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HomeMy WebLinkAbout1530A 1531A WORKERS'COMPENSATION DECLARATION „ _ � - ' � '� �" � �� — -� , � ��,ebY otf,.m that I have a certifica�e of�o�5e��,o Se�{ APPLICATION FOR BUILDING PERMIT insure,or a ceni4imte of Workers'Compensation Insurance, , , or a certified copy thereof(Sec.3800,Lab.C.) �� - � ' � � 73wc005-77O— n'6 NATIONWIDE 61 A COUNTY OF LOS ANGElES BUILDING AND SAFETY PolityNo. `Cotn�rty� � � Cenified copy is hercby fumtshed. FOR APPLICANT TO FILL IN ADDRE55 23731 E. Goldrush Dtive � Certified capy is filed with the counly building Inspeo- BUIIDING 2 - � �ion deportment. AODRE55 3731 E. Goldrush Drive Date 6-3D—H� qPP���a�� THE ANDEN GROUP crtv DIAMOND�BAR ziv91765 �ocnutv DIAMOND BAR �CERTIFICATE OF EXEMMION FROM WORKERS � � NO.OF BiDGS. � NFAREST � COMPENSATION INSURANCE SIZE OF lOT NOW ON l0T caoss srDIAMOND BAR BLVD. + GOLDEN SPRI S (Thia section naed not be comple�ad if the parmir is for one � TpA� 43435 BLOCK LOT NO.12 �ESSOR . - � hundred dollors(5100)ar less.) � �P���� � oAGE PAR�L owNeRTHE ANDEN GROUP nio,967-9541 � z E 1N P i�� /� I certify Ihot In the performance of the work for whith Ihis �— NO. �7 permit is issued,I shall no�employ any person in ony manner pppRE55 P.O. SOX 3329 .svean� . � so as to become su6ject to�he Workers'Compensation laws. � � �C� CONDITIONS � aTr COVINA ziP 91722 v �are Applicorx � � � � ARCHITER OR TEt. �yOTICE TO APPLICANT: If,'afler making�fhis CertificalB of ENGiNEER DAVE SZANY AIA r,o.445-4073 DISTRICT GROUP OPE FZIRE GROCESSEDBY � ! 'emption, you should become subject to the Workers' - - / � V ..ompensation provisions of ihe labor Code,you must forrh- poortE55 1 i� ��3 �� W with comply wifh svch provisions or Ihis pe�mit shall be . . . . (y deemed revoked.. � TE�• STATiSnCAI ClASSiF ATION APT. C NDO. (n coNrancroRTHE ANDEN GROUP Na. ..�—I z LICENSED CONTRACTORS DECIARATION � . . . ���, _ MSS NO.' DWELL.UNITS_i_L . I hereby offirm Ihot I om licensed under provisions of Chapler 9 ADDRESS AS ABOVE No.510560 . (commencing with Section 7000)of Division 3 of�ha Business and ��� SEWFR M4P . . Professions Code,and my license ii in full force ond effect. CITY CU�.55 � � � BK � � -- YAUDATION - 50.FT. NO.OF NO.OF CHECK ' licensa Numbe�10560 Lic,Class B SIZE 2634 STORIES 2 FAMitiES 1 �ONE , � � � � � . � VALUATION �, � ControctorTHE ANDEN GRQUP pa�e 6-30-87 �ESCRIMIONOFWORK NEW S 157�00 GARAGE 643 SF ADD � , ❑I am exempl onder Set. � ALTER � '� 5�O A 6.8P.C.for ihis�eason REoqiR ❑ s � � - �r• •• •2� USE OF Dafa: -EXISTING 6LDG. DEMOL ❑ . 1 •4 1 S 5 9 -� Signatura - �� � A7ttICANT � - TEL. FINAI ! - vawr THE ANDEN No. OWNER-BUIIDER OECLARATION � DATE �/ �� � • �4 1 8 5 9 csi I herehy affirm that 1 am exempt from the ConiroUor's Limnse ADoae55� A$ ABOVE Law for the following reason(Setlion 7031.5,Businass and F�NAt �,,� �9,� � —8 7 Professions Coda): �� � '� ��- �� � ���� Bw�oiNG ," BY �j ��� � I, os owner of the property, or my employees wilh qoortE55-'� _ , � wages as Ihair sole compemation;will do the work and -- ��A iT� j" � ` , the structure is not intended or offered for sale(Section . `� 5�.� � 7044,Bvsinees ond Proieesians Code). - - � MOVING tE�. . - � � I,os owner of ihe property,om exclosively conlroding COMRAROR NO. � �• • • e •,� wi�h licensed wmrocton to mnstruct the pro�ect(Sec- - qDDRESS � � � � tion 704d,Businas and Professions Code). � ��,� �1 ';y S', C �+6 7 ra�� CONSTRUCTION LENDING AGENCY SEi BACK YAR� HWY T�TApROTP IINE WioiH � ' � I heroby aftirm that thera Is a construction Ianding agency for fRONT � "� � � •�'7 5,��c=.o �he parformance of 1he work for which this pa�mit is iesued P.i.� . . ' �� .- . • � ' �9.� � —fj 7 (Sec.3097,Civ.C.). SIDE � . � � � CITIBANK v.�. Lendar's Name � . tender'sAddress_444 S. FLOWER. LA 90071 G.C.Fae S 418.59 pe�mn Fee . 664.SO IDAM Ref.N � � � 10.50 ' I certify that I have read this application and stafe fhat the iss�ance Fee �DMA P/C M . above Iniormafion is correcl.I agree lo comply wifh all Couny Imest�pa��on Fee $ ordinances and e laws reloting to building construction, . ro�o�Fss —675.0� lDM4 Pe.l.M � � � - -- R and hereby ze represen�olivee of this County to enter � upon the v rioned pro erry for Inspaction purposes. g 5 G� �G�J��� � S!! [ItIE Kbll E%ttANATONY LANGV�I�E � Signoiure of pplicam or Apenl pcte � - � � � � PLANS TO APPLICANT INSPECTOR'S NOTES � ��-O�l'\IiK•IiI�ILD1iR DIICI.AkA'17UV . I h Ly off 11 t I �n c �t h If .Con� ..�cr's � To: , ,. . . . Returned .' � , �i � �1,.� ',.Li x :l v f �Y . iollo y cn u. � (Sec. 7031 Sj �,.APProved ' Ilrit�neccund 1 ralr�vms 6ndi.Ilnl'a!1 nr,�iunfti u l�ic! .__ .., . ., . ._. No. Dale � No. . '.�`,�alc'. .� ... �. :. ..�..� . � 1••. ,.! ... i , -.. ;. , nyuir�•c�f�•rnrr((n<nristruaf.✓Ifrr,nrrprv �.Jrnruln!•, � - — .. . . . . ,_ .. -__ . rf/,ni unYi/rurb��re./�ri.rloihissuaxa<.�a�snrryin . _-_ i . j,� . .. � ' . " . � ��/r✓/,�,li.ent fnr u:h pri.nit�n/i!r a s;�nrd ab.trm�{rv� , ., , ,. � .� c,., . .., .,, ..� .. .,.. �c --- - -- . .._.._ . _ . �---- � ---� - --..�.. . ._.... .._. ., .t1 a�.l�is licrncrJ pur>uane tu r/,r fn�'e�inne n/rhr('ni�� � ��: !'1 i�� ;� :t_�i��_ � tra.Yar'F l.irrn.r leir/Cl.eplrr'>l/�Vrirnienrin,q a��i�L Ser- ., ___. . _. _ ._____ _. - ._. ... . . :. ... __ _ - _._._ __ . _ . c; . . ;. .. . - .. � ; � � crn non IOOUJ r f!) i n!th��!iu ' <<.,�nJ ProJ�a „�� � � � '• �-�� ... �! ' -��-.1 .G��drJnrthetl a..�'.��pttl�.rrJr,�mundlhr/.nclafr�rtl�a r- . ___._ . ._ . �-'. . _ . _. � . _ .. —.__ �_._. .. --'_ - '- . . . , .. . a!lrRrd.crcmplinrt:Anv��•ruldnor�n/.fe�tinn:P31.S h�. '�� � � �� '�Pe uired�' �� �•.,, �,. . , �• _ .._._ .____ ___.._ __.._.__....._... ..._ eun lna.ir•il ._ . .�.....- •.Q ---DnfeRaeeived � ..... ."-- �� - un�a/�/�L��en(/arnpernuesuhfrclafGenPf4 I '; APProvole or Approved. �� _., � . �, "., .,. . '-�-f�nalet'n/rrnt mnrr t/run/'rc L�endr.�d dnlfurs/55(10/.J� ;_ . .� � _ _ � Yes No _ ... ... ._."__ . __ .. , , . ____ r -.., -. .. _ ..._'_ .._. . . __ __.__.._._ . , j"Jo'e�_Cert�fimie C' ��.� -� � ���. ': �- •.) . __.. :._... _._. __. _ _ . .. ... _ .___ _. ..� woges Psnhe�`r aole compenzan n.w II dn hela.o�Ls.and �- � ��. �he shucture ii not intended or of(ered fo•sale�(Sec.70d4) � iieal�hDeoonrnem-_... '_____.. .__ '..���._%J �.: .."' '. -._._.. __ . . .._.. . _ ,. ^. ' ..._ . -:Ui�tinrssundPrn/ruiurisCuJe:TbeCnnfrdrtar's/.i.rnre � � _. ._ ._ . _.__._ .! ..�. .,-, - , l.ou•Jn��nnt h � t I (J� ��� FI.rDe.pu�tm�ni_. ..____ . .._ _.: _..._.f_.i__-.. . __ orim�nairctJ rr rsrunJi 4 d ,�!r� �k!`r ..!/nr , ` � .� , _ - . . ,..'�. � \, . ; � ... � .. ; .•. �'. '� : �llroii,�b-�bis �un ru�pf�ti��.�.�prnuJaJ-tbJt�ru.l�.rJ� G•nd��g.,;��,�1 I �.`..i J, `y' �- .j'..i .,,. • �.•.. -. . � :-�prorementc�,are nnt i.rirndod nr ul/rred/ur snh�.�' ' " �':;- ��Gnuwrrr,fbefiuilJinXnriniprnnen�cntir«�lJ�eit/r�inn. � ' ,__ .. _ __ . ___. . .-.. �.- __._ � . .._. . .. __ _ __ .. .� - ' ��..:�.. . Geoloyltnl-. �. . . ., . )'rur r�'cnnrpfclinn, tbc�uu�nrr-/uilJrr „•rrr�n�„��� :r��• �, '' �•. .. `�.'` � ._. ._ _. ... .'�� `:__' '_.t'.:':. :-'�_�.�._'. � ... r11cn n/1�rnrin,�dmf bc Jid mr�breil.!or improro(nr hrs .__'-�-.�. �. _ �......-- � �' ' tfie pu fnrc o/iulel. : � � . Pedestrion ProleU�on . , - ' . - - . � � "�. `, �", �. .� ... .' . . � .. : ... IFence�(CnnoPY) . .. �� � i .-.... � . �_ .__.______'....___ _ _.....__. .-'..� ,�...•r��, I�, � prapen-,ame.clvs�vrl .. �sow c�ofthc� � .y c�nao- _ _ ..._._ ,._�'_.- ��_ ._ _.._._ _ .. _.. .." _ ;I�ing th Ilcensed conlrnctors ro Consautt ihe p�o�ecl(Se:. -.. . �-�- "" 704t Uusinev dxJ Yro%�s��nc�Cudv: 7'6c Cnn�rna'tnr's SFeual InzPec�ion '. . ...-. .-�_ ._. _� � . , _ � (Co.+c 1(Masonry)(Welding) :�� � .' �� .. .' __ ._. , . . . , . : 1 ' ._ . . _ r.;«�n,.<•r.�r<•d,��s�„r�ppr,r�,.�n���„��.,�p.,����.r,•u t,,, _ - - -.._ _._ ..: - ;;��.�'.'.�:.�' , . huildc-nr irn�rr�ros}Licrrnn,anJ u�/�n?untrncfs/ur xu.Jr � .. ... . . . .. _ Lo�Droinagc � ��'�� ��''_: ;' � � ., .'-- ---'... . .--... . � . . .-.--_ -.-. prejcrtt�uith,a cantraefar(aJ liirnsr<l�ueauant m fh� . " � . �--'Cnnlra.r,ir'r I.icrnse l.ai<•l. - � - -' . , � t.: , . , , �;:�� �, � .�.. i- ,. �, Pmking . . . . � . . -- _ ._____. .._-_.__ ._ . . .. r . � � � � �_I I om eRempi unde�Sec. .6.8P.0 lor ih�s _ ___..._ _..___....__._ . . �.. . _ reason . , .. . �. __, _ . __._ _ .___ . . __. . ___"_ _._.__ "___ _... '_'.___ _':. �... _ ___ . �-.__. _ -. .._ "_'__ Date O � . .. ... , . . . , __ _ . . __�_ . . . , . . ___.__.. .__�_ .__i__ _ _ ...._ , . . . ,. _ ..._.. -� . .. ,� . , „I . �. ,- , � ._...... ___.__.. .__..._ ... . . , . Approrals�. Dote Inspectois5ignature "-�� � �� � � ���- � . ' .. �� . . �- - - ... '..�' INSPECiOR'S NOTES ' .. � , � lncu�ion- � ....._. .__: . ___.. .__'. ._ . . .. ISerhn:k 8 Yards) _ - ...__. _ _ ����-- : �� �� ' ., r � �. � , . , i f'i'� _ � ,- Foundotlons , ,..� _._'_._ ___.____.. _._._. -___._.. . ____'..��'.__ ... ..� .. : 6 ��.:'. '., . � . �. ... Slob , . . . .-..... ,.,.� . , . . , .__'__'_. ._-_ �_._.____ .-__ __ _. ._. � _. . ..,... ..i �...,�., � Frame . ' Z�/�.� ��� � .: . . . . ; ... . . ,.� " l.��... . � ,, .. . . �{ '_"'_ _._"'.': _.'. ...__.._:__.�.._. _._. , ' . . . ,, .. � Energy Insulation - f i ,- :. - ;. . : . .n; r. . ...., .y � .,�!. _L� � � - , .... _._._'.___..._.....____ . _. _ . ._..__.._ __�. -. Laih;Drywall.. . .. . ....�. ,�� .�,.. ,/� , ___.__ ... ._.__ ..._, .. Imerior �! G� . I � . . Lnih-Ealeno� r .. . .. . . ___'. _—_ _... . _ . � . _ � 28'Fs� -—_ __ _ ._ _ .__ _ _. __ Hause Numbrr .. , . .""_'_ . . .__ ..___. ....__._ - � . .. ..___._._._ i ' - Correa 8 Posied � ---�� - � . � , - :: .. ; _�.. .... ..i__ F�nn�.. . _ ..___... . __.._..._._ .......I . . _ ' , .. , ..__.. __._____.._. ,. . � Enier on Fronr - - � `..' , � ,-. I�� � - . 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