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03_29_1989 - 769 S NEWBURY WY
, WORKERS'COMPENSATION DEQARATION p,� p, � ��:..�. � �7 I hereby offi�m �hat I have a certificate of consent to self � � b�z e7F� • � insure,or a certificate of Wo�kers'Compensotion Inzoronce,or � �� .'�y� `µ � - � � a certified cog,�,gi.��om�seoo.�Hig�land �'"m;�e`. �.:` ` . � APPLICATION FOR PERMIT Polrcy No. y - � . . ❑Ce.�ified mpy is hereby furnished., � � � �� �fS�� � SEWER - SEWAGE DISPOSAL �� - - � � . C�Car�ified copy is(iled wilh the county bailding e "#'���� ��OF LOS ANGELES BUILDING AND SAfETY - � ' departmeM. � . ��'�.��� �- , Dare 5�1�89 qPP�i�p�� $L8uk11e8 CA. Iric. , FOR APPIICANT TO FIIL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' euimirvc . 769 S. Newbury Wa suriaa oErrH � � � COMVENSATION INSURANCE ' noorz�ss (This settion need not be completed if�he wo�k involved by the � ip�,iitr Diamond Bar H��.1.8� Ct� 91765 �`NHpLE REFERENCE ��p permit is for one hundred dollars(SI00)or lass.) , 1 certify rhaf in the performonce of the wwk for which rhis - caosssr. - - . . r rve�ovcoNrxaiori �r�rNFaa.+ . - , - [URB F.L.. . M.4 TO P.L. permit is iuued,I sholl not omploy ony person in o�y monner . c.c.r�o. so as 10 become su6jecf 10 the Workers'Compensolion Lows.. . Ow�q Btamalea California�, IRC. co.u+v,Np, �pg�ap. �. � ��� 7RUNK PERMIT NO. ROAD PERMR NO. � Date Applimnt � ' Qooa�ss ], , AFFIDAVIf WA�VER EASFMENT VECORO.IN$TR.NO. DATE NOTICE TO APPLICANT: If, oher moking-,this Certifimfe of , ��n.. Cost8 MeSar¢�.ra. 714-850-1001 �. Exemption, you should become s�bject to �he Wwkers' iEcai - � � Compenwtion provisions of ihe tabor tode,you musl forthwith p[5[pIPTIpN � LOTNO. H4W,plt ST.W�DFNING � � �ply with such provisions or this permi�sholl be deemed ��"" kEt�. &OCK TRACT 42564 STATE ENCROACHMENT UCENSED CONTRACTORS DECLARATION � � -� ^'o.a&°�s. � �pMir na. I hmeby affirm that I am licansed under provisiona of Chapter s¢eoF�oi taOwON ior 9�commencing with Section 7000)of Diviaion.3 of the Buzi- e�uiio�rocs � � autc.�s ness and Profes3ions Code,ond my licenx is in full force and , effett. �� coNrpnaoa Bramalea California� Inc. - - �°""F�"°"°'aac�r�E . LicanseNumber 409610 licCtass B p�u 3151 AiLway Avenue, Ste. N RE�MBURSEMENTi[E � �ontradw Bramalea CA �1e 7/31/89 osta BSS � O— OOL DISINICENO. GROUP nar axoceuc�er v CITY 1EL.NO. BK PG • Z ❑I am exempl under Sec, of the L.A-Co. iicer�ise ruo. 4OJ61 O �uss $ �Q��7 � ' PlumbingCodeand/orSec. ofthe �� -�s�RiPTionto�wORK r�e � FiNr� U ' P"u°eu�v,"rtse conu+Ecnnw To onre VALIDA ON a B.8 P.Code for the fallowing reoson� ScvnC i�rac.S�vnGE v�T Ok fINAI 2 oare Z P'au���caJ�cilNc to BY .�1� .Q�{1 L L� l� ��� /���x/ wivare oisrosAi srsrv.� � Signature_�-��! . ccN�raFci awinoKai atD�.oa � �OWNER-BUILDERDECLARAT�ON pWVE�RRow�SEErnC.��iRORSMFlEI� , g � I hereby affirm fhat I am ezemp�from the Coniractor's Licensa . ex7N.c[ssrooi,dtrMu.nuNNot¢ . � � � Law for the fallowing reason(Secton 7031.5,Buisness and Pro- ut�w,aecniR uie nenNoor+Hous[ -. . � . , {�SSIOl12 COdl�_ � �WFR OR DISPpSAI$YS7EM n 1 oa owner of Ihe property,or my employees with woges os � �,�he�r sole compensotion,will do the work ond the srrucrure . . . _ _ _,. _ . . . '�7 2 9 7 A � is nol intended or offered for sole(Setlion 70dd,Business ond Professions Code). OWNER�S Permit E � #�� • •� p ❑I,os owner of the property,am eaclusively controcting with AUTHORIZATION TOTAL FEE 7 IIC@fISCd[Oft�fOC�015 10 COfI51fVC��I1@ PfO�EC}(SECtIOII JOdA, I HAVE AT THIS DATE A CONlAACT WIiH iNE NEREIN NAMF�CONT4PCTpR i0 �����•'v O BUSIf1B55 OIf(I PfOfBS510f15 COdB�. CONNER ME ABOYE DESCRI9(p ESISTING�WEIIING 10 THE%1BlIC SEWER. � CONSiRUCTION LENDING AGENCY � �f _ - , °P°2�•Jr C c=.� �. � hareby affirm that there is a conshoUion lending agency SiGNEDTHiS��-DAvoF //C.�'��J�o_ . for the performonce of the work for wh�ch this permit 7s °�ROR 15Y3mH128 California, Inc. 0 5 1 2-8 9 iSSUbCI(SOC.3097�CiV.C.). � � OWNERSAGENT lender'sName Toronto Dominion Bank � Aoocess 3151 Airwav Ave.. #N. Costa sa�� � �e�de:s ndd�ess San Francisco, CA I tarfify thol I hove rcod Ihis opplicoiion and state�hat the _ - obove information is correcl.I agree to comply with all Coonty . _ ' ordinancea ond S�ofe laws reguloting Plumbing and Sewers, � � and hereby ov�horize represenlotives of this Coonty to enter : upon tNe above-memioned properry for inspettion purposas. ' - � - " " � �� -- �,�r��.�i�'.�e�v 3 zy _ ignotureofPermiflee Dafe SEEREVFRSEFORE%►LANATORYIAHGUAGE � �� �a �� ' ^qQ �� �• ��Sm � � � � 9�" �O➢� � A��� � � �� o �� � � s� g� � � �.. 0 . - , . ��x� p a z,�o"' „ o � q P � 1 `, � r���g��',� ;„-�,�� G y�.c� s�� o`, ° 9' , ��n+Z � �'� p� ir � . ' � '� �' . �. y+',N �CJ '��j � . � . z��OA � ,.� � z� O . . . - � � , � � . - . . ` , �, � � , �, "�', � . . ; . `x , � . b � � � N N � ` _�- . .} � � , � ` m . � . , . ... . , l � � , . �. ' � � _ ` . , . � . , , . � . , _ .• ._ � -, . .. ' . �1 . 1 " � (� , . ' r _ � ' . � ., ', N � '. �� �F� S', _ � . O . 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