �Approvod` ButinessandProfrssions�Code:Artyrityartoenfyu�LicG No. Date No. ` � Dat� � �� � � - - � � •-•• �� � reguires a rernril lo tonslruct,aller,imf�rour,demolish, . .� orrep6iranytlrµcturc,priorMitsirluancr.akorequirea I . " . ' � � . � ,, , , !be applitanl jor tucG permit ro frle a si,qneJ slatemenl � - � , Mat 6e is limnsed(>ursamnt!o tbe f�rorisions of 1J e Cnn• � • "' .. . . •��, I. . • J�:JJ:.� "�"•:.� � -�, �''�1 � I'�. ... (rarlor'tl.iFenseLau�(Cba/rter9l(tomn�encinqwit�Seo -- - -"" ' - tinn 7000)nf Dre•iArnn 3 0/tGe Burinrsf and Professions � �• . . ',..+.� � ` -.'� :��.. � . .. �;CodcJnrtliat_Ge�isrrrcrn/iltbcrefromanJJbe�basis/ortbe I - -�. - .. . .� - - � - � . "�� �-'..."- �-���--1 .- -... .�..... .� -- � - - nffeged exemption.�•Any.x•iolalion of Secfion 70j1.5 by - { Raqulred Daro R�e�iwd � -. ..� --.-�� __. ... . . _ ... . ' . � an,Y af�Qli nt fora permit ubjects tLe aQQlrcon to a rioi ca s t ! i � �Approvali � � ' ' ' � � peaalty oJ not more than fiae Guxd�ed do!lars(d500J./: . ; � • . Y�s No or Approved � � _)� � ,.f � . . - - - -- - � �- � -- -� ❑ I,os owner of fhe property,or my employees with '� - - - -'. �- . �' _ . ...._. �.. -- --� �- -�---- the e u�ture is'not intended or oftered for sole�Seck,and Water Cenificote �, . �� � _ � _. .,, • _. :___; hev sole com enzation,will do the�'o!�044) . ._.... __ ..___- __ . . . . _ , Heolth Departmenl_ ___ �� •� ` �;'� � _ ._ -�Durinesa nrsd Pro/cstiurts Code:.TGe Contractor's Lircnse . .�. . __'_ . ..._ .. . ..___._......_ . .. . . -�-- - --' - � � - , I,au�does nbt apply lo an oumcr nJproperry mGn builds Fire_Department ... _ � - -- --- ------� � � or im/�roecs tGercan,and mbo dors sutG urork GinrseJf or _ .. ... .- ._ _._ _...__... . . . . . �1Grnugl��Gis ossm eniployces,/�rorided lba! such ir�. � Groding . �, '. ; : � �proncnrents�arc not intended or nf/ereJ jor sale.� - �i , ,.. . . . bnwrrer,tGeburldingarimJ�ronrmentissaldu�itbinons Geological��' , . _ � . �. � .. --' year n/conrpfetion, t!e ou�ner•builder udll 1 ae�e tLr , . .___ .. _... ._. .. _.._.. _ .��. barde�oJQroring tlat Gc drd nn!build or improrc Jnr . ..� _ .... ' ..� .�...' ... tGe purpnse oJaalel. � ,. PFe ceriaC�Pr�otecfion . .. . - . . � . . . " .� ( )( PY) .. . __.. .._. '. . ._.. _._.- -. --. _ . . . . . � ❑ 'I,as owner af thc propert �am exclusively contrao Y• , ling wilh licensed contraclors to consiruct the projett(Sec. �-� � - : ---- --�-�=-- ---- --- � � �- ��- 7044)Dusinest anJ Prn/estions Code: Tbe ConMacror's Special Inspedion- -��' � --' ' ' � �' '� � Lrornsr Lau•Joes nnt aPP15'�o an nuncr of prn/�crty u�!o (Conc.)(Masonry)(Welding) ` � � - . ; . � . . . � --" -"' - -""- -" �� " ----� _ -"-buiGls or irnfrot�es fJ�ereon,anJ ubo roneracts for surG Lot Drainage � � "� � ' ' � �� - .___ , J�rnjetls u�itG a mntrartor(sJ licented pursuant fo tbe , .,. , � �. ._._.. _ _ _ . . _ .' _ � -�, -"�"Contraclnr's Liccnse l.auJ. "- "—'�' """"" � ,;�' Parkin . .. . . . . _ . . _ . . . . '_ . . . _... __. _ ' ' -' .': 9 - � . � � �-� ��� � - ❑ I am exempi under Sec. ,B.BP.C.for this � . ,.- , . _, ---- - - .._ .•. ---- � ... , . .. . � ��7 �� :�' . ..._reoson`- -- . . ; .,.. .. . ,,� . ..---.._ ._ ' .--- - � Dafe �' Owner �� =... �. , � . . .._. __ __' , ' ,1 ">'� _. - __ _ _ __ ' . ____ .. . .. . .'�`;� , Approvals Duta speefor'�Sigeaturo � . � . ' - - � �. . . . , . . . . � ' INSPECTOR'S NOTES �-.i � Locotion- _ ,_,. ,, � � _ (Setback 8 Yards) � � � � - ' Foundations � , �� .. • ,. � � . .. . . . .. . Slab � �' � � ' ' Fmme -�G'� r . . - . . - . . - . . . .. , . Energy Insu�ation ' � - - ... , ... _ __ _ . . _ �. � . _ _ _ . . ��. � ,. . .��. .. �. . � .-., , Lath/Drywall- ._- .- - --- __ , . . . ... --- _ - . Interior ' o . . . . . . .....- � � Loth-Ezterior , . ' � . . . ' . . . . ._'_..._.. _.._ _-_-__ __.. _� .. . .,.. � .� � � . , � ,�� � .. ., i House Num6er- " �----- .� -._:. ': -.-' ._. . ._._-...-�...�. � .. _ . _ Correct 8 Posled � ' • i . �� �� �� � ��� � �- . 1 .... Final- . . .__. ... . . . . _. • .. . ._. . __.... ...__._... :_r,.._ ;.___.. .. .,��, ,� . . . . ., .. _ . . _, , . .. EMer on Front � � ' '-.i - . . ` - - .,.: ...: �, �- . �.� � ., •���_: \���.`t:"�. - . . . '.. -�....� , • . - . 'L,._r_�,;_.� ' : � � . �__.., � .. . , '"�J-.-- " .__"__. . . . J .,..�.�.:._.��.._..