Loading...
HomeMy WebLinkAbout1588A 1589A (9) _. . __ . . .. . WORKERS'COMPENSATION DECLARATION � � � " � � - � � � � � � insurebor�ofcerfif�otaofWokent1Compensaiion��;�,a�e ��� ��� � APPLICATION FOR �BUILDING PERMIT � , or c cert�f�ed copy ihereo((Set.3800,lab.C.) COUNTY OF LOS ANGELES BUILDING AN�SAFETY PolicyNa.73c`'c005-2��m�Q�6 NATIONWIDE 31 C � Cer,ified copy Is bereby(wnisbed. FOR APPLICANT TO FILL IN qDOREu 23618 E. Goldrush Drive � Certi(ied copy Is filed with the covnty buliding Inspeo � �� BU�IDING 23618 E. Goldrush Drive � � fion deporlment. � - ADDRE55 Dale 6-30—$�� qpplimnt THE ANDEN.GROUP ciTr DIA?SOND BAR nr91765 �ocnurr DIAMOND BAR � CERTIFICATE OF EXEMPTION FROM WORKERS'� � � -��� - - � � NO.OF BLDGS. � � NFAREST � COMPENSA710N INSURANCE- �� 5¢E OF lOT Now aa ioT caoss srDIAMOND BAR BLVD.��+��GOLDEN�SPRINGS (This setlion need not be<ompleled if the permit b for one - �� TRACt�43435 � � B�OCK � lOT NO.41 I,�WpSBOpK PAGE� PARCEI hundred dollors(5100)or lese.) . . . � i[t. owr�eaTHE ANDEN GROUP No.967-9541 us�oye ti+n �� _� I cerlify thof�In Ihe performance of the work far whlch Ihis PG / NO. parmN Is Is�vad,I ehall nol employ any parson In any manner ___ P,p.. B�g 3329 . . : ���A� O 50 oe fo become subjecl 10 the Workeri Compensofion laws. AOORE55 �00�� CONDITIONS arr COVINA ziv 91722 v �afe� � � Applitanf ARCHI7FR OR TEL OIS7RICf GROW�TYPE fIRE PROCESSED BY O �NOTICE�TO AP7tlCANT: If, affe� moking�thls Certlficote o} ENGiNEER DAVE SZANY AIA No.445-4073 � ��T. � � � U cxemption, you should become sub�ed lo the Workari �,? Compemation provis�ons af the Labor Code,you mus�forth- nDDRE5S314 N. FIRST ARCADIA 91006 �� �3 1�/ � w with comply with such provisions or this permif shall 6e �- TEL. • SiAitSTIUL[LAS51ECATION � APT. " CONDO. Z deemed revoked. coNrRnCio�E ANDEN GROUP Np, IICENSED CONTRACTORS DECLARATION '- � � - IIC.' - C1A55 NO. v DWELL.UNITS� � I herehy afiirm Ihol I am licensed under provisions of Chapter 9 ADORESSAS ABOVE n,o.510560 � ��R�P (commenting with Sec�ion 7000)of Divieion 3 of the 8usiness ond _ . . . . . _ . . - LiC.� � - Professions Code,and my license is in(u�l forte and effect. Ciiv CiA55 B BK pG - -� VALIDATION rJ1�rJ6� � B � ' � S�E�1786 S OR�S 1 � FAMI�S 1 CONEK � � � licensaN�mber � Uc.Class VALUATION� � THE ANDEN GROUP 6-30-87 �ESCRIFiIONOFWORK SINGLE FAMILY • � NEw � 89 000 Conrroaor Daie App � S � , �1 5&8 A ❑I am exempt under Set. GARAGE 445 SF � q�TER -� �• • ••2� 6.8P.C.{or this reawn . . I RE7AtR � . _ . . . � •2 9 Q O 7 USE OF � "� Dale: .. . � � DEMOL � EXISTING BLDG. � n Slgnalure .. . . . � ... . APPIICANT TEL. , FINAL � 2 /{� ► d`9 O O 7 U OWNER•BUILDER DECIARATION vRiM THE ANDEN GROUP NO. . DA7E � ✓� v/ - � �- - I hereby affirm�hat I om a:empt(ram the Comrotlor's licensa AS ABOVE ' � D 9, 1 y 8 7 law far�he following reason(Section 7031.5,8usiness and ADORE55 FINAI `�� ProfessionsCode): � � -� � � � ����� � -, . aY �^ BUILDING �� �.� �. J I, as owner of�he property, or my employees wilh ADDRE55 wages as their sole compensation,will do Ihe work and ��i�iY - +' , . � . '�� cJ a 9 A the strutlure is not intended or offered for sole(Sectian � 7044,Business and Profeuions Code). - �-� - MOVMG � SEL � . ' � I,as owner of tha properry,om exdosively conlrattin9 � CONTRACTOR NO. i �• • • • • � wi�h litensed conlraclon to comtr�tt ihe pro�att(Seo- � qDDRE55 � !l I •4 5 Z 5 0. tion 7044,Business and Proiessions CodeJ. - L - � �CONSiRUCiION IEN�ING AGENCY � EET�eACK � YARD HWY- T�TAp OPB tME W�DSH � � . -r � • •y 5�],�,O� . 1 here6y oNirm Ihaf lhara is a mnstruclion lending ogency for FRONi 1 ��r� , � �-:j the pmformonce oI ihe work fai which this permit Is iesued � �v.�. . � , I � �9.� �`�7 (Sec.3097,Civ.C.J. SIDE __ S'p_�-�` CITIBANK r.�. ' � � lender's Nome � :`: t $ - � P.C.Fee S 290•07 Permir Fee 447.�� ��Ret M {' j� lender'seWdress444 S. FLOWEK� LA'90071 - , � I certify that I have r ad�his appltco�ion and atate that the . . ivoo�ce Fee � i�Mt�.V/C N � - � �- a obave infarmatio rrect.1 ogree 10 comply with oll Covnly tn.e+i�gotion Fee � $ o�dinantes on t laws relaling to building constructian, „. To�ai Fee 457.rJ� IDMA Perm.M � - �- � R ond hereby i ize represanta�ivee o�Ihis County to emer � upon f e e �roperty fo�Inspection p rposez. .. .. �� �•75 $35 : ..� . . . . . . ���cy� L SEE REYERSE FOR EX�UNATOIIY IANGl1�GF � � Signarure o1 plicani or Agent � Dote - . - . . . . . . � �.� � PLANS TO APPIICANT INSPECTOR'S NOTES „ U1F'11iK.ilUll.U1{I{,UlCCI.ARA'170` . „ I her�by<iffnm:hoi I��m exempr�lrcn.�he f_�nr�unor's To: .:;..: i Retumed �. �. � ��. � '. •� � '� � :��.• � . ;� ,� Lice sc Lc I �thc.follo g 1 e:;`>Oil��5) , ., . . .. . ���ADProved - - � �lf� . nJlr�hs.w..rt.�(.uJ�..int�ut� � uunh.t F,,r3i No. Date Noi `� �ole . . .... . . . . � ., . ..„ .. �.�s� rryur ec o fenr�il7n u�nU �f 7t��r,.�uiJ�r �.Jr r,fish, ' , , . n .� -.._�,if:f�uirunVi[ructur�•.��r...I.itsii-�i��nai.uli�.r��)r�iirs -�fi �'} .. ,;f . . I ..'�1 � . . the�ppli�Jnt/ur.iuiF pern�i!fn/ilr.aai,pned swt.•n�erN ' �`;.. .. ���. '., t .. ..� �.., �� i'. �'�,:. . .. . . � • ' .. . ... ._._. __ .. ._.. ' _'. '_ '___ " ���.�. tba:GeirlireasrJ mrsu�nttnlbr rurr�i�m<nJd�rCnio- i '. ` ,'[ 'J�'� . ,:I:. .._ . ... tra.huil.in•nsr�l,,�a�ICl�apirr'JJ(�nrn� n�in��<it1�.1er . ' . ___ __ . . __.... '_..' � _ , - -..-- -- --- -__ _ _ ; ' ou r � � tir�rr 70 J rJUn ninn j rrl f/�e liusin . .��J rn i m. ,.,. ,., .�- . , - ` , .. . ., .; nr`rFJr rhasis/nrrhr ;-� , .. �. .... � : �.. ,.�,-. � �,.: _.._ ._.��Cn�}rJ Gaireirn�fe�LemJrnmu J.t! -___ ._. .__. . '_. ._ � -_....___ .. . .:. ._..... ._.__.._ .. . _ . _ . _. _. .___.'__.._.__-.___ .. . aAr,ieJ.c .nrftiun.Any rinlalinx nJAerf�nn?03f.g f,�� ':" � � . ';'� .. ,.Roquired . �::Dat�RaeeiJed . '--..-.' ----.- __.-___.__I ___ . _. . .__ anl'uj�(�lii.tnl/nrn f�meit a h� h7L r afrlr�unl�n.e iirr! � .. ._ ___. ._. ...� ; App ovall 'Ves No or Appioved �� . : . . . .i ,- . ,,Tersully r.�nn1 nrnro�ll>an/ir 1 dred du!laia(C5/IOJ.J:�� � .......:, _ _.. . . _.�_.. -.._.. : . .___.__ �. _� . ._ .. � .'�'. . � . � " -�-'" --"�" ��� I,as owner of rhe o t �� r.m �o . 5 w��h P P.r y.o�mY P yrP � .. . .. ,. �.-� ,;,� . . ,'. ,wo es as ihe��r sole m a eosai�on,wdl do ihe wor�.ond Wate.C.rtd�mre ' \. �..�, . .._i ._ . ..�..r_:._.: �.� �. . _ _ .. _ ... . .......... ._.. _ ,� ...8 . - .... . ... . . ' � - � -- - --�-- "" ' �� �� - . .,'��ihe�strui��re is noi inien ed or offered fa sale,(Set�70a3) .�. . .� U�.. ..:�. , . . � , . Hcal�h OePanment_._._.'_. . . _._-. .: . . ..--..__—_... _..._._.__..__....._ _.__. ..___.__ . . .� .,.:I3usirieas aed P i/essiin��.0 J•:.7%�i��Cnntr;�rtdr's l.i.ense __. ._ _ ._ .._... .. . . �. � /,uie Jnrs nrd nfrl�•!n ori nirrser u/properts�rh��hurlJ.� , _.. " Pire Oepa:imen:__. �. .. -- - . . . . ...-..- - .. ..�...�.;•,. ur inrprm is tbrrrnn.anJ�!n durc�u b u ur�F i.inrc�•I/� ._... .. _._.__.._._ ._._.._ .. _ ...__ ..... ._ .. . .. _ . . � � �,�. . . � . ' lLrouRl his-nu�n rrnplu� s..prnriJeJ rLut au7-�-n•_�' Gradmg � ' ! � � ' �.: prnr�e�nenrs arr nnt �nt d J r.oJf � J fnr sul..�Il� � , . , � � 'i�^�. ' ��..i ' �� �. : •. ;i: , � . ..... . ,. , ��.L+mre��rqtLebseildinXnnmprnremcnt�unhlirifl��or�c � � Geologiml"•��.- . ..i_�._. �- �---� -� --�- �� � .�.:�"' '�� ��-�� � � �' � � �. '�ear nI'mmrletian. tbr��nu•nrnbuilJr uJl.larr,the ' r.i hurden n/p.nrin�tba�!.e did nnf hai1���ir nnhm�a/nr PF�desFna�na r�ote��on��"-,- ` �.� � .' . ::�-'.-' ----�� ;� � __.— ........ � __'_1'_ purpnse'o/.<,ilrl•he p ope fy,.am c dusivcly con!roc- th l )l [+_ � . -. . _ -.- _ -. �'�� 'I,�asownerofr . �;ling w�ih Gce�se.c�co�ho�tors�o<onst��u ihe projeci��5e:. SPeciolinsPeciion�_. ���. ,- ' - � -.z.�. _,_ .. _.. _ ..__ _ (Ccnc IlMosonrYl(Wetdm9) �' . . . ���-. .. �- �- �- ,��� ��70a r ss Pr a�C J� ll r nm's 41 fi senr. ond nl�.s . . ( r , , ,, r.� r �,•�r ,R,��.��rr,��,,,��u, ,,,r�r,�f��r,�<r�„ . . ..... _....__ _.._ �_�,... .. _. _. _ ._ --FuifJi��u�im �irs��fierrr;n;and a•hn�nntrac�s -..G ; �.�> >,.. lotDrainage �.(' ,i.�� , .�. .G__'.___ __.....:... �-�:--�.�__...�..�._ ... _.__.:. Arlren�u�{I ninnlracir(c)liccnsrdpnrsuantt �le , _ . --��Cnnna:lnrcf.i.ense�L�u�1� ... . _� �" � '�, . ,- .,., . � �--1 Po.kmg �. . _ .. , .. .. ._._ .. .. .._-_____ .. .. ,_.... . . . I. . .. .__. _. _._.__ __..__ ____.___._ _ .... ❑ �am e.empi under Sec. ,B BP.0 fer Ihls ,.. . ___._"_._. ._._. . . _.___._.., . ... .. �.. _ � eason : �- �� . ,.. . -'_..'.. '_.' _ ... .�. . , ' "_'__ ...____.. __ __._- ' � �. 11•� . . . . . , Da O ner .. .. '. �„r.. .�. ...; . 3:" ._. . _- _ _____ . _. ._ . �. • . .. .. ,.,. .. .... .__.._._ . ..__.__ . ', .. Approvolt Dcfe _Inepector's Signuture � �. . - , � . . . .. ,� ' �IRSPECTOR'S NOTFS ' � ' locat�on-� . . . . , . .. _ _ .__ _�._ .__'. � . . . ,_ (ScibacA 8 Yardsl '�.' ,/���.._I.'Ji���7i. � " . . .. .. .-_ � . __ . .. , . �.. ., ,.... .. ;. Foundo�ions V � . � . Slab � . .... ,. . . . . . , . .. .. .. Frnmc � . ,�� n.� Q,� �', . . . .. , . _. .. . .. . . . . . . , . . .. vl�L 1 J Enerc�y Insuio�ion =� _f�.� �} . _ i ..____ . .. ..._. � - . _ . ,. ,. . .. , . . ..... . , . , , .. �1_' . ... ; . : _ .. .. .�. la�h:Drywall... � . _.__._i�.. .._''_._._`__ .. __'__. . : _'__ ' � . . .... . ._ _...__., , . .,.. � , . .�. . Inteno� .. _� : .._._ _ ._... � . . lo�h-Exterior . ..�. . . ,. ..� .. � ... . . .. ..� .. � � . �-i- ___ _ _- - _ _ _ , . , -��� , __ __ . ,�, HouzeNumher- � ^ � - .� , -_.._` ,:.I-i--...._.._ .__..' ._...._____.._ . _-�___ � . . . .. . . ' . Correa 8 Pos�ed . '� --�� ��'��_� ��. . .._. . . Finol_ _.-..__ __.__ __...�___._. _.'_."_.... _._ __._..._._.. .'_. _..._.__. . .._ . ._ . .. , ' Enfer on From .._._ , .._._ . , . . .. ..,.i- . . , , \_' . .. ... � . . . ,.. . .. - .. . . . ... .... .. �. ./ �� .. � Y— i � . . . .. . ._, .. " . : . ���,t. . `����.i..:\ .1i/