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HomeMy WebLinkAbout0773A 5082A 5175A 5175 (4) .. - __ _ __� _ _ _. _ , � , . , , ___. _ _ . . _..._.. .. _._ __ . _. __ . .._. _ ' . V Q4KER5'COMPENSATION DECLARATION � �'i t � :,: �, �� �,�� �� ... ,. .. ..,� . .. : , �..Y .---__.... . ' I hereb alir �har I have o cerhficate;ot consenl.ro self � � � ! � Y-` 1" - APPLlCATIQ.N��FOR�BUICDING�PFRMIT - � �nx re Fr a certifim�e of Workers Compensohon Inwrance, � ', - - ." - -.... . . ... . _._._ . .__. .._ ��.. . �. `t,a�C�.if�d copy thereoi(Sec.3800.Lab.C), '..'.� . '-.� � . "" . .'- . � -. : ..--- � � 'j,(/ ��-� � • . COUNTY OF LOS ANGELES, ., BUIL�ING-AND SAFETY ' ,PolicyNo.�O�� � Company J.. _�S__. . � . � .. ..... _ _�. �.�. i��. �- Certified copy-ts hereby furni ed.� � . .�t�d�k.c,�,.,,�v FOR APPLICANT TO FILL IN � �� . .DORE55 �Q; i � �'Cer�ified�copy�is filed with the couniy 6uJding IA'ipeo- "'�� guaoiNG 9 > � . �. - liondeportment'� AD�RESS � , � � �.... • � . _. ._ ..__�____.. _ ._.. . __ . . �..�.. . __'_ __ ..__. ` ome -1� nPPucani�fC/C��r�iQl��i�(�' an D13morid r Ca:�P 1 6 iocAurr � � �' � ���CERTIFICATE OF�EXEMPTION FROM WORKER$'=�'`. "-�-�- --...-----Zh H �SOO��S�•FNO�OF BLDGS.- .. •. .-._. .;. NEARE57... ..___.. . _-' .'----'-__ '--_.--_--'_... I: �`' � 'COMPENSATION INSURANCE'` �� -�� � SiZE OF LOT � NOw ON iOT � �RO55 5T.. v I ��.„ � ' (This section oeed not be completed if ihe permit is for one--._._... . .. _._. .....__.____ -__...._ __........_.. __ . _..�.___ .. . % ASSESSOR _ _ .. ... -... � �' , �... hundred dollars(5100)or less.)-::�. . : . � ..--.... OW ER' � '...BLOCK ... 'LNONO. - . �ZO q( �P ; c � /�G`�rl� PARCEI., . I I certify thot In the perfarmance of 1he work(dr,whith fhis - ;} T permit is issued,I shpll not employ any person in any monner _ _ , . .. � -� - �--- SPECIAI� -----� . � - -��- - . .-.'. ADDRESS. . ._. .'. - - - -�'-". CpNDITIONS � �I... � so as la become subject to the Workeri�Gompensotionlows. I� � -.�,� ' ' __. ��TY.__Diamond_Bar...Ca��P 91765--- _ . ..... _ _ _ _ � P�.� _--- - � Date ...,, .�.� APPIiCanl � ARCHI7ECTOR TEL � ... . I . • ,.l . ��a NOTICE TO APPUCANT:�If, aRer making�ihis Ce�lificote of ��� _OISTRICT.. GROUP� NPE ____ FIRE./ _PROCESSED BY �O Examption, you should become aubject to'Ihe Workeri �� �' '{� �'[O�T., ZONE ��j ENGINEER Y7a ne Tani dreh o.8 Compensation provisions of the Lobor Code,�yoV musllorih• qDDRE55 --/�-� 1\ � --�-�l�-� -� � -- �� ���a with�comply with such provisions or.Ihis�permil shall be ------ � � ,Z deemed revoked: � ����, •�� � . " � TE�� . �� STATISTICAI QASSIFICATION � �, APT. CONDO.��-^ ' . ..����;� ��.,:�-�'.: � CONTRACTO � L NO. ' .... ._........ .. . ... :.._. ._I._. .. _�_ . , ._.. . ...__.. _.. .." _' " LICENSED CONTRACTORS DECLARATION�..,. . � .--- -.._...-. . ------ . �-.-.-�-- ---ttC- .. . a0.5S NO. � �� OWEIL.UNITS ' . I hmeby affirm ihat I am licensed under provisions of Chapter9 ADDRESS NO �i ° , $E4JER MAP ' � ' (tommenting wilh Sedion 7000J ot Division 3 of Ihe 8usiness ond ... __ __�. .. .. _... . _ ..___.._.,p�.. . ., __.....____ � i ' � ,Professions Code,and my license is In fuil force and effect. GI7Y A � CIASS �--��-BK-�--- �-����-`,� ��'-��-f- ��` -�, � �����'yplipp7�pN"" -- �; � �. .�. . ., �. � . � _.._._ . 50. NO.OF ."' _'�.Y NO.OF ._._ _. .CHECK : LlcenseNum6er �� Lic.�CIa35� SIZE �STORIES FAMIUES �ONE �� .... -.. . � . . . . IfiG► 'GV� ' � ���� ��NEw--' .-VALUATIQN . . !..__. '� .._._' � ..'.-- DESCRIPfION OF WORK. ._. ...'-" ...' . - � i _' Conlractor_,��(��Dpfe� � ADD � S � - ' �7 7.3!1 �_�; . ❑I am exempt under Sea ._.. . _$6_.- .U211't..�0'r.Bl _ _ . _ _. .. .__'_._ ," _ _��p. .. _ 2.3 ' .. � . , AUER Q e s ..'B.�P.C.for�Flis I¢asOn . . ; , .,. ,,.. , ..'"_.. REPAIR.. , ._S.�/�/✓�'IU�V '. ._"'I ._._..�'t �2 2.b�l ' . ... _..... .. _-_. ' __..Date: - . . USEOF T1�A DEMOL - � . . ExISTING BLDG. � � - - -- . .._.... � � .. ..._.:Signature � -- . _.... ... .._ . ._ ._.... AFPucAM � . te�. FINAL [ � t O G 2�J� _i FRINT �fa e Tani N0.86�-� � � OWNER•BUILDERDECLARATION � _ __ _ ., .._ . ,.__. ._..__ _._._ ._ .._ . .._ .., �--0ATE (� ;3�0��� "-' � -a�F � S--S�6 I hereby oifirm rhat 1 am exempt(rom the CoNradoPs License qooaESS ZO96O GOZCL RU71 Dr1V@ �. ' FINAC ' � ., ..... .,. . .: � ' � law for Ihe following reason(Settion 7031 5, Bosinass ond ' , ___c Y ..ProfessionsCodaJ:""-'--..._. _.__ .....-. ._. �..._.. _._.. R ..eY . . .-.._ .. _�-: .-. ;; - 08-2��i"'..; BUIIDING � ' `,•� _ '- � . _a_ I, as owner of the property,.or my employees with aoDRe55 -:-�- ..-_.�_;_ �- � .�y .h o e •`e'�3-.-;�-� _ . _. . _...... . �.- wdges os Iheir sole�ompensation,will do the work ond� '�. � � i ,. , � ' the structure is not Intended or offered fo�sale(Sechon ��`��TY .' ��- ,- r n- -_.. .7044.Business and Pwfessions Code).-"."�..-- - '_'.- MOVING . .-. - ...., ._ . ._ ..-'TEL �.." '--.. - ..- [-�'�' -- -'�-g' {;-� '�. � I,as owner of�he property,om extlusrvely controdm9---... cOrntinctOR ....... _.._ ___. __.._ .. .__.N� ....-. _ ... ..-' -.. . C�l..�. ' pG_1��� _�j �z� . . i - with�litensed�ontracton to consnotl iheprojecl(Sec- � � � � - � j tion 7044,Business and Proiessions CodeJ. AOOREu �. ' - C.j�LJ�- .. �t c P�_^���, =_ .-.. �._ .. ....... _REQUIRE�.. .TOTAl5ET8ACK ._ . .. .. ...___.. . ._'__... :J - - � -CONSTRUCTION LENDING AGENCY-"- "-"� � set encK -YAR��� �� VROP.LME wioiH �- - � �±.2't H O O �� � , I hereby offirm that�here is a constroction lending ogency for FeoNi � � -- � � -.ihe performance of the work for which ihis permit-is issued--- - v.L: . __ __.__. ..._.. . ___.__.__' ___'._ _____��. . __ _.._._.. _'......_._ ..:.-.. . --��,,.- 4�G E- _ ,., �.�.r. : (Sec.3097,Civ.C.). � SIOE � ' - �-' � - � ^ � P.l. .____ : .__.___-'_'__:. .: ' . m __... ..._.. . ... ... . .. ___._ . . ..__ ..._ .. _ . . -_. � _ � � Lender's Name ..: - .. �. � � f . •. t7� �L� " . �y WMA Ref.M� . .- ' $� _ _.. _. : ......... . ....__ _ ......__' _"". �.C.FeeS. . • .__- PermhFee. '_ � _'i�� � .._ _ i , - lender's Address �/�- c'� �� �� i �. _Ltertify fhoi I have reod this.applicafion and atate-thai the _�__. ���.... ...,�v.�..._.Issuonce Fee� � � �LDM4 P/C N��1��-- "- '- I; .- -- ..� .. ' � - above informaiion is correcL I agree w comply with oll County � � (�- � � � g _,ordinances and State laws relating to building construction, ____._ . ��_. .��=_ Torol F e�� �- l) - -LOMA Perm.�N � � � � .- � � u and h r .. .. . _ ....___.� . . '____ �.._-. . , ��- u on b i ed ra en for Ins ection ur ses. ry� a0 � � a Si Nre of A lic orA t -"' -" Dore ... . ..._.._ - .-. � �•`` ..�u • .. �� � �� ��. .��� � . o � 9^a r'PP gen _��� SEE REVERSE FOR E%►LANA70RY LANGIJAGE� '� ,� re eseNotrves o 1 is ounf to enter P P P Y P _ �\ � . .._'_ _....._ _ . . .___..__. . . . .._ _ __ _. . _ . . '.___."' ' _.___' .'__.._ ._. ._ ti.�- _ _ _ --- . __ , -- -- — --..._.�-�-�--�- -�_.,., , ,.O�YNER-BUILDEK DECLARATION • - ' PLANS TO APPLICANT INSPECTOR'S NOTES I hereby affirm that I dm exempt from tF.c ConvaGior's � Ta: RMurn�d � - �' � - ,�� �J �..' ��.,z �r� ��" ' License'Law fo�.i6e.'iollowing reason'(�ec, 7031:5). � � " '" ' �-� � '- ' `'Approvad` '��'BusinessandProfessi�nsCode:Anyi+lyorcouniyCb:t3�' � No. Date � No: "ti:-;pa���. . � �_"{ �� � � ��� .•;�:' , r'equires a permit to-eonttrarR alter,imf,rove,deneolisb, �,orsepair any sduclure,�prior to iu issuartce,also regu ires, . i . ,-.:�. . �� . -; :• - .. .. .: �l - , �° ":'.. ..�...;•,..'... .�. . . .. :.!Le appficanl for sucG fermi!.lo file a signed tlalemert! � ����� ' �"� - �" � � .„ , , � .;..,tl�nt.he is liccnsed ursuant to tbe rooisions of the Con= , . . p p. � � ' " � � � �� �� � tructor's Litense Lau�(Cbapter 9f(rommenting u�ith Sen ! � -�� Y---" --'Z3"--- "��"--- � . _linn 7000J of Divisron 3 of the Uusiness and Profestions � � - -- +,� ' � . �' �„ ;.�:� "-' =Cnde/orSGatGcisexemptlherefromondtbcbasisjortbe j. - __. _ __ _ _ -� ' �1�1 rf '�/1v�P i - � � _ i Roqaired . � � _r_ _ ___._-! _.�_ .__�.�_.. �..� .�. _ _ �an,y�plicant/orofermiltubjetutheop�l�ant�oa�ioil -- --.-- - -Dafe Rac�b�d-� � . Approva1s or Approved , � : ,.i�, ��-�-pena ty of not nwrc tban fivc bundrrd o!lars(SSOOJ.J: , � I � :...:��.: -���,Y�� No • � � , .'�,., ,; , ,. . . '-"�•��� � `� �- ��--�-�-���� - --'-�----"�-���-'�-� -�' ' ❑ I,as owner of the property;or my employees wifh Wate Ceniiimte � � �•� - � •.,.i �',-�,_�- . .. _,.• . . . wages as their sole com�pensotion,will do ihe work,ond . ._. . . , ., :... .:.. �..�. -.�. ..., . . .�� .. __ _ ._._.�._.. . -. . . � . ( F--'.� .p... '�� '.- �j: �' .___ . �._,_.�.,..... __ _- ;-..._..__ ... ciureisnf)nten edoroffe��f�sa� Sec.)044) �- � ihe stru ' �� Heohh De artmeN, -.,.A siness orsd Pm esrions Cnde:.Tbe Conlractur's Lkente � i � ,�,` �� � � �� Law does nnt a f�fn an owner o ro ert wbo builds . .. ___ ' .. _.�,_ _ '.-..'_. _.'__.�' , Grading .. � � �.��.-�_ � �."'. .- �-.,�,' i'.�...�, � . .,•.1,• .'.prot •a du�Lodoess��wo�bimrcljl FireDe artmenl_. ' 1 .,,. ,,. : ' _.. : ..Ir ,�` G u LL6r'stoun emQloynced or o ered or snle. !1 ' � t g �s, proriJed �ba0 sacb iro '. ements�are not inte d . � � � 1 � -•�� G ueceqtleburlJin,�•orimprovemenluiolduytbinone ;'. � .... _.... _�_..._. � .__�. -.--. _ �. .-_-,-.-. ' . . �ear o/..mmpletion, tGe aumer-builJer wil!bave.ibe - �eological . : . . . :•- � . � . ,Y . .. . ._ .��.:, . � ..�..�,:. .,�,�� �� ��.-.� .i-� burden of/�roe�ing tGat Ge did no!build or imfsone for PedesrrionProieuion..�-� - . . �_�_ ` � . �..� l .�. rr��r„�r���afsnfeJ.�. �:,� .,: ..� . . .; �, '� . (Fence)(CanoPY). . �`•. . � , -. ---' '. _ .� .. -`�,. `. .��-" �•:�❑ �I.asowneroftheproperty.'amexdusivelycontrac- � _ i,�, ��,� �-ling wdhiicensed caniroUors b construct fhe project(Sec. � . _ , . - ... .�...,. . � ,..,,. , ': t� • •` �--- •'•» -"--� -�- --:��� --- -- ' -.-� �7044)13asiness and Prn�essinns Code:TGe Conlrartor's $peciol Inspection"- --- -..- �.��...�� . .. „ - . . � _ (Conc.)(MasonrY)(Welding) i� .�. � - .. : .. . : ,�- � ,. :�'� . . � Lrcense Lawdnes.nnt a/�pJy toan oumernj/nnperly u,ln �� . ...�. . ..`. �--.._.".1`..�. -� - � �..; • • �'.__ �.... . .� "...-,: `."""builds or-iisf�mecs lbcrcon.and u•fio�cnnhacts�nrsucb Lot Dminage � ,�� , � r,;-... .. '` -., !'. .. :__-_.__'..__.__. __....... ... __.__._. .. ��rojeclt`wit!a ronlmrtor(s/lrcensed;fursuan0 to�tl�c - ^ nntrac nr's LicchsdGbuj. ° - . . _ . : ,. _. . . - Parking . . . ..�*: . � ,...�..,•__.___. _._..__.. ..._.__._.. -'-- _-- '..._ .. .__. . .___._---_.--' � . . ��� . : � - ��.. I - ...- ---- .8.8P.0 forthrs I'. , . ,, ._ ... ❑ I am eaempt under Sec .... .'. , '... .._.'.. .. . ': ', . ..."' ' .. i . . ."_ ' lCOSOft . ' . ' .�.":: . �. . '� .._. .�._ . i "� .."_-_ . .__. .. _._...__"___'"_. ._.._"__. ' - � � . . Date Owner ; ' �.�,.. .. . . . ��� . . �. '- ' '��i i �� .�::. .�i.'� ,::.. .. � . ._._� .___._ . __ _ _ __ - . . . ,.�.. � _ ,.r �.-.� , �q:, . : .. .... . _... .,._.. __. Approvals Data �' .._ -Inspaatois Signatui�- . .. ..�:'_ . :.:.: _',: '. ��,.'�.�� ':.�.' ..... .�INSPECTOR'S NOTES,.' (Setback 8 Yards) __ )'P� ._. _ J._.��_..:...__ _' . . . .. , _.. . _ . . �, . .;. '. 0 / Foundations .�r_�Y .� . . � .;�.�.,. , . . .; � � . ..�.. , .., ; . � . . , . . . ... . ..... . . . siob = ,, y. ., _. a�,� ;� 9--------' __ _-- _-__. .__ .. -- -_ ., _ Frame �.�2c.:� t, -��� F ..., . .. . . ... .. . .;....__ ,.:, .. . ... , .. . ,. �. � ., _.. Energylnsulafion y e-K l� , '.�.:.�.I._'__. . . I . i . . .. .. :.,. , _,; ..,... . " .. . „_. . , Lath/Drywall- .,.___. ______-- _._____ I _ ..�._. . _ _ _ ._, '.�. . . . Interior �'. r.��--�-...________. I , . 1. • � _ Lmh-Exterior � �. . � .. ...:.�. �-�_ �. .��.� ,... � . . .. . . ..�r:� ---'---- - ..._. .. . . �__ . S"' . .. . . . . ,. . , � � i . , . , . . . � House Number- ' r �'r --' __.__ �.:.�_�_.. .._._.___.�.__.s,..:_-- -._,_..-__._�_ , ., . . . Correcl 8 Posted '� ' �. ;. � . �� _-_. . ____. . . . ... _.. ___ .. I i i � � . . � �.� .�, �. . Final- ___ .__..__ _ . .. , .. ...... ..._ __ .. _.__"' `_ . , . , ENer on Fronl - .., .. . . � �---, -. . ._. _....- ., ,� �1 � . .�. ; . .. .. � ,� ; _. ��.- , _ . ,. , . . _ _ . � ;, � . - - . _ , . . _ . . ,:: , ; .` , f __ _ ---- ___ ,___ _ _ \ . ��