Loading...
HomeMy WebLinkAbout0888A 0889A � t �NQRKERS'COMPENSATION DECLARATION � I hereby�ffirm fha�� have a�ar„f,�a,e of�o�sen„a se�f qpp��CATiON FOit BUILDING PERMIT insure,or a certlficate of Workers'Compenstlon Insuwnce,or a certified copy rhereof(Sec 3800,1a6.C.) [OUNTY OF LOS ANGELES BUILDING AND$AFETY Policy No. Compony � Certified copy is hereby furnished. FOR APPLICANT TO FILL IN gu��o�N� aooaess •i � ❑ Certified copy is filed with the munty building inspec 6WLDING ��on a�Par�m�n� Aookr:ss 2544 Wa on Train Lane �ocn��rY Di.amond Bar N[AREST �ato Appl�conr cirv Diamond Bar ziP 91765 ceosSsr Stee 1.2 Chase �, CERTIFICATE OF EXEMPTION FROiYI WORKERS' NO.OF BLDGS ASSESSOR � COMPENSATION INSURANCE SIZE OF LOT NOW ON LOi _ MAP BOON PAGE PARCEL " This setlion need no�be com leted if ihe ermit is for ane O p �USE��L-OJJE MAP '� hundred dpllars($100)or less.) p TkACT 3Q570 BLOIX LU?NU_ IQO �f'�'/ NO /���'�`='�' � � �, T[L .����� SPECIAI a ''� I certlfy ihat li ihe performance of ihe work for which this �WNFR pll�S Piermarini N0.598-26�6 CONDI7iON5 � ��.. permit is iss'ued,I shnll nof emplo rson in any monner DISTRICT GRDUP TYPC FIRE PROCESSED BY (�y � so as to 6emme subjecl lo Ihe orke ' a+�ensation Lnws. AooKEss 1633 Derrin er Lane �ONST ZON[ u t R',n--' � %���,��r uT� Diamond Bar CA z�P 91765 10 R3 -c« � �, Date— Applico t� �- --- 57ATIST�C.At(:LASSIFICA�ION AP�. CON�O, �j �� NOTICE TO P.PPLICAM: If, afl,r making this Cerlifimte o( ARCNiitCTOR F c � '��, Exemption, you s hou l d hemme su bjetl t� t he Wor kers' ENGINEER �� ^ 1 ^ V 1 CIASS NO r� �WEIL UNITS_ � '�. Compensation provisions of the Lobor Codc,you must forth- nnuetSS �ran�e t CO lII8 SEWEH MAP � ,, with mmply with such provisions or Ihis permit shall be TFL �i deemed re:voked. CONTRACiOk �01115 Piermarit��. BK PG, VALIDATION ��, LKENSEU CONTRACTORS DECLARATION �i�_. ! I hereby afflrm that I nm Ilcensed under provisions of Choptar 9 ADDRE55 ,,SB,jIIe yq��� ri��ry� ,.R.>. '� (commenuny wilh Sechon 7W0)of Division 3 0l Ihe Busmess and pC 7/ Professions Code,and my lir�r�se�s m full force and effecf C;iv CLA55 `� e�'�� 158432 17�•1 SILtF.,.CJ,� 5T012E$ AMIIIFS CONFK I License Number Lic Class I Controcto�L•ou;s� Piermar���. UESCRIPi�ON OF WORK NFW � S � I arn exempt from ihe Ilcensinq requirements as I am c s ruetion-/�e� , ADD � �Q�i�,��A licenseti arci�itecr or u registered professionol engineer � A!TFR � FINAL a�r��9 �� mY professioncil �a�a���Y (Sectwn �os, / G L 3 . �E�,AiR � OATF �• ° • °,Z� j Business and Professions Code). USE OF � EXISfING BLDG. DEMC>L � FINAL � s �G 3,G 0 158432 oa,e A�P��cANT � e'' � Lic.or Reg.No. q n � ! OWNER-BUILDER DECLARATION �PRiNi OU=TS Piermarini �A8-2666 -'-3�2 G�� � I hereby affirm that I om exempt from!he Contrador's License �2 Gt 5,��1 � Law for the following reason (Secllon 7031.5, 8uslness and ADDRESS �� � Professions Code): PRESENi 6UIL�ING � I, as owner nf the property, or my employees wnh ADURESS �� j I � wages as�heir sole componsa�ion,will do the work and � �,z(�b'�E,,C�� � the str�cture is not intended or offered for sale(Section ���A�'�Y � ! 7044,Business and Professions Code). 7d�OVWG TEL. .,(�- �j� � ,,;; , I � I,os awner of ihe properly,am exclusively contracling CONiRACTOR NO rw� ��� �- �J with licensed centractors to mnstr�ct rhe project iSec- �� -- � m u �,�j(� Ition 7044,Business and Professions Code). �DDRF.55 . I NE(]UIRED TOTAL SFTBACK FROPn EXIST. � ' 2 CONSTRUCfION LENDING AGENCY SFT B�CK Y�RD HWV pKUp �iNE WIDTH /"TC ��� � e � � '`��� I hereby affirm thar there is a construction Iending aqency for ;gnNi ' J tho performancc of ihe work(or whl<h ihls permrt is issued P� �� �2. .�—8 I (Sec 3097,Lrv.C.�. 9Dh � � PL ` � Lender's Nome NOIIE �� �� \ C� `��� � ;� — � P.C.fee 5 Nerinit Fee ��J.,,`�� �J Lender's Address_____._ (1, � „', I cerfify thnl I have read this application and stafe that ihe Isw cc Fee � ��\,y ` � Q above Informotlon is correcl.I agree to mmply with all Counry irnest�qaiion Fee � � � ordinanceg � � laws relating to building consiruction, inml fee �'�� ��..>� �� �� a d h +'eb ihanze presenta�ivr,s of ihis County to enter �� D upar 1 ove-men ned propxrry for inspection purposes. I �._.._. I �f ����"��°:�--<"�—C.�—'�a..,,.s--s SEE REVERSE FOR EXPLAN,4TORY LANGUAGE - � �� Siqnrnuro 04 Apolrcnn.cr Ayen; Doie �s _ ' _ ---_;_---i � i "".' �i��� � � � � ,� '�� � Q t � � yyy ~� T� �'J C7 Q � j p� �r A i N �3 4 fl- � r� C (9 � w �� 3 N s � Cl � r^ "^ �� 1 O N n X U � n' J� o � � �� ! . � �. • '� ¢' t° �O O ro � .� _"."�" m-�C�x S 9 m ° �v 1 a Q c i Sg W � ° fl ^ I � � �� '� � N R��C I 3 O� � 8 � F� � �Q �u'+ 4� . :3 ; � p � n l � O p 'i �� X m�1 w � �� � � fl-� .'o� o � � ` � 1 M p i W o � � � -�n Q°`' � ° 9 c N o a ' o 't � , � y. � "' i i � �R� O i � A, � '°` �.� J� i ! � 1 �� � � � � � � � r I � ` � I � 3 � � ! ._—� 2°� -t 1 ' i � � � - � � � � M 1� ` 0 4 � � � � , , ; _ --� -�� � a� � � � � �— - — '� 9 � + o � �� � ro °" � t � --- � � --____.'----� `_`�`� �- � ,- � � � _ : � � � � , � ; ,, � op N � 1 � O I � �� � � I � ., � ':� �S � � 9 � I ' � � l � � , if E � � � � � � I '� #i �.� �. ' � �j ` '' � � � �� ` i L_ - l , ` �--- I i � I i � i � � � Z � � N f q m � � � � � I ; � � � :� Q , � . � � � � ; � N ; � � , � � � � ` �� � � I ' � , I , 1 � � 1 ' ° � qn� .��. n cY n::.-i s�s�w,a H m s t c. O l�1 s� � O � A a a ^t � ) K C]"Z S'� t:� "w1 '� (D Q - +� L 'c A'r f' p p �-g N tp �`tl' M r,�-� p � � O o .�° V j�n !_ ��� �.�!-°4 m"�ey� � y cD CT � T O p n A� l `t 3 cn C O C ' ' Q O � u. 'w A �.I� R. C �o a R} Q N c �C'7 , C�"y .Y y� � r� ..�+ I � o ❑ � � �� �f. �� �,� � a� N � � UQ `,p� �.,ann��p � � �� S � v`~, O �`� S Q O"�"p w h y � �R,m fJ C ���C 'r�N H`"`a' + � D � � � o ° p � •n � �,'o. � ^'r w � s `'^� m C7 e� m ° *R ^•0 7��' x t+S� a�.H � � `�c,o�A � ��000c'-�o � A � A'»•a.v�� `n�"' oN s$ C • ' � �� � � � �ro �� 0 0.� � ° �;, � � °, "m �m ° � e S a o y � " t�. � j � xov � a.00 ...�ax » '� � �coo T ;S.`� s � � (��'r'sy o° C " ^ K � y �i �a w a � � 3 M ��b.Wsa m r .' 3 er � ; � cJ '`S w '� 3- p �'U � � rn O..Ty � �.. N O A .`4 ^t �t �O � 3 �,^�A � oao m �'� � o0.� nQm� �ti o »�•,'crK� � � � X � � an � A :, m,��,�^--a � .A:z � o o N o c'� %s 1° o �' _ �' � co C� � n �, �.o ���.�-°o �e'� m� a� ".��. o °� ��'.ti,a `s.ti �•a�ca.3v � � I _I � �SS � � O cD �+,�1.� O R. a1.`.�R �..i-"°'i,j K �°` +n' .Y O ����y y� t0 •r.r � C � a J p a�Z."� O � .u'..o� [J i.'Y'i `. � I � � n a.x n� � �' �� � � ��`" a�. ,-�, �`"Q � � C a a =`z ° 3 'Y � �' �� �� � s...�°,�i.� � ^\ =3 a'� ��R.� � �^ "•n"�`^`e � ? 5« ` � a.° += �' n x ^,� :� �;'� a,v� x � Om ?,°a.`�" 3.� � �G' `° e " in`° n � .� *j �^�eym -� aQ 3 »oc� � �aro ° ` ` `°' £ "� � ;,,,u s c '� a�u�� Q m'�a � �' � �'��o ° y o W� `•' ° � ;� �,,� m co �'. °% �. n� rn o h.� �'-" ,� ;z � ; � � m ti � ? �-o � �• <..� � y 3's n`ccno o� `�=o w�.,�:'m o.c � � p° - . � y � :b � �.'� '^,qS .A^' N � �� � �n F N �„yy.p �..O N u � � �.u G:p n^n y- N n `Z'p S,n aT n V' .? U K p(n p o �4 �, n �� n � � � � = o � � O � ��,� A 3 �. `�:��y n � � y � �" v � ° �, x � a m o o"��a -°� ���°"�" .__.� `�+ n � -q m � I S m� "' 1 � I • N . _.�.y_�`.� � ,_,_._.�-�"'���_...`��_ I ,,,_.._�..-,.--�-^e"'"""'_"'_..___.- __�_----.--'___-- ..�.-.-----�_'",...-