Loading...
HomeMy WebLinkAbout0890A 0891A . .. .--- ------- - . _....._.._ ._._._ - WORKERS'COMPENSATIONDECLARATION .. . . . ,." .... . ... . ......... ......_...._ . _ _ _ .... .,; ... . .. -- -.--' / . . . ...--_.....-- ' . .. . , I.here6y o(firm �hot I have a ceriificate o(consent to self - � �J insura,oraterlificaleofWorkers'Compensation,�,�,o��e, APPLICATI�QN � FQR.BUILDING -PERMIT � - or a ceriified copy thereof(Sec.3600,Lab.C.) ' �� ' � " � - �� � COUNTY OF LOS ANGELES BUILDING AND SAFETY � � PolicyNo.61WETX799aom��y� : _ �Cer�ified co s here furnished�� BUILDiNG ;`/`/� Y. (Yi A ❑. PY' �' FOR APPLICANT TO FICL IN ADDRE55 �Y'y L ✓�L�.�-�C2v (� Ceilificd mpy is filed with ihe�count building ins eo- / BURDING � J�(� lion depar menl: � � ADORESS 24419 � Da�e��Applicont � CiTV Diamond Bar Z�p � LOCALITY ' � ' CERTIFICATE OF EXEMPTION FROM WORKERS'' � �� - - �-� - :--�� - NOr OF etoGS. � � r�nReSi.- .. . . __._ ___ _ . _ .__. „__ .. " � " �' COMPENSATION INSURANCE � S¢E OF l0T i NOw ON LOT CROSS 5T. ' � � (This�section�need no�be comple�ed if iha permit is for one / - - / ASSESSOR hundred dollors(5100)or less.). ;. . TRACT ✓ BLOCK LOT NO. '�J Mqp gppg � � � FAGE PARCEL ow�R Bramalea Limited No. 850-1001 ���Qj^� ""^" 1( y I terlify Ihat in Ihe performanca of the work fo�which this � Np, f I y �• :} pe�mif is issued,I shall not emplay ony person in any monner 57EGAL � � - -- � - -� 6. so as fo b�ecome subject to Ihe Workers'Compensation tuw:. � Aooaess�-�-3�5�- A1 PWd V �- " """" ��J CONDITIONS Q . . , u _ - - .. . , .. .. . Date � � Appliconl . .. .' .. . GITY. .. ZIP _ ' .- - � .� JICE TO APPLICANT: If,�of}er moking this Certificofe oF ARCHITECTOR 7Et. _ DISTRICT GROUP TYPE : FIRE PROCESSED 8Y �nption,'you shouid 6ecome sobject to'the Workers' ENGMEER NO. �p T: NE �O / f� v l:ompensation pravisions af�lhe Lobor Code,you m�st(orth- 3990 We � P� .j(� /�3 ur ADDRESS a ith comply with such provisions or this�pe�mit shall be � .N deemed�evoked.. ' .., .. � . TE�• 7 STATISTICAL C1A551FICATION AP. CONDp. .,Z ' ' CONTRACTOR NO.F3rjO-�OOI .�� . .. _ _ UCENSED CONTRACTORS DECLARATION ' - - �-LiC. -- . an55 iv0. � DWEiL UNITS—L n I hereby offirm Ihat I am licensed�nder provisions of Chop�er 9 ADDRES ryo. (commencing wHh Sec��on 7000)o(Division 3 ot the Bosiness and _._,_ .__ _���. SEwee hwa � Professions Code,ond my Ikense is in full forte ond effect Cit�' CL455 B � - BK � � � ' - � ' � VAIIDAiION -� 50.iT. NO.O Np,OF___ CHECK �ICenSeNUmbef '- A���1e � Li[.C�a55 g $IZE STORIES� FAMILIES� ONE . , . - , C� � .vawanoN _ NEW _ ', ' BPaffld�Ea'�Ca��lf�. ' '�, --� -� DESCR IQN FWORK- � -���' - �/�/ � � � Con�roUor � Daie ' s ,��� � � �G E 9.0 A A�D .._. � I am exempf under Sec. �� • � • • � . . ._ . ' . . ALTFR � . • • •G� B.BP.C.for this reason NQW Constructi o REPAIR ❑ s - ' -"- � e?(�.',(�� . .- � 1 .. . Oafe: E IST�ING BLDG. DEMOt ❑ • � J • n;;�CL,�.��c'_._ �� Sinnplurn ,� "' '-�'' APP�ICANT TEL. FINAL � ..� OV NEf1-B IDER DECLARATION �RiNT NO. - _ DATE �- -- � � -�� -- - 1 hereby affirm ihat I am exemp�from�he Contracror's license qDDRE55 3151 Ai rway Ave.,N� COStd Mesa � ���r 0—8 6--� - law(or the follawing re6san�Section 7031.5,Business ond FINAL� � � � ' � � ' . Profe'ssions Code):� " ' ' - - pRE NT 8y � - - � • '�] BwiowG . 5 I, os owner of Ihe properfy, or my employees with ADORESS ... wo9es as iheir sole compensorion,will do ihe work and � � - . the struclure is not in�ended or offe�ed for sole(Secrion ���ITY � - 7044,Business ond Professlans Code). - - ��-� -�-� MOVING'� � �-��� -- � -�--�-- TEt. -- ,-- � � � � � ��= � • . C'�9 1 A I,os owner of the property,am ezclusively conlratting CONTRAROR NO. � � , � �._ _ _... y.�w • • o , wuh ficensed mntrocrors to�consrrucr the Project(Seo- .. .- - - -.--.-. - . ... -. . - � - - --. .. . . . . . tion 7044,Business ond Professians Code�. ADDRE55 , c ,r , - - � � REQUIRED. .IOIAL SEiBACK FR M I I �G a G O - CONSTRUCTION LENDING AGENCY ' '� "� - - 5ET enCK YAeD� �HtVY PROP.UNE WIpTH �� �� �� - I here6y aHirm thal�hera is a tonslruc�ion lending agency for pkONT � . ��;,�Q G�_ ' _ i. � ..Iha performance of�he�work(or which Ihis permit is issued �- �- v.L. �-- . . . .-... .... . .... ....'- ''--- .._. . _ _ . . .--- ----.._._....._. .._ _.. ($eC.3097,Civ.C.). SIDE - � 0820.—&6 m _ . -- - -. . . _.. _._..._.. _. _._. _ _ . __ -- �.._ Lender'sNoma Toronfo Dominion�Bank� - , `? 144 SanSome St.�-SUi te 700 - r.c:rea s - .� 7:- oe,�„��Fe, vr77�S� �DMA Rel.p , . Lender's Address � � I.certi(y ihaf I have read Ihiz app icatian ond state of tha _._. _ . __ .. ._�.-rl� � Issuvnca Fee. �0'�� . LDMA P/C N �' -- . . �. �.. . . .._' . ._. _. obove informalion is correct.I ag�ee ro comply with all Counly Invesnganon Fee (�p .ordinancez and Stafe lows relating fo bvilding mnsiruction, ..___ To�ol Fee� �O p• � L�MA Perm.M -� - �� � � _. _._ .—.__.__ .' ._. . and here6y aufhorize represeMatives of this County to enter - ��--�� - � - � �� �, apon Ihe abov -meMl ned pro rl f r inspetfion porpos � . . .. _ . . . . ._ _ .. .. ..._' .' _ ___ _. _ _ - SEE REVERSE FOR E7fPLANATORY LANGUAGE �� ! -._... ar of Appll Agen . _ ._'Dofe" _ . _ _.._. ....' "_ ' ' . -._... . _ . ... . ... . .. .. .l. : . _ . _. _ _ .ni ,. ;'+ n 2 0 0 � � '^ o v+o 0 o nv �m `�- -tl- -�n. _�. .� ---... --- - - o 0 � oo - � o c � �n - o � a. o �c o � , �o o c T s 3 � � �o � o � n ,', �o ° a o i� ' o � ;;fD I �o � �o 0 0 o D , � o �o' co � � � m '�- . � Z x �.� n-� v - � - o F' c° v C 'co �+ °'� � o F ' o Q, � t' 0 3 0. n� o o � D. �3 � 1 p c N o � p� o .o — o "' v � ° � ° c o o � o n ' o;o fD ' o 0 0 .. a l I ° " � �� `� `�° = � " � ° . � _ . v,o - « m � � � � a ' � i�' � � ' , ; , D O yZi � 1D ' O �1 n ` ° . . - � m , ' - ' a 7e � - c � v m C r 7 . � � � a Z a w O -i � 9 - . O . . � ' M. � �. . .. � � 0 N - D� � m - � v so y � , � m � c� � . . , ` m �, m __ � Q,`o < a o . a i . . . - 2 N ._ , � . .- T n _ y t . � • � _ Y1 " '" Z - 0 �i : i '— N i : ' . ' 4 � . ' � . � . . i ^ . . ' � . . � . . ' , � [��.T Q��V � Q``� �. � C �►�ui � C ^ w w �: '1 � r � ' ' Q � ' ti i .O 7 �'fi � C � C� G e S� � �O�C �`ti �0 N n — . , " � � `a.:. '�' V iO A � -°i � e ' z`'E _ u �o ❑c �oo�C a n w ° �� o S � � - . . j � � i %i h h f ❑� '� �' '� t' 0.�•.''H �� n `v" �,pj ^.s-_� to . . • n � o C -- � .. e 5 � �°i � N c cc?�o C� ^=E H-io m ,^� '^ T- b �: � t"o h ^'o - ��,, p^��. �"^ h v : . o o ti �N _o c�,� s e-� M c c; o `,L's. `o ^�c ° c '` O _ - ' , ' . � 3 M`F.` � � � o �'� � m � ��� � C.�. �c � ` `- .�. � o ^ ��e n L f ° C • ' . ' � x r'``y �+� � F `^ � o-� o �o R'� � f ��'La.`�`a �`ti � '' ="Z - - . . . 3 � � ^ « ° mam c �'.��. �." � n �tioo � � � c`'.� C� 4ie_;�� o3 �, � " � N x � ' .m . a � M•� '^ � H s . � � _ . �. .`s .. n n ��� :c 4 N n b C / � . . ' , � � w � G p O ` S �•�'�'. '^ � n 0, n� Y, G n k � h S O. 7 C`� � � ..�a` � ^ .. N " - � � a aa�tib �o' � � i-xa•� ` a � a3m c��e � w�lcb� a � . pC - - . . � r^ � � ."..n+�;n � . `.� � .. �'C�� rn� ` .� ..� �� i � � � � - _ ' -�i � <n �� °cr'« ° o � � � ��z� S c a��� ` -�`b•.. � o'� c o 3. . - � . � O � ' � �`�•- �•�-o . c..F� C�N `�FC� ov eSo-an �..A�o :�� .^. e � x .z 70 � c � Z O � C.� o C`r' C � n . 1 n'ti ♦ � 1 w' • '� fD v ' . , N � A N n-< x � r_ �ry ..Q.O �N �'` b�p .1„'`��O 3 I'� ' � � - - Z - �'�x ?� o w 7 � o c M ,���� � a.` ���ti h 4 v C� , ' ' O� �' : n �F ;�� 3 °'e� o ' c� � a f. o � ��c a`° � „ �.� .^, o �'.> : . m � ? 2 � � r� ��� � o =3 Ca.cn� H ; _ a A.:-� .o ° x -- - � . O � :,�o � �= n ' P..i C'�•C`''tr � �a-� �a � C.a " �'�, a+� o � 3 � £ � . is~c�cN . � . � C�F � c o3 �b .. �� �.�•�'n �,., '. s..� . . . , � : � � i b �'� <' .�..'`C\� �.�•� co�� �c �_o-c`a'.H C�o` c in�D O v F Nj o o � z "'� =� �.E �°.�v, o ,�:v� �y°�.M a �a � 0 7_ � a .� 'b �..: N ...L�a �p,£�c y,�.�.C�• �F �.c � � � � ' �' ~C� C n � C r �C n � C �".^•�N �� ,�`N � w. � '��' V O � o ° �� c m o `wO���`�.�o f �� `^� o�n� �•�-� �=o � � � ` � - `e"ae- � � %, . , � � ' . N ., ! n�^ M'n n' � � �e .�ti m d S ' �''•r_ � H � w fn �C'�N