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. . ,... ._. ._..---�-----. _....... ___._...._. . .. __ _ __...,. insure or a te trf�ca�eOMPENSATION DECLARATION , �.�' : 'I � � *;' `� � � �. � I here6y d�fvm that,I,have a certificate of consent to self � / WORKERS C ... � . , ..._-' � ' - - .. - ofWorkers'Compensa�ionlnsurance, APPLIG " TION-FOR��.BUILDING�PERMIT -� or a ce�1i(i�d coPY iBereof(Sec:3800.�Lab.'C.j� . .., -�. . ..-.. .. . . _ _. _ ..... -...-. --..._. ._. __ . ..� .. . ..._. . - ...___ . `73WC005=279=0016 "Natiornaide� � ' 2/A COUNTY OF LOS ANGELES s BUILOING.AND�SAFETY � . ' ;:9} Po icy No. � �Company.. --� - -- --- -� '-� BUILOING ' ��: Cenified.copy is'hereby(umished:•.\�•.� �. . . . � FOR APPLICANT TO FILL IN � aoortess 510 .TOn CouLt ' ' �� Certiiied'cop�ie filed with the�county building inspeo- --� ewtOiNG , . ��tion dOpaAmenl%•�'�' ' ADDRESS 510 Jon Court I , ..,, � ... ,... � - ,- `• - � - —._ . _ .... ._ ._— -- _... �are.,7/8/87 ,,APPi;�a„� THE.ANDEN .GROUP ciTM Diamond. Bar ziv 91765 ��,�in Diamond Bar � . ` 'CERTIFICATE OF EXEMPTION FROM WORKERS' - � --.-.. -- . --- . ._ _ ..._..__. NO.OF 61DG5.--._-.._.. ._. NEAREST_ � _._.__ _. �'. ___..._..'._ "_"..:- -': � � � �•��COMPENSATION'INSURANCE�'-�•�:',t . SIZEOFIOT NOWONLOT caosssr. Diamond Bar�Blvd: Golden S rin S . (This�section rieed nol 6e'comple�ed if�he'permitii for one -.-.-.. . . ..- -.._.. _....._ -_.. . _.. __. _ . E . -.-- --. : -., ... TRACT BLOCK lOTNO. �i7 � MqpgppK� � ' ^'? � � PAGE' PARCEI,�'. hundred dollars(5100)or less.�, .�., ., . ., . . .. .. � ...,.: . .. . , TEL . . USE ZONE MAP �i �� � . . ;,.• . , - - owniea --THE ANDEN GROUP_ N�67- 1 . 1 tertify that m�t�e,performance of the"work For which�this �� � �� + ' �I} permit is lesoed.l sFiall�noYemploy any person in any manner . �----- - � SPECini..-----�.-- .... . .-..... - . . -.C. -'----- ADDRE55--- -- -� -------�--- --�--�---��--' CONDITION$ - O so as fo become sub�ecl lo the Workers Compensaiion Laws. - . V `,. � ,,'. , � � , '' _. _ aTr _ Covina_._... ziv9I722 .._ _ —._..- - --- __ _ _ ne ..�e .. ` APPII[allt'�� . . ARCHI7FCT OR ' TEL _ _ _ �.. � �O bTICE�TO-APPUCANT: If, a(fer mokirSg this`Cerhficate of ENGMEER - N DISTRICt _ GROVP. TYPE , FlRE PROCESSED BY , Ezemption;-'you-should becorrie'su6�ect•��eo''the�Workers' ' --"- - CONS. ` �ZONE y� , �1�j Compensetian p�avisions of ihe Labor Code,you must idrth• pCDR£55 314 N. First, Arcadia 91006 �-I O _ _.-C-o U nc�� q .1'�Q� W wilh mmply with.su�h�provisions or this,,permit.shall be -. . �-r-� ���� ��N deemed ravoked:..a,,... . ., . t TEI. STATISTICAL CLASSIFICATION AM. CONDp.'��•� : Z .�.- . ` .-,�.,,`,., . �.^ � CONTRACTO H D NO. • ��n�._ . UCENSEDCONTRACTORSDECLARATION� '. �- ��- --��- -� � �- -�� ---� --�i�----- -- --� GLnsSNO.�DwEL4UNIT5 1 � � I hereby aNirm.thot I om licensed�ndar provisions o(Chvpier 9 ADORE55 $aIR� a5 above No5105 60 . . (Eommenting wilh Section 7000�oI�ivision 3 of the Bosiness and ,...,__, _ _ ���._ , ��R�� , . • � ���� ..__ ..... .__ . ....._ _... . _. . _.... .... _.._. Professions Code;and my Ilcense is in full force and effect. Gltt CW55 B � - ��;�---�- � � �-- . ��� ������� VALIDATION�-"-� �-�- .. , ... ., . .. ... .. - . .� �., omber'''S10560 � 50.FT. NO.OF NO.OF CHECK � L�t CI455 B -" $IZE�- ��� � $TORIES � FAMILIES ONE � Co�r.ocro . . , . '. , -- - S in le Falttll Nny. VALUAT�ON .. ' r THE ANDEN GROUP DESCRIPTION OF WORK g Y-- � �� Date ��8�8� '`- n0� . . ; . '. , ❑ ` _. . .. OZk.BA ❑I am ezemp�under Set ... .. -�� ----GdTB 0 -��i�i$�$r'. ...--�-�-----.. -._ -- ; . .. . •.... � ..,. . .... .-., ALTER ' ' . / ,�.., SLAB ONLY � _ --- ... ;..- --'. . . .._�..s . . .',j' 8.8P.C.fOr this fea5on __. REPAIR Q � s � ._._'.'.___.._.._._..._. ._ _. _._ Date:.._..�...�� � USEOF DEMOI ❑ � .....:_..._ ... I.�".6.H.O.u._. .. _... E%ISTING BtDG. ...:-,. .Y. __ ...__.. _ ..� � APPLICP.NT TEL ' Signdfure � PRINT) THE ANDEN GRO NO. FINAL 2 � �.,1� ,, i • ° •(��Q O` OWNER•BUIlOER DECLARATION .._. . . _„._,___ , , . .,. ._ , -�DATE-- � - l�r�-�-��' ' .-1 hereby affirm that 1 am exempt from fhe Confraclor's license qD�RE55 $�e aS above ' 0 8 1•7-g 7 ' w/or iha follo,"iing'redson�Section 7031.5,Business and FINAL'��� � � �teszions"Code 1"' ' ' ' pkE eNT � BP � � ' � � � l BUILOING � �' ,�.�� � . _I, as owner of the property, or my employees with nDORE55 , • ' _ � •- � � �' �� ' , wages as their sole tompensation,wili do the work and �� � � � � � � - _ the slrutture is not intended or offered for sale(Set�ion LOCnuN , �� , _ ' ; - , - ; '70<4,�Bvsiness ond Professfonz COda).'- "'-" ' ' MOVING � � '""- - ���� ��TEL-- �- -�- � -� . -��-• � �- --- - ❑ CONTRACTOR NO. '� 1 �� I ,. � I,as owner of the property,om exdvsively tomracting - r.;�,_ � ;�' - --wilhli[ensed�confractorslo�consirvctlhepro�ect�Sec- -'-- ADDRE55-�� --�---._...._ .. .. . __.. __..' .__. .._.._. _. . .. __ ... . r�:�• �.'.i � �__ ._. . ..,. ._'.-t tion 7044,Business and Prafessions Code�. - ,., � ,: REOUIRED... . IOiALSETBACKFROM_.. _XI _._. .._ __. .:.. . ........ ;..__.. ... -'-"' '_ "-"�"�-`"� CONSiRUCTIO�SLENDING AGENCY '�"� ��" �" �-`� SET enCK -�YARD� �HWY PROP.LINE wioiH - - - � � -- 7 I hereby affirm that there is a mnstrvc�ion lending agency for feOM . � � - � � -Ihe periormance of the work for which��his permil is issued ..... P.l:------ --. ._ . ... . ..."-- ..... _.. _......_ .._ ,. __,..�.... .... .. ..... .. .__._...._.,__... _ _ _ ... (Sec.3097,Civ.C.). SIDE ��'�- � , _.._. P.L. .... . . . . ._.. ......_.. .. . ._.._... .°:.��.'..__...�' ..... _.._.._....,.._.._..._..._ . . .. . '_." __.._ _.___. _ . tender'sNome Citibank . .. l➢A1A Ref.q i . , . _._......... ......._ ..... . . _.''_. ._.... . .. .. P.0 FeeS . . .. ._. - PermirFee ...S�J:S�.. ... _._.. ...._..'._._.._ ._... .. lender's Addreis 444 S. F7�wer� T._A_ 9(1071 �� . ..1 certify that I.have read this opplitotion and stale that the -. _. ... .. . . .. ...... �ssuen<e Fee - �� -� � �Dn+H P/C M -- �-- � -�- '---- � '.---- ' '�- .� -`�� obove info tion is mrrect.I agree to camply with oil County Invesugation fee ` _o�dinan s nd Stata laws relming to.building tonstruction, -" 6$.���.. ...... .LDnMPerm:M- -- : ��. �. ,.-'.-. . .. ...__ .. ._....._ -. Torol Fea..... ._.._ . . _._:_ ...... . -.. _' ' ond h e aulhorize rep�esantotives o(thls CouMy�o enler 1 u o t entioned properly for Inspe ' purp ses. � ... ._ ._ ..... _ _ .. ___ _ . ... __. "... _ _"' "' .�. .. __ _. _. ... Q�J' ..._.... . .'__' .. .. . .._ .. _ i. � O/ SEE REYERSE FOR E7IPIANAtONY LANGUAGE ' -- -Signmure of Applimnt or Agent- - .._. _' pO1e. .. _. _ .... ___ ._ . . . .._ . ..._ . _. ._ ..... . . - .___. . _ ._�OO� z '�`� . ,.: • .,...- — `_ o �.o ,. �.: __ ..x.. _�- � . c� _�'- �m o ".� :- `� T�.� ' ��1 ,� '�� '^ co a o, a .� T ,n . . i ,- , v o p m ��m ol '3 � � c� T�' � p o � ^. �1� co•' `° Q 9 �.=' v�=. � � �`.T... ..F O ✓p �;.' �.• m -� in o � o n� ° - 3 ° a `. � , � �' � c `° o . ,o � �N o -o � 3 'co o � �o r O j p � � Oo D � O� _ �.o _- ± .N� � � r m T O � T � t0 R �. �� � � �"� 9 n . � �. • . Z ^O .cn ` ?.O •c � R°1 �� ��� 'a . .. �. .':- ,�` �1 � � x �„� �, � a o_ � , � � z �.. o � v�Z % a o � n- " �i�o - - g. 'a , o 0 3a' ° 1 0_ '' n'_. ' � ` ; o � � � �p� � m . . ' t. • M 4 4,: �'G r(�1 � . . 11 a� , � .S. Q ,o. y o , z a ,G=� _ � o. 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