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HomeMy WebLinkAbout0814A (4) ' . ., . ......._. _ ...___ __ .. .._ .. . :_ . ' WORKERS'COMPENSATION DECLARATIDN � � � �� � � ��� '�� -� '��'- "" . � '" " �" ' .""'""" -' � - �- _ ._ ._. ��.�_ � r,. � . ..: � -., � � � , Y . . _... .. __ ._ � � . _ ,. ... : DING PERMIT .__ � msure,or o certificote of Workers'Compensohon Insu�self � � _..« I hereb aifirm ihat I hove a certificofe,of consenf 1 , .' . anCe, ' . � ' o�r�f'cY�fiedcopy�hereoi��s�e�n�Natcnnwi�' ' 3�A ��!�U'�TIONGF�R;BUIL�DINGANDSAFETY " 7 W 05-279-6 16 P a Certified copy is beraby furnished., •,, „ FOR APPLICANT TO FILL IN � BUILDING . . , . ' , .... A�RESS I I � 'Certified copy is(iled with�the county bu�d ng inspeo- ��-- ' gp��DING - ' ' � ' . . .I '. . I "tiondepariment.' � � , . ' AD�RE55 24234 G2m Place � - � . ,-'. � .,, . .., . ,._.�� .'�'..�,. ....� .'_ ._ '_' ... .... ..._._... __.._... ........ .... .. _ ...�. ..,._ .�_. . . oai� 8/5/87 nppi;caor �THE ANDEN GROUP cmD'afnond zic iocnurv � ` CERTIFICATE OF EXEMPTION FROM WORKERS'. ---�- -- �� � �� �_-NO.OF BlDGS. ' __. __ . � NEAREST � � �� �-����,��'-COMPENSATION INSURANCE� ..�����; � - SRE OF l07 NOW Orl LO7 � � �-� caoss sr.Diamond �Bar..Blvd��& Golden��S ing: (This eection'need not be completed if Ihe permll is for one ... -_..., �_..__ �� � ' ' ASSESSOR i� • { . h�ndred dol lars(El OD)or less.) ,, . . TRAR"�}2 S H O BIOCK �"" '- �� LOT NO.� "-" hM,p gppK ? : .�I � pqGE PARCEL .. ' - � TEL. t ONE MAP � '1 cerfify tha�in the�performonce of the woik for which this � ��� OwNee - � � -No. � �_� i �. ��� I �3 � permit Is issued,I shall nof employ any person in any mannar - ' � �' j -� p S�FCIAI _ _._..�. ADDRESS .P.�.a�}{ 3329 . ._. __. ..._ . .. ' OQ(Jd CONDITIONS I .'.. . . . � .. O -so as fo become wbjeci to Ihe Workers Compensation Laws. � � �ie ,.. . � . � .9 ...:..' . _ .. CITY �V1Rd ZIP 91722 '. . .. ...... ( ..'..- I . . . '. . _ ... V „` :Applicanl-. . . ARCHITECf O , TEI. � . . � � OT�CE TO APPIICANT: If, af�er mokin �1his Certifimte of DISTRICT � GROUP, ttPE FiRE PROCE55EOBY p - Exemptian,you shouid.becoma�su6�ed t0�ihB-WO�kerS- ENG�NFER dVE Szan AIA No.445- 0 -� - nar. zorie� - � � �-. Gompensation provisions of Ihe LabocCode,you must forth- qDDRe55 314 �N. First Arcadia � r� � W wlth �omply with.such provisions or'Ihis permlt sholl be .. . ... .. . ..... ... . .. .. ; TE� .. . -� STAT�STIUL ClAS51FICATION � •APT. CO y deemed�`�CENSED COMRACTORS DECIARATION ,... � ! _ �aMRnCiOR - O. I Q�NO,��_��� � ' Z . .' . ..., . .,, .. i . , , .-LIC- =.�—�'FLL.UNRS . . . �- i � I hereby affirm 1ho1 I am licensed under proWsions of Chapfer9 � AODRE55 AS dbOV2 � NO S 1 O S 6 O ` i �yyER MAP �, (commencing wilh Seclion 7000)af DiWsion 3 of the 6usiness and . �-LIC. . - � - � � Praiessions Code,and my licenze is In fu�l fo ca a d eHect. "' �'-� CrtY��� � � ' - � ��� �� �� -�'�Ctq55 B ' - '"� .. _ ... - . . ,- ., ,. ,,... .. . ,. . . � � �' eK. ' fG:', . ` ...: . -�VAUDATION-..� � S�.O S G O� .:, ._ ,� ..�� SQ.FT. NO OF NO.OF . CHECK ' � 'Lltense Number" ' Li[.Class ' ''�-� $ �'����-�.� SIZE .14�9 ' STORIES -1- ' ' FAMItiES"1 ' '"'ONE-�� . ' ., . •. . :, . vawnnoN '` THE•ANDEN GRO[� 8/5/8 7 . . oescRivrioN oF woaK ' • _.� New_: ---. „ -..-- -- _._ . . Contracfor te ADp . . S 7 2$� � � � ❑I am oxempt under Sec . '462 SF � ALTER �� i � � . ��$�.ZI a B.BP C for this"reasbn SLAB ONLY I S REPAIR. . . _._.. . ......_ _ .._ Data: � � ,., ... USEOF . , - - I � ;_ . � . .: . -_.I . .._._. _�� • • •��- _ � � -��� � �- OEMOI . E%ISTING BI�G. '� I �❑ '- sq�aro e . . . nPrucnNr . __ _ _. _ __Te�. ..i. ._ FINAt 2 _ _ .. .I • •7�.2 5" , , FRINT DATE OWNER BUILDER DECLARATION . � � J�I. . . I here6y e(fum thot I am exempt from the Contractor s License ��� � � ' ' "� '-�-'� " " `-� `I �� . �• '7�I.2 5 � As above "" � �' U w for the following roason(Seuion 7031 5 Business ond ADDQE55 '� FINAL� J� •"'� .._.... . . ._. .. .. __ ,. .... B -�� ���fessions Code):...... ... _.._.... .._.._...._ . _... .... _ N .. 1 y` %`�,.L .I . . + . ' . . 0817-87 .� ... ., BUILDING . � : I . � I,�as owner of the property,or my employeez with AODRE55 � � I -" �wagesa:thairsolecompensotian;willdotbeworkand- - �- " -'-�- � � -��'- ��-��^ - -- - � - � � - ��� � the strucwre is not intanded or offerad tor sola�Sechon � ����tY ' : , . •� i . . .„ • 70d4,Business and Professions Code).-.-........ . .--•.--.. MOV�NG -- --- ... - ..- . .:tEl� —`. -... .. . I .. . . ____ .. .. ❑ COMRAROR ' NO. �� �( � ' ' � I,as owner of the properly,om eativsive�y controcting ' . � wirh licensed comroaors fo constr�ct�he project(Sec-. . .-.. ._. _..._- ,.._.. . ....... _......_-. ; . _.. . ._. _�. .. .._ , .. ._ ,..-- _ . _- - iion 7044,6ustness and Professions Coda). - /DDRe55 - - � . . � � �� , _ . , REQUIRED , ,._TOTAL SETBA K � WIDTN� ""� � i � �CONSTRUCTION LENDING AGENCY--��- � '--` -�T BACK YARD� HWY� VROV.UNE ' "� - - ' ' � ,'� ' �' - ' ' I here6y affirm�har rhere is n constrvcfion lending agency for � prtoNr � � - - - � . . �. : �� � . ihe performance of�ha work for.which�his permit is iswed�....__: � p,�. ._ . . ' . , . ..:. . . ' . .� . . ..._ :_._�. _ _ _. . (Sec.3097.Civ.C.). � SIDE . � � � � . P.L . . : � : . . . . .lender'sName'-Citibdnk.. _ : . —.. . _..,_., .�_ i . ._ . . . ( " 63.75 LOMA Rel.M q - .-. . .. . . P.C.Fee S--. .. -.._. Permn Fee � -- ._ .. . _ . _ ._ . . . lender'sAddess 444 S:"Flower. L.A: 90071 I ', ' ' I � ..._I eertify.tha�I have read Ihis applieotlon and state Ihot the.._....,_', _..- . -'-'- . . � . . . iuuance Fee �-�•5� '�° IDNJ+P/C N� .' � � . �. .� . , � � obove 7nformo' n Is conect I ogree to comply wfth all Couny �nvesuaonon Fee � � � - �� ` - � $ ,_ordinances SIa1e laws relating l0 6uilding construclion.. .:.. _ '.__ . ._. __.._ .�._. Tofal Ra ._74.z5 ',. ....... �pM,q Perm.N..' _,... I... _ � .. _ -. R and hera orixe representmives of�his Coonty fo enter , . . � up n th - ionad property for impacti purpoeas. � �_ . � . . � j � i � � � � ._ _ _ ,-_ . . .._...._ _� . ___ _.. ... ... _._. .. . ... _ . , . . .__ ._. . . . ... ..- _ ._.. ,F, � . .�,1-P � . ,SFE REVERSE fOR FXPMNATORY LANGUAGE , � .� � . . .. ..Sipnaiure af Applican�or AOenl .... . . . ' � �.. _ . � .. . _. . .._ .._ __.._. "._. ...... . . .'. . � � .. ._. ..__. . ...� . ' ..:. ._. ..__. i ( . � . . . , . . . , I i . � . ��`� PlANS TO APPLICANT INSPECTOR'S NOTES V�O11i11 N Iillll DI R Uf(1 AR,11IO� . I h cby ofl m ihoi�I am c e. r(r�m T e Com a ior's � f . r.l.l�,i��. I � � � F".. '�,r'" r� I' �ha .L.'.Bri llec � o - � To: �. i;s� ��-c r�� 6! Relumod i. w.�' V l n�:i 4. �,„ �f t... a �� Lice,s. �Lo f �lhe (ol�o ng r,A o �Ac�'fJ031�51 I �::. . � N t � . r. � ��'�s e:: f;�: y �d '� . . . , , � . . Appraved �O�u�nr c and 1 r f tt n-<�di flnl��rt� r unh e L�b � � � �. �^, i.3!..t;'f!:tOJ i6;1 YT!�'7�J3 ���f- �t> rt rn rn.nrr rr,Jlnr��e� n�` ��r lee1;' � .•. No. Date � Nn •D i . • rcyqirrc�f i. . ,(� (�!'r, , � UE: "' .. . . -. . � � .._... . . —�.rref anVxlra�[ei�a�.fr l �f.ssu�i�ca,rLnrryuirrs -'1;',..'?_t,:�7. .��>.:•�( YLiIJJIt.C�TI{^,��,���� �5::; i�, tLcupplwntfurauth/�r'rult �/lrasrQneUat�tro�i�v:f L----=- - ' — - -- ---�ih '—^-"^C --`--' ,e�tlae bcu;li.cntidpursuunt tn�br,prnriciuns��/!hr(,+rn- ' . �' �.)f>1'1 �.I�'�V Y'('�i'•C 2�7�::.".A:� fI(tilt)rSj.J<Y'nfl'�MI['�L���rll'YJ��CI��I�n1YIl['lI1.Q1!•It�r,Sl'[i `—-� -' —.—i�._ —. -— —'--- --' lion ib0(lf r�U�rriinn 3 q/(he flueines.�unJ 1'r��c�inns � �.Fa�.�>.CjC;CI.f..i.:l vn_a.��-,�.?' ^_LS)SL�..:i` "•'l,F? F)f10i�IF.-_(C?vtq�' 7jJ(jf':Cn.fcl�i)i�1La�.befa`�.r'cmpltGerefrnntu�nJt).FhAst�fr.rthi� r - ' �. +:- ' _ ,"" , • �� al7rketl exqnrptrnn.Mnv�� lat'un�rJ 1< t �U31.5 bti B�fIt :,�--�.�:i�iu� a i,v r. -i � i�� ..:a�>.. � .� r:it�� �•� rn� - •E'�, -RaqJtrod --Da}eRatervcd "— �nL'aJ�rlicant/ �dJrernntY-hJeflnfh��,rru«�<<,�u.r�•�r ppp ovais ' -' or ApPro ed, � �� T .---�� �n^pnnaltY'nf�not�m�re�.�thun/nr bu J ed Jn11cn f�3(101.J:. �--- ��s�..a-. — _ �Yos-- NO- �---- - ---- --.Ss, 1,� __�_'._L.,'��1.4:��._-:.__; ' rr�.;, r._i . - - V�3-,r . (� I,as owner o(ihe propPrl'y;br my emp�o�e4.s`Cti•�ih 1,'��,. \ 1 l .0� T �V.� ..-�-__ _-..�.1.. ,_-.-..._.....a . . � ,•,�I wa9es Qs�the salg c,o pensot pn w 11�1F�he,�vof�,an�l . � � .. � , �.. �'91erSeetd�care�`�-�__ - .. _. :..I �_�`� f'_ .., _ _ _ _" _• ' �� ' :�C C^ ^n� �<? � �,���he,si{uUytre as pqt intended pr pFEe�d fo tsule(S�4�oaa� eateh-Depo•�men�---_— — c>�i�c��e'.� v.i L L_-�_ __'_ '._._.___.__,__.., .._ ,w:l1 si�vss� d.Pr f cs� +s,C!!c !/c.<r t,�t �! sv C.: I' t� � . I.nu d t uppl�! a+ i�ner.uJ pr pe t���1 /u!dc �. �.,��Q v3 F>Cl 1�"O�1 v. � ��r ii rfmi�<fbi rrnnl und u uf�Ju s.n fi �urF:hi.rtsc!/'��t c De imen� � � - [i �'� �,.�?`,"... _.��� �%,�.�.—'-- 3tvi �6c5� I i+r';� k: ��' , :Ol_Y .� lc cfl rr 1Jhis'm n,m 1 � �(�.(lA-c:}��^_.n � t'�If V�CF ; _��T>C� e i`#� .4 h�n s IJrowrleL tGot aath�1. . C.odmg.. - • � (�1 C.... _ ' "' " . . � „�r 1'rmentr!ari.�n ii �ntexd V h�rc�// d,�fur>s(�:JJ. I ��3 �i �.��-.._,!.-.� I ° .I� C_ i)fD�:/_ 7i:7.� � .Ii .T,fF 7�. i., ".'2rnii�+er.'tbFbni�din,e��riii/rfMllf'fr�VSVN/<!UllttYltlY _ '.��__�»�' , $�r '('t4im feti�in,�lhr �vmer•6vifr�nr' i!!lSnio�tFv Fieolbg�cnlJ I f,: - . _ . . .t G Z C,J J .r.l"fat:�: .rn CZ1 f.',r•.. iM c'.;TJ' .�J�`'� ' burJrn � r�rin thal br drd n..f Fnt 3 n�'ini nre nr � ` -_Ci9.� _ ._LI�L�I_ , p c t P I , --- .-- - . .i �. � rb purp,c el eh/�1 '.� �na,�c�cv � , �edesriionProTeBiori:�T. '_ .... __. � . � .. UciLU1C.U� ' 'OC.L 2�. , P�3�:;,�1 � a . t �,�. , i �.,.,��,-.�+I .. . . . ..yA�Ta�,.3: . ; ^ .. �,.,..:.f, cr:. J. � . P �� _ �s elY.cc�nt�oc ' IFencr.)�Conopy) -"--"— asownerqr�he o�erly��prtie d � �: •.""'" ' �� - �:.�� k ~�r�ing w{�h lice�sed co �oUaos to.cqrtisirpct rfiey olect f Sec. I - k �`f'�- —�. h��h'J ,�v_> C., . "�i:�r-- a .,.�' 704a1 Uusines and 1 /csi v C de 1! G nt u<t rs ' Snecwl InspeU o� i , �: ,7:irrnsr I.uu�f n r pplti i �✓�r�u i SI P{pe h a A r� I (Canc.l lhlasonryl(Welding) f�'.1 'T � .`�^,, t.�..�..�� Y� �=— - —."-i—===' � --r. burld�or irx ers flrereo--�n,nu�, ubn i�nntraatr/ u�b i F ., , � n � .�:�r-.- ; . .. _ r. � , LotOramaqe fi�` (`, ``' i r:-,.•.•---��._�. �fDrnjerYs\u�ifh d�riaf�ac�nr((J%i<�.irivid;J�iiisi�unf 11 !be � ..'i Ccit,�`•.�J.•.•••..,,.�,. ;' `!�lrn�tor's/,i�rnseLair, -- : � . � � `i? CnA .. .--• ', • � ',,.�,... �q 5 mc�� '� PnrkSng.� "�,1 ' . �. � � °���.I- .. . _ . . ]�jyin�£�t�.7.: r. __—C' I am erempt undc Secny� t t r 6 B�.0 !or Ih�s � � s��sv_ � � . . . ,, 4, - t'1 �c-v '� _ reoso�� �.. .,_._.�_�_________—_-- I, " . . ��-- .. . ��.rnci e t!� . '� �._ ., � � - � �: _ ����• .. � - Do�e -O�nerT_� . I i • JA �0 4'Gn�Ii1�1:'IfL�ili� r' iut }: --- — I -�.� . � . ���.=�„ � � ��7n:<,J�:;��3.1'.lE 91:,�,J �, .,� Approvals Dcta k! Inspector's Signoturo [ `''��r � !� z . b; (�.r,.�.l .J6U\r T�' I /�, I � 1'�-- i l � � _ ...r::':_.s°t.::�_.._._.:: _ . �i . ... • INSPECTOR'S'NOTES enr,, :; 1 � locahon-. . _ ___ _._'f � : . . II . ISelbo<4&Yords) /� �, -- 7 3 ?� r,:•z J ICT9 Ym �n 4. ; f io e I i � Foundn�ions f�� .:� _ _ _ Y � _ r��io�U^..� ��.io'.c .19n i:b:�t n I I_�¢ t o � s��h o � —_ <,=– — .���_:;;.._,,r, .. _ � `� � , - � ` ��'_. _ _l� Cn11J0'.I�.^>t'InY n���1:9','\y-)�f?. . ' ._.... ....,.._ . .. �...- . .,� �� ::' �' , . �no:�olci'1 tn:-rz..�.zuJ,tr:.no..l Frnme y ,.,,... j ^=. . (`�� ' . • F. 1 '1 "111�,,,������ i� R, I ' Enerqy Intulo�ion �• — '— I " �' —„. 01 y�n t.,..I ro ��n,^c�. '.t!cnf n�id'o y? •^�i I � n�,._. i�,n;o,,.won_. Y - - -------- ,. ��.���:;o,z.,�z; �, Inierior I� ._.J�i _�. �..�i.�'��_�_-;1_� � ._:..._._.....:.....:.._...,,'- ';t . ... .�._._..... � ...... . 'J'_Sd�L:,� �. laih-E��enor � y, j,sp�,'^_ ,',U. _ _ ��mnN.i .ineJ = �.1.F�I _I v _ .�� c . HCuse N�mF�Rr_- �.('. �'i!' ' [ _t ✓ F._/��__L� . _._. . _._..t2�it�.H t�`.�.�:1 Gorreu&Posted `"�•.F .#�r d C�..�� A�'-_ —f' ��{. ..a�. .y.,, �t.� F ..a 1. ,i�, . u�.�. ..., _ ,. . � ..�� ., � „-. .. .,,� . Final. r,.-__.. __..-._...__ .__ . _,',.. .�.__'______. �_ ___ . (`� coi r,c.rc;,�:�� I{. �(•r��o�I a ri+iw tl� �ot��.iEo I I� o� nttr,m�M�'. <<�n Enie�on Froni P� ��� ?(' T. _I T �k �r•.;n rrib�:.�d m nnir,, .:!n21�' , . , ... ,rn... �, w�.....- . -�..., .. .., . ..._. .....�._ ._ .,.�_.l.../_....�` _:. .._. ,. . a.,... xt��ot��i�.i�J t 7 � v��3i .._. .^:" .. .._ . .- '_ ._�..,. _ . :. ..�_ , . . . . . ,:. . c•nry^ ^ .._ � r nit�:n.. i� Y,io �io� no�� ���..at HJAU+'.Hl.lYF�T:.I"A79;:'.t.:ii3:`.:':�a3.2 �1��`j\�_� �'V�!\�,�j��� ..