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1163A 1164A (5)
. . - � --- ___. . _ _ ____ ____-_-----.. .-----�-- - - - - - _._._._� .._--- WORKERS'COMPENSATION DECLARATION "��� '�'��' ' �• r-,��� �- ,• - 1 heieby a(firm�hat�have o certificare of�o�,e�;,o,e�f - -- —�-��-- qpp��CATION� FOR�:BUILDING��PERMIT� � -� insure,or a certificata of Workers'[ompenfation Insurance, or o certified copy ther�of(Sec:3800,Lo6.C.)�. .. __. ...� ___ ._ . .. .. __. . .... _._ .. --._-_-- _ , _ _.- --•.- '; . . . . .._ . � a3WC005-27�=0004� Nationwide � 60/A (2 Car) COUNTY OF LOS ANGELES BUILDiNG AND SAFETY , PolicyN . ompany . .. -- - - -- a r FOR APPLICANT TO FILL IN nooaess 765 N. Featherwood Drive . �� Certified to y ie hereb furnished.��, , � 'Certified copy is filed wi�h the counry.6uilding inspeo- ' �"- BURDiNG � � ��tion depariment:�� � ' - . ADDRE55� 7E1S N. Featherwood Drive � -j . � . � . . , . � ,�., ...,... - �. ,. . �. .. ' "_"'_ _ "'.. .__..._.. ...... ....__._... .._._. .. Date 6/19/86 .APPi;�a,,,:THE,ANDEN GROUP �in. z�v ' �ocaurv Diamond Bar''� '"•'CERTIFIGATEOFEXEMPTIONFROMWORKERS' " "� �" "'-"�� - ' " �-"--NO:OFBLDGS:--- � -�- --. NEARESL.___ � � ___.. � ��- �� ��COMPENSATION INSURANCE' � SRE OF tOT NOW ON LOT cxoss sr._ High�Knob`&'..GoTderi"Spririgs � �� . .. :, (This seclion need not be completed if Ihe permit Is forone - . . .- -'-� -- -"�--"-"----'' '�- ' --"-': �ESSOR„ ; �— -- - ... ,.:v.-;.�... hundred doilars(SI00)or less.) ,-, , TRA BIOCK LOT NO. M4P BOOK ���' PAGE PARCEL � ., . . -- own�a- THE-ANDEN-GROUP -----Na 967-95 1: us o "'^P , �. Iz, .3 Pcertermit is issued,1'shall not em lo an erson In o Which ihis �_� �� '`% "`' ify fhof in the performan�ce�f'��Pwork for,nymanner . - �ECIAt -'- -.-.--.-. ... .-' �- -- - -.._...�. .'LL I . . "..... ADDRESSP.-'O.-'SOX-33L9'_"._'._____.. .'_.._..__..' 9Ut1'7) CONDITIONS � ;u so as to become subject fo tha Worliers'Conipenso�ion Lows. 'm tio� '. .,: ' � qPPlicoM'. � ' ..�., .__._ CITY.. .......____ _'. '__._ZIP_._. _. . -_ . _.'_.. ._ , _'_ � . .. _._ '. ' :OG �TICE TO APFLICANT If, afler'makin 7his Certificofa of ARCHITECT OR TEL �DISTRICT G2DUP NPE FlRE _ _ PROCESSED BY �'� 9 ENGMEER Dave Szany AIA No. 445-4073� cor,s -�-- e� � _ p n,�you should bemme�subject to�the Workers' - '- �- ' ��ompeneation provisions of�he Labor Code;you must forth- ADDRE55 14 N.�First Arcadia 91006: .-Iv-- .�3 . .I�=N �� ��-� � - -�d with comply wi�h.sucfi provislons or this permit sholl be _ .._ � �� - �n ' deemed re�oked..,. � � � TE�• ; STATISTICAL CL4551FICATION � APT. CONDO,r�� ;Z , _.. .' . . . .. .•.. .�.�, CONTRACTOR NO. : .- IICENSED CONTRACTORS DECLARATION� � ��� �� � �� � � � ' -- '-.'-'.' .'- ...... .-.' .. .•. '.'.__ '......... ..... ... .... ...... . ....LIC:.. _ -..' . -� QA55 NO. DWELL UNITS � I hereby aifirm thot I om licensed under provisions of Chopier 9 ADDRESS k�5 above No. 371580 (commencing wirh Secrion 70W)of Division 3 of rhe Business and _____ . _.���. _ ��R�P � � � '" � � , __..._'___._'_.'-.._ _'._'_._ . . . Fofessions Code,ond my licensa is in full force and effect Ciiv C1A55 B . -�-- - -- - - - -'--`-�VALIDATION---'-��� .. . _. ._;.. ;. •� . - . . .. , �,,. ., ., � . �. :� � -; � SQ.FT. NO OF NO.OF CHECK BK. PG, ., , . :, . LicenSerlumber ��37�-58��� LiC.C�a55 � "B'�'� SIZE � -2375 STORIES � � FAMIllES �1� �NE �� i'n• ���� '�� � :� ,. . �., .... , , . . uan , . n . _VAL ON___..�, ... - -- --..-.-"'. ---. -..-'_. � �THE ANDEN GROUP '�G�L9�HG � � - DESCR�PTIONOPWORK- - ' '��-� N���--t� Contrattor' Date ADD s $6 �� � ''.j .� . . . ❑I am e.empt under Set. . ----- ---------G2i'8 e..-. 510-SF.._._.. ❑ � ';- -----�1 1 d 3.A.-_ � .._ __ _.... ...❑ . _. .� . . . _ �,.., ., . ALTER � � " ' _.... _ ' ; , � 8.8P.C.for�this reason _'__.__ � RE7AIR_❑ .S.__..__._.__.. ..._._ •. ...-_�_ . __.._�r� • • ...z.� '.' . . . ... ._'. .. ". .'.""._ .. Dale:'_' " '� USEOF DEMOL ❑ "_,'.'...__..I_o J_v�,� 2__' ' EXISTING BLDG. � �� �� �� AP�LICANT TEL. ._..-Signatura ..-"_-- --."--, _-'_.-" . FINAL = , PRINT � ° °J:)�.� 2 OWNER-BUILDERDECLARAiION ANDEN G OUP NO. _DATE-Z�S.d ...... _._ _.___._.._...... `�. ' -IherebYa(NrmihatlameaemprfromtheContmctor'sLicensa ---�'-.. �-- �- -'------ �-'--' ' "--- --�- -- "" --- -� � ; . .. Low for ihe following reoson�(Settion 7031.5,Business and ADDRESS � FINAL� ���7���'-% '���'� � ��`?���`�5 6 �'�pfesslons CodeJ: ---......_...._•............. .... .._. -- -- NT - : BY.._---.. .�^,`_ ,. . .�.-.--.-.� ...- �--- -- eUItO�NG .�^. , _ 1� I, as owner oi the property, or my employees with ADDRE55 � � ''�"'�� � "" ' )S wa0es as iheir sole rompr,nsation,vw�ll do the work-e^d - -� -- � . . .. ' ;,1 � � . fhe structvre is nof intended or offered for sale(Section ����N " � � '`' ��-�-' �� i� � •�`• ' . � � - -" --7044;Bosiness-and ProfessionsCode�. ----"- ---... MOviNG� -...---'-`-='+ �- "� ' --� - 7�t.. -__.r. _.. .-, , .--. .--. .. _._. _ . .. .;-"-.,�.� ' i .. � I,os owner oF ihe properly,am exclusively controtting CONiRattOR r,o. , •- 1 Q 4 A�. �� ..-' "'_ . �__.__.. . wi�h licensed mntratlorrto tonstruct Ihe p�o�ett(Sec- --��--- qDDRE55 . -� � f�; �- � -�"�" ''e'e�i • o � ,. 1. . � tion 7044,Business ond Profeesions Code). - �- SE BnCK � -r�iAVRoa unKiEf M � WIDTH � ��','� � ',�� , 1^`'' � -'� - - CONSTRUCTION LENDING AGENCY ---.. . -' - YARD- -NVJ1' .. .._---- "- - ��( . f'•)� +.. f'e'lj Q I�', . : 3' � 1 hereby offirm thol there ia a constroction lending agency for FgONi r'_'„ _�,-�• a i . ,\��. ' J , - the erformonce ot�he work(or whicb this ermit is inoed �-p.L- -- -- - - ---. . -_._... .-- -'-. ..-_ . ......"��--'�:.•;+- ^ 1..il���t.�.`�', � „„�'1,'� ry �0� . P P .'-'_. _.�_ . . .B -' (Sec.3097.Civ.C.). sioE , • ' `„� � � .. .- - - - - �ContinentaT'Illinois.. ___.. a.�. __. --- -- _.-_,t.=�-{'� -_'ti ''!�� ' . fl _- - Lender's Name ,/,tiF�.�I 7'.'�y�l�,i , ,� . . ��� : t'2'/2 �6 ' LDMA Ret.N � � ��� '�' . .i . -� - � 231 S. LaSalle Chica o' II;" P•c.F«a s 474.00- - , �- - —.------- � Lender's Address s g s - 31." �.2 � Pe�m�e Fee--�-� �� � �� , : ..... I tertify Ihot I have read thie opplication and.s�ate Ihal.the 6069 .-- ----_•.- -------.-.- -. �,,,b„«Ftt_ ..10.50 . .� .�onu oic�--- ...._. ' ` . ',� .��' -- - . .. _ ►-- -- ... _ ...__._..'_'. above informa�i is torrecl.I agree to comply with ail Coonry invesri oiion Fee � �- ordinances a�e lows reloting lo buildinq mnsfruction, 9 484.50 � '� � � �� ' ' :: ! _. ._.._. .__'__._""'_".'_._ '__' ToWIFee'.. _. ___..� IDMAPerm:M _"'.._. '_ . _.. ...,_ �. __.. , and hereh o or'ze representotives of this County to enter y�� �� � ! upon -m ' ned property for�nspecliqp�oses� __ L��-_ � _ ._ _ �J - -$75 —--- --$35 -- -- — !JJ // SEE REVERSE FOR E%PIANATORY LANGVAGE i . ._ . � SlgnaroraohApplimnlorAgen� - ...-_.. -pcte-- '.___ ' .__�.____._._'__'_�_ _' . ._'_._' ' _._._ _ __'.. __•.._-_.. . ' ." "" "". .. ':''QO� _ z � _- . _ , :o � T� `� •Q __ 1 � N ;T-O- '�` p+ N O �cp ,. \ r (�'O �G- O� G- � ? - O p �� n7m �' � .9 �O .im y . , ,� r F � n ' �'�. m�: � '0 9 �' �'� �i - O - r m �" o i �9 0 � �' ��: R� � 3 � p y��,' ' � ' r p � O � � �" � O Z'i w . p.,o . f0 3 � . 9 .. ' -o n x a �0 3 a. o o � �o a v :. �, _ � � �m �� a� S � � m O F� 'o m o� . v g" ?, •M 1 •. . '° m o � 1 �o '� o w� o � • �n , i ,- � > � n � % ,�„�+C � w -G O ..�.��'�� O - 1ti . 1'� � Z 7 ¢�C m �0 C � i� �• �� 1 ' ���,� " � T ro 3 Q � d' W - � ,�� x , O ° iT 1 'o ° ? �c� � a ' • ,. 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