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HomeMy WebLinkAbout0912A 0913A . . , , , . .�_.. ---- -- . _._ . _ __ __ _ . __ -----.... .. ........._ .. . . . . . WORKERS'COM�PENSATION DECLARAiION, r .� '�*' - " ".". i . � - . -{',[ - . t�.hereby offirm Ihot I hava a certifitole,o(�ConSeM lo=e�f ��- --- �����APPLICATION FOR .BUILDING PERMIT -�-���; Z� insura,or a cer��flcme af Workers'Compensation Insurance, � '- -._. .. ._.. . _. ____ ,. . or a certified�m t ereo �Sec.3800,186.C.)" '�' "'� - - - . - . . -..- �--- �- -- �' 61W��fX799�3om��Y Hdl'tfOPd'Gl'OUp..._ ... COUNTY OF LOS ANGEIES I� BUtLDING AND SAPETY -.. �' . _-- -- - ._ ; PolicyNo. - -- O :Ce�tiFled copy is he�eby fumished.`� �.r.: ' FOR APPLICANT TO FILL IN eunoiNG / � ! ADORE55 ODS • �'.Certified-eopy is fileiJ with the cou� buil ing'i�SpeC- - BUILDING •-I !� � ��lion de p�arlme�f..�-' '.�. , � . .� -.. ADDRE55 . � � p/• . ,.� y. /� - .� .�-., .�� .�. __ .__......_ .__.___ _.______ ___.-__ _ ._-__._ _ . � �� ,� Datei��APPlicant� dTY 2�7 LOCALITY -� �� CERTIFICATEOFEXEMPiIONFROMWORKERS` � � "'�-" ��-- �"��-'"�� �-"""" - '��"� -- ��-NO:OFB�DGS:-�--------� taE.4RE5T.--- _—_.._ � � �... , •, . ...: SIZE OF LOT NOW ON l0T / CROSS ST.. ..-'_.. .. __._..___'_..._ .'_""__"_' "` � -'�COMPENSATION INSURANCE - �� (ihis section'need not be compleied if the permit�is for ona ----- -" . . .. . .-"�------..._.... .-�- --"�- ,.. .- -`- �_ '._...� ; . .: ., TRACT 4Z568� s�ocK lOi NO. Z�L ��- MqP Bppi( � ' � �PAGE PARCEt hundred doliars SI00 or less. . .,. � � �� � I-ce tif that in the eriormance TE� ermit is issued,I shall not em lo an erson � � � U�ONE �+P y. p of the work for whic6 this own�u- No. - � AD �• � � � � '� P � P Y Y P in dny manner • • . SPECinL. . .___ . _. .. . . _. . p, I- - so as to 6ecome"subje�t to Ihe WorRe�s'Compensotion Lows. -- nooaess-3 5 -A11'Wd AV2: - u1tE-N -� - � �Gc�`7'� coNoinoNs - ,�� v � �ICE�TO APPLICANT: If, ofter makmg fhis`Cerfificafe of _ ._. NGHNEFR �R � �- --. --ZIP..NO.- STRICT.._.GROUP� ...--�� . . . .: - . . ..-���-- -�'� , . '. '. � ' . . ... - - . I - :OL Date 'APPhcanl . . �. . . 0 I DI TYPE ._ _FIj�E PROCESSFD BY.. . � jmption, you should 6acome su6ject to'the Workers' ' CONSi Compensatlon provlsions of the lobor Code;�ou-must forth- qD�RE55 .��iJ L�'3 ... �''__ .. __-_.�_. �OW. wilh tomply�with�su�h provisions or��.this permit shall 6e ��-- TEL. - STATISTICAL CU1551FICATION � AVT. CONDp.- Z deemed revoked.... , . .. .•._ ,'..., , COMRACTOR Brdmal ed Cdl l f r�o.850-1001 ` , ___._.. _. __ .�� ._. _..__ . LICENSED CONTRACTORS DECLARATION-, %,. -�-� �-- ----- - ���- ��---��- ----- �-� �i�. -- �-�--�� ��: an55 NO. U� � DwEtL UNITS 1 hereby affi�m thaf I am licensed under provisions of Chap�er 9 ADDRE55 � NO.'rJO96�O ��R�P „ ( . : g �inQF�n'.� , ..,. ..:, __ ._ SQ F7. _ NO.OF ___ NO.OF_ �IC. CHEIX � BK. '_._� . _._. . .�_ __VALIDATION'.._ : commencin with Section 7000 of Div s on 3 of the Bos ness and _ _ _ _ _ _ _ _ Protessions Code,and m I¢ense is m full fmca and effect. Cit'/ COStd Mesa -CA C1a55 g UttnseNumber L¢.Closs� � R SIZE STORIES FAMILIES ONE -� �-O 7�.2�A �° I .. - . . . . .. .. ... . z . VALUATION.__: __..; ConlraUor... .�. ...,.. ,. ...'•- .Dote..,.. . ..... . _ ... . DESGRI o d�woaK--PLAN 22- ✓�--...... _ NE,v - -- � �{{-: •..�.•2,� s �(���rri� . ; � ADD ., . .-.. ❑I am eaempt vnder Set. ----- --.._ • _ •. .. • —._.. _ .------,❑ _ ,�. . . I��2 8 2 0 3 � . . . . . .. ....... . ALTER . _ �- . .... ,. � , . . 8.8P.C.for ihis reason _"__-- � . - REFAIR- ❑, .__._...___'...._.,..___... ;. . __.'.....__._'i"e.C C�2 a J U�� , . . .... _ __ _ .. . .._ . __.� .�� USE OF �Date[� EXISTING 9LDG. NOI�e DEMIX Q �� ' � ' . __� � —.... .. o&�a=86 . . 5 -tur . � . � --'� APVLICANT TFL. FINAL �y � PR�NT Geor e Vedel l NO. B�J�-����• ' � O NER-BUILDER DE RATION __. _. . . . � DATE-a.;ZG ,Q� ---� -'�-•-- •--- --�--�-�- -�I herebyaffirm that I om eremptirom theConrracror'zllcense ADDRESS 3151 Ai rwa AV2.�N� �OStd Mesa � - ���- ���•�- -L � Law for the fo�lowing reason(Section 7031.5,8usiness and � FINAL � " ��� � �..___._.�__.... ._...._._ ..B :: -:-. �_ __, . _,-_. _ _ "�Profeisions Code):"' "- "'�" pkeSeNi � Y ,c�t � �-;.: '7 BUILDING . _ � � I, as owner of the property, or my employees with AD�RE55 _ I =�O 9�.v� ` _/ wages os their sole tompenw�ion,will do the work ond � � ,- - �ha structure Is not in�ended or offered for sa�e(Section ��`��Tr ' , � ' � {�s�b'•'s'��- -_ .. -..7044.Business and Professions Coda)................. . . .. MOVING__ _____.. .__ . ._.._. ____..___.TEI.-____...._._.__.__. .. .__...._..__.......__.. ...,.-.:__ __ ..._. .._. ......._......__. I,as owner o(the property,am ezclusively coMracfing CONTRACTOR NO. ' .. 5 Or � - �..'wilh licensed contractors�to construc�the pro�ec�(Sec-.. ... . . ...---._......_._ ._._..._. _...._ ._........_._. . . __..._.._........._.. .. ... _. .. . : . -".-- ----.-' • ..�- �� °��.Q. ' tion 7044,Business and Professions Code). ADDRESS ' . , . I a o����Jr r s.: ___._ .REOUIRED-' - "TOTALSET6ACKFR M- ..--'-'...._ .. ._..- '. �_:.. .',. .�... ... .:� ._ � ._.... _....... . YARD_ 'F�, . _._._._ ..._'_.._.� . -CONSTRUCTIONLENDINGAGENCY'"'---��-� seiena PROP.IWE W�DTH . � I hereby aifirm that�here is a conshuclion lending oqency for ' pqONi . � ' � 0�����'8'b''�'' -tha performanca of the work forwhich Ihiz permil irissued . ...-_ ,p.t—. _' __-._._.. ..._._.. ...__..__.__'_._...__ ..._ - . _...._.___. __._. . .. :. ��.. :�:_ __ '__ _.._.. _ _ . (5et.3097.Civ.C.). SIDE �. '�' � ' - - - Toronto Domi ni on Bank - .__ P.�. . _ _ _ _--_-__ _. ___ _ _ ._, .. .... . . ___ Lender's Name - . ansome. _ � (' 7�, LDMA Ref.N -.: .. .. .. . •.e . U 7 @.. Q_,._ V.C:Fee S ''�'O�'�3 - Cermif Fee _ .�.. . _ ' _ ..'__ _ _ Lender's Address �a n Fransi sse,�,-6� ���0� (''� '�,` / � -.I.certif that I have read this o licalion ond sfate fhal.fhe � [� -'" � Y - PP __'__ """ " '__'�J�.�'[l .. hsuenceFee.-__G�.:��._".� LDMA�P/CM'___"_ '.'___..'. ,'_. " ._. ___ '. ..._ _... obove informatian is correct.I agree to comply with oll Coonry Invesn9ation Fee �/p � i _ordinancas and State laws reloting fo ilding tons�rotfion, _.. _._-. - To�ol Fee -' 7'0�'� --�' LDMA Perm:�8�--- - � � � -�� ond he�eb auihorize r rese ativ thiz Coumy to emer - :,� -,�. •�..,..�.. upon i v emi ed p f r inspeclion pur ose ,Q�/ � - � � �SEE RFVFRSE POR E7(PIANATORY UNGVAGE� J � ' .. - i� ' '-' , �� Sig alure of Applimnr ar Agent- '-- pote-.. . ._. ... . ""-...... .._ . .__. .. __..___�. . .. ._... . . . .. , Q I i.. . i.1 --- ,., •-• . _ . . � � o: ;' � " �� .�..-- -- � ° r..�_ -c}• -�- -.T_ _�. ;p. T � � .. , v o (1v� m a, o t a, .p 1��. 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