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HomeMy WebLinkAbout1520A 1521A (8) WORKERS'COMPENSATION DECLARATION .� - . � /'� t!hereby a4iirm that I have a ce��ificafe af�o�,e��,o se�f - qpp�ICATION �FOR BUILDING� PERMIT insure,or a ceri�(icate of Workeri Compensa�ion Insurance, '�J , or o certified copy ihereof(Sec.3800,Lab.C.) � 73wc005-77p f1!116 NATIONWIDE COUNTY OF LOS ANGELES BUILdING AND SAFETY PolicyNo. K:oinpc'r�^ - ❑ ADDRE55 23630 E. Chandelle Place Cert�fied copy is hereby furnished. fOR APPLICANT TO FILL IN � Ceriified copy is filed wiih the county building inspec- BUiiDwG � r�o�departmenl. AO�RESS 23630 E. Chandelle Place Oare 6-30-87 qPP���e�� THE ANDEN GROUP ciTv DIAMOND BAR Zir toCntrcv D CERTIFICATE OF EXEMPTION FROM WORKERS' � � � - NO.OF BLDGS. . NEAREST COMPENSATION INSURANCE . srze OF tOi NOw ON l07 CRO55 ST. (Thiz section need not be compleied if the permit is for one - n55eS50a . h�ndred dollars(E100)or less.) TRACT 43435 BLOCK LOT NO.L{ MqP BOOK VAGE PARCEI I certify thm in the periormance of ihe work for which ihis owNeeTHE ANDEN GROUP No 967-9 41 U ONE �P � _� permi�is issued,I ahall not employ any person in any manner ppDaE55 P.O. BOX 3329 /�1 SPECIAI �� so as to 6ecome zubject fo 1he Warken'Compensation Laws. � ���V CONDITIONS � nTr COVINA zia V �ate " Applicont 1 2 [r �NOTICE TO APPLICANT: If, after making�this Cerlifitafe of ARCHITEQOR TE�. DISTRICT GROUP TYPE FIRE PROCESSEDBY O Exempfion, yo� sho�ld betome s�bjecl to the Worke�s' ENGiNEER DAVE SZANY AIA No.445-4073 �pNs a 1I Z� U Compensotion provisions of Iha Lobor Code,you m�st forth- qDDRE55 �D v`�3 �/� � w with comply with such pravisions or this permit shall be 0. deemed fevokeCJ. . TE��� STATISTICAI CLASSIFICATION APT. ONDO. [q cor�rcenaoaTHE ANDEN GROUP No. 1+ Z LICENSED CONTRACTORS�ECLARATION . ���, CLASS NO.� � DWELL.UNiTS�l�L I hereby affirm thol I am licensed under provisions of Chapfer 9 ADDRE55 AS ABOVE NO.S 1 O O ��R�P (commencing with Sec�ion 70W)o(Division 3 0(ihe Busineu and . LIC.. � Professions Code,and my litense is in full force ond effect. GTY - Cta55 - BK � VALIDATION �10560 B s°eFT'2774 TORIOES 2 F MROIE$ 1 CO EK License Nombe ��lic.Class � VAlUAT10N Con+ractorTHE ANDEN GROUP Data 6-30-87 DFSCRIF110N OF WORK N�"/ ADD S 164,000 , �� 5 2,0 C� ❑I am exempr�nder Set. GARAGE 643 SF q�TER ��. . .,21 B.BP.C.for fhis feason REPAIR s USE OF � °(1 3�.�� � Dote: E%ISTING BIDG. DEMOI � Sfgn0lUfB APP�DRIM NO. FINAL � d • °�.'.��,Q b'� OWNER-BUIIDER DECIARATION DATE 3/'t'.�/�" �I hereby oifirm fhot I am exampl from the Coniractor's Llcanse qDDRESS AS ABOVE ' FINAL - �9'� � —$7 Low for the foilowing reasan(Section 7031.5, 8unine3s and Professians Code): � - � by ���'t�"�� � �•('1 BUIIDING �J I, as awnar oi the property, or my employaes with ADDRESS <� S�L� A woges as Iheir aole mmpensation,will da the wark and � � � ' ' . the atrucWra Is not intended or offerad for sale(Saction �ocnuiv - • 70d4,Business ond Professions Code). MOwNG , � � � � ' �TEL.� . � ., ' �% •"• • • � � I,as owner of�ha propeny,am axctusively contracting CONTRACTOR � N�� I a b 9 b 0 0 with licensed contractors to construct tha pro�en(Sec- aDDRESS � � �- tion 7044,Business and Professions CodeJ. e �,G�f`O�� CONSTRUCTION LENDING AGENCY bET�BACK YARD HWV T�TAp�pp��NE �WiDTH � � � -� I hereby affirm thaf�here is a consfruction lendin9 a9e^�Y fa� FRONT - � �� , ��, O 9.� � `�i 7 tha performance of the work for which-this permit is issued RL . . � . �Set.3097,Civ.C.). SIDE ' P.l. lender's Noma CITZBANK . i Lende�sAdd�ess �+44 S. FLOWER. LA 90071 v.e.F�e s 431.08 - r�.m��Fsa 685.50 �on�o.aet.x ,i � I certif thaf I have read fhis o lication and s�ate Ihat�ha �'�•50 , Y PP Isauance fee LDMA V/C M abova informotion rrett.I agree to tomply with all County Invesiigaiion Fee 696.0� $ ordinances on laws relafing lo building construction, Toral iee IDMA Pe.m.X and haraby th ze representativas of lhis County lo enler upon Iha o entioned proper�y for inspection purposes. !/ LDMA $75 $35 ^ Q � SEE REVlRSE FOR E%�LANATOLLY UNGUAGf Signalure Of plicont or Agenl �ple . . . . . �/^ / PLANS TO APPLICANT INSPECTOR'S NOTE$ .. Ull'tih:K.ISU11.UliR UIfCI.AN:1�IlU\ � - � I heret:y aflurn tF�nf I am eMempi from fhe Conva^o�'s To: �. . . .. � . Returned . � . . � . . � �Lice.nse Law-fnr ehe��following r �nson �(Src. 7031�5� Approved .. . �f3��sirz�:asundl'r�Jrarinm(:odr:/InY<itt�nrr��uah'u�(ri.b No. Da1e No. 'Datc .. -. .. .. . ' ... � . . . ,.� . n�ynirrs a��rrniif fn rr�n�trucL✓llrr,iinj�;�, .drvrnlisl., ' ---- —---— . -- .��,,,, ,,.,� r a'r.�•:p ;,;fi�.s ��r.,,�.,y„� . . �. �.. . . i!r�eppfiwrrt l�,r su.A prrmit(n Jile a sr,enrJ stJtern��,� i. ... .. . . . , :, '. ,';. ..' '. [ ' .._ ___ _ _. _. _ ._ ____ .._.. ' _ . ,..tleticic.G:rn�rdf,ur.aieJ.ittn�Lrprarrsuvsn/.IJ�eC...r- . , ,.I ;.. � -�', : tl'L�;i._ �.u.inr',t.;n�ns��l,,u�lCl�aprr.'lJl�,,,n..u•ncrn.�u•!N�1c.- �......�. . ... �--. . .. .__ . _ . __.... -. _- �. .__.e: . , ., .._.____-- --`-. - - t�on 'OOOJ�i/U�r von 3•�l th��I)�ecrrc�.a.ind Yr�����n,r�� r ��. s. .' ' � .. ;,' ;. :� �..•�,-� �'� .�C,kr�l nr�!at be i�.�.r�'nrpi tl rrrJrn.0�nJ�br Poaic/�,r 7hr . . . _ _'... ..__ _. . .',. . . __ . . .. . __ _ . - .. .. _ _ , .. aR�,erd exemfNnn.Anv�i��/afion r�1e<tinn i'(i?LS h�. :''� ' ' ''� Raquirod. ..� ' .:� . -... --�-- � �- � ---- .-. -.._.--.- '....�... � unyappli.Nne/nruprrm fa l�c.tcfhcdpphc<iarhra�n�if ... .APprovols' � - - Date^Receivodd �. i . .prnulrt.of nnt mnre�.ehd-/ �1rursJrrJ dull:�rs(5$(10/.j� � '- YM.. No PProve _�__.. ,� , . � .. . . ..��. . . �i� ; � � .- . _... _ ._'__. . . __. .__. _'_ ' '_ __ --_ - � ._ I,as owncr ol ihe prop��ty;�o�my c�ployr.es w'irh 1L'oL�-Crtrirf�mie. ._ � t � � �� . - . ._ �. wages ns�helr sole rompensa�mn.will d:�he�-or6,and , . , �� ,� .._ .-._ ._..-_._._ ... . . . _�_ __ ' '_" . ,. . �� -�-- - � � . ;. , _ „ �- ,. lhestruUure�isnc•intendedo�of(e.ed��4�;sule(Sec 7�a-) .,.. .., , .. , ,f3uri�,ess uaJ P �/��lnou CoJr:�.7'bc Cowir,��tnr�! .. :. Heolth Deornimen� _. . .. _ . :...:_1 .. .. ._. . _ . . . . u __. _. ._ �.�_. .. . . ._ _ ,�_. . . �.,.- Lu�r Jnes not ur/�1�tn an nv�ner.�/j�rnprrt�uJ.�hudJs �.e OePa Im����_. ._ _..,. _ . __.. _ .. __ .� � ,� , 1 .. _ � ../'. . J u hn . e.! •nrk, .� /�K F tbrmnn.un do�r+� u ! / . . . . - . . �rlrnuF/, G,s ni�n �•r.�pl�,yres:prnr•id.�d th�t sud, im-'"� Cr�dinq � , , . `i. ��i . �-�rnt�erner:ti arr nnt inlundrd'or ��//rrrJ fur r4 f/ .�� ; �., .�� ._ _:.�:` - . „ .. . .�.. ., r�hmrrrrr.tl�ehrc�IJinXririn+pruncmrnti<<uld�ri�hmn.e�� � . . � _ . . 1 __ . _. .1.�!... .. -.i. .. �.�__ .. � .._. G�oloq�cal '� � . ' . � . � , 1'rur o/rnmJr(rtu�n.�fh<•'nu�nrrhvilSrr rril( bnre'th�• .. .___ ._ . _. _ _. ._. hurJen n(frnrrnq thut!r Jrd n.,t Fuild nr nrrrrnr r/nr Pedcsinon�Prateu�on � �. . . . . ' .� : . ' , .. .,. ._ .. . �. � . .. . �. . .. ,� tJ p�rpoa��/s�lrl. ��.'. (Fence)(CanoPY) I; . . , . -._. �,:.C,. ..__ .__._ . ._..' ��1".. ..�._._. ,.... . [�,.1.as o <r of thn ProPeny,cm es.l��<rvely cnn�roo . ,ting wnh I,censed co�itrocwrs m mns�ruct rhe pro�scr(Sec. _ ._. . ._ _.6�. . . . _ - ' -. . . U�esmns�unJ Prn/ c C.�Jr: 7Lc Cnrstr��tnr's SpNclnl Inspec�ion '. - .=.. - .... . . 70aa) iConc.l(MasonrY)(Weld�ngl � ��.. " �. � .. -. . . . . ,.� ! tr �r�1,.a�rJorsnnr�J,pl�� frtnu�•nrr��prnfer�7�•hn _ ,.,. . _._ __.._. ..._..._ .. _. . ._ .. _... .._.. . .._ ' _ . . . .�, huifJs or i�.,�.�,res ihrrdr,n,JtiJ i��bn.untraets/i�r s�a.fi lot Owinaae �'�. . . . . � :�. . .. ...- Q �jc<'ts u�itl�.x annlrpctnr(<,J lirerurJ,/.ursuant h, !Lr ,. � , . �. .....__.... _. .._ ......._._ ... . � . � I . � ���--C ba�lnr'sl.icrrrrrl.auJ. . . ,. , ' .... , , ... � ' _ '.__ . I i fn•king . ' . ` � ..�..._..�_; Iamaxempiunde.Sec. .6.6P.C.fo.�ih�is ' ____._.__...'__'__ ' .. . , .._..._.. .,_ , , .... .,�� - -: rcason _' .._...__ ._ .____ __ _. . .. _.... "'.'_ ...... __. ... .. . � . � . . . Datc Owner __'.._ .. _. _..__.__. . ..... . � . . � . .. - . APProvdis Oato Inspector's Signal�ro . . . . . � , . ... � .. _ . .- ,. . -INSPECTOR'S NOTES� ' � �� � Lccoi,on- -- . _.'_._.___.... _._ , .� ... � . (SPrbacl 8 Ya�ds) - � . . � �^ ` --- ...__ .. ._._ . . .._ . ..., . . . , Foundatlons ',�AI '.' 6. . ._. ..C. .c..- � .• : �� . � . Slab . .. ..._. _1) �I� . _._����. .... :.� .. ... _ .�.'. . . .� .. . ' . Fmm� �� I�1.. � � ' . . . . . .. . . . . . . . . . Ene.gy Insuiolion 1 I � ._ _ _ . _ _..._ ... _..�. . ._ ... . , • ... . , , . , .. . , ,,.„ ', 1. �.l - � ' � . �. ' � ,.. ..,. �.. ;,�� . ... ., La:h:Drywoll.. l 1� .-._. __..___.-. �._._ .-- - _.._.._ .._.. .._ _ . .. -._ ' Inter'or � � ' Loih-Eaierior '. �� � . , ;,. - . . . � . .- � .__ '..._ .._ ._____._. . _._ __ � � ' 'M .__ _. _.. ___ n ::� . _ __ ,... ,. .. -.:.� HouseNumbe.._ , .._._ , "� '___'_. _.. ._ _._.. _.. , , .. ._. . _ ..____ . . . .. , � i , . .. Co.rr.cr A Posted , .-. � . ..�.. _. ...�. . � P�nni __ ...� � .. _.._ . _._ .. ________ ._._. ___ .-__ � ,. ' - � . .. .... . . , . Enier on Froni � �.,_"� . � . � . . � . .. - . .. . . � . � , . . . . � . � . _ . . � � .. , , .. . .. ., - � � � � _ _ �'��1' _._._.S.t �;� '��•� ___. '