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HomeMy WebLinkAbout1786A 1787A (10) . _ __ .._._. __._ __ . ._/, /'q� ._......__ � . ..... _ _ .._ ..._ � _. . __ _ .__. ___ . __-, � ' WORKERS'COMPENSATION DECLARATION , , '"` '.�, "'�(Q I.J�J �� � ,' ..,- �� ,: , . . ,.. . __..._.____. ...__. � i .. .. . .. . _ � I hereb'y affirm that I have u certificale ot consent to,e�{ APPLICATION�FQR BUILDING �PERMIT�� insure,or o cerrifica�e af Workers'Compensolion Insurante, . _.._._... �...... • or o certified copy�hereof(Sec.3800,tob.C.) ',^ � COUNTY OF LOS ANGELES i 'BUILDING AND SAFETY PoliryNoP�ICGZ�GQ4MP�^Y �pSC Fm�1p�JnrS-__.- . _ ,.., . _ . . . _ .. . .. . � Cerrified copy is here6y furNshed. ' FOR APPLICANT TO FI L IN euitoiN� �,/�� �. �, [j��. A�DRESS 7' a�'✓��^yC, (� Certified copy is filed wilh the county 6uildi inspec- BUUDING � �.Q � i `� , fion depaAmenl." _ AD�RE55 ,Y � . i . , _.. . .. ..'_ . .. ..._ . . _ ' "_'__. ' " " oa+a�z�Applimnt CITV Diamond Bar z�P 91765 �a,,�,,,. i CERiIFICATE OF EXEMPTION M WO KERS"'� '""--- ��"---"-- --- "--�-�-� -�--'�NO.OF BIDGS'--- -�- - NEAREST-�-- ___.._.. _ .._. ._._. _...._.___.. .... COMPENSATION I URANCE'' � � 5¢E OF LO7 NOW ON IOrO- CRO55 5T., (ihis secfion nead not be tompleled if Ihe permit is for�one --���-- -��- i -�------ -�--- --�--Q ----' �S:SSOR '�. � - '-� , � ' hundred dollars(5100)or less.� - . . , ' izaci �Q HLOCK LOT NO. �f MqP BOqC' � �FAGE PARCEL TEL. ZONE �P 1 I tertify thot in ihe performante of the work(or which this ��'N v � - �Q �� 1��' � � � �} �permil is issued,I shall not employ any perzon in any manner ._ --. ADDRE56•0.-Box-350 -�-�- � ,,��- sveaA��-��-��- -� � �� - -•�-�� -- - - � a . .................. . � CONDITIONS �,O so as ro became suhject fo the Workers'Compensation'Laws, � V ' � _.._. . _..._ _ . ,,. ., . - .., __ aTv Brea CA-- -- - -zia_92621 _ _ .._ - 'm Dote Applicant 9 -- ARCHITECT R , TEI. _ ; D �� roNST.� _ Z� � O /-��TICE TO APPLICANT: If, afler makin this�Certlficole of OtSTRiCT__ GROUP ivve _ Flke. PROCesSe�eY... .F ! " . ENG�NEER FI NO. ] ,_,.,`. ,fmption;'you should become subject-to the-Workers' / , V �ompensation provisions of fhe Labor Cade,yoV must forlF- qDDRE5;lO8�F1 S. Paramount AV2. DOWI]e �� � - - -a with:comply with such pravisions.ar th�s.permu shali be --��- � � '�n deemed revoked. ' ', � ,-.; � � TE�• � STATISTICAL CU1551FICATION ; APT. CONDO, � �Z � • � CONTRACTOR NO. � � r UCENSED CONTRACTORS DECLARATION• �. �� � � ..'__. .__..__... ...__.. _'_."_' LIC:_...' "_"' QA55 NO. N DWELL.UNITS� . I hereby offirm that I am licensed�nder provisions of Chaprer 9 nDDrtE55 NO. I (commencing wifh Section 7000)of Division 3 of Ihe Business and _._._. ��� SEwER MA7� � �� � Y. , .,_ ." _ '__ ..'.__..__ .._. .___.—.__ , ', nd effecL CiTv Cta55 • - '... _-. ... .._.- . . - -- 'VALIDATION - Professions Code,and m license is in fuil force o BK -� 50.F7,_._ _ NO.OF . NO.OF.. _ CHECK.� ' � � . , litense Num6er 54Ff�+R �Lia CI6ss R� SIZE STORIES FAMILIES ^-- ONE . �' , .-,.� ' � . � � VALUAT ON ' ' � � � � -� '- �� '•�'�� - -- DESCRIPTIONOF WORKN@W �Slil le �famil - NEW- -❑ ��/ �� - :1 7�&6 q CoMrotlar ' Dole s ��W��v � �I am eaempt onder Sec. �- - Wlth SttHC}12C1 g3rdgE. __ __ ADo O , {t o . . .2,1 ,, • . . ., , AITER B.BP.C.for fhis reason "__ REPAIR �'S -- - ' . .. . . . - I •�4 1 b 8 0 " � � ._ __' _ ._ . . Da� . ... � USE OF DEMOL . ��" . . .� - : ' .� + ._ ..._ EXISTING BLDG. _ • e � 416.80� Signalore '--" -' APPLICJNT TEL ' F�NAI ' PRINT M.J. Brock & Sons No529-8170 O ER-BUIL R DECIARATION ._-_. ._ ._ . . . . . ' .-UAT l� — -� . ... . -Q 0,rj�-�C 6'-- - I hereby affirm t i I am exempi from�be Conhauor's license qookess P.O. BOX 350 Brea CA 92621 � ' � � ' Low for Ihe following�reason(Section 7031.5,0osiness and FINAI � ' � ..Professions CodeJ:. . . _,...._..._"._"_.'._._ .__ ... N - By- . . . ... . . . - - . -' - r.� BUILDING ' . �_ 1, as owner of Ihe propeny, ar my employees wirh ,., qDDaE55. { _ � �' I ' _�..__ ' _ „ - wages as Iheir sole compensation,will do ihe work and � �� 1 � � �-�� �� Ihe siructure is nof infended or offe�ed for sale(Settion ��`��TM � ' 1 � ' �t t � ' � - '� 7044,Business and Professions Code).��-----�� - - -� - MOwNG ..- -..... ..--._..__._ '.-.. -�i. ' --- .. .. . _ . ..--.- : --��.7�.7.{� �; (� COMRACTOR NO. � � * � _ . 1,as owner af the property,am exdusively coNra[ting ' ��,` : ��.e a • • • � � .L�� with licensed coMradors lo construct the project-(Sec• ' - '� --`--"-- - -'-- --� �--� - �- - � --'-• ..._. ... . tion 7044,Business and Professions Code�. AODae55 ' � '�, � . • aeouiueo .. rorni seren K ' ' � °�1 1,0 0' , ' � -� CONSiRUCTION IENDING AGENCY SET OACK �YARD" F�NN� -- pppp,pNE W�o7H - - � � I hereby ofiirm Ihot there is a tanslruction lending agency for FRONi � . � � ' � ' • � �� �.���'� � ihe erformante of thework for which thie ermiris-issued �- - --P.`.-�- � �� �- -��-----��-� - - � � - --- � - -- � --- �- - � �-- ' ", (SecP3097,Civ.C.). P SiDE ' . ..�_ C Q�fj-,�6� . I . _ .. . .. '� .. . . ..._ .. . ._. . .. _..___ Lender's Nama None �� �- -�- � ; _ .� ; . , '- .. - -.. .. .' -'-- P.GFeeE� :8�"� PermltFee OO.S IDMARet.N . � ..._. . . _ _. ._ .. . ..'___ .. ' Lender's Address S� ; �:'�- .-I cerrify that I have read tbis appliwfion and stota-that the �--- .-..----.._._. - __--_. �„�a„ce Fe�� � '--� "---- iDana.PiG M .. ...-.-.- . .-- ' �- - .�-�.--� -- o6ove information is correct.1 agree la comply wilh all Counfy Investigotion Fee � .ordinances ond Stafe lows rel ing 10 building constrvction, Toral Fee�- � ' �� �� -LOMA-Perm:M-� � - . __._ " "' '. _ .'"'_ '_ _._ ' _'._ ... _ . . . .'._ ' and here au�horize repre tafives of t 's Counfy to enter upon th above- enti properfy fo specfion purposei. _ ' _'_ _ �s'. '_._ _ _.__. �`. . . . . .� .. .. _.._'__ ' . . . _ .. ._ .. . _ .. . . __ ���� SFE REYERSE FOR EXPLANATORY IANGUAGE ..� SignaturaofAp mntorAgant .. .. -- - 'pote-- -�- - - - -�- -� ' —_ . � _ . . _. ._ _ . . _ .._.__ ._ _ _'. p - ____. . . _.__. . .. _.'... '. .' .'.__ .i 71r. �. PLANS TO APPLICANT ` �_��JIySPECTOR'S NOTES OWNER-�llILDER DI'sCLARATION I hereb�y offirrri ihat I qm exempt from Ihe ConfroUor's- � � �' ' • � ' Licenie��Law for Ihe�following reason: -(Sec. 7031.5) To: ` . . Retum�d' �" � . . ,.., . . , . " ' ' ' �� "'Approved "Business�aaJProfrssionsCodciAnycityorcoantyu�hicG . No. Date No. ' ��Da��.�� � � � ".�. _.�., .._:`.`I;`2..,,. reguires a permit to conslruct,alter,improre,Jemnfisl, ..�_-or re/iair any slruct�err,J�rior tn its issuance,also requ ires ' . - ' ' . ���� . . . . tGe applicanf J r sacG permit tn file a rigneJ staeemcnt �� - . �� �. �� . . � ,t: �., . � t� , � �"j��j. f .��(. �.�� � trarfo,r'sl,icenselnu�(CGa�ler9ll�ommrncinPurit!$c- � , . . !�'.� / 'J,�i.+-� -. :1.. _. .. ,, .� - -- -- " - �"" � - �"" - '�.tion]000/nfDivision 3 n !be Uusiness anJ, rufessMns . ;� ��. . ,. . _ .. _ ; �� .� �"' < . -, ' � ' �� CndeJor tbat Ge is exemp!tbcrefmm n'yd tbc bnsu�ortLe .•. �.- __ . . . . .__ _ ___. _ .� .. _..._...__._..;._'__'___ '_.___ .. ._.___._ _.. .. .. .. ... -- .. �. a!leged exrm/rfion.�{lnp vin(alinn of Settion 7031.5 b�� Raquirad DafaRoeoiwd : .-_ _.�- . ._-' . ___ _ � ... anyapplicantJirafcrntitsu6jettsfbcapJ�litantMatiui! I'� --� Approvali- -� � , � . ' ' , cnaf{�o na0 nrore lban ioc bundred Jollars tS00.J: � � - Yvs No or Approvod y � .J` � ..P 1 J J ( � -----' - ---—� ---- �— � - �-`-� �� ❑ I,as owner of the property,or my employees with Waier Cer�ifica�e � �- '. ' ���� ��,, "�� �- . , .. � wages as their sole compensa�ion,will do�he work,and ; . - ._. . .. ` .. . `.'•�• ��---- �--'-- -� ����--`.—.� .. - - .. -- .• •...._�.,- ..the strucwre is nat intended or oftered for�sale{Sec.7044) HealthDepartmen� ... _ � �',-_;�� �. ' �' '�•�� .__- __.__..- _ -_ _.. . ...__.___ '. __..-.. ButrnessanJProfessiontCoderTheCnntractor'sl.iceRse �� � - �� � -- � � , ,, l,am�dors not apffy to an ou�ner of praperty u�bo builJs FireDepanment . . ... ._ _. -- --�--- �- � -- ---��- -- -� - � � � ---�� nrinrprooesllcrcon,and��hoJocssurba�arkl���,ucljor ', � - �� � � � � . - 1/rougG.!is nun�einployces,.prorided tb61 sucb.ir�. Groding , ' � ., prurenrents.are no1 inlended ar offered for saJa, " - � �' � -. c,.bmveecr,tbeburfJingorrmpranementissoldu�itGinvnr ,� �. . . , ��.:i ,.' :� . ; ., . .� Geologic6l-- -'� � ' -- � . . . . .-- ' � '� ' - . . , � ,ycar of rompfrtion, tGc owner-buildcr u�il1 bare !Ge � burden of J�rnving lbat be Jiit nol builJ or improne fiir , � . . ___.. _.__. _.'.'-...._' ____ _...':s: . .. ._'___. Pedestrion Gmte�rion.-'...- �.. ' . . � - � � - -- tbe purpnsc of salel. '� . . . ' ' � � �' � 'I;os owner of the ro ert om exclusivel comroc- (Fence)(CanoPY) . �,. . . . _.______ .._._.__.___ _._______ �-..__ . ���''lin w .. � . P P Y: Y ., . ' g❑ itKlicensed conirauors lo conshuc�the projetl�Sec. Speciol Inspection�- ' .. ----"-��--"-"�� � � ' � - ' 7044)�Ifusiness and Professinnt Code:Tbe Cntttrattnr's (Conc.)(MasonrY)(WeldingJ " . �. .. . �� .' '__ �__ '_' �'., � ..�•.� LrcensrLa�oJoesnntapplYtoanou�neroJ/rropertY,u�bo ..__ .,_ . _ .. _ __._ _ . ___.. . .___. .-.--baifJ:br imJ.roe�ei tGrrenn,and u�bo contracts for s'ucl Lot Drainage . '-� , , .__ _.____. . _.. _ . _._ . . ._. /nojerti u�ifb a rnntraclnr{sJ firensed nursaant !o !be •. .; � . , .. : .._., � • � � -� -Cnntroctor'sLirenscl.auf. - ---- -- ---- � Porking . - _ _ . � . .__..._. ._. _�. _ _ _�_. . _ . __..� ._ .' . _ _'___. . ..;. .,� . .. ,.; , , t] I am ezempt under$ec. ,8.8P.C.for this ��( reason )� �� - --1e�. C " . ' :�- . . . _ . ___�_____ .. . -_ . -� . . - . _ .� . ... . . Date . Owner _` �, 1. , �� ..._ .�. � ,. -. ... ��� � Approvals Date - �- Inspector s Sig tur6 � � . � ,., ��� � • • - �. INSPECTOR'S NOTES' � Lomrion— . � .. . (Set6ock 8 Yords) � � � , �� '� � , Foundaiions � , ` � � .. . �.�.• . �;, �- � ". . . . '. � Slab / , � . .:. ., '- � . . . . .. _..._ ..-- - -- -- � ---- � ------- - - ! �::,. . r� :�. -- Frame �? . .. . . _ .. . . ., . .,h�, . . _ . - � . . � .�. Energylnsulalion A . .__ ._�.-.._-_. _._..,._..__ _�.�__.j_......_.-- .-( .� ' . .,�.. , . � , , , . . . . '/ i I I Lath/Drywoll— �7,�_�' , . ._..--."'. '--.__—._.._._--_..._------ -- -.-- --. -� - � . .. � Inrerior ' !� ��P� - -----_ _ _._. .' . � . . . . . . �. � .... . .. . . . . . . . .. . .�. .. . --_____..___. . _..._ __- . .-� ` lath--Exterior , . - � , - � - � ' r . .: . ,..�� rl_ � J, House Numbei— ' � , ----_..._•_ ' -t i .-.. '_- -._r.�--_...--.- , . . _"__ _.._ .. � Correct 8 Posted " - . r;�:; ! . __ ..__._._ ___..__ _.___. . ..�.�� � :� >.t ' Final— -. . . �. , .___ ._ ._ . _ - Enrer on Front _ ' -.`_ ..._ . ----��-- .-,- - �-� - . �...� . . . - . . .� � .. - ,. .... .. .� i'.. ..�'.>�- - .. , � ,.. .. , ` �... , , - - :�_- - ,`:`.- - `\.��� �.