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HomeMy WebLinkAbout0818A 0819A 7 , . , _. : ... . . __. .. ..._ ... "-._"'-.r�__.___.'- ' WORKERS'COMPENSATION DECLARATION . . :':.� . :.. .� .. '-.".._..-- --"- ....�: .- �.-.._W_ .___, � ._-.,_ -'� . .._ . . CZ. � .I hereby�oifnm Ihol,l hava a certrfica�e�of.consent ro se�f "APPLICATION�-FOR�.-BUILDING PERMIT--���� . msure;or a cert�ficote of Workers'Compensation Insurante, ' Or d certified copy lhereaf(Sec,3800;Lob.'C.) �"�'� � - �-- -' - - - . � � . .____..__..__� ..-t PolcyNo:�61WETX79$�pa�yHdPtf01'd GT'OUp COUNTY OF LOS ANGELES ; BUIIDING AND SAFETY . , ,; __ _ _ _ _ - - � Certified mpy is hereby fornished ��.� , � ���. . FOR APPLICANT TO FILL IN BUIIDING ADDRESS ID c � �Cerlified topy is Filed with.tha county bullding inspec -- gUILDING .!' - -��i0n depaffineM. -- ADDRESS � .�' � Dale�Appli�on� . CitY Diamond Bar z�P ��,T,. � . ..�CERTIFICATEOFEXEMPTIONFROMWORKERS.- .', ..`. .. --�------..-. _.._-..NO:OFBLDGS:.. -- -- • n�EqRESi.__._�. .. ..._... , -•-';___.. �....--- -�-�-�--" , '� � ' COMPENSATION INSURANCE"- � . SIZE OF LOT NOW ON l0T � � CROSS ST._ (This�section-need noi be completed if Ihe peimil is for one - �` TRACT ���- ' �--- � - ` -�- ASSESSOR,,. , ---�- --�� �••-� - ; ; , hundred dolbrs(E100)or less.).... ; ,, . - 4Z5 ��BIOCK LOT N0- iZ'� Mqp BOOK �• �' '� . PAGE PARCEL 'Y, P • � � • �- owr�R Bramal ea-Limi d--�--- No850=1001- �g��E �P /�_ �� - � 1 certif �hat in the erformance of the work for which this � �[ 3 •'j permit in issued,I shall nol employ any perion in anymonner . • ' • �- �` -�-�--� SaeCiat� ---- -- �� � -�------ . '} I nooRess-3151-A�rwd -Ave.-Sui te-N --— �ao� '°- so as ro becama subjetf'to Ihe WoFkers'Compensauon laws. O CONDITION$ - ',0 - .. ,--.. .,. ., . , ,. , . � . � _ arr .Costd Mesd .CA.____zir_92626..___ , I V Dote �' . . ..�Appbcant�' - �... ..,�.,.. --_ _ ____. ""...._. '. ..._ . . .. ... _ .___. _ _ . . :� I ^ICE TO APPIICANT:��If,�oRer'makmg fhis'Certificote OI ARCHITECi OR ' • TEL. � _DISiRICT. GROUP� TYPE . �.FlRE _PROCESSED BY. ENGINEER Aram Basseman NO.7rJz-1864 ' � - ' - - -O prion,-�you��should become sob�ed�rd'��he Workers ----- � : CON �7.]N E� - l.ompenso�ion provisions of Iha Lobor Code,you musf forih- � � • � Q 3 � . J// j�,.� '�`�•� 'W viilh com I wilh�such rovisipns or�this ' ADDRE55 3990 Westerl Place SUlt2 170 -� _ .._ .._- -. lr - .-- �-��-._- � o, py p permit'shall be � �- � 1 / N deemed revoked: , TE�• STATISTICAL QASSIFICATION APT. CONDp:��. ;_ .� -., . �•�•. • �." .�. COMRACTOR � NO. : ' .__.'___ ._�l_... . ' "''.__. ... ._ _ . . . UCENSEDCONTRACTORSDECIARATION .- ... _.... -. _._._... _ . ..._._....-'-'-' . --'_..--LIC.— -�------ � �; QASSNO.�SC��WEIL.UNITS ��_ I hereby offirm thet I am licensed under provisions o(Chople�9 ADDRESS 3151 Ai rwa Ave. N No.409610 � (commenting wi�h$ettion 7000)of Division 3 0(Ihe Business and _ �. SEWER MAV .. _. _ . ....._.. .. ._ ._._ll , __ ..__'_ . Grofessions Code,and my Gtense is n full farce'and effect. pTY Costa�Mesa, CA. ��p55 B '- --------�� -- ---:-� --', � ....' .__ . . . �.. ..� . �;. .. ...� ,. eK. vG. i : � ATION� vauo ... - . � _. .. SQ.Ff. NO.OF � NO.Of _.___ CHECK_; .. ., License Nu�nber 409610' �ic,Clas�' SIZE STORIES FAMiUES ONE � � ,...., , , �� , .. . . . , ,� gp-.. / _.VAIUAT19N__... . . � • ., ,-�. DESCRIPT N OF WOkK._ ' /� .. New--�] -"•Of 18A�• Cont�actorBrama 1 es'Ca 1 i f. Date '''� " ��� � � 22g• � - � � �� �p I ❑ s ��v� _ ❑I om eaempt under Sec. -- 111 1 e Fami 1 Res i dence---___ Aoo �� � , �2� -----❑ � . AUER ' . ,. . . . ...., .. . . � , n Y .. i. B.dP.C.for thisreason NeW Construction REVAIR.� -s- ---""'-' ' -' - -'-'-'--I ��8.G,O J. '.: .. . . ... ....... _. .._._. �� USE OF � -- �Dote:- - � � E%ISTING BLDG. 110I1e DEMOL Q � � ! e • ..__ ...._.. _ . �..-Sianefure � .. .. 9'�'v - �... APPIICANT TEI. ' FINAL � ... . -�_ •QO-' O NER-BUILOER DECLARATION vRiM) Bruce L. Abbe r,o.850-1001 �. : . 0&1 9-8 6 .., —_ ._.oare-._ �3-..'7.. ..'..... __ ___. . _ _--- - I ere y a irm that l om exempl from Ihe Confroctar's License � Law for the followin reason Sedlon 7031.5,Business and ADDRE55 151 Airwa {�YB. N Costa Mesa - � � � . . ; -��-»-•.�. s ( FiNa� ., ,.. . .. . 'Protessions Code): . .._. ... . ......__ ...'--- � pRE N B � .- .. . . Y .._ .. ._.._,. _ . .. ,_ .-- -�-- '-`, BUILDING ; 1, as owner of Ihe property, or my empioyeee with ADDRE55 .. ._._.. -`. �'� woges as�heir sole compensation,will do me work ond � � , - -- V � ' the strutlure is not inlended or offered for sale(Section ����TY � � a � . - - -- �70aa,BUslness and Professions CodB). ..._. . . .... . MOVING . . .. . ......." �-�- -'--� TEL:' . _........-.-� ' . ...._..� - #{• .• • • ir as owner of ihe propeity,am ext�uSive�y ContfaCfing CONTRAROR NO. '^��-1 ••�' • '.y , _�Q.--with licensed mntractors ro construct tha prolect(Sec- .... '---� .--...... .. --��-------- �-------� - ��---�; --------.. . . ._ .' . _ � - ,..�'� e[j�(��Q----� tion 7044,Business and Rofessions Code�. ADORE55 . - -- --- �-��- .REOUIRED IOIALSEiBACKFR I ' � � ' -', CONSTRUCTION LENDING AGENCY-..__. .. . --- SET BACK �YARD 'HWY' ' PROP.LINE -.. WIDTFI --"--'._.__ ....._.._' ..'_''' _ . -., _e o 4�jl�Q�-1 I Fiereby oifirm thal there is a conshuction lending agency for fRONi . ' �-the performance of the work for which this permit is issued-.-. ... .. P.l.-- — �-�-'- -...._.. .-�—--....--"------ --- --. _-�-.__-- ...._ .....'-'-_�____-...�. : . .0 8.�.Q_�$b_.__ �Sec.3097,Civ.C.). SiDE , �� .., _.. --- Toronto �ominion B�nk .. -. _r.� . _ . _. .---- - ---- ..__.. � , Lender'a Name .I . .. -"----. .. . �� 1� ' . � ' � -_ _. - • T7 _�__ I�MARef.p � . , _ . ,._ .�___. tender'sAddressSanFFansi�5coo- ^" Q4104 � ���� � P�e:F�ea--�.ZS �O � PermilFee� � � - . .... . _ ..:.. .-I certify that 1 have reod this appllmtion ond stole that the_._ _. Q.t .__,.��6^t) �J-�� � - �.. -. . �- - luvance Fee - -� -- .'. .lpMq P/C N.... .. ..__ ..- - obove information is cortect I agree to comply with all Counly Imesr� uon Fee . ordlnances and S�ote laws reloting,to_building mnstructian, _9� , j��'/ ' - . S?�__ ! � .., .. -� �. _'_'_. .. . . . _._ .__..... .._ Tolel Fee."/ T' I�MA Perm:N .. �_ _..._. ..'__ _. ""__ ' - . and hereby authorize represenlotives of Ihis County to enter �- - � � � �- . upon Ihe abave-menllonrd pro�er for inspetlion p�rposes. . y�� �f� � . .._ .. _.. .. ..... _ _ __"_. .._.. ... .... .. . ._ -_.___ oc '_. '._.._. _ .. .._._ . __ .. "_ .'._.. . . SEE REVERSE FOR EXPLANATORY LANGUAGE J �—Z��� . '�' � ' '. r .__. .. �gnatureofApp antorAgen�. _..._.. __Dara. _.._•; _ '_"_'__-__...._........ .. .... .._. .._"._ ..__..._. ._..... . ..__. ._ . .. .._ __. _......._ '.�___.- O : r i .i. •� . -� o 0 ..G1- •��.p �.� ```'`\ ,� . ,Gl" m 1^ � .�i+m to' o• 'd ? '(1 q, O �-i/` m'.a � � 9 'a ��? o, ° .,�. .�� p N f�'N �� 1Q O 9 :., :. � ' p' � 7 �• p.-• n O ,�•n . s� ,Q f, .D �' O �p� O' � � �.�. � ` , � . � ' � ' , T iPn � p ��9�', 7��, ^ ' . . N -- � '^ O G� Cf�' 9 N O n� 1�n , Z . O � � o rl a o o v , � • ..._. o � o m 3 0 �� '� .c�`, o ', • 9 . o ? � . \ o -� ? :.. � -� n Z �o o v� s. � . - m po ? �� -c 7 { Q � ., - . 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