HomeMy WebLinkAbout0803A ,�; . �, �...
WORKERS'COMPENSATION DECLARATION . �
I hereby affirm Ihot I have a�e.,�f��o,a of�o�sa�„o se�f APPLICATION FOR BUILDIhIG PERMIT
insure,or o certificate of Workers'Compensotion Insurance,
- or a rcertified mpy thereof(Sec.3800,�ab.C.) Z�A COUNTY OF LOS ANGELES BUILDING AND SAFETY
��a{�I�cy�05-279—O��pany_Nat-i nnwi r7a
� Certifiod copy is he�eby furnishad. FOR APPLICANT TO FILL IN eu��o�NG
AD�RESS
� Certified copy is filed with the muMy buitding inspeo- BUaDING �
tfondepartment. nDORE55 656 Armitos Place
Date 8/5/87 Applicom THE ANDEN GROUP aTv ' ziP �oco,��rvDiamond BaI'
CERTIFICATE OF EXEMPTION FROM WORKERS' SiZE OF LOT Now oN`�o� c oss sr.Diamond Bdr B 1 VCZ & Go lden $ 1II S
COMPENSATION MSUR4NCE g
�This section need not 6e completed if ihe permit is for one TRAR42580 BLOCK LOT NO. Z� Mp,P�gppic PAGE PARCEL
hundred doliars(E100)or Iess.J
��' U ZONE M4P �
I certity thot in the performance of ihe work far which this OWNER NO. — / p�p, t7-3
permii is issued,I sholl not amploy ony person in any manner qDDRE55 P•0.BQX 3 3 2 9 ��a SPKIAI �
so as to become sub�ect ta ihe Workeri Compensation Lows. CONOITIOPIS
!��ite Applicant Ciiv Covina ZIP 91722 �
ARCHITECT TEI.
�OTICE TO APPLICANT: I4, after making�this Certificate of °'�ave Szan AIA No.445-4073 DISTRICT GROUP TVPE FlRE PftOCE$SE�BY 0
E.emption, you should become s�bjecf to �he Workars' ENGINEER / CONSt. ZONE �--
Compensation provisions of the labor Code,you must{orih- pODRE55 314 N. First, Arcadia C� W
ith comply with such provisions or �hia permit sholl be
1E1. STATISTICAI QASSiF�C ATION APT. ONDO. a
deemed revoked. �pNiRaCiOR O. _/_� Z
UCENSED CONTRACTORS DECLARATION ���. C1n55 NO. � '—� OWELL.UNITS
I herehy offirm ihot 1 om licensad under provisions of Chap�er 9 AOORE55 AS above No.5105 6 0
(commencing with Section 7000)of Division 3 of the Business ond t�� SEWER MAP
Professions Code,and my license is in full force and effe�t CRY CLn55 B � � VALIDATION
SQ.FT, NO.OF NO.OF CHECK
liC8n56Number 510560 ��� ��Qyy $ SIZE 1314 sTOR�es 1 FAMILIES 1 ONE
Go�rroc�o.THE ANDEN GROU�,1e 8/5/8 7 �ESCRIPTION OF WORK NEw
vnwarooN
A� s 6,820
❑I am exempt onder Sec. q��R , r'0 8�.3 A
8.8a.C.for this reason SLAS ONLY �PA�R � s �� � � � ��
paf�; use oF �EMOL
EXISTING BLDG. I � •6 8,0 0
Signature APPIICAM TEL. FINAL
OWNER-BUILDER DECLARATION iRINT DATE /� �� +<-�6 S,O O�
I here6y affirm that I om exempl from the Conlrpctor's license j{S above
�.,�aw fo�the following reason(Secfion 7031.5,Business ond ADDRESS FINAL r o 8.1 7—8'7
ofessions Code): � By �,��t*-��v
, � BUILDING - , . . Y
I, as owner of ihe property, or my amployees wi�h ADDRE55
wages as their sole compensation,will da the work and Lo�`iry , ' .,, .
the siructore is not inrended or offered for sale[Section
7044,Busineas qnd Professions Code). MOVING TEL. -
� I,as owner of the propeny,am exclusively contratling ONTRACTOR � NO. �
with licensad contractors fo construtt the project(5ec- qDDRE55 ' �
lion 7044,Business ond Profesaions Code}. �
REOU�RED TOTAL
CONSTRUCTION IEN�ING AGENCY SET BACK YARD HWY pROP.LINE WIDTVi
1 hereby affirm that there is a construction lending ogenry for FRONt
�he periormance of the work for which this permil is Issued i.t.
(Sec.3097,Civ.C.}. SIDE
P.L.
lender'sName Ri'Fihank
Lender'a Addreu a 4 4 S. F 1 OW r, T,,A. Q Q']�, P'C.Fee S Permit Fea
5 7.5 0 ��Ref.N
� I certify�hat I have reod this qpplicotion and stme�hat the issuance F�. 10•5� L�AAP.P/C M ,
obove information Is cortett.I agree to comply with all County i�vestiqoilon Fse .
q ordinance d Sipte Ipws relaTing lo building tonstructlon, Tolal Fee LDNU1 Perm,M
and her y ulhorize represeroatives of thia Counry lo enter
� up n o eMioned propeny far inspection urposas. - -
mp � � SFl REYERSE fOR EXPIANAlORY LANGWGE
519noture of Appliconl or Agem re .
PLANS TO APPLICAN7 INSPECTOJYS NbTES -.. U�l'tif.K-14�i7LU11;Uf�t'.l.AR41[t.)N
I I..�,by o!t n t'�nl I nr t :-��ir ir e Con �_ , ..,
To: Rsf
urned , Lic L- r .Fc. f�l �� .ec On.S:
Appeaved ---------._�..� ----- 8 - IYr J -.� n.-( d Inv �ti � r h f l.
_,- ..._._..�—...__ .
�a.� ppt Na pntt .....i . . � .. r�yo < �j r rt t s .�< r ✓ft r i ir j� �� d� r lral �
_ _._. --- - ��� p v.t t � t rt � �
�- - ..__ _ _ —r— _- t—
I r7 j/1. r1 � 1 p tr.I'l sc [ r n�
�Wl __—_ _� �-:_ � ._::� �._--. _..-___�__.� , tbu[7 !: �.J/ r- u t �I f� i� /N (
� � . ,_ e. �r �:L<<n -l.e (�l,i�..11/-., v � iy < al.1
� `
{� -- -� -}------ ----�— ---.. . -.— ti r Oqli/a/Ui�r. 4 t tl�fi -�r � i 1 I �/ .�n�+
I .� � . _ . i . . - . . � � � � �. C, ttlx elet! :� �>+rptlL�r�/� Jx�tt h�.�is�rrlf�
��_,_,,,_ I _� , —.__._._�_ -.. all q.d sr mept > Anv r�ru�,ednaa ry ti t ,(i31. h�.
�
. . � . q . � .... � . �� . u�ro PPI�<<�n11ur e Ar•rnr�t�u5�rcf�thi i(. I�unt t�,�i.�e i!
.: � . .-Rro uired - pat Raceivad � �
�porodai --T o App oeed �--_,.,__..__�._�__�._____._..,.,. p�n�lE�n�nne r�•tiian I �hurcdnd d�17 /.FSqOJ,r:
Yas I N
�_ } . � ' I o ,.of ihe p�P. ry. x y . pl�y .. N 14
_,_ _
_.. _.�.,, . .�
._.. , �. : _....� - ' _
� . ... , � . ---- ... . . — w �. rh s e i:np . , I � 4 � d
� .i. .�re . � � FheS��ucri�r�iS oi m��,au�..f� .f�crt,dfa . i6n.1
t _- �' ._ . .-. . �. , I C!
�-
H.,,��, .i e ...� . � . .: . --�_..-. . " l3urr r sa:dl �/ �r r. ( r( rt t .�! :.n
�_ �_.— .
__ _. ._ ..__._._.._ � ,
� .. . . . L i d<� r pph I � t _l r !dc
C : ��._._�.� .._.__._..__.__ ,.A ..-. or j � �! inJ i 1 / : i ! k!» .� t/,-
4 . � �� r I � �
..� _..___ _.—.1 T . . . .. . � �f �,L !�.� . n � j�!„y .� / / I t!�e .u.1
� -.,<, . � —"—_ _— ,Ar nla�arv nue rnl x l �l ✓� 's.! Il,
���.,,� _ �—�-�--� , . . .. . L+x<<e r t/r��bualdin,�or i r j i.r cn�ia a f(i tl�. ��
( �Jnq.n. ' . ..��.�� -� __.-_ Y�a (c�n:�il��tinn tR�. �r .�r b �fJ it rf ! � ths
�
hu f 1)r { rGa�!�r A�d n�,r h�!d� i,rr�:e(r
__ __......__ ��. . --.-._..�__. .. _. . . . .
� . u p ry� ' r( �1.J
I t �u t ��.cnyf �n I � . . . . . � I ]. vw ��. f r r p-p-�.iy ��r r I r ���
� �,.,__f�_�_, "" — ;I y .r I��r r s.,1 ccrrrncto�ic.c�nst � t .���.c.. Sec.
a � � I � � � 70a4 B � �F / (. J 11 ( t r c
_
�. �-p
( , , .. Y (V '�i�� . ... . _'_' !. na l.�� d a f�l'P111 .�n r /rr>j� �zc1� �
i^ n-' _� � ... _ _
� ` ; � , �hu ii vnr �:N. f��7 r �:c�/ � �1,
� ��� � �__�__.� � . A � r� r� F � � r (�l L<<�._�J E,«-.u�r„r �o rb�
� , ;, -
C r r,rsl lavl.�
� �.k, .a'_ _�.-_ �� ' � . -
r , � � ---_ - _
�._�_...�,_�_�� �-w ' � i. I 7me e�{�i �ni�rS��c.__,__�.8.8P.:: torr��v
, - _...� . —_ reason _.._�._____
- ._ ��..._ . _. . .
�.-_'_`_""'_"._"_ . . . ' D;rle��.�. �(7,Nn. _.
� Approvvis i �cte Insgacfor's 5ignaivra � � � �- . ,
F - _ . -_ .. :._, _�_. _
� - � � 4NSPECT4R'S N6TE5
___ .._ _. _ . -___.-_ ^
�r, 6 Jsl � . .. . , . . . .. � -
. _ �� ;_ ��_ � __�_ ___ .__
�r �.,s
� � —____ _____ __ _
�__ __.__ _ � __ __ _ _ ___^__��
9Q �
M �.:yF� �. J..�Q����_ - .._. . _..._- . .. . . , �.�-.�...._.._.,.....�...,_._...� ---_-.- .
h _»�.__ � .—. .—{.._ �_�. �,._....�._._�.. _._._
�Frnma - . ' .
�`...�"' '_.'__...__..-.._.___.._ .-_,_.�.__ �___.,_.. �__._._��_
i"=�.erc�Y ilof�on ' "_ . - . -_ � . _
' �.,._.._____.,.. ..._...,..... ....__....._.. ....,_....�.._.
_ ..._.............._'_......-_..__.,.,_�_.__._ .__..-._�..�...—...-"-" �__
... _... _,.,._...,...-. .
�iu. ,�.val�. ... .. - . . _ . . _ .
t
� I• �e
� _._____..�.__.�._..��___.,.' __._�._�."_"'_ , . . .
J- _ �.. � _ . ..�_" _.__ _�__ ___..___�-�
s N t -
� g -;
_-_' ,.�.....�,. ! ,
F _ .__. - .._ .
, -" . . . _ . . . �� , .�... __ �
6 ix Fo � �
-_'�'_�___. _ �. ". . � ... �- _.....
..
, � . _ _ . . � "__ ' . .
—.....�-.�...._'_ .__'_,._. '
_____..����_�._.�_ _'.� _r-. _�.... .._.' __.____..._ �-:-._..�_..._
� � . . "-"'•�' . + �.. . �..��,� .�.
i � � ' .'., ' _'" - . '
t.......___..��_._.1...�...._�......1....,._.,.,.�..��.._�_....._,l_.�_.__.__-__.�_.__..�.._..._.� ____...�..� �__.�._...-�_.��.....�._.�.__�.__'__