HomeMy WebLinkAbout1510A 1511AWORKERS' COMPENSATION DECLARATION
I hereby affirm that I hove a certificate of consent to self
insure, or o certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.)
PolicyNo.73wc005-2�$mR�16 NATIONWIDE
Certified copy is hereby furnished.
Certified copy is filed with the county building inspec-
tion department.
Dote6=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, I sholl not employ any person in any manner
sees to become subject to the Workers' Compensation Laws.
DateApplicant
TICE TO APPL%NT: If, offer making this Certificate of
.emptian You
-should become subject to the Workers'
Compensation 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 NumbeY10560 Lic. Class
ContractorTHE ANDEN GROUP Deja 6-30-87
0 1 am exempt under Sec.
B.BP.C. for this reason
Signature -
OWNER -BUILDER DECLARATION
I hereby affirm 'hot 1 am exempt from the Contractor's License
Low for the following reason (Section 7031.5, Business and
Professions Code): - - -- -
n1, 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 sole (Section
7044, Business and Professions Code).
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec. - -
lion 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 Nome CITIBANK
tender's Address 444 S. FLOWER, LA 90071
L cert4cS
read this application and state that the
abovcorrect. I agree to comply with oil County
ordino laws relating to building construction,nd e representatives of this County to enterupon 0perty for Inspe_cttio(nn purposes.
Signature Plicant or Agent - r Dote -
APPLICATION FOR
75/C COUNTY OF LOS ANGELES
BUILDING PERMIT
BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
AUILDING 23820 E. Goldrush Drive
ADDRESS
ADDRESS
ADDRESS 23820 E. Goldrush Drive
CITY DIAMOND BAR ziP91765
LOCALITY DIAMOND BAR
SIZE OF LOT NOW ON LOTs. '
umsSsTDIAMOND BAR BLVD. + GOLDEN SPRINGS
TRACT 43435 - BLOCK LOT No.31
ASSESSOR
MAP BOOK I PAGE
I PARCEL
owNERTHE ANDEN GROUP No967-9541
u3yzoNE
it
IOD G
MAP 117�
NO.
ADDRESS P.O. BOX 3329
SPEC Al
CONDITIONS
CITYCOVINA zip 91722
ARCHITECT ORDAVE SZANY AIA TEL'445-4073
ENGINEER mo.445-4073
DISTRICT
ld
GROUP
R3
TYPE
CONST. J
FIRE
z
PROCESSED BY
ADDREss314 N. FIRST ARCADIA 91006
CONTRACTOTHE ANDEN GROUP. No !
STATISTICAL CLASSIFICATION ,�%
CLASS NO. V L DWELL. UNITS_L—
APT.
CONDO.
it
ADDREsSAS ABOVE NO51056O
.. LIC.
SEWER MAP
CITY CLASS B
AK
VALIDATION
SO. FT NO. OF NO. OF
2774 2 1
CHECK
SIZE STORIES - - FAMILIES
ONE
VALUATION
6 164,000 ,
DESCRIPTION of WORK SINGLE FAMILY
N;;—E)
ADD [:]
GARAGE 643 SF
ALTER ❑
REPAIR ❑
$ - -
FINAL
DATE �2/
.1 1 5 1. 0 A
# e • . 21
1 -431.08
USE OF
EXISTING BLDG.
DEMO[
APPLICANT - TEL
PRINT THE ANDEN GROUP NO.
ADDRESS AS ABOVE
FINAL
By
e e 4 3 1. 00 8 3
PRESENT
BUILDING -
ADDRESS
0 9. 1 1 —87
LOCALITY !., \..
MOVING - I ' - , • - -- — . TEL.'•
CONTRACTORNO.
15 1.1 A
ADDRESS
yr�
"- -
1Dh1A R.I. "
✓ , .
eREQa r e 1
1 e 6 9 6 0 0
-
09.1 1 —87
SETT BACK- YARD HWY TOTAPROP LINE WIDTH
'
FRONT
SIDE
P.L.`
P.C. Fee s 431.08 Permit Fee 685.50
10.50
Issuance Fee
IDMA P/C N
Investigation Fee
Total Fee - 696.00
LDfAA Perm. N
-
LMA $75 $35
SEE REVERSE FOR EXPLANATORY LANGUAGE
9