Loading...
HomeMy WebLinkAbout0886A 0887A I Y . � ..._ ..._. .. . .. . . __ _ . _ . .. _ . � . WORKERS'COMPENSATION DEPLARATION � . ._.. . . .... ...... . . ._ _..._.. .._._ ___ ..... .- '.'' - . .. APPLICATION=_FOR,BUILDING PERMIT � � . ,. , o �I here6 affi�m iha�I have a certifico�e of consen�to seli ' insure,or a cerlifitate of Workeri Com ensalion Ins�ronce, o�'a ce�+iRed copy thereof(Sec.3800,lob.C.) ' COUNTY OF LOS ANGELES . BUILDING AND SAFETY � ��YNo61WETX7993comPo�yHa'rtford Group _.,. � -- - , BUILDING Certified copy is hereby iurnished. FOR APPLICANT TO FI�L IN ADDRESS 2����- �'. � � � Certified copy is filed with the cou uii ng inspe- " � BUiLDwG �, ro de a�r e . ' � � � nooQess 24442 East Thunder Trail � ,/ _. ... _. _. --._ . _ .- Dafee��PPlimnt � ! CIiY ' ZIP IOCAtIN . _. . '' ' �'CERiIFICA7E OF EXEMPTION FROM WORKERS' -NO.OF BlDGS:� - --�- NFAREST.._.... , , --�-- -- .. . _ . _. _ ��� � � �� COMPENSATION INSURANCE � � - SRE OF LOT NOw ON tOT CROSS ST.. ' ' (TMs section need not 6e mmpleied if tha permit�is(or one - � / ��� a.55E550R . -- � � � ' � '� .hundred dollars $100 or less. . TRACT \/ BLOCK l0T NO. 3���'� � MAP BOOK- PAGE PARCEI � ( ) � 7EL. yyy5557� 7 I tertif thal in the erfo�monca o(the work for which this OWNER m �111' d -- � No. 5 -�1001 �{�73 A �P /���^J } I ..- �r��/�J� SFECIAL .. _.._ 6 permi��s iss�ed,I shall not employ any person in any manner pDDaE55 -- - ' ' so os to betome sobject to the Workers'Compensat�on tows. "Ldd 0 CONDITIONS 'O _ _ -_. or� Costa Mesa _CA_ -_-z�P 92626._ - � I Date�� APPlicont � ARCHITECTOR ' TEt. � '$ICE TO APPLICANT: If, oiler makin� Ihis CeNificata of . � DISTRICT GrtOUP TVPE_,. _ .FIRE.._ PROCESSED BV . �!- �npiion, yov shoold be[ome subject to th0 WO�kers' ENGiNEER Na� - CO�S�^ Z�NE U Compensafion provisions of the Labor Code,yo�must forth- ADDRE55 3990 Westerly P1.� SU1 t2 ��� . .- .�v_. �3 j�I W _ . i! a wi�h comply with such provisions or this permit sha�l 6e ���� TEL. STATISTIG�MSSi�ICATION ' / APT. CONDO. � deemed revoked. � .. � �� .�. �. COMRaCTOR Cal' No.850-1001 ____ . �Jv - _-_-- z . __ _ LICENSED CONTRACTOR$�ECIARATION � � - � - � ------ �-- �-��� -� -UC.- �-- Cl/+SS NO. DVhtt.UNiTS� I here6y ofiirm�hat I am litensed under provisions of Chopter 9 nDDRESS NO. , (commencing with Section 7000)of Divisio�3 of 1he Business and • IIC. - -... . SEWER MAP � ' Professions Code,and my license is in iull force ond effect. CITY COSta M2Sd CA QA55 B - BK � " "' " � -' 'VAUDAT�ON (� � �-� ' ' , $Q.FT: NO.OF NO.OF . CHECK • ::V U t1 U�7 " Licensa Number 409610 � i;�,cia„ B � SIZE - STORIES � - FAMItIES .� ONE�� � '� ��� ; , . .. ,, . _VALUATION. , .... . .__._._ �:• • o •2 . Bramalea Calif. oES�R�PTo� woRK PLAN 24. "E"' Convoc�or Date ADD g S I/ �� , - G •j ll,�i G� � �I am ezempl�nder Sec. ALTER ❑ . � 8.8P.C.for this reoso ❑ s - - ... .. • n�!! yl.��?-, REPAIR a��e: usE oF None oenno� ❑ 0 F 2 0-�G EXISTING BLDG. . .�$i nOfUre � � APPLICANT TEL ' . 9 PRIM George Vedel l Np HSO��OO ' FINAL O N R-BUIlO 0 ARATION DATE�-�/�-�'� - --•- v a � 3151 Airway Ave.,N, Costa Mesa I hereb affirm ihal I am axem t from the Conimc�or's License ,yooae55 FINAL - � - '�'� Law for�he(ollowing reason(Section 7031.5,Business end _ �-�Pro(essions Code): � - " �' -� vRE EN --By �C�������A � BUIIDING . . � I, as owner of Ihe property, or my employees with AD�RESS l: • • ° . •-�. woges os their sole campensaiion,viill do the work and ' tha struUure is not intended or offered for sole(Section ����TY , . , � o J f�[i� _. � i o�e 7044 56ui�es so d P�fen eodcCode).Praject(Se c .. _ D Q�DOR ...._"� ..-�. . lOint 5eienCo . .. . ._..� ..-•.,. . ��� '._. -- � C S�G o.s V�J � YARD HWY .. _ . . . - ..__. ... _ .., � -"CONSTRUCTION LENDING AGENCY Sei BnCK PRpP,LINE WIDTH . ' I hereby atfirm ihot thera is a tonstruction lending agency ior cRONT � � �� . • the performente of tha work for which this permit is issued � - -a.l. - -- - - ' ' �-" - - ' - - - '- (Sec.3097,Civ.C.). SIDE , . � . . m Toronto Dominion Bank -- P��� - - �- - - , I m Lender's Name • lpN,q Re1.M , ' � � •� P.�.F«s ��3•6 z., �.m;,F�, - � 7•sn � - lender's Address$a�Eranci sco f.A 9a1f14 I � .I certiiy Ihat I hava read ihis apPlication and state ihat the ._ .. . . .�S_�� ..- issuance Fee - �.�D-..�. ��nnn P/C N -- . . ,i `.- - �-- .. .' � ' . � obova in�ormorion Is cvrrect.I agree ro comply wilh all County invesrigonan Fea g ordinances and S�a�e laws reloting to huilding conshuUion, ._ ._ .__.. __-. - io�al Fee � ��v -- � -IDMA Perm:M -- � - �-� ��--.-� ' u and hereby avthorize represent tives o this ovnty to enter � , _ -_.. "' � m opon the a ve-men' d �o erty fo in lion pur osv�q ._ _. _.. __ �� __ _ _. . _ ._. _. . . _I --- ..._..-__ .. /11 �ti�l� " - - -- �.� , �: a ��VI/ SEE REVERSE FOR EXPIANATORY IANGUAGE . � � ��� y � _ a . �" . , . . -, ,. . _ _ ' '•�' ' ni I - . - 5 awreo IimMorA�n� Do�e .. ._.... _.. . ._._ ___ _.. ._ .. . . . . .. ... ..._.. __. . _ _. ._ . __. . _. . . - �.,, ,{. a _ o o- ' T � �O � .. .p.. .�� '"O� � O m ' . � o o� 19 n- ° a` ,� o �� � C o' � .. o �. ro,� '4` `° a v � t, o ' � � � �° O O 3 a �n '. '^ 'u'o � �. Cn� `° 3 �i'o n. �v -�, ✓_' C �p o . '° o �N � �a ? co e �- r j o °cr ? o 0 9 �c o�", o o_ 3 ' q ... n ° � m m ° f' "'°°^ 'D �C•. :o cc . . z S ..�.� ' '" ` �j �� ? :O '� � w� � �> > � o ' �O wl N L � 1_� N � ^� ± lp j N • N C M L r � 9 1 �� T Q°? ^ o � O � 4 '� , < �yp � e� � O 1 ' �^�, j � m o - . � C1 � l'p^ 1 7 v �' � M � O O 'Z .k a-1 � o g, o' '� n„ � � a, o C ^ � fA N l �1 0 ' O , {1 y� "C W ! l N � � C� � h � `, � � � � ' O p Q � �1 � O .p �J � ' "'� J M, vy o � '� \, 'o . o • ° ,` � • ` t 4 \/� .�. , � � O Q� M• � �6 � l � ` 7 � � � � � C � � � _ ` / � � .. . � � -' . _' . • . . � .. � _ , 'Q . �� ' . � . _ . �,` � , 1` � N r� , • . _ • z , _ �,` T . ', - �• ' -- 1. �, ; . \ . • ' ,� , � ' ' . � ` ' - . . � , , , , , . . . � � � . . . �, , . . �� , �. � . ,'" C--. m � — . ' ca-"c. � �D-c�o - . . `O F ^C�.n w� n,.^ + � N �{ �'a� �.C.'Z +.b a ie ��.. m � . - � p C'T O X 'JO ' J y �o'O .N �w r.[.O ' ' � C.O .._=� N.(9 c0 �G.y��p O . � L p � Q 1 -� a'��„ o p c a•5 �= N ve � . o^:..F a� c...f �7. ,� Q'`'� �'� � e� L-t » '° OKc`Y G"'^ ^ � J �C`^L n e�+ O � � � �" '„ � O 3 'j.+ ' !.'' ' �� .�. ^ �� O� � C ei _ `�' � � C ~�.. u� � �3�•�`�•x N C� e'`C-�. , . , Q , � w` N N.� `c � ..�-...i y �,F ,x ��o•�•o ^^.�^ m d m Cr� ,^„ H 7� C Q O . � � � q �=' O`^O � v�,"w in -. �G » y �....�.��SFF.D. ' � '� •, � �� • � ,,, � �,�, ^ o �`? � n � _ .—. a �op � �,c� c � i' '^.6.�., n.� c �.". oG � 3 N�,.��« N 4 �`=-" � � � c f N ?no� �' x� v�ac.^���c o m x n + m � �' k, ^��c �, : 'co o c��c� � c s c � c�. f x C x. �•C r ��.. .f'. 6-1: � ^ a ^ V p O � a� t?0 '�'3 N �' '.�..� �' " q =. n.; �p.C^ " ' :t . � A n � � c.p �,` C� � �•� F•'^ cv co'o �� o m+,10, � " � o �`fl � C) . _ , 3 a _ � �_•, c .. � �a no.� o � g» �, `Lo ^a� r' , - C 10 � ��o o � a-� �•��,C.F�° °,�co� �'.^ �'�•c:,b A���'' �. ° o qx ' _ 4 ° �'.^. "'" No p c.F,� 'O - �" ..�`?-� a � � a '° c Qa ��e � 39 - (. tZ/� ' N \K'..C �" i".v�'O ' �� O C",� 1 L,.,C� � G_L'....�,�����N.M 3 b � ?O � N �' '��� p � 'J ti c C -� " �C.,,e, Cu �G y �' V+•3'� " ,pe n C � c9 �' T N ��..C � �n,`+'� ^ a-M -s O.�^',r C��'�-3[ Z�..b w»C.n� eYa P � C N L •�.' ' 0 , n n t`� C'>> G Ct'�•3��"II"�C � � O N �..�".o m"C..y� G-G' 3 � � �+ , a � c,,,� 3 r c.^ � c_: e � �^ 3 a o s'a''o�'`°.,,'" ° A�,_ �+ N �-� e� C f� 'y � �� F -� L O 3'O ,"n ��l�:. '� �`«p w 'S ..Q O t+. v� �+�C ^ (C�.N C '� � � ' �7 7.w.Q SN C 1 �•S..`..^^�,�N(9 O � 1n G O 1 �^•V:C R'��L'C..i N ' ' �+ , � _ •..w ;,.: �,0 � a �'� � yC,i""nFw �w ���� ��X,� '^ •v � � f cP "� � o 0 0 .m.'c ,� a�Q ^ - °''•�- � �r-c� � . p M b 7 , (, C �C� T. �.O O .:.:,� ; . ,fD q « `w; ' O r iy 3��',�".�� n n-S " � .�„'�� "' C y 7 r �, C C ' / • (l -��t -' �..._ '� . " / ' O H � O-N � =� 'o �' �� O � ...-t (+ Q. . _!„�� . . , . ? ,�^�...� ��� • . N � __�� � _v .� ' ,