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HomeMy WebLinkAbout1582A 1583A (9) , _, . _,_ .. _ _ __ _ . . . __ _ .� WORKERS'COMPENSATION OECIARATION � : �, � � � , I he�eby affirm ihol I have a certifim�e of�o�=e�;,a 5a�� qpp��CAT14N FQR BUILDING PERMIT �] inswe,or a certificote o1 Workers'Compensa�ion Insurance, , or a ceriiFied copy thereof�Sec.3800,Lab.C.) � � � - ' � �`� ` - � ' � . . . 73wc005-2 6 NATIONWIDE 31 A COUNTY OF LOS ANGElES BUILDING'AND SAFETY Q�YNa. ��d�p�- Cerrified copy is he�eby furntahed. FOR APPLICANT TO FILL IN qppqESS 24028 E. GoldruSh Drive � Certified topyls flled with the couMy 6oilding inspeo -- Bw��wG 24028 E. �Goldrush Drive �� � fion deparfinenl. � ADDRE55 Daie 6'3O—$7 �'Applieont �E�ANDEN GROUP aTr DIAMOND BAR na91765 � i�co.uTv DIAI•SOND BAR CERTIFICATE OF EXEMPiION FROM WORKERY �� SizE OF�Ot NOw oN iois� cR�sSsrDIAMOND-BAR� BLVD.�+"GOLDEN SPRINGS ' � COMPENSATION INSURANCE � � (This sec�ion�need nor be completed if the permit Is for one � � TRACT 43435 � � B�OCK � �07 NO.�24 �ESSOR hundred dollars(EI00)or lase.) +ti'AP sOac � '�� vnGE oaRa� 7E4 VSE 20NE �? II �� 1 certi(y that�in the performonce of the work for wbich this owNeaTHE�ANDEN GROUP- No.96�-9$41 h!r . permit is isaued,I aholl not employ any person in any manner r � SVECIAI . - � � ADDRESSP•0. BOX�3329 � - opd�7 CONDITIONS ao as to become su6jec�to the Workers'Compansalion lowe. � U cnr COVINA ziv 91722 ' � Date�.. APplicont.. � ARCHITEQ OR lEl. �;IOTICE TO�APPLICANT; If, ofter moking�fhle Cetlifi[afe of ENGINEER DAVE SZANY AIA N�.4k5-4073 �ISTRICT GROVP N7E FIRE OCESSE�BY � r iemptlon, you sho�ld become s�b�ect to �he Wo�keis' CON�Sj'' � V �ompensafion provisiona of�he lobor Code,you musr fohh- ADORE55314 N. FIRST ARCADIA 1006 �J �3 ,Y� � � W winc �omply wiih such provisions or this perm(f shall 6e n-' / deemed revoked. �oManCtoa�E ANDEN GROUP NEL� STATISiICAL CLASSIFICATION yI APT. CONDO. [q LICENSE�CONTRACTORS DECIARATION � � C1A55 NO. � �- DWELL.UMTS� Z IIC. I heraby affirm thai I am licensed under provision�of Chapter9 ADDRESSAS ABOVE No.510560 (mmmenNng with Section 7000j of Divieion 3 of the Busineu ond . . . _ _ . . _ . .. . .���, SEV`'ER MA� Professions Code,ond my license is In fu�l forca ond eHea. UTY � CwSs � gK � � � - -- � ' VALIDATION � $p.F7, NO.OF NO.OF CHECK �L�J�6� $ ' $IZE 1]S6 ' $TpR1E$ 1��- FAMIllES 1 �ONE Licensa Numbe Lia Class� � � VAIUATION Cont�actorTHE ANDEN GROUP pQ�a G�3O—H� ' �ESCRICTION OF WORK SINGLE FAMILY NEw s gg,000 �1 5 8 2 A ❑I om e.empr u�der Sec. GARAGE 445 SF . . A�DR � t �r• • • •2 1 B.BP.C.for this reason ..... � REPAiR � s � �� - -�� � •2 9 Q�7 � � Dofe: - - EXISI�ING BLDG. DEMOI + 0 2 9 G,0 7 u Signature - APPUCANT TEt. FINAI 7RINT THE ANDEN GROUP No. a OWNER•BUILDER DECLARATION . _ . . . . . - OATE- ��� . � _ -. �g�� '� �8 7 I herehy affirm that 1 am exempt from ihe Contractor's limnse ADDRESS AS ABOVE �- � �� Low for the follawing reason(Seaian 703L5,Business and FINAL��'' � Proiessions Code): � � - - ' � ""' " aY "'�` � � � � BU�IDING � . �� tJ�3 A I, os awner of the property, or my employees wilh AD�RE55 wages os Iheir sole compensotion,will da 7he work and iha s�ruaore is not Imended or offered for sale(Sec�ion ��`��TY , � � �'' � ° °� - 704e,Business ond Profess�ons Code). - - � MOVING � -� -- �� TEL. - � � - .� 1,as owner of 7he property,am exclusively tonfracting �ONiRACTOR NO. �, � � e 4 5 7.5 0 wlth licensed contractors to consiruct fhe projett(Se[- � pppaE55 {,�� ,` � tion 70d4,Business and Pro�e:sions Code). ._ ��.,�1 t .` .��.�-t e^'��5 7,5 0 c.� . � � CONSTRUC110N LENDING AGENCY ' ' � SE�eacK � YARo HWY T�rApROP.IINE WIDiH . � � � 1 hereby alfirm ihat there is a construUion lending ogenty for FROnIT ° '�4•1 1 `8 7 rhe periormance of fhe work for which fhis permil ia iseued � �P.l. � � � �� � •` �� � . (Sec.3097,Civ.C.). SiDE ' CITIBANK v.i. �. ,- � lender's Nome . - � P.c F«a 290.07 c�.m�r F« 447.60 �nnan z�c w � _ . lender'sAddress 444 S. FLOWER, LA 90071 10.50 � 1 certify that I ha read this applicotion and s�me fhat the . ivvonce Fee mhta v2 M . � � _ above informa�i mrretl.I agree�o comply with oll Counry in.e:nga�ion Fee ' j ordinances o 5 te laws relpting to 6uilding t0�shuct(on, . Tolol Fee 457.'rJ� IDMA Perm.It - ond hareb ize repreeallolives of Ihis County to antar upo the u.-m p�opertyforinspecfio� �� �`'Jc $35 � SEE REYERSE fOR EXPLANAiORY IANGUAGE � . . $ignvlure ppiicam or AgeN � - Dole . . .- . . . . , PLANS TO APPLICANT INSPECTOR'S NOTES �Ull'XIIK•13UII.UIiR.UIf(:1.AR:1�PI0\ � I he.c6y affirni�il,n'i�n�e.emp�Ircrr��he Contm:to�'s io: � l �,�..,. � .: �'� Returned .,'•� �� . ��"�. � , ._� �. - � ��.� ' r.�. .� �: .. " . .Lice _��low�l �hc follo �g�r scn� (Sre'7031;5) . ... .., . .,. APPraved .� �. 4�� �Ru ineaundJr J.ccun.r(.ul�..ln}.i71 + •��urtf1'trbicG No. Dato No: '���Datc ". ..: . •, . _ .,.. . . ,� , reyuirrc,u�ernuf.fn<'nnslruc6 yln r,u il �r.denu.lish. . , - . . . . '_-- npoir un�:lruetura�.prinr m itc icsnJ e •.'akn r(y � , .,_ t� _ . .. c. . , ..�. 1;.�,t.:� . . .,-, 1�l c op/�fl�Jnr/�,r.eurirp�rnrif m JJr.a si,S•nrJ sWteortut .. . , . . ,. , �..� . .. . ,.. .�, ..: ; . , _ , � + , . . , ,.� r ...,. ; � �'� ' '� ' � ...- .. ..-._...... -.tbu:br islitcnsrJputsu�nt tn tlri-prnroinn�aJlhr Li�n: . �,.i.-.� ,..tru:for's 1.ia�ansr l.a�r(f7w/�t�r JI/<nriim�ncin,e v ith Svr! . , ._� � , � .'_'_' .�'�_: . '_�-...._,._ -\__.._ .. _.�'___ `.: _ .:��.. . . _------ ' - --.. ._ _- _._- �-- ---' rir,n 7(lOfl).�/Uirisr,�n 3 oI tbr li�sine<c und Pr��J�•ssi�rns � .... ...�„ C �. -- :. 1�_'- :.. . ..�-� ':CnJrJnriL.+1L �.a�rn�j��lLerrJrnr�nJtlrh�+cr.�lurlhr _,. . ' _..__. --.....__�. __. ._-___' _'.. ...____..__:.. � � .. .... ex�•ne rion.�Anv rr,ilarron n J<<�nnn�U31.5 A�. �. .._... _.._�.__._. . ._._'__ .. _�.__..-_ <dlr,qcd f � i�.. . '� '. . .' •�.P.equirad .. ,...,. . ��.'. ' ._ ___ _ .__..�� ... . :_.. _.__ ..__. ..'._' . ._.. an�a(fLidntfnra�rrne�tnrhjecle�heuffLenn�in✓.iri! .. �Approvols �Date R teivad . �penalty nI nn�.nu�rr fi�n/�nr Lundrrd Jn(fnn(SSUpI•k _ �. . � ' Yat No ar Approved � . � ",�._ . � . _ . ' . . . � .. _. _. _.,_ . . .__,_._ . ___... ...�.' _.. . .::-:_'_. . .. - . �.� I,as awner ol the properfy.or my einploycPs�w�ih VJ�ter Cert�ficate C �' �_� .. � ����. �!� . ...�.:_'_ _' _�� _.-_'__. _...__.___. .._.__....___. ., wugrs ns lhev sole c�n a ensot on,wAI do ihe wo�4.and . ' r�� - � - - - - -�- �� �-- - : � � ihe st ct e c et len ed o offered fo sole(Sec 70dA) Hcalih�epanment _ - '..:- '.,`��: .' -.'.-_ ____ _ -'____.._... _ .____ ..___..____ ..__ ffv n ssu dP 1 s�i �a C'J l�c Gr [rd r rsliaro�n , ._ -__ .' _ . _�_. . , l.an J i�, nn(uppl�Io an onmrr u/Truprrtv t<!�u huiLl� � ' FireOeParimeN_____, . _._' :.�-.':�� ;7.,_ .. ..� ; .�� .�.� , .. . . � -, 71ii Rhtbisto<n�ernpf�beaJ� ��JlJitla�t/suilll _ _ s �+r •'� � . � j.,..fr renfs rtrr nnt_in�enJ J�r, .J/cred Jor sal. !�' . Grod�ng . , .�•� � �, fr � ....Gmrcrcr.tbe J�r�ild�ng ar i np.nr an��n�rs u�ld e•i!/ v , .`... `,� , .• , ,., . . � ��: :_.' . . ;. ` ....__ . _. _-. __._. . _ . . _. ... . ` 'i�aur n/rnmpfehnrs, tbc�mm�rr.builJr.n��!!.bnrr�tbe . Geoloy�col �� � � � ., hurden n rn�t6nf!r Jid nnf hmlJ ur imnrm e �r , -.. f 1'rr. '� /r, , ': . � ..._:. '.-.. . . .r__..�_ � . , . .. -__ .'-.. - - � (hr purpore n/suled� C ;;�� . Pedestrwn Protecnon . -- ... . .. , � ,� -.. � ' � ' . _ ' (Fencol lCenoPY) . � . . . . .�. . .. _ ..' .: .'. .... .. .. ._ . _.:_ .. _: '_ . . '���i.J I o w r he p pe m d�s ly ce �ac ' � so n rofr ro f�a �e 'vc n1 � ' ��lnc�wrth licensed convocrors�o�onitr�ct�hr.°p�ojea��5ec. . ,...,.,. ., . __ :'.�: - ',. ._..._ __.. .___ . 70441 U� rne d!r�.v a G de. 7! C m s $paool I speclion�� ; . ...-. .'.�, � r ss an . . . . . , !rd t �. :.. __ ,..�� (Cenc 1(hlosonryllWelding) . ... � � . . . , - . �� '. � l.ire ! � d t pfl�t ¢n u n -.f j�.ferh ul� . ._ . _.__ ._. _ _-. _. __. ____AuilJs.ir-un�r.naslherrnn�an�tielai �f�irsu.b ,p ��+ttfrudi LoiO.a�no9e �..'��1 •�,.. , .. . _... . .�.,,.. �--._ .. .. � r ct -.u't, �:con racn . .. ...... ' - .- . p 1 ( I r�I 6ren�rd�,pvravant 1n lhe , . ..__...___.. ._.__. . __ ._�_ .. . ' ? �, � .. --Cnnda�tnr's-l.icen.ir Lsu/ -. . .. _ . ... - . , , . � ..., . . . Prnkin -` � ._, _._—._. -_.—_ _____._.. . ..._�_.. .._ _' . _ ___ _._ . .-" . � �- . : . 9 � - � ' ❑ 1 am enempt under Sec .8.&P.C.�o+iFrs i . _ '____'_-___.. _. ._.__.' __. . reason � � i �. . .., '._'__—____ ._.. . . . Dn�e ..__ '__'_ .'_ _ _._..Owner.._. .__._ _.... ._ . _ _ ... ' . Approvals Dolo Inspector's Slgnature .... .... . r.'-i;.��. �. • ."- � � .,:, ;�:;- INSPECTOR'S NOTES ' � � � . Lom�ion- � '..._... . . . . . .. . .___ . ...__._-._ .._...__. ,�,-� .- (Sethack&Yords7 - . _ Z d � �' � �'� �' � ' � ' '�' ' �� Foundatlons :.� :�.� �.��. .:���.. . • . . . Stob � � _ :�" __` � �.,,,. ... �� . r . .;.,_..., .:�. . Frame ��0� �. . . . . ... . . . '�" .. . ... ., � � . . Energy Insulafion ��� . ' ' ._.._�-� . _.... _... _' . ' . ..� ,.. .,. .... �.� . ., . F_L� � � . . , �. . . lafi:Drywoll-. .� _...__ _ .._. . ..__..._ ... __... � .. ._._ __.. ��� � . . '__.__ Inier or '��^ ._ ._ ... �, . . . . . larh_Ex�erior � 7.O.a. . .K, ., � � . � � ' . ... . __ . _ . .. . � - � f 1� , �,��., ... HooseNumher-. .r. __'._. _.. __ _-._._._'- .__.__ _ .__._._..__ ' �.� .� .. . , , Coneci 8 7as�ed " +K.J:. ..T , _..__ _ _ . _ . .. ' . Final -_.. .._____...__. .. _ ., _.._. . . ..__.�._ __ __,.____.__. __ . __.____.. . , . , . . . . .. 1'\ . . , . , .. . .. . . � . � , ! � , . Enter on Frcnt • -. .,.... I . _...., _ . ' . . ,.. . , .� .. . `,. . ,. , . . - � � � �I'.'• . .i .'I . „ . .. . . . _��\ll� . , � \ �yt� ��i� �. .