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Home My WebLink About0948A 0949A WORKERS'COMPENSATION�DECLARATION - ' � � � `5 � � . . . . . . .. . . _ . _ ... � I hereby aff�,m ,�o, I hove a certifiwte a,�o�sen<<o self qpp��CATrC�N��F�O�R BUILDING PERM�T� insore,or a certificate of Worke�s'Compensa�ion Insurance, o�a ce�ti4ied copy rhareof(Se<.3800;�ab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pou�Y No.61 WETX799�,mpany—�a„+rc�vr�� Cenified copy is he�eby tumished. FOR APPLICANT TO FIL su��oiNG ��c � �,/, ADDRE55 '�y,� �f � Certified copy is filed with the co�nty building inspec- BUILDING �;a�departmenf. ADDRESS 1180 South Crestbrook Court Date�'�L_��,Applicant CITY Di amond B r Z�P IOCAIITV CERTIFICATE OF EXEMPTION FROM WORKERS'� NO.oF e�oc5. t�AREST . COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This secfion need not be tamplefed if fhe permif is for ane TRACT 42568 B�OIX LOT NO. - A�`ESSOR hundred dollars($100)or less.) MAP BOOK oAGE PARCEL TE�' US ZONE �P OWNER f`f�-� I certify that in the performonce of ihe work for which ihis gr m � NO. - �� r permit is issued,I shall not employ any person in ony monner qDDRE55 3151 Ai rwa Ave. N e.tLQ D i7 CON�TIONS � so�as to 6ecome subject to the Workers'Compensafion Laws. Q V Date Applicant � CITY ZIP , � ,+"A�TICE TO APPLICANT: If, affer moking ihis Certificale of ARCHiTECT OR TEL �ISTRICT GROUP NPE FIRE PROCESSE�BY o ,nption, you should become subjecf to ihe Warkers' ENGINEER NO. ,/� CONST. ZONE V Compensation provisions o4 Ihe lobor Code,you must forth- qD�RE55 �6 u�� with camply with such provisions or this permif shall be TEL. STATISTICAL CLASSIFICATION � � APT. CONDO. � deemed revoked. CONTRACTOR NO. �y� �/ � LICENSED CONTRACTORS DECLARATION LIC CLA55 NO. �WELL UNI75 I hereby affirm thot I am licensed under provjsions of Chapter 9 noDRE55 37 51 Al NO. (commencing with Sec�ion 7000)of Division 3 of ihe Business and . �� SEWER MAP Professions Code,ond my license is in full force and effect. CITV COStd Mesa CLA55 B eK � VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number 4Q9(�i�(�Lic.Class $ SIZE �88 STORIES 2 FAMILIES T ONE � 3 VAWATION . . Cantractor DESCRIP ON OF WORK �- � NEW � , ..V�;C!,��' Bramalea Cdlif oare s ��f �G7� AOD �I am ezempt under Sec. Q s?u " '' ^C i ALTER B.&P.C.for fhis reason NEW Constructi on REPAIR ❑ s i °�C��L� a�e: USE OF DEMOI ❑ - -'- ' EXISTING BLDG. NOYIE ' .:G f�.�' I �- S�gnafure _ APPLICANT TE�� FINAL ' OW ER-BUIL�ER DECLARATION PRIN7 F^ NO. - DATE ��q�� !Ci"�S E. I hereby affirm ihaf I am exempt from fhe Coniractor's License Low for the following reason (Section 7037.5, 8usiness and A��RE� FINAL /' Professions Code): �- PRESENT By /( � BUILDING �� I, as owner of the properfy, or my employees with ADDRE55 wages as their sole compensation,wili do the work and ihe structure is not intended or offered for sale(Section ��TM ' '��' 'U'��F' - 7044,Business and Professions Code). MOvinlG TEL. � I,as owner of Ihe praperty,am ezcl�sively contra<iing CONTRACfOR NO. . � , e a7 0 ,, r, � with licensed coMroctors to construct ihe project(Seo- � - r�� - tion 7044,Business and Professions Code). ADDRESS . ,.-��,C�v' REQUIRED TOTAL SEf6ACK FR M E%I T. CONSiRUCTION LENDIIJG i4GENCY -- �T gq�K YARD HWY pROP.LINE WIDTH � ��C�.y.�,�i�z I hereby nffirm that there is a mnslrudion lending ogency for FRONT � � � the performance of the work for which this permit is issued p.t. � ' �;��...&� � (Sec 3097,Civ.C.). SIDE ' P.L. _ Lender's Name Toronto Dominion Bank IDMA Ref.N x ]44 Sansome St., Suite 70C P.C.Fee$ �p.�f Permi�Fee�3�-a'�� , - Lender's Address . a^ I certify thaf I have rea ihis app ication and state ihaf fhe 3 "G� Issuance Fee ��*�'S� LOMA P/C N x above information is correct.I agree to comply wi�h all Counry investigation Fee ordinances and Sfate Iaws relating to building construction, Totol Fee a •-G� lDMq perm.# and hereby authorize representatives of this County to enter ' upon the above-memioned prop rt,�for inspecfion purposes. � ' a ,�. 3_� SEE REVERSE FOR EXPLANATORY lANGUAGE Signature of Applicanf or Aganl pa�e . . . . . . '- - ..-..n', PLANS TO APPUCANT INSPECTOR'S NOTES O�S'VI:R-BUILDF,R llICLARATION I hereby affirm ihat I om exempi trom the Coniractor's To: Retorned License Law for the following reason. fSec. 7031.5) Approved Rusiness and Prnfessians Cnde:Any erty or cor�nty mhich No. Date No. DaTe � - reguires a pernrit to cnnstrucx,alter,improae,demnlisg, . or repuir any reraca�are,prior to its issuance;ulsn reyuires the applicanl fnr sucb permit tn file a signed statemena that be is licenseJ pursuant to tbe pmvisrons nf tbn Con- _ � _, , _ - � �•• , � � : � ' traetor's License Law(G�apter)/(rommenciag mitJ Ser- tion 7000/nf Drvisdnn 3 of ihe Business and Prnjcxsir�ns ,. Code/or tbat he is exemf�!tbereJrr�m and tbe fiasis for tbe ulle,qed cxcmprian.Any rialation of Serliox 7p31J by Required � uny applicana jor a permit suhjects the applicant tn u cit�il Approvals Oafe Reeeived enalt•o not wenre tiva ive l�undred dnllurs �500.r Yes No or Approved P } f j � » [_ I,os owner of the property,or my employees with Warer Cerlificate wages as their sole mmpensation,will da the work,and the siruct�re is noi intended or offered for sale(Sec 7044) Heahh Department , Busrnesr and ProJessinns Code:Thv Coxtractor:c Lirense I.au.�does nua apply[n n�ouwer nf property¢:bn bailds Fire Department -- - � nr improv�es tbereon,and wbn dnes sucl�work bimse/f or tbrnuRh his nwn empinyees, prncided thut sud� '- Groding � � � - prnvements are nnt intended or offered fr�r sale - 1 nu�e:�er,the buildeng or rmprnveme�t is so1J u•dthin nne Geologiml veur of rnmpletinn, tl e nu,�ner-buifder u�ill hax�e t{ir � burden nf prnring�bat fie Jid noa breild or empmne for Pedestrion Pro�ection " . tbepurpose f.ruleJ. �Fence)(Canopy? � - � ❑ I,os owner of the property,om endusively comror iing with hcensed coMroctors to consiruct the proje<�(Sec. Speual inspeclion 7044)IIusixess and Pr<fessions Cade:The Contractor',c (Conc.)(MasonryJ(Welding) I.icexsc I.uir daes no[apply to an ou�ner q(prrperty u�bo 6uilds or impro��es ehereon,uxd mbo cnxtructs.fnr.rucb Lot Drainage � projects mith a rontracanr(sJ Trcensed pursuunt en thc Coneractnr'.c I,icenae 7.au+J. � Parking . . � ❑ I am exempt under Sec. ,B.&P.C.for this reason Date Owner Approvnls Dafe lnapector's SignaWre . , . � - INSPECTOR'S NOTES � locafion-- ' ' _� (Sefback&Yords) Foundations siab G �'L6;� Frame �� Energy Insvlotion !�y/7 U Laih/Drywall- - � � - Interior .��a,�7 ��1 Larh--Exterlor �,"��-�7 � . � . .. House Number-- � Correct&Pos�ed (J,' �� - � - Final-- Enter on Front � L" 2-�S'E f . „" - . ,