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HomeMy WebLinkAbout1552A 1553A _ _. . . - . _.__. � WORKERS'COMPENSATION�DECLARATION � � � � - I'hereby affirm that I have a certificote of�o�,e�,�o,a�, � ��� � �� qpp��CATION� FOR BUIL�DING PERMIT insvre,or o certificate of Workers'Compeneation Insurance, , or o cernfied copy thareof(Sec,3800,lab.C.) COUNTY Of LOS ANGELES BUILDING AND SAFETY voi�cyNo�3wc005-27�$�{d�6 NATIONFIIDE 61 C 3 Car � Cerritied copy ia hereby furnished. FOR APPLICANT TO FILL IN BUILDING 237ZG E. GoldTush Drive ADDRESS � Cerlified copy fe iiled with the co�my building inepee- BWIDING 23 � flan department. � ADDRE55 726 E. Goldrush Drive Oareb-30-87 AppiimmTHE ANDEN-GROUP C�Tv DIAMOND BAR Zii91765 DIAMOND BAR IOCAUTY CERTtFICATE OF EREMPTION FROM WORKERS' ' � � - NO.OF BlDGS. - NEAREST COMPENSATION INSURANCE SiZE OF t0T NOW ON l0T caoss si�iAMOND BAR BLVD. + GOLDEN�SPRINGS (This seclion need nol be complefed if ihe permi�Is for one ���� TRACT4343S BLOCK LOT N0.36 - � �ESSOR � hundred dollars(E100)or Ie25.) hMP BOOK VAGE VARCEI owNe�HE ANDEN GROUP TE�967-9541 us�o�e � '/�, I certify that in the performonce of the work for whlch this N�� K NO. �3 ri1 permit is issuad,I nhali not employ any person in any monnar 0. BOX-3329 / - sccciai . so as to become subject to tha Workers'Compensmion lows. � � ADDRE55p• - / (�� CONDITIONS 0 aTrCOVINA ziv 91722 v Date � Applicant � � � ARCHITECi OR TEI. �NOTICE TO APPUCANT: If,�pfle�moking�fhii Certificafe af ENGINEER DAVE SZANY AIA No445-4073 DISTRICT _ GROUP ?ypE FIRE VfiOCE55ED BV O Exemption, you should become sub�ect to the Workers' n CON57. �pNE F— Compansation provisions of fhe Labor Code,you mus�forlh- V wiih comply with such provisions or this permit eholl be -- nooaess314 N. FIRST ARCADIA 91006 �C) R:� /� 1 w deemad revaked. E ANDEN GROUP TF�' STATIS7ICAL CIPSSIFICATION APT. ONDO. y CONTRACTO� ryp, Z LICENSED CONTRACTORS DECLARATION ' �'� - � - ���, CtASS NO. �� DWELL.UNITS� I hereby aff�rm iha�I om licensed under provisions of Chapter9 aooRE55E1S ABOVE No510560 (mmmencing with Setlion 7000)of Divlsio�3 of the Busineu and . . . _ _ _ ��� SFWER MA7 Professions Code,and my license is in full force and effecL Ciiv CtA55 B - eK � -YAIIDATION CLOSE1� B ' . . 5a.FTZE73�i' NO.OF 2 NO.OF 1 CHECK ltcense Numbe/ Llc Closs SIZE STORIES FAMRiES ONE .. ConiracroTHE'ANDEN GROUP 6-30-87 oeseaivrioN or woaK SINGLE FAMILY N¢w � VALUATION, Da1e App a : 157�000 � �� 5 5.2 A ❑I am exempt under Sec. GARAGE 649 SF O ALTER 8,8�,C,for Ihis reaaon �• • • •G� - REPAIR � s ' Data: EXIST�ING BLDG. DEMOI. ❑ I •Q 1 8.5 9 S�qnaiure APP�pRINTT THE ANDEN GROUP Np, FINAL 4 �/ • •li 1 Fi 5 9� OWNER-BUILDER DECLARATION _ . - DATE :/ �JI/.76 � I hereby offirm thot I om eaempl from ihe Contractor'a Licansa qDDRE55 AS ABOVE � - 0 9.1 1 —8 7 Law for fhe following reason(Section 703I.5, Business and FINAL' �Profeulons Code): - - SY � �,,,�,. BUILOING � �, as ownar of ihe property, or my employeas wHh ADDRESS . ` wages a:lheir sole compensation,will do the work and � _ � � Ihe slrucNre is not inlended or offared for sole(Section �OCntITY ,� � � 7044,Business and Professions Code). � nnovuvG t ' ' � " �TEL. ' � � .q� �5,3� � 1,os owner of Ihe property,am ezclusively contrac�ing CON7RACTOR NO. , with licansed confractors to tonstruct tha pro�ect(Sec- �- ' - � $��+ • • �� ADORE55 tion 7044,Bo�inass and Professlons Code). , �' ;� ,r REQUIRE� 70TAL TBA :�f'� . `� I •6 7�J.�Q CONSTRUCTION IENDING AGENCY - Sei BncK YARD HWY PROP.IINE WIDTH � �.-/ � � I hereby affirm that there is a canshucfion lending ogency for FeONi 1 �• • d(�7 r�O�� the performonce of ihe work for which ihis permit is Issued P.�. . .� �•��+i � � �-,. (Sec.3097.Civ.C.). . SIDE ' , ��,� � �a 7 CITIBANK P.�. , � � Lender's Name � LDMA Re(.M � .../�','\• � �ende:s e�ddress 444 S. FLOWER. LA 90071 P.�.Fee S Pe.mit Fee � ; '• ' � I tartify Ihat 1 have road this applico�ion and sfate that tha ivuance Fee � 10•50 IDMA P/C k above inf6rmoii is torrect.1 agree fo comply with all Caunty tnvesrganon Fee q _ordinonces a �ate laws reloting to b�ilding construclion, 7o1a1 Fee 675.�0 IDMA Perm.i! and hareb o iorize representatives of this County to enler ^ upo�th - ioned properly(or inspection� 7 �p r'7 �S �� S�-�ELERSf�OR EXPL�NATORY LANGUAGE - SignaNre o pplicont or Agen1 - - pe�e ' , PlANS TO APPIICANT INSPECTOR'S NOTES .(1q'NF.It•liC4l.DF.H UI'(:I.ANr1'170�. I hemby affuni�thni I n e.e,npi I,om t{;d Cnnnncio.'s To: . Retumed . . l� ' ' '��:Licenxe Lo•.v�tur�rhe�,follnH.nq re�su•i �fSec. 7DJLSj . .�. .. , APProved 13usiae<cattd j r l��sainns(ndrrAnt�c�rt�r�r.��unh•ud�id� No. Dale No: � ��ale� .. . '. .. � �� , .�. , . reyuircc u perrrril!n c�nr��lrurL aGor,ir»pr,�rr,drnrr.liJr, � , _ .__ rcptiiruriviiructurc.prirrh,its-i.s:i3rici�.`Jlsi�roy¢r ; . . �...i i:�.��;.,i;� ' ..: i�:-�.:.:_ �`'. . .t ;;'� �'r-^ �. �I i^�F , . .., � ��be uppli:.�n�f suil�perndt!n/i!e a si,erred alatrmen� �.. �. �. • ur ..� ._. . - .. . -.'"" -". � � . .,tbu:Ge ir lirense•d unu.�+it tu�Lr inns n d�e Cou.. . �, �.,,,,, � . . . J.t��'J _.. . . . - tror�or:al.icensr/.air(Cl,app�r'Il/c'��nrn�rncrrt.¢t<�ilh.lr<�- �._ _ .. .. . .____ ' __ '. _. ___ _ '_._ . -. ___. _..._.... .:'!-__ _ ' - _ I . � ii,.t �.'. !.; . Non?UOOIn/pr:dviun3olfbelivain<�.n���nJPrnJ,nn�ns � .. . ____._. .......'_"'_ '_._ . _ ...� . .__'_'' . . ._.__. �__ ' '' . . . . _..___�_ ___.'. _- � ..'.', .. '�t��. 'CnJe/nrtlatbri�rxinifld•errfr.n�unJFho�F�urc/rirll�r �"-".. _.___ __'__ _ _ .. . � aNeKrJ rxumption.ilnv rinlariurt v/Se��ri,nr 7(13J.5 hr � ,.. . _ . . . � . - - - .._. . . . _ ... __. . __ equired ,". .`.,�. ., _....___.'. .___.. .__._._. .__.'_ . _ _____. __ un�appli:rnt fnraTrrnnf xvhlafs IAr.rfrLcartf fn d nri! - R --Dota Recerved: � ApProvals ..Yes No or Approv¢d; . �,i� ..penullv n�nnr vrorr,f/ur�/ir�.hundrrd dr!l�in(SSUp/.J: i .-� " . '.___ � _�_._'____.. .. ... .. ... ._.' _ .._; �..! I.as owncr o1�he o e � ____ . . . . . ` p� p rty.o�my employr.Ps wnh V:olr..CrrtiLmie '��� '< <� " ; �� ����� '� ...._.._ .... .._____. wnoes as�herr sole compensotion,wdl do the wo.4,and �_ ,. __._..___ .__ � ._. ' �'-�" � �"- "� �" �''� -'"�-�� "� � �� _ �,Ihir shuuure�s�noi��iended o�olfemd fo�iuie(Sec,70aa) . ,' .., . . '� � � � Hcalth�epartment _..__._ . __.. __�� __ � . .'-��.-' '..'_'... ..�._ _ ..... .'__ .. __.__ ...._._ . . . . __....�. d iuii•s.cunJPr�il�isrnncCuJe:7'FrCmitraofr,rili,enx� , - - -� i �. .- . �l.u�<�Jnrs nrit�upplv�r�Jn nu�nrr n/frnrorle�e�b.i Fuilds � Rre DePanment__.___. . ._. ._. _.. . __._ ..__- __. .-- . . ._._ . _. imprr ••� bern rs�a d �rs� ri �imcr!/n t n �! J ! 1 r ' ' ',;�1 r_4 , l..I . ' 'i� . lGrougL"hu mrn r cin/�fu1 s�/roi iJ ! el ut.auah iml�., Grnding _ i � , .. � : .Arnrrrncnh are.nnL inlrndcd or .�/rrrd Jur.au(o. fJ� ; . ' ,.. . -�� Gnurorr.tbr builJin,e nr i�nprurenirn!h su1J u•i!l�irr nnr- Geeloy¢al'.�\ ..-. �� �- - _ '� �- --- . , . . ' yrur nf�mmpf�•linn. tGc�uu�nrnbailder �rrf!bar��.tbe .... 1 . � �� �..'� : '� �__-. . . . � ..,� '. I>urJrn��/pror�rng r8,d f�e J1d noi h,�ilJ or i��nro�r frir . , . . ----- -_-� -._._ .--- - - - . , , .. � - - . ._. ., f'edesinan Prateciion �...-. .. . , .-". . t!e/�ur/�nse n/t�Irl. �..,. . ,.� (Frnce){CnnoPYl �� �:� -.' ---'--' - "-�-.---�- ---- -. -_._:-.:�. �_.'.�' _:.- . � ���'�.'I.as�owneroltheproperty,omeK<lusvelycennnc� '" Iing with Ikensed contratlors to mnstruct ihr.p�o�ecr(Sr.c, SPe.wl Inspeclion_. ! _ `'_.. _.. : . . .. - . -rf' .'_�_ .___-; .._._-_""_. ... _ . , 7044�`Urasiriess unJ Prnfcseinu:c Cude:�bc ConUurenr's _ (Canc.)(Masonry)IWelding) ,. . . .... . _ ., � . : --.. .. .. . ' .. /.irensefa���Jnns_nn/�nrl}�fn�x��wuerrJprnfertvu•bn .. . . ._. . . .._..._ ... _ ._ ...... � --builds nr"inrpi�irrs Ibereon:-and u�Ln rnafrne[s/nr�sai! lot Drama9e � ' .�;i,'��%[ • � �..__ '_'�.�._ __': _.�._.....�'._..'. . _ _ _'. . pr jrtt; a�it!� inn�r�otur(sl liirnsrd,fr�rvuanl �u 1br . . . . I , '--L/�MiY�Ii I�I�T 1,ICPIl.iC f,�tl!'�. . . . �. Parkiny .r . . ,__... . . ."'�.-._. .__� . _ _.___ ... ..1. .. . __._ . � � . .. i�� .. � . - ❑ I om c,empr undc�Sec. .8.8P.0 fa•lh�s . . ', � . '_ '__._,-.. __ _-.' _ �.'c� .�' - �eason . . . . _� . .. . . ._ ..__. ... � ,�.. .____ _ . . . _'__. _._ . . _. _ ... ..� � ..,. Dore -Owne� . . , � i. �• � � ' � ' i, . Approvals Dalc ; Inspactor's Signafurs, � � � . - - - � � .. INSPEQOR'S NOTES ,� -�� _ . . . .... . . . _ ,_. . �. locahon-� .. ._... . . ..._. ,. . (Set6ock 8 Yords) �� ' ' � � ` �'^ Foundmions ..._ _ _. _ .__ . _ .. ..._. .._ . _._ . �� c' � ._ . , . � . .. _�., �a•z-�z��. __ _._ ,, , _ ': ' ° Slab � • � �"� . Frame �L�� . ... .`. , . . � . ., ,- . .. . . � Energy Insutai�on , . . . � � .. �-, . ..�...,. . . . . . 3`�R __ , _ __ _ __ __ '_ _ ._ _ - , _ - � , ,_. , Lath�Drywall-- ! -_."._ .�_... _. _ . . � . . - . ..._.. ____ '... ___. -. Intcrior� �-/S lEV '_ � _ . . _ _.- � , � . , - ' , __{. � ' _ � Lo�h-Ex�enor �^'Z-pD' 4 . __�_'_ _ . "_ I _... __ _._.—_.._..__ __.__-L -._ ' HauzeNumhe.__ ,.� _...-'_."._ '..__.__.__..__.__ ._....� • .�. . . . � � ..., �:�. � ,. - -_ Conec�&Pos�ed " - . . ._. ._ ___ _ . _ . . Final. .__ .._�_ - __- '__ . _ �� . .. . , .______ _....___ .t _'_.__-_ _'_..._ _'__. , Ente.on Proni ��,-: , ,. . , � . . . , . . . . .. .. ... ... . .. . . . . . ., . ". . . , �� . ,. . . . . , . . ..- .. . . .. . � . . . �I �^�..`� " .. .. � , � , '\\ . .. . . .. . . . . .: �.. , ,_ .. . ." �� . . '. . ��-� .. � . ..�. "_ �- _ ".•.t;!._ .�.�` .