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HomeMy WebLinkAbout1584A 1585A . __ .,_. _ .. _ _. _. . :.. _ . WORKERS'COMPENSATION DECLARATION � " ' � � � � �� I hereby afiirm thot I hove a cerlifica�e of Consent�o.e�f � � --�� � � APPLICATION �FQR BUILDING PERMIT .� Insure,or o certificote of Workers'Compenna�ian Insurante, . or a cernfied copy�hereof(Sec.3800,lob.C,) � � � COUNTY OP LOS ANGELES BUILDING AND SAFETY - � � Policy No.�3wc005-27���16 NATIONWIDE ' � Certiiied copy is hereby furnished. FOR APPUCANT TO FILL IN 6UILDING AD�RE55 23828 E. Goldrush Drive � Cerlifiad copy Is filed wilh the-counly building Inspeo- " BUILDING . � tl0n deparlmenf. ADDRE55 23828 E. Goldrush Drive Date 6-30-87 qpplicom THE ANDEN GROUP ciTv DIAMOND BAR zir9176 � �ocAurr DIAMOND BAR CERTIFICATE OF EXEMPTION FROM WORKERS' � - � � � � NO.OF BtDGS. ; �� NEAREST COMPENSATION INSURANCE � �� � SRE OF LOi NOW ON LOT CRO55 STDI O A -F� (This section need not be completad if�he parmit is for one � ASSESSOR . � hundred dollars(5100)or less.) TRACT 43435 eiocK �ot No.30 MAP BOpK FAGE PARCEL TEL. US�.�ONE �P ,���/, owraeaTHE ANDEN GROUP No.967-9541 y- I certify Iha�in 1he performance of Ihe work for which this /�� � permit Is issued,I shall nat employ any person in any manner � SPEpAI � - � ADDRESSp.�. BOX�3329 - /u0o.7 CONDITIONS so as to become s�bject�01he Workers'Compensation Lows. � O urr COVINA ziv 91722 v Datc� Applicant qRCHITECT OR TEI. � � �IQTICE TO APPLICANT: If, ofter making�this Cerfificole oi ENGINEER DAVE SZANY AIA No.445-4073 DIS7RICt GROU7 NPE FIRE PROCf55EDBY O emption, you should become su6�ect to'tha Workers' - . �J ���T' V ��ompensalion pravisians of the Labor Code,you musl for�h- ADDRE55 l� •�'3 t W with comply with auch provisions or this permit shall 6e TEI. STATISTICAt ClAS51FICATION APT. ONDO. � deemed ravoked. - coNrancto�HE ANDEN GROUP No. ' ,.J�� Z LICENSED CONTRAQORS DECLARATION . �. � i��.� CtASS NO. � � DWEIL.UnlrtS� � I heraby oNirm thot I om licensed�nder provisions of Chapler 9 ADDRESSAS ABOVE ' NO.S LOrJ6O ��R�P (tommancing with Section 7000)ai Division 3 0�Ihe Busineu and . . . �i�, Professions Code,and my license is in full force and effect. GTY CV.55 � BK �� � �� VALIDATION �10560 B sae"�1786 sroR°Fs 1 F MIL�IES 1 CONEK license Numbe Lia Clau � VALUATION � Com.aeeorTHE ANDEN GROUP DO}e G�3O-S7 DESCRIPTIONOF WORK I N� � ; 89�000 �1 5 8 4 A ❑I am exempt undar Sec. GARAGE 445 SF ADD ❑� � #• • •�2� AITER B.�P.C.fo�ihis fea5on . REPAIR.� _ ' '� . � •�9 Q.Q 7 � � Date: � - USE OF DEMOL ❑ F%ISTING BLDG. � �2 9 O�O 7� Signature . . . .-. .� APPIICANT TEL. � FINAI OWNER-BUILDER DECLARATION PR�NT THE ANDEN GRO P No. ..o�T[ ✓ �Z/��'. � � O 9,� � �B 7 ' 1 here6y affirm that I am esamp�from the Comroc�or's Licenea a�DRE55 AS ABOVE FINAL �� �J' � � Low fot}he following reason(Section 7031.5,Busines�and � Profeselons-Code): . .. .... . �. . . `Y ° �'''"�`�� � � � BUILDING � , ' I, as owner of fha property, or my employees wfth ADDRE55 wagaiaslheireoletompenscHon,W�udorneWo�ka�d , � .. � �1585A tha structura is nof Intended or oifered for sale(Sectian �OCAUtv � �+ . ' � 7044,8ueinees and Professlons Code). ' -� � MOViNG � � ' � � TEI. � ' , ��•�•' • • � � I,as ownar of fhe pioperty,am exclueively tonfracting CONiRACTOR � NO. . wNh Iicensed eomracrors to eonstruct the pro�ec�(Seo qooae55 � I •�l 5�,5 0 tion 7044,Bus(ness and Professlons Code). ����` � ' " -f - CONSTRUCTION IENDING AGENCY� - � �SE�BAC��� -YARD HWY T�TApROR LWE wioiH � � ,f���'�`� � � � °�'�5 7•�O�' I hereby ofiirm thet Ihere is a constroction lending agency for FRONT • ��'-�� I.�!�: (.'. �9,� ,� �$'] , the performance of the work for which this permit Is i7wed � P.l. - - ' i ` � . (Sec.3097,Civ.C.). SIDE -�..". CITIBANK a.�. ,._. . _, . lender's Noma . . . 290.07 Pe�m�rFee 447.�00 �DMA ReF.M _' _ lender'a Address 444 S. FLOWER. LA 90D71 v.0 Pee S � � 1 .50 � I certify thot I ha read Ihis applimtion and state that the . Ivoance Fee IDMA V/C N - � ' above informo� s correcf.I agree to comply with all County Invesliqa�io�Fee � � ordinances d iate(aws reloiing to boilding construction, ._ Total Fee 457.50 I�MA Perm.M �� � and here ize representatives oi fhis County to enter � op th � roper�y for inspecfion porposes. �� $7r, $35 //�/��� �/,7 SEE REVERSE FOR EXPLANATORY UNGUAGE� cl --�C-�-�- � Signature�Applimnr or Agent . ' po'e . . . . . . J PLANS TO APPLICANT INSPECTOR'S NOTES � ..-L>K'�'FiK•I]U7LD{?R.UECI.AR�7'lOV .. I hnreFiy�af'i i Ihat�l�m�xemp�I�e���'i ;'C_onvortm's To: . i Returned. ... .. . . . . � „ �., i' lrccns..ln�n�in, thc �lollov.ng ro is� � fSec�70i1 51 . . . . • . 'APProved ' . .�.t ..13r�s�neav�rrnJ 1 r!��s�an.r(.oJi.Ars�'�t��i uiinh a�l,id� No. Date • No: '. , 'Date�'' ���� ° . .� - . � . : . .. `,. i,. tcy 'n•�.0 pr� re(�c'nn�f c! �hrr e j ,rr.Jrmr,lisl�. .. _. ,. . , __..�rrapai+'uriY.slructurr�.hri,rhiiLi7.c�u:�acc:nl,cnrr����r �-�J' ��.t:' � �. ' . ...... , ILr�ppli:.�uf/nnsur/rpermittnJileasi,CnnJst�t.•wrn� - - . _.tGa:br is(icrnseJpr�nu�nr rr rl�e prnt�tsi��n�n/fhr Cuh. �.V�'t . �.� �. ..tra�lor'sL�rrrs�rl,air/ChJprr.'llf<� '<in,c,6a•r�a.t,��- �- - -_.._. _. _ __ .__. _-- . ------ -. _ '. .� , „ ",, _ -_ _ - - � �, frnn?OOfIJ r/Uiuv m 3�d thr lfusrn c an�Pr( ins ,�-� 1,'. � �. .����. ,• ��., _'. c.����� ' � i.��. r `.('uJrJ n�th�l!e av cxrmrt!!•ere/r�m ar+JtGr Fne s �r 1hr ;. . , __....__-__'__ ._._._ .__ _._. _ .. . �.__ ___.._ ._ _ .._ _.. _. ..'�'�.': `__'_.�. .... . _. . � � " " a!!e¢J�exenrpfinn.Anr�rn4�tiun��f 1r f m-7(i31.5 h�. � �+PProvals .i ;�. .'. _..'�Raquirod.i� Dat Reeeived-� "—"'- `—" �..�.....'��.-� ------__ ._ .. _. ._. un��p/,h�dnt/nru p�•rnnf,auhjc.'Is fL dJJ,I��nn�rn.e uri! � or Approred . , i,� .. . i . .. ., �..� r• .pFnaltl�n(nnt rnnsr�eian/ir�.hunJr�d d��ll�r.a/$$bQ/./". . :' -: i�Yes No .,. ___. _ _._ _ . _ . _�'.__._.. .__.-_ ._. _...:._ ....._. ._- ____. .... , �..�� I,os owner o(thc propnrty.'ormy emnloyeas wrtli V:pie.Gendkaie� '-��.:` � �'��• �:'; ".�'. -_-- .��.•,". . ._..__..__. . ._ .__. ...__: _ K'nges as iheir sole compensanon.will dc ihe wo�b.ond . : ...... .. ... . _ _._.._. ___. ..___.' I � { ,'. .. '� �.��. � . .. �..... . .. , � , �the'srru<w.eisnotintendedor�of(eredForiale(Sec�7044) � ' , ` _�. •�-� Heolth DePanment.._._ ._.- _..._. -_ ' . ' '� � '_'..___ __..___. _ _.__.'_' _�...-__.� ..' ..' . . Ouiruris und Pr/�.isi„�i,�,CoJ�•;7b��G �t urinr's l.icrnsr . ._._. ._____._ . . . . � . Lu�r Jnrs nnt af/�/e�n an nirnrr di��,���.�����,•r�n huilJr . � , �...i.. �,� ' • ,-�� •� Fere Deponmem . ._..__. ___-_ __ ..... .__ _.___ .__-_ ... ' - �----- . . r r nfron r t! r�n,und r<•Lo dues sr U irurb.l,urrc<1J��r � . . 1.,� . . _ :;_.tl i.�/ 2.-s... . nfl� .� j � !-:l O i,a �l .. Groding _ � � ., � , �prnrrentr ar ��K�intcnd d �r //rrd/r su! - ,_ .! - - � - .. . � Iro��ri�rr.lbrbmldin,e��nmjrrnv.virrct�csuldu•ribviorr. . . . . .� ..! , � ;,i , . .. _ . ._ . _ . .✓..�� . _' '.'.. .'. . . .-..._..__. _^..__.-' _ . .._... . . � ' � . Geolog<at . _ .,. .. , 7eur n/�cnm(,l�.tinn. �bc.uunrr.h:ulder uil!ficrr�tLa �� . , � , .::-. � - - .�.,� �' �" �..- .-.:i!,. :; . .:� � .� �hurJrnnll'rorin�MaileJidm+rb�.ilJorimp.�nr,Inr I .)l PY) . :.__� ^: '.; . . . . ,.,_ _.. ' .�,. _'----.. ._._ _� - -- p r/sse�n t '�•.�� F 9P 1�amc cl s �elyconso'i Pgdesman Protechon �� _ ���, ll / ! Fen<e Ca�o � � ----- 1� � aso n. ofnc� Ff o ' i n<,� �ih'I�censcd convncro s io<onsiru,�thr�.p�o�P< ( rc. sc«�ar i�� , ,._ _-- _ — -__.....-- � . . peciion..._- t .. ....-..-'-- .._ . ., .. . , . . 70ea��73:uinrxs and Prol xsinrir C�ndr• 7'Lr('nnfru�t.iri� (Conc.l(MasonryllWeiding) I, .. . � -��. ' ... ._.I. __, _. .... , . ._'_., . .� , Lrrens�l.d�rJurs,nnlufrfltow�nura r...fPrnrarlVu�lrn , � . .. ".. - - "...bui7Ja.�r-imprures'fhu�rr.ir,.�nd�<'/�u iunfruces f�;r sa.l� . ; �'� ,.,.. .. , : .. � pnjrttc,u;r{!�n �ntruct .{.J liccr� d prrrsunrst m 1Le LotDwmage , J, . ,�..0 i - ._.... ._ _..._: .. ._.�.__. __._ . . ..,- . �� , - � , '�� ' . i ': � , ,. ..,. .. . . . •' '_Cnntrn.tur's�/,icen.re�LaiiJ._ ._��_ -__.'..:r� :..._ _ Parking � . , �"'__ _ -_-__. . ._..._ _.�.._ ... . ... _.. .___ .P_.. . � � ..,.,., ', ' . . [] I am e.em t under Se�. 6.&P.0 lar�F�;'s . . � . . .. ' .... ...'_'._._._ '._�____.___..._��. � ��� �...., , � '�� reason . . .._ . :.-:�;�. � ', "._..____._"__ ' . . _._ . _._ _ . _ .. � ' �� " � Date Ow ner _ . , ' ..� , � ,;}r. . .i, . . ., ' � ""'. ... . � Appravals Dofu Insp¢cfor's Signcturu ' . � . �, .. .. . . _ . . . INSPECTOR'S NOTES . � � Lncahon-- � � . ..... . . ....... . :. (Seiback B Yards) � ,.�;�1�'. - .. . ,�......� ,.., �- . . i,."^ _ _.. . ._._ ._. _- � -_ . .. .__ . Poundaf�ons � � ..; t. : . .. . . .� . . � --/L-2— ,. . . si�e , ... ___ - _ _ : _ _.._.. - _:__: _.,_. ,,; .,_ ; Frome `�Zl' V . . . . . . .. . . . .. ,. � � . . . � �. � ^ , O Ener4Y Insulation F. '�-:_:_'._ .__._'.._ ._.._'._._". ., . . '_._. , . ,,. . . � .. . �,S_ � _. , , �a,r„o,yV,ou.. �r� _- --- -. _ __ ._ - --- . _. . 2_- �� __ . - , � ; _ • i��e��o. �1 ��. _ K-�- i �o�h—Ex,e,o, y_i�_ . � ---- ._ _ __- _ � - , . ;� G:. __ . House Number- '� .�, ...._. _.__�__ _._____ .... __ _ ______. ____. I � ' ...-�,. � +-., � � . Correct 8 Po:!Nd � _ � ,. . .. � . _-'-. - . -_. . . . _ . FinaL. ._.__ ___._'._. __'. _ .. _ . . , i , � . _ ___ '.. __...__.__. ..._.__. _.._..._' ,.. ��..��, .,.. _ i , Enrer on Front . ,. " . . , . . . . . ... � ' _ � � . • ,. . . .. . . .. . . .. ' ' . ,�.� . � . ., ., - �t�. ... . . .. .., . .. . 7`. � . . ._ .. t.=.\`��`�'. . ��,\_.�-=,�tL� ' _. .., . ��:.,. .. . . --=, 1 -_. .._� � : .�' ... ,.. __ .