Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0511 2887 5726A
, ? ._..._ _ __ _... _.._. .. .,_._.� ---- -------- --- -- - ------._._ . _.:_, f� VJORKERS�COMPENSATIONDECIARATION �"' '�� ""� '��'•��'-�- ��� '-''� � 1 -., .. . . ... . . . .. , _._-_... ' . . i I hgreby offvm that 1 have o�e,,�,,�o,e-.of.��o�,e��fo se�f —����APPLICATION ��FOR-BU�ILDING. PERMIT�-�-�- ��; " or a cerlificate o{Workers'Compensotion Insurance, � or a certif' '' (Sec.3800.Lab.C.)...,. . �.• . _ .. .. . . .... . .. _. . . . � -' - -_ - ..._. ; m u Po��� N �����§� � • COUNTY OF LOS ANGELES BUILDING�AND SAFETY -,' y o. com��y Hartford GrouP. __ . � - --- - � _. _. _ � � -- �� �• Certified wpy is hereby furnished.�• • FO -APPLICANT TO FILL INr BU�LDING 10�i0 Souf�i Jason Place ADORESS � � Cerli4ied copy is filed�wi�hlhe.coonty�building inspec- -�- BUILDING i Diamon at no� epar eM._ `, '' ADDRE55 1060 Sou h Jason Place ' ; . , ..: ,. _.___ _ __ . oafe ppi conr.Georee Vedell CITY Diamond Bar z,P ioca,uTy ' ' � i - � . .., ..._ ._._.. .._ _. . . . ._. _.NO.OFBLDGS: _-_. . ..- .: NEAREST .._.;._..__.._. _. ..._ :_ � 'CE TIFI TE OF EXEMPTION FROM WORKERS- SIZE OF LOT . NOW ON l0T O � �ROSS ST... � •� � � '�COMPENSATION INSURANCE'-- � (This sedion need nof be[ompleted if the pe�mit is fot one ..--'- TRACT 4ZS69../. BLOCK.... ... � LOT NO. 14� - Mpp B��: •�• ; �.1 � PAGE PARCEI,.. hundred dollars(SI00)or less.). : . - ,. . iE� � � � ' - � owraea--Bramalea LTD - -� 714 0.850-1001' . - �ONE �P ' 1 cerlify fhcf m rho performance of the work for whicb this �Q ��iA` ���-3 � �'3 '' _!� I_ permit is issved,I sholl nor employ any person in any manner ..._.. 31$1,AlxWay.AVO..�.?Q_ - �-�' ��� -""�" -- �""- ` so as to bemme subje2l to the Workers'Compensnhoo Lows. /�DRESS-- � '-`�---� - 00(1 �pN�ITIONS � �� ' �� '' ' ' ,Costa Pfesa 92626 ,.,' .- - nn _ _ - --Zia.--- ----- — .. --- ._ __ ._ --— -�m � bate- _,., . ..�,- �APPIimM . �..... , ., I ��CE TO AP%.ICANT: I( after makmg Ihis Certificole of �+RCHITECT OR TEL .pISTRICT GROUP NPE.;.. _ .fIRE FROCESSED BY- _ r on,' ov should 6emme su6 ect to the WOrkeis' - ENG�NEER Aram Bassenian No.752-1864 � roµs zo ,. '� P Y � 3990 Westerl 1. �D 3 _� _� �" _ � Compensation pravisionz af fhe Labor Code,you mast forth• ADDRE55 �� y --- - �- �---- - with comp�y.wilh�.suth pravisions or ihis permil shall be -� �- TEI. � STATISTIG4L C1A551FICATION , ' APL CONDO. • �,7Z deemed revoked.-::' ., •. ',� �• ,-•...�• �•�,:...�� CONiRnRORBT3ID3123 Calif Na. 850-1001: , _ LICENSEDCONTRACTORSDECLARATION .. .'. --- - -'- �- '-- --..-'- .-. -- .. --.-UC:� --�'-- � .-.. ��SNO.-. . � DWELLUNITS �/ '-- - -- - ' -- - I hereby affirm that I am licensed onder prorisions af Chapier 9 AD�RE55 3151 Airwa AV0 N No. 409610 .. 'i commencin with Settion 7000 of Division 3 of the Business and .___._ ' ��R�p ' � � ��� ( 9. ', .. ,.. , � ., . _ 5°e�' 2542a s�o�s 2 _._" A I�s'�il B"�o eK.'.. Professions Coda,and my license is in fuil force and effect. CiTV M55 - -BK-�-"-�" �� " - "' ' VALIDATION� �� �� licenseNumbe�`409610 Lic.Class B �{ Qs�� ��r�o�,�woRK-Plan 25./ --- — Ne,v- � --vawarioN . . . - Bramalea Calif -� oe : ' Commcror Date � ADD � S 172.400 ; .23 , �I am e.empt vnder Sec. . . . �-� - -- - - -- - n�tE2--❑ ,,`_... `. -S�Lf�!�(7j� �'i 6.8P.C.forlhisreason . � .. _____... . REPAIR-❑ . s.� .. ... .�_ ._. _, _ . . . _.._ .._c_ _ - . -.___ .. . _. ' __ .__ .._ . .. .. . USE OF � � &..�Z O�p . ��. Date:� EXISTING BLPG. ROttO � �'`a -' - - - -- -�--- . . ..�' _____ . '-��-"Signature -. ._ .. -.. .. .. �." -..... . . AvatIUNT . y TEL. ; FINAL . ' - PRINT Geor e Vedell rro. 850-1001 � � OWNER-BUILDER DECLARATION ..... . .__.... � DATE-..---.--.:- -..-�- - - •"- ��' - . �IherebyoffirmthatlamexemptfromtheControcfor'slicense 3151 Airwa L�V2.� N�Costa-Mesa ,.. , „ ��`��.I.��� Y,. law for the following reoson(Section 7031.5,Busfness ond ADDRE55 F�NAL --�' �� ������� :' � � ' .__._. -- _ __ `-ProfessionsCode):.. . '_ .. .. , . ...__... .... __ aRE NT 9y. �.- - - ,_ � . -'_ .2 , . ^�' I os owner of the ro er y P Y � BUaDiNG � � 3�� �-�' � 1 _, p p y, or m em lo ees with _ aDDrtE55 _ _._ . ___, _ _����� _, � � wages os thcir sole compensarion,will do Iha work and �,,e ,,f_I� �� ._.. �he strucfure is nof intended or offered for sole(Sedion ����TM /J�-�- V�"""' _ .. . 7044.8usiness and Professlons Code). ��-� ---- � nnOviNG- - - �-�--. .. . _.-.... . .- h�: ..� ... .. 'O � :`�._ . . - _. .. .. �b-�Q..�Q�p � 1,ns owner of the properfy,am ezdvsively mnt�atling CONTRACfOR NO. � �nl __���' /'`^s}��, � - -�with litensed controctors to tonstrvct the projetl(Seo- -- ... '-''-�-� - ---._..-. --�..- --... . . ' . ... Q�''`�'�:- 0_._ �. '. Iion 704d,Business and Professians Code�. ADDRESS :C.- ,Z�,r-�7, � .. .__._,_...._ ' ... REQL11RE0 . i0iAl5Ei0ACK FROM_ . %I � . I .-._. ._ � ._ - ---CONSTRUCTION LENDING AGENCY�' �� -�` SET BACK YA�tD HWY CROP.LINE WIDTH (�'�.e"`d'�"'1-i I hereby alfirm that thera is a mnshutlion lending ogency for fROrvT � --the performanca of the work�for which ihi�permi�is issued -� --- --a.t....-� -- -----' -- _ _.._. .___.._.... ___ _ .-.--' .__. ..��.�. .. ..,_,.� � ......�5�7 2 6 A . (Sec.3097,Civ.C.). � SiDE . � - - --- -..... _ --'- - . .. ._ .. . .P.L..__ ... .._-�- - --... ..__......._. ... ._._.. . .. . . . #! .. .'O . . .. ._ •�• • lender'sName Toronto Dominion:�Dank �� � ' � IDMA Ref.q � :.. � _ .... ... .__ . _. . ._.. . ____' . . .. ._.. .... P.C.feeE� i!3 Permirfee ��$1:$�- ----� .__ .... 7b2� _ Lende:s Address San Franciseo : � • �� '• �-�; ..I certify tha�I hove reod this app�ication ond slate Ihol the --- .-� ��--.. .'. -. � lesuan<e Fee---.IO.SO . ' �p�P��� ' � • •�7�6�2 Q Q� ; . .__ . _.. '_ _' _ ' obove tnformaHon is mrrecf.1 agree 10 comply wiih ell County I srigotion Fee � � � ordinances and State laws relaling,to building con5lrucflon. ____ ._ ___ _.'__`.�_..___ .. 7oral Fee-....�62.00-.- -�. �LDMA Perm.M-- O�O S"'8 7,�_ ._ _. _. ._. . _.._. .. . ... and hereby aothorize repres nt �ives of this County to enter � up n he ab v�¢me ioned erfy for inspection urpas _ LDMA_�`3$.Q�______ _ _ . C7�/ �i) �� --._"'.. - - - . ._. _... -.. --�-- - �I SEE REVERSE FOR EJ(PLANATORY LANGUAGE � � ._._.. . SignofureofApplimn�orAgenr_ . _ .._ .. pO1e ._ .._ " __..._.. .. .. .__ . ' '.."... _ _____' . .__ __ ._ . ..__ ..._ _ Q . __.___ _. .... . •� __. -- —{.: z :.�. ' r � '� N T fA0 O O (l� �N '� ..�.. ,T_ ��. io. '_"_ ''_ __ _" � 10"' � j O O � � � O O c �?� ir p 7 � ��fa � 0. � � � ' . �a , � � � �0 3 °�_ 'a. o- . '� o `•' o �'� �°' � a T i� i I � m o > • �o �.. _ . �a v � ;n ��.! �Z x m� � '� 'o_ 'r j �' r, 'o, ��i n� o' .a � � �. '" v3 � o o � . „ w :< , � _N�= �::° ,3 ° .= � i ` � o P o p . o o. o _ , �o o 'i ? ,� �o o. i O i :- �� � 'o' o- " 'vo, -�-� � '� c 4 � .. a� > >- - � _ — �. - � �, �� _ ., , '� o , O I� ' .. '' � ` N o � Z . y m ' � .c ° - O _ o7O D . .o _ � - + ;� • � ' V 1 . , ! , 0 0. � 4a 2 �� , . • ;• o -� ' o. _ , ' o Q , . M . . I ' - - .�. _ _ D m . -. . . , ' N � � tI 9. � I � tC . � ' -1 9 . � ;�: - . . , _ < o .. 9 . • � ,e . " i - . : ea' . .. � . . :'m . • .'_ ,,✓ a a c ; - ; /. �a �� ' 1.. • . ' - . . . , ;. � , . i i � � �- _ ; j ' � � , _ _ � _ , �� ' i ;- �� � ' , � - i � �, �. _ ; , ;i 'i , • ;.. , - - -- . � - � i 'i ' ' � ; i � � j _ . _ � . i I , , i , -, .. � - � - � --� I ' � . � i� � � ' - (. 7�0 . � , . . 1' � . . ;f.� ' - N �' • -. ' Z �, '�' " , . �� . , . ' • • � . T ;' ,`: _ ' I i ','' ,':_ _ , �' l �, ,. s' . . j _ • i . . i : � � - i, i � ' ; 1 �' . � � , ;r ' , ' , ' ' i b . ' i , - 'i _. IiJJ i• ' i . �: .. - � vi � 1/,.Q�v-_ ` o-� C-4'L i �.��S�f " a �,1c c s�,'.�n A o'� � �'.— : m ' � "�� _ '.o� ' c o ti -h W o �ce e� � � ,� r m T i ' o ' o c '+ a�p � � A � � p �•E- � ❑1 00�� n 'a � N' �'�e 'f�,� - . . . . m � a I ❑ -�•�� � �0� �• `° � c�s .a�' N b e� �va C���.=i�.a ��:., � t , _ . - , � o . .;/�:�., � f. � = o C ..�0:4 �n.C ir_ ,�e Q A� .� ti.� � ' ��. - �•'. - i 7 . _ �:'••^.c " �Srb �~� �'�',o � � � ° -`�y � �.�•n �.c � o'� O .� t-� n o `'.„ a -� if �- _ �' i� _ - . - � �: ,;Z y.G �.;;,° �� C �C-~ C�m a.� ^� TN .. � e�z O �•�•��rb C f.��'C l. �'� 3� �n:.� � �.fD `S io ' f"�ww ��'"fD O �O � � �'= 1 �.Z • " � �� r� .�.b 'w° ��� � '^`a a ' �' f ��'C �"a �., .�'�j•�-�. i- _ - x, I� -��C�,..,n.f �� o'• C:�a b� w � �3 � .m Cn,� ��L'� 0 3 r w �u -•n c ° _�o � a -.�e �e �,,,�.a ., � . i e � , i� � - ' 3 �. cNnam c `a • � mb\oom oQ M� ..c�w � ^M, s ' i`: _ � � v s� H.a iya.o,• `o' � �^.m•�`�N'.�:,�, o Ay.-i� o.8�e n � � :'�?o.0 � i`_ = 2 i c �. � �:. +�� S- oo ` o c'm'-o �� a � L� �.c � N c .0� a 3.. .—�,., . i � I a � � i� � fl �o �,°, `a'�� a.M n� �i � w M b`.^,cn-c b� H"^ o o � i - � ,�_ _ - in • i �. C+, �����..,�. �.a �a- t� ��p � .. o a-� ti .;.�1 3�Ii: �.r ^ - � - � '.t : � .,� �, : m `i��� = ,o o . Cc'e c.�a•e-fi �C'�o�� � e� ����\b.:.�� � w-.'. £ X�� y I O . f1 ` ` �.N� F ti 1'.f M C � !� .�� .�J Vp�1 ��7'� � �� � W�C / F ^ c C' " o' 10� '� c� I,� ' y�'� . � I ? i.�_c.� � p :< � i � o'o.r^`'+'� .�<' xMa:.C�o `R a�vC� :.•' ' ` f ' 2 �' ' t. � �.00� o . ° asno ��m � o� ca.'o. �s��.o� c��'.'a` .4,.m.,.� i'' � � � e-� 0.'-" 3 �-� e� � 'o '' z�:na f• � �~'n•'z o � a ..• ° o-z : ' T ; ' o x ,^;.c to�� �.CtitiCn o.o =3 1Ln-cna•^� e a " � 0 3 rn • �� ry n x , � �.ti .�cb a-o a< �b w.A•N �.�•'^ ^ta o > > �J. _ _ • O i .. „b � y n c:� � � A �,N p m =b c a.c'� � � T.`"• i:` , � � _ , ; M a��m N ;.� c A'y o � n p T3 a^=�f•G.«.H � �� o..in1D O '% . � - - _ • � � wr � c� � <' .�C�.� �'�'o � �� ,� � �-�9v.o � " � _.nn 'L . w� z N o e m s '�� � � � o �er� � `.w c �a c . ` _ �� _ '� r a ? a �..c ^a 0- .M'k �'L N•�p O co v���'�'"`.�.�� � •''� �� � .:n- �c~ � n p O � �'P- M C.r,'+_�N H A ��ti q n.c p o �.: �. ' - - - ,'o. � ':� � 3 A " �� c"' e:���' o� ..�^ " ��„n? � 'e- �o . '� � ; :_ � - ,z _ in ,., o�•.�, �.o o f � o'� o ', ��•;; �'S� �� r ' . � S___ ,.m t�� N�� � � � m �� �m ��-aT ~...'�t�A N ? ? .."M �'C,,,��w __ . � . _ �_ ... � i ' . N