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HomeMy WebLinkAbout1522A 1523A 1 � WORKERS'COMPENSATION DECIARAiION - . ' ; � � � �--� � - � -- - �- � � I hereby a�f;,m ,ho,� �o�a o terfificore of consenr to=a�, � - ��APPLICATION FOR BUICDING� PERMIT ` insure,or a certificate of Workers'Compensafion Insurante, �� , or a certified copy rhereof(Sec.3800,�Lab.C.) � " - � ' � � _ . PolicyNo.73wC005-2�Qm��6 NATIONWIDE ] COUNTY OF LOS ANGELES BUILDING AND SAFETY � Cer,ified copy is hereby fumished. FOR APPLICANT TO FILL IN ' a�oRE55 23615 E. Goldrush Drive � Cerrified copy is filed with Ihe toonty building inspeo- � BUnOMG � tion deporfinent. ' � � � ADORESS Z3615 E. Goldrush Drive '. � po�e6-30-87. qpplimnr�E ANDEN GROUP crtr DIAMOND BAR ziv91765'' iocntiTv DIAAIOND BAR CERTIFlCATE OF EXEMPTION FROM WORKERS' , � NO.OF BlDGS. � NEhREST - � � COMPENSATION INSURANCE -� � SRe OF l0T NowON LOi caoss s�IAMOND BAR BLVD.�+-GOLDEN �SPRINGS (This secflon need not be comple7ed if fhe permil is lor O�e ' ' TRALT 43435 BLOCK LOT NO.� 3 �ESSOR . � hundred doliors(SI00)or less.J , � MAF BOOK�� PnGE PARCEL owNeaTHE ANDEN GROUP No967-9541 �° r� I certify iha��In the parformante ot the work for whicfi this u ) �P r '3` y permit Is isSued,1 sholl n01 emplay any person In ony monne� . pDDRESSP•O. BOX 3329- - � � � � - 3�ECIAL � eo o:to become subject ta ihe Workers'Compensation Laws. ' OD[JC7 GONDITIONS � cmCOVINA zir 91722 v Oafe � � APPlicont - . . � . � /�.�TI�E i0 APPLICANT: If, OfIOf fnakin Ihif Cenificore of ARCHI7ECT OR TEI. DISTRICT GROl1P TY7E FIRE �ROCESSED BY Q ( " 9 . ENGINEER DAVE SZANY AIA No445—b073 . roN T � H ampfion, you should became subjan to�the Workeri �� ' ! '� V Campensotion provisions of the labor Code,you must forth- ,n0oRE55 �� -3 /V � �— W w0h comply with such provisions or �his permit shall be � , �- deemed ravoked.. � . �.� TE��- �, S7AiI5TICAt ClA55iFICATION APT. . ONDO. � tA coNTancroTHE ANDEN GROUP No, �j../ � Z IICENSED CONTRACTORS DECtARATION �� � - - -�� � - ��C. � C1A55 NO.�� f�� DK'FU.UNITS�.i I here6y affirm�ha�I am licensed under provisions of Chaptar 9 ADDRESSAS t�BOVE No.510560 (commencing with Section 7000)of Division 3 of the 6usiness and . . . . ���. � SEWFR MAP � Professions Code,and my license is in full force ond affect. CiN GiA55 BK �. � � - � VALIDA710N 5a.FT NO.OF NO.OF CHECK � LicenaeN�mbe�lO5fi0 ���.C1O5SB sizE �774 STORIE52 FAMILIES 1 ONE ""i"�'�'Yi'bo Conr.acroTHE ANDEN GROUP pd�a G-3O�SJ OESCRIPTION OF WORK A D s ' �1 5 2 2 A ❑I am ezempt vndar Sec. GARAGE 643 sf , � AtiER � � #• • •'Z� g.BP.C.fo�fhis reoson USE OF RECAIR ❑ - s/-S�'�7/7 - � � � .4 3 1,0 8 �Dafe: EXIStING BIDG. �EMOL - APFLICANT TEI. ' •.e�i J�.O�i=i Signature � PRINT THE ANDEN GROUP NO. FINAL OWNER•BUILDER DECLARATION . -� DATE ,�—Z 3` - - � I here6y offirm thar I am exampt fram fhe Controdor's licensa qoDRe55 l�S F�BOVE � � � O 9.1 1 �8 7 Low for the following rcason(Setlion 7031.5,Business and FINAI � �Pro�essfonsCoda): . -... . .. .. . .. . . . BUnowG � . .-.. ` j ey � I, as owner of fha pioperty, or my employees wifh AD�RE55 _ _ _ , _ , , , � � wages es their sole compansation,will do the wark and , � the srructure is nm Imanded ar oHered for sole(Saction ����tv ' � �� s=1 5 2.3 A 7044,"Buslness ond Profeufons Code). � - � MOViNG TEL. � � � � I � � � I,os owner ot the property,am exclusively contracting CONTRACfOR NO. � . �;• e: . . � with licensed toMracton to construU Ihe projetl(Seo - ADDRE55 � •6 9�,p Q tion 7044,Business and Prafessions Cade). - �-'i � -�� CONSTRUCTION LENDING AGENCY -SE BACK YAR� HWY tOTApROP LINE WIDTIi - � �t = 1 he�eby aHirm ihar tbere is a conshacrion landing agency(or fRONT ' � 6��Q�� tha performance of�ha work for which this permit Is issuad � R�. - �� � �" � Q 0,� '(�8 7 (Sec.3097,Civ.C.J. sioe CITIBANK v� Lendai a Noma ��� - • .- � . v.e.Fs�s 431.08 J r�,mu F�e 685.50 � �ornn aer.x Lender'sAddresa444 S. FLOWER. LA 90071 � . � � I cerNfy that I hwa read Ihis appllmtion and state that ihe . � Iss�ance Fee 10•50 IpMA C/C M . ' - above informotio ' orrecf.I agree b comply wifh all Coonry Investigation Fee 696.0� ' .ordinonces an f e laws relating to building contfrouion, To�al Fee- IDMA Perm.N - � - � ond here6y ut i e epresenm�ives of this Coumy�o enter ��, upon e �, ed properry(or inspecflon purposes. .. . . . . . . . ���� G E�PC LDMA $75 $35 p SEF REVERSE fOR E%►IANATORY IANGIIAGE Signoro.e�of p=pL<ont or Agent . . ...� . . -. . . . . . . . FLANS TO Af'PIICANi INSPECTOR'S NOTES .,.0�1'i11'.K•IIUILUP:N,UI:CI.ARA'110V � . I h rhy aff� .ho�I nr. e e .pi tro �he�onau-�r•'s To: „ � . . Heturned � � � � . . � �lice z �L -i.-1� ihc':follo .q rrror It.c�'70J1.51 , . � . . APPro4ed � -�fArsirsrvsand7rJiacions(ad� .leicit� roiunhii�J,�i:li No. Date � No: `-.Da1c . . .. . '. �. ... ,. ...�.. . -' raquirrs��rrn I!��nn.�1 !..rlt�r.impror��.�1�moli�h, � . . .. , _ .r rrpairwnc xtructurr,�fn�r h�r[5 e.�s�r.�i�.r.af'o rryr�rrrc f , -��;. , .._ �� ., .-. . �bc appli.rn!/ur.suo/�frcrmit fn J7��..a�i,qr�rJ staternrni' �.,�. .- .. ; � . , , , :-. ,.... _ .:� ., i . ' ' .. �.i .:. � . .�- ._ ._ . _ . ,. _..__ ____ __ tGatGeL�li.rncrdpxrsu.�nr+utb��prore�iovs,JtleG�n: � � � � 1Cl_.. �� tr�.1nr'sl.irrn«�l.arc(Cl,dpfrr')I(tn irn:in,�t�ifbScc_ . , , .�❑ .,_..� � nen - _ _ __ _ -.- _ _ _- - -._...- ---.__ _ _.� . __.. ._ __:. nn�ianu/„/U;ricr'�,n 3,�lu,�lt,.,�„�•F�,�„dP��,��•.u,��� � : . � Ci�... :��. • . .. �..���,'. . ; '.: J..� � :'GiJ)nri/�ar/ mptlbereJruneanJibvF�ces/Jrebr __-�-- - --._..—�--- -�-- -� ---- _._. _ . _ .___ _ .. __.. ..-- - - `-.:-_ .�. .f� -- -- u. i_�•.� A�.' ;li' �_' '_ _ YetQoi�ad.�.' .���-Dat ReceiJed.- ._._._ . ____ .�� . _ .'__._ . _ .._��.: . .. � un��ppl curt J ra.pnrnV�tsuhj�y�rrtl rajpli � .�`h usiu! � _._ - I . pp ova No or APProved . ,. .. . . ... � , . . ,:,..frnu111 nf unt n�r�h tl�w�/i�v l�i.ndr.-J J�!lJr�(.CS(7�J.1-.. � _.._.. � __.:' . .___ _ '_, : � - ' - � ���- �� �� - � '- (.� I,os owne�ot rhe prope�ty,or my employe=s wiP� , �... . , . . . . Wale CFn�Gm�e �' .. �.'.. l ' �,i � �.�� -'_. '.__....-.:_ .__. wages os the�r eole compensat an,wJl do the�-orF.and . . _ _._ _ _.. _ ' _'..___t'._..-. _ � .... . . . ' -'� -� --��-"""�- �- ��-� --'—"" �� � � � '��the skvUu.e is no�i�iended o�offered lo�sale(Sec 7Us1) Hca11h.Depmtmenf___.. ", �.� .�,.��•. - .. : .. . � .. . _._ .. � ..'�. ,.�.� , .- .._. ___"__ __.__'...__:_._ __._..__. - iti <ssartJPr sv r�GJr:71rrC�ir.�� rsl��ense .�.�.--- �— �- - - - "�l.au J�,cs noe a 1! ro�ar�nunrr o/ � i� h��Furhfs .. � ,. -, ... .. �. � Fire.DePar7menl _ �__.., . _._.__ _ ._ ...._ . _. . .. . �- . . - -. _ .. ... .-.. - _ _. . � Jr �.l�nr _ . �' • l � .... or �s t! r n.�nd ! J c n !u i:/.ur -� .."� � . �lb �u.Q/r-Gis urs emphil�ri..prnfad.l:J7at�Su�b i�,��, Grading _ , �.i ' ,. pr � n� u.s,a � . ��t inrF Jd r�� J/orrJ Jur.sa(a � � - '�� � � •,biu�rner,fbr builJinX��r i nJ rm�.nu nf i�sul.!�eilbiir unr � . ., i . �. . , ,.. .,. � .� _ .._._.. ,._.._ __.. .. __ _.. . _ ..� . _ . . .. .. � Geolog�cal �. �.. , - . . . . . ye�r o�rnmplctinn, �tJc uumnr-bnifJrnirill�bar•r tl,a• � . � � t-,�'...._.y`�!._..� .:�.� � � ' � � . hurJrn n/prnriqy�Fu1 Lr Jid nu�hrufd nr imhmr�fnr ___ _ __. _ 1,�•r n � � � - -- ur uie of s.�frJ.. .. � .. . ,.': . ,. � ._.. . . , Pedesvion Proiechon �' .:. . .: . -: . - , . „ � , . .r. . . ,�. �Fence)�ConaPY) . : .: . : ._"._ �."__�. ' � _.. __....._.__. ._ '.. .�. .�..�.. i .. �.... . . . P� P Y Y � : t,os own-r of Ihr o err,am e.du's�vel�con�roc� , $peCollnspection� � , _..,._-.:....._ . ..�._ ,�. _.' _ :.I._ _.___.... _.__. . _ .- 044)13 sCesSEa d 1'o�os a��C,oJ( c tf. (. fruct.ni ti i i i �7 !! jConc.l(MaSonrY)(Weldin9) . ' � . l.ic nse La¢•d�es ao!ap/�!}t qn���onv i�[��nfrr7v u•h.� '� _:.� - _ "..:t_... ._._�'...__._.._.:. �. .:.�.:_ . _._.huildsur�irnpru�estherrnn,�m�du�Ln��nrstrac�sJurraib ' ' .. ' .. � � ., ro'rrts u•i�lr a .'ontrucu a licensrJ uarct m 11rr. . Lo�Dra�nage . � ..•, � . _ t..__.._._.�� . �_�. .. �� . . .. -..... '_ .__' ' ' �. �P..1 . �l. . . .. P�r�,. . � . - �rnntractnri I.icense l.un•/: . _ . _. .� - . Porkinq � , . „ �. _.____ -_ _ ._. ..� ..._�� .. _... . _'..�.�... . . .,,. .� , . - � �.I I am e.empr�under Sec. '.B.BP.C.far th7s , i .__'_ _ __. ._ ,,, . .. � .i .. . '. � . reoson - _.._._ , . . ... i .. .� . - __._._ _._. _., _..__._..._..__.__ . - . " - .. Date Owner"-��- ' _... .. . . . Approvats� Dofo �_- Insp ctor's Signatora, .... ... . '. .. .. ;... . ,.. . . . . � . , . . ..... . . ... __ . . . . •• . , � iNSPECTOR'S NOTES .i.. lomhon- � r... . . � . . . , ._..___ _'.. . ..._. . .. . ISetbo<k 8 Yards� �' � -� ����� � � - Founda��ans '�� . � . . . . . .. .. Slnb . . .., � .. . .. . . . F,ame . �_3_ - _. e�e,9Y�„sUioro� ' , __.__. _ :_ -- --- _.__.. _ � i _ ,, Lafi�Drywall_ • . ..._.__ . __�_ ._._. . ._ _. . ....__ _..._._ . . . . . . In!..�'p� . ��vF ._'_ ..._ . _._____...__. ' . . ... . 1 , lmh Ex�enor . .l, . ' � . .. ' - •. . � ..`� ...,� .. . . � .. ..__. ,..-. . ,,. Floi�seNvm6er.. . "_' ""._._..._._ _ .... .__ ... _�.._._.__.__.._. � ,:'�,�.� ,� . a.,.: . . Corre<i&Fos�ed .. � . ...1 ._—' ' -- .-, . . -.. .� .. . • Fnol.. __ ' ._...._..'__�. . � � ., _-.__.- ____._..____ .______. _.'.. .. . . Enter on Fom ' � . � , . � . . .. t` , . .. .. . .. ... . .. .... . . . .. ,. .., . .,�. ., .., . . . . . . . . .. . . .. . - . , , . ._Kf .. , . . . ' ... , � ... .. _ `R� .. .: ��-\- � ,���'`