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HomeMy WebLinkAbout0792A (4) : _ . - _ . _ _ .. . _ . � �� W VRKE3o�CpMPEN5ATI0N DECIARATION .. . . �� .�, .i,. � . .:_ ��-�.. ,,..:-" ''... _-: ... - .... . ._. __.. ... � .� _ . .. . . � .._.- - -._. . ,. .. _ , I hereby affrm tho�I bave o tertificafeof consent�o self ' �pp��CATI.ON� ��FO�R��.BUIL�DIIVG ��PERMIT.���-� - �� InsuFe or n cert 6mte of Worken'Compensohon Insurance � ; �� ' or a cenified copy thercof(Sec.3800.Lab.C.) , ...� � :.. . . - . ...-'- " . .. .. ^� . ! ..- . � I i �7qWr 005=279-0(�16 '. � : - . 2/A COUNTY OF LOS ANGELES " '. BUILDING AND SAFETY . - " � Po?icyNo. Company� Naf'i nnwi r1F+ . - a: Certified copy�s hereby fornished. � FOR APPLICANT TO FILL W BuuoiNG t`' '� �'� �� �� � A�DRESS � � ��Ceitified topy is filed with the tounry bu�Iding�inspec- -'�`' aua�iNG � � '� � . � 'tlondeparimenf. .�-. .. . ,. ��� ADDRESS �2424� Gem-P1aCe� -� i � . ; ,� � . � . .. , ,, _ . Da�.... �.�, � ., . .�.�I.�� �.,��` -�.....,., ..i,: , ._.. ,_...__...._... .._. ....._ ._ ................... . ... .. . _. . .i . _ ... ..�. , �.. .. ._.. . . ._ ._. .. .. �+e ' 8/5/87 qPPl�co�r THE�ANDEN GROUP cin Diamond Bar z�d 765 ' �ocaurv Diamond Bar �"� ��CERTIFICATE OF EXEMPTION FROM WORKERS -�-�'� ' --�- "-- --•-� -"------ ------NO.OF BlDGS.� � �� .--��.�..., NEAREST �. � � � � � � ��� ���COMPENSATION INSURANCE �� for one - -- �.. , I . .._ ��ST- D1dI170AC�{ Bar.Blvd��&�-�Golden �S ring: � ��,� . � 512E OF LOT NOW ON LOT ' ! . hTundred�dolla sef100)oE.less, lated if the ermir Is - � � . : . .�._... __`- ��---�.� ,.,,.. .. . ( J. ': ..:.._.P._ . :. � . TRACT 4 2 S H O ��BLOCK ... _:-_ i LOT NO. � ....4�} .; µ�p,PE Q��.i..� , � I��.__PAGE VARCEL� . . ,�i _. ...,.. .,. �..... -� .. , .. .. . ..�_ OWNER...� _ - � . iEl U/�-_7 MAP / I tertify that in the performance of the work for whith this � -�N� ' � NO. � !� ��- � : � permlt.is Iu�ed,I ahall not employ any person in any manner � ' " `� �; �. �'� y ... SVECinI. ._..,_.__..._... , � I . , ...., ADDRE55 _.P..O.BOX...3329 ...._. �-.._ .:: pOCJ COND�TIONS _... . _ so as to become subject�o the Workers Compensation Laws. " . O ., ,., . �...: . ' _ i - '' ,, arr Covina na 91722 • -- _ __. c� ,�+� _ � T �1e�..�: •:�:... APPI¢oni � . .. . __._...� , � i . . . ... .. � � � ARCHITECt OR ' '� i TEL. � � � � �.O T I C E,T O A P P L I C A N T:�I f,��C f t e r m C k i n g��l h l!C e�l i f i c o f e o f ENGWEEN Dave .Szan � A I A r.w. 4 4 5—4 0 7 3 D I S i R I C i G R O U P�T Y p E I __., �F I R E N i O C E 5 5 E D B Y Q � Exemption,'you��should betome sub�ect�-to tha�'�Workers'.---���� ' � _I �� CONSi. '- � �ZONF�- ��� � �. ►- , p p ,yov musf forlh- �- pDDRE55 314 N. First, ��rcaaia � : . lo. ' � ' � ' � � a LICENSEDCONTRACTORSDECWg Permit shall be �---- _ . . . .. ..,�� . . . .. � ' ��' deereb aH�m that I�om licensed under� rovi� � .�' CONTRACTOR .. . i -t ..... N � .APT. CON00. ,- y oemadsro'vokedovis�onso t e o or � ETonO ofCha�fer9 ADDRESS._ AS...d170V0�..-... ._. .I NO. S�.OS(O-.i STAT�SSNOClASSI��GTIOD�U. '... : ._. .: ....._ , �.�Z � ' '-- - �'�� I .UNITS� — �h Y P P (mmmencing wlrb Section 7000)of Divlaton 3 of�ha Businass and _�._... ._ -._--_._. ..._. t�c._ ' S�M�ER MAP . i . . - . .. . , '. I fessions Code,and my license is in full force arx!effect . . Cltt�.�...........:... ._ . . � CW55..'�B.. ........'�� . �"BK - .� -.i___._ '. _._ . . _ � . _.. ; � " ��'.��VAIIDATION� , � .., ,:., �.. . ,... . . ��.. � � SO.FT. NO.OF �: � NO.OF�_.__ I CNECK , . . , � '�. . , _ . . � � Lf enseNum6er ' 510560��. �,UaCloss� " '. "B .... - �� SIZE" . .. -�SiORIES ..._'..._ FAMIUES 1�-�'! '-�ONE--". � ..� .. __. . . � Co . ._. .... ,. . � D�i .. _. _._ � � . ' � __VALUATION .. , .. , . . , : � THE ANDEN GRO �8/5/8 7 oEscaivrioN oF woaK ' - � 1 NEw = 6 I - _ ,._,. 'nrractor e y820 , _ ❑I am exempt under Sec. _ GdZ'3 e _ ! � ADD � � _ -;..�0 7.9,2 A� _: __._ .. . _.. . . � ��,�. -. . ,.... . . _. ALTER , . . .. _..� .,.. . . B.BP.C.for thii reeson _ SLAB ONLY i i eevnie ❑ s.-. ..- '. 'c. _,._#� �_��.�_�. _ _ .. _. .._. _ _ . .:_ .Date: . ... : , ,.. use oF ; I �� ❑ ; ' ► . :b&0 0 � . EXISTING BLDG. - . .;-Signalore.:.. ... .... .:-- -...._:__ ...-.._� .�... � �� . . . .._ . ' . FINAL i �,.. .. ._.-•- -�6�OQ�. . I h OWNER•Bl11LDER DECLARAiION � � �� �� AS �2bOV2 �� � �-�DATE..Cf ✓�.OR_._�;.. � • . ..._ � PRINT ..._. . . ... . . ,-.._ ....: � ereby affirm thot I am exempt from the Contractar's Ucanx � � � � . " �-� � '; , Q$,� �]�$']� . __..._,'..'. ........_. .____,._..._ :_....:._. ADDRE55 , . , i TEL. It .. � �� Y.�. � , .,:'7. :.. : , . . . . ,�. w for fhe followiag reason�(Sectwn 7031.5 Business and FINAC � i �Sfessions Code):�-� . . . . . ti rv . � � E ,���.. � . � � -.-��. . . �. •�. '1 ��. � BUILDING . � i . � � - : � �J_ _I, as owner of the,property,or my employaes wHh ADDRE55 � ' .. _ ".. . . . .. ... . �. � wages as Iheir sole compensafion,will do the wark and �. �� - �. '�� � �- - -� ; the structare ia nor imended or offered for sole(Section ����iv �'- � � � �� - : � ��'_ 1 � �-�7044,Business and Profassions Code} .--... _-.- ---�.. MOVING. ..._..__ .. __.._ _ . -..,..TEI. . r-... - .. ._ .�_._ _ � . . � . . . a - CONTRAROR � � - I NO � .. . ' ' ... .��I,as awner of the properfy,om exclusively contracting 'with licensed mmractors to construtt tha pro�ect(Sec ...'- ..- -.' .-. --. _ .--.. ... ..-: ..: ' - . ... .... __. . .._ : ' tion 7044,Business and Professions Code) . ADDRESS - - �� ! - -� �� � � �-' i � . . '� . .... . . _ � RE�UIRED ._iOTAL SETBACK � ..... �_.. . � �CONSTRUCTION LENDINGAGENCY "-�"'�� ��"'� SET BACK �YARD- HWv�� � pROP.uNE � �WIDTH� � �" - � „ ' (� �� t�h�ereby affirm ihat there is a construtlion lendmg agency for� . FRON7 �� � � � � � � � � � � � � � � e parformance ol ihe wo�k for which this permN�Is issued:.-.--_. ..v.L-.... �. �:--._.- --.=: -� ......-.. !�. ._-.�..... ...._ � _:. .. ._ . . .�..: ;:�.'.._ _. ._,.. � _-. . . � . (Sec.3097 Civ.C.). ., . . � SIDE. � . . . . . . _._ . .� .� .. ........._ .__._.. P.L. �. . � . - . . I � ! 1 i� � - . tendar'sNama_ Cit�bank' " � ' . � ". ... . .. �' . �. . V.C.Fee S - .-.�.. . .. Pe m t Fee i� . � ReE�M .... . IDMA � Lender'sAddreas 444 S. F10W . �.A. q0�7 ! 57• � I � -I cenif .�hat 1 have read fhis a litation and state that.the �� � � ' �-�•50 i. ...I.i.. � . •. ' ' ' . Y PP ._ �..._... .. . _. .� Issuonce Fes- . .._,. . _.. IDMA P/C.M.- i �.._ . � above inform 'on is correct.1 agrea ro comply wilh oll County In eetigotion Fee � _ $ .,o�dinGnces n StotelawsrelafingJobuildingtonstruclion, �- � .. _.. TmalFee I--�68•00 � .IOMADe.m.M ' -�I+ �' � ". �. _�,._ . ,�_.. _. . .._... ... . .' ..._ _�... R and hero t orize ropresentatives of this Counry to entar . , ^ ' o t e• ' ned property for inapect'on u�poses. .� . .� . i � . i . � � � o ,. ,. _... ._ .. .._ f_P.,.,, � __� _. .._. . ._�...... :�.. . . . __ .. ,_. .. ... . . , ... � . ._ . . - X//A1/ ��I-- .: . ,�. V < V� SEE REVFRSE FOR E](►IAHATORY LANGWGE - Signature of Applimnr or AqaM.. . _. ..i._ ,o6te. ._... . . :.... _.. . � ._. . . _i.._ �..._.. ._ . .... � -.._, . .: ... � . . .� . . . .. . - . . , - . �.. . : �I � � . � .. � , ,� �'�.�. . . . . _ . I� ' PLANS TO APPIICANT INSPECTOR 5 NOTES . �q�;O«��!�!t.��4U1�Intlt llb:c:�.nt�n'f111�: . . ' � I hrreby o ho`t I cr f o r6� �'onrractor's � �` I a f . r. e.., " t'b � ?,�,y!: t 4 6 4., f+jy rr'� !'w� Y, 7, E')C.�, r j� ' ���'L�ienie�Ltiw°fo. rhR 1el('ow ��en o ��}S�c��I05Y�5 � _� To: ��. C�,e 5. �.d i.r l Returned A :.t'k,h � L ��.:��. ��� IW ���'c o� ��c` &4`'�'l� .s�nm�.n�no t�.. : � �����: , � �. ,i o i< `, , . . APP o-�ed `� f3usinccv nnJ,f nJ.!rion�(r� '-(17.j'.pt�.n�;.nunt}_u�l>i�U • I ��� No. Dote � � Nle' ru`�Dofe°�:•!.) .%;i a',31:7�SPz0�;0YTb�:ffi7 � (�� reyuireeu%�•rull nnchm glteptnjtl�(�':�JJ.� lsli• ;' - ... .-» •.-�11 11 Q i Tb Jf I � .Ji•• . �,, •-':�r'ri�uiran(strLat ;'� 't�i�tz i.uua i c..,ts��ra y n*ra � tt...,....{,.. ,,,_.. ,.. .. . .. � . � . . ; _ r� > 4 ;t;� l.f,Ci., � i� ��£,1� C:fi� (��L�'•$ .. p.::^:^r,l� �o:trm'l�r's�l.irrn��l,,iaJ,uant,-t�.�,��lr;rssi�mr.Y�at�ite.�inf 4 urnnt m. � t ' _ _ . 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I r� �P P , � - -- — � : � „ Ihe si u5fu �;s o� iended o otfe ed io Sule�Sec�.704�� � , n c c r vn;� n�rt � Y �g � etr iu�Jr !1 ��Z int.�!r s f tens ' �` ..�<o�� � �v., 4 . `. • ^� ,:»�ssand f ', C..r Ncalth-➢ePartment�__'__ _.__.�_�_� . --- _ .zw� _ ... .�:�.l. . , ... _ ._�S„ �' �, C} 1 - -E . � �.�. _ Luto Jnr.v not a/�plv 1n an nn•nrr nJ prnperfv teb��Fuihlx . �f Q .� F�(�qt1'l � 1Gcrrun,and e! d s sr b a F:hi i. 1( �. F�re-Depanmen�� ___.. . . . - . , orimprr_u . ..✓� '� I ,e . ..i j r,�t r�T v�,t�j t;,.':o � � .J'� ,,,� S:iT` �. .r q.�,fGrnu�L�/�a{oa•n,rm/�lo}t s�,.p nrrJ�lilut��su 1��•r, ... �. cn� �at �,., t�rr, �rn ,..�. :;a � ,i ���. C` rodnq.. � �..�:��; q ` ��. i ` f��� 'r,v/�riermemts,lare;nnt in(enJeJ pr��(/ereJ�fur.iulv.,lf, . ' �t � 1'~ �v.. -�� ,-7.�- .� I `� -b1F�F�YfI �J�.'S 7 � j']V�.�•.�[. 2 - 7l.1•i -dtidirntvrrr,Jlr�$railJin,enrrmf'rurrnerrtt� su6lntill�'rnoae � �d Ya'r h. - i: eologicbC� 1�„ � � .40���,'I��EC.-A!^n�liJ.. I --"-' --- � 1; /..tnnoflrlinn,+tGe'oumrr%bw1Je •artill harritbe � �'-�"-Y''� �c� _C.,yf1�7,���i,'.!I v�,�; ••��y` c,�_-:.'�;.:^_��� hurdrn nf frne�rn,�fhn!bc JrJ nul burfJ ririrriprnpr Jnr' `V � � �' � '� '.� l! pup�<en/io1¢7721:)J\� lt ,^, -��3�1 � �,¢tleS�)(nProPYltion_�.'�'. � �'S . :. . �, Ud�UJ.0 o�t �VO;S:i 2:f ` `R b .:� �1 asq Ae otiF�e�io Y i, Fence Cano ; �w 4 -�--_---- �---— .-} C�:'O r v. pe\fY bm�etcl�s�el tn r ac�. r� � � �,��1� ting w�IFt�I ce�SVcJ cqn�atro s to�onsrruct)hc` �o�c� � Y7�,' .I ���„ S P! I ISec. � •.'.•�, t� �`_____ Q ' -` t 704e)Brtiness snJ�Prn� sima ZuJ 1!c <'oulruatnri SpeciallnspeUwn ..r �'n� i . i��—�7'1.-�} qc I (Canc.�(Masonry}(Weld�ng) "'s' �,... -. ___ t '_'_��� El.icrn.ae l..a�r Jnes rtn1�j�j�It�fn drt�u�nrr��.ipqrft u�bn , .. ; Et i liit� � , E"".�—��� ,� ��..� _ ^Fii1Js or iiqp r es II%ie - nd i<bn�nn�rucYi f re'ab i lo�Oroma9e 4 U t � . z �.. ••,� ..:-..r..t.y__...a_..�i..�i._._._. . ._. �pi.jrttc�G�itb 6 1,_IeTot dsl Un'��mod 7�1�t±uant r� rLl o � (1_ F _ � a,a —C�ntsatt+,Ye-1,uentr l:,rul. 'o� '(-.� Pa.kin9 • o �'�� �4 4'� � . ._ . .'�� . f SJ,Jt.j�-_._...__�._--���.�.�..f'-'_c �J --'� I am e.empt undnr SecJ•;2 vl-n�r ByBP C�far fhls ` t ' 'Y 5::0 £. f� �'. ; i .....,•i �� ,: �, ; i, � _.�� ._ � . �n?c Q� :d< < ' �� ; :' � � 7 � 1 rooso , . f _ _ . . 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