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HomeMy WebLinkAbout1518A 1519A (8) WORKERS'COMPENSATION DECIARATION � � . � � � I•hereby affirm iha� I have a cenifica�e of COf159I1110 6tII qpp�ICATION� FOR BUILDING PERMIT insure,or a ceniiicata of Workers'Compensation Insurance, , or a cerrfied copy rhereof(5ec.3800,lab.C.) COUNTY Of LOS ANGELES BUILDING AND SAFETY . PolicyNo.73WCOOS—Z��mPQR�}6 NATIONWIDE�` 75/C � Certified capy�s hereby(umished. FOR APPIICANT TO FILL IN suii�wc ADORESS z3616 E. Chandelle Place � Certified copy is fited with�he counry buiiding inspec• eUttoitv� 1i0ndBpGrImBM. ADDRESS Z3616 E. Chandelle Place' Dote 6-30-87 APP���o�t THE ANDEN GROUP �iT� DIAMOND BAR z�v91765 �ocnuTv DIAhiOND BAR CERTIFICATE OF EXEMPTION FROM WORKERS' � � �NO.OF B�DGS. � NEAREST � � COMPENSATION INSURANCE . � 5¢E OF lOT Now oN toT ceoss srDIAMOND BAR BLVD. + GOLDEN SP I (This eection need no1 be completed if the permit Ia/or one TRAR 43435 BLOCK LO7 NO.46 �ESSOR hundred dollors(5100)or less.) NJ�7 BO�K �AGE PARCEL THE ANDEN GROUP �E�' OWNER No.967-9541 USE NE NOP ����J 1 carNfy that in the performance of the work for which this , `?-, �1 permii Is issuad,I sholl nol employ any persan in any manner P,0. BOX 3329 � �c'^` � so as to bemme subject to Iha Workers'Compensolion laws. A�DRE55 (�DUC7 CONOI710N5 � aTrCOVINA ZiP 9].7Q2 V Daie Applican� � � � �NOTICE TO APPLICANT: If, after making�lhis Certificate of aacHiTeeTORDAVE SZANY AIA TE�� DISTRICT GROUP ttPE fIRE %tOCE55EDBY O NGINEER No.445-4073 CONST. Z E 1— Exemption, you nhould become subjeet to Ihe Worken' j n� _( ' W Compensmion provisions of the Labor Coda,you mus�fonh- ppoaess314 N. FIRST ARCADIA 91006 /v « /V with comply with such provisions or this permit shall be O-' deemed revoked. HE ANDEN GROUP TE�' STATISTICAL GlASS¢ICy1TION APT. CONDO. [A CONTRACTO� NO. �/ UCENSED CONTRACTORS DECLARATION � �i�, CtA55 NO. w �WEtI.UNITS�L Z I hereby affirm tha�I am licensed under provisions af Chapter 9 aooaessAS ABOVE No.510560 (commencing with Section 7000)af Division 3 oi Ihe Business and ��C, ��R�P Professions Code,and my license is in f�ll force and effect. CiTv C�A55 $ BK � VALIDATION 510560 g SQ.FT.2��(+ NO.OF Z NO.OF 1 CMECK Licensa Number lic.Class SIZE STORIES FAMILiES ONE VALUATION THE ANDEN GROUP 6-30-87 DESCRIPTIONOFWORK SINGLE FANILY NEw � co��.a�m� oa�e GARAGE 643 Sf ADD � s 164,000 :=1 5 1,8 A �I am axampt under Sec. � , � ALTER $(• • •�•'Z� B.&P.C.for ihis reason REPAIR - _ use oF I •E'.3 1.0 8 �ale: E%ISTING 9LDG. ��0� ❑ Signalure � " aPPucaNT tE�. FINAL • "���.O�� OWNER•BUIlOER DECLARATION aRWT THE ANDEN GROIIP NO. - DATE 3/�'�/�� I here6y affirm thar I om exempt from rhe Controctor's liceme AS l�BOVE 0 4.� � -a 7 Law for the fal�owing reason(Section 7031.5, Buainess and /DDRE55 � FINAL f� �J y.s Profeesions Coda): euuowc � sY � �� I, os owner af Ihe property, or my amployeas wilh ADDRE55 , � wages os Iheir sole tompensation,will da the work and �p�qiiTY Ihe:tructure is not imended or aifered for sole(Sectian � 7044,Business and Profess�ons Code). ' � MOwNG TEL. � �� 5 1,g A � I,as owner of the property,am ezclusively controcting CONTRACTOR NO. ; with licansed contractors to mnstrucl tha project(Sec- ADDRESS $t• • • • • � fion 7044,Business und Rofessions Code). � RE�UIRED yARD HWY TO7Al SETBA K . � � ' ' - I a�9 6.O O CONSTRUCTION LENDING AGENCY SEi encK VROF.IINE wioTH I hereby affirm ihat there Is a conslrutlion lending agancy!or FgoN� � ` ' Ihe performanca of ihe work for which this permi�is issued v.L � ' � . ° 'fi G���c� (sa�.309�,c�.e.�. p�oe . . D 9,t l —8 7 CITIBANK • lender's Name IDMA Ref.N�., . ' . m tender'sAddress444 S. FLOWER� LA 90071 P.c.Fe�s 431.08 ve�m�rFe� 685.50 ' • � I certity ihat I have read this oppliwrion and siate thoi the iss�o�ce Fee 10•50 mhv+P2 M abova informoti z correa.I agree to comply with all Counry in.ev�ganon Fee 696.00 ordinantes ate laws reloting ro building conslruciion, _ Torol Fee IDMA Perm.M � and hare a orize rapreseniotivas of this County io enter up e- ioned property for inspection purposes. �A y�•7S � �3S � ^ � �z SEE REVERSF FOR E%►LANATORY IANGVAGE Signarore a Appl¢on�o.Aqenf � Do�e PLAtlS TO APPI�CA�lT WSPfCTOR'S NOTES ..�O�l'tiliK•Dl9LUliR UIfCLAR:1l�lO.V I he�eby nffvrn:��ai I mn e.empt bo���he�Cnr:o-acic:'s ' To: - Returned j , . . � � � . � . . �..-Licensc Lo�.v lur ihc �ollow�n� r��vtu•� �Se<.��70�1.; .. . , � ..� � APProved ` Ilreirnrs��and�Ir�hsii��nv(:nd�.•An�`.r(1nr.:iunt�'i<(�i,b No. Date No: .,:.pafe . � .... . • , . . , ...�. rcyuirrcu J�eru�it fnanns��ur1.ehr.,.i�n,�•.urr.J�•nrulia(�, � --- �- � . . �. �;�'` ._-.�rrcpoira.rralruct�ir��./�riorl:.ic�i>v�.�n�r.�als��n•yuirri - . �� .' . ... ... � .. � . , _.... � _ , 1Lr uppli.ant/or:xrab��rrmit e��/i!�•.n si;cnrJ stu�r���ra� I '�. : ; ..� ' , '�• � :.:,�.i � i.i�� .� .:: ('. _-�. " - te,r.lnr4 7 ii�<mcr l.�+a((7w%ti r'')lI su+ r '/nc�'it!`�1rv i � ___. _ _ .. _ .._ .. _.. . _ . ___ _.. . - ." ..�.� r!o„700oJ IU' 3 / � n �rh�n,n u{tl�r&u ' �.s.�nJ!'n,r.�i mc � .. . �� . ,.'� i�'. . .-, !��`.;i � - �` " '. �. . .�.:� f lrl��•d�urlel�i•�enrptrhrr�Jr,�manJd�e�h:..l�fo�rbr �'� -� - --- —.. __, ._ , ,.. ._.. ---� - .. . . ,_. .__ ... _. _: .. ._._._� .. . _ all,e Jcremprn,o.�Inr-�d,�larlr,n u/�1r.rr„n;U3LS bi. .� � .. � �" � ��.:�. •�F:equired �" DotoRoceivod- . _. - ... �'.. . �.�.-_-- __.. . . ._ _ .. �.. -_'__ unv�rpL��rctfaraprrnii(mhje:rslhra��phu�n�t.���irr! ApProvalc . or App�roved ' . j,rnu 1v nl n.+t rvurr tl an/i�0 1n�nJr�J dn!!an/SSllp/.J. �� �. . Yes No . .... � � . . � �-��� �. _� � . , __ ....� _ ._. . _. . .. __ _ .. . � �, - � � ._ I,os owner of ihe p�ope�ty,o•my r•mployr.as wnh W��Pr C�ri,h,oie ,' -.'� '�� .. �, .. .�__. �:�_. . _ . . .. _ ..�_.. . _ _ .,. wuges as+heir sole co�npensai�on.wdl de�he��o��.ond �., . .. . ._._ . _ . . . . _.. __ _.. . ,. Ihe structvre is�not iniended oroffered fo•sole(Se< 704d? . McolfhDepvnmrN_ .. . : - - . � .:- �•, .... - . . . - --. . - .. __._ .. . Il��srnrnandl 1 iuiu�CoJr:.f7,rC.�iitrecrnr'c�li.rnse -- -- -- -�- - ' - - �-. -��.. � l.u�r Jnrs nor apflr ru Jn nirner uJ pruprrre�ob.,l�urld� � , . . .-, . ...__ � � n � �rurv•e tbere,�n,unJ iebn doec aerl�:rurk l�imn!/nr ' Flre DePanmem ,._ ._..._._ __._. . .,_..._ . � _ � _� . . _. � _ , .:- .. . . 1 n�a�n.rrn /trr�. ud ! t!>�r! smb n � � - � tl r�tt,cG-�l+ir p q �)ru•'�v rr• ' Grod�ng I -_ . . � :,,prircnrrn�c.urv,nnt inlenJed or n//�red/nr snlr. !l,^ . - r. . .- . ..� . . Gmeerrr,fbr builJin,�arirnpranrmrn�is�dd�riel irz une . � • .i� ,�� � �� .. . ._ ., .. ._.... _._... ..__ .. . . . ' ' ' . . .._ ' Gnelog-ca. � � . , . P�ar n/ennrpletinn. ebr nu�xrr.builJer<ri!! lrurr�fb�� �; �. . . .�� . ' '�.�.. .... ..�,:'. .'�. . . . �6urJen n/prurin,�thu�hr Jid nn1/n�ilJ rrr irnnrnrr/nr _. _. _ - - —_ __ �n�•�u.r�,t���i.�uf.•t < „ PFencrr�oC�Proreciion . . . .. , . ' �.. . . . . l 1 1 PYI � � . . . . � � ._ . -... . .. - - -�-� � � � -1'% I:os owner oi ihe prope�+y,�om eaduz��ely com•oc. — ��liny with�lrtensed co�frouo�s lo<unsvuct ihc p.oiev{Sec. . •. .._.- _. ._... __ -_ _. ... . _ ._.. . ...�' ... 70ce)'Ilrvrn��ss und Pru/r.troir�C"dc 'lhc Cuntr�ctnri Speciol InspeUibn-- ..-.-- .. � l,icrn�r l,.�io does nnl a r ! �o uu nu�nir u tr u�bn (Conc.)IMasonrY)lweldin9l � � _...:. . . . .�-. .. _ . .� �• jp i. frrnfer . , . . - _ _ _.- huifJ:ur;n:/�rures ll rreun�.�nJ u�bn���,ntrade fur.���i.b Lor D�ama9e . .' . - . .. � . .� �.. . . � ._. Pnjrots�ci�! u iunlrurznr/�l lifrriced rvnu�+ni !n fhr . . , ...� - - _ _. .__. ._ ..._. . � � -��'Contro�7nr's l.icensr l,au•/.- . .... . . � Pa.king . . .- . . _.._ _ .. ..__..._ _ _, . . . _... _ ... P_ P ..-. .,. . . ' C I am e.em t und_r�5ec. .B.BP.C.�o�ihis . .... . _._._.._. .._. . . ._ . . reoson � . _-_Date. ... _. ... . _ .. . _Ownrr .. . Approvals Dafe Inspeqor's Signalura .,. ' . . � . . � - IhSPECTOR'S NOTES ��, � � Lamrioh- ...__ __ ..... . .'_ (Seibock 8 Yardsl - - - � /� Foyndations � . _._ . . ._ ._ _ ._ ��._ r:� - � . . . . Si�b _ F,om� r � . Enerqy I�sulaiion � � }�%/� ,� . , . .._ �� '� d � . . -� .� ... r __ �, , la-l-�� � , Laih:Drywall.. � _.. .. . ____ . . __ . . _ f . . lnr�rro. - � .Z�. _. � . . _. ' . '. ., " larh-Ev�e.ior �71` . . . _._. .. . .� � .. � � � Lb ._ ' _ �_ -. ..� .� H:;vs�Nvmbe.__ . . . . .. .. __ ._. ._._._ .... . __:.. . _ . ._. . �. . . � . . ... Co..e<�8 Posir.d � - '��:�.. . _ . . _. _ . _.___ . F�nol. . ___.__ __. ...�. .. . .._ .__ _. ... . . , � .. � . _ __ . ..__.. . . _ . ... . Enter on FroM � (. � . � .. r. . . � . . . . . . - . .. ' ' ,. . . . . .. ., .f 1`_ .�- -.. .. .. . . . � ,�y1: ����..� •,I\ _•�•1•