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HomeMy WebLinkAbout1560A 1561A WORKERS'COMPENSATION DECLARATION � : � /"� � I'hereby affirm iho�I have o certificat�a of�o�,e�f,o 3e�f � APPLICATION FOR BUILDING PERMIT `�j inwre,or a certifico�e of Workeri Com ensation Insvrance, r or a tenified copy rhereot(Sec.3800,Lab.C.) � � . PolicyNo.�3wc005-2��m�,�.6 NATIONWIDE COUNTY OF LOS ANGELES BUILDING AND SAFETY � Cer;ified copy Is hereby furnished. FOR APPLICANT TO FILL IN ADDRE55 23622 E. Chandelle Place � Cerfified copy 1�flled with the county building Impec- - BUII�ING t�on deparimem. ' nooaESS 23622 E. Chandelle Place Dme6-30-87 qPPucanr THE ANDEN GROUP crtr DIAMOND BAR ziv91765 �ocauTv DIAMOND BAR CERTIFICATE OF EXEMP110N FROM WORKERS' -� � � NO.OF BLDGS. � NEqREST - � COMPfNSATION INSURANCE - SIZE OF LOT Now oN ioT � ceoss siDIAMOND BAR BLVD. + GOLDEN SPRINGS (This sec�ion need not be completed�f�he p�rmlt I�for one � 7RnCT 43435- eLOCK tOi N0.47 A�ESSOR _ hundred dollon(f100)or lesa.) 1w1P BOOK PAGE iARCEL I certify Ihaf-In iha performance of tha work for whieh this owNea'i'HE ANDEN GROUP No967-9541 u zoNe � �f permit Is issved,I ahall no1 employ ony person In any manner qDDRE55P.0. BOX 3329- - . ✓/ SaECinl � so os�o become subjecr ro the Workers'Compensoilon lows. ( d v(� CONDITIONS � ntrCOVINA zia 91722 V Dote APPlicanf � � Lr ARCHITECT OR TEL. DISTRICT GROUP iyPE FIRE PROCESSED BY I/^NOTICE TO APPIICANT: If, aNei making�this Certfficote of NGiNEER DAVE SZANY AIA No445-4073 -�r,�T ZQyi � Examption, you� should become fub�ad �o the Workars' T /(1 R)/ '��{ Compensation provieions of the Labor Code,you must for�h- aDDRE55 14 �U Y\� � I�/ I Y � wi�h comply wifh such provislons o� this perml� shall be � O..' TEL.� STATISTICAL CIASSIFICATION AGT. CONDO. (n deemed revoked. corrtRnCro�'HE ANDEN GROUP No. LICENSED CONTRACiORS DECIARATION � - - � � �i�, CtaSS NO. � � DwEu.UNiTS � Z I here6y offirm Ihat I am litensed unde�provisions of Chopter 9 ADDRESSAS ABOVE No.510560 (commancing wilh Section 7000)of Divieion 3 of the Business and _ ��� SfWER MAP � Profassions Code,and my�icensa Is in full force and effect. CITY cw55 Bx � VALIDATION S10560 B s�°ze�2634 STORI�ES 2 F MIOES 1 CONEK License NumbeY lic.Closs � VALUATION connac�oTHE ANDEN GROUP 6-30-87 DESCRIPTION OF WORK SINGLE FAMILY NE°`� � �1 5 Q 0 A ooie S 157,000 ❑I am exempt�nder Sec. GARAGE 4G5 $F ADD O , �'• o a •2� AITER 6.8P.C.for this reoson . REPAIR S � 1 •{:1 �.5 9 Dafe: - USE OF DEMOt �ti, � o F�,� E%ISTING BLDG. e U J Signafure � � APPIICANT TEL FINAL OWNER-BUIIDER DECLARATION PRIM THE ANDEN GROUP NO. DATE 3.�/� O 9�� ��H�I 1 hereby afiirm�hal I am exempt from�he CoMractor's license qooa¢55 /�S ABOVE Law for the follawing reoson(Section 7031.5, Business ond FINAL yy J � Profeuions Code): ey /iJ7�•2'�"""'ro r^!"1 BWtDING ( J 1, as owner of ihe properly, Or my employeei wilh ADDRESS wages as their sole compensmion,will do the work and i��TY �- � •�1 5 b 1 A Ihe s�ruttura is not intended or offered for sale(Secfion 7044,Business ond Professions Code). MOVING . � - ,TEL.� '� � � � ' - � �. • • • • � � � I,as owner of the propeny,om excl�sively controcting CONieAGTOR NO.� � with licensed contracrors to tonstruct tha pro�ect(Seo- qooaeSS � - � � "G 7��� tion 704a,Bustness ond Professions Code). " � . . CONSTRUCTION LENDING AGENCY SETOBACK YARD HwY TOTnvROTP LWE Wi�iH ' �°��a O O� I here6y affirm tha�there Is a consfr�crion lending ogency for FRONi ' •r.._� O n., 1 `.�..1 ihe performonce of the work for which ihis permit is iesued � � BL ' � , � • 7 (Sec.3097,Civ.C.). . SIDE CITIBANK °'�' ' Lende✓s Name - r.e.F��s 418.59 Permir Fee 664.50 �DMA Ret N � m lander's Address 444 S. FLOWER. LA 90071 10.50 � / � � I cerlify that 1 have reod lhis applimtion and state thot 1ha iseuance fee - LDMA P/C M - � obove Infarmatio ' mrrect.I agrea fo mmply with all CouMy ,��,,,;s,,;o„F�, � 675.QD q ordinonces o r e laws relating to boiiding consrrocrion, . , ia�al iee l�n�u ae�m.N � and hareby ut rize represenratives of�his Counry fo entar - � F opon e ��y for inspection pu� � �� aLDMA $75 $35 Z SEE REYERSF FOR EXIIANATORY GANGUAGE Signature of�pliconl or Agen�� � po�e . . . � PI.ANS TO APpIICANT IPISPECTOR'S NOTES .. C)l1Tl(H-111�1[.U)CR UI�.CI.AK�\fIOV . . . , . � Ih .bYof F< I .�. .< c.Fil p � .�r , s To: . . , . � Returned �. . � .. . � . r' �Lic nse L� I> �the foll � n lS.c �70�1: ; �Apprcved ` D�vr�r�s and!r,h:i ms Lnd...1n�nti n .uunit i��Lr�G ��.. ._.. . . . . .. ..., � � � r No. � Date ' No.� � Dalo -� "-� �' � � � �- � �- � rryuiresu(,ernel! � nslu't,altrr,jm�nnr�,d,�un,lich, � . . r�r�./��rany tr�ct r'.f�r � t ri'issrr i i uf��riyu�rr� .... .... . ..'. �` , .. �� �-,`i : ... .. . . ..�be a/,pli:enl f r xuih prrmrt tn/ife a uu��d seet�mu�� ,.� ��� : �;, , � , . ,� !; � , . � - �- � .- _..__" .__....._ ....____ .� � ..,.t/�:Ge.is li:rnsrd pursuant t�r tbe rrnrisinns u/�1���(:r.ii- . ,: � . . tr�.ior'sl.i�rnsrl.dio(Cl.aptrrJl/io inirn<in,��rith.li��- _ . . _ _ .. _ _ -- -- _ . � � _:- .' : f�,.n;unu�.r o„ � i„�tr,�nu��;<<.,,u�d r.,,�,. . � ,��.�.�� � ; ' ; , ,,.. , �„� ..__ ...._._ __._.. .._.. ._.�. .. . . ..�._ ----'- -' . ". , .CnJrJnrll�at( i� -acniptrl�crcfn�mnnJllu�bni�aju.�hr . . . -.. � . . .� . . . � n!!r,¢rJ r nrprinn.Anv rinlatiun nJ.fer�i.rn 71H I.5 h�. , , � • . Yet uireNr. . � : � ..__.. . _._. `_.'...._. . _ ._. . _.._ _. unla/�LYarct�nrafrrnntc�biels!( uf�L�vrrctrn��irrl a o.ali 4 Date Rocoi.ed - � f VG� -.. orApproved � frnaltvn/n„i.���,�.•-u��/� l.�,�d�.-d,a�u�,.�/ssno/.p 0 . . . _ -- -_ _- - - -. _.._ . • , _ � " "�-- -�-� � ' ,__ I,os owne�o(the p.ope'ty.�o•my empioyces w�lF. � , . V:nr.,.Crn�f�<o�e .' ' - ..`,•��� . .. . �.. , ._'_.:._. .._ .'__..,...____. . "� .:_ .._ . woges mpen s ihe�r sole co snrion,will do the�. ,o�d � a a.: :. .... . __ _. '. _ . . . , � . . . - - � thc�struclure is�not intended o�offered for sale�Sc�<�70ad1, Hcolih Depanmcnt .� �- : �'. '..� . .-. _. . ., ...� � .. ...Urisiness and Pr�JcssiuriaCnJc:7hr Cnulr,��rur'sl.icrnse '.._.._ .. '_ _._�. .. � -..__ ..._. ...._ .__. _. . .._ . .. . __ '. .l.mr Jnrs n�ni uppf�•�n an menrr o(prup��r(l'p�L��huilds Firc DePoriment .. . . . _ . - ..- . .�� � . .. ' �� . ur rmj,rnrix d rr�,n,and uJni d�n•c ar !u�orF.l�i.rrn�!/or . .... .. ...... -�. . � . . '� . �, �.,-. , . . . . , . . �.. ..�, �. llrruu,qG bu nu�n�-rnipfuticcsr.%r�miJdJ-il�ui.surb.ini----- � Groding : , � - i � �, . � proreruents arn.nnt irslended pr uJ/rrrd/ur s61.. IJ. _.. . _..._ .._ ,..,_... .�.�� .�,.. .-•� .. .... . - _ '� �' . : . � . ��Gnmre rr,tbe 6vifden,e nr r n/r r.emrn�is solJ�rilGin nne Geotog�col � '� . . . � . . •� 1'Nur n/tnnrplrti�,n. ebo omnrr-builde�,�rr!! Gar<•,tbe � ' � .� � ; . `: '' :� �, ... . . �burlrn nf prnrrnX llml hc Jicf nnf hr�dJ or imhrore/nr . . �. . "� . -._.. _ _-..'.. .._:.�-- --.. �.. �-- -'� ': . Pedesmon Pro+ecnon . .,. � . . . 7!c purposr nl+afcl.. . . . ):' � ' ��� '. ;; ;. . Fence Cono ��.� . .. � .. •. . � ( 1( PY) . . . . .,.�. . '. .. '_�� . `.." ' ._. ._...-... � .. . - � � . . . `�% �I,os owner o(the p ope�iy,am e.duslvely cnnttac�. . , .tiny wnh licensed contraclo�s to'construu ihn p.pi�C�5ec, � __. !..". _ _.. _. . ._.._. _. . ......- _-.-. -� 70aa)'Ui�sirteac unJ Pro(�.. ,nc Codr� '77��Cont�u<l,�r} Speclol�InspeUion ' � . �� . . .. � -� . . �Conc 1 iN,osonrv)lWeld�nol - � , � , ' . .:. .. . l.in�n<r f..ru�dues n.,r oppll to un.au�rtrr nJprn/�erh�u�Lo , ... .._ ...'_. . -_ . '. -. �_. . . ... . . � '--7�uilJs nr i�nprur�s Ihrrenn,,��J e�(�n c�m7ruces Jur ru.h loi Ormnage � , � - , • _ . _.__ ._ .. . �' . _.. .___. ... .. . pr�jects u�itl n�pntrartnr(c)li�rnard�purtuant io 1he ' � � , "--Gintra.'tnr'r f,rcrnsr-la�r).�'�� ' � � � ' Porking � , ._____ _ __ . . _... . !. �. . __. .. .. ___ .._ . .�.�� . - . � . i. . ❑ I om eKempt ender Sec 8.8P.C.lorl'n�s ___ . ._.. ... . . . - reason ___ .... . . __._ . _ i • ..___ __'___ _' _ ' . ..___ _. Dnie Ow Approvels �afe , Inspector's Signature � ' �... . .. . � � � . � . ��� �� - ` IhSPECTOR"SNOTES -- � � Loconon- �- i -' __. . . _ . __ . (Setback 8 Yards) � � � �'� _...__ _ ... . _- -- � � , .. _.. Foundafions � . / • r cc11� . _. _ .. - ._ . . . _ . Siab � - Y `—/����� �-� ., . _ . � . �. . . Frome II 2) I . - . . . . . , ._ ' . . . . , . Energy Insula�ion _. ...'� _..__. _.�. .. ..... . ......� . ._'. . _ � . . . ' ' .. Z` ' � , -- ,. . . , � Lo�h:Drywoll-- . ____ . .. __._ . _' __ _'...._. .__ . .__ .._. ' � . . in�e�lor � _ - _-._ _ . , , � , . � - . . loih-E.�erlor . .. . . . ...� ..... ._ _ _ . _.. ._ ._ . � � - . . ._ ..�_�_ .. . r... I r -.., House Number ' .. .-.- -._. _..._____ .—.__" ._.___ . ... i. �. . . . � . , Correci R Pos�ed � C .•'.��I. ..-_ . - - . . �� -. . . . Finol.. . __ .. .. _ ___ . . ._.._ ._. .. .. . ._. __ ....._ __-._____... ...._. . Emer on Fwn� . - . � � . s'.-� - .r _ � . . . . ,\-' . . . - .. . . �_� . � _ . .___ ' •�`"�;' . ., ,._,. ,. . - ... _. , ._. . -� . , .� . .., ... . ,,. _ . . . ` _,,.. . . ,,. . . .•. �_ -= �. ��.. , .. � \_! \� . . ._ •`___ �'�',..�_ �- . .