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HomeMy WebLinkAbout0794A (4) J .._ ... e. ,., .�.. . . ,. ,.._ . _�_____ ___ _.._ ... .. :. _:_,._...._. ' ' WORK�dS'COMPENSATIONDECLARATION ." . .._..._ � .."..."'I -- '--.. ....... ..... ..... ......... ! .., . . .. , ..-__ �....-..._..._ - '_"" : . ' � � ' - � �_- . .. I hereby affirm that 1 have a cenifiwte of mnsent�0 3elf . + C��I�� � insure,oracertificoteofWorkers'Compensation��,�.o��e, : � APPLICATIO�N��: � � ' or�6tertifiedcopYthereof�Sec:3800.La6.C) .�'�. . . . _...ZIC. .. ',.. .-.... . .._ .FOR BU1L'DING���P., � � , ... ��W���5_279,0�� , �. COUNTY.OF LOS ANGELES BUILbING AND SAFETY o pany Nati nnu.i Aa O Certified copy is hereby furnishad. � � � FOR APPLICANT TO FILL W � Bu��D�NG .I . I ADDRESS � �Cerlified eopy�ia filed wNh�Ihe county building'inspea'. ' BUILDING - � I tiondepartmeM;' ' � ADDRE55 24254 Gem .Place �. . . . �., ,_ ...,',,� :�' r . . ' . . .......... . . . ' _'_'_. . .___ ..._._ _ _ . . ...__ ._ ... ... .. . . ..,.,. . _..- .;.. , Dc� . . . . ..� .. .. ... . .. . . ... .... „ 8/S/87,.�.APPi;�o,,, •THE ANDEN GROUP arrDiamond Bar z�v91765 �ocnurvDiamond Bar � ��I"� CERTIFICATE OF EXEMPTION FROM WORKERS'�'^` � �-`�' � � � '��--"'-'"-` - NO.OF BLDGS. -- � �� ..:_ NEAR�Si � ' � '" 'COMPENSATION INSURANCE-�� . - . � SIZE OF tOT - NOW ON lOT � CRO55 S7 D1'HIIIOIICl"BdL'.��B 1 VCI--&-GO 1 H@II�-S�J ings .,..:.,.,. . � huis section need not be tompleled if tha permit Is for one .._._... ..- .� .... ...... -. ' . ' ASSESSOR � ,.--.�.... �,.., . . Th TRAR�I L rJ H O BLOCK L0T NO. � 4 2 ndred dollon(5100)or less.).-�,... .,-. � NJ�v BOOK '���� '� �: PAGE PARCFL ao ostt betome a�b ect to he WorkeneCom�ensan manner � -..TE`, .._, ; ...: u��(�Ov� O� ' ' ' �:. , j � . . � . .. . _'_ OWNER �- .. . �� y, p work for whieh this rmil is Iswed,I shall not employ any p y '- Gn� � --- .- ._. . . . . .. . � p r�on Laws `_ ao�aeu.P..O.BOX -3329 .... - .- --- � , o �. ,; ,:, :� ^� . . . ,. .,, . . .� . .,. . :... uTv Covina ziv 91722 ._I i oiT Ns. j - _.. _ . U io t fe APP������ � ARCHITER O � TEI. DISTRICT GROUV TYPE i � FIRE PROCESSED BY � � JTICE TO ADPUCANT�If atra�maktng'this Certlficate of �� �ave Szan .AIA No445-4073��� o ENGiNEER , Exemptlon;'yoo'ihould become sub�ect�lo•the�Workers' �� � � CONST.� - �ZONE' . ; U Compensallon provisions of the Labor Code,yov musf forth - � ADDRESS 314 N. First, Arcadia STA¶-,�.� .!. � {,tl wlih tomply with"�.auch provislons or.�this permN shall be �-�-�--- _ . . � , ' �' " � ��'� . p,' daemedrevoked., CorrrRncroA5H1UOVeEN ROU ��SZOS6O ��R�PIF�GT�oN � APT. �O. (n ctass ; , . �. . � ,., ,,.., FNo. . _ : z LICENSED CONTRACTORS DECLARATION�:�, . �. --��- � - -- - - ���, MSS NO.'�-°Z'�� 'OWEIL.UNITS�� I hereby affirm Ihat I am Iitansed under provistona of Chapfer 9 _ ADORE55 NO. �' � (tommeneing wiih Section 7000)of Drvislon 3 of the Businav and .:... .. . ,.. _..._.., ....... � ... ..... ..._LIC _.. _ . � . .. , . Proieesions Code,and my license is in.full force and effect _ ' c�TM 1314 j �5S . _. , � � � �� -�� � V��DATION � .B. _ _ _ _ _ __ _ _ . ' ..... . �. SQ.FT. NO.OF NO.Of � CHECK BK. ', PG � ,, License Number'51 O$6 O l�Closs B 5�2E STORIES FAMILIES 1 " ONE ' .� . .� �. .. . . .. YAWATION - t THE ANDEN•-GROU •8/5/87, - oeseaivrioNOFwoaK ' am' NEW a s 6,820j• � �079,4A - Ontro[lor afe ADD � � Gara e.....44H -SF- n�na I am exampt under Sea � ' �. --:.�..... ...... � .....� I .... #�a :•�r� � _ ; , SLAS ONLY ' �, , ��5� narure �his teason �..__._ � � REPAIR , ...s .`.. �' I- j -- � � �'��•�.i(�$,O b '. . ._9_ .. ._ .. . _ _ ._ _ _,.��.� USEOF ' � 1 � I oa��: -- exisnr�eioc. � I:: ._ . . :5&0 D�., 8.8P C forot _ ._ _ _ ,- . ; • " . APPLICAM� TEL ��� aawT THE AND N R 1.� WNER-BUILDER DECLARATION � ' � ' --DATE`..S .�I �._O�„ . .. _ �O S� 7..8�I � -. .__. .. _..._._ _� - .. ._ . ... , �- . �� ereby affirm that I am exempt from tha Controctor's Limnse �� -� AS above' �� _ � i � � -�� . �w far the follawing reason(Section 7031.5,Basiness and � ADOaE55 �� ' FINAL'.�'' � �'.. ,� ��� . � �fessions Cade): . . . . .. .__, . .. ... g N � Ey .- -a2«f� �,_ � � BNLDING � . � �I, as owner of fha property or my employees with nDDRE55 ' � ' ' � i - : -wages as their sole campensatlon,will do Ihe wark ond . .. _ . . . . .. � -- � '�� �•�� '-. . ... - - '' the structure is not Intended or offerod for sale(Sechon ����TY � � '' ' ,- I�. . : � , ��f- �7044;Business and Professlons Code). --� - � � ---- � MOVING-" ' � -�-�� ` ' tEL:� 1 -� �� - . � - - - �� -- �- -� � �j .t,as owner of ihe praperty,Om BxCluSively ContfOCting COMRACTOR NO. � ` . . �. '. . . �.• i 'with licensed contractors to constroct the project�Sec �` REouiREo. .� . �. ..-- �..tOin .._�.. , .. .�.-�- --.. � . ' i �� I . . . ... . .._._. .,.. . _ � �. tion 7044,Business and Professions Code), nDoaE55 ' I ,. I ., � . . , "�- -'���-�" CONSTRUCfION LENDING AGENCY' �-'�' ' '�- ' YnRo- Nwv �sETBnCK �� i _ �`�,�, . . . � ._, � SET BACK � �� PROG.UNE � ' WIOTII � �, � ! , 1 here6y aTfi�m that there is a canstroction lending agency for ikONT � � � - � � � I �. - �Fie performance of�he work for wbich fhis permi�Is issued -. --. -v.�. - ... , .. _ . . _. .. _ .._ _. t ..�. : .--.'_ �. _ -Xi .. ... . '�_. .... ... . ..' (Sec.9097,Civ.C.). SIDE , . . - , ,} _..._ . . , �.. . ... � � i -' , . i I .. . Lender's Nome-t.'1t1b3ri�C . � �P.l. . ... . . . . .. -. � ... - . . . .. . . . . . � P'G Fee S Permit Fee ��S�I. ��Ref.N � ' - ' � �ender•sAddreas444 S. Flower. L:A': 90071 ' 50 � i - � 10.50 ' � I �. _._ _ � ,.. -.I certity.that I hava read�his applicotian and state that tha _....,.�... . .._ , iuuan<e Fee . � .--.. :.� �DMA v/C�1 I._ ' .. _ . _�. 9 above Informotio is corcect.I agree lo comply with all County invesnpouon Fee� . i . � $ ...ord�nances on a�e laws relating lo bullding tonstrucllon. ' _ Ta�ol Fee- .6�8•�� . `IDMq Perm.M�I -��' - ' � . . . . ._ � .. .. .-_._. . .. . .,.._.. � .. .. ....... . :. £ and here6y orize represanlatives of�his Covnry to entar�� , . � pon the • Ioned property for inspection ppurposas. . � � � � �� � . _. _ . ._.___ ..5/'�//,(/)� . ; _. . . . . ... . . ' . _ � _..._ .. .. . .._ . . .. , � m U'� _^y/�.ry � .. SEE REVERSE FOR E%�UNATORY LANGUAGE � � . I . . i -' �' . ' StgnaNre o APClimnt or Agenf- ...._ _"-- ��— � _. _.. . _ _._ .. . . .. ... ..... .. . . :. .... . . _.:._ � � ... .. � . . _. . Do e I i ' . i . . ' I. . �,, OR:N H I LI11.U7 H I71(1 AFt"''�1(�\ PlANS TO APPIICANT �INSPECiOR S NOTES N� 7��� �,o 0 0,s { f{� I h ehy of oi Yan c e t rro I�e : ��I To: E.. �:�{Y,t�'i r.:. :..,{ �teluined i.1'.:'q y f.,.� ,r ��. ::a �s+�ry �. p� .F ��j� �y Z �l.�NC'.�. i�rLFce te la�n�Olo�tl� iol(�iwa j��t n c ��S, .Y��031'�55 . _ ... � .r ,.�E: E ��'�q� k.a�.. Y. C .,�nn n � . na r'� i . ' � ,.� APProvod `� f , l\� !)��sine�crt.rJJ'sufg�innct,id iFlntertl,�i�� �niiull �.t . � '� No. Date No:':•U::Da#c"•:`^��: r'.:'.1-+i}�iii���=:0 Y�d�L1G7 �' - rryurrcc u p<�rn�i�1..cn.nrri ��ult��nn) i r�!� l...k:r 1 �1. ,.i {. .___� _...__ ._:. . . .. .: �ir tr - t ... ,.�.. t.....,._ _ .... � .. f . .,- ' . _„r-�ap rdqZt Je (, ! s ucur a �.�unie �. . - - -`''a� I.�I Ip�� _i�r�C q - _ :,t' l�i{J�i Oi ii1A;;1J99A 5��� -- -�� /1��applic�nt J�+�: f prr ir t /�fr u cr d it�temrnt - -- - . -. _. . . - ,...tbut l r��s lieeq d/�e�r{ua it t f/,n•�r.y�s ;�f tl. G%i .. ��. LaJf�� f?9� I.•�C",S .:.p.�. 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I --N ✓ I, R ._ I '=�� Gir�C;J7c". ��;::_.5.: F: .•.E� sfi' -r��d,nu•rnrr.'r[,ehr�i(dinR��ri,xpr��uc>ncntrac�lJ.�eti�fiiunne :� i,.; Geolo9icolJ J;A�'7 -� �L n,�:2'i.:�Y.�[.:.�a r.`, � .�.. - - '.- '.� � _ c:l {�eu�A/r2nm/�lefinn..tbe'auaer.huildervari!!,/ai�rithe . � � I O'°'UC?;�'7 I_:�Cf��i/'_`t i ,�p i .i� burJrn�Jprr i n,�t/ f[e d d n,1 h !d rrrrprn rv�/rr � �- i _ < .n ..� - -' �- � ' - �hr purp sr n(vdf 7� Z.�� . �. � ] J Pedestriaq'.Protetnon i . . < � l'd C U 1 C�_ E�:'OC.1� ..(. .� .H: F "i J� .. �. . � �+� � � (Fence,)�Co�opy� u^ 54t Ho��._ , --^---••----^ �-.r. t '; r � 6so �e of}F}epoperly ome c1ui�Jpfy��onliae�� �. Imy w�{,�2ensed to fJado s lo<on t "cr t}�e p ojeU($et , . . . . . i � iea.t: Yi�Y� 1 'Gs � t �. 1 � � ,�, 70aa'Ur s e uni!1 lc >�(n.l II ( n,1 o r � Specia�lnspechop� i ~'f-- --'� � "�T_-- - ��'� ` "`�� ' ., � . . � f� r � /:tten l.ai•d r n>��pplt fo an J�u�q r r ro ertt u Irn �Conr.}.(Mos`Bniy)��(Welding) q��. ' . ....... -.c._ ..�_._�._11..___=�.r..3._____�.._ .��'.�� � �,I ' • NOt 1 n1+.V � �.:J ''—" '!. �^- '-fiu�t nr irir�r r�s IL�re n o iJ�eY�a�����ntructs Jur�su.h Lo10�raino e1,; :� �. (r , -�� �� •. �-.-y.� ."�1�._•.a__�� ,;�. /�f���[tt�e•R! a �infr5�tv(�I�I�iniS�d J[�r��in( ln fhr i . � tr� _ _ _-Ci � O t i C^.+r� ^—"'�j.— _}„ '-C�ntraifA�s l.icrnir7.au) ...J . "•.�••,� ..... n r r "'-� � Park < e m �, � . .. . . _ . .. 4�;..: - t n°I� � ^9 m -^�am exem t unde Sec � B&P.C.�o�ih�s � . . E�- l - ,�,� XilTi:? ���2.f.: �_.� _ orn z�dt _1..i.C:G u v„.. �. � p�. i _ �, _ , ` ,� _ . _ . =',ti137� �-� �? ^eason . _ _ _ �i .• . � C, - . . �� Dare Owner 1AV t7 ___ —... —9�u�:�r C' �' � �r, k� V'-�t`',, ,ilr`5�_� t: '� .fi ;dli'1 i �;,.. � — t-,.,,�. .�� , �.�3-s,� :�o ., A rovals Da1e C Rector s SI nalure � ' �" '���C � � i:l. ��t� �.: � . ^ .�� ... '. . .. ___ PP ��>. �^_ _ 9 ., ,.�.,. �-^ft Lnc r..e-:�.,!� _iEOC,INSPECTOR'SNOTES�,,I�.. :�+: � �. -�. . ..•. ,...rr._�;:��..,. .. 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