HomeMy WebLinkAbout1500A 1501A (8)WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
--insure, or 0 certificate of Workers' Compenstion Insurance, or
a certified copy thereof (Sec. 3800, Lob. C.)
Policy No.' 7634=8118ompony Pac. Indemnity
Certified copy is hereby furnished.
Certified copy is filed with the county building inspec-
tion department.
Date Applicant S. McGinnis
CERTIFICATE Of EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
-
(Thissection need not be completed if the permit is for one
hundred dollars ($100) or less..) -
I certify that in the performance of the work for which this
permit is issued, Ishall not employ any person in any manner
so as 10 become subject to the Workers' Compensation Laws.
Date - Applicant -
NOTICE TO APPLICANT If, after making this Certificate of
Exernptiun, you sfrbuld. become subject Ia the Warkers'
Compensation Prov kions of the Labor Code,you must forth-
with comply with such provisions or this permit shall he
deemed revoked -
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
-(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
license Number 465688GBC Lie Class B-1
Contractor Ahmanson Dev. Date`_
am exempt from the h -rising requirements as I am a
licensed architect or a registered professional engineer
acting in icy professional capacity (Section 7051,
Business and Professions Code).
Lic, or Reg. No. Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
-.Law for the following reason (Section 7031.5, Business and
Professions Code):
I, as owner of the property, or my employees with
wages as their sole compensation, will do the work and
the structure is not intended or offered for sale (Section
7044, Business and. Professions Code)..
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec-
tip,
Sec-
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.)- -
.Lender's Name none
_ Lender's Address
I certify that I have read this application and state that the
above information Is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and he eby authorize representatives of this County to ter
upo fe above t?n}ion 'f.Toperty for inspectio Pur ses.
Slgnotlre sof Applicant or Agent D re .
APPLICATION FGR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
9,1
ADDRESS
BUILDING
j ?
ADDRESS Bldg, 19 22861 Hilton dead
LOCALITY
- -
NEAREST
CITY Diamond Bar 71P 91765
CROSS ST.
NO, OF BLDGS.
ASSESSOR
-
SIZE OF LOT NOW ON LOT 0
MAP BOOK PAGE
PARCEL
36346 5
USE ZONE
—'/
MAP 77v— /
�Y'-
TRACT BLOCK LOT NO.
NO, J `'-
coNo�
TEL8188147152 f vOU
OWNER
_
ioNs
DISTRICTGROUP TYPE FIRE
PROCESSED BY
ADDRESS 1001 Commerce Dr.
CONST ZONE
CITY Irwindale- ZIP 91706
ARCHITECT OR TEL
"STATISTICAL CIASSIFIC TION
APT. CONDO-
ENGINEER B&E Eng. - N0.2132545134
CLASS NG.�DWELL. UNITS
ADDRESS 825 Colorado Blvd. LAL 90041
SEWER MAP
CONTRACTOR Ahmanson Dev. 'N'h48371279
BK, PU-
VALIDATION
23861 El Toro Rd. No465688GBC
ADDRESS
vawanoN
El Toro C.Lass B-1
294,630
�� 'G 0.0 A
s
SQ. FT NO. OF NO. OF QQ CHECK
7392 2
( e w 2 1
SIZE STORIES FAMILIES' ONE
-
DESCRIPTIONcondos OF WORK NEW ®
I ®r`J % t� fj'
ICITY
.:4 it
a
o ®E G 4. G
ADDR
lop_-
FINAL
- REPAIR
DATE �n,�-,iS
1'
n 19 _'8 5
USE OF
EXISTING BLDG. DEMOL
FINAL
By t, f
-
SEE REVERSE FOR EXPLANATORY LANGUAGE
21 `=G.1 A
11,12a0I0
-'1,1280;05
9Z 19-85
0
4%