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HomeMy WebLinkAbout0880A 0881A rWOe tdi o . . . ., . _.__.:... _"-. ..... _. .__.... . _................ ..,._._...._..... ..__ .. ...-.. ___.__ .. ..." .--. ._.__..rjCi I hereb offirm thot . • . ".. . ._.-- __ .. . . . � . - '� _�' ` .. ", . .... _ " ' �� . . ._._ COMPENSATION DECLARATION _ insure,o a c c te of workers'Compensa�ion Insura'self -" COUNTY OF LOS ANGELES ' BUILDING AND SAFETY :; '• y I hove a certifitote oF�o�,e��,,o � APPLICATI�ON��F�_R�.BU,ILDING PER_M__ I_T _ _ _ ���� ' nce, -- -- ----�-- 'or o tertified copy.theieof(Sec.3900,lob.C.J"� � - - � � - 1WETX7933 H . _ ._ .. _ . -- PolicyN� com��Y artford Group __._.. , --- ��•Certiiied copy is hereby furnished.• � FOR APPLICANT TO fILL IN BUILDING p ' nooRess �/0 �' �Certlited copy is filed with�he coum buil ing ini eo- -�� BUnDiNG 1 , �� ;� , lion de rt t. " ' ' " �� ' '�' P.DDRE55 ,. � . � . �. - .. .. '_... .._ ._. . _'_'. ' _. � i oerB�PPlimnt CIN �g��'� D18 011d Z1P �ocnun I , � � '�`' CERTIFICATE OF EXEMPTION FROM WORKERS"�� �� --���� "- ' --'-- -'- ---'�--� .OF BLOGS. -�-- -�- NEnaEST_,-.._�.._�--.-._-,-_..... ` ��'�'�-'� �� - �-COMPENSATION INSURANCE -� SrzE OF LOT NOw ON LOi CRO55 ST.., ' ' � �� . ..;•.. : � � �.,.. , (This section'need not be mmpleted if the pe�mit is for one ....'--.. .-._.... �}Z56S...- --- --- - .-__. . _ _... 38 / n55E5SOR...� '-----.-... . . ..., ;-,";- -hUndred dollars($100)ar less.),.. i . TRACf BLOCK LOT NO. `� Mqp gOOK'"'" PAGE 7ARCEl . . � ; -� TEt. � -I�cerfify 1ha .. , . . .,.. .,,. . .... . . .. "'_' ' OWh'ER'_"' _ .. . .. .. __NO. � U� ONE �P �� : . �'- �� t iri the performonce of iha wo�k'for w�ich'this �� � -!- -permit is issued,I shall not employ any person�in any manner ` �f��� .� SPECinI -- - ---��/ -� �- - -� � �� � --.a I- . ...... ADDRESS.. -. • _ :,. • _. ....._• �vW✓ CONOITIONS : . . . � �O � �he Workeii Compensation laws. - ; so as to ecome s� 'ect to , V � . , . -. ... ..�. � . . . . .. . .. .; .. -„ ._.._. CITY . _ ... ... .......ZIP _ .....—_ .._.._. _ _._....__ .. __ _ __. _. .._.. .;OC Date ��� � ��Applicont ARCNITECTOR ' • TE�� � ._DISTRIQ. GROUP,TYPE. _ ._ ' FIRE_.. _.aEOCESSEDBY �� ' ICE TO APPUCANT: If after moking this'Certificafe of Aram Basseman NoJ52-1864 �, roN E � : I r �ption,-you should bemme 3ub�ect to'�ihe"Workers' --- ENG�NEER ��/Y� j�J�/'�J -'�ompensa�ion provisions of Iha Labo�Coda;you must forlh- ADDRES5399O WFEStEC� P�. �U1 t2 �7� � --�-^�---- �V- -��y�• --�- J+(� � W viith�tomply with such�prov'slons or,this permit shall be �-- �,� ' T , deamed revoked;_t, � E� ' STATISTICAL CtASSIflCATION � APT. CONDO. � ,� =� +.': ',.� � coNraaaoR Bramal ea Cal i f No.850-1001 ' �/- _ _. — LICENSED CONTRAQORS DECLARATION� � �'" ��-� - � �- �- --- �- �� --- -�- �------ LtC- --�--- - C1P.55 NO.�DWEIL UNITS_L .. . � I hereby affirm that I am licensed under provisions of Chap�er 9 ADDRe55 n10. , (commencing with Section 7000)of Divisio0 3 of ihB Business ond _____ • _ ��� . SPNFR MAP ; ..�'. "� - Professions Code;and my litense ii in full force and effect �ITy COStd-MQSd-�� C{1� �- �GLASS�� B � -'----' ��'--�'-` � - -- ���- --"'---� -VAIIDATION�� -- - . . . ,, ,.- ,,�.�, .. �. . ., ' ., 5�.FT. NO.OF . NO OF CHECK ' � �.U G U Fl Ucense Number'4096�O �ic C�o59 8 S�ZE STORIES FAMILIE$ ONE . . BK. � C _VA W ATION..__ Bramalea•Calif . � oesea�rr�oNo�woRK -PLAN -24-.--__- - "�'+- X� / � - - ; �%' ' -"21 Convattor Date '���..� .. � S I � .. . .., : .... . . . . ."'__._ ADD , � . ...___ e J f1" �y �I am eaempt under Sea ---.... --� - '� ---�� ,f 5'b,C • . .. . .. . ..... .::............. AITER � , i � I 8.8P.C.for this reason ____ NflW Constructi on REPAiR._Q -- s -� �-` � -', '-" ��-�• °�-�l 3'�7 2 c=''�� . _. afe:-- .. . use oF �eMa ❑ � ; ...D&.2 d-S b -- EXISTING BLDG. ... .�-; ..__ _ APPIPRIMI g NO. . i s�9�a,��e - " Geor e Vedell 850-1001 ! FiNA� , � . OWNER-BUILDER DECLARATION .. __ _ -�DATE�----�-�-�--�-�-�- .-_'- .._... ... . _.._. .-'_'�-.-"._._.____..._. ��I hereby affirm tha�I am e*empt from the Contractor's C ense . „, � . Low for 1he following�reaion�(Section 7031.5,Business and AD�aE55 3151 Airwa Ave. N� Costa Mesa FINAL''"� ` � � � � � ... � ..--=--�-'---. .. .._.. _ . _..�._ . . . ._ _ �� ' ._.._�_..... _ ... '_. - - -. ._ .... . , -�Pro(essionsCode)r..�.._._._._.._._..._---. ----� pRE EN � y . . . - BUIIDING ' i , �. . � ' I, as owner of the properly, or my employees with ADDeESS ' ___ . .._._ .. .. . . . _.(}���1�.A ,„V wages os thcir sole tompensa�ion,will do the work ond � '� �he srrocrore is not Imended or offered for sale(Setrion ����TM ' ' � '+• e � � -- 704d,Bosiness and Professions Code).---�� ���----- �--�� MOVinIG- � ---�----- - � ---- � � TEC.- - - '� -� '' � � � - __ . . _ _.._—" --- ' '--- --'''.- - CONTRACTOR NO. �_ I,as owner of Ihe property,am exdusively con�racting ' ' ..___.__ ._I�.5 . ... -with-licensed-connacrors ro construct Ihe project-(Ser._.. .' -.--'--.. .. _... _.._... . .......... . ..--_____� .--__., .'_- -_.-'--- __.-_ '- -- . I. ' ADDRE55 eBaQ . lion 7044,Business and Professions Code). ; : � r t� - x''- ' . . REDUIRED... .lOiAlSEiBACK FROM.. � : °�&a G O.c�_� YARD ..NV.�•.. . XI . .____ -._ ._ ..__.____ _'___..'.i__.�. . . -"-�-�"--�-��--CONSTRUCTION LENDING�AGENCY "�-�-��� - SeT BACK PROP.lwE WiDTH � ' 1 hereby affirm thot there is a consfruttion lending agency(or FRONi ����b������ �' ";Me per/ormonte o�Ihe work forwhich�this permit is�issued--- -�P.l.-.-- -�---- ----- --'-'--'.. _.__ .._. _--...-'.,f --.'-. "--... . ..-'.--- :--_._. ._ ._.. .:_- ';..' Sec.3097,Civ.C.. SioE � ! .... ._.__. . ....__ ._ ._ . . _.. ._ _._ _._ .P.L . _.. _. _ ____ . .._____.__ '___ __. .. _ _. _ _ .. _ Toronto Dominion Bank-"- - - ` ' Lender's Nome a. (/ / �7 lDM4 ReL N _ _ .. .144 Sansome St.y SU�be-� 700- - p,�,FeeS �T3•bTi�- PermitFee�-S/��.fa---- ' - - - Lender's Address • � �7�- f-� � J.certify Ihat I have rea t is application and stote Ihat.lhe ___.__ "_ ' . _ I�'.6'� .... Issuan<e Fee-.../��.v�v_. - IDMA P/C M -.._..- _- ,--- - ' �. . .. ... . above iniormation is corrett.I agree fo tomply wilh all Coonty Invevigm�on Fee � � ordinances nnd Sra�e lows relating to building consvucuon. ._..._. . . . ...___....__ ioia�F��--...�cSrU77._...! .�pr,qq Perm.M-.._ .- �....�., ..�-.- - � ----•�---- ..___ .. .. _.. '�1 and hereby ou�horiz represeNatives of this Couny to enrer upon the bove•men ioned op ty or inspection p�r oses . . . . ... . . - � - --. ... _.. ._.._.. .. . "---'- ' - -- -'- ' "� � SEE RFVERSE fOR EXPLANATORY LANGIJAGE, � - � .,_ �g meo4 pimnto ge . .. . . �� . ..'__'. .. .._.. ." '.. .__ . _ _. ..__.... _.. . .. __._' .. , �O , � I � � . . _ _ ._.. _.__. ._ '__._ _'._ "'_' _"'""....""_ � ri _ ' o ° , . . .'. T..����'Q- `_ ,l •�_ ��, �,�� "�' �-a � ° 'W � I ,o r. n.o m.a o a o 7 ,c� + . 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