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HomeMy WebLinkAbout0922A 0923A -, .. ----.. _.__. .__. __. _._. _._..__. .—- --._ _____ ......r..:� --- -- -. - ---. ._:. WORKERS COMPENSATION DECLARATION ; - "'• �-?��'�� - --`�"�� �- � � �. . . . ... • � �;�;��bora(certifca'teoiWorken'tCompena;o�s��,��e��e' --�- � ����i4�PLICATION��FOR .,BU.ILDIN�G �PERMIT�� ��� , , _ ._---. . _ ar a cerlif'ed copy fhereof(Sec:3800,tob.C.) � - COUNTY�OF LOS ANGELES BUILDING�AND SAFETY � �� -�� � � PolicyN��wETX7993 comPa��Jiartford Group ___ __ �� - . -�-- �� - , � - �. Ceriified copy is hereby fum�shed. _ . , FOR APPLICAN7 TO FILL IN nooae55 1�Qg -;�j ��' CertiFied co� �is filPeP with the count 6uildtn Ins - -- � BUILDING , /� +� �tion de a.rm,,ey f. ADDRE55 . �OOH SOUth LO V _� _ � ! '.7 PY Y 9 P i „ y.. ,((�. . � . _ . Da�e`�—+�A licanl � GIN ZIP - LOULItt �. � , �� CERIIFICATEOFEXEMPTIO FROMWORKERS'� ��� �-"- -'-- - �".-`-"�' ��""'-NO.OFBLDGS:---------- -�. NEAREST_.._.�.... . � - '•COMPENSATION INSURANCE`��' '� SIZE OF LOT / NOW ON LOT . GRO55 Si.,_ ,.:• ^. � (This'setlion'need not be compleled if the permit is for one - -- � ASSESSOR,_, ,. � : � '�• ��-'� � hundred dallors(S100J or�ess.) . TRACT 4Z5E)H U BIOCK �OT NO. 35� :/ MqP BOOK PAGE PARCEL ,' ' o,vr�,ER Bramalea Limited N�SrJO-�OO�- USEZONE rnnP .. ... � . ,. .. .. I certify�that in lhe pedormance of the work(or whicfi this R�� �� ' I��3 - ��� `- permit is issued,I shall not employ any person in ony mdnner • • � . - SPECIAL ...-. .._.._._. ..__..._......._.. .. ...... ..:p, I sb as to become subject lo the Workers'comPe�Sot�a�iaws. � - AooREss-�-3 51-� i rwa �Ave.-��Su i te-N �- - ��� CpNDITIONS �v , . ,.. ,.�. . _ ---._ . aTr. ...Costa.Mesa,_CA __nP..__92626 ... . - .-- - .._ . ---- - -... .. . -- �m Dafe �� �� ' �ApP���^� � GHhtEER °R Aram Bassenian N�52-1864 '� I CE TO APPUCANT:�If offer makng�this'Cerfificote of OISTRIC7._. GROUP TYPE FIZE PROCESSEDBY. .;F �nption,�you shou�d become subject to"the�Workers' -� CONS � �QNE - � Cvmpe.nsa7ion provisions of Ihe Labor Coda;�you masf forth- qpORE55 3990 Westerly Pl.� SU1 t@ �70 �� b .3_ - :d with com I with such rovisions o� Ihis be �--�� � � deemed revoked.,. � , . BPdllld�2d Cdl lf TE�'H�JO-�OO� � STATISTIG4L QASSIFICATION � , nar. coNoo: - 'Z Y p ermit 5F1aPI CONTRACTOR . NO- � , ...., .. ._ PY P P . . ... ' . .... .,.., , . . � ' --. .. ..._._ _ _ .. . . UCENSED CONiRACTORS DECLARATION� -� - -- iiC.� M55 NO. Dwelc.�UNiTS I hereb atfirm that�am licensed under rovistons of Cha ter 9 nooRess 3151--Ai rway-Ave:;P1��No 409610�- ' � SEWER AMP , ..� . . (commencin9 with Sec�ion 7IXID)of Division 3 of the Bvsiness and . _ ---..-.-.�-�COS td�M258�--�R ��-���'-�� B - �--- ' � Professions Code,and my license is m full force and eHecL CITY � QASS - ---BK " "'�,�.� -"-��-�- -" - VALIDATION"-���- � ., _, .. ..: . . . . , $Q.FT. NO.OF NO.OF; CHECK '� � � ; Licens'e Num6er d(19�i�(� " Gc Class' R� �"� � SIZE �-254' - SiORIES� 2 � FAMILIES-� � � ONE � � �'�- _^Q C� 2� . VAlUAT10N_._ 2 � � � Bramalea.Calif . •„, . , �scR�P I�oFwoRK PLAN p5,� ` - Nc�v._ � - . ... ..._ Contracfor - Dafe � ' � ADD � s ��`� � {:e • •2�� �� ... . . . .. . � �I am exempt undet Sec. ._"_ .__ ' .. '. . ' .___ - AITER�..� � ,� _.. �� � �J��.� ��.- . � . ._ .... ... . . � 8.8P.0(or ihis reason . . .. ___ _ NeW Construction REppiR.❑ --S-- - �------� '------.:_ . ,-..-. -. . . _ - - - - ; > +�81.1G� .__. _ .. ._... .. USEOF � � � . - �Da1e:- ' DEMOI , � EXISTINGBLDG. N0112 .- - - � ,_ S ..-� - ' _.�� . . . . �. . �� APPLIfANT TEL FlNAL � . PRINT Geor e Vedel l NO.g5�-���� : G �ao sb OW ER-BUIIDER DECLARATION _.-_. .. ... . . . . _ - . _ . . �-DATE'---�y ���+-- ..._ ..__ . _ ... .-I hereby afiirm that 1 am e.empr from the Conirocror's litense 3151 Ai rway AVe.�N� Costa Mesa� , , � law far the following reoson(Sedfon 7031.5,Business and .4DDRE55 � FINAL�- � � �� ' -�'� " � '' ' ... ._.._.. _ _ __. ...._ ' . �..._ . _.. _._ _..._ .� .. . . . _ _. -Pro(esslons Code: - .. _ .. _.._.... .... . -�- --.. . veE Ni -`. y . � .I - � , BU�LDING �• � <0 9 2 3�A ' I,as owner of the properry, or my employees wtth ADDRES$ _ _,_ .,__ � .� wages as�heir sole campensafion,-will do rhe work ond-� ��� ' �1• • •,�.� , the struc�ura is noi intended or offered far sale(Setfion ��`��TM � �- � -7044,Business end Pro�essions Code):�� -' ' - -- MOV�NG��--� - -- � � ��� � � TE�.- ' -���� - � - ---- - � - - ' � -� �I,as owner of�he property,om extlusively tonmociing CONTRACTOR r70. � , . ,. � �� 5�,�� . - wi�h licensed camractors ro mnstruct�he projett(Seo- —" - .- . .--. _._ .__._..-.-'-'. - ' -.' .'— ... . . ..._... �_.e b . tion 704G,Business and Professions Code). ADDRE55 . � �.� � `,.� 6 5�.C O� . __ REQUIRED . IOIAL SETBACK FROM._ i _ �-.-��- � ' '• ' __... . YARD MWY - . _ _. . _.'_ - CONSiRUCTION LENDING AGENCY--"`—"" " SET enCK PROP.LINE wioTH � , D C C O-II-Ei�� I hereby aifirm that Ihere is o conslruction lending ogency for FRONT f�ti���T i \��.�=1�=? � _ -the performonce of the work for which this�permit Is issued �---. ..P.L. .... -.- .-. -". ..--' -...----`---. _ ---. -..--- . . . - . .-.... _� (Set.3097,Civ.C.). SiDE . � '' - ' - - Toronto Dominion Bank- - '`' ' � �� - - _.. _ _ Lender's Nome . �� � . ansome t.f U1 t2.. _.. __ �,�'/ lp_ A�� . LDMA.Ref.N ` . _ � . � \� a i. . . -"- - - P.C.Fee S � D--- Permif Fee-- Lender'sAddress r__ r._____,..,,: rn nn7nn � � , � �7 ' � ...I certify.lhat I.have rend ihis opplication and stete.that.the . . _. .___ .. .._�./f!(/�-- Iseoonce iee- �-'��..: -LDMA P/C w - .. ._.. ,.�-- ��"-"-� � ' above informalion is torcect.I ogree�o comply wilh oll Caunty Inve��igo�ion Fee /��.r•�O j ' . ordinances ond Slo�e.laws relating_lo building constructfon, __ ,__ __ _ . .. ......-._. _.._. Toral Fee��-b �/� --� LDMA Perm.-M �' �� -� . and hereby authori=e repre nlaiive of h' County to en�er � � ._. . __ _ _ _ _ .upon th ove- ntio e pro ert o i eCti n orp es. � . � _. ... . _. . .. __ ._.._ ._.. . .... ., _ ._._. _ _. ._. .... . . . � ✓ SEE REVERSE FOR E%►LANATORY LANGUA E � � �,��`?�\ _ __ . _ ._.__.. .. __. _. .. . _. _.._.._. _. .. ._ . . _ _..._ . _. .. . . i � . . . . � , ' . ._. nowr of APPI� nt or Agenr -.-_. __._ .Date-.. _.—_ . .. . . _.. '. ... . -"'_. �O� , � _ z 'o�" ._ � o . . 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