Loading...
HomeMy WebLinkAbout1107A 1108A � � � WORKERS',COMPENSATION DECLAR.4TION �•. Iinsureborafcertifca�teofWokesrtCompensatoninsurancef APPLICATION FO�R��--SUILDING PERMIT or a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY P❑olicyN�lGTIiRK4484Company �rFORD GROUP BUILDING ���r. �„7 g Certified mpy is hereby furnished. FOR APPLICANT TO FILL IN qooee�s--- � � Cerfified copy is filed with ihe caunty 6uilding inspeo- BUiLDING .f�S , fion department. ADDRESS 1401 S. Vt1LEVI�W DR. �ocnurr o� NEAREST Date �J�^Applimnt � CITY ZIP CROSS ST. ERTIfI ATE OF EXEMPTION FROM WORKERS' . _ NO.OF BLDGS. _ ASSE550R COMPENSATION INSURANCE SIZE OF LO7� � , NOW ON LOT MAP BOOK PAGE PARCEL (This sedion need not 6e campleted if ihe permit is for one USE ZONE MAP hundred dollars�$too)a�less.� TRACT 42556 BLOCK ior No12 No. ' ` 3� TEI� 1 SPECIAL 7' I cerlify ihat in Ihe performance of the work for which this OWNER g L A LIM T Nd��04� CONDITIONS �� �ISTRIQ GROUP 7YPE FIRE PROCESSED BY � permit is issued,I shall no�employ ony person in any manner ��������3551 AIRWAY AVE. SUITE N CON ZO�yE � ADDRE55 so as to become subject to the Warkers'Compensmion Laws. rO �� � T � �,TY cosTn r�s�, ca. Z�P ` � Date Applicanl STATISTICAL CLASSIFICATION APT. ONDD. �"` NOTICE TO APPLICANT: If, after making this Cerlificate of ARCHITEC70R TEL. � ' a;yotion, you should become subject to ihe Workers' ENGWEER AItt�7 BASSENIAN r,o.752—Z864 C1A55 NO- �� DWELL UNITS�_ 5"' 2, ��pensation provisions of ihe labor Code,you must forth- qpoRE553990 WL''STL''RLY PL. �F'17O NEWPORT BC . sewea nnAP � .wdn comply with such provisions or this permit shall be � -;deemed revoked. CONTRACTOR BRAMALEA CALIF. N� �— �OL BK. PG, VALIDATION � LICENSE�CONTRACTORS DECLARATION S g��IC. 'I hereby affirm ihat I am licensed under provisions of Chapter 9 ADDRESS 3151 AIRTdAY AVE. � NO. 0 61� VALUATION -`.� � ; � I �� `(commencing with Settion 7000)af Divisiol�3 of Ihe Business and ���. S �� �D O .Professions Code,and my license is in full force and effect. CITY CLA55 ► �:)e m e �+i� . SQ.FT. NO.OF NO.OF CHECK License Numbe�+O9G1O Lic Class R S�Ze 1637 SioR�es Z FAMILIE51 ONE � W���(�,� S �Conifa[tof BRAMhL�A CALTF. oate�� DESGRIPTION OF WORK ZZ CR NEW � � � � � �; - ADD ❑ ,`/i .. '❑I am exempl under Sec ' ' AITER ❑ PINAL �1�����'��`�� B.&P.C.for this reason NEW CONSTRUCTION REPAIR � DATE J'�� �/(r � Date: � EXIST�ING etOG. NONE DEMOL u BY AL Signalure_� .�—� � i4PP���'"r BRUCE L. ABSL+Y rEi. OWN R-BUIIDER DECLARAiION PRINT NO. — OOI. ' � � C rC A. I hereby affirm that I am exempt from the Comracror's � 3151 AIRWAY AVE. N. COST A�C . , ti e = �� j ,Lqw for the following reason(Section 7031.5,Business an ADOReSS � g � `.Professions Code): Y P SENT � �:G � L �('� +: BUILDING :6� I, as owner of ihe property, or my employees with ADDRE55 � p : f �, ` ,.. , � wages as their sole compensation,will do the work and ' ` ��•�- �= fhe sirudure is not intended or offered for sale(Section ��ALITY �-/� 7044,Business and Professions CodeJ. MOVING TEL � ��L["<< .�p(� I,as owner of ihe property,am exclusively mnfracfing CONTRACTOR NO. , `�'� wi�h licensed com�actors to construct the project(Sec- tion 7044,Business and Professions Code). A�DRE55 REQUIRED TOTAL SETBAIX FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YAR� HWY pROP.LINE WIDTH , � I hereby affirm that there is a mnshuction lending agency for FRONT the performance of the work for whith ihis permit is issued P.L. �Sec.3097,Civ.C.). 51oE P.L. �ender's rlame TORONTO DOMINION BANK � 11�F SANSOME ST. SUITE �OO � v.cFee$ ������ Pe�m�1Fee 7 -�� = lender's Address vn nrrn na i ni � o�,'�-,-�a-aQ��6E9>zff��rvg ().S?J I certify that I havenread rhis application and state that the Issuance Fee � a above information is correct I agree to comply with all Counly Investigation Fee � � ' `.� g ordinances and State laws reloting 10 6uilding construction, Toial Fee �� � and hereby authorize representatives of this Coumy to enter � upon ihe a6ove-mentioned property for inspection purposes. n `�G `�.'�,�,sY ,p nl J �,—'/ '( � n �-�_i..M� .d 1� p SEE REVERSE FOR EJ(PtANATORY LANGUAGE Signa�ure of Applicant or Agen� Da�e �f � � � 3 � o e °�Q � �' Q � o �o !_. � � o f�-a � =,,� � � G) �'' a � � f� I � -a � m'fl Y N � s ' �- � � i � � � a-fl.i � � o � n i � �? ° � � � ° i m � -- - a o ,p i n N X m(J ,G i Q � �i �y � O � O [D � � �� � S � � 7 b 'Sf _ .� ....� � O c � ry p s s � � � I I Z9 Q i �3 C i n � p O 3 @ S- � -� fl c Cl7 4 , N �. � o 3 ua-, o' o -G c m � °� � � I ; Q a', I � I�, Q i fI 3 � c ci. � �. _ 'r' _a � i ? ' � �� � i p I � � � ^ � j �G � � n I f5 P �I �� � � 3 4 �o I I � v O � I � � � ���..,,�;.,.._.� ��_`' _� __�f....._, �. 1 °- � � € � � � --� ,. I���� � +^�, � � - � � i -- — --- I � � ! , � �, ,�..� ��-;.�� �� � - � � � � ,�, �,;�. � � . � A � �� _ _�!.__._.__ I ! � � � � - - 1_ _ , _ �-;, � � -, i �- • � � � � � i � � � � #k � ^ i � � i m 3 ^ � en .p I � — .. � O �S � � 2 3 � �P_.. � ,, � � �' � � � P � � � -_�� I � � ' �_ � I ��.J 0 � I' i I � � J � � � � f ' � � � I � � $ � � � � �. � � � �.� � � < t � . 1 , � .. n I � � - ° i -- --�------- -- �— , -- � --- -�-- —.- -i---�— �_ -- � -- - e — -- I_ � l 9 � � � � ( � I , � � I � � � , � , � � � j i , ' � , : , � � � a � i ; � 1 I � � ! i I � , , , , i � i � I i i � _ - W I I` I i r^_ i. � m I n � � � � i = - ' ! I - � ' f � i I � I �. �. �; i - . �. i . � . i � � � I � _ __ , ; � i � � � � ; ; � I � ► _, . ; i , . � � � : , I � � . I _ . �, - ; ( ( ! I ` I I � � � � i � I i i i I I � I � � I . � � I � � -�`� �. : I i , ,.:� � `° �','r� � � - �. ��< �'� - o ;•�:a T€ - '� � �;��:.�: � - �_� r - '' ( '� V '� `,s-o� `-� ,� ^ � `^N A s � �-3-� ^ "c� :Mo (� �3.�-s v' [j,a m v ry °�o :: � � , �a a� A.� a � A �� y � �- � _ ' . i _ — � .. f� ��., C.� _' �_T t V �``:'�.h �.�' fC I �,. p `n � � S,]'- ,�; ��a,� � �o � �^ n N _ 1 M' �`'q O� .��•� ^ '� �' I 'j.-' � ro ,�.'...a a — p N "'O � �a` y w C C1 �'• .�' n^.,`'�F n�� � A � v ( I'.' I � ! f , 3 ^ u"��:_ S�3 0 0 . �.'r+ -4 '�s' � s o � ? a n��,,� �, ^ � � A. `c, Q..� � 's m :, v � o �c � N � � . � s ^' •�; i � • p w � �, 'r'' cr� o �,�, 'L'� � ':.� S, �!A ,;.'ty -°,�. I _� , � o ,� c� 3 a ` h^° P� � '� `, ti N � �o C7 N w o' a � o�� ,n �.I- � n � `^ s °-� p� o'�x � �".•^o o m � a � ;• � ��.� n ^""�°�, � � y 1 = . , � . �� �'� .,.,, �.�x � � 'z � � o ��" k � .0 � � � `' F �-.-� .. � � `;� "i � x � "` 'Z7 � � �c o �.m :� =e -, m° C �n Q �' '� n c. �e -' s c,�, � " W � �- � �.��� �--�,y a,'� � • � � �' � C A �•,�,���O � � �n q �y',�,�� y ri.� �p � �',w ,� w�A Cf,y, y ^ t"' �._ ' �..! ( cn � ° x cr_ r ° � c � � q � H � c�a� -° `.:`^ `��'�,� � � ���i ��` �� 'Y I � � .��° �'` � " -o ^.C V �m �� � ° C� ° � � �.'� _^ .. � m �C I . Y' � � � r M 2 � z y a �.c•A�`a�a..� � � f x ` � ( e' � ;( �� c � �h A' �m �,o � �'n m � ��.^. `. `�. � � � G � � � C �"� o ' � � � � ap3�„m� � r• ��y����� ���� C� -a � a� R,'� 3 �..s��,. � W �'� m � o �..n ? '. d�' '��.�.`� m f � _ � i I r.s � -� ' A �J�s '?. c .`^�i,��, 'C' f;2 . ��a~•,A � � C m : � .W Q -a'D I ' i � O !� ,��:.o y-� ? a,;c��,.���� x �o� €",: n �.":� 4'� � �;y'`o � � "a � 3 � ..,�, �c p c. � � m �,�," ;a � p-oq' � K -�: � - I . I � � � I' 'D � � m � , � o �y O n a s3 n�� s ~ s � � o � 1 i A � ti �7 a m �'��o: �� � m �p v � a � ,�„��`" �,o ^i �o in� v v n o "K 3c o H c:� � n i . � � I cl .z,. �� x °.� 'b S,� . N w�a.a'F -�c � o� �� `,Y O �„� n o :� O��-. �a n Q O A �A �. � C N'n � � �O W���..�� � �L 3 I ' �....�.., i � � h � '� -3. � 'J `.3 t A�.cj Q r�'V F N �P � „ u� �� p �` �Q I N .. E: r`- D � p ",�e. O � �^� A� � �.�. �w O�,O�c� ^••^u 0 f � � � . 1 . � ���.;�n n .t � � . :� 'R'�0 .'_�-C�T ~^,•cCtj�� �, � .7 „'v.v° N