Loading...
HomeMy WebLinkAbout1576A 1577A (9) WORKERS'COMPENSATIONDECLARATION APPL�CAT�QN FOR �BUIL � I hereby affirm �hm I hove a teriificate of coneent to salf D1NG PERMIT� - �� Ins�re,or o cerlificote of Workers'Compensation Insuronce, . or a ceriified copy thereoi(Sec.3800,lob.C.) ' � � �� � - � � � � . .. 73wc005-27 �,(, NATIONWIDE � 36 A COUNTY OF LOS ANGELES BUILDING AND SAFETY � Polity Nd. ga� Y � BUILDING � Ce�tified copy is hereby fumished. FOR APPIICANT TO FILL IN ADDRESS 23601 E. Goldtush DrivO � Certi(ied copy ia filed with Ihe munty building inspeo- � 6Ulloirx�3601 E. Goldrush Drive � lion deportment. A�DRESS Date 6-30-87 apP��ca��THE ANDEN GROUP citvDIAMOND BAR �1765 ����T�DIAMOND BAR CERTIFICATE OF EXEMPTION FROM WORKERS'' � - � � - � �� NO.OF Bl�GS. � � NE4R COMPENSATION INSURANCE � � SRE OF l0T NOW ON LOi � CROSS�rIAM�Nri BAR SLVD.��+ GOLDEN SPRINGS �This seaion need not be tompletad if the permi�Is for one 3435 � � � 2 �ESSOR . . hu�dred dollors(5100)or 1055.� . , TRA� BLOCK l0T NO. � MAP BOOK PAGE PARCEL owN�E ANDEN GftOUP N�67-9541 us��zpr� auv � _� I tertify�hat�In ihe performance of�he wark fa�whlch thie K �- pormit is Iseued,I shall not employ any perion In any manner ADORE�•0.. BOX 3329 -�- 10pd��eo`No noNs � �� so as to become subject to Ihe Workers'Compensation Laws. O aT60VINA zuA1722 v Oate � �� Applitant � .,.. � ... .. . . , � �>TICE TO APPIICANT: If, after making�this Certificnfe oi ENGHNEER °BAVE SZANY AIA N�45-4073 DISTRICT GROUP TI�E FIRE vkOCESSEDBv O .emption, you should 6ecame subjec� lo the Workers' ,� ��T•' ' Z U Compansaiion proviaions oi Ihe Ln6or Code,you must f0�ih- ADDRES31�i N. FIRST ARCADIA 91006 ...f D /C-j v l�/ � � W with comply wifh such provisions o� fhis permil shall be TEt. STATIStICAL QASSiFICATiON AFT. N00. � deemed revoked. �pNtRAR�E ANDEN GROUP No. Z LICENSED CONTRACTORS DECIARATION � - S ABOVE ���10560 � �"`�"o.—�_DWEIL UNRS� - - I hereby affirm thot I am licensed under provisions of Chopier 9 ADORE� N ��R�P (mmmendng wiih Section 700D)of Divis�on 3 of the Business ond . . . . . ���. - . Profeesions Code,and my Ikense is in full force and eNect. CrtV C�ASSB �- BK � � � VALIOATION � �S 10560 � $IEF�658 NO.OF .z NO.OF 1 CNECK license NumKff Lic.Clas STORIES FAMIlIES ONE � VALUATION�, Connocr�TE ANDEN GROUP pa�a " 6-30-87 oescaivnoN oc woawSINGLE FA1�fLLY NEw � s 100�ODO :1 5 Z b A � GARAGE 456 SF Aoo , 1 am ezempt�nder Sec. q�TER � �'� • • •�� 6.&P.C.fo�Ihis roason . _ REPAIR = �'� G`S / ( •3 1 (z�� USE OF � � � �Dote: EXISTING BLDG. OEMOL + o v,� ��1 U Signatvra � - � nvvuGr+i TEL. FINAL �' . OWNER-BUILOER DECLARATION vRiNT THE ANDEN GROUP NO. . DATE �^23-$� - 0 9,1 1 "S 7 I heraby aif'vm lhat I om exampi from the Comronor's License AS ABOVE ' - law far Ihe following reason(Section 7031.5,6usiness and Aooae55 FINAL ,� Profeufons Code): � ' ��" � � ' � " � BY " � BVIIDING � �� � - I, o�owner of Ihe properly, or my employees with ADovE55 � wages as their sole compansotion,will do tha work and i • , , �1 5 7,7 A the s�ructure is not intendad or offered for�ale(Section ��`��T� ' 70<4,Buslness and ProTeeeions CodeJ. � � � MOVING - Tft� - . ��y � . �1 � I,as owner of the property,om exdosively cantracting �ONiRAROR NO. � wkh licenaed contracton to construct Ihe projeu(Sec- qpDRESS � � � � "��7��0 t�on 70d4,Busineas ond Profeas�ons Code). , � ,_ REOUIRED TOTAL SETBA • � o v x � CONSTRUCTION LENDING AGENCY �� Ser BnCK YAaD MWY DROP.LWE WiDTN , . � O L O O<= I hareby a}firm�hm fhere 7s a consVuction lending ogency(or FRONT ' ihe performonce of the work far which this permit ie iseued � P.�. � �, � �� 0 9.� � �8?� � ($ac.3097,Civ.C.). SIDE , CITIBANK v.t. I lendar's Name � �� ' ' � v.e.Fes s 316.84 � PermHfee 496.50 IDMH Ref..M ' m lendar's Addres��+4 S. FLOWER: LA 90071 � � 10.50 I certify ihaf I have reod this Gpplimtion and alale Ihal the . ... Issua�ce Fee IDMA P/C M� a6ove Informali is torrect.1 agree to camply with oll Ceunly ���eai�gm�on Fee O�dinonces ale laws reloling fo building Conslruction, .. Toral Fee �j�7.�� IDMA Derm.N � � ond here a oriza�epresentolives of this Counly lo enier up e- ' pperty for inspection orposas. . M1 G�z Tt�y���$75 $35 p 'SEc IIPlERSE FOR EXPUINATONY LANGUAGE -S�gna�ure o Applieone or AqeM paro . . . . .. � PlANS TO APPIICANT � INSPECTOR'S NOTES ,,.�U�}%ti�`.R-FSUII.p1�.N Oh:(:I.AHA'170� � I h. ,by at?� ho�I arr �. e p fro f ��f�-qrcctn's � To: . . ., . Retumed �; � �.�� � �. � . -'lic�ns low��io� �hr��.follo rg r '.�Sec. 7031,Sf APProvod � �firs rsnnJl np�una(:ndr.:In�`�crtynr.uanh�u�bi:L . .... .. . ... ,, ��. . No. Dafe � �' No. `. �ele��. .:' ..�� '. -` • '.:...` � - '�, '-��.'� ��\�.:. myuircsufir i/lu�onsf uY a11 � dvin(ulr, . --. p �n�'�truotun:pr � �/ n : -'t,� ` '�h„-nyui:r: � . . .�� . . .. . ..- -, ..� . . I 1. _, , ,. .. .. . �b u),pL:,�nt/nr su�h permrt fn/ilr.n s�,�nrd.r��trrnini . ��. , � ��. ., , � ... � _ .". - ' ..,,tGat I c is lkcnsrdpvnu,�nr n�rbe pr�� .� .n(N <'uu= ' � ��i .. !:iV�".. � . r, �...tra.Jnr's 1 irrmr L�ir fCh�ptrr�')1(.�.ian�i•nunq�ritl 1��c �rl. , . __. ._. . _ .. . ._. _.. .__.. � ��--- �- �...� -- . ....._. _ . �__ _ _.__... ._....--'_ . ._ '._". . '�I. � .�__- .�.. __._., ..���._� ._._...___ . _.'. � .�•.._. ..."_�_� ��'�����Y,/' �t[il,l [IP�fY�I41lJI ltt��Il�rf Jn/U ., t nd1 ha77 � !. �brF.r ' `...,:. . . .� , Re vired '._. ' ' - � � � • f! � ' • _A v, ! � 1 'iorr 7 l3 f.5 b ��__ ... . . �....�- .-ye 4 --.DotoRoceirad .__. ... ._ ___. �, . � __'._.___,. - ._ __.. . _ _ urs�u�fli�n(f rur rnrtx h�t I.11 .r�+f�l�uirtf`tna.ir•r! Approvals , or Approred. .. _ -penv tl'��/nnf mor�dhan/��bundnd dnRnro.(SSOUl1' , '� � No ...��� .�____ _ .• " �8� ihdp.o � . _ _ _ _.r : ._. .__ .:_.' . . '_ _ . _ . Wo!e Cen�fimie . �. .�� 1 � .. a es os�theW sole com ensa�ion,�w�fll�do tl e wo.Y,ond - � �- ' �� � � - --- �- �- � .- . - '_. . .�.� . - � the troctore is oi��nien d o�o1(ered(or snle(Se; 70aA) . . . _ .c:t. � �..�:' -..._....._'__.-_____. _...._ „_ �._...___._�� . ... . , NeaitF Deponment _. ___. .—._. _._ ' - .. .. ,� � < • �. (�odri 7he C trdrtnr's l.i:ense Q� rnessun�Pr/.uon� .. l.au•J.���s xnt uf/�1���o an.nrnrr ni�.,,rl��t,•«�i�.��hui1.L .. Fire.DePorlment .._... __.._. . ._. _ .. . ._ ;� . . ;.. ., . _ . .._- ;.� ', .__�, ur nnprnree t!erv�un,und�r!u dnrc�u:b u�or6 l�inue!/��r - � . •�.� . .� . .. . tl i I 1 ! t � . . . � �r g!� _�.s. n c,pll c.pr � 1 t t su �� '`�. G�ad ng . _ . ���� � �. ' , � . pr i e�ents n n 7 1e d J � , �/ d f ,sal�! � �� �i i. ` � - �Arnn rrrr.flre hailJmX ur i r J rn� nu nt rr suld�e i1L�n�inc . , . . . .. � . •, _.. . ... . . e. ;. , � . _� _ ..._ -. ..___... -.. _ .._ � '. n/enmpletinrs� tie uanrr.huilJnr v�ill6arr�tLe • Geolo9lcol : . ' .. .. .. . ��..� .. , . ' yP�r . . . , � : . .:. � � � . �y, ,.. , hurdrn n( rin�lhnl Le Jid nnl/,ui .. ., ' ' - - frn ,� !.i nr imprm•o f'r . __ .._._... .:._.__._ _ . . t!e se�n/s�fel.. ,. . , pv.p�, Pedesrnon Froreaioo: �:... � _. �.:. � • �� ;_,.,.- �:. . . . ��.�: . . � �Fen<e)(Conopyl ,' ..� .., -- -. - _.._. _.. ._.___._.__._ ._. ._. ______.. . � � �[.;'•l.�ai a�.-0ncr of t6e proPe ry,dm eidusi>riy centron ' � �ing�wnh licemed cantrocto�s io<onT+�ucr ihr.p.o�ecr(See' Specinl Inspection � ' '� '--.-.' _..., �-'-�- ' '.- ..'' ,......;.__ -...�- -----_.__.-.�. . 4aJ Husinris unJ!'rn(c.vr�n.�(.�'Je: '!'hr Cr�ntru��tnr's � 70 iCon�.)IMasonrvllWeld�nc�) .. ' : .. . ...". . .... . .; .. ... , .-.. . l.icrnsel.rie Jnernoiappl�rnwi�n��iur<Jproferti�rbn r.._'_ .._ _ ._. _._.. ..___.._.._� --hui7d.c�nrimprin�•sUnrr,.n,�an4ul�nrnn�mds/u.su./ lot Droin��e ,. ...� .. � - � � _.._.___ ' '..._:r."_'__'. �. ,. �.,.-(;'�prnjrrtc�urth� rnrsrrutn.r(�l_li<ensrd parsuan� fn the . , ... , � _ . - - -. . __ . . . ... _ . _,. ..,. . . -. Cnntra.tnh-l.i�ensr-1,nul. -.- . . �_ . . . �� - ____. _. � Par6ing �... _____�-_ 1 . _ � . - �. .. .. ; _ , . _.__'_ __.-__' . . ,. ".... . -. ; .� ��. I- .. -r.J� lame.empiund«,;Sec� �.6.8G.C.forlhls , � . ..._.__ ........... . . . . .. . ..._�___...__ ..._ , . � reason .. �. . ... .._ . '_-'- . ... _...__'__'.�.__ ....._._"_ . � �'.. . . Da�e O . . '_ ' '... ___.._. .._.. _ . . Approvols Dote � .-...Inspettor's�S�gnature .i'. ).��. ;.'. ,:. . . ,' . . .. . .. . .. � - , , . . . - .. . ���� . INSPECiOk"5 NOTES..� � ...�, .- locaiian- , . � �� � . ,.. .. . .. _ . . _ . (Setback 8 Yords) - --��--� � ��-�-� � - �� � _. - ,���r,� �, Fa��do��o�s , ,: „ ' . , _ s�o6 : Frome ?J._3'Og . . . . . . . . . �. . ... , . . 0 EncrOYlnsula�ion ' ....__-_._...�"'.._. _._'_._ ,.'_'___,- � :. ,. _' . ..� : �... . . � i _ .. � . .... � � . . . .. � Loth.'Drywoil._ .... ___. '_'_'."..._...._�..._'_"_ �.... . . . . . : ._..... _-'._. .. Intc.ior ` . _ ___. .._ __ ' . . , Lo�h-En�er;or . ' - '.� � . . . . . .. � . ._ _. ..'._.: . ..,. , . . - .� Hovse Numher._ � ,. . ..- - ---. . . _ . .. .__.. ._. _ __ .._.... . .�. , . i Correcr 8 Fosred � � � . � ' . ... •�,J. •:• �- � .. � .� .,`� fmo�- _.. __ ._'_.-._ . ,._�� . _.. ... � _ .. � .. . . . . . , . . . _ _ . _. .... __ _ . . . .. ._'_'_ ' Enre.on Fronr '� , ..". � `.- . - . . .. � '. .. . �� '.. �. � _ .. , .. . .. . . „ .. . � . . . . . . -. . . . . . . . .,�., ... . . . ,. . . . . . � __' s S -..i'` . .,...' .,�, ... . ._ . . . _. .� . . .... � . . .. , , ., • „�/ . � \� ._:)'.�l�: � r � �� � ,;v