HomeMy WebLinkAbout0670AWORKERS' 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. )
P❑olicyNIRRV4424company Hartford froup
Certified copy is hereby furnished.
Certified copy is filed with the county building inspec-
VR---14T
tment
Date Applican 71-►►+� �/` ,
CE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for o e
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
�mption, you should become subject to the Workers'
_ompensation 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 Code, and my license is in full force and effect.
License Number 409610 Lig. class B
Contractor Bramalea Calif. Date 6/:6/85
❑ 1 am exempt under Sec.
B.&P.C. for this reason
Date:
Signatur
WNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contract '
Law for the following reason (Section 7031.5, B siness cl
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).
❑ 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
(Sec. 3097, Civ. C.).
Lender's Name Toronto Dominion Bank
Lender's Address 144 S�a^nsomee St, Suite 700
I certify that I have
San ?haisnappli.catQian an s ate t at 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
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APP ANT TO FILL IN
ADDRESS
vs� a c
BUILDING
ADDRESS _1.409 'Svp
LOCALITY
Diamond Bar
NEAREST
CITY ZIP
CROSS ST.
NO. OF BLDGS.
ASSESSOR
SIZE OF LOT NOW ON LOT
MAP BOOK
PAGE
PARCEL
I
USE ZONE
MAP
/
TRACT BLOCK LOT NO.
NO.
!
SPECIAL
OWNER Bramalea Limited N`�.14850-1001
DISTRICT .GROUP TYPE
FIRE
PROCESSED BY
ADDRESS 3151 Airway Ave Suite N
CONS
ZONE
�®
CITY ZIP
STATISTICAL CLASSIFICATION-7
APT.
OFICATION
ARCHITECTTEL.
Aram Basseni an No.752-1864
t° )
JCONDO.
ENGINEER
CLASS NO. DWELL. UNITS
ADDREss3990 Westerly P1 Suite 170
SEWER MAP
CONTRACTOR Bramalea Calif.. NY 14/.8501001
BK. PG,
VALID TON
R
ADDRESS 3151 Airway Ave, N No. 409610
VALUATION
9 o ®®� 2 1
LIC.
CITYCosta Mesa,CA 92626 SS B
$ Jo 7crb
I -320,41
SQ. FT. 1884 NO. OF 2 NO. OF 1 CHECK
IFAMILIES
►z0
SIZE STORIES ONE
3,
DESCRIPTION OF WORK Plan 23BR NEW
$
06.13@-85
ADD ❑
Sinale Family Residence
New Construction ALTER E]DA
J
EL %�4`
REPAIR
S
USE OF
\
b T D A
EXISTINGI®LDG. none DEMOL
FINAL
By
APPLICANT TEL.
4
PRINT NO714850-100
ADDI. 3151 Airway Ave, N, Costa Mesa
®
1 5 4 9' 0 0
� 56,9,00il
PRESENT
BUILDING
ADDRESS
® 6 1 3 —8 5'`
LOCALITY
MOVING TEL.
CTOR NO.
ED TOTAL SETBACK FROM EXIST,
K YARD HWY PROP. LINE WIDTH
LADDRE
ry$ �J r Permit FeeIssuance
Feetion
Fee
�p
Total Fee
upon the above-mentioned pro erty for inspectio purr Es,--
4-1r/q�
SEE REVERSE FOR EXPLANATORY LANGUAGE y6
Signature of Applicant or A Dat
0
U
W
0
ILA
S�
Os
LI 1 iNSFEC _,OWNE4,151JILDER DECLAR 1qN'-..,
AT
®D
of from the �ontcactor,s
."I hereby, fJrmJh..Gt I,Qm_qx@nnpt
To: R! twel License Lawfor the foLl.o.wirig .re,.asom., (-Seb.,f7b3,1,6)
Approved Business and Professions Code, Any city on cozwty vbic;h
No: Date construct, iter zsieprose' uesnolssh,
0 alsorequiresor repair any strudi?re, fir or t its isiiM�ic
me,
the applicant for stxh2pormit, to file 'aszgned i state t
that be is licensed pursuant,W the Ped visiqos-4fthe",
e
actor ";cense Law (Chapter 9) (C'o'MJW with Sec
C
a _j;of Pr6fesWdW,
qfMrii 'the4) -
tir- 7666 1p,
Lath/Drywall—
Code) or that -he beriq#6i�i and 46e Wdf isfor the
I I s e�xerhpt . therefrom
alleged exentpdon'. Ahj`� 646&46
't ir'ofSe�tion 7031.5 �y
cant oraper"rktSLI an 6 a civs
b1'ec?s the li�,
u
penalty of not more than fifvie h�'ndied dollars
as owner of.,the proper.ty,,or.my Pmployees:with
Approvals
qu i"ad
qu
Date itetelv.40,
or Approved.
Yes
No
House Number—
Water Certificate
Correct & Posted
7.7
as thei sole�cerrtoenscrticrn will do,.the wotki:ancl
*herstrUcture,isnotintended or-oifered for sale=(Sec. X044)
Business and Professions Code: The Contractor's License -
Law. does not appy to anlotimar of -property -who- baiM
Wealth. Depqrtment.'r
Fire Department
or itnTroves 4bervon, au&`t&bo'does'4ue
tbrougY his o'wn'- I "d d b b"
omp Oyeds, proof- e "t at 'Siid�
�Me�iits,iiie ot:
77 rov n inten ed "be, offered0 s e..
however, the building 'or intjbrav�e'nieir
v
year ar completion, cF c,uner-builder wi leave tie
All bui
burden of pr6ving tb& je t b 'V
affVn9" at or
YN-4—
the.,P o.sale
#rpqse;o"
I - as.erof he prop perty, cim excIus!Vc0yi:ontrdc-
Gradin 9
Geologltbl
-7
Ped strion Prate'
9 Protection
(Fence) (Canopy)
V_
ting with licensed contractors to construct the project (Sec.
Special InspeciVon,7040B"ness
(Conc..) (Masonry) (Welding)
and ?rqfessiohs_o eTb. GOAtract.r,,
License Law does not apply to.an ownprpf ropertywho
p
t�s I . � X,;,, -b t&for; ssu--h
bu . ...... o r roves 09' qhl'and, w' 'o colnblac
p
Lot Drainage
projects with a contractor(s) licensed pursuant to, the
Cotm wror's License La
Parking
El I am exempt under Sec.---., B.&P.C. for this
reason A
7it
Date ---Owner
ECTOR
''S NOTES
ADvcr, _-
tsps 3 Date
T Inrloader's Signature
Location—
(Setback & Yards)
Foundations
Slab
Frame
VAI�AJ-t7
Energy Insulation
Lath/Drywall—
Interior
Lath—Exterior
fG,g5
House Number—
Correct & Posted
/Y
Final—
Enter on f rant