Loading...
HomeMy WebLinkAbout1532A 1533A (8) � � i . _._.. .. � „ .. ._ . .._ ... .. ... ._ ... . . _ . . WORKERS'COMPENSATIDN DECLARATION -' - �- ' � � - - I hereby af�„m fhot I hova a certifica�e af�o�,a�<<o.a�f � � -APPLICATION ; F4R BUILDING ��PERMIT � . �I insurc,or a certificote oi Workeri Compensation Ins�rance, . or a tertified copy thereaf(Sec.3900,tab.C.) COUNTY OF l05 ANGELES BUILDING AND SAFETY PolicyNo.�3wc00$-2��m��16 NATIONWIDE 61 B 2 Car � Cereified copy�s hereby furn�zhed. FOR APPLICANT TO FILL IN nooRess 23803 E. Goldrush Drive �� Certified mpy�is filed with the tounty buliding inspeo ��- ' BURowG tiOn deportmeM. � - ` � ADORE55 Z3803 E. Goldrush Drive : ' Do�a 6-30—$� ' qpplicant �E ANDEN.GROUP a1r DIAMOND BAR z�v91765 � �ocAUTv DIAMOND BAR CERTIFICATE OF EXEMPTION FROM WORKERS �� � - � - - � NO.OF BiDGS. t�aaeST � ' COMPENSATION INSURANCE SIZE OF lOT Now oN ior ceoss sTDIAMOND SAR BLVD. + GOLDEN�SPRINGS (This section need no�be completed if the permir Is for one ��� � TRA�Q3435 BIOCK LOT NO.Lfi �ESSOR . hundred dollan(5100)ar less.) . , . - �P�� �AGE GARCEI o,r„vERTxE ANDEN GROUP No.967-9541 U ONE n+nv �� _ I certify�hat in the performance of the work for which this �� permit is issued,I shall not employ any person in any manner p,0. B�X 3329 . . o —f S�ECIAL � � AD�RESS � 00 O CON�ITIONS ao as to become subject to the Workers'Compensation Laws. � O arr COVINA ziv 91722 . � Date �- Applicanl � ARCHITECf OR TEL. DISTRIC� GRpUP TYPE FIRE PROCESSED BY O �—NOTICE TO APPLICANT: If, after making�thls Cerlificate of ENG�NEER DAVE SZANY AIA No,445-4073 ,y� ( �:emption,�you should become su6(ect �o �ha Workers )a p;_3 �N�l' . t ;,r � W . � _ompensotion provisions of�he Labor Code,you must(onh• qDDRE55314 N. FIRST ARCADIA 1� 6 � �� � r� �v � wiih mmply with such�plavisions or this permit shall 6e �-- TEL. . STATISTIUL GlAS51FICATION nPT. CONDO. � deemed revoked. tONTRnCToaTHE ANDEN GROIIP No. � � UCENSED CONTRACTORS DECLARATION�� - -� � � -- Ct.455 NO. -� DwEIL.UNITS_.[_ � �� Z iIC. I bereby affirm ihat I am licensed under provisions of Chvpter 9 aooeessAS ABOVE No.510560 (commencing wifh Setlion 7000)of Division 3 of the Business and _ - ___ __��� . SEWER MAP, � Professions Code,and my license Is in full farce and eHect. Cliv Cv.55 BK � VAIIDATION ,510560 B s°eF1.2634 s"roR°Fs 2 FAMI�LIES 1 CONEK Licanse Numbe Lic.Clau � � VAWATION' CommctorTHE ANDEN GROUP pa�e 6-30-87 oeseeivtiorv oF woRK SINGLE FAPfILY A p a s 157�000 -�� 5 J.2 A ❑I om exampt�nder Sec. GARAGE 445 SF � , , At�a �;♦ . . .2 1 B.6P.C.for this reason . '�eevniR � s ' � - - � Date: EX STOING BLDG. � DEMOL I •4 1 $5 9 Sfgna�ura - � � . APPLICAN7 TEI. FINAL �� • •4 1 �.5 9 c=i OWNER-BUILDERDECLARATION PRWi THE ANDEN GROUP N0� - DATE �-5^�� � � -- - � - - - I hereby affirm that I am exampt from iha Controctor's ticense qpDaE55 AS ABOVE � � � � 0 9.1�1 —S 7 law for the following reoson(Section 7031.5, Bus(ness and FINAL � Profeesions Coda): � � � " � "� ' . sY �- � � ewioiN� , I, os owner of the proparty, or my employaes with A��RE55 �� . wages as their sola compensation,will do the work and � the etructure is not intended or offered for sale(SaUion �a/+��7V , - 7044,Business ond Professions Code). - MOVING " TE�� � � �� $3,J A � I,as owner of the property,am ezclusively controcting CON7RACTOR NO. ' �. , with licensed conrroctors to consuuct�he ro'ect Seo- � � � #�•' •• •� tion 7044,Business ond Professions Code).P � ( A�DaESS - , !;�- . REOUIREO iOTAI SETBA K ����J�' � � I �b�I�O O � CONSTRUCTION LENDING AGENCY - � Sei BnCK � YARD� HWY veOv,UNE WIDTH .. ( I hereby affirm Ihof Ihere is a construction lending agenry for pRONt �, ;j, .- . _� Ihe performance of Iha work for which Ihia permit is iosuad � �� P.t. � . � ' • n 5 7 5,0 0� (SOC.3097�Civ.C.). SIDE O 9.� � `S rI CITIBANK P�. - Lendei s Name � - . i � � I�MA Ref.M ' 444 S. FI.OWER, LA 90071 P.e.Fee s 418.59 v��mu Fee 664.50 , Lender's Address 1�.50 , � I eerlify ihot I have read this appliwtion and slate ihat fhe lasuonce Fee Loht4 v/C N - � above iniormali 's tonett.1 agree to comply with all County Invesiipa�ion Fee 675.00 � $ ordinancea ata laws relating to bu�lding comvocrion, . imai Fe, IDMA Perm.N - - R ond hereb o o'a repreaentarives of Ihis Coumy to eNer � � ^ apo h -ma d property for inspec� � . � p� ��� LDMA 5�75 $35 : /�O SEE REVF FOR E%PIANATORY UNGUAGE � $iqnaNre at Applicant or Agenr pote . . . . ' . PlANS TO APPLICANT INSPEGTOF'S NOTES ,.:U�Y1F.K.11l�ll.l)IiH.UECI.AHA�I'10� I h�rck>y offvni iVini I nm exc��pl���o�,�Ihe Cnnt��x!�:'s �.. To: .. � '�'. ��" � i, Returned.. ,° � ^. �i � � : t'���. ,. : � i; . . . i�. � .:'t c n�e"lo�..� iu r}t.,�fnllo '�q n� o� ISec. 7011�.5) . '. • .. . `APPraved ` '�- liasmrss�imdlrl�xvnns�(.ad�.�Invutyar..�nunhnG�cb , ��. .... .,. : _...,, .. ,... . No. Dat¢ • No: � ...Date�.. '. . . ., . � ... . .-�., rryurr�s u frr tr!!n cu�nhv�t..✓!lrr.urrfr,��r.Jrmr.lisb . . _. _ -_'a�rpuir'an�`it utt�irr,p � �i�;i�si'ssil.trs.r.�ulti.reyr<a . -� , . C..� . � ' - . . � ��" .,. � . . . !he ap/�L�vnf/nr sudr�reimif!o/ilr a si,��ned sfatrmrnr �:.: ..: I'.:� :�" .' ��: �., , I � � . . . , �. . , ._lJoe/ci ! �ns df�usuenfrntbi•�r.rti�innsu/fh�Curz. . , �•. ._. . � .` c.�'��.'. ..��.. I �ro.l us L�<�rns�l.uu�/(:lwJ��rr'JJ(coran�rnnn.4 srith Si•<.' . ..... . . �_ .:_ --_.___._ _. . , _._ _ "' -_- — ' ' - n IU f ! dP 1 .. - _ � .. .. ��. !i .;� "�.c: ' � � ':�� '] - Cndrf/rl�tlu!!� �r.rcn�/+1tleref, m� J�lbrFnci�fr,rlhr r ( .. .—. _---.-_-.-__---- � ---- -- �---� --� - - —___._.- ._..-.,__...._ . . . , ._ n n � , -�-- .._ _ . .. _. . _ . . ��. ... -.", i • .� ,_ -'-.� Rnqulred��.�. li-.DataReceived � -�- ___'___ .. ._� . '.���� _. ___._, _ .....__.. __ unl'u/�plxuotf,�uffrmilcrh�liLrllraJf(�rrnifh�:i��il �. ; Approvals ... or ApP�oved_:. : _ � .. r.penul(v n(nrit-nrnn t<an� ..!uhd.rJ Jn!!nn(S5/ip). . ,. ._. :.Yes No� . . . , ,_,_«, ...,, , . /�, .'.. . . _ .._ ..__ ._. .__. .._.___ __ _'._ � --- �-� '� ���- �.. 1,as owner of the p opc ly,�o�my rmployr.Ps wnh Wn�er C.rrd¢ote • ,�.. ''� ."1. `. �� ; �:�. ___.. ______.... _._._.__ _ .____ . .. � ... woqes as Iherc sole compensatian.w�ll du ihe worL.and ' - --------�- �--'--- - -�-��-"�� � `;;tf e str�cfure is noi iniended o�ofiered io�sule�(Sec�704.1� '� Hcalth.DePanme�t__.______—__'. _ , .-_ .. � � ',� .. _.. _._'.' _'.__. . .. �....____ _.�.�_.__ . ; Uisir�rssunilPr�/�aidrlcCpdr:7��rG itrrrlor'sli�rnsr _'._.. •. . . , _,. , ,.,_ ��'• l.uv d�,r:nof dppl��r��vn nu•ncr uJ p�rnpr�h•��rG,i�burlJc ' fire-DePanmerv_.__'..' ..'......" __.__ __..__.__........'_"' ...... .__. �. _. ... . _.._._.. _ ..._ ____._. � . .. or imprnrrs t!crrnn,anJ u�!n Jr�cc srn!u�url-.l�inesrl/nr . ' � ,;� � :�i . ..�tL rim,ql�bea.�mrn,ernplr 1 es. ),rn�dJeJ"tGot r�'1 ' � Grndin I � . � .'t . , prnrementr.� t�rrstarsded � ffrreJ fur sale..rlf"' . 9 -'t �i f'..�' �'1 r( -- . ' ,...1.rmerrer,fbehu�fJinXorunfrnr�nu�nlinen4liriflirt�in, ., , , .. ,�,.� . '.- �. ... . .� ' .:.. . �'- � � �" �i�r�r n/rnm f t�nn. tle ou�nrr.AvifJar xrif!har�••tha• . __. _ .. . .__... __._._ __. _ . • Geolog�cnl . : � ti - . - �'��� �-' .. � hurJrn�if fr�rirc,q 16u1 bv J�d nn1 huilJ nr imfrnrr/nr � � F nce)IConra reaion _C_ . �`.� �..-�� .`.,. .� ..� � `� . .... __ _ . _ ... . ' N r ��155 a r��r�+ h�� o i 1� Sm e d s vrl y ccntrac� ( PY) �.� ��� � 1 P Y,'b , �li y w�th icense ontroc o s o con vuUlh�pra�A�r(Snc. Soaclol lnipecfion__ .. -�. ..—..—.� . : _.____ _....___'__. _.__ _..______. . � �. . ,� r ---�� �70aa�'73�.si.esa and Prhl..r rrc C�,J: lbr�('int u<r,��r'r ___ .: .. - - , ...� . (Cenc)I65osonrYl(VJelding) i . .� .�_.:.."� .�. ' � . � ...�. ., -'.._�._ ,..,. /.rrensrl,a�rJuvsmi��pfl1'lnanpu�nrrifproprrtiu�bn _._. .. _-___ _. - . . .. ... _.._ . —huil�h ur inrpnnrs 1Gerenrs,�r�d tt�bn-�'un�ra�[sJor.iie�h Lc1 Oramage i��" i . " --- ... .- . . . . � ........__ __ . P I,CGc�u�i!!., a runtrartnr{�J Rrrnad pn.reN�+nt in Ilrr .,- . .. .. . ., ,. .. . .� . . . ,... . . � . .... . -C��ntra.-inr's Li<ense-1.ariJ.-. .' ... ."'" � , „ .: . . .... .... . . .. Farking � . ..� :.._. '_.. ..__._..____._ .� _ ._.._.- . _._. . . --..' .'_._" _:� - . . . . . .. i � I � I am eKempt under Sec. .6 BP.0 fo Ihi"s i , '_.___'_.._'_'_ ' .. . • , "__....__.._ ..._._ . r � ... reoson , � . ,,.; : -, ... . . . __ ._..._.""_.� ..�___—__._. ... .. .. . _.."___. - � �- �� Daie � Owner ,. ._ -. :, . i. " c,•::., . ... . :. .. _ .. . .._ . . .�. . „'� . .,,.i�..�� ,: �. . ._.._... .._ _- __." _. '. .. , . ._._. _ ._.__._ _ .. . . .�. � � ,,.',� . .�..,._ . aPProrals Dote � Insp ctoi s Signuture ,- .':',: .� .s,. ��� � - > .. If:SPEROB'S NOTES- � . I . � ... . � Locahon- .. . . �.. � , - . . .._____... ._.,.. _ .__ _ . . ' (Sei6ack 8 Yords) '- � � - .. `"� __ . .. . .. . ,-, ,. Foundations � .. . �� ",�.���..• .�`- .: � .. - ... Slnb . ... .. , . . . . .. , . _.__.. .'.'_ _' ._."_ _... � . . . . , .. ._____.'__._'_'�_'� _ .�._ ..-. . . i I irame L�'U 1 � . . . . .... .. . . : . . � . � � . . • '�. �. . � ' -. . Ene.�Y Inzula��on 2..ZS„O • � . ' ..___�.:_ __...._._._ __..:_ . . . .. . . . .. . . , ..�... . . ., . ___ a . . - .. ,. . . La�h;�rywall � __. .. .___.. _ . ___._ ','___ . __ , '.' ' '. . �. . . _ _. IM..nor. __. _.. '_'_ ._ .._....� , -' . , . . , i I laif�-E,�enor ��� I � � ._ . - . .. . . : . . .�.. ,.� .,_ .. � � . . . . .�_ . , ,... . � .... _.._ ._ . "'__ i _... .r�:r. . �,.� Hcuse Numher_ . ._.___ ....: _ ___ _._ .__ ._ . .,:,: .:. . - .� ,� . „' . :. . ,,. � ... i . . _ _._ .____. . . .___ _ .. _. . Corcect 8 Posted � � � ��'� � ' im�l.. ... ._".._ _.. . -__. . ___. _ _.. .... _.. .._._.__.... __. � � Enie,on Fronr . � - . __ , ' -.. , . . � 7� _. � . . . .. . . . . . _ . ,. . � .. . .. . , _. . _,. . . .. .. . . . .� _ , � .. .. ... . � _ . , . _ —• ._ i� .. _ . � . , , ... : , -, � . �. ..�� , ;' � --- ��- _.�_. = ' + __....