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HomeMy WebLinkAbout1105A 1106A I 6eieby oifirm that ,., . . . ,. . _. ..._.-�----'----'-�-- .:_.--,.. _._ ,,; _... . .... ._... ...__..._-"_.. �_._.._.._..._.___... . ._....__. ........-__.._ .. . , ... , V✓ORKERS'COMPENSATION DECIARATION :. . � ^ '^ � '<`-�•' � - �� �: ' . _.. ,. . . .. . I hova a certifitoie.of.consen�.to,seif ' y ' COUNTY OF LOS ANGELES ; BUILDING AND SAFETY � i.�.:�� _ _ _ . _ ---- {nsure,oracertificateofWorkars'�omPe�,o��a���,�,o��e, . APP__LICATIO_N �F�OR��::BU,ILDING� PER�MIT� � �_ or a certified cdpy�the�eof(Sec.3800;Lab.C.)" � � ' -`�--'-' ���--� � ' ' . _. '_.. .___ Poi��Y�3WC005-279�00�4, Nationwi8e ' 10/B - O . Certified copy is hereby furn�shed. . `. FOR APPLICANT TO FILL IN BUILDING j ' �' - ADDRESS .HOS N. Featherwood Drive � �� Certified mpy is fifed wiih the mumy building Inspec- '" guitoiN� � j �lion deponmeni: ' ^ ADDRESS 805 N. Featherwood Drive � . . . � . . � .. , ,';'.-„�^� � , _.._ _ __ - _-__-_. -_.___ _-_. _ _ _. _ _.__ __._- . , i oure 6/19/86 Applicant THE.ANDEN GROUP arr Diamond Bar zir 91765 iocaurv Diamond Bar j "� '� 'CERTIFICATE OF EXEMPTION FROM WORKERS'� � �• "`- - ------ ------NO:OF slDGS.-- ------'-: NEAREST.--_-'---._-'- '-- '-'---�._ .��._.__ �__ .' �� �� � ��-� COMPENSATION INSURANGE^ SRE OF lOT NOW ON LO7 �, CRO55 ST._ _ KIIOb�F< GOZdOR S rin 5 ... . (This dection aeed not be compleled if Ihe permil.is for one ----�-- � - �=- --� ----�---��--� �- �-�--- � ASSESSOR '- --�`• �--` ��'��� hundred dollars(E100)or less.),. �. , , i2n 576T eiaK lOT NO. �S MAp BOOK�' � i ' PAGE� PARCEL' � �I'cenif thai n the I e�formonce of tFi . --- _ `-.-- -- '967-9$41 �S�� �P �y � p a work for which�this �NER��- NO. � � ,Z,3+35G �.�,} permit is issued;1 shall'not employ any person in ony manner ' - -- SPECIAt----�-:- --- - ---- - -- - ---� �+O. I � ---'--- ADDRESS P.--O:BOX-33Z9 - '__"""'_ -' ."- UYU CONDITIONS : sa as�b became"do6'ect to tha Workeri Corripen}ation laws. �V --. le ' •' ..., APPIicaM' . ,.. ,��''.,. ., .�.., �-��-- - - ' �- �- , 91�Z2_ '-....__ ...-_-- ---- ..___. ._ . . ... --�,,......:_.__. . CITY.. ' .. . .. ... ZIP �� � , �jTICE�TO APPIICANT: If;niter inoking this Certificate of ARCHITECT OR , TEI. � �' DISTRICT,._ GROUP, iYPE � FIRE... PROCESSED BY � �0 _.t em non, eNciNeee Dave Szan AIA No.445-4073 coNs � �- I p you should become subject'�to'tha Workers' �-� - , ,p• �_ ,W Campensolion provisions of ihe Lobor Code,you must forth- ADDRE55 314 N. r'lYSt Arcadia � 91006 �-��-!�-�- "�'��� �--�� � � with.comply with'svch provisions or,thls permil shall ba'-- - , TS ��� deemed revoked...��,..;_�,:��, ,�, .:. ..,' .,,� . � TE�• STA I TiCAi MSSIEICATION � APT. CONDO. ,Z � COMRACTOR NO. � Vt). :.. LICENSED CONTRACTORS DECLP.RATION•. .� �� -�� - �---- �-�---�� - -�� - ��� -- � - -- -�---; CLA55 NO. DWELL.UNITS� � � � � LIC.- I hereby affirm�ho1 I om�itensed under provisions o(Chopter 9 AD�RE55 E�S above � No.371580 . . (tommentingwithSection7000)ofDivision3oftheBusinessand -_-' . .. ..'- "- '-.. ..--„'.---.._. . . _LiC.--....._ . _.: �R'�P � � �; � .. ,�� i Rofessions Code,and my license is in full force and eifect. diV QASS � -- --- ' - � �- VAIIDATION�- "- � � � � , � _ Sq.FT. NO.OF ND.OF CHECK , ' . --BK. PG. _: � � s�ze 1446 STORIES � FAMIlIES 1 ONE LicenseNumber ����=3g8 �" LiE.Closs" ��$ � � � � , , . , . . ,. . �--VAWATION !._. •. ... .. ��'„� �.�.Jr' A . THE'ANDEN GROUP -6/19/86' -- oesceivnoNOFwoaK-- Sin le Fainil •- NE`^`--� S 54,000 � � e � Contractor Dafe ❑Iamexemplonder5ea �,. . . . .. . . . __._. - --GaTH 0 ---47�-SF.__._----.---- ADD --� ,I._ . .�' _ 2�,--- ,,. � .. .. ... . . AITFR ..._ . , - � •2 J��� b � B.8P.C.far�his reason REPAIR_� �'-_---"�'-'.".'... _..:_"_'... ... '' .... _. ... .. - ..� -. . ... USE OF . •. °�2 3 1,1 6� � -� " "-Date:� - EXi57iNG BIOG. DEMOL ❑ . ._ _ _ __ ___'_ , , �. ..•.� . .�. APPIICANT TEL � _ � _ . ._ .... Signclure OWNER-BUIlO'..� -�--� - -�--�- FINAL p� ' O��2�`��J .- ER DECIARATION PRiM THE ANDEN GROUP NO. __.DATE -2^S�p 7•----�� ' -I hereby affirm that 1 om ezemp�from fhe Contractor'z License � � � � �- -� � - � �� � �� �_ , ADDRESS AS above ' Law for Ihe following'reasan(Section 7031.5,Business and flNAL`�� � ' �- �� � � � IBSSIDnS COdOJ:' ".' '_' _... _..........__.._... ""_' PRESENT . Sy _ '. _ _ __.. _.. _... .. BUILDING �- _ a 1� � i . ,l... . I.. __ _.__ .. . ... . . _ ._ � _ ' _, . , . , I, as owner of the property, or my employees wifh nDDRE55 � � •,y•ges^_s their�ole cornpen�••tion,�vill do the wcrk c.^.d - - .. �,.: • , � ..'�i the stroctora is not intended or offered for sale(Sec�ion ����TY '`" �• - •�- �� ' ��� � ! � U'd K�= � �il -= - 7044,Business and Professions Code)r-�- -�-�-�-- --�--�- MOVING------"" �-''�..• ' '--'� TEC��;` "- ' ' - - . . • . -- -'-'t I,vs owner ol iha property,am extlusively contracling COMRACTOR NO. � , �, ��' . . -O--wiih litensed contracrors-to construct the projecY(Seo--'---- -------__...-_'.'-_'-.--_"-__-__----_,------. •----.-.."-....--..' -'--'-.--' - -. .- - ' ' ' ... ..... . .. tion 7044,Business and Proiessions Code. ADDRE55 � ..,�--�-_ �;� � � � � _ � _ _ REQUIRED -TOTA�SETBACK FNOM ���'"'`� � � ' I;�!' ' �� '__- ----- �CONSTRUCTION LENDING�AGENCY ----- -- - �Ya.aD Hwr. _. . xi .. .... . _�..,.. ��1_� .",;.;,'`;_; I J J�O O.=� . SET 9ACK PROP.UNE WIDTH 1� � �3 S G.O O c� � I here6y affirm�hat ihera is a tonshuction lendinq agency for FRONT ,;- ��}, ' �'_ e'� 2 2 - Ihe rformance of the work ior which this ermil is iss�ed -Rl:'---- ----- ---- - '----- -----'-- -�----� --....- .,• I� . , �''` ` I Pe P -'--' - ' - (Sec.3097,Civ.C.). SIDE ` .. . t- ��� . . -- -------------- ..._ContinentalIllinois _ --_ a.�. ._ . . ._..�... •?�\}-���. _. . ---- ._ lendei s Name � - . ..1 -� ..��� ` . ' IDMA Ref.N ��.1 .i. , r � ... ...: ..��•� _.. . ... . �231 S: LaSa11e; Chica o, IL-���� Pc.F«s 231:16 -- Pnm��F�e- -325.50 � "� `�" - lender'sAddress g � �� - � ��• � ; .,... .I certi .ihat I hava read this a lica�ion and stare.ihat.the 6069 „ ys� 10.50. "'�'' � "" ' ; fY PP . _.._... ...._......._. '—'_' onceFee.._. ..." . -LDMA P/C.R....._......_ _' ,____.___-'". __.-' - above inform ion is tovetf.I ogrea to comply with all Counry invesr�ga��on Fea �, ' " _ordinonces State laws relating_io_building conztrucHon. --. ..._..._..---._....- ---._-'. 33G.�Q.'-'- . ..,-.` ....... ', -'_.-_ .. Tolol Fee._ .• . . LDMA Perm:X__. -... . _.__..._ _..___.'______ _ -.�. .� ond her �h rize represenmtives of this Counry�o enter � upon e• tioned property for inspection p�poses. � � . . '-- "`-'- --- ._ . .--�---�---_-.- '-. '.--._ ...... ----'-._. �_.. . ... -' -.. . _. .. -' '. _._. _ _.__ . .- --- ' ; ' ��6 SEE RFVfRSE fOR EXPUNATORY IANGUAGf� _ � �� ' � ; '-��----Signolure o Applimnr o•Agen�. .._.."-- -pore-- -...--�-�-•--'----'- __'_______'___._ __-. . :..____- .'_' _._'__'___ ..__`_.'__.'_'_.__ _ ._ '._... . .Or� - - 2 0 - o �� '` ..- . ' ' _'rz � _g� • _ ' ..G� �• o 'm •, ''� ,..s� en �d "tCo °' �.o S '�,� 7 �'� �p , O' N �f7 �O r C�'fl 7 l9 O' � �O N . 'O,.� � ��� � . 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