Loading...
HomeMy WebLinkAbout1157A 1158A i ; WORKERS'COMPENSATION DECLARATION / I I hereby offirm ,ha, � ha�e a mrlificale of�o�5e�f�o=e�f APPLICATION FOR BUILDING PERMIT ' II insure,ar a certificote of Workers'Compensation Insurance, I or a cenif�ed copy theraof(Sea 3800,tab.C.) COUNTV OF LOS ANGELES BUILDING AND SAFETY PolicyNo61WBMX7 Q'�mPa�y Hartford Group � Certified mpy is hereby fumished. FOR APPLICANT TO FILL IN BUILDING ADDRES$ � � Cerfified copy i5 filed with fhe coUnty 6uilding insper BUIL�ING � �iondeportment. a�oRe55 916 $'. Wh1teC17ff Dt^1Ve I oo�e 7-24-87 nPPr�o�, Rramalea Calif. c�Tv D. ziP iocAutr D.B. Hills I, CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST � COMPENSATION INSUP,ANCE Si2E OF LOT Now ON LOi CRO55 S7. � (This sec�ion need no�be compleied if ihe permit is for one TRAQ 2575� BLOCK �Oi n10. 15 � Y '455ESSOR 4 hundred dollars($100)or less.) /saP BOOK PAGE anece� TEL. �q,,�� ,.! I certify fhol in 1he pertormance of ihe work for which this OWNER Bramalea Cal if. Tn .No.85D-1 �Jdfi�E NpP �� ��7 permit is issued,i shall not employ any person in any monner 3151 Ai rway Ave.� '�N �7�7 SPECIAL � so os to become subiect to ihe Workers'Compensation Laws. ADDRE55 ac{�(��r� CONDITIONS ry c�rv Costa Mesa Z,P 92626 � Date Applicant � ' TICE TO APPUCANT: If, ofter makin fhis Cerfificate af P.RCHITECT OR TEL DISTRIC7 GROUP TYPE FIRE PROCESSED 8Y O � � g ENGINEER Aram Bassenian No.752-1864 ��� � U i �mption, you should become subjec� to the Workers' �� � �ompensation provisions of the Labor Code,you must{orth- qD�RESS �� d� � with tomply with such provisions or Ihis permit shall be LL deemed revoked. TE�� S7ATISTICAL QASSIFICATION APT. -CONDO. (!) CONTRAQOR O�B NO. _1.f � LICENSED CONTRACTORS DECLARATION i��, CLASS NO. �� DWELL.UNiTS -� � � � I hereby affirm�hot I am litensed under provisions of Chapter 9 aD�RE55 n10. � (commencing with Section 7D00)of Division 3 of the Business and ��� SEWER MAP � Professions Code,and my Ilcense is in full force and affecL CITY CLP,55 B eK � VALIDATION � 5�.F �NO.OF ' NO Of CHECK License Number 409610 lit,Class B SIZE�- STORIES 2 r FAMIUES 1 ONE � � VAWAT� Contracmr ��B Date DESCRIPTION OF WORK NEW s SFR ADD ❑ t �f ❑I am exempt undar Sec. ALTER � ` B.&P.C.for this reoson PLAN 25 R � REPA,R ❑ S �`��� (J :j ; `a.7 A �ate: USE OF DEMOL jE E%ISTING BIDG. � i Signatura APPPRANTT Brama1ea Cdl if. No 850-1001 7 � ° , � »2� FINAL OWNER-BUIIDER DECIARATION . DATE � /I � I hereby affirm that I am exempt from the Contractar's Licanse ADDRESS 3151 A i rway Ave., #N Costa Mesa p�Np� x� r a�� J� 5 Law for fhe following reason(Saction 7037.5, Business and P ak� I .).(J<t Professions Codo)� 8Y .]�.�,,ti�.,- BUILDING � � I, as owner of the property, ar my employeas with ADDRE55 �j�;;��c«.s� � woges as iheir sole compensation,will da ihe work and ' tha strocture is not intended or offarad for sale(Section tOCAIITv 7044,Business and Professions Code). MOVING TEL. � I,os owner of the property,om exclusively confracfing GONTRACTOR ND. with Ilcensed contractors to tonstruct the project(Sao- qDoaEss '=1 1 5,E F� tion 7044,Business and Professions Code). CONSTRUCTION IENDING AGENCY SEQBAdc �ARD HWv T�TApROP.LINE WiDiH F{ e o e e e � I hereby affirm thot there is o mnstruction lending agency for FRONT � � a 7 0.`:.b 0 the performance of Ihe work for which Ihis permit is issued P.L. � (Sec.3097,Civ.C.). SIDE T � Toronto Dominion Bank P` 0 7��5��U � lender's Nome I m � . �..3 .�.y� LDMA Ref.M ; �t�$�C H`�7 Lender's Address San Franci sco, Cd�1 f. P.0 Fee 8 , ��mir Fee I o I cenify tha�I have read�his applicmion and s�ate that the �5.�� ,ss�a e Faa 10.50 LDNJ+P/C M , � � above information is wrrect.1 agree to comply with all Coumy in�asf�gm�ao Fee � o ordinonces and Si e law relati to boilding construction, iarol Fee �'�7�-� �oMA Perm.p � h and hereb aut on e re se at ves of this Cou ty to enfer � a upon he ov mion r p ty for inspectio pur ses. I ` SFE REVERSE FOR EXPLANAiORY LANGUAGE � � � Si nat�re of Applicont or A nt Oa�e , � � � -,.. . ., ..._ ��'� �._ .i. , . .. _ . .. `-_� i. T � � : I _ 1 ; ,� i , 7 ; . 'C�� �' :.�- � t i i ��r... ., .. F . .r " 4 I j � � - , �, , � � : _ .. ...-- -– � ,. ; ` � � ' � ! � � � � � ;- i� � � � ��� ;_' - _.. .�. # � ( ., i .� t _ � ;i � � ... i � , ', ! ' ' � '_: ��� > > ' . (� "? � j i a � i � , :; � ., I ; i� I : i �. ` ' � , � . i ; , � } , , � � i 3 j ,. � ; ' , i i ;g ; �'�°i �e� �_ - � i 1 � � I { { � � } J' r . I ,i r ; I i,-. 1 i �.�. � i ' _ ; � � , i! i � ' � ._ - � :" � I � ( I, ; . i � ? . ; : � � � _ � � . � , � , : : . ! ; �y , : ; : . , ; , ; , � ..W..�_ ._ ._ _....._ .._ ._ �a_..__ .... _ . __a_ _ .__ . , _ II � � ( I } i ; i � f 'i� s ' � � � � Ii 3 � jl i � —� ( ,_` , t �.iw.�;�. ,> , , ' i ' '' ; � � , : p � i � I � � -� .,� , .�.�� � �+�.....'` �' �C'���`�` �' I t ! � - � f '� � i �� ? �� '-` —, !�, E i t �� \ •., �'' . < `^� � ; \ v. '�� � �--- - ;-- - •--� — -- —.l . _. _ i� .. , � _.. ��- ----�; . �--- '�...:. ;° �. _�..�=' _�. ._1 ' . ,;. : L_ ° �` � `„�-G\ ; f -�..--� , \ � �� .. � � ; j,� � ::a�� ; ,:� � i � '� � i � � I I:. ., ! � •v � ; ;� � '� � ` � � � . (�� €....... -- ---fi --� 3,„ , , _.,...y...o-...___._.a.___...�......._.. .__._.,......_ .... ..�.�. .._-. . ... ..... _... i _..._ ! Y „„ € f �� V ' { � � i i � { ' t � � _ k ' � � � � �. . , �. . . _... _.. ._ _ . �-_'—_ -____._ __. . . _...y�.— � t �. .f. .'.,�"' . �,�V�� ' � ; .�`� i € 1.. �_ _� i �.. �_ _' � � � 3 _ (I. rt �'�� � � F , ! �r '.� � � � i� � � I 3 I I ( � � ,I � � � - � �a � � �� � ' ', � 'y f i S : f : ( i{ �•. M k ,,. ' � ' '^ i � �. _'_" " __'"_' _"_' __" _ ....__'__ _'"".i__...}_._.. .""_i ._._{q.....�.__ ..,.1 �+ E h T I i... '� � � { ; � �{ . � ' ' �1 ! ; .. I 1 � 4 � 3 � r i � .: � . i , ( {t ' { .�_ .�.. � _f. . � � -. . �� � ' � i � . I �: ( { �' — ' �' --�. ... � m .« � ! _ , , , ��. i ' ; ' i , ; : � . .� � �z t-'..... ,�, , € S I �_ .I�� i £ 1 � '� y � i � � � t � �� � 1 � � I� �� � '� � � � � '' i I � � _i "� t �� I ,� I # � � ! I! "� .� } y ' F� �" � � j � � '. � � � . I � ! tt 's � ;{ � � I ' �: � � i i � � � ! �i ' � � 1 �� r � � � I � ' � � I ( ' �� �tD � ( 'j � � � ( ' ' ` i ' � ' € j� � � � ! ' � i� �' � _ . . , � ; ; � I � i 1 ( I � � , . ;. . r-___,_....__.:......._.._,_. ._ ---..........._,..,......._..__. .>,.........._,..... __ - --- --- -..... .�__ .._ --�-_� __ _ -�__--- ..._ _ .. .... -- - .._ _....- -- — i �' , � .�1_ ,�.. � __.� � 1 , � � __.� � , i , , _ I ' r �-.. _.�. �_ .�..._.. I , , . : . ; � ; �: z...� t *. I i i a � , � � . , i � . j � � T.. _..�.. i � � � � ' � � � � � � I � I � � � ' 4 ' � _� _r � _ � � ; { � � � � i I � � '_ � � � � j � � � i � i i ; � � 1 1 -� � ` + ' ; .i ` i � I g i ` , �f i ' : ` ; � � � � � ( } ` ; � `j : � ! � k , � i 1 � i i f � � � � i � f � � � i . i i � � ' ! E I �t ; � i ; i i � � � � � � � � � i ;' j � � �' i ( ; F � i j � , � : i � . ` ; i i � � , � ; f ; : i € k 1 � . I � { ! ' � I � I 'f: i i q € E � ( � I i � � � � � : � i { � j � i ' s" ( i ' �! " � i" � � � i � i � { � [ � ` '-'� � � � I ( � '` � ( � � � ( 3 � � �wi i : ; ; � , i _ � i a j .. .,f � � � ` I � . i '� � ; ; '� : ; �8t` i i � � i ; � ( i i + # � 1 { �� t i i 1 � ( _ ' � '! � j i . . I j ` i � I � [99 � . � � � � , ' f 1 � � � . � � ( i � � � �- � i � . ' i � �� i i � i i � ; , k � ! j � E ( i , � ; ; - ± � � 1 rj3^-� j ' ! � � � � i i j � � E � i � � � ( € � � ..� i ' -�1' � 1 � R�•k� i� � ! � ; a � : ° � C j � ' � ' i ; ' ; � _`�' � . . � �,� ; 4 ? � ; ' � ; . i � � ' � � - ! � ' � `� � � � j � ; i j � ; � i � + � ' '' i . � � � � � � ` ; .. ! � � I � ; s , � ; , � ; ; ; � � � , � i � I I � ; , �; � ; � � � ; F � � � � � ` � i t ( � � � , � � I � � � s � ! i ' I � � i j � j � ; i 1 i � 3 � [ . � } . � � � � � � ; i , j ° i , � ' _ � i j � � � I E � � i ! ` ; ; _ � j y y � � � i ; i 4 j � � ` � � I E I � ' ; � � ! j ? . F � i . . . ' 1 � 1 � I , I 4 � . _ . ; , E � � � � � � ; ; � ; ; � � ., � ;��.:y :�__ � -_ n ,._ ��� � . - � :� , � . ; ; � , , �, ; : r :; - . . , M. � j j ,, , s � � �� ry a,,� . ,. a. „ :. ? �! ' ,�S '� _ r. - t � ; i . I � � Iro ` �, • � n '�. .;�` ^o q fi . � ,�,a -., c { � � !. , ' I ; - _ . ., _ � :i �' :. h: � _. .:� il.-' w: _ + � I � � ' @� v. , ' • y'� ~:� " rv �:�, � �P". ', i 4 � � � t � � i Y '� . ..."y � w r .., ' �T, .. , °,. ;.) '.., i ( I a � ,"�'' � ` - ' �q" ( ( i ' ! i . m ti : '; �' : .-``� .l,^» � ,' �w , r. � ; � � ; :. � � � � - �, z. �' = w � = � �* F� �� _ `� - � � .( . i ( � k � "N � w' �' •� � � .�' _ $: ' , } � I y ! ��_"� � j .. ' � [`'-O . S �' 4 . .. e . ` _ ,. - I i � ` � �s -; _ _ r ?: .. =' � '` �. .. - - i ; i i ( �-aa ( 1 a. �;„ _ _ 's :; � .. ,, � t � ��� � .°� _ ;� _ - , „, ��: :, I t � . ( i cn � :y . � ` � �.. .. . o, .. - � i ( { 1 � � � ��� � .. - . . , U � _ .�, i `.-..s .., j � i $ ; � i rr` i � �� � c p: `� . . '� _ ;, t i i i i �„,� k j �^ ..� Y � � � ,. { ( i � ' I ' � t 1 f i `,_ '� y m . . .. `G _ �^'� .. < < � , � i i j;�� ( I - G:.. *i _ � . �e . : � ; �I' j i 1 � . � � � .. c q ;`, i, . _ 't y _ ^ _. .. . I � � � � ' � � 3 "'� _ c:, . � �;.:, - ._ :.. p � `�, � �' . . c�` .y - f + � � i t � - .. .. �' ':� "�, ,ro . ,� �. ` �^. C: a � .; . E , ; ' G � � �' � :�: -� �'� � . � , ' �-`_ �. ,' ;: � i i � i I � � p ,r; - ; "� - � •. , Y � �. � a 1 V � � � � i � 4 < � -• _ _ � . ;�: - _ � � i 3 � ' � ' ' � � , : � '' 9 , - 1 i ; i � i j '^, g y ; - '' s r" � ' € � ! i , � f C � � .� , _ w .. ' ' . .. . •' . .. • .. <. . .. _. . . ., , . .. . . .. _ . ( � , 3