HomeMy WebLinkAbout0902A 0903A , _ _ .. _ . _ . .... _ _ .
� WORKERS'COMPENSATION�DE�LARA710N � � .��. � � � -
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•I hereby affirm thqt I have a�certifimte,of consent to self AP�PLi�ATIONV���R�.��BUrC.DiNG PERNIIT
insure,or a certificate of Workers'Compensation Insurance,
. .... _ . _...._
or o cer�ified copy ihereo (Sec.3800,�a :C.) COUNTY OF LOS ANGELES BUILDING.AND SAFETY �
�1WETX7993 compony Hartford Groun -._,- _ ,:. _ ..._. __. ._.... _,. . _. _ _ .:.
Poi��Y - o�/� y
� Cerlified copy is hereby fumished. � - � FOR APPLICAN7 TO FILL IN AooRess�j'�! � a���6�vy� �-
� Certified copy is filed with tFe county building inspeo- BW�DiNG
tiondeparimenf. ADDRE55 1171 South Crestbrook Court 1�-�..
� . ... . ... .... .. .. _.. .
Date���Applicant CITY ZIP LOCALITY
CERTfFICATE OF EXEMPTION FROAM1 VJORKERS'���� � - NO.OF eLDGS. NEARESi . . _ . .... . .
COMPENSATION INSURANCE �� . 5¢E OF�OT NOw ON�Oi CRO55 Si.
- (TNis secfion need nof be completed if the permit is for one � �ESSOR � � -
.6undred dollars($100)or less.) TRACi 42568 's�ocK LOT NO. 56 , MqP BOOR ` PAGE PARCEL
TEL USE ONE M1AP.P /
I certify ihat in the performance of ihe work tor which this �`�'�NER NO. - ��� NO. /dJ`� �) ',� 'Ct A
permit is issued,I shall not employ any person in any manner � SPECIAL - - � - � 0.
so as'fo become'subjecf ro fhe Workers'Compensaiion Laws. ADDRESS pc.OQ�C�"T CONDITIONS �
arv Costa Mesa ziP 92626 ac
Dafe� Applicant ARCHITECT OR TE�� DISTRICT GROUP TVPE FIRE PROCESSED BY �
,P°Ai�TICE TO APPLfCANT: If, after making ihis Certificote of ENGINEER Aram Bassenian No. 752-186 �
mption, yo� should become subject to the Workers' CON57.,� ZONE W
[.ompensation provisions of the Labor Code,you must forth- qooRE55 3990 Westerl P� Su i te 170 �� �`3 Y�
wlfh comply ith such provisions or this permit shall be - -� �- - `f' �
TEL STATISTICAL CtASSIFICA710N APT. CONDO.
deemed revoked. CONTRACTOR � NO. - � ,,��
LICENSED CONTRACTORS DECLARATION �i�. U-ASS NO. DWELL.UNITS—L
I hereby affirm that I am licensed under provisions of Chaprer 9 ADDRE55 3151 Ai rw QV NO. .
(rommencing with Sedion 7000)of DivisioY�3 of the Business and � ��� SEWER MAP
Professions Code,and my license is in full force and effecr. CIN QASS BK �� VALIDATION :
� SQ.FT. NO.OF � NO.O,F CHECK 4�`J-�
g yQ,2F�
License Number 4'O9E)�O u�.class s¢e sroRies FAMILIES oNe - �
a�li,t� ;t% VALUATION
comro�ro� Rrama 1 Pa C��l f Dote oesceiPri N o wcakK P ' Aoo O $ ��� gz;� ', ' ' � °'j
❑I om ezempt under Sec $l ll 1 e Fami 1 Resi dence � ' � `4�!(%�%
ALTE2
B.BP.C.for this reason New Constructi on REPAIR � S ' "�'�'E,'✓i�%
USE OF
Dote: DEMOL
E%ISTING BLDG. NOYIe R:�
S'nn�1i re
fj . � APPUCANT - TEL FINAL U�.r U-�.�
� NER-BUILDER DECLARATION � PRiM1 NO. - DATE-��.��v,.�
I hereby affirm ihai I am ezempt from ihe Coniractor's License qppRE55 3� � A FINAL
Law fo�1he following repson(Secfion 7031.5, Business an d
Professions Code): ' PRE ENT ' BY
�A� I, as owner of the o t or BUILDING �+,�Cj•(;�.�;
pr per y, my employees with ADDRE55
wages as�heir sole compensa�ian,will do the work and LOCAIiiv � ' f-' " � °' � i �-
the structure is not intended or offered for sole(Section ��� �" " '
7044,Business and Professions Code. MOVING ' TEL.
� ' CONTRACTOR NO. . . . ..1.c?'��Lu,�C7
I,as owner of ihe property,om excl�sively controcting
wiih licensed contractors ro mnsiruci the projett(Sec- nooaess � ��(- ('.•4,J il i �
lion 7044,Business and Professions Code). �
REQUIRED TOTAL SETBACK FROM %I T. � - �� - �
VARD HWY (:�+ i,
CONSTRUCTION LENDING AGENCY SET BACK PROP.LWE W�DTH O...G O�'�c.
1 hereby affirm lhat tMere is a construction lending agency for FRONT
tha performance of ihe work for which this permit is issued P.L. � - �
(Sec.3097,Civ.C.). SiDE . � �
Toronto Dominion Bank P`
Lender's Name .
= Sansome St. uite 00 p,�_Fee$ .2�.,2.�3 Pe�m�,Fea `7 ",� `�"'�`Rer."
- tender's Address ��mfY,aii�i�£e—.-(`�,�.�.� �7 - '
I certify ihar I have read this application and state that-the /.�i"� Issuance Fee ��`�� LDMA P/C#� � - �
above information is wrrxL I ogree b camply wirh all County Invesngafian Fee �( '[
ordinonces and State laws relating to building consiructian, 7mal Fee 7�T"� LDMA Perm.k
and hereby authorize reprasema�ives of ihis Counry fo enter
a upon the obove-memioned prop�e,�rtyp for inspection purposes. �
° �/�,.�-�.LU��"� `���-ekl- �c�
� SEE REVERSE FOR EXPLAh1AiORY LANGUAGE
a "
.^ S�gnalure of Applicanr or Agent Date ' '-. . . . ... . . . G�
PlANS TO APPLICANT INSPECTOR'S NOTES 0�5'NER-BUILD�iR DECI.ARA'CION
. , , ., , I hereby oHirm that I cm exempt from rhe Contracfor's
To: Refurned � � License Law�for- the following reason. �Sec. 7031.5)
Approved Business unrl Pmfessians Codc:Any city or coundl'whicb
No. Dare No. Dme"� � reyuires a pernze[zo conserucr,aleer,improve,demnlial,,
. , .- .._ M., or repa;rany strurrure,prinr to its issuursrn,a[sn reguires
� � . - � - � ��e aPh�icunt/or swcb permr[to file a siqned slatement
. , . _ thaa he.is licensed`rarsvant to tbe proa:ds[nxs of t!e Con-
-- , - � - . . , . trador's J ioense!vu(Chafiter 9J(rommettci�g u:itl�.Seo
- � tinn 7000f f Dicision 3 of the Buseness and Prrf ssions
c�,d�J or tbat be es exempt tberefrorn and t!e basis fnr tl�e
. ulleqed cxemptinn.Any:�lo(atiox nf Section 7031.)hv
. Required -� �� �ny applicunt fnru permit suhjecEs fhe ap(�licant tn a civi!
APProvals Dafe Raceived
Yes No
r Appreved . , penulty oj not mnre t5ax five hunared�tor[ars/s5no�./:
.J I,os owner of fhe properry,or my employees with
Woter Certif�cote - � � , - wages as their sole compensation,will do ihe work,and
� � � � the sfructure is'not in�ended or offered for wle(Sec.7044)
Health Oepqrtmenl . . ... -' �� �-^'- ��. �� :�- ._ .-:-'���� Husiness and Pn fessinns Co6e:Tbe Contracmr'.s I.irewse
I.�u,do�s n�e pp(��ao an�um�r Jp.�pe>ey u t��,buitd�
Fire Deportment �� -----�.-....... . .-_.- or improx�es tbereon,and wbo doez such work Gimself or
- � . tbrough Gis ou.�n employees, providerd tbat such'` ,
Grading . _ . . provements are not dntenrtell or rffcreJ for.vule
� . .. fiou�aver,the basilding nr imprr vemexd rs sold uitbin one
Gealogicnl . '- i•aar bf 'ompletaon, Ehe ournenbuiJdar uzll bar�e�the
� � ' fiurden nf pruring tl at bc diJ nnr fiuild nr imprnx�e fnr
..... ... . . . .
Pedesirian Protectian 1be/+urpnse of saleJ.
iFence)(Canopy) . . . ` - � � - � C �,as owner of ihe property,am exdusively mnirar
. ting with licensed conlroctors b conshuct fhe projeci(Sec.
Special Inspection "' � ' � '�' "-' 70441 Busiaess und Prn�essrons Code: I5e CnnCrartor's
iConc.l(Masonry)(Welding) �� . _ l.icense Lnu�dnes mot apply en aa nu�ner nf prnpertp�u�l o
� fiuilds or imprnves thereon,a�d u�fio cnntracas(or sucfi
Lot Drainoge ., . . . . .... ... projecu udtb a contrrector(sJ Jicensed pursuune tn the
- Cnntractnr'.�Licensel,awJ.- -
Parking . . . . . . - . . . . �
� I am exempt under Sec ,B.BP.C.for this
' � ' reason .
. . . Da1e � Ow
Approvals Date Inspector's Signature -- . - .
. � . INSPECTOR'S NOTES
Locolion--� �� ,.. � � � �'
(Setback 8 Yards) � l � �
... ... ._ . ...; ,,:,..: . �... .-,,,.,�„ ' .
Foundations _6 �. ' �
siab 17' lt.�4- b ,�J-- , ..� ,.
���
Frame '� _u '1 - - � .. . .
Energylnsulmion r-� � � , - , . ., �... .,. � -. . �;>:.: .� ..
Loth/DrywalL ���� - . . .. . . ". . . .
Interior
Lath-Exrerior •3 �.--' . . . � . .. . .. . . . .. , , . .. '
r l!
House Number- . . . . ... ... . . ... _. , _ . .. ...... ._.....
Cortecl 8 Posted �_�.- 4'�-'"' � '
Pinal-. _ . . � . . ,... .
Enter on fronr �
. . . .. ,,.... ._..
�ZGG� �.�5_,f'7 Gi . . . .. . . . .,. . . .,. , . .
L�I _SI'�.-�73�� �,���! ��--- , � ' . .1 .