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,.. . . . . ---_ . ___-- __.._.._...... _.__. . _ __..__..._.. .... .._ _ __ _ .. � _ _._� _. ._.__ __. � - WORKERS'COMPENSATION DECLARATION '�"�- ���'� �-" " � ���- -�� '�''�: � :. - .i. . , � .- . . - ..__..�--'-'-- - . . . insurebo�r�ofcer�ifcateofWorken''�om'Pe�ga,a�t,�;��e��e` . APPLICATION-���FOR�-:�BUILDING� PERMfT�-��-�-��� .. _. _ ._ - - _ . or a cer�i£ed copy�hereof(Set:3800;Lob.C.) ' �OUNTY OF LOS ANGElES BUILDING AND SAFETY � , a�YNo.61WETX799�am��;,.Hartford`Groua _ eu��o�Nc Cert'rf'ied copy is hereby fumished. �.� FOR APPLICANT TO'fILL IN aDDREss l�vn1 � .-,Cerlified�copy�s filed wiik rhe county 6uilding'inspeo- �"��� - BUiiDiNG �' ' lion departmeM.- � ADORE55 1056 South Lo : . ., ...�., .PP...,.; , , ,.� ���' . .. . .. . ___ .--... .. ._.._. . ' oo�e �7i7�"� n I�com on Diamo d Bar ziP iocaurr ' . . „ . . . ._ . . .__'_.. _. ..._.. .._:. . ...NO.OFBlOGS...... . .._ .. ... NEARESi.—._'.._ . ........._.. CERTIFICATE OF EXEMPTION FROM WORKER$'' '''� Si2E OF LOT i NDW ON lOT CROSS ST._ � � I � ���� �� COMPENSA710N INSURANCE '� � � (ihl's�seciion�need not be compleied if�he permit is fo�ane ------ �- - �-� � �- - �-- -- � �-- --'- 0.55ESSOR ,; .. - - � � � �l�undred dollars(5100)or less.) . . , � 7RnCT �/ BLOCK LOT NO. MAp gOOK' PAGE� PAR�� TEt . • owHeR-Bramalea Lim'ted - -NoB5 U ONE �P ., /� �� ....-. . .-"' _ i I�certify�tho��in the perforriionce'of�he work for which this ��� � �} - permil is issued,I sholl nm employ any person in any manner _ - SPECinI�.----- ; �-� -- �---� �� �� ��� -�d . �� �� ADDRE55- � � " -- � �-���- �� CONDIilONS so ds�fb 6ecome subject'to�the Wo.kers'Compensauon lhws. . ,.. ... . .�. ,.. . . .,.: ..._ .- -'-- -. __. _ . .' .-- '. . _._ . �1 . �a�e' :.` . . �, nap�Ea�i . •„ .. _. . cm Costa..Mesa _CA..__. ....z�r 92626._- - m ARCMITEC70R - TE�� DISTkICT__ GROUP TYPE � FIRE PROCFSSE�BY � �ICE TO APPLICANL�I(, oiter making tbis Certifimte of ' � ---� � - � ENGINEER Aram Bassenian No.752-1864 co�ss-. ZONE �~ 1 jnptlon'yoo should become subjecl lo'�the�Workers' ' �"- _ . � 3 ' l> '�� � �W tompensotion provisions of tha Lobor'Code,you mus�forih- qoDeE55 3990 Westerl Pl ace SU1 tE 1�� --/'�� �� ( d ._ _ � wilh.eomply�wiih'wth provisions or lhis permif shall be' ��..- ; . - ,�n de¢med�evoked: . �.�, --, . � � TE�• STATISTIUL QASSIFICATION : APT. CONDO. _ . . .� ...�. . . . CONTRACTOR � NO - UCENSED CONTRACTORS�ECLARATION��•,- ��. �- - � ���--- . � � ��- -- • --� C1A55 NO.- W �WELC UNITS� � IIC: I hereby affi�m that I am I�tensed under provisions of Chapter9 nooaess3151 A1 PWdy AVe. N No409610 (commenting with Section 7000)of.Division 3 of�ha Bosiness and _. . .��� . .. ��R�P ' � � '.� ._. . . ,__ . _..._...._. .__ ._._ ._. -. Professions Code,and my license is in foll force and eifed. CITY $ ttn55 B ---� �--� - '�--' -�- - ` �VALIDATION' � . _ . , ' � .. . . ` . • • � .. $Q.Ff NO.OF �f NO.OF CHECK , . . . . ltenSaNumber � �4O9G1O�'� L16CI655 R ���� � SIZE �ZG37 ��� STORIES G � FAMIUES 1 ONE �- �BK. PG . - .. . . . . � . _,VALWTION_ I � � �-„�• DESCRt TIONO woRK _.._.. 22AR'�- -- .- ... . NEW . � . �.�. '__;'._ . ..:O S 3.b ' COontrecror Bramalea Cd�lf. Da�a ' _. ADO � f ��� ��� ,� �+� • �.A � _. .. . I om exempt under Set: ----- � � n -���---� -' � � � • � ALTER • ^ ., New Constructi on � - � ----...._.. .:. _ . .I •.2.8 2 0 3 • . B.BP.C.for�ihis reoson � _. _ REVAiR. ,....: �� . . - .... ._.__... . . __ . ....Oate: _"'_ - EX ST�iNG BLDG. T10112 DEMOI � .. .__ �°t�,..�'[�.Q J c2.�.... -.....Signalure � � . ...- AFPIICANi - TEL. FINAL . OW R•BUILDER DECIARAiION 7RiNT BPUC2 L. A�7b NOSSO-ZOOL .pqTE,33�'�"7 ,. .�. ��� �`�6 � 1 hereby a(firm tho11 om exempt from the Con�mctor'sUcense .,,... / , ' � � Low for the taflowing reaeon'(Sedi6n 7031.5,8usiness and A�d��l Airway Ave. N Dosta M2S2 � flNAt�� �� � � �' � �- � �� . __... /� /�� .. �.... _ ..� ..�.! � Professions Code)•..'...._'."_.. '•' --"'.` - - PkESENT 8Y �- � (lXdc�r " . . ^ BVILDING . �, . . ,. � \ I, as owner of iha property, or my employees with ADORE55 . . ...... '- / �wages as�Feir sole cempensation,will do the work ond ; �� �� ' .� � - � +�0 8 a 7 A : the strocture is nat imended or oftered for sale(Settion ����TM �� � � � �'-' '7044:'BVS(nesi and PIOfESSionS COf�e�.-" .. . .. ..." MOVING .". . ..... .' "' - "--"TEL -... .... .._. , .."".. . . , .. -.."f�e e • a ..� . CONTFACTOR NO . .:�YM` �t".. � 1 . � 1,os owner of the property,am eKclosively wntrotling ,� " > wllh litensed controttors�to-construtt the pro(ec�(Sec- - ._.. ._... .. .. _..__. _...._ . _. . _... ._ . _.._..-.. , _ .�__._ . . . . ,,. � �.��t�_�_� . . �ion 7044,Business and Professions Code). ADDRE55 . _ ._._._. . .... . .RE�UIRED. YARO_ .H�,n. IOiALSEiBACK F M.. . XI T.� _. _ ___...'_'.'_..._..__'�.-��-��. : ' � �_..�'.....�.«�ri�'•t.`;:7����,'; CONSTRl1CTION IEN�ING AGENCY�-""�� �- Sei BACK PROP.LINE WiDTH�, I hereby ailirm ihat there is o tonstruction lending ogeney for FRONt � .� ' � - � � - � the periormante of Ihe work�for whith Ihis permil is issued �'� '- � V.L -.- '_ _._ . . ._.._ . .._. .. .____. ..__,..: __ _._"'._ . .. .. �-..�:�...�. - - L.� -rj-1�(� . (Sea 3097,Civ.C.). - SiDF �� � �, � . _. . .. . . _._. _.P.L . . : . . Toronto Dominion�Bank -- � -- � � Lender's Nome e y p � ' ..._.__..LJd SI'1'dC151$��. C�U`J�1���� 'C0.2. p . !� �7 IDAAARef.M . � ` �"� � - . . .. _._ P.C.FeeE... O..l ._. PermifFee . � 7� ._.: . ...._. ._ _. Lender's Add�ess n ���-,� � �' �i�- 7S'.v� f�..� _ _. � ' ; 1 cer�iiy thal l have�ead tfiis applimtion and slate.lhatJhe _..__ . -__ � � Issuonce Fee .. . - ....-�- -LDMA P/C N._ .. , .'.__ . :�.'� . - -. abova informotion Is conetl.i agree fo comply with oll Couny invesugonon Fee �_ ' � - " . ordinances and S�ate lows relating ro bvilding contfroction, _... �- -� � Toiol Fee--�-- ��5�-- � -IDMA Perm.M��- ��----�--- � '� � � _. . ... ._._.._..___. .....__.. and hereby authorize representa�ives of this Co�nty lo enler � upon t above-memio d pr p ny for inspection purposes. Y,r�n y� �� - _ � � � -. _' '. __.._ _ .. . . _' __.. .._. ._..._. ._. ... _.. . ....__... O �`r � .. � -- .._ . .. _ .. .._.. . •- y � � � ��ji SEE RFVERSE FOR EXPLANATORY LANGUAGE V� . ���t _ � _'__' � -_.._Signe�ureolA icanforA9ent . . .__ ..Data . .....'._ ' ___ .. _..__ '__" '.. ____.. ._. _. ...___..... .�_. .� _ � ' __. .._._ .... . ' _._ _ .. OOt •�� ' o ° � , � '\, � _�- G ` � ' ._C..-��io ° ;`^ ,'�. . a f ��� ;o�- °- � `° d �D o ' 0 '� O- C N+. N= tP. � p .n O . . � r- a ��' C>> S � N � ,M' ys 7 �• i'7 O .'O " ± , � N ,� v�� i6 p ov - p•o' � �p � ° `° ° m o�' j�, ! . o T ? �i. 9 J�. ' T � 7 � 96 O F7 � J7.. ,? . � = . ` r O t� � . � O � O T ip � 'p Q� c . �!L ` . . . < � � TT p C ? j.Q 'c N 0 M N� . N p ' .e. ,9'Z %p �r � a.t 7 4 . . 9� � .p, .� � O � ^ 2 ^ � �' O � � . � � � - p . . � � Q�c Z G -� �', o p�� � \ � C 2 " o `+ � ' o-\ � . � ~� � � . � . �� ° ' O , 9 (,` � � �� d � ` °% 9 � r' ', C ,G���� �' �� ' -- � • ' . � 4 � O� � �`n � �,,,� � „ . � �. '�- � �J � • � s . � a , \ �. - o-o. �, •.� �(,� . • . M °` -�.. �A � - . Q' �' ' � :, . ..� � �� `�'. �N �•! ' . . . ' . �\ �� ... � . . l .c / •4' .. . , .�: ' . _ n , � o .. `� l� '• . �� '• . - N �, . � Z , l� ` " ., _ `, � _ ��,_ " � o�' . ' .` ` : ,� _ _ , - . ,. '\`` � .` - •'` � . - �, • , " , - ��,. , ' ,` _�� ; . , `\ . - . ''� , � � � -' `,: ,^`� ',`t \ . i - � . . , �•; � �` t ,, , `\ . � �Q����:��. - _ ' _ .' p�p.�.0 C P � 4,0. " N'lD.,.dG � ` � . . . . , . '� ' " ��'J�a�:•r�A�=�Q P,'�O O��•X , -1 . � � ��i,,?p Q�p a`"p�i •ei P� 7�.�G ^'Z � �' •L,�,-a c''� i N � �,�?�, �o t'•Nn�.M��:p 9 � . � . ', �-x n X c c b a N�,"N '°^�M:.°.,�'?,o�,��;�' ?G � � ..� . � '. . '+J 7 � f..~ A '�''A � N C p ''S .O �'CSA �° ~ M� N �O G ,. � - � � 6' O O..y A C � C'O P' ? C,�, ao �.�n O N r� , 1 � �"?�.� �`� K3�...�, a -� a ��.�.�.� � � �.N_�.a �� nO :-'O�C�i ' , t � \ ��',, o A H�. 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