Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
No Permit Number
� WORKERS'COMPENSATIORI DECLARATION ��� I here6y affirm thoi I haye a certificate.of consenfi to�self �insuYe,oracertifimte-of Workers'�omPensar,o�.�n5�,a��e, . APPLICATION�-FOR BU-ILDI-N-G- PERMIT or a certified_copy rhereof(Sec.3800,Lab.G) COUNTY OF LOS ANGELES._ BUILDING AND SAFETY Po,;�,,��.CK12723SPl�ompany Aetrra Casualtv - � Certified copy is hereby:furnished FOR APPLICANT TO FILL W - Bu��o�N� . 35�4 ydWkW00C� ROaC� ADDRESS � Certified copy is filed wfih the couniy.buildiog inspec- gUiLOWG ro�depa�rmeni. nooRess 3514 HdWkWOod ROdd iocnurv ��amond Bar Di amond Bar "E"REST n Date APPlicant � CITY ZIP CROSS ST.- S,'�- .d � 3 .�-�-f v"' {ERTIFICATE OF EXEMPSION FROM-WORKERS' - � � - . - - No.oF e�oGs. nssessoa r � COMPENSATION WSURANGE SIZE OF LO7 NOW ON LOT MAP BOOK PAGE PARCEL This section need not be-com leted-if ihe ermit is�for one USE ZONE MAP [,',7;ry a ( P P TRA�T34161-V BLOCK LQT NO. NO. 7 ✓ ^.�.�� hundred dollars(�100)or lew.) ,� � - �?/ � � TEL SPEGAL I certify that in the perfoemonce of the�work for wFich ihis oWNER Ponderosa Homes � No. 833-2180 - �s� � coNo�r�oNs - . i permit is issued,I shall not em plo y an y person in on y manner _ � - DISTRICT .GROIIP TYPE fIRE PROCESSED BV Ped - so as fo become sub�etf fo fhe.Workers'Compensaiion Lnws. ADDRE55 2 0 8 2 Busi ness Cen ter d}"���}�0 0 CONST. ZONE � arv : TY'Vane zip 92715 ,��1 �'� ,� 'j✓✓ �r Date � � App�icdnt - '��- � � � � . :STATIST�CALCLASSIFlCATION . / �APT. CONDO. � NOTICE TO APPLICANT: If,�.gffer mak'ng��this Certificate of �- '''��H�����^�m-�'BdSS@hl:-dfl ��`NO �rJ'2.=��64 � �� � mption, you�shbuld become subJecf.fo the W�prkers' ENGIn1EER . � CU1SS N0.- i*'''"'�y'��-- DWELL.UNIT$_J :._ -.,._ ,_. ..� ���pensation prov sions af the Lcil7or Code,yQu mUst forlh ' � A�R� 39��_�ryQStp�"�.�/ P�� �ye�rf �T"� BeS�(,`h $EWER�MAP - -- � � with comply wifh Such provisians pr this parmif shal� be � �7E�, �/�. VqLIDATION ��' deemedfevoked. . � - � � ' CONTR:4CTOR .P�naer�Sa-H0�172$ -' Np 8�3-�2�8�. ' 6K�. . �PG,/Yt -LICENSED CONTRACTORS qECIARQTION-� - - � � � � � - ��i�, - - � I hereby affirm ihof I�am Iicensed under provisitlns.of Chapter9 -AD�&E55 same as�above � .No:343456 VALUATION (commencing with Section 7000)of Divisio/i 3 af the�Business and - �� Lic � Professions Code,crnd my license is�in full force and effect.� � Ciir ,� . C�ASS B $ ��� �''K"� ► ' S NO.OF NO.OF CHECK LicenseNumber 343456 �;�.-L�ass .Li� � � s��00/639 srozies FnMiues oNe NEW $ ' P�nde�^Q$a H�me$ ' - DESCRIPTION OF WORK ' Coniractor Date - � ❑�am exemP���de�se�. Si ngl e Fami 1y Pl an 220Q AX Ao° ❑ . ALTER �- FINAL � ,J � B.&P.C.for ihis reason DATE � � r�g' �"� � ���+ REPAIR � a . . Date: E%ISTOING BLDG. pFJyiOL � FINAL y-s��. 9{e � �' '"L 1 APPLICANT TEL. gY �/ Signafure� � � `� . - PRINT � NO. � � �`�?Z.�� � OWNER-BUILDER DECCARATION � . I hereby affirm ihot I am exempt from fhe Coniractor's License �- � ► c i v'(,1(7? Law for ihe following reason_(Section 7031,5, Businegs and A�DRESS � . � � Professions Code): � � . - � PRE ENT �)�,�`�/{--�j(L ^ - . . �BUIL�ING � . .. . . . . .____._... • � 1,as owner of fhe property, or my employees with aoogeSS- - -�---� _ wages as}heir iole compL>nsation,will do-the work and --� � . . . .- the sfructore is not intended or offe�ed for sale�(Sectian LOCALITY . � � 7044,Business and Professions Code). .� MOVING TEL . , �' � �t�A � I,as owner of the property,am exdusively confraUing CONTRACTOR NO. with licensed�contracfors to consirud the projecf(Sec- pDDRE55 - � �� ° " � r� � �tion 704a,Business and�Professions Code), - - � �CONSTRUCiION LENDING AGENCY � �SEQBtiCD � iOTAPROP ACN�FeOM y,�ioiA ' � ( �5��O O YARD HWY I here6y offirm ihat fhere is q construction-�lend'ng agency for - FRONT f ,y � � - ihe performonce of the work for which this pe�mit is��issued p:L�� � ��-F� G< ���f �f"'� � � � %J:;r'Q(1 ti (Sec.-3097,Civ.-C.). � . � . SIDE > Q I,� l'�*�j�6 . - Ponderosa Homes P` �' �`�� 'f�f' � " Lender's Name� � . � - - .. - - - . 2Q82 Busi ness Cntr Dr, Trvi ne P.c.Fee s =-3`,�.�-�� Pe�m��Faa G�5�/ ��'� • lender's Address � � - ' � � I certify that I hove read ihis applicafian ond sfate ihat the � Issu ce Fee �U..�� � � x above information is correct.I agree to comply wiih.all Gounry � Gvesf�gar�oo Fee an �/ g ordinances and State lows relating ro building consinuction; � � ioml Pee .7 J�^�� � u and he�eby-uthorize7epresent tives of this County to enter - s � upon�he ah ive-m nhbned p��erty for inspec�ion purposes. � . . - � - � - . - -- - -��� '� ..e (� � �Iti..���'' ^ , �- � �Cg"".p . �SEE REVERSE FOR EXPLANATORY LANGUAGE . � Sgnature fA�nfarA9ent ... .. -�-.—Dote ' � . . .. . . ..-"----�---- ---�--�--�-�-- — �5 � h e � as� �z} ca w � " w w � u u.-� o� � "� € �g � � I � �o ua� � oi � � � ��� -� . c � '�w ° ��w° � c A"�' " -� I ' I � � � - � UQ �.� � �tJ�'� e"� �.',o �.�C��. v� y;�; °°- -°' � �. c-�� � �. ° ° i i �. � � � a a v� , II� 4 � °':.'� . . c7 . o� u , _ �c. � n �� O . . . d � � h � �� � � '� � - � .. 5.d. , . �; � � . V . � . w . . . . . fl� � � � ��� `�..,., m o� ro o � o � a h c� � �,., V � � � V � ,.. � � c> >. .�,-4 � � � � ,. � � � � i ; o u `� � �,v., a. �,� �. � 3 :"�. ^� a a N ,� � �� c: �U N 'a G "w�'+� C ��.c ��:a�', i2 e� � a �"� �`�'.� 2 � G�,J � � � � i �� � ' + � . g o� a ct N � m a, �� � v a; ��s F e; . �w� � �i � � � � � �, f^.= . � �,�, v.�� a �'� � �;R� � o � � �'a° �„� � � � u ��S�� � � 3 ' � � � j � � j � S �? �� `'a, e�, � �, �,`� m a�L� y.'�7�-,� �, "c� �, ,�3 ,� �E� s � i � p � � i: � , g �, � . �,_� � c, � .n� � S � �ty`��s�', �.Z�C� �..w�� �.�� � h� _ � � j. i '� i ��i , ' j a �i - � �. � ° � � � � � � a�`,� � � c c y � q p �' � � �, t' �' �`*���� a q ,� ; > c a� � � .`��, c� ¢ a c�'' ^t M1� � �' � i I � � G-^ . e'�' .� a w � � c�a u�� ��,q � °j �.i' � c ' �� � � k _ . . � � 5 �.. fi'e (. vi C �.J - t7 F q � � � . ! � f�i� � a 6 � C .l+t 75 � � � I _f . �� .7 ' _ .� ' . 1 l .� y �� l' y . � C�� � q s b� � ��-y � �S � � ' r § � � � : � �� � � � � n`o -� �: �-rc„ti ° � e� C `.> �' �� & 'i i � � G i � k. � � i � , '_ �, y�" ;+�. � � 3 J � � � v.. � r a; �� �, ,� � � � � � i ! � �, ; � y � � �r� ' 3 � � � � ^ - ,� : � ;I, li F , f � � C� y a.i �,c� �,. . � a ,,, � '„ ,� Q .. � ;, i, . . i E " � I � ` � ��� � "' g P (.' H.,� d cl :� 3 � V ` C 1 I' . � P� , , � � tv c ca � � � `� c i c� l � � � i � f [ • �n�.,� .�}y .'�. '� ,, `i, �u � � C3 . � j +� _ � ,n � �K { 9� �ry- � � � _ & � �� �. 1 � R " wa C� "h. .d � C: ' ^�r � ' �` G �) y� : , '� ; p � � ! . ''S 6 � L _ � l ��� � _ � n c7 � nw i��. a _ � � �� j y � 1 .._� � � � � � -�� �� e, �. w C? �e a c, CJ. , 7 Ea � - ` �,`°� '� _ . i a_ � b ' { p ' i r � . � N °� �f� � V J' i! �' `� � ?.� L9 - U` S - . ( � ..� � � � � �' ' ;�..s t•� 't� .��' v� � `a^�a '�''��t?,. � t�- � � �, c � F t � � '� I �' I i . j v � . P . ' �y � <G`�+'`-. o,' e� �,^� , . . , , ' . k � � � a�'. � a �"e2 a� a � ❑ v' `� � ° � ���a � ��z �i-� c, : �; � �'� �, , ! � � �y i � � } I —�} �; `� ry"> m, � w� ... . 3 s[ti � �'� Ya,�' ..��`� r .�1-� �.�i � � � � � 9, � . C. � I � € ' ` J � � j I u � � � J � ` � � I , I ' � f � � i ' � F � N y � � 1� '� I ' ' � 3 � i �� � ° _ _ �� � . �� � , � � j . � �. .� � � �� - _,� �� � _ � � 4 f � . � � � � { ' f � { � I ° ! c � $ f' C . � � i � � � � j ' �_ � 9 � , € � � � ' � � � ; � �9 � � $ � � � � � � I ( � � ' ' � � i ' � � � � � � � � i � i t , � � � � � � ' ; � E � � , I � � 6 � j �_ i ,, , � ; � � � �.' � � � i ' � � { � z �� � � � � �I�� j � � �. . � �� , �� � � q � � , �s� f � . � . 4_ f. � i . i � ..i � � I' � . ; � f � . �-ra i � S . � � � � �'� � , � .� ' h � ��_: ��. ..� -` ( - � � - i� �_. �'� � . S � ! - �.� � �� .� � ' , f � �� . � . . �: � ` � � �- � � �' � � � � � �� � .� � � � 4 y r�a-4 � - � 1 � @ p: . � i � � � E � � � . � i � � � j i �` f � I � � � , � Y �m� � � � � � � d � ' � � � �: p 9, E � a � 1 � � � tl i ; ; � �' y ' � � � � � � � I p � i ! ; � � � � � ; � � � � � ' � � �� � ° � � i � i ; M � e � � � i ! � i { � d � � � � � � � i � ; � � 4 j ' � ` � t � i � r � �, � � w ; � ; � � i � � � � � � ��� �� � � � � . � �_ _ k..__ . .— —..� _i . lm.e,...m.� � `"""} . ��} . ,� . .�. P. -.��..., .. � ' ' i .. � � ' ' � - � � E i i � 9 � � � � .'g . ��' � � � � � � � 1 � ' � .'. � � . � � � ' �. . � , �� � � E I i � : � � � � € p � � � E � f . . �� i�. � � f� �� � �� � � � � p � � f : i - ' - y.� � .�,',, ; { � � � � � �j� { I � '� � ; , R .. ,:. � � . 1 . � . - � � ° e b � ' . � ' � v� g ' . . __ � ., � � p � � z � �. +� � ��, ,p � � � yp� a f � �� � � �tt � � �� ^ f � � y � � � � � � ;�.+ y i � � � � p � V � � � ; & -x, ,; � 3 � � � � � � k � u. p � _ �;�_� - � � � � ; i � I �p°� � ��: � �� ��� ,� � j � � ,, oa� �k� � I em � � . ��., � .� Ft r —. } ! � � � �� ��i� � f 8' �wc,. s� 6--.w�,� ,,, —r---} �� � \ � �' �'j + �"��� �� � �";' F' I. �'�� ��l ;� �� � � \ '� i `�� ^� � �� � � ,; 4 � � �J��' � � ^ ' N �� � I '� J � ' � i � < <s , �g ;`J�' `�9. �5�` `� ��,� � � . � �: �, p I � � r � y —,�"''`''"�y—�—�----;S� `�`_—` U . . � � . ... � _ � 3 g 4 q r ti � � , a � � �� � �. , � �� �" i � r a � � �° e � i � F �� � , � � �� � � k � � E " � I U h .�T �. O �- € � F .� ', � k � . � fl ` �'?Sj R � � � � f � ^� '�. � � . 0 1 � II � ��., � � p � I � c: � , ! -i €s s��. � j p . .� i � ,� � -' i� '. t � ; �. � i �. I =s � � ; " �- c`�s �� Wn � °�" s c � _ � s� ! a� �c�� a.` � : E f j � x, '- � � � r cc,; i =� � c� � � r � �� o i c T� � ��ah G : � `� C,�j I s.� a3� ' �;� �� ty; ��f - � ��o u` t3 � >.. �,p� � �� d u� � e� ! �, t � I� � s.. � �� � ' p I �as � aar � � � ,� ` � -�I :C � s ���� I � � � � €d� i � r � � ,.. E� '.'.:.� jp � V p .0 ,- *- � � � . C c7 � .. � .� �� � � p "� � ��� � Sa .s � � d�e� ' m � � � oa C� m R dS f O a69 � � � � 4 � � e - ` � 2 ii I�2J ("J & ,�,�..� E �Cy � a a � :,i u� e� � au s.U i�esJ� � � . i � � ��