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HomeMy WebLinkAbout1770A 1771A (10) i . . . , . . ._ .... .,__ _�....... ... _ .. ...._..._ _. . .. __ .._..._.. . .. . _._._..., . .. _... . . . �! ... -.. .. ..,.. . ...,... � WORKERS'COMPENSA110N OECLARATION . . . . . UQ � . , . I hereby affirm rha�I have o certifico�e,oi conseni ro sclf - AP`p���qTION�FOR BUILDING �P�ERMI' insure,or a cer�ficale of Workeri Compensa�ion Insuronte, � . . . __ ' _. . . . ._.. ... - or o certi ie copy thereot(Sec.3800,Lab.C.� ' COUN7Y OF LOS ANGELES BUILDING AND SAFETY Polrcyr��'WCC253824Compony_Pac. Employers _ __ � Cenified copy is hereby fumished. �' FOR APPLICANT TO FILL IN BunoiNG �'� � � /��� ADDRE55 ��t� ,� �,Certified copy is(iled with rhe county b ilding Inspe- "�� Bu401NG ,� '�tiOn depailmenl.� � ' ' � '' �� ADDRE55 � . �.-, .�. r�.. . '� . .. . . .., . ._ .._ . ' ' � Date��PPu�om•� c�Tr Diamond Bar � - � � z,P� 91765 � " io�,�m. � � ''CERTIFICA7E OF EXEMPTION F M WORK RS' " �" �-� - � -�- - -� ���� NO.OF BLDGS.� � �-- � �' nIFaRE57. ._ ._.. .. .._. ._ . . .. . ._ . . .• �� �'�� COMPENSATION INS ANCE ��� � - 5¢E OF LO7 NOW ON l0T -�- . �p$$$T. . , �, . ._. . .: . . (This secfion need no�be completed tf the permit is(orone - -- - ,�r� - ------ � - ---- ' ASSE550R - � � � �- hundred dollars(5100)or Iess.) .. „ . TR/�T V BLOCK lOi NO. /.�qP BOOK �� � DAGE PARCII owNEaTL-J. Brock & Sons - - ni�29-8170 u zoNe nv�a �� I cerlify Ihat in�he performonce of the work for which this �/'J NO. � �„ permit is issued,i shall no�empfoy any person in any monner pooeE55 �P.O. BOX�-35�- . _.__ �d.a� SvEQAL- - �- �- �� � � � � '0. so as ra become subjetl lo Ihe Workers'Compensation Lows. � -- CONDITIONS O . ,, ., � . . . .� . . V rDOTICE TO APPLICAN7 If,I�afrer making�hls Certifimte a{ Aooae55 LR 7El„ DISTRICT �MU�P � . . . CITY ZIP PP Y ENGMEER C. Ma'or Bf ASSOC. Nds62-8177 n'PE . riae PROCESSEDBY � �mption,�yoo�should 6ecome sobjecr to the Warkers' � - CON ZOwE �ompensatidn provlsions of ihe Labor Cade,you mus�(orlh- lb w�fh comply wuh such p�o��s�on:o�.�h�s permit shall 6e 10841 S. Paramount Ave. Downe � - _ � ._.. � .. ,. ._ 0. � �� TEL. STATISTICAtClA551FICA710N AP7. ONDO. �Z de¢medre�Oke(f. ' � �. � ' � ,�, �. '. �ONTRACTOR OIJIIE'I' � NO. �.(,�� UCFNSED CONTRACTORS DECIARATION � .' -� �i��_ �- -�-- � - cin55 NO. ���DJVBIt.UNRs� _._ —--- `_ . .._ ---- _-_ __ . I hereby affirm Iha�I om licensed under provisions of Chopler 9 ADORE55 NO. (mmmencing with Seclion 7000)of Division 3 of the Business and ., , _..._ ___._._. .._p�_._. . . ��R N'AP � .' .� . _'.__'...�_._._. - Prolessions Code,and my license iz in tull(orce and eitect C�7Y CW55 . ..-. ..-..� ...-' --.. . -- � �VAIIDATION� .. . . • . �� �. ,� . . .. •�. SO.FT. __ NO.OF ______ NO.OF..._. CHECK eK. FG. � "�- , ,.. .. . ___._ � • . licensaNumber.54Fi4A �- ' lic.Class' A1 � Srze- STORieS vqrniues ---� �oNe � -.. .. �,� , , , � . �.. . . . . , yN � .. - .� � ._YAW��[J '-�- . . — - oesceienoNOFwoRKNew sin le-famil N� - - Contracior ' .Daie - s O�'�� �� 7 7.�A. ❑i am examP�o�de�se�. _ with attached garages.__ AD0 � -�;. e. :�� ' � AITER... �. � 6.8P.C.for ihis reoson _.-_ aepqie- .-s - . .. - � a Ci 5 6.-d 7�• oa�e: �SE oF o�,a� 1_��_p,7 E7c15t1NG BIDG. . •e�$�.0��., I he eiby a'ff'vm t 1 om exemp�irom tbe Contractor's AwiiCANT tEi. FINAL - ' 9 DRINT � N . � ' ER•BUIL�E DECLARATION - DATE -n � ' -�' - Q 0,(�8-�$6-�. l�cense AooREup.O. Box 350, Brea,CA 92621 Low for fhe following reason(Section 7031.5,Business and FINhI � `� �' '�-' ' .. Pro(essionsCode):-. . . . . . . _. ..._.._. .---- ..___ .. By - : - . _ . .. . � BUItOING _ , � I, os owne�of tha properfy, or my employees wifh ADDRE55 � � _ _ _ � _ _.. - :. . . wogea as lheir sole compensalion,wilt do the work-and �� ��TY - �� � - ; � . � � �`-�- ' `� .�7 ;"A' � ' 1he strucime is no�intended or offered for sale(Section � � 7044,Business ond Pro/essions CodeJ. -- �-- � '��-� MOVWG - -� - -� - -- - � TEL � �� - � -—� -- -• -� � - �- � I,as owner of the pioper�y,am exdusively conrrocring CONTRA�TOR NO. , . � . .,, . $r• •+ • �� . ,� . • 1 . . with licensed con�mcrors to consrruct�ha pro�ecf(Sec- ....- -.-. . ...-. �.. _ . ._... ... .. .. ... .... . . ..-..-" . � � --- . ' � . ��on 7044,Business ond Professions Coda). AooeFSS � , � . . � o'7 7'j,�Q, �` --- -- - REOUIRED i0iAl5ET0A K � - CONSTRUCTION LENDING AGENCY�- -�' - - 5ET gq�K YARO' HWY- VROP.LINE WIDTH � � - o .l%7,�Q�;- I hereby aftirm Ihal�here is o conshuc�ion lending ogency lor FRONt � � � - Ihe pe.formonce of the work for which this pe�mil Is issued �� -�-- � G.L- � � � -� ---�-- �- - --�- - - - � �--'� �'�-;� -�- � �- - O .. �se�.309�,c��.e.). s�oe 0 C3£i 8 6.-",, -- - _ . _____ _ v.i. � , Lender's Nome NOIIe __. _ _ _ . . . . . � .. . ..._ _..'_ ___ �( /� S� � LOMA Raf.N \ ..,� '.. . ...' _ __ _ .. _... ___ ._ . .. . P.C.iea 3 �"`1�0. � '" Permif Fee i_ _' . .._ _ .._._. Lender i Address � � I cerlify that I have reod�his appiication ond state that fhe - -._ ...._.... - -- iasuenee Fee -- •S�� �DA1A PiC M--. . ._-.-_ ►. -. : _ ' .i.'.._..: � above information ls correci.1 agree to comply wilh oll County in.esugarion Fea � - ordinances and Sfine Iovn relat�pg�o bvild�ng mnso-uu�on, � �< '�� �' � ' _. _.._ .__..._. .. .'_ _ ___.' 'TolalFee. ." .""". LDMAPerm.M___ . ...' .' . . .__ .�_ .._._.. . ._.� and hereb/authorize represe btives of�h s Counry ro enter . ' upon the bove-menr'o roperry for' patlion puiposes. � ' � ._. _ _S�v,, . __.�7S. _. _ . . •35_. . _ . —, _ �� SFE REVERSE FOR EXPLANATORY UNGUAGE ,.�1 . -� Signat�roofAppli niorA9enr_ "_ . Dofe . ._._. :_.. ,_. "' ' _"'.__.'_.__'_... '���,v . .. . . _. . ._'"" '' _. ' _ ' "_ _. _ _._ Q•i PLANS TO APPUCANT �r/ '-J--INSPECIOR'S NOTES �.�-OWNfR-6UILDIiR DF.CLARATION , � I hereby affirm ihot I om exempt(rom the Confrector's ,o: R�tum�d ;� - � ` � � , � • � ' , license�Law for�the following reason.��Sec.�7031.5) ' '� ' � Approved " DaeinessaxEPmJrssionsCode:An�•cityoroounty'wbicG . No. Dafa � No. ' .�Da1� � -��-.-�-�• �+ . � � - requires a pernrif to ranstrucf,af(er,imhrove,den�olisfi, , . _ _ , � o�sepairany�tructure,prinrtoitsissuanre,also-reguirrs . . �� . .,, � . � . . tbe applicartt fnr sueb permit to f'le a sig�eJ statement � . t1 at!�e rs lircnsedpursunnt ro Y/cpronisions af tbc Cnn- ��. � � � %.'i',..(.t r' _ _ ,'_�����.�.� � � � tracior's l.irense lau(Cbapter 91(comrnencing witli Sec- - -- 1 tion 7000f�oJUinision 3 of tGe IIusiness and Professrnns �_ '_ _ _ _ _ _ _ _ _ .'__ _ _ _ _ _. ._ . . ..___ � ._ _ _}�CortrJorthnl�Lcis;exem/+1lbcrefrnmandlhebnsuJnrlLe � _'.__. . ._ _ .. _. Raqufad _ " � � .,__�.. �� �- _.... _ . ._ _ __ � anl�a��r!'antJorarrmYiesudjeclslhca�plicantOouri�i7 � APProvalr Dalo R�cAv�d � �, � �� Y�s No °f APP�ovad. ',. , . , , .. '�� � , .. Qena ly o/nol more f5an Jiee LundreJ o!lars(SS00%/: ',. • � _.__r' _ .. . �. _ . . . .....�: v . : . _., . , • - � ' , ❑ 1,as owner of the praperly;or my employees with ' Waier Certifica�e ' ' .. _ _. __ _ .. _ ,. _ _ _ , wages os Iheir sole mmpensation,will do the work,and - - " �� � � the slruUure is not iManded or offered for sole,(Sec.�044) Heahh Departmenr, _ _ .._. . - �� -� - � .._ ---�� � - � --- �—- � � --� � Uusiness and Professions Code:TGe Conlracror's L.irenie � lam dves nnt apply tn an oumer of properly u�Go 6ui1Js Fire Deporfinent ,. .. .. _. __ . � � � �. ; -- ar imfrot�es tGcrron,and uLo does svob uork bimsel�or . � . . . � .' -. tlrou,qG�Gis.own.empfoyees;prorided�lGnt.sutl,ir.ti � Gmding � � . ��Qro��enrents ¢re nn1 inlended or ofJercd,for safe.. � . � .� � � , � � �bou�rver,t!>e builJing orimpronement issoW witbin on� , � . . . .. . . . � Geological �. . � , �' � yrar nf cmreplceinn, 1Gc nu•ncr-buildcr u�if!baoc:t1 r - ' � '...: �'� ��,- �- durden of proving lGat!e did no!buiiJ ur lmprore/ir '."- - --- ----.'._ .--' .'- ---- .._:._... _ tGepurposcoJsaleJ• , ,.. ._ ., Pedeslrion Protection ' � • � . " �- - .. �� ". �.�. . �. '. {Fence)(CanoPY) � ;. ..._.. . . _- . —..-.. -- - -�----.-:.-'-_. , ;.._, ❑ �I,as awner ohhe properiy;om exclusively'contmc- .. ling with licensed contraclors 10 construct Ihe projecl(Sec. '�'� ' � --r�—• 7044 Buainess ondPmessinns�Code:TJc Corieractnr's ._ .._.�- . _... .._.__._r $pecial Inspeclion� . . � . - � . �- � ---- . ) � � (Cona)(MasonrY)lWelding) �. � . . : . �. � . :'� ..�. License I.ou�docs not apply tn an o«mcr nf property u•l o ' �'�..-. .-�- -��-� �--.._...._�.. .�-'�'— '-. ... .-�builJr'or-7nrproves'11 erron,and u�Gn rnntracts for sucG lotDrainage � � ;��. �. �` . .� . ��. _.. . �-.: _, .____ ..-.. frojrcls uif/a contrattor{sI ficenseJ fursuanf to�tbe .. � . , - -Cnntructnr's Litensc l.aaf. � "---- -- �-�� � �,. Porking , : . . . .. ... .�_.-..- . -.... �.. . . .. . ... . .._ --❑ I am ezempt under$ec � .8.8P.0 for tFi s . � I . reason_� ._ _. . ___ . . , . ,� . . . . .. , � ___.__.._.... .. ,. � __.'� .w___ . . ... , . . Date ' O ner .. Approvals Dalo InspoNo s Slgno}uro � �- :� , � - � � � - � � � � �� INSPECTOR'S NOTES" . Loca�ion— - (Setbock&Yards) - _ ._ -'.__' . :..; . . ,. � .. . �. .,, . �.;;.. ..., �. ; , ,.. . . _ _. .. ._ . __ _ . . . _.. , Foundorions � � ' ' - ' ' '- " � ' � � � Slab � � � .. � � - Frame �L_ � . . . .. .. . .' ' Energy Insulation , 6� /�i17�/C---�,.L�'_. . .____ __ ..___. . , .". .. _ _ . . , .�. . .- . ,� . , . , . . , Ci{� Lath/�rywall— . . ...______. _. __.. _ __.. . .. . . , . __._ _..__.. . , Interior - _ .-..--'' i . ' . . - . lalh—Exterior 2 � , �; ..,`-.. � . . �. . " . . . . ��..., _._ '_ __ _.. _.__.. . _. _.__. . .. � ,�n . ��. , ., . Hovse Number— �- -- -:.. �-.�._. ._. _ . •.:..• � • . .. .. .___'. ., Correct 8 Pos�ed �� . �. '�-.l. � ' -- �---._.-�-�------ ._ ._._ .. _ ._.. . . .�t Final-- __ . .. .. _. _. .. � ' - .. _.'-_.. . ... ... .. .. .._ ._ - --_ .. ..-- _ Enfer on Fronf � - ••t . . ._ . . , ..- �.. . . . . . ... . '. . .. . _ .... � � .. . ' . . �..-. . , ..� .� , . � ��; . , .� . ... .. . .. .._. , . , '- . .� .� _ :C. ��,y_._. '\ \.'��", �.