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HomeMy WebLinkAbout1568A 1569A (9) _ . _ _ t�t 25 Pc��c-e�l� s?o� ooSodS WORKERS'COMPENSATION OECLARATION . � : � ' � I hereby affirm �ha,1 hove�a certiiicaie of�o�,e�<<o se,f �—�� � ��� A�PPLICATION� FOR BUfLDING �PERMIT insure,or a certificate of Workeri Compensation Insuronce, or a ce�t�fied copy the.eo4(Sec.3800,lab.C.) COUNTY OF LOS ANGELES BUIIDING AND SAFETY Po�icyNo.�3wc005-2�7��Q�16 NATIONWIDE 36 A � Certified copy is hereby fvrnished. - - FOR APPLICANT TO FILL IN AD�RE55 24020 E. Goldrush Drive � Certlfied copy is filed with!he ceunfy 6uilding Inspec• ��- BUILDING Z4�2� E. Goldrush Drive � lion deparlment. ADDRESS Do�a 6-3O—H� Applican� THE ANDEN GROUP arv DIAMOND BAR ziP91765 iocaurv DIAMOND BAR - CERTIFICATE OF EXEMPTION FROM WORKERS � � � NO.OF BlDGS. . NFAREST COMPENSATION INSURANCE� - � SIZE OF LOT nrow oN ioT caoss sTDIAMOND�SAR BLVD. + �GOLDEN SPRI (This sectia��eed not 6e compleled ii Ihe permit is for one . ASSESSOR hundred dollon(E100)or less.) . TRn[i 4�43$ eioCK LOE`NO.ZS MAP BOOK PAGE PARCEI owNeaTHE ANDEN GROUP No.967-9541 u zoNe �+P �� �� I cerGfy thaf�in the perlormonce of the work for which�hia �—� �� permit is issued,I shall not employ any person in any manner . qDDRESS p.0. BOX 3329 v J SPECIAI . � so as to 6ecome subjett lo�he Workers'Compensarion laws. (�!� CONDITIONS � 0 U _ arr COVINA ziv 91722 ' • � Oate Applicanl � ARCNITECT OR 7EL DISSRICT G0.0U7 �YPf � FIRE �ROCESSED BY O r"'�TICE TO APPt1UNT: If, after moking�this Certifimte oi EnIGwFEa DAVE SZANY AIA r,o.445-40�3 �. ro T,��, p � �mption, yov should become subject�to the Worke�s' Q 2 V Lompenwtian pro�isions of the la6ar Code,�yau must forrh- ADDRESS 1 �� �`'v �/ � pw.. with mmply with such provisions or this permit Shall be . - �-jEL.- ' ' � STATISTICALClAS51Fl ATION AFT. ONDO. N deemed revoked. - � � CONiknCf02THE ANDEN GROUP No. � � . Z UCENSED CONTRACTORS DECLARATION � � LIC. UASS NO. OWEIL.UNiiS I hereby affirm Ihot I om liCe�sed�nder provisions of Chapter 9 ADORESSAS ABOVE No.510560 SEWER AhP.P� (commencing with Section 7000)of Division 3 oi the Business and , , __ . LiC. , �� Proless�ons Code,and my license is in full force and efieci. CitY CU55 eK � VALIDATION SQ.Fi. NO OF NO.OF CHECK LicenseNumber5lOSC)O �� �� ���.Class B � srze 1658 S10RIE5 2 vnMiucs 1 � � oNe lq�OJ� � NEW V�1�UU�UVO ContractorTHE ANDEN GROUP pa�e 6-30-87 oe5caiaT�oN ov woaK I I App a s :`_�� b G 8/� �I om exempt under Sec. GARAGE 456 SF A�TFR � , �• •• •2� 6.8P.C.for this rooson .. . � . RfPatR � s �., � •3 1 6 8 4 �- Date: USE oF E%ISTING BLDG. ��� s = 5� naWre APPLICAM TEt. FINAL "5 1 Q 8 4� 9 PRINT THE ANDEN GROUP No. DATE �'��/'� OWNER•BUIlOER DECLARATION _ . . . O 9.� � �S�I I hareby oHirm tbat I am exampt from fha Contracfor's Llcense � qpDaESS AS ABOVE FINAL � �,� � �,/ � � law for the following reason�Section 7031.5, 8usiness and gY �/,j 1�Na�✓//. Profes:ions CodeJ:� �� �� � � " - � � - , ' �'s ��� �� � 8�����NG . . . .. .. . , �, . I, as owner of 1he properry, or my employees wilh ADORESS wages as their sole compensa�ion,wilt do the work and � � , . �� 5 d 9 R the s+ructure is nof intended or oifered for sale(Sedion ��'��T� , � 7044,Busincss ond Professions Codc). � � MovinlG - � �� °��iE�. ''� ' ,� � �f� • • • •� 1,as owner of the property,am exclusively contracting CONTRACfOR NO. � wlth licensed cenfractors�o conatroct Ihe projeU(Seo- qDDRE55 � '. � � I °5�7.�Q �ion 704d,Bosiness and Professions Cade�. �---!" ` � � ����J-�' � _ REOUIREO T01AL SE(6A K � � �� ' • a�,G 7.0 0 u- - CONSTRUCTION IENDING AGENCY SET BACK YARD HWV PROP.UNE WIDTH ��' ��_r��'. I hereby affirm Iba�there is a consvuc�ion lending agency(or feONi , �� Ihe performance of the work for which�his permit is�s��ad . - -P,�. ��. r��` •=�—`���� 0 9,1 1 —8 7 (Sec.3097,Civ.C.). SiDE . . . . CITIBANK �'� � ' lender'e Nome LDhV1 Ref.N �� +-�" ,:,.`�� ` . � lendefs Addrcss 444 S.� FLOWER, LA 90071 � � � P-c.Fss s 316.84 P„m��Fsa .496.50 �, !�� � � � 10.50 I certify�hat I have read ihis opplicdion and stata thm.the - ies�e�ce Fee �DNa G/C M ? obove informmion Is correct.1 a9rea to comply with all Covny inve:i'�gm�on Fee � . q ordinonces o ata laws relating t0 building[onslrucfion. _ Tobl Fee .rJ�7.00 ��MA Ve.m.M � � Q ond hereb u oNze reproeanta�ives of�his Coumy�o emer a upon�h - ' ned properly for inspacr' n orposes. �� �..75 .. e�3rJ . ' . . . ^ �/� SEE!£YERSE i011 EX�UNATORY UNGUAGE � I . . . Sfgnaeure oF Applieon�or AgeM - � Dota . . . . . . �. * , . � PlANS TO APPLICANT r �INSPECTOR'S NOTES .-UR'�\lill-RU11.Dh:K UI:l:1.AftA�I�IU\ ' . I f k y aff II c i I a np(-f o �ihp Con ..� ' To: �. �� :. ; � � Returned �.:: � APP��"' � . :� .� • . � ��� : � C , .. � � }c sF�lnw I itc�4oll�wi g� ,•no '(Sec��7031 � � �oved .� . . •�BitamcasarsJl r I scu�ns(ndi.Anyatt ir.��unft.ulrtrl� No. Dafe Na. .'.Uci¢ .. '_. .. .�.. • •. •• . . ..._ . ,� �. rryui •s�e J�rr»iif tu rnneln�rt,��eltrr.irnprn r.Jrnruli.�L, -- -._ �h unv�r� ih ��,h t� t.�ei� ����lsor�yu�u �� '.C - ' l.. +_ .. . ,��. . � - . . il� a hc�+nr :suJ� - . ..,.; . •. ,.'� ... ��•. ,�.' �"� ; ': �� � rur rn/i(�n u�nrd sratenrrnr ... 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(Se�ba<k 8 Yords) , , .., ._. .. .. _ ,.. Foundations ' . ,. - , � � �,•,�. . .. . ' �. . . .. . � . .� Z .. .� ._ .., . _ ;.._. �. ,. �.. SIPb . ' ....- _�. � ..._. F,om� 2—�l i �r-- __. ' . Energy Insulonon �� . .�...__ ' _ .: .�_____. _ ..._. . � _ ._. . . . . .. , 2^t L .�ii __.__ � � _ i ; �___ � Laih;Drywoll. ' ._..... __... . ..._..____ .__ .. , � b.. __ — In�er�or Z3-� ;. .___. ..__ ......_. a i ,. . . , ..., . �'9'QQ i. . .. .. . .. � ..., Laih-Ex�er�or _'F_F • - . , . .. '____. ..._..... —__. . ._ ._ ._._."' .�,� . „ - __ _ �•". '. ' . . ... _ .. .� .,r, � Hoose Nambe�_ ,. .. i - _"._._. _._.____.. ._.____...___... . _ _._-_.._.__ �.,� . , ,.�... .. ... . i .._... �.:_.. .. . . _._�. , .__� .. � : : Corren 8 Posed ' � . � � � •l'.� � � ����..., . ... _ Final.. , . . -.-. � . �.. ._. ___ . ..._ � rv:�,. � - ... . .—.____ ._. . _......__.. __._.. ... � . 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