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HomeMy WebLinkAbout1807A 1808A WaRKERS'COMPENSATION DECLARATION - �� hereby afflrm that I hove a certificate of consent fo=e�f 3�G APPLICATI4N FOR BUILDING PERMIT �svre,or a terYifica�e of Workars'Compensafion Insuranca, r a c t'ied mpy thereof(Sec.3eW,Lob.C.) COUNTY OF lOS ANGELES BUILDING AND SAFETY �'�-CK-956-104-CPA AETNA �IicyNo. Company BUIIAiNG � Certitied copy Is hereby fu���shed. FOR APPLICANT TO FlLL IN ApDRESS 24 164 A 7 Certifiad copy is filed wi�h rhe coumy building inspec- gU�LDiNG �iOn[Iepallmenl. AOORE55 ZQ LOC:AUTV NEARE57 1fe1f23/84 qpplicamTHE ANDF.N GRrlrin c�rvDIAMOND SAiT, ziP 91756 cr.osssr. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BioGs. �n55eS50a COMPENSATION INSURRNCE 512E OF LOT NOW ON LOT MAP BOOK 7AGE PARCEL iis section need no�be completed if ihe permit is for one USE ZONE MAa ndred dollars($100)or ie:s.) rancr33Q2 Q siocK �oT rvo7.Q7 2 No. r.�3-�.�9 ertify that in�he performance of the work for which this own,ea THE ANDEN GROUP N� OY-9541 cOnloi7iON5 e rmit is issued,I shall not employ any person in any manner DISTRICT .GROUP TYPE FIRE PROCESSEO 6Y (�i as to become sub�ect ro the Worke s Campensat on Laws. AD�RE55�.Q�I C PA R KU I E W D R fQ �� cONS� z0 ., �� y� �i.• G, le Applicanl . CITY C 21P STATISTICAL C1A551FICATION AP7. CONDO. � !TICE 70 APPLICANT: If, after mak�ng th s Cerfificote-of ARCHI7ECr Oq - .�_TE4 ., . �s, �.mption, �you shauld become�sub�ect��lo the Workers' EN i�ER .U/�: �F� �SZ l�� � NO — �C�ASSNo. �Ca� pWELL.UNITS�,.L � � npensatio�provisions of fhe Labor Code,yoV mU91 fortfl- qDDRE55 3S 4 N. F�RST AV E. A R D I A A sewee nv+v � h comply with such provisivns or this permil sholl be TE� � emad revokad. CONTRACTOF�j'[( , ,4 NO. BK. FG, VAIIDATION UCENSED CONTRACTORS DECLARATION ���. veby affirm Ihat l am licensed under provisions of Chapte.9 ADORESs j a]4 pAR KV I EW D R.No. 3 715 8 yq�pATION nmencing with Settion 7000J of Divisiorl 3 of the B�siness ond � ���� 6 6�9�� �essions Code,and my licanse is in full forca end effect CI7Y COVINA CLA55 $ s � nse Numbe� 3 7�1 5$Q SQ.FT. NO.OF NO.OF CHECK �i� [�Qyy R SIZE I S 7( STORIES FAMILIES ONE tractorTHE ANnFN RRfli�te , �oz�o,, �Es�i rioNbFWORK CONSTRUCTION NEw ; �amexemptunder5ec. �— OF SINGLE FAMILY HOMES ADD (] nITER � FINAI � �f�Y T B.BG.C.for this reason REPAiR � DATE USE OF FiNA�Li'� Dpte: EXISTING BLDG. DEMOL ❑ By 1 S+9nature °'�pRINM THE ANDEN GROUP N� -9541 �r OWNER-BUILDER DECLARATION � S O.I A 'ebyaffirmthatlamexemptfromlheCon�ractorsLieense ADORE55 .107Q� Q/\R$l7i£�1' DR. COVI � • e for the following reasan(Section 7031.5, Business and �= • •2� e:��a�g code�: I •2 2 8.4 fi � ��BUILDING •s owner of ihe property, or my employees witb qoDeE55 � xs as their sole tompenwtion,will do the wark and �p�ALITY ` "'�L�'.� �u �tFe3rructure is not intended or offerad for sole(Section . . 7044,Business and Professians Code). MOVING TEL. • � I,os owner of�he property,am eXClVslvely[Onffdt�ing C NiRACTOR r+o. U 2 2 9-8 4 with licensed contracton to consiruct the project(Sec- ppD�u �1 �6�� �ion 704d,B�siness and Professions Gode). _- REQUIRED 70TAL SEiBACK FROM EXIST. CONSiRUCTION LEN�ING AGENCY SET BACK VAR� Nwv pgpp,�IN[ w��iH �;�e . . . . � I hereby affirm�hat ihere is a construcfion lending agency for fRONT the performance of fhe work for which this permif is issued P.L 4G� /'�� � •�C�[�.,5� �SeC.3097,Civ.C.). SIOE P.4 S, .,t�C� /S� • ::Y L' J G u Lender's Nome Lendei s Address -L.Fee a � v�.m�+Fee .d`�i'� �`�` 0 2 2�-Fi 4 I cartify ihat I have read this opplicarion and s�ate that rhe isxuance Fee �O•✓�0 above information is correct I ogree ro comply with all Couniy Invesngano�Fee ordinances ond Stote laws reloting lo botiding conatruction, io�a1 Fee y�.S U and ereby authorize r resentatives of rhis Coun�y to enter u the above-menti property for inspecNon purpo�ses. �; �—� SEE REYENSE FOR EXtLANATORV lAN6UA6E Signa ra of Applicanr genf Do�e �� ,....�.,.. ....._.,..,. ��,. —;— ,�.a ...F.._-_Wm.-^..- ` p.-.:� ... .�� Ik )�, ...4....�.�-3,:,a,��� . .�i�+.� !� 'R'3�.. .. .� r�, •,�..,.� �,. _.� ��...a:� I ,I . Cc.�ic I�r's Ta:�e....,.. ..� .__ - L L I�>e , 7037.5) � ��+"6� _ . __- .__- -- __-_ . . .�::Y?�+ .,5ieb fdc. �__._. . _____..'_ __._,_ -. , � , . .. . . ._. .. :. ...euli.4, . 4,...:,, i .. . .. . .-.H� . ._' ___'_. �__ . .� 7I .-.' 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