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HomeMy WebLinkAbout1534A 1535A (8) i __ _ ; WORKERS'COMPENSATION DECLARATION . � � - - � I hereby affirm fhat I hove a cerfifitafe of�o�,e�„o s��f -�- � �- �APPLICATION FQR BUILDING PERMIT � insure,or a tertifico�e oi Workeri Compensation Insumnce, . or c cerrified cbpy the�eof(Sec.3800,Lab.C.) � � ' � � ' � ._ . PolicyNo. 73wc005-2�7��R�}6 NATIONWIDE 61/A 2 Car �OUNTY OF LOS ANGELES BUILDING AND SAfETY � �� Certified topy is hereby furnished . � FOR APPLICANT TO PILL IN '.. euuoiNG 23819 E. Goldrush Drive AD�RE55 � � Cerfified mpy is filed with tNe munty building inspec- BUILDING 23g19 E. Goldrush Drive ' - � fion deparfinenf. ADDRESS Dme 6-30-87 qPP���a�� THE ANDEN GROUP cirv DIAMOND BAR zio91765 ��inY DIAMOND BAR CERTIFICATE OF EXEMPTION FROM WORKERS' SiZE OF LOT Now onei�ioTs� � cRosRSSsrDIAMOND BAR�BLVD. + GOLDEN SPRINGS � � COMPENSATION INSURANCE � �� (This seclion need not be completed if the parmit is for one 43435 � � ' nssessoR � hundred dollors(5700)or lass.) . TRAQ BIOGK LOT NO.��1$ Mp.p gOOK � ' VAGE PARCEI THE ANDEN GROUP TE�' u zoNe naP OWNER Ho.967-9541 I certify fhat in Ihe perfarmance of tha work for which thls � �70. �3�� parmit is issued,I sholl not emptoy ony person in ony manner � ADDRESS P•0• $�X 33Z9 �' VC�C7 p ENDITIONS � so as�e hecome subject to fhe Workers'Compensation laws. � - p arv COVINA _ ziv 91722 v Do�e � Applicant � � � �' . . . .. � AR[HRECT OR TEL DISTRICT GROUP TYPE . FIFE PROCESSED BY O �10TICE TO APPUCANT: If, nfter making�this Certifimfe of ENGNEER DAVE SZANY AIA No.445-4073 � � eo T. E F- , smption, yau should become su6jact to Ihe Workars' . V _ompensmion prov�sions af�he Labor Code,you must forth• AD�RE55 314 N. FIRST ARCADIA 91006 �� �-3 � ! W wi�h tomply wifh such provisions or this permit shall be �- - . ' � d' deemed revoked. . [oNTrtnCrortTHE ANDEN GROUP �E� ; STATISTIGAL CLASSIFI_Cl�710N �� APT. CON�O. [n NO. LICENSED CONTRACTORS DECLARATION � � ����,� � � 0.A55 NO. � ���� DWELt.UNITS Z 1 herehy affirm Ihat 1 am licensed undar provisions of Chopter 9 ADDRESSAS ABOVE n,o.510560 (commencing with Section 7000)of Division 3 of ihe Business ond . . . ���, ��R�P � Professions Code,and my license is in full force and effect. C�Tv M55 'BK � � - � � - VALIDATION�� � .�1056� . B � . . SQ.FT.•L634 NO.OF 2 NO.OF 1 CHECK litenSB Numbe UC.Class SIZE STORIES FAMIUES ONE , � � � VAL WTION THE ANDEN GROUP G-3O-BJ DFSCRIPTIONOFWORK SINGLE FAMILY � co���a��o� Dafe A p s 157,000 1 5 3.4 A ❑I am exempt�nder Sec. GARAGE 445 SF � q�TER S � • • • •2� B.BP.C.for�his reason ' RE7AIR s - � � •�} a 5 9 USE OF Date: � EXISTING BIDG. '�. DEMOI S � Signot�r6 .. . . .. APPUCANT TEL '.. FINAI 7 b �4� Q�J 9 U � OWNER•BU�L�ER DECLARATION �CRIM THE ANDEN GROUP NO. � .. DATE S-J'�� � �� �� �� � �I hereby affirm Ihat I am exampt from the ContraUor'a license AS ABOVE ' 0 9.1 1 --8 7 Law for ihe following reason(Section 7031.5,8osiness ond ADDRE55 ' FINAI '� Professions Code�: �� ' �" " " " � By ^� BUILDING � r �, as owner of Iha p�operty, or my employees with AODRE55 l wages as their sole compensa�ion,will do the work and �p�qi�iv , �1 5 3.5 A the srructure is not intended or ofFered for sale(Seclian 7044,Business and Professions Code). - MOVING � -�� tEL. �. � - � I,as owner of tha property,am eaclosively conhac�ing COn�TRnCfOR NO. ' �f�' • • •� with lic[nied conlroctors 10 COnslroCt 1hB prOjEtl(Sec- - qDDRE55 ' , '�, � •6 7 Jr.�� lion 7044,Business and Professions Code. ) S�- ' � � REOUIRED TOTAI SETBA K '�� � 6 7�O O= CONSTRUCTION LENDING AGENCY SEi BACK YARD HVl7 pROP.LWE WiDTH � � - - ��� i, •�` c I hereby affirm Ihat Ihere is o construction lending agency(ar FRONT �� � -�.,'.t 1he performante af fhe work!or which this permit is issuad � a.L � ' . ' - , Q(�,� � -$'] (Sec.3097,Civ.C.). SiDE • CITIBANK P'�' � � lender's Nomc � � i�° � 444 S. FLOWER> LA 90071 P.c.F�e s 418.59 a�.mn r�e 664.'50 ��'�Ref.M m Lendei a Address 10.r70 ► � I cenity thot 1�hove reod this applicotion and stma thm the ise�o�ce F<s iohu viC N - above inform 'on is corract.I agree to comply wi�h oll Co�nty invesr�got�on Fee $ ordinance n Slate lows relating to build��g cons�ruclion, . �� ioioi Fee 675.�� IDMA ie�m.N � � � R and her y ulhorize represen�atives of this County to enter � u on t entioned property for inspection� � M1 � LDMA $75 $35 SEE REVERSE FOR E1CtUNATORY UNGVAGE Signature of Applicont or Agent � - �- pero . . . . ... . . ' i � � PIANS TO APPLIGANT � INSPECTOR'S NOTES ,.�U11�\IiR•til01.U1fN,UIfCIAN:\'f10\ , I ha•eby nf6, -iFai I a e,emp�hcm q,c Co,r,cri^•'s To: �. �.- q,� ; '_ Returned ` �. " .. ' . . '..� , t� �. . ' � ��Li2 se t6w�f�. he folin � g i- (Sec ��7031-:� � � . .� . . . Approved .� �� ' .. .• • "�� �'��.: . ���, : .: �/3�umrsi nnd�l r�/Lecu�ns Gnd��..lnt rrtl r.-in�nh�hr�li No. Dale ` Noi � - Dofe. � . ,.• -. .. . +.. .. � . . .. ,r.� rcynircc�/rr> f�n annitr c�� ftrr,i ( �����.J�r i,fi�h, � - - . .. . .. . ._ �r rcf�ir An4 ttrur4�`rr,hr t �(s u�i d -c,_dL�.rr'yw � . .. . , ..� " �: ' . -�_ �.. �.1. �;�� � :' , . . rbe�+f�L��ur/nr s�rL/�crnn!tn Jilc.rr srcttrJ sfutrnr)rN ,.. ... .. ,,� .:. � � ,�i� . . . . .'. . . . / . ._ . �. . -. . � . . . . aGo: ,�is licvn�rJ��nrs�mnt tri Ibvprnrr�iiEnc u/1�r Cur:• i . -�1 <: .. .l ; .__ -lra�l.rril.i<'�ncrl,aio/CFJp1rr')ll��uwnrrn�in,Cu•itl�5eo : :�>> . .�-��,.. � . . .... _.. �__- ------ -- -- -. . _. . - -. ._-- .._. _ _._.___ . __.. � �--� ._. . . .. --� -'----�--� -� -�-'- rir,n,•U!!0/n 1 Uir rcinn 3 n!/!�r liusin<..s dnd P.��Jrc�i,�rs< � ;:�: �S::� .I t� , �,-_. . .:�,.i c� :I. .r_�.�- ..�-.; "� or th�t l �rpa�fGcreJn�m an�thr Fiirr�/nr_1Lr C.!J rr .. . .. . _ ._. _._. .. �_-�-- -_.__. .. .:.._ ._._ . __ �. . .____..___. -_'...__ .'._- __'. .__ _ ..._ .. ..._ �Ilr,edcrenftnRArcv��i.�lahoxn/S�tiun :INl.$hr �. .. '.�. �... ` . ` ..:Requiredr_ � Doto�Received���� .-.-___ -__-. t�}'�..�__. ..___-_____._r,• . . . w�t'appli.on�fnrufrrmit.�nhj<•ihll�p�pplre�int�nurrrii ; Approvole � : Yes No or Approved:�,' , . . :,., . , ,. ..�., �c J�rnolt�'o/nnt.runrr,Uou J :hunJrrd J,�tru.,lssoo/./: _.. _ -- ------ �-� .- - ...- ..' "' �..� I,as owner of ihe proparty.br ni lo . Y rmp yra wnh Wo�er Ce t hcme ,i .�i.����� � .� � ��. .�.,._ ._.._.___.. .._ .. .____-__ __ _. wages as Ihert solc compe.nsat on,w�ll do ihe worL�o��d . . . ... . _.__.._ .._ ... .__. ..__. . '_:!. 1..', . . .... . - _.. ..�. ;��. . . .. . -� � � � the svvuure is�ot�niended or of(ered fo�S�le(Sec�70J»� �� Nealth DeParrment__.__.___ _.__'._- _�. . ',.__. _ '�.-_"._��. ;:� _'__'_ _.._____._______ . __...__. _ _....._...___..., .r.liiva<isunJPi /as'inic( ! 7l�C it�1 sli.mse . f.uu�Jnrsnbiupf/���nann rser�o/pr�pbr�ii�h��buil.Ic ���. ,. � Fire.DeOartmen�.__.._'. .. -.. .-- .. . ._- '-. . .__ ._. ..-._ _ nr f �a f n n,u Ji b c r�I i k. m �ur . . - ,. -.._. ____ .._. . .___ __, r n J s / ! . . . . . . . . �.��tGrruql�lu�.;m n.en/i!���i, prnirJ ! 7lul�.-iie�l-�r• � Gr�ding � . � . �-� .,pr:ener�n a .� t �ntcnJeJ �ir �//rreJ Jur ra/ ,� - � ',lanu et er,f(r�buildinX nr irnfrrua•mrn!�c suld iria/+n ri�. . , ... .� , � . ..., .�, .,. ' . ' '_ . .. . __ '-__ .__ . ... ._ ._._ ' . . ' .. nur n m /eL n lie h�ilJer ar �i a . Gecloq cal_: . i' . . . ' �Y � m/� � , �.u�ner.� i!!ha�v th � - � Furden nl prnrin,�lhnl be did nn1 hreifd nr impmio/nr .. pedes�no�P.oiection � ,.: _.,-.,� � �� , .. ..-_.-- _'-�-_----:�. _. '_.�"' ' �_. Ibr pur/�r,se n/sufel.;. . . � . .. _ . .. � - �- . . �'. .. ,.. �.,.. . � I � . . . (FPncellCc.noPv) . -�� � - � ` � , .�, . _......:�- .___'.... _.. __._ '() �}.'ds o�.n�. of the proP�ny am e d ely cennoo � ..__ .._ _.._..__ � � t�"iing wnh Ucensed com�ncro�s io convru.i rf .p:oj�n(Sec . . ., . _-- � _--.._ .._..- � -�--- - . . : . . . . SP�cinl Inspection� :;� . � - �.: ..-.. ... -, . �� . � �704 sirirss.+nd Prn i•s C J f re a)U / i I1' ( e� (Ccnc.l(Nasonry)IWelding) . . . . . l.ic . (.a�rd n�>�applrin.�n.run rj�proprrn •bn .. .' , _ _" . _ .... .._ . -- -.._ . .huilJe ur�impr es lber�•un;ar�d irl n��mfra�ls fur su�h i � � , La Ormnnge ,p ;��;' ...'.� . . _ . . pre jrrtc u�it1� a ann raetr d pur vrt �u �/r � . -. . _... r r{1 drerctr su� � , ___._ - _._- ._. �__�-_. -:� .. • ' .. �i . � ,� .�. ; r� . --...(.'nnirmrnr's l.i�rn.ce l n�i•J. . .�--- .. .. _ . .�� . P ..' .� - ... '_... . Pa.Fing � - � � �` ... . -- . .- Ih�s , .�� , . '..___ .__ ._.__. _..__. _._.._ .__... . —� lamr.em iundcrSe<. 8.8P.Cfo�� .. � . . ' __'_.._'_____.'_.. ___"'"'. .. . �.�.. . � � � � - � f¢OSOn . .' ' _'_'_ _. _.. . .. ..___.. .'_ _' . . . '_ _ ....' "-_ . . � . Daie . ..� .Ow . ., . . '_.. .. . .. .,. , . . Approvols Dote � Inspe�for's Signature. :`:� �.. ;,� -. �� . .. .. • '•'... . � I�. . .,.. :�. .�.-_�- IRSPECTOR'S NOTFS , . . Loca�lon- — . .. ., - , .. . ' "_.______..._ . .-.. ISe,back 8 Yordsl _..... . . ... � �:� , . .�... ,., ..._. . �. I:'_', ioundanons . � �.. . . �. ... . . . . . .� � 51ab ' . ,. . . � .'.'��� ., _ .. . . , . , F,��,� ��q-� �+^�,� . _ _ : • -„ , , Encrgy Insula�ion '. ." :,... . . ; :. ,,. , , .. ., . ,., _.�_.�.� . .. . . �..__ ._ .._._ ' __.._ __ _. .. �.. . Z�/fg ,, . , , larh;Drywall-. (. � .__ . . �.___ . _____ _.__.. _ _. _._ „ . . . . Inte•no• � r� � .._. _ ..._.._.'._'. . . . I, � _,. , .., .. ,... . .. . aloih-Ex�error . , .. . .. . . ._�_. ' _.. '.'_' '._...._..._ _.._._. _.� . �,•... r' n•, HouseN�mhe.__ � _. . . .___-_- .��_-__._._. _..... ..__...._. � ,. ..'_._. . . . , ,. � . , . . ,.� __ �_.___. , r..: ,..�.. ..�. .�, �..,. Correcr 8 Posied •. . .[ . ..__.._ .._.__ _ _.-.. . . . . Pmo!_ . _.______. _ '... _ _. _._.-'_______. . ....__ __ ____... __ .__..... ._. . _� Enie.r en Fron� �. .. ,. , . , ..� �I.i -. . - . . ..,.,, . - . . . .. � . . ' .. _ . - - . . � .. ,. . : . .... ���� . . . _.. , .. .. .,. ... C�\�� \._ ��.-y'�� . .