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Home My WebLink AboutNo Permit NumberT arab -WORKERS' COMPENSATION DECLARATION _ i. rhatl have, certificate of consent to self , APPLICATION C7►R '�t��,�ING. PERMIT h' Y ificate of Workers' Compensation Insurance, msure, or o tart qhs f., ec:' 'Boo, fob. . ord cerHf PFJpVply l3 Jb.� P'fi I on Insurance Co ,. COUNTY OF LOS ANGELES,,., - :,BUILDINGAND SAFETY Poli -N Co n... ,�. - .. ... ... ❑cy o. mpa y Certified, copy is hereby furnished. .._, 'Certified copy is filed with the county building inspec. tion department.. _ - -- Dare ,Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE - (Thls section need not be completed If the permit is for one hundred dollars '($100) or leas.) I certify that in the performance of the work for which this permit Is issued, I shallnot employ any person in any manner so as to become subject to Iha Workers' Compensation Laws. Date- Applicnt - .NOTICE TO APPLICANT: Ifa , after makingthis Certificate of Exemption,. you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- %i;ith .comply with such provisions or: this permit shall be deemed revoked. ". LICENSED CONTRACTORS DECLARATION - I hereby affirm that I am licensed under provisions of Chapter 9 (commencing wNh Section 7000) of Division 3 of the Business and ' Professions Code, and my license is in full force and effect. License Number 43456 Lic. Class -B Contractor 'Ponderosa. Hom1e I am exempt under Sec. - B.&P.C. for this reason _. Date: --Signature - _, _ -: - OWNER -BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): 1, as owner of the property, or my employees with - wages as their sole compensation, will do the work and the structure is not intended or offered for sole (Section 7044, Business and Professions Code). - QI, as owner of the property, am exclusively contracting - with licensed contractors to construct the project (Sec- , _ tion 7044, Business and Professions Code). FOR APPLICANT TO FILL IN ADDRIESSS 21010 Chirping Sparrow Road ASR "S$ 21010 Chirping. Sparrow Road- ! LOCALITY :., Diamond Bar . the performance of the work for which this permit is issued CITY Diamond Bar ZIP NEAREST CROSS ST. - - - - NO. OF BLDGS. ASSESSOR •� ' SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL TRAC29�53-IV BLOCK LOT N0. 72 ONE NOP e -44'-; Permit Fe. 7 SPECIAL CONDITIONS ....,.TEL. ._ ... .._, OWNER — �C)C'J ADDRE552�82 Business tN�O Center Dr DISTRICT .GROUP TYPE FIRE PROCESSED BY ON$T. 'Irvine _ .92715 .._ ..-.. .,. to _I m clTv' zip TEL STATI$TICAL CLASSIFICATIQN_ APT. CONDO.] , ARCHITECT OR ENGINEER Aram` B sS nl an NO.' 52-186 ff ,, C1A55 NO. DWELL. UNITS ADDRESS Westerly ....Newport. B SEWER MAP _ .. j ...:. CONTRACTOR TEL ... NO. 3 — BK. _....�. _.. . - VALIDATION ADDRESS same as above - No. 343455 VALUATION CITY - UCLCASS 21E CONE Sig re foApp nt or Agent .Dote 255 66 TORIES FAMILIES ®s $ DESCRIPTION OF WORK NEW Q 1 �'* 4 Single Family Plan 6 BRX _ _ #}.• • • •'�-�1 ' .. ... ... .. ALTER . . _. ... ._.:.. REPAIR O FINAL ... .. DATE _ .. 1 •3436'- USE OF _... FINAL '... . _...... .... .. .. - EXISTING BLDG. By _ • • 34 6 v APPLICANT TEL. - -. PRINT .. N0. ., - . - 0803-a ADDRESS .. ..'i3 PRESENT BUILDING ADDRESS . -... .._ ...... .. , e 8 4 *a 6 ft . LOCALITY 'TEL r 4 i �t 1�1#•• e e •,,�. MOVING CONTRACTOR ., NO. t _ `','i` 11 �. _. .. .. I r 1, .. I • S S 8, O 0.... ADDR REQUIRED TOTAL SETBACK FROM iST . �.i ( .. _, + _, A • j 8 FS O n V u d CONSTRUCTION LENDING AGENCY 1 herebyaffirm that there is a construction lending agency for SET BACK .-FRONT YARD HWY PROP. LINE J . the performance of the work for which this permit is issued P. L. ,Sec. 3097, Civ. C.). SIDE •� ' I Lender's Name_. Pandiornsa HnmpG' Lenses Address 2082 Business Cntr Dr's Irvine P.C. Feet e -44'-; Permit Fe. 7 f cern that I have read this application and state -the fY pp Issuance Fee 4` above information is correct. I agree to comply with all County investigation Fee- -ofelinances and Statelaws relating to building construction, ' ` + -Tonal Fee .$^jP� �� - ' and he by authorizer presentotives'of this County to entor _ _ - upon r a - enr ed property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE, Sig re foApp nt or Agent .Dote _. ®s D44 NLKrBt1iLD�Ji„[�ECj.ARAT1O\ ,;,.,j hateby,,pffirm Iha' Lam e>xempt:frorgrihe;Contractor.'s CLiicensef� LcyJr(wj• fnc: tker fako it,+g reason. (Sqc,: 3031x5). r'St CZ'0+s% `irofessions Cje.ytfrly'eitly or county which ---requires aperntittacontract, alter,'#mprove, 4rno4lsh, or repair any structulre; prior to its 10fiance, also't�quires -� 3be Applicant, foraucb permit id file a signed staterdent that be is licensed pursuant to the provisions of the Con= tractor's License Lam (Chapter 9) (rommeneing with S ti.. 7000)-ef Division -3 of tbrl"Basimess and ProfesA`oiis Cade) or tbat'be is exeMi bt therefeorii aisd the basisfor Ibe alleged "—pile.: Any W latrorl'ofSection 7031.5 by na4S app lkiintforapenititsitirfetuirbe$pplicgiti�oaesti) penalty of not more than Ji a tiut(dred dollars ($T 001Jr g..! "0'. I, as owner-of7the propec;yi or my employees with •_ ,"rages asdheirso)exompensation,llwill do the,wonk,-and a iheiwuciwe ls,&l Intended oruffered for satelEem. 7044) Business and Profanions Code: The Contractor's License iaw.doesunt apply to an-ou'npr' of property.nobo butlA* t or improves tbereon, and ieho 4loes'sucb work himmiy''or 'tbrougb 'his” arc* employees provided tbas'sucb°4ni- pronenr6 ft rel nbt intended or offpred fo►'sa1e.'If� however, the building or improvement is sot'd toithin one year of .completion, tbe,owner-bui4Arywill have tI. t burden of proving tb f be did not build or improve fpr r' ❑ t: i, asnv3ner'af the property, am eXd usi"vely tvnfrac- ting with licensed contractors to c erect the project (Sec. _�lZ44I::Eusincss'e d Profcssioh) ' 'Tbei:Cotntractark License Law does not apply to an u ne"f property who ___build., nr, ,nproves til e!re�n, .p`n u>bo tontracirfnr:sueb- projects witb a cortractor(s) licertsed pursuant to rthe _.. p . . -...`. _._. ._. �- (am a em t under Sec B 8P &P.C.C. for this Date Owner INSPECTOR'S NOTES I<.l; �l 01-iT`l'11r"f',1 , ° AANS TO APPLICANT &: n' a 6 '; INSWTOVS NOTES To: .z.. _ Ra�turned. t - ?Approved I ^� a^"ce' - - n'' _.. .�4fe�.,-� •. - ..,. :.�, ... _:..� ..:, .: ' �.; ..... . r•r ,-:: "gin ,' I e}i Ras IvYes .. Appra�afaOpp} No ns;Ap !Pvsd 'f r- -do, 14 �.. �_ �.. ��: .._ �.y__..7 `_);_ (, 1 tom _ V I VU 11 Fuc Departmeht ,..�.t u,, ,, , t`,7 G. .'..a::, _.I - Grading Geological Pedestrian Protection (Fence)(Conopy) `�: _ ��' .+ `'1 .. ..__�_ '.?. Special Inspection- l (Conc.).(Masonry)(Welding) w ': •,. ,, a0 l.. Lot Drainage :, .,., la Parking - Approvals Date Inspector's Signature Location— (Setback 8 Yards) nom, Foundations Slab Frame ` I :,•- v Energy Insulation 3a 1 Lath/ rywa I— + : ' Interior Lath—Exterior House Number— Correct 8 Posted Final— s,. '-t` 't• 'i:. -Enter an Front D44 NLKrBt1iLD�Ji„[�ECj.ARAT1O\ ,;,.,j hateby,,pffirm Iha' Lam e>xempt:frorgrihe;Contractor.'s CLiicensef� LcyJr(wj• fnc: tker fako it,+g reason. (Sqc,: 3031x5). r'St CZ'0+s% `irofessions Cje.ytfrly'eitly or county which ---requires aperntittacontract, alter,'#mprove, 4rno4lsh, or repair any structulre; prior to its 10fiance, also't�quires -� 3be Applicant, foraucb permit id file a signed staterdent that be is licensed pursuant to the provisions of the Con= tractor's License Lam (Chapter 9) (rommeneing with S ti.. 7000)-ef Division -3 of tbrl"Basimess and ProfesA`oiis Cade) or tbat'be is exeMi bt therefeorii aisd the basisfor Ibe alleged "—pile.: Any W latrorl'ofSection 7031.5 by na4S app lkiintforapenititsitirfetuirbe$pplicgiti�oaesti) penalty of not more than Ji a tiut(dred dollars ($T 001Jr g..! "0'. I, as owner-of7the propec;yi or my employees with •_ ,"rages asdheirso)exompensation,llwill do the,wonk,-and a iheiwuciwe ls,&l Intended oruffered for satelEem. 7044) Business and Profanions Code: The Contractor's License iaw.doesunt apply to an-ou'npr' of property.nobo butlA* t or improves tbereon, and ieho 4loes'sucb work himmiy''or 'tbrougb 'his” arc* employees provided tbas'sucb°4ni- pronenr6 ft rel nbt intended or offpred fo►'sa1e.'If� however, the building or improvement is sot'd toithin one year of .completion, tbe,owner-bui4Arywill have tI. t burden of proving tb f be did not build or improve fpr r' ❑ t: i, asnv3ner'af the property, am eXd usi"vely tvnfrac- ting with licensed contractors to c erect the project (Sec. _�lZ44I::Eusincss'e d Profcssioh) ' 'Tbei:Cotntractark License Law does not apply to an u ne"f property who ___build., nr, ,nproves til e!re�n, .p`n u>bo tontracirfnr:sueb- projects witb a cortractor(s) licertsed pursuant to rthe _.. p . . -...`. _._. ._. �- (am a em t under Sec B 8P &P.C.C. for this Date Owner INSPECTOR'S NOTES I<.l; �l 01-iT`l'11r"f',1 ,