HomeMy WebLinkAbout1498A 1499AWORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.) '
CalicyNo.73wc005-2�&MW 6 NATIONWIDE
❑ Certified copy is hereby furnished. r
❑Certified copy is filed with the county building inspec-
tion department.
Date 6-30-87 Applicant THE ANDEN GROUP
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one
hundred dollars ($100) or less.)
certify that in the performance of the work for which this
permit is Issued, I shall not employ any person In any manner
so as to become subject to the Workers' Compensation Laws.
Dale Applicant
,, IOTICE TO APPLICANT: If, offer' making this Certificate of
r emption, you should become subject to the Workers' "
.-ompensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be
deemed revoked.
LICENSED CONTRACTORS DECLARATION - -
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and "
Professions Code, and my license Is In full force and effect.
License Number 10560 LIc.class B
ContractorTHE ANDEN GROUP Date _6-30-87
❑ I am exempt under Sec.
B.BP.C. for this reason
Date:
Signature
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and
Professions Code): '
I, as owner of the property, or my employees with
wages as their sole compensation, will do the work and
the structure is not intended or offered for sale (Section
7044, Business and Professions Code).
❑ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec-
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
Lender's Name CITIBANK
Lender's Address 444 S. FT.OWF.R s LA 90071
I certify that I have read this application and state that the ...
above information is correct. I agree to comply with oil County
$ ordinances and 1e laws relating fo building construction, _
R and hereby ize representatives of this County to enter
UPC the roperty for Inspection purposes.
Signotura a PPlicanl or AgentDate
APPLICATION FOR BUILDING PERMIT
7S /R COUNTY OF LOS ANGELES BUILDING AND SAFETY -
FOR APPLICANT TO FILL INBU
LDING
ADDRESS 23725 E. Goldrush Drive
BUILDtNG
23725 E. Goldrush Drive
[ADDRESS
Y DIAMOND A z1P
Lo 111NO.
OF BLDGS.
NEAREST
OF LOT NOW ON LOT
CROSS STCT
ASSESSOR
MAP BOOK
PAGE
- -
PARCEL
43435 BLOCK LOTNO.
TEL.
OwNERTHE ANDEN GROUP NO. 6 -
us�,zo�E
%%��
OP
- '3,
cIr
ADDRESSP.O. BOX 3329
SPECIAL
NS
CITY CO INA zIP 91722
ARCHITECT OR TEL.
ENGINEER DAVE SZANY AIA No.445-4073 -
DISTRICT
j a
GROUP
iZ.3
TYPE
CONST.
FIRE
-ZONE
V
PROCESSED BY
ADDRESS
ha
1
TEL
CONTRACTO;THE ANDEN GROUP NO.
STATISTICAL CLASSIFICATION
CLASS NO. � DWELL. UNITSJ_L
APT.
CONDO.
LIC, �
ADDRESSAS ABOVE NO. 16560
LIC.
SEWER MAP
CITY CLASS TZ
-
BK. PG.
VALUATION
VALIDATION
SO. FT. NO OF NO, OF
SIZE 2774 STORIES 2 FAMILIES 1
CHECK
ONE
DESCRIPTION OF WORK
NEW ID
ADD
= 164,000
Poo.
GARAGE 643 F
REPAIR O
DEMOL
$ - -
FINAL�,/�-
:21 49.8A
9 • • • • 21
USE OF
EXISTING BLDG.
APPLICANT TEL.
PRINT NO.
DATE/��/Y"iJ
FINALPRESERT
byi..�
..
( • 3 1,0 8
ADDRESS AS ABOVE
BUILDING
ADDRESS
oil1
LOCALITYMOVING
TEC
CONTRACTORNO
, f'
/
�• •`,
4 9. 9 A
• • • e 1
) -69600
ADDRESS
REQUIRED TOTAL TBA
SET BACK YARD HWY PROP, IINE WIDTH
j -
1
LDMA Ref. Is
..
• e 6 9 0 0 0 c�
09.11-87
FRONT
P.1.
D.C. Fee $ 431.08 Permit Fee 685.50 -
10.50
Issuance Fee-.
LDMA P/C N
-
l—e.gmmn Fee
696.00
T
Total Fee -
IDMA Derm. N
LDMA $75 $35
SEE REVERSE FOR EXPLANATORY LANGUAGE
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