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HomeMy WebLinkAbout0524A 0525A _._.. _... 1 A � WORKERS'COMPENSATION DECLARA710N� Plan D-Z � �. �� �_ ��_ ��'/� �r - . .:... . ... _ _ .. ... . .. .-� �- ._ �,.- . '.. _�._._ � I hereby offrm that 1 �ove.a certfimte„oi consent to self �eV. A App`�C�A�T10t����O1��������������NG P�E�MI�T����� �� insure,or a certificafe of Workers Compensot on Insurance, or e cert f ed ropy-thereof�Sec.3800,Lab.C.) ' �� - � - � � " � . . � ' � , - - COUNTY OF LOS ANGELES BUILDING AND SAFEYY v����S-945=I04 �Pa�Y Aetna _�... ,_.,. �,. _: , ...,.__. ._..�.._, _____.. . �::;:: _ Certified co is hereb furnished. � BU�LDING � � ❑ pY Y fOR APPCICANT T6 FILL IN _ _. aooeess 24371 I�rriri Drive. � �Ce t fied ropy s f led�wifh ihe county building inspec- BUILOING ,- � no�departme r. nooaess 24371 Darrin Dr'v Date 5�2��$j_Appiicant �]�� (,R(1iTAT7 . . CiTY • . .. ..... ... ZIP . .. LOCAUTY • . . . . ..... � � - CER7IFICATEOFEX�hA'PTIONPf20NfGVORI�ERS'"'�� ��� �� NO.OFBLDGS: � � NEakEST � ' COMPENSATION�INSURANCE size oF�oT rvow Onl�oi ceoss sr.- Carpio & Go].den Springs � ('fhis section rteed nof be complefed if fhe permit is for on¢ TRACT 4ZSH4 � BLOCK LOT NO. / A�SSOR -��' ' . .. . hundred dollars($100)ar less.) AAAP 9bOK � ' PAGE PARCEL �'lE �Yl CiTOU TE`� 967-9541� use zon,e AMP "' I cenify�that in ihe performance of the work for which this OWtiER p NO. � J,�js q r permit is issued,I shall nof emp�oy any person in ony manner • SPECIAL � � �- �- so�os to 6ecome subjecf to fhe�Workers'Com�Sensofion Lows. ADDRE55 1074 Park View Drive - R-1 CON�ITIONS � �ore eaPh�a„} _.. cirv COvina zia 91722 a .+�'°"` � � ARCHITECT R iEL. .........-� O �TICE�f0.4PPL1ChNi: If, ofter�makin ihis Certificate of DISTRICT GROUP TVPE FIRE PROCESSED BY � 9 ENGINEER�'L'aT] & �$$ NO� — � ampfion, you shoold become su6jecY"to the'Workers' � - �Q CON�ST.J � Z�OyE W Compensation provisions ofihe La6or Code,you must forth- ADDRE55 314 N. lst Avenue .Arcadia �p V`� .f�� - � d with �omply with such provisions or ihis permit shall be � G�Q ,.TEi� � �n deemed revoked. . . �.. . CONTRACTP�" �Z�� , NO. STATISTICAL CLASSIfICATION APT. CON�O. � �� � LICENSEO CONTRACTORS DECLARATION �� - ��-- -� ��� - -. ��� - aqSS NO. DWELL;.UNITS�J._ . ... I hereby offirm that I om li<ensed under provisions of Chopfer 9 ADDRESS ,.Np,3'] (commencing with Secfion 7000)of Division 3 of I�e 6usiness and . . ... ..... . . ��� SEWER MAP � Professions-Code,and my license s m full force ond�effect CI7V : QASS � � VALIDi4TION-��-� ��- � � SQ.Fi. g NO.OF NO.OF CHECK �' L�cense Nur:�be� "371584 Lic.CIasS B SIZE J�� STORIES FAMIUES ONE r'C J G�1 r, Controctor�'�'��CxPi�P Dote 5/29/85 S7.T1 F3CCl. �P5. NEW VAWATIOM.. . .. ... � � DESCRIPT�ON'OF WORK �S• � � � � ° �'L I �� ' ,/ ADD S 61,146.00 i �I om exempl undar Sec . ridYd - y'� Q , � � 6 C i a� .n. .. �-�.'� .. AITER 8.8P.C.for�his reason -� ... ....._...._.._. . :...._. REPAIR s . .. a a.:�.I��1 i ��c�i � . . . ... ,,.. . ._ .. ._ . . . Date: �..,.., . USE OF E%ISTING BLOG. DEMOL f�6.i 2`�'s v -Signature� �- ... .. . ...'. . .. ...... ... . ... ..... APPLICANT. . . TEL FINAL '" OWNER-BUILDER DECLARATION� PRiN7) N�� DATE I�f i��'+� . -.. . z O C z''H. I hereby offirm that I am ezempt fram the Coniraaar's License � Law far the follow ng reason(Section 7031.5,Busmess and P.D�RESS ,,., „ ,., p�Np�/.�-���/�� - ��� /` �� '{-� o���b'� . �fessions Code)' ' � ' PRE NT . ....BY !y-"" . � ' ,. BUILDING 1 �7 L,'��J I, as owner of ihe property, or my employees wiih ADDRE55 �� - woges ds their sole compensation,w II do ihe work and - � � � � �- �� - the s�ructure is not intended or offered for sale(Secfion �a�^��TY �� � ._ ..,�. / °i � r�,C J� 7044,Bus ness and Professions Ccde): ��� � -�-� MOVING � � �� 7EC - �- � �- � - � I,as owner of ihe proper7y,om exdus vely controcting CON7RACTOR NO. �� I r"8 Jr" with licensed coMroctors-to-ebnsfrucf'fhe'project(Sec- qDDRE55 tion 7044,Business ond Professions Code). SET BACK PROP.'UNE �WI�TH' � ��- - CONSTRUCTIOIJ��LENDIIJG�FCGENCV�-���� ' ' '-""''� REQUIRE� YARD HWY TOTAL SET6ACK F20M EXI 7. . . . _ . . .. . I here6y affirm that fhere is a mnst cfion le d� g ogenty for FRON7 � � � ihe performance of the work for which this permit is issued P.L � � ---- � - --� --�.-�--.��- (Sec.3097,Civ.C.). SIDE . ... - , . .-.: �... . . 9 ... . . ... . CAI1t1R211td1 I1..175101$ , . . P.L . .. Lender's Name . . a 361.50 �DMA Ref.q � Lender's�Addres399 Park Ave.,�N:Y:�-10Q43 � P�c.Fee s re.m,Fee - - , � ��---�---� �-- r I cerfify ih ha e r fhis oppLm��on ond stote fhat Ihe Issuonce Fee ,'�'�O -- � �� LDfnA P/C M � � ��� � 3 a6ove inf mmio is o ec1.I ogree to comply with oll County Invesugotion Fee � , ardinan s on t e aws relating fo building consiroction, ' io�ol Fee ���� LDMA�Perm.# � - i and he by i r resentav es of this County to nter � � � � �-�- � - � ; upon t e o e nti ed properry f r inspection ur os . i . . .......� . . . . .._ . . . , ... - ' - . c . .. . . - . _..._ . _. F ,.. .: -:, . : SEE REVERSE FOR E%VLANATORY�LANGUAGE ��� Signal�r of Applicant or Agent -� .Da . . .... .. ..... . -. .. . �. . ... . '' . . .'00� � � '�PLANS TO APPLICANT INSPECTOR'S NOTES . . 0�1�'M1F:R-BOIL�ER DtiCLARAT'[ON . ,,�, .�._�. p.,,„.,.<.� f hereby pffirm thm I am exempt�from the Con7roctor's . . ....,. .. ..... ,.,. . . .. .. .. .,_ .._..... ...a., , . To: . Refumed - .. � �"License�-Law�for the following reason. (Sec. 7031.5) - � -' � Approved Business¢nd Pr��essions Cwle:riny city or cowney wbich - No. Dote � No. =<<Dofe � - � � reyuires u permit la rone�truct,aleer,improve,demolish, . . . -... .:.-,- ..._.....�.... �k;,;,,.:.., .,,.,:,;:Ma.;. �..,�;;:: .-. or repuir anv seructure,prior tn its dssuaxce,r�de�o requires �� - - .. - . tbe upplicunt for such permit to file a signed stntement . . _ , _ thut be ix licanse$prersuant to the provisions of tbe Co-n- ....�. .`....... . -, - � . .. .. tracdor's Licen.�-e/,aw(Chapter 9)(crommencing wit!Sec- . ... tiox 70001 jDiv' n j f the 13usiness und Prnjessinns esm - �� �� - . � CndeJ or tho-t he is�exemJid tberefro»a a�d tfie basu fnr Lbe . .. -.-__.... � �.: :.�.:... . . . . . elleged Fsxempteox..Any vialatinn nf Sect�an 7031 5 by � .Reqoired Dafe Received �� � � any upplrcant for a yermit aubjects the afiplicunt to a civi! APp�OYO�s or Approvad � . .. pena[ty qI not mnre tban five hundred do!lars(.5j00J./: -.� -... Yes No ... -r_. .. ,._. �-. ... . �� �� � -� � [] I,as owner of ihe property,or�my employees with Water Certificafe �"` - �� -��-�� -���- ,..sr, wages as their sole wmpensotion,will do ihe work,and � . , : the�structure is not imended or offered for sqle_{Sec.70a4) � _ ... :. . .:� . HealthDepartment. , - - ��--�� � -��--��- - ��-.— �.�..:..;, . Bu��inessanr(Profe.vs�oniCde:The�ConeradoriLitense �. Lau�does mot upply tn an owner of property wbo huilJs Fire�eportmem _... .- . - ���� .-... . ._..___.. � '��... . ..._.;- nr'mproves therenx,and u�bo dnes surG work bimselJ nr _ � , .- ,,,_ �-�ehrnnKb�has owa emplo,yees,pmvided��tfiat aucb ir�"� Grading � � � � - � . provcmenes are not intexded or,offered,/or sule. - - - � bom�ever,t!e b:eildsng nr improvement is sold witbin one . ..:_ ., .... . _; , . , Geological .� ��'�. . . � ,�_�, �-..., �. ` year�aj completiott, tbe oumer-builder will haae tbe � �- .. � burden njprovin�5.tfiat he did nnt bui(d or improve for ehe r nse q/s¢[e. Pede5lrian�Protection- --� - . . . � P"P � (Fence)iCanopy) " ��� - � � - . � .. � � � I,aSowr+ehbftheproperly,omezdusivelycontrac- � .. � . .,..: g wi . .... . ., uct ihe projeci(Sec. ..., tin �h Ilcensed conlractors b consir Special Inspeciion - ��- � �- . -" �� � 7044)liusi�csx und Prnfessinns-Cade:�The CoRlractnr's (Conc)(Masonry)(Welding) � � � ._.. . Licnnsa Laic�lnes not ap�ly m aR owxer�f properay u�ho '� � ��� ���� � � �bui[ds or i»eJiro�es tbereon,anJ wl o��oxtructa for such �. Lot Drainage . , � � ��.� ���- - � � -.�--� �_:��.-�.:� •..•...,s. �prrpects with a c'nntructnr(sJ licensed pursuant tn the - � � � Contractor's I iceiise LawJ. '- � ""-� Parking . . . .. . . ... . ..:..... . . ..:... . . . . . .._ . ...,,..,.� . .. ..... . .. .._ .. � I am exe p�under Sec ,B.&P.C.for this . . . .. . . . _. � � � .. . .-� reason � . _ . . . ...._. � .. �� �' . . � Date Owner � � INSPECTOR'S.NOTES Approvals _ Dafe � Inspecfor's SignnYure � - _ � , _ Localion-- .'.. i _. . � . . (Set6ack&Yards) � � -�_��--� - �" `� � ;- Foundarions '�f'� ' ,�,�.'� _ � . :...�_�.:�• �-.�.� .... .. .� . .:.. �1 ` n. ..:..,. .,. . ..� :,.,:,:, .,,,.v _ -,: Slab � � �� � ,\� .. . . . . . .. . . . _ . J .. .,.:..,� . �.. ,.. .-. ;,.,. . , ._..� Frame 'D�.a�e..� r'�,yv°� . . . ... .. . .. , . �_ � . . ' ... u� . ... .. . .,. .. Energy Insulafion .a.2�:.� ' f` "� ._:... . ,.., , .-..�.�.� . , , .._.. . _ _ . , . �i': N���j � . " '�'� jr v� , .. ., . . . Lath/Drywall- .6 '¢,�4a - . . . � . ,- _. .� ... ;._�. ,.. . . . .. . . ..,.. .� :..,_.:...... ... ._.� .. Inlerior �p-�i tf5��. f��f��.. � .. . .. -.�. Lath—Exrerior ,fr„ .� _.__... „__......., ,. . . . . . „. . . ��, y�,�' �t?� ..�;,. ,_.; �, House Number-- .� .. , � , . . .._ �-.���,. .' . :;s> � ,e�„<. . :.:.:.... .... . ... ..._. _ _. .,•i� . Correct&Posted � '�•: ..... �� ��:�� �..�.'�,�'� ""�:;: Fina7__ . . . .... . ' ... . ... . . . . � . : . . -��- �. . ..__.� :� .._ ..:�,... ,,�,.,-.. .:,,-._:,..�...;, : Enfer on Front � � � �" "' � � ' �