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HomeMy WebLinkAbout1540A 1541A (9) _ _ _. . .._ . .._.. . _ _ : .. _ _. . . - _ __ WORKERS'COMPENSATION DEQARATION � - �' � . - � �� � 1 fiereby offirm tha�I have a cenificate of�o�=a�,�o,e�t --�� - -�APPLICATfON� FOR BUlL�D1NG��PERMIT �� insure,or o certifitate of Workeri Compensation Insuronte, o�o certified copy rhereoi(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 ; AooaEss 24005 E. Goldrush DYive �� Certified copy is filed wilh Ihe covnry b�ilding Inspeo � BV1lDING � . 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 � COMPENSA710N INSURANCE , S�ZE OF l0T NOW ON tOT CROSS STDIAMOND A BLVD '1- LDE (This settion need not be complated�f the permit is for bne � - TRnCT G343S BLOCK LOT NO.22 MAP BOOIC � � RAGE� PARCEL hundred dollars(SI00)or les:.) � � � 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 nol employ any person in any manner . . qD�RE55P.0.-BOX 3329 �d�� CONDITIONS � so as to become svbject fo�he Workeri Compensation Laws. � O urr COVINA ZiP 91722 � U Dau Appticant � . . aRCMiTECT oR TE�. � NOTICE TO AP%ICANT: if, offer moking�ihis CeAificote of ENG�NEER DAVE SZANY AIA r,o.445-4073 aSTRICi GROUP ttPE fIRE PROCESSEDBY O r""aemption, you ahould become su6�act to Ihe'Workeri - �ONST', ) ZOyE U ompenso�ian proWsions of Ihe Labor Code,you muat forth• qooaESS �� ��3 ��� � � with comply with such provlsio�s o� Ihis permit sholl be - � - TEI. � S7ATISTICAL ClAS51FICATtON A7T. N00. N deemed revoked. �pNTenctorsTHE ANDEN GROUP No. �y � Z LICENSED CONTRACTORS DECLARATION �� � �. - � � -� - - � -ltG-� �� --� ClASS NO. DWEIL.UNITS I here6y offirm�hat 1 am licensed under provisions of Chapter 9 aooRessAS ABOVE No.510560 ��R�P (mmmencing wi�h Secrion 7000)oi Divislon 3 oi the Business and . _ . - . .t�C, . . Professions Gode,and my license is in full force ond affect. CiTV CLA55 � BK � � - - - �VAIIDATION �10560 B s°eFi�2634 s oR°Fs 2 F MI�ES 1 ONEK Lfcenae Numbe �Ua Closs � VAWATION . . - - THE ANDEN GROUP C)�3O—H�I DESCRIGTION OF WOfiK NEW 157 000 Conlrotlor Da1e ADD s � � '�� �J�.�{� ❑1 om exempt under Sec. GARAGE-649SF a�rEa ❑ s p. . . .2� B.BP.G for this reasoo RErAIR ' � . � oma: usE oF DEA40L I �4 1 &5 9 exisTwc eio�. Signofure � APP�GRIMT THE ANDEN GROUP� No. FiNA� �/��f � � • �4 1 �5 9� OWNER-BUIIDER DECLARATION . , � DATE �� � --- 1 hereby affirm Ihat I om exempt from the Contractor's Licensa qDORE55 E1S ABOVE � FINAL ,, � �9'� 1.-$7 Law for the following reason(Section 7031.5,Business ond e /✓I�% ✓ ProfessionsCode): � �-- � � , y ,/! br�w'" � B W LDING � . I, as owner of the property, or my employees wilh ADORE55 wagae as iheir sole compensation,wi�l do Ihe work and � �he srrucWre is no�in�ended or offerad for sale{Section �ocnurr �� 5 41 A T044,Business and Pre4essions CodeJ. � ��- � MOvtNG � � -� � � TEI. ' ' � I,os owner of the property,am axcl�sively tontrac}ing CONtRACTOR NO. �� � � � � � wHh hcemed mnfrauors to tonstrud the projeU(Sec � fion 7044,Business ond Professions Code). ADDRE55 , C' ` � ;�-j—`� � •6 7 ra O O REqUIRED. T01A1 SE 6A K '� ('���� � CONSTRUCTION LENOING AGENCY- � � Set encK YARD hM'Y PROF.LME � WIDTH � � � I hereby affirm that there is a canshuction lending agenq for fRONT ��� � , . •6 7 5,0 0 r.x� the performonce of fhe wo�k for which�his permit is iswed o.�. - � - � D 9,1 1 —8 7 (Sec.3097,Civ.C.). SIDE � CITIBANK �.� , lender's Nome '��"(-.'; .'.i"�.� ; P.C.Fee s 418.59 � v�,m��ree 664.5� . 10"'"R`f.x , . . , 9 lender'tAddre:s 444 S. FLOWER. LA 90071 10.5� � , � I ceriify.that I have read this applica�ion ond s�ate that�he iswance Fee IOMA P/C M � obove infarmatio correct.1 agree b tamply wilh all Couny ��.es���gmwn Fee 675.�0 j ordinonces a te laws reloting to building Consfroction, . - total Fee� IDMA Pe.m.Y � Z ond hareby u riza rapresentatives of fhis County ta enter � upon 1 e ened-propeny(or inspection �,PoS�.. � $75 . . . . $35 �� � � � � � A /� SEE REYERSE FOR E7fPlANATONY UNGUAG4� Signaturo of Applicanr or Agent . . . pore. .. . . . ,. . . / \ 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 � < �>_:.� � , . _. - ` � _. ___ _ _ - �-