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Home My WebLink About1508A 1509AWORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self - •insure, or o certificate of Workers' Compensation Insurance, or o certified copy thereof (Sec. 3800, Lob. C.) - Policy No. 73wc005-2C7 �QI.6 NATIONWIDE Certified copy is hereby furnished. - Certified copy is filed with the county building Inspec- tion department. Date ..... 6-30-4plicant 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 shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws. Date Applicant ^NOTICE TO APPLICANT: -If, -after making this Certificate of xemption, 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. LicenseNumber510560 Lic. Class B ControctorTHE ANDEN GROUP Dote 6-30-87 I am exempt under Sec. - B.BP,C. for this reason - Date: Signature OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and Professions Code): - - - I, 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 sale (Section 7044, Business and Professions Code).— I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- - tion 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 LenderiAddress 444 S. FLOWER, LA 90071 1 certify that I have read this application and state that The above informati is correct, 1 agree to comply with all County $ ordinances ate laws relating to building construction, _ R and hereb a rixe representatives of this County to enter upo h property for Inspection purposes. Sigri I— &r9piplicant or Agent - - APPLICATION. FOR BUILDING PERMIT 75/B COUNTY OF LOS ANGELES WILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS 24002 E. Goldrush Drive BUILDI 24002 E. Goldrush Drive ADDRESS CITY DIAMOND BAR zIP91765 LocauTr DIAMOND BAR NO. OF BLDGS. SIZE of LOT NOW ON LOT NEAREST CRoss STDIAMOND BAR BLVD. +- GOLDEN SPRINGS TRACT 43435 BLOCK LOT NO. 27 ASSESSOR MAP BOOK PAGE PARCEL TEL. OwNERTHE ANDEN GROUP TEL. —9541 US ONE MAP MA1/7-3 ADDRESSP.O. BOX 3329 OQ%[7 CONDITIONS CITY COVINA zip 91722 ARCHITECT OR DAVE SZANY AIA No. 445-4073 ENGINEER DISTRICT GROUP TYPE CONST. FIRE �jnNE PROCESSED BY - ADDREss314 N. FIRST ARCADIA 91006la-3 TEL CONTRACIORTHE ANDEN GROUP NO. STATISTICAL CLASSIFICATION 1+ CLASS NO. w DWELL. UNITS -J APT. CONDO. ADDRESSAS ABOVE LIC NO.510560 SEWER MAP LIC. CITY CLASS B BK Pol VALUATION VALIDATION S10ZE" 2774 I S ORIOES 2 FAMIOLIES 1 ONE DESCRIPTIONOF WORK SINGLE FAMILY NEW ® s 164,000 ADD GARAGE 643 SF ALTER ❑ " 1 5 0 8 A - REPAIR I DEMOI 9 FINAL DATE � 1`j 1 � e - e - `Z 1 I -431.08 • e a3 1,085 USE EXISTING BLDG, APPLICANT -TEL. PRINT THE ANDEN GROUP NO. ADDRESS AS ABOVE FINAL /f O 0 9 1 1— 8 7 PRESENT BUILDING ADDRESS LOCALITY MOVING - TEO - CONTRACTOR NO. § 15 0.9 A - ADDRESS 1, "1S—� it e • e e e 1 REQUIRED TOTALSETBACK SETBACKYARD H WY - PROP. LINE WIDTH ( p.� , L' �' r S.', I •69600 6-69600 FRONTPAI PA. _ 1 _ LDMA R.I. N u, 0 9, 1 1 —8 7 P.C. Fee s 431.08 Permit Fee 665.50 Milk, ' 10.50 Issuance Fee LDMA P/C N - - Investigation fee 696.00 Total Fee LDMA Perm. N - LDMA $75 - $35 SEE REVERSE FOR EXPLANATORY LANGUAGE 0. PLANS TO APPLICANT INSPECTOR'S NOTES To: i : ('. Returped Approved No. Date No. - Date - - - - - i, - t. Approvals Dal. Received- Yes No or Approved Water Cernhca+e Fne Deportment-. Pedestrion Preto[hon - - - ._ i' U i , (Fence) ICanoPYl Spacwl Inspection (Canc.l(Masonry)(Welding) T. _ Lot D,, age Prnk,ng Approvals location-- (Setbock & Yards: Foundations Slob Frame, Energy Insulation lath.' Drywall - Interlor la'h-E>terior Neuse Number -_ Correct & Posted 11= nal.. Emer on Front Date Inspector's Signature JYM&M „ Ol1',\lilt-BLIIIJWR UCCI.ANA MLIN I hereby off— +.1 1 are --rep1 barn the Cororaclar•s Lice se In f6"'hi! i (0110.41 y (Seca 7031:5) @ mess and l r J..cuuns Lod,, rinvnts n ..runtytrl,r;l ray uir,s y per it 1 , con.sl r 't; elver, imp.., drmn1kh, -- pairanv ser t'rr`:p'r 't t�is.inaiir.i: atcn rryrnrrs the appli, r f, r seer permit to file a signed stat—,'ent .that b, is lien,nsrdpursuantsrr the pnrrrsionc nf,I/,,, Cn>r- erartn s Livens[ Late (Cbaptcr 9) (nn»mendn,C with Ser- tion 7(1(1(1) of DivAmn 3 of lb, 13-inel, and f'rnfrssiuns Cwt, -)or that! r urrpt the-frnmand Me heifer the alleved exrniptiein; Any r'inlatiaa t/f Svrtion 7011.5 be- am applicant fn t permit subjects the applicant to a civil penally of not mein., than fire heindrud dollars ($500).p 1_I I, as owner of the property"., my'employee wnh wages ns,the, sole comp- s non, will do the wort, and the siructure is nct intenders or offered for sale (Sec. 7044) •Uusiness and Pn,/Fssions Ludr.: Y7re Conl,a, mrs 1.ircnsr l.aw dors not apply to an of—er of property a bo build, _ or iurf roar r (! n, and r bn does su,h evert hirrr,ellnr dlrmugb. Gis. nu n ,ernp7r. t ru: J r vid,d lbut soch irrr,--,, prooernents are nn( init'nded or a//reed for, sure, i hnu ever, the building nr my--ran-t is snl,l vithin unr "w of &—phting 'tbr nu•ner•huifdrr trill bore the burden of f, ai ag that be did not build or inr)rrnre for the purpose n/ iti1e1.. .. . .- � � I,os owner of the property, nm ca,tusbaly ccmroc ding wnh, hcens d coelractors to construct lhr project (Sec. 7044) Vn.ciness and Prj s,i xs Cndr 17rc Cnnuarinrk "__f. --,Laud rs t Pplv m in onva s(Pr,,Pe,ev »bn hnilds rr hnp ores ib(rer n, and wbr, c—tracts for nob proiceft°pith n cattmrtnr(s) lire..... 1, ppn»ant to the - -Cuntra�hrrs I.ia-rn.ie l;au•): - " -"" 1 I I am a e pT under Sec . f3.&P.C, for ih1s reason Date Own-____._.. ' '- • 'INSPECTOR'S NOTES "'-"