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HomeMy WebLinkAbout0599A 0600A � __ _ �..... . � .M,, _}:: :.. .::. : G � WORKERS'COMPENSATION DECtARATION - . ��• - � � �O .. .- . .. . �_. _ .. . „ _ _ .��., .. I hereby aff m iha� I have a cerifmfe of copsent to seif PId11 b-�.� ����'����o�- ������,�����h ��[���� � i�sure,or o certifimie of Workers"Compensat on Insoronce, E12V. A� V R or'o certified copy�hereof(Sec:3800,laki.C.J � ' �� �� � � � � -•-� - ._.. -... ,.. `$3-�.tc-945-104 �PA A2tY1d COUNTY OF LOS ANGE�CES BUILDING AND SAFETY o i<y o. ompany . . ... .... . ......�...._... . ._..., ...,. ...::. . , __. ,_, . ... . . ...._. . .____. ... ... � Certified topy is hereby fu�nished. . FOR APPLICANT TO FILL IN � Bui�owG � � . _. ..._ ,.... ...:.:. ; . ... ... .............:. � AODRESS 24378 Darrin Drive � Cerf lied`copy�s filed wifh the county building inspeo- BUILDiNG � - -� � � tion department � ADDRESS 2¢378 ]. _ 5 29/85 _ Dote � Appli<ant �g+ ANDEN �UP arv Di2inOrid Bar ZiP 91765 �oc,uiTr DiamOrid Bar CERTIFICATE OF EXEM1APTION"�ROM�WORKER$'���`��� � NO.OF BL�GS.� NEAREST �- � , . . -_._, .. . . - SIZE OF LOT NOW ON LOT CROSS ST. 10�& GO Ca.2T1 S Ylh S � �COMPENSATION INSURANCE � (This section need naf be�completed if the permif is for one � TRACT BLOCK LOT NO. � �ESSOR� �, hundred dollars($100)o less.) �1P e�K PAGE PARCEL � TE�' USE ZONE� �+P I�cernfy thar i the pe for �ance of ihe wo k�for which�this ��� OwhleR `j"j12 AI1C12ri Grou � No.967-9541 NO. �*�-� - > permit is issued,I shall nof employ any person in dny manner R-1 SPECIAL � d so-as lo become�sub�ect to Yhe Workers'-Compensafion Laws. - ADDRE55 1074 P$Y'](. V12W DI�1V0 CONDITIONS ,..„,.,., � ... .. . . � .... . .�� . . . .. . .. .. . . . . . CITY � . ZIP . __.... .. . . . ... . ... . . .. .. � Date ApplicoM ARCHITECT OR TEL ' ��������' O �^'�JTICE TO APP(ICAt�(T If, afte �king fhs Certificate of ENGWEER 52a11 & .Assoeiates�o. 445-4073 �ISTRICT GROUP CONST. ZON PROCESSED�BY V �:mp�ion, yeu should become subjec7 fo the Workers' J� }' � � ..ompensation provisions of ihe La6or Code,yoo must forth- ADDRESS � " ���- •�"3 f R! A- ith wmply with such provisions or fhis permit shall be � �- �- - - y deemed revaked. � . � � CONTRACTOR See�Owner TE�' STATISTICAL CLASSIFICATION APT. CONDO. Z NO. _.. LICENSED CONTRACTORS DECLARATION. � �.�..�������- �-������--����� ��- �IC. � �� Cw55 ND. '��owElL.UNi7S I hereby affirm thaf I am licensed u der provisions of Chapler 9 ADDRE55 No. 371580 SEWER MAP�� � (commencing wi�h.5echon 7000)of D vision 3 of ihe Buslness and . uC. �- � . . .. . ..... ...____...__... ....._..... .. Professions Code,and�my Ifcense is in full torce and effect. aTv CLA55 " � � ' VALIDATION���� � � ' -� � SQ.FT.) ?r NO.DF NO.OF CNECK BK' �' . � � -• License Number 37158� Lic Class B � SIZE l��.J� STORIES FAMILIES ONE . �� ' . . rm....... .. VAWATION Confractor T�' �.� �iR��4Jate 5�29�8.5 � .. DESCRIPTION OF WORK • ."."...... ...".`..... . -....: NEW a 8 ✓ ., .. . ._ G Jr r�,4 n .... ...:. G3Y�a.CJG,c" ADD ❑I am exempt onder Sec. �� ��� �+ / � ... . ALTER o «'�1 ... ..n... .••., � . , � B.&P.C.for this reason ...: REPAIR ❑ S " � fl f%�g'� C� - . . ... ... .. ...... . ... . �ate:. ...._. ,.:.:-:� USE OF . . EXISTING BLpG. DEMOL ❑ .. _ ^ � �, d �55, , �.� . ..Siqnalure . .. .. .. ..__. .__., __..., _ . APPLICANT. . . . _. . tEL - FINAL I � OWNER-BUILDER DECLARATION PRINT) , NO . pATE �y'�t�/ �'� (i q�� J-R 5� �I hereby affirm thoi I am ezempt from the Cont actor's License � ,�.. Law for fhe Pallowing reason (Section 7031 5, Business and - ADDRE55 . . , : ...,...,::.,.,, FINAL�? �� - � �- n . ('EL'.GN 7rofessions Codej: � � � �-'�' � ''� "'�'-�' -'�--- PRESENT' - gY ' ' - �,�.r,-� BUILDING .. . . . . . ... .. .. . ..... h � I, os owner of the property, or my employees wilh ADDRE55 , �a o�o s o '� wages as ifieir sole compensotion,will do 1he work and � � � � the structure is not intended or offered for sale(Section ���A��TY , ' ( U C,i �,�(j � 7044,Business and Professions Code). � �� "�" �� MOVING �� -� TEL - � �-� ������ �� -- � ����� � �� �--�-�� ����" ❑ CONTRACTOR NO. . ��;°,F �� : 1? I,os owner of the prope�ty,om ezdusively wnfracting . :.(�c , c . . . .. .. '....5.....,. with licensed confractors 10 construct fhe projetl�(Ser qDDRE55 - tion7044,BusinessondProfessionsCode). '� "-" '^"" �:q � `-�5�� � . "._........... ...-CONSTRUCTI(SfV�LEND�IIJG�A�GENCY ...`...-_. ..:...:-.:. REQUIREO VAR� HWY . ..TOTAlSETBAIXFRO XISi. - . ... .. . _..._ . .. .. . . SEf BACK PROP.LINE �� WI�TH � I hereby affirm that fhere is a conslruction lendinq agenry for FRONT � � the per{ormance of Ihe work for which Ihis permit is issued P.L ��-� - � � - �-��- - - - � - - � �--- - (Sec 3097,Civ.C.). 9DE � .. . . ... � ... ....._. . , . .. . P.l ... _... .. . .. .. . o Lender's Name ��}�}{�?��� �}z�i3B39 LDMA Ref.N � � Lender's Addre 3�9 Park� �Aire_, ra:v_��i ona3 �� � P.c.Fee s 239.19 Permil Fee 402.00 � � � . � - , x I..certify t 1 h ve re this aPPlicmion and state+hat the -..--._ .-. .--i,soa��e Fee -..�-Q�•50 ..- L�nnA P/C Y. . . . ... ..' : a o6ove in rmati n is rr ct I agree to comply with oll Counry investigat�on Fee � ordina es ap�St ws relating to buJding mnsiru ion, To�ql Pee j�''�J �OMA Perm.# - � and re6y/qLth r resentanves of this County en r � � � � .. n po the�/hf ve en" ned properfy for nspec� urp es. $lOg.00 LDA9A $55.�� � � ...... . . , o , _. _ . .. .__.............._.`.. ,...__ . . .. ..._ ._.. a �� . SEE REVERSE FOR EXPIANATORY LANGUAGE- � . . . Signarur of Applimnt or Aqent ote . . .... .._...... .... . .. . ..... ....._....�._.:........ �... � .. '� � � . OO i � � PlANS TO APPLICANT INSPECTOR'S NOTES .OR'NF.R-BUILDER DECI,ARA'I'ION �- . . , . .. . . ..: .,... '. _.�.. . ..... ..,, . ... .. ... ... .:.... ,. ...„.,.,,.,�,� ,�,. , ._,. I here6y offirm thaf I am exempt from�lhe�ContraUor's ��� reason Se<. 7031.5 To: �� - � Refurned�- � ' � � �� -��'License Law.for the follo g , . ( ) . . � .. A roved . . . . , .... .. .. � � �� " � PP IIus ness anJ P nJessdoxs Co¢e A.ny city or rouxty wbic& _... ._.,., . ... . . No. Dafe No. Date'�"��� ... reyuires a pernsit ta tnnstruct,plter,�im(rrove,demalisb, . . ... . . .. ,. ......__... ... ..., . ...,,,,.,.. ._ or repuir any structure,Prior tn its issuance,ulra requires ,... ,..,�..._... . -� , - � � � . � � . tbe upplicuxt for sucb permdt to f:'le a siqned statement . that be rs lice,n;eJ yur.euant to tbe prnvisinns nJ the Cori- ' � � � tructor s Lrceuse Luw/Chupter 9/(commencang witb Seo- ._...... .,.. ... ..,.�.-„�. . ...:.� �� '���- � � � - arnx 7000J r f Di�risinn 3 J tAe Business und Prufessions - ' � ''��" � � ����' � � �� ���� : - Cnde/or tJiut bc is exempt aherefrom and tbe hvsis jnr the . � . . . . � . . . .. alleged exeinpt¢on.Any ololation of Section 7031.5 by � � � Required � Dafe Reeeived - - � . .. �n,p applrcant for a permit suhjecta Ehe applicana to a cir�t! Approvals or Approv,ed, - � . . penalty of not more tbon ftve bundred,do(lars/$SOOJ.Jr Yes No � � � -�� � � � � ❑ I,as owner of the property,or�rciy emp�oyees'wilh �� '�� �' � wa es os their sole com ensarion,will do Ihe work,ond Water Certificate . ,_ ..:.. ....''�.: ::��....... .. ... ,.:-,. �._,:.: ',:'• :-.. 9. . P . � .. -� ��� �the st�uc�ure is:� t ntended or offered�for sole(Sec.7044) �� � � �.�.....,� . Bu�ness uxd P asi�nn.�Code:7'be-Cnntr�ctor's Licente Heahh.Departmem . .. . . � - . �. ....� .. .�.. . ....: ... .... . . f . , ..... Lau•daes not apply to an nwxer of(�ro[�erty wbn builds Fire Depanment � - � �� ������- . - � -��.�. . nr dmproves tl ereon,and mbo does such wark�rimself or :. . . .. ,..�....... . .... ... . thrnugb 1 es ow�n employees, Provided�tbat sucb irp=-- .�...... : .: . Grading �- � �-�� ��� . �� , . provements are nnt.iretended nr.ofjered Jnr sale._ � . . - hnmever,tbe building or improvemett!is sold within o��,. " � �� ���� ' """ � �� -"�ti��sar o com dciron, tbe nwner-builder udll haae tbe , Geological . .� _. . � .. .., ��- ..., ._... ' . f 1' - � hu�en nf provinq thua he did nne builrl or improne.for . . ...-:.:. . .. �. .. . ' �, Pedestrian Protect on --.�� . � � ..: � - ' t!e purpose nI-�'aleJ. . � jFence)�(Conapy)��� � ����-- .�, � � � � - � � � � �. ��_ �,as owner of ihe property,am exclusively<oniroc- . . . � Iing witF licensed coniractois la consf�u'tt the project(Sec. ...�:•- . . . . ... . _..,.._ 7044)8usiaers and Pr f.e on.c�Cnde: The�Contractrir's Spe<ial Inspeclion ., , .-� � ..: ,::;. . . . . IConc.)(Masonry)�Welding) �� -� � . . . , I.icenae L¢u�r[,oea xnt pply to an om�ner ofprnperty mho . . ,. .._ . .,,,. . ... .. . .. �. . . • _ . - � bu!de �r ianpr� es fh�emoa,�und u�bo eonErdei.��jor e'uel� Lot Drainoge . . ' . . .......: �. � ...�.�. :�'�:. pr�jects witb u cnntractor/s/decone�ed pursuaxt to the ..._:�... - •'.. . ., ...._ � �Contractor:c License Lau�J. � . . . . _..'_ ._..._..... �� - .... . ��� ���� �� � r. Iamezemptunder5ec ,B.&P.C.fortFis Parking , ; . . . .. . .. .. . . _ . ... � . . . . .. .r reason . . ��-"�" "" - Dcte Owner Approvols Dafe Inspecfor's Signafure � ��� � � . . . ��- - ��INSPEC70R'S NOTES �� � � Localion— . .. . . . . . ..'. (Setba<k 8 Yards) (, y � �� Foundations � � � �. � - � � � � - � ��_ . .. .. . ... ..._ ..;.�.:. r .. .. ..,-. ...... .... ,_�„� 51ab ,k'j.i,.� �n ` � � . ... ... . .. �d t�_ '-;�. i�% _... ,. _ Frame � .. :..:.. . ._... .... ... ...� :. .�j�f��" ���.��$ . . _ .. . .. .. �. . .... , ... . .. .. . ,... � . ... . Energy Insulatlon !.y�<:,f ,..-,'J . . . ' . -: .. � . .. �....,: � ._ . .... . f:.:. .'; ,�o,.... :.. :...._ . - . .. . :.:;-::�. � . . . ',,.,.., ... ... . ..,. Lath/Drywoll - 1f . .• � . . ..- :::... � - , .,,.. _.:; . Interior :�:2�;��'s ..;il�-�" . . ...__ _._._ .. � �� ... ._.:_ ... ....:... . .;.....� ...:.:..: �. . � Larh-.Exterlor : .;.�d .. . ^. ..::- . ,...._. ..,... . .;,. . . . .: ,{,x.., p.✓ . ... � � ._. ,t•.: ' !�".�,t� ., . ' .-. ' ..�.,. . :.-, .' ' House Number.__ � z � .. .. ...,_..' . . _.. , ... .... . ... . . . ..__. .�. .. . .. Correct&Posred � . _�. ...... ......�....... � ....-_ _ .�......: ...:.:.... .. Final . . . . . . .... . ,. . . ..... . . .._;........,_.... Enter on Fron� � ...... .. . . �. � .. ..� .� . � . .,.,