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HomeMy WebLinkAbout0826A 0827A � WORKERS'COMPENSATION DECLARATION ..- .... �.._..- �......._ .. . ._. _.M.��.� �._�.. �._ � ... ..' ' - ---- � T .-_..� --� I � I hereby affum �hat I hove a cerhfica�e of tonsenr,to.self .- - .._� . ...�.' w . '�.. . � �. '.'�'.�' ' ...��,j,., 7 . ,�=��e,oracertificateoiWorkers'Compensationlnsuidnce APPLICATION��FOR�BUILDING PERMIT�----�; ��, � or a certified copy thereof�Sec:3800;�Lob.C.)� '� -'- - � � � � � - �- - �- - - � . .. . - �--_.- _.-. ' beu�,,No. 61WETX79$3m��YHertford Groun COUNTY OF LOS ANGEtES BUILDING AND SAFETY - ---_._._. ._. _ . . -__ _.__._. Cenified co id hereb furnished.?,,-, � �����, BUILDING ❑ ` PY� y FOR APPLICANT TO FILL IN ADDRESS p � ` (2a�„r � �' Certified topy is filed wir6 the counrybvildmg inspec- -�� BUa�ir7G �% , � -��o�deportmenL � � � • AD�RESS 1032 South Lon V12W , j - : Da�e [^ZS-. naPr�a�, arv Diamond Bar z�v- - -- - - �ocnuTv ; �. "-�CERTIFICATEOF"EXEMPTIONFROMWORKERS•, •' .. -.... ._.. .-�--� �--- —' � NO:OPeLDGs.. . ._......_..._. �. NEqpESt--_. '-- --- - - --__---_----._._. _ _i � - ���-���COMPENSATION INSURANCE`� - . SiZE OF lOT nIOW ON LOT 1�: CRO55 ST... . , .,,.. . , ._. � ; -�_ _ • I This�d"eition'�need not be com leted�lf the ermit is for one �---��--- -- -� --�-����-� ��— � � ---� �- �,, : f ( P p TRAR �425 BLO�K l0T NO. ]1 f ,' Mqp BOpK'�` ' PA E� PARCEL � hundred dollars(E100J oc less.):.� .,. ��t ��"� �� - oWNeR-Bramalea Limited -Ho$50-1001 � zo n+nP . I certify tho�in the performonca of Ihe work for whic6 this ���E NO. ��j' �� ,3 '� !} � permit is issued;I shall not employ�any penon�in any manner • • ��-- . SaECiql� -. - . .. -. - -....-. ,- so'as to become subject to tee workeri Compensarion�aws. -- Aooaess--3165-A1 PWd -AV2. Su i te-N-- --�- 0.'oao coraoinoNs , a � , arY. Costa_Mesa VA.-- Z�P_92626 ' ---. --- -' - .i-. ` 'v __. .. Date... � ., � ,..APPl�tant�`. �, - . . . -.— . . +-- - '-- - .... _ ;� I T�10E TO APPLICANT:�If;ofler makmg ihii�Cerhfimte of ARCHREROR � TEL. DISTRIQ. .GROUP. TYPE FIRE PROCESSEDBY ENGINEER Aram Bassenian No.752-186 ;� � fnption,�yov should betome subjed to the Warkers' � h ' CO �DNE ' Compensolion provisians of Ihe La6or Codn,you musf forth- y `�� W wilh tom I �with such- rovislonz or�Yhis ADDRE55 3990 Westerl Palce SUlte 17� � -����---�� y`�3 -. � - __. PY P .Permil shall be�.-_.._.. � --- - -- .._- o- � deemed revoked.,. . . . . . TE�� STATISTICAL QASSIFICATION APT. CONDp.�� � � � :• - �"� � �",� COMRAC70R Bramal ea Cal i f. No850-1001 ` � _ _____� . _....__' ' ...._. .._... _Z UCENSEDCONTRAQORSDECLARATION �.,� .._..... ._. __._- -_- .' .._.---_.-- _. . ._.L�C.. -'. ._._ �ciq55N0.�� ��""-Dv,�IL.UNiTS � . I hereby oifirm that I om licensed onder provisions of Chapter 9 ADDRE55 3151 A�rwa AVe. N r,o. 409610 (mmmencing with Settion 7000)of Division 3 of iha Business and SEWER MAP � �� � . � �� ... . _ ._ _ __'_.._ UC.._ '.__ .�:.. Professions Coda,and my license is in full force and efFetl. GTY Costa Mesa CA. CW55 B .� �-- - �-- -- . - -� ��---`yALIDATION���-_ -� .. . .-. .. � . ,:..� BK. PG. i _ '_ . .•: 50.FT: NO.OF � NO.OF CHECK '� � . . : �� licdnsaNumber 409610 "-• � �,���ioss B ��'�� ��-� SiZE � STORIES � '. FAMILIES � ONE ��� . � � ; . . - - . ' � (�J�1� qCy. y .VALUATION_, ._i � �O F3 G 6_}�_ � ConlratlorBramalea...Calif.� ..�.,. ...,...• ........ DESCRIPT40R1bFWOkK[ A- �.---.....__...—... N�- � p/ C/�' ..�.. . . . . . � Date " ADD � S C��o�CJ'�i� : Y� . .� ❑I am exempt under See. . . . .. ..------.. .. ' . ' .. ' -----.... _._._. - ._. . --_� - _ t-. .- . ."� � ALTER � I , ,I'��� . . I �?R2��''�'' 8.8P.C.forthisreason W Construction REPAIR a s. .... ..__. i__"" ; _'_�I.._. ._o'�'C.�""'__' _. __ � ... . .._._..._.._.._.. . _. Date•. .... -� USEOF DEMOL Q �C::�. N �'�_v ��(} Q EXiSTiNG BLDG. n ne � ___.. � ' Sinnalurn �I�LoLfi7 L(�{T(vG4J ' ' --� APPLICANT iE�. � FINAI ; O�� 9 8 6 NER-BUIIDERDECLARATION PR�P�T Bruce L. Ab6e No.85O-ZOOI .DATE.- a ` -- - . _G_ _ _. . _-- _ �___�� _ __._ . �-IherebyaffirmthmlamexemptfromtheContmctor'aLicense ADORE55 3151 Airwa AVB. N Costa Mesa �. - � Low for ihe fallawing reason(Sedion 7031.5,Business and flNAC���'� - �� •'- . � � � ,. .... 'ProfessionsCode): . ...... ._ ....-.._.- --....... . _..,- Prt eNr -By ��- � -- -.. . ! - - -� ,-- -- "-� BWLDMG � ` ' - � ' I,as owner of fhe property or my employees wilh ADDRESS � � _.� ,\� I �Q F',�,��]f{ ,�! _� wagesaslheirsolecompensaiion,wilidothewo�k�ond � � � �� �-- �- � � � -� - � �� � ,.. 1he sirocture is nof intended or offered for sale(Setlion ��`�m ' � ��' , ��• • �a�r���� •� _ ' "--' ..._. .._. 7044.Bosinessand Pro(essions Code).---------- MOVING-'. - .. .-.-_ . .-..... '- TEt:._._ . , -.. . -. .-. ' . . _ . .._- . � 1,az owner of the ro ert am exclusivel coMraclin CONTRACTOR NO. � -'" -� ! >��� � P P Y, Y 9 ...7`a. �� 'I�• �'Y�„�O - -wi�h Ilcensed contractors to tonstrucl the pro�ecl(Sec-- __. .-. .'..... . -. ._- ...-.. .-- -...---. --..- .--.. -....- . . ..- --..- . . .. --�- -"- e, ADDRESS tion 7044,Business and Professions Code). : � . A( ^�S� . , • �, ,� � - � -. REOUIRED. _iOiALSEiBACKF , XI . .._. .._"' '-'_ _�" �_ '- ' ,-- . --- . - CONSTRUCTION LENDING�AGENCY -�"-" '-' �" SET BACK YARD' �HWY- pgOP.LINE WIDTH I hereby ai(irm that ihere is a mnstruction lending agency(or FROM � - ����9��� . . -�he pe�formance oi the�work for which-ihis permil is�issued ----- a.L-- -.-. ...-. -.... -. ..__.__. _....---- . --.� _.. _. __.___. . � ,,__ � �_ . -_-- ... _ �Sec 3097,Civ.C.1• SioE � . .� �.. . ,;'1 .. .. _.____ .- � .. ' Toronto Dominion-Bank- "� "` ' lender's Name -.--- P.L........ . . _. . ..... , . ansome . 2�.�.0 _'il7 _�'- LDMARef.M • Lender'sAddress S3n-Fransisrn;--�f.A--94104 '" �` P�e.c���s-- 3-- armnF�e-- 7 , . .. . -.. _J certify_1ho1 I hove reod this opplimlion and.state thaf.lhe ._ ., �� A. .. ��'i .Z.-..-_ IseuanceFee-�-�Q•U��v---+- LDMH P/C M--- ---�--�� ','� . . . � __. _ . above informalion is correcf.I agree to comply with all Counry Imes�igmion fee � ���� _,ordinances and Siara,laws relating to building construction, •- Tmal Fee�----- ��•S�Z� (DMA Perm.N---.-�-- � ' � � ��� � _.'--� ---.__.._. .__..--...___. . . ..._ . _—�----- .. :. ond hereby authorize represeMalives of this County fo enler �� , --��- '-- , opon rha obove-meMianed prop fy for Inspection purposes. �e � �, , � � - .-._-_- ___.. .. . - ----- - -- -'--'--- ---- .�,�A �7 r-/ ---.. . . _... _ � /� � SEE REVERSE FOR E7(PLANATONY LANGUA� �� � -f � I � _ � � � � ... t .._ ____ 1 \ :i� _1 ignatureofApplimnrorAgent-... —.__'Date- __ '__' _'. _' _ . ._ .. . ___'_ "'__' ' ......._ ...__' . .__ . ._�. � .: -._ _._ '. .. 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