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0795A (4)
_ . ___ . _ _ _ , : ; ; .___, _-- : .. __.�:.�. _ �``�'�JRKERS'COMPENSATION DECLARATION - . � . � e.-.=__... � ._:.c _.:...,....... .�._._: � "...' -. ..._...._. ._ . ,_;.. ,.,_., , . . , _.,. .. . , , _...... ._ � . . ' .'„ . ___ - .� .. � . . .. .� .. , �,.� � �. . I hereh olfirm �ha�I have a wrti(icate.of consent to self � � ' - " ��"��� . � ,�insure,oracerlificatcofWorked�omPe�=a,�o���;�.a��e .� ������APPL�ICATIQN �,FOR�-BUIL�DING�-P�ERMIT���- ��.�, �, �� ' a certified co 'thereof(Set:3800,`Lab.C.).;'. .,- . '�."-' ... . ..' -... . .. .: - �.. ' . �.. .,.'.. . . . � . �.. . - �/3WC005-2��-001� �� � Nationwide •2/B COUNTY OF LOS ANGElES BUILDING'AND SAFETY � �PolicyNo. ompany .......... . , � '� :'�' O -Certified copy is hereby Turnished.. FOR APPLICANT TO FILLIN qo RE55 24243 GOIR PZaC2 � �Cenified'copy-is tiled with Ihe county bu Idmg inspec• '�-� BUItDING �� � I i - . � � � �: - � ' no�dePanme��. �.; . , , nooaess 24243 Gem , , ° . Dote ���H-$-H��� •APplicont�-THE'ANDEN��G .., . ._.._. ._.._. ._. ._._.__.__... .. ........ .. ..... _._ . .. _,... ._.. .._.. . . _ ._ _ .: ROUP arr ' Diamond ar ziv ' �ocn�hr Diamond Bar - `CERTIFICATEOFEXEMPTIONFROMWORKERS'`....`. .__. �. ...._._. .______..._ .__�._._..NO.OFeLOGS ....�..__....:.. NEnREST.___: �_._. . �_.., ', . _ . .' . '� '� � '�`COMPENSATION WSURANCE� . �� • �. SIZEOFLO7 � - NOWONIOT ' . GROSSST. D�gtt7011[I'$8t �$LVd GOZd2R T� S -(This section need nor be complerod if�he permit Is for one.----.. . --�-- .--- - . -.- ..._.-.- � -..-':.. n55e550e . - - � . �.,.- . . . hundred doltarf($100)or less.):. .. �... . . . - TRAR . BIOCIf. . . 'LOT NO. �. MqP BOdC .�..:. . . �.. �:�'. VAGE � PARCEL . - I certify Ihat in�ihe performonce of the work(or whieh this �''1 � Owtaett--THE'ANDEN'GRO P �-��i�No. - �( NaP � �l f - � . ; U5�ZONE �� ermN is�tes�ed.I ahall no�employ any erson in any manner . . . � . . � . . ' �"'r` -. saeCwi ... �. 3 .. . � . ._. ...�... P . P -.--� A�DRESSP.O: �B�X�-3329- .....,- . - ���-�-� - corvoirioNs I � ...... .._.. . . . O so as�o become'wbject to the Workers Compensahon Lawa. : � �+e". . Aaal�caor ._ ' an Q. . nv 91722 _ _ _ _ __... . _ .._ _ y ARCHITECT OR � - 7E1. '. . :. .� . ....... , . � � �,..JTICE TO APPLICANT:�If, C/ler making�this Cerhfitata of ENGNEER � � ' � �I No.44 - DISTRICT GROUP 7YPE i _ FIRE PROCESSED BY 0 - . Exemption, �you should become aabjecl��to�fhe�Workers' -'� .i.. �� �� .. OONST. ZONE-� " � f. P P Y • ADDRESS 31 �N.�F'r§t� Ar' adia - 1 - � �- �� '.... . . �. .... w tom ensation rovislons of ihe Labor Code, ou must forth- ' � ' ' �� d wi�h.eomply wi�h aueh�proWsions or.lhls permtl sholl be -- . . � i 7EL. �, � STAIISTIGU CL4551FICATION f � APT. CONDO. a deemad revoked. � ,..:. •.'- ;,:, :, ::� CONrRnaoa THE ANDEN GROUP. I No. Z � � LICENSEDCONTRACTORSDECWRATION .�� ,.: -..... . ..- .. . -.-�.l�c. . - .-_. ..cu5sN0..�'..'�..:ov.�u.UNiTS :.� .. . ...... . . . I herebyoffirm ihot t om licansed undar provisions ofChaprer9 ADORESS 8 ��.5 above �NO 510560 ��R� (commencing with$ection 7000)of Drvision 3 of the Busineu and - . -_ _ ,. . . _�i�._ ; � . - . � � .�� �.��� � � ' S�-OSGO�. �8��"� � SiZE� �� S70RIE5'�� � FAMILIES � . :. .•• ' '___. S�.FT. ^ NO.OP ...__. NO.OP:� . B ". ._.__._ _.._.' __. .__. ' ... ._._VALIDATION ._.� . � . . Y •.,. qiECK : ' BK. PG. : . Profeuions Code,and m license is in full force ond effeet CITv ����tASS i . Li�enseNumber ' � Uc.Class . �'1 '�ONE� , .- ... ... . .. . � . . .� . . _ . . .�. �.. .,_.�_ �, � .. . . . pN ��. �. -.; ` �,�. '' .INEW. .... ....�.._ :. ._ .. .__ . ... . ❑ actor' TA N,f Rl1TTBate- R-5_R7 . ._.'-�,' DESCRtv710N OF WORK_..__ ._ .. _I_^ __: A�ER�_�❑ VALUATI . •p 7 9,5 A� .. _ Contr R �ANj� ' S � � � Bomexemptvnder5ec 448-SF- � � �' . , . : ..� , , I � &P.0 for this reason . .. . . . ' . .I� ' � REPAIR..� .. s . �.'' ' -. . # . , _ .�. �.�.:68D0 . . .__ _ . :... . .._... . _ ....� ..._... USEOF � � I � ., PEMOL Q bate:' EXiSTINGBtDG. � . � � . � � . A . . .._.Signature � _.. _...__.: . . ....___ " .,,.. ___.. nvPI�CANT . . �. ,.I TEL. . . -„ .FINAL ._ ..• i�6�V� . OWNER-BUILDER DECLARATION � � vRiM � i NO �� � .��,.pATE-_� . '._ _... _ ._ ._.._. _ . _. ,__ . �� � _ oa��--s7U �--I herebyaffirm thal l am exampt from Ihe Conlractcr's Litense ADDRESS �k�5 above �•.��• ` � w for ihe fallawing reason(Secfian 7031 5 Business and � �� ` �� � • �FINAC°����`�" ° • . ' '' . . ..,._ � � _ ..�_. _ _ ���fessionsCode]i..... _..._ _....._.__..._.__._..__..._ ___... R . . ;, '.6y ../f' �. ._ . .. . ' . . BNIDING ' - v � ' ,� ��I, as owner of the property,or my employees with � � � qoozE55 � � �' ' : �, � : - \:.: � ����'� � � ....weges as iheir sole compensation,will do the work and �- ----� � . � �- ! - ! - �. - . ... �� �. . . '... .--. .. �the atructure is not iNended or offered for sale(Section � - ��`��TY � � � ' �' � :,` ' � � `�'� � - . ....-7044,Businezs and Professions Coda). ............ _:.. MOVING --.- ..-.�_ ..,.7EL �-. .. . . . . .. . i , .� 1,as Owner OT�Me ptOPe�ty,om ex[IuSively tontraCling . CONTRAC�OR ' . NO � .' �, � � . . . -.��with licensed�contracton io constr�ct the project(Sec- --. -- ..._. . _. ..- ..._ . _ . .� . ._.__ . . ,.... ... .. . �.,�:. ' ' _. . ._.. _ � . .tion 7044,Business and P�ofesslons Code). � ADORE55 . .. ........... REOUIRED. . . .iOTA�SEIBACK .. .._... _.. � '_-.... ._I_'_'_ ....'_'... . � --.CONSTRUCfION IENDING AGENCY -"'����- "��-�'` � -vnRD� �HWY� �' �SETBACK GROP.IINE WIDTH �� I hereby affirm tha�ihere is a construction lending agency for - fkONt . . . . � , � � �, , �'� � , � � � � - . � ..the performonce of Ihe work for which ihis permi�is issued ..-. . a.i. -.�... .. ... .�. ..-.- .. .....-.__�.. . �.:. .._ ...�; .. . . I .:.__. _._._. .. �.._.�.___ . .. . _ ,. . (Se[.3097,Civ.C.)' . . . , . . SiDE . I _ ._. �� , . � � � . .... _ _ _. _...._ . .___ - _, F.L , �. �. . .� �, � Lendar'sName....Citihank �. ' � ��� . . .. �. --- - I . ___ _. .__ .. „ . . . � � . . � �.- . , IOMA�ReE M .1 .- :.� . m - - - - . ac r��s _ _ a i�r � 57.50 ,- . ., _ .. � �ender's�oddress 444 S. Flower. L.'A . 10.50 ' ' � .I ceqi( �iha��-I have read Ihis 9 �lica�ion p�state thai�h� ._�., �nves��gairo�Fee ..�..�. .... eiee�. - �..-..... _�' iDM4viCM ..._- --i... �_ . ...__ ..�:-. -' ' . . Y PP . _.... .y. e- obova informati Is mrroct.1 a ree lo com I wi�h all Coom � . , I . j ; . . $� ordinonces a tate laws rolating to building construtNon. .._. . ._._ .:.......' �._To�a�Fee..�.6 H•��. - .�..i mi�n,4 pe.m.�M;.:. ...-.. !;.. -... . _-�.. . .:-. - �. ... .:- '-.�_ ._. . . . .._:_ . �,� � ��and hereb a orize�epresentalives of thia Co�nty lo eMer , , � . � �pon v ;m ed property for Inspection pwpoees. � . � .� . . . . ' � - � - m -_. .. _. _. . .... .. . .._. ///��� ..._. . ._. . ._-- ....__ .. ,. i..._ .. .._.. . _ . _._ . ..__. . r ,��� ___�y��, � SEE REYERSE FOR E7[PUNATORY IANGUAGE . , � � ' _ � ._......Signoture of Appliconr or Ageni ....�__._..._.. � .._ .' .__'. . . ...�_ . .._._ ...4�. ....._ .� _.._. __ .._�.i � . .. .. . . ...... .. _ � .. � .. � . . . .. ' . , _ . , i .. . i. . ... �� . � � . . . - _ I ��� ' PlANS TO APPLICANi ' INSPECTOR 5 NOTES ��-Ol5'1f K,1344ll pl N Uf(1.AXA'I'.�(7�..' .'?, .{ _ I hPreby of( fhc�I a e e i f om�ihe�Con�ro-ro�'s �. , i t "tr.�� �' �.s 4- ...f.- k I I� � �4 f .. . y ��� �i` P s.� ?! } � .Y �Ix_ ll,�z • f 9��enso S�ec`'�7031�5 To: t [i L GL r",er 4: Raturpcd ^'�.,..� �:i: G . r r � d;.�: l�cenie�la�x for i}� 'fol(ow y �'� ,.� xf:� k A��r� ?: & �'�i e � Y. •���„��ve��n-� c� .�'z � ��c io , . � Approved IirraincscunJlrNcc��inc( �d hlnynt�;or:��unt�ujil . ' No. Dcte � Ndr =�:bofc•"�-=J �-%^ 2�!_ct„?,r._r,39C)Y'fo+l!i}: fj�S rC�J+Eirr�,r(�rrn�Nt��nn�irurtry7(�{).u�/�nn�g.U4ii,l�..f� ' J ,J,. .° "'.."`..."•.�.- "' . -. .�' .-...." '..•-._.. —�� r urun�il�iUur '�ni-! ui.ui ,�l�nr ) 'rre ' ,-_. r r � � �-- '- "�51� .fl!^7 f,�Ci � Z�.�:'�.'i�,�.� � l^.IL� GTi:SF.:iIJS9:,so� __ .f. ri,�wr�r.,�.,f�od,ru:hrrrnurtul/rl��a �CmJ'amt rnf ; - . .-- . ._ _.. ... _ --_ . _. ._ . ___ J -��,�tLat r�;us/i_ensrdj�vtsu�nffudrr rnt•iriqrtsaJNeCun. � . . , , F� . .. /'� .,. ,..� � � � nlF_�� f;_ v) Ft�_�n,� ��,.,��' lm:l�»kl.i�rn��f.�«•�cr•Jrr,�.vik,,,,�,,;�����„�.��urtl.�cc� �,, --' -- —`--- - - — � - , rion 7(IpOJ n�!)irisiun 3��/tl,r!)usre <c�nJ P�/_� �'. I_' - ---- 7.^.�f�IIOfTS•.j I_`!'i�',_-� ' _LflC�� - - - Y�ti f�'tnrIFLCI vi�,°- ,�jlCu�l��Jrirtlu'G��<.c�Frim/�tlGer�fromnnJd�Fn?�a/r1L.r � � �^ "' `- - ' u!l�ged cxcqpj n:,Anv7 !at n.�f.1 i!u �;7�'_3Ls hi . �r r�,f c t.�l i 01�_.S 7�.�. Raqu'Iied b i ['7:.�I1 t ... , _:.__ _7'� �•,�����.i __�. t0J ��� •� an�'u lic�nt h l F'. fF�u i �r A o als ' . . - Dato 6aea ved-�, '}'-"--' � �-{� pp JJra rrmif n b e f 1L e n 1 ��n!hi.e cir�l � � or App o d; '� i„i�ii.� .�.�r I I" � � 7 encprnaffY n/no1 ni�rr!lLdn��Y J�ndrrJ dn!l�rs/SS(1f)f./'1 �_ PP._.= �L___'3 Yos_'NO- -__ _. .._.'�•..._11���_—.1�_'_'.__�_�.i..L.t�_���i' . �'� ,;�i ;•, L: I,os o�.+ner o�the p ope iy(bPmy empioye s MWilh K'orPr Cendicaie �. ;`'C`. � � C7; � •,�'�•���p .f..:L��,L:,,____i . ..._. �_� z,�,wo9rs ns��he r`so�e cQ enso�on dl de the yvo k and , . i - _-�-'— ,.-. , p . � ''��' • —� ���iFie si��±�re�s ro�v rended Q p�fered I�o Sale,�Sect 70Aa� � � i�` Hcalth.Department--. _"' _.O�f V J�.Y, '� _ ,_ . ._____ _'' .t��1J rinrsrwnJPr/esr� a�.0�1rti�!�.(, ttt�a 1 r's�; rnse � t' � . . �4 CC'CfD ^',� .-,g.� lu�<J�c.cnufa(�fA•fnavmm�rro/prife�h6�%nhu�ldc '� fire.DeP�nment._, � - - - � orinr,rnrrstGercnrs,unJirl�ridnessua�bu�urkl�imcrl�l !.. I . U..���..;.- I ..-1 —_ ,il�::..) T]:;.-i: �'I 1;' . . . v�T .IN�.' ' _t-_` ya,-. � ' - io�r,., f'Cfli�-:l.P. rr r�h ..,.-.,. -..r � aa i p io.tGrnqqL�i„T,,�u;a„�,nrr�,,;.«�s:.���;�•!a«l�tlot�,�at (, rnding Y 1 �y� I i• �.�. ^ 'ei3pmr�emrats;�a NOt,IAIf�(�PlI r�r��//rrrJr/m,-sa1<, {/,JI . I,• � - �. I ' ��' 1� - I �'� ° . tl(1i��(� 1'_.f>t J7:', � 1 ��� .i�i i+Ji �;i„�r. r+;�bm�rrrr,-tAebreitdrn,qnr�mprrren�en[issold�cafl�n�vnB , c:: Geolog�mlJ .T'..:�(—� t�. ' e�. ;:.'.D lA?�'i t�.�?.: -- ' ' .� .. � -� -'- --"- "� j;ear A�:rnvrpletiun,:tbe'au�nrnbuilJrr�utilf.'haredtbc � i � I n� r' -' . 4U(iSi7 �z�_r,,,�,�:[y „ ��:n�• burdrrr o/prnrin,e fhul!�e Jid n��r bailJ�;.vnpma�r�l.�r , � PeAesrrian Proiection>.� -- � �.. � . .-..�- v q. ^ - ` '- �.. tbc/,urfl.sr nj,folcl.79' �,aT110�C- � �J ' (FencellCanoPY) �• . •...t� �iAMs�.,�-�.� j: U����.CC .c�__ �JC'C_. C:7. 1' 2 -�_�� �^0.7['}�}1.'aso���neo�thepope�lyBmeiclJi e(y�fontrac! � p ,.,�.,_ T, �ting w th,�iicensed co°irocio s to<orisi vn i�+r�proieS±,�Sec: � SneuollnsPeci on ��� - -' ��'+_' I r.•I�—��.C�:;4 "- �q n.�'- 70a4)Ifi�sinece nnd�Prn/easinna C�udv: 77c C.unNac[br's � 4Co�c.)(MasonrYllWeldingJ ' . .-�' .'_;�,�.. _ i - �� _� i __�_i�_L_ _ ; l.iceprefa:rdus,xntu/�p117ndn nvnvrrf(�nfrrh•_u•Lo ��:� ,1;0 t.U,,t —'I--'--'� 'd.�. "`bui(Je.�r�nrruers!/i�rrr n.��nd u�/rIl lllfl/f4d3 JOI�SIItIJ i Lo1 Oroino9e.(� * 4� = F.-i--1„i-- - . t!: l� !s u�ith a curs�rat't r(s)ku�.<rd_J;rrrcua�rt m tGe 3-�,;t-ti; , � i -�•,n"cJ �, � �' - '- �^.^ � J� Cc.�.�� �, ; �'`�'o�ntrddnr's I.ic'vna�`l.QiPJ u���.':-•. ' . - �,,� „, �, m:Yqn,.�f l . Park�n9 a z c a ��, {.. , . ... . � c7.�,.�_.—.._�- _"�'v. ' , p� ' I �- i� I am exempt un e Sec '.B BP.C.for ihis i;� �.,� < � - ? ^..:., •r tr-!� rrr r —____ cozcc: a..�,�.:.�:::t' �� _ � :. � - . . �� . . ...... _ ._ I �.l0••.7�I �.. .�,i'',::" �eason __.�. - _' _-' ., e ,_ "�, .•. . •. . �� -- n � Dote Owner r i '-�� !;,:t i ��� .;:t _cfl.:!`�r_:1�i�..i`I. ..:( k __ � __ �i. � � .. . S'J{Tl�;'41i37 b.��,.r�.y:.'.yJ 9 ' APProva�s Dafe j ':Inspadar's s�9�a���." = g �y �Yr � `.- . _ ,. . . r - � - t�nn, n.. 2.(L9.rINSPECiOR"S NOTES I 1 c � w� ' loco±�on- i. --`� r. .• . (Ser6ack 8 Yardsl ��7�/// ! .__ __ _ ��e � r .r �, � , to -, I ��'• fou�daiions %�� Y i no.� � c;i , ��� o e.� + a- .�::� fi .n:' r��, �.{Lo i.,,.�,�Ln: , �:.�. .�,i I Slab . � < :;a �_,_ �•� y D�x � . ..f Pzi . ..t vl � � l � c r i � , Frome. � ��� ..��.- .,- ._. z , ,,.. ����,�� .,. _,i t ,�.�,. L.� ..,i. � Energy Insula�ion _ ;'�'.:.., � .. _._( ^.�f _�' ' . _. .x _� � ..�- b..;� �G, 'iol Y,n e�:r�i.. .. o r_ ��,..�e _ . ��r�i.�•9n Yac.,�;1 � • `�e n r ,..,�n lafhlDrywall-- �I,.,�. t k��_ . , , ... . _ Interior �. _.F.� `� �� � 1 3:" �: .(.�.��. ,(P;.: .,,,,� n. :.� .: ....��: .. : .-. ..�, . . •-;' ��.:�slr,sfi�iJ _ 1 ,,,�.;,,....,-,� lath-E,rerior '{ * a.,a�,,:, . .-. . I , _�. n.� �-� HouseNom6e._ ' �.^.':�j —_'_ _ _ __ ___. . ,..�..i-:. _a..�,.L�._c�a_3C�_�"L_S,_+�i3f'__er;�';!;av�:�b��_1 �' Correct&Pos7ed �:: _ ��'�,� `—l�C.�l.j ' I jr YJ� F � Finni- __-. `-1 __'iroi i:. V�:wcJ'Icd �vvl�r �c �.col r _ r:t '.. �c�n'�,,._q� � Enle�on FroM � �� n n.Q C� t. ,n., �r.. n'F I n ' � �'_':'.,., """v'_' ��.. ,..�,-..-_.- .._. , . � i . "'"- „__, .,i.�. �.,. ....-_'. .",:.':... . :;':"^' :..,.�':..;, ".: rfi ctyt��.,Jxr,i . '., .. . - ..� �. �,.--� _. � ��, q � .,r. .�t t.�,,., �y I:�y���..: _ cc�� � . � :pA:�J6-AJYFO:ls.s,l;..:A�......., . . � • CC_�\`1�\Q. �-�^\'�'--�-.'-�,�/,\ ,