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HomeMy WebLinkAbout1548A 1549A WORKERS'COMPENSATION DECLARATION � � ; �� � �� � � - � I�hereby affirm thm I have a cenificofe of�o�,e�<<o,e�f -- - qpp��CATION i FOR BUILDING PERMIT � insure,ar a certificate of Workeri Compensatian Insurance, . or o eertified copy the�eof(Sec.3800,lab.C.) - ' � - - - ' COUNTY OF LOS ANGELES BUILDING AND SAFETY � vou�yNo.�3wc005-2��m��6 NATIONWIDE 61 C 3 Car � Cemfied copy is hereby fvrnished. FOR APPUCANT TO FILL IN Buitowc 23810 E. Goldrush Drive ADDRESS � Cerlified capy i�filed with Ihe counry 6utlding inipec- BUitDiNG 23810 E. . Goldrush Drive Ilon[JEpar}ment. � AODRESS D6re6-30-87 qPP���a��THE ANDEN.GROUP cirv DIAMOND BAR nv91765 � i�,iRr DIAMOND BAR CERTIFICATE OF EXEMP710N FROM WORKERS' � • NO.Of B�DGS. � � NEqREST 'COMPENSATION INSURANCE � SIZE OF LOt NOW ON LOT cRoss sTDIAMOND BAR BLVD. +�GOLDEN SPRINGS (This section need not be completed if the permit is for one iRAR 43435 BLOCK lOT N0.32 "- - /�ESSOR ' hundred dollare�E100)or lass.) � � NWF BODK � PAGE PARCEL owNer�E ANDEN GROUP No967-9541 u zoNe rnnP f� � I certiiy�hat in�he performance of ihe work for which this +�_J NO. � permit is i53�ed,I Shall not employ any parson in any manner P,�. BOX 3329 . �p S�ECIAL � �� � so as to become su6ject to the Workers'Compensalion Laws. AD�RE55 QO C7 CANDITIONS � arrCOVINA ziv 91722 v Dore Applicant �� � ' p� ARCHITECT OR TEI. DISTRICT GROUP TYVE FIRE PROCESSED 9Y O r""JOTICE TO APPLICANT: If, affer making fhls CBrfifiCO10 Of ENGINEFR DAVE SZANY AIA No,445-4073 �pNST. ZONE {� xemption, you should become sub�ect �o the Workeri Compemation provistons of fhe labor Code,you must forth• qDDeES531�+ N. FIRST ARCADIA 91�06 �� -3 W . with comply with such�provisions or �his permit shall be TE� (L' deemad revoked. , mNTrtAcror�FHE ANDEN GROUP N� STATISTICAL CLASSIFICATION -��' APT. CON00. (n IICENSED CONTRACTORS DECIARATION� � - ���. RASS NO. � DWEIL UNITS�� Z I hereby oHirm tho�I am licensed undar provis(ons of Chopter 9 ADDRESSAS AB�VE No 510560 (commendng with Section 7000)of Division 3 of ihe 8usiness and . . . . ���, f�EWER MAP � Professions Code,ond my license is in full force ond effect. Crtv cta55 B � -BK � VALI�ATION �10560 B S0 �`�2634 No.oF Z , NO.OF 1 CHECK Litense Num6c Li[.Class ' SIZE STORIES fAMILIES ONE VAIUATION �` ControctorTHE ANDEN GROUP DO1e 6-30-87 oEscaiaTioN oF woaK SINGLE FAMILY NEw � S 157,000 ='� 5�S A � ❑I am eaempt vnder Sec. � GARAGE 6�V9 SF A�� � , - #�' • • •2� ALTER � B.BP.C.for�his reason _. REpq�R � S � •�>1 B 5 9 po+,: use oF oeMa • �Ct 1 8 5 9� E%ISTING BLDG. ❑ Signature � APPIICANT TEI. FINAI n OWNER-BUILDER DECL4RATION PRiNi THE ANDEN GROUP � No. . oATE L�/�!/�Q O 9.� � —S 7 -I herebyoffirm thal I am axemp�from the Controctor'a licensa AS ABOVE � Low for the tollowing reason(Sectlon 7031.5, Busines�and AD�RE55 FINAL �j Professions Code)i - ' � �" - i; � Ey� �%�j�� ' - � � I, as owner o4 the property, or my employees with q�oRE55 �� ' � � E -�1 5 4,9 A wages az their sole compeneo�ion,will do the wo�k and � � ' ' the structure is not Iroanded or offerod for eale(Section ��A��T� ' ' #• •�� � � 70d4,Business and Professlon:CodaJ. � � MOV�NG - TEI. CONTRACTOR NO. � � I,as owner of the property,am exclusively contracting . � e 6']��p whh licensed contractars to cons�roct tha pro�ect(Sec• pODUE55 tion 7044,Business and Professbns Code). , �,'_ ��j_.� � !�� . _ RE�u1RE0 TOTAL E B �- � � � '6 ��O O o CONSTRUCTION LENDING AGENCY sei enCK YARD HWY pRov,uNE wio7H �� � � I here6y affirm�hat�hera is a mnsfruction lend�ng agency for fRONT ,, `�� �r�_��.�. 0 9.1 1 �8 7 �he performance of the work(or which this permit Is iesued � ei. /'-'� - • - - �Sec.3W7,Civ.C,). SIDE � � � CITIBANK a.�. . i� �--�. , �:i-' lender's Name LDhL4 Ref.N '� � ` � Lender's Address 444 S. FLOWER� LA 90071 P.C.fee S ' Parmir Fee 664.50 ��� ' � I certify thaf I have read this opplitation ond s�ate thot 1he iesuonce Fee 10•50 tDMn V/C M ,, obove infor i n is mrrect.1 agree b mmply with oll County Irnestigaiion Fee 675.�� $ ordinance a S�are laws retating to building construction, Toral Fae l�nnF.pe.m.N � and her �horize repre�ematives of this County lo enter � u v d proparty for inspect' n purposes. j�A $75 � . �� SEE REYERSE FOR EXPIANATORY LANGWGE Siqnatura af Applicanl or A9enr pote . � . . PlANS TO APPLICANT INSPECTOR'S NOTES .,�UIYI�IiN-1jU1LUliH.l)1`.(;I.AHA'l70\ � I her�hy allvrn e��a�I�n �,empi frr,.h iLe�Cr.n�•n^rn's To: . . � Returned ` . ' . . � , • . ' � lic�nse low I> rf c:�ollo rq r.r ur 1 �,:7031 i� . . . . ' �� ApArovod � � � Ai+�irtr<<nnJ/r�/rr��uns(uh..ln1'ullonprenfti<'/•i�! Na. Date � Na.� ' � Oate .• , . . . . -..� . .�. .• , •�•. rryuirrsup��rmiLl�+���n�lrurl.a7frr,inrr,r��re�,drnrLli�l�, - , _._ur r�p�;r un r arruceurci pridr ai�;ri r;ciiJn".r,a/su.,�q�,tro� ,��t � :u'J .., _ .. . ,,..�,'t��:. .. , � , � i, f/r appb:✓nt/r.a�.i'b prrnria fn/i!r r+t��neJ xeatrnri ni. , .,:.,.� -- .�,, � � �, � - - I �. . :�. ' ` , ��; � � � __ . : ..u'fili . ('f_ . _- lba:'L'r'.<lii��.�v��l,drr(Cl,,pr�r�7J(ro„�nu�nunc i!rl�S�a- ..: ,.: �. _ -_-. . .. -. - -- --- ----_ - - . _. .. . _. _.. . .. ..'- .: linn?U(IO)uJlbiici,on3nithrUui �sc.�udPri,/rui��n< :��'l.: (?":.. �'.•i �. , � _ ,.:���'.- �. ,'.�, . .:�,'.. , .-.; `(:�d<•/nr d�af I �rm(�t 11•ere�ranr� d Ilrr h�ei.e%.r 11�r , _..__' _ __.. . ..__.._ __.. _.__.—_.__... :___- __._ . . .. ___�.__ __� ___ ._ ._ .._ _._ . ._ _ _�. . _ . . �d��XoJrxrm�l �n.Anv uulafion u/.1eCnnn iU37.$h�� -..��-.;A'�� •. �. ...._ _'�Required-:. :,. .` ... " � __'_." ' _ -_.� _._. _ ___- _. __ --_�. __.. _ un�appli.anlfnrafrrnut�rhjeilsd�ru/�flr�nn�hia.iril -� �pprovol� - ��Dato Receivad � � .,,(�enalh���lnnl rnnrr Uian. i.hi�rtdmddullm�(SSbQ)./• . , ,� -�Yai No orAPProved.,.�, � . ..� ,. .. .. ,__ , ��• . . . __.__ .._ _:. �_-�__ __ _. . :_ :_. . __.._..: __ '.'._..:� �.� 1,as owoer ol�he pro�,nr1�,or my rinployn�s wnh Wo�or Cerof��coie ` ,' ' ' .� T � � - . .--- - . _-_ .._-_ - -. --.._ .__-_ wages as�he��sole comp�nsaiion.wJl do�he worL.o��d """- - .—...- . -.---'�-' --'-- .... . • ' ' . . .-'--- .. ��..� � ..the siru��ure is nof iniended or oFferrd ior salP(Sec'%Oa.il � HcahhDeParimem __.___ . _. � " � . � �''���'��� � , .. . ' � __.. __ � Uusinrss uhd Pr /vs iric('udrr 77�e Contrdrfn�'s 1 i`� ov � ----' ' —�-- --- - --— --�--- ' '- -'.._ ___ . . . . . ___.. . . . _ ._ , . ', i:. h l.au ilurx nid nJ�r/c/o an u�rrsrr�u//�rnprrh u1n hu�lJ.c :.' Firc_Oevanment._'__ --._ .'_ .'.__ _ __.,,.. .. _ _ ,- _� . :.� '. .,,_ . - ' . Lroupl��/�iarr tn'nnj+! 1�.s./rviiJululL.�tjsurJ�t�u�,.--. . ,• . --. ' ' .i . � . �. � . . . . Gr�ding , - , ,.prut•rrnrnh.,nrr r�nt,inhnded ur.e f/rrrd(ur aaf�. 1/. , .. • 1 `'� �,: , ' ' . E ."¢ni���t�er.fbeF�eildinknrinrprnremrnfic�ul.li�itlinnnr � ' . : � ., , . Gr.oloy�cal : .. .� ... . _ . :1'rur nJ rnmplrnnn. tic�mm�t�nl•uJdor.vi!!lrurr dLa• - hurden nf frnrin,q lbnf br did n.�1 l�rrild nr impmr•e/rrr Pedesuion Pro 1 �. .� ^ . _. � , . -�� -- --- - -- - �r/�usr n/salcl., ' . ` . � . �lectlon-.�.'.' , . ` _. .__ � �.. .._ .�. _.' . „ . .. i , . l_: . t) p �Fence�(CannpY} , � . . � . ._... .-. - . ���) 9,os�owne•olthepoperP/,ameeEi�tieelyco�nvc• �., , 11 g with I�censee�Comrnc�ors to�o�istrucl ihr p.ojec•(Sec , _. . .. . - `� ._. ��__ ' -_ .. .._ . ... _ e�inr ��iJ!r�/rvrrum`Ci,J�• 1'hr ConU✓[� s SPeuaf InsPecfon._ . __:. .. .. . __ � . ,.,,- � ,- . .:_ .... . , ! n !n�•nr�n rn !� 70ea)li r ai , {Conc.l(hlasonry)IWeld�ng) ' . � '_ _ ' .'._ _.. _� _ . . _ ..'__' . Li�rnar7M«Ji s n I.+Jp 7! an�,< � fP Pe r� �. , --huilJ�-ur irnprnrrs thrrrnn,snd u•l�n rnntr��fs fur'ru.b Lo�Dra�nage ,' (i;'.� .�, .. �.-. . . .._.-. . � ._'__.___. .. �nnretc a•il6 a �un r�dr . _ ._.�:r��r. .. � � . ..., ._. , '-- _ ._. _.... --: .. r �r(cJ lr�rnm ���nrt to rh�. -� , trarfnrk l.irerisr l.nu/.� _ Fark�n �, . ,,:- ;__ _ _" _. . __._ _.�__. _�_ - .'_.' . . __ . _ ._ _. ._ ._ . 9 (1 lomexempidnde3ec. �.B.&P.C.fo��h�s �. ' .. . _ .'_.___.. __.___'_— ':.. : . .. . . , �� � reoson � � ; .:' , -.. . '. , _.'_.__.___"'__r.._..._ ....____ . . .___._._. � Daie Owner �. . . �� ;i�, . � - �, _ . ,� . .. .. '� __. _. _.__. ._. .._ . . . � __._. .__'_ .__� ' ..::.�..` :.' _ .. 'C,.. ' � '_. .� „ ,r � , � ,, � , � � Approvals Dato � Inspector'sSignoturo . . . � ,., , , . � IhSPECTOR'S NOTES �' locahon- ;. ,. .. . . . . ... � .^-� - - --- e�- .1 Z-Z�� 1�7� -- ISelback&Yordsl �--' -- � I ' . ,. ;.,- .. .. .•.... .... � ; ��' . Fcundctions . , .' �.� �' ' �. .���� � � ��� ,. . .�. . Slab � . . ; . - � . . . , . .. . .. , . �.:. , ,,, . __.- -�------ -.._._.-_..._._. ..'.�... . �. . ,,� , .. ,.. . .. � Frame Z-1�� _ . . .. . .. '': ` ,. . � .. �.. _-� Enrrgy Insulanon Z'j_pq ..__. _. _._.__ . .. _ . .. , .. . . . „ .. , , . , ... ,. . �. 6 0 ., . ., . .. La•h;DrvH,all- -- --_.- ' -' -. _ . . ._._.. . .._ _.: ._ - . Infor or `L-�Z g�: __��.1_.._ tarh-Ex�erior L' Z_{� �''�n'`_ . . . . .� _ . I.. . . __' _ ' _ _ _"... � �.�_. . ._ � , . , HouseNomha.._. � '_. .__ ._ .... .. __..._ ._._ -...._..... __. � _ ��..�� ..i.. ._ ._.. _ .._ � . . . Corre,r.�8 Fosted �IC:.�): j �_ �-�-- � � . Finol_ .. ._ __-_ '.. _ __. . , _..__. . . _. _'_.. -__ _-___- _._ __.- _._ _ , . , . , . . ,` . ,. . . � Enle.on Front I .. �r � . , , . ��\�� � � . . . .._ . . . .. . . . , . � . , _. ,� . . . �`��\ '�. � ' . �--'�t � .�. .. s�\`L _,�...�•',� =;r