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Home My WebLink About4601A 0799A 0800AWORKERS' 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.)'- Policy No uaann„_,v1sT CompanyPP© Certified copy is hereby furnished. 0 Certified copy is filed with the county building inspec- Ll tion department. Date 7/2/84 Applicant Kripp,l 1Zeev, . Tr,,. CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE . This section need not be completed if the permit is for one hundred dollars ($100) or less.) 1 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. Dole -Applicant . NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Coda, you must forth- with comply with such provisions or this permit shall be deemed revoked. - LICENSED CONTRACTORS DECLARATION I hereby offimt that I am licensed under provisions of Chapter commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number 287828 Lk. Class 81 ContractorKoppel Services Int. Dore 7/2/R4 1 am exempt under Sec. B.BP.C. for this reason Date: Signature OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law 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 sf:uOura is not intended or offered for sale (Section 7044, Business and Professions Code). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- tion 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 ISec. 3097, Civ. C.). lender's Name Far Nest Savings C Loan ac Arthur Blvd. Lender's Address Newport Beach, CA I certify that I have read this application and stole 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 abo -r ntioned property for inspection purposes. Signature of Applicant or Agent Dor APPLICATION _FOR- BUILDING _ PERMIT COUNTY OF LOS ANGELES. .. .BUILDING AND SAFETY FOR APPLICANT TO FILL IN- I DDRESS L BUILDING Garage Cluster For Bldg. #15ADDRESS99• CALITY LOCALITY MOVING TEL. -. _-_ .. _. r. .- c l ('• EAREST CITY Diamond Bar ZIP 91765OSS ST, NO. OF BLDGS.SSESSOR Issu a Fee ' - InvestigationFee enc C) Total Fee SIZE OF LOT NOW ON LOTAP SEE REVERSE FOR EXPLANATORY LANGUAGE BOOK PAGE PARCEL SE ONE MAP log 3 / I TRACT 34831 BLOCK LOT NO. 3-5/1NO. O d'7 I SPECIAL OWNERTEL: NO. -/ Z CONDITIONS D15TRICT GROUP TYPE FIRE PROCESSED BY ADDRESS 4001 Mac Arthur Blvd. CONST. . ) ZONE ZIPCITY CLASSIFICATION APF. ONDO. ARCHITECT ORTELATISTICAL ENGINEER Red M 1 z C Assoc. - NO.547-56CLASS NO. DWELL. UNITSso ADDRESS SEWER MAP CONTRACTOR Koppel ServicesInc.NO,213/59 BK.- PG, - VALIDATIONLIC. ADDRE5s3703 Lon Beach Blvd. N0287828VALUATION CITY Lon Beach CA CLASS B -1s x2;R6f SO. FT.NO. OF NO. OF CHECK SIZE STORIES FAMILIES NIA ONE ID S [' f S460.1 A DESCRIPTION OF WORK NEW J u • • • • 2.1 ADD. _ ALTER FINAL o/4J/13• I • • 5 b 5 3 Detached Cluster REPn_R DATE 5 b 5 3 USE OF DEMOL FINAL EXISTING BLDG. APR ICANT TFI. _ BY 0 7.1 9:= 8 4 PRINT nuppca oerraces enc.. _ NQ.uoF aaa--rota ADDRESS 3703 Lon Bea tfi Blvd., Lon Beach, CA , -- - 7 nF+ PRtbtNTBUILDINGADDRESS LOCALITY MOVING TEL. -. _-_ .. _. r. .- c l ('• CONTRACTOR NO. ADDRESS • •' ` REQUIRED YARD HWY TOTAL SETBACK FROM E%IST. SET BACK PROP. LINE WIDTH - - FRONT SIDEP.L. r P.C. Fee S I r S Permit Fee /3 • 7J Issu a Fee ' - InvestigationFee enc C) Total Fee 1 G SEE REVERSE FOR EXPLANATORY LANGUAGE 0, zg nI tn, Ll•: a(°L_IQL"dr7O tz i i i .i -t fi O N C. a ^ .ice' ti ... ^ 1 `O ll (: •. in' x \ L„ M ti• N ... -. SNI `c•... Ng4ru a.ar.^ ,,.w°•_'T''•: Ti _ I j ..` U C G ry :C' C.il.' ` CC °• L tib•.• n ~ :.• O._ j' C ti IL r,', - ! 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