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0968A 0969A
, .. _ __-------- --- — - WORKERS'.COMPENSATION DECLARATION . ... . .. . ,'. ._._.....__ ........ ._..._ ...._..._.._ .:-� .. . 1...:_.._._..... _ ...'--..._ , �. , , .... . .,. .. � .:,.: ._...._«.--_"- . _ ' . . , . . I APPLICATION-�F�OR,�BUILDING �PERMIT �Z� . I.hereby aff rm�ho�,i�ho e a certif�cate:of consenl to�self nwre,or a ter�f cate of Workers'Compensation Inwrance, � -----.-'-.. .. . ' " .' " - ' -,— - • br�a ceni�ied copy ihereof(See:3800,Lab.C.) � -� � , .,_ _. � ......... ' " ' 61 WETX799�"`"' ''`� '` '' '"' ' " COUNTY OF LOS ANGELES BUILDING AND SAFETY • �, � Polic No. m n � �.___ ... _. . ___ .. .._... _. . .._ ... � . y Po y�lartfnrd f,rnun ._ __ •Certified�co Is hereb furnished.�� BURDiNG ' ❑ PY Y ' • FOR APPLICANT TO FILL IN ADDRE55 DO9 � � /�-� (� ,'Ceitif ed�topy is f led witkthe covnly bui di g�inspat- "" BURDING -' . v� liorideportme-t:� � � . ' �� � --� ADDRESS 1009 South Lon view /� ,' , .. . _, . . ..-- . .,� , _.. .—... _...-----. ....-- __.------- ---- ---i i Date��Applicant - � .,. . CtTY Diamond Bar ZiP ' tOCntITY ' ' � .... ` CERT�FIG4TE OF EXEMPTION FROM WORKERS•... ' _`-'-- � -"'-'-'.-._._.. ...._.._..._..NO:OF BtDGS. �----�----' NFAREST � � - ._..._.._._.'-i_.___ .. . .._a-....,. __ ...,-.._._ _.__ _ •"' `COMPENSATION�NSURANCE�'����''������_� � SRE OF LOT NOW ON LOT � CRO55 ST._ . �............ . � (ihis section need not be completed if the permit is for'one -���-- .' � - � --,� � � �� ���.� . _. .'__�_...__..' � '. _ __________ _'___."__. - . ASSESSOR_.. , ... hundred dollon(5100)or.less,),.�:�;..„. . , TRACT � BIOCK LOT NO. ' Mqp 6ppl('��' ' .P,4GE PARQL . . . . :�, . . TEI. '. ' ' - • -• --- owr,ea-Bramalea-Limited - No.-850-1001, "��i°P"� ""'4P ' I certify that in-the'performonce of�he work for w6ich thiz No. '. ///-3y .� � �� . I permil is issued,�sholl nof employ ony person in ony monner ' • - - �-� SPECIAL��-- --�� -- ��-� ---- -�--��-� �O. - • -- AooREss 3151_Airway-.Avenue, Su�te-N - . �000� CONDITIONS , '0 so as 10 hecome subject to t6e Workers Compensotion�taws. ,.. � . . .. �,. , : . �. �� � .. . 'V . ' ,- '-... _ --`-- -- -.. . .- �- - �- - ..r.„.� .���., ..'_'_. CITY..__C.�$t .. $ . _�. .:OC Dale... �.. ,,.•-APPI caM- . . _.. __..._.ZIP..___ __ __� . _ ..., . •' ICE�'TO ACPUCANT: If�oNer'making'ihis`Certifica(e of ARCHRECTOR � , TEI. I DISTRICT GROUP TYPE_.� .FIRE PROCESSEDBY �� I _ ENGINEFR NO. �. - - ' ' ' ' ".�"' 'ptlon, yoU�should become subject to'the•�Workers' --���-- ' �J CO�SL, � Z-�ON-�E , W Compensa�ion provisions of�he�La6or Code,�you must fenh• • ' /y " with�comply with:such provisions or ihis permil shall be ---...... a�oREu � . _._.___.. � .._�j _...__ .� . _ . . . , y deemed revoked:.,,:.•,..,,.•._, ,,_.� TE�� STATISTICAL CLASSIFI�ATION APi. CONDO. _ ��'�� �� " �' � fONTRACTOR � Np, � LICENSEDCONTRACTORSDEQARATION .,, •. .....-- '-. ....--.-- _-.__..._.. .. .,-_.__- -.-LIC: - __ _. . .. �nq�5N0. - � DwELLUNiTS� .. . ... .... _ I hereby offirm thot I om li[ensed under pravisions of Chopter 9 ADDRE55 � � NO. �� / (commencingwitli5ettion7000)ofDiviiion3ofihe8usinessand ,___,_ ._ i�� � SEWER1+v+P � - . � ;,'. •��;� _., . --___ . _._._ -- -------- .._..-----. . Professions Code,and my'I cense is in full force-and effect CiTY ctAss �� - -� --�- ���� ���� - � �-- �-- � . _,.. ,. . .� , �.. ., .� . :. � � 50.FT. NO.Of NO.OF _. CHECK � BK. 7G Liten'se Number 5(19Fi�(1 ' ' Lic.Closs R " SRE STORIES �FAMILIES ONE , VA`�O 9� . . , , . . ., VAlUAT10N : ,.... ._ H A Contr6ctor- B1'�3ffIa�PA-C��l�afe .-. ..� '. ..�. DESCR�PTiONOFv�o- PLAN--23'��--- - N�. � - - ---.. ... ". - - �Iamexemptunder5ec. . . . .. .. .. � �' .-..- --� lfl 1 �F ' -R 'd ..._ Aoo �..-_ _. '; •'• •�� o : loi 7Uv � . . , - . �; .,..�:.. .. .. . .... ._ . ALTER � �,� . , I °J2QU.� . . B.BP.C.farthisreason -'-_-_ � -'5---- �- ... ....._ _ .._ . REPAIR- . .._ .,_..'__.. . "' . .. .._.._'._' ......'__ �� USEOF , . � �� -Dete: �� EXISTiNG BLDG. N011e DEMOL Q ' � � � °�G Q 4� � �� . ...., � _.. ..__ � • _. _._.__ ...._ _ _ _... -Signature - . - ' ' APPLICANT TEL FINAL �/ """ O 9 L O�'�..�7 '. WNER•BUILDER DECLARATION PR�� N�' - ' .....DATE�-0- r � � -'-.'-" �'.�. ... __...�...___.__ - ---- -�1 hereby affirm that 1 am eKempt(rom the Conhactor's license - - - - - - �� - � �� � low for Ihe following-reason�(Sec1(on 7031.5,Business ond ADORESS � ' � FINAL-''� -'�� - ' •` . 'B _,_ .... ..___. _"__'-___. _ ' .._... __ . _.._. .. . :-�.:.. _ . �:. --Professions Code�: - - - � pRE ENi . y - - � .... BURDWG � - I, as owner of the property, or my employees wiih qooRE55 ^ � wages as their sole compensation,will do rhe work and �- � . ' `.�� � � �.- - �Q 5'p y��j{ -- �he strucfure is not intended or offered for sole(Section �OCAtITY '- � . . . 7044;Buslness and Professians Code).- ---� �-- '- MOViNG..'. _ .._.._..-_. -_ ____--_-TEtr.._...... -...- ,.-.------ --.-- � _ .. _. ., �+• � ♦ • • � - � � I,as owner of the property,am extlusively conlrocting CONTRACTOR NO. � - . : � � with�licensed contractors tv tanstru[t the proje[I�(Se[-"""�- ADDRE55 � ' __'�' � - ..._._ .... ' .... . ........_ ' ��-� . , ,-���°J Q�i.�(� . tion 7044,Business ond Rofessions Code). . . - � - . .REOUIRED TOTAL SETBACK FR XI .. ' '� " ' , • e rj(!O. _ � __.___. """_' _.__ _. .. _' _. ..._.__.__ �.__' _ ____-_ .-_._ ._.__._.�.. _.._ . . . . .._ . Q . � �CONSTRUCTION IEN�ING AGENCY - � SET BnCK VARD- HW7 PROP.LME WiDTH � i � -p I hereby ai(irm thol the�e is o mns�roction lending agenry for ,RONr � � .o_f.2 0_-�fi��b.: , �he performance-of the work for which ihis permit is iswed --P.b—���� - � - - � - _� - . (Sec.3097.Civ.C.)• SIDE . ..... _'.. ".•'.•'.'___ __ _ ' __". P.L..__ _ ._______ ______ ___-___... ._ . ...... ._ . . . _. ._.._'___ ._ .� �� . . � _. ._ .._ _ . . _ ._ � ._.__.-____'..._ ..._ . . � � . . . tender's Name Toron£o Dom�ni on Benk ,; • '1 IDMA Ref.M .. �� . . .. -- � 144 Sansome St., Suite 700 - � P.c:F�es--e3:Z0�T�--- PermieFee �38..fD-- Lende�'s Address � � � � � . I certif that I haveaead t�aa�lisoTiodan stote.hat the - /� A �S Yt� ` � �� � Y PP -..--' M+1�-'.- � '--. Isavance Fee -���v-�--" IDhM P/C A . '-.._.__ '-_ .. . -- - _ . above information is mrrect.I agree 10 mmply with all Couny imesrgm�on fee �!q . �� . ordinontes and Smte laws relarin to building constructlon. _... .. . .__.._.._........_.... .._ ___ rmal Fea�T�/��-m-v---' � - � � � and hereby autho�ize re resenta' es of ounty fo enter -LDMA Perm.N-- ��-- -r- ------- - -- �-�'-�--- �� -� � upon ih 6ov -m �to ed pro rt fo ection pvr oses --� �� � _ . _ . .. .-- - ... . _ . . .-�/.���}'- . � _ . . -' - - -._._. ._...... .._..._. y ,+ . . . __._ .. ��� . �� . . � -� . SEF REVERSE FOR EXPUNATORY IANGUA � __.'- i . . . __� - i reof icn or gent _'.._ ._._.._ Dme_. ..._._ ..-'_"___... .._..__.__'._�.'_____ '__'._ _.".__...___.__. .:.___.. .. ......._..._.__'._..__' _ _ .' _ _'__..._..... ._ . 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