Loading...
HomeMy WebLinkAbout1570A 1571A (9) I _ .. _ ._ . WORKERS'COMPENSATION DECLARATION � � '� � �.- � ' � "�" - - � � I�hereby affirm that I have a certi(icare of�o�,e�„o se�f � � �APPLICATION; F�R BUILDING� PERNIIT� � insure,or a certificate ot Workers'Compensation Imurance, . , or a cerutied copy ihereot(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING ANO SAFETY Poi�crNo.�3wc005-2�m ORY 6 NATIONWIDE 36/B � Certified copy is hereby furn�shed. FOR APPLICANT TO FILL IN BUILDING ADDRESS 23802 E. Goldrush DRive � Cerlified copy is filed with thc counly building inspec- BUIIDING tion departmeN. � AD�RE55 23802 E. Goldrush Drive � � Daia 6-30-87 qpplicont THE ANDEN GROUP cirv DIAMOND BAR zic91765: ;pcf,tiTv DIA1�i0ND BAR � CERTIFICATE OF EXEMPTION FROM WORKERS� - � � NO.Of BIOGS. NFAREST � �COMPENSATION INSURANCE SiiE OF l07 NOw ON lOi caoss srDIAMOND BAR BLVD. + GOLDE � (This section need nat be complared 14 the permit is for one TRAcr 43435 BLO�K l0T NO.33 �ESSOR - hundred dollors(E100)or Ie33.) . NJ+P BOOK PAGE vARCEI THE ANDEN GROUP TE�� U or+e r✓w.P OWNER No.967-9541 J7�t��j-' I tettify that�in the performance of the work for which this �/ NO. permit is tssued,1 shall not employ any parson in any manner qooRe55P•�. BOX 3329� 5°Ec'"� . � so as�o become sub�ect to the Workers'Compensotion laws. ddd CONDiTiONS � Date Applicant nTYCOVINA ZIP 91JZ2 � ARCHITECT OR TEL OISTRICT GRpUP NPE FIRE VROCESSED BY �"�NOTICE TO APPLICANT: If, after making'ihis�Certifimte of ENGWEER DAVE SZANY AIA No.445-4073 , � E . O -xempfion, you sho�ld become svbjecf to Ihe Workers' 1 j(7 Q�T�A!1 V,_., Compensafion provislons of Ihe Labor Code,you must fonh- qo�ae55314 N. FIRST I� /�=J y!./v � �W wiih comply with auch provi:ions or fhis permi�shall be � deemed ravoked. TE�• � STATISTICAt QASSIFICATION APT. CONDO. coNTancTor�'HE ANDEN GROUP No. I .{ � / N LICENSED CONTRACTORS DECLARATION � . . p�. QASS NO. � DWELL.UNITS�L_ Z I hereby affirm thar I am licensed under provisions of Chapter 9 ADDRESSAS ABOVE r,o.510560 (commencing wiih Section 70W)of Division 3 of the Business and ��� . ��R�+P. . Proiessions Code,and my license Is In full force and effect. � CiTY � CLASS �� - �gK � � VALIDATION 510560 B s°EFT�1658 sioR°Fs Z F MIOLIES 1 CpNEK L(cense Number Lta Class VAWATION ' ��� J�Z O A Con+rocrorTHE ANDEN GROUP� pa�e 6-3O—H7 OESCRIVTIONOF WORK SINGLE FAMILY A D � S 100�000 �,, 2� � , . . . ❑I am exempt�nder Sec. GARAGE 456 SF ❑ AITER 1 •3 1 6 8 4 B.&P.C.for Ihis reason �RE7AiR � S . . - . Date:- USE OF DEMOI � A •`�� d'���� Ex15TING BLDG. ❑ . . Signalura . .. APPLICANT TEL. FINAL / z/�p- . . O Q,� � `S 7 OWNFR-BUILDER DECLARATION vRiNi THE ANDEN GROUP No. DATE �/ � / I hereby affirm Ihat I am exempt(rom fhe Confractor's Licanse AS AB�VE law for the(ollowing reason(SeUion 7031.5,Business and ADDRESS FINAI ' � � Professtons Code): � - - � � � 6y BUILDING !�� I, as owner of fha property, or my employees wilh ADORESS � ��� 5 7.� A wages as their sole compensation,will da fhe work and i�iTM � i � � � the structura is nat fnrended or offered for sale(Section � 7044,Business and Profeesians Cade). � � - MOVING � .� ' � 'iEt:-� �- � ' . . #. •.a . •� � � I,as owner of the property,om excl�sively contracting [ON7RAttOR NO. . with licensed controcfors lo oonsfrotl ihe projecl(Seo qDDRF55 � - � - � ' �� � ' - r ' � 'S�7.�U . tion 7044,Business and Profe:slons Code). ' .— � REOUIRED TOTAL SETBA K �-"�' - �'''-����` �S�7,O O� � �CONSTRUCTION LENDING AGENCY SEt enCK YARO HWY pROP.LWE wi�iN � � ��' - �' `� `�� �- �� I hereby affirm that there is a construcfion lending agency for ppONi � � `r`-�r � �9.� 1 `8 7 � �he performance of the work for whkh this permit is Issued 0.�. . ' ;'i',,' �. � (Sec.3097,Civ.C.). SI�E � CITIBANK P.�. � S't t-=' Lendei s Name I�MA Ref.M .�, • ' 444 s. FLowER, LA 90071 P.c.Fs�s 316.84 - P„m�,F,� 496:50 �� �� �- tender's Addreu ' ' � ' ' � cerfify that I have read this applicmlon and smte fhar,�he _ iu�o��e cas 10:50 LOM4 P/C M bove informoH n correct.I agree to tomply with oll Counry � Invest�gatian Fee � SO7.�0 �dinances rate lawe relating to building construction, _. To�al Fee tDr,w pa�m.M � '�here horize represeNatives of fhis County to enter ' '- th e- ' ed properry for InspeCct/ion porposes. �� $�$ $35, . 6 �� SEE RFVERSE FOR EX�LANA70RY LANCUAGE �� .Signarore ApPlicant or AOant po�e . . . . _ , . INSPECTOR'SNOTES , Ul1'tiP;It.11U1l.UliR�IlCC1.AK:1'IlU\ ' PIANS TO APPIICANT I 1 .C,y�a!f i�ar I n e .p�-I il .Conrcac�nr's � ' To: e �. � �. .. ' Refurned ', .. �. � � � .. �. '. .. : �� .. . . � . . 'l`< sc lam� I il c iollc (5 �r o �_(S� . 70J1.5; ' �Approved :�� .�� '�. � � �; � ..�. ,. .. :.� �IJr�s�nrsa«ndlrilisvnns(ad�..An�aipir.uanhuhi./ '`; �- . � . ... .... •,�-i.i- �""' ., . rr �'r��a frrn�i[(n co�rslrur[-q4rrfuttprurr.drrnnlich, . No. Date No. '�`Oafe ...' r_ .. .'� � . . . . Y _ ... , _ - — - -- . . . _ . .. -�- �..r ptUI4t1V clI4CIlNP.^ :.Y��itc{�.� .�.rLcn rr��avc.. i .., . �.., .- a.�� . ' - . . ' . ) � �L�•�,pL�mit/nr se.l,prrrni�1n/r!e a ai;�nrJ sl�trvien� -. 1 , .._�...'- -. . : . �,�' . .. , �.,.: . ...'� ._.__._. -._ ...._. ' _..' _. _.__ _ • . - -.._.--- - . ._ . .._. i.,.. - .. ltiJl �C11�I�fIl.��t���Lfi�[J�Ilf��llr('r/ fl1 �l�rt(.�it�- �i ...,. : . . . . . ...�r�Juri l.i��vna l.+u(Cb�p1<�r)l(�'u om�nun.S.trith tc.. .. . ._ . .�_. . ___ '_. _ :._.. ,_ _..__. _._---- �----- �-- ---�- � -��-' rn7 0 o/Ur<<�n .frhrltr.0 i � Pr�,/ ,�na , tr� 00 1 .3 , . i/ r<�i . ' ' .:� �i . ,'.�° .�.:,i � �.;�.�.� � _'.C+�Jr/nr tl��t L�cri�f a•f�rnrpe tl rrr/rnm a J1/���F��ci.jr.r�br _._ .__�.1...'_. ..__ . . _ . .. _�- _ __ _ ._.._ __' .. ._._. . .. _ ... -.__ __.. . . .___ . . _ _.__.. __._-__.__ .._ . olle�rJ�rxcniptinn.AnV rinlatian�/.trition i(H1.5 h�� '�.. ., . . � '-_r�-Raq�irad '-�. �.-., _� . ` . .. ...'_.'._-_.__..�_ �..:'..��...____. .� .. .._._ �_.. .__ �n�ufpli.�nf/orupermi�tuhjc.fafbeappLurrs�ma.iri! ... . . . Date Rece�rod -� -� rxa(1P nl nn�mnre�thun r c Lundr�-d dnUnn ISSppIJ Approvals ar Approved: . . . . _� ... ... r ���. ��._ _ . .. �_ ' ... . Yes No '_..._ _�:c_.�': .._ _.__._ .__ � . . . . __. __..._.._. ._. '� � , (_' I,os owner o��he p oprrty,�o�my rmployce�w�rh �a'^�Crrbf,�nte _ .� "� ' �._ .�- .--_ ..: =.1 �'. :' : -'�._� . '-.�_..-.' .. woges os the�r sole compensahon.wJl do the woiV.and f: _ _ _._.._ . ._ _.. -�-- - -�- �;;.ihe srruc7ure�is nm intended or offe.cd fo,s , . . . .-.... ul.,(Sec 70441 Heal�nDe enr - . ...�,..�� �.� . • -._'_ ._._ _ __._.__._ _ ..... --- .-_._.r l3usinescanJPrnfrniur�sG�Jr:7brLn1 a i x(i'rn.cr � panm .___ _ __ . :__.._ .__ ... __.. � . . _ � � . , .. .. .� . l,au��lnr�nut upfli•�n�n uirnrr nJ prnp��rt�u/rn huilJ.i � , � n , : p ' .P - _--- .. .-._._ __. :... __ . _ .: _ _ o e tl r n,u d 1 s 1 .1� se ne.De anmPni, , ,,.: , -- . _ ._ ".;i. . ' . . . . i...;.. ' �..,+, ,.. . . dlrr�u,�l:l�ia�.o�rn eurpl�ti<a..)�me�d�d tLat/sur!r� Groding � .. � . .. .. . � . .prnecmenlr�nre nnt int<rsJ d ur u//errJ/ur ertle. f.^ . � � . � � �;- . . �'lruerer•er.�GP I)IlII�Iltl�(is 1 fl1 Ctlf IC SOIAI[Ylllttt UAC ' ._9 . �_ ___.,.. � '•;1� ; ��:� ._ ;,, . . _"__ ...`.. _ . ... ., _ _ ' Ceolo cal�'� �, , . . � , . �� . -` T cr n/mnaf/.tlin. !!r nviiervluifJer v�ill !nn thc - �.� ,� �.. .. . . , , . .. . .- '..- ' . _ �. . ____ G rJen r�(pr e n,�1G�r he Jid nn�FrrilJ or inr/� �-e fnr '--- ----. _ .�. .._ � I ... _ .._. . ._ . 1�l�Lfflltfn�fG�C�.�, . ' . ', Pedezlrian ProteUlon '-..� .. -, . :�:. . ..: .� 1.„. . �,.�.. -.. -. � .. • ' . - , (Fen:el(CanoPY) . . ___.__ ...__ _ .... _ .... . .. . . .'__.._.. . ' �_). I.asowncrofthe . � � prope.rty.amc clvs�rciyc�nnoc- � �,ti�g wrth license{!contrnciors m wnsnuct Ihc prol"��l5e<. _.__...__ � .. �� _.r_. : .�.�. ;--.-. ...----- ... .-- - :, , 04a)liiisiness unJ Prn/c�siar�s Cnd�•: '1'hc Cuntru�tnr's SPeuol InspeUioo . .. .. . �� � _ _ .- � �.. . • � . .. , . � '. !�rrn.�l.aivd �.,�rr,r e e �: � �r.,�r<-�n���r�a (Conc.l(MosonrYllWeld�ngl . . . � . . :-,_.... ;..._ . _ ._ - ... ..___. _ - __. . ._. _. _ . . . -- -��-hurlds nr-rv�prorcs!1 i�r�nn,auJ id17i u,nlracG�f�u eu.b �.., " �-.I:. - i „ :' .. .., , : . ._...... � �rta u th a.innlr✓rtdr(cl l�<rris J.pirsuan! 1n fhr lo�Dramage. . ., _ . , . .... . . _ ..�__ .. ._... - . . _ _ . ..'�� ...,i,., - ontru.Lirsl.n:enarl.a�r/ � - .. . . , -__ __'_._—_.' �.,. . .,. �i.:�: _ Fork�ng , . . . . �. � , �_J�---I am e.emp�under Scc. .B.dRC(o�fh��s •.�..� ' __._'. . .. . .. � rcoson .. - ._,- ____ , . .. ._. _. . _. , . :i . ' _. ___.____ __._ .._. ' _______ '.'. ' '�'__.___.. _.... _. __ - _._____.' .... . . � . . ; .. - , Da�e Owner . , �, .\ .. ".-. . . ...__ ____ ____ __ ' .. . . ..._-_______ . ...__. . . . APProvals Dete ' - .Inspecfor's Signelma ...; ... � � . �-.� . . ' t �.. .... . ., �. � , ,... . . , . . . , . . ' "' � � INSPECTOR'S NOTES � � �� � lnca�lon_ _____.____ ..._._.____. . . .. � � . (Selbock 6 Yards) , . .._ ._.__.'_... ._____.__ ..,-. � . : ,� .�... . „ .,. .. _ , .. , � i,a _. ; . ,. i . . . ___. _._ .. . � . Foundnrions ..� :, : . �� , ...,.. �.:?' �,....,�. . . .i ... ., � _ _t2-L-�---��-- ., , , . ' s�ab , F,omP z�a� - _ , _ , Energy Insulation �. � ._:`_ __;_:_ :_.S_". "... _.'. ��. .._. ' ' , n .�.. , , ,.. .. .. , z-S-� �.ti — � --- ,, ____ .____� __- _---------T ---- ..__ , Lafh.'Drywatl-. � � . � "_ __ " __ �n�Prio, �-',2"� _�� - - ! i � � ,_ . . —_ . ... . , , - lnth-Ex�e.�o, `'�L�(y��� P , , , i, --- '---_ -- - - . . /i' _J!-'/2��'__ '.... ! � ,. 4� �..� . ... . ... ...., . . House N�m6ra._. . , .. _..�___ . _'_'__ ___.._. .. ..____. . _.... __ -_. _ ... ... �. . .. , � ._-_. __—._ ._" _ ' __ . r:�. '..�. . i ' Correcr E Posied - •�� � -'� '� ..q� � „ � � - ,. .....__ .�'. '_____.. .._ .__.._ _. . _ . F�ni. � - . . . . . __.._ . . , . . . . _... . . . Enrer o�Fron� � 't f'- ' .. .. . . ' . . ' .. . . �- ' . .. � . . ., . . .. . ,. .. . � .� �\\ . �t'" - ,. " �. . . . � .. ' ., .._ _\\�' ... . �.\`}��,�'.\' '. .��.��.`Y\ ... . ... ..._. ..,. . ...... . ... �. i. . .__....___. _�. _..._..____-',..�� :'. _. .