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HomeMy WebLinkAbout0793A .f. WORKERS'�COMPENSATION DECLARATION ' , - . �� � � � � � � - " � . - -� ^ I here6y affirm that f have a certificate of�o�,e�„o Se�f �- -� � qpp��CATION FOOt BUILDING PERMIT � � ins�re,or a ce�ficate of Wo�keri Compenwlion Insurance, 1 ' ' or o tertified topy thereof($e,..3800,Lab.C.) ' � � � ' � �-� 7��C�05-279-0¢�6 ' ��� ` 2�B COUNTY OF LOS ANGELES BUILDING AND SAFETY � o. pOnY Na. �_Qr1W t!�P � Cer�i(ied copy is hereby(urniihed. FOR APPLICANT TO FILL IN BUILDING Onooaess 616 Pantera Drive � Certi(ied copy is filed wi�h the munty buildinq inspea - BU����r7G 616 Pantera Drive tion deparlment. ADORESS . ome 8�5�87 Applicant THE ANDEN GROUP �,rDiamond Bar Z,P 91765 ��,i,rr Diamond Bar - CERTIFICATE OF EXEMPTION FROM WORKERS' � - - � � NO.OF BLOGS.. NEAREST Diamond Bar- Blvd & Go lden $ � � � COMPENSATION INSURANCE SiZE OF l0T NOw ON LOi CROSS ST. j� ings (This secfion need not be tompleted i(rha permir�ts for one . rRAR¢2$H O g�p�K � LOT NO. �47 ���R . - hundred dolbrs(5100)or less.) . . . MAP BOOK.' � PAGE PARGEL - OH'NER THE ANDEN GROUP �nio.967-9541 u oN iw+P / I certify that in the per(o�mance of the work for which Ihis ��� NO. !1�7"3 permil is issued,I shall nol emplay any person in any monnar P.Q.$��{ 3 3 2 9 l SVECinI � so az fo becoma subject to the Worked Compensofion laws. A�DRESS � � - SdOV CONDITIONS � 1'• �+PPllmnt dTV Covina Z1P 91722 c�i ,.tSTICE TO AVPLICANT: li, after moking�this Certifitcle o( ENG iEER ��dVe ,S2d1117 AIA 7�.445-4073 OISTRICT GROUP ttPE NRE PROCESSE�BV p Exemption, you should become subjecl.to tha Workers' - CONST. ZONE U Compensarion provisions of the Lobor Code,you munt forth- qO�REu 314 N. First, Arcadia �d W with campfy with s�ch provisions or ihis permii shall be a deemed revoked. � STATISTICAL QASSIFlCA710N A7T. ONDO. y GONTRACTOR THE ANDEN GROUI�o. Z LICENSEDCONTRACTORSDECLARATION AS above �"�•510560 -�"o. - '� DWELLUN�TS 1 hereby affi�m fhat 1 am litensed under pwvisions of Chapier 9 ADDRE55 NO. (commencing wiih Section 7000)of Division 3 of the 0usinen and ��� B SEWER MAP . Profetsions Code,ond my license is in full force ond effect. qTV � M55 BK � - � VAL�DATtON SQ.fT. NO OF NO.OF CHECK Li[enseNumber 510560 ���Closs B � SIZE 1314 STORIES �- - FAMILIES �-' - -ONE � THE ANDEN GRO[bP 8/5/87 �sca�PnoNOFwovK Sin le famil r,ew � �ALUATIOH Canlroclor aie ADD ❑ = 6 8 2� , #�g 7 9,b,A ❑1 am ezempt under Sec. GdTdCJ2 448 SF SLAB ONLY a��R � s I • •6&0 0 ' B.SP.C.far this�easOrl REPAIR � - h - Data:- E ISTNGOLDG. DEMOL ❑ � �'�6&O V� Signatura . . . .- - - . APPUG4NT... -i�, fINAI �/ . . . �8,� 7`�7 OWNER-BUILDER DECLARATION ��M THE ANDEN GROId�i. DATE G� �s� .I hereby affirm thai I am exempf from the Controctor's licrose " -� ���AS dbOVG' � � - � �- � � " -�ow for the followin reason Section 7031.5, Bosiness and ADDRe55 FINAL� /� i ' �jfessionsCode): 9 ( -. . .. pg EN � - dY �l%�f j . '� U I,os owner of the property, or my employees with � n��tiE55 � , � - � � wages os their sole tompensotion,will do the work and - . .. . . _�.-.�`.-..-- . -. .. .... ..-. . . , � - - the strucfure is not intended or offered for sale(Section IOCAIiTY � •� . . . 70G4,8usiness and Professions Code). ��� �� � - MOVING -- � � TEL. ' . . . .. . - - . � I,at owner oi the prOpOr�y,om ea[lusively toMrocting CONTRACTOR NO. , � � wirh licensed coMractors to constrocl the praject(Sec- qODaESS - � �� - - - �� �- � - � tian 7044,Business and Proiessions Code). � CONSTRUCTION LENDING AGENCY - � gQgp K YARD HWY T�TAPROP L NE WIDTN - - � - -� � I hereby offirm that there is a tonsirottion lending agancy for F20NT - ihe performance of ihe work for which this permit is issued - v.t. . . ($ec.3097,Civ.C.). SiDE Citibank P'`' lenders Nama - � -- � - P.C.Fee f Permlf iee 5 7.5 0 LD�a°f.x LendeisAddress 444 S. F1oweL'� L.A. 90071 - , � I certify that I hove�ead this applitation and stale thof.the . Is�uonce Fee-LO.5� IDMA P/C N � � above informall Is corrotl.1 agree fo compiy with all Counry Invesrganon Fee ardinances a tate laws relating to building tonslruetion, Torol Fee_-._(8.��- IDMA Vefm.M _ �. � � ond hereb orize reprosentaiivas of this Counry to enler � � ' -� ��� -� � � �pon th Noned properry for fnspecfio(n purposes. 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