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HomeMy WebLinkAbout1562A 1563A (9) , . _. _ . ._ ... _ ._._ _�__ _ _. .,. . _. . . WORKERS'COMPENSATION DECLARATION� � � �� "�� : -� ��� .s��.� .�� � ��-�-� �� ��; . . . _. . . _ . .__ _ .. ' . . �� " . ' •� I-.hereby�alfirm thar I have o certifiCate af consenf fo self qpp��CATIQN�-F4R� BUIL�DING��PERMIT� �- ��;-; insule,or a ceriifi�ate oF Workers'Compensaiion Insurance, � or o cei�ified cop �hereof(Sea 3800,lab.C.) � �� ��-" � �� "" - - - � - - � . � - „ _,,._ .,_,__,; WCP61�5241 " - Crea[•American Plan 2BR COUNTY OF LOS ANGELE5 BUILDING AND SAFETY PolityNo. � Company- � . ... . . - . . . � �Ce��ified copy�s hereby furnished.. .. .�,� . .:�. FOR APPLICANT TO FILI IN BUILOING ��y�(�/ q ' � � �Certified co (s filed wiih�fhe cooN buildin ini ea � - ADDRE55 l/O G PY Y 9 P BUILDING �'lion department.� ADDRESS , .., ,..�..- . . _ .. .'._ _ . �7?LL-Z-- . Date�..1Z-ZZ-SC7 Applicant . THO.,Wm..LyOn Co. ciTr Walnut ziv 91789 �ocaurv � . �` � �CERTIFICATE OF EXEMPTION FROM WORKERS'- � "�" "� �� � - "- " ' �NO.OF BlDGS. - --� . niFAREST. .. .. ...._ __ __� __ . .. .. � � ��' ���COMPENSATIONINSURANCE' �� S¢E OF tOi 3 SOO SF Min.r+ow oN ioT O ' CRO55 57. � (This seclion need nof 6e mmpleled if 1he permit 7s(o�one - -- --- �� �� -- - � ASSESSOR ��� � � �.�� -�-� . hvndred dollars(5100)or.less.) � . „. . , 7RA�T BiOCK LOT NO. ,V,qp gppK' ' " � FAGE PARCEL , ' � 1 ' owivea THE WILLIADi LYON C0.-nio833-3600 us�zoNe +�.u�v I�certify that in fhe performance o(the.work(or which this NO. � �02�3e2- ,y permit is iswed,I shall not employ any person in any manner - --- SPECIAI- �-� �- -- �- � -� --- - �0- so as to become subjecf to Ihe Workers'Compensation'Laws. - ADDRE55]9�COi OT -�P - - - �- ''--' " ' bpNDIT10N5 � ;V ,, _..,•.. .. , „, , aTr _Newport Beach, CA zia 92660 -- - _._ .- - Date . . . APplitant ' � . � yp ARCHISECT Ok TEL. .O / TICE 70'APPIICANTd lf;�afier makinq Ihs Cerlificom o� Hales-Lan SCOA .DiSiRiCT _ GR P. TYPE . FiRE SSEDeY. _ I mption, you�5hould become su6je[I fo'fhe Workeri ENGINEER No. 547-0862 CONST. ZON Jmpensation prov�sions of Ihe Labor Code,you musr forlh• qDORE55777 S. F1 i �� �✓� .� d with��mmply with such.pwvisions or this permit shall 6e - �� ' ' -� � �n deemedrevoked. .. -_�.�. .. ,. ,,.-,... �, SflmO AS �WilE'T' TE�' STATISiICALClA551FICATION AFT. CO -'� COMRACTOR NO. � — LICENSED CONiRACTORS�ECIARATION - �. .- � - .- �. - � - - �_ - ��� . . �C1ASS NO.�DWEIL.UNITS�/ I hereby aFfirm�hat I am licensed under provisions of Chopter9 ADDRESS NO. (commencing with Seclion 70W)of Drvnion 3 af the Business and _ . _. . ._ _ . . .._.. .-. IIC. � ��R'�P ' � .. P.oFess o s Code,and my I.icense is in full foice ond el(eti. Ci7Y ttA55 '� -'-- �-�� ---� �-���� -- � - �--��� - yq��DATION�� � �... . .... , ' S(].FT. NO.OF NO.OF CNECK . BK. p�. ' I.icenseNurr'�be.�2�6801 � ��c.Class'B-1 � � srz SiORIES - fAMILIES ONE � . , . - � '� � TItE.' Wlil. LyOR CO. ,. . SZ ZZ-SG � � ' DESCRIP110NOF WORK '�' '-�' - " NEW� -VA�UAT�I[O�N ._ . ' Conhocfor Dare ._.. .� i .y Qd0_ ,� ...� � ._. _ y,� rJ�i.2�t . . .. .. .. . . .. ADD ` � '. � ❑I om exempl under Sec. � �i 1 � AITER...� ., , ► .. ..�• • i •`���. .�� � B.&P.C.for Ihis reason . . ... , REGAiR . S._.. -_. _-: __.. . _ .�. _. _.'.. _. . ___.._ _._._ . _..._.._. ..Date:'.... _.. .�.. USE OF ,� . � •2�l 7,2� � EXISTING BLDG. DEMOI __ �J he�eby affir .. . . . . �_ . .. �. ... - nvaicaNr Te�. FINAL � : i°2 Q%,2 J� . Signature OWNER-BUILDER DECLARATION PRim • ' No. _ _.DATE 7 J�i1g�rJ�.....-i � - ... _- -.-. - _- - _... ...- .- m Ihat I am exempl irom the Conlractor's LiCense � � - � � - �J -8 6 Low for the following reason�(Section 7Q11.5,Business and ADORESS FINAI^ � ' '� - � � ' �Professions Code):_' . .. -._ .. � _.._- _ .. ._ . .._ R 8y � _ �..�'�� J�E J A�--� -� � ..... BUILDING . , . . . . _ . .. • ' . I, os owner of the properly,or my employees wilh AOORE55 ' ���• •�� -wagesasthairsolecompensatian,willdotheworkond ` � '..�:..�; � , , the strudwe is no�iNended or olfered for sale(SeUion ��`���Y , - ; ,' � •[i 2(y Q�� . -- ...7D44,BuSiness ond PrOfesslons COde). .. '... .... MOVING........ . ... ._.. ... ..- �TEL. -.- _- . ... . . -. . _. .. .... . - ... � 1,as owner of ihe ro ert am exciusivel comractin COMRACTOR No. . . . , . .. � P p Y. Y 9 _ .- �, ... . .-� . • �Q2Q�0�' -.with licensed con7ractors lo tonsnuc�the .. .. ...... ...- .-.- . ._ . .. .... . . . - . . -. . projecf(Sec- ADDRE55 lion 70d4,Business and ProFessions Code). .��� . ' �2,�j� -�(�. ,;. . ' : :�•"; ..'�4 REqUIRED. TOTAI SETBA K � � �� . ._� � "`""� � �� CONSiRUCiIONLEN0INGAGENCY- - � '"-- vARD� Hwv- �- �-� �� �� -- � ----� - �- SET BACK 7ROP.LINE WIOTH I hereby affirm Iha1 fhere is a conshuciion lending ogency for FRON7 " -....- �" . ��.j{ .� ' �' � � � --�he periormance of�he work for which rhis permit is issoed ...-._. v.L.. .. . . . . .- ... . . .- �-- J .`--...- - -'� .. ..... ...- -- .. �Sec.3097.Civ.C.)• SIDE - .•.i���. ... - � . �. � . . ..,. _._.._ _.__ ... . _ ... P.L � -. - .� � , . � . .. . . . _ . _ _ . _. .. _. . . lender'sNome GOntinenta7 T1linois� Rank - � {� IDMA ReF.M ; � _ . . . _ .. . .._ . . -._. P.C.Feet-� . �Ve.mffee ��/ � .� . . lender'sAddress�'�� � L � ' � � � O- 8 $811a S�(`,rh�9reg0 ��7 ' '� .�. ..I cerlify ihat 1 have read Ihis opplimtion and s�ate thae the ... . ..... .. ... ... �u„o��e Fce -- �O�� ��Dnv�V/C B--IJ�'oC ► ..- . .. �.- ---� abova Informafion is . ree ro comply wiib oll Counry invesugm�on Fee / �. -� ' rd" SI e laws rel q.lo building conslruction. ._ . ._. _.._ _. To�al Fea� (p D Q -tpMq Perm.N.. ��- . . -=.- - . .... - : nd hereby auth ¢e repres t ves of ihis Cou�ty lo enter ' onih e- fioned o yforinspecfionpmposes. _.�L!j'5..�_ .. f-�'���. . ... .... . .___ __ ..._:. .__. _. .._ . -._...'. ... . . . . _ _ ./ . . . . .. �-^ZZ— SFE REYERSE FOR EXPUNATORY IANCUAGE ; ' � , ._" _S�gnaiureo4Ap Ircan�orABen� .. .... pa�e ._ .. .._ .__. .... .. .... . .. ._. ... ..... . . ... .. . . . _. . _:. .. .. .. �� . . . ....._._ .p.� PLANS TO APPIICANT INSPECTOR'S NOTES � 015'NER•IIUILDGR UC�.�.an.-...,,., t here6y affirm 1ho7 I am exempl from ihe Contractor's � � � � � � ' � � � ' � �� License law'for�the-followmg reason.-(Sec.�7031:5) ' , . .. . ..., ,.. ,. . .. . , �,_ . To: r , � � RNurn�d ' � PP . . .. :' ... . ,.,� : . , , y�. . . . ., „ ... �� - � � A roved '� Dusineas and Pro essinns Code;An dty or county wbiab No. Data � No.� � �� �Dat�`�-� � � �� �� � � � - �� � �.,.requires a ficrnait 10�onstruct,alter,im(�rorc,Jemo/isfi, __-.or repairan�•structure,priorlu its issuunce,ako requires =--� ' �- � - , � . tl e appli�anl for.aucb Permit to file a signed statement � �� � .eGa1 b�Ir lu�ns�d suant to Ibe sinns n tbr Con- p�,. pro J � . . . � �� � ,:.:,..I...., :��_,_.:,i ..., - p� �' ._•_-��� Jrarlor's Lireue Lau�(Cbapter 9J(rommnering u�itb Sec- � tinn 70001 of Dir�ision 3 0/tbe Basinesa and Pr%rrians �' \-• .; .',� ;. .. . _ _'� '_`�. .. �.. .. '�'_'._.. ..; •�;__.CoEcl nr!!wt 1 c ir exeni(�t tbereJroai+and tbe basisJor Jhe � _.... . '___ ..__..__ . ___.. - -���-- - - � � - a!leged exemptron.Any nialutron aJSertion 7031.5 by � , .: • ..,._�_ •Raqakad •. . ...'' -_ . . .. � '. . ' �, . . anl'a plican�Jnraperniirsabjecist6eap trcanttoaaini! ' , ___ _. .. '�Dafv Racair�d-. .'. ; , . ' h P Appro ais or Approv�d �� .,. ,.., , „ . ��penalay J nnt mom�ban Jioe Luadred doflars(SSQOJ.J: ��� _ .,.; Yaf ��No . .��:. _ .t..�._:�'_._ . _.. . \..'.. _ . . . . . . �� - �-- . � � ❑ I,as owner of Ihe properly,'or my empfoyees with , Water Cerlifi<ate .-,�. . '` r . .. �. . .� . .. • - :. ..•. .-� .•�.. _ . . . _. wages os lheir sole com ensafion,will do the work,and �. p ._'... � .�. _ .'___._ '_ . .. ...._ . ,. .. � .. . . . �--- - � ----��- - � �� - ��• Ihe strutWre is not intended or offered for iale(Sec.7044) [� HeoRhDeponmeM __ . ��� '' � . . -----� -. --�-��- � � -� - ��� � _ .DqsinessandProJessionsCoJe:TGeCont�uctor'sL�icense �` � - - �- �� . � Law docs not appfy to on owner oJproperty mbo bui7da ,. Fire DepartmeM ....- . � � ���- -- . -� �- � .� � or imprares tbcrron,nnd wGo does sutb u�ork himseljor . ' _._�i ���._ . . tb�ougG bis.ou•n�cfxpinyces�r ouided tLat,iu66 im-.� � Grading , � �' � . .� pro��ements a>e nn! inlenJed or ofJereJ Jor safe.,� . .. . . , � �. �� � :. � .�. '� .. . -., : ,, ��•� : owerer,tbebssildingnrrmprnvementissoldwid�irco. .. � . a . • ._ . ..._ �- _ .. . ,. , ' - �year of rnmfletinn, ehc.omn¢r.buifJer mil!Gave,ibe Geologicol � � � . . . ., . �. . � burden f pmvin,Q tbat he did not build oi in�rrore for , Pedestrian Protecfion .�_ •. ��.. �--; _ , � ..� �.. _ . ___ � __�. . . �...�_ � , .. 5 .� ' .�: �...,. � (Fence)(CanaPY) ... -� .. . �_....� .._. _. ` Yn❑wthlke sedcofntracorsfo'conslr�utlClheVroYeclnSec! ' r r f . . . 9 P I .,( c• ' Speciol inspeclion"� > ._ .t_ � _ ..._. __.�. _.. _ _.. .., . __. ... _ .. 7044)13us �s and Professions Codc:Tbc Contr6ceor's (Con<.)(MasonrY)(Weldin9) ,. -� � `�� � .:__ .. : , .- .... _. .1\; .^ . l.ice.r Zau Jocs nni appfy ta un ou��er of(�rnperly u•bo . � � '� �--�-buildr or imprnves!!ereon,�and u�1 o eontrarts/or sut! � �. • '.-'. . ... . . .. . /,'rojrats��u�itb a mntraator/sJ7i�ensed pursuunt to !6r Lot Drainage i . , �"�� ,.� ._.. ._. .__. ..__ __ . ._. O ,.�. �. ���� . � ` -'. ...- � -- ...Contrarlor's Licettse l.au•l. �_�� . . ,.�. ,. , Parkin :. .� - . .. ._ _._. . .... . ... .. _ .__ . _ . . _ . ��. � .. 9 � ' ° , . ��� � ❑ I am ezempt under Sec. ,B.&P.C.for Ihis . ..__.....__ . _ . _ . ...__.,.. . . _. . � � � . . � , �. , reason , ,,,:, . . . .._._ .. . . . .__ __. ___-_' _. _.__.. � - �� � Dale Owner , � . ... .: .:- .. � �, � `�. ' .. :.-, ._ . .. . . _.... .__. . . . Approvols �� � Date - ...-Inspedor's Signofur� �� . . . �. . _ - _ . . � � � INSPECTOR'S NOTES lomiion- . . (/ - - - �- � � _ _ (Setback 8 Yards) . !P , : , .. . ., . . . -' . ;�.:� Foundaeians . /��� � � - -. _ .. � . . _. � �. . . . � _-__ ____ . ._ ... _ .__. __.. '._'__�. `:.� . ._.: . . ., . -�,� . , . � Slab �� .. � �� .. _ . � _ .._ . :.-� , . . . .. . frame � �- i . I �� 1..�"L-.r� . . . . . . .. . � .. .. . ... � �... . _. Energy Insulation 1�.� ��.� �.-.__ .__ �..�_ . _.___ ., _. ' .. ...� ._ _:_. . � . . . .. ' ' . . .,V � . � • � .� � . � Lath/Drywall- � ���, _.._., __ . .._ .__ _ . _. _ _,. ___ .�.... ........ .�' . . . . �,. �.. Mrerior. - ....._-.... . . Lo�h-Exterlor ... � . ' ' \ . . �_ ( . . � . ..... .. .�..._..._. . � , .. , .. . .. � . , ... . � . `,.. HouseNumber- . .. .. .�_-- • :�-. .. .. _ .__, -...�.• ... • �:� —_._.._.. <:� .�L:.-_�.::. ^i1:�-. .:�-�.. .: . .�__ . . . . .. Correcl&Posted � � - f``�� �' � Final- _ '. �._�_. _ _ _._. _.��n . .. . _ � . . .. . . . .. . _. . _... ..__. .__ ._ __.... ... . Emer on Fronl � ' �.r\•. � . . ' . . ' . . � .. � . . ,. ..-. .. . . . , . . . . .._ .. ,. .. � . � .. . . . ._ . . . "'Y, t,.. .. ,. . . . � .S. S . _ � _, . . , _ . ' ' / . � r ..., �. .., �, . � , _ 1 , i.5' t�".', i 't .( J i I.