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HomeMy WebLinkAbout1584A 1585A (9) .._ . __ ;:, . _. . .___ . ._ _. _ ._. � ._ ,Y WORKERS'COMPENSAiION DECtARATION .. . - �- ,.., . ._.. __. _ _. . .. . _._..__... . . ... . . _..._.. ` � - �-APPLICATION �FOR BUILDING PERMIT- - � C_hereb aifirm,thar I have a certificate of�consent to self iniure,or a certi{imte of Workers'Compensorion Insurance, oi a terfified to lhereof(Set.'3800.Lob.�C.) ....-_.. _ _. . .. ..._ _.._. . ._ . __. . . ., . . . . . . ' ' ••FICP6��5241 Great American Plan 2A COUNTY OF LOS ANGELES ' BUILDING AND SAFETY � _ Poticy No. - Compony - � - � Certified copy is'hereby furnished. '. . _ FOR APPLICANT TO FILL IN Bu��D�NG �/ i . ADDRESS �' Certified copy�ii filed withlhe county building�'inspec- - -- BUaDiNG � � : � `��tiondeportmenL'�` ' ADDRESS 20814 East Boulder Lane � " 12-22-86 The Wm: Lyon Co. Walnut __ 91789 - ' Date �Applimnf- CI7Y 21P � LOCALITY ' .. . . .. . , .... � ... _ . ...... . . NO OF BLDGS. . . . NFAREST -� _ ... _. ,../j .._' . .. ._ .. �... . � �� CERTIFICATE OF EXEMPTION FROM WORKERS' ���� -� 5RE oF ioT 3 r SOO SF P11T1.NOW ON LDT � �� � ��`��COMPENSATION�NSURANCE� �� �� CR06S SL . 7/ L_� (This section need not be completed if�he permir is forone - �- - - � n55E550R . --� - �� � hundreddo�lors(E100)orless.) , , , , TRACT 43760 BIOCK ZOSOO LOTNO. 9] p/�qVBOOK- ' PAGE' PARCEL , . ', -- ox,NEa THE WILLIAI�1 LYON C0. T�833-3600 use zoNe nuv I.certify�hat in ihe�performance of the work�or whic6"this �� � �" - �Y permif is issued,I shall nat employ uny person in ony manne� � ��� - � Saeua�- � �--� --- �- -----� � � � - ��- �- Compensa��on taws. ' Aooaes519 Cor orate Plaza ------ ` mNoirioNs � so as to become sub ect to the Worken', , : . CITY Newport Beach� CA Z�P 9266D �. . .. ...a � _ , ._. . __._ . __ . . . .. _. -.. .. . ._ . . _. __ _ _. ._ Dale ' - App�iCant � ARCHITEC70R TEL. � � � O (�OTICE TO APPLICANT:�If, after mokmg Ihfs Cerlifitafe of ENGMEER Hales-Langston No 547-0862 DISTRIR . .G UP TYPE . FIRE R SSEDBr_ . ��mption, you�should 6ecome su6�ecr �o the Warkers' ���--� . � �ro�T�//' Z9� ' V ,mpensation provisions of ihe Labor Code,you must forih- qDDRE55��� $. Main St. S[e. 1o5 Oran 0 -.Y .- .f W wilh comply.wi7h such provisions or this.permit sholl be � �- a deemed revoked.. - : . � . .�.� , , � � Same E15 Owner TE�� '� 57A71571CAt CLASS�FICATION ' � APT. C . �.Z LICENSED CONTRACTORS DEC � CON7anciOR No. • � � . IARATION, . . . - _ .. .. _. __.... ___...__'. ' _UC.. . . .. . CLA55 NO. �� OWELI.L1NIT5 I I hereby affirm that I om licensed under provisions of Chapter 9 ADDRESS NO. ��R�p . (commencing with Section 7000)of Division 3 of�he Business and _ . ._._.... _. ._. . _ ���. . � � � � �� Pm(essions Code,dnd my license is in full forte and effet�. Ci7Y C1A55 '��BK� - � �, "---- - -, ypLIDATION � . ..,. . . .. . ,, . .� _ .. . � Sp.FT. NO.OF NO.OF CHECK - L cenae Number'2768�1. 'lic.Class Byl ` SR STORIES FAMILIES ONE " . .o. . . , , .., .� , The Wm.,.I.yon,Co. , IZ-22-86 -- - DES[RIVTIONOFWORK' - ryEyy - VALVATIDN _ I' ._ Contraclor � ' Date ADD � S � O dV � � �� '� �I am exemp�under Sec. � - S1II le-famil }1OI118.COIISti'llGt10[1 A�TER� Q , , �'1 S�4 A . ..,.� �... ' . __ _.'.. . .. .,�. . , . `- . . B.BPC.(orlhiS�eOson _._.- REPAIR..� _� -� -..... ... . ... ... ..�.,.... .-.21 .' ., . _ _ ..._.__.._.. _. ._'... . USE OF � � '� Dofe:._ . � . _.. E%ISTING BIDG. DEMOt ❑ .. ... ._.._ . '. ' AVPIICAM TEL FINAL � � ... , ..1 hereb affirmOtha ...__. __ _. . . _. . . .. . � I •24223 ' 5� nalure DRINTTFIe William L on Co.No. 833-3600 NER-BUILDER OECLARATION . . _, _ . .. . _._ _. . . . . _ -��DATE-- ��-�� ._.. ...... � _ [Jc. y t I am ezempt from the CoNractor's license � . '. low for ihe following'�eason(Section 7031 5 Business ond ADDRE55 p�ryq� � ' ' - . � 2 3 1 ;��� � '-Protesstons-Codej:-._. .__ . ... . . .. ..___ ..... -- xe eN -BY� ...- ` � �- � , ) BUIL�ING • 1, os owner of ihe property, or my employees with ADDRESS � , � . \ � � ��.�. : . ?1.5 8 5 A� ���,� . . . "wages ds fheii Sole compensation,will do the woik�and �p�q��TY � . '. ' • � the strucWre is not intended or oftered for sale(Section . � _ � - �• • • � � � � - �7044,-Business and Professians Cade).� -�-��- � MOVING������� � � --� TEL. � � � - -- � �-- � � ^, --� - � � CONTRACTOR NO. -_ I,os owner of�he propeny,am excluzively wnlmcting ��.- � •Q 2�i�� .. � :... �.' . ',. • . - ---with licensed coMractors to construcf the prolect(Seo- �. -. . .- .. .. ..�... . . ... - �. _. . . �'�' :� . .-:_ . - .� . . . � .. Iion 70d4,Business ond PrOfessions Code). AD�RE55 � • �4?���'�� U -""�-'�- - - CONSTRUCTIONIENDiNGAGENCY-� --�--� - � ��QBqc� �ARo Hwr T�TAPOTP.urKie wiorA � - '�� ��. � � � � - � I hereby offirm ihaf there is a construction lending ogency for ,RON, �� . r�., � - .• �, � 2 3� —8 6 �Iha performonce-of4he work fa which Ihis permit�is issued -��- �- -P.L � -- - — -� � -��- - � - - ��� � - -�� -� ��-- �- ��-��� -� . (Sec.3097,Civ.C.). SIDE , -� ' � LendelsNome Continental�Illinois�Sank -� P��� �� � � � �'� ` ��' � � ��- - � . _... . ... . _._.. __.. . .... _.. -� P.C.Fee S . �- Permn Fee�- LDMA Ref.k .. ... � � ~ � _ _- - Lenderi Address 231� So. l.a Sal l p Sr_, Chicago ' �� � � ; ..I.certify thaf I.hove reod Ihis.apptication and stofe.lhatthe __ . .. . ._. . _ ___. _ hsuonce Fee . , '. .I�MA v/C k .��a.- '.- . : _ . . � . � . � a6ove informo�ion is I ogree�o comply with oll Caunty Imesngorian Fee q ' � a inance d fe laws r ating to 6�ild�ng.cor,s�ruc�ton. ... ._ .. - -- Toea�F�e- . LOMA Parm.M-��V .. . .- ." �.. i and y aut rize repre r� t es of this County to enfer � � po �he entione pr e ty.for inspection purposes. . .. ..�,-/�r.c-Q�. ..._.. _f�s� . ._. . � .. [ .. _ .. . . _ . ._._ _ . . . . . ._ .I -._ _ _. _ ' .___ _. __.... _._. . o � L L�- SEE REYERSE FOR E%PIANATORY LANGUAGE : �� � � -'-- �'Signature o limnr or�Agem - - pare . .. . . - - . . . ..-. . ! . - _._ . ... _ ..._. . __ . _.. . .. ... .. � _... pi __1 PlANS TO APPIICANT INSPEQOR'S NOTES . ON'NGR-DUILDLR DECLARATION � 1 hereby affirm ihat I om�eKempf from ihe�Controclor'S To: � R�tum�d��;'.� � " � '� . - � ' � . � 'license�law�for'the.:following reason. (Sek;�7031.5J ' � ' � �� � �� Approvad ' - UutinestundPr%trioneCode:Anycityorcottnlyu�bitb No. Dofe '' No. � :..-Del�. . . .:_ . '. ..... , . .. ..- _. . . �, . , . _. . . � ..� . , . . .... .,. i". ��.-�.r¢quires p pern�it lo cons[rutt,alter,improve,Jemolisb, i , . _.._orreJ�airqnystructure,/,riortoiltusuance,qlsorrquires , ',\ . , � � . . ' - _ . . . .. � �. !Le applicanL for sucb permit to Jile.a signed slatement . .'.1Gat Gc it licensed pursuont to tbeprorisions of t!e Con- . ' �;;. � � � . lmctor'sLrcensrLaw/Clapeer9J(conimencingu�itb5ec- , � - 4��,;�; . tion JOOOJ of Dii•isinn 3 of tGe➢uainess and Professions �� � : •'..- '� .' � . ... . �' � CoJo)or 1Lat Ge rs exem/rt tGerefrom n6d 1Ge 6asis for tbe !_. ... _. ...__.__._.. _ _._. ... ...• : _ _ __ �. __. . � _ .._ . __ _.___._'_._ . _. .. ._.. � - alleged exeinption.Any vioJution of Section,,7031.5 by � �'..'��. � Roqu�ired._'. ��`..DafoR�e�iwd - -- �.-.. . . ; .:'� '..'-' ._ �. . =. � , anY�J�licantfaraprrn:itsubjecestbeap�li�a�troa�ior! � Approvals ., yvs No' or Approv�d . �.t� ��-Jrenu ty af nnt�mnrc!1>nn f:vc hundred nllars(S$OOJ�Jr, _. .. � �'. ' �. .... . _ _ . ._..; . __._, . . . ❑ I,as owner of�he property,or my employaes with . Water Certificate -,.�, . , . . � , � -�� _.____ _�. �:. . ._,... .._ . ._. .__. .._._ ., weges as their sole compensation,will do the work.ond �- � ���- '���� �� ,Ih siroctura is not iMended�or offered for sole�SecJ044) � Heollh Deparlment __.._ . . . . ." ��� . . �'. .____ � --- --- � ---�� - - �. � . -_-_ .-� ..,1lusinesi andPr f ssions CoJe:T/r Contractor's Licert.ce � �' ;� . , . ., . , � _ � I.aw dnes ttot apfly!o an otoner oJ j�ro/�erty u�Go builds i ��.�.� ' . ., , . Fire Depar�menL._,__. . ____ . __.__.._�� -- � � � - � -� � � -- �� or imfrones Jbrreort,ond�eGa docs surb a�ork Ginrself or . . � � " � .;, '.,_ ;. � ,... ,;-,',_: . ;,.:.�.�.` . ..� . tlrougblu�.oron�crnployces,.rroviJed;tlotsucl im- Grading ' - . . .. � .�..,� �.� .__ .; � �. . . . ,��: � � ..pmremenes arc no! infended or of/cred for sale.:�`. _ , �, , . , , ,., ,. . ; '��� ���Goecever,tGe burlding or improvement is sold witGin a . .... . . ., _ _ , . � � ' ,�.' „�.� , � —, . � .,. . ._ ... __. . . . Geological �� � , � � . . . � � � ��,yenr of ro�npletion, tbe ownervbuilder will�bae�c Jbe � - � � - burden oJ f�rnning tbat bc did nnf builJ or improvc for i , , _.________ - �-_ .___.___ _.___ _ ___...__ . PedestrianPro�ection . " -. . . . tbrpurJ�"oseb/saleJ.� �. ' . . . . . (Fence)(CanoPY) , � � .. . . . .. ..-.--- - -'�:. --- . -.---' ------ .. .--- . � - � ❑ I.asowneroffheproperly,am_eccluzivelycontrdc , . ling with licensed controclors to constrUcl Ihe�proje<I,(Sec: .. :-.... . ... . � ;' . f . Speciallnspectian"�" ' ���� � � -� �- � - - - � oessbns�Code:;Tb Contractnr's � b"urlJsUatinvss anJ Pr e (Conc.)(MasonrY)�Welding) '�, � .. ._ .., . , �.... ..� .._ ..�,_ . . ': . .��.. �,.;�., . . _ l.itrns Laen does nnt a/�plti to an�ou�nrr oJpmperly ud�n ' � � � - - - or iinprores f/rrcon,"urtd'u�bo co�eracts for srsr! Lot Droinage . '`',<� ' . �=�c\ , _.. _ _ . _. ___ . _ _. .. . hrojec(s-ss�rt!a mntractnr(sJ licens�d J�orsaant to O�e, ,' . • ; ' ontraoior's l.icrnic Lael , �C❑ lamezem t�underSec BBP.C.,(orthi� � Parking f � ,:: ' .. .,. ..--- _.�._. -� .._� .. . _ . . I� �. � � . . .. .. - � --- . . P .. . . . . 5 reason �, , .. .'.'.� j � -_...__.._.. ._. .... ..... ...-_-_._.__.__.—_. ' . � � � � � � - Dote Owner ' ; r , . ,.... _. . � ,: ..�,.. - .., . . .. - � ._'___. .. _ _. .. . .Approvals. , Date InspeNor'sSigeofuro.- . � i . i - . '" . , . . ' ` ' . INSPECTOR'S NOTES �' ��'��:� � Location—� � . - . . _'____.._......' - ' (Setback 8 Yards) ' � '��' .. -- � � ... .. _-- --� - ,. . ... . ,.,,. .. . .� - -. _. .. .._ ---__ .. _.. . �. Foundations , , � dA,,. �- �. ... �... ' ..� ' �� . , Slob . " �. .. . . .. . .. � Frome � .. /��7 , . ... . . .... . ., - ,� ��. .�., .,,� ,: . ..�.... :.:.r. . . . . .�, � , � � . � . . ... . .'_:..� '. ._ ___ '_.____ _ ._. .___. _:. _ . .: ,..-. ;. . .^ .��.._. .�.��.. Energy InsulaGon� '� �`.. ./,� . . . ,. . . . . . .. . ..... . . ... ._ ., La�h/Drywall— , .. -_-. ___.. . . _ . _ __ �_. ....,___ . ... _. . _. � � . . • � lNerior� .%� __. ..... . ._ ._ :. ' . . 1.'� .�-..'.:... - Lo�h—Ezterior. ' � . . � ' .. .,,�. � .- .. :�. ..� ,.,� . . ` . . _ �\•.. ! � _. _ .. �� __._'_. , . , � HouseNumber— .�� ; � __��_.. ...__�.- •_. ..._.,, ...�'-...`'. •. • :_ .._ �_ �.. ,.'.: . .<'__. _.,. .,. ..._ .{�r.._i� ..._.-. ��,. �, . Correct 8 Posted . .. ' . ..`"' � ' .,. ,. � . .-.- , ., ._ ,, . , Final— ._.� .._ _'_. .._ _ ._ . - . ._.. . .. . _'_.__.... . ___ ._ .:.. .. � ... .. . ._ Enler on Front _ . ,.\. ; . . .._. . .. . . . . . . . . , . . . _ .... ... . . � . � � .. . . . . -. _... .. .. . � . . .. . � ,