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HomeMy WebLinkAbout0823A (4) _ .. _ _ _ .._ .., - _ .. _ .. ; , _.. _ __ . ._. _..__ .. � WORKERSYOMPEN�ATION OECIARATION - � .' -�' �'�. ` i - � � � I � � ' " '• ' _ ' . _�: . � . .._. __ �_ _ __. _. . _ insurebor�afcerli(caleof Wokenr�Compensatwn Insoronte ` ^~APPLICATION ,_FO-R::BUILDING--�PE�RMIT -�-�� ��^�.�� . ._ • or a ceri�fied copv thereof(Sec.3eoo,�ab.C.) ' � " 1�C COUNTY OF LOS AN I 7P3�dC�05-279-0�16 , . . . _ _ _ GELES , BUILDING;AND SAFETY . a�ty o. - ompany NAf i OilWi(3P BUIIDING . I � �; ' � Q Cer,ified copy�s hereby fumished.' , FOR APPLICANT TO FILL IN ! ADDRESS ����CerHfied�copy�isfiledwith�thecooniy6mldinginipec• "� " BUIL�ING 24224 Gem PZdC2 � • � � ! I� � � � `�tion depa�tment� ADDRESS -�t .. , . ,�. .. :,'..�i ... :':��. ..,, t_ . . .. _ . _.. .. . __ . ,... . ... . .._.._ .. � . .. i; . _. .__ _. ,_. . ._.. . .. ......� . . Date 8/5/87 Appllcam THE� �ANDEN GROUP � arrDiamond Bar � � z�P '� �ocauTv Diamond Bar' � � � �� � �CERTIFICATEOF�EXEMPTIONFROMWORKERS - � � —'--�' " '� ' -�-' - �� -'--" ����NO.OFBLDGS � -�, �-� � � NEAREST . � � � � `� ��'-�� '^����COMPENSATION INSURANCE�•�' ,'.���`�� ' SRE OF LOT NOW ON LOT � � CRO55 ST.D1dIilOI1CI BHT�,BZVCl St GOSCICIl�S ings ' � ' 1155E55OR , : . ...�_. !_ ..._. (TAIS SeGfiOn�neeCl nof I�C[Ompleted if Ihe permif Is foI anE "''�' TRACT 4 2 S H O BLOCK lOT NO. � '�4 6�� ' M,qP BOOK" ��I :".I� .GAGE 7ARCEL ' hundred dollars 5100 or less. , ,. ,4 1EL. � U O I certi ihot In he erformante of�he work fo�whlch ihis --- N�' — � � ' NO. ' I —3 � _ . — '. SPECIAL.. . _... __ .. permlfisisnued,�lshallnoftemployanypersoPioonymanner� ,P Q.BOX .3329�-� �-�- . . .� --- ` BV�v� � � '�y �� � �� . ow - fY. P so os to beCome sub'eCt l0 the Workers Com ansation laws ADDRE55 • CONDITIONS �.. .�� . .,` ... . �:.,.. ' . . . , .. , ' ._..__ .. _. ..... . ' ' _ _. .,_ _ � once ro nv � , , ,', , arr Covina z�v 91722 ; : ..I- � . �?e ;.. APPIicaM " . .� � PLICANT•�If;a$er�makin }his�Certiflcate of ' ARCHITECT O ' TE�� ' � '� DISTRICT GROUv TYPE I, FIRE PROCESSED BY • 9� ENGINEER RDave 5zan AIA r,o.445-4073� ���- � - �o�T;�•--- �� �-zoNe �� -� � v Exemption,�•you'shouid 6ecome eub�ect�ta the��Workers' `--`�• � � ' Compensation provislons of iha lobor Code,you must forth•' ,,� ADDRESS 314 N. First, Arcadia � . �a. �� ' � W with comply�with"such provlsions ar 1his,pe�mit shall 6e. -�.-- � - � .� - �- . 7��, i� - --: STATI571CA1 C1A551FICATION � � �APT. C N00. _ t�i) deemad r L10ENSED CONTRACTORS DECLARATION � � COMRAttOR O. � I � � � . .. . : � � ... .... .. ...:„- . .- - -�- - ' � j� . .._. _� _ .._. ._.... .__. -�-�UC. � . ., C1A55 NO... '..�WELL.UNITS_ . _ �. " I herebyoffirm thot I am licensed under provislons of Chapter9 . ADDRESS AS above � � r,o.�10560 ; x�, ,. � (tommencing with Setlion 7000)01 Division 3 of the Business and .._. __.. � ��R�'P ' , � �� � ._.__. .. ... _..�.. ._...... --- ..� Wo(essions Code,and my license Is ln full farce and effect. � CITY C1A55 B �-• '-gK�-':'-�"�',�"-�� " "" ' ' '""�VALIDATION . -510560.; , g __ _� soE�•1535 sroe°s _ ' v"a°rn°Es--1 .4 _�oN� : � Lieense Nomber ' llc.Class � . � i ' :' ' ' � � , ,... , .. . VALUATION .. . .. . _ THE ANDEN;GROL� 8/5/87 _ -. oeseaiarioNOFwoaK ' + NEw....�] - � � , - Comractor te . , � �D O S 7�809� : , QI am exempf onder Sec. ' . .. ..� ...,.__ -GdTd 0....418..SF�-..-.. .. .-- AITER� � i� � � � ._._.. . .. . .. � �... .:�.�. SLAB ONLY I -S.- �.... .. � . . 8.8P.0 for ihis reason .___... � REPAIR.. - �- � . . � � -� �. ..�Q-H���J A _..... . ._. ... . ___. _ _ .. .., �. USEOF . � . Date: ' � F%ISTING Bt�G. ' � - I D�a ��- -'�' � �"• ' � � ............ . ..... ._. ._ _.:..... APPLICANT � TEL I ; . � �• • � . . .�-Signcture - PRiM � � FINAL !, �,`'/ � - OWNER-BWL�ER DECLARATION ' _._._�_ . . . . �� --�DATE�j ✓7��-- �.'. --. -. -�.�..►']'�, ---... .,_ _ . . . . . . .... .._. . --I hereby offirm that I am exampt from the Contmctor's Licansa � , �, w for the following reason(Section 7031.5, Business and ADORE55 AS above I ' ,� FINAL'�'"- � � ' '�' e • •'� 5� ' . � .....--' . _ . �'��fesstons Coda):-. . ....._.,. ...._._._ ._-. ' ."-- R N ,, , . . �. . � f • , . . . , By � - BUILDING� : i ` - I, as owner of the p�operty�or my employees with ADDRE55 . ._ „ _. _ , . _.. __. _ �, • � .. � rs �. _� _ 0$,1.�`.87.... �wages os their sole compensation,will do fhe work and � - � �. � r � �• , - ..... LOCAUTY � . �he shucture is nol iNended or offerod for sola(Sectian , " � ' . � � . _ ' � 7044.Business and Professions Cade):�'-'-- "--- -�;" MOVING ... ."'_.. . ...... . .. _....�1.. . .. ..---- - . . .. - . � I,os owner of the properly,am exclusively contracting CONTRACfOR �� . � ., _ _ - ` .wl�h-licensed conirocton to construct tha pro�ecl(Sec --':-.-" ......'.. .. ,. .. .' . ..""".. . . .' '.... -- -- '"- . _ ' ._'.. AODRE55 ' � . . ' . . _ tion 704<,Business and Professions Code). � i ; ' � ._ ..__ . _. ... .REQUIRED - �YARD 'HWY TOTALSET6ACK , .. .. .. ' .- . -CONSTRUCTION LENDING AGENCY SET 6ACK VROV.UNE � . WiOiH � . . � � � �-�� . ,� -�� I hereby affirm that there is a conslroUion lending agancy for FRONI . � � - the performance of the work for which�his permit is iuued� ..-- .. .v.l. - --.- -.-__ ....... .. . . ..:.... . .:. . ... ... . ... ..�_.... . : .1._ .. . .. . , , (Sec.9097,Civ.C.). � Si�E � . - , ... _ ..__. . . _ __ .... . .. .... ._ _. P.L. � __..... __ _ . . _ 1 ` � - . ' IDMA Ref.M !. (� .. '� � .. � •. . lender's Name C1'�1}Jdri�C� _ � . m . . . P.C.Fee S - --'- � Permit Fee 7 S- - . � . � . .. . ... � Lender'sAddress 444��5: Flower.�L-.A. 90071 , , . . - � � � 10.'b0 - 1 certify�hat 1 hova read this applicction.and siale that the�. ... .. ._ .:.._- . - . ia�aoce cee . .-•�. -. .' �pN,p piC N. I . . '. I� ...... � .__.._. . 0 obove information is corroct I agree lo comply with all Couny , Imeaiipation fae � � . ' � $ .ordinances an te laws relating fo build�ng construcfion. .-_. . .... . . ._.. .. .�. .. ioial fee... . � _ .:. LDMA Perm.M.� ....._..I;. -. .-. .:--- . . ��-.' • . R and hereby � rize represantatives of�his Co�nty to enter � . � . � upon the m'onad property fot Inspection purposes. : ' . . . . .. .. . . . ... i . .. . _ _. � . . ... . . _ . - . � ..--' .- -._ ._. _._ . .. .. . ... .. . .... . �� m _ SEE REVEKE fOR EXPLANATONY,UNGUAGE ' , ; � � - _. Signmure of pLconi or gen� � .-�. . ._... .. . _ ., . _: ... ._ .._.. _. _I . .. .._ . .... .. .,. . _ , _ . ._ . . . . - � . . . - . � � � ' � � ' . . � �] PIANS TO APPIICANT � INSPECTOR'S NOTES � �,�(.�}4.Nlilt-I1�qf.!)!R D! L4KA I`fOV � �.I p;f *,t.(.: .ro w. N . , [ I h .by of� n ttol(a e e�pi1 o Ihe Corr a io s. � ; ..I To: � l'8 W�3 a�c-l� Z ketur ed Y�.,'.F� �.� �9 1� ; 1' ;'""� ��1� �' r iyr. p.�'. �4 k 4 . 1'�:�fcen'}e lb -fo �}ie 'idllrow �ei�o }5l.c ��7031 5 � 84... � .f� .� W L�6 :. �7 ! D. '.tr�.� 1�`: r�1 ( .e.�nnuziinur ��nc, c ioA'�>^ ,a�e�- � ., Approrad l3vsrrsr<sonJ�!'rufrxinn�(a�d ;�Inl'nfy �r punt�t<� 'L ' � No. �ate ° No. �`��'•Uufe':10`� u'� �3+%�,.''f:zO1 �11�:1t1Q, � � • rcY i>rc�pr� ��i �srrp ir�7rl��rr�rp w��rleaJlr h�- � ; _ —� .�I�U'l . .....�..�...... . . . ... �.. . .. . ... ...I . �MlY4f+U1{4AY� Y!I f�� fJ l CLC � Y�Y� '�� . � n-�; r:� C . 7'."^:.}. ��: 1 I�OT i6lS � ����..��,�SJ� 4 �n�•„p�c.,,,�r��rirahprrrrrft�[n1Ji!<�9sicxrJstlerrr�• ' I __. '._._..__ . . .. �4 .._3r7._S�_.���. . . . -. • __. ._.__ _____ . t ;I � � . . . ¢ -���tlyt�.re is lurm-eo!f�ur{u�nt�it j!n•froeisi�ms�/fl�r(i.r�, �i 9JFjC I:.,7 ��.S�t`�.S g ,�, !rrl ..r,<�.�n����,.,�.•rca���,�.»r<<, c <r Cuy`lh.Scc.� . � n 7U(!(11 u/Uirrcinrt 3 al tl�e Buun s und I ru/esvnn� 'i �T, :r:i f]rinr_, C1 rTl "' ,r c�L,�4�aiT � _ff;r f '7n�'_ CIr_� . ciiJ.:15{t. Jrf ntbatletti.rcnftrla��r�frun�� Jtl �isis'lnrrb�; .'::`��" � ullc,�trl trcmfh� ,�-Anv��ila(inx�rr/S I rt�1�!.S I.ti F���LIl'.�.c. ti ,ulUc� � u�1c q t� ivi,!i»u- . rn�t� *OilJ-'__�'I, unva frc�ent �ra J 1'�P. . ` --' —Re �ulred�—Dato-Rece ed--F'� --- - /'/' I h�'�rt Sn c�t(t.1he a Laun!tn d:iril� I'__. Appoval� � .1�. T I r. _n: r »_:,` a7Yes No arApproved.'` c_� :ni ar_, vriC:.•.- i. a:i;� f nolfv�.nf.wot.m ie�lbJn/ry.ln.ndredJ.�llu>�(SSbuJJ�, � -- -�-- �---- --- - � ' � � ' �-1--- . .. ' -� � ', � �,, � I,as o ne o�rhe p ope 1y�o�rny ekiFloyc s�w�+h . Wa�!Certdicote \�'�'���,� �:V y - .� � .�__.i,_,...y.f._.�_.j.� ,:,,i i_iil:_i �_ ���.wo�rs as��ae- sole romp r+nsal op w II do Ik e o k!onc( q tepded o offe eel�#o ale Sec"70a� -- - - , . - ^,r 4 c �rr, r�r. �7 t! �.��th,e�sr�v�tyrg�Js� j �S ( ) "1 Health-0epanment _ _A ?_'/']1^1�'__4... _____,.._._� , ,z.,N(}r sru sr,und t'n/us r n��.pdr�,lJ r�Lr !.t t ra/ c�Se � a i i � . �,�, . � �,� l.aae J��n�,�.,r�i.�,,:,, i<rtrr /P Pe h u1.n/,ur��� CfP v� % (11Vn'1 F:re-Depa i em _ '_ � _. . . - . - - � o r r r e<•s tGcrenn.anJ t</�i dr s s L u L hinue(/,�1 I ��', I �.� -� �.,�.rv___T_3�., a�irl qi.ov� i ..��-_i '. r� 7 r i ,'a . � n�'�� !�., IIfJG�QG�I�iri�n m;crn/d l��Ilh.ne�✓,J�(�aK7Tr, i t�..� i �CO: � l.CI� vPt,�;�. :J�:��, c N I �1 �rodnq`_`. . � p.. E., I-1 I .,.� ]. 'z'•:pMeene q:•are�nnt inlenrlcd v�rdf/�rrJ/nr_sul�.�!/, I _' __ _^ _ F Cf� '?1�1 �:;3T.L7 .li (•.LE C., •�+ntM�«:o.:�rhebailders,qnrtmpnnrnrrnUca !Ju•r1l�rcnne ..t �-. [. f�.Pologicnl� .7vA ._ �� �'✓�7' .'.4U� � �,'ql x� �— a. ^'�{'e4r oJmrnpletinn,.Ib�:. un�-6uefd'rea�al[�ba�r•Ithe , � „'.,,;__il(l;�;��y(]J�"�. .'���' ' � . hurden e f j�r n,{lfrnf!e diJ n r�br il�/ irnhr���e f ir 1 � . Z w. �v� . � ._ dxdesnian Pratecr�on�.�. ,,,.a., ,. , U c)c'U 1 C„� �V oa i' th pu p <�nJ atr/ ���r�r,s;n��o � t;� .. �. }_ -N • '..:. • . . 7�. .A. 4 5�3'G:f't � V.,. ,��... '� IFence)(Co�oPY1 � �:< N.r -. E.,------., ---- .---� F. 1- J oso'nerot thepr9�iedv�am�e clud efytomra'c� .� ..F' ' � t.,a1L y h ... .sod . . � n . ,q 1�c n co �raUo s to conii cr�hc- � I ,� . i. ""�� ..._ __ vi .t� .i:' y5 .P o�d�Set. '� Soe<iaT InspcUion t.,";,,-,� ^ ,:r� 1 �� o+ � ��.u.•� �r' r.� n k. 7064)Ur s�nesr and Prn/aitroira C 11a !( C iitruc! r'a � (Conc.l(MosonrY)IWeldm9) f� � �.-. . .�` ' .� � cnn.ny� �_..__�,_ _�., L�rencclan.dJcsJnnl,rpJ�11�M(rn rtx<rrf(irnfrrttulr . + 1!:9� :U r..,'.- t .._ `{- --�'."' --fiuYJs r—inprueai!7�%rrnn,unJ u`Uii a•unfrucls fur:ui� • ,^ " ,._..i .. .. _ .._ F ; lc�Dra�nage �, t•. _A���C ; �' 1 C04��i���j����u.i._.e_ _�.' _,��. , fi� l�tt� uatl. a��1 n7rycF��r(117keik��1 rarfuun! 1n tbr � f . . .. ,. .v —Crintra.lnr�'�7rcr�sel.��a�). �,n�:,nn! � . .. . .._ ..._ . � ; -.. _ _ ... _ . �. ._ � Porklr,g .�,;'. ��u;� c),:^ �.�___..___—.r_--'__` _.�e.��o`.m,�q�-.c,.e ,e� . �. I�� � �, ' .. —� 1 am eaempr under5ec ,8.8RC.for�s �. . _ � ,:� Y�II;G I3°�Tr. _ .._��i �, � .. � ���! r..�,z,r,,_ :4i,.3 � . �� '-'.. _ .--- .. _..._. . � ] �;:i.� _�. . � > �� � reoson ' � .. . . , t' _. . � JCH:s � __ i ., __.._ .. _. ' '� ;F Dote l O e �� ' _ 6, f_•� �T�Z..n.Qi�.�'L.1��:2��i�Li1:._ 'T _ — ` ` , . ,. . . l^ �1.4;a13;i 1d'_711�)h S�: Vrv _..,Approvals Date � Ins ecto's Si nature .:.. .. ,' ....4+.'•....'.`.�.�-C�TU, �.,�, ezr� . � . � " �. , ,-. . �. . , , P S 9 . , _ . _. . +� br�n a._n�e�.,9 ,L.fCD:rINSPECTOR'S NOTES ;r.1..r�, ..y� Locohom- - , ioi "_�__'�� _'_—___'_ 4� , _ ._ . .. . (Seibock-&Yards)J ---- .`;i� r�nw :o��cdnn,3 vm , �•.u:._,o .t �'� ' brr,ew+�em ou i�,w, ^• Foundations ,.+t ,�v <. =n . ��,u:��5 ..... �i�ip�....�` ' - ..i.' noih. ._ioi bfli_�1.��}�c,;:�r.,�;ran;,. .,uin;��:�vi $106 t� /�'+ r .C'�, 5�,:)'.�,� �', c.� ' .;_. ,�._..... _, .,.. ,... ._,....,.. n . � G� t��� -- -- o' . pn:U-,i: ..t���vizu . .Y����-{: :♦o„ .. ,� � � � y, -J:`..��. . ., . . , . Frame . i � ' .^:r� . 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