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HomeMy WebLinkAbout0842A 0843A � .,. __ __ _ .. --- -----_ .___ ..__._.. ._ ._.. _._. __--,-. ___._.__ ._....., 7`i WORKERS COMPENSA110N OECLARATION -�' " ���-�� '�- ` '�� � " �' . �1 heahy afhrm that l hc e a cert�f�cate of��onse��,o=e�� - � -� ., , _,.APPLI.CATIQN.-��FOR��BUILDING--PERMIT��� --� ' ,. msure,or a cem6cata of Workers'Compensotion Insurance, . , or�a cenified copy lhereof(Sec.3800,lab.�C.)....... � ... ... .-... � -. .... . _ . . .. - . . . .... ... .. _ --•. . . , ,;. . ,., , COUNTY OF LOS ANGELES BUILDING.AND SAFE7Y • ,. .•. aol�cyNo.fi1WFTX7QQ3omao�vHdY'tfOr�{ f,rn ,TIiD _- __ _.-- - _. :___. - --- ; . _., , - - - ��-Cerriiied copy rs hereby(um�shed. . • . � . FOR APPUCANi TO FILL IN qppR u O ' • �� �Ceriifled copy is filed;with rhe county 6uilding inipeo " -- - BURDwG ! � � � 'Hon deparlmerit ' � " � �� '� � � ���� ADDRESS . _., . !� :. .. .. .� . _"__ . . . ._ .. .. . _ .. .. Dale{?7�-W7ApplicaM� �- �'� CITI �18fi1011d BaY� � �� ZIP '� LOCAItTY ' _ _____._._ ... ._., ...-.__ t ' . ; .: :.. CERTIFICATE OF EREMPiION FROM WORKERS' ' � �-� . __ ...__.__. -..--NO.OF BL�GS.�- - -�- - �' NFnRESi.-'-''--'---'- . ' ' �� � -�'COMPENSATION INSURANCE '�•- � �� SIZE Of LOt r NOW ON l0� CROSS ST. _ (Thii sedion need not ba comple(ed if the permit is Forone ---- -'-�- / . ASSESSOR., ., "' ' - ' " '" _ ._ .._ . _ _... . . _ - � _., hundred dollors(f100)or less.)., . ,,,...- . TRAQ 4256 BIOCK LOT NO. 79• � MqP BOpK � ' - PAGE PARCEL � ' . . TEL ' U�r1/E MP.P . • .,,:. _-. - - - o,�ea Bramalea-Lim�ted-�- - -No850-1001- ,,,o, /3 / 3 - �� I ceAify ihat.tn Ihe performance of�he work(or which this _ __ __. __ r permit is issued,I shall not employ any person in any manner • • . � �� SPECint-�� -�- �--- �� � . - - ,�ooRess 3151 Ai rwar - Ave: Sui te N - --� eD CONDITIONS 'V so os to becoma'wbject lo Ihe Warkers Compensahon laws. . � .� .,v.... . ., . � .... �. �, . �_ . ... ._._..". .'--�,- '_ _ - �--- ..._ .. ' _ _.'.:,, v- . - . UTY .._ __.____ZIP. _......_._ � ; ,. - �pG Date � �.`.. �Applicanf ARGHf(ECt OR . , TEL. ' DISTRtCT. GROVP� TYPE fIRE �.� I , �ICE TO APPI�CANT. If, ol�er�making'Ihis Ceruficare of N - . __FROCESSeDBY... � � ENGINEER � - CON57� . . . 71NlE.. �nption,'you should bemme subject'to�ihe Workers' �"�--'" �� Compensationprovlslonsof thelaborCode,yoo must forth- ADCRE553JgO W@St81�� Plaee S1alt2 170 : . �a_.___ _e�3 __. ._.._._.. _jlj. _ . -._....._ �d UCENSED CONTRACTORS�ECIARATION� ' be TE{, � STATISTICAI QASSIFICATION -� t APi. CONDO: �� ,2 deemedrevokedh'suth rovisions or ihis erml� Sha� � coNTRAnoRBramalea Galif. NtS50-1��1 � .. ____ . ._.....�..... .. _ __.._ . .. . . . PY P P , .:• �. . ... , � _.. ._. __ ... _.. - _..'...- _.__ _�...._'" ' tl ' _. ._ . �-CLASSNO. � DWELL.UNITS � 1 hereby o((�rm that I am licensed onder provisions o/Chopler 9 AD�RE55 VQ. � N�09610 �R n+HP • . .' � (mmmencing wi�h Sec�ion 7000)ot Division 3 of rhe Bvsiness ond ..._..... __. ..'--_....� .._ . ...._..__IIC. � - :� • . Pro(essions Code,and rriy license is in fuil force and effect. CITV a Mesa CA. CLn55 B - '-�""'BK ��-��:- - . -��--� � �-�`VAUDATION: ����`' � � ' S0.F � NO.OF NO.OF,_ CHECX �� ; � ' licenseNomber 4O9FilO '• Uc Clas's ' B' � ._ size�144 . STORIES 2' - - enrniues 1 oNe ' __vnWATfoN_.. '-.-- __: _ �._ 0 fi L.2 A �� � . ..-._-� NEW-- , . . 1�n .•.�.� ..;., , . . ., --- oese o�o�woaic---24BR- --- -� G � Conlrocror Raramalea-Calif-0a,e ��� s � )O�� ,� �1 om e:empt under Sec. - •- --�Sl ll 1 e Fami l Residence___.._.___ ^oo p❑ _._ . - ...--.- ' - . a��rs a , -_- . I'a.�U u b[:.� 6.8P.0 for this reason ....._. W Construction REVAtR '�s�-"------- ���-'"'��� � '�- - � USE OF � :i E;L c, � '- - - � Oate•.. _ � � EXISTING BLDG. f10118 DEMOI ... . . - . s�9�aror�,: - avaiv�.Hr rei. Flr+a� � 0£`1 1 9-8 6 O NER-BUILDERDECLARATION IPR�M NO.SSO�lOO1 : .,_DATE...�..�Yj7. ,___.�._..__.._._.�.... _�.__.__' . . . . .. - - �- -- .._ . _.. ..__.- . --_. � -�I hereby otfirm thot I am exempi from the Controcto s License nDDRESS 3151 Ai rway Ave. N Costa M2Sd ' FINAI - � - - � , . . .... . ..:�. =r � � ._.;. Law for fhe following reoson(Section 7031.5,8usiness and � e . .,. __ ... , .. Professlons'Coda): - .. . ._._ �-- -- -�-- ... ..._ . vReSer+i �� "- Y " - - � ^ . . BUILDING � �,v li I, as owner of the property, or my employees wilb nDDRE55 ��� � �R � .. . .. .. ._ .�- �� �wa��'s os�h�ir sole compersction,will do the work and ����n, � f'` - , � e�•.r� the strotture is not in�ended or offered far saie(Settion . �� '\ ..__ . . - . -� ..- -7044;Bvsiness and Professions Code)... _.. ..�-' - �- MOviNG'- -`- ---�--`."._. ".... . ...-------.... ,-.. .... .. __ 1,as owner o(the properly,om exclosively cantracling CONTRAROR NO - _ _ � •U��Q C� � .a.'with ficensed confrocfors to constroct the� ro ect Seo ---' -�-----" "--"'-- - --'.._... .. . ..... .---�---� - '- �- - '- �• ' , fion 70<4,Business and Pralezslons Code)P I ` ADDRE55 � � .. � � ������;r c=i,.�, .RE�UIRED... . ._fOTAL5E7BACKF .. XI 7. _ - . \ �.! _�`�."_�..:. _ __ ' ' ....._... 'YARD' HWY' _.. ... . . .. _..._ .."_ ' . "'".... .. .. : _ .. .� ��- -"CONSTRUCTION IENDINGAGENCY "�"�-� - �- - SEienCK PROP.IINE wioTN . • 0 8,.7_9,-,8b -' I hereby aifirm ihaf there is a canstructian lending ogenCy For faONT �' � i� `s�` ��.I __ . _ _ �the performance of Ihe work�for which�lhis permit is issued . ..P.l:-' ---� --"' ....'.._.` . '.'-'-� --"' '--"----- "`�-.. . . .... . _. - .. (Set.3097.Civ.C.). SiDE '- � � - ' I . . .._ ... .._ P.L _ _ _ .. ... .. .. ... _.. .... _._ ._ _... .. ..:: _ _.__. .. _ � Toronto Domim on Bank � Lender's Name (� -f �� IDMA Ref.p :� � ..., .. \ ' , ansome . P.C.FeeS.�T3•�Z--- PermrtFee S/+J..�--• _ _. Lender'sAddre�5an Gransisco. CA.��94104� --� �� n�,�,�. .,.` -- �� �� ^ � ` . . __i tertify thot I hava revd this appllrotion and state Ihot�he ____ o�',l.� --�S'`��---� Issuance Fee --/���- ��� LDhIA P/C N-� --� - - - '- �� � --- � - �� - -�• obove information is mrrec�.I agree to comply wi�h all County Inven�igalion Fee pp� . �: � ordlnonces ond Sote faws relating,to building conatryction, ..._.. .._ __.._.._. .,..___-_- � Towl Fer-- S6 O��--._'. -LDMA Perm:M.....-. .. ..-._ .-...-.-'' '`. -- - ':... �'-: �and hereby authorize�represen�otives of this Caonry ro enter . - '� . j upon the bove-memloned property for inspection purposes. � �. � '-'� . "'" .. -_. _-._.. . ; .._. . ._ _....._.. . ... . _ . __..__�._----.'._...-------- .... .. ..._:� .._ �� \ ", a. o�''�A- ��-- --------- � �LS� SEE REVFRSE FOR EXPLANATORV IANGWGE _ �� , -��,-��� �,..- �� � • ' ' � _��:._. ._ . .. ._ '_ '...__.._.:. _.Oi�' . i oiureolAPPimntorAgen� ....'.__"_�a' _ .. _.._.__.___._...__...... __. ._'_'_ _._..._..._ _._'_____ ....___. ...-._._. ___ ... . ..._ 9� .. � . T m -n N �n r � r (/� T O� ��.. ��. .�T. ..,_� ,�<.. _.����� � _..�_ __ O �O . (� >> o o ° ° � o o � c"'o ° ° ° o m `D�a o; o cc q � i �� � � ° m � � 7 � 3 � � ��. � � n `-' ^'� o� n' v T �m i � o � ;fD � �o �c � a � o D o :_.°� �;. m' ip `D :n ! : rn o n �O 0 � x � �-� � � - 'O n �'O yc �+ °°c m' o f ' N a, � � , o �N: n� o '° � `° D � � 1� o 03 - . o c � � � ov : ,°� � 3 0 = 9 � ... � ' m � ° ° ° � ^ ' vo;g _�" � ;o o'' o 1, � I � M � v� . 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