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HomeMy WebLinkAbout1611A 1612A (9) _ _ _ � WORKERS'COMPENSATION DECIARATION � � "-� - � � I hereby affirm that 1 have o certificote of�o�,e��,o aelf APPLICATION . FOR B�UILDING �PERMIT _ Insure,or c cerrif�cate of Workars'Compensorion In�urance, . or a carnfied copy thereaf(Sec.3800,lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Por��[�005-279—OO7�mpanY Nc1t1(1TTW1f�G 35/C ❑ ar r FOR APPLICANT TO FILL IN nooRess 618 Bowcreek Drive Cer;iiied co is hereb (urnished. � Certitied mpy is filed wilh the co�nry b�iiding Inspec- BuuoING � tion daparfinent. ADDRE55 Dote $'1$—$7 Applicanf2'� ANDIN GROUP aTr Dia�rtond BaT zio 91765 �ov,u,r Diamond Bar CERTIFICATE OF EXEMPiION FROM WORKERS' � NO.OF BlDGS. NEAREST COMPENSATION INSURANCE SizE OF lOi NOW ON lOT CRO55 ST. �Thls 6eetion need not be compleled if Ihe permit is for one � TRACT BLOGK lOT NO. �� � - hundrod d011an(5100)or IeSs.) haP eOOK PAGE PARceL owr,eaTI� ANDEN GROUP Tri�67-9541 USE ZDNE � r I�7 �T V I certify thot ln the performance of the work far which this �'(�—( � � � Z- permit Is i�sued,I shall nol employ any person in ony manner qD�RES SVECIAt . � so as to become subjecl to Ihe Workers'Compensation Laws. �� CONDITIONS � U �I1Pte ApplicaN � . GTY ' 21P . . , � �TICE TO APPUCANT: If, ofter makin �fhis Certificofe of ARCHITER O TEL. DISTRICT GROUP TYPE fIRE PROCESSED 6Y � 9 ENGINEER �ave Szan AIA No445-4073 � - .emption, yov should bemme subject to Ihe Workeri - � CAN�5T7.� 20NE U Compensation provizions of the labor Code,yov must forth• qDDRE55 � ' �� n-� � .K� � W wf�h comply with such provisions or lhis parmit ahall be TEI. STATISTICAL CLASSIFICATION APT. CONDO. a deemed revoked. � CONTRACTORTI��''+ ANDELV GROUP No. � �� Z LICENSED CONTRACTORS DECIARATION � ���, CLA55 NO._�DWELL.UN�TS'J_ - � I hereby offirm that I am licansed under provislons of Chapier 9 ADDtie55 N � (commendng with Secfion 7000)of Division 3 of the Businass ond . _ ���_ SEWER MAP Pro(essions Code,and my license is in full force ond eHetl. Crtv C�ASS BK � � ' VAUDATION S�.R. NO.OF NO.OF CHECK Ucense Number 510560 Lia Class B SIZE STORIES FAMILIES ]_ ONE � THE ANDIN GRO�]g B—ZS—B�J DESCRIPTIONOf WORK � VALUATION ' :^-� (���� � Contrattor �g NEW }� ADO S 7O,�JOO , #• • • �P 1 ❑I am eaempt under Sec. 441 SF �, „� airea ( .p 3 9,1 9 8.6P.C.for Ihie reason REPAIR = - ' Date: EXIST�ING BLDG. DEMOL • °G J 4,� B c=..� Signature � APPLICANT 7EL. FINAI /�� 0 9.1 1 —8 7 � OWNER•BUILDER DECLARATION PRINT No. . .DATE � 9 ��, 1 hereby affirm that 1 am azempt from ihe Contrattor's litense j�$ a�OVe Law far fhe following reaeon(Seclion 7031.5,Business ond � Aooae55 FINAL p'/ Professions Code): � � dY /�'�J�� BUIIDING � I, os ownor of�ha properly, or my employeas with ADDRES$ ' �� G� 2 A � waQes as their sole compensation,will do the work and �D�q�ITY � ' ' � Ihe strodore is not intended or oifered for sole(Sectian � � �. . . . . � ' 7044,Buslness and Professions Code). MOVING iEt. � � � I,os owner of ihe properly,om exclusively coMrocting CONTRACTOR NO. � '. � � � a{I�� z�5 Q , wflh licensed mntractors ro construcf�he pro�act(Sec- AD�aESS � tion 70Gd,Business and Professions Code). '� • o(�� 2,�0;� . REOUIRED TOTAL BA K ' CONSTRUCTION LENDING AGENCV � Sei BnIX YARo MWY pgpp,��NE WiDTH � I hereby affirm that Ihere is a tanstructian lending agency for FRONT �, � �9.� � �8 7 - Ihe performance of�he work for which ihis permit ie issued v.t. (Sea 3097,Civ.C.). SioE � P.L. lendar i Name �-'1t7b317}C � 444 S Flawer, L.A. 90017 P.c.r�a s 239.19 Permu Fee 402.00 ionan asc w lender's Address �, ' I certify ihot I hava read Ihis applicmion and slate that Ihe Issuance Fee 1.�.50 �DMA PiC M ' . above information is mrrect.I agree b comply with all County Investigaiion Fee � � ordinonces an fa laws rela�ing lo build�ng consrruclion, To�al Fee Q12.5� t�MA P,�m.N ond hareby t rix reprasentatives of this Co�nty to enter upon� • enu roperty for inspect'on urposes. � LDI'I11 $�5 $35 �� � SEE RFVERSE FOR F%►LANATORY IANGVAGE � SignaN�e o App icont Or Agenl pe � PLANS TO APPIICANT INSPECTOR'S NDTES ...U�\'tiF.R•U1�11.U1'.R U4:CI.AR:1170V . .. . I F �f•�'iy ql�'.. 'h(�I I f1. C�f�t�; f -��I�e�rn 'rJ`i^r�5 To: i , . � Returned ; . ' .� � ' . '� Luense l❑ ��Inr'..nc�.��liovrmg i on� ISe .�-i071'j! � APProved � .. I)u�'n�ssundl'rrrlravnnsCndi:Arsy �i�. r.�i�unh'rrFr.l • No. Dote No. '"'Ootc' '• _ � . . ... . � .�•..� - - r�•yaires�fro rrillu�nnvnnt.o/t� i�i�r,�r:�.��rr.ruli.l,. -- . --___—.�.__ ' . . . _..urr�pnircnY.Uruet��ro.j,n�rl,.itsia.���.+n.r.dlaorr./�n e - . � , ,_ ' 7Gr up/li.duf/nr xad�prrr�iit fn�/d��.o.rit�¢rd afatem�tn� - ' -- - - - .. . th✓t,hr it litrnsrd punradnt�.i d,r prnruh�na n/d�<�C...�- . ��I -'. :..,. .:- :. . .� .� . n.ror i l.i<rnx�L.�u•(c:��;;pr�r 91A�r,�„n�rnrinc u•itl�S�r� _ _ _ � -- — - - - - _ '::. ,�.', ., . �.�� i�-.-„ " r.,..:. .' . .��� tr tiru�7b00J JU n 3nitb��Uus' rs�,ind! �m �� / i s ..-,'. •'C,�JeI���rLur t e .�.r���r�r r!•��.Jn�.»�nd�h�•'A�c/ rL�.� . _... ._. .. . .. ..,- --- -- ._.. . ...-- �- - _ -----' . _ .._. _. . ..n!l�rrd c.r�m�frun.Any rioldtroa /ti•�Iinu'p37.$h�. �. ._. .._. .___ . . ..�-. . Re9uired�.> -.'�DatoReceivad-� .____.._._ . .. . �..- �.. _____ .___._. ._ _ _. � arn•ap/�li.dnf/nra(��t'n�it.aihjafsl! rJp! ��nttnd:iri! ApProvals or Approred . ..prnufl��n(nnl nrn r lhun/irv hnndr�.d J.i!lars ISSf10/.y�, , ..Yei No . . �,... : �, . �.. „ r . ._ . . ... .__' �: _". ._ ._'__.._ ' � . - ... . . .. �_.�� I,os owncr of the proPr.r!y.'or'my em�i�y���s w'itli . , ..:. � ._ . ... _. , W�!er Ccn,flm�e . �. . i . .� 1. .�,� .:..�_. _. �__:-_..... . _' -- _.._ . � . .wnge.s as;the�r salo compensorion,w�ll do ibr.v.�oiV.and � � ,� ��� � ���' �',IHe,s�r�e�ure is�no'intended o�of�e�cd{o�sai<��sec.�oaa) . Hcalth�coanment __._. __ ._-_ _'.. _. .. :' ...�'� . 1 .. - . ._ . ." _'_.._. . .�_.� .. -�.. . .��UiiaessartdPrdcu�inniCudr:l'br(:nutrd�tnril.irrnse ....l.am Jnrs nnf ufrl�•Iu ur�uarnrr��J/�ruprrh'�rhn buiL/c ,..-.`� , . , ..... or i�nprnros tberr�m,anrl�rbn Joe.c sud�u���rk:l,ire��r11�rr � F�rc.Dennnment . .. _. .__'__ . _ .._ ..,. � - � � .� � : _ .. : . _ , , , : u���,u.er, t„� �•��;,�pr ;<�;•,:�.��„„r„r ra„� .��,.� , � Grodmg � -- �� I , . ,.� .. pro�einen�s�orr >in[ rnlendeA ��r //r>cd/r sr�lr. .^ �� . . �.2,oarerr,tbehvilJin,�ori�n)rnrcrn<mt�axnl��<afl�none , . � : -.-, .� G cloykol. .- . .. � � -"�-. . ... ......... . . ,.. � . ..,. , . . , . . � Paar n/'rnr>rJ�leeinn, �tGe nu�nrr.bailJrr�u�ill Garv tl�e n ' hurdrn.f frnri�i,(thal A�Jid nn1 GuifJ or irnprnrr Inr , • _._.... _ .. .. :-__ ._._ ._.'. � ' . � t'edesvian Frorecnon . � . . .. . . . . . �, . . . Jl e pur/�os��nl a��lel. � . . , .. .� (Fence)�Cenopyl � : . •. �� . ...-. '���` '�� .' _--.--. .. . , � � . . [E 'I.�asownerofrhe prop�erty.�om�e dvs�bcly ro�!rac�. �� .. � , � ,ting w�7h licensed cq���ociors�o<onst.uc��he p.mFc�(Sec. � . ... .- ..'. ..... ..... -� 7044 �Hi�s'vic�s�nd 1'r snnrsc f�o,l��: '!'Ga(:nulr�rinr's Soec��ol Inspecnan � � . . .--- .._. .. �- . . � . .. . .. I / �Cenc.)(M�sonryl IWrldingl � _ _._ . . l.ic��nsr L�em dues nrrt.+pp11�tn�m�.�uv�rr r f prnpertv¢'/�n ...• ..,� . �.' � ' .. - � ..... _. '. .'..� ... ��.. "_..h��fdr br"-i . '�i Il�i rr�,�,aud u Ga7��ntracls su.l� r pm /ur . , ,.,, Loi Dra�naae .. '.� �� ,.� � _-.. .. .. . . . . . .�_ - _ . .. ��.�P•rj�irte�u�itG�Y�aretr��tnr{�J�li:ra.i�d pvrsi�amt !r, llrr . . .�. � ;:- . _. ,.. � -Cnntr.�rlur'.ul.icrnse�L.ua•l.- -- - ' . . .... �� . � Fn•kinq ' � .. ,. . . . _ . .. . . � .. ... ..F.-__ - `. -� . s., � , �. � _._ . �_. . �. LI I am e.em t undcr Sec. �.&P.C. o.�th1 ...__.... ._.. _..__..-,_. s .. . ......_ .._ ..__._.__._._., .� , reoson .,. ,'. , _ .___.�.__.._. ._._._. . .._. . Dote Owi . . .. Approrolz Dale Inspeclar's Signat�re �� � � � . � . �INSPECTOR'S NOTES -�-� 1,� _— __ -. Locai�on- � . . . ���^� , . . (Sei6a<A 8 Yardsf ^J�! 7,A,�I�_ � ��/� �7. .: . :.. . , .._. , . . , �^ iy. Faondotlons �•� ... �, . �. . . . . . . � _. .....__ ._. ..... ._ . .. '� �i . , . ,.. . . . 5��b �y s,., ' - - - F,Um� i ,, �, �t7 � _ , EncrGy Insuiarion f; , � . � . .. � � � : � . ._' .. ., '.. - � . , l i;s fr7 ,L(� -- - . _-- ����,-o,tiw��� . — _ ... _. ;. - � -- /I _. inirr:nr ��SK �� .. __. � J .... . _ . . � . �. . , .., ., � I lnih-Ezterlo� /] • • . � . __ . ___..-.. . � � . � . ,j� � ' �,�.� I " _.'_ . . - .. .._. .. .... ,.;, . �..-. Ho��s�t��mbe..._ - . . . : ..., ., _., , ,._ , . _.. ._ ___. . .. _i_.. ___ . __.. ._. _ '. -- Con�c!h Pos�Nd , . �-. fl t I _.. ._..__. .. .__._ __ __ ._....__. . F�na.� . . . ..__ __ . . . .... .. _ __. ' ' .,� . �. .. . _.��, .. . .. .___._ .. .._...__ . _ � . Entc�c�Fronr � . .. . .. , � . . . . �. . , , . � , , . .. . . . . - . - .. . . . .. .. � . , . .., . �. �. .. ... . ., ._ �.. ,\ .�.��\.1 �? . �� '�' \ ._ .�.. . . . ,.. '� : _�_ '. . . ' �s' . � ..