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HomeMy WebLinkAbout0832A 0833A VJORKERS'COMPENSATIONOE�. _'- ':-'._.__........ ...._..._.__"-__.....-"--_ .. .. __...._. _ _ . .._. .. _ ._.._..--'•..._.,_, L{ . ... ,.. „ ..--"---- - - -. .... CIARATION , ..,..., . . :�:'.'' . ..., ; _ ��.. ., �.' '' ,�••• , :, - ,.. .. , _ .� �-'� ,_ ..�-_"-'-'._ .- -' ' ' . . . . . � I here6y a(6rm ihat I have a�e,��«<o,e of�o�5e�,:,o se�f . � APPLICATI�ON� FOR-BUILDING-PERMIT- -�--���� . inmre,or a certificaie of Workers'Compensation Indurance, � oracerfifiedcopyihereof(Sec:3800,Lab.C.) . ..'. .-..... ..' "'---.- ." ... .. ... .. .. . . .. . .. . . .: ._.. _ ----'_ - .. . . .._- .. ' ��� • COl1NTY OF LOS ANGELES BUILDINGAND SAFETY _ . , vair�Yn,o..61WETX79�3m��y' ;. . ---- - - _.. - . __ ... O � Certified copy id hereby furnished. �.r ++. • FOR APPLICANT TO FILL IN BUILDING � �` , ❑ .. ' ' ' ADDRESS O . . . Certi(ied�copy is filed�wilh the county buildirig'�inspec- � BU4DING 'fion dephrtmenf. "� ' ��� ��� ADDRE55 " � � .., , . ,....� � . �-. , ( ' '. � � .. p� _�. ........ . - _.__ . _ .... . ... _ � Date� ' � �a�7 AppLmm� an D1dRl LP - . . . � tOCAtIN . . �. . '� CERTIFICATE OF EXEMPTION�ROM WORKERY ���`' �- -'� -' "'� � ' ' ��- �--��OF BioGS: --� ���- - ra64aE5T 1 � SIZE OF LO7 i NOW ON LOT CRO55 ST. . . ....._..,........_._.-...._ .., .._..._'.._... _ . ....-_. ' ' � "' �COMPENSATION INSURANCE��-��' � . �. ,,-,. . ... . . (Tfiis keclion need nat be�compleied if the permit ts for'one -..._�... ._. .--4Z5(�_.�,'.. .-_ ..._ __ .._..74—��; nssessou •-.. ... '. -._., �.,:; . ; — hundred dollars(SI00)or less.). .• , ,. .. TRACT BIOCK lOT NO. MAP BOOK�'��� =�' PAGE• PARCEL i � �- � • � --- owruea Bramal ea Limi ted- -� No850-1001 -' �" r^" , USE.j E I cerlify�hal in ihe per(ormante of the work for which.thrs d! �' NO. ���""� �'� " i} � parmit is issoed,1 sholl noi employ any person in any manner . . � j�� �-- SPECIA� �--�� �-�- --�-- -- �� � �� - -�G. � ��'- ADDRE55�-� ��� ----��---"' ,� Q CONDITIONS , � .,. ... V so os ro become subject Io Ihe Worken Campensauon taws. ��'� - - � . ..� .,t� • .� . . _`-. ' -----. _ .. . . ... � , ..: _._._ aTr_C - d C • ____ziP_92626- -- m �ma- ' - � � '� Appl Cant�'� ARCHITECT OR � - TEL. :� I OTICE TO�APPLICANT If offer m6kmg�Ihis Certfica�e o( DISTRICT. GROUP TYPE_.. _ ' FlRE , PROCESSEDBY_ C __ _, FNGWEER � NO. - . - CONS '� ,smption, you shoold become'�sub�ed fo the-Workers' j , : �ompensation provisions of the labor COde,-you must forfh- ADCRE55 � W p� AVQ. �U1 t0 1�� '� -�/�--- ��`3- � � d with�comply wuh such provisions on�his permil shall be � �-- ���� - � � �� � � deemed revoked.,...,,,,' ',,. ..� ,,.. H.. � � � TE�� STATISTICAL C(ASSIFICATION ' APi. CON00. '� '� Z- �, coNrRncroeBramalea Cd17f. No.850-1001 ' . _ --- . . — LICENSFD CONTRACTORS DECIARATION . •��� -- � �--�� � -- ,� � - - ��--�- --- �- -L�C:�-�-- --��- ��� QASS N0-�� DWELL UNITS � . � I hereby affirm fhat I om licensed under provisians of Chapter9 ADDRE55 NO (�ommencing with Setlion 7000)of Di ision 3 of the Business and ._..._ _._ _.. • ._.__���, . _ . � - '- �� � �' ; _ _.. _ ._. . . � MAP Professions Code,and my I cense is m full(orte and effect CITY Costa Mesa C.A. QA55 B � -�-"BK.-----�:--'--�--�- --- -� � ��-VALIDATION �-""- . . ��- S�.FT._ NO:OF ,.NO.OF_ __ _ CHECK ; - ' -^' GtenseNomber 4n9�ilO Lic Clasi B ` SIZE STORIES FAMIUES � ONE :O S 2 A ' I . ... . � �. ' '_VAtUATION_ � co�f;a�;a. Bramal ea Cd�1 f Daie • ,. . " _.. oescrtivrioN�v�oaK-- -23CR � �-�-- n,ew . - .. _ _.. ._#:. . . �1' � . _ �o� 7� - AOD ! �1 am exempt under Sec. - ---- --- � - � - � - .. . --.'----❑ � ] •.�2 Q ll�„ ,� . :'. � ,.�:,. ..,,, .. .. , AL7ER . , . : ' - - - New Construction � � s__ �B.BP.0(or this reason � ' ' � REPAIR._. .- ..__..___. ____. , ____. .. .. ._. __. ... .._._... .. .,, USEOF � . . - .._ . •-riiilti��-c;' ; ..... _.._.-DOtei_ .. EX�sTwc e�oc. none �Mo� ; ; - :..._._ �.�_�..9_�.6.. . - Signulure - -- ._.... APP(ICANT TEL. F1NAL � . O NER-BUILDER DECLARATION PR�NT B1'11C2 L. Abb _ NOSSO-IOO1 ' __OATE �--.C� �� ' � . _ _......._..-�---`-_.�_---'_- -I hereby oi(irm ihm I am evemp�from the Conrmctor's License AooRess 3151 Ai rwa AVE. N Costa Mesa ' ' ' - ' law for the following�reason(Sectibn 7031.5,Business and PINAL'=� ��� '�' � "� • � , g ...,,..: ::� � - - - ..', -'----- -...__.____� .'. .._. -_.^._ -�--- � `Pro essions CodeJ: .... __.__.__ ....---.. -- rke eN , -- y .__ --. .' � BUILDING : ' � I, os owner of�he prope�fy, or my employees with ADDRE55 ' - � -�� `�� -. . _ _ . ... _ . _ f- wa esostheirsoleceni ""--"'�- �-' - -- -�-'— " .� 9 pPnsotion,will do th?work c�d i ' � - i �+ � � tha structure is no�Intended or o(fered(or sale(Setlion ����tt . , `� �� e • �J o � +� � '� 7044.Business and Profeeslons Code)... . . '- - � MOVING� ---.._.._.. -'... ... 'TEL. . ......_ �. . ._ _ _ . . _ __.. I,os owner of 1he property,am evclusively conirocting . �ONTRAROR NO. : ��-` � - j+ - .❑. wi�h Iicensed controcrors ro construct the'project(Sec- -..._... .- '."_-'.. . _ . _. . ._.__._ . .._. . ._...._ .---. . _._'- <.'�• . '�._',`�5 4 Q�_ 9. `� Ilon 7044,Business and Professions Code). AD�RE55 . . . , , q ��(G,G.�U �"-"" '- CONSTRUCTIONLENDING"AGENCY--�--� ---�-� ���gq�K ' �YARD� -Hwr- -T�TAVROv lFnKiEFROM �WioiH� ' -- -" - -- . i . .... ---��----. ..__._....... _.:.. .. ..__._.. _..--- .. . _ _ ' I hereby affirm that thera is a conslruUion lending ogency for pgoN� _ , � ��,�-9�.-�b-..;'' --the perfarmance of fhe work for�which Ihis permil�is�ssued ---- ��P.l.-.. .._ ___._ _...- _._.....__ ....__.. _ _ '______.: _.._._.__.__'..._. ._'... ,...�. :. :=..._..�l_"..__' . __ _ (Sec.3097.Civ.C.). SiDE . . . ' ...... .. ." ..__.. .._ ...._ . ' _._'__ P.L .. . , . . . ,,..�;.. �: ____. .... _ __ _____'. __ � lender'sNome Toronto Oominion�Bank�-��--� ���-�-�-��-�- ---�� - �����'���-�--�- ��' ., ,-• ,.-: . ,;:: 144.Sansome_St. Suite 700 :-ft �n^"'R°f." ' - ; �Lender'S Addres ' � �-- P.C.Fea S---3����-�� Pvmi1 Fee - - .V v` - -i dan Fransisco, CA 94 04 /��. - ��f , , � .I certify thaf I hove.read ihis applitafion.and stafe that.the . ._... u'fl�.-..%�:��. ._- IssuonceFee-----Iv•U�"�-�� �LDMA7/C N�---� �' -- �� ��` � . _.. _..._. . ____ . _.. obova informolion is torrect.I agree to comply with all County invmngo+�on Fea �} . �� �'"' �� _ordinances and Sfafe laws reloting to building mnstruction. ...__' Torol Fee--- '"�"--'-' -IDMq Permr N-�'-- -... .. ... •, . .___"__._____.___'_._ . __. _ _ ......', '. . . .. and heraby authoNze representatives of ihis Coumy to enter . . ��,�� � upon the above-mentloned propeny tor inspection purposes. � - �- - --� � ._.... ' -- -'- - '--"- - 3��� - -- - q�� -- �--.. _.._._._. . /�,���.� ��e� Q�((7��J,�f[�/�__Mz�� SEE REVERSE FOR EXPLANATO�LANGUAGE � •� � . �� ����.� - � -�igmNreofAppli�orA9em -r/' �. . . 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