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1133A 1134A (5)
Y - . ' .. .. I -�...__..'._'_"____..__._.. _.......___._..._..__....._ _...._........_.__ �__.. _.�_.. . ............_.,.'_._'_..__."...._._... ., ..,, , �,. ..:..:,:,.-......,... : . ........ �. . . . �,..,.. ..� .�.. . .. ;....... ; ,, . � �� I.hereb affOirRmEhot IahoveNoAceoifitateLofcolOent to '�-�-'---'--' ' - � � � -- , inwreForacertificotaof Workers'Com e�za,�o���,��a�a APPLICATION��FOR-BUILD�I�NG�� PER�MIT---� ��; � P or o cer�ified'cop' Ihereof $ec.3800,'1a6:�C.) �''� -' -."--.....' ---"._ _... .. .. . ........ .. _ .... -. . �•���73WC00�-279-b004 � Nationwide � 35/A. COUNTY OF LOS ANGELES BUILDING AND SAFETY . . ; .��. PoliqNa. - Company . _ . _ - - - - - - -- - O:�Certiiied copy is hereby fvrnished.. • ,., FOR APPLICANT TO FILL IN � nooee"ss 815 N. Featherviood Drive � � Certified mpy is filed with t6e caun(y building'inspeo- -" '- BUIIDING / � . � • ��fion deparimenl. � � � � • � � ADORE55 . . ,. . . .. . . .,��,'.�. � . . ._.. _. .___ . . ___...... . . ........... . _ � ' . Dme ,6/19/86. qPP���a��THE,ANDEN..GROUP. �iTy Diamond Bar ziP 91765 ��,iin. Diamond Bar ! ! '''���'CERTIFICATE OF EXEMPiION FROM WORKERS'.•"' �---- ---- -- ' -'---'-- ---�-��NO.Ov B�oGS. �-�- � NE4RESi � _ �- •�� �"'+�� ��COMPENSATION INSURANCE s•�� '' �•� SIZE OF LOT NOW ON LOT caoss sT.�.�Hi"h Knob�& �Golden�Spring§� (ihii�sectian need not be'compleled if Ihe per"mit is for one �----� �-- -'- -- - --�- ----- ----� - ASSESSOR_.,, �„ r -� -•� -� .�.^„' hundred dollars(5100)or less.) ., ,.. ... , TRnCr 3$�El. s�ocK LOT NO. �6 i �p gOOK'� ' PAGE PARCEL . . . ,.. . .: . _.._-._ owr�a THE ANDEN-GROUP - -No.967-9541 ' us� E "�"' .. . I.certify Ih'al in tha perfo�mance of the"work for which this �! NO. � �' • jy I permit is Issued,�sho�l not employ an'y persoP in any manner SOEqnL�--- �! -- ^ �� - --- so az to 6ecoma sub'ect fo ihe Workers Com ensation Laws. " ADDRESS�-P�:-O: BOX�33Z9 '' " ' -' '' - CONDITION$ � ;u ,., � .. .' •„-... ,. -,.�,.. .� , � VY17 . .. ., . . , , ��, . ., --..._ ciTv. Covina - - .zir 91722 �---� -- - ---.... . --__ - - ,� �e' 'Aaaif�e�� . ' Arcadia 91006 f(� �i� i 1_ _�j� ., . ARCHITECT OR TEL. ¢TICE'TO APPLICANT: If,'offer making Ihis Certifimte of ENGMEER Dave $23[1 E�� NO. 44S-�FOJ3 _DISTRICT__ GROUP �PE_.___ �RE _ __PROCESSED.BY_. _!� I f5mption,�you should betoma�subject to�the Workeri - yST'. 'W Lompensalion provisions of fhe lobor'Code;you mVst forlh- ADDRE55 314 N. First, /t 3 N . . .�n. with comply with such provisions or Ihfs permil shall be --�- . � ��� �n deemed revaked. ..�.,,�,� ..� , � . . , •,.,.�,.�,� TE�• , STATISTICAL ClAS51FlCATION ; AP7, CON00. ^� �Z , CONTRACTOR NO. __ ��� ' - LICENSED CONTRACTORS DECIARATION,... �. ... _. __. ._ .__._.._ .. ._'.' __ . - - � �LIC_� - �-- . N+SS NO. DWELL UNITS� '---�- -....-...."��- '� 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS AS above No. 371580 � (commencing wi�h Secfion 7000)o(Division 3�of the Business and _____. _._..__. �iC.-- . .. _--- _ ��R�P i ' '��"''���� ' � 3 71580 , ------ ----- ----- , Professlons Code,ond m I�cense is in full force and eHect. Citt C�nnss B --� -BK.---��: �; � -- � - -VALIDATION"-��- � ,. Y �� � � � - � , � B� .� SO.FT. � NO.OF NO.OF CHECK . � .. �.%I �� -� SI2E- ��.531- STORIES������ FAMILIES 1�� � �� ONE�� • License Number � � lic.C�ass.,. ' ,. . .. . : . , . .. ... . ... ...•. . . VALUATION. . � ,��. , - _ _, Com�acid� THE ANDEN GROUP DO1e 6/19/86 --- oescrtiPr�oNOFworrK-Sin le-Famil -- N�-� % 1 1,3�A,_-', ! � � � � � ADD S 56�,560 : . . �I om exempt under Sec. � �-�-- �------�---GHLd e—.441.SF_____ � � --- � , . . . . � ____ ALTER � ,i j,• s-e e�2� _,�i �,., . . „ � .. . . _.._._..._. , ' 6.SP.C.fOr�f1151eaSOf1 .... __.... . . REPAIR_a '_... ' ' "" " :'....� . "...... .- ..�_I'0 2-i.9.-i 4 -.� _..__ .... _.._.. ..__.. ..' _..Dote:_.. '. ..., USE OF DFMO( � � � - _'_. EXISTING BLDG. ❑ — '_.' --�.•C"�,'-�,���7 u': .."'Signatura � � --�-� -' "- . ..._� _. . �. � APPLIf�tNT TEL. FINAL p : OWNER•BUI�DER DECLARATION PRwT NO. .__OATE-��-Z-Z--�8-�___.. ___.� - j1$,e�r��,-(�----i . . . . _ __. _...- - --- �- �-- - ---- -1 he�eby affirm that 1 am exempt from the CoMmctor's Licensa � � � - � � � law for the Following reason(Section 7031.5,Business and ADDee55 � FINAL''�' � ` I � ( __. �jfessians Code) ."- .. .. -" - -' ' '-' PkE EN �-SY �--- - - � (7 BUIl01NG '. .n . _ _.. ' . _ _. .'.'___ ' ' ' __ _ _ -.. .' . _ . � i '� I, as owne�of tha properly, or my employees with a0DRE55 ��,'' ' � �'� � we�esesrF.eir¢pledempe.^.teticn,v�ill�do!hew^rkand ' -._,',�-- ..:, fl.�� -�. •.� �he structure is nal intended or offered for sale(Section �• � . ',y � � =�� ���3:�t}�� � � ` iocnun -.. ; -�--- -7044,8osiness and Prafessions Code�:--. ..-'- --'-- MOVwG'----.. ... iEL. l ,----- . .. .. _.-... -'�- � - --- � - , � I,os owner of the property,am excluslvely coMmtting CONTRA[TOR NO. � -�• . , ;,'o • • o • � �� -wifh licensed cantracrorsto mnstruct-the pra�ect(Seo- "-'--. .'-�--'..-.......--'-'-`--'-- ..... . _..-'- "--- . .--"-'. _�_' '_ _.'_ ____ _ ._ _. __ __.`! __ " __ _ ' i. \ A�DRESS � tion 70d4,Business end Professions Code). � -�:'--_,f_-a�.:5 i,.�,�,����. � 0 3 4 9.5.G . -�- �� ���CONSTRUCTION LENDING AGENCY ��--�` '--� SEIaBACK �YARD-� NVJY- ���P'pROP LMEFROM.. �WIDTH y, - � � � � x�-� 1 hereby afiirm that ihere is o construction lending agency(or pRONT , ; \ `'\ ��y`�.Y 1 , ° °�'Q'S(;.c', -�rhe performonca�of�he work for which�this permil is issued -- -- -p.t.-----. .._. . .. ..--�- -�--- -�- ----- ---- - - ' , � .. . � �---�-�� _' (Sec.3097.Civ.C.). SIDE � . � 1 1 ,� ��{�C�`�6�:.' ---- .- Continental Iliinois�- � ------ v.�. �;,'r _-.._. :i1C'�•y1 _._. - --- lender'sName � � �� -- �- - ---�- - � � -- � -- -' . . �, � _,.. . •��, ; - - 231 Sr-LaSalle Chica o IL=--- r.c:F«a:239�.19 ---�- a�,m��F�e-- 339.00 __.: IDMA Ref.p �t• ;i1-S i ---_•- -- --- Lender's Address � �' � . � , ; .. '.:�rv. . �certif .1hat I have reod this a licotion ond stole Ihat Ihe60693 � ; ;-, �. -..,,.-'-�I Y PP '-- ---�--'- ---��'------ Issvance fee -- lO.SO-._. .LDNJ+F/C M -.._. � .._ _ _'_ __. __ _. .. . . ..._ .: obove information is correcl.I agree�o comply wi�h all Coonty Invesrigation Fee ' -,:, ordinonces State laws relating to boilding consrrvction, ____. ___________ � _i ',��� �.� ��'i ------- - ro,ai F«...---- 349.SO.....-. IDMA Perm:N-...._'_."--' ---- ___ _ _. .. and hereb o hor'xe representatives of Ihis County�o enter , "- uponth a -m ned propenyforinspecHon urp ses. � �' ,���Q� y/y �J ---------LDMA-- �$75 ----� . $35-- - -------- .... .. .:... . . ------ - ---... ,' '/ly�'��� !/ P /G � SEE REVERSE FOR exPIANATORY IANGUAGE � � � -.___. Signa�oreofApplicantorAgene .- -._ __ -- �e_' _....... .....,.._ _"_'.__"_..._. ..'__..'_._..._. ..._ . . ..__.._ ____ .... .'_____ ____`'____._.__'...__ _....:pOi - ` �- o �9 .a_ _G�. --o"`'io !�^ W f,1 �n �� o` a o �' `'n ' r 4- - p 0 �� �R� �, � .0 O .� 9 ;� � . . T NO 7 "i�'. I-j D '3 � ''��Q ; 0�.. � L... ID .�'... ^ � o co � _ a � �' o�-o � tD 3 iu ° t . �o r j o Q � g o• T � a�: o;o- " � � ��. . , 9 �n Cl s a ` � � O F 7 9 � 7�,� ���i+ - Z �'p O O � I � � � � 7 �1 � �� ,':j 1� � .. Z � O �l9 fn t��c 7 �' 0 � �"' � . 4� O �t Q°? �^ � � p a M m ' � ' . ` .p '. "�O T v 3 0 0- - + ' < oo �' o G p o6 � o � o e -- � ^ . M � p,f� ] t� , . C ��, �, �. 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