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HomeMy WebLinkAbout0826A ... . ..... . ...: .___' ..:___...___..:. _,:...._.._ ... � i _ ; _. _. _ _ . ___ _ .... . _ , . �WORKERS;COh!PENSATION DECLARATION ... .�:'� '�„t'�._, '�. ."� '-'-'." ..-_: .. :- .- .-.__ . ....___ . , ... . .. . ,.. .. _.�_ ..� � � � � � _.. � _, _.. .. I hereb.y.offum Ihat I�hav3 a terlifitote�of consent to se�F _ - PLICATION�;���FOR��BU-ILDI�NG��PERNiIT��:� — � �-�� � insure,,or dcertificme of Workers'Compensation Insurance, � � � ,,; ' aceitifie co Ihereof(S�ec.3800,1a6.C.J ".,• .. .. . .---��.... -. . . ' "" �...- . . .-,�.��. . I - � . �3WC00�-��79-0016 - '1/B COUNTY OF LOS ANGELES BUILDING;AND SAFETY - " � "' � . PolicyNo.� Company���Ndt10T1W1Cle O:-CerHfied copy�s hereby furnished.. . FOR APPLICANT TO FILL IN Bui��wG I; ADDRE55 �� �CerNfied copy n fJed with the covmy bmld�ng�inspec--�.--`�'' gUi�DiNG ��� � �-� � � '�--�' � i - � ��'ro�de�n�„em. . , � � . . ... ADDRE55 •� ._ 24�L�L1. Gem Place �: . �.. '. .• _ . .��. .-. . � ,�.�.._ . , . � ..: . ... _.. . .. .. ._.... . : ... ....� .. .._.. .._ .,._ . . oa�e $�5��87 • aPPi��o�r .THE_ANDEN�GROOP- cRrDiamond Bar � z�a 91765 �ocaurr Diamond Bar � ��-'CERiIFICATE OF EXEMPTION FROM WORKERS:.��`. -----.-. ....-._... .-.. -.... . . ..NO.ocs�DGS_. .C..... .�...'. NFAREST .: ' � . I�����`.��.�'.'COMPENSATIONINSURANCE .,5 : . 512EOFl0T �NOWONl07 �� I � - '� CROSSST.DI3I'flOI1C1-Bdr�-BZVCl�'�&"GO�.CI211`�S rings (This'sectiod.need�not be complefed if Ihe permit is for one ��-.�-��-. � �.�._:. ' � _ ..'..�_....j � '� " ASSESSOR� �� ' � � , ,__,_ - ._... .,..,,., . � TRACi��ILSHO�" � BIOCK�- iLOTNO.�����-37��- MqPBOOK��� ` .�••I�� PAGE PARCEL' bundred dollors(5100)or.less.). .._ . � � . � . �. . . . .. _, . . 7EL � .;. _ . . owr�x--=THE ANDEN GR D `_No _ nv+e �l7 _ u zoN - � _3 I certify�har in the�performance of Ihe work�for w6ich this � �.r��- NO. . permit is usued,�I shall not employ any person In aqy manner �� � � i ��'� � .G�`� .. S�ECULL� , . .... _._. _.. . ' __. so os to become subject to the Workers'.Compensmian Laws. -'�-'� Aooaess_P•�.B�X �33 2 9 _ .,..., �! .-,- ,__.,' -pvy U, CONDiTIONS �: � � '� �� �� � .�... .:,,,� . ... ...... . ... .. �.. �. i . . . , . . . . - cirv Covina z�6 91722 _ __ I . t�i ��te .' , .'..' Applimnt. ..�.. . ..�, .. ...:.._._ . t. , _. _.. . � � ,�.AICE�TO APPLICANT ff, afler mokin �Ihis Cerlificate o� � ARCHITECf OR � � �' TEL DISTRICT GROUP iyPE i FIRE VROCESSE�BY ' 9 ENGINEER Dave��Sz3n AIA I�rao.445-4073 - � - _. .:� ., �� o •�,E�emp�ion,`,you�should'become sub(ect:to.the�Workers' � -- CONSL ZONE� ' �- -- �}- ,Compensafionprovisionsof,IheLaborCoda,yoo,moslforth- , pDDRF55 ' 314 N.� First, Arcadia� � L`� � �� � .W � .v+hh comply w�th such-,provisions or�this permit Shall be __._... TEL.-� �� STATISTICAI C1A551Fl�Tl .... ...._ ........ _.�.. deemad�avoked. , .,.. ,_ ,... , cotviRnttOtt THE AN E R o N � A�' Z O I' . ..._ NDO. � �. IICENSEDCONTRACTORSDECLARATION .....,��., ._ .:.:. .-.--.---.-AS"�3bOV2 � � . "`t�e.$].�56�-.... ���NO.-`O�' ��-Dwett.uNrrS .: ..- .�. - . . � — I hereby affirm thot I am licensed under provislons of Chapter 9 -. .4D�RESS � � Np. ��R� ' (commenang with Section 700D)of Dw�sion 3 of Ihe Business ond � � � LIC � � � � � ' � ' � Professions Code,and my litense is in foll force and eHect ��"���� clri �' �����-'� � -�'"� �- ' "�"� � - � � � . . .. i..ClA55 ��B . �. �... . . ...:. � � �� S(i.FT. .NO OF� NO.OF � �. CHECK :.. . BK' ... �'. ..._VALIDATION LicenieNumber"SIOSF)O� ���CIa53 �`B �'-��-". 5�2E �1S3S��S70RIES ��'z- FAMILIES�� 1-�� i ����ONE� � � . , THE�.ANDEN GROibP .`�8/5/87 :.., oescaia�ioNbFwoaK. . ' • I Ne,v - .�j . . VALUATION � . _. _ � Conlroctor ate' _ I ADD ��� =7�809 � � . . � . ,�.: . .. , �.-.,,� . � . � .. i Gara e � . � ❑I am exempt under Sec. . . AtTER_. �. . � � i ' ---"��8 2 6 A- . _... . ..B.BP.C,for thid reoson ..._. ._., .. , . SLAB �NLY. '. . ' .. � REPAIR� �. S ; ..__... .� � ..�. i I. .. . _ �. . .. . . . � USEOF . . ... � _ _.'.. ..�•��• • •� .-.. ....-- Date�- , E%ISTING BLDG. - � i 'i D�a . . ��Signaturo � � .. .. . :. _. _.: _ � . �.." APPIICANT , .__.._ ........ _-^-TEL ,. . . ., DA E` �rO� � • � �� OWNER BUILDER DECIARATION . PR�M H ' � � . 3�4 ��.� �; .:_.. .�-p,2 5� ..t heraby affirm that I om eaempt from Ihe Contracror a 4cense �." - �'-'���� '-��AS above �-����� -�� " � � � �w for lha(ollowing reason(Section 7031.5, Business and � . aooRe55 .. I � ... FINAL�^:� ���_..,.. _ ... . fessionsCoda):_._. .._...__.. ...__.__. .-..___._. ...____. . .. _. . , ,; , By ' �,�.� _- oai� a� � � � BUILDING . � �. . � . ���,� . . � � I,�as awner of Ihe properry,.or my employees with _� aDDRE55 � ' . . �� " ..wages os their sole compensotion;will do the work and `...:. ..-.- .:.. _.._. . ..... . _ . ... 1.:. :. .._ . . � r. ..... .... .. __. . .. . . LOCALITY i � � �. , `�'�� .� , • � � Ihe afructure is not intended or offered for sale(Secuon � �.' , ��� � :.-.J044.�Business and Professions Code)..�... ..-.. . -_-�. n40wNG. .... --.. - .i..iel. �.... . _.�.. . .__._. ...:. . . .� . .�_. _ _ � � � COMRAROR� � � '�NQ � �� ' � . I,as owner of fhe property,�am ezdosively contmcting � r�����•- . '._ - with licensed mn�mcton to construct ihe projett(Seo- -'.-.. � � .->- .-�. -. :....�..-... -..;.�.. ..� --:. -. - - . ..�.. -.'':�,�' .. ' .. .. .. ..... .... _. .,.. . .. � lion 7044,�Bosiness and Profe:sians Code). � ADDRE55 � , _ � REOUIRED YARD-. .HWY� ..TOTAL SETBACK . �....:. . ._..__ . �..._..._. �.�_..._. . __..__ .. . � ���'-'-'`-� �-�CONSTRUCfION LENDING AGENCY��- ---' � -� �Sei BnCx��� 7ROP.uNE � ��WiDTH- � I here6y affirm Ihat there is a cons�rutlion lending agancy for .pRONi � ' �� . � . � � ,-�-tha performance of tha work for which this permit Is.issued ---. - � v.L-� � ' '� � � . � � ' � _ (Sec.3097.Ctv.C.). � � � � � � SIDE ', . ., . __ .._. ... .. � . � � P.l. . •� . I .�, . . . , . lender's�Name�� Cltlbdrik -.-.. _.._ . .;:. . �- . . . . , ..LDAM Rel.M • .� _ �`- . • � �� s a.c.F<e s . _ rs,mu Fse i_6 3 7 5_ � . _ d Lender'sAddress�44'4-"S:��Flower; L-.A. 9.0071 � � � �� ._I certif that I have read.this o Ilcmion and stete that fhe.� '� i �. 10.50 �� .' � � � 9 PY tY Investl ationFee ' .,. . ..-. ' . .. ,'. �P/CO I ... .._�.. ..:.' ... � � a6ove information fa tovect.I a Pee to tom � wtrh oll Coun �- � Iseuanca ha. �D --- — ._ . . _ _ _ $ ._ordinances Stare lows roloting)o building construUlon � � .. i 74.25 � � I. ; . . � . _.._... . ."__'' . To�al Fse . .IDMA Perm.N . R � and hereb a orize representoHve:of this Coony to eNer ��` .-'-�� ' � ' - � � upon a • ' ned property for InepecFlon urposee ' �.. . i . � . . .. . ._.... .. _ ]�{y � . m � . .._.:��.v IO.. �..... .�.. SEE REVERSE FOR E7(►IANATORY LANGUAGE��.. . . �,.�... ....._ . _ ... . . ... ... ._.. r , ..SiqnoNro of Applicant or Agent . .-. - ..- �e � . � ' . .... . ... �- � ... - _ _. ..._ .... . ..' ... .._.__.. .�. _ . ___ ...... ._._._.. . . � . . � , � i � � . . � . . . .. . . � � , . . �. . � i ! � ' � , � �� l JO1Sh�K 13llll t)I.R IZ!„C�I A.K 1 Llp♦ �-'� PLANS TO APPLICANT � . , INSPECTOR'S NOTES �h rby off �Fqi I a e c pi f o d e Conrronor's { � }, �!, �� d-� '� �' . �e..��' } H � � .;' �'- F,� ,�'• a-�' t: �� � ��:, F� I ��'` -�71�.,1 jI.��L¢msc taw°lu the-�(otlownt�j �r�asun (Sre�'7091�57 l_! To: _ . l.E.�c- �i �Relurned�S_:_. �:�t a.�. .., d ��...� 5 C: e� 'w ..a�; k._: E 3� ,9�r�. n.,�.� y ��. .. .� . , �, , ApPro'ved I3«s;nrss nrd!r,f scronv(ndi.(I nv ut1: .uwnh+fn<h- .. No. Date• � Na•• r�bale`'"v.:.'.)c Z:.I:,i:3.�c��'i•�i Y71:1!CJ3 � f;�I trQUllf<.NQP/!I�It.7oCOpS/T(tfl.)SIfP�:lUlfrtr[,{•(i(CV�ryti.il�, - =�:rrhi�runyFFruaturc:�rinrN'1rt.cu � � .Ihnrr�u�ri�� ..,,,��.e. - .._ ._. . ... . ... . ..... .._.. _.. . I �,��,(Q C C d %� !1!JJIi CT P i/� 1;9�IF�SJ � rb a/�/�! .�„�J 'surh pdrniinm/ilra�r qneJsl�tcnrrnf , L_.. ----- "�1-37_J S..�', - - P _ � .�,,�1but�L�_+S�Gccrssrdpursurqt tu dre pr un nx /il�r(;�n V. c3�L 1�j f'_9c) ��S{S . _ �..,a...���I era�lnr's l.irensr l,uu�/G��rr�.��r���,,,�„��.���,�,q.�;;,i,5�.� �— — -- �J'. •___ � .(. . Iio�J(�f11{J,��Ufr�irxn 3r�/!brllusincss.qnd.PqF/r�ssions `V _YL� UIIO(IIf t❑ r�_A�ry' _ C�`.�e 9,':_ � 7f>FL f)t10;�'IEi.iQvt��`r. �iU�=t�Cri c%o��th.�1/,�tisitrcmfllGsrefronrunJll�Fhasizfnrtln• . r — — �— a - � . � �. . uflr¢rt!rxemptiin.^�ny�i�inl�tinn;n�1eY�nn�7(!?! S hi. �.I�(tl .��, . � � _ �iO�l'l��rn` 70J � ' - -R quired- `