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Home My WebLink About1528A 1529A (8) _ ....,. ... � WORKERS'�COMPENSATION DECLARATION � �� 1�r � ��'�-. �� . I hereby affirm ihat i hove a certificote of consent.to self w �� o� �,��' � insure,or a certificote of Workers'Compensation Insuronce, � N . �I�I�NG�NPE�RI'VI�fT� or b�certified copy tFereof(Set.3800,Lab-.C.) T'�� - �� - , _._.. .. . _ _ . 7634-8118 Pac. Sndetnnit COUNTY OF LOS ANGELES BUILDING'AND SAFETY PolityNo Company, . y . . ,...... ...... ..._...-. .__..._.._ ...._ .... . .... .. � Ce�+cfed capy is hereby furnished. FOR APPLICANT TO FILL IN AooREu a�Z-G'7�` ��-�¢�i7� � , r'I - Cerfified copy is filed with the�munty buifding inspec- BUIL�ING qp93 ZZ9�4 Lakewa Dr. Bld 48 44a fion deparfinenf. ADDRESS y g' �� S.McGinnis Diamond Bar 9ll65 Dole Applicant Clrv ZIP LpCAIIiV CERTIFICATE OF EXEAAPTION FRO7vC G�YORKEkS' �� -�� NO.OF BLDGS. NEAREST ... COMPENSATION INSURANCE ' .. ' SIZE OF LOT NOw ON LO7 O CRO55 ST. (This seclion nead nof be completed if the permii is for one 363/+6 � ASSESSOR� -- � h�ndred do�lars($100)or less.) TRACT BLOCK LO7 NO. Mp,P 900K� PAGE PARCEL � . TEL USE ZONE Mi1P '[, 7,�[ I certify ihat in ihe-pe formo�n<e of the work for which this OWNER ' A�'liri$IIS011-D0V.- 'NO. NO. � �T`'�T� T peimi�is issued,I shall ot employ pny person in ony manner 1001 Commerce Dr. . .. sveuni - � �� - d so as to become subject ta�he Workers'Compensdlion Laws. ADDRESS CONDfTIONS V oa�e APPi;�o„+ arv Ir�aindale ziP .91706 ' o NOTICE TO APPLICANT: If, pfier makin ihis Certificate af ARCHITEC70R TE�� DISTRICT GROUP TVPE. FIRE PROCESSED BY 9 ENGINEER $&E EII CONST. ZONE U Exempfion, you should become s�bject to ihe Workers' � y y,o Compensolion provisions of the La6or Code,you musi forih- qoDRESS 8�5 Colorado Blvd. LA 90041 /� N wifh comply wifh such provisions or this permit sha�l be TEL� --' -- �� STA71S71CAL CLASSIFICATIO APT. CONDO. � Z deemed,revoked. . . . CONTRACTOR ��RSOR Dev. N "" UCENSED CONTRACTORS DECLARATION � I.IG CLASS NO. �WELL.uNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE55� NO. (commencing with Section 7000)of Division 3 of ihe Bosiness and �� SEwER MAF� Professions Code,and my license is in full force and effect. CRY EZ TOYO C1A55 B-1 BK � VALIDATION ��- SQ.FT. NO.OF NO.OF CHECK LicenseNumber L�hShRRGRC�LicCloss iL1 s¢e sToeiEs FAMIUES oNe - .. � VAWATION . co�r�acro� Ahmanson DOV. pa�e DESCRIPTIONOPWORK Carpor[s New S f ❑ aoo � J Q� , _�i ti[�+f1 I am exempt undei Sec ALTfR � � ❑ s �? n c, i� B.&P.C.for rhis reason aeaaie �- � � ��- - - � USE OF Date: . . OEMOL ! v n 7�,[L �Cr EXISTING BLDG. � � Signature �� ..... . . �� APPLICAN7 . . . .... .. TEL. . . . FINAL_` �; - � '-'/� ^'-'. OWNER-BUILDER DECLARATION PRINT) S.MCG1riri1S NO.�I�VHCIZ.3� DATE �"�� ' y� �I hereby affirm that I om exempt from ihe Contractor's License . . . . � ( � C—�-c ri Low for ihe following reason(Sectian 7031.5, Business and /+�DRESS FINAl�� Professions Code): - `�- -� RESE - � � - By i�+��:- ��— � ❑ BUILDING .. I, as owner of the properly, or my employees with ADDRE55 wages os their�sole compensation,will do the wark and LOCAUTV Ihe siructure is not intended or offered for sale(Seciion , `�.�L.C�G �� 7044,Business ond Professions Code). � -� � MOVING TEL. � � � � � � �� " � I,as owner of the property,am exdusively conirocring CONTRACTOR NO. },'� I � � a with licensed conirpctors ta consiruct the project(Sec- qD�RE55 tion 7044,Business ond Professions Code). ��'- � L �� " CONSTRUCfION lENDING AGENCY �� SE78A��CK� YARD HWV TOTAPROP�LINE R �NIDTH � � I here6y affirm tha7 there is a consrruction lending agenry for FRON7 � ' '� �� =i the performance of the work for which this permit is issued P.L � -� (Sec.3097,Civ.C.J. SioE ��(.j y�-�� '�� ''v . . .. . ..._. . .. .P.L . � Lender's Name none / LD7v1A Ref.S - lender's Address "�� P.0 Pee$ �v' Permii Fee �/-�r , I.certify that I have read 7his opplication and state thar the �Issoance Fee �� jp`S� tDMA P/C It �-� - . above information is mrrect.I pgree fo comply with oll County In�esigor�on Fee v. . ordinances and S�ate laws reloting to bvilding constr�crion, , , io�al Fee �7�'��..� LDMA Perm.# - and her auihorize representotiv s f ihis County to e e o upon 1 ibove-me tiqhed proner y f r inspection Lr�sr 3 ( _ . . . . . . . 0 /` SEE REVERSE FOk EXPLANATORY LANGUAGE � Si9nature ofi Applicont or Agenr Date . . .. . . . .. . . ... .. . . . .. . ..... .. .. ...... .... . .. ..... . . `� PLANS TO APPLlCANT INSPECTOR'S NOTES OW VER-BUII,DER_nECLARATION. . . : ...., ... ._._ :.......„_„„ -.,. _. . I hereby affirm thot I am exempt from the Contrac�or's � To: ReWrned � _ � �License-�Law�for the following reason. (Sec. 7031.5) � Approved Basixcss axd Professions C�de:Any cit}�or c¢unty wbicb No. DaTe No. Dafe � � � . reyssires a permit to runstrucy alter,improve,�emo[ub, � � � . - �. � .,....-.... . , . ::_... ..:.,._��_ � or repairaray striicture;prior tn its issuancc,ulsn reyuires � _ . al e anpdicana fnr such nerneit tn Ji[e a aiqned xtretemeat . � .,..: .... lbat be h�licensed pursuant to tbe provisions oJ Cbe Ciin- � � � tractar's License Lau(Cbapter 9/(rommencing uitl Sec- . _ .. aion 7QOOJ nf Uivision 3 oj the 8usixess¢nJ Pro%ssions Codef or eb¢t 1 e u exempt tbereJrom and tl�e bu.alsJar t5e . alle�ed excmptir�x.An.y vial¢tion of Secaion 70315 by . Required �- . . uny nPplicant fnc a permit aubjecas tfie appficaxt to u civi! A rovals DaTe ReGeived PP Yes No ��APP�� - pe++adty f nnL more tfiun f:'ve hundred dnllars/5j00J.f: �- � I,as owner of ihe property,or�my employees wiih Wo1er Certificole � � � . . �'� - � , � � �, wages as their sole compensalion,will do ihe work,ond � - � �� Ihe structure�is nor intended or offered for sale($ec.7044J Businesx and Pro essions�Code:Thc Conaractor i Licensy Healih Department .. -- . � � � j . . . � Law dnos nnt applti�to mn nwner f property wha bwildx Fire Deportment . . .. � � �� -- ��-------�-� ----�� or iniproves tLrereon,and u.�l o does sucb u�ark himself nr . . . . . ehrougl his o empinyee, provided that such rm- Groding .. Qrnaemext.s are.xnt intended or offered jnr sale. IJ. �" � _- � � -- - � .- � �-� ��- .- , bnw•evor,tbe buidding or improvement is sald�witbix one Geologicol . . � �- _ - � year of om.pletion, tbe orz•ner-bui[der uil!Fiune�thc '� � � � - �� fiurdcn j prnnix,q that be Jid not builit nr dmprai�e jor - . � the purpose of sa1eJ.� � � PedeslrianProtec�ion � � � LI I,asownerofthe o ert omexclusivelycontrac- (Fence)(CanopY) . .... . �� . .. ... ..... ... . P� P Y. . . ting with licensed�conhoctors td constrpcilhe projecr(Sec. Spec-ial Inspectian � � - 7044)Uus:nexr and PrnJe.csibns Code: The�Cnntractor'.s lConc)(MasonryJ(Welding) � � �� -- l.icensc l,uw doe.e not apply ta un owncr of prrperty u�bn - � budlds or impmves thereon,arid u�bn rnntraces.jor srsch Lot Drainage � -� �- -.�� . _�� hrnjectx u>itb a contractnr/sJ licensed pursvant dn tbe Coretractor c License l,aw/. Parking - � . . . _..._ _ . � '] I am exemp�under Sec. ,B.&P.C.for this reason � �-��- �� . � ,. Date Owner Appro�als Dafe Inspeclor's Signafure. �� ...... . .. . ... . .. .. .. .. �....f..,.. .. '. ' .,.. . . �. INSPECTOR'SNOTES Lomtion— . ... . . ..... - . (Setback 8 Yords)- . . ,:.,.,.. .;: .... :: . ._: ... Foundations � - ��, p . . .. . . .. . .. . !:. b .�;, :_:i-c'.c—.� . . . . ..�... ..._.. . ........ .. ... _... Slab � - ..... . .. .... . ._. . .. . .. . Frame � - ... . . . .. . ._ _ . . . . .,. . . . ..,.�_�. . . ._.-.: . � Energy Insulation � . � � , � � Lmh;�rywall-. _ . ., . . . .,- ....: __ .. .. . .. ... ... . . . . ,._. ,... ,. InYerior � � Lath—Ex�erior � House Nomber— � � � � � �- �� - . . Correc+8 Posted � Final-.. � . . . . . ... . . .. . . . . . Enter on From � � � � � F !� - . ._� ... . ... .::. .. . ', ,;ryii..,� ��C�� .. - . . . . . ... .. . . . . ��