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HomeMy WebLinkAbout0774A WORKERS'�COMPENSA710N�ECI�RA`TIpN .. . . ... y`��` ' '. `�0 ti�`.. y'� � . /���p���•���=.�.��-� iii``` �. .{-�--- yyy�r Kr .�_•x .,.. " ��. 1 hereby affirm that I have a.certif'cate of consenl jo self . � ���y 1�����o� �r 'y ��'����� ���A�� ��� i�sure,or a cerYficote oF Workers'Compen5atron Insurance, � L . \��� , , ��Ir\ �5 ot a�certified copy thereof��5ec/3800,lab-.C.) .... . . �. . . . . �. . :. ' . ". .N ��. . �� : . �. Pouc ���ified copy�:ne�b���Y Nationwide Z � COUNTY OF LOS ANGELES � euapiN� B,Ut4DING AND SAFETY � ;, WC065-279 ' - " r . .. � y f�m�st+ed. FOR�APPTI'CAN7 TO FICL IN Ao�aess 525 Dole Court O ��Cerfifred eopy's filed with fhe county 6oJding��inspeo� . .. BWLOING ..... ...... -..._ ..:.,,..._.__.__._ . . �fion deparfinent. ��� ADDRESS -SZS� b0�-2 Court � � .. �� , , �. ,;. , _ _._ . _ __.. Date �IH�H�-� Applicani THE�.t1ND.EN GKOUP � � ciTv Diamond Bar ziP 91765 . �ocnurv Diamond Bar " " �CERTIFItATE OF EXE10lP1'ION FkOIv1 WORKER$' �� ._' � � ����� � � � ' �� NO.OF BLo�S.� � � -� nIeAREST D123IIORd� B&Y BI.VCI�.�GD1d2.R S YlR 5 ' COMPENSATfOIV'�INSURANCE�� ' SIZE OF i07 � NOw ON tOT �� CROSS S7. . , „,.: P g � (This�section�need not be mmpleted�if the-permit.is#or�one �-� � � � - . -� � /+SSESSOR (� „ . � � ,hundr�ed dollors($100)o.r less.) ,. � TRAQ�+Z579 BLOCK LOT NO.� .51 /�n,qp gpOK �� ��_' PAGE PARCEL . � - .. � TEL US�Ez/ONE... . MAP . ... �/ . .. ......_-.. ,; ..... � OWNER .. . . NO.. �- � /� I NO. �I "3 Y' �' I certify thot n ihe performance of the work for'which ih s � permif is�issued,I shpll not employ any person in any m6nner P,�� BOX.33z9 � . � . SPECIAL � -� � � � so'as to become 40bjecl toYHe 7Jorkers'�CompensatPon'Laws. P,DDRESS � - �Qv� CONDITIONS � � . �.. . .. . .,.„ , .,� .._, . ... _ _ . . :�""^' ; , an Covina ziP 91722: ` � �e; '�_Applimnt � . -. ... .- . �- � � ARCHITECT OR TE� DISTRICT__. GRQUP ryPE fIRE, _ CESSED BY vOTICE�TO'APPLICANT. If, ah'eF inaking ihis Certifiwte of ENGiNEER � : � �� NO. _ � Exemphon you should became subject��to the'WoYkers' � �-_ . . - � �v CON� i Z�)/ . � Compensation provikians of ihe Labor Code,you must forih- A��RE55 314 N. First, �1YC2.dl$ ��-0�6 . .,�j N. +'. .. a' � wiih somply wrfh+.soch prov.isions or this��.permit shpl�be �. - --� ' -�-� '�"TEL "F "�� STATISTICALCLASSIFICATION � AP7. CONDO. Z deemed re�oked. �. . coNrRncroeTE� ANDEN GROUP No ' LICENSED CONTRACTORS DECLARATION�-. � � ��� - -�j,��, �-��='� "'" � � C1A55 NO..�DWEIL UNI75 ' �� I hereby affvm that.l am license5l under,provisions of Chapfe�9 ADDRE55 NO SEWER MAP � � �� � - - � (co menc ng wdh Secf on 7000)of Drvision 3 of ihe B�sineSs and . , . _ . . ���, . . ._.,:. � ' � P ofessiBns Code and my Imense is iP f�ll force and effect _ ., , � CITY � CtA55 � �� �BK �� � "- � ����" - -�- VALIDAiION License..� .: _ •.;,. . : .. .l . 54.FT: � NO.OF NO.OF CHECK - � � � ':'�� N�mber 510560 � �,�.cio55 B SIZE� IS3S STORIES Z FAMILIES� �. ONE � . - - "�� . . .. •.: . - .,.,_ .� . �. ... VALUATION ;._ , _ . .. TAE A.NDEN GROUP 7�S�H7 DESCRIPTIONOF�WORK � ' � • NEW -�� .7'809 Coniractor Date_,r,_ � � � � ADD ; ❑I am exempt under Sec � � C.aYdg2.- �}Z$ $F' - ._..❑ , . ' . � . ,_r . ... � ALTER - , : SLAB ONLY - . ..,.. . ._., _ -_. o� S 6.&P C.tor ihis reason - .. _,.__ . � REPA�R-❑ . .... . . . .' ....,'.. � . . .. . . .... ........._......Date: ... ... USE OF . �EMOL ❑ .. . . . . EXISTING BLDG. .- .- .-. .-. :-(j`�-7�[J;.� . ... •.•,, ,:..� ... P.PPlIC.4NT .:. .,..._ �'"TEL. �/ � ...._Signature� � ._. _. .. ..__... _._..:. -� PRINTI T�, E1�?EN GRO� NO .. '� FINAL � l,'r1i/i�O �, . .. . .�p o.� c e e '�_�.... OWNER-BUILDER DECLARA710N . . ._.. _ .. . -� DATE � � . - . _� . � :. _. _...:. I here6y�aftirm ihaf�l omexempt from ihe Coniracror s License qDDRESS Same as .above FINAC �� � �� � ' e!"^�w for ihe followinq raason�(Sechon 7031 5 Business and ����� .� �*�"���,�G Jr ��.- ..�. .. � ....�_.. . . .. ., �'6%�"""y . � �fes5ions Code:.-'' ..".. . � _...` PRE ENT . .. , ...... BY ..... . �� I, as owner of ihe. _o ert Y P Y . BUILDING .. ... . . . . .... . ., . �-...� $ c�]j;2'��... pr p y,_or m em lo ees wfh ADDRE55 `" .� . .. _. _. .. . , . . ._._ ._... , _ ,. _. - ,. . .. wagas as iheir sole compensotian,will do ihe work and `o�L TM , ' ` ��i •�,�:8� _ ihe sfrucfure is not intended or offered for sale(Section ----.. -7044,�Bosiness and�Professions Code). .- .. ... . MOVING . . ... . ...�....�. . ... TEL .... . . � I,as owne�of ihe property,am ezdusively contmcting CONTRACTOR - NO. �,-�, ^ '� '- � ...... ..^-� : � � with�licensed�coMractorstoconslruct�theprojeci-(Sec- ppDRE55 � �� ' � �� � � tion 7044,Bosiness and Professions Code). �� -"��� - ..... .., . . REQUIRED , VARO HWY. . TOTAl5E1BA, . . . . .. ... _... .. � - �CONSTRUCTION�LENDINGAGENCY - -�� - SETBACK PROP.11NE �"�� WI�TH 1 hereby affirm ihqt there is a constru<Yion lending pgency for FRONT�- � . - � the�performance of ihe work-for�which�Ihis permit�is�issued - ��� P.L. -�- �� � � � � , - � (Sec.3097.Civ.G). SIDE � . . . . .... ..�::�� m P.4,. ...... . .. . . . .... w . . _ .... . .._. .. .. .. . . . . ..._____ . .:. . _... . . . .. . . . . . . � . % Lender'sName Citihank � .. . .. . .. .. ... . .. ... . ._.. - . - - - LOMA Ref.# ' m ... .. . ._ . .. . .... . . . _. P.C.fee$ Permit Fea F)'3.�J rJ .. .. .._._.. .. _. . , .. .. . .. - Lender's Address /.�!!+ R- J�' py�EY� 1. �, �nn��. - � �� � " "``' > rc .I.cerfify ihat L have read this,applimtion and state ihat the . . IssuanceFee ],Q.rj� -� LDMA P2# --� - Q obove inform ion is mrrect.I agree ro comply with all Counry Inves+igmion fee � � -- -� � - �' g ordinances . $igie lows relating to bu)Iding construction, . Toral Fee� .� 7 L�.z�j� -LDMA Perm:..#�- -� : � and her y horize representatrves of ihis County to enter . . � m op n t e 'oned properfy for inspe�n urposes. � .. ... . .... . , _,. . „...... ., ,__ . , _ . . .w„ . .. . . . e a ' / `� SEE REVERSE FOR E%PLANATORY IANGUAGE � � e � ..�.... ..Signature fApplicant�or�Agenf�� ate . . ..._ .._....... ... ... . .. .. .. _..... ........_. . ��_ . . .... . _... --. . O�. � PLANS TO APPLICANT ��� INSPECTOR'S NOTES O�VNER-BUILDER DECLARATIOIV I hereby affirm ihntl-am ezempt from the Contractor's .. To:. Refutrted � > �'. � - License Law.for fhe follo ng redson �Sec. 7031 5) � ' ' � Approved � � � �" �Qusiness and ProfessiAns Code:Any ciay or county whicb- � . No. Dpfe No�.��- �Dafe. . . .. . . .. . .._ . . . . requires a.;6ermid to cor+strucg¢lier,impro�,�e,demalesh, , . ��� ... . -_-- .. . or repau anv striscture,prioA eb�itt lssvance;'a�o reguires � ' . . � .. -� � � . tbe applicaxt for such perm:t to jile¢sigxed statement ' ' ����- � . that be is licensed pursuaxt to tbe pro isinns of tbe Can- � . ... . . . � . --�- � tructor's License L¢w/Cbafiter�9J��usmencinq u:itb Sea.. tibn 7000)of D+,ision 3 nf the Business and Professions , . . �,�,_. ,,;, ..�� . . .. - ��_ - �� .-CfddeJ or tbdf he as exempt-tberefram and fbe bar(s fnr tTie . :�'.� - ... " -- . .. .. . .. ... .. ..�. ... .. .. . . ...... . . . . ulleged exemption.Anl'vi,olation oj Secaion 7031.5 by ... .. .��. `.'�'.� Re9uifed�. � Dofe Reeeived- ,� - " � . . . . .. . .. uny mpPlicamY.for a permft�subjects the aQpldcaxt to a civil � APP�O°a�s or Approvod��� � � . pena[ty ojnot.mose tba�.fioe..hundred doll¢rs($SDOJ.J: ....___ �-Ye5 No . .., � �. . .. . _ . . . . . . . --- �� � . - - � - - ❑ I,as owner of the property,or my employees witli � . Water Certifimte � � �� � ���� -�. , +� � . ����� , .,. . wages as�(heir sole<ompensation,will do the work,and -__ .�.._. ...�_.:�..... .>:_ ... .. . . . ., . . .. � ��- ���-- � � � � �� . __ihe structure�is not inte�rided or offered for sale.(Sec.7p44) Heal,th.pepanment _ .. . � �.� � .. ...� _ . . . Busimess dnil Professions Cade:The Cont acto'r's Lxc nse :� ;� .. . . . . � La:u does no6 apply�eo an ou�ner of proQerty wbo bu¢ddc ' _ Fire Departmen,t.�.___.. . . � � � � -- � - � � . or improves Zhereon,and mho does such work himsel -' �� ���. �� ��- - - thrnugh Ais owx employaes,providetl�dhal�iuch��in.. Grading .. � � ��� . �provements�.are not,inFexded or ofjered Jor s¢le,If� . ,.,' . . ^." = .��.; _ .., ._ . �,. .._:. !.,� .;_� however,tbe bnildimgorimprovement issold widh¢n.oxe _ � � .. �... " LL . . "........ -.,..year�oj�completion, t5e��.atoner-buelder will.�buve ihe Geolog ml . , , .. � � � _. . � . - . , . burden oj prnvdng tl¢t he did mot build or�imprave for Pedestrian Protection � . � � , � tbe purpose of saleJ. . . . ` .�.. ;..__ • .. (Fence)�(Canopy) - _ -- � -� ���� ��- � ^ �-'^�--�- -��� � -❑ I,dsowneroftheproperty,amex4lusvelycontrao �� � �� ` �ting wlth l�icensed con,lrpciors to const�uct the project(Sec. �'��� ��� :, � � - � �� -�- �� �� � � 7044)Busimess and Professions Code: The��Corilr¢ctor's Speciol Inspecfion - - -.�.: � •�� � (Conc.)(Mosonry)(Welding) ��� � � � � � . . � Lacense Luw.does not apply to dn owne'r of property whn. ,� ; � ,.r., . �- . . . . �builds or improx:es Lhereox,und who contracts fo'r.vuch Lot Drainoge ;� � . � -� � . . - � projects�with a co�tractor(s/lice�'sed pur.cuant m ahe .:.: � . :�.. _ _....- �:..�.. ._ _ . , _.._. . � . -Goniracaor's Luexse Law/. . Parkin , . ,.... . . .... ._.. __.....: . . �___. ..... " � .`:�- _- 9 -, ������� - -��� � �� � ❑ �I am exempi under Sec. ,6.8P.C.for�tFis . . ,. - . .._.__. ___....... .._...__........... . . , . _.,....< . ��.. .. .. .. . .. . ��- reason . ': ..:,.��_ ... .�. ',_ .. .,�: _ _ . �Dafe . .._. . Owner. __... Approvals Date � � Inspector'i Signature.�� �'" . � . . .. � � ���� .. .. _.. . , ., . ...� .. '�'� ��� � - . WSPEGTOR'S NOTES ���" Location— ��� - � � � - � (Setback&Yards) g q � � ������ � -�� � � � ., . .... ._..�: ,.... , �.::.. . , . ...._ , . . Foundotions � ' . _. . __ . . _ � Slab � .. . _.. . . . _ . _.... . . . . .. .. � . Frame .. .. . . . .>. . ...,. . . .. ,. . �. Energy Insulofion � � .. .. . � .. � . .. � � . . . . . . .... .. _. _.. Lath/Drywall-- . .. . , . ... ._. . : .. ... ,. . .. . --.... . ....... . .. ... .. .._. . � . ::.: . Interior . .. ...:.:. .......,.. �; � . . Lath—Exterior . - . . � � � .. �� �: . . ._.. __,.__.. .,:.;,... ::rx�. _ . r. - House Number— ... ���� � . � � � � �� �. . � � � � ., ,.:<., .: :,:.: � .:. , i..L> .,. d ,... . ,.. . Correct&Posted ,���.�� �. � - . -:� .. :. . .. ... .- . . - .: ^ � . .... - .. - �-,e .. „ - �-� , . +� . . Final-.. . _. .-.. . ,... ...._._ . .v....:. .. ._, _ ..__. ......... . ..:.. - . . . .. . .. .� � �. .En1er on Fronf � � � ...._, ..., ..- . . . - _ . ., � �.., . � . . . . . . . . . .. . .. . . � :.,� ?,��`q . � � , � .. _ . . . ,. � �.-a .:;'�,� .