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HomeMy WebLinkAbout1536A 1537A _ _ , i WORKERS'COMPENSATION DECIARATION . - : � �� .� ��-- � � n � I hereby afiirm Ihot I hove a teriifico�e of�a�,e��,o,��E APPLICATION� FOR BUIL�DING PERMIT � � insure,or a certificate of Workers'Compensation Insurance, �� or o certified copy�he�eof(Sec.3800,Lab.C.) � � � �" �"� ' � 73wc005-77 n�7,6 NATIONWIDE 61 C 3 Car COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. `C�pnm� � � � Certi(ied copy is hereby fumished. FOR APPLICANT TO FILL IN : nposess 23835 E. Goldrush Drive � Ce�lified copy is filed wiih the covmy bvilding inspec• � BU�LDING 2 . _ fion deportment. nDDRESS 3835 E. Goldrush Drive � po�e 6-30-87 qppl�cant THE ANDEN GROUP aTv DIAMOND SAR z�r 91765 iocAUTr DIAMOND BAR � �CERTIFICATE OF EXEMPTION FROM WORKERS' � � � �� � � � - NO.Oc BlDGS. - NEAREST � COMPENSATION INSURANCE � � 5¢E OF l07 NowoN ior � ceoss sr.DIAMOND BAR�BLVD. �+ GOLDEN SPRING � (This settion need not be�comple�ed if Ihe permit is for one � TRAR 43435 � e�«K � ioT No.'20� "uEuoa . � -�, . hundrad dollors(E�00)or less.) � . 1vV+P bOOK PAGE PARCEL TEL. USE NE N✓+P Z awNeR�E ANDEN GR�UP No.967-9541 I.certify tha�in the performance of the work for which this �� NO. � �d � permir is Iseued,I shall not employ any person in any'monner � SCECin� . . . so as to become aubject to�he Workeri COmp0n301ion LaW3. ADDRESS P•O. BOX 3329��� J�0 d a �ONDITION$ � atr COVINA nr 91722 v Date APPlimnf - . , ` ..... � ARCHITECTOR iEL. . .� .. .. . . � NO110E TO APPLICANT: If, otler making�this Certificale of ENGINEER DAVE SZANY AIA r,o.445-4073 DiStR�Gt GROUa OPE �RE PROCESSEDBY O �emp�ion, you should become s�b�ect�ta tha�Workers' ompansation provisions of Ihe Labor Code,yov musr forth• ADDRE55 14 � re 3 ��r� �. �� W with comply with such provisions or this permit shal� be � TEi , � � � � � p.,� deemed revoked., �onrtrtnclortTE1E ANDEN GROUP NO. STATISTIG4l CL4551FICATION APT CONDO. (n LICENSED CONTRACTORS DECIARATION � . � � � . . . . ClASS NO. � DWELL.UNITS� Z UC.� I hereby offirm ihot I am licensad under prdvisions of Chopter 9 ADDRESS AS ABOVE No.51�0560 (commencing with Section 7000)of Division 3 of Ihe Business and __. . . _ . . . . . UC. SE�^/ER MAP � Prolessions Code,and my license is in full force ood eHect CiTr M55 � � � � - VALIDATION - 54.FT. NO.OF NO.OF CHECK BK. VG. Li[enSeNum6er�10560 � i;�,��io„ $ � � SRE 2634 � sTOR�es 2 FAMIlIES 1 ' ONE �� - VAlUAT10N ContractarTHE ANDEN GROUP pQ�e G-3O—S7 - DESCRIPTION OF WORK SINGLE FAMILY ' NEw � s 157,OOD ' �1 5 3 6 R GARAGE - -- 649 SF noo � , �. . . .2 7 �1 am exempf under Sec. - � AUER � � B.BP.C.for fhis reoson . _. ' REPAIR � f � - � � •4-t &5 9 � Date: - EX 5 NG BLDG. ! DEMOI ❑ � • ��.1 �5 9� SignOluf@ .4PDl�CANi TEL ' FINAL OWNER•BUILDER DECLARATION PRiNt THE ANDEN GROUP NO. . .DATE �.5-3— Q . . O 9.� � �H 7 1 hareby affirm�ha�I am exempf(rom the Contrauor's Licanse qDDR[55 AS ABOVE � Law tor fhe(ollowing reason(Seclion 7031.5,Busiriess and FINAC� �� ' � � � Professions CodeJ: � � '�' � � � -- �6y - - ^ . . BWLDING , , . . r` � I, as owner of tha propeny, or my employees wi�h qDDeE55 `� 5�7� � wagas a:�hoir sole compensa�ion,will do the work and , ' � ihe struc�ure Is nm inrended or offered for sale(Sedion �aAUT� ' � � 70d4,Bosiness and Professions Codej. � � � MOVING• \ iEL. � � . - - �+�,• • o o � � � I,a4 ownef Of tha property,Om extl�tively[onlra[fing CONTRACTOR; - NO. �� with licensed mntroctors io construtt tha project(Sec- � ADotie55 � � � -I,�_� � I •6 7 J.�Q tion 704A,Business and Professions Code). ' .c,;,,�-. � CONSTRUCTION LENDING AGENCY - � - SET�BACK YARD MWY T�TApROR LWE WiDtH . � .J � � ° e�7�O O u 1 hereby affirm thm there is a consvuc�ion lending ogency for FRON, . . ;:.� �,. p q � � _8� ihe periormonce of fha work far which lhis permit is issued G.L - � � (Sec.3097,Civ.C.J. SiDE - � CITIBANK °L "� Lender's Name � , lDhL4 Raf.N � � �,�� . Lender'sAddress_444 S. FLOWER. LA 90071 P��•FeeS PermNFee 664:50 - � � 1 certif thaf I hava read this a Iication ond stare Ihat the � - tssua�ce 1'�:5� � � - Y PP Fee �DMA V/C M obove IaformaY is correcl.I agree lo comply wiih all Couny invesfigation Fee $ ordinonces d ate laws reloting to building tonstruction, . Tmal Fee LDMA Verm.M - -and here a orize�epresanlalivas of Ihis Counfy to enler � upa t e- 'oned property for inspeclion p poses. � $7rJ . SEE REVERSE FOR EXPIANATORY IANGUAGE ^ Signot�te o Applicant ar AgeM � pale.. . . . .. . - . . � PlANS TO APPUCANT INSPECTOR'S NOTES �;:011'}7'.12•ISUII.UIiH.IIlS(:LANA7�10.� 1 h rFy afh r �c 1 I�m< e .pl 1 o I� �on�o-. "s . . ' ` ��.. � '. ,.,lic�n C lo ��I� tFc.foll� q i > (Sn..�70�1.�� Tm ' . . . Returned i''-.:� �. •.;. . . ' �{ ;.. .-�' 1 ' , � - .. . � r , . . . �. APProved � ��Ilrvinr�crmdlru/���inm(�iJ�..lnyait�u .uunt�r�l�,:/� � -� � ;.:. �� .'� :':.,' .':' .�'••-.•..�, ., -. rc uirrsuprrnutl,��r�r�slruat.�ll�r�.� i(n�r�.Jr n(ish� . No. Date ' Na: �.. �: Date ••-- ' . . . ;.. .�: � �' ' :.' �..urr��(+oirmiy.clruc[urc.'hrinr7��it�it���� :�lsunyuirr� � , �. . �. . r � ,. • • '�,-'-��� :.� .�,, '' �1'.� .. ,.. .., 16r aJ,pL.�nt/ uarlr pc�nri�1n/i(r a si¢nrJ xl�t.arui� ', _ .. :i: i .J'_,�..0 .,-.. ._�. <.__ ...'�' ��i. ' �: '---- -'� -.1Gu1 br it!i rn.�rJ/�unua�it.fr�Ibr prn�isiuns u/.tbr Coro- � , �' .. - � �rn.'!nr'al.r�rn�rl,dt<•(Cbd/7er-')/(run -��nun,��iith.Sn•' : �L." ::"' .:�. - . _.._. ... .._..- __._ '_ ._'_.._______. .. . .. ._. .� _.....__' __ .__. ' __". . "."_'. ` . -�-- � � fion il/OOJ r�!)ie•ni��n 3 r.I7hr Ilu�in �s mrJ 7'ruJre�iuns � , . ..,... �: � ��`�. �,• '--: �"��.�.� ��C.�JrJ nr tFdt(�r ir rx��nipe tbr.re/r.�m und i4�c h�,�is lr�r.lhr �_ ._'.." '._"_'__.__.. ..__. , .� ��.:�:.. .` .. i_.�,.�.' �__'— _._ ._�.,.._.__. . .....__. ._.__. ._'_ __� . vrinla�inn���3rrfiuri7i131.SFt� �AeerJ c.r�•neffinn.An :�.�� • �`�:� �.:t� .�. -.� •�Roquired�._. .�. ' . .� � . . ._. _.______ • ...._-__ ._ . ._ ._ .. . __.�_ . ❑r�Y�PPL:anf/r�raprrnnL�ahjr�trtlrr�.�fpliarrn�tn�.iri! -�Dato Racelvod-- i APProrals or Approved_�.� ,. . fenultY.al nnt�nnrr tbun/ �bvndr�d Jnllors/�SOp/./:. .,� ,. .: . �.�Yes No .._..—. .. ., . .. .. . . , . . _... __ . . . _ _ ._..'_---._ __ ._ .___ .. � . . I,�s owner of�he p opnrty,or my rmpbyees wilh Waie.Crrt�6caie �' � �� 1 � �� `�• f � wnfl�s ns�heir sole compensotmn,will do thr.work.ond . . . .. . . , ..�,; . _ _.. . . _r_ � .._ ._ � .... ;., .._ ..-:. . . -___. . . . .. .-_. -' th�s� uure is n�inte.ndr.d o�of(e ed Fo t le(Se[._7044� . � Hcalth Depanrnem _ .. :. '-',-�' -... --- --�—-� --- ...�..... ....., " � .,,�Uvnricf�unJ�Pr�ctriuns.(' !c I!e G rtrd! r's f.irense ._ _, .' 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"'", ,;� �,bs ownrr of thc p ap�ny',am ezflusively tnnv�t� 1 1 l �Y) i . - -- . . . .._.__......,. . . . -._- � ' iin-w�iih licenscd�connoUo� ., . � 510 cunSl�uc�Ihn p:oj�c�t5r(. .. . �.. .-�- ��--- --- --- - --- 4 �sirsrai u d 1 r •< 'w�f'oJc 11 ('r�U�a1nr's Specio�InsPeclion ��� _ . "..� . ... . . .... . . � . . . �04 `te n r .� , „ (Conc.l @lasonrY)(Weldmy) :. . . . . .,. � . . .. - l.m�n. I.atr r/r.n I a//�1�In an nuvi r-r f pr�fcrtv u�Ln . . ,. _._:_ _.__ _ . .._.. _. _.:-. .. - ---huild��i�r irn rurrs lhrrr��n,-anJ rrbri-rualrurL ! � P �ur. � lot Dra�n❑ . .. ., �.�..- . �� ___.� , �. ,:_.. .. . ..".. . . �_,_..: !Tttv u•i!� a .nn ruci _ . . _.. . . , �� � -i�_ 1 ._. ... Pr 'J � r(v/l�rneilp rsraan� �n �J�. � .. . , ...Curtbe.lnr's Llrrnrv-1,�u�. Parkin9 , ..�.�i� ,,._.._ ___._� .__.._.._._.—' -' -.. ___..._.. _.___.� _Iamexemplundcr5ca � _.• .B.BG.Gfn�� ; iha . � -�--------�--�--- .__.. ..._ . . , . • . ' - , , ..._ . ' .� fbU30f1 � . �. 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