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Home My WebLink About0821AC)RiCERS` COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) 7a Ch05-279-0416pany Nationwide om ❑ Certified copy is hereby furnished. ❑Certified copy is filed with the county building inspec- tion department. Date 8/5/87 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 ($100) or less.) I 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 the Workers' Compensation Laws. te Applicant .OTICE TO APPLICANT: If, after making this Certificate of ,exemption, you should become subject to the Workers' Compensation provisions of the Labor 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 Number 510560 Llc. Class B ContractOITHE ANDEN GR21W1e 8/5/87 ❑ I am exempt under Sec. B.BP.C. for this reason Date: Signature OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License ,Law for the following reason (Section 7031.5, Business and ofessions Cade): Li I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). ❑ I, as owner of the property, am exclusively contracting With licensed contractors to construct the project (Sec. tion 7044, Business and Professions Cade). 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 Ci ti hA nk Lender's Address 444 S. Flower, L.A. 90071 1 certify that I ho read this application and state that the above informot* s correct. I agree to comply with all County ordinances ate laws relating to building construction, and hereb a ri r presentatives of this County to enter upon v -me raparty for Inspecti n purposes. Da6ret ^� Signature of Applicant ar Agent APPLICATION FOR BUILDING PERMIT 3/A COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS 681 Armi 11 -ns P1 Am, BUILDING 681 Armitos Place ADDRESS CRYDiamond Bar ZIP LOCALITY Diamond Bar SIZE OF LOT OW ON LOOTTs SIZE NEAREST Diamond Bar Blvd & Golden Sp TRACT 4 2 5 8 0 BLOCK LOT NO. 7 ASSESSOR MAP BOOK PAGE PARCEL TEL. OWNER NO. — USE ZONE ! / OU f22 MAP NO. 117-3 SPECIAL CONDITIONS ADDRESS P• O •BOX 3 3 2 9 CITY Covina zip 91722 ARCHITECT Ob a V e S z an AIA TEL. - 4 0 7 3 ENGINEER DISTRICT j.d GROUP TYPE FIRE CONST. ZONE PROCESSED BY ADDRESS 314 N. First, Arcadia TEL. STATISTICAL CLASSIFICATION APT. ONDO. CONTRACTOR O. 'Lo CLASS NO. DWELL. UNITS ADDRESS AS above LIC.5 0560 LIC. B SEWER MAP CITY CLASS BK VALIDATION SQ. FL NO. OF NO. OF CHECK SIZE STORIES FAMILIES 1 ONE VALUATION DESCRIPTION OF WORK NEW AD REPAIR DEMOL $ , $USE FINAL DATE � �� !y FINAL E0821A # • + • • • 1 1•• 7 4 2 5 -74.255 6 a 1 7— 8 7 Garage 462 SF SLAB ONLY OF EXISTING BLDG. APPLICANT TEL. PRINT ADDRESS As above PRESENT BUILDING ADDRESS , LOCALITY MOVING TEL. CONTRACTOR NO. ADDRESS REQUIRED YARD HWY TOTAL SETBACK ROM EXIST. SET BACK PROP. LINE WIDTH FRONT P.L. SIDE P. L. LDMA Ref. R , P.C. fee $ Permit fee 6 3.7 5 Issuance Fee 10.50 LDMA P/C N ' Investigation Fee Total Fee LDMA Perm. It SEE REVERSE FOR EXPLANATORY LANGUAGE pings q O U 0 W D: N Z OWMA: 41C111 Di(H DV( I.AH.4.I ION -- Du and l r! n s( I 1 s i s ---ti a 1 t 1 Y 'I Is, l , l l 1 1 7G. alp! t J- ) p -r i t fil"a rc l st J. ` t tb h, is It' --d P --.t to t/ pry , n ) tl tra Yt I t m I t ((1 p1 , ))( n ..F tion IOf!) t f Divw i / tl Du,i .. rid Pr, f ,ns Cade) rthatIrrs--crept t1..,efro„ and t)s hay.c!r the allc,Yed—en,ptian. An.j s'rnlation orf .Scitinn ,7(!3!.5 bs ant ppl cant f p ,nit sob) t tl e applicant t u ."I pe Ih /nn1 : r than fn 1.n,d,,d dnllarc (95U(J)): —g- os the sole co tip o o 1 d tt ci fl- i ct r- -z e de ffe Ad fo (Sc'c 704,1) Dr s,ness and) fecs,nm Cock_ Ibc Contra, (or's) t. -nse Lain does oat applti h, an (inner of p p t u ), /,ilk, or inti cs tberc—, and who d-,, sra h k. ) , - lC thr•oagh Cts nun ernphq-,, P,a rdcd that -,h , pr en-ts a- nr,t intended rn ufl d f b---, the building or i,np...... I i, sold , itJ in one _year f camp! t n the - n. fiuldcr -ill hae c fl- Burd- I f re -+r r g that be dad nut build or imprrsr e for the p«rp — of -le). 1 x omc of tr,e p f ar^. < s. -dy fmq —th hcens_o mntraclor i° <anstr _i mr o. ode S -- 7044i and 1 f c i, L d 11 ((nlract rs Li I d —t t u un t'p ,p utt of , bu ll tip th r d n 1", t ct-,/ sal, pi) c u 'th a tra -t r(cf lrce,iuc l pursuant 7, the G ntra L>r's f n c Lain) oro e,z p. order 5ec. . 8.&P. C. for chis reason ._ Dodo � INSPECTORS NOTES _ PLANS TO APPLICANT INSPECTOR'S NOTES To: Appoval —._'-- -— ------ ?Aa Date r. ---�—� ARRrova4s I` Required Date kaceiv®d pr. Approved ov � I No Yes —"'--- J - o - i orie-tr a teFren _ � 11 M ,•vl ) ' tLJ Idin07� —T—t— i � oru 11 I I Approvals Dorn In,; �Cto,'s Sipnoture rqy I .rxr i [? y oll ,r. CYir�r N r�.- c+ h PC, --j I OWMA: 41C111 Di(H DV( I.AH.4.I ION -- Du and l r! n s( I 1 s i s ---ti a 1 t 1 Y 'I Is, l , l l 1 1 7G. alp! t J- ) p -r i t fil"a rc l st J. ` t tb h, is It' --d P --.t to t/ pry , n ) tl tra Yt I t m I t ((1 p1 , ))( n ..F tion IOf!) t f Divw i / tl Du,i .. rid Pr, f ,ns Cade) rthatIrrs--crept t1..,efro„ and t)s hay.c!r the allc,Yed—en,ptian. An.j s'rnlation orf .Scitinn ,7(!3!.5 bs ant ppl cant f p ,nit sob) t tl e applicant t u ."I pe Ih /nn1 : r than fn 1.n,d,,d dnllarc (95U(J)): —g- os the sole co tip o o 1 d tt ci fl- i ct r- -z e de ffe Ad fo (Sc'c 704,1) Dr s,ness and) fecs,nm Cock_ Ibc Contra, (or's) t. -nse Lain does oat applti h, an (inner of p p t u ), /,ilk, or inti cs tberc—, and who d-,, sra h k. ) , - lC thr•oagh Cts nun ernphq-,, P,a rdcd that -,h , pr en-ts a- nr,t intended rn ufl d f b---, the building or i,np...... I i, sold , itJ in one _year f camp! t n the - n. fiuldcr -ill hae c fl- Burd- I f re -+r r g that be dad nut build or imprrsr e for the p«rp — of -le). 1 x omc of tr,e p f ar^. < s. -dy fmq —th hcens_o mntraclor i° <anstr _i mr o. ode S -- 7044i and 1 f c i, L d 11 ((nlract rs Li I d —t t u un t'p ,p utt of , bu ll tip th r d n 1", t ct-,/ sal, pi) c u 'th a tra -t r(cf lrce,iuc l pursuant 7, the G ntra L>r's f n c Lain) oro e,z p. order 5ec. . 8.&P. C. for chis reason ._ Dodo � INSPECTORS NOTES _