HomeMy WebLinkAbout1568A 1569AWORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -
insure, or a certificate of Workers' Compensation Insurance,
ar a certified copy thereof (Sec. 3800, lob. C.)
POrcyN0.73Wc005-2�76 NATIONWIDE
Certified copy is hereby furnished. -
Certified copy is filed with the county building Inspec-
tion department.
Date 6-30-87 Applicant THE ANDEN GROUP
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE'
(This section need not be completed if the permit is for one
hundred dollars (SIDO) or less.)
certify that in the performance of the work for which this
permit Is issued, I shall not employ any person in any manner
so as to become subject to she Workers' Compensation Laws.
Date Applicant
r"'aTICE TO APPl1CANT: If, after making this Certificate of
sorption, you should become subject to the Workers'
Lompensation provisions of the Lobar Code,you must forth-
with comply with such provisions or this permit shall be .
deemed revoked. -
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Number510560- Lie class B
ControctorTHE ANDEN GROUP Date 6-30-87
1 am exempt under Sec.
BAP,C. for this reason
Signature -
OWNER -BUILDER DECLARATION
I hereby offirm that I am exemptfrom the Contractor's License
Law for the following reason (Section 7031.5, Business and
Professions Code):
I, as owner of the property, or my employees with
wages as their sale compensation, will do the work and
the structure is not intended or offered for sale (Section
7044, Business and Professions Code). -
1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec -
ion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is Issued -
(Sec. 3097, Civ, C.).
Lender's Name CITIBANK
- - L•ut ms Pc�Tce�� slot oa5ob5
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
77
BUILDING
ADDRESS 24020 E. Goldrush Drive
nooaEss 24020 E. Goldrush Drive
CITY DIAMOND BAR
zIP91765
LocALlry DIAMOND BAR
SIZE OF LOT
NO. OF BLDGS.
NOW ON LOT
NEAREST
CROSS sTDIAMOND BAR BLVD . + GOLDEN SPRINGS
rgncT 43435 BLOCK
LOT NO. 25ASSESSOR
MAP BOOK PAGE
PARCEL
owNERTHE ANDEN GROUP TEL* —9541
U ZONESPECI
—�
v0a J
NO.
ADDRESS P.O. BOX 3329
CONDITIONS
CITY COVINA
zip 91722
ARCHITECT OR
ENGINEER DAVE SZANY
TEL.
AIA NO.445-4073
DISTRICT
)J
GROUP
�-'�
TYPE
CO T,
FIRE
PROCESSED BY
ADDRESS 1
(
- TEL. -
CONTRACTORTHE ANDEN GROUP NO.
STATISTICAL CLAS51-FIXATION
py
CLASS NO. DWELL. UNITS
APT.
ONDO.
LI[.
ADDRESSAS ABOVE
N0.510560
SEWER MAP
BK. PG.
p�
0
VALIDATION
LIC.
CITY - - CUSS
s°EFT' 1658 S10ROE5 2 FAMI�ES 1
ONE
DESCRIPTION OF WORK I
I
NEW a
SALUATI UU
llUullll,
'
� 1 5 6 8 A
ADD
GARAGE 456 SF
$
FINAL
DATE /'' ''
}} • • a •2 1
1• 31 6 8 4
• Y 3 1 6 8 4 Z
09.1 1 — 8 7
REPAIR
ALTER
USE OF
EXISTING BLDG.
DEMOL
APPLICANT TEL. -
PRINT THE ANDEN GROUP NO.
ADDRESS AS ABOVE
gNALWO
Y —„"�
PRESENT .
BUILDING
ADDRESS
11
� !
5 6 9 A
$i s • • a • 1
-
LOCALITY
MOVING - ^` TEL. '-
CONTRACTOR
NO.
T
1 e 5 0 7. 0 0
-
ADDRESS
t
- T �) -
r_L,;, ;_ `.)
• • 5 0 7, 0 0
09,11-87
REQUIRED
SET BACK
YARD
HWY
TOTAL SETBACK
PROP. LINE
WIDTHr�r'.
FRONT
SIDE
P.L.
LDMA Ref. M
'
-
P.C. Fee $ 316.84
Permit Fee .496.50
10.50
!
_
Issuance Fee
Lou✓. Pic K
LDMA Perm. M
-
Investigation Fee
Totai Fee SO7.00
1
O
U
!r
O
w
Us
N
Z
Lender's Address 444 S. FLOWER, LA 90071
certify that I have read this application and state that the
-
? above information Is correct. I agree to comply with all Count'
q ordinances o ate laws relating to building construction,
Q and he f u f prize representatives of this County to enter1110111111111111111
S upon Ih �- ned property for inspac(}YP/n urposesIDMA .
$7r,
$35
-
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent - Dore -
- -
•
PLANS TO APPLICANT
INSPECTOR'S NOTES
Approved
No.
Date
No.
.,.Dote
'' " --
pprovals"""
-
Dofe Received
or Approved -:
•Yes
No
.: ...
ti;VOIPr Cell Y�ote r•'
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_. ".. r.`
c;
GrocLng a 01
(edeslrion Protection .:_
Fence((Canopy)
-:
f
-.
- - _
•- '. ...-
;,,.. , •. ;.,,, - -
--__. ..�_._.___.__-__ _ ,. .... .__.-
(Conc.l (Mosonry) (Welding)
Lo,0--ge
"--- - - -
Parking
Approvals
Data
Impedor's
Slgnaturu
(Se,boct, & Yards)
-
Foundations
$lab
Fromm
24
Energy Insulation
I �
Wh, Drywall-
Interior
Z tttt
3_D. :'
-
...._
._. -- 1 _
' ,.
Lail, -Exterior
House Number _
Correct & Posed
F, nal_
fnler an Flan,
`
- ORVNFIWILIIIAWR UECLANA I ION
I herehy aff I Ihol I a mpl from ihp Comroatar's
_L the follnwmg ienson (Sec- `7031 5
Rresiness arsJ 1 rr fessions Cndr: An y eitt or..runit.u•hisl
rryur •s a permit to cnnelnrctt..rltrr. irnprn r. Jrnruli.sh,
-- r r/•rrir unv t uiti, rs•,-/i rtir-itc ii i,rala, reyuirrs
rh, applicant / r suds prrrnit to /de a sienrJ sr tt.....•..t
- thatbc is G.ensed pursuant to the pna•i.cb,nc r,/ the
I—ior's l.itonsr 1—-(Chapter cJ)(cnrn.rrrncitig wilt."!
tion 7000) of Uis icion 3 of Ibe Ikusinrss and 1'.r,Jrseions
..�i. Glide) or tNt/.e rs.v.. nrpt therefrrro, anJ rh,• FaAfor the
alle,l"d rxunrpfinn': Any r44,ti— of Sec6o11-7031.5 by
ant applicant f,ri, prrmrt subjects the appli,.,t m a civil
penults of not nuire`thmr /. • lrundn•d Jorlars (SStlrl).J"
I, as owner of the proparty,'or my iimployrr wnh
wages as their sole,compensmion, will do the work, and
the structure Is.PoT intended or offered for sole (Sec. 7044)
l3usinesc u 1 Professions Cud,: 77,e Contra. rm:<Lic,ri-
I.am dn,.s nor apply man owner of pry pr tt• ,.I huiIA
_ er iurprnrr s then nn, anJ wbo dues sucl I t •..rk hmuryf ur
thrrru,yh .his nu•n.-enrpl,tcce, j,rm idvJ�th,ir. a b
;prnnernentr are not inrended or. "Ife,rdd for sale.
'"'borr,r rr, the huilJi nX ni inrprneenrenr is mfd urtl in one
year o/ cnnrplctiun, -fhr atrn,r•buildrr will -hart t!
b,, rdrn of prn..;,,r; that be did nut build r,, irriprni•e frir
t! pa pose �/ i•,i! J. -
_ 1, as owner of the property, om o+cLA,.ely;conii
"ring wnh licer]sed contractors to consi vct the project (Sec.
7044) klusinesc anJ Prnfections Cnde• 7b, Contracmr's
_._ l.ic,nsr lAwdors nor apply err do nunrie`, f property u•hn
hurlds'nr rmprnrcs 71ii•n•nrc; irdJ It•l+ii ii,rifrads fr,r srich
prryectt' witt, n co.weeor(sJ licensed p irsu,mt tr+ the
• I am a emp, under Sec. , B &p.C, farr ihis
reason
Dave Own