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HomeMy WebLinkAbout4604A 0819A 0820AWORKERS' COMPENSATION DECLARATION I hereby affirm that I have o certificate of consent to self Insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3600, Lob. C.) Policy No.YoanO33111 Company etsoin Tnde•n;Fy Certified copy is hereby furnished. Certified copy is filed with the county building Inspec. Ilan deportment. _ Date 7/2184 Applicant Kapel 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 affirm that I am licensed under provisions of Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect. license Number 287828 Lic. Class 81 Contractor Koppel Services Inc.Date 7/2184 I am exempt under Sec. B.&P.C. for this reason Date: Signofure - OWNER -BUILDER DECLARATION 1 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 structure is not Intended or offered for sole (Section 7044, Business and Professions Code). 1, 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 Sec. 3097, Civ. C.). Lender's Name Far Nest Savings E Loan Lenders Address 4001 Mae Arthur Blvd. I certify that I hav Ni rQ`his ap Fcdtion 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 u Cbave-ned property for inspection purposes. ant or Agent Date APPLICATIONFOR BUILDING PERMIT COUNTY OF LOS ANGELES . - BUILDING AND SAFETY OR APPLICANT TO FILL IN - noonss C.a.[it ING i-3ESsGarageClusterforBldg. #*V LOCALITY NEAREST Diamond Bar ZIP 91765 CROSS ST. NO. OF BLDGS. OF LOT NOW ON LOT None ASSESSOR MAP BOOK PAGE PARCEL USE mAP 9 r / T 34831 BLOCK LOT NO. rO3NE O T SPECIAL CONDITIONS TEL. ER Far Nest Savings C Loan No.833-8383 /fl ai D15TRICT GROUP TYPE FIRE PROCESSED BY ESS 40 1 MFR4 CONST. ZON ZIP STATISTICAL CLASSIFICATION APT. CONDO, ARCiNEERT Maltz Eled Assoc. No.547=5679 CLASSNO. DWELL.UNITS ESS 1823 E. 17th St. - Santa Ana, CA SEWER MAP TEL TRACTOR Ka el Services Inc.. N0.213 595-48 BK:.. P'• VALIDATION RESS NO. VALUATION Long Beach, Ca cess B-1 44604Aa -L&, FT. NO ,,NO. OFCHECK1680STORIES1FAMILIESN/A ONE h 23 DESCRIPTION OF WORK NEW © S pC 1 • 1 Q 'Z Q O 8) Car Garage ADD.. 0200,cALTERFINAL Detached Cluster REPAIR DATE J3 % 0 %J, _ 8 4 USE OF DEMOL FINAL EXISTING BLDG. - APPLICANT TFL- _ 9y f' e r e c SEE REVERSE FOR EXPLANATORY LANGUAGE r 1EE, IN 1217 Et 1 • 191.E,0 1217—;;4 f c I 7 I ^f :. -'' c -; r ' G H • 1. . %r:i r ti n ^• f7 CJ . I °. ti ..., _ o o, n ` •, : n c N ;,• y _`-,.., ` n c r a a 'c O cz rn N ., . p fir, .. - 'acac- ._ ;',,+y`coc c-°-w-h0..ti„-•,__!-. i= t. ti, I' - C.j_ 4.. r i'e - r ti __ L I :..'^"-'.."1= 3 o - +• nom`<_. ° .`, V '° c M.n n o. I Y -.,` rL fi `•' 1. '' w `' fico'^c o.^ v O. O -O N ° '. A n : q ;• V • Ory VI l w ' n .`. • : W n - a it M mT f1S rO r mT to No C nfn Tm Oj00oOynOnd O C Q O 40pOOaO0D n fp O i o n D; fncl 0 K Cl Cl. Aty l IL O i 17 c I I f m CA 1 L• C) v C. c I 7 I ^f :. -'' c -; r ' G H • 1. . %r:i r ti n ^• f7 CJ . I °. ti ..., _ o o, n ` •, : n c N ;,• y _`-,.., ` n c r a a 'c O cz rn N ., . p fir, .. - 'acac- ._ ;',,+y`coc c-°-w-h0..ti„-•,__!-. i= t. ti, I' - C.j_ 4.. r i'e - r ti __ L I :..'^"-'.."1= 3 o - +• nom`<_. ° .`, V '° c M.n n o. I Y -.,` rL fi `•' 1. '' w `' fico'^c o.^ v O. O -O N ° '. A n : q ;• V • Ory VI l w ' n .`. • : W n - a it M