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HomeMy WebLinkAbout1526A 1527A __ _ . _ . . .. . _ _. _ . _ _ __.. WORKERS"COMPENSATION�DECLARATION ��" �"' ��" - "� � � � � �-� � ��-� �- � , . � . . . . . . . . . ... . . . � ..... . � I hereby affirm thot I hove a certrficate of consent to self P r�CAT�fO�N�---FC�R�,BUICDI NG� P�ERMIT � insure,or a certificate of Workers'Compensation Ins�rance, or b�cerirfied copy thereof(Sec.3800�,�Lab.C.) � � � � � � . � ' - - .. .. . . • • - _ COUNTY OF LOS ANGELES BUILDING,AND SAFETY ��yrvo. 7634-811�o�„Po�v g� Pac. Indemnity /n Certifiedjcopy is hereby furnished. FOR APPLICANT T0 FILL IN qpoREu ��7 0�(rl• � __ ____._.___... Cerfified topy is filed with Ihe county 6uilding inspec- gUIL�ING ��fion deportmenf. - ' ADDRE55�f9Z 22979 Lakewa Dr. Bld . 48 .1� . Date . Appli<ant S.PicGinnis �- aTv �� biamond- Bar Z�P 91765 --��`� �o�iiT� � CERTIPICAiE OF EXEMPTION FROM WORKERS' � � � ND.OF�BlDGS.�����-- -'��-���� ��� NEAREST � ... � -� � COMPENSATION INSURANCE SiZE OF L07 NOw ON LOT � CROSS S7. (This section need not be completed if the permit is for one 36346 ASSESSOR � � - . .. hVndred dollars($100)or le5s.) TRACT BLOCK LOT NO. MAP BOOK � ' PAGE" PARCEL OWNER Ahman50T7. Dev. �� N�188147152 USEZONE -�'N+P �� �?ir����� � � � � i certify that i the performance of the work for-which)his . ,. , _ _ _, , NO. d�y� - - } permit is issued,i sholl not empioy any perso m any manner 1QQ1 Commerce T7Y. SPECIAL � � so ps to become subject to ihe Workers'Compensation Laws. A�RE� CONo�i�ONS o Irwindale 9170 u Date�� . .� APPIimM � ... . .... CITY ZIP . . . . � NOTICE TO APPIICANT: If,�after makin fhis Cerfificote of ARCHITECT OR TE�� DISTRICT„ GRO,UP TVPE_ ,,, FIRE PROCESSED eY � g ENGINEER B&E. Eng. No2132545134 h Exemptian, you sho�ld become,subjecf b the Workers' '' . .. . D� CONST.� ZONE �y. W Compensoiion provisions of ihe Lpbo�Code,you must forth- pDDRE55$25 Colorado Blvd. LA 90041 t �T 6 with cpmply with su<h provisions or this permi� shall be .._...... _..,,._.��___.._._ ... ._. � ' w deemed�e�oked, .. - . Ahmanson Dev. 7148371279 STATISTICAL CLASSIFICATION APT. CONDO. � � - - � CONTRACTOR NO. � LICENSED CONTRACTORS DECLARATION � � - -��� -"� �' CtA55 NO.� � DWELL UNI7S I here6y affirm that I am licensed nder provisions of Chapter 9 AD�RE55 Z38b1 El Toro Np 465588GB (commencing wnh Section 7000)of D vision 3 of ihe 8usiness and . � � ���� �- - � SEWER MAP Professfons Code,and�my license is in full force ond effec�. GTV �'1 TOTO CLA55 B�1 � � VALIDATION �: . ... SQ.FT. NO.OF NO.OF (F CONEK BK. PG. . . Li�enseNumber 4h5688GBC Lic.Class B-1 SIZE 800 STORIES FAMILIES � , . �� . . . . �. � .. . dALUATION Contractor���AhmanRon_ D2ti. Dqte � � DESCRIPTION OF WORK Car orts � NEW � 5 �� �� - �� , ��i..6 ri . ADD �I am exempt under Sec � AITER � , �� f ° "� �- � B.&P.C.far this reoson __ REPniR ❑ s ) r, `.!j,4`� .. . . . . ' USE OF ❑ ' Dafe: � DEMOL EXISTING BLOG. ��� � . � .. .. ..__.. G ]: ' S'i nalure . . . APPLICANi . . � 'TEL �..-. �5 V,` `': . 9 PRINT) S �MC�s1T1ri15 No 714861231 FINAL � OWNER-BUILDER DECLARATION OATE b r � ��C�-��-j�� � -I hereby affirm that I pm exempt from the Coniractor's L cense � Law for 1he following reason (Seciion 7031.5, Business and ri s Diamond YB ^, � � .... g FINAL ADDRESS P 'Professions Code): . . . . PRESENT . �....en. ...1^. . ..:' .... . Y �,'���c'..9-=-' . . ❑ BUILDING . . . I, as owner of fhe properry, ar my employees with AOORE55 G� �L:;r ... ... ... . . .... _.. wages 6s their sole compensation,will do the work ond � � the siructure is not intended or otfered for sale(Seciion �OCALiTV 7044,Bosiness and Professions Code). MOVING �� �TEL� � � � � � f:� a - - � j � I,as owner of ihe property,am exclusively confracfing CONTRACTOR NO. ' with licensed coniractors to mnstruci the project(Seo- qDDRE55 + g �6 '' � " iion 7044,Business and Professions Code). REQUIRED 70TAL SE7BAIX FR M I �•�/).".�.�� . ' � COIJSTRUCTION LENDING AGENCY � SET BACK Y/RD HWV PROP.LINE WIDTH "�" I bereby affirm that ffiere is a consiroction lending agency for FRONT � - ihe performan<e of the work 4or which this permit is issued P.�. . . � ("� ��`=`�. (Sec.3097.Civ.C.). sioe - Y.l. Le�der s Nome none ' �� ,�/. �y� LDMA Ref.# `�° � � P.C.Fee$ Permif Fee '�J . , - Lendei s Address > I certify that I have read this opplicotion and state that ihe . Issoance Fee �� ��� ��LDMA P/C N c obave information is correct I agree to comply wiih oll Couny Investigm�on Fae / ,� g ordinances and State lows relafing to building conshuction, Tmal Fee � �.+�` �, LDMA Perm.# � � and hereby authorize representatives af this County to ent r < upon th ve menhonQd property inspection�urp es. . . . .. . . ..'.. . . .. . ... .. ....'.' , ".'...' ." , _.,� �.-. . ... . ... �• 6 .._ .._ �:.:.�., .. .. . ... . _,. � � � �, . / - . � .. _. a � , e ,�,�.�.t_ G SEE REVERSE FOR E%PtANATORY LANGUAGE � �i � Signoiure of AppLmm or em pare . � " � PLANS TO APPLICANT INSPECTOR'S NOTES OLVKER-AUII.DER DECLARA'i7pN . I hereby offirm�har I om exemp��from�the Comractar's To: - Returned � � . � . License�Low for the following reoson.' (Sec. 7031.5) .' . . ` APP�oved ])usrness and Proje.ceions Cnde:Any tity or county�iiwhlcb No: � Dafa� No. Date� ��� � - r�gulres a parmit ao cnn,struci,alt�r,imyrove,�Gamolrsl, . . :... . . -�•'�r'repuir on5'stracture,prior to its rssuhxce;also requ�ires - � ' � . abe applicunt fnr sv.ch yern:it to fila¢signed statement thut be i.e licenscd pursuaut to afie prom•isiou of t5e Coie�- . - � _� . '�' '�'•�. --�:�. " tractor's I.ic'ense Lu<c(CSapter 9J(cammoncing with Sac- � . ��-���-�""'� trnn 7�OOJ nf Dtr»sio�.3�j tbe IIusiness and Prolesarons .. . � �� � � -, ., ,� . CodeJ nr ahat 1 e u�exempt tbereJrom axd tbe basisJnr tbe . alleged exemptinn.Any riolation of Section 70315 5y _ Required Dote Received � umy applicunt,/r u pernait sufijects tbe rapplicaxt to a civil Approvals or Approved� . � penalty�j not more tha�n f'a:e hunJred do!!¢rs(SSOOJ.J: Yes No � � [] I,as owner of the property,or my employees with � will do ihe work,and '��� "�� wages as their sole compensation, Water Certificaie - � � � . . . . . � .. , the s�rudure is not intended or offered for sale(Sec.7044) Health Deportment � � � 8usiness and Profession's Cade:Tbe Contra2trir's License . . � .... . � Law does not apply to an ou•ncr nf pmyerCy wbn fiwilds Fire Deparrment - � � or improves thereon,and wi.�a daes suc5 work himselJor . � � � � . - ' � lfiror�gh hax nwn employees, provaded that sucfi im- Groding - Qro:;ement.r are rsoa inte�eded or oJfered for sa7e. If, . � � � �� � hou�ever,dhe bssilrLia,q or improvement is sold mithin one Geological . , � � � � .. . . _ Y�ur o�carn/�letrox, t!¢ ou�ner-buil�ler wi(1 baoe tbe � � hr�rdan f proc�ixig abat be diJ reot baild or�omprove for Pedestrian Prolecfion ... .. . . �. ... . . t{v Jiur�oae oJ.vuTe/. ;Fence)(Canopy) � � � -� - � � �� �� ❑ �I as ow.er of the property,am exdusively mntrao- _ .... . . ,.,_,.. . . �� ��Nrig with licensed contraclors to construct ihe projen(Sec. Speciol Inspeciion � 7044;Bussne���and Prn�ess:onv Code:The Coneractnr's � '�� Lioemse Law does nnt a 1 to an nu�ner o n ert, hn (Conc.l(Masonry)(Weldin9l � � -�� . . .. � . . . .-...� �. . .. _ . PPY .�hrP Yu - �� "" � - - - ����� � �--� �builds or i»:prnves�Efiereon,uxrl u�ho roneraets for such Lot Dralnage . '. ... .. - . . . : . Qrnj¢ets witb ¢contr¢cfar(.cJ liceneed purswarst to Che � � � �Cnnaraotor's'Lace�.ve LawJ. � ' �� Parking - . . .. . .. . . ._ _ .. . . . . . . : � I om exempr under Sec ,6.8P.C.for this . .. .. ...... .. .._._.. ..._.. .... ... . ._.... reason � . ._ , Oote Owner Approvals Date Inspec}or's Signa}ure � ' '. `... �' `.•. . . .. .�. . . .. . ,. � ...... � .. . . � ..-...:... . � � �� INSPECTOR'S NOTES Lomtion-- - (Setback&Yards) � Foundations �t F -..,� f �l„',i, , � . . . .. . ., . . . . . . � 1 J �i."l`R�� Slab . . . .. . . . _... .:._ , . _ . Frome . � �� � � . ... . .. .., Energylnsulafion -�- � � . - Lath/Drywall-- . . . . �... . . . � .. . . � Interior �� � �� , Loth--Exterior �� � . .. � .. � � . . . Hause Number— -- � � - � � - � � �� �-��- - � � �� Correct 8 Posted � .........:. . . _ _..... .,...:.� . �. .._.� :. Final— . . .. .... . . .. .. .,. Enfer on Fwnt � � � i���. ,�.i��dY.a ,i.S:. �C1-x: