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HomeMy WebLinkAbout1562A 1563A I hereb a fiRmE har lO ovaNaAteOrtificoEPLo(colnOse � . . . _ : . .. ._ . .. . .. ... . .. ... . .. . .. .._ .. . . .. . .. ' .. _ , O1O6e" APPLICATION FQR BUILDING PERMlT � Y insure,or o cenificate of Workers'Com ensation Insurance, or a ce.rfied copy thereof(Sec.3800,tob.C.) ' ' COUNTY OF LOS ANGELES BUIIDING AND SAFETY aot�cyNo.�3wc005-2���Q�.6 NATIoNWIDE 61 C 2 Car � ' FOR APPLICANT TO FILL IN ADDRE55 23631 E. Goldrush Drive Certified copy is hereby furnished: � Certified copy is filed with ihe co�nry building inspeo- �� gUILDING lion departmenl. '- - ADORESS 23631 E. Goldrush Drive ome 6-3O—HJ �qPP���a�� THE ANDEN GROUP arv DIAMOND BAR z�a91765 ioou�rv DIAMOND BAR CERTIFICAiE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. � - -�- NEARESL ' COMPENSATION INSURANC@ � �� SiZE OF LOT� nlOw ON l07 caoss sTDIAMOND BAR BLVD. + GOLDEN-SPRINGS- (7his section need not be completed if iha permii is for one � /�SSESSOR hundred dollafs(5100)or Ie53.], � . . � TRACT 43435 BIOCK LOi NO. Jr MqP gOOK � PAGE� PARCEL� owNeaTHE ANDEN GROUP nio.967-9541 u oNe �+P � ,� I certify ihof in the performance of the work fo�which fhis ��� �� permil is issuad,1 sholl nof employ any person in ony mannar SPECIAL - � � nooRessP.O. BOX 3329 00 � CONDITIONS sa as to become subject ro iha Workers'Compensarion laws. , � , . crcr COVINA- ziv 91722 Date ApPlimnt ARCHITECT OR TEL. DISTRICT GROUP IYPE FIRE PROCESSE�8Y O OTICE TO APPLICANT: If, afler'making�this Certificate of ENGwEER DAVE SZANY AIA No.445-4073 emption, you should becoma sobjecl to Ihe Workers' � {1 ,/n� NNS {,yj .� U `�Ompensation provisions of the labor Coda,you must forth• qpDRE55314 N. FIR "� •`�� �/_ �� � with comply with such�provisions or this parmit shall be - �-' deemed revoked. � � � • . � TEL. STATISTICAL QASSIFIGATION APT. CONDO. tq coNrRacroaTHE ANDEN GROUP n�o. ,.�—( Z LICENSED CONTRACTOR$DECIARATION' �� ' --� ��- ii�, - CLnSS NO. � DWELt.UNI75_L I hereby affirm rhat 1 am licansed under provisions of Chapter9 ADDRESSAS ABOVE No.S 10560 (commencing wilh Section 7000)of Division 3 of the Business and . , , . ��� SEV`�ER MAP � - Professions Code,and my Iicensa is in full force ond eHect. aiY � CW55 BK ' � � VALIDATION- - SO.FT. NO.OF NO.OF CHECK licenseNumba�1056� LiaCloss B � Si2E 2634 STORiES z FAMIUES 1�� � ONE�- VALUATION THE ANDEN GROUP 6-30-87 OESCRIPTION OF WORK SINGLE FAMILY N� 0 �1 5 6 2 A Contmdor Date ; 157�00� �I am eaempt undet Set. GARAGE 4�iS SF .- A�D. Q , r�• • • •�� ALiER 8.8P.C.for fhis�reason . . � REPAIR ❑ . _ /�� l oJ ✓ .. � •�� a J�9 � Da1e: Ex 5�NG eloG. DEMOI ❑ .� . o ��.� Q,S 9 c�i � Signaturo . .. . APPLICANT tei. FINAL OWNER-Bl11lDER DECIARATION '� PRiNi THE ANDEN GROUP N�� DATE�Z?— . 0 9.1 1 —8 7 I hmeby a(firm ihol I am exempl from the ControUor's Licansa AD�RE55 AS ABOVE � Law for the foltowing rooson(SeUion 70�1.5, Bosiness and � FINAL ' Professions CodaJ: .. . . . .... .. . 6Y . . � BUILDING �',� -� I, as owner ot fhe propary, or my employeas wiih ADDRE55 ��� 5�3 A � wogas as their sole compensotion,will do the work ond ; ,� l � •' � � � � the structura 7s not inrended or offered for sale(Seaion �aAUTv ' . � - 7044,Business and Professions Code). -� ' MOVING ' � � ie� � i#• • • • �� � I,os owner of tha properly,am eadusivaly tontrocting CONiftAROR NO. with Iicensed confroctors fo construct the p�ojecf(Sec- qODRESS � ' � � I ,b 7�O O lion 704a,Business and Pro(essions Coda). �, --�� - � z CONSTRUCTION LENDING AGENCY � � s[QanCK YARD Hwv T�T pROP,UNE WIDTH � � , � " ' �''���O O c� . I hereby affirm that thera is o construUion lending agancy for iRONT . O 9� � —S I the performance of�he work for which fhis permit is issued - �p.�. - , ' � � � •- (Sec.3097,Civ.C.). '�. 5i0E CITIBANK '� � Landar's Name ' - � ' ' lander's Addresa 444 5. FLOWEK: LA 90071 v.c.Fes s 418.59 Ps.m��Fee 664.SO �DMA Ref.M " � 1 certify ihat I heva raod this appiicotion and stota that tha iuuance Fee 10•50 �DM.4 PiC M � above informa�ion is correct.1 agrea to comply with all County In.earigaiion Fee $ ordinances and tate laws reloting to building construtlion, Totol Fee tDM4 Pmm.M - -� and hereb ut representatives of this Co�nty�o anter 3 upon i -m ropery for inspec�on� j�p�A $75 - $35 � � - � SEE REVERSE FOR EXPUNAiORY LANGUAGE Signoture oh pplicant or Agent - - Dore - � � - � -- - '"' 1 S _'„r� _'___ � ' ."_ ' , , � ��.^�•� •ci'.' f�`�'.C.• . , ......... ... .. . . 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