Loading...
HomeMy WebLinkAbout1580A 1581A (9) WORKERS'COMPENSATION DECLARAiION . . '� �. � � I heieby affirm Ihol I have a ceriifiwie of consent to=e�� � �qpp���CATION ����� FOR BUIl.DING �PERMIT � insure,or a certiiicate of Workers'Compensation Insurance, , o.o cerrified copy thereof(Sec.3800,lab.C.) CpUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo.�3wc005-2��m��6 NATIONWIDE 31/B � Cernfied copy is hereby f�rn�shed. FOR APPIICANT TO FILL IN BUIIDiNG 23751 E. Goldiush Drive ADDRE55 � Cerlified copy is filed wilh the county 6uilding inspec- BUILDiNG . tion department. nODaE55 Z3751 E. Goldrush Drive Date 6-30-87 qpplicont THE ANDEN GROUP �iTY DIAMOND SAR Z�P91765 ' DIAMOND BAR LOCALITY GERTIFICATE OF EXEMPTION FROM WORKERS' � � � 5¢E oF�Oi � NOwON ioTS� � CROSSSSTAIAMOND BAR BLVD.-��+ GOLDEN SPRINGS COMPENSATION INSURANCE � (This settion nead nol be completed if Ihe permit Is for one TRA�43435 BLOCK LOT NO.15 �ESSOR , h�ndred dallan(5100)or less.� AM7 BOOK GAGE PARCEI owNeRTHE ANDEN GROUP No.967-9541 u z Ne �w+P I cerliiy ihal in the periormance of the work for which ihis �g NO. � �3 .S permit is issued,I shall not employ any person in any manner qDDRE55P•�. BOX 3329 �OO d D COENOITIONS � so os to betoma subject lo the Workeri Compensation laws. an COVINA ziv 91722 v Dafe � Applicanl ARCHiTE[T OR TEL. a �TICE TO APPUCANT: If, after making-ihis Certificaie oi DAVE SZANY AIA G45-4073 DiSTRiCi GROUv C PE FltiE a�toCf55Eo Bv O � 'mption, you sho�ld beeome subjeu lo'tha Worke�i EnIGiNEER NO. / p `] _.mpenso�ion provisions o(the tobor Code,you must forth- qooriE55314 N. FIRST ARCADIA 91006 I�1 r13 �i/v ( W dith comply wi�h such provisions or this permit shall be , _ p., eemed re�oked. HE ANDEN GROUP 7F1' STATISTICAL CtASSIFICATION AP7. ONDO. (q CONTRACTORT NO. � Z LICENSED CONTRACTORS OECLAR.4TION . ���, C1A55 NO. d� DWELL.UNiTS �I I here6y affirm that I om licensed under provisions af Chopter 9 ADDRESSAS ABOVE No.510560 (commencing wi�h Section 7000)of Division 3 of Iha Business ond ��� ��R�P Professions Code,and my license is in full force ond effecf. CItY � - Gu55 $� � BK � � � VAlIDATION �10560 g �EFT.l�gb NO OF 1 NO.OF 1 CHECK li[ense Numbe Uc.Clasi - S70RIE5 FAMIUES ONE ' VALUATION � ControciorTHE ANDEN GROUP po�e 6-30-87 DESCRIPTIONOFWORK SINGLE FAMILY Ap' O s $9�000 ❑I om ezempt�ndar Sac. GARAGE 445 SF ❑ , "��R 21580A B.BP.C.fof Ihi3�Bason REPAIR � S , _ Da�e: u5e Of � �r • • • •2� EXISTING BIDG. DEMOI � Si nofufB - ' AP7�IC.4NT - TEL. 9 PRIM THE ANDEN GROUP NO. FINAI r f •2 9 0�0 7 � OWNER-BUILDER DECLARATION DATE j 3 'a I heraby affirm ihaf I am axampt from the Controcfor's Licanse qDDRFSS AS ABOVE � � • °L��,�7� law(or the(ollowing reoson(Section 7031.5, Business ond FINAL " ' irofessions Code): � �- � - � �- � - � , By � . 09.1 1 —87 �, as owner of Ihe property, or my employees wiih A�DRE55 ���'� � wages os fheir sole compensalion,wiil do the work and , � ihe structura is nof inlanded or ofiered for sale(Section lOfAli7V , 7044,Business and Professions Code). MOwNG � - - iEL. '� � � � I,os owner of IMe property,om exd�zively conlrocfing GONTRACTOR NQ �"1 5 8.1 A with licensed coMractors to mnstruct the projecl(Sec- ADORESS � _ � " tion 7044,B�siness ond Professions Cade. � ' REQUIRED TOTALSETBA K ` + � :-%}� :t'�i'� �*• • • • • � CONSTHUCTION LENDING AGENCY SEi BACK YAR� HVJ1' ' fR07.IINE ' WIDTH I �4 5 7,5 p � I heraby affirm Ihol�hera ia a conslruUion lending agency for iRONT i �. - � ' Ihe performance of the work for which Ihis parmit is issued D.L � � . ' � o�_5�,5 n� (Sec.3097.CW.C.)• SIDE . '.` 0 1 1 �87 lendariName CITIBANK � � � � , . , O, Lender's Addre:s_444 S. FLOWER, LA 90071 o.e.fee s 290.07 permit Fee 447.00 �°A""R°f." - ' I certify fhat I have read this applitalion and stete 1he1 Ihe Issuance Fee �DMA P/C M ' abova information is corract.I agrea to comply wiih oll County ���a��;9a�;o��Qa . ordinances a �a�e laws relating to building conslruclion, ra„i F,a -457.5� IDhW perm.M and here6 a orize represematives of Ihis C nty to enter � up th • tioned propeny for Inspe on rpose�. L�I'��1 $75 $35 �' � II SEE RlVERSE FOR E%�UNATORY IANGUAGE . � Sipnarore af Applimnl or AO��� Date ' PIANS TO APPLICAN7 INSPECtOR'S NOTES �,�>«���-�t-ISI�]LUP:N UI'.(:LANA'I�ION I hr.rci:v��f!�rm�hoi 1 n em.p�frcm ihr Con�•aror's To: '' - � . � , Returncd . . � : � .. ' . . , f -L,e �c l�w i� fhe.tollow ny r«ason (Src 7091 5) � APProved ��� �4• . .Iir sinrsv and!r{!uu�ns CoJr:Arsy'.r(ti�ur..run(t'u•he,l; No. Dafe �lo. � Datc .•�. .. ... . ,..}3 •._ . �.. ... rryurrrs a/�rrn�il lurnqstrneL-altrr�-impror<�.d��rnnli�lr. . . . . . . . --- ,rnpar unrs,.k�tu.��.f.;,.t;,;ts-i.ir,;in�.�.'acs��.r�,ru ...,,i-_r, �.,;. i�::f�, :� �;- -'��. ' ,i ..'- " �bc oppli:anf/�.r tx:)r.p mit tn/r7r a sigarJ sWtrrn:mt _ ..._. .... ,.. :_ . r �� .,,. . ..�; •.' i. rr ' -,- -_ _--- - ----- ---- .,rhaa 6c 6Goen.+edpursuant r�i rl,��p.,n��vl„n�,Jrhr t:,�;i- -- - -- i::.�� •.>._� ..- ... ���� . ..�. tru�inr'sl.i..•:,c� !„�r(Cb�pr�r'll(u.inn,en<��n,�vir/�.5cc. ��-- - -- - . ._... . ' ---�- --- ,.. _�,.---�� - - - - �------ . .. _ � .. . . . � . � ln,n 7Ub(11��/D e i n 3 n!t1�r Ifusi �.,�nJ Prn/��su,ms , ;. ,.:�: ...' . : '�� . - < . . ,.�• • ' •. �dcf�nr tbJ�!�i a ipt!1 rrrJr rr�nJlb�Fu�i.fr r tPr ,.,:. � . _. . . . __ '_. ._ .: . _. '. '_' __ . ._. ._. ___. _. .. .�Cr ' - ------. ..__. ._.__.. ___. _.. ._ . ��., ��. . u!!r,¢.J c.rcmp�ion:�Anv rr,�l�,rinn,f Jei�ri,m;U3L9 h�. � .. ,�. r � .�' � � unt� iYnt crn) :11!l�en !i<<tnit�i�i�ti � APFrov Is Yo's9wr Nu�. _ PPtolvod _._. ___ . _ . .. ___.. _ . . .. ._ _� APIi farrt p rb! � PP ' .�_.._ .. • Ro 'ad- ,.-•=" , . rer 1 � Da�o Re - ftv n(m,r mnre�tf,J /.�endn d J,illore(SSOUJ./� i . . or A ".oved . . ..r,"^ � �. - �- - --. ._ ...._. ..__. ._'� _. _. . . _.-' �._ ._.`_. _.' . ' .. - _ _ - , �_' 1,as owner of�he p�ope�ty.o�my emptoyrPi w��h. Y.'ai .Cr.td�cn�e. r. � �1�'�, ` — .�.,.�� � --�_ .. ...-- - - �-� -- --- -.-.. - -.. . ages ns)hen sale compe sar on v II d_,the w .� cnd ' � - - � � -" �'�" ' ��- � " . � ��ihe siruUure s noi intc�nd,d o off��cd fo�sule(5 70A») . . , , .., i ...� � �, ., �.. . . ,. Hanlih.Dep�rrmen�_ . � �� ': - , . _. ... . . . ___.. .... _. '_ . _ ...__ .. ,��!)usinessundPrnf�•isi�n�(��t�. !ln�Cr�nbac�or'sl.i.rnse . . _..__ .. .._ - _ -_ .. .. _._ � (.asv dnc�noi upph•tu on nirnrr n/prnpr��}•erl���hui1J� � �j.e OePanm=�i - ._ ..... _---._. ... . .;... _.... - . , „ . _ - inrprar�s r1 r .nJ i Lu l�.e�sr.�! ..rk �J/or F t�I 4 �`irr�. �;; : }b.�,u,�b e,;. �,���n ��„pr�„�<<��.�p.�,�•,d��d �hur su.1�;,.� .. ;rod ny . .. � ,�hrunrmer:ts.�nre nnt inH ndrd ev n�J/��rrJ/ur rale.� . i 1 '' Yf '-`r'.� �li�����f� i •1" �:l '. (�mee�er,(fLebi��IJenknrimprnnrmentis.�nlJ¢rth�tt�._. _ ��., ,�� _.._.._ .„' ____' '_' � - .__. . :.� ' _ _' ' . , ' , . . Gculo9�col � .. . � . � �� , � . , .,�.. ,.. . - lrcr n/�nnrfhtinn !bc nunrr.luJJ�r ur!( 6nr�'th� � i . � ' �.�-. . . _._._ ..__. .____._ _:_�..._.. ._ � ' _ . hurJrn ol),ruring rhar I�e J�J n„r huild�,r i.nj;rr��r fnr .. i - - - . . ' _ � - -- -- - t! (,urfr.ii'n/rafrl.�.. .,. -'I FencelfCnPr�lecbon � -.,- .,. � � . '�-'�.. _ ; .'_...1,.�..ul�. ..i __._ _._.._._._ � ...'.__`"_�'.._.' � � �epoperly,�ame�dua�o ( �y� � � � - - ���_ I.`osowneroftf e�iyrcmr�c� .ting�wiih I�r.e�sed contrnnnrs�o cons�r�r.r tf,c p.o�eu(Se;. - SPFcroI Inspection � _ . _ . _ � �- , ._..._ __ _ - _. _".. _ _.._..__ ... 7Q4a)U vines��nd!'rnfc<c �i. (�dr. '!'he CnntrJrenr's (Canc.lfMosonrvllWelding) ; '.. '��' . �., � . � _��.�., � � - . l� . I.�orJnrsnu�apph� �unu�rerr/prnPc{rsuhn .-���, .... �_-... . _ _._.. .-. . . , .. , ., . ' � hurlJs oi�imprurrs rhrrenn.'udd ii�b,�.nntru�tsJn.s���l� " � ., . �.... . � �;udtl�a��nrruct r(1!<'r.ind p rc ,nt ru U:r . � loi0�n�noae . ' t _ ____. ._ _..._ . ... .... . _ _ .._. .._ , .' . .. P 1 [ a u� ' . : . _. ...- � . ::]• . ., �� ._.(',nt:n�fn:s l.icenst-t.ai<•/... _--- .. i Si:�., .. .( �, Va.king ' - �' ��- - - � ' [] I am e.empi under Sec .B.BP.C.1or�h�s � _ _...-'.�---�-------..... . ... . . . .. . � : , - , reaso� .. _._. . .. . .' . _'-'__ _ __ _. _._ _. . ._. .. __.._... .__.__... __.(.I .._ __. -"': _ , . � ,, : - " ,- Oote Owner • .. , - _, !' ..� , "'_" ._._ ._ "_... . _' _ _'�. . , .- ."'_ __' . . . ,..._ - Approvals Dato Impactor's Signofyro � �� •� , , . � ... . .. ._, . � . . . � 'INSPECTOR'S NOTES �. � � • �o:a„o�__. __ — - - ���}�'Z—l��-��- � - (Setbnck 8 Yords) . , p, . .. �. ... .. . . .... . . . : :. .. , ;^` � i � �- ., . . . fa�nd�tians ,q ' - . _ ._ ..___.._"...__... _"__'_ "__'_.."_'__'"_.'�..-�'.': � ,_� ..: .. . :�.,.-��i. � � ,�� , �� � �. . Slob � � .- ..__.'___. _ '_. '_ _._'_ ._ . _ _' .,,.,..; _ . , .. , , , . v,o�;� �y.li�q� . - _ , . Ene.gy Insulafion Z� � . . � . •�- . . . . . . . . .. . .. ... . " , rZ� f _ i'._ _ . .' __ _"__, ._'_I_ " __' . . � ti i Lath:Drywoll-. -__._ ___._. .'.-.___- '. _'__....__.._... .. __ __.. ,- '. ` , ' Inierior ^� _ __ " '�__... . . I� , ' . . _ . -. ..._ . y: Lo�h-Ezteror U . __'._ ".'_.-.-_ -.-_� . __._ -� .. . � � i ��,��.' .� -�, '_. .. ._. . . .. . � Ho�seNom6e. .. . .___. .'____'....._ .. .,..____._ .__'_._ - ' . • _ � ._ . _ _._ .. . . � Correo 8 Posied � •l'.�. �-�� ��-- --� -� - - � - � � . ,.., imai- . . _ .. . _ .. ,, r . . , , � , - -- -.. ._. - ----. . � ___-'_ fnie.on Front ,. �. - . . _ ' � � . �.. . . . , � . - . . � ... . . � ' ., . _ . . .. . . . . . .. _.� i.., . ' . . • . , ., .. ,. .. . _' ``, \ - ��.`:J�` '1��;'_`S