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HomeMy WebLinkAbout1772A 1773A �----_-. - _. . - - -- -- - --. ..__ . :_.�. _.._._ -- - - --- _ -- . WORKERS'COMPENSATION�DECLARATION _ � " ��� � -" - �"��� . ' .' ".._. ..__._'_.. .' _ �" . _ � . _ t�hereby 6ffirm ihat i have a certificate o��o�,e��,o,e�F APPLICATIDN FOR�.,-BUILDING- PERMIT� -������ insure,or a certificate of Workers'Compensa�ion Insvronce, , _ . • or o ce�tiiied copy thereoi(Sec.3800,1o6.'C.) ' � " COUNTY OF LOS ANGELES • BUILDING AND SAFETY � PolicyN�W•.�?4ddl.,pon��c_ FmployPrs ----- � Ce�rified copy is he�eby fumished. FOR APPUCANT TO FILL I qpoREu 2 2�y�' �,• �7yv..�(✓��-rQ� � ,�Certified wpy is filed wifh Ihe tounfy bui ing Inspe BUILDING � (lL � : ;, fion departmenf.� ADDRESS �/��' Dote GZ� �Appiicant �� C�iv Diamond Bar z,r 91765 ��„i,t� � � � � CERTIFICATEOF�EXEMPTIO OM W KEHS' " �--���� �- ��- � � �� -�� � -���NO.OFBlDGS. �, NEARESi •---I ....,_ ; ..._... . ..._..._,._�._.._..__._._.. � - ' - ��COMPENSATION�I URANCE-'�'`� ��� SiZEOFL07 NOwONIOT �- ' CR05SST.. - ' (ihis section need nol be tomple ed if Ihe permit is fo�one --�- - -� - � � -'-- - �--� � --- � p � �$SOR „ .: - �--" -�'^•.� ' -bundred doliars(�100)or less.) .- . 7RAR BLOCK lOi NO. O Mqp gpOK �FAGE PARCEI . � _iE4 ... , USEhZONE OP .. . . .. , _...._ . . ' " _ I cerfify�hor in the performance of Iha wa k for which�his OwhlE N lS,d� SFECin� - �r� '0. permit is issued,�1 shall not employ any parson m ony ma ner ._.__ . �- - --�- � -� � �- � ADORESSP•O• BOX-3SO --'-� --' �---- '- CONDITIDNS so os'�o become subject to-i�e Workers'Compensation Laws. ��N �� .. . . .. ,,, . . ,- ,,;�. .,� .. � .._ _.. . . .. .._ . . ._ _ _ _ V .— o,r_ Brea, CA ___. __. nr 92621 , Date � � APPlicant --- ...�- ' " � '. a �TICE TO APPLICANT.�If, oher mak7ng this'Certificote of l ARCHITECT O TE�� _ _DISTRICT GROUP. ttFE. _ ___ FIRE .PROCESSE�BY. �O .rmpiion,�y0u shouid bemme subject to ihe�Workers' " - ENGWEER � O. Cpry57; ZONE V Compensation provisions of Ihe la6or Code;you musi fo�lh- qDDRE55].O8G1 S. Paramount AVO. DOW{lev � ���v �� � '- 'y wifh Comply w�fh'a�th prpvisions or�.this'perm�t sholl be'-- --� TEL. � S7ATISTICAtClASS��TION APi. CONDO. deemed revoked.., � � � •�� :� � ' � �'. ..� CONTRAC70R NO. �' ,� -- --�-� — Z LICENSEDCONTRACTORSDECLARATION 't ,�' --- - -����-� - ' �' '-�-' �-��-� -" 'LiC.-�- - �- --� " �SSNO. � �WELL.UNi75� I hereby oHirm thpl I om licensed onder provisions of Chopter 9 ADDRE55 ND. ��R�P � , (commencing wi�h Section 7W0j of Divieiart 3 ai the Business and ._._. _. ._ .._.._ _. _.. . . . .._'. liC. -.-.. . ---� ' � � Professlons Code,and my license is in full force and eflect. CIN CLA55 ' '�'"BK ��-�"`�;� � �- � ,�- - VAU�ATfON - � � . .- . . . . . �. SQ.FT.._._.._ N0.9�___._.... NO.OF _. _ ... CHECK � licenseNumber$4G4$ '�� ' Gt.Claes Bl '� sae STORIES vauiues oNe yqtu noN � . ;- ='1�7 2 A ; � • :. �: • - oescaiarioNOFwouK New sin le famil7 NEW s �'�� � � �� Conlrador � � Date I � •2} � � width attached- ara es.- A°o ►' � i om exempt onder Sec. "�" ' auER � � � ., : I •45�C7 B.BP.C.for this reason . REva�R . S-_._: .. . .,.. .-� . _.. __ . ._ ._ _ . . .._ . � useoF �C:6dp7� .._ . _ . . ..Dote:-� � EXISTING BIOG. DEMOI , .... .. . . . _ Signature �..... �� " ' AGPpCANT TE6 FINAL . 8 4.�s��i 6 . NER-BUIL ER DECLARATION . . .PRwT N . _ -DATE -•-� �- --. .."- '---.....___ ._.- ._ . -1 hereby affirm o11 am exempt Irom the Controclor's Licanse ADORfSSP.O. BOX 350 Brea C,EI 92621 FINAL jy' � �� � � Law for Ihe fo owing reason(SetNon 7031.5,Business and �_;.� i r . 'ProfessionsCode):... _ .._.._. . ._.__._.. . -... . BUUDING 8Y � ` � . 1°i 1 !7�.�R � � . �_.1,os owner of Ihe property,or my emplayees wilh _ __ ADDR4SS _ � .. . . . _ ... . . . woges as thev sole compensat�on,wJl do the work ond . , �. fr o:s,• t� , . ihe strucWre is not in�ended or afiered for sale(Seciion �ODU7Y � . _ • � '���, � 7044,Business and Professions Code).�._. . - ' "' - MOVING�� - .._ . ..._ __. ,_.�i __. ._._. --� . . . .. � I,as owner of�he property,am excluzively Contracting CONTRACTOR . . . N� . . , ' - � • �7 7.�� with licensed coNrocbrs lo tonstrutl tha o'ec� Sec- -�- - `-�. . .-.- . .. . . . ..._. .._ . .._ _. '� -.�.�• . . tion 7644,Businesz pnd Profes5ion5 Code}P, I ( ADDRE55 � ° �7 7•O O�', _". . REOUIRED. - iOTAt SETBA --.- .. -_ "--� ..• -'- ' ' " --' �" - -CONSTRUCTION LENDING AGENCY-`�� � SE7 BACK rAR� F�WY PROP.LINE wioiH� , , � . U G.�S.-ES b,- �� 1 hereby oftirm Ihat Ihere Is a consrruc�ion lending ogency for fRONi � : >� � " � - � �he performonce oi the work for which ihis permit is issued.... p.t. . . _._.. ....._ _. .._. _._. . _ .. . .._ . _... _ , . '.__ . __.,.'.- -.-_.. _ ._ (Sac.3097,Civ.C.). SiDE ' ___ . . . -._. . _ . __"_".___._ ..__... P.L . . ._ _ ...__._ .._ ..._. . . �. .'_' __....'_" ''. . ...._.'. . :.._.....; Lender's Name '1�?nn�, �� � � � �( �.. O � WMA Ref.N . i .... ... . . . . .. . __.- .. ._ .._ .. " "' P.G Fee E'�1�.S� ' ' Permli Fee' . ' ' ." " . .. lender a Address �j � �� , . '� .I cerliiy tbaf 1 have reod this application and slafe that Ihe . -. -- .....__ _._ .. _. ...- ���ance Fee- -S -...- .. LOMA P/C M . � . '-'�,'.� . ...... ... ... . _. . _ . _.. obove informotion is mrreU.1 agrea ro comply witb o0 Counly Invastiga�ian Fee "'( ' .� ... _ IDMA Pe�m'#- � __....,._.__. . :.'..._._.__ _ . ordinancee and Stat laws reloting to buiiding oonstruttion, __... - - - . - ... ._- .._, taal Fee� -� '-'�'--�� - � ��� � . ond here aulhori representayY ies of Ihu CouNy to enter . upon�h abov mioned pr�rty for inspecrion purposes. gC ._.. ... .__ ___. , ____. __.._. . . _.__� . , .. . _ .. . /.�... . _ _. ry(uJ... .. ._ _. ._ _... .. _�t7.7 - _ . ' ��Q SFE REYERSE FOR EXYLANATORY tRNGU^A�GE � ` . . Signor�rolAppLcantorA9en� .._ . . _'_'.�re ._... . .__....._ .. ...._._.. ._. -. _._ -- '!'�rl..{� '�...._'__.'_ ' ", '__. ._ _" . . ._ . ... '�ri / . � PLANS TO APPLICANT ' ' � �-1NSPECTOR'S NOTES .-O{YNCR•DUi1.U�n u.:.............. 1 hereby affirm Ihot I om exempf from the Controcfor i • � "� ' � ��` Li�erise law for ihe'following redson.� (Sec:��7031.5} -Tox , ,� � , � R•rurnsd; ,. , . .. , . . ,. . . . . - Ayprovod � 'QusinessmJPr%ssionsCode:.Anyrityor.eounryu�Licl� . No. Dafe ��. No. ���-`-OaM.. ..;' �. �. �.�'. � �;-.�i. ": l'";:,,t'.-,"': requiresapermitlornnstruct,altcr,improve,demalisb, . . _._oireyairanyslruclure,priortoittissuanre,alsorequirei � � �,��r.; . � � . tbe appficqn(for aucl permil fn file a aigned tlalement " � � tGa�be.is lirensrdpursuant�to tbryroe�isions of!hc Cnn- . � � �� ..�.�� F'�. �' �� 1'.�.��(" ' �*1 trartor's'�I,irrnse�4aa�(Cbapte�91(coi�rorencin,qu•itl�5ec- , - � `�=1ion 7000J oJUirisinn 3 ajtbr I3uainets anJYrofessions , ;_. . ' . , � . .. . , ". �' . .' "Code)or.tl'a!/i`iscxenp!lbcrefrmnaxd7$cbmiif rtJe ___.__._. ._._ ..__._ ___. . __ . ._. .. ..____. '_._ _ . _ . ._.. _ __� _._._ . . p7leged exen�f/ion.'Any piolation�nJScclion 703l.5 by � _ kequtr�d DaroR�eoiwd � � .._. ��'., . - . _ _ ... . . . ���.�.. � anVapflitantforapermitsabjetestbe�upplitanftoacivi! }� 'App�oJals"-� � ,,Yas No � , � . ennf( o not mnre 7Lan ve bunJrrd dopurs(5500.: - , . . . or Approv�d , . .. �� ... f Y f f l�. , . . .'_�..._._ .'' _. . .. . ��;./.'_. ._;� . . . � - --- ---- � - ❑ I,as owner o(Ihe properly,or my omployees with Wofer CeHificate � '.�• , ��� � � . • . _ . -:-_ .� ..___ _ .. . _:�,_ ,. , , �� wages as iheir sole compensnlion,will do the work,ond ' ��--------- -- -- �- - - � - �' '� - �, �the structure'is not iMended or offered for sole($ec.7044) �, HealthDeporlment _._ _. '��� .� .'-.. . ._ . ... ._ _._ `___._.__._. _ '.__� . ..�Dusinessand7'rofessioesCodeiTGeCoxirarmr'sLi�ense � � -�� , . ' l.aw Joes nut u/�fly!o ux oumer n//�roperty u�bo buifJs ,� Fire_Departmem .__�_..._.... .... . _, _. . ... . . . � .. ..... .. . .. ...... . .... --- �- �---�-- _Aor m�proncs tGcreon.and u�ho dacs such u�ork bin�se J,�r . . . . , - �- � ,. ab�ougL !ii ou�n��employees,froi�Idrd tfiat�su�L i� Greding � � � ,-pmuements,•nre nne in�ended�or �Jfered f r sale.' �`" � � � ' . � .. . .P�.Gnu�et�cr,tGebuildinForirnprovcmentissolJuv#�inone � Geblogical-:" � . -�- . . . � .- --��Ycar oJ ron�pletion.'�be�oumer-builJcr utill.baoe t1e � burJen oJ proning!1 at Gr JiJ not br�iGJ nr improvr Jnr ; , ' _.. _ . .. .�_._._..__'__... ___.. ..".:. . . Pedestrion Profecfion � "" - " � fbe(�ssrfnse/sqfe% . . . -. � �� (Fente)�ConoPY) � �� .� . .. � �. �., .. -. -. .-: -----. .-. ...- --.. ..--�. . .:. ❑ 'I,�nsowrierofthepropeny.ame�dusivelymntroc- � , �ting wi�h licedsed controaon ro conslrun the projeU(Sec. ' " ' ` � � - � �-- ��-�-- �--- --�r--- � �-�-- - 7044j'Qusiness and Prnfessinns CoJer T!e Contrac[nr's SpeciallnspeUion""- - - - � f,icenseLa�nJorsnota 1 Manoumero r er(_ ub . .. . . � .. ,. . (Conc.)(Masonry)(Welding) , .. . .. • .,�� . . .. � . hP.l' IP°P Y„_'� . . ._- _. ._. __._ .. .__..._. . __ --�6urfJsmimhmnestGcrcnn.-andu�Goronhadsforsu�� ' lot Droinage . � � .:�� .. �. . . � � .. � pr jects u�itG a tnn�rac�nr(sJ firenseJ pursuant to tfe . - ___._ .�..___ __..._-._.. .. . _ • � �i �. -��-Canera�Mr's�f.ioensc LouJr--- ------- "�'�. 9 - . , . .. _.._ . ._-___.�..____...... .. . . _.___. . _ _. ____. _. _ .. �i Parkin .. � ❑ I am exempt onder$ec,'.. .. .. ,8.8P.C.for�IFiis . ..., / '._"__"_"�" ' __"' ._-. .. c7 J��1�-�- .' � . . �� reason � �. � . .. . . � . ' r. '.�.. �... . .- . .�. Da�e '- � �- � `� Owner -�-�-� - . • . � , ._�'___'_. _ ..� _ � Approvols Dafe Inspoctor's gnofuro . . �- �_ - - �� .. ' i,. . - INSPECTOR'$NOTES ' . . Locatloo- �Setbock 8 Yar " � � • ' � Foundalions � A , . � ; �,�� �� , ,.. - . . . // ' "."_"__ _.._".'___.... ___'.. __._.. '....:_�_ .�;.�.. ;..�.^' , Slab /' �^ ; __: . _ ____ _ '_ '_ . . � i.;.. .,. .,...�.. .. ..,,, "' Fmme �.�(��.- � (.� - . . �� - . . . . . � - . .. . . .. . . ._ ... . Energy Insulotion �� /�'� -_:. .__. .-..__-_._ . � � � _...., ,. �.: ,:.� • . , L ___ ___.._..._ _ . . , , la�h/Drywoll- , . ....._. _. _._ .__._... _�. ._..�. , . �..,. � . .. Interior --�" - - . .. . , . lalh-Exterior .._�... " -",:. '. :- �, ��:.� ' ' ____.__' __. ._.__'___ .. . . . .. ' . L !. . t � , ... . � i � � ,_ HouseNumber-- ' --'.•. .•. .�_�- .._...._ .�.._._ . . .. , , . . ._—.____'__ . Corrett 8 Pos�ed - � _ . I . .__.___.________ __.__ __... _ . � ,� Finol- _ _ .__.._ . .. _ _. _. .. . .__.__.. - . , _. ... __ . ____. _. _-_...__ ._ EmeronFroM � �1..� � '. � . . , . . �.. � .� , .� �..., . . � .. . �� .. . .� . �:�-�'`�` ���`" ;'�•��•