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HomeMy WebLinkAbout1490A 1491AWORKERS' COMPENSATION DECLARATION L hereby affirm +hat I have a certificate of consent to self +insure, or a certificate of Workers' Compenstion Insurance, or .certified copy thereof (Sec, 3800, Lab. C.) Policy No. 7634-8118Company Pac. Indemn;tr Certified copy is hereby furnished. Certified copy is filed with the county building insti tion department, Date Applicant S.MeGinnis 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 theworkfor which this permit is issued, I sFail not employ any person in any manner so as to become subject to the Workers' Compensation Laws, Date_.— Applicant NOTICE TO APPLICANT: If, atter making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed a d.r 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 46568 CBBC - Lic. Class B-1 Contractor Ahmanson Dev. Date _ I am exempt from the I icensing 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 Codel: F1I, 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 sole (Section 7044, Business and Professions Code). t, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 Stole laws relating to building construction, and hereby authorize rep,e ml t es of this County to enter U pon II above -me joned pr ,r} tar inspection urp }es. �xd G— S,gnatvre o-Ap'c.i 0 — A enl 6.,e APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ADDRESS o?-ag oREss Bld . 27 22889 Hilton Head Dr._ LOCALITY ..t�. j LI Q F; Y Diamond Bar ZIP 91765 NEAREST CROSS ST NO. OF BLDGS. ASSESSOR {`f ® ® s 'n • t E OF LOT NOW ON LOT 0 MAP BOOK PAGE PARCEL CT 36346 BLOCK LOT— 6 [ENGINEER UZON_3a MAP / _) NO MOVING L NER Ahmanson Dev. M kik81881471 2. b001 SPECIAL CONDITIONS CONTRACTOR DRESS 1001 Commerce Dr. DlbCONS GROU TYPE NRE ZONE PROCESSED 8Y Irwindale 91706 L %� PROP_IINE WIDTH , FRONT P.I. Y ZIP SIDE ONDO- CHITECT OR TE S TP.TISTICAL CIASSIFICATION' .+�j APT, B&E En . Nd132545134 CLASS NO._'YDILLE UNITS I' ADDRESS 825 Colorado Blvd. LA 90041 1 SEWER MAP _. In vesligation Fae TEL.PG CONTRACTOR Ahmanson Develop . NO. 7148371279 BK. _ VALIDATION LIC. ADDRESS 23861 El Toro Road NO. kfi3kRfi4656i 8G44QUATION S CITY El Toro_ LIC ASS B-1 s 294,630 50, IT NO OF NO. OF CHECK 7392 2 • ° a • 2 SIZE STORIES FAMILIES$ ONC s i abb,92 DESCRIPTION OF WORK conrin NEW r £� ..rA tt ADD �l• 4 ) 6 ALTER �,; FINAL _ DATE REPAIR E],I USE OF DEMOL EXISTING BLDG. ❑r' FINAL (� Rv hl """(pN IS.McGinnis nid148612311 ADDRESS 22900 Golden Springs Diamond Ba j LI Q F; PRESENT BUILDING - {`f ® ® s 'n • t ADDRESS LOCALITY - I. h 1 2 R. 0 0 MOVING LEL.- e 1. 12 O 0 15 CONTRACTOR NO. O. ADDRESS ii 71 7 "' CJ j REQUIRED YARD HWY TOTAL SETBACK FROM EXIST, k - SET SACK PROP_IINE WIDTH , FRONT P.I. SIDE P.L. k P.C. Fee 5 4 • STS }} Permit Fee 17/7'- -- issuance tee J© i1 �_-i _. In vesligation Fae [� )/02S - Totol Fee • 62 CC7 - SEE REVERSE FOR EXPLANATORY LANGUAGE it u ©s