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HomeMy WebLinkAbout1544A 1545A (9) _ _ _. .. . . __ _ . _ _ ._ _ WORKERS'COMPENSATION DECLARATION . � - ��� , �� � � � � � � '� /—� � I hereby offirm Ihat 1 Fwve a certificme o,�o�,e�„o 3��F APPLICATION FOR BU1L'DING PERMIT insuro,or o ce�tificate o(Workers'Compansa�ion Ineuronce, �j , or a<enified copy thereo4 i5ec.3800,lab.C.) COUNTY OF LOS ANGElES BUILDING AND SAFETY PoltcyNo.73wc005-2�8m�J6 NATIONWIDE � Cerrfied copy is hereby iumished. FOR APPUCANT TO FILL IN i suuoiNc ADDRESS 23844 E. Goldrush Drive � � Certified copy i�filed wilh Ihe counry building Impeo- �"���� BUi�D�NG � ��on deparlmeM.� � � ADDRESS . L3B�F�+ E. Goldrush Drive Dote6-30-87 appt�canr THE ANDEN GROUP crtv DIAMOND BAR ziv 1 �oc�,urr DIA1fOND BAR CERTIFICATE OF EXEMPTION FROM WORKERS' � Si2E OF l07� NOw onei io 5� ! � cRossSstDIAMOND�BAR BLVD. + GOLDEN SPRINGS � � COMPENSATION IPISURANCE � � (This section nced not be completed if the permif b for ona � ASSES50R hundred dollan(5100)or leas.) . Tancr 43435 BLOCK LO7 NO.28 MAP BOOK� � PAGE �ARGEL � TEL. �S�N� MAP `�"� owNedTHE ANDEN GROUP- No.967-9541 I certify Ihaf�In the performance of the work for whlch this NO. TU permif is is:ued,I sholl not employ any pereon In any manner � SaeCiAl � - . �� � � so as to become subjett to tha Worken'Compensotion lowo. -� aooaessP.O.�BOX 3329 � lOQdC7 COnIDiTiONS 0 � arr COVINA zia 1 22 �"� Date ' �APPliwnf - �' . �, . �. ... . � . . � ARCHITECT OR TEL. �1QTICE 70 APPIICANT: It, ofle�moking�this Certificole of DISIRICT GRDUP �E FIRE HtOCE55EDBY � xemption, you should beeome subjeet to the Workers' ENGINEER DAVE SZANY AIA No.445-4073 �j � ) Compensation pravisians of Ihe labor Code,you m�ff fo�th- A�qE� I� �\-� `�f � w wi�h comply wHh svch provisions or this�permit shall 6e � -� � � � LL' deemed revoked. - � � . � TE�• ; STATi511GAi CtASSIF�iON AGT. NDD.� Z coNTanctodfEiE ANDEN GROUP rvo. �..�r IICENSED CONTRACTORS DECLARATION � , �� � � - � �� ���.- C(ASS NO.�� DWE�L.UN�TSJ..�. - I hereby affirm Iho�I am liconsed under pravisions of Chapter 9 ADORESSAS ABOVE No.510560 ��R�P (commencing witfi SecGon 7000)oi Div�sion 9 of�he Basl�ass ond . . . . ..._. ���, .. . Professions Code,and my licensa is In full face and effect. Cii� � ttn55 � BK � �- �VALIDA710N�- License Num6eb 10560 � sa.Fr. Ho.oF NO.OF CHECK � lit.Closs B SIZE 2634� sToeies 2 FAMIUES �1 ONE . �i N� VAlUAT10N. . . `1 ���A ConfrattorTHF. ANDF.N r.an rr pa}e-5—�n—R7 � DESCRIPTIONOF WORK S LS7�OOO ❑I am exempt under Sea GARAGE 64 SF `+DO , �� � � �2� ALTER � . B.BP.C.for this reasOn . REPAIR = � � � •t�1 fl 5 9 � �� � � Dafa: � FXIS�NG eLDG. DEMOI ❑ � •4 l 8 5 9� � Signature . . . . �.. . � APVIICANT TEL. FINAL �,r�/ . OWNER•BUIIDER DECLARATION PRiNT NO. � QATE , � y� � 0 9,1 l�8 7 - �I he�eby aif'vm ihat I om exempi lrom I�e Contrac�or i License ADDRESS AS AB VE FiN�t ' �� � � , Law Tor tha fallowing reoson{SeUion 7031.5,Business ond /j � - - � Pmfesstom CodeJ: . . . .. ... .. ... . .- !y ����-i-'� . - . �"^1 ' BUILDING . . �� . � J I, as owner af Iha property, or my employees w71h aDDRE55 � wages as the�r sole companeation,will do the work and � ��q��iY `� , �� J�Q.Jr A the struuora fs not Intended or offered for sale(Secfion � � 7044,Bvl�nefs pnd Professlons Code)." � " - '`- MOVING - � � � � � SEL. �� � - � � ,❑ I,as owner of tha properly,om exclusively contracting CONTRACTOR NO. �. ����" ' ' � � with licemed con�ractors ro construct�he pra�ect(Sec- ' ADORF55 �� I •b 7�rJ.Q� tion 7D44,Business ond Profeuions Coda). � ' •' � REOUIRED TO AL ETBA K .`'� . .7,� �,\ �':' � ` CONSTRIICi10N LENDING AGENCY � -���� SEi e.4CK YARO NWY DROP.UNE Wio7N � � � •6 7 5�O O u I hereby oHirm thaf 16ere Is a conehuc�ion landing ogency for fRONT ,;i t� � ��,j. � ��he performance oI 1he work fo�which lhia permit is issued �- P.L � - � Q 9,� ��$7 (Sea 3D97,Civ.C.). SIDE " �� �� ,i { lendar i Nama CITIBANK P.t � �.�' ' � '�' y IDMA Ref.N � ��� � � � = lender's Addresa �+4¢ S_ FT f1WFR� T.A 9(1071 v.c.F�s s 418.59 . P«mi�Fss 664.50 ;"' ' 1 certif that I hove read thts a 1 catian ond atate that Ihe 1'0.5� - .� S Y - PP� . . - Issvance Fee � LDMA P/C N � � obove Informo' is m�rect.I ag.ee b mmply with oll Counry ���ef�igm�ion Fee 675.�0 � , o�dinonces d late laws relating}0 6uild�ng consVutlion, . Totol Fee IDMP,Pe�m.N - ond here o riza represantolives of ihis Co�nfy�o enter upon�h - ' ned property for inspection purposes. . ` - � Z _ LDMA S75 $35 , SEE REYfRSE FOR E7(►UNATOIIY IANGUAGF�. � Signarure of Appl�cant or Ageni � � � paie � � � ' � - PLANS TO AVPLICAN7 INSPECTOR'S NOTES �.,OLS;\Ii1LNUll.1)IiR.UGCI.nk:1'170� I hmeby afll ' fi;o�i I nm . emp��'tro �I c�Con!rectnr'o- To: 4' I.� � .. . Returned�' .�� . � ' . � ,' � . .�".�License.Lmn•..for ehe,.foUo . g .aron I <'c„70�1�i1 I. . . �APProvod - �Ilr�nurssnndlr�I�aannsLnJ�.An�.citlru.tnrnfv�il,id� r::. No. Dofe ' No. - `.-Oate-... .. " ., •.. . . '�.�1 ,.. .. �. ,. rey ..+f�rr 7 r t nnfn t oft r,� rJ �, drninli�h. . .. :.. . . . . __'lirrtf tranl•Struciuri•�hritrf�i�Isls.�ti✓ni[:ulsi.rfy�tirt�� . -:�1 � ' ,. , .,�.. I.�i�.:.:i �!r uppfi.mit(ur urlr prrniit ro fifr a si,ineJ xtuterrri�ni - -- .lGuf Lr isliunsrJ(�ursum�f!0 1Ir<�f�ruricinrta o/fhe Cun; �.: -�� �� r �.,;� ' �tru�lor'xl.i�rns���l.au(Cl,apfrr/llcori� r �r�Girith.S���- , ,.--, .1 c..� . . ,_. ._ .. , __ , � . . . .__. __.. _ . _. . _.-._ . _ -_�___... ___. . —.._ . : ._.' ______' -. _." .. ---" ---"� lron?UOOJ.,JUi+�i�ion3?/d�rl3usin�sc,<ndPruJ.•<��„n. � ; .,:.);� .,: •_ �.. �, "�•: • . `�•�. '���,�.i�l '� rG�J�Jnr1La1(dis�'senrptlberefrnnranJlbrbnsia/nrlhr __.._.___."_.'.__._. .___ ._ ..'_.. . . _"_ .�. ___.____ ._��.. � '__'____ . _ �.�_.'.�..._. __'..__._. �_ . ._ . . �!!�¢rJexev:ff n.,:lnv�erolahnn/Jechnr�JU37.Sh�. ':.�.:' .. �: :�. ..�:�, . -. •_�Roqulred�.� � . � .'... `�' �' -.__._.....__. .. _ ._..__ _ ._._ .. . __.'_' '..._ a�iva(��,L:sntf ur uls h/i1s�tlrupjrh�nnttn,e:iril : ... .- . '�Dofo Recelvod - '.� .� �.. .., . .. �... rnalh�a ,nnt nu,rr.(l.+n/� l�und.ed Jnf(ms CSIIUJ. . ; ADProvols .__- Yai No or Approved ..�,� � � . � .�� �_�.., � -. � -�.P � l- 1' . , . ..____ ' .___� _,....____. . .. .�_._ ' ._ . . __ .. ..... :` �.�� I,as owne.r of rhe p a�crty.�o�,my empbyA�s�w��h Wo�er Ce.ilflcaie 7 . ^ ' " .' I .' �. . . . . . .. .�. , , .. ... . . wnges as ihe�r sole.compensahon.wd(do ihe wor6,and , . .�� , , ... , .. ,� . . . __.__ . ____...' __ "_ " . _'"" ., . . . � ����-- ��-- - � -'--� .. -..'�. `-...... ..._... '� � ..the sfrueure it noi'mended o�offFred�So�5�1e(Sec�IOa4) �.. . " . .. "��' ' ______._.__ ._... _ _._ . . . . .�. . . .. �Uusinest unil Pr.r/iscivric C �!:Jlri•C tr�c tnr's l.i:rnsr , � HeolthDePanment .._"_. ___._.... .._ '.___t__ ... _' - . _ . :_. __._._.--. . . .-: ., . , . . . !.0 i d�rs nut�upflr ro�en nu•nrr i�f prnprrtt•��rL.�hui[Jc • , ... • .. �.,. . ' orra f!errnn,unJ�!�dncs�u!�u•nrk l�inrsr/ r Fire OeOanmen�. _...._. . _. ._ ..'_._ _____. . . ._ _ .. . .. - '.' �� _"_ " � . ��� . r .r ,�..,�: `,.i� �.� ",� , .., ' .. .':.�.�: : . . �.4b l�is.:��an ernpfu,l .�.J�����iJeJ-:tlot su�l.im.--•_ !/` Gr�d ng .� , � z..f+rnrcmenls ar.� nnt in(ceJeJ ur,!ffcre{!fnr,.sulr.../. r �.�� - . . . ..' lrn�rrrrr,tLe huildinX or irn)nni�cmrn�rs guld irill i�r nnc ; , ,. . . _. ' ,_.... ..._.... ._ .. _ _. _. '.', ,I � : �. � G�elogicot. - i� -, , -� -_ ,-'.- � � '1�nar o/enmfh7i�,n. eLe���mnrr.ha�ildar eri!! 1ar�� thr ' I ` -.��� � : '�.; �.i.�.. .•'.� '� . i .. hurJrn n/1 ,�thul!�r did not hurld ui irnArnrr/nr � � , ...: �� ."_.... .. . -'--� .___ ._.___ . .._ .__.... ._._- .__..�t�� tbepurpsv:n/sifel:;: - - c.:�-).,_. ' Pedesman Pwrecuon - ; .� _ ....r.. ..�.: . �, •.��...."_... ____.._..__r��•�� . _.'.:•. �_r:.. .. ... (Fencel lGcnopY) . . .. �.. l 1 I.ds owncr of�he p ep.rty,am e.8u:ively[n��t.a�! .. . . ting wrth Lcensed mntroctors io'<onstruc��th�pioje.r�(Sec. SPec al Ins �. ':: - .._ ._ P i:�_.. ." .'_.... .___.__ �� - . .o podlon ___'._". _.... .. �. . .. , . _ ., . C�Ji ! (�nfr�afnr's - ,.. �. 7044)liarinrs. nd Pr/c. I. (Cenc.l(MasonrY)(Weld�ng) ' ��- .. . . . � � . _ •. ,. . , . l.innac I.aord s nnf dpff�tn qn ure�rt r.//�rnfertv u�bo ,,. . _. ____ _ ---_ , __ ---Rarrd„�r p��„�,rf,�.�-,�n..�,�<i�,t„� 1 ��tatra�ts ,.i�,.r� tetD:mnnqe .:,- i'�:'.� ..-... ... ... - .. prn�rcis ur'd,a trurhrr(c)licenmd`.p��rsuant fn �Ir<� . ��,: .. ,. ....__._.�-. ..... ... ._ : ..•iin '� ,. .._... .. ..._. _, ._. _ , . . ._ � , �. . '�_Cnntra:�nr'sl.iceriar I.ai�J'"'..,.._��..__.._..... � �� - � . . � ,. ... ,.. .. � . ._..p._.. .. ._. . .. �_.r.�-�. , ,., - Vorkmg . . . . . .."�-'-'.. ..-�----�"-�- ---- . .. . ..__' �]..I om�xem i undcr Se<. B.RP.C.for Ihl� _.___ _ 5 �.. � -_ __._. _ -__'_'..._'_-'_' ._�_....;., . � - "; . . . . reason • � .. .. _.__._�.._.__._. ,.�_.._ _._.__"_ _'_.. . .._.. .__. � � " Date Own � � . . . _. . . .. -.�.:'.�'. ��„i_ , . ,. . . .,�. _ . . , , , . . ._'_ .___�.- -......__ _ ' . . . .. . .. , ,� , .._ ... ,,, .. __ .._� .: ..� . . � �.. � ..� Approvals Dote la�pactor'c Signatura�� . '� � , ,- , - ��r, ,�1�SPECTOR'S NOTES-- �� � � loca'ian._ .. . � . . . . . __._._._._.... .._.'._. .__. Q r� � (5eiback 8 Yordsl ...�,'L-�0 - �9-�-�ALf�Y -�-� "� _ . . . . . . '.. .� . ;., , , . . Fo�ndo��ons '� � '� � - ,. ;. ����:,�,. . �.. :.,., . Slab . . . . .. . . , . � _ � . Frome �Z7'P � � '� . � .. . ... . � - . . . � . ...�. � .��. . . � e�e,gy i�su�a-o� .L„S_ � ---. .....-- - - -� ' � . . _ , .- .�-.�. " . . - . La�hiDrywoll-. ' � _..__ _- .___'.. .... .. _ :_. �_...'._'_ . � ' .. _ ��,«,o. Z-►��� . P-�,�-_ ____._ . , - - �a�h_EK«„o� ; _ _— — --- --- _ :_�:.:., . �iz�� �,�, , . , __ , � . ... . Haose Numbe._- : .. ___. . _�.______.. _....._.. . .-.... ....._ _.',i �.� � �� � , � . Gorreci B Posied �. �1�. { . . _...__�_. .. _._ .. . � Final_ .. ._._. _ _.__ _� .._�_... .. . - �. ,.___.. ��.:.__. .._._ i �_.'_.. � . . . . .. .. _ _____.___. . . . 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