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,, .... . . . , ,. ___.----- _. _..._ ...._.. _ �`� .... _.. _....___._._.._____.....___. ._.. _......_..._-----...;.__..... .------_ . _. _ ... __ -___ .� WORKERS'COMPENSATIONDEGLARATION P;"��� ' + :'•�r�' �� � ��;��•.�� � .•' � . . . .; ... . . . .._._...._ ......._. _ - .. ' . ' ' . • I here6y affirm thet I have o certifimte of consent.ro self qpp��CATION� -FO�R�BUILDING PER�MIT-�� ���� � , , insuPe,or o certifico�e o(Workers'Compensation Insuronce, or a'cerrified copy thereof(Sec.3800:tob.C.)� ''.,.. . `--'----� � --- -.- .....- . . _... . ° . . - - _-._ _. .._._ .... COUNTY OF LOS ANGELES � BUILDING AND SAFETY . .;,. y ' 61WETX799� '�'��'Hartford�Group - --- - , Palic No. ompony. _..._ - - - �-Certified mpy is hareby furnished.••,�. FOR APPLICANT TQ.FILL IN eui�owG /�� " - ��� ADDRESS 'Certified copy is filed with�t}ie coonly building inspeo ""-" BURDING . � �tion deparlmenl.�� � ' � ' � �� ADDRE55 i �• ' . ., , _ ... .. Do'.. . �,. . .,� � ,:�';��... _-"'- �-------- ---------- -- ---- --- -.._-- - �------.. _._ �te�Applicam Gtt Diamond Bar ZiP lOC4tITV , ' CERTIFICATE OF EXFMPTION FROM WORKERS' �., ...-�- - -�-�--�---"------- -'`---'-"�.OF BLDGS.--.. .. -.-.- I taEnREST."'.� .. .____.. _ ...-'._�- ----- --_. . __.___ . ,. -'"�� COMPENSATION INSURANCE""" � '�•' SI2E OF LOT % NOW ON LOT /� CROSS ST._ . _. � ��: - , (This�iecrion need nor be complated if rhe permit is for one --� ��- �✓-� --�-�-�---�--��--� --�------ `✓---� ASSESSOR..,.;._ ---- ���-� - -���� ���� : . hundred dollars(E100)or less.) �... , ., . TRACT 4Z5G BLOCK LOT NO. 84 MAP 800K ' " ' PAGE� PARCEL � . ' . . "_ TE�. ermil�sissued�l �.. .. . .�. . . .. �� " ' - -'- � ' . U E NE �+P Pcertif tha}in�th'e performance of the work fo�which this ��ER' NO � � � � f �� � -._�: �� Shall nol employ any person in any manner • • ; SPECIAL�,- - --�. - --., . _.--.- .-. .. .... . n. � sa as l0 6ecome subject to the Workers'Compensation Laws. -���- ADDRE553].51-{11 PWd -AVQ.- $Ul t2-N -�� - -� --. �C� CONOITIONS ' " . • �U ,., . , •. ,: . ---- arY_ _Costa-Mesa _CA----z�P_92626 __ __ __- -- _. _ _. . __. . _ �e Dale . . .,,APPlicanf � ARCHITEC�O � � TF . � � �� CE TO APPLICANT: If alter making fhis Certificote oF ENGINEER Aram�Bassenian r,c�d52-1867 o�sTR�cr GQOUP OP�.__. � �REE_. _PRp�E55EDBY.. . ..,�� I 1 �nphon �you shoald�become subjen �d the Workeri ' '�� r� . l,ompensotlon provisions of'the Labar Code,you most fonh- ADDRE55 ' _I�--- . �3 --� -.... _ � -- ..�.- - a wrth tomply with'wch prows�ons or-this permit shall be -��--�- .y deemed revoked:, ,;.,,,;t.;. .��,.•� TE�• • STnTiSTiCAI CtASSiFlCAT10N . � APT. CONDO. ,Z mNTRnaoR Bramalea Calif. No.850-1001 __ � ° A-,� . _ ._ LICENSED CONTRACTORS DECU+RATION„--..,..� ._._...._..._.._--.-.-..-.---.-.- -.----. .iic-- -..---........_ �cY.i55�N0. �/�/ ' oWEIL UNITs � I hereby afiirm thol I am licensed under provisions of Chapter 9 ADDRE55 Np. (mmmencirg�with Secfion 7000)of Division 3 oF ihe Business and _.__,._ • _ ���_. __ ___� 3�N�FR NJ1P � , . � - ' � .._ _'_'. ..,.''_"""__ _"'__'._ Rofessions Code,-and my license is in fulfforce and effect. CITY C�n55 � --'BK�--� . -- - -'' --- ���-ypLIDATION � . � . �: �. . ,.... : . ... SQ.Ff. NO OF Np.OF__ CHECK_ ' . licensallomlier 409610� � �• ��' i��.�cia5� B� '�' �- s�ze Z 44 STORIES Z FAMILIES 1 - ONE � .. �� � . , .. .� . . .. . � . :.� Cj 5' .. . DESCR�7TtON�t40R -.�... ...24BR�i'."""'_' ryFyy '.9-1 _..VAWATION .._ . � _. . ���0 c�i 1 Z A : � . , , . . .., , __.. co���o�;o�" Rramalea Califome ' O s %/t� &pv �f e e . �� ❑1 am e�empt onder Set. ---$l Il 1 e-Fami 1 -Resi dence Aoo _ ---- - -' -- —� '- . . �� . . . , . . . ALTER : , . . . . _.___._ . „ . • I �.�4362 B.BP.C.forthisreoson NeW Construction aeante_Q s - ' ` _.__ USE OF _ . .._.. _ . ...oo)e: -- ' /��(/�, � � ex�sT��e�o�. none o�,+,,a p : '_°a�i 3.6 2= ! -- S nnf�ir� ,�[� �:'I/I.OT�iY.til/ � APPI�CqNT TEL - � - .. .: OWNER-BUIIDER DECLARATION PRiNT NO. - .__DA E`--'y � � ' O�� G 8 6 � : ,�•23_.�7 .. _ .---- -----.... -I hereby aifirm�ha�I am exemp�from the Contractor's license - ,, � Law for the foliowing re65on(SettiOn 7031.5,Busines5 ond �+DDRFSS FINAL'� ' �' " � �" 'ProfessionsCode)'.......' "" ._. .. ..-.._. . .. __-� PRE N -�BY� -' � �� _- " ' � . .. _ ewmu� �'" �, _ ��I, as owner af the property, or my employees with ao�eE55 __ ____ _ „ , �. � wages as their sole tompensation,will do ihe worR�and � . - -� � • � - � Iha shutlure is not iMended or offered for sale(Section ���Itt : - >�` � ��-I, -' '�' 7044;Bu5inessandProfessionsCode)..�. ...-'.. .._..... MOVING �---------'--"------��--��TEL. --'- �-- ' --��- ---� - �� - -- - -; � a .�a CONTRAROR NO. ,�- i'. . �.,e i . I,os owner of Ihe properly,am e.clusively contracting ��� , e � `❑.- with licensed contratron ro construct ihe�prajett(Seo-'' ..- . ---- �" ��-- --- --�-'--- ---�--' ---- '-- .- .-. - - ._,_ _. ` _ ..'�'. �t�. .. __ SQ� ' ADORE55 ' . tion 7044,Business and Profesitons Code). -�. �� . � r � .��x�� _.REOUIRED. TOTALSEiBACK M_ . %I '=`�' `'������ �f��O V u � ..-....... . _. CONSTRUCTIONIENDINGAGENCY�--�--�- ---- YAaO- -Hwv- ...-' -_'_..-- ----.. ..- �_.�. .._. -1.:._°..". a. ..... .. . SET BACK PROP.LINE WiDTFI� I hereby afFirm that there Is a construction lending agency(or pgpNT . . . � Q�'� (�".�'�-6 � Ihe performante of the work for which this permif is issued .-._._ ...P.l: -..__. .._._._.' .._'' .._..._..__...._...... _. . ..._: ._.__."'.__.._'._._._". . _ _ _ . . _ ' (Sec.3097.Civ.C.). SiDE ' ; ' .,'�� ,.. _ Toronto Domi ni on Bank_.. - -�- P.�. .. _. .... -- --- - _ � --_:-`'-- ---.. _ � lender's Name .-...-'- "-'--�--' '�-- -... � ansome . ui 2 ; LDMA Ref.N •'.:;� _-.1 S ..._ .. . ._ . . . .. - ...__. V.GFeeS'._3 �'•�o �L--� PemmtFee" . ' .'�'�. _ ....__ . _. lender'sAddressSdfl F1"aRS1SC0� CA Q4��4 • 7 � 1 certify that 1 hove reod Ihis applitation and stote f6at the ._._._ DwJ�} ...._._`S��_ .- lesua�ce Fee-._ ��'�. .-.' .�DM4 P/C k --�-- � �-'---- '-- -- � " � � . � . ' obove informalion is correct.I agree to comply wifb all Counry in�es+� e�on Fee . � � �' ordlnances and Sime laws reloting�0 6uilding mnsfructlon, _ 9� �"�*p �._. ' � r��-.:•'���:' - .'. __'__'__'.._...__ . To�ol Fea_" p' , 'lDMA Perm:N"._--.-_._ __ _'.__.� .__.__. _. . ... �and hereby authorize representatives of this County to enter ���� -^&� upon the above•mentioned p�operry for inspetlion porposes. y��� , � _ .. .._. . .. .- - - --- ...p�/j"`'T7�J-- --- .'-. __ ... ._ _ , � �'��.Q�� -�—ZS-g 6 SEE REVERSE FOR EXPLANATORY LANGUAGE� � � __.. _ SignaroreofApplimntorA�. ..- Da�e . "_"__"_".�__ . ._._.._ .. _ __. '__ ___'.._ ___' .._..._ ... _'____. _ ._- �-.._.. .__.. t _..__ ..'QQ� . Z a: o . � , ,�� .;^. 'm `,c , . ,�� A o 'c� • ' 9 ,Q\ a Q �v � 4 0 �'.. =n.m m �-N� l0 O- j -p � .. .p p ,� � p N �f+N t�0, t0 O �p �: - 'p 7 �• ��. n. O ,t+ . L . 'O ' � ° �° �� ° � 3 m' �.�. , . ` y' � � NO � 7 �7.�N,' 7ro � ` � , N N � �pn O p�9• o �' - .� . -� O G 6�' y lo p �,' 1 n ". , 1��� Z . � r- � O 6 0 �� v �?'; �.o 0 9 o m � S. n ` ,p � o w� � �- . ' . • <w' � "�'� °° \ ?.a � �' p °„+, c�o� " o `m �` � 9 �$�m io � �-� w o. a M 9 p 'w Z p � "Z m O� � J � i . O, .O' .� x � 7 qo� . 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