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HomeMy WebLinkAbout0796A ` ...�_ _:,.. .._. _ _ _ . _ _. _ .. . _.___ ._._..� __.�_ _.� _..:. ...�.__. , .. ._.._ ...._ �.-- - __ . _.__ � � ..WORKF�S'COMPENSATION DECLARATION .,- � .. '.�._ .1' .,. �:� � � � :.`�... .: , � �. .-..• � -.�. , . '��� � . ...� . � ._.._. ...__:.�... ' . � . .. .�i I he�eby ofiirm thm 1 have a�certificate of consent to self . /� I ,�s�,e.ofa<<o�f,�a,ee�Wo,ke3��ab����o���5��o��e. . �F�JR �BUILDING-PERMIT_.__ . . �, . Y P Y P . . � .. . .. I . ,, .,. � . PO11'��1(f� '2''��.etl��^ Nafionwide ~���iOUNTY OF LOS ANGELES ' BUIIDING AND SAFETY " : 2/A � � �Cer;itied copy is hereby furnished. . FOR APPUCANT TO FILL'W I Bui�o�NG � ADDRE55 � �Cerrified'�opyisfiledwiththetovntybuilding�inspec- �'�' gUIIDING Zq22� .Gem.Plaee� � �..tion deportmenl.,.�,,... . � .... _� ,..��, , , ._. .�..�� A�DRE55 �. � .. . � � . � ' , I.• ' .'. . . , .. �., _.�, �.. � . ,.� - ... . ._._..._ . � ._.._.... .__ . .. _. .. ._.. ,. .. ' _._.. .._. ... .._ . . . _._., . �1e-,�HI.SY_H�J�. Applimn� ,. ,� . , Citt � Ziv 91765 . ' �ocnurv �Diamond Bflx'� . . . pa` 'THE',ANDEN�GROUP: Diamond Bar ; � ��CERTIFICATE OF EXEMPTION FROM WORKERS'""� --. .' ....' -.._. �'...-�'-�--... .'----N0.OF BlOGS.� �-��- . � �. .. . . � �'�� "'�"��"�'COMPENSATIONINSURANCE - ��, � � � �� SiZEOFlOT � � � NOwONIOi � I �� ��' CRO5555T.'D1dI11011C1-BdT'-�BZVC1�.&���(�iO1C3EI1���S ring£ . �(This section ne`ed not 6a completed if the permit is far one --•---- � �Q 2S H O � - � ' --'� ASSESSOR ; ' .�-- - ---- ' . .�� � , hundred dollars(f100)of.less.), . . . . _... �. TRACT �...-' BIOCK:_.�....._.-.....- LOT NO..'.....3$ 1pqP BOOK '" , : . ,c�(.� PAGE �PARCEL � � i . . . --- owNea-• THE .ANDEN_GROUP No.967— zoNe 1 tertify that In Ihe performance of�the work far which Ihis � u��r � �� '3 �� � � permit Is iesued,l shall not employ any pereon in any manner ._� ' � P.�.B�}{.33 Z 9 - � ;� �o� � SVECtat. -..I�. ..._. . _... . ... . . .. so'as to become subject to�lhe Workere'Compenoatlon Lawa. . -�' ADORE55 ��- -� � - ----���� -� p00�C7 CONDITIONS � � �, , ...-,, „ ,, : cirr Covina z�o 917,22 _. . ... _ ___ . _ . y ��e ,:.:' .., . APPlicanf :'�:, ...,., ' � I .. � �� JTICE TO APPLICANT. I(, O�fer mOking�ihls Certlfimfe Of � ENGHNEER �RD3V0 Szany AIA��No.44�5-4073 � Rouv� rrae� F�ae. PRoc�sseoer . � `Exemption, you"should become au6�ect��to the��Warkeri '-`^�-�� i �� � ���. CONST, �� -ZONE` �"' �, U� Compensation provisions of ihe Lobor Code,yoo must forth- poDaE55 314 N. -Flx'St� ATCdClld � . [� � � ' � .. �. . . W `.,Wslone or,lhis.permH shall 6e -...._ . - .. . ... � . . ' STATISTICAI C1A55 . � � "."_ ... . _ . � I TRI wuh comply;with a�ch pro iFiCaTioN Avr. oo. deerobdaffi mehor I om liten � �ONTRacrort THE ANDEN GROU�, I �:: � � ,I� UCENSED CONTRACTORS DECLARATION.�:. ,-, . _. .... .-.. � �- � -���-IIC. � ; �C1A55 NO:`O�� �DWEU.UNITS � �� ' �� � —� � __ . _ . .� Z� . y sed under provislons of Chapter9 � ADDRE55 AS� �dZ70V2� .No$L�O S E)O . . . (eommenefng with Secflon 7000)of Divlsion 3 of tha Busineu ond -.-.-- .... � .......UC.-.--$.... ... _� �. . � .'. , �, .' .. . SEWER NAP . Professions Code:and my license is in full�(orce ond effect � - [Itt..._ ...---. ... . �CLASS ��'. . �. .BK..... �. j.-...-- . . ---YALIDATION -�� -' � :,. 1314_ _ :1 _ � COemeNumber � LIc.Class � � OESCRiP7iOr�OFwORK �Slri le �famil �� �coN���' � - . . � � � . lit 5�-O S F O. ' � B ....._ SIZE SlORIES FAMILIES .1 A D � �-VALUATION _,_: __. ,.. ..... . � . . . ... , , � � _� SO.FT. NO.Of NO.OF _ ntroctorTHE`.ANDEN GRODae B�5/87 g i ._ S6 8201 ' �D7.9,6A , � ---.. Gara e..:.' ' � a I am ezempt under Sec. .. : � � . ._ ._ ...__._._...:_.._.- ALTER Q .. . . •1 � .-�-- �-'-#� .''���� - � , ._ .. .; SLAB ONLY Revnie - - �_.i.__ . � . - 8.&P.C.for this reason � � -� . ._....,. USEOF � . . � .� s ' '�- __. ...._I �..•GH.00 , . : _. . : _ome: __ --- exisnn�e�o�. , oen.w� ❑ _ _. .;.6 8 0 0� . - '�.Signafure � ... ..... ...__ __...._ .___. ..: . . APPLICAM � T � �I ��FINAL �,�,� . Peinn THE"ANDEN GROTc�� I � OWNER-BVILDERDECLARATION �._-.'__ . .. '- _. --_. ..... . ...-_. . � - DATE .�J�l^J _F�6I .. ..:__. _�. _.. OH���I"S7� _. . -d heraby offirm thm I am exempt from the Cantrador a Lieense . -�' ����AS 3bOV2 � •�� I . �. ' �w for Ihe fol�owing reason(Saction 7031 5 8usiness and � ADDRE55 � � � FINAI •' � '"' ' ` � � . �fessions Code:_-. _..-... _. .. .._. .P. Y .�,.:. BU i0 NG � , . J .: gY ._:�"f�j i .. _. �_.- . . .-_I,,�as owner of the ro er�, or m em lo ees with . _ qooaE55_ . . .. .. .._ ! �_ ( . ..r. � .. . �.. ' "� � wcges as their sole compensa�ion,wlll do fhe work and �� - � � '� � ' - � � .... IOCALITY I I � 1 i�• . Ibe structure is not intended or ofiered for sale(Section � i �� � ' _,.__.704a;Business ond Professions CodeJ..._..__...-. -- pnOwN� .. .._�-- -- ....... ._....��. -i..... .. . _... � . . . . _... ._ ._. . . . ..,. � .... ._.. . , � .I.os owner of tha property,am exclusively contracting. [OMRnttOri� - � NO. ,. .. i ..,� ,,. . � . �with Iicensed contractors to construcf 1he pro(ect(Seo- .... . . . ...�.. _-,., ___ . .. . .. ... . . . .. . ; .. ___.: _�._ . .�: .. . .. . � tion 704d,Business and Pro(essions Code). . . . ADORESS � �� . I � . ' . � ._ :...' � _. .REQUIRED. �. , IOTALSETBACK ..-. WIDTFI � . ..�......... �.�..... ._. _ . _..'.:.._... - ';�_._�_.._._..___.'-.. ' . � '� � ��"CONSTRUCTION LENDING'AGENCY��"� -� -" � �"�- �Sei BnCK � 'VnRD �NWY-� � veOP.LiNE . ;� . . . � - � I hereby affirm Ihol there Is a construclion lending agenry far � FRONT . . � ' .� .;� � � � . � the performance of�Ihe work�for which�lhis pe�mit is iss�ed ...-,_. -p.�.-..._.-- ._.. -_ _,_.... . _ .�_��..._.._. �.. . . ..1. ..�-_.� �� . .... . r__.... _ ...._�- ._._. ..�. . (Sec 3097 Civ C.�.- �. � . .S�DE. � . . ; ' . . . � � , Citibank :. v.�. � ` . . - - - ( - . . " : Lender's Name -�� � .- LDAM Ref.N � � � � � $ -444 -S. Flower, L.A. 90071 P•�•FeeS � - P �1F 57.50 � - � � �e�aer:naa.ess 10.5 0 � � ...Itertify_thotJbave read this application and state Ihat the ..:._� .:,_ �.�_�.- -_.:isa�en<sFm. -..._- � .�onn^.v/Cil. � _�--.__ ('-. �. ..... .: .�_'� -� .� . � above informaY is mrracf.I agree fa comply with all County � � Investiqmlon Fe � � ' � � � � � $ ,ordinances o �a�e laws�elating fo building tonstrodion. ._ ;�_ .. ...__ �, ._:....._ ..._..To�ol Fee. ..- � ...�...� L�MA Perm.M � . � , .....��.. . -, . . .:.. I.._�. .,..)�� , ... _ .._.__. . . :, R end herab a orixe�epresentatives of this County to enter � � � �< on fhe - tioned proparty for.inspectio purposes. � , � �� �� . � ; � � � - � � uP . ���� . . . -.��(i �J-.�... � SEE REVERSE FOR EXRANATORY LANGVAGE. � . .. . � I 1 .. . �� ' �_. ,�.. .-. . ^ � --Siflno�vre o�Appl�nm or Agent ....._._.. ..,.. _ �e ..._., . . _. _ ...�... .... . ... . .. �....... .. :. ... ... .._ .. : .... .. .._. _ . .. . ._. .. � , . . . . . � ... - , ., . . i . . . . .. . ' ' .. i . . . . .. , . � r-. � O�\'11;R.F3llIl.U1:1{,UI�:CI_ANG�.I�lO\ . PlANS TO APPLICANi INSPECTOR S NOTES � � NO . - . . I h�reby nf� m hol I am c crtp f o`�'�il' Co r� ,n's � ���i� t �y ��. t :��.r r � ' �;�. �� �' � +�. !' '�:.r- {_��'r 'q�4� k� f 1 R�� ' ,�.�, �""Lft�enie'�YZ�.v fo f�ie ialf3w r non �ecYhD9'1�5 . To: 0� G n L�_t Y.c_ I1 ketVrded t 1 . .��.:; E E . L E�+n�:.,' � �` I p '��..�F' 4' f:1 n�. .,�� .�r.iccn a�o � y , � � � . .`� APProved - � Ifisr:r�aRJJr.Jys�v.n�C d �.Anl'afy.�r unh�ajl��r. . � '- No. Date i No}`,10ibafe-�,u1 �.I= � �.?=c�Si��i0���?��iw.t�01 ��S fvYuitcfN ff!rnrif�fai'nndru�f ul(-�;)ry/r6iv,�Jrr.inln`!.. � I .��,.i'l':�� .. .. _..,........ .. . . . _ .... _ r i� Y c i'i� � r.in ..+ �ar _ ':+ �1! t � rt t L.�� !-nr� lirT� ' ...��e`q '���.CCcT,C -,'�-,�y _ � 11f J1�ti�T iVit�JIJi7A_9C�t _----- - A-.. t/n✓pp! ant J m/.yu nnt tr�/ifrasrqn d�etdteru��nl --- - � .��_tba!/n�s.li.rni�J/+ursuantfo�tJ�/rr t��tn.�/1l c(im. I I _--- —' . _� . — `J��Jn R13n) ��SS�S Z ��; �tru I <l.icr . l..0 /(la/�f r'l1/��,irn�<n�m�..u�rl 5c�� �' ..hr�n.�U001 o{Ui p n j II7LC IjLSftl[KS UI(I P!(��i urts � ��_ �� "rU� fJII00if.CQ Y'i�c_,�7•�'.. 2cC1� �_�; 1F>fi :if:U:i1=SUy�.6. �J�1<�'nJrJni�th3lf<➢s.�rcni/r!lGvrpfru_nnJllrh�araf�,qll.p � ' -"-_� �- --_ .'. "` .. . ��. aR�grd excmpfrnrc Anv_�r lahrn��/.!e f i �l�! 5 ht j2j_7fft _!:c' 1 . -il�J ��V .�Rs�uir`edl" ���.:,. 1 � - �_ _ 771 C' C.+ �_:� �' V% un��fpLianl�rrapetnultlb/rttsdq�aJ!f! + !t J i��A � App ovals r � Date Recelved M-. '�— '�'- _� I �` i or ApproJed.-� '� . ,-��:�, r: i . ; an:�prnulJYn(nnf n �rr!tAurt�r.i 1 ndndd Ilan.(SSDUJ./:: . _' ' I 3 �Yes No • "` .�• ,, " ^^ `_____ -_..'_ __ '___._ .-,�.' _.._.'.._. _� _,.„ . � - - - -- - - - k �"�'.� -,� � � I,�s o e of Ifie p o(+r 7y�pi Fny rmplo`y�d3 w�ih IWoier Cen�F�co+e �� -��1, ,'� �1���` t- __.�.�.� - ; ,wa9es as�he sole com�e sot on II�do d r wo.k,ond �J-"`_.-. �-'``- • � l �c ' z��lhesiruet#� �s oi qtendedo.'O�fercdfo sale��Sec'70�d� �.U_ 4 E ?'c)£!.0 .4 F ,:�- 4,"rT � � , i� �� Heol�h.11epor�meni z�. "'� ti - - - -- . . .,�Uruuirss.and Pr�)cszrnns�dr�i71rc 4 injia 1r�r.i I.,��ens� �� � — •. ^ <- " 7.u¢J nnt a h��c� ¢ner 1t t I h i1J� , • s ,te r�rr�o G. rr /r r I ^�� Kire-Depa i e.t - .-�- .-- �@ - . .. ... -. .. . a -��r i pr a tf rr anJ ft 6 r.J s /u nrk Gr c e!/�1 <:' i rr i.:: .. +..i a^ tl 1�;'��1 r,ic�r:� -t^ '-� ' � � y'. {—¢lrru 1,l�it.nua en!te�-- r.rrJJ.(bat��s_�1�` j __, ,. ��t � t �,;. r I h ��a_..� :>v _� ='ra, .e r � � <; �rnd�nq :' �^-- �: � ,���� � � �� �� " r 5Pr ternrn�s.�.are,unt inlend d u,�J/c��1�/�r.sulr..lf � � t:� �'.S ' _" _ h 'L�_Y_`4`. _ 7;!,:)r�7�i �:�%'Y C:t .j� L f�_� .. F: l��Gmtetc �the6r�ilJirs,�nrrmpro ementir !Jr<�rl! tone � — -7 y�var A/tnarpletinn,�16n.rruxer-buafJrr y![�hat ithr � Geol fm"I% .ls. `^ VO > :1 1 ' � � �___+� � o � ��� V �G$_!U.:t:7 tii�'IC111�': :li;`�' 5.•,^. t .�' bvrdrn n(frni�eng�haf he J�J nnt h i!J r unprni�r J.v � -� � �-_'�- �. -� ���� �. - � _ -- . — 1hc purptuc o/aa(el� r J� b v�(]�: , I PedPstrlort:PrD�ecuan.:�•-.-- S ` ' -;, U C��V 1 C. ' :.:v�ux, i ._.. . _ . _ <M'_ �Y._.___ . � C••: ��i -. � � i , ... I (Fence)�CanaPY) k. �fJ \-- ' . . t•ioz �}�1 aso �er6ltfie.P0�e41� amer I.Ti�elyEoniroc�. 2>.l� y�� � .�1mg�it¢`1 censed co.I�ouQ's'io`dns�!r iU thc p o�etl(Sec � "'•• _ .-- �a - ^�.� — - � i 7044)U�rrnric.�nd Prnf�uruns Z :lc 11 (�nihoa t�ir'a Snec�aTinspecf�on r 3�]I� -�---1� J � , ( Y � Conc.) Masonr Weldin � �.."� . �'' . ^ .,• - .. . ci 'l.ice s l.at d etn rapptt f'�ax uSrt r f(�r.�rrh ul�n I 1 YI( 91 _'. �__'_ _1�-=-_ ---��, . ' * �: N.�.li f.l J;L' � .. I _ _,: ,._ ` . . . q "'.h.JJi�r�m r Lct lbcrrun,.ynd��i%�p rnnlr rIs fur sri:L .• , � � . ��� � _ �.... - � } ��t.. a�itl a�cr� irdtri�r(tJ licenied prii Lant �o rhe Lol Drolnoge���- {� (j C��� 5 h V-__=�_...__��..._�__._:n{� . }<i�c�•,�� I a . :, : . _.'.._ ,. .. .' .�. cl,:'AI , "'Cr�nlrs�lnr's'l.�aenfe'l.uu� �-" „ � r � , �,-�;-,-r k'� r Fork�ng `_ ° ' h � �f _' _ . io`::.,famn�r��I I I � ��'�'�� , :J.�.'``j -- ��~Y�l�!� . , �� I�-am exempt unde Sec .B RP C.for tFs . �� ` i ��,..� I � � ---- .:.n e��'..,oi.�.S;:.F. � w,U���:: � ,. � �, . . �'- { a.-,iJ���� reason k' -- - - -� 4 ) ,,,,,� �F ,,� _�.�... .. �;i "�";�` V: �'�JOST7 N�G F. :[:i i -� Da�e G��t �., O ne��.. t c,, it r.� _ �J.: _ �-"— F t�uu» rn �, . , _�J: .. I Approvalz Dote � ,` ;Inspecfor's 5ignatura, ' •,�` b��, � , ..� .i;.Lu.rINSPECTOR'S NOTES, s ����':p:.�, �I� lomiion- :�-._.—_—__'___ i . „ �,L . � ___ ...,�. � i (Se�back 8 Yords) �. �.� A��:v. -cic,.^ �d� i:. -o .I ,�'7- �'� Foundo�bns � � ��� �� ��� ��' - ..- :� ,�"�,�::. ��ri �i: .,o.�_Ik ti <Le, c .,t_ne .i�_�.it..> �' Slob p C.�, � �'� �' c:� s,�r-c i...�-,`.� . f^ � Z'/ / �.' �_� .-_ ..� n...c�.r_r�yl,�v„ . .�.- � .'...,I i . , ..� 1�i � ^ � � :� Fmme ' p .,. ..,. ,�.�........ y-.. ,...-..�-0�:.,�.. , � y(�.oJ.n..:.�- _,i r-.o i.�.,l,.,r, _,no� I Energy Insula�ion � ' . � :�,� 'r ! , . - ' I � � 1� _....__�.I..��_�—'7 .1� i�; i,!,��. _a��h,m u.>>t:� i z _ �i.nlPv�-'�i„1� I ' � LathiDrywall- 1�: , . . . � Imerior �' . �• � ��� .1'rn �k'. .1.�.vi�,CFCC�;•;:1 � lath-E.rerior k N :A" `�. ._.._ .. .....:... ,.. '_,. �.. .._�. . .._.. . �� ____ _.._—..� �.___-' _ . ...,'-1 i . „` .-� � � . ;e m . - . . .. I House Nom6er_ l�"- -J�:' ---'"�' ' " ,____.. . -�_, , .. � �..._ �� . ." . �, Correct 8 Posfed `^t.l� ...' �• ��•�j _ I. � � Fina�_ � _ _ __'_.I.��. ,.., ,:�,.,.��� e ;,7 I::d�l�� .. :._ . ' , Emer on Frnnt s=�� 1 0 ;a I U^.no�z ;C�. ,nC,�'� �tl nt^ . ..... ,�T._s. ._. . . ...':i" .. . ..._._ , 1.... ._a.. ...�.. .. .�. .... -_. ..a.. \....-O'\•1^, :rl� . �t_.'�Il• .,a.^�' i- ...�_ - , i��'a:i".�.... irto4 ttt.3: ' �b...f.���,� l,a.�-�{.nn`�� . con_����•.vv,raF�n�ir;rea.:s3v:�s�r `\� ��� �, . °\i_.�''\ � �___. 4-<S,:�, ,