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HomeMy WebLinkAbout1149A 1150A i . _...__--- ...-----._..- --- -- --- - _._... _.__._.._---.... .--- ._ _ . ._ - -- - -; - --------�------ ti, � WqRKERS'COMPENSATION DECLARATION •��- ��� � • • -� _ orharcer�iaffirrpthatefhavSe�e.,;,I�L�o����`self -�-------.._. - LICATI�O.NGFEO U.ILDING�APER .....� _ _ insure,or a cerlificale of Workeri�om e��,�o���s��a��e, APP R:.B. MIT - - � - - ._ __ ... �0�--g � b0�° a e 60/A (2 Car? . Policy No. Company "'�-- BUIIDING ' O �Ceriified copy is hereby furnished.� �� . .� �% FOR APPLICANT TO FILL IN pppRESS 691 N. Feathen,uod Drive � � Certified copy is(iled with the caunty buildinq�inspec- - BUiIDWG �T]. FeathetV�ood�Drive � � � �' fion deportment..• � . . . . ,.,.. ' ,.. ADDRE55 - , �......��.� � ..;, � � 'i�� :. � . ..._ ..__. . .� � Date Fi-1 9-Rti �Applicant�94�1F. AT7nF.N (�FXYiP arv -.. Dlamorrl-Ba�' - ---Z1P 91765 - � ' ����rv DlclifqTlC1 Bdr • I .� . �'.' CERTIFICATE OF EXEMPTION FROM WORKERS•.. ... ---. .. ..".."-�-" �-- -�NO.OF BLDGS. ---- .... - ; NEARESL-- • - --....._ --� -� -- -- � � � '�� " 'COMPENSATION INSURANCE�' � �� SIZE OF LOT NOW ON tOT caoss sr. High�Kmb &�Golderi Spr� S (This seclion need nol be completed if the permit is for one -� - � TRAR '3 S7 E Z BIOCK OT NO G O I �p g�ppK'`'��' � ' PqGE PARCEL f h�ndred,dollars($100)or,lasa� ,' , . , . • . _ ____ owNea TH N--GROUP No - u o e � No. /13-��54 • �I I certify ihat in Ihe perfvrmance of Ihe work for which Ihis -7 � } permit is issued,1 shall not employ any person in any manner .. _ .. � - SPECin�• . . . ... ...........� -----�'---"��- �I 0. ' ADDRE55-P.D.Box 3329--..__ ... ..__. _ ..._......._: ihrz� CONDITIONS . .' .. Q so as to becoma subjeci lo fhe Workers'Compensmion Lows. ..., � . � . .., . . ... .. , . . . , .. . ' --_ . _..�_. � . ... --- aTr ' zia 91722 --- ._--- . - , _. .. . te.•� . ... ��.: � ppplicoN' . . .,.� ARCHITECT lEl. L: ... � �� , . M �� )TICE TO APPLICANT: If, oftcr mcking fhi;Ccrtificcta cf ENGwEER �`Ve S"tm� � No 44„-4073 , o,sre;rr... c�oue. nFe _F�ae _�R�sxo nr. l .emption, you should bacome s�bject�to'�ihe Workers' -- '"� �� Z� ' must forlh- ADDRESS 314 N. FiYSt Arcadia 91006 � -_(v_. R" �. _- -_ -�_- a , with com I with.such� ovis�ons or.thiz armif shall be �� - ��. ��IN��.�P TEL. � STATISiICAL C1A551FICATION j APT. CONDO.'-' �Z Com ens Pi�n ovisions�the labor Code,P ou CONTRACTOR NO. ' ...___- . -...�� _ - -_- _- ...__ .,- P W Y deamed revoked.. ' .. UCENSED CONTRACTORS DECLARATION� ���` - �-- � -- - - -� - �----�� LIC.� -��• C1A55 NO. �" DwELL UNITS-L ; 1 hereby affirm that I am licensed under provisions of Chapier 9 .ADDRESS AS c 1�O Ve No.3 7 1 5 8 0 (commencing with Section 700DJ of Divison 3 of ihe Business and __ _ i��. ��� ��� � ' ..... _ _ . ._. __..._-- ' -' � � Professions Code,and my license is in full force and effed. GTV CWSS "-'- --�-""- "-"--�- -� '--' -� VALIDATION�'�r���"�� . . . , . .. ., sc�.Fr.2375 NO.Of NO.OF . l.. . B CHECK__ BK. PG. � �,1'1 4`/IY � licenseNumber 371580� �•� �;�.,eia;s 'B• .' -'-'-� SIZE STORIES FAMILIES A�D NE `SA`86`'080 . '_'_", "': ' __- fh-�"� ���L'� . , .. . �.... ._ ' . . ..❑ -__"_� •-J-��.�.n',1 � ConlrOCtor �� ATIDEN GF�OITPDate 6�19�H6 DESCRIPTIONOFWORK � `S�IK��-e fNIV'lY " NEW � ! � - Gati'a e 510 SF ❑I am exempf under Sea � -- � " � � ,: � �. �. � . . .... �_ AITER � _ , G , .;�� . . _ _. .. _ ._..�31...1.c� '__.-- -- . �8.8P.C.for this reoson __ REPAIR..❑ ..s.--�-'"-- , � _. ._ .. . _ . .__ _ Dafe: -� USEOF DEMOI O � '._ '._____._GE22.�..A�G_ ;_� EXISTING BLDG. -'�''Signature . . . . - .. .-_ �•. ... ._ ��P NrT G NO. FINAt � OWNER-BUIIDERDECIARATION _ _. .._ _ ..__ . .. .....- ---._--_-.-- --- . -DATE•2�'Zy-`�. ..--- -----�- . - ---- .-.. . --. -�1 hereby affirm Ihat I om exempt(rom Iha Conuactor's ticanse � �,'1�,�pVe . . �,,,, � . ' � iaw for fhe following reoson(Section 7031.5,Business and aoDkE55 FINAL" �� ' •' , �fessionsCode): �. ._ ...._ .._. ..__.. __.__�-- � ---... N ., �By�- -- - -..._. .. . - ^�-� .F.��Fi� , 6UILDING� : ,n . .:\ ' `�� :.t �.:\'� I . ° � I, as owner of the propeny, ar my employees with AD�RE55 ��- ' ' ' _ '_- �.�-- � -------- � - ��•-.� - i.- .... . ----_ -...-- -.._._� .. .-Fia- c a .�- -i wages os Iheir sola compenwtion,will do�he work and ' , : . � �he struciure is not iniended or offared for sale(Sec�ion ��`��TY. • '--- '• � . - �-''i ... . 7044.Business ond Professions Code). --''•"' -- � MOVING'� --------"- -"` .-. .._. .���TEi:�:.. ..•: .:�._.._., , .�.... .. .. ..' - - . . � p 4.���O- - � I,as owner of ihe property,om exclusively contracting �ONiRaC�OR NO. � � ' _ .. wiih licensed wntmclors to construct the project(Sec--`"-"- ---�- -'--�" -�-�---- ._----_._-.---_--_- _._ .._.._. . ._ . ._ _ __ ..._ . ; � � tion 7044,Business and Professions Code). ADoaE55 : �D_�-'"'���' r-i`,� � `4��'`��`�-? ._' '_, ..REOUIRED'-- TOTAlSETBACK M-. '_-' ---^ ��� J�-. �- "•.,...D E,�2�8 b�.. � ..__._ YARD. _H�,_ '. � -- CONSTRUCT�ON LENDING AGENCY" '-�--- Sei eacK GROP.LINE WIDTH � I hereby affirm that�here is a mnstruciion lending agenty tor FRONT � �...V�+��'�•:i 1 ��ti���"'J � �� - the performance of ihe work for which this permit is issued - �- �P.l.� ' -- ----- - -. - _ .._.--'__.. . . ....... . ..._....__ . .. .;..-f,. �..-�. _ '--.._... ..- -_. (Sec.3097.Civ.C.). SIDE � . ''' ..'� ..'.1 m �-. P.L. ..,... - __' ... . ' '_. . . '__ �.\ . r��.� ij^,._•,_. . "'""__'_.. .... . : _ ..... Continental-Illimis -- I � lender's Name . � • . : .� ; - , ' � � 474.00 �7`r'A'Ref.X . "" -231�S.-I�.S�ZE��CcZC�O�IZ....__"' P.C:Fea f 331:•�.2 ___ -.' Permit Fee -'. '-" = Lender'sAddreu 693 - � - �� , ; ' � . �� . �. � . � 1 certify ihat I hava read ihis opplimtion andslate that Ihe .__..'-- - .__-- __ ..__�__'_._--.h:uanceFea ZO.SO•----" LDMAP/CM . . �. .. .' '-- -"' ""-".�-�.-.���.. _ I¢ above informotion is orrect.I ogree lo tomply with all Caunty Investi otion Fee j . " 'I a ordinances and lows relating to 6uilding construc�ion, 4H4.5� � ... - __._ . .'_ '_9 '_'_' " _"' -' - Ta�ol Fea' .- ... . _' LDMA 7erm:il " ' ' " " "' _ "" ' '� u o�d hereby a o e representoiives of ihis County to enter , ' m upon the a v en ed property for inspedian purposes. ' ' o • -LI�7A-$75- - -- .�-$35 -::. . .. . _. . ._._ . .-,- - -. - ._ ..- -- -� a i ^ SE�pEVEkSE FOR EXPLANATORY IAHGUAGE � O '-... Signarore of Applicant or Agent- .-. ... - ie ' ' � � ..�'"..',.'_. .-� - �--'� �- : ,. .: _ _ ' .... . _' _ '_ '_' . _.._' ' ""'_ . . . __... � ' . .r i ( _ _ i . ... ��,y� G"vC'"C_-V G � T�� .0�O Q y ��'G G �l _ N C.� Ol.,�.,.�N / _ •O%�"^.M ��6C� C .�.� "1 ' COV =.��' � .� .��.'� 'ON `�-� .�.�. � .� - _ ` ' _ r � �. . , i vr� � '`a'=V y ��n'i.p 3 o'c :~ .: ' � v� � h � i` � O:.. 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