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HomeMy WebLinkAbout1564A 1565A � WORKERS'COMPENSATION DECLARATION . �. � � � n I hereby affirm ihot I hove o ceriificaie of conseni io=e�f - �- � � - �APPLICATION 'FOR- BUILDING �PERMIT �j insure,or o certi(icale of Workers'Compensation In:urance, , or a eeriified copy thereof(Sec.3800,lab.C.) � - � � Pouc No,�3wc005-2��m��.6 NATIONWIDE 36 B COUNTY OF LOS ANGELES BUILDING AND SAFETY � Y BUIl01NG Certified copy�s hare6y furnishad. . FOR APPLICANT TO FIIL IN ADDRE55 23717 E. Goldrush Drive � Cenified copy h f�led with the county bvild�ng inspao- BW��wG 2 . tio�department. ADDRESS 3717 E. Goldrush Drive Date6-30-87 Applidant THE ANDEN GROUP aTv DIAMOND BAR ziv91765 ' toCntRv DIAMOND BAR CERTIFICATE OF EXEMPTION FROM WORNERS' - � NO.OF e�DGS. . . NEARESi COMPENSATION INSURANCE 512E-OF LOT NOW ON LOi � � CRO55 SIDIAMOND BAR BLVD. + GOLDEN SPRINGS (This aection need nof be complefad if the permit is for one -- - TR,y�43435 ' a�ocK l0T NO.1� MqPSgpOK PAGE PARCEI hundred dallars(E100)or less.) . . TE� - I certify fhot In the performonce of thc wark for which ihis � OwNERTHE ANDEN GROUP - - NO9G�-9S�i1 ��j�N� pP �7�,�j } �` SPECIAL permit is Issued,I shall not emplay any person in any manner AooaessP.0. BOX 3329 �Ol1�� CONDiTIONS �" so os to become subjetl to the Workeri Compensation lows. "� - � � U cirrCOVINA zir 91722 Da�e - ApPlitan� � � pgCH�TECT OR iEl. DISTRICT GROUP TY7E FIRE PROCESSED BY O + �OT�.CE TO APPUCANT: If, afrer making�this Certificate of EN�iNEER DAVE SZEINY AIA N0.445-4073 emption, yoo shovld bacome sobjed lo Ihe Workers' � ��� � � a ..ompensarion provi3ions of Ihe labor Code,yau must forth• qDDRE55 �D �"3 winc �omply with such provisions or this�permit shall be . iEL. STAiISTICAL CIASStFICATION AF7.' CONDO. (A deemed revoked. �pNTRncrolHE AN➢EN GROUP r�o. ,,�/ Z LICENSEDCONTRACTORSDECLARATION . . . . � IIC. QASSNO.�DV�LLUNiTSLJ._ I hereby offirm that I am licensed vnder provisions of Chap�er 9 ADDRESSAS ABOVE No.510560 (commencing with Section 7000)of�ivision 3 of Ihe Business and . . ,���, ��R M°'P - Pro(essions Code,and my I�cense is in full force ond effect. '� ciTv GlASS' � � gK � � , VALIDATION � ' � 50.FT. NO.OF NO.OF ' CHECK . License Numbe�10560 � uc.ela:s B size 1658 STORIES 2 FAMItIES 1 ONE � � � VALUATION CoNroctorTHE ANDEN GROUP� Dole 6-30-87 � �ESCRianoNOFwoRc I E ILY �"EW � S lOO�OOO - � GARAGE 456 SF . Aoo � , I am exempt under Se�. � AITER B.BP.C.for�his reason �'REPniR ❑ s �1 5 b 4 A USE OF Dofe: Ex15TINGBtDG. -DEMOt ❑ .�. • • .2 1 Signolure � . � APPUCANT - 'TEL. FINAL 7RINT THE ANDEN GROUP No. _/�8 I •3 1 6 8 4 OWNER•BUIIDER DECLARATION .,.DATE . . � 1 hereby oifirm that I am exempt from�he Contrador's Ucensa qDDRESS AS ABOVE ' FINAI � ' • • low for the following reason(Section 7031.5,Business and 3�1 6 8 4� - _ Professions Code): - � � � � ���- � � � -� � - � SY � . � BUIIDING - _ , p 9�� � -$7 ... � I, os owner af Ihe property, or my employees with ADDRESS � woges as their sole compensotion,wlil do the work and ' � � - ! � � , � � � the structure Is not Intended or offered for sale(Sectfon ����T��� �-�' " � � ���' . � � 7044,6asiness ond Profeseions Code). � �� MOwN�' -� ' - ' 7E�. y, - � � I,oe ownar of the properry,am eacluslvely contracting CONTRACTOR �� NO. with licensed controttors�o conurutl ihe project(Sec- ADDRE55 � � � �1 5 G 5 A lion 7044,8usiness and Professions Code). : � � �,i ;;- � CONSTRUCTION IENDING AGENCY - - SE�BnCK �AR� HwY TOTAPROP.L�NE WIDTH ��. ' ' � ' #• • � � •� I hereby effirm ihat�here is a construction lending agenry for FRONT -� � Ihe performance of iha work for whith ihis permi�is Issued D.L� � . � - -� � •5�7.Q� (Set.3097,Civ.C.J. � SIDE , lender's Nome CITIBANK - °.�. • °5 0 7,0 0� o.c.cae s 316.84 Pe�mif Fee 496.50 �oM4 Ref.M O 9�� �"8 7 lender'snddross444 S. FLOWER. LA 90071 ' � 10.50 I certify that I have read this applitaiion and state fha�the ia�ance Fas IOMA P/C N abova informotion is correcL 1 agrae lo comply wNh oll Counry invaeugaiion fee . q ordinances an te laws retaling to building canstruction, _ ioial Fee �j IDhW Pe.m.M Q and haroby t riza representotives of this Counry�o enter � upon the lnofld.Properry for inspection porposes. � A `��� �/� - � LDMA $75 $35 : SEE REVFRSF FOR EXPIANATORY LANGUAGE Signarure of Applimnr ar Aqent � Do1e - . .� . . PLANS TO APPIICANT INSPECTOR'S NOTES � ��-OR"\IiK-11UII.UIiIi ll!`.C.I.ANA7'IO\ I h�reLy aili.m Iha'I am c.empi 6om ihe Comr�:tar's Tm i . � .. . .. Returned �. . ' ',' ! . . •'.� . ' �:L c . c�( .� ( �ff c.fol( - ng re so '�(Sec�70�7'S; � APProvad � ��.�lir�sinrsannJlrnl.cxinnc(.nduAttyat�nn��untt+��hi./ No. Dofe No. '. ,.'�ole . ' '. ... . �' �.�.. . rayuir�c,�p�rmit ln cnnifnrct..�flrr.iuyn��v..drnu,lixh. . --- - -'---- -- � ��' -� ur��),ni.unV.cr�ultriie�/�ri,��b;it�-ic���:dn�r.rL.nri�yr.r.��� � .:l . .-1 '. __' �. _.. . . . . . 1br oppfr.w��/nr sre.b pr nt ti�/ilr o s{pnrJ xt..t.-rr�e•ni ,... : . . .�i . . - .. . .:' _ •-�� � . :-., .,. rn , ._ ._ .`.- ...'__. _. .. �. _.___.. .._ .._ _. _._.. .___. . ...tbut Gr is li�rnsrJpursuant�u tL�r prn��.�iun c nJ.�/r(:..rr . � �� � • • '�:.';:.�..'��,� .t� �:',�,_. . . . -...fru�lur'sl.irerurl..�u• <.l,d,lrr7 �. ..:5 (' J .1/�rurrrriennn�,uiN�.}cr: __. ._.. --_. _ _..:_ . . . . .. . . __. . ___ ... _ . __ ' _ � ,... �,i.' . � ., � _ f...-I ��;j r �..i sur .. /inrt i(1(1(1//l) 1\ir�n i��%f(�r/111 � t tc ynd f'rr��r�lrr�lts __�_ _ .....-_'-_ --'. . -- . ., .. . __._ . __ . . . �- � �CnJeJor�tl,JtL�i. x����ttlrrrJr.,munJtb�R��<�i�Jo.tLe - . __'._ -. _ . .--. -�� u!lr,qrJ rxcnrh7irin.An9��•inlatinri nf.lertinn i113I.5 R�. �.., . ._.� • � .�-... - .. eqvirod ..I.�-� �� - .�� _'_. _�. .... -.._.. ___ . . _ . _. nn�a li.Nnt b crnu�trrh�ilrthen H��infl�r�.i�i! ' A ovols _ .. . ��.;Ye�s No or�Appro.d•.. . ._._ .. _ .�.G.___. .__ ._-�.. � . . � PP for !' / J PP rs(SSOUI.I PP[ ... � rnallyn7nn�mnrv�lL�a rri lnandreAJn!!u __ — . �� � [� I,os ov.ner of rhe p op.riy_'o�my emPlayces wrtF WSPr.r Certihcaie.._.. _�.t_�_ t �__.. . � � ,•...: ...".'.� ..,_ .�.. _. .___.'_. ..... '. .. .......... ..... wagr.s as ihelr sols Componsai�on.w�ll de ihe,,.�or4.cnd � � , �the srruUure is nor intended or offercd for sale(SqL 7044) ` �. Healih-0ePonment- --__ " �. : .•.. .. ..-....__.'__ _..____-_. . .� ��_�__. ._�._�-..... .�.. �:. 13�irinrssanJPrn/essioasCuJe:Tbe.Cnrr7rJ.tor'�l.i:ensr .._.._ . _ . ._ ._ _. _. ..._. � � . � . .. l.au•Jnrs noe affl���o an ni<•ner n/proper�v trL.�Fuihla � F�.e OePortment .... . . ..... ...._.. .. .. . ... . �. :��; . . e� � j �. n�anJ d e ! � � � �1/�,r : ,.. _ t! �/ �<c i rA 1 . . .' �. � �...i f .! , p:; ` �:�..��: , � .:- . '" � .flrae�,�!.brs.. i n ernp!t .�rrn��l�J-tlut. !�inti. r i Grod�n -�_, , � ' �, "- �r i � . .rrot rmenlr�are nnt infrndrd e.r�u/frrrJ Jnr:s! �-� ` 9 ' ,, � ��• , � . . ,, ' < <.���; � ', . -. �nu ereq�be br.ildink nr i�nprnnement is.�nlJ uYtl rn orr. '.._ � � , : : , .` ._ _. ;�.._.. .��.) '� , Geologiml �� . � .. .-' �,."-� . ... '. ". . �•�'r n��eunr/>lrtinn. fbr � aildrr �r�l!hne�'the ' ' � �_ _" �, .'.' �_' _'_ �'_,.' '_ . rn�iu,�Nmt brAid n��/�aifSnrinrprm•��r 1 _ - .. � burJrn nlh . . . ._--- --- -.'. . - - �n��pu,p,,.���!��d�l.• . . .. � . PedestrionProtecuon . ..''. '.�. - �. . .. fFence)IConoPY) � ' ., '' ��-t. .�.c.�.��.�..... .-�'�-._._.- ��': �..�.'.! :.�'�"�.... � � � �.� I,as owner qF the p ope.rty;am e duslvely conir�r.� . . _. . .. ._. ..._�i_._ ._� _. .__.___._._..__ _ _ling wilh licr.nsed controcto�s Ia construa the pro�eU�Sec. Speclol Inspec�ion -_ - .. -. . - � - -� - 704t1 ISusinetv arrJ/'rnlrsaianc Cnde:7he C�iutrort��r:a �Conc.)(MosonrY)(Vlelding) . . - .:�: .,_�..., � -..__.�_ ' �_.�..__ �.. . , . .... !u�n. �l.u�v J��er nnl uJ�plY fo un i�q nerrJ fr,>per(}•u�!n . .------. .. _ _. _. .. _. . .. ___.. . . ... ---- � . ' huifJs ur im�rnres lbomun,onJ u�Gri<�bntra�lr Jur suri . . �. . . ' .. . . .. .. . ... LolOramoge. � . ;1('�i.(;� : � ,._.... _- ,. •..... ..._ _�_.._.__._..__..... /�rlects}mdtl.acnnM✓ttnr(s/lrceuardpursuant (ofle - . � ,�'•; .._Cnn(ia:lnrkl.i:ensi•l.riuJ. . _. .__ . . � Pa.k��g � . ... � i. . . ._......[.I I�m e.empl unde.r Sec.�� . . ....B.&C.0 fo�ih�s . �. � ' ---. ..__._--- --- ' . . � . . rcason . . ... .- .. .. . . ._. . .... '. ._". . _....._._ � .. .' -_- .__..____ . '_. . ... _"__' . "____'""_ _" .. ..__.-._"'_____.. . _ . __ . Dale O . .' .... ,. . .., ._.. _ . � . . ' i. �� � r` ..� i , . ,.- ,. - .... . _.._ ____.. . _..._ _.'._.. ._...r "_._.._.___._` __ ._._ ,. . . , .. ,. . APProvais . Dato Impedor's Signaturo P�� .'.'�.�..' f.., � � � ;� . . , ..'...,�� ._ . . . . ...... . . . �. � • , . ,� ..,�. 'INSPECTOR'S NOTES �'- �� � '���� . Lo<ollon._. ._. _ .., ... . . .. .. . . .. . . ...._ . . .._.. -_ (Setback B Yards) � , :-__r _.. ._ y/} , � � . . . . _.:. _-.___ ..____..1_" V. � . . , ,. voundaGana � . � ..2.3 Op-- � -, - . `:,,� ..;•� . � .,,. ��. .-......� , .. Slob Fromr � . . . . . . � �f_��,,. .. � . . _ . . . . . . Ener ' '_'.____... : �_.. __.._ __..._.'. _.._. . _ � _: �. ._ , . _ 9Y Insula�ion - �. . . .. . . ...... , ... �- . �. ... . . . .. . � �..._, Lnth:Drywall- . .—._-...__.___'._..____ '..___. ..__._. .. _'_ - . .__. .__..____. � i I :: � � t..� . Inlarior ,��.. �,y�,Q!._'_" '__ ; I � � , .. . I s�✓.J Laih_Ex�er�or ���� ! .. . ' .. . � . . . .. . . .. . . .__._.._._._._. ._._.. _._._-_ .. - ., _-_. �j._._. _�.�. r ':�� . �� . --.r Hause N�mbe._ ,� . -...._.. ._. _ . . .. ___.. .._'__ . � . r . . . � � ._._ � __ .__ .._._ . ' •.� . ._ . . Correu 8 Posied '� ' ��- � ._.� . _�.:._ � � �.`i . ' .. J .�_._ _ .. _ . . Final - ._ .__ _ � .. . ._____._.__ _. . _.� _. - . _"_..__ ......._ ___ •. . _ . _ En�er on Froni . .. n, .� . 1� . � . ��. _ . .. �� ,. ._ .. . . :., ..' . . .. ... . . � , - .... . , ., . .� . ... . .�. . . _..,� ". . � -. ... .. :. . . ...� . . . - .. . ... . .�r \�" � . >.,.-.�. �.l. . . �:.. �.. . . .. �`.\.0 �,.. \:\� \ \ . .. :�.. �. . . . .. � ..�.\: ._: .. . ��