HomeMy WebLinkAbout1504A 1505A (8)WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.) -
PolicyNo.73wCOO5-2PI:77P,}6 NATION14IDE
Certified copy is hereby furnished.
Certified copy is filed with the county building inspec.
tion department.
Date6-30-87 Applicant 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, 1 shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws.
Date - Applicant
�OTICE TO APPLICANT: If, after making this Certificate of
emption, you should become subject - to the Workers'
.ompensotion 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 Number. 10560 - Lic. Gass B
ConlractorTHE ANDEN GROUP Date 6-30-87
Fit am exempt under Sec.
B.BP.C. for this reason
Dote:
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): - - - - - -
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. 3097, Civ. C.). -
Lender's Name CITIBANK - - -
Lender's Address 444 S. FLOWER: LA 90071
I certify that 1 have read this application and state that the
above Information is correct. I agree to comply with all County
$ ordinancesa tate laws relating to building construction,
R and herab a Drize representatives of this County to enter
upon th a tinned property for inspecti�%/
rposes.
�-
Signature of Applicant or Agent Date
APPLICATION FOR BUILDING PERMIT
75/B COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN]ASSESSOR
noozess 23811 E. Goldrush Drive
BUILDING
ADDRESS 23811 E. Goldrush Drive
CITY DIAMOND BAR ziP91765ocAuiv
DIAMOND BAR
- NO. OF BLDGS.NEAREST
SIZE OF LOT NOW ON LOTcROss
sTDIAMOND BAR BLVD. + GOLDEN SPRINGS
TRACT 43435 BLOCK LOT NO. 17
MAP BOOK PAGE
PARCEL
TEL. 10
owNERTHE ANDEN GROUP No.967=9541
11S ONE
Odd (7
MAP / % ✓Y"�
ra ✓`i
ADDRESSP, O. BOX 3329
SPECIAL
CONDITIONS
CITY COVINA zip 91722'
ENGMEERT ORTEL,SZANY AIA TEL, -4073
DISTRICT
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GROUP
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TYPE
CON
FIRE
PROCESSED BY
ADDRESS
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TEL.
CONTRACToFTHE ANDEN GROUP NO.
STATISTICAL CLASSIFICATION I
r�
CLASS NO. l�� DWELL. UNITS
APT.
ONDO.
LIG
ADDRESSAS ABOVE No.510560
LIC.
sEwER Mae
CITY CLASS R
BK PG
VALUATION
VALIDATION
SO. FT. NO. NO.STOOF 2 FAMIOLIES 1
SIZE
CHECK
DESCRIPTION OF WORK SINGLE FAMILY
NEW ®
ADD []
ALTER
$ 164,000
Pool
=1 5 0.4 A
GARAGE 643 SF
REPAIR ❑
DEMoL
f
FINAL
DATE 5'31 B
• • • • 21
( • 4 3 1, b 8
• • 4 Z, 1.081
USE OF
EXISTING BLDG.
APPLICANT TEL.
(PRINTl, THE ANDEN GROUP NO.
ADDRESS AS ABOVE
FINAL c,,!
B �J
Y
0. 9 1 1 —87
PRESENT
BUILDING
ADDRESS
1 505 A
LOCALITY
MOVING _ _ TEL.
CONTRACTOR NO.
4 • • • • • 1
ADDRESS
_
- I
I .69600
REQUIRED YARD HWY TOTAL SETBACK
H
SET BACK PROP. LINE WIDTFRO
PA
SIDE
P.L.
LDMA Ref. N f
P.C. Fees Permit Fee 685.50
oil,Ifa.anr.
10.50
Fee
LDN P/C Y
I—Vigotian Fee 696.00
Total Fee
TDMA perm. N -
-
75 35�
$69 R VERSF FOR EXPLANATORY LANG AGE
0
'sem
O
U
0
I—
W
IL
Z
' Approvals
PLANS TO APPLICANT INSPECTOR'S NOTES
:.
To: '. .. Returned '_ -.'. '1 _, .. • ' �.
Approved
No. Date No. 'Date
(5etbock & Yards)_
_
Foundations
Approvals - _
' Y.No
Dal. Received
or Approved
i
-
Grodrng
Z_I—L
2-z -
PedestrianProtection
(Fence)(Can.py)
Sp—ol Inspection
(Cont.)(Masonry)(Welding)--
Lot Drainage
Parking
' Approvals
Data
I
Inspector's Slgnatare
-
(5etbock & Yards)_
_
Foundations
Slab
frome
Energy lnsulotion
Z_I—L
2-z -
..
..- .,.
___...____ '.._-__•-. _._:.. .
•
Lath; Drywall
Interior
Lath -Exterior
g
--
- ... .
House Number ._
Correct & Posted
,., ._ ... _
_
_ _ _ _ ,:..
I
i
Enr.! on Front
-
1, OSl',%VR-IILIII.DP:K DC(:LAKA TION
I h .rrhy a1f i that I nm c•xe•npt t o. II c farrro-tnr's
•+ Licrnse,.la',. foi the follow ng re ,6n �Se ' 7031.5)
llusin,s and lnfesriuns(:ada:4.ycityn unts'uhicl
Y h r1 r..a nnsl r tali f ,Jrnmhsh, .
slrarJuY pn r t•i its ,sla✓uu.'✓Lu nvpnrr•r
tbr• appli-tit fin, curl. permit tr, /ilea r{(ued st✓trmeut
_.. that.he.is liaenseJ pur ✓at to the p t .,JN,e C'dx:
Ira, 1-1; l,irr'. 1 (('!,✓ptrr 9)(t nr>m.i.�u.11"1u-
Min7ll00),(Ihrrvun In/tl+r liusricss end Pr n(r-rs,,,ns
__`.- Ci+drJ nr rl,Jr / r ss r.yrnrpt rl areJronr unJibc• J.nsis /r,r t1,r
a!lrgrJ r.renrptinre. .Anv min!✓tinar trl`Jrrtinn ,7071.5 by
any ✓ppli.dnl /nra pernrit suhjerh tle pplimnti—ei,,!
...-penalty afoot more fban/ive band- d:Jnilant (SY04,
[-• I, as owner of the property, o• my'rmployces -i,
wares asthe,, sol. compensation. wdl clo the w.nr:. and
the structure is nr_t intended or oHe>ed for sale (Sec, 7044)
13usinvu and Pr„fcsssuu (ndct 77u, Conti✓c tor:. I.i.cnsr
/.mo dnes nor apply (n an owner u/ prap•rty rely, builds
_
or inrprur rs thereon, and a hn does .sur h u orb !_+inst/f or
lbr.ugh.bis n,n e+np! �r•es, pro rlyd lout curb im-
pror•amrnts a i, of intruded or nflerrd fur r'l
ho rrrr er, rhe buddi ng nr inrprnnrrrren I r.s .a,ld uithrn or.
' - year of cnnrplrthm, 1Gi, nuarrr-builder will 'ha- the
Gurdon of pronin•k that hr did on1 build nr inrprnrr./ir
I& parpate
v Ii 1. as owner of the property,arnlc Io Sry Cly
•,hnqwith licenied co niroUo s o co s uct tf c project (Sec.
7044) lirrsi.e and !'rn/s ssrnnC Lots. lhr (.nntraciur.r
14-nse Lau, does nn( apply 1. art nu i .r if prnprrty a•bo
- -, adws nr;,npra,r il,'reun, andi ,,i :,in tracts fvr sorb
prhjcstr with a ci-metur(d /icrn. erl.partuanl fn rhe
torn c—pt Sec.�B. BP.C �i
p C. 1oriF�s
eason
Date Owner
INSPECTOR'S NOTES -
1
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