HomeMy WebLinkAbout1540A 1541A _ _ _. . .. . .._.. . _ : - - - _ _ .. . . _ __ _ WORKERS'COMPENSATION DEQARATION � - �' � . � � �� � 1 fiereby offirm thai I hove a cenificate of�o�,a�,�o,e�t -���- - -�APPLICATfON� FOR BUlLD1NG��PERMIT �� insure,or o certifitate of Workeri Compensation Insuronte, o�o cerrified copy thereoi(Sec.3B0o,lob.C.� COUNTY OF LOS ANGELES BUILDING AND SAFETY vol�cy No.�3wc005-2����6 NATIONWIDE A � Cer:ified copy is hereby fumisbed: FOR APPLICANT TO Flll IN ; AooeE55 24005 E. Goldrush DYive �� Certified copy is filed wilh the covnry b�ilding Inspeo � BV1lDlNG � . tion deporiment. � n�oaEss 24005 E. Goldrush Drive � Da+e6-30-87 . nppl�canr THE ANDEN GROUP ciTv DIAMOND BAR zic 1 6 iocnutv DIAh10ND BAR ��CERTIFICATE OF EXEMPTION FROM WORKERS' � � � � � -�10.OF BLDGS. � � NE4REST � COMPENSATION INSURANCE , S�ZE OF t0T NOW ON tOT CROSS STDIAMOND A BLVD '1- LDE (This settion need not be complated�f the permit is for bne � - TRnCT G3G3S BIOCK LOT NO.22 MAP BOOIC � � PAGE� PARCEL hundred dollars(SI00)or less.) � � � 7EL ZONE o � r -3 _ I certify�ha�in�he performance of the work(or wht�h rh�s � � owNeaTHE ANDEN GROUP No.967-9541 �_r permit is issued,I shall not employ any person In any manner , . nooRe55P.0.-BOX 3329 �d�� COwDITiONS � � so as to become svbject fo the Workeri Compensation Laws. � O [ITY COVINA ziP 91722 U Dau Appticanl � aeCNiTER oR TE�. � NOTICE TO APPI�CANT: li, affer moking�ihis Ceriificote of ENG�NEER DAVE SZANY AIA r,o.445-4073 DlSittlQ GROUP TfPE FlRE PROCESSEDBY O r"`aemption, you ahould become su6�act to Ihe'Workeri - �ONST', ) ZOyE U ompensolian provisiona of Ihe Labor Code,you must forth• nooaESS �� ��� n� � � with comply with such provlsio�s o� Ihis permit sholl be - � - TEL STATISTICAL ClAS51FICATtON APT. N00. N deemed revoked. �pNTenctorsTHE ANDEN GROUP No. �y � Z LICENSED CONTRACTORS DECLARATION �� � �. - � � � - �� - - � -ltC.-` �' --- �au NO. DWEtL.UNITS I here6y offirm�hat 1 am licensed under provisions of Chapter 9 aooRessAS ABOVE No.510560 ��R�P (mmmencing wi�h Secrion 7000)of Divislon 3 of the Business and . _ . _ . .���, . . Professions Gode,and my license is in full force ond affect. CiTV CtA55 � BK � - - - �VAIIDATION �10560 B s°eFi�2634 s oR�`s 2 i MI101ES 1 CONE Licenae Numbe �Ua Closs � VAIUATION . . � - THE ANDEN GROUP G�3O—H�I DESCRIGTION OF WOfiK NEW 157 000 CoNrotlor Da�e ADD � S ' � -�1 5�.0 A ❑1 om exempt under Sec. GARAGE-649SF a�rEa ❑ s . p. . . .21 B.BP.C_for this reaion REVAIR ' . � � � � Date: � USE OF DEA40L � �^4 1 &5 9 F%ISTING BLDG. � Signofure � APP�GRIMT THE ANDEN GROUP� No. FiNA� t�/��J � � • `'�'' � $5 9`_' OWNER-BUIIDER DECLARATION . . . , � DATE / �� � --- 1 hereby otfirm Ihat I om exampt from the Contractor's Litensa qDORE55 AS ABOVE � FiNnt �9'� 1'-8 7 Law for the following reason(Section 7031.5,Business ond e /Y/�� � ProfessionsCode): � �-- � � • y ,�� � B W LDING I, as owner of the property, or my employees w(th nD�RE55 wagee as their sole compensation,wII�do Ihe work and �OCAIiTv � �he srructure is no�in�ended or offered for sale�Section �� 5 L',� A 7044�BU31(18i5�'1(I PfOEBSS10nS COdBJ. ''- � MOVfNG � � -' � � TE�� � � � � I,os owner of the proper�y,am axclusively tontrac}ing CONtRACTOR NO. #• • • • � t with hcenaed mmraUors to construd the projec�(Sec � tion 7044,Business ond Professi0ns Code). ADDRE55 , C' ` � ;�-j—`� ' •6 7 ra O O REqUIRED. TOiAI SE BA K '� (' �'' � CONSTRUCTION LENOING AGENCY- � � Set encK YARD MwY PROP.11NE � WIDTH � � I hereby affirm that there is a canshuction lending agenq for FHONT -�� � , . • •6 7 5,0 0� the performonce of 7he wo�k for which Ihis permit is iswed o.�. � - D 9,1 1 —8 7 (Sec.3097,Civ.C.). SIDE i CITIBANK �.� • lender's Nome ( ,- - 1 �-,` P.C.Fee s 418.59 � v�,m;,F,e (j6t�.S� , IOMA Ref.N , ` lender'sAddfess 444 S. FLOWER. LA 90071 10.5� , � I ceriify.that I have read this applicaiion ond siate that�he i5.oa�ce Fee �OrnA P/C M � obove infarmatio correct 1 agree b tamply wilh all Couny �nvev��gmwn Pee 675.�� j ordinonces a te laws reloting to building Consfroction, . - total Fee� IDMA Pe.m.Y � Z and hereby u riza rapresentatives of fhis County to enter � upon 1 a m+ed.properry(or inspeciion �,PoS�.. �� $75 . . . . $35 �� � � � � � A /� SEE REYERSE FOR E7fHANATONY l0.NGOAGS. Signa�uro of Appl�can�or Agent . . . po�e. .. . . . .. . . / \ VLANS TO AVPIICAMT INSPECTOR'S NOTES .�.�1W�1�`;H-UUll.l)1'.H DI:CI.ANr\J�Ip` I hercliy offvrn��-�a�l I�nro rKempr l�om If,r.Controc!n•'s . To: . �:��.� . . Return¢d . . i' - ' . : � ;-'License La 1> ��fe lollov.�irg rtrnza (SF.c JOJI.'S) . APProved -lhrs acund(rfrs.u�nsCnd�:An�.ah•or.uunhuLrrb No. Date Na. -� Datc � �_. . . , ... . , „ _ � �... , rryu�resu frrnu�li� �nsf u!ult��r. /."'<•..d.•�n�,lish, � – , __ irripaisanystiuctiirr.�ri�i�f�:iti�iserrJ��ce.alinrr./uirec .,�. ,. ' . :_�1 " :. � . . .. . .. tbc�fpli:�nt��r surG prrmi7 tn/ile.a sienrd a1�t�n�r��t , . ., ., � r,,, � i •• ; ., �:,, . , .,� � �.. . .- . .. - -. -. .., -.tbu:/re i�li.rnsrd�urauorit�u fGr ricinnx n �l+r<:un. .. � . . � � . ' tra:tnr'al.ia�e>isrl.au�IChaplrr')I(r�mmiencin,q¢df1,5<•a�- � ".�_ ^.;.i'.:,�.'�., ., '.�;�t �� _ . .. ._.._______ _ _.__ . _ . _. _.._- -_ . _ . _.. ._.. __ _.__._.. .. _ .. . Nnn 7UDf1J nl Uiri<inrc 3��{tbr ftusiu�•a udJ Pr,�Jrssinns ' �;. '� .�.�. .�:('� . . .�`. ._ ��'�`,.•�,.�� .'___ ;''..�. . �1:-..��J.��. �t� '.��C�drJi,r't!ulLciac.ac�m/rlll�erefnimanJlGrba'sisJr.r.lhr. �_. _..'._...___._._.____'. '___ _.�. _ _ _. _ . _' . _. ...'_ .. �...-� _.. utfr,erd exerrepri��n.�Anv r1,�larinn/1 ��r'or;�)ji9L5 b�. ;�, .' '. 'I•. .: ',. '� .;Roqulioi! _; '..DatenPProved . . ...__._ �.�..__. ___.___ ..._. ._ . _.. . an�appli. ntJoraprrn�i�xuhfe.�s�Lh,,rrr,<<r�<<,�,,.,�ar . a �o„ai� ., . �, ,... PP -.Yas Na � . , , � .�penaliy��/�nnt mnn•.il�n frr�bunJ.�-d d��!!nn(e5bp1./: .,:r. . . � -� _�_,� . . � .. ._. . .._ .. _' ____-. . _ . .�..._ _. . .. , . .- . .. .-----– �_.� I,as owner ol ihe propr,rly.or�my empioyees'wnh � Wnv,�Cendicaie "• 1 . , , '�. .____ ..- -. � ..... ___. wages e ce de n de�Il,e wo���oa) .. � . . �. .... . �. . . . .. � . ns�he�r sol sar on,w�li �.. . �.. . .�_. ._____ . . . , � . . . .... . .. ....._. ... _. .. ."-�-:� . , �- - . .::'ihe�trucwre is not in� n d o.offered{or So?{Sec.'. �� Hcalth Deportment.___— . .. . .'-"� ' ---_._..---..__. . ._.___.__. _.�_•.,...... _: � •. . ._ � l3usinrss cnJ 1 r,Icirrurii Cudr:,71r�-Crwhd�lor's Lrirnse _ _ ..__. _. �_.�.. . _ _. ___. . ' - , . Lmi�Jora no!applL�/n�n i�u�ner nJrrnprrly n L�n/;uifds Firc DeParement_._ __ .__.__.. ._ .._ _. ._.._ .._ .._ . ' � - � -- – - .._ nr e�s 1 e d n k. ci , . ,__'._ . . � p t. r un tr! Joecv !t li.n.•lf.�r �. , i . . . i!nu.�!-A,is�"m n einplqv�ee pr��riJ / �! i��su�G ir- � ' - -prna�ernents arv.nnt inlrnder! nr uf/r d/ salr !/^ �. Grodin � i:�--� ± . '.' �� �,.. � . -�'�.bn�ee�rr,tGe baild�nX nri�nprnnemrnJ rsauld irilhin rrr. ., � ,. ,. . .;, ,.. . .,, . ___ _ . . _._ . _. �.. _ .. .,:� �.. . ., � , i� .� . Geologicnl �, � .. .._ - .. --".Tear nJ.rompletinn,�tbr�nuvirrvbnifJer��ri!!Aarr tha• . . - Gurdrn riJ frnrirr,�Ibuf l�e diJ nu�huild r�r rmpmre fnr 7edestnanP.oiect�on !.'1�_ .-.� _,. �, -::. .... .�.. . .. � l � ...�� _.'_1._ .�:.. � � � 'Y � t!e pi�r/�ose n/s�le1'.- �Fence)IConoPY) . . . . - . . . . ... - - �� ��) I.�aiowneroflfiepoP r1y,8meecios'acI eenvao � �ling w�ih Gcensed convoctors io mnstrucr thr p�o�Ac��Sec. Speci I In peciia'n � p�. . �. -'.–. . , . ._ ..- --� ---i� ---�- . ... � _ a4)l3��sinesa und Prq/��s i. (�Jr 'ILr CanlrJ�or's _ _.'.70 � ` (Cone)(hlosonryllWeld�n9) ? . .�.. .-� . , �, .� .._ . - _�_ _, ..-.. . ��__. . . ._._.. . � l.rcrnselatrJnesno7�ppl�t a "�•ner.fprnprrt�a�/�n " � . � huilJs�nr Lnprurrs Il�rree+n,auJ u Ln�onfruats Jn>in.b Let Dromaqe .. �7,�� �,.� .. , ' . ..� .. ., �: ... � .� _ prajratt u•itl a .un�rurt r(J 4reriseJ�pursuant lo �!e _ �__..,_�. ,_. ._._ .. .�_.__ . , .,. .. - . . -��- --'Cnntra:tnr<l.icexsr f.uie J.. . ... ... . � . .i , ....�,. . . , Parkinq � . . . �...____ _ _. ._.__. . .__ .._'_. .._. . .... __. . ..Se<. �� �.� ..�'.�.BP.0 for � ❑ i am e empt under the's .. . � .. , __'_reoson . .._'.__'_'..__.. _._ . , �. . � , . • ""____.___–.._... . .. _ ....__-_ _..._ .__ _. . . � � Dn1e Owner ,�. . -; .. . _.�. . .. . , -�, _'_...___.__ ... ... ._.. ..__.._ . . ����.���. . , � `.APProvals Dote Inspector'a Signature. .. .., . . , � . � � . . IhSPECTOR'S NOTFS � Locaiion– � ..__ _____ .__ _ . . ISeiback 8 Yards) �.. � .:.,. ,. . `. - _ . _.____ _____. ....... . ....___.... ._ . . : ... Foonda��ons - . ..:. .. . . . � . . ��^ - Slab. .. . . . . . � . . Frnme Z S g� _ .. . . E�e�9Y��z��o,,o� a.�3,� _ : _ _ ____, , - _ - ,, _ ; � Lath;Drywall_ – ...._. __.__..____._�.._ . _. . . _ "._ . ... . In�erior - - ._ . . . _...__ _. , ,. , . . P � loth–Exferior ��Z 1. � , .,. . ' .' . _ .. . . . _�_:._, . , , ....... .... . .._ _.___.. _... r Hcuse NumFe.__ . ' � _�.. . . _ . -...._ _ .-__._ ._ __._._. . . _ . _ ._� _ _._.._........ , �., �. .. . ,. : . �. .� Correc�BPosied .. . � .t,., .i .._.��. . .. .:_�... . .__ .. . - - . � Finol . _._ _ ._ . __.. . _... ... . . __.__...__ . .._ ___.. .__ _ . ._..... �, , , , � . �, EnieronFroni � •�'� . � . . . . .�. . . . .. - . ,. .. .� .. ._. ... _ . . . . � .. .. . ,.. . . ., . _ . .. . � � \\ �.`� , � . .,,. .. . �.�\'� .�l � < �>_:.� � , . _. - ` � _. ___ _ _ - �-