Loading...
HomeMy WebLinkAbout4598A 0805A 0806AWORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab, C.) PolteyNoWPH0033111 Company Acme_ Trul—nits Certified copy is hereby furnished. 0 Certified copy is filed with the county building inspec- tion deportment. Date 7/2/84 Applicant Koppel Services Inc. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. Date' Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby offirm that I am licensed under provisions of Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number 787828 Lic. Class Bl Contractor Koppel Services Date 7/2/84 I am exempt under Sec. B.SP.C. for this reason Date: Signature OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and Professions Code): I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). - 0 I, as owner of the property, am exclusively contractingwithlicensedcontractortoconstructtheproject (Seo - lion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued Sec. 3097, Civ. C.). Lender's Name Far Nest Savings E Loan 4001 Mac Arthur Blvd. Lenders Address Newport 8Pach CA I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the ab ve- enti ned property for inspection purposes. igrature of Applicant or Agent to APPLICATION FOR BUILDING PERMIT COUNTY. OF LOS ANGELES.. - BUILDING AND SAFETY FOR APPLICANT TO FILL IN A DRess - L t s ouv BUILDI IG 2yADDRPamrageClusterForBldg.#4.0_5 LOCALITY - . /"J Diamond BarCITY ZIP 91765 NEARESTteamssr. NO. OF BLDGS. SIZE OF LOT NOW ON LOT None ASSESSOR MAP BOOK PAGE PARCEL us MAP 0TRACT8BLOCKTRACTLOTNO. XiONE NO. o '-V OWNER Far Nest Savings C Loan TEL. No833-8383 p6 SPECIAL CONDITIONS DISTRICT GROUP TYPE FIRE PROCESSED BY ADDRESS 4001 Mac Arthur Blvd. CONST. ZONE Newport Beach. CA 92660" ary zld ARCHITECT R TEL STATISTICAL CLASSIFICATION _ APT. CON . ENGINEER ted Holtz C Assoc. NO.547-5679 CLASS NO. DWELL. UNITS ADDRESS SEWER MAP CONTRACTOR Koppel Services Inc. TELNO'.213/595-4871 BK.. PG,' . VALIDATION - 3703 Long Beach Blvd. No 287828ADDRESS VALUATION CITY Long Beach, CA cuss 0-1 SL2r SO. FT. NO. OF NO. OF CHECK SIZE 12 STORIES FAMILIES ONE s`)459.SA. DESCRIPTION OF WORK New © 2 1 6) Car Garage ADD. ALTER FINAL I -5653 Detached CIristeiv REPAIR DATE 5653USEDEMOL. ElFINALEXISTINGBLDG. nPP11rANT IFI - By 1 ( pD7. 19 8 4 SEE REVERSE FOR EXPLANATORY LANGUAGE_ - es i GLC5f. 21li„ tact bl,: 1217-54- FF,C, . 1 1'0,26 121 7-f;L SEE REVERSE FOR EXPLANATORY LANGUAGE_ - es i III N I T O Af 4 Q It o I C `_,mac••. - %i n'= ti . . E ... N i c •'!. .ZZr ^' _ ca_. c - ' G-,. C Ctc-'u• n +. o n m: : x. c y . a_ y c.. U 0 O •...^r. ti N j n O •e _ •. ',^. _. G i ti _' _ I `i :: ti _ 7 i %• A C O' ; U . # 3 c1 '^ - C :' C v+ I I C:' i - Iti •c .ci O ' - c - , 1~ . N flZ f"v f W G c` b . '^ O C i t I N tic 'p1 1, o o e" o i i ..i ^. ` ti :01 n i ^. -. _ r r, c m t' a :. -``'+, C ;, c = 3 i:, r.. :, A n m. ' o c. C^`:i `: x •.-i' ..`' O < Com^, a r-O -' j , _ : ti R• S W `.O C = , • x: O p• ,c, `.t m ..f1 ,f - Imo.. ..O MOO ° '•`.;1' FlN O NnVr;, ti NC .A n0 A sy L•'C hn_ w uL.tiO a `O n W C) C) •_ l U 10 L I I rD mmo 2H s \ m 3 Cr o F v-._n0cc I Oyy n cD 7 t0 O a v O o u 7 mTj' N L I• D O O n i p m :. o.v av 3 a. a v L-. c I C 1 I fl^ O7 C 6 7 j_ 4 V III N I T O Af 4 Q It o I C `_,mac••. - %i n'= ti . . E ... N i c •'!. .ZZr ^' _ ca_. c - ' G-,. C Ctc-'u• n +. o n m: : x. c y . a_ y c.. U 0 O •...^r. ti N j n O •e _ •. ',^. _. G i ti _' _ I `i :: ti _ 7 i %• A C O' ; U . # 3 c1 '^ - C :' C v+ I I C:' i - Iti •c .ci O ' - c - , 1~ . N flZ f"v f W G c` b . '^ O C i t I N tic 'p1 1, o o e" o i i ..i ^. ` ti :01 n i ^. -. _ r r, c m t' a :. -``'+, C ;, c = 3 i:, r.. :, A n m. ' o c. C^`:i `: x •.-i' ..`' O < Com^, a r-O -' j , _ : ti R• S W `.O C = , • x: O p• ,c, `.t m ..f1 ,f - Imo.. ..O MOO ° '•`.;1' FlN O NnVr;, ti NC .A n0 A sy L•'C hn_ w uL.tiO a `O n W C) C) •_ l U 10 L I I rD I Oyy n rs- c v m I N L I• D O e a O L-. C 1 I C 6 I ro c c: r•. C-- l" iC fir. I C L U III N I T O Af 4 Q It o I C `_,mac••. - %i n'= ti . . E ... N i c •'!. .ZZr ^' _ ca_. c - ' G-,. C Ctc-'u• n +. o n m: : x. c y . a_ y c.. U 0 O •...^r. ti N j n O •e _ •. ',^. _. G i ti _' _ I `i :: ti _ 7 i %• A C O' ; U . # 3 c1 '^ - C :' C v+ I I C:' i - Iti •c .ci O ' - c - , 1~ . N flZ f"v f W G c` b . '^ O C i t I N tic 'p1 1, o o e" o i i ..i ^. ` ti :01 n i ^. -. _ r r, c m t' a :. -``'+, C ;, c = 3 i:, r.. :, A n m. ' o c. C^`:i `: x •.-i' ..`' O < Com^, a r-O -' j , _ : ti R• S W `.O C = , • x: O p• ,c, `.t m ..f1 ,f - Imo.. ..O MOO ° '•`.;1' FlN O NnVr;, ti NC .A n0 A sy L•'C hn_ w uL.tiO a `O n W C) C) •_ l U 10 L I I rD I Oyy n rs- c v 3 ^ a a I N L t. D O L-. III N I T O Af 4 Q It o I C `_,mac••. - %i n'= ti . . E ... N i c •'!. .ZZr ^' _ ca_. c - ' G-,. C Ctc-'u• n +. o n m: : x. c y . a_ y c.. U 0 O •...^r. ti N j n O •e _ •. ',^. _. G i ti _' _ I `i :: ti _ 7 i %• A C O' ; U . # 3 c1 '^ - C :' C v+ I I C:' i - Iti •c .ci O ' - c - , 1~ . N flZ f"v f W G c` b . '^ O C i t I N tic 'p1 1, o o e" o i i ..i ^. ` ti :01 n i ^. -. _ r r, c m t' a :. -``'+, C ;, c = 3 i:, r.. :, A n m. ' o c. C^`:i `: x •.-i' ..`' O < Com^, a r-O -' j , _ : ti R• S W `.O C = , • x: O p• ,c, `.t m ..f1 ,f - Imo.. ..O MOO ° '•`.;1' FlN O NnVr;, ti NC .A n0 A sy L•'C hn_ w uL.tiO a `O n W C) C) •_ l 10 I I rD I Oyy n rs- c v 3 ^ a a I I D III N I T O Af 4 Q It o I C `_,mac••. - %i n'= ti . . E ... N i c •'!. .ZZr ^' _ ca_. c - ' G-,. C Ctc-'u• n +. o n m: : x. c y . a_ y c.. U 0 O •...^r. ti N j n O •e _ •. ',^. _. G i ti _' _ I `i :: ti _ 7 i %• A C O' ; U . # 3 c1 '^ - C :' C v+ I I C:' i - Iti •c .ci O ' - c - , 1~ . N flZ f"v f W G c` b . '^ O C i t I N tic 'p1 1, o o e" o i i ..i ^. ` ti :01 n i ^. -. _ r r, c m t' a :. -``'+, C ;, c = 3 i:, r.. :, A n m. ' o c. C^`:i `: x •.-i' ..`' O < Com^, a r-O -' j , _ : ti R• S W `.O C = , • x: O p• ,c, `.t m ..f1 ,f - Imo.. ..O MOO ° '•`.;1' FlN O NnVr;, ti NC .A n0 A sy L•'C hn_ w uL.tiO a `O n W C) C) •_ l