Loading...
HomeMy WebLinkAbout1163A 1164A , WORKERS COMPENSATION DECLARATION � � Insurebar�afce�tifca'teofWorkersr'Compensatwnlnsu�ancef APPLICATION FOR BUILDING PERMIT o�a ce�rified copy thereo4(Sec.3800,Lob.C.) �OUNTY OF LOS ANGELES eUILDING AND SAFETY PolicyNo.�7y�A�mpany Nar+fnrri �rnun � � Cenified copy is he�eby fumished. F,�R APPLICANT TO FILL IN qp oe55 949 S. Whitecl iff Drive � Certified mpy is filed wifh ihe munty boilding inspeo gUR�ING g49 S. Whitecl iff Drive fion departmenf. AD�RE55 oare 7-24-8� ApplicoM Bramalea Calif. aTv D.B. Hills ZiP ��cAUTY D.B. HillS CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEARESi i�� COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CRO55 ST. { (This setlion need nol be completed if the permit is for one 42575 � 4 ASSESSOR � hundred dollars($100)or(ess.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL I cerlify thot in the performance of ihe work for which ihis OWNER Bramalea C.d�lf.� Ine;.;`o. 850-1001 U5�'}�E NOP �/ ,�,�j� permif is issued,I shall nof employ any person in any manner 3151 Ai rway Ave., N ��� SPECIAL O' � so as ro bewme subjeci to ihe Workers'Compensation Laws. /ooae55 K.,d�'1Q El COnlDiilONS �,TY Costa Mesa Z,P 92626 � Daie Applicant � �' '�710E TO APPIICANT: If, affer makin Ihis Cef�ifiCale of ARCHITEC70R TEL. DISTRICT GROUP TYPE F'RE PROCESSE�BY � 9 ENGINEER Aram Bassenian No. 752-1864 CO T. / ZO �emption, you should bemme subject ro thv Workers' 1� �� w �;ompensotion provisions of ihe Labor Code,you must forth- qDDRE55 1"� P� 1 � �-J �V 0. wi�h mmply with such provisions or �his permit shall be ie�. SinnSiiCa�CUS51FiCA710N APT. C N�O. VJ deemed revoked. �ONTRACTOR U�B NO. � � LICENSED CONTRACTORS DECLARATION ���. CLA55 NO. a� DWELL.UNITS� , I hereby affirm thot I am licensed under provisions of Chapter 9 AODRESS NO. SEWER MAP (commencing with Section 7000)af Division 3 of the Business and ���. B Professions Code,and my license is in full force and effect. � CITY � CLP,SS BK � VALIDATION S4.F NO,OF NO.OF CHECK License Number 409610 i��.c�ass B ` size — sroeies Fnnniues 1 ONE � � VALUATION Q/g DESCRIPTION OF WORK NEW �c.p Coniroctor Date SFR App � S ��tiv , �I am exempf Vnd@r$et. A�TER � -1 t L�}; PLAN 23 p s 11'�i1 �(oC� �t� s ° '2 1 B.BP.C.for ihis reason RE7AIR Dale: USE OF DEMOL ❑ � m(,Q �,y f EXISTING BLDG. Signoiure � APPLppjNTT Bramalea Calif. No850-1001 FINAL G 1 7 ,� �� [ OWNER$UILDER DECLARATION .li DATE �'���-Z/�` "4''�' - �" Ihere6yoffirmlhatlamexemptfromlheContractar'sLicense - 3],rj], A1T"Wd AV2. ItN COStd �@Sd Lpw for fhe following reason(Section 7031.5, 8usiness and ADDRE55 Y � FINAL ,(� ��%�"`�i � Profe55ions Code)' - PRE EN BY ������� � 6UILDING 1, as owner of the properly, o� my employeas with ADORESS wages as their sole compensation,will do the work and ' ihe structure is not intended or offered for sale(Section LOCALITY 7044,Business and Professions Code). MOVING TE�� �' t (�,[�A � CONTRACTOR N�� � e � I,as owner of fhe property,am exclusively conirading wifh licensed contractors ro mnstruct the project(Sec- ?;" • s � tion 7044,Business and Professions Code). " ADORE55 CONSTRUCTION LENDING AGENCY 5E BACK YARD HWv T�TAP�SE�TPACNEFR M WiDTH I 9 5 y��'U U I hereby affirm Ihal ihere is a consiruction lending agency for fRONT h -�-r�r� i: -�he performonce of the work for which this permit is issued P.L ^' '� ����'*+�' (Sec.3097,Civ.C.). SIDE � P.L. li:5.L�`'`�S'I �ender'sName Tnrnntn �nminion Rank � San Franci sco, Cal i f. P.G Fee s ��i`8���mit Fee `�584� �DMA Ref.# Lender's Address 75.00 1�.5� ' 3 I[ertify Ihat I have read this applicafion ond stafe ihat the Issuonce Fee LDMA P/C p abave informafion is mrrect.I agree b comply with all County Invesligauon Fee �7 ordinances and State laws relafing to building mnsiruction, Totol Fee �/' �DMA Perm.M ,, and hereby authori repr sentatives of this County ta enler � upon�he abo e tione p o y for i�specti�n pur ses. � iq (✓ � � �� $EE REVERSE FOR EXPLANATORY IANGUAGE ��J 5 gnalu of Appliconr or Agenf Dot � " ' ' —.-..__._ ...._..._.. .............'._ .... .� '� _._ ,._ ___ .... _ � .J.. _ �} -... �1�.���'t, e . - � ` , - .. . . ;... .. ........ ........ .`.... _.. _._ , ...._,�.. .. __._ ....,..�.. .. ......i.. ....' __ ....... _ � • ( � . . r � � :' � . �s, " r� : . . e f. �� e `�"�i , ' ) .. � ( _ ... ' .. ... , ' . .. _ � . . , � i � , � i �' ;.-�_ � g ( � � � 'T : ' _ � 3 \' � � j .b 3 ( E; ' � `_' � I �{ ��� � , J ; ., � � 1 : I ) . � ( _ ,� ' � � _ _- :i 1 I .." :x � � �� Y �� 1 �`�. F�- � r� ;�;•' � - i; I: � { . , ?. . - _ 'I " � ��` 'n �\- �� , . .3 i .I =� � � . '�,I ( t�. ��" f ' � l� �p� ,! a � � � ` , � ' ' ' ! , ! b ��.f� � " I � ., 'l 1 ' , q i. i cD , � • i _ j .. i, � • �� J`` E � , ; '� ' � t i: � 3 , ( i � , : :: : . - � ' � ' i ; t i 1 � � � ; : � : ; �� £ I . , � , _ � �o : '; �; � r_...........:..._.. -i"...�............i....... .�..�_._. _.., ..._ __.... __ 4 I � i ' ' ,ii w � i , �: i., ' . .n..._ ...' , � �,� -.... 1� . ...' � _,�...__. � . ' € . : i i i i ;� ' 'j��(� V � f f\; Q] ;�` : :� '..� �, � i � ` . 'j � � i� 3 � . � 1. . M� +."'��`� � : `•`�� '� \�.. � I :t `� f � I . . . .k 1 . : � :i i r, ... . . 'y� �` �:� . ' � i�' . �',, '� .� -�.�^. : , � i . .. � .�_, : � ,��� : .... -.-' . a ..... .. .. . .....__ _ , !. ... __. . _ .. . . ._ ..i_.r_;�_.� .._F. %i� . -C. ; i_.. l �� ; ; �.;� � :'�• �;: . � . � ��� � ..._.. ,{Y t : !: + , y� � � �: '�� ' i ,i f ,,. � •r1 ' ( ' �`' � � 'V ; '. ? � ! ,i > , �, _ ..;. .. _ _ .� . � ;� , � . .� : � � I y . : : . ... , � , � : ;..._ ....;_.._.__ .._.._�..___..._ ___... ._ .._... _.. - -� : ' 1 i . � , .9'. .......... ......p.............._..... . ! � ( .� ' t �� ' } � � { i ✓8 f � ' � � ...�: ; � _ �' � • ' � , : � t ����_ ' � � �I l'4 _.... -' '_' ...�.. . _�. _... j...-'-".. __. � _,. (_ ..__ __.._� ..__..��._� _ : li ny �: , : � ,^ 5-�� ! �! .,.� -;�� �i 4 , 1 I _.€ _`.. I, 9 � ;� '' -�... ..,. _�_.. , .� .,. # . � fi.:. ( ° � ; �� r , � i �� i :? � ? ; � : � i�" ° I < i� ' � ;� 4 � __ ... � _ ' --�^_...... . ........ _ ' ...- --•-� _. i; . ; � ., � . � : r ' � ': 1 r ;i C :r "r. �., �.. � _j_ , � , II � :; :; , , , � \ . ` , E� � ' f �.... . ., � . ; , � � .. . �.... ...t. � _.�.. ., .} � � i i i � , � ; , . i . ; � ; ! I � ; - ' I il i j I� , ' � ' � ,: I � f"p> : . ' : i �� : � . '' � � I �'-,. _..._.�-� IW_._..�. �� ° � I � � I � � W� l i : : � �� ;; 9 ' � � ' � ; ' gti �, � � ;; . , j ; ; � � ! i �- �P [i � � � , ; C { -'� � I � ,: i d � � ; j ; ; i � � i. � � � j ( � � : �t' V cN', � '� ^�" � ' ;° ,� i � I I :, � � ` ±i � � ; � � � � � � � � � �� �s t � f � � j 4 { 1 ii a �' i ; � i . ' . ° � � ( : � � _ ' � i I � � �., i j� j � ' : � R . ' � F ` : : � ' i � , � � ( 1f � � 3 : _ . P.._.__..; ..._.i__. _:._.,.�_... .. _� ._ �. � _ .u ._ ��___ _ _.�i .. �i,�___ _ .. � . . _ _ ... ,_l_ -- - -- ..W _ _._ ; _. � � ( � i � ; t �_ �. -�E g-� ..r.... , j _.e� , ; ' ,� , . � , . � r � � : , : . , . ; ( . . � � , � { . � ' � � ; � : � ) . ' � I .'. '.. � 1 _ : ; � : . . : it � . E _'.� � J .�.,� a�.. :, _�.. _ ( � ; r ! 1 ` • � � : � � ; j + , , r � j j• � . , . ' � r a � . 1 � ` I I � � � � � � � � i � � i � � 4 F � � � � � � i ' ( �i }. i � i ? � - k . � � � � ! � , { � 3 � 1 � � � � � : I : ; i ' ` I � � � J� i ! ; : _.) j � ? i y . f 1 I . ' I ` f � � � � i I i � i i '{ + � , t �� f i � 4 ! ( ; I j i i 1 i � i I � � m a , £ ; i � ' ' � f , ; i i ' ' ' � + ` �, ; � � � � f �i i j j i � � � j � . � � j � � � 3 � t _ ' � j ,. i � � � . � � � t.' : ; . j i ' i � { j . � � ' � f ! ' � . � ; i._ t ' l � i'".3 � i � i � � I � ' � � .( �� ! � �{ � , ' , i I � • , � � � � � I 1 I ) ( t ( F 1 � _ I I I � , f ( ' I � 1 € ' 3 � 1 � � � I � € ` � � � . . + � �� ! I f � � , � i I I � � � + I ' 1 ; I ' f . f i � i i I i � � i � i � i J �.x^� - - � � i � i i � ' � � _j � . I , i f i i .� i i ' . � I � � �.,b � + � � i : 1 . ` � � . � i � i : � , i _ � ( ' � � � j j � ' i . � i i � � � i i � ' ; ; I � I i . - � � � ; i � � t � � � � . .i ; i � i ; f { ; ; ' � � { ' : i � �, ! � { s i ; ; , � ' " g , } I " 3 [ ( � { � ! { ' ; ' � i ! I � � I � i r . € � . � � i � j � � � ( f � � j i � � � ! j � j i � � i a ; � : { ! � ! i � � � I i � i [ � � I ; ; ' � � € . i , i' i � � I 3 . . � ! . � ' ( s � � , � , � i � � fi ' � � ; i � � t ._ " " _ � �. ; ^^ �;, . I i � € i , ' � 1g (`ry � � r r�;��� - ` ( � � � i I i (} F il '` � 4. .. _ � � t s,r. � ,. ,� ! i ! ( � i � "� ) I � a (.�+ . V . v } ry � _ �. y � tl�✓ � ' f i , E � I I ( ,.`� $ } c` 7 , , � ,. ( � ; ! i I ; i �L= j ; _ � ` tiu .. �� .. • � i ' � � � � � ��; � �. .. � . ;� � . � � �� - � ( i � i � I I`��' � ± ' ' ' .. e.. ... ' :� S X ' � � � � � � I 1<s � . i� ,, c: . � < � "� ,. .�• '�y�'� „ ., ;� _ � ; I - . i ; ! � i 1 ' �. � � ,, t• .,. � j . j i i I i � �;� i ; ;• Y , w �:, j� a - ' , ( � 'I � Y � � Y l � q .. i; i � i � ' '� i � � � x. . , ,. .. • ��...} :': �: •.. f k . f � 3 I i � �< ., � � I � � � � i . ' � : .x ' ; _ - „ ` � i I � � {, � _ • ' � ? i , � `� _ M.:.. ��� . . ; ; I ; �{ . �- . . . . , _ : ... . - _ � � � �� j t .. . �_! _ . ? 3 ' : : I i^� gi ; t . . ., >t • i ( ` � � � � , j I t � ' , . .. ., �, ., � �~ .. �F�v � . . .. ,. � ' .. ' ^ r < < . .. . .� .. , E . ,..-:�ixaa,., ._�_.. _ �._.,.__.,�._,._'_--_____N.._.__.�._�.�.__-.__.n!`� _ .