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HomeMy WebLinkAbout1550A 1551A _ . _ WORKERS'COMPENSATION DECLARATION � � .�' . � f� I hereby affirm Ihot I have o cenificaie of consent�o=e�f � . -�— -- A�PPLICATION FOR BUILDING -PERAIIIT � � �� � insure,or o Ce�tifica�e of Workers'Compensation Insurcnce, L� or o certified copy�hereof(Sec.3800,Lab.C.J� - ' � . 73wc005-2 �Q,�6 NATIONWIDE 61 B 3 Car �OUNTY OF LOS ANGELES BUILDING ANO SAFETY ��YNa. �2�s Certi(ied copy is hereby furnished. FOR APPLICANT TO Flll IN ADDRESS 23738 E. Goldrush Drive � Certified topy ia filed wilh the coumy 6uilding inspet• , BURDING 1io�deporlmenl. ADORESS 23738 E. Goldrush Drive Dme6-30-87 Applicom THE ANDEN GROUP �rtv DIAMOND SAR ZIV9176S LOCA4TY DIAMOND BAR � CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BlDGS. - NEARESi � COMPENSATION INSURANCE � Size oF l07 NOW ON l0T ceoss siDIAMOND BAR BLVD. + GOLDEN SPRINGS (This seCtian need nol be tomp�eted if the.permit is for one - Tqqcr 43435 � atocK - �oT No.35 /J�qP OOK PAGE PAR�EL hundred dollars(5100)or less.) TE� I carlify�hot tn Ihe performance ot the work�for which�his � owNer�HE ANDEN GROUP � No967-9541 � �N� �P �/�,3 ef permlf is issued,I aholl no�employ ony person in any manner SPECIAL �. ADDRESSP.O. BOX 3329 0�� CONDIilONS so as�o becoma subject to the Workers'Compensmion Laws. - - U crtv COVINA •ZiP 91722 �ate � � �Applicant � - � TICE TO APPLICANT: It, after makin �fhis Certificate of ARCHI7ECT OR 1EL. DISTRICT GROUP TVPE FIRE �ROCESSED 6Y O � 9 eNcweea DAVE SZANY AIA No.445-4073 eoNsr. z,9eiF I— emption, you should become subject to�the Warkers' - 1 ,I V �ompensmion provisions of tha Labor Code,you must forth• qDDRE55 f� 3 �� !V �T a . with comply wifh aoch provisions ar fhis permit sha�l be . . . . � TEL � STATISTICAt C1A551FICATION A7T. ONDO. [A deemed revoked. coNTaacro�HE ANDEN GROUP No. ,.{_� z LICENSED CONTRACTORS DECLARATION - . . . �i�, �M55 NO. � DWELL.UNITS_{.._ I here6y affirm Ihat I om licensed under provisions of Chopter 9 aDDRE55:�$ A$��7�; No.5105fi0 (commencing with Setlion 7000)of Division 3 of Ihe Business ond . _ . . ���. ��R�P. Professions Code,and my license is in foll force and affect. CiTY GLnSS �BK - � VALIDATION �10560 B s°e��2634 s"Toa°s 2 in°rn°�s 1 CONE� ' License N�mbe lic.Class - � � � VAWATION � COnlra[torTHE ANDEN GROUP Dale 6-3O—H7 DESCRIPTIONOFWORK NEW ' ADD � S 157,000 � , �� 5 5 0 A ❑I nm exempt�nder Sec. GARAGE 649 SF � . • ALTER . �• •,Z,� B.BP.C.for this reasan � REFAIR ❑ s � � � � DO1e, � - USE OF � pEMOI � �•�1 8.5 9 E%ISTING BLDG. - Siqnalure - . . ... APPIICAM TEL. � FINAL ./ / • •$1 8.5 9 c=i OWNER•BUILDER DECLARATION PRtM E DE RO No� .DATE .//��/�' ..1 hereby affirm�hat 1 om ezempt from Ihe Con�mcror's License qDORESS AS ABOVE p�Nq� n � 0 4..1 7 —H 7 law(ar Ihe following reoson(Section 7031.5,Businees and �+ Professions CodeJ: � � - � � � - � � � 0Y /� =��^""� � �, os owner of the properry, or my employaes with nDDRE65 �. � woges as their sole compensarion,will do Ihe work and �p�q�iTY � • � . � � the srrotture is not intended or offered for sale(Section �� 5�� A 704a,Boeiness ond Profeuions Code). - � — rnovirvG �� '��ie�. � � -� ��- � - . � I,os owner of the property,om eaclusively cororauing CONTRACTOR � NO. �F.• �` • ' .� with licensed controetors to tonstrocl tha projed(Sao- qODRE55 � � � � � � � � � tion 7044,Businass and Professlons Code). - ' , ��j �.� S.! 1 •6 7��Q REQUIRED iOTAL TBA K � J .. � CONSTRUCTION IENDING AGENCY �- �� Sei enCK �ARD HWY ppOP.IINE WIDiH . + . ! � o �(��J�O d� I here6y affirm ihai there is a conatruction lending agenty for FRONT � ��„;�� ,-�{�-.�•-. � iha pedormonce of Ihe work(or which�his permit is iasued � � V.L � •� O 9.� � �8,� . (Sec.3097,Civ.C.y. SI�E � � CITIBANK o.�. �-: , '�' '.�'�:� Lender's Name � ' P.G.Fee S 418.59 ve�mu Fee 664.50 ���a�r.« -����- �.` .c�, ` � Lender's Address 444 5. FLOWER. LA 90071 � 10.50 � ' � I cerfify that 1 have read this application and slate iha�the . iseuanes Fee �DMn P/C k . . � obove Informatio ' mrrecf.I ag�ee lo comply with all County Inveetigation Fee 675.�0 $ ordinances a � le laws relating lo building mnstruction. . _ Total Fee LDMA 7erm.N � � - R and here6y u rize mpresentatives of lhis CavMy to enfer . � upon Ihe e ' roperty for inspectionpo poses. Q L�DMA $75 �•x $35 [! Sf!REVlRSE!OR EX�UNA70RY IANGUAGE ~ S�gnaturo of Applicant or Agen� pote .. � . . . . . PtANS TO APPIICANT INSPECTOR'S NOTES „ O}l'11iR-Ol.ql.l)I�.It UCCI.i\RA7�fUV I hereby affnm Ih�i I om c.em.p�fro���+he.Co���o:ic�'s To: �i '. . � !, Refurned . - � - - ' . � � Li<e� e Low 1� the��foll-,�ing recnon' (Sec.'70JI�51 . ApProved ! . :Hr c..��xdl r!.� .m.rC d�:.qnvcil7'nr.uunt�'���Gic/ No. Dafe No. ' Oatc . .. � :..' ' •.!` : . � .• . . - -'� r,-. rrq irrx�Trr u!n cnnvrurt..rl�rr.un),r,�r�.d.�nn,(c�b. .. ,_.. ,.. . ...... ., .. - . �. � . .. ---irry,uirane.clructurl�:rrivh��ti&:uaei[e.�.+lsnmqur . .,. i.t, � . . . . � = the�pplicJn�fnr sd:h p��rndt tn/i!v a si,qrirJ xt..ernr�ve� <, _. . � ..�, , i . .. . ., ,, , .�„ . „ . - � . . . �. ._ .__.__ �-- ._.. ___ .__ _. .._._ - .'... ..._..__. . ' tbat/rislicrnsrdp�.rsuer�ttnl6�•p ni„ns,�1L� (:.n�. . ...i.'... � ._�ir_'. rm��nr's).in�i:r�•!.«,•rc,����,�.»kr�n��n�-anain,qu•itPS��c�' � .. i :.���� . �..� .,�. .. . .__ .__ . ___ _._. .-- -�- --- _. . .--- - - .-_. ..__� .. _._ rr,.n 7000��,f U � ,�� j„/d,r�t�.�t., hd l�r„, �„�� ; � (�..�-' +':.� ' ' : .,�,���:. .. iJrJ�nrlball�.aecmpttberr/im+� JtIr66in{nrd�e ...._.._. ____. ._... ....__ . _ . _._. . ...._. .. � ..__.__.._ .__.,� �-_ � . ___ ___.. .. _.. .. . . . -..�, � . aAc�yrJ crcmpfi.�n.Amv�•l��latrn�/.frrri,���.:U31.5 L}. .- � . .'.__. �_-' :.'RoQolrod_. -c` � "'__.. ..___...., .,,:..�. .'__._ . . __._ _._.. antdp/�G.-dnt/araJ�ernuftuhjr.:L�thrappl�cnnitna:i��il � Dato Roccived � Approvals or Approved �. . .... . i .; , , � ,TenultV n{nol nrorr tbun/irr bu�dnd do/(ori/55U0/.y , _•• ..-Yes No .. _ .__'__ ____. __.. ___ . . - '� . ...... ..:_. ._ _ . -. .....' � �_� I,as owner of rhe p.bperty.�o�my e�nplayc��w��h W��e�Ce•��ficare �• �-�.� � . . � ...�.. ., - .. !, .� � ;woges as ihe�r sole comp?nsnrion.wdl de the..�o.�.and . .._ . .- .____ �_....._.__'_�_ .._ .__. _ _. ._. � .._. . . _ __ _- _"__. ..._.. . . _' , � ' ' �, �hc airucture is no(iniended o�off�red for sgle(Sec 70a.71 � ! � Heal�h Deporrmen�-�- ----- � ` - ' '�,"` .------ -._. _ - -----.--.. -- _-.�.. . .�.-.. .- , Busiarss und Pru/cssir�uc( J< 11.L�i ir��fo s 1 .rnse ..__. .. ..__ . __.__._. � _ . � l.au�Jn��nr.�upplv�r��x nnmrr n���,���.�,ie L,-Guild�� � �.,';._.� ,� i ,�. .. . , ; ._�e ___ ' , ., _ ,-.-, _ � _, � . . - or :)r ��! rrnn.anJ.eliA �<ea�liuor/l�ir .�r!!nr p _ ._ ___.. . . . !. . . , F De onm=n� .. - , i � . ..,.-, ..� : �. .f!nu,�G�brs�nron erupLq� Jru su p...r. � . rrJcJ ll.�i l.r � Grod�ng � . . , � prne•cmentr•«rc nnt infrnd.•d or;oJ/r.��d/nr.rnlr. . • ( ���� . (�nu e�er,-tl�e buifJeny nr imprnurn.ent rc a��fJ i�•rtl m uri. , i „ �. . , _ . ., ._.___ ._. . - - - - -- ....._. . . , Geelog�tol. . ., �i . .. . - ..' l•r r ��7� /de.tiun.�fl�• nunrr-huilJ�•r'u�ilf/>ne•�tlre � .. .��,.�. _-"--_ -. ;:, `..�.'_' '" �` . , .......�. :, hurden nf prnrm,;,/hn!be did n�,t Fueld nr irnpn rr/• . .. t! rurf�ir n/ !.).�--� . .. . � , � . Pedezinan�Prmecnon ' � �� ' �'�' � � ' '�I � �.I,osa�+neroflhe ert omc+cluv�ei conrr�c� (Fence)ICanoPYl ' . ' , _'_ ._ ' ___ _.__... _ .. . . � '",,. P�oP Y. Y � .ting wdhlicensed coniroUers to cons+ruU,rhe pr��ec�(Sec. . ._:.._. � .. . ...� ."'_ _ __ _- .-__ ._.. Speual I sPcuon " . -. .:.- -- '- ' . ; ' -�.- 7044)B 'nnsi and 1'r.r/�.sr c C.,J� 1! Cnntr��lnrs {Conc.)1�.lnsonrr)(Welding) � ' ..__ .. .� '. l.icrn. 1�u�.J,,,-s R„���rn r an n�rr /p oPrrh u�hn .. . - - _ ___ _ ,. -�, � . � . ..hurlJs�nr irnfrores tbrrni� ,ui�J�e�L�:i'i�onrra�tv/ur u�l� Lo�Dra�nage "�. "',�"� ". � � �.. ` .. .. . .... .. . �.. 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