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HomeMy WebLinkAbout0993A 8193A �. '. .WORKERS'COMPENSATION DECLARATION ~ � �` ' �J - - l � -- � � �\ � 1 hereby afiirm that.l hove a certificafe of tan5ent 10 self APPLICATION FOR.�BUI�.DING PERMIT � Insure,or a certificate of Workers'Compenstion Insurance,or � a certified copy thereof(Sec.3800,lab.C.) � - � COUNTY OF LOS ANGELES �BUILDING AND SAFETY , _ PolicyNo. ' Company gUILDiNG �J Cerrfied copy is hereby furnrshed. FOR APPLICANT TO FILI IN qooeess 23702 Fal con Vi ew Dr. ' -1 Cer�ified copy is filed with�he couNy buildinq inspec- guilDiNG2 . , J tiondeparlmeN. ADDRE55 3702 Falcon View Drive �ov.�,T� Diamond Bar> ,Ca. 91765 , - NEARE57 � ' )ate � � ApplimN CItY Diamond Bar Cd. na 9U65 cRosssr. • � � � �CERTIFICATE OF EXEMPTION FROM WORKERS' - NO.OF BLDGS. .455ESSOR . F1 t0 6 , � � COMPENSATION INSURANCE SIZE OF LOT � NOw ON LOT MAP BOOK PAG`f PARCEL . This seclion need no�be camplefed if Ihe permit is for one USE ZONE . M.4P .Vundred d011Ors($100)Or less.) . TRACT , BIOCK LOT N 3 � / NO. � � �, ' � TEL SPECIAL d �. �:terlify that in the performonce of ihe w for h thi owNeR �� No.594 5156 QC�'� CONDITION$ p � ' iermif is i55ued,I Shafl nOt employ an r in nnel DISTRICT GROUP TYPE FIRE PROO��ESSE�BY V . �, o as ro become subject to the W r5' n n � ADDRESS 23702 Fal eon e D ��(e � CONST. ZONE (/� O � QZ .�F% � �ote App�ant� — GITV � � . . 21P STATISTICAL CIASSiFICAT10N APT. CONDO. V , IOTICE TO APPLICANT: r ma ' i Cer i'rtale of ARCHiTECT OR lEL. tu ENGWEER NO. C1A55 NO.�DWEIL UNITS a aemp�ion,,yov shoul co to Ihe Workers' tn �- ompensation provisi of t ode,you musf forth- qDDRE55 � SEWER MAP z "i1h comply wifh such pro - ons ar this permit shall be TE� . � 9emed revOked. . CONTRACTOR ' NO BK. PG, VALIOATION -. � � . LICENSED CONTRACTORS DECLARATION �iC. -. .. - . �� - ierehy offirm 7hat I am licensed under provisions of Chapter 9 ADDRE55 ND. VALUATION . ' Dmmencing wilh Seclion 7000)of Division 3 of Ihe Business and . � LIC. � , pfessions Code,ond my.license is in full force ond effetl. CiTv CLA55 S � � D'� � � SQ.FT. NO.OF NO.OF CHECK ' �ense Num6er Lic Class SIZE STORIES' FAMI�IES oNe � -�0 9 9.3 R �E ' � DESCRIPTION OF WORK G�'G ❑ � 'nlrottor � Date NEW ❑ . . '�#.� • • •��•� , I pm exempt from the licensing requiremenls as I am o C � A�D - • � . � licensed orchiteU or a re9istered profezsionol engineer AttER � FINAL� �'��,� •7 9.5 0 . � octing in my professional capacity (Sectian 7051, J REPAIR 'OATE ' Business and Professions Code). uSE OF OEMOI ❑ FINAL � �,�'• •7 9.5 0� . E%ISTIN BLDG. 3 S��/ �or Reg.No. - Dale ADPLICAN7 TE. • BY �T � �I 2 1 4--8 1 ' � OWNER•BUILDER DECLARATION � I�RinIT� 7 NO. F7� „ , lreby affirm thot 1 am exempt from the Contrattor's License . � � � . ,.far the following reason(Section 7031.5,Business and ADDRE �. - , , . fessions Code): ' � pae EN � � . e�imw� ��,� -?8 1 9,2 A � I, as owner of the properly, or my employees with ADDRE55 , � wages as their sole compensation;will do ihe work ond . . , ' � ' ' the siructure is not intended or offered for sale(Section , IOCnLITY , � ' '!� � �� � 7044,Business ond Profesiions Code). MOVING ' TEL � � � � , I � � •8 D - �. 1,as owner of�he properry,om eadosively contracting CONTRAQOR NO. � � with licensed confractors ta consV�tl the project��Sec- ADDRESS - . •�• •5 6 '1� - � tion 7044,Business and Professions Code). � . ' REOUIRED TOTAL SET9AIX FROM E%IST. �. CONSTRUCTION LENDING AGENCY , SET BACK YARD Hwv PROv.uNE - wioTH O E�O J�—S�� ' reby offirm Ihal�here is a construction lending ogency for FRONt � . per(ormance of the work for which�his permit is issued v i � , _ ..aov�,av.e.�. s�oe �$1 9.3 A ' � ' - P.L. . . � ler's Name +' � �rl,�.� � �23 ler's Address v.C.fee E Permi�Fee �/'�v , , � _ l� . � . .5580 �ify Ihat I hove reod this applicotion and sta7e that Ihe ' luu ce Fee .J _ e informotion is correct.I ogree to comply wiih all Covmy lo�esrgm�on fee a� O � � �� - � � �, •.• •5 b 8 0� . ;ances d la �il � g construction, ioiol Fee � � 0 Ct O S—S� r � e thoriz e , ives of ounly to eMer C Ith 6 e-mei er p t for in .l:in purposes. � � . � � � � — �� �• ...i ���J SEE REYERSE FOR E%PLANATORY IANGUAGE � ' � ' gnmure Appl, n�or nt . Da�e � . . � �� , • PLANS TO APPUCANT. �- � � INSPECTOP.'S f10TE5 Otit'N�R•IIUiLDER DECL'ARATION , ' I hereby offirm Ihat I am oxempt from the Coniraclor'a To: � � � kefurned � • � � � Liceneo Law for'the following�reaeon. (Sec. 7031.5) �, � ,Apareved . Dr<sinesenndProfeseiorcsCode:AnyeilyorcountywbrcG tlo. Data � No. Dato . . ..rrguircs a pernrit to construct,alter,1>nprove,demolisb, . �,', or reparrany structure,prior lo i1t issuancq also reqaires . . ..- . • . .V . .' _ . .... - � .-.' � .' - .. -- tbc npplicaat jor saeb pernrit to Jile o signed statenrent � � , , , . . ., � - _, �tbat he is licensrd pursu¢nt to tbeQrouisions ojtbe Con- � '�- � � - ' , � - - - - � � - � -- trattor'sLicrnselaw(CGaQter9J(tommeperngtuitGSeo- . . „ , „_ , , tion7000J jDivision3oftGcDasinessandPsojessrons ��. � . �� � -� � � - - �- � ._ . - CoJrJnrJhatfiersra�emj�tlberejromondtbebatisfortbe �� - „ ... ,. . .. . all.,qcJ rsenrption.Any e•iolaeion of Section 7031.3 by Roquired 'Dcte Received ,- � ' ' ar.vahpficantJoraperniitsubjeclstGeapplicanttoaciri! . � - APprovais..,_ �''' Ycs ►.o -�or ApProvod ., ...., ... �. . , J,r.�alty�ojnot rnore tbaxJive hundred dollars(SSOOJ.J: .Q I,ae owner of tho properry,or my employaes with � Wator Certifimte - - � ' - ' �� ' � � wages ds their sole�tompensafion,will do the work,and � • " - ;!��,�" '� _ihe structure is not intended or oHered for sole(Sec.704d) � ' liusincss uxd Pro essions Code:Tbe Contr¢cior't License . _ Haalih Dep6rtmenl� . _ . , � f - . _ ,::;�� ;:, , � . , Inu�dnes no1 apply bo an owncr ofQroperty wbo bullds � FireDeparimenf � nrim�rnrestbercon,arsdwladocss��tbu�orkbinrs¢Jar - . . - - - . . . ' tbra:fi1 Git.own cnrployces./�rovided tbat sueb int- ' Gradin� � . � . proccmenls are not inlended or ofjered,�or sale. lf, '� ' --�� - - • 1 o¢�rncr,t!c building 6r i hroven+ent u rold mit�in one , Geologitol ' _ __ _ year f conplelion, !be ownenbuilder u•i/1 bave tGe � Lurdun oJJ�muing tba!he did not build or imjiroce for - � t!c pnrpose nf snleJ. � Pedestrian Protection � - ' - - -- -- � ---� - " (Fence)(Canopy) �. � . ❑ I,asowneroffheproperfy,emexclusivelyconhaC- - , _ . � firrg with licensed contracrors to construci ihe projet�(Sec. �, Sp4fiol lp7pa4tion � � ' � � � 7044J Uuermcss ond Professions Cade:7Ge Contrpttor's (Cdn2��Moson`'ry)(Welding) . . �� Liccnselau�docsnotapplytoanouxerojQroperlymbo . _ , Guilda or in�rones tGcrcon,arsd wGo mntracts forsueb� Lot rainagay �� . projects witl�a eontractor(sJ lkensed pursuant!o tbe� - ' .: ' , Conlrac�or's License LauJ. - , - Par��in�., .� - .� . . .� „� � . . , , � _.. '� ❑ I am oxampt vnderSeE. ,B.BP.C.forthis o _�� r L .�... � • reaeon , � q! , . . , , . .. . . , . _ � Date � . .Owner � � Approvals � �. Date � In�;.acfor's Signcture { � � � � '� " " � � . • � � - INSPECTOR'S NOTES � Lomiion= � , . , . , . . . (Setback 8 Yards) � / ' � � -� . � , � Foundations / / j - � � - , � � - � , Slob � . .. . .. _ -� . , . �. Frome � " . � . . Energy Insulotion . , � . .' .. . . � . Lath/Drywall— , . Interior - � � Lath—Exfer(or � . . �,.\' . , ,, � Housc Num6er—' ' � - Correct 8 Posted - � � ' '� Final— � � . , � . _. , . Enler on FroN . � ' � � � � �