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HomeMy WebLinkAbout0775A (4) i , ..�... ,. .r _.�., �._ :.�- ��� :.. �. -�� � � _ �. .. ._ .. WORKER$'COIVIPENSA710N 6EC'�L%�RATION .� . � � � 1 hereby affvm thpt I hove o cerifimte of consent,to self �������������� ����'������� �� �' insure,or a cenificare of Wo�kers Cort�pensotion insurance, orq ce�t�fied co y ihereof Sec 3900;l'ab.C.; '' COUNTY OP LOS ANG�4ES � BUILDING AND SAFEYY ;, 73WC005P--279-Ob16 1Vationwide _ 1/B .. ,,;�_..,,�...<w.�n.h-. ,.�.. ...�_ :.a.�.__.__.___,.�� __, , PolicyNa .Company. . ._ ._ . . , .. ._:.... . ,..»..�, ,:. . � Certified,copy is hereby furnished-. FOR APPLICANT TO FILL IN suuoiNG , Q _. . . ,.;, _ _ n�oRess 5T7 Do1e Court -,�Ceri fied copy is fi7ed with t�ie county buiComg inspeo- ��" � gUiLDING tion departmenf. . AD�RESS 1 Dole O t .:,� .-. ' .. - .._. .. .. .,. _ _... .. . . .. . _.:--. ... . Date. ` 7�gI 87 APplicant THE ANDEN��GROUP... . aTv Diamon.d Bar „P 91765 ,._ �ocaurr Diamond Bar � .. � "CERTIFICA7E OF EXEIv1PT12�N�Fh07N'�VORKERS'��"y � � � � NO.OF BLDGS. � ---- --���� NEAREST .. - � �� � COMPENSATION INSURANCE � -� -� SIZEOF LOT niow oN ioT - ceoss.sT. Diamond�Bar,B:lvd�./Go1d`en .�'ipT1RgS . (This�sect�on need��nof be�completed�if}he permit�i's for one �-�' 7RAC7 �+2rJ79 BLOCK l0T NO. ,rj2 . �SE55QR��-' ��� - � -� � � hu dred dO��ars($1001 os less.) � MAP 800k�� �� ,.. PAGE PARCEL . . . � � . TEL USEZbNE.. NAP �.. � '_' _ . . f cert�Fy rhat in the performance of rhe owNes '-' THE ANDEN GROUP No: 967-9541 -^� _ wark for which ihis ,,,,J ha� ""��'�� �� permif.is issued,I shbll npt employ any person in any mpnner qDORE55 F.0. B ox�3324. - � ���� SPECIAL � � - �� �� -��� � so as to become sob�ect to the Workers'Compensation L6ws. �� cOnlDiilONs , ��.. ,,;, ;V ,:_. ,: � , ;.�_ „ ;:;. ° .,�_, ...'.... .CITY . ' . ZIP . . _ JfZ���+ � . .. _ . � �*e '"' " Applitant - - ARCHITECT OR � � TEI. � 61STR�CT.. GROUP TYPE � ��.FI$E PROCESSE�BY a �vOTICE TO APPtICAYJT. If, ofter mokiny this Certificote oF �ENGINEER Dave Szany AIA � No. 445-4073 CO ZO U Exemption, you �skould become sub�ect to 1he Workers' � �� �- " �- ^� � . . .y� Compensalfon provisions-of�the La6or Code,you must forth- qDDRESS , 32�+ N. F'1TSt ElYC$C�.13 9�-��.� � �� ��`�' ��� � �' with comply�with�suCh pro-visioh5 er fhis permrt shail,be � - -� - --� �� --� . .. . . � deem@d revoked.,._ ,,.� . . . TE� STATISTICAL ClAS51 ICA710N APT. CONDQ �2 � �• '�'' CONTRACiOR TH N � NG �_.. � UCENSE�CONTRACTORS DEGLARATION, �,_.. �-- � � - � --�� iiC. -� c�a55 ni0. _.,,.,DWEu..UNITS � I hereby aff rm thai I om licensed under.provisions of Ghapter 9 ADORE55 NO. ]: . (commenang.wi�h Sect on'7000)of DivisioR3 of�the Busines5 ond ,, . ���.� SEWER MAP , � � Professions Code,an�l my license is in full force ant1�effect. CITY .. C1A55 B ��. - - VALIDATION� SQ-FT. 1535 NO'OF 2 NO.OF 1 CHEIX �� ��� - . � . ......... . License Number '�51056Q� L c Class B �SIZE� S70RIES � PAMIOES ONE - . � �. � - ....,,,::.., .>.. .,.._. .. : ... ..,:.,,.. VAIUATION Controctor THE'ANDEN GROUPDate 7I8/87 pescR�vr�or�oF wokK . ' • "Ew a � 7�8 0 9 ' q Gara e - noo � I am exempt unde�Sec. - -'�� � .: .- . ALTER , ,. SLAB ONLY S �G 7 7 5 A B.&P.C.for this reoson � -. - REPAIR - .__.. ..,.__�__.:..... .._ __.. .�Datei .;:.�.,. . USEOF . DEMOL ❑ • e..� . EXISTING BLDG. � � . °����{� -- � APPI.ICANT ..-�....... .:... :.�TEL. � � _ Signarure' _ PeiNrl THE ANDEN`GROUP No. FINAI Z y�/�/�:. _ ! �_�1,�,25__ ,' OWNER-BUILDERDECLARATION � � , ,_ _ DATE-- �- ��- I hereby offirm fhpt l om exempl from fhe Controctor'slicense qDbRE55 SdiRe a5 .dt70Vfl �' "' � " � c � � � �P^w for the following'reasbh(Section 7031.5, Business and � -�- •.���-- �� �-��� �^ �' F�NA�� �.. � �_�2 J o ' �,fesslons COde�._ . ..,.. . .._......._.-. � PRE ENT _�.... . ...... .,.__. By ��.� 7''�-g 7 .': ...�. �. . BUILDING .. _.... . . � �� .. � f� , .. I, os owner of the property, or my employees wifh ADDRESS , _,_ � � ' ;,., wages as�their sole tompensation,will do the work and , - � fhe siructure is nol intended or offered for sale�(5ection �OCALITY .. .�+-�� "� _ _ r -� � -� 70d4,Bosiness and Professions Eode). MOVING ������ �- ��� . �fl. - . . . � � I;as ownar of the properfy,am exclusively cont�acfing COFJTRACTOR - .... NO ,. , ;: � � - � with licensed contractors to-constroct Ihe project jSeo . . .... -_. _. _.. .-.._..� . �.. . __: tion 7044,Business and Professions�Code). /+DDRESS . .. ,....._. „,:. ' � � - - CONSTRUQION CENOING AGENCY ��-�" �� ���- SET BACK YARD H4VY �T07AL�SOP.ALCNEFR M �y�pTN � I hereby affirm ihat fhere is a construction lending agency for FROM � � � - ihe performanceof ihe-woek for�which.Jhis permit is issued � �P.L . � — (Sec 3097,Civ.C.j. � SIDE - ���"-�-"'"`� m . _...... . . ... .... .. . .. ... P.L . .. . e Lender'sName ('itihank . � P:c Fee s ae,m��Fee 63.75 ionv�Rer.a - Lender'sAddress141��� � �Fla�•ae rL � Qn��� � , - �� �. I.certify thot I have read ihls applicdtion ond.state.that the . �ssuance�Fee� .�.0.S O �LDMA P/C# � � r obove in£or mion is mrrect.1 agree to comply�with all Co�Ny In�estigat�on Fee _ , , 0 ordinanc nd Sjate laws relafing to b��lding consiruction, , ._' Total�Fee 7L,�.2�j- LDMAPerm.N . � ' - '- �� y and h ouihorize represeMatives af ihis Counry to entar � '�' ��"�" . o upo Nioned properry for inspection vrposes. � �'����� � � � � 3 -. . .. . . . . .. .. . . ._. . ... .. L I_ , � . ... _. . ,.. , .,.:� .� .�--, _ :_.� � 6� 4fE REVERSE iOR EXPLANATORV LANGOAGE � � � � . ,.. Signature-ot Applicam or Agenf . � ..-. fe . . . . . .. .. : ... . �.... .'. . _ . ."�� .�... . . ..��� , �.:. .;;,.... .�:�.:, i ��� I 4. ;.-. . .. �,� 'i PLANS TO APPLICANT INSPECTOR'S NOTES � � .:0�9NER-BUILDER DECLARATION '�, , ..u� v,, ... . ,,.;,.... ...„.,�- ..,- . .... . „,... „„_.., r�....:, .„ , I heieby affirm that I am exempt from fhe�ontractor's . To:. ,;.,.. Re}urned � � � �� � . �� - � ��license'Law'Ofor the�following�reason:�(Sec. 7031.5) ..... . � . . . . . ' � . �APPioved �`� �. � ..` . ... � BusinessandProfe.rsions�Code:�Anycityor�countyuwbich e:c,. , �� No. Dote ��No. ����aie '� �-- �` �-��' ^� "� -'��- .;_. � require5 aQermst,to cbnstruct;alter,timprove,�demdlrsA, . � � . . - -.. ....... .,....„,,.,,.,w,,.,,;,„,,,.�,„.;,,,,,,�,,,,,,.�:,,�,;,ty„�� . ..:. or repair any siruciure,prior to its issuuxce,ulso reqriires � � � ,�..-, � �,� � � . . � �tbe applicant for su'sh�permit to file a signed statement � ` � � ` . .. ,. ,�,;,. .. tfiuz he is,licenseJ pursuant zo tfie provisip,+u uJ tbe Con- - +���� . --�-� � - � �, �- � - � ;- Eractor'sLocense�Liew(Chapter9J(co»tmencing.urit55ec ,. ._�. ._ _ . �-���� � ' - ' �'-" ��� ��-�--� " . tion,7Q00J.uf Divrsiox 3 1 tfie Businw�s.axdProfessinns - � , ,� , , � �� �� � ,����'CodeJ or�tbat fie rs exempt therefrom gnd t5e basis for tbe , _..._ _. . . . . .' ._ .._.. ,_ . ....-: .. . aRe,qe�l exempaion.Any v:olatson of Secaion�?031.5 by . ..:'. `.�,- Required� �' ��� _ _ ..' . .`�.� . ..:.�-_. •_'�:� any apPlicant for¢permit subjectsZhe applicant to a civid � A rovels Dafe Rec�jped- . pp � Kes No or Approved� .. ,,,....,�.. , /iexn[tg�oJ nnt more than firoe.buttdted dollar,c($5�0J.J:- �::: _.. ��- �_- . . . � � ' .::' . -,:�. , . � _ .. -� � - � ❑ I,as owner of the proper(y,'or'my"e'mployees'witti ' ��� �"�� �". .� � ,�:wages as fheir sole compensarion,will do the work,and WaterCeniflmte - .'. ' .��.:' '�..-" :�.-"• . °:�.-..n•. . � � � � � �� _ �: , �� -�' - � - the str�stuie is no�intended or offered for sale�Sec.7044) Heai}h Depqriment... . .. � .� . .` � '�•�+�- .°,•• -. . . ..•�.:..� �; Bus ess pndPr f aseons Code:The C t a}to�'r's�l cease Law daes not a ! to an owner o ro ert wfio bu`Id PP v fP P v .,� y fireDepartment. .:,-.. . .. � � � --�- � - �-•-- - � �---------+-..� �r'mprnves tAereon,and h doessu h work bim y . � ,� � � : . -through G#s.own employ es prourded that��sucb t,,. . . ... . _..� . � Grading. . . . .. .. ., , .. . . .,�;gy. ..,. . provemenu ¢re not.intended or offered for sale. If; bowever,tbe building or improvement is-sold witkir{one ... . _;:.:.` `."' .``...._ `..".'.. . .:::�, �year�:f completion,�tbe�ou,meribxilder wi!l.bave tbe - . Geological. ....� . � - . �': .. � .�. . . ��" " ' burden of proving tfiad fie did not build-or lmprboe for - .-. a�, _. �_ .. ... � ' �.- _.��� ` � . . Pedesir�an Proteehqn,_ _ �, tbe purfiose of saleJ. � . . ,:- ...�: . . ....., , .._. � (Fen<el(Cpnopy) � - -• � � �� -`�` ' - -� "�: ;�..� I,as owner of ihe'property,om�e cl'us vely contiac- � �� � _ �"ling with Ilcensed<oniraUors to consiru<t 7helproject(Sec� � Spe<ial Inspection-�� � - � � ��-� � � � � - � �� 70A4}Business and Professioxs�Co(le: The�Coritructtir's (Conc.)(Mosonry)(Welding) � � - � � - ��� �� �� � -�,-�- . . Ldcense Luw does mot upply to an�owner f property w�b� e-.. ���-.- � � � � bui(ds or iinproves Lfiereon;'and�mlio rontra'rts for suc5 Lot Dminage � ;.:�i-� , ,". ' .. ' . -...-., .-. ...., _,._..... p� ts iyitl o eac¢or/):! en5ed pursannt to the - . ;- ,: _ ._ .._.'_ ,.�__ .... . _..... _ ..,�.. � . - �"Contracto�r's�LscenseLdii/J. - � � �- ..... _. ,: . , . .. .`. . �... ..�. � ��� ....[]...I am exempt under Se< B BP�... �: Parking � �' _ _ . . . .. ..:,-.:� �.:.__.... .___: .. , � .C.fortFis . ... . . .., � ,_....�....:. ,.reason� .. . . . . ._ , . . . ... .. ..;;,: :..`,. � _. Date. . _.Owner_.. APProvals Date In ...ctor's$ignature .. .. . � .�. -: ..�...�.. ,., ...��.�..,.�. .� �� ,.. - � � INSPECTOR'S NOTES - Location— - - '- �� � . .. � . . " ' ... ��� . (Setback 8 Yards) - ��� -� � - - �� . � � � - '� Foundations � � �. �.. ::;�..-.�, �r o: .,:,an�:�. � .::.,.e.�,.�. ..��,:�. Slob . ...,,. . - .. . �. , � . . � . .. , __ . . ._ . .. ._ .,.;._... , .,...,,.;..� �,....,,. . Frame , . . .... . . .,._. ,.. , :. _. ;.:., . .. . .. . . . .., . . . '... . . ,... . .,.�-..� .::. _ +:�:: �:..:: Energy Insulation - � �� � ��- . . � � � � - - , _ Loth/Drywall—' . � - ,.�. .. . . .. .. ... . __:�.. . ..�-,_.._ . _..:,� . . . . ..,.. ... ..._,. _._._.. ...-_.. . �lnterior . . ..._ .�.... .. . . , .. � ' � �:� . Lath—Exterior - . . , . . . �� ;., .. ,,......,....�„ . ..:... �.,:�, .. ...._ . .. . .. - .. _.. ...,. ._.�_.:,._ ..,�:,. . .:.,. ...r,...,�a;��,,.. ,.,:�,,..- . House Number-- ;. . . .. ..._. . . -" ,. <„�:;_ ,s„..�i.� ,. �. . . Correct�&Posted � � �� � Final— . . . . . .. _ . . ,....�.. ..._.. .._.__...,, ..._._.._._.... .._..,.,<.. . � . Enter on Front � � �� � ��� p��.,a:, ., . .:.... . ..�...._. . ' . , . .. �. . . _ . . '� . , � . . .r.,- ....<.w. � .,, ,.,. .J .. .. . ..t-..,.'_. . ''�,:.+, ,....: '. . ..,. . . ,.- ,�-..,. . , . . . . ... . y... , .,f ^ ��:.. •` �°ti ,.�.... � .... � . - . . . .. . . . ,.,t .