HomeMy Public PortalAbout9807 RICHMOND WAY_Building__ f • r .
WORKERr COMP wiow DECLARATION
hereby affirm that I have r cwgNccftComp of tion dormant to self APPLICATION FOR BUILDING PERMIT
Insure, or a certificate of Worker'Compensation Insurance,
or a certified copy thereoflab. C.) .
,.OR%y $;. ( n COUNTY OF LAS ANGELLg BUILDING AND SAFETY
Policy Co pony ■6. BUILDI '
1:1Cortlfied copy is hereby fumished.' ,R APPLICANT M FILL IN ADMMNG 0 1 lth
Ce ad copy Is filed with the county building Inspec. BUIILLDING
tion department.
• �: Cj ZIP 91780
Dara 1L—2 3—A G'7►ppll LOCAL" UP.
CERTIFICATE OFDD:JIAPrIOhF sm OF LOT 87000 O.ON LOT 0 OF BLDGS, NFJ1RlIST01
COMPENSATION I CROSS OR
Is section need not be com lged If the permit Is for one TRACT 43136 BLOCIL 2' A OR
undrod dollars(;100)or lea.
AARP BOOK PAGE PARCEL
Tu"II.asrlify that In the mance of the' Na —3 6 3 6 uBB ZONE 11"n. 144 MAP
t' a
perfo work far which thipermit is Issued,I shall riot employ any person In any manner ADDRBiiB 14 2 5 MelanieM e 1 a n i e L n. CA
so as.to become publect to the Worked Compensation Laws CONDmCINS 1 ■
clfYAroadia• ZIP 91006
App O
NQTICE TO APPLICMI'�:Applicant
making this Certificate of EI�d011�� Same � .Di ICT GROUP ITYPE ....- . PI ■ BY
Exemption, you.ahopld become w ect •to the Worked
Compensation bions of the Labor Code, you-must forth- ADDRESS P-3
with comply with provisions or this permit shall be - T� _ SI'A17SfICAL C1A551pGTION • _• � A
deemed revoked. OONfRACfOR NO. Z
uaNSED'OONTRACTORS DECLARATION UC. aABS No. UN R5
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRBSS NO.
2 6$8 6 4 ■ Q
(commencing with Section 700Q)of Division 8 of the Business UG
and Profes.Ions Cod:,and my Itcerui b In full force and effect. TY 5 8 L BIL PG. •
�c Ckss BIg Fr-2 0 5 0 I�2 rNONwu� CoNB 1�IDATIhDN 00
ucenw Number �� ■
D tIPnoN of fLIORK
ate/ ' S�L ng 1 e F am i 1 y New ® VALUATION
Contra $ 4._ 0
0 am exempt under RESIHENZIAL attached -2aar '7 W
�lDAD-OQ01 81
irSO4 1I'C 9:06
PLICK
B.BP.C• for this rbason -"'-
REPAIR
• n,,.,. UROF ❑ .:
UROFGBLDi Single Family Rea ❑ �o �/ 633 a 05
Signature APPLICANT Geon e W i e a a dIm 286-3636 NNS
owNER-Bu1LDER DECLARAnoN
- •-~
I hereby affirm that I am exempt from the Contractor's License ADD 4 2 5 Melanie' L a. Arcadia DATE '
Low for the following reason (Section 7001.5,•Business and
Pic Ions Cade):
BUILDING 4-
c�1, as owner of the property, or my employees'wRh ADDRBIG +wages a.their sols comenstion,will do the work and' LOCJLLTn 'thestructureIsnot Inr offend for sale(Section
7044, Business and Profaslons Code.) OB�O RRt3R 1TIL
E] ✓ly.(I'
I,as owner of the property,am exclyslvely contracting ,
O.
with licensed conitactors to construct the protect(Seo- ACDIalE6
'
flon 7044, Business and Pic lops Cods.)
CONSTRUCTION-LENDING AGENCY ' YARD I•IWY _PIEP!196FROM
�. .
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
Lenders Name B H Mortgage P.L.
.7� LUMA Ref.
Lender■Address 383 'Wilshire Btaver1y .HT1 .c'r es Permit FOR ,
I asrttfy that I have road this application and state that the G Fse LDIILA PIC/ �
oboes Infomratlon Is correct.I•agres to cam ly with 611 County Inve0gallon
ordinances and StoW laws relating to building cond ucflon, f ■ Total Fes LDMA perm•
and hauthorize ropresentatives of this County to enter
upon thea mentlo for Inapecflon pu
! BO.�POR IDaLANATORY LANGLIAOB
Slg of/� pllm ar A t