Loading...
HomeMy WebLinkAbout1705A , � _ ___ __._ _ _ --- --__..,,.. ---_ _._.._.._... � WORKERS'COMPENSATIONDECLARATION ' � � ' . - :' . 7�:.','. � �*', ��^T � ,� - . .. . . .J. "'-._� ._ . � � .: . � - ' - --- I hereby aiFirm ihot I have o certificote o(�a�5e�„o=e�f � APPLICATION FOR��.BUILDING PERMIT��- �; insure,or a certifimte of Wo�kers'Compensation Insurance ' � or a tertified copy the�eoi(Ser'3800,tob.'C.) ., ...--'----- ..- _ . . . ._. _ . . --- -.. ,., .. .- -_ .. .- - ' � . ._ -_ ..j Y xCs.13788�, Royal Tns. Co. Jos �1998 COUNTY OF LOS ANGELES BUILDING.AND SAFETY �•� ^ ! :�; Polic No. mpany � --�- - - - ' . : ... . . ... . O BUII�ING . .. ..- � . j_....: Certiiied copy is hereby furnished.' •• '+ FOR APPLICANT TO FILL IN ADDRESS 1068 Overlook,Rid e . ��.�Certified copy is filed with the counry building�inspeo - �-"' i BUIL�ING . i , tion dep6rtmeM: �� A�DRESS 1068 Overlook Rid e Diamond Bar 91765 . ..: . . . ♦ . - , i � .� . . �. . . . . . . .�.-. ..__� . _ .. . _ _. ._ __..... . . Data 2I16I� '�-Applic - � CITY n�M�D �R ZIP 1 65 � �ocnurr � � `�� -CERTIFICATE OF EXEAAPTIO FROM WORKERS'� '�' -'--"-� ` "---���`-� -------'"--- -NO:OF BtoGS.----- ---�- ; NEAREST--.- •� � � � � ..___.-- --.__._ ..---._..___. _..__ ....:._..: � � � -�� 'COMPENSATION INSURANCE � � �� - SiZE OF lOT NOW ON tOi CROSS Si... ,.... . �I / 1 � ASSESSOR ..; ._ ' • - .�.... (Thii section�need�not be compleled if the permif is for'one ---��' TRACT�c JJ�� BLOCK� � LOT NO. [✓� � �,yp gOOK � � � � GAGE� PARCEL�� � hundred dollars(E100)or less.) -,.�. . `' � � , . � TEL. U��NE �P . .. ....__�' _"" _'_. _'_'". / / . �. .. ` : .. OVJNER..... I certify�hat,in the performance ot the work for which this d-" NO. / . , /��/'.j •' '�� I} I pe�mii is issued,I iholl not employ any person in any manner qooRE55---1068-�VCC lOOtC R�d E � �/ SPECinL-�- --, - � ��- -� ----- �-� - -;n. ___.. .._. .. . __.._.i ��/� CONDITIONS . . ... . ..... Q so as to become subjecl to the Workers Compensotion Laws. V , ' . ..., - - arr__.. ._Diamond Bar-----_ _z�a.. 176 ..... r __. . . .__._.. _ . . _�. - -- �m . Date.. . �. ,qPPLcont ' . . . . � .. .... .. I � ARCH�TECT OR TEL - . DISTRICT _ GROUP iYPE.... FIRE ._ ....PROCESSED BY_. .�V NOTICE TO�APPUCANT: If, ofter�rrioking-lhii CeNiticote of ! --� �... Exem lion,� � • .._.._ ENGINEER NO. CONS� ZONE p you shoJld become sub'ect�to Ihe'Workers' /J � -„ .: ,� Compensa�ion provisionz of tha Lobor Code,you must fbrth- ADDRESS --I�--- -/[.-�� .---�--- ',/� ..ca.[.�/ �a iih comply.with-soch provisions or this�permit shcll be - - " v� � deemed revoked. , � TE�� SinTiSTiCnL CtH55iFlCATION APT. CONDO. • ;Z ' .. � .. �. . ,•.,.' CONTRACTOR .. . ..._ . _ _ �• ...__. . _ ._ __' . ......_. � . UCENSED CONTRACTORS DECLARATION �,'� � - --�- � - ----- ---- �-�- - ii�; --• � ---� �• CUaSS NO.�.LOwEIL Unl1T5 � I hereby a(fi.m�hal I am litensed under provisions of Chapter 9. aDDeE55 6l.$ N. ECkllOff St.r,o. 379503 . (commencing with Section 7000)of Didsion 3 of the 0usiness and .. _ .i�� ' ��R''tiO�P �, .. .. . . .--- .._._ _. ._ ..- - � - - - -- - -_. -Professians Code,ond my license is in foll force and eflect. CITY �Y'$ll e Cu55 $ �� � BK. PG ! � , �..., . . . :.�. . � . ' , -VALIDAT�ON" .... . ... � SO FL NO.OF _ NO.OF_ ..__ � � � . � .379503'�-' ' - � - . B..�. ...-�--� SIZE - --�'��— STORIES �- '� FAMILIES -. . �CO EK �, ' . license Nomber � lit.Class- . . � ' � •� � �� - _ .. . . . . . . .� . . .... . _VALUATION---- ---�- __..... _.�. CoMra � rr�2I1GIS�4�� � � - DESGRIPTIONOFWORKRF..-ROOF�WI18-DECRA N�-"� S 8�(]S.00 � �• i ' Tile _35.3 s -'s -ICBO �3409- aoo _ _ _ �I am xempt under Sec. . .-- -..---� ,, .. . . . : _� ,. : . ... ... . . � AUER , . . � . .. ._... ' : , � : � 6.8P.C.for this reason _..._. � - REvnitt-.� .. s___ . ..._ .. !..___..:. .--_ �.._ .. .._.... ._.. ...--_.1' ' �'�` USE OF ' ' � . . .... ._. ... . . . . . oa+e:- _ exisnN�eio�.SINGIE FAMII,Y DWELLYNd oenna ❑ � ; � _..__. _--.. ..- -- . ..._ . , " - APftICANT TEL - I , s�9�aw,a -__ ,R�NT CAL-PAC ROOFING r,o924�OSOS FINAL : . OWNER-BUILDERDECLARATION , ___.. . •-DATE--�---���� - - . . _._ '_ " "" .' . __ _'_' ' _ _. ..__ _.. ._.. . ._ .. �-I hereby offirm thm I om exempt from the Contractor's License (],$ p� Eekhoff St. - �� .���� � � Law for the following Feason�(Section 7031.5,6os�ness and ADDRESS � FiNnr�- - ��1��7°p;5 A ._ - e -- ..PrOtessions Code): ....... ..... ' � -'•`._..."- - -... PRESENi . Y.' . ..- ,`-.. ❑ BNLDING . . . . . �{'• • •_•,��.�. ,,, ' I,os owner of ihe property, or my employees with qo�RESS ' ' � . � � . ---- . .--' .. ..--- ---...._ _. _ . , . wagesos�heirsolecompensotion,willdotheworkand . � ; the strvcture is nol in�ended or offered for sale(Section ��`��Tr ' , �. ' � •.•8 Q Jr Q �� . . - -7044,Bosine5sandProfessionSCoda):. .-. ._ . . "'"' � MOVING--- . _.. ..-.....". ..-�---� ----TEC...-' �- --�---- '--.._. . _. ._. _. _ _._.... . , . �_. .'_..__. '_ � CONTRACTOR NO. ' ' ;��• • I,as awner of Ihe property,am ezdusively coMroding ' . I 8 Q 5��� ' with licensed contractors to consrrvct the project'(Sec---"'.'. .._.._..- -'.-_-'--.._ ..-- -. ._... .. _._. .._... . . . . ___ _. .._....._.. . . . _..— - - . _. , �ion 7044,Business and Prafessions Code). A��REu � �2 2 3� 8�l- � _. . ... . NkOUiRED - -.i0TAL5ETBACKFROM_. XI _._� _ .__._ . .... . . ._ _ CONSTRUCTION LENDING AGENCY �-���- sei BncK rAao-- �i�W PROp,IINE WIDTM. �,��� - i I hereby oftirm thot there is a tonstruction lending agency for FkONi : " � ' � � -1he performanca of tha work for which this permit irissued ------- -P.tr--.--. . .__. -.--- .. _. . . _....__.__._- .._.- ' _. -_.--..�`�\- -- .. . -.'- ' , -_. . - -. - (SeC.3097,G�.C.). SIDE �� � � ' . __'..._ __...._ ._.._._.. ._P.L_..._. . ..._._ . ._.... . .. , . _ .. ._ __ . . _..'.' . "'... . . .. ' __. _._. _.._.._ ..... ._"_.. . ... ._._ .. .. lender's Name . . � �4 � LDMA Ref.M � " ' �'I _ ... ._ _. . ..._ .. _ . _ _ -_-___'_.._' __.- P.C.'FeeE '._. . "_._ _. Permitfee�-'P �.�._._ _ _ . _._. .. lender's Address .��. --�� .I tertif tha�I.have read.this a licatton and state.that the .._ � " ' Y PP .._.. _ _ _. . .. _..._. . ._ i::�o�c�r�a--ZO. ��� ---� mnwPiC�M-�-----..__..... _._�_!_.__.. __-_ ... _ . above iniormation is correct.I agree to comply with all Counry i,,,,esrgae�on Fea � ' _ ..ordinantes ond Sia�e laws reloting to building construUion, ...____ .____, ---- Totalfee-- O,� � �"� � - '�� __- - --�--- - W- O "'_: lDMAOerm.-A_..--- ._.-...._ ___....__...�;_.___._._.._. __. .,. nd hereby ou�horize represen�a�ives of this County to enter � n the above- itione propeny for Inspeclion purposes. .. . _. _.._ . . .. ._. . .. .................._. ._ __.__....... _ ..._......._..._.....- -- ._._._..`------..._..._._-- .._----...- ----� 16 $(} SEE REVERSE FOR EXPLANATORY IANGUAGE � i � . _..... 9naNreo Appliconlo�Agen� _'.._.."'... .__Date _ ._ .._.._�_. i ..._..... _. ...._._._ .._'__.__'_'. ' ""'.' _'_'_...__._... (� _ ...... ...._"_'__"_' _'"_...__ '_.___ '.. .. ._ -.._... :r 1 Z 'o - � o • � - `� . � ,.G�- �� o �'�io� '` . . �.�' ��' a o ? \n ' 1 0 ;-. .-,n m a ° � ��p 'o ,� b•� g , .:: �o -O O� n�N �, � �O '�O '"' 4' � � ... O Q �o �,. r, O �.n �� t, . � o ��, n� � � � °�-� . o � r'O,. -o iP� � 7 ��,:. o•�o ' ' ?. to '--�a . y � o m p .: o �'o.- o;o _ � � N N �. ' • r ; D Q a O O � � p ��, -9c� , �� r, � p � N 3 .•O �'�r� .'D �?'' 'i•O ' _ ' ,, o f' 0 -n (Y S" � iO �? p 4�\ � � -7 , '�j p' ?p � N ` 7 O "� , .�, .0 .o '�� ` .. ' �1 � ` r f,0� fD (p tff (D.< N O �r � � � � �. ,r . o \ .^-2 � o# c � . 4a o- . o o � �'j :r, ^ y � wc c� o a , , � M p � .o io : $. :. � 's.. � -^ -o� g \ o , -� - .t:' `.� g a j N (dj 7 t. � '� M ��' O " °'� O � p � . �,,, � _ � 1� �"i � m p .� ^m 4�: `� � _ �A � •6 q : `� , ' . , o O, r;; +, 1. � � �:.� . . . \ �' / • � t , . � • � n �� . - . �'O� . , • i . . . e . ' ^., , . . y` '� �`,, �. N �C' � .. . �. . . � a5 • , •� , ' O , . ' ,\ '- ' �. ' ' ',� ��� ..,�� . , `� � i .(h �, ' 1 `4 � •.r �'��y�A ��1 t '��. � r� �D . ` � � ' (1� ". � � i9 '±� � Z . , . ..� , �t`� . , 'Q' � . , . . M . c. ''1 . ,` ^ , - ��„�, - . tn � � - ' :i' � U � ' ..: � . CA � 0 y ��� }••� � `:-'- � � � ,� y � ;;, % ��.'�, • u � o �` �;�� � `, 1 � S�"` '� '��i N^n�• � ' .; -, '`� a > c�� �� G�; < < � � `t=t • _•, , r^ ,t� � N • �� 1 ,� . '�t' f ; ',� �• . .r�, , ,, '� J � � :,. O o ,l ,' .• �'� p ., � � t:{ � j� 1 ;V .^., ` � - � ' ` "� F'! :t `. S%� ,C„) � •;. " O tG �� . � 0 `=• ' • , � , �''' t� �t� . �.} '! N � �; � � �• iq �� i�� � .�. �F> >.. '��l ,.` °, v `�� ,'' � ��' �!,, " ,,`. :r; . t� � � � � �" 'J > _ ti c � � n �1 t C �G �', . , `' "- � �� J ,\ . _ , `` �. i �� '�' �, . , .. �` ', , \, , . � ��.�C�p n O���. A �� � .b ....p R..�,o, :a ca 6. ' � ` .. . �. ; ' .. w ',� n 0.`'t' ..�'— r�?��„ .�"+. < .Q p f p ! . . . �,.. C . � w �� � lD t� Q F.-.0 C�O C�N'^�G'� � �.O.Z �•`' •1 , ` ' . �'�c oay =�.�� N �;Lv r,r,�-- _.�� �.G" . �' � � �' a.c'o.�: .1�� ' �`�° ��•b ,��, H LN�� �"�3n'`'^a y cr`�°°^ ?'G ' U `' '�. ` ' . . '1, ` 1 �'i�� �.� :f � �`"�.' �� � a:�'co,�° �''^^•� C'� t`� �^''oH. c?o� � � p .m'. .' N r� •.,,y ^ h ..�:.v� o �;,,, " f « °s c .�'�' N�'a��"n ^ ...� � a °` Q �.� 'A ��- o`^o �`^ �"w � oo,a � •� � c� � N �"� � `� �N ��• O'' �C�n � H O '^e,,1 " ao y�O��nb"�^..p Q^ r••� � }• v�,�.'�, �3�'� ' � � �m'.o ,. ..� a A � �'�N � o. � a - n =, m'� p �.°. .z _ „ � f `"� «=. �:c�< � 3�� a-��e«"'pz.-. '`°' or c.�� % d , . _ ', 3' N1�'e' o N � m fi�i o r':o.+� _ c � 3 �o s -- c,••`"'=� �.;�,� `...�3 ..r - � a r o � c. a A � a - o ' rav c A.o " o ^> vn - ;� �. W'. �:h M� s„o ��y � �'�'C.�'(�0-7 o e ao,� A��•a r � m -^9 't,,.� _ :�� .,` � 4 1 3� �1e� c-°" '+o�• '"�ya� cc A� �A �„�o�o"�'�K� �. o3.'�Y . �- ,�,� �' io � �... o � .: .„ Q � ,3 J ' ' , a �' " c�' N ° ° F'E c �� c-• c c�� Q n'�`'Q N,3 's •a '' ^� O ' Z, 'i � �-° �.�•,c `o = 3 7 � �c M�.�.a f� c,n A s...'" ���c� `-'[:� c W (1 L % 'e u` ��.'»�' x _r. � f1 3 Rr.�.,,.s. M y " n'=' n n o �' . . � . . �p� �.At� !�-G . �Q''� ^ � -,.p O.a..[ ^b .C'.� • C.�n 3� 7 ', � ' � ��. ,�y,l�� (�j p ` a.�.���.C"'�o�.�, � � F+3.Q-'..�7xo�?.�^ �m se ..�p ' . � � . , C ���i C.� 3 �.��•t �'� -1Oa c. O?9 -pi w��i�"� � « ° � �� ��'.. � ti V. r0 C� �,C p� ' ' N � . \.i^.C�`;: n. n ` F"~ M'" F C'-Ci� p �. £.�G N O W�M..'J H L^h " �`•l�i.y�n��lT �n . . 2 � . r..., � � c -°,�.c..'^=�� " m o co �^� ".c _.v,�;,��e.: c _' . , . O . '"!-a y C...�a cso �. ^� � � .c C t"" �`'�^ o'�` � ,�,•,.� � . . _ ' �1 , . � c .. �y.. � ' � J `C Q„II- N ' ' `, ' N .t O�'. .�� , iC �� O O •G � F �F't'io C'r+ �� £� �.:� e.� � 3 � A. .- ��.$o.s:. : _ . . ^;1 ' �, , ^�y p +? �n�C ��� N �� . ' .C1 ' '�+� ..•.N� �.�A ' . O n � - .O.. � �.�1 ^ �1 . • � N'•'�t '��y,p i • . .