HomeMy WebLinkAbout1502A 1503A 1504AWORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a._erti;icaie of consent to self
insure, or a certificate of Workers' Compenstion Insurance, or
'a certified (!,Tpy thereof (Sec. 3600, Lab. C.).
Policy No' 7634=8118cmponyPac. Indemnity
Cartified copy is hereby furnished.
®Certified copy is filed with the county building inspeo
bon department.
Data - - Applicant S Mcrin31 iS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section 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, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws.
Date. Applicant
NOTICE TO APPLICANT: If, after making this Certificate of
-Exemption, you should became. subject to the Workers'
Compensation provisions of the Lobar Code, you must forth-
with comply with such provisions or this permit shall be
deemed revoked.
LICENSED CONTRACTORS DECLARATION
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 -n Full force and effect.
License Number 465688GBC - Lb. Class B-1
Contractor_AhTRanson Dev. Date
om exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer_
acting in my 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):
1, as owner of the property, or my employees with
wages as their sole cempeusalion, 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 I- tensed contrectors to construct the project (Sec-
tion 7044, Business and Professions Code), -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is o eanstmomr, lending ogen<y 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 hereby authorize representatives of this County to enter -
upon bone -mentioned proper rinspecti aJn/_p'�urpo s.
f "y rP ,?C
Signature o. pplicant or Age to
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
Bao�RESS
BUILDING Bldg. 25 22881 Hilton Head Dr.
ADDRESS g'
LOCALITY
CITY Diamond Bar Zlp 91765
NEAREST
CROSS ST.
NO. OF BLDGS.
O
ASSESSOR
51ZE OF LOT NOW ON LOT
MAP BOOK PAGE
PARCEL
TRACT 36346 BLOCK LOT No. 6
U O E
NOP ��
p
4
OWNER Ahmanson Dev. N081881471S9
3fd
SPFCIAL
CONDITIONS
ADDRESS lOO1 COTnIIIer Ce DY.
DISTRICT GROUP TYPE FIRE
CON ZONE
%�
PROCESSED BY
CITY Irwindale zip 91706
ARCHITECT OR Tf
ME En
STATISTICAL CLASSIFICATION
All. CONDO
ENG!N[[P, Na�'132545I34
CLASS NO,_DWELL UNITS
ADDRESS 825 Colorado Blvd. LA 90041
SEWER MAP
TEL
CONTRACTOR Ahman O De — we 8
RK. PG,
VALIDATION
23861 El Toro Rd. No.465688GBC c
ADDRESS
VALUATION
CITY El Toro Cass B-1
$ 350,140
Sit. FT. NO. OF NO. OF CHEEK
= 1 v 0 2 A
SIZE STORIES FAMILIES 8 _ ONE
" i r NEW
DESCRIPTION OF WORK Condos
ADDQ
) e764,Cs8
ALTER ❑
I
FINAL
IlaSO
a a ` L 1!.. £. 8,
REPAIR Li
DATE
USE OF
9S EXISTING BLDG. DEMCL ❑p�
FINAL j'
L, 1. 1 9-85
.v rii.,viv le
PRINT S.McGinnis N 148612311
,
MOVING TEL
CONTRACTOR NO.
ADDRESS
P I_ I I I_ h
SIDE
PL
I �yI /}
LP.C. Fc. $ % R9 Pem,u Fea "s-0 F
f
Issuance Fee
f --I vestigatiun Fee
T,,ci FPx
REVERSE FOR EXPLANATORY LANGUAGE
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