HomeMy WebLinkAbout1560A 1561A _._ .._ .__ _ . _. _ . . _ . . . . .._ � . - ... . .. . _ - WORKERS'COMPENSATION DEC�ARATION . �.� ' '�. -�� "� � ;�. . �� � � ; - � --- � APPLICATION FOR BUILDING PERMIT � I hereby afivm thot I hava o tertificata of conaen�to self �/ inwre,or a certiiicate of Workers'Compentation Insurance, or c certiiied co�pp�thereof�Sec.3Q00,Lob.C.). ' . ..01 .-�---�--.. . . . . .. " . � . ..-- � ------ WCP6GS5241 • Great American Plan 3AR COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. � - Company -� � -' C - � Cerrfied copy�s hereby furn�shed. FOR APPLICANT TO FILL IN BWIDING �OO IS G•' ��CG ADDRESS � � Cerlified topy is filed with the�county building inspec- -� - 6UaDMG . . . . �`}iondepOrtment � � ADDRE55 20815 East Boulder Lane .. �... ..,. . . . .' . D61e .,.1Z-22-S6 ApPlicant TI1C Wm. Lyon Co......... aTr Walnut . - ..- .. Ziv 91789 i�m, . -�� 'CERTIFICATE OF EXEMPTION FROM WORKERS � - -��� � -�-NO OF elDGS.� -� NEAueST-.- �.,.. , . sae oF ior 3,SOD SF Min.NOW ON L0T � - —... . ._ _ . '-COMPENSATION INSURANCE � � Ce055 57. . (This seclion need not be[ompleted if the permit is for one � TRACT 43760 � a�ocK �LOBOO �OT NO. ��J /�,qpssgpq( ' PAGE� PARCEI hundred dollars(5100)or less.) �.. � .. .. . TEI. --'� owr+ER-THE WILLIAM LYON-00. No833-3600- ; us�zoNe rnno I tertify thol in Ihe performance oP the-wo k for which this N�� � a permit is iasued,I shall not employ any person in ony monner ` �-- �- SPECIA4 � �- � -� �- - � - � - so�as to become wbject to the Workers'Compensohori laws. � /+DDRE5519 COi orate P18za �-- -� - -- CONoinONs � �.� -�. �V - , aTv Newport Beach, CA ne 92660 _ _ . _� . - a ; __ _ Date � �� �`Applimnt' . . .� ARCM7FQ OR TEL � /-`'OTICE TO APPUCANT: If, after making this�Cerlificale of ENGINEER t�ales-Langston No 547-0862 DI$RICT.. GROUP NPE.. ' .FIRE Pk $SEDBY . � ! �mpHon, you��sfiould bemme�su6ject to'ihe Workers' �' �� CONS� ' ZO e� _�mpensotion provlsions of Ihe Lp6or Code,you must forlh• qDDRESS�?� .S. Main $t.� $CC. 1�5� Oran e W wiih comply with.such.provisions or this permit shall be .� -��� � _ a deemed revoked: .,,� � $8mC AS �Wl]E9r TE�• S7A l CL4551FICATION ; ' AP. CO .� �� .... . . � �.' �. � �. �.�. CONTRACTOR NO. ' , . - �.., � . .. . . ;� LICENSEO CONTRAQORS DECLARATION � � ----- � �� --- - � - - � � � �IC.�� � �-� �� QA55 NO. oD DWELI:11NlT5� I hereby affirm that I am licensed under provisions of Chapter 9 aDORE55 NO. . • (commenting wilh$ettion 7000�of Divizion 3 af Ihe 6usiness and _.. . . ._ .���, .._.. , SEVJER MAP � � � .. .._ . .__...___ . ProFessions Code,and m'y license Is in full force and effect. CI7�' CtA55 � � �--�BK.- - � -�_� � � �� ' -� "VALIDATION -- �. i��en' 276801 B-1.. so.c�. No.oF _. _ _.No.oF cNecK_ se Number - Lic.Class SIZ STORIES FAMILIES ONE � � �., , � . The ,Wm. .L on Co. 12-22-86 __.. _ _ _ NEw vnwn oN _ ---_ _ . Y . . � .._..._ �ESCRIPTION OF WOGK .-. �OQ(/ . . - ContraUor � . ..... Dafe AOD � s .. �IomezemptunderSet. lII Le famil .�home..construction AiiFR.- , � ,. B.&P.C.forihisreason ... . REvnlu .-s .. -_ , . _..._.. ; .. . ... . .. ...� . _ . _. . ___ .._ _ _ _ useoF ' �15b0A �Dafe:- E%ISTING BLDG. DEMOI __ ... ..._ . . _. . . � ,�� - --" APPIICANT iEL � .._ ...Signoture� --- . -. . . . . � . FINAL �• . . •�� ceiNTThe William L on Co.No. 833-3600 OWNER-BUILDER DECLARATION .. . __ . _. . _ __. - DATE�r��f�-'--�. . .,- _._ ..._ _. -•I hereby affirm that�I om ezempt from�he Confmcfor'z License �-�� - ��� , �, � •2'j(a 6 a . Law for the following'reason(Settion 7031.5,Business ond ADDRESS FIN � � '" � 'Protessions Code):� - --`--- . .. _ . . _.._.. _ .. . R N , ..9y � . ... �� ��2�7 R 6.�8�.. � BUIIOING , � . , � • I, as owner of the property, or my employees wi�h aooRe55 _ , � , . __ . '��� _ ' �-�wagesastheirsolecompensalian,willdolheworkand �� -��� �, � . _ � � ���� � 2..3� '86 the structure is not intended or offered for sale(Section �Ocau7Y � -�, ��� � -- ��- 7044,Business and Professions Coda). -- ��--� � �- �- � MOviNG -��- -� �- � - ----���TEt. -� �- ' , -� " - - � '0'1�5 G 1 F-�-�- CONTRACTOft NO. : ' �. ' � � ;•.:: ..`� , I,as owner of Ihe properry,am exclusively coniracfing � '� ' * ' � �-. wi�h�licensed contractors to�construcf the projea(Seo- --.�.- _. ..... . . . . . . .... . . . -.- �.. . ..- �_ � . . - . � � • • • •� " - • tion 704a,Business and Profesxions Code). A�oREu � . ..--- f.__- t� !�' . aeoweeo _ roTn�serencK _ . _ f •4 7`a S O ��"� �" ��CONSTRUCTION LENDINGAGENCY � -"- �-� SEt BACK YARD HWY PROP.LINE WIDTN. � I hereby affirm 7hat�here is a mnstruttion lending ogenty(or FRONT • -'-� - ' ;� � v �� �• � �q� x � the performance-of the work for which Ihis permit is issued � - �F.l.� --- -- -��- --- -- - - - � � �-- -� � - � � - -` '' �4 7'- �°'��- �se�.so9�.ei�.e.�. s�oe ':��.;' ! 2.3 1 -8 6 � ... _ .__ __ ___.. . _ . �_. . P.l. . . " �. 'f.'_. . ' "' ' iender's Nome Continental Illinois Bank � P.C.Fee S . Permit Fae .� IDMA Ref.q . � ' � ...__ . . __ . .. . _. .._'. ._ . ;.._ _ _ _ _ . - Lender'sAddress 231 Sn. T,a Ralle St. ChiC8g0 . ' � " � , � ._l certify.that 1 have read Jhis application and state Ihat Ihe .. . ____. . --._laeoon<e Fee ����•�� LDMA P/C N� ��� , -�- ----� - � ab e i ' 's corre e b comply with all Couny tr,�esngaro�Fee � . � � � � g , antes and Slare ws relalin o building.construclion. _.. . . ..._ .. . - '_.. imal Fee � � �� � � iDMA Perm.q � �� - ..._...��.. .. �. �..'� . u an here outh � represent v of this Counry fo enter i � upo th a v n ned pro er or Inspectfon purposes. �"�_ . .�-�Jt �� � � . a �__ -- _. _ _ __ _ ._ __ _ ___ _ .. Z LZ, SEE PEVFRSE FOR El(PLANATO0.Y UNGUACE a � . ^ " 9nat�reo Applic genl ..._ _ -_Date. ._ .._ _ .. . . . . .. .. . . . .. '. ; '�r i � " . � .Ol5'NER•BUILDER DECLARATION • PLANS TO APPUCANT � INSPEC70R'S NOTES I hereby affirm thai I am exempt;irom Ihe�Commctor's To: �- � �� Roturn�d � � � � . � G.��, � � " � ��license Law ior-the following-reo3on.;(Sec.'7031�.S) � � ' � � � � �Appro4od � '� �BuiinessandProfessinnsCode:Anycilyorro�ntywbitl No. Uate �- No. . ���Dota�� � � � - � � � � �. • ' ;, regvires a perniie ta coxstrucl,alerr,improe�e,demolisl, _ _ , _ . ._.orrepairnnyslruclure,firiorMresissaance,alsnrequiret .' . \ � . . . .. , . . . . . !Gc a�plirant fnr sucb f�crnrit ro fiJc p signed statemcn! ...1Gat Ge is lrcrnsed pursuant to!he prooisinns o/tl�r Com. � •;i�.,,� .. � ;�.I;:., � � traceor's l.irensc l,au�(CLapfer 9J/conrmrncrng a•itb Sec- � - tinn 7000f pf Diuisinn 3 of!Ge Business and Projessiorts - �._ ___.... .. _._._.__. �'; • '��_�' ��..�' -_ .. .� . - -. `-. .. .. .._-_ ' .._'--. �I��!�� �'_.. . ' : CnJeJnrthatGeisexe��pttbereJrom�aridthebasis/nrtLc . . aReged exemplinn.Aqy,riolation ojSec�iort-]031.5 by i � . . � .. .. . i �. . . , . . �.. . „':��. �Re9uirvd.. � -DafeReceir�d - -- � - � � -� � � - --�,..�„`•_� . . an}'Pplrcant/oronern�itrubjeclnlGea/�flicanitoarreif � Approrals -,Yas No or Approved , ,� .. . � , . . .,,. � i„ � . - �pe"a/t��oj nnt mnrc tban fi've fiundred do!lars(fS00J.I:. -�.i _. ___ . .. _ . . � . _. _. . ..._ .. . _ . . . . , ,_ ... ..,.. . . . , , , . . - ❑ I,as owner of the properfy,or my employees wifh Wo�er Cenifimte �� " .� " �-�'� -- ��� � .._. _. .__- . _ - ._- . _ __.. ... ..� _ .'�'a9es as Iheir sole compensation,will do the work,ond �'� - '- ���� --'- �'���� ' -� � �-' ' '�he structure is not iniended or o(fered for sale(Sec 7044) � HealthDepariment ____ . _ .__... ._ � .'��. . .. . .� ----� - - � - -- - --� - �. _. BusincrsnndProfesrronsCode:.TGc.Confrartor'sLicense , �� . .,. r,�•,.� l,aw doea ttot cpply to on oumer njprnperty u�Lo builds �, Fire Deporlment._. .-_ . _ _.__. _. _.. ._.._ ._. - � � � ' -' �- - � � _ or inrprones 1Gereon,and u�Go does sucG umrk GimrelJor .-.�:., �!• ' •,i;:_ � ' .. LLrougG hrs oum enrployces,provideJ��tbat sutG�im� �� radin .- �� ' `; -'� ' �� �' � ��" -., � ��prnrenrents nre not intended or,of/ered for sale.: G g ,I � - ' � ._. . '��1- . . . - . . .. .�. �\l� :'bott+et�er.!Ge breilding or improvemen!ir solJ a�il�irt�. G � � �. - ,;_ .i ,� ` ' ..� -. ..- - --. ..-- ..' .�<.,.... ��,. ,� _ . � <''1'ear oj ron�pletinn, !br amner.burlder.wrll.lave�tbe . eological . � ', . � �. � � - � �� - � � � .� burde++of pme�ing 1l at 1 e did nnt buifd or improve Jor ; ' ' � ._.... . . .. - .-_._�..: -. ..��. t!e purpnse oJsuleJ.� - . Pedestrian Proteafon�..' ` - . �.."- �� - - ..� . . . � ..�.. . ,� . (Fence)(CanoPY) .. �: ,. .. � . �. .. - � . .-. ._-. . .. ��- -- �--- -- -.. ..... .... .. .. � „ .❑ I,as owner oi Ihe propeny,om ezclusively mmrac- , ling wifh licensed controctors lo wnstruct the prolec�(Sec. 5 ciallnsetlion � ����-� -��' � ����-��' ' � ���� � �� --�`�-�� �� � -"- 7044)DusinessundProfestinns�Gode:Thc�Contrattnr's Pe P .. , _. ._. .. . . . _. , ..� : (Conc.)(Mosonry)(Welding) ' � � � ��� � �-� � � � � �.� �. ,- , ;��;_��.� � I,irnttSeLau•dnetnnta/�/�Iytoanou�irerofJ�mQcrtyu�bn �-� �- � - � � � ��- ��. ' � `-bailJs�nrimprorrs�tberenn,-onJu�Gn�conOractsJnraucG � lm Dra�noge ', "��. .� -_�. . " �' . . .. . . projeou�etit!a cnneraceni{sJ�liicnsrd parFuant to a!e . - -'. . . �'';.1 � . .. . . .. , ..-- .--Cnntractor's Litense l.au�l.- . . .-`-� . .. � ,... _ ..� .. � . �� Parking .. - . . ._.. , ;. •. ._.__. ._.__�_._.._.. ._ _�. . .. _ . . .... _.. _._ .... , .. .-. �.� �. , ❑ �am ezempt under5ec ,B.BP.C.for this • '� - ..,. ;.. ..,... �" I . -, . . . ..._._ . '__..__. _ . ..._ . .. _ �. . � � �eason . � � , .... �. .. ., __ _-_.. _.__...:� . ..'- ---._ _._..___.. _ . i . . �: �� �, .. � . • �. .�. . ... . � ' .. _. . ... Date Owner . ,_ . li _ _ _ __ ._.._ _ �APProrals` % pote - Inspectors Signafuro;�� . . . . . . . . � - � � - � �� INSPECTOR'S NOTES-'�� � � location- � - � . � � (Setback&Yaids)� �� - � � � � '^= _.. __ _ __ . _. ._., .. ... . „ Foundoiions �. � � , . � .. ;.. ' " . . Slab � . � ' � n�C ��^'�� . ... . �� � � .. .. ..� � ,� . ., , . �� k�� -.-_-'- _ . ..�. __-.. . .__'_"-- - �-�.' � ... ,..,. .,.� i � Frome � v�✓� . - . . . .. � . . . , . . . . ., . . ,,. . � . , � �, _ Energy Insulation +� --- '. . ' _ __.���-"._ .c.__ . ___�...... _ . .._' . . � , ' . ,. ,.. .. , ,. . Lath/Drywall- � ( - - ... -._ _ _.__._. .. . .. .. "' , . INeior : .- : ' . �/��_.. .. .___ . . ...._ ..__. . _ .._ ._, . , . . . Loth-Exterlor . . . . . . � . , . . . . _ . . . ' . ...���(.... . �� .. � ,. . _ .\ (-. . . . ,.... . . .. , �, House Number- . _.._._�.�.,. . . _ . _ . . ...,�,` . . , � ..�. � . � - _ .._ ._. _ . . _.... __ . . . ..,I . . __....... . . . Correct 8 Posted �- � - C��.� Fina�� -_. .'_ . . _._.. . . �_ _ ._�._ _... __.._ ___-_.__ ._ _ ... . ._.__._� .. ! �� , _ _ _ ../.:r. - Enfer on Fronl . .. �•�-... . �.}_ � . '.�. . .. �' . .- . . . . , � . ., � . .. . . . . . . �.,,,. , . , _ . . . . . . _ . . . ��� ..� . . . .. � . . � . � . � . � ..,. .. . � . � . ._. .. ` . . ' . . ,... 1•�..� C i .f? i y '. ,' .5 � . = t. ��. . /