Loading...
HomeMy WebLinkAbout1615A 1617A (9) _ . .. . WORKERS'COMPENSATION�ECLARATfON � � .. -� � . . ... .. . , . .. ,.,�,,...... .. . ins�re6orofcertifcat�eof�WorkersrrCom'pensofionensurancelf /'�■ ■ ��CA ■ ■O■r �o� i/�r��D��NG PERMIT� or o cert�f�ed cop thereot Sec.3800,�ob.C.; COUNTY OF LOS ANGELES BU1lDING AND SAFETY 73V�005-2�9—DOl� . . 60/C (2 Car) ..,.. ,. Policy o. CompanY Nd �OT1W�CI . .. .... ... . . . ... � Cemfied mpy is hereby fumrshed. FOR APPLICANT TO fILL IN qopREu 24415 Deepsprings DY1V2 ❑ Cerfified copy is filed with tlie county build�ng inspec- �flU0.DWG � �ion deparlmenL ADDRE55 24 Dee s Y'ln S DYiV po�e 8-18-8? APPlicootTHE ANDEN GROUP aTv Diamond Bar . z,P 91765 �ocA��Tv Diamond Bar CER7IFICATEOF EXEMPTION FROM+NORKERS' � NO.OF eLOGS. NEAREST . COMPENSATION�INSURANCE ' SiZE OF LOi NOW ON�OT CROSS S7.0 10 & Golden Springs (This section need not be�completed if�the permit is for one a55E55bR hundred do�!ars($100)or less.) TRACT 42589 BLOCK �O7 NO. 67 pnpp gOOK PAGE PARCEL 1 cenify that in the performance of the work for which this owNeRT� �� GROUP No967-9541 use zo�e o ��•� ,�� permit is issued,I shoil nof employ any person in any manner �� SGECIAL . �� so as fo become su6ject to fhe Warkers Compensation Laws. ADDRESSp.O.BOX 3329 (J'(f"' CONDI710N5 n � CITY ZIP �+ ate Appliconf TEL. ,.�''-. . ARCHITEGT O D{STR�C7 GROUP TYPE FIRE PROCESSED 8Y O � 'TICE TO APPUCANT: If, after mokln �this Ceriifica�e of RDave Szan AIA 445-4073 9 ENGINEER y � N�� CONST. ZQf�E a'"' .tmp�ion, you should become su6jeU to the Workers' i� �� ./� %t . U Compensotion pro�isions of the Labor Code,you must forfh- qDDRESS 314 N. First Areadia 91006 r V ��� � wiih tomply with such provisio�s ar this permif shall be . TEI. STA7ISTICAL ClA55iFl ATION AP7. CONDO. L� deemedrevoked. coNrancroeT� �DEN GROUP No. �--� ,�� Z LICENSED CONTRACTORS DECLARATION ���, CLA55 NO. DWELL UNITS I hereby affirm that I am li[ensed under provisions of Chap�e�9 ADDRE55 AS d�OV2 No510560 SEWER MAP (commencing with SecYion 7000)of Division 3 of the Business ond LIC. Professions Cade,and my license is in full force and effect. CRV aa55 B BK � VAUDATION SQ.FT NO.OF NO.OF CHECK � LicenSe Number 510560 �j�,C�a� B s�ze �2375 STORIES ' FAMILIES �- ONE VALUATION r� C���R '1'j�', j�]J��]��Q�,]P $-1$-87 DESCRIPTIONOF WORK.SI.T1 le famil NEW }� s 1�.��6�� , �jI n a o e L� CoNrottor ��aie ADD � Gara e 510 SF �I am exempt under Sec. ALTER ❑ � o j�);,� L 8.&P.C.for thcs reason �pp�R ❑ S _ Dafe: ' USE OF DEMOI � n :�.5�� I. I �'.�. EXISTING BLDG. Signature . . . . APRPR NTT. . �,�10�,' PINAL Z y" /�!/ ��:� � `� � OWNER-BUIL�ER DECIARAiION �� DATE D � I hereby affirm that I om exempr from the Contrador's License I;S a�OV2 Law for the following reason(Section 7031.5, Business and ADDRE55 PINAL i _p �rofessions Code): PRE N � 8y ��v ��L . 1 BUILDING J I, os awner o4 the property, or my employees with ADDRE55 �j (��, ��� wages as their sole compensation,will do the work and ia�y,�iiv � ihe sfruc�ure is not intended or o4fered for sale(Section 704d,Business and Professions Code). MOvtNG TEL. � E v . U�' � I,os awner of the property,am exclusively mn�ratting CONTRACTOR NO. with licensed caniracfors ro constr�ct the project(S¢o- qDDRE55 lion 7044,Business ond Professions Code). - � ��-� CONSTRUC710N LENDING AGENCY s�eACt�c YAR� Hwr T�TApRpP.LNE R M wioit+ I �� � ��C p I here6y affirm ihat there is a mnstrucrion lending agency for FRONT �°�J�1.(%';�c . Ihe performance of the work for which fhis permi�is issued P.�. 1 (Sec.3097,Civ.C.). SIDE �.. 3 � Q� P.L. Lende�s Nome C1t1b171k L�MA Ref.p o n -- =Ce a 444 S F1oWeY'� L.A. 90017 r.c F�5 331.12 Pe�m�r�e 556.50 < ..- � . ;..: . ' Lende�'sAddress —. G� ✓;i � � I certify thot I have read this application and state that the issuance Fee 1�.5� �n�.+a P/c w � —� c. O� r � p6ove information' correct.I aqree to comply with oll CovNy Invesligoiion Fee ; � =� � -' 0 ordinanCes an fe Iaws relating to bVilding[onsirucfion, Total Fae 567.�� LOMA Perm.M Co O O� � � R ond hereby f riz epresentotives of this Couniy to emer , v� :,� p —• � g opon f e eMi erry for inspecfion urposea. � ����$-75 $3.rJ �;{ SEE tEVMSE F04 EXPLANATORY LANGU�GE � Signo�ure of pppitcont or Agent aro _ ._.�.,. _ _ .__. __..____,__ �w_, ._ �_ __.�__..� _._� � � , �, � � � ,�� .,irl^rti, , ' � - .. � ... . ' ......e.r._...�. _. , .,:,........��� ..._.:_,_.': ..__,.�.,,.........�...e_--,-.�,-.....,,.r..-...e.,..�._ 5_.--........_. �_,.Y......o. ,�...�.._..�..,.. ,m._, ,a,. ... ,....._,.�...,_........_.. .,,_ . . ",�„ ' . _. . , . >..-,� . ..: r ..... ,v�. . .. .. �. �' ..i . . , . . .. ..., :., _ , ` .r . �c ... ',. , �.. ,, ' . � . ;,y.y�„r , . .,.:: t ` � ......7 _'"___ _. .... .... ."_'...... .'__... ._._....._._..._ t., .. .. � ,x. _._. � _.._ i_ ...; y ' , ... .. . .. '� Z �.� �',.P7 e , _ . .. , . .. � , � . � . .-.�:�...-.._._....,. � -: , ...:- _ �,,-...__ �:" :�'--_-.:._.._____., _..._.�-a. . ._ ... �. ..-._..._.., _. , ..� , , .. . � .. ._ _.., . . . .. .� �✓.._ . _ i . . . , . - .. ' .. . . . !r . .� .-. . . ,. �k�_. . .. , '_ _. ,. ,.. . ....._...._ " _ _ ... ., e .. �.. . � . ..._._ .1--..__..,...._, _,__._..._� .._.�.__....._.. .�__..__.. ._ .. , ... - — i.' '/.�:.. . �_'�� ..__. ....::... '.. _.___ ... .�i, � .._..__..... ._.....:......__ ,. . . � . ../�.,f .. .. _i_ ,... ..r-", 'r:.:�.i _'i..�:: �.. : . ' '. k . ..,.. : .._.. ... . ... ,. . �, t.:... , . ,..�-- �� ._. ...1..__ ..----..... �_.......--.. _ __� .'._::...__._._.- --_._� _.____._�_.._.� __ ,r; . ( �_ ! , ' 1 ..-_ r _... ._.. � � ' .r'.s_l . 1 �'> �r9 f >.] , t� �..... ..............._ . � i �.. . � . . .. _:. __ - . . �� � . . . ... , ..._.._......� .__._....�_ . ._....._� _ ._._. ._..___ ..__ �.< e .h t � : t .. ..^. .__...�.....i-._.__...... . ,.. C . t .- s !� t t�. � ....__:�......._...._..�_._ �--.-..._ . - . , . �. � f� .,r� �:hc t.n..a,c<r�€ � ..,. , , .,_ � .( _ ,_ _. �...... — ,-_. � x.. i �� . . t[ C' .p�g q ,.�....___ __,__..____ ...._._.._. ....__� ._......_ , . ... _ w �� f. �. __ _. ...._L :_ � .,..�.;_..'�__.',_...� -_.. .__,. . ..._...._ ._...�_ _ .._� �_'_ . ., . � . . .. _._ . . . . � . . .r__:- .._.,._-.._ ........,'"'.__._...._...,..�_.__.._..___. - .,. _"_ ., •, .,;. ,,�.... j � .�' .. i .. �rv ' � c.;, ..._ ...._1_ .__"_ -..� _._r__..._.- ' F _. , ...�. � .... . . __-..._.__.,..__�.,_.�._ .._._.....- .,,-..:..._.,�.._._..�_�._�.- _ .._ .�i ':S �'� I . . 1 - . . . ...._.. ,.. . i r � ..��., ....,:. , �_. ..... � :. . • . ... ,.. : , _ . . . • ._.._...�. __�.__.__. � _...__..,.,_ .. . . . _.�. r . _.,._T ___ � t---_._- -i __._...___.____�;.__ _r�.._,._.. ., � -,��., ,. . . �. , _- F .,, ,. � , , � � _ _ ; �., , ,� _ �.�... -�. ._.._ I �.�. ..,.� i _ _... ._ . .. br C c . . t .r 1 . � ...,�- � . _ .. � 1 > t e h ! it� ... .. .,� _......_ � .-., ...,.. _._ _ _"' ' _ _ _ _-_'.. ____ / ¢ . . , .., __ .., c:. . .,, - � `�, l . . �" . _: . .. �f n ff�Ali. .,. , � > r � .� a.__ .a..._._::._.__._......_. . . :I :. ..._ . . ., .i I� . - _'_....__ _._„.__.__ ._ ..�_.._.,..,.� _.._�..._. . . ... f f. �. i � �r , 1 , v I' � ,. . I I T 1 � ti.' :, c I �; a - ' -a_t.___ � . -_....._...._...-....____ '_.. ..__..._.....�..,,�._ .,...,-.._ __ �r' a , c -, ��.,i �. .- .� _1 .. ...__..._�.__'"".._......... :...��____" " . . . .. ��. � .. . .._ C �-v: J 5'.�..� I . _. . . � .. . W ..:, I I ;, � �: I ' l._�___.__......_......._ ..._._..._,.._... .._._.... _ ...... . ,... _._._-� .: I:� . , r. . t � ( � I , - . ` �, t.i . .::. . 'i �,. ... - f C N �t �___._._......____.__�__... : ......_....... J! f� , a •f., ...... . .,,......__ _ ._. ...._9., t........ . .__.._..�.._.,.. .. . . ...... .... , . , . I--- ....._� . .. ._.._ . . ..,.._... _ i � I ... .. � ,,,. � .... . 1 t __ ..... . .'. � _�_" _.y.r . ' � 1.� ..__. .._.......__,. ..._.._.__.... �__..._ ... . ' _.. ,._ . ._ . ;h c i � ...., . i � I . � .: a*�,� f;�:�I� .. .. ,.�__,..._._,.,. ..._._.....�.� .r..._..:... ..._L.�,.__ i�_...._.__......_..._.- . .... __ _.......... . t . ; , ....r_,.,..._,_.....___. .,...._..._._" ....._......._,_._�..,.....�. _.._._._..�_ ._..... _.. _.... a ,,�, ., , � � . " .,_' ' I I ' I ... ... .. ....._.. , �-.:: .....�-_._�' . � ... . _ "_.,_.... 1 I I ; I ��� �Al��'�r. /f���'1��f,�, --� � __ .__ _ ...t. , .J .! ., K .y _ __ _ . - - �,.,m.._n ,# . .... � < 5 sa sa I �,� �����wiy �r�,s . . - �.� - �¢c�F P,j c - -. -^t _-.- .�...,.�.. .. / .....�_. ,$ t � k � i����� 9���/ �..�. �dJ . .. .� Y . � ' � 's � �i __ � ....... ._._.__...._.__.._.m - . . ... -.... . � P I a��7- _ �__. � -���"- - s�K^'' F ._� .._�_� _._., , .._._... �!d. �#_�.- ----� . � . H . � - � a � f�� � �'r 1'C-_,-' .. � . � _ . . . �.:' .�. 1 .. - ... . . _ � ..._.__. __....,_ ._ � _. . . �.... . ._.. . _�_ . ._�_ - � , _ ... _-. . .,� . �..... , � ,� �,�r�.� � ..._.__._ - _._. �? .'`t �. �._ _.__ �__.__, .__ _..___.__..__._ _..----..._.,.- --_._. _ : — . . , . - - -- . _ � ,;^ ,;. _..— J1f��'� f/� _. - - - _ _.. _._ ___ .. _ ` _ . __ ... .,, g����,aa'zrj ' ✓?��'� .. __ ..___.__ --'---..:_ ...__._ . ._... ..___. .. ,_-._ ...._._ -L.f�._.7 _ .__._ 4 .,,._... __.._ _._,- . _.._ �_._._ .__......, ..__ . .,�... . .. .. . ..- ... r r � i _ �^� . ' /�^`�,l�' - '' � �._ ..... _ .'._'..... ._..... .. �. , .., :.... .. '''. ...�._ . �..� ...__ _�+__ _._.. .� , ...� ._...- ...-� .- .. _ � :.:: � �A" � Y�j`�^�,A .. . .. _ .._ _'_ " _.._� " �'.....�... � .. .. ,i.�'- ,..__....._._.. ... .. .._ .�.�...�_:.._ . .:. ---. �__._...__ .. ___.___..._. ...._.._.. _'" __. ,... .. - ". ... . . ..�,-,. j� ' . -. . . . �. I \....,,, -::.,1 � ; .., , _ .. .... ._.,.. . .. _:_. .,_._..__. .,.___.. ,._:..t......._. ., .......___ __..__..._; .u.. _..__.._.�..�.__.,..._. _..___.� W. . . .._... ....._. ,. . .. _ .. i . .. ... , .... ... S.. .�:�, ,. -€ . ..._____._.__. __.�.�....._ ..._..___.__...__ . ___. x_._ ..,.,_' '_. ,.-' ' _..- ._._...�"""._.�_..T.._..._.,_..... ......- . :�.:'- . ,.-. -- {__..____ ._-.._.__.. _;,._ ..__.. .t_..�. _ , . .. .. ,.. ..�" .�.::a� _.. � 'c: . • ..i_. .. . : ..._�,..... � .. � . . � _..'__.. ...._'_.....___ .._.�__..... ._.....__ ..__.,_'___ '_..__'___ '____'_ .._,_.Y..__._..... ..__ _.___.......�__ ..__ �.._._...._..___._ _ - ..,. ....__ , __' ^ it . . � � . _.. . .. _ �. ., � . i ! i � .....__.- .__..._. ,,,. ,."""__._ ...__..._""..._