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WOR�FRS'40MPENSATION DECL4RATION - insurebor�afcenifcoroo�woke,.'�em'��;�;o�'��s�:e�e` - APPLICATION FOR BUILDING PERMIT � . or o certified copy Ihv.eof(Sec.3800,lab.C.1 2�L. COUNTY OF LOS ANGELES BUELbING AND SAFETY vo�7�3�'C005-279-O�m��Y Nationwide � Ca�tk�ed copy Ie heieby furnished. FOR APAIICAI�iT TO Flll IN 11ppRESS 24203 GEIn P1dCE � Certif�ed copy b(iled wirh the covroy bollding inspeo- BunOwG tbndepanment. �oDaESS 24203 G2tr1 P1aCE po�e $-5-$7 Applicom THE AI3DEN CROUP c�n Diamond Bar z�v 91765 ,�,inr Diamond Bar CERTIFIGiE Of EXEMVTION FROM WORKERS � NO-OF&DG3. NEARESi . ' COMPENSATION INSURANCE 92E Oi LO� Now oN ior -=aoss sr. ngs (This wcrion nead no�be complsisd il fhs ps�mit it for o�e 42580 - °'��R � hundred dol�ors(5100)or lesa.) T4ACT eiacK ioE nio vwv eopc vAGE o��� ow�a THE'.ANDEN GROUP no 967=9541 Z�'''E � / -,3 1 terrify that In the pe�formonce al the work for which th�s ��J ?- permi�is Issued,I�hall no�amploy any penon in any monne. . �C''4 O w as to be<ome wbjec��o tha Wo.kers'Compansai�on low>. ��Fu P•0. BOX 3329 �' p J Cowmoras V aTv Cov Z10 � �Ne Applicanl �RCM�hR�p . iEt. ATICE TO AGPIICANT: If, ofte�makinp Ihis Csrtifico�e of E���ER �.p. Di3TR�Q GROUP n"PE FlRE OCESSED Br Q �E.emp�ion, yeu should betome subjec� to Ihe Workeri ��T� Z� U Compenwrion provisions o4 Ihs Lobor Code,you must forth• ADDaE55 1 N. F rst Arcad ia 1� 6 /D w with comply with tuth provisions o� ihis permil tholl be TEI. SiATiSfiUl W351f1UTION ' A71- C DO. a N desmed rovoked. �Qf�TRACT�R NO LICENSED CONTRACTORS DECLARATION - �K, MLS NO. DWEIL UMTS � I hereby oNi�m that I om licensed under provision�ol Chaprm 9 �D�WF35 �10 ��R�P (commencirg wiih Secrion 7000)o�Division 9 of the Bualness and . uG. Yrolessfons Code,and my licen»Is in full lorce and eHecl. �tTV M55 BK p� VAUDATION 50.FT. NO.Of NO.Of CNfCK Litenw Number 510560 �����pSs B s�ze sroa�Es FAM�UFS 1 a+F WIUATIOH ocscr+�r��or�,or wa+K "F"' :6,8 2 0 '�0 7 9.8 A Commc+or THE ANDEN GROIISM�e R—S—R7 �o , ❑I om aaempl�nder$ea � ALiER Z.. • • •� B.dP.�.for Ihis Isofon Y REVAIR : � •�6 9 0 Q USf OF � �ate' FXi5I1NG BLDG �Ma • � •��i�Q V S�qnoturo � ��NTi t� FINAL i.-��J OWNER�BUILDER DECIARATION _ DATE .I �1/� Q�� 7��7 I hereby afG�m Ihol l om�asmpllrom Ihs Conlmcbr'a licsnx �ppQFSS I�F HboV fINAL�� �aw for�hs foltowing reawn(Section 7031.5.Busineas and ,` bfessionaCode)� - � eY N J ��,�o�� I, es owner of the propeny, o�my amployses wiih wDDRESS wogea as their wie tompenao�ion,will do�he work ond i«wur , �be anucwrs is no�Iniended or oflerod fo�wle(Sec�ion 70��,Business and Pro(essions CodeJ. mOv�r+G Tit. � � I,aa owner of Ibe propeny,am aMclvsrvely cont.ad�ny �7R�'RQR � � with licensed connac�on to consv�cl the p.oje<t(Seo- �ooaFss lion 7W�,8usiness and Vrofaas�ona Code} � CONSTRURtON LENDING AGENCV ��gq�� YARD Hwr ���Ar^�iiNE w�oTH � I ha�eby o4}�rm 1ha�there ia o consbvc��o�lend�nq agency for FaON� ' t6e per4wmonce ol fhe wor4 lor whlch�hb pe.mi�i�issusd o l � (Sec.3097,Gv.C.�. SiDE v i. lendei s Name C f t ibank � o c rs.s n«�.��r.. 5 7.5 0 �or.a asi � Lendei�Addross 444 S.-Flower, L.A. 90071 10.50 ' , � I c�rtily that 1 hov�rwd Ihis applicotion and slate Ihat Ihe awo�ce F.�. ionM vic r obore Infama�i n b corrxt.I agrse to comply wi�h oll Counh im.s��pa��on P.� 6$.Q Q $ ord�rwncea o �ate lows relotinfl lo b�ildiny constr�clion, Toal f�. �Dn�w rmm.I R and harob w ori:e rspre»ntalive�of thfs Co�n1y w�n�er � upon Ih �bned prope�ty for Inapenfon purpo�es. � � Q�'QP � B� SE!REVEtSE�O�[X►UNATO�Y UNGUAGE Sipneiw•�AOo�Kan�a�Pn� �� PIANS 70 P�PPLICANT INSPECTOIt'S NOTES ��«���t-�tt"II 1�7�H 1>I l 1.4H:11 IU\ I F..r[.v t .._ �I, . i�._ .I',�.,..� . 70 � .. � . RNv.nod L `.--� � �� � � � , t� �sv lae�..' �i.1�( {�;�.,....i�..!,�., 709,�. AVProred ll��.n.�����+Jl'rnh��um�L.�.L•:ln�.u�w,u nl�ubr./ No. Dar• No `' Dol� . . 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