Loading...
HomeMy WebLinkAbout1526A 1527A (8) WORKERS'COMPENSATION DECLARATION , ' j � � - � ' � I hereby af�;�m ,�o, I have a certifica�e af�o�,e�,,0 58�f � �� ���APPLICATII�N FQR �BUILDING -��PERMIT � - �. � insure,or o cernf�ca�e of Workers'Compensmion Insurance, , or o certified copy�hareof(Sec.3800,Lab.C,J � � ' � � - � Policy Na 73wc005-2��,��,}6 NATIONWIDE COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ ar' v FOR APPLICANT TO FILL IN nooaess 23637 E. Goldrush Drive � Certified co is here6 furnished.� .� Certified copy Is(iled with Ihe coonly boilding inspac- BUIIDING �, �ion deparrmem. ' aooaess 23637 E. Goldrush Drive Dme 6-30-87 nppucanr THE ANDEN GROUP � arr DIAMOND BAR ziv �ocnurv DIAMO AR CERTIFICATE OF EXEMPTION FROM WORKER5 � � NO.OF B�DGS. NEAREST � ' � � COMPENSATION INSURANCE � SRE OF LOT NOW ON LOT - CRO55 5 - (This settion aead no�be completed if�he permir Is for ona � � TRAR A343$ BLOCK l0T NO.6� '�ESSOR � , . . hondred dollors(5100)or less.) . , MAi BOOK PAGE PARCEI owNe�HE ANDEN GROUP No.96�- 41 �� E "w° I certify that in Ihe performance of ihe work for which ihis �� NO.'� permit is issued,I shall not employ any persan in any manner .. S�ECini . . so as to 6ecome subject to the Workers'Compensarian Laws. /+ooRe55P.0. BOX 3329 IQdC�d CONDITIONS � �, aTr COVINA ziv U �ate � Applicont - . . . . � ARCHITECT OR TEI. � /"OTICE TO APPUCJ�NT: If, afler making-this Certificoie of � DiSTRiCT GROUv Trpe FlRE PROCE55Eoer emp�ion, you aho�ld become subjec� to �he Workers' ENGINEER DAVE SZANY AIA r,o.445-4073 [/ CONSL ' 1 Z Q - �ompensalian provisions of tha labor Code,you must forth- qpoRE55 "D �3 i�/ �r W � with comply with such provisions or ihis�permit shall be � p, deemed revoked. - . . �TE�• � � STATISTICAL QASS�IC¢TION A7T. CONDO. Z � corrranao�'HE ANDEN GROUP No. LICENSED CONTRACTORS DECIARATION .. . .. ���, M55 NO, - �� � DWFLL UNIT$ �7' I here6y affirm that I om litensed�nder provisions of Chopter9 anoaessAS ABOVE NO. (mmmencing wilh Section 7000)of DiviSion 3 of the Business and ���. `��R�P '�, Proiessions Code,and my license is in ivll force ond effect Grv � CLn55 � gK ��: VAUDATION . $10560 50.FT. NO.OF NO.OF CHECK license Numbe uc.ela:s$ � srze 2634 STORIES 1 � FAMIUES 1� ONE . . � � , � YAWATION ��. ComractorTHE ANDEN f:ROIIP Date�]-3O—Pi� OESCRIPTIONOFWORK NEW ADo S 1S�J�OOO , ❑I am exempt under Sec. GARAGE 44 � ALTER B.BP.C.far this reason = /,r �1 5 2 6 A REPAIR Date: - USE OF ' ' '� � �E%ISTING BL�G. OEMOL �� � � �2� SignOlure .. . . APPIICAM ' TEL. FINAI � OWNER•BUI�DER DECIARATION PRIM ND. ' . DATE{p/�C �i5 I •4 1 fl 5 9 _ I hereby affirm Ihat I om exempt from the CoNratlar's License qODRESS E1$ (�$� � FINAI � � o .�4� g 5 q= Law for the following reason(Saction 7031.5,Business ond � / � Pro�esilons Code): - - � - —� , , 6y f�' +�c-r � neuuowc — 0 9,1 1—8 7 I, as owner of 1ha proparty, or my employees wilh nDDeE55 �^' �'� " ��" � ' wages as their sole compensotion,will do tha work and . i�q��TV �'� ' � , � � � ihe structure Is not Imanded or offered for sale(Section ' l � � � 7044,Business and Pro4eseions Code). �� - - � ��-� MOVING tEL �� . . - � - -.- . � I,as owner of ihe property,om exclusivaly tontrocting CONTRACTOR NO. I with licrosed confroaors ro eonstruc�the pro�ect(Sao- � � qoose55 � ' � � � � � � - tian 7044,Business and Professions Code). . i REOUIRED 10TA1 SETBA K - CONSTRUCTION LENDING AGENCY 5E7 gq�g YARD h+wv pROP.LME wioTA � � " � � � � � �1 5 2 7 A ' I hereby affirm thot thera is o construction lending agancy for FRONT - . , ' � � a�� � i . Ihe performance oi the work for which fhis permit is issued v.L . ' � , ... � tt • • • � � Isec.�oa�,cv.t.�. s�oe � - I •6 7 5 0 0 . � CITIBANK P.� . Lendor's Name . . . . . .� � - - • ♦d 7 r�O p� r.c.Fee s 418.59 . �' ve�mo Fee 664.50 ��Ref.M . ", lender'a Address 4 44 S. FL,OWER. L.A 90071 10.50 'i , 0 9,� � _$7 ' ,I certify�hat 1 hava read this applicaiian and stote thaf the Iss�anes Fee ' LDMA P/C M . � above informar is correcL 1 agrea to comply with all Counry mvestiqoiion Fee .675.�� � ordinancea d fate lows reloting to building construction, To+al Fee � � LDMA Pe�m.M �and hera orize representatives of this County lo ante� , � op t ve ' ned proparfy for inspaction purposes. � � �, G LDMA $75 $35 . . . p SEE REVFRSE FOR EXPUNATORY t�NGU1lGE . . Signaf�re of Appli<anl or Apenl po�e . .. . . . . . . . . . . .. PIANS TO APPIICANT � INSPECTOR'S NOTES �•-Otit'\EK-llUlLUIiH.DY.l11.AKA'1'ION ��, i here6y or�i�m I�ai I am exempi Irom ihe Conno-!o•"s To: i. . �.,.., ¢ Relurned : . ' '.. � . . � � � ; , . � �lic'ense la�n f 'iFc�lolio mg rc u '(Sec��7D91.5� Appraved �. �.. IJrreincacnnJl J..cunmZoJuAnyuttirir.i�un(t'�<drid� No. Date No. � "� Date . . ..... ' .1. i. . � ..-..� rryuires u prrn�iLto cnrcsln��L.dtrr,irr.pr��rr.dernnli.J,, . i^ , _ - ' ' . . -. ir r�pairurrt�s!uttiire,prinr 1J its is��uJro�c�.Ll�n�ryunri .�I j••(' '.�'� . ._ . � .. . . . . � t/e�ppli;,e.t 1 �ud�prrmit tn Jifr a.aprsrJ st..lc�nrnt - � - - -- �- - - - ' - ,�th�Lhe is fitrnsrd pursurrrt t�,�L•rpr.�rrsionr n/Ihr Cnn. • �, i:.•;� ...; , ...�.._. _;- ' tra.lor:�l.u�ena��l,.��r((:l�aplrr 91/t .�nrr.+q n�irL 1«C .. _. . . .. .-__ - .-. ' -- . - ... . _ . ... .��. .. . . _.- - . ,. ..... ��,� . . .,. . ,.._ .. __�_.__ . _.•. ' . �.� �'!, _ � '�. . _ � .. _ _� ....'���� � .i.. . . ..��� __�< a!</nr,!!��!/,) .. ��+t(Grr `(asJfbr�n�r�rrfC+o er rliu PJ.� ,��. .. -�_. ��. ..'.'._��. .•lRoq�irad'�,. � •'DafoReceivod ._...'_'_._..__ ��, '... . ___...._ _. _... _� ....._ unva�pfwn lr ���rnV 1sa�h�cYc.f1e11f�r _:rf�3Lieri/ Appro.ols . or Approved. . prnu!{v n!n�f m.,r� tbu /n�Gendr.d J�i!l,�n/�Sbp).): ; � � . . . .:.Ves No � � ,.. . . : . . . _, �- .-.. .... - . _. . -.. . . _._ �i , , _ . _ �•�.. ��._..-� 1'�l '- j-.y. � ._.. ._.. _._.._. ._..<_.. ..� _. ' �9' I,os ne ie p.oPrrly.c�my rmPlc� � �ah Wo�,m Crri�i,cme .__r:.�. ' � . .. . . wa es as th� sole co+penso��on. II de if e o and , " � ... .. „ . . , .Ihe sfruciu�e s mt'ntended or oflere,d fo sale�Scc �0'4) ' Neo��h.Depnnmeni .. . -__.__ �� _ �:'�:.! � "".___.. . ._. . ._-..__. . ___. _ . _____ . _,. LutrneasonJlr�i/cs.nuruC:oJ��:7RcCnntra<tarnLn�n3i• _ � . . . !.u«�Jnrs not app/v!n arr uumrr o/properte irhu l,urLls ,. . i.; , , �. P t � � � � '__orin���rn sdrr<nn.nndttlnll�.esu«buorkl,ir.n�!/nr �_ Pne De anmen _.... __'___ ___._. _.._.._. . .. . : r� . ;_ . ...". . - .-��.��'-; i ' ... � . ,. . _ . .. . , , ; , ;,;,: rr�,,,,x� ��, �,�,��r ,� r,�,r d rr,,r : r � i� C;rad q _�.i ,��'i , . �•, ,- '�1 `.;�: i . ���ro�e�nrntr�arrrxnt rn�rndrd �r J/ �d-/�.r ia!<o�r•1 '. . . ��,: �, . ... , - .,c��,L'! .. .�..���� � . .. _._ ...•. .__. . ., >����eeeqlLebi�ildinhnrimprnnrmenlrs.��fJ�<•ithn�rinv � GeoloyKol. ... �..� - - � . -. .. .. - .. �:ear i>/ram�lrfi�m, tbe nuner-lvilder u•i7! h�irr ehc _ ...-_--- ---- _ .-_.'� _ .� - .._. hurJ<n o/prnrin,r thnl!�e Jid m�l FuifJ or rnrprnr��Jdr PedestrianProteceon. ...� ..'-... .... ;. '';;.: 1 ._ . � .,. '_._..._.._. �.�� b pvrp.rco/calrl. .• ; . . . ._._. __ _ � � t . ; .. . . � � , � , .,. - � �.. _,. (Fencc)(CanoPY) � - ---.....' ��� -` --� � . . �� d;as�owner of Ihe p operty;om e I.svei�.rnniroo , . . .Y g w�ih licenied cpnvacrors�o eons r�c�,�he pro�ea�Sec. _ . .__. .. ..__-_:__ _.. ..__..'_. . . Speual InsPection � � ., �.'� .'-,; -�� -....: . '� . ��: ' . ��' -"-,-, •- . . 7044)I/rerrrtr.es und 7'rn/rvsioas Cudr:7hi�C:nn�wrtnr's (Canc)IMasonrY)fWelding) .: . , . _ . .__ ...---�:_ �.._-'--�. _.—�---- .."- :.�.-_- .. , /.irrncel.uio,duesnnlaj�pltl�uir��uu ,n/��„r�-�r,��i,,, � �� � � bur7d�ur irrifraret!1 i�mart,�enJ u7 ,ntrurla Jur sr�.h . .. . ��^� ��, . ,; ' : . .'_'_______......__._.'._.. ._..._ __.___ Contr�i�lnr's 16unse f.au �cJ li�rnsrd.pur _.. 1hc lo�Dramoqe f t[,v tl a fro�ia seant {a -- � . . Po�klnq - :" � ; �� � --�'� .�I�'-I am exempl under Sec.�:. .�� .:'- 6.&P.0(o.lh�s . . _.._..-..._.'. __ _ . ..__ � . . � ' ' ' reason . _ . . . . . _.___o'._.._'._. .. _ , . . _-_..._._ ___. ... ___. :_..... .... __'.__'. '___ ____..__ _.. ._. ' � �� � - . D te Ow . -. ,.. � . . . . . . .,. '. _ _. . .....�, . ., , ,, .. . . . __ '_...__....__ '____ ___ . _ . .. . . _._ _. _.._.___._.._..�. , . .. � . .. . ��. . . . .. ... .� . _".. _'_._._ __ _. .__. _. � , Approvals Dote � Inspe<1oh Signafure . � �� � ����� ���� � � � - -- �- � �� 'INSPECTOR'S NOTES�'�-� �� � � loc9non-. :. . .. � .: :.' . . ._ . . _____'_..___ __ . (Se�bac4 8 Yards) � _, , „ ...'_ - � � .. . .. i� : ;.. _`r���6�� ---�.� �_� Fo�„d���e„s , _ ; . .. a . _ Slob • Fromr. � -l� . . ,. . . . . .' , ... .._, ,i • - ._.. � .�.. .�. . . . . . Energylnsuloi�on .._- _ . .__..' .- .'�._..___ .�.__. . _.'__ ___ . ._ . . . .. .. � � � � . �. � _ . .. . . . . .,_ .. : Lmh;Drywoll.. , . . _..__. . . . . ._.._..'_.'.. . � ... . � . . _. _._ _ .__-___ '._.. Inter�or . � '' ' ' _'' _._"_"_' . . . � i . . , . .. . � la�h-E.terror � . . . . . -. . �.�.' . . . . .. .�..• e - ,. x.�.:, . __-_... ______'_. .__"_.._ .'_'_""_ _. "" ..__._.. . . _..___'.._ �,-: �.q` -' n ::ar� _ .'� . HauseNamhr,r_ .- . .__. ...__."__._.____. .__.._.__' ___. . Cor.ec�&Fos�ed � ,. ._ ..__ ._. __.. _...._,.. .._, _.,__. . . 1•' ._ � . . � ,. F�nnl_ � . - . ,. - .. . .__ . . _ _. �_.. . __ Eme.on Fronl �, . _�__ _._'_ . ' _..r . , � . r�. . . . . . ... 1 `..' . . . _ . , . . . ;, � ... . . . . . .. . .. . . . . . . . � . � . � . .._ t.,,.� � . , . `� `\. , � . . �-, . . . � . - � _ . . . �\l� _.- - - ._� �'� � .J� __ ._ .