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HomeMy WebLinkAbout1528A 1529A (8) _ i WORKERS'COMPENSATION DECLARATION � " � ��. ' � � - insurebor�afcertif co'te of Wo kers''Compensat oo Insuroncef /'1 P P L 1 CAT I O N �F O R BU I L D I N G �P E RMIT�� � �� , or a certified copy thereof(Sec.3900,1a6.C.) COUNTY OF LOS ANGElES BUILDING AND SAFETY coi�cyNo.�3wc005-2�7���}6 NATIONWIDE 61 C C � � Cer,if�ed copy is hereby fumizhed. FOR APPLICANT TO FILL IN i ADDRESS 23711 E. Goldrush Drive � Certified copy is filed with the touMy bullding inspeo- BUiIDwG 23711.E. Goldrush Drive I �tion departmenL � ADDRESS Dole 6-3O—S� � Applitont THE ANDEN GROUP atr DIAMOND BAR z�a91765 ! �ocnuTr DIAMOND BAR CERTIFICATE OF EXEMPTION FROM WORKERY � � � - - - NO.OP BLOGS. NEAREST � �� COMPENSATION INSURANCE - . SRE OF lOi NOW pN LOi caoss srDIAMOND BAR BLVD. + GOLDEN-SPRINGS (This saclion need not be compleiad if Ihe permit ii for one TRAR 43435 BLOCK lOT NO.J - ASSESSOR , � � - hundred do�lors(5100)o�less.) � � �P�� PAGE PARCEL awrieaTHE ANDEN GROUP No.967-9541 us� oNe No _� � I certify that�in Ihe performance of Ihe work for which this �►� permit is tssued,I shall not employ any person in any manner P,0. BOX 3329 - r� �E��A� - O so as lo become su6ject to fhe Workers'Compensallon laws. ADDRE55 6*aC7 CONDITIONS cirr COVINA ziP 91722 U Da�e �Applicanf - � ' � ARCHRECT OR TEI. DISTRICT GROUP TYPE fIRE MtOCE55ED BY O �a7.TICE TO APPLICANT: If, after making�thls Certifitate of ENGINEER DAVE SZANY AIA � No.445-4073 �pry�T, ZO E� f— ( 'emprion,�you shoold become svb�ect to �ha Workers' � � A, � V ..ompensation provisions of Ihe labor Code,you must forth• ADDRESS3IG N. FIRST ARCADIA 1006 ,v ', Jv !V �'-� wifh comply wilh such provisions or this permit shall be .� 0-' deemed�evoked. - . . . TE�• �, STATISTICAI ClA551FI�ATION APT. CONDO. t/7 coNTancroa'rHE ANDEN GROUP No, ��» �r�� Z UCENSED CONTRACTOR$DECLARATION � - � - � iiC.� C�ASS NO. OWELL.UwTS�L � I hereby affirm ihot I am licensed under provielons of Chopter 9 aDDRE55A5 ABOVE No.510560 (cvmmencing with Section 7000)oF Divislon 3 of�he Bu+iness and ��� SEwER MAP Pro�essions Code,and my license Is in full(orce and eHett. CITY CL4s5 - gK � VAIIDATION 50.FT. NO Of NO.OF CHECK � ucenseNumber�10560 ���.cia„S size z634 STORIES Z vnMiues 1 ONE � � VALUATION��. ComractorTHE ANDEN GROUP pa�e 6-30-87 ' oescaivnoN oF woaK SINGLE FAMILY NEw � �1 5 2$A S 157,000 �I am exempt onder Set. GARAGE 649 SF �A�� O , $�• • • •2� AItER B.BP.C.far this romon . . _. 'REPAIR � _ �. � � •�� �S 9 �- - Dote: USE OP ; DEMOL E%ISTING BLDG. � � � • •4.1 �,5 9� SIqn01Uro � � APPUCANT TEI. i fINAL PRINi THE ANDEN GROUP No. 0 9.1 1 �8 7 OWNER-BUIIDER DECLARATION - DATE � � f�� - �-�- � I hereby offirm thol I am exempt from the ContractorS Ucense ADORE55 AS ABOVE � � � Law for the following reason(Seaion 7031.5, Businest and - FINAI yy/�i/ Professlons Code): '� � � � '�� � _ ,- � ,, sY .O/�".'.ri� � eunoiNc . • . .�.,. � : ; � I, aa owner of the property, or my employees with _ a0oRE55 . , .. , wogee as thair sole compensotion,wlll do the work and i�p,��7Y � ' � i ' �1 5 2 9 A the etructure is not Intended or affered for sale(Sectlon , � 704a,Bueineu ond Profeseions Code). � r,�oviN� � � � - iet. � . - ❑ CONTRACTOR NO. ��� � � � � 1,ae owner of the proparty,am excluslvely controcting � with Iicansed tontrattars to can:lrutt the pro�ect(Sec- qDDRE55 i � � ��'7�•Q� tion 704a,Bwtnees and Profeesions Code). - , . CONSTRUCTION IENDING AGENCY - SEi BACK YARD HWY iOTAPROP UNE WiDTH - - � •b 7�.O O csi � I harehy affirm�hot�hera is a constructlon lending ogency for FRONT ' Ihe performance of Ihe wo�k for whith this permit Is lasued -� -c.�:� � - � �, � ' �- , � 0 9,1 1 -8 7 (Sec.3097,Gv.C.). St�E . . CITIBANK � v� Lender's Name � �- � � P.C.Fee s 418.59 � v�.m��F�e 664.50 ��Ref.N � - . : lender•s Addreis 444 S. FLOWER. LA 90071 10.50 � i certify thot I have read this applita�ion and s�ate that fhe _. . _. issua�ce Fee � � . iol.ts.we N � '� - - - _ above informotio is mrrecf.1 agree to comply with all County Inves�iqaiion fee � � q ordinantes a �ate lows relating to buildinq construction, . To�ai Fee� IDMA Perm.N � � ond hereb u orize representatives of 1Mis County fo enler � vpon Ih -m ed roperry for inspec�ion purposes. �� $75 - �' S3S ; � � - � � SFE REYERSE FOR E%►IANATORY LANGUAGE ' � � Signature of plicom ar A9ent . .. . . Oote . . . . . . . . . . � PLANS TO AFPLICANT � INSPECTOR'S NOTES �..U�t'ti1;ft.IlUl1.D1?H,.UICCl.ANA'I'10.\ . , t horrby afl�im ihnl I am exrc�.pi-hom Ihc Conrrnnp.' ,.. , ... .! ' ' - j '. . ' . . ,. ��.� i. ; � . To: . . _ _. . 1:. Refurned.j.'�:, , �� � � N �: "-�•License LaN tu the follo g .��oi �(Sec.�70'11 5; .. �+PProved ` � � Ilusmr�snrtr7lrlrsaons�(.od�.-Anyeiryns.uunh.ieL,ieb No. Dato ' No: ' . .'Dafe� ' •....� �. . .. �. .. -. i , �.,� rv yuirrs u pc rtu!f��tnnsln�U.dltrr.urrJ,rn�r.Jrnn,L�h . - . . ._ ._. u�rtf��u�rllnl'x7rLttr�r.�'.rrr�.1'/�itt(�ic. � ilGf.u�-�.r���(r�irPf I . .�-I . - . �. . i !. . .. . . , 1br appli:unf/nr sueh pesn�rt tn/r!r a�i,e��eJ stut�mrnf :-.. ,..,- �.:.� .:. .�, � :_: � '�' . . ' .. ..� .- . ._ -'... , tLu:�lir rs li:easrd/+ursum�t�u!Le pr r�'nns n/(h� Cnre= t.: '. ��,:� 1.��\:�. . tr�.t�v's l.ironsrl.au(Cl�Jpt��r)f(tu mrnun,r u•ilL.lrr- - ,' � .� . � .:, re ._ . __..__ _ '.. _.._ .. . �._ _ . __ .. __ _._._ _ _ . _ ... OOU fU j ! !J ' IP / � . .. :�_. (�...,�- . � ��._ �, ',J�._. � ' (.'��Je/or�elat/r'� nnrrtilrjnfruma�J��+lrhr�n..�i,r1le .._ ..____' ____..____ _ . _____ ...._. . . _.. . .._ .... _- _ _-_ _.�___.__. _ ._�'� '._ ___.... .._._ . _. r� -"- uflc,�rd r nepliun��Anv i�iolarinrt n/Se<linn ifl3l.5 l,�. `:.". .-, L. . .'. _'.Roqulred�'.; �`��,patonRecovedd�J _._. .'._._' __.___.__ .. .. _ . ,.. „ '? '. _ . . . ._' ._. __. � ._._. __. .___� . _- .. , ' , � • t � ' anrr . _..� un „�rr�.unrfnr p<rnulxvh1 � rb��lp6��r.,rr, f , Approvals PP� ' . ...penu!(�'�rfnn�nrnn'tl�ur�/na,h��ndrrJJ•�!l�rrs(cSpplJ�- - � -'Y¢i No . . .._ - � .. . . . ...__ _. .._ ...._.._'._... ...._:. .....---.... �..-.. - (_ 1,as owner of�he properPy.�or my emploYePs wl�h Wa!er Crrid�coie � �. �t l, .� -.. � . ,_..�.� _.____'_'___._' '.:._.. . ._�____.._ .. _._ woges om�e _ . . , as rhe r sole c sar�on.w�li do ihe wor�,and , - ... . "_.. .. ..:. ..�__.. ._._ �... . ., .. ,, .. . ., . . . ., .. . .. . Ihe s+ruUu�e is hot inien ed or of�ered�o�sale�Se:�70a4� .. Mcalih Depanment.._'_ ._ � "... .: :.�'� _._"'..-.__.'-. __....'_.___'___..'. ... _ . .�_. _ �.�.Ui tirirs.i�nd Pr/cvsiurts'CuJe:7�he Gnntrd.tr�r's 1lrrns<' ,._.__" ._.. _ . .___._. ._ .... . .,.. . � . . . - - . . f.a�r Jnr.v not u�+rlr 1n an riu�ner of/�rnfort�'irLn huilJs � ...,,��. ,. ., � Fire OePartment ...._._ .___ .—... .__ .. __..... .- . .. _ _. . . . u �nfrnrrs d rum,und u b d�e.c rr�!u�urk Fmisrl�nr . , . , .._ ���. .� i . .-,-, '...��, ' :�. ., ;,.., '...,,� .' . r, 11rnu,Qb�-.bu irn ernph� . �)rni•J�llfiht�,7 �l,i:.r;� . Grading � �� � � � /�rnremenh� arr nnt rnf�ndrd ur .//r d fn�.e�! � . . \'�� I.� . ,�i - . . . Lmreneq�br bnildin,e nr unprnrenu-nl�a snLt iri(/nr nn.. • . .. ; .�,..� _ _:1.� � .,: _.- ...._� .,. _..��'; Geeloy�ml . . .. . ��.--. . 7�ear �;r�,�mr�et�nn. �Fe oum�r.bnilJrr u�i!! bnr<�.tAe ' ' . i , '.: ' --.� ���%'..�� .� :�.,..� . .:.� '-. •r.�,� burJcn of prui�in,�11ra1 he Jrd nu1 bnild�.r im�rorr/n�r Pedesi,(n ProPY)ion-... �.:.'. � .-.,.., :. . _ . �'' . . _,.__ _'.._..__' '_„,�_ ru,��os owne rof rhe o en a�m exdvi�vel-ccnroo � UC ��rncr Cono �� . .., � - . ' _ _ .�' '..; ..� �% � P Y•._. Y ;:.. . -� �iny wnh�icensed coniraUors io cons'r�cf ihe p�ojea(SeC. .. . . . . .__.._.. "_._.' .. ',. .. __ __..._. __'_'_.. ._.'. . Special Inspeci�on..... �.. �--..:-... .. .� - - .' 1 . �: �' 70a41 Bi<siness mrd Prn/.r'oru Cnde: 7'hc Cuntrare�iri �Conc.)(MosonrYllWclding) � . . ... . . .. . � ' .� _._:'..��� , . .- l.rcrncr/.+mJnesnolappf7'fndi�nu�nrnufNnfesl��u�bn ,. ... , .. . .. __._. .._:.. . ..�. ..�_ .. .. .. ..huilJ.a�ir'imprures�tbrrcun,�axd u�1�a i�ntr�ch/��r�su.G lci 0ra�noge ' " �' �." : ; � - .� ,.�., _... . .. _.. pr jrcts,.v i11� n �nntrurt s/aJ G�rns !parsuant ln tbr '� ... .._.._.._.....-. . .. .' �.:-'._ . .. � . � '- Cnntrnrinr's Lrcon�e l.ni�1. � .- . . _-. - ' .. Po�k�ing .. - _ ..._.. _ .._. . _ .�.... .. . . ._ - _-... ...... ... .. . . .. :� . � �❑� I am e.empi under Se<. .H.&P.0 �o�ln�s . . .... .__._._ _..._.... ... ._._ .. , . .-� . . . ' � �� ..reason _. �_ � .. � � _.._.'.--`----__� .._ ___ .._. --._ . . � , � . . Oare Owr. . . . . '.. . . �. :� -�,. . . . .. . , � .._ ..._....._._ - . _ , . . . , � . ._ ..._ ... _.._ __.. .. _ z Approvolt Dole -..--Impe</or's Signoture . . ... � ... . � . . . - . � � . . �- �IhSPECTOR'S NOTES�� - lncal��on- . ._ ...._ ... . , , , �. ISerbock&Vordsl .... � . . ����/�����/' .� . �..� . . . ��'^.. Foundanons ' � r'1 . ..,� . , �, . .�; . ._. ,, i:',. :� ..�� .,. , . . . Slab ' ' � . . � ' � � � ' . . " Frame ' �� .�. • . . . . .. . . �..� . ' ' . . .. . .. . E�e�gy insula�ion -,J .� _ . �_ .__ . .._. .-. �._�__.___'_ _ . . .___..__,. �; � ..._ .., �.,. .�. �� � � � . Ill�. ,: . i_W , laih;Drywall.- . ..___ ' . ......"'.._____. ._'__'_'. _. - . , _.._..._... _ ��re,�o, �588�! .__. .__--- � La�h-E.re.ior 3 2`fToD ! , . . ' ' � ..: .. . , � .. . . .. . ._. � .:.: ..... ., ' "_.__. ... ..._ ..___....__'. ' ' ' n'� __. ____ __ . . � ,., .,:. HouscNumbc._.. . _-.— _._ . ._......_'__. _ _ , ,�.. , . __ _ _..... . _.. . . . . � .. � . Co�rec�8 Posied .. . . , _ . . . ',i _ . . . .._ . � FinoL. ..._ .,.__- ._.�� - . . ____. �.__ ..., ___ ____, .___.___ _ __ . _ _ Emer on Fron� . , ._.-„'- ...., ;.,� ,...,. • . �'_, . . . ,�. , .. �. , :. �.. - . . . , _ . . .. . . . ,_ ,. � . . ,, ..., �, � � < � .. .... . ... . . . . . . . .. . .. . . .. . . � � _ . , ,. \�r `�.�...`\ . . �\ R .. . . . i..- . .... , `�\�� .. ..:�� _ �\ � � �'�l\',`� ._