Loading...
HomeMy WebLinkAbout1578A 1579A (9) WORKERS'COMPENSATION DECLARATION � �. '�' -. � � I hereby affirm Ihot 1 have a�a�,��,�a�a of�o�=B��,o 5a�f � ��� APPLICATION FOR BUILDING� PERMIT . insure,or a certificate of Workers'Compensotion Insurance, , or a certified copy thereof(Sec.3800,Lab:C.J ' � " - � � a�YNo 73wCOO$-2��m�Q�.6 NATIONWIDE 31 A COUNTY OF LOS ANGELES BUILDING AND SAFETY Carrifiad co s he�eb f�.n�shed. FOR APPLICANT TO FILL IN • euuoiNc 23703 E. Goldrush Drive PY' Y ADDRESS � Certified copy is filed with the couNy building inspec• �� BuiLDiNG 23703 E. Goldrush Drive lion deparfinenf. '. ADDRESS Dote 6-3O—S�. qPP��Ce�� THE ANDEN. GROUP aTr DIAMOND BAR z�P91765 iocnurv DIAMOND BAR CERTIFICATE OF EXEMPTION FROM WORKERS'� �� � � �- NO.OF BLOGS. NFAREST � COMPENSATION INSURANCE . SiZE OF t07 Now oN ior ceoss srDIAMOND BAR BLVD.� + GOLDEN SPRINGS �This settion need no�be compieied if tha parmi�is for one � TRnCT 43�+35 BLOCK iOT NO.$ �`ESSOR hundred doltars(E100)or less.) , A1AP 600K � FAGE PARCEI THE ANDEN GROUP TE�' us zo e � �3 I cartify thol in the performonce of the work for which ihis � OwNER No.967-9541 �`� NO. parmit is iss�ad,I sholl not employ cny person in ony�manner noDaE55P.0. BOX 3329 Dd 0 c� �ECIAL . � CONDITION$ so as to become subject fo ihe Workers'Compensation Laws. � �. ' arr COVINA na 9U22 � Dot@ � Appli[onf ARCHITECTOR TEL. OTICE TO APPLICANT: If, afier making�this Certi(icale of EN��NEER - DAVE SZANY AIA No.445-4073 DISTRICT G20UP ttPE FIRE PROCESSED BY 0 emption, you should betome wblecf to iha Workeri � a p CONhS p� ZgWF^ U `Compensmion prowsions of the Lobor Code,you m�sr fo.�h- noouess314 N. FIRST ARCADIA 100 � ,`'.3 ✓ 1� �v W ❑h comply wifh su[h pravisions or this permil shall be . � TEL, � STATISTICAL QASSIFI_CATION AP7. NDO. � deemed re�oked. , HE ANDEN GROUP CONTRACTORT NO. IICENSED CONTRACTORS DECIARATION . . . . ���, aa55 NO. �J7� - DweiL UNITS� Z I hereby affirm that I am licensed under provisions of Chopfer 9 ADORESSAS ABOVE r,o.510560 (tommencing with Sec�ion 7000)of Division 9 of the 8usineu and ��G SEWER MAP - Professions Coda,and my licensa is in full iorce ond effect. CITY CIA55 BK� � � VALIDATION �10560 B . S�EFT•1�H6 NO.OF NO.OF CHECK LiGens@Numbe LiC.C�a55 STORIFS 1 FAMIUES 1 ' � ONE � � � VALUATION THE ANDEN GRaUP 6-30-87 DESCRI7TIONOFWORK SINGLE-FAMILY "E'^� � COntfa[�of �afB AOD � S ❑I om ezempt under Sec. GARAGE 445 SF A�TER � ' �1 5 Z 8 A 8.8P.C.for this reoson REPAIR ❑ � _ � � �• • • •2� USE OF . . Date:�- E%iSTING BI�G. DEMOL ❑ I •2 9 Q O 7 Signoture " .. APPIICANT � TEL. FINAI OWNER-BWLDERDECLARAiION cai i THE ANDEN GROUP NO. DATE �/i�`�/� . .. - s ., I hereby affirm�hm I am axempt from the Controctor's Licensa ' � 2 9 O.O 7� law for the following reoson(Sedion 7031.5,B�siness and Aooaess AS ABOVE FINALJy/� ' - 0 9 � � _8� ProfessionsCode�: - � - � -�---- � � � , , By //!" � � BUILDING � � � _ " ' � • � I, os owna�of Ihe properfy, or my employees with AD�RESS � wages as rheir sole compensolion,will do the work and ' - � � � ' � . 1 , � � the slructure is not imended ot offered for sale(Sactlon ����TM� '' �1 5 7.9 A 7044,Business and Professions Code). �- - � h�OVwG -�� � � -iEl. � � � - � , � I,as owner of fhe proparty,om axclvsively conlracling CONTRAG70R NO. ,�� �,� � � 1 with I�censed conrractors to construct the project(Seo- � qooaess -� � - � tion 7044,Business and Professions Code). � .!� �• � ��` . I •4 5 7.5 D � CONSTRUCTION LENDING AGENCY SE7 6ACK YARD HWV t�TApROP,IINE wioiH � - � � � � � I heroby offirm tha�tharo is a constr�nion lending ogency for FRONT 1'- � - - • ""J�,5 Q�� the performonce of the work for which Ihis parmit is issued � �a,l. O 9,1 ��8 7 (Sec.3097,Uv.C.). �. SIDE � � CITIBANK P�. Lender's Name � � � � � �� P.C.Fee S 290.07 ve�mn Fee .447.00 �M'°`Ref.M � � � ` Lendar's Addrea 444 S. FLOWER, LA 90071 � 10.50 � I canify that I hove read this opplication and s�ate that�he i.me�cs Fes IDMA P/C M . above informati is mrrect.I agree to comply with oll CouMy inve:riqaron Fee � � ordinances a role laws rolating to bullding tonst�uttion, To�al Fes � 4S�J.50 lDM4 P•rrr�.M � and hereb a re resentatives of this County to�en�er � upon th o me ione property for inspeclio p rposas. _ � ��� LDMA $75 $35 SEE REYERSE fOR EXPIANATORY UNGUAG@ � Signaluro o App�icont or Aqenl Dots.. .. . . . .. . .. � ., _. - ---- �-. --._ ..._ _ _ �� ..; �� =�= ��;��� ,. �::: . ,.�.,�,-., . � � . \.\��'. 4.. i.. .. ... . ...�• �..:... ..�::: �:..i 1. � '_ ,. , .. _ . .,.. e. .� �:.. '�' ..1 ���_'" . ' � ,.i�.�1-� , :: F... ., .. .. . _ . . . ._ . ..\. �. . . - ..i, i- ... ..,. ... . I�io�j uo ialu3 . �.� �i�. �.'.�: . . ._ ... , :.�.., . ,.. .. �:..� ,...;�..;.,,,_�,� . ... . . i�. F:. . . .._._.._ _.� _... .__.. �oUij ,.. - '_"."_. .._' '______ "_ — _ _ � . . , .� � . . ., , . .. . .�. . �1�': . . .. � � alSOd b+lJJilO� .-... .. .. . :.:_. ;.. '...._ ,.7_;_^`.:..__. ._. .. ....._ ! _.._'_..-'_:_(''�•.� � ', ' ��aywnNasnoH _'____ . _...'_ - � � � �� � .. , . _ _._. � _'__"�� . �„ .. ,� , � .I'�_. : . �. . . � �� ioua�e3-y:o1 . . . _,. ._... . . . . . . . ... . , .. .._ � � i � � . � �o�iaiul i" '. -.'''(: �' ,�� _.! � I � .. _..._. .__'. � �..._.._ �' - o.MRip. � _. _ _._.' - ' -- - 1 -1 �4io ti _ ��� ,',. ,_ . �., . . , �„,. . ..i`'` ' '�'' :....�' . . __. .-' --�- ..__ �y� q�[� uo4ol�nsu�A6iJu] , . . . .. . . ._ .._ ]/1 �4?�� . , . , , . , ' . . . . .. .. . , . . v� �p� . . G awo.i ,. . ; .... ., . .,.��. .. ..�. : . __...._ ._.___ � . ... . ., ' � . �..� � �,. .�._ . _ . . '--._.-- -� � --_.._._ .... . 9�IS . �.. -.,: ..;,,,. � :,, �.. .�._,. .._ .__'--� ---�----. . .------- - -... _-- - --.�_ �. � suo�tupunoj ��, . . , .: �.� ,�. � .�. .,.^ . �. _ .. . � , ., . , . ..-_�. �� �. �.: . ��. � ����i —! //1 Isp'oA 8 MJ°9iag) .� •� . . ___ ...__. ._.___ _. .._ .. ' -uoiimo� � - � � 5310N S.MO1J3dSN1 - -:u. : � , , � ' ' �ein{ou6�g s�o��edsu� u�np s�oeoic�dy . . . _.__ .___"... ' ._"...... . .�....____'_ ... .- �, �. . . . , __ , . , � 'ia�ump aod � � . , . . . . . ,.� ,.- . .� . . .___ .__'__. .___.__._ ..._._._ ."'_ _' ._ ..____.._._. __.....___..."_.�_ "--_ _._____' . . . ' UOT031 • _� . . � ; .. . ... . , . ,.�I -' _._ . .. ...... . .._.__._ . . s'4+iOf"�d8 9' . :.�ag apun Idwa.a wo� �'� i ' ' �. . , - , � . _. . . -___. __ '. _.._ �'. . _ .. .'� . Gui��od ` ,,. . - �rin7,>ru.»rl s ! quuJ ; . . . �. 'i�. � :,_�: � � .. . , • -- � . ' ay! u!`tu�rrr.:�id�J�, �d.rr�(�f ul�r�lvu� n-y! n sfr.fu�� _._ .. ._ _._. .___ . . : . � ., . �; � a6owo�Q�o1 (�1I5 J�� SJl�17Y�111 �t S' !�(IJI>�J SJ.I!)JVUfI J!1 f IH •. .• 1 .. � �. . . r ! r _t r ,_ r� -'�--- �...... � �,i�.n.ifl.�Jo�d�',�aunuuroltjJJrluur�np.nr•�a�u.nr� ,-.. . .... s__ ._'_ ,,.__._ .__. .'___._. �. '.. . (6wpIaMllhiuosoWll'�uo�l s�uJ�n�n•u7 aq./,:,iT ���suu�s�:fb�d Pur rsaw_�n�(cvOC ' , . � ��� , .,. �. : . _ _ �� . o�padw��ouadg ._ ' _ ._.-L ..'. u . , ...__..___ ..�...—'__"' .".____ _ .__ � . ��ag)patmd ay:�pniifuo>ot vo+�oiwo�poiLa�q�ypm 6ui�� + � ' � � I . j�aa wo'dt�aAoid ayi�o�au.no so � � -� �"�r ' ._..._ . .._. _..'._.__'___''. -..._ _ . (Rdouu�l(awail aonuu�A� �sn ; . ,.� .. . . , . . . uvn�aroi�{uouixapad . •�elna fo.,.,Jln,J��J.• . . �uf a.�u�1 ��o r�ui/7�u p�p ay tnyt Xnr�ui��l�i.u��pang _..' __.. ._.._ ...____ _.. . ._._... ' ' . _ ay7 a.it�il lli.r: applr�/.aaunu aJl.'u�,rp.i�Jmw fii lra.i. _ � , i.i : ��� . -� _._. ,.i ,_., { ' . �� 6o��a .. �o�, � . ._ ..... . o- .,:. __ _ ' _ . �uu�nr >i nrrilu�maanilun.suXur �ar I.t��anu�� � .-L lrr. P! . Pl. 1 I- .I� ..... . _,-� �.. '� � .-�._ . ;,- ,.-.-. , . -__ . ..�. i . � . �•.itns mf p.ri�f/n � p.�pu�pu� toa�an.�� JLIJqfi1(I .. . `F •�I �' . ��� _ 6uipo.r, . � ar.ris"tnql�j�,�p(�i1/ •�artn�Ju�a uaio irq.�Huo�7�7 � ..�. .. - .. - .' .. . . .r,_' __ .�ir ... ,. ... .-,.. , - i i����xrury�:y�unry�.ni3ri�pi�q.r�pun�-u�,a�.utti:m�dki�Jn.. . , ..,� _. � ; :�....�_ ..__ .�`._�_'..'_� ____ '_..... _ . idaQ:.�y . j,i..w�n .�J�nyn��n.ti1.,,/o1J/,��.,unuarofer✓Jn�n���npmr�l .„, ;., _,. .�. . .. . � . a.u�,.•� it>rlpuo.��y]:.��o�j snrnrr�fi.fd Pun rsaursnFj,.� •... . ___.___..___............. __ ._ .�.� ._.. . _ .__ .....__ _-_-._�.awuodap y��oaN . (ChOL�iogJ a�os�d�Pa au�°'o�P d uo�eii�os��ain�inqs oy;;�. :. . .. ; .. ... `�� . _ ._ .__ _ __.___ - puo�{iom ayi oP II'� i a4i su s�6om�.,� : . ____.__'_. _ .._.._ .._.....___.._ ' . '��� -. .. .. ._. . . . ... _. ._._. , � ' -� i 'a�o���ua�� :,ii;h� � . yu.M saa�o�dwa 6ui�o�A�iodoid uy��o�aumo so'� � „ � .::. . ,, .,.. � ..� � •� . ' .-__ —— -_._____ .. _ -_ ,.J ___ __ 'd'/Ob55/cant�up paar unq..�.�f unqYoluw�ou/u�111nuud-�-��. ' .� � . _ ._ ._, _ ' .. '_ ,. . �panwddy io - ..oN � soA. _ rr.,u�r,lJ�a�qJJ�,,��ur��(yr�s�m<.�Jo1.��ur,irJJraun _ .. � ___.__ -� __._ . ' .. .._._ ._ � _.pan�aoaye7oa.._. _ .. s� oitldy.. _ - _ poi�nbda.- - �' .�Y 5"lf�1L euqir���,u„rJr�„„�Auy•�r„�J,�a..��r�x���» . u�t�u r�.;ri ❑rrunfo�,ir lJwn�.�n.�� r��i�+� . . ---. .._ _ _____ ._. _. ._ ' -__ ...- , -- - ---.._._._- . - - - l f�' , l�llP / -17 77.f fP!'.9.-- -__:. .___._� ^i.. ... _ _. .. . . .� , r.T,', �,�.. ..,,. ,,.. .... ._, � . su,q��:y,�1dPu>,.:�upn�fa��r/,.f�u„��,ruQ!^(upp[ u„!r., . . -� r ; �. .., . .� � . ,�04�rn.n.'ui.irae.rdri�l/f 1.�p/ryJ).rirv/,»u r�e,�o��n.�t •• '1 I. _.__. __ . _. _ _____ .__ _.__. _ ...._ .._ ___ '.___._ __ .___. •uo� . . y,�,rno�Joc t u . . . ",�, � ; .�'-�.�. �aq�f�r .. / l7urnslnr/peruairJsi�ir��ryr.��... .. �. : �. ., i. . �, .. _ . .. . _.. lu.�e��.,�..�f]i.�ul�s v�)r�uJ il��u�t�l if,nJ Ir f tur,i)!Jr J�/+ '. '.�' '�� ' ��... I._..._J . ._._.._._.... , : .' '._ :_,.� _ f,'. , �l". iinnba�n jr'�,ur�rsn sr;n7�uuJ afnr�nl�.r n n¢uw.� - . ..� . .• . - . �q�quiu✓f:�in.�lwn fitJr-�•1>n�iv �iu77uuioJ� s.��inh�l ... . � . . �,elop . :oN ^eloO 'oN � q,�q.n.iium�.�o.4�>lu�� ipr�su n�a���dlu � nrrnr� .. . . . panoitldy�� . . (S�ICOL i�gl -uosov �6wMopo� oyf ib� ..,07 asua�i� � � . . � � . � , � . - . " �',Powniea �, � . P :°1 , s,�apoiwo)ayi woi��dwaxa wu�-ioyi w,ij{u Aqaiay� �� � ,�n��_�:2��;:�:�.���N.����.��nt�.2����,���Q... � 5310N S,M01�3dSNt 1NV�I1ddV Ol SNVId