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Home My WebLink AboutNo Permit Number (79)WORKERS' COMPENSATION DECLARATION T I hereby affirm that 1 haver certificate of consent to self , APPLICATION C7►R '�t��,�ING. 'PERNI�t Insure,' or a certificate of Workers' Compensation Insurance, - oracertif ec.38D0, b. - COUNTY OF LOS ANGELES- :;BUILDING ANDSAFETY 1�� 4Tsr53on insurance Co Poli -N ,.. - ... ❑cy 0. 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 - - (Thissection need not be completed if the permit 1s 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 Lha Workers' Compensation Laws. Date- Applicant - .NOTICE TO APPLICANT: If, after making this, 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 HomE;a 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--- AooRESSS 21010 Chirping Sparrow Road ADDR "ss 21010 Chirping. Sparrow Road- ! LOCALITY :., Diamond Bar . the performance of the work for which this permit is issued CITY Diamond IP NEAREST CROSS ST. - �e ilt - - - NO. OF BLDGS. ASSESSOR , SIZE OF LOT NOW ON l07 MAP BOOK PAGE PARCEL TRAC29053-iii ISLOCK I LOT N0. 72 ?NE P eW-4• G Pe mit Fee CONDITKN.IS , . . ._ ..., TE"An-2 OWNER NO — ADDREss2082 Business Center Dr DISTRICT .GROUP TYPE FIRE PROCESSED BY �N�. 'Irvine _ .92715 10t m clTv' zIP TEL STATISTICAL CLASSIFICATION_ APT. CONDO.] , ARCHITECT OR ENGINEER AramB sS nl an NO.' 52-186 ff ,, CLASS NO. DWELL. UNITS_ ADDRESS Westerly ....Newport SEWER MAP _ ..j ...:. CONTRACTOR TEL ... NO. ... — 'BK. _...PG. _.. - VALIDATION ADDRESS same as above - No. 343456 VALUATION ' CITY - UC.CLASS $ZE�255 Sig tore Appikont or Agent We 66 TORIES FAMILIES ONE $ DESCRIPTION OF WORK NEW Q 1 8 (L Single Family Plan 6 BRX ADD _ _ f #},• • • •'�-�1 ' .. ... ... .. ALTER . . _. ... ._.:.. REPAIR O FINAL ... .. DATE _ 1 •3436 .. '- USE OF DEMOL_ Q _... FINAL '... . _...... ... .... - - EXISTING BLDG. _ . . _- -. ... By _ L • • 3 LL 3 `1 5 APPLICANT TEL. - -. PRINT .. N0. OR03-83 ADDRESSBUILDING ....' ADDRESS ADoaEss _ � - e 8 4 *a 6 ft k . LOCALITY 'TEL r 4 i �t 1�1#•• e e •,,�. MOVING CONTRACTOR ., NO. t _ - .. -58800- ADDR ED REQUIRED TOTAL SETBACK FOM iST R ` . �.i ( .. _, +_, A • j 8 FS O n V E CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for SET BACK .-FRONT YARD HWY WIDTH" ...- ... poop. uN.. L.. - " _. ..-,..,.. , `t .-. J rljr 1 C 4 ,, I B O — B . the performance of the work for which this permit is issued P. L. } �e ilt ,Sec. 3097, Civ. C.). SIDE , _ I Lender's Name_. Pandiornsa HnmpG' Lender a Addreaa 2082 Business Cntr Dr,Irvi ne P.C. Fee S eW-4• G Pe mit Fee , . f cern that I have read this application state fY pp issuance Fee above information is correct. I agree to comply with all County Investigation Fee- -ofelinances and Statelaws relating to building construction, ' - Total Fee S 4 06 and heby authorizer presentotives'of this County to enter _ _ - upon r a - enr ed property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE; Sig tore Appikont or Agent We D44 NLKrBt1iLD�Ji„[�ECj.ARAT1O\ ,;,.,j hateby,,pffirm Iha' Lam e>xempt:frorgrihe;Contractor.'s License Lfoe: tker fako iOg -reason° (Stic,: 3031x5). Asener.+sahHProjessionsCj""irry'dttyoreount�ywhich ---regatresapernttrtolconitnict, alters#mprovp;dpmolisli, or repair any structure; prior to its 10fiance, also't�quires - "the applicant foraucb permit to. file a signed statendettit that be is licensed pursuant to the proviaionsLof the Con= tractor's License Laty (Chapter 9) (rommeneing with S ti.. 7000)-ef Division -3 of tbe"Basimess and Profess%iit Cade) or tbat'be is exeMi bt therofeohi aiiB the basisfor Lbe alleged "—pits.: Any Wolaii..'uf°Section 7031.5 by naiSv app11cciit for aperirtft LVie sublt'tts pplic¢ipo a titin penalty of not more than Jia tiut(dred ddllara (ST 001J: g,! "0'. I, as owner-ofahe proper3yi or my employees with •_ ,"rages asdheirso)exompensation,llwill do the`wook,-and thefwuciwe ls,&l Intended oruffered forrsate$Eee`. 7044) Business and Profanions Code: The Contractor's License iaw.doesuat apply to an-ou'npr' of property.wba builds t> or improves iberebn,andWho Voes'sucbwork himmif"or 'ibrougb 'bfs' arc* employees provided tbat'sucb°7ni- pronemet4't%dra! nbt,iritended or offpred fo►'sa1e.'I`i'f�, however, the building or improvement is soil toit9in one year ofeontpletion, tbe,owner-bwwrywtll have tI. t Jwrden of'proving tb t be did net bulyd or improve fpr ,�t(pe purftoseo��aaloJ .! a� •� .;... , n , . i; .. .� ,: r' ❑ t: i, asnv3ner'af the property, am eXd usi"vely tvnfrac- ting with licensed contractors to c erect the project (Sec. __f14Q Bgsincss'e d Pc%sssori! dud 'Tbe:i:Cowtractark License Law does not apply to an i<ne"f property who wiid' _ , dnproves t%ie!re�n, .pin u>bo Yontraciafar:fueb- projects witb a cortractor(s) licensed pursuant to rthe m a _..emPt under SecB. (a8P &P.C.C. for thio reason Date Owner INSPECTOR'S NOTES' I<.l; �l , ° ` ANS TO APPLICAFIT &: n' a 6 '; 1NSRECTOX'S NOTES To: Ra�turned t - ed ?Approv I a^"ct n'' N'. ate _.. -No.- �4fe ...... .�.,-� •. - ..,. :., ... _:..� ..:, .: ' �.; ..... . r•r ,-:: "gin ,' I �`- . )'Rsqulred Op}e Ras Iv Vi . j ;ApYes No nsFri` ed _.._ . I` mer Certs{lease th�tle!rr Fine Departmeht ,...t u'•a: ' tA'7 G. .'..a::, .717 7 _.I --. ` +. . - Grading :., Lai..'. ,.. Geological -:, i ': .y -:c;. ___ Pedestrian Protection (Fence)(Conopy) Special Inspection- (Con4.).(Masonry) (Welding) w ': •,. ,, v� l.. Lot Drainage :, . .,., h) Parking - Approvals Date Inspector's Signature Location— (Setback 8 Yards) nom, Foundations Slab Frame Energy Insulation 3a _ T_..__-__ _ I I 3 Lath/ rywa I— + ' Interior Lath—Exterior .. t° \'111e.. ` \�, i:._ .,. .,, 1. House Number— ��..__;i "..... ----__.. _�� --- Correct 8 Posted Final— -Enter an Front ` r' • - '.. t..:: ,-. , ,' .'::>' .;. D44 NLKrBt1iLD�Ji„[�ECj.ARAT1O\ ,;,.,j hateby,,pffirm Iha' Lam e>xempt:frorgrihe;Contractor.'s License Lfoe: tker fako iOg -reason° (Stic,: 3031x5). Asener.+sahHProjessionsCj""irry'dttyoreount�ywhich ---regatresapernttrtolconitnict, alters#mprovp;dpmolisli, or repair any structure; prior to its 10fiance, also't�quires - "the applicant foraucb permit to. file a signed statendettit that be is licensed pursuant to the proviaionsLof the Con= tractor's License Laty (Chapter 9) (rommeneing with S ti.. 7000)-ef Division -3 of tbe"Basimess and Profess%iit Cade) or tbat'be is exeMi bt therofeohi aiiB the basisfor Lbe alleged "—pits.: Any Wolaii..'uf°Section 7031.5 by naiSv app11cciit for aperirtft LVie sublt'tts pplic¢ipo a titin penalty of not more than Jia tiut(dred ddllara (ST 001J: g,! "0'. I, as owner-ofahe proper3yi or my employees with •_ ,"rages asdheirso)exompensation,llwill do the`wook,-and thefwuciwe ls,&l Intended oruffered forrsate$Eee`. 7044) Business and Profanions Code: The Contractor's License iaw.doesuat apply to an-ou'npr' of property.wba builds t> or improves iberebn,andWho Voes'sucbwork himmif"or 'ibrougb 'bfs' arc* employees provided tbat'sucb°7ni- pronemet4't%dra! nbt,iritended or offpred fo►'sa1e.'I`i'f�, however, the building or improvement is soil toit9in one year ofeontpletion, tbe,owner-bwwrywtll have tI. t Jwrden of'proving tb t be did net bulyd or improve fpr ,�t(pe purftoseo��aaloJ .! a� •� .;... , n , . i; .. .� ,: r' ❑ t: i, asnv3ner'af the property, am eXd usi"vely tvnfrac- ting with licensed contractors to c erect the project (Sec. __f14Q Bgsincss'e d Pc%sssori! dud 'Tbe:i:Cowtractark License Law does not apply to an i<ne"f property who wiid' _ , dnproves t%ie!re�n, .pin u>bo Yontraciafar:fueb- projects witb a cortractor(s) licensed pursuant to rthe m a _..emPt under SecB. (a8P &P.C.C. for thio reason Date Owner INSPECTOR'S NOTES' I<.l; �l ,