HomeMy WebLinkAbout1798A 1799A (10) . �_. .
WORKERS'COMPENSATION DECCARATION '"� . S�O '
• .. _-. .. .,... . . � . .. . .
Lhereby affirm thaf f hove a certificate of conseni to self p�p�����p�T�fON� FOR _BUILDING PERMIT ��
insure,or o certificate of Workers'Compensation Insuiance,
� . _...._. . . .. . ., . ,;..
or a certified copy ihereof(Sec.3800,lpb.C) - ' ; .._,_.. _ .. . .
P��yrvoPWCC253824do'6�PonY Pac. �m�lovers COUNTY OF LOS ANGELES BUILDING AND SAFETY�
__........... ,_ _..
PY Y FOR APPLICANT TO FILI IN bUILDING
Certified co is hereb furnished. aD�RESS ,`Z 20� �,p�lyy.l �.�.
(}� Certified copy is filed with the county 6uilding� gUUDiniG -�� � - � � �
U lion department. ADDRE55 ��Q� � �,
V ��� . .. ..... . ... . ..' .._. . ... . ... ..__....
Dote � . Applicanr aTv D1amond Bar z�P 91765 ���iTY
CERTIFICATE OP EXEh1PTION OM WORKE 5' NO.OF aLDGS. - � ' MeqeESi ' .
COMPENSATION I RANCE SIZE OF LO7 NOW ON LOT — — CRO55 5T.
(Thia section need not be completed if the permit is for one TRAC7� BLOCK LOT NO. ASSESSOR �
hundred do��ars($100)o�less.) MAP BOOK PAGE PARCEL
TE�' USE ZONE MAP "- -
I certify that in the performance o4 ihe work for which this OWNER N . — ��� � 1/f�� �
permit is issued,I shall not employ any person in ony manner qDDRESS P,O. BOX 350 � �Qa a�t SPECIAL d
so as fo become subject to ihe Workers'Campensation Laws. CONDITIONS �
�
Date � Applicant - CiTv Z�P � �
NOTICE TO APPLICANT: I4, after making ihis Cerfi4icote of ARCHITfCi O TEL. DISiRICT GROUP NPE FIRE PROCESSED BV �
ENGINEER C �'I T' Px li �� — 7 �
�'�Exempiion, you shoold�become subject to the Workers' CONSL ZO �
""� Compensotion provisions of Ihe Labor Code,you must forth- �U '
ADDRE5510841 S. Paramount Ave. llowne �-3 � �% �
wifh comply with such provisions or this permii shall be . - _. .._- .__._. ......... ..._. ...... ._. . tel
?El. $TATISTICAL CLASSIFICATION ' APT. CONDO.
deemed revoked. �
CONTRACTOR Np.
LICENSED CONTRACTORS DECLARATION, LIC. CLo.55 NO. �� DWELL,UNiiS�L
I hereby offirm that i am licensed,onder provisions of Chapter 9 AD�RE55 NO.
(commencing wilh Seaion 7600)of Division 3 of ihe Business and ��� SEWER MAP - �
Professions Code,and my license is in full force ond effect. CITY ��� BK. PG. VALIDATION
S�.Ff. ND.OF NO.OF CHECK
license Number �4648 �;�.c�oss Bl size sroaies FAMILIES oNe
. . .. . ...`- VAIUATION
co�rra��o� pa�e DESCRIPTIONOFWORK New sin�le famil "Ew ❑
ADD p s �9oZ��+� ,_'� %9,��F.
�I am exempt under Sec. � Wltl'1 ach d T q�TER � ' 1; a<, c�o[�
8.8P.C.for this re son � S
USE OF REPAIR , £�4�,�,C�
' EXISTING BLDG. �'IA �FMOL �
Signature. APPUCAM . .-�. . TEL FINAI '��`t'�'��t'�' '
ER-BUILDER DEC ATION PRIN77 NO. — ' S,��7 w
._ -.. _ . __ _ .._.� —.__._.._...._. DATE .,�YG�/ �.�'�"�'.C�
I hereby affirm t I am exempt fram the Contractor's License . �'`% �
Law for the f owing reason(Section 7037.5, Business and ADDRE55 FINALiy �
Professions Code): � E E - � - � -�� � BY
L'
�(� BUILDING .
��^�.� �, as owner of the property, or my employees with ADDRESS _ _
A..� wdges as their sole compensation,will do 1he work and � � '
the struaure is not intended or offered for sale(Secfion LOCALITY ' . . :� �/�,�j,.�
7044,Business and Protessions Code). MOVING � ' " � " TEL � � � � '
� CONTRACTOR NO. ?�� �� � r �+ �
I,as owner of 1he property,om exclusi�ely contracting
with licensed mniractors to construct fie projecl(Seo- � � \ /
lion 7044,Business and Professions Code). ADDRE55 �.�/ � �a� G, �:v
REQUIRE� TOTAL SETBACK FR M X ST.
CONSTRUCTION LENDING AGENCY '' SEf BACK YARD HWY pROP.LINE WIDTH - � E `:��`lJ G�
I hereby affirm�hat�here is a cans�ruction lending agency for FROM
the performance of the work for which ihis permit is issued p.L F G���_���
(Sec.3097,Civ.C.J. SiDe
P.L.
Lender's Name None
�' �(Q O g 5"� �or�nn Ref.a
Lender's Address P.C.Fee E "�`6 Pa�mit Fee a O' - �� �� �
/.� 5'0
I cerfify thal I have read this appli<ation ond siote fhot tha Issuance Fee �V LDMA P/C# ,
� o6ove informafion is correct.I agree to compiy wiih afl County in��rigotion Fee
ordinances and State laws relating to building conslruction, Toml Fee �� LDMA Perm.N
and re6y authorize r esenloti s of fhis County to enter
� �po the pbov - ned pra ty for inspeclion purposes. s',�. 9�� - --� � � ' '� � .
�zl�6 �
a SEE REVERSE FOR EXPLANATORY IANGUAGE
Signature Applicanr or Agem Dme ' - � �'
I
PLANS TO APPLICANT INSPECTOR'S NOTES O�M1'N&.R-BUII.11ER DIiCLARA'1'IOti
. I hereby affiirm ihat I am ezempt from the ContraUor's
To: Returned , License Law for the following reason. (Sec. 7031.3)
Approved Business and ProJessiuns Cnde:Any ci(y or rnunty u.'�fiicl�
No. Dote No. Dafa . requires u Qermit tn con.etre�cd,alter,im(rri� e,demolixb.
. - nrrepairattertriccture,/�rrortoitarsauance,��Jsn''requires
� ahe applicant jor sucb permit to/'le a.vi,ened stutement
ahat 1��is lirerssed purauaxt to tbe proursinros of tbe Con-
� �� � -',/ - tracaori�Lirense.Luu Cha ter) �
. . . ( p 'J(commenciregwithSec-
,, tion 70QOJ oj Uiviainn 3 nl tGe Busines.��axd Prufe.asions
� ' CddeJ nr tbat�l�e is exempt thcrejrom:and cbe buss.i fnr t!e
� alleged exenxption.AnY a'iolutrnn ajSe��tinn 7031.5 hp
Required DaTe Received un1'upPlica�¢t for u permit xubjects tbe app[rcamt M a drel
Approvals Yes No or Approved ; �., . . �,��pena(t��rf xo[mnre than��v�bun��e�d�,ira>s�s5no/./:
� � � � ' ' � I,os owner of fhe pr6perty,or my-employees wfth
Woter Certificafe , � wages as their sole compensotion,will do tne work,and
the structure is not intended or offered for sale(Sec 70441
HeahhDepanment . �� � Busi�essendPmfessinnsG�ode:�T6cC�mtru�tnrsLicunse
Greao doe.e aot aj�(�lry tn aa oumer ojprnperte mhn buildv
Fire Department � nr impmves thereon,and u�fia daes sucG sork GimselJ nr
ehrouqb bis own empJnyeer,(�roride�l tbat sucb irn-
Groding prnnements are not intended n q[(ercd for sale. !(, "�
�6nu�eacr,LAeSraildin�+orimproi�ementi.rsoldu�ithittone
Geological '�year of rnmpletron, tbe nwner-5uildcm a�•ilT have t!e
6urvten of proving ibut be drd not huild nr rmprove fnr
Pedeslrion Pro�ection tbeQu�ose n�saleJ.
(Fence)(Canopy) ❑ I,osownerofthe property,am exdusivelycontroc-
Iing wifh licensed contractors to construct the project�(Sec.
Special Inspection � �' � � 7044!Husiness and Pmfessions Code: TGe Contractar's
(Conc,)(Masonry)(Weld�ng) � � � I.icense I,au�doea nnt apply en aa nu�ner r f property u�l o
buidds nr iniprnves tbemnn,¢n�d vfio cantracts fnr sucb
Lo�Droinage - projects u�itl a co�azracer,.(sJ lic�nseJ p:�r:.-uunr ta�t/r
Cnrstractor's License I,au�J.
Parking � . . .. ..� ._ �,..�.
� I om exempt under$ec ,9 BP.C.for this
60 reason
Dote - Owner
Approvals Date rapedor's Si aWre . _ -
. . INSPECTOR'S NOTES
Location- /y' ��
(Setback&Yards) � ,/ '. � _,
Foundafions �� ,,.% �
Slab " `�
�:
Frame ��J" � J...✓.� . .
Eneigy Insulmion Y�7 � ., �. � - � .
� r
Lmh/Drywoll— ,f�j �� �
Inrerior �'�,�?/ �If,,,,ti�i'�,j ,
Lath--Exferior � � � � ,� � •
�'_.i 5� C� i`„'" �. %� ' �.�.
House Number- . ' - � ' .
Correct 8 Posted
Final- . . :.. . .. . . .. . .::,.
Enter on Front ' � � � � �� ��