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HomeMy WebLinkAbout1524A 1525A WORKERS'COMPENSATION DECLARATION � - - � � � . .- � . .. - . . . . . � . .. . .: - . I hereby affirm �ha, I hove�d,certifimte of�o�se��,o self qpp�ICATIO�N� �FOR BUI�LDI�N�G �PERMIT � -- � insure,o�a certificote of Workers'Compensation Insurance, or a certified copy tliereof�(Sec.3800,Lab.C.) . . .... . .. ."... '.. .... . ...:. . ... .. .. ... ...: - . ' . . ....._... . - - 7634-8118 PAC. INDEM;3ITY COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo._,�.��t Company . � � � . ... ... ... . . .. ... �Cenified co is hereb furnished. BUILDING � ❑` PY Y FOR APPLICANT TO FILL IN Aooaess �� �ti 1—I Certified copy is filed whh�tFe�county building inspec- � BUILDING - � � - ������� - � � � �� - ��- � �" � , 4�i uo�deporiment. ADDRESS f90 229 9 L kewa B•i$ �•-�. _ oo�e Applicont S.McGinnis �iT� Diamond Bar ZiP 91765 iocaurv � �CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OP BLDGS. � NEARESi. . ... . . ,, .... . . . � COMPENSA710N INSURANCE- � S¢e OF�oi NOW ON�Oi O CROSS ST. � (This sec�ion need not be mmpleted i4 fhe permit is for one 36346� nuEssoR,-...- � � hundred dollars($100)or less.) TRAC7 BLOCK LOT NO. MAP BOOK�' � ' PAGE PARCEL ��' USE ZONE - MAP 7'! �,/ I cerlify thot in the performance of the work for which this OWNER Ahmanson Dev. � � No.818814715 NO. ``{'--�-y� �. permit is issued,I shall�not employ any persan in any manner �.��Z Commerce DY. SPKIAL � -� d stl bs fo become subject to fhe WorkOrs'Compensation Laws. ADDRE55 ���- � - ' CONDITIONS u Date Applimnt � � CITV ziv 91706 � ARCHITECT OR TEL. O NOTICE TO APPLICANT: If,�after making ihis Certifimte of B&E En . 21 o15TRICT GROUP TVPE FIRE PROCESSED BY ENGINEER g No. 3254513� . o- Exemption, you should become subject to the Workers' / CON57. - ZONE U Compensation provisions af ihe Labor Code,you must forfh- qDDRESS $ZS COLOY8d0 Blvd. LA 90041 j� d wifh comply with such provisipns or 1hi5 permit shall be � ' ' "' 7E�: - - STATISTICAL ClASSIFICATION �. APT. CONDO. Z deemed revoked. CONTRACTOR Ahmanson Dev. No.714837127 LICENSED CONTRACTORS DECLARATION � ��� - �i�. aA55 rv0. oweu.UNi75 - � I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE55 23861 EI TOYO No. 465688GB (commencing with Section 7000)of Division 3 of 1he Business and .,, _ ��� SEWER MAP Prafessions Code,and my license is in full force and effeci. CITV E�- TOTO C�A55 $-1 - YALIDATION � � � � SQ.Ff NO.OF NO.OF CHECK 8�' �' License Number 465688GBC � u�.aassB-1 s¢e � 800 STORIES - FAMILIES 4 pNE �� � - � - � � VALUATION � ConrractorAhmanGnn�Tlev_ Date ' DESCatPrioNOFwoaK Cax' orts � MEw S ���Q� � ADD ❑I om exempf under Sec. � �"��;j i,G_� � ALTER B.&P.C.4or this reoson REPnIR S � �� u E o s%� � :..- Dafe: ' " USE DF EXISTING BLOG. DEMOL ❑ ' � .y G�; Y � APPLICANT . . .... TEL....._.. .._._.._-_ Signature �- � � � PRINT)S•rZCG1L1S115 No.714861231 FINAL OWNER-BUILDER DECLARATION DATE � ��� � ` ��'Q.4 S'�. I hereby affirm ihot I am exempt from ihe Cont octor's License 22900 Golden $ Y111 s Diamond SdT' Law for fhe following�reason(Secfion 7031 5 Business and ADDRE55 p g FINAI�� � f � � � / '��Q-�5�� _.........__...__. Y `��Ce��.•l`__ _ Professions Code)': ' ' '"' � '-"''' ��' '- - PRESEPI7 ' " � ' B � � � ❑ BUILDING . . I, as owner of ihe property, or my employees with ADDRESS . .. . . _.. .. ._._ .........:... wages as i eir�sole compensation,will do ihe work and � - -�-� � - ihe sfrucfure is nof iniended or offered for sale(Section LOCALITY ' � 7044,Business ond Professions Code). MOVING - TEL � - � � `Z'"r�, � I,os owner of}he properfy,om excl�sively coniracting CONTRACTOR NO. g'� _ o G f with licensed caniractors to wnsiruct the project(Sec- " qpDRESS tion 7044,Business and Professions Code). � „ o�� ��.v . . CONSTRUCTIONLENDINGAGENCY � �7�gq�� YARD HWY T�Tp'p�p'��'NE� `NID7H - I hereby affirm that there is a construction lending agency for FRON7 ° � �b�I.r'��� the performance of the�work for which ihis permit is issued Rl. -� - � (Sec.3097,Civ.C.). � sioe � �� j y.-�.6;; . none v.i. Lender's Name �[� � ' ' ' " ' ' P.C.Fae S �(}• Permit fee S��.UV �DMA Ref.M - Lender's Address ' I.certify that I hove read this application and state that the Issuanca Fee �v'"J � IDMA PiC# � � -- ¢ above informaiion is correct.I ogree ta comply with all Caumy Invesngaiion Fee {''� ordinonces and$tate laws relating to 6uilding consirucfion, 7oral Fee r' `� � LDMA Perm.# and hereby authorize represenfotives his Counfy to enter " ._. ..�_ ._,....:......:.. _ m upon 1 e ve-men"o� prop ty or spection p pos . - --��� �� � � � �� � �,� � � � �. ` . . . _. . ' . a r/ n i (� SEE REVERSE POR EXPLANATORY LANGUAGE o t_.-- Signai�re of Apphicvni or A enl te / ... . . . . . .. . . .-. .. . .. . .. . n'. � PLANS TO APPLICANT INSPECTOR'S NOTES OSL'ViiR-BUILDF,R DFCLARATIOIM1 ., ._ . . . , . . . . . . I hereby affirm ihat I am exempt�fromlhe Contractor's To: � - � Returned � � � - License Law for fhe Following reason.'(Sec. 7031.5) � Appioved Business and Yrofessions Code:Any city or counLy wbich No. Oafe No. ��DoTa � �•-. .,..., _.. . �. ...�- 7eqaires a fiernsiR to ronStrrict,alter,irrspmve,demn/rsb, � . . �� nr rcpair urz,y structure,pnar tn dts isaaaxce,a[so reyueres .� . . � . . � the applicant fnr sv.cb parmit to file a.aigned statc^ment � ���� � � ���- � ehut he es licenxed purauana tn tbeproc�rsions.uf tbe Con- � -�.. ..,.,,.�,.... .� .. -.:: ... . . � trurtor'.��I,rmnse Luw/Cfiupter 9J(�mmencing u•i[h Sec- . . . tion 700pJ of Die�ision 3 of tfie Busiaes.v und Pro%a�sfons . . � � � � . CodcJ or�tGat Ge rs e,dempt dberefrom and the busis for the � alle,qed exemption.Any violatioa of Sertion 703L.�h�� Required_ Date Received . -�� � - - � � - any a[�ylicunt fnra permrt subjects t5e applica�nt tn a ci�rl Approvals or Approvad pexal6y of not more than/bx�e buxdred dollars(�500�./: Yes No �� __. I,as owner of the property,or my employees wilh Woter Certifimre � " � wages as their sole compensation,will do the work,and � . . - ., the structure is not intended or offered for sale(Sec.7044) Heahh Depqrtmert.. _ Busrness andPr fessions�Code:7he Coxtracdnr's License . Low dnes mo1 u/iply to an ou^ner nJ property u�ha builds Fire Depanment .... . - � � - . . or rmprvves thereon,und wbo rloes sucb work bimsel�or � thrnugl bis owrn ¢rrsployoes, provulod th¢t smch dm- Groding � , prouements are no1 indended or ffered fnr sule, If, �� � �-" � -� ��- ��•-- �-- - �� $ntucxrer,tbe braildin,�nr improe:emext is snld withix one ._..:. Geological � - -�. .�. y'�ar of compdc[ion, tbe nu�ner-fiuilder wilf laave tbe - - � � - burdan nf provirzg aGrst fie dtd not build nr lmpro¢�e for Pedesrrian Pro�ectlon . � � - � .. � the purpose oj.auleJ. (Fence)(Conopy) � - -� - � � n I,asownerof fhe - property,am exdusively contror ., ting with licensed coniractors to mnstrucf the projed.(Sec. Special Inspection � - - � � � 704d?Busine.rs unJ Professiosu Code: The Cantraitor's fConc.)(Mosonry;(WeldingJ � � ��- � � I,icenseLuu•dnesnnaapplytoanowncrofpropertyu>ho � bui(ds ar i»ipra+�er tGaraan,and u,•ho comdructs fnr sudi Lot Drainage . . � � _ hrojecG- with a contrr�ctar(sJ licensed pursuunt ao tbe � � . . Contracinr's License Lau:/. ' Parking � - -- � �� ❑ I am exempt under Sec ,B.&RC.for ihis reason � Date Owner Approvals Date InspecTor's Signature. � .. . . , . ` . . . . . . � INSPECTOR'S NOTES Lomtion-- . � . (Setback 8 Yards) �-�� .. .. .. . Foundations t�� � � � � . . . . . .. I \�,`r(a 0�;;�,. . . . . . . . . . . . SIa6 Frame - . . . _, .._ .. .�_. .. . . ._. . Energy Insulotian � - � - - � -�- � . . Lafh/Drywal I-- � Interior � � � � � Lath-- Exlerior � . Ho�se N�mber-�� � ��� - � � � Carrect&Posted iinal-- � . . . . � . ... ... EMer on Front � � � �- - � { ! J �!� ,�( ��31.1 p;o . . . . . . . . . . . �.