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0815A (4)
, .. _ , __ . ___... . , . _ __.._. ._,_:. _ .. . . . __ I ._ � WORKE(i5'COMPENSATION DECLARATION . . � ;:;� .,-; ... � .." . ,-... ` .: '.`-- ' ;-�,. • -;. .,. -.-- _. ._. ... . _ ... . . .. .��,; ,... ` � �� inwreboracertiica�eof Workesr�Compensatons�nwrance` ������� V-�--���APPLICATION' FOR'"�BUILDING��PERMIT `�-�- � - .. or a�certified copy thereoT(Sec.�3800 Lab�.C) .::.�; .-.. . ..�.... . ..... `. .'. . ..'. .. . .. . .___ . _._..... - 7��T�,R05-279-00�1�" ` �' - • `' ' 3/B COUNTY OF LOS ANGELES , � ;BUILUING"ANO SAFETY o. a Pony Nr31'.l OT1W�(�P � � . . _... , . . . :a .. __. Q ar v . FOR APPLICANT TO FILL IN sunoiNc � �� Certified co 'is hereb fumished.-�.�, ,.�- , ; � , �� �� ADDRE55 � � .'Certified copy is filed wirh the�covmy building inspec- ..-.�.- BUILDiNG . . . . . . ..... . .-` . ....�. ... . .. �� : ,. � . . ��- . . ��tiondeparlmeM.� � � �' �� " ADDRESS -242SS� G2111 PZdC2 � � I . , ..'. � � �_.,.,.:,, � ': � , .;:�,.1', 'r :.l., .:_.__. . _.___. .._.__ _._. __._...... __.___. .. i__.._ . _. _ . . .. . ..._.. _. . . .__ . ___. .. . . .. � Date�Hl SI H�I� ��Applitanf THE�ANDEN-GROUP�, ; crc�Diamond Bar � � � nv91765 -� � �ocaurrDiamond��Bar ' -�� � � � ��' � � CfRTIFICATEbF�EXEMPTION FROM WORKERS'..�-��`�� �--�� - � -��--��-�-�-NO.OF BlDGS. �.',._�_... .' NEqREA� � - � - � �� ���������COMPENSATIONINSURANCE��.:�-....,-... .�_ :_� SiZEOF�lOT � � � NOWONt07 � � ' CROSSS7AlaIIlOI1CI"'"B3L'�'"BZVCl""&'GOZCI2II�-Sp ings -� (This decfion�need nor be completed if the permit Is for,one ._..I�_ � � � � � � ! ASSESSOR �- '����- --' � � -. - . . hundreddollars(5100)or.less.J„_�:, , TRAQ42�J8�������� BLOCK�"������ ��� LO7N0.� '� ��41� ��� MHPBOOK'� ' � •�� I� ����GAGE � �� PARCEL� � . � . . , , . .:....-�. :..�� . . . . _... TEL. �� µqp.. . .. .- .�. :� . � .. . ... �. OWNER.. ... - .. ...N � � USE�ONE . �. � �I certify fhbt'In�the'performcnce of the�wark�for which this � � , K.. � �� ' I � � � � � , . permit is issuedj I shall not employ cny person in any manner � .� I � . . /� SVECIAl . I' . .. ..._ ._ ..�___-- . .. ,�, so as tobecome svbject to the Workars'Compenwtion Laws. """" AD�RESS-P•�•BOX...3 3 2 9 _ . . , . � .:... __. gpp J CONDITIONS � ' .0� , , .. _ .. , , ' � , arr Covina z�P 91722 I � ��e..,- . .���. . APPlicorrt -� ...- . �.. .. ... . �_ . ....... _ .. ..-" . - . .- . . _ . . � JTICE�TO APPIICANT If, ofter making�}his CerfiRcate of' ARCHITECT O TE�. DISTRICT � GROUP NPE I FIRE PROCESSED BY � O �---Exempfion, you�should'6ecoma subjecf.fo fhe.Workers' -�. ENGWEER �ave Szan "AIA . No445-4073� � ��T. �zon,e- � � � , �V �Compensation provisions of the Labor Code,yoo must forth-��_ pDpp� 31�4 N. First, ArCdClld � � I�a-. � . � -� ' . W .wilh comply with avch pravisions or this permlt shall be ,.._.. ._..... ......_ ____.__ . .. - T�_._ I._.. .. - ATSTCAI.C]AS � � O a' � .deemed revoked. ,. � . ' '"E� � �� 5T I I SIFICATION I• �.APT. NDO. . . ..:- -.. . �'. .. :. .:- . -,.. CONTRAROR D. �. � �j _` . � � � � LICENSED CONTRALTORS DEClAR.4T�ON . : ,_... UC .__.�� QA55 NO.�LOWELI.UNITS �- - � ��- � Z � p ' nsofChopter9 ��, ADDRESS AS dbOVC �. � � NOr?Z��J6� 1 hcreby aH rm Ihal I am licensed under rovisio `.-..� � �.14 0 9 NO.OF ..1 NO.OF CHECK ; : (commencmq with Sedion 7000)of Diwsion 3 of the Business ond ..UC. .B ... .�, BVJER.Mp'�- , � --�... ..... .. . . . 'Professions Coda,and my limnsa n in full force ond effect CrtV M55 . �--VALIDATION � llcenseNumber 510560 ���,��ass � B SRE S70RIE5 FAMtUES 1 � ONE—' . , .... . ._...� ..•�. �. . ... .,.. � � . � � VAL ATION � ,THE 'ANDEN-GROUB 8/5/8 7. oeseaiarioN oc woac . , j NEw � ' ' : .. .. .. . Confracto ... afe ,..... . � . I ADD � S 7�Z S O .'� I .: � . . . ❑1 am eaempf under Sec. i , �O II��J�A . . ,,., ... : ..,.. ALTER._.❑ . . r .., .. . � .. . ........ .. . . � � ' � � . � . � .� ; #�»• •�� . 0.8P.C.for this recson SLAB ONLY REPAIR_� S. . .. -. -..-. --. ._ ._. . .. _.__ . _: ---.�, � s �awre. oaie:_ .._'. ner�oen�aioc -__ ._ 1ei i oennoi ❑ F _ I •+7.4 2 5 � .. _ 9 .�. . ..._. . .,.� . _. . . �� INAL [ ,�i /�/ . . OWNER-BUILDER OECLARATION � � � -.,DATE_�,% _��,I _ �__. _ .��*�/1.Z Jr c=a. � ...I here by a f firm t ha t I am axemp t fram t he Con trac ror's License � `����- � ���j,5 a bove ���� � � � �pw for the following reason(Seetion 703L5 Business cnd , ADOREu � �� � ' FINAL�� ' '���� �` . p���� 7�$7 � r yfessions Code): ___,- _,. ...., _,:.._ _. . . . ...._ _. �_._. . y : i. B a � - � � - BUIIDING �� '`� I,as ownar of Ihe properry, ar my emplayee:wilh �� ADDRESS � ' � .,_�:, . , � ��' . . . '- 'wages as their sole compensation,will do the work and .'...' ....." . .'.. . .. ' . . . _� . '...' .` .. . .. . . .... .. ..r.: - the strucrore is not intended or offered for sale(Sect on . ��`�m ' � "'��. �� \ �; -� � � � : . . � P P Y, ' P I .( 9 _:: . . _ �. . _ .. . .'. _.. ._. _ .. ..... _... . � � I,as owner of Ihe ro er1 om ezclus vel contmctm � CIX�iRACtOR � NO. � �� � •�,: , -'- �. . � ' � �J044,Bosiness an Pro essions Co e. �— MOVING �TEL. i . . ..with I�censed contracron to construu the ro'ec� Seo . .-...- - . . . .i.--� . - —.-.-. - --.- .-. -.-. . , �tion 7044,Business and Professfons Code). � � ADDRESS � • � ; ....__...._:_.....CONSTRUCTION tEN01NG AGENCY..__'__ _...'_.__. .SE�BtiCK�-' �YARD� HWY. .._TOt P OP UNE - .�- WI�TH. ... ..... -. :.. .�- . .. ._..��. .._' . __......_._ � . � I hereby of(irm thaf there is a tonstruction lending agency for - ,FRONT � � . - � � � � . � � -..the parformance of Ihe work for.which thia permit is isaoed . '�._ �p.L... � .. '- �. " . ��-: �: �..:�. .. . �. .� _. �. _. . :..�. .. ��..,_�. ._. .._ ._�' (Set.3�97�Civ.C.�. � . . ' . � SIDE . � . . . ... . '. � � � �P.l.. . � . . . . , . . _...... ... __ .., ...__ _:. .._:.._.... .__.._.. I . , �- . , . �' .. � .. __.. ._.___ _ __... _. _ . . ., - lender's Name �`i t�hank � .. . , �pµq Rst.A . . �., m _.. __ I . _ . ._. v.C.FeeS . _. . __. oarmirFm- 63.�$. .._'' _ . _ . _ . lender'sAddrossdd4 R_ F1t�wPr. T:.'A. 90�']1' 10.5� ( P � - o6ove in{armati n Is torrott.I agree to tomply with all County . .....• Invaatiqotion Fee� . . � ��. �P/C N . _ ._.... _.�.'..__: .',, $ � , o d eancea o I havate laws rielo�ing to'build7 gs o'nehutlione �: _. �.Towl F�e ee ...� �.. ._ ... .LDA,tk Verm..M. - I � . _ • . Y PP _ . ... .._..._ . . _ - . '_--- � � - - R and hereb� or{'�e repre�sematives af this Counly lo enror-, � , � � � � upon tha v /ey���b�w�y property for inspatlion pvrpoaes. : -,- . . � � . _ -.VjC�JJ?.�.�_ ...,y�-�— ... _.. ,. _ _ . _ _ , _ __ . _ _ � . . . m �j SEE REVERSE FOR El(�UNATORY MNGWGF . ~ - -Slgnmuro of Applkonr or Agen� . . ._.. - fe ...�.. . . __.. . .__..__' . ...'_.._ _. '__' ' _. � . ' � .. ..-. .. . . � ... _ . . . ... . ._, . . .. . I . . . ., . . . . � ��� pLqNS TO APPUCANT iNSPECTOR 5 NOTES � N Q11\!It IlUll I)FK-pl�(�L\}!.\11(�\ , � f I hr ebY a�l i d ql I om c e p f o Ihe CoN a lor's .. I.t ��L� .�. .� ;�' t �, r� �a�.. ,.. � ° 1 a�{ 1 ' . [' �:�"' !p��>. l ce xc fn �the�ol ow n n on . ,. I, Tn: �� fi'.y 1_.�c'�.�► �teturned�, �.f: C ,1...� i `'r" L i��tC� L �F'�`...-ca 'E'rr: x ..y�� ll�:c� n�� ., z, �. �� ^g : (Sr� 70315�j �, � Approved r�Ifneinrss unJ!r�J a�ron�< d An��it�qr iunf�ul+1� • �i � No. Date � �No:'^v:'�aio"'•:s')` i:-":1��liF i'71�i�1'T:'.4i3�J � �`£. reyu�ncuperne�te rr�n�rr(�rtalt•r.lnfpi d.� lxh,C � �� ' �-- _.. ._... .__ ... —rnmfKi an�+lr ctri �.f�n r�f itc.iF � u�,.rXirr'�qurrrx .... .._. . :. ;�� � b111J 10T 1L'i!`711?ii�S i + rL J ! ,�nr sdrh' rnut! ' —_��2i.��T1i�'s�S�.C.� . ���•�-1�.—� , A. PP J p /iloa�b¢nvJ�r4tn_ i � ' - ->�n:Ibut 1�at fi r �rd/�r�rsu�n[t�.fh�•,pr usi nc /1!r(..m- ., � . . . �:.�: . � �7F�j fG.:J r7 f.C.$s C i - .�;�• . lra.lnrk f.ire>�ar l.au�%Cl�.e/��rr J/(a nueicnung u itl�cc+ '�� -- - � -- �!r - - — f n 700!!Jo/Ureiriuo 3 1!leli ��i�� unJPr J< s'nas� ' 7b� �f(Ofl'L�1�t ..� � 2U��� 7f',� bf(. �.:1F CCN� �''� if.11l^ � r � ', �. . _ .._ —— — -� " ...... , 1��dcf r fJ+�i!(c x-a:rcnrhl.fbPrefY r a J FI r.has�.J r flei� - u!!�f d-c,nnert 1n�AnS�t+ l�p�n�nf�l��t nn J037 5 1 ti ''� 2�11 �.. � •�•.• _�equir'sd."'_' Daf�Rataivad • — .. "� .�-'.�_" �—� `- �„•�rrr.�„��r.u�rrni ISaA��7717L�ahJhcanttnauril ��', �!Approrol � ar Approred� }� .i .._� �l ��v i. � enuf�rnoltY��I-K��t�nrord�thun�,/rrc hdxdr d el�(lara�./SSDOJ.); - , i , �_..._ -` -- . Yas_ _1�0—--- �. . .,;: _ ., 7' ( I ._.._. .__�_. �_�_. .� �11�9��..I." __. _". "_ _. .. . _. . - .. . �� --- -- - 'f' ��- � �— --�' -'"�; � . L' I,os awner of the p�opr.rry,or my cmpic}ees`wlf�+ '�, Y�l^[SP�I Ei.[atP ��`.- � — �.-� ,l..;�.".`'- -'^---•.i'-=`�.- -�'.'^� �'-""-"-.'-••�— - . �.��`!{oges Ps Ihe r sole compensar n wll de the wo M,an� I �� � r �� � � G c'f F vllF: f� a .'�'. �„��ihe struaure�s qo��nie�ded orp�(ereJ fo�sale��c��709�f - ��, '�J rol�o-�eP�•waeni� - I c -7�J_1_?�•�".^:h�' '_—__ _ .�__.__« . .zw;f3usi�esc.unJP.+�as�o��sC i� Ilr.(� itra iur.!.e�sr� �� �� I �- �. . � S C�i.� q'. Ff[J'VO� �� . !ya J e nr�tapfl�lnui i ner .//.r fe�h�<•! heilJs � �.. -De r�re�em--,--- � .—�'.�- qi � t_7 n �.rrf.mr s fl r n,.anJ uQ d s s�1 u rF.!�irc!/�1 I Cf ��"�v�P;°..�_..., - 79.��a_,,.>"-�-'(7y,.7 4i E1�^ '.i.t.�'�' - �j�ti.�-i�f1GJ�: `�VF�IJ ,i:n.`. 10 �dr�ru,�lr�fris�loun:ernnlitr.ell/•rq�dcd,q[Gui.fiurh,�i., .. �� I .,�' � '"•."'� . .( f,:.- "..--.. .. ' - ,.. z�'f+r%r��emeulttarranot inf�ndeJfnru//rced/nr�talr lf. '�� I�i f3•nd ng ;�i ` • .4 � ` I V� 4. _ �. ,.._.. . . _.. . ft�>6�i!': ���2.1_C'1 .�J ����C 2l � �; �-rihq���i,ir�rr,'tAe'brrilJrn,Grirr frreurtnfir.sollu•llinit �� .,__ _ __..._'. ._' ... .' � _.' .{ i..... . .._ . ' � j. clbgico� 1�^ k . .7'.i;:2.+...�.:.. <�'.nL'Fi __ �"` ,y�r¢r n('cnmplctiun•TErc �unei.h�i7Jar�uJ!'Im� tbi� �I ^. j'� ���- , n � l. r,.�[Jrlf�� 'R 'T T ?'�•��:.i^.,.•f. � burJrno/ rnrin ll�alGedidnnfhv�Ilnrnit mi�e/nr. '- ___Ls..�:�Ql�._��_._ /' X P ._. ! � , _ , -- - rn pu.p,te�r<�r j i aF. �o�caz,a u PeFfeitraon P olect on'K�l.. . ..: ... . i C v t c�:- � ,3V:)(' .y- . r .. q _.� }c .' p � • �� I o rt �}��.�1. -, , _.. I. � .. ..�,� .� _,.: �> . _.�-'` . .. � (Fence)(Co oPY) f, c<,.r,_�..� ,�'--- -- �; �..�i .[J .1 as0 eto[i�iepioPeriy_ome I i elycc ttoo- � •-->t•.^..... '' ��� � .<..�.i.• . � .� .. i�F - .t!!ng wrth.Ucensed<oMractor �o��nstrvct if�yroi U ISec. I - "'- . �.�,',; . _'".'-'-' - �� 7044 (iresinrn und 1 rn c nr n� Cudr' !hc Gontrurinr's Specinl Inspecrion ��. — -' � , 1) O�� r : =..C>� n n n r j ���I; ) ' � ..._ .__. . _ ` �Conc.)(M1lasonry)(Weldin9) 9t�_ ,�• ....�.v. .:r' . ... ., . _ __ ' '�. � .. _ ._ , ._ ,.. .,i--- �. l.icrnael.uu�d�t,x 1dr�+IYlOar:j�un,r{IPrQp�rryu�.n . �. �., 1;C�i�.. �.1� •�� v.;.t r-- - --- .. i�. ,. huifJs nr irnpr�as��cr��in,�rsd ud n tuntrncfs.���ira�'h Lol Ora�noge�� �, 6;� �u � �\ i S'�`.�.' • -^ �-.�- - � . -' - +j�T�slr�ytS�•if1�a�d 1ny'rbrt�r(aJ li«�sF J� fff<ant !o tbc ''. ;... � i;.. .�, ,...... _.....,.._.._ . .:. � � C.:. ��� ��tra�rnr's I.�rense 1.'au J �.� _.�_V �--,:—•- r' -f `; . Fo rkm9. .. y�I - .J ..� . _ .. .. _ .�i��. �t a m � n:�i�. i .r �'� ❑ I om exemp�unde Sec B.BP.C.fo�ih�s : ` t ;�.,,,,� �sti. > :Ir„i . �: — ------- �.,,,�_, ,��.�q�� _ _ _ _ � �i �, � i�;tiq7 ; i. .. .reason- . -, ...-, r . � « �. ...-.�.,- .. ....n, .,,...,_ . �. ' � _1_--_______._:__�._------_- ,_3� - - -------------- _ ...: . i.: .�\' _,`,, JlY.cl� i� � ... . ..,� �ate Owner ,. . , . . ' . ��_...� _ � _.. _ . �i\'' .r� �_'Il��"1...�.::�IL2�_?�': tnGi�;vn;:,r�,.:. ;�no CA ovols, • Uafe � Ins actdr's_Si rtmure P�.. ........ .. ..:. :..... .. ...."__ _ i � �, ' �^{NSPECTOR'S .� .... . ..f 1 m ., . PP� � '• .'` P 9 vUuf ;�. b�.,^ or. i. .� . �. �"�.,... e �..,r.:.,_...� ',?? _ .;.? `. ,.�, ,�. r.U. NOTES '., e,.. ,}.�.., �'^,. � Locolion- _ . • ' (SetoocL.&Yardsl �� � . {�'_ � � ji� . . �. -�� <i ra �.t� .�r � � v (i_q .�.i 'o i I �,. 1 (� , ,. . . . ... , FoundnNons �u/ r+� IJ �1f��. rtoiLo.�olu..o't .J�oio6� • U�: �u�.a:� � �,/� .c ; Slab O(� y� v��j Y 5'' �C��1 _ i vJTJn.� ..R_. " �;"iunm�o�vl.r�r'�x�mc,yi� r.q sr1�;-.�•��iw�zo.1 �.� � . . •>�?' . , � ,��— I �. Frome . .. . � ...�_i .._ c �:.+:z-•- .:.;.... . �, "� . (- o�e ,. 1 l zz i.��5 L�r n� • ' .',.�� 1 � ,. t: � � - Energy Insulaiion ¢.� -"�� ... Y�'"-' � .�'--'"1� ,-��. ir,1�� e t �.�bn� c U nWro� ei e � ti . h •tc Im t: .>•,,�?I i h3� ' laih;Dr wall-- '_'—._ . � .. . ._...._ . .�.:. .. .. .,. . . . .. .. :. I Imerior C._._ . �. .. 7:'.'. F,: . l.�.vi�,(cU�� -..>� . _�,,' I —1--_�'____.I �s b � ... _. s h:.. ..r:... �. .._,..... .. . ..,.� ..,:��..�. . . �,..,. ;t1t;r'�r-t��) e.•ro:t t•,�:,neJ ! lath-Eeterlor k �yap/::�. � ^I p . iHoose Numbe._ � �r„ a t^ c`. _ . • r ...1 v�l�?_,_ ._�..n.�:i,i!..._l.._�;.._i'.z'1.zz-.•.�A x io:.^V � Cor�ea fi Posted _ H . OC.OI �_� .�. �.,.��a...i, F. .�.+�ti,. ..{iF .>� i • . ,�,., �- . .._ � , . ,. � Rnal.. ' .__. _..._._... . ___'�—� .. ' . � , "' k e-9no:t..��.v.o.,d1�� Y"�ucJl�. n �� yIG �� c ��1 t� ^�a n in oi� ..n u I Enter on Front � I' E �r>i.., o�nn�iii...01�..•.:6. eto�ct`��e xe�ia�.F.�o � �, . ...:_'c... - ,. _,T .,�:��`:.... ._.:'.• ...,.., _;'_ ....=. . ":" . . i.�tne e �i. z n _. �o� n o,o - _;n Z. \ I ......... .._.,. . .. _ ... .Ie+J ❑f..���'�y^!n .,3FIi.,y�,� .�� T .���Pr�^y� � , � 3::A43.:;r..l Y"G7A11.1J J'l f.0i 32SI1?J 3Y:. . � `��\C`�\ "�, C�_.5�.,'`.;,�_ i��� I . �1\_> �__'_ __" ___ .. 1 �