Loading...
HomeMy WebLinkAbout1536A 1537A (8) � . _ - _ _ .. WORKERS COMPENSATION DECLARATION `� � �� � ' � � S 1 hereby affirm ihot I hove a�ceriificate of wnsent to self � l � insure,oracertificaleofWorkers'Compensafion��s��a��e, �APPLICATION� FOR� -BUIL�DI�-NG- PERMIT ��� � or a certified eopy�hereof�(Sec.3800,Lab..C:) � � .... . . '- Poi;�YNo: 7634=811�omPa�y Pac. Tndemnity COUNTY OF LOS ANGELES BUILDING AND SAFETY � � .Certified co is here6 fumished. � . , ADDRE55 ����f+.l r'r-� i�s-C� ' ❑� PY 1' ' � FOR-APPLICANT TO FILL IN ' �� � Certified mpy is fifed with the couNy 6uiiding Snspeo BUILDING � t]_� - . � tion departmenC ADDRESS ��85 22585 Hilton Head Bldg. 26 �� � oma nppu�anr S.McGinniG cirv Diamond Bar zia 91765 iocaurv �`" NO.OF eL�GS. NEAREST- ������ � � �- � ' I '� - �CfRTIFiCATE OF EXEMPTION FRONi WORKER$`�� - �---- -�--. _-�-�-� �- --•��-��� ---�� -�� ���--�� ���� ; ' � � ��°�COMPENSATION INSURANCE . SIZE OF LO7 NOW ON LO7 O �� CROSS SL � � E (Thi4 rection-rteed nof 6e complefed iF ihe permit i5 for one ASSESSOR � i hundred dollqr5($700)ar less.) , TRAC7 363�+6 BLOCK LOT NO. MAP BOOK PAGE PAR�EL � � ' � OWNER N�� USE ZONE ....�P. ... .._. ... _�/' .� . i certify ihai in ihe performance of the work for which this �� !'Y"�� �� 'Y � permit is issved,i-shpll,not employ any person n any manner - - SPEqAL �d � so asio become'subject to flie'Workers"Compensotion Laws. ADDRE55 �-��I. COIRtReI'CC' Z1Y. �- CONDITIONS ;.,o =- Irwindale 91706 jDate.,".._ '" ...' APPYimnf --" .' :� ARGHITECTOR ZIP TEL. ` . .. . � NOTICE TO APPLICAP3T-�"!f;-�cfter mokin fh�s Certificate o4 � DISTRICT GROUP lYPE . fIRE PROGESSEDBY ,�'o i 9 eNcweea $&E En . rvo213254�134` eoNsr. zoNe !v � Exempiion, you should become subjetl to the Workers' Compensofion provisions ot-ihe Lobor Code,you must forth qpDRE55$Z.Jr LOZOT�3.C�0 $IVa.. I,.� 9�QI}1 !u . ^°� �-a' �{ with comply witFi:�such ptovisions or this permit shall be y , deemed re�oked. = Ahmanson Dev. Tt� 714837127 STATISTICAL CLASSIFICATION APT. NDO. ' � _ .„ . .�.... .. . CONTRACTOR NO. .__._._. _ -- :� ._.. :__ :..: _ ... ,.: i LICENSED CONTRACTORS DECLARATION ��� CLA55 NO. �'�- DWEIL UNITS I I hereby affirm tha�.i am licensed under provisions of Chapter 9 qooaE55 23861 El Tor.o No.465688GBC �,�., i (commencing with Section�7000)of Division 3 of the Business and - ��� SEWER nnnP - � Professions Code,and my license is in f�li force and effect ` CITV CLASS $-1 � - eK- -� - -� -��-- - VALIDATION I � - � SQ.FT. NO.OP NO.OF CHECK : ' �icenseNumber 465b88CBC �;�:classB-1' ' sizE 800"sroRies FnnniuEs 4 oNe ' �� '_� I vawanoN � � �.� DESCRIPTION Of WORK ��''�'�Y������5 NEW � - �� � � i co��ra��or Ahmanson Dev. pare : s K�,e,q ; CARPORTS aoo � - �I am exempi under Seu ' - � �� i _ , ..` : - ALTER ❑ �, �� � 'l...� �'. REPAIR -"" �� � �� -" � �, 8.8P.C.for this reason � �a S � - --- I Date: usE OF ❑ 1 a- ��4-�/ � i .. EXISTWG BLDG. DEMOL �� ' � APPLICANT T:L � q� �}i,.C S-�: �� Signarore � pR�ti7� S.P1cGi.nnis No7148612311 pATEL ,S(D � � �� . �� OWNER-BUILDER DECLARATION �., . . . �7 .� ��v .. <I hereby-affirm ihat I am exempt from ihe Controctor's License _ , � �law for the fallowing��reason{Secr�or,7031.5,Bus�ness and � ADORESS 22900 Golden 5 Tlri S DldmOnd Y FINAL � /yy� " ' �� . '`"�- - Professlons Code)�.. .. . ......._. PRESENT__._. .. . . . ... . .. .. . . By r�,'���"r �zr�--�� -: -_...._._.�.��-. .-_ . .� ❑ BUILDING -- I, as owner of the properiy, or my employees wifh ADDRESS wages as iheir wie compensation,wiil do the work and . � ��� the slructore is not inlended or offered for sale(Section �OCALITY , � ' J.�..7�` 7044;Businessand Professions Code). - - - 4noviNG 7EL - � �,as owner of ihe property,am exdusively contracting CONTRACTOR NO. ' ' . � �a n � i a"� . ���- with licensed eoniroctors to construd the project(Seo- � . - � �� y � N��� ADDRESS , m w O'�,�r rj tion 7044,Business and Professions Code�. � � � . RE�UIRED TOTAL SETBACK FkOM - � -CONSTRUQION LENDING�AGENCY ' �gq�K vrRD Hwr pROP.uNE WioiH e u o C,;-J j�," � I hereby affirm thai there is a constr�clion lending agency for PRONT - � . -ihe performance-af ihe work for which-this permit is issued p.L - � � - - -�-7 � g,_,&i` -�- (Sec.3097,Civ.C.). SIDE , - � P.L. � Lander's Name riORC.' ..... . . .... . .....::..-��.... p LDMA Ref.N P.C.Fee$ ✓L3+ PermiiFee �/"�S ,� �- - Lender's Address . I cerfify that I have read ihis appiication and state ihat ihe Issuance Fee �a `'S� IDMA P/C# - M a6ove informaiion is correci.I agree to comply with aIl Counfy Invastigation Fee /' ] ^�[ - ordinonces and State laws reloting to 6uilding consiruction, Total Pee (y d' /Y LDMA Verm.# - - -- and hereby authorize representatives of this Coumy to en r m upon fh , ove-me�n�per/y��-�'�,,r inspection�rp, eg. � f;s,� ,� .Fy}(i/�v„�v--- � SEE REVERSE FOR E%PLANATORY LANGUAGE � Signature o�App cant or Agenf Date � � - -n� o ° � y Q G� �D a "m � u, =n.� � 6a � S . � Cl'6 7'� O 7 .N �CJ N � � . 'O O q O� tN+ � 'n i9 'n p �p b . q -r� o � 4 '�4 .Q b 4 n p � . T �P, o �� cQ 7 � 4� � a 3 � = � . v Q � � � 6 O- � � t � ��t7� . 9 m � w� . Z .�- fn"^. �� S 3 � (D 4 � t � � Q ..�i.�.. N }�7 .. G � }Q < O S2° � �J p . � �l N � (9 �p T N,G 3 N < Q � ,�I. Q „_ o � � Z X o 4 � ° '" �z ° y � � Q'G � � p Q � 7p y � O� � � O � N Q C n >" `0 � 5. O � � a � o + o- � " 0 2 a W H A O .--�-' y � �`"'(P---� - . . O fl 9,,.�.._ .e';: q,� �o'. �*` N :.;,: �� �.. ^ W � �iD• o. � � o o.a. '�j � N N � � w C W N 'O n a O A N Z � N . � � �7 ^; CC � � -z � N ry 5 �'(�`. p_.F m -s� 3 � . . . . `� � '£ � � m Q.� �' +�'y � N � 6 . .,. o C,,,CS 3.O � 'Z Qa `�l� m�p -G Q . . . 2�S� ^S,r A � N�a�b ��.O n <.. � 4 F' O 9 � " S,� � � o,� � � � � �z'�;� Y o--!.,i ��p. `� ='Z �, �r�3- � ,� � � � �b O�-C 9 � �,,.� S„�� c. �y z b 3 C�1 J O �'� ����� '��.,�' �to S O v� p C S Q � � 3 p•�•.� n O'� �",o,� T TA 4 c . � ��� �``' _ '�`v o � � �N � � m m o »�.-'�A �`°.'a,' c�, H g G . � �O � F' v�, ^ =,^W� s O`-w O S�n �, p S3" V� -. � j ,j p N "' `7 .0 �' � `^' (D� r� n � �. �na t0� � `° E' om�oo.o� � p � :� �:� � a„� o y od 3 � � ��y � p} ��'c? a-�� c�� I, n O T � � w`.�S���� p o ry � K r Q o � p o � `'ao ��o `° � c �� 3 m ��•��°.,•p� � � -°t �^ m � m 0 % � n `� a ¢o °..: �" !°" •op 4 y m m o �gA� �"` � oo..��c° v r�' 3 � � 0 3 � o � �,� nQ� r - C m � �A q Q �� �„m ��L � o a�y� Q-o � A `-.,m ����N io�z m -.+Y a Q � �Z, yoO �� b �ti � � `•° ooj � � � o � 0� � �� " o3 'Y Z � � o °�'i�.Nv zy�3op- �-, H�� ' ¢S�p �� '? s�,.�dc ? +� '° � �`-Q o y o ^ � � m a o.v °.,_`° m � � � c �a,'^ � "�w m o �` �D a n' � ^:a:� oL * �� o � K� coa-3c a-b "' s� r �,� Q �° � noZ (��� 9 Q. .��.,.,�. c � m �.�o m ia. �� � � � '� .:.y�-� m c co... �,�y��...�A 4 Q �% .p^t �J Q���-•'Q m.� L O 4 Z m °. m w � . °' o �.�..°'-z � S9 0` o�,�?, .��.o o � w � '�+ ��c..��N:: � �.:.��� sa-o��o m �`Q��� c�.�n�io ��s�..�o �i � O .�y .i`� � � � � �.� � C.� F m � � � o m � � �, _ . �. � 07 . � y c o O.-G� � P 3'F �,� �� O 9 �. O �"�'+.�L A '�^ '� - ' � -�o � �0 � n O C A 7 `� �,^.N �a��' .r �.-� =� N � C � � sa,� � �„ n ��2 ��..ir `�s�`� �-'� o � �o - ,��,.,....r^" .. , p C � S� � 4. „� .. �. , A �� �� . , N ��„�,,.,..�..�'^'"'.�� . , �r�,,.,r�� �r..n� '-^!���^,,,.�..�..��.. �� �'�,..,.�✓.