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HomeMy WebLinkAbout0840A 0841A / . _ _.._...----__ _,. ._ . .__._._._ .__.._..._. ...___.___ . . . . , VJORKERS'COMPENSATION OECLARATION ,..��� � •, ��� � �� �--��� -��-- �-�-� - � � � 7 S , . . . ...,. . . . ....: ._. ... . . � ' .. _ � .. . : �I hereby aitum.that I have o cer�ifica�e of,tonsem�o se�f �qpp��CATION-�-FOR���B�UILDING -PERMIT���---��� . insure oi a ce liFicaie of Workers'Compensa�iodlnsurance �. � ' or a certi(icd topy thereof(Sec.3800;Lab.C.J � � � � '-` -- � -� �- - - � � �-"-- '-' � � ' � ��� veii� No. F,1W�TX 9�m oo Hartfnrd ('roii^ COUNTY OF LOS ANGELES ' BUILDiNG AND SAFETY �. , - -- �'� v � a v • _ _ _:_ . -�Cerfified to is hereb fumished.` BUILDING /' � O �' Y '` FOR APPLICANT•TO FILL IN ADDRE55 /� //�.�,�-- � � -Certified wpy is filetl�with the tounty building inspec- �-� BUII�ING ✓ �`� tiondepar}ment.' ' ��' � ���' � •�' AD�RE55 1064 SOUth L011 V7eW i - „, . . �;�,. ; __ .._ _ . . _- --...__._. _. _ pare��Appliconr ���- an Diamond Bar ziP �p�q�iTy i � - � � .'CERTIFICATEOFEXEMPTIONFROMVJORKERS'.`.,� .-' -. -.... --_.. .. . _ ... .__......NO:OFBLo�S.-.. _...---.._... NEAREST.'�'-'---- .- _- . _-. _... '-'_. . __ __.. � -� �� ����COMPENSATION INSURANCE � ' -� SiZE OF LOT � NOW ON LOT ' CRO55 ST. , - - • _ , .,._.�, (This-section need not ba complefed-if 1he permil is(or ona -� ��- � �-� -- �---�--�--��-� � ----� ` -- ASSESSOR_,.,,_. •--� -�� � - � � - '� hundred dollars(b100)or ie,,.� . TRAR 4256 \�BLOCK LOT NO. 78 � �p gppK' � PAGE� FARCEL� • ' • • - - owNea Bramalea l:imited -�- No. 850-1001� U�N.L) �P ��'3 '} I certify Ihat in fhe perfarmance of Ihe work�far which ihis NO. � �� -3 ' I permit is issoed,I shall no�employ any person in ony manner - qooaess-�5151��-A1 PWd ��AV2. SU 7 t0�N�---�-�---J ` - �Ecia�;-- � ��� .�- -..-� �-�----.. - ,.--.. �-- -�o. - so oi to become iobject fo the Workers�Compensotion Laws. CONDITIONS � �� • . .. �. . . . ..._.� .. . ,_., . �.V Date . ' �_ ' �.�'.,- -APPLcont`_. .�. ...-.... .. . . ._. CiTv . _ ._ . __.Ziv - ._ _ .. ____... _- ___ . __•_ _ ........,.._. ._ _.... _ OC ARCHITECTO � TEL � �� I ICE TO APPLIUINT: If;aiter'moking this Cerfifitate Of Aram Bassenian NO.7rJZ-iHE4 � DISTR�CT.. GROUP NPE _ _ . _ _fIRE PROCESSED6Y_._ _,�,,, ENGINEER � �P ..Y � . -._ . __' ZONE. . � ... ._ _.... � W �ompe satlon prdv sios o(ihe labo 6Coder you mo t folhl ADDRESS . ...... . . CONST. .. ...,'_ -_ :a with.comply.w�th suth provisions or this permit shall be _. _. TEL. 'y deemed revoked-.. ..� •. � • i STATISTICAL CUtSSIFICATION ' APi, CONDO. '.' •,Z � �'�� �� �'�� ''�-•�-''�' '"� CONTRACfOR Brdmdl Cdl�f. No. 850-1001 . ' 1 — LICENSED CONTRACTORS DECIARATION� .; ��� " �-`�'-� - �-'"��- "--�� --" --- -- - """�"�� � ��� ���, QASS NO. � DWELI.UNITS I hereby offirm tho11 om licensed onde�provisions of Chapter 9 ADDRE55 3151�Ai�rwa� ���Ave.� N� No.409610 -� (commencing with Section 7000)of Division 3 of the Business and _ ��� 6 __, SEwEti Mt.v ; ��� . ' - -. .. . . .... .... .. .. .- - --- Professions Code,and my license is in(ull forca and effect CI7V (�,OStd Mesa C.A. CLA55 ` ""'"'��-�� '--`--�--- � - ' "���VAUDATION- -- _. _'_ • �, � . . .. � , ..�,�. . .. BK. PG. � � � ' 54. Z_ NO.OF NO,OF __CHECK � � - . .., , , �...: ' ' license Number 409610` Lic.Cladi'B ''`' s¢e STORIES 2 FAMILIES 1� ONE •� . � - �. '. . ,. . ' 'i . .. . . G f _ VAWATION. . ' Com�oao�Rramalaa rrl�lf. Do�O � DESCRIPTIONOF oaK 25CR �'----- -� - - "E`^� -� � �/- �j"" ' --- 'OoG.OA . . . ... . . ADD S .7v O� ❑I am exemp�under Set. - S111 �e_Fdllll�}/_R@S1 d2f10E_ ._. � ��• •�� ` ..: .... - : . ALTER Q - � ' , ., . ..... ....... .�. ; . . - B.BP.C.forthisreason onstruction REPAIR.� .. f....._.._._.... ..._' �"_' . . �... .._.1. .' _"I..�Jl4,.�..���C1 ...., � _.. .. '___.._.._........, ... ..... _. ..'__� . -.� USEOF . ' Do�e: exiSriN�Bio�. Il0Ii2 oUna 0 ' __ __ _^�o.i.1 G�_� '-"�Sighature • �e.r.���� - ...-- APPLICAN7 TEL FINAL , � �� �� • OWNER•BUILDERDECLARATION PR��'�T . Abbe No.850-1001 ....oArE_3-Z����. � �I oE.19-86 • O - ... _ ..__... _� -- • �--- . ...... __ _ _ �-I hereby a(firm Ihat I am exampt from the Controctor's License qDDRE55 3151 Ai rwa AV2. N COStd Mesa z Low for Ihe foilowing reoson(Secfion 7031.5,Business and FINAL"�"� '�"'' ' '- . ��•' � ..Protessions Code):. _._ .._._. __..__. . ...__. ... _.... . PReSeNt � ..,By= - -� .. ... . _ ..-� � _ �- BUit�iNG .... � . � �,.. � � I, os owner of ihe properfy, or my employees with ADDRESS • - 'M n�!"��� �t.', .,l woges as their sole compensation,will do�he work and � � - - � - - .. . - �he struUure is not intended or offered for sale(Section ����TY � " .� -- -�7044.BusinessandProfessionsCode). - .-.. ... ----�� MOVING --- ...._. - .. ..._.. ' TEC. .. -- -. . . . .. ._ ..- ... -. - . . -'- � I,as owner of the property,am evdusively comracting CONTRnQOR NO. ; � - ,� �o . _'_" .. .' _..__ . _.____._' ' _ _'..""' •' .. .� . e e . - --wirh licensed wntracrors to constrvtl the project(Seo---- � -- -�- - - � .- . � _1 °6 5�,�.Q , �- tion 7044,Business and Professions Coda). A�DRE55 � � � : , .... . REQUIRED.__ . _�OIALSEiBACK . XI .. "_ ' '_ _'"". �".'_ -.-��.:._...�_ �`r�'��U U u ' �����-�' -CONSTRUCTfON LENDING AGENCY-' -�--�-" ��" � SET eACK YARD" HWY' PROP.lWE WIDTH . - - � � - I hereby af(irm that there fs a constructton lending ogency for peONT . : , �� � : � � 03.1 9��G - the performance of Ihe wo�k for which this permil is issued ---- --P.l:---- '-..._ ._..... ....._ ..._ ......._._.. .... ._. : .. .. __ . . _..... - .. _..._ - - ._. ..._.._._ .._,_. (Sec.3097,Civ.C.). SIDE . � �� - Toronto Dominion�Bank . _ '.� ._. . ---- . lender's Name . . _-- . ..__. . . ... .. ... .-.'---... .. ., � � ansome . U1 @ Q / QCf..� LDMA Re1.N lender's AddressS�h FY'0f1515C0. CA. 94104 - P�G.Fee S- -�O�� f7- - - Permrt Fee ay � . -.- . . . ..Lcertity.rhat�.hava reed this applitaeon ond.atote.thot.the _... JLJ __75��.� -- ImuonceFee ��-!0 �`S� � -LDMA V/C X�- R ��: . _ _ .. �� o6ove informv�lon is correct.I agree to tomply with all County in s��ganon Fee / � ' ordinonces and Sta1e laws relating.to 6oilding conslruction, Toiol Fee� `�'�I��-� � �����-� - .._.._.. �'i . _. _ . . .._ ._... _.:_ LDMA Perm.M_. . ._.:._. ..._..._ : � . , -and hereby authorize representatives of this Coonry to en�er �--� �-- . .� - � vpon the obove-mentioned pr e� for impection porposes. � � _. .._.... _ _���... ... ._...__. ___ �__------- �13�l� --- __ - --._ __ _._ . SFE RFVERSE FOR El(PUNATORY IANGUAGE � ' i 1 i � .__.._.SlgnamreofApplimmorAgenl .. . . Date... -' ._. -.._.__.....___..._......._.. ..._....._.'_._�.__.__. _ ._.l__ ._ _..___._'_._.__._.....__._ . �....._.... . ..- . _ .__. .......�QQ� �,.. . - . . - ._.. ... .. . .. . . . --.- � `` . � . . . . . . . .'� mT O O � � � O O � fp �n .p' . 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