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HomeMy WebLinkAbout0827A (4) .WORKFpS'COMPENSA110N OECIARATION J� I hereby afl�rm thot I hove o cer�ifica�e of�o�,s�„o.s,� APPLICATION FQR BUILDING PERMIT inswe,o�o cernfim�e of Workeri Compenwt�on Inw�oncs, �� - or o ternhed eoDv�herool(Sec.3800,lob.C.) 1�A 7�o�C�05-279-0(�,16��Y Na �onwi d �OUNTY OF LOS ANGElES Bi11lDING AND SAfETY � Csrnf�ed copy�s heraby 4�m�shed. FOR APPLICANT TO FI�I IN swtairic � Certif�ed coOY�����ed w�lh the counry buHd�ng Inipet- Bu�tDiNG ADORESS liondepvHmen�. ADORESS 24215 Gem PlaCe p„e B/5/87 Appl�con7 THE ANDEN GROUP c�ryDiamond Bar z�o 6 �ou�„r Diamond Bar CERT�FICATE OF EXEMPTION FROM WORKERS' NO Of B�DGS. n�EnRESf COMPENSA710NINSURANCE S�ZEOiIOT f�OwOnil07 cRosssrDiamond Bar BIVC� & Golden $ ].IICJS (Thii b<��0��esd no�bs comple�ed ff Ihe perm��la fo�one rn�ct 4 25 6 0 BIOCK l0T NO 3 6 ,Nqi Bpp( VAGE VARCEL hy���Od dO��b���_��'O��eSS.� iEl USE ZONE �`� II I cen�ly�ho�ir+ihe pe�formoncs o�the wo�4}or which this ��4 � — � f � ' } permil li luved,I tholl not employ any perwn In ony mannar ��pE� p,b.B�X 33 2 9 �G� L1, w os�o become�vb�ec��o the Worke�s'Compen�o��on lows. O v CONOitiOraS � i 'te qPP�i�e�� [iir Covina 2iP 91722 � AYCHITEC7 TEI. .JTICE TO APP�ICANT: If, of�er makin Ihif Cerlifiw�e of DiSTRiCT GROUP IYYf FlRE SSED BY o E,,�,�cFq ave Szan AIA No4A5—A073 � E.emption, yeu theuld bemma subjse� to �he Wak�ri CON51. 20NE Compsnw�ion provlfiom of Iha Lobor Code,you mus�forth- �ppqEu 31Q N. First, Arcadia �� W wi�h comply wi�h such pavitioni o. Ihis p�rmi� shalt bs TFI. p„ deemed esvoked. ��q�R� SiAI15iIG1l CLASS^IiIU.,TION MT. DO. N IiCENSED GONTRACTORS DECURATiON iK ✓-� Z I hereby aHirm tMt I om licenud under MSS NO. DWEII.UNITS por�i�on�ofGhoyter9 ADDRE55 AS above r.,o510560 (commenang wiih Section 7000)of Division 3 of�he 9usinev ond �i� ��R�P Pro(essions Code,and my license Is in lull force ond�Hect Ciiv M55 B sK � VAl1DATION 51056U B soeFr sroa�s 2 `v'�°M,�s 1 �oiai licents Nvmbe� lia Class VAtUAT10N THE ANDEN GROU� 8/5/87 DFSCRIVTIpJpfWpRR �+ Convactor aie S 7 $Q 9 , �I em s.smp�onder Set. d d "D° -�082.7A AITER 8.6P.C.(or I�if rsoson SLAB ONLY REPAiR = �` � � � � � ; Doie: Exlsiin�etoc �� I • •7 4 2 5 Signatura APPLIUNI �El. FINAL �� � OWNER•BUIIDER DECLARAiION ��NT DATE s��� •7 4 Z S 1 herobyo(fum�hat 1 om��empt Irom ths Controctor i License �ooa[55 AS above 0&� 7..$7 �iow for rhe following reason(Seciio�7077.5.8usiness ond HNAL �/ ( '�fessions Code)• w �%,�r�.r.+✓ � � ew�ouac I, as owner oF�he propeny, er my employee�wi�h ADORE55 wages as iheir wle compenwiion,will do ihe wo�4 ond ' - the�i�ucture i�no�In�ended or ol(ered for wle(Searon �����rv 70�1,Businass and Professions Code). MOvnaG �Ei � I,os owner of Ihe pope�iy,am s.clusively wnvactinp �+T°�RO�t �o ' wirh IICen3ed controc�ors to consMvcl the pro�ect(Sea �ppoFSS hon 7W�,B�siness ond Vro(ess�o�s Code). CONSTRUCTION tENDING AGENCV y�eA�K Y�aD Nwr lOtAt��uNF w�c1H I hereby afi,rm�hm�hare is a cem�.�cYon lendmp ogeory fo� fROrar Ihe performonce o/�he wor►lor wh�ch thfe permu n bsued o t (See.3097,Civ.C.). SipE vi �e�de�.Name_C itibank $ 444 S. Flower. L.A. 90071 r c r.s s ve.m��v.. 6 3.7 5 1OA""ae� • Lender's Address � I ce�ufy thot I hom read this opPliwtion and uate that�he in.,eMs c« 1�•5� �Otiw aiC� obova in/ama�ion b corrx�.I oqree ro comply wrth oll Counry in.•u�qoeo�f.� $ orduronces o o�e laws retonnq to bulld�np construction, iowt f« 74.Z 5 �DhU Owm M R o�hs•eb nze raprawn�at�ws of Ihn Go�nty lo�nNr � upon loned properry(orinspection pvrpoaea. . Y �4�� Lori'/ tE��EVERfF�O�[7f►UNATO�V LANGUAGE S�qnaM� Apphcont p Aqem , PlANS 70 APP�ICA.NT INSPECTOR'S NOTfS � �������{•��<<����k��<<���k��1()\ I h�,nl:� i�4•� . 1, r� n;,•1�, �.!'.� . To� ,. . ' Il.�urn.d .1". � � ' � '- F"� "���r.:.... 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