HomeMy WebLinkAbout0904A 0905A (4) _ . . ... . _ . _.. . _ _
WORKERS'COMPENSATION DECLARATION " S G
I here6y affirm Iha� I hove a cerlificote of consenl to self
... . . .. _ _ . .
insure,oracerlifiwfeofWorkers'Compansation��5�,on�e, � -�APPL�ICA�'I�O�IV� �FOI���BUILD�IIV�G PER1UlIT �
or o cerlified copy thereof(Sec.3800,Lab.C.) � �
COUNTY OF l05 ANGELES BUILDING AND SAFETY
Poi;�YNo 61WETX7993omPa„y Hartford Group r
� Certitied copy is hereby furnished. FOR APPLICANT TO,F$LL IN BUILDING '��! ���
AD�RE55 f
QCertified copy is filed with ihe county building inspeo- gUILDING sn
tipn departmeM. ADDRE55 1186 South Crestbrook Court /�
.: , ( .... . .. .. ... .
Date��l4 Applicant � Clrv ZIP tOCAuiv �
CERTIFICATE OP EXEMPTION FROM Vi70RKERS' - NO.OP BLDGS. NEAREST �
COMPENSATION INSURAIVCE SIZE OF LOT NOW ON LOi CRO55 Si.
(This section�need not be complefed if the permit is for one TRACT 42 8 � BLOCK LOT NO. r'J8 � �ESSOR �
hundred dollars(5100)or less.) N✓+P bOOK PAGE PARCEL
TEI. USE ONE �p fr
I certify ihat i �he performance of the�work for which this OWNER - NO. - — �1, NO. � �'°�`7� }�
n _r SPECIAL
permit is issued,I shall nof employ any person in any manner A�ORE55 x.-�7"dc°� CONDITIONS �
so as to become subject to ihe Workers'CompensaYion Laws. .
arv z�P 9262 �
Date Applicanf ARCHITECT OR TE�� DISTRICT GROUP TVPE ' FIRE PROCESSED BY �
,�.,f�'�TICE TO APPLICANT: If, ofter moking this Ceitifi�ote o4 ENGWEER Aram Bassenian n,o. 752-1864 CONS ZONE {~j
nption, you should become subject to the Workers' n y�
wmpensation pravisions of ihe Labar Gode,you must forih- qDDRE55 3990 Westely P1., SUl t2 �]� '�° v`'3 - �' V A
with comply "ih su<h provisions or this permit shall be " TEL STATISTICAL CLASSIFICATION � APT. CONDO. �
deemedrevoked. CONTRACTOIi Bramalea Calif. No. 850-IOCl
LICENSED CONTRACTORS DECIARATION. �i�, a.455 NO. `�DwELL.urmis�
I hereby a$irm lhot I am li<ensed under provisions of Chapter 9 ADDRE55 3� 1 Ai r Av.. No. 4 6�
(commencing with Section 7000)of Division 3 of the B�siness and ��� SEWER MAP
Professions Code,and my license is in full force and effect QTY c C1A55 BK � VALIDATIOH
S�.FT. NO.OF NO.OF, �f CHECK
License Number 4f19fi1(l Lic.Class R SIZE 3� STORIES 2 FAMILIES I ONE .
� � � VALUATION
�ESCRIP�I N O ORK N� (� �j �
Coniroctor Bramalea Cd�lf Date � $ fJ� J�� --v y C'.�F
��amexemptunderSec. Slil9�2 Fd1711�y RQSIC.I2YlC2 AD� a , , c e s��
ALTER ,
8.&P.C.for fhis reason N2W Constructi on REPAIR � S ( �;���G i.'�
� Date: USEOF �EMOL �� -�
� s �� � EXIS71NGBl�G. N011e ❑ � ,�� r+-
APPLICANT TEL ��C i:.i u .
S'�nowre � FINAL
NE�R DECLARATION� PRINT) No. — DATE ir?`�.L��C'`���J
I hereby affirm that I om exempi from the Coniroctor's License qDDRE55 3151 Ai rwa Ave. N. Costa MES FINAL �
Law for the followinq reason (Section 7031.5, B�siness and
Professions Code): - - �� gY
.r'� I, as owner of the properfy, or my employees with AD�DRE55 _ , _. ,
wages as Iheir sole compensation,will do the work and , G'� - '
the structure is not intended or offered for sale(Section LOCALi7Y � �"�% =�_"^
7044,Business and Professions Code). MOVING 7E�_ ' � .- � a �
I,as owner of the property,am ezdusively contracting CONieaCTOR NO. 1"�.` s
� with licensed tontracfors to tonsiruct the project(Seo- qDDRE55 I � �:c:rb:b(i .
tion 7044,Business and Professions Code).
REqUIRED TOTAL SETBACK FROM EXI 7. -
CONSTRUCTION�ENDING AGENCY SET BACK YAR� HWY PROP.LINE WIDTH �+ �G',��,',�G�
I hereby affirm that ihere is a construction lending agency for FRONT
fhe performance of ihe work for which fhis permit is�issoed P.L. [;��tj—��(;
(Sec.3097,Civ.C.). SIDE
P.L.
Lender'sNome Toronto Dominion Bank
744 Sansome St. Suite 700 �z..c �7 -r�3 1D"''°'R"` "
— Lender's Address , ° P.C.Fee S _� Permit Fee ' _
I certify that I have read ihis applicption ond state ihat the /��C� Issuonce Fee �o�� LDMA P/C N
¢ above information is corred.I ogree to comply wifh all County Investigmion Fee ,
ordinances and State laws relating to building consiru<tion, Torol Fee �" °�.s� LDMA Perm.R
and hereby authorize represen�ati�es of this Coumy to emer , _
� upon ihe above-mentioned proper for inspeciion purposes. } • .
2 �..� �� �/� J_�
Q +%.�Y-�r'.hP'J SEE REVERSE POR EXPLANATORY LANGUAGE
_��'i_=
� Signature of Applicant or Agent Date . . .- - C�
�
' PLANS TO APPLICANT INSPECTOR'S NOTES O�tinPR-BUII,DF,R DF.CI.ARA'CION
. I hereby affirm that I am exemp�from the CoMractor's
To: � ReTurned �- � License Law for +he following reason. "(Sec 7031.5)
Approved Bue�iness and Professio�s Code:An_p rlt�,or c'uun ty u•fiicb
No. Dafe No. Do}e , reyuires a permdt tn rnnstruci,alter,imapro��e,demalisb,
or repairaxy strucaure,prror�to r[s rssuunee,also requdres
tbe applicenl f�r such permit to jile a signed statemext
tbat be is lirensed pursuant to tbeprooi.eions f the Con-
. . ,. . . . .. _,
� ' �� � - _ , trador's I.icense Luu�(CSupter 9/(com»iencing woth Sen
tion 7000J q/Dicisiore 3 of dbe Business anJPrafessions
- Code/or ibat he rs esempd therafrom anil the baeis for tbe
alleged exemftion.Arey aiolatio�f Section 70315 by
Required Date Reeeived uny applrcuat(or a permit subjects thc applicant ta a civil
Approvals or Approved penalty�/not morc tl�ax jire fiundred dnllars($j00/.J:
Yes No .�. . � ] I,as owner of ihe property,o�my employees with
Water Certiflcote wages as their sole compensa�ion,will do the work,and
� - - �the sfructure is noF intended or of�ered for sole(Sec.7044)
Health Department .. . �Burixesa aroJ Pr<fessson.s Cndei Tbe Contra�fnr'.��License
l.au;does not ayply�to an nwner of pmpertl'u�bn builds
Fire Deportment or improx�e.��tbereon,�end ie•/n does su�G u�ork bimselJor
� .. . tGrnugb l�rs ou•n employees, provided tfiut sucE'7•-
Grading pmaemexts are nnt rntewdeJ or nffered,jor sale ~
. � _ . , homever,the fiuildin,q nr imprnvemeret fs sold mifbin m.z
Geoloqiml . yeur qf rompletion, tbe mm�ervbailder will bare tge
burden nf provJng thai he did nnt fiurld nr inoprono jnr
tbe r ose� sale.
Pedestrian Protectian � P"P 1 _
iFence)(Canopy) � - - � [ I,as ownerof the property,om exdusively wntroc-
� ting with licensed controUors to construct ihe project(Sec.
70441 j3usimess and Pro ersrons Cnde: The Contructnr:v
Special Inspection f
(Conc.j(Moso n ry)(W el d i ng� Licenxr La u�doee nnt appl y-tn an orener of(irnperty u�bo
huildc or inrpra��es therenH,r�nd�ubn rnrstructs jnr sucl�
Lot Droinage projecu u�itb u coniractor(sf licenxeJ pursssunt !o ahe
Cnntroctor's Lacensa I.au•/. �� � �_
Parking
[ I am exempl under Sec ,B.&P.C.for ihis
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reason
Date Owner
Approvals Date Inspector's Signafure , , . � INSPECTOR'S NOTES
locmion-- .
(Setback&Yardal �/� �.-�
Foundafions �4 � '
s'
Slab 'l� ` �'
/-zC� y�--���
Frame . . , . � �
Energy Insulafion . - , -
Lath/Drywall-�� -� - -�
Interior ' � -
Lalh--Exterior � - - �-�
House Num6er-- - � � ' , ,
Correct&Posted �
Final--
Enter on Front � � � - �
r2�::= �ri=� �'�> .. ,
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