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Home My Public Portal About10815 FREER ST_Building__ i ' WORKERS' COMPENSATION DECLARATION reiiaffirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T ' insusu ore, or a certificate of Workers' Compensation Insurance, or a certi fied copy fSec3800 L�) COUNTY OF LOS ANGELES BUILDING AND SAFETY , Policy N BUILDING I t ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the countybVilding inspec- BUILDING 1 e� q)-7p ADDRESS / ! (o U Dateion dep trpent. f IJ CITY If4l ZIP LOCALITY it ■ V� Applicant0 NO. OF BLDGS. NEAREST Q CERTIFICATE OF EXEMP N F OM WORKERS' SIZE OF LOT NOW ON LOT YreQ� CROSS ST. r C COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT4:7 BLOCK LOT NO. MAP BOOK PAG 7¢ PARCEL hundred dollars ($100)or less.) T ) , /` (� OWNER NO / !/ US ONE MAP 1 - ��-7 1 certifythat in the performance of the work for which this / NO. _/ I SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS (/V /� CONDITIONS d so as to become subject to the Workers' Compensation Laws. J p T O CITY. • ZIP / (f(f �.� Date Applicant ARCHITECT OR EL.�]] DISTRICT GR UP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO."I CONS ZO Exemption, you should become subject, to the Workers' t yl „I p n fig l'��j V Compensation provisions of the Labor Code, you must forth- ADDRESS L '1 h v i�/ w o_ with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR a.O. �`•rrQ Z LICENSED CONTRACTORS DECLARATION CLASS NO. DWELL. UNITS — S hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS d >f NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business / LIC. 1 1 6 �"1 l0 and Professions Code, nd m I' nse is in full force and effect. CITY LASS BK PG -VALIDATION f SQ. FT. NO. OF NO. OF CHECK I — License Number Lic. Clas/.) t,@� SIZE I STORIES FAMILIES ONE VALUATION ,`j .�5 / DESCRIPTION OF WORK NEW ❑ p •i€ 25 Contractor�� Date ADD ❑ $ `� � 1 ��-LH� _�L A- ❑I am exempt under Sec. r , s I �A --,. ALTER ❑ •o�a._.F - 225: B.BP.C. for this reason REPAIR ❑ E 1..HECi=. L`'-z Izs Date: USE OF _ EXISTING BLDG DE MOL ❑ p -- Signature APPLICANT (PRIT) y NO l FINAL i ••?�� OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License 1-:it t. �10! r r r _ Law for the following reason (Section 7031.5, Business and ADDRESS FINAL �C,iI_, i_1_UI1 t5/ i_r" 911 WIN BY i M 1�°0-Professions Code): PRESENT -`,`BUILDING -= ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ' the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the.property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct.the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction'lending agency for FRONT the performance of the work for.which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE. P.L: t t _ : in Lender's Name `LDMA' t. # �O �a t t� m P.C. Fee$ Permit Fee ;;—i 3 Lender's Address a 1 certify that I have read this application and state that the Issuan a Fee �/ LDMA P/C# 0 8 above information is correct. I agree to comply with all County Investigation Fee o a ordinances and State laws relating to building construction, Total Fee Q- LDMA Perm. # a and hereby auth ze representatives of this County enter m up- bov - e e property for inspection rpos s. - -3 t-_;: r a _rt a - rrt t••t Cw v i 4.. Z. .� SEE REVERSE FOR EXPLANATORY L'ANGUAGEM '2 01Y7, ignature o Applicant or Agent Date y=�•, t••••• ',�;;; . t WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insute, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certifie/ copy �t�he�reof (Seca 3800, L f. r, ! COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. "Company. �•� � vkv ' , ElBUILDING r Certified copy is hereby furnished. � FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the-county building inspec- BUILDING tion,department. ADDRESS �,G+ ZIP Date - Applicant CITY LOCALITY T� NO, OF BLDGS. r NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT ( CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK I PAGE ' PARCEL hundred dollars ($100) or less.) �1 TEL. ,�-�(� USE ZONE MAP OWNER Ce NO. O/J(J N0. '7 I certify that in the performance of the work for which this r7 A -- SPECIAL permit is issued, I shall not employ any.person in any manner ADDRESS G— f Y fff�� CONDITIONSCL :so as to become subject to the Workers' Compensation Laws. 0 CITY ZIP ®� Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. �� f$�' DISTRICT GROUP TYPE FIRE ROCESSED BY 9 TYPE ' ZONE O Exemption, you should become subject to the Workers' r� Compensation provisions of the Labor Code,.you must forth- ADDRESS ��% 5'L./� '3 a with comply with.-such provisions or this permit shall be P �/ TEL. o[� STATISTICAL CLASSIFICATION APT. Z dCONDO.revoked. CONTRACTOR v{(_`�L � 0. _ LICENSED CONTRACTORS DECLARATION uCr g�i�(� CLASS NO. �� DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS A NO. I 1,t5 (commencing with Section 7000)of Division 3 of the Business LIC SEWER �� i and Professions Code,and my lice is in full force d effect. CITY CLASS BK. �'• PG.� w V/fLIIDATION 1e�'n r SQ. FT. NO. OF NO. OF t CHECK AC•C•T� License Number y°`�' Lic. Class r SIZE � � STORIESr FAMILIES t ONE VALUATI NI�7 =' el -17 �-6L: a— �1 DESCRIPTION OF WORK 'S r E. /?,' _ NEW s i ITEMS Contractor DateS t i MS ❑I am exempt under Sec. } ADD ❑ n e� p t: �� N CJ ALTER ❑ �1 p�(/�D0 ► I.Ifi7� � m 07 6.8P.C..for this reason REPAIR ❑ ; CHECK 698.0. Date: USE OF EXISTING BLDG. DEMOL FI Signature APPLICANT TEL FINAL CHANGE , (PRINT). / OWNER-BUILDER DECLARATION rNO. q "n' DATE I hereby affirm that I am exempt from the Contractor's License - tt // r— Law for the following reason (Section 7031.5, Business and. ADDRESS L/`! ? FINAL � � 10/111t'4 Professions Code): PRESENT By s i^77 q qpe�{ BUILDING dN'Y i 1 A 110'-14 ❑ I, as owner of the property, or my employees with ADDRESS ' I wages as their sole compensation,will do.the work and Z/ �D�� the structure is not intended or offered for sale Section [Invesficjation ALITY 74c .L=?`+' ==�On=`= 7044, Business and Professions Code.) VING TEL. ' ^•^ r;- TRACTOR NO. i 1•LM ❑ I, as owner.of the property, am exclusively contracting `�� with licensed contractors to construct the project Sec- ,»E' E i_,i' µi P I ( RESSeaL :- L.A•.; tion 7044, Business and Professions Code.) y . ; .,�, , . QUIRED TOTAL SETBACK FROM. EXIST. { {^%s, i.,- :;,t CONSTRUCTION LENDING AGENCY T BACK YARD HWY PROP. LINE WIDTH �' �`./ I hereby affirm that there is.a construction lending agency for ONT the performance of the work for which this permit is issued L: #f' (Sec.,3097, Civ. C.). DE L.' . Lender's Name, I',i Fee$ 793-.0 Permit Fee • LDMA Ref. # 3 i AiN :a j_i Lender's Address 7__ u / - 0 1 certify that I have read this application and state that the ,?,V ' 7 ` Issuance Fee /� LDMA PiC# 8 above information is correct. I agree to comply with all County Fee / R ordinances and State laws relatin to building construction, Total Fee (�-� LDMA Perm. # and h reby authorize rep a ntati' �s of this County to enter upon ie above-mention rope f r inspection purposes. ^o SEE REVERSE FOR EXPLANATORY LANGUAGE _____/Signature of_Applic _t or.Agent - Date •,, WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 1005574 Company Bello Construction BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ® Certified co is filed with the count building inspec- BUILDING v lOc�i5 mat t��/ copy Y g p ADDRESS u ch Temple City CA 91780 tion department. 5/10/91 Mike Bello CITY Temple Cit ZIP 91780 LOCALITY Freer & McCulloch Date Applicant NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT _ _ CROSS ST. Freer COMPENSATION INSURANCE 47219 ASSESSOR 1171 47&48 (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. OWNER Michael Bello 818 NO. USE ZONE MAP 357-4880 NO. / _ — -2— certify 7� I certify that in the performance of the work for which this �( y-1�. SPECIAL � permit is issued, I.shall not employ any person in any manner ADDRESS 290 Whispering Pines Dr.. V` CONDITIONS so as to become subject to the Workers' Compensation Laws. CITY Arcadia, CA ZIP 91006 OU Date Applicant. ARCHITECT OR TEL. 0 ENGINEER Artech 818 445-1882 DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of NO. CONST. ZONE U Exemption, you should become subject to the Workers' p w Compensation provisions of the Labor Code, you must forth- ADDRESS 218 Longdon Irwindale �Y�L�v �� d with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONp N deemed revoked. CONTRACTOR Bello Const. 714,10599-1245X Z LICENSED CONTRACTORS DECLARATION ' 2250 Llridsay Way N0 LIC. 605484 CLASS NO. CSU DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS (commencing with Section 7000)of Division,3 of the Busines's CITY Glendora0 SEWER MAP `C and Professions Code,and my license is in full force and effect. BK PG. VALIDATION SQ. FT. NO. OF, CA 9174CLASS B NO. OF CHECK License Number 605484 Lic• Class B SIZE STORIES IFAMILIES ONE VALUATION ContractorBello Const. Date .5/10/9.1 DESCRIPTION OF WORK NEW 4 $ ❑I am exempt under Sec. Construct 7 detached condos ADD FL�J ► ALTER ❑ BAP.C. for this reason USE OF REPAIR ❑ $ Date' EXISTING BLDG. DEMOL ❑ r/ Sign Lure APPLICANT (PRINT) NO. FINAL Q Q OWNER-BUILDER CLARATION DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and , the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 7,r tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. w CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH tl I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P:L. (Sec. 3097, Civ. C.). SIDE . California State BAnk P.L. Lender's Name LDMA Ref. # " 3 lender's Address 925• Badillo Covina 91722 P.C. Fee$ Permit Fee 3�.3 0 1 certify that I have read this application and state that the �' Issuance Fee LDMA P/C# , 8 above information is correct. I agree to comply with all County Investigation Fee d ordinances and State laws relating to building construction, Total Fee ,4:T �6 �Z LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property f r inspection purposes. C_ 1 �/ � o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date -