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HomeMy WebLinkAbout1542A 1543A (9) . _ . __ . ;. _. . , _. . . WORKERS'COMPENSATION DECLARATION .� . , I hereby otf�.m that I have a certifito�e of cansent to,e�f �� -- �-APPLIC/�►TION � FO�R� BUILDING PERMIT � �� ���I insure,or a certiiica�e of Workers'Compensoiion Insurance, . or a certified copy thereof(Sec.3800,Lab.C.) � ' - � �� " � " ' � . _ 73wc005-77q� 6 NATIONWIDE 61 A 3 Car COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. '-C:otn�R� � � Cerrified copy is hereby fom�shed. FOR APPLICANT TO FILL IN no�sess 24010 E. Goldrush Drive �� Certified copy is filed with the taunty building inspec- ' BUaDiNG � tlon deportmenf.� � � � ' - � A�DRE55 24010 E. Goldrush Drive : � pa�g 6-30-87 qPP���o�� THE ANDEN GROUP ��T� DIAMOND BAR zir91765 �o�nuTv DIA1fOND BAR CERTIFICATE OF EXEMPTION FROM WORKERS' �- � �- � � NO.OF BLDGS. � � � NEARESi � COMPENSATION INSURANCE • � SIZE OF lOT Now oN ior caoss sTDIAMOND'SAR BLVD. + GOLDEN SPRINGS (ihis satfion need not ba complated if Ihe permit la for o�e TRpR 43435 � a�ocK lOT NO.26 � �ESSOR � hundred dollors(5100)or less,) . . MAP BOOK VAGE PARGEL owNeaTHE ANDEN GROUP TE�' u 20NE NOP � _�� I certify that in tha performance of Ihe wo�k to�wni�h�n�s . - r,o.967-9541 permii Is Issued,I aholl not employ any person In dny manner A�RE�P�O. BOX 3329� � 0—� SFECIAI . . � so as to become subjec�to�he Workeri Compensaiion Low�. � -� Od C7 COnloiT10N5 0 ciTv COVINA ziP 91722 v Date � � � APPlicant . . . . '� ... . . . .. . Q.' ARCH17ECT OR TFL. �ISTRICT GROUP C pE . FZIRE PROCESSED BY � �"�OTICE TO APPLICANT: If, after making�lhis Cerlificete of ENGiNEER DAVE SZANY AIA No.445-4073 .emption, you sfiould become sub�ect lo tha Workers' � V Compensatlon provisio�s of�he labor Code,you m�st{orth- ADDRE55314 N. FIRST ADIA 1 a W wt�h mmply with svch provistons or this.permit shaff 6e �� _- -� -3 , � O..• deemed revoked. coNtencioa�E ANDEN GROUP Np STATISTICAI GLASSIEICATION APT. ONDO. [q l Z UCENSED CONTRACTORS DECIARATION � - -� - � p�,�� .. M55 NO. �V DWELL.11N175 - I hereby offirm thot I om licensed under provisions of Chopler 9 ADDRESS AS ABOVE r,o.510560 � (commencing with Section 7000)of Division 3 of�he Business ond _ . .. . . _ .���. . . .. . `'EY'`ER AMP � Professions Code,and my litense Is In full forte and eHect. CI7Y QASS � .gK �:- - � � VAt�DATION 50.FT. NO.OF NO.OF CHECK LicenseNumber51�560 Uc:Closs B srze z634 sTavies 2 FAnniuEs 1 ONE � � � � � VAIUATION - Con�ractorTHE ANDEN GROUP DO1e 6-30-87 DESCRIPTIONOFWORK SINGLE FAMILY AD � S 1S7iO00 ❑I am exempt under Sea - GARAGE 649 SF . , � AITER � �� 5(�`2 a . 8.8P.C.for Ihis reason . � � REpA1R ' _ ' � �-- � . . .- .. . --DOte: � USE OF . DEMOI �j• • • •'Z� EXISTING BLDG. Signature . . . . � - APPUCANT TEL. FINAL J •�.1 8 5 9 OWNER-BUILDER DECLARATION 7RINT THE ANDEN GROUP NO. _..pATE � /�ty�� . -I hareby affirm�hoi I am eKempt from the Contmctor i licanse �� � - � � ��� �� � - • •tl 1 II�5 9 c=i Law Por tha(ollowing reason(Section 7031.5,Business and ADDRE55 ELS �.BOVE � FINAI ' Profesatons Code): . . .. . `... . . .. . ... �6y �;,�� ' 0 9.i 1 —8 7 ' � BUILDING . i, as owner of the property, or my amployees wllh ADDRESS wagea as their sole compensa�ion,will do the work and � . � „ , � Ihe str�cture is not intended or offered for saie(Section tOULiiv •'� �� _ - 704d,Business ond Professions Code). � -�� MOViNG- - ! !� �` � � iei. � � ' , � � � � - � t,as owna�o(Ihe properry,am eaclusively wntroning CONTRaCfo¢ No. � �1 5 4.3 A with licensed comraclors to tonsiroct ihe ro ect Seo - � - - � � -� � -- � - � - ' - ' - -�; # - o .. � tion>Oad,Businass and Professions Code}P I ( aDDaE55 ..`�� �� � . � � • • � �- REOUIRED TOIAlSETBA K � CONSTRUCTION LENOING AGENCY � � 5eT encc YAR� HwY pROP.UNE � WIDTH � � � � � 1 � � �I •G 7-1 O O I here6y affirm Ihat there is a construciion lend�ng ogency for iRONT j`" � �e'..c• . the performance of�he work for which Ihis permi�ie issued � � P.i. - �,�j '; ' " . •a�(�7�,Q p� (Sec.3097,Civ.C.). SiDE � • • CITZBANK °� 0 9.1 1—8 7 lender i�Name � . . P.C.fee S�ZH.59 � v„m;,F�, 664.50 �onu a�r.x -- _ `' <��";— � � �ender's Address 444 S. FZOWER, LA 90071 � � 10.50 . , I cert�fy fhat 1 have read this applicatiop ond stote�ha�the - issuance fee tDrnn P2 Y . abave informati 's correcl.I agree b mmply with all Couny Invea�igmion Fee $ ord�nances o fa lows�elating to bvilding constrottion, _ Toial Fee 675.�0 LDMA Perm.M � - and hereb au orize represen�atives of Ihis County lo ente� � � upo 1h m oned propertyforinspection purposes. , ^ ��.,�p S[[YRYER6[FOR EXPIANATORY LAN011�E � - Signat�re PDiicom or Agent � .'� . . .. .. . . . PLANS TO A7PLICANi INSPECTOR'S NOTES � ..Glt'f1fiK-I3U1[.UIiN.UP:C1.r1R�7'[Oti I hr.rchy�afh.m ihal I am r empr�Ircrn�nc Con��acin.'� ,. . . ,, . ... ' . ' - �'. ' � , "liie e LnN��fo �thc��Follo , q� .no 15:c`7091 5) To: :..�. � . .:; .. Raturned {' ; , , , . . . . , . �. ' ., . ,. . .. ,, , . . ... . 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(Fence)(ConoPvl ..,. . . :� �, � . _ .,' .�.- � �.:.._._..-'—.__ _... _�:.. � :•.t�.-__'.�__. i: I.asownrroithep.ePe.ry.`um'c<ciui�aetyccnNor ieceo� , .�i . , „ linp,wiih lice�sed coniroc�o�s to<onslruct Ihe�projecr lSec. SP�dal�lnspection� - '� .. � - - . . . ..-...-.-'-'.-. . . .--.�?-'- --.- .ti-'..- ....----.-:- 70441 U�ezrnnss unill'rn/r.i�ivttc CoJr: Il�c Cohtr✓r�nrk �Ccnc.l iMasonrY)(Welding) � .� --� .. �� . .. , .. .: . ..,., .�. �.. �-� � l.irrnsr l.�md�ies nnt�ppl��o�en nv�iirr.iJ fsnfrrts u�Ln . _ __.. .... _ . _ ,... _ _.- - �- -���,w,,..;,�p. �r rr�,�,�,.,r-�„���a,� � ,�n�crs �..,.:r, . LciDru�nage '� ��,r.� ,-. . ' . � � „ . .. _ ___ ..... ..... ..__ 1 ! - � ,. , . _� ... .:- projn'ts ui/!� a ounhvr�nr/�1 lrccnsrd p�rsaant �n�tbr .____�_._.. .�.. -.-. ... ..Cnntra.rnr's� • . . . ..... . . 1 .- , - .i�rn.ar .au)� .. . .. .. . Parkin9 . . , -, ... ; ... .,,: _. P . .. ..'. . ,.._ � . _..___ _.___.___. ___.._... ...._ __._. .._._ __ _ , ,... . .i � "��� . ❑-��I am e*em�t unde.SP<. B.BP.0 fo�'ih�s . ' .____. __.....__—_ .__ �� ,_. ., � . � � � . , � reason i . .. , .. . .� .___."""'�'_ _-..� _..__-'__ ... .. _.. . , � �n�e � Owncr . ..�; . . . . . , ..: �"- . � r ., . ..,�. ,.. .�. r . _. .. .. , ' , ..___'__' .. _.. . ..:� . - ... Approvols Dofe ' Inspec}ori5ignatur�, � � �-��� ' "' . � _ `.: �. �... . . .. ' :. f:'�': INSPECTOR'S NOTES ' � Lncor�on- ' .._:.... ' ,. .. _ .., , �Seibac4 8 Yordsl , . .-.. , ' , . � ,_'� . .__.__._._..___.._ ._..._. ..__ ., �_. .;.,� „ ,. .. . � i- Foundaiions ,. . _ _ � . . � �,.-. ��.. �.�. , • � . _ _ /Z-10-i' -- ,.. `�: _ - - - , ,; S�ab �� � . ... . . . . . . . . . . �_l �Z .. .; Frome � D� - .. .. . . � . . , . . . .� . '� . . , . � . . ' . . .. , . . � Energy iosuloi�on Z yp � --; -- _. _.._ ..._ ._._ _. .._ . __. , . ._ .. . _ 2 up , "._- � ._ . � ._. . . , Lafh:Drywall.. .- . -., . � �... ' . 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