HomeMy WebLinkAbout1512A 1513A (8)WORKERS' COMPENSATION DECLARATION
Thereby affirm that I have o certificate of consent to self
Insure, or a certificate of WorkersCompensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No.73wC005-2Z2fRQ46 NATIONWIDE
Certified copy is hereby furnished.
Certified copy is filed with the county building inspec.
Ilan department.
Date6-30-87 Applicont 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.)
I 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.
Date Applicant
(—NOTICE TO APPLICANT: If, after making this Certificate of
! ixemption, you should become subject to the Worker.
Compensation 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 Numbe> 10560 LIc. Class B
ControctorTHE ANDEN GROUP Dale 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):
r—ID 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. 3D97, Civ. C.).
lender's Name CITIBANK
APPLICATION ;FOR BUILDING PERMIT
,e ,a COUNTY OF LOS ANGELES BUILDING AND SAFETY
Lender's Address 444 S. FLOWER LA 90071
I certify that I have read this application and store that the
above informal' is correct. 1 agree to comply with all County
8 ordinances tate laws relating to building construction, __.
and here thorize representatives of this County to enter
upon th a ed property for inspectiGon LDMA $75 _ $35
Q Z SEE REVERSE FOR EXPLANATORY LANGUAGE
S�gnarvre o Applicant or Agent - - Dote -
FOR APPLICANT TO FILL IN
ADDRESS 23746 E. Goldrush Drive
BUILDING
ADDRESS 23756 E. Goldrush Drive
CITY DIAMOND BAR ndJ1765
ocAurr DIAMOND BAR
- NO. OF BUDGE. -
SIZE OF LOT NOW ON LOT
NEAREST
CROSS 5>DIAMOND BAR BLVD. + GOLDEN SPRINGS
43435 BLOCK LOT No.34
ASSETRACT
MAPSBOOK SOR PAGE
PARCEL
OWNERTHE ANDEN GROUP No967-9541
UtJ?7E
/Odd
NO % 3
ADDRESSP • O. BOX 3329
CONDITION$
CITYCOVINA zip 91722'
ARCHITECT OR TEL.
DISTRICT
GROUP
TYPE
ENGINEER DAVE SZANY AIA No.445-4073
3
CON
0TEL.
ADDRESS 14 N
L:L
ANDEN GROUP No.
STATISTICAL CLASSIFICATIONCONTRAao�HE
CLASS NO. DWELUNIT
LIC
ADDRESSAS ABOVE NO.510560
SEWER MAP
-
- LIC.
CITY CLASS
- BK. - PG. -
VALUATION
VALIDATION
$ 1, 2 %i
SOEFT.2774 STORIOF 1 NO, OFF 1
CHECK
DESCRIPTION OF WORK SINGLE FAMILY
NEW
®
: 164,000
,
4----P1
ADD ❑
GARAGE 643 SF
ALTER
Q
1. 4 3 1 0 8
REPAIR
t -
• • 4 3 1.0 8:
USE OF
EXISTING BLDG.
DEMOL
FINAL
0 9, 1 1-87
APPLICANT TEL.
PRINT THE ANDEN GROUP NO.
y
ADDRESS AS ABOVEPRESENT
FINAL
sy ��
BUILDING
ADDRESS
_
.
1 5 1.3 A
1. 6 9 6 0
LOCALITY
MOVING -. ( .., ` .. ` TEL.
CONTRACTOR ` NO.
-
s -69600'.
ADDRESS
w, ....., 1, L. I . I
O 9. 1 1 —87
SETCK FRO:
T BACK YARD HWY TOTAL ROP LINE WIDTH
FRONT
P. L
IDAM R.I. N - -,' -''`'`
SIDE
P.L.
P.C. Fee $ 431.08 Permit fee 685:50
10.50
Iswance Fee
1DMA P/C N
Invevigation Fee 696:00
Total Fee
IDMA Perm. N
L�
. 01VNF:R•BUILUIiR UECI.ARA'I ION
PLANS TO APPLICANT
INSPECTOR'S NOTES
-
I h .reby ofd h i l a r• e �p� f I e f'o r o cr's
To: �'
_
`' ..
Returned
i
IN, {olio g ran on '
'L ce sc Law f hi' IS- 70 1'5,
.
•Appraved
•� �
„•
us rrs nnillr 's f:nd,: !!nr 'tt rinfs+htcG
No. DoleData
•,-
" ` " -' `'--- _
r • urns u r trait. hr c >rnrrm t, ✓4, r r J ,lobo
.
__ rprir anbstructurr;pnur t•, it, issa' ,'also n•yrnrec
,. _ -
fl r app/i<✓nt for rail+ purnrit fn JrJr a srgrred st✓te.nrut
lirrnsrr!/nrrsuant t.,. theprovisi,ms o/ fbe Coin'
tot's /. ruin• /.air((:hapirr 9)( nrn+enrin.c rvifh.1'rt_
tion 7f100J n/Un+r-n jo(tbr liu< - and Pr ins
r
'_!. drJ,ir That l •+s gar nip! N•crrJr.rnr u J tfri• F:r<ic/ur thr
n11 ,L rd —!p.t A v -r /µtion , 5, t e 7 r 1.5 by
/ (3
- '.'
:'_ '! '
Dasa Received •
_ ,_
-" _-'_'' - - --- -
u 7upp4 antf apt n + htcsn rl ry/pl r !t ✓ iril
Approvals
Yoagvired
f' No. or Approved
,. ,... I t
':pe uAr,of not or- than /ica 1—dr-,d dollare (S500).J;,
'}darer Ceridim,e
-._.,_ :,.
l _ 'y i<
I. os owner of the pofe,ly.o my employe rw 9i
, eir sole compe saeon, wdl do the wo e, and
-' _ -. _-�- ___ - .. _
_ ,.- -
...._.
,
s of iondedo o77,c*f i,s 11-', .70441
ff-ed
......,Decor
nasal urne'
J Pf l limns (nda.7lr<'G r t actor's Li,; se
Lau- Jnrs not app/s- n, an nu—n— nJ p pa tv ry n hui1.L
Fire.DePartmem
imp rnra c III crrnn, and erho docs curb umrL {•irrne!/nr,
- - nu h -his. ow-ri !u a rin-J J thin sri I in .--,
it X p c •es /,
:.,.prnsrmenh
Grading__.
.. �., _. is `.•i
or _. not intended pr ,J/ rd /nr -h, 1/r
' a •:
t! r
•., ( - - :., j : n
.. (Inf1'rirl'r, the baildirg rir i,n/ f v-,nt i,fnlJ wilh, r nnc
eoloyiml --
. ..G
=Tear nf�cnmplatinn, Jlic nu-ner.br+i/drr.u'ill bate the
burden n/prnvhi j:• that be did not build or imProve Mr
Pedestrian
tJ` ,overt•
(Ca..py)
----
jail,+asdwnc�(Fence) oF the dme Jusly
-Iinu with licensed controctors to constfucr tfie pip ject (Se!
SP—.1 Inspection.__
�_,.. ..__
..--_. .-, ..: _..... _�.., ____... _. -. -,., ._._ _.. -.. , _.
7044) Business "d Prn/es rfrnes-Code: 7Lc Cr,ntr✓etori
(Conc.) (Masonry) (Weld,ng} ., ..
.:: ... , . _
Lucnm- l.an• doe: nor apply to an nrrnri i f p-prrh• u'hn
..-..,,.,�
_..__. _
__..builds or7rnp"rrs't/rrrron,and tio rnnlruds Jur su:h
Lor Drumoge
l: ''r�','"';.._
._'.. -_ __. _ -_
project,. u.itb a contract r()/<rns / f rmauf m for
-contLicense t.au J.' -- -- -" _
Park mg
';,,
,-. � ,. _... _. ,-.. _. --__.__. . ...�, ..
__._ __.
- ❑
-.
I am exempt under Sec. . .8 &P -C. fo, this
•.
.�
reason._
Date O
-
Approvals
Data Inspector's Signature
- -
'
INSPECTOR'S NOTES
(Setback K Yards/
Slob"PQ
Frame
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..., .. - ,... :.
.: .;.-. -,..
Energy Insulo7on
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La!h-Exlerr
-Exnew
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Correa R Posted
Enter on Front
- -