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HomeMy WebLinkAbout1792A 1793A . _._ _ _ ._.._ s-p.o -t3 _-. _. ._ . � _ _ _ �__._ ___ _ _ WORKERS'COMPENSATION DECLARATION � �_) � � ��:,�'• ' ' "�;� �� . r � ,. insurebor�afcertifca'reof Workers'rCompens�0�5��=�'.o�a'f � -�� � A�PPLICATION F�QR�,+BUILDING�PERMIT� -� ��� - _ _ • or a certified copy�hereof(Sec.3800,Lab.�C.) � � �� � - -- - - � � ' - . _ __. . ._ _.. voi��yN�WCC253824dd6,��Y Pac. Employers COUNTY OF LOS ANGELES BUILDING ANO SAPE7Y � � Ce�ii{ied copy is hereby fomished. � FOR APPUCANT T FILL IN euuowc 2�a�D '�- /� / �, � ADDRE55 �,V�yp')J.�/Git/L X Cer�ified��opy is filed with the'coony boildi 'inspec• eua�iNG� �a � - � , 6�fion deparlment. ADDRESS Doia —U �� APPticant . c�n Diamond Bar . . Z1P91765 ��tin, - CERT�FICATE OF EXEMPTION OM WO ERS. - .. .. ... . . .. ....NO.OF BtDGS. - -- � --� n�AaE57-...._�_,.._...'-.:.. . .. ......_ ___. __.,_. . : � � COMPENSATION I URANCE' � �� S¢E OF l0T NOW ON l07 -pO- CRO55 5T. � ` (This section need naf be campleted if the permit is for one � -- TRAC7 BIOCK lOT NO. U -� AUE550k ,_ - � ,- - . � ' buodred dollors(E100)or I853.� , ! ��bOOK �PAGE PAR�L owNeahlrJ. Brock & Sons ni�29-8170 5�.,Zq E �/ I terti4y tha�in the performance af the work for which lhis U/'C PNY OP � � l�3 T '� � �� �' y permit is issued,I shall nol employ any penon in ony manner qppRE55 P c�. BOX-35� - - -- -� ��- � - �---- �dr�- SPECiAL - �� -� � - - � � --- - � �6, so as lo become subjecf to the Workers'Compensation Lows. CONDITIONS . � i 0 �__ aTr Brea CA zia 92621 - - __ v Date � . .qPPliCanf � ARCHItECT O�{ .. �.. . 7EL. ....� � ' . � r'7TICE TO APPLICANT: If, after making this'Certificate Of ENGINEER �+.C...Ma'ors�& Assoao.862-8177 �� o�srR�cr GROUP' NPE FIRE VROCESSED 8Y ��� � _mption, you should 6ecome subject �a�the�Warkeri - - CON�ST! Z E � rj �ompensofion provisions of fhe Labar Code,you mosi forth- qDDRE55 ZOSG1 S. Paramount Ave. Downe � - ���- -� - OW.. with comply-with soch provisions or this permit shall be" �- - � �� � tn daemed revoked. .. ,�� . �. •. � TE�� StATISTICAt CU155¢ICATION � : / APT. CONDO. .� - CONTRACfOR Owner NO. _; __ _ ,__ ___ UCENSED CONTRAGTORS DEQARATION���� � - -- --����- � � ��� - --- ���, -- -----� - C1A55 NO. U� DWELL.UNITS� I hereby aifirm thaf I om licensed under provisions of Chapter 9 AD�aE55 NO. i (commencing wilh SeUion 7000J of Division 3 of ihe Business and ,_ . . .. ._ .__ _ ._ ���, . . . . _ ��R�P � '. • , � Professions Code,and my license is in full force and effett. CrtV ctnSS - eK:-��-� �� � -- �� ---" -yALIDATION -��'�' � ' � � SQ.FT. NO.OF NO.OF CHECK . . . . License Number 5�+��+� � Lic,Class R�� SIZE � � � STORIES FAMIUES� ONE � � , � DESCRIPTIONOF WORK�- NeW Sl❑ le�famil NEW --� VALUATION � � _ _ , ... ... . ... _._ .. . . . _ ._.__. Commcror . . .. .' � Date . . , qpo ❑ s °2 �� , ._.. �1 7 9.G A .-� � ` .. with attached ara e. -...—� I am axempt under Set. �. � , . ,. ALTER � ,. . B.BP.C.for this reason � ❑ --S . .. ; �• o a •L.�. REPAIR ._ .... .�_...-_. ._...' _'"__ ' _' .. Do�e: use oF DEMOL ' 'I •4 S 1.0 6 __ EXISTING BIDG. N�A � . . . . r' ... . . � Signalvre ' - � APPUCAN7 7EL. FINAL ' _ � ; 4�1,06� NER-BUIL R DECLARATION PRIN N . . -DATE � � , . . .___. . ._... ... . . _ _ .._. . . __._�_ ... - I hereby uffir at I am exempr from the Contractor i License qDoaE55 P.�. BOX 350 Brea CA 92621 � 0 9 0 8-8 6 � Law for the f lowing reason(Section 7031.5, Business and FINA �' , ' Protess�onsCode):-_ . . ... . .__.. . _.. ... _ N :gY� .-.� ; : �. �-. ._� �^� euimwc . . .__:...--. . - . . - -- . ___ . . � �, as owner oi the property, or my amployeas with AO�RESS . wages as their sole mmpeosation,will do ihe work and � , . ��� � �' ' Ihe shutfure is not iMended or offered for sale(Section LOCAUiv � . . ., : - . � � - �7044,Business ond Professions Code). � - ��-� ' MOVING � - � --� �-'� -� -- -- TEL. - - ,� ��� � � � . �`- ' � - ---- -- -� CONiRACTOR NO. `- �- " � �, I,os owner of�he property,am exclusively contracting � - r� �q�p -with licensed contractors to construct the project(Sec-. . .- -....... . . . .. .. . ._� .. . _' .--. .. .. ... .... . .. .. .. _ _ . _._.. . ..... lion 7044,Business and Professions Code). ADDRE55 . , " ��' �-� t'ooa • .��' � REOUIRED . YAk�' HWY - TOTAI SETBACK . . ..."""� . ._. � .. :.- .. ._ ... . .. .. . . ' � - -CONSTRUCfION LENDING AGENCY � �- � ' � SET BnCK PROP.iwE WIDTH � I hereby affirm Ihat lhere is a consfruclion lending agency for fRONi � . . � � •E'� Q.Q� � �he performance of�he work for which this permir is issoed v.�.-- -�� � -- --� ���- - - � - -- ' � ' � - �- --� ��� (Sec.3097.Civ.C.). SIDE • . •a�,''�'� �',�i�L�i � S .. _ .. .. . ._. P.L. . __ '_ _ _ _ a Lender's Name—_. NORB �(a Q . � .� . .... ._. _.. .-- .. . .. . ....- P.C:Fee b'_`V _: O '" Permit Fee U�8 S IDMA Ref.N �.' O C1�S"��J - lender's Address , �� � , . � ..I certify thm-I have read this applim�ion and srate that the _... . _.. --_ __'-.- -_--. .... i,,,,a�,ce F�s . S� �- ioht4 aiC N� ,- . .. . . � �0.� - ¢ above information iz correct.�agrea to comply with all County Investiga�ion Fee � ' ' � ordinonces and Stare aws relating to building constroction, _ ._. _. . . imai Fee . --- LDhta aerm.N� � � � � . '-._. .- . _ - .-. -. _-__. .._ _ . .... .. u nnd here authori representoti s of this County lo enler . � upon Ih ob v ntioned pro rry{or inspetfion purposes. /-JN,�r � o . . . . .. ..._ . . __ ".__ ._'/J -_ ._ __. '_ ... .� . . __.. . _.__ _.. . _.. _.. . _ _ _.._ ... _ _.._. �_ ^ �� . SEE REVERSE FOR EXPIANATORY IANGUAGE . O . . Signoture fApplimn�orAgan� . .. . pore.. . __. ...'______ _ .' '__ ' _' _ . .� (' l .___.. . . . ..._ . .__ _ .'_" __ ' .. _ . .... _ /7�_!�Y .'.I PLANS TO APPLICANT - ' `' ='�� INSPECTUR'S NOTES ,. .OR'NER•�UII.DER DHCLARATION , I hereby affirm that I am exemp�fiom ihe Contractor i To: r! � , RNurn�d ' � � • -• . ' � � License law for the followinq' reason.�(Sec. 7031:5) � ' ' �- '� - ' ' " �Approved' pr�siness and Profcisions Codc:Arsy city or counly wbicG , , No. Date No.' <� Daft � � - �''����� ' .' �' �",." '`-. requbes a pernait m ronstruct,a!ler,ina�+rove,denrolisl�, ' , . -� orreQairanyslructure,priorloettissuance,alroreqaires =. � � , , � , . , , . � ' ' tbe appli�an!for sucL permit to Jele a sigaed slatemenl lbat be islirenseJpursuant 10 tbrprorisrons of d�e Cors• _ '�'� '; ;:'t ll ..y:.).)lr •.tl ,. ..� - . ♦ �ractar'aLicenseJ.aw/Cfiapter9l(�ommencingwithSeo- - - " -" - tion7000JoJDr��ision3oJtbeQusinessandPro1essinns i � � '-� - _ ' � � �� ,\Code)nrlhat be rs exempt fherejmm anJ�11 e buisror tbe ..... . __ __'_. . .... . _'.. . _ _. . . � - �---- -- -�- -� - - � - - alfeged exemption.�l ny t�infation n/Seclinn 7031.5 by ' � Raquired � �� � .__- '- '' • . .. . . any ahpJicarttJnra penrci!subjcqts tbc ap/�licant lo a civil � ----._ . . - - � Yes No ---Data PPcdwd- . . ,' !. '.�_ ': .. _ � _��; .C:_).� . Approvals ena[t o not more Iban n e bundred Jallars SSOOJ.J: j or A rov�d 1' Y � I�' � � - - ❑ I,os owner of Ihe property,or my employees with Wa�er Certificate � - � �. , ' _. . _. � . __ . ._. . . _ - - . wages as iheir sole compensation,will do the work,and -- -- - - - � itie structure is not intended or offered for sale(Sec.70d4) Heahh�epbriment . ._ . _ . �. - �-_ � � - - - � � � � � � - � -- -� �-��- , fJusiness and Profesiions Code:.TGe Contraclor's Lrccnre . . Lam Joes not o/�rly tn an ownrr of fro/�erty u�Go builds FireDeparlmeM_. _ , _ _ � - - � - orimproocstberenn,�artJu•Godorssutbu�orkbimtelJor .� - . . . � . � � � ' tbrougb,bis.ou�n enr/�layees.hro��ided lJrs! sucLr r.--� Grading . ' - � ', � Qrovements are xot inlended or ofJered for.sale.- ' . . . .. ; • . bou,•erer,tGe bveldrn,q nr in�fimvement is m(d¢�ilbin one Geologiml � , . ' • , year o/�rompletinn, !bc oa�nrr-6uilder a+i!!harr'tbc � � burdert rJ prni�rng fLu!bc Jid not build or impronc fnr . '. ' ' . .._ ._ ... . ._�.'_ _..._... . Pedestrian Pro�eclion � � � � ' �- � tlie J�urfosc nf saleJ. ' . . _, � (Fence)(CanoPY) . ..�... ���- .-.. ---- --._ � . . -- � --- --. .-. .. ' � I.asownerofihepropeny,�ameaclusivelycontrac- „ � ting wi�h�icensed comraUors to consiruct�he projec�(Sec. ' "' ' "�� ^ -� � - --�� - --� �' ------ - � � 7044)Busincst and Pmfcstinns Cndc:Tl�c Con[ractor's Special Inspeclion-- , �- ------ -" � � - � - (Conc.)(Masonry)(Welding) �� � , _ l.icenselau�doesnotaphfl'toonnwnerof/imrertyu�bn � � '-builJs br irnprot�es tbemon;anJ u�bn conlroctt for sacb Lot Drainoge '� � � �`' ' .� __:_� � projetts u•i1b a cnntrartu'{sf lkenred/�ursuarst !o tbe _ . .• , . _ . . ._ ___ _.- _ ._ -___ . . . " . " " �Contrattnr's Licensc l.auJ. --- .. Pa�king : . . � . . - . ,.'_ _ . _ _._ _ ... _ ...� .._. . . _ . .. .__. _ __ . . .. � . ,. , . � ❑ I am exempl under Sec. ,B.BP.C.for this � . : �.. ,. . � �� 7i"�' ' ._ . _.., ._� _ -_. ... \ �, �'. �,..: p , , reason � . .. . " _ . _ � . _ -� Da�e - • Owner � . . � ' � __._. ___.. .... .�.�.. _. _,. � �Approvols Dcte Inspactor'� gnaturs ' ' '.. , � � . , � � ' , . , � ,� INSPECTOR'S NOTES .` � � Lacation- .. ' � (Seiback 8 Yard � --���� - � � - - - � � Foondotions '� " .� . . . . , � . . . . .�� . Slab . � . � . .',' ' ' Frame . _ ... . . ,. . � ' , . ' ' . . . Energy Insulation ., � / /Y ' .- ''' .. �. . ' ' . � . . � .. _.__ . . . .. _`.... ._ ,_. � _.. _ ,. �.V (,' .�. - .., . .. ,. ., , . . .:. ��..� . ,. .. � lath/Drywall- �n ----�!-- -- - - -----'--- - � . � Interior / --� - -- --� � - -� - - � - .. � , Loth-Exlerior �..J ) � ' �� .'.' ,. . . ' . . ' ___. ._ . . � . .. , . . ._....____._.. __. . ..,. � G .7 . I . .�: . , , .. �. House Number- . _ . �-.._.__..-_._ __'.__-___ ..< : �.. _ ._. _� ... . . . � __..._ .._ _ .. _.._._.._._. . ., .. Correcl 8 Posted ' � 1-� 1� � � . Final- . _. _ _'____ _. _. _ .. • � . . . . _ _ . _ -- . .. _...--- �--_ . ---.. Enler on Front '� �, . � .- . .. � .. . . . . . . .. . . . ' . �J.. � . • . . . . . " . . . . , , .. .`\ .. .... . . . , . . �._ ' .. ' .. . . _. � �� `� t, �` �_ - \ . _ - �\