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HomeMy WebLinkAbout1564A 1565A _. -- __.... _ _ . __.. .� . .. ._ .. . _ ,,. _ _.__ . _ _ _. __.. ' WORKERS'COMPENSATION DEQARATION �"�' �- --" � �_,._.��, . , ., . ... ..._ ...... ` ' � ' :. � , . .�. .. . �.. I hereby affum�hof I have o certificme of conaen�to,e�� ��--qpp��CATl4N �FOR ,BUIL��DING PERMIT�-�� � t insure,or a certif'cate of Workers'Compensoiion Insurance er a cerfilied copy ihereo/��Sec.3800,lab.C.) � `'-'.: ...�.`... . . . . � - " . .. . , . . . ._ . _ ..._.._. . WCP6255241 Great American Plan 1BR COUNTY OF LOS ANGElES BUILDING AND SAFETY Policy No Compony _ . . ' � � Certitied copy is hereby lomtshed. FOR APPLICANT TO FILL IN gu��o��vc, � aooaess ����' � _ Cenified capy is tiled wiih the county 6vilding inspec- BunoiNG lion dePcrtmenl. -� " � ' ADDRE55 QO 23 Ea B 1 r � :�'.� " ' - .- ' Do�e �.1Z-ZZ-86 APPlicanf . ThC�.Wm:.Lyo�n Co...._- arr Walnut . .. -... -� Z1P.... ...91789 . �ov.urr i - - � CERTIFICATE OF EXEMPTION FROM WORKERS' - `- �� "-- �-"� -�� ��10 OF BLDGS. � --. NEqREST -. .- _. _. . . .. . _ . � - � -��COMPENSATION INSURANCE � �� � � size oF ioT 3,800 SF Min.Now oN�or 0 � �ou sr. � (This section need not be complefed ii Ihe-permit is for one -- iRACT � � 6tOCK - l07 nlo. "� �ESSOR - - - - . �o - hundred dollors(5100)or less.) . . , , AMP BOOK �� ' � FAGE� PARCEL I tertify Ihal in�lhe performance of the work for�whfch Ihis OWNER THE-WILLIAPi LY�N C0.�NpH3.3-3600� USE ZONE oP �_,,,' 33 _ „ permi�is issued,I sho�l not employ any person in ony manner . -- -� 57ECIAL- � � �� - . -�-- - ���-�- � --- � �G�. , so as lo beCome subjeU lo Ihe Workers'Compensotion lows. �-� A�DRE5519 COY oYate P18za - � -�� - -- CONo�7iON5 � �O . ' _ aTr Newport Beach, CA .ziv 92bb0 _. _ _ _ . ee Dole.. ..�. . . ..APPlicanl .. ., � ARCHRECT OR TEL • �O �.QTICE TO APPLICANi: �f;ofler malcing IhiS CeAi}i[afe of ENGMEER }iales—Langston No. 547-0862 �15TRICT, GROUP TYPE '�FIRE PR SSED BY_ _ M � `npton,"yau�shovld become subject to'�the'Workers' � ��/ .2 CANST�.ZON V .npensa�ion provislons ofihe Lobor Code,you mvst fonh• qppgE55777 S. M�in St. Ste. 105 Oian e �1 ..... �� . ' � �m wi�h comply��with such provisions ar fhis permtt.shall be ----�� - tEt. �� deemedrevoked.: �,. � -. .. ,,,-, . SdtnO AS Owner ND ' STATIS7ICALQASSIFICATION APT. CO .�� � 2 . ��� CONTRACfOR �/ ,�. LICENSED CONTRACTORS DECIARATION� ,, . � --____ _ �_.. ._.._._-_ .. . _ .. . .. .��C. -. .. . . C1q55 NO. Q� DWEIL UNITS__L .. . I hereby oHirm thor I om licensed under provis�ons of Chapfer 9 qDORE55 ryo. (commencing w'dh Settion 70D0)of Division 3 of the Business ond . _. . . . . . ��� _ � SFWFR MAP . .. __ . _ . . ... .... P�ofessions Code,and my license is in full force ond effect. Q7y C1A55 � ' �BK-�-�-� �- ��� - �� ��-�-- - VALIDATION---� .. ,,. . . . .,�.,. ..., ,. ., � ..�. . � . .., SQ.Fi. NO.OF NO.OF CMECK � LicenieNumber 2768�1 � - '�i� Clais'B_1 Si2 SiORIES FAMIUES � ONE � ,. .,. . - ' � . .. . � .. . . ' . , VALUATION , ', � ��.� � � The Wm. Lyon (�i0. 12-z2-�E7 -- DESCRIPTIONOFWQRK " " " NEW � / DOQ ` CoMractot � ' �Dafe ; /_ , �� �, ADD � Y ❑iamexempiundersec. Sin le famil home-construction Airea �1 5 G 4 A ' B.BP.C.forthisreason �. .. REPnie -.S . . - �... -. -. .- ' .. __. _. . _ . .......... ..... . .. ._ ; � USEOF �ate:- E%ISTING BLDG. OEMOL � � � �� � � ��� __.Signafura '_-. .-. - . .. _. .. ' ` APPIICANT TEI. i .�.� .��.... � . .... �.. ... OWNER-BUILDER DECLARATION VRIN7 W'11' ,No. $ _ p�� �FINAL ' i � I •G P.rf.H� _ _. _ n DATE 7 I�j g7... . .. �. .._. . ._.._ . -I hereby affirm Ihat 1 om exempt from tha CoN octor's license qppRE55 �- -�,..- •,� ; �, • •G G�J�i�S�c=i � Law For�he foliowing reason'.�Section 7031 5 Business and FINAL;� Y 1231 -8b _. _ _. __. _ _ ..._ _ -Professions�Code): - ' pR 8 � - BUItDING ' • � 1, as owner of ihe Properfy or my employees with AODRESS - . � _ .,., � � .. r ' _ , -wages os tFeii sble compensofion,will dolhe work ond �p�AtITY , . ' `1 ��5����� _ the structure Is nol iMended or offered for sale�Section , � ��. � . .. 7044,..Business and Proiessians Coda). .. ..- .- �- MOVING � - � - �. . .TEL. .-. . _.. . ..-. ... . ..-- - ���-. •-� . . � I,as owner of the property,em exdusively contracting cONiuncroa No. �. , ._� �-:.� -i-'-_ -- �- 'wifh licensed controctors to canstru�t the projett(Seo- . -� . - . . - - . . - -. . .. .... . . ... . ... . . . ' � . _. . . .."�.....'- -�-•,3(�Q Q�-.. ADDRE55 tion 7044,Business and Professions Code. , -- •�:( ... 1 _- -.-_... ._ RE UIRE�. . TOTAL SETBACK • � � "CONSTRUCiION LENDING AGENCY' -" �- SET BAa rAR� H�'�' vR00.LINE W�DiH �� ' � � -� " J - ' '�`�9�-a�O`_'' - 1 hereby afiirm fha�Ihe�e is a construUion lending agency for FRON7 - -�� --- i 1�-�':',,>�� � � '� '� -Ihe perfarmanca of the work for which Ihis permit is issued �- - v.L-- -- �- -� � - �- - � � � - --- --- , � -�- - I 2 J� -'H G. . (Sec.3097,Civ.C.). SiDE � � � ' ___._ .._ _ . . ..._ .. P.L. ; . _'. . .:�.; �, . . tende;sName Continental Illinois Bank ' '- -" i LDAAH 2e1.A � ..__. . _ . .' '_' _' P.G Fe¢E � �� . Vermir Fee .. . - r.__.._ . .. _ . . Lender'sAddress ��1 Sn_ T.a S�lln Ft.� ChiCBgo � .�. ,., • � _I.cenify Ihol J bave read lhis applimfion and state that 1he _. . . ._.. - Issuonce Fee Q•-�Q LDhM P/C k � ,- -�- - � � -' ob ve' tion is . agree fo comply wilh pll Covnty Invastigation fea �Q D.O h � i , ,.. nonces on �aws re �nq to boilding construclion, _ .. _ .._ Taral Fee 7 CJ �p,Nq va.m.M. .._ ._.---', .- _ � . on her auth Iz repres i ives of this Coonty lo enfer , � up Ih o - e ioned r rry for inspeUion purposes. � � � , _ . .. .. .. ._ _. _._ . . .._. .. _ .. .. ._ _ ... . __ . -_._ ._ . . . . . . . _... _..__. . .. . ___ ` , � gna p �g� G L� SEE REVERSE FOR EXPLANATORY IANGUAGE . � ....__ .Si �ure of A hcan�or nl... ... ... Dat --. . . . ._... . . .. __ . . . ...._ .. . ._ . _.. ..._._. �._... .... . .�Q� P�ANS TO APPIICANT INSPEC70R'S NOTES � ,.O1FNF:N-IIU1LllEH�DECLARATION •- . , . I hereby�affirm iho�I om eaempt fromlhe Confmcror's To: � " � RNurn�d ' � � � . � � license�Law for-�the�,following reason.���(Sec.���7031.Sj _ � . . , �. .. � ...... .. �aPProved ' . '. . ' . ��." , ' ,- � Business nndProfessions Codr Any riry orrounty wbicb No. Dnle ° No: � �Dalr-� � � ��-�-� � � ' � � - ' �;;j �,. � �requtrrs a pe>mie to ronstruct,aJtrr,inrprorc,Jrmoluh, , . . _ , - orrepairanystruclurr;rriortoiuissuance,akoreguires . -c-- • .. .... , .. ". . ... _ � t!e applicant fnr surii permi!to fi[e a signed stulenoent . . !l�at!c is liccnsed pursuant ro tGe provisions of lHe Con- , .. I � .':1:�. }'�..•,).. . � � tractnr'sl,irenseLaw(Cbapter9llconnr�cncinguriflSer ,��� ,. .�r.��," ' . �__:..�. �- � � -� �-� �� ��� tion 70001 f Dnision 3 0/tbe Du:iness and!'r�ssi�ns i ���' �:- '� �-•.� � '" � ��'` � ' ' C�deJor77atleiraxnm/�ttlerefroinandtbebarirf rtbc . _ ._.__ _ ._._.._..:� ._ . . _ i. . ._.__ . .. __ . _ ..._.. . __ _.._.__ �. .. ' ' ' - , , ,. alleged rxemf0ion.Any t�iolation nJSection 7031.5 by . � �-' �Reqoirad �'� .. _.'�. _ . . ... � '-'�. 1_e' � '.�' any appficant for a perorit subjerls tbe applirant ao a civi! �Dole Rac�ived Appro oli _Yas Na or Approved�. , ` . � �Penulty o,/nnf morc tHarc froe hundred Jo!lars(55001•k " . ..- "� . . ._. . " . . .. . ❑ 1,as owner of ihe property,or my employees wifh . . ,. ..,_.... � . . . . .. Woter Cerlifimte :,.�� - '� � � � � . _ ' .. .. . ___�� �+ages as iheir sole compensotion,will do Ihe work,and ." .... . .._._. . ._ ._ . ._ � _._ . . . �- -- '��- � -� � -� ��� " �' �� �he strucfure is not intended or offered for iale(Sec.7044) �� Heolth Deparlment _ ..__. '.' ::�_ . . _. ----- � - � � --�- - _ ._ . Bu:iness and Prnfessions Codm.TGe Contrnt[ori Lrrense � � , � �,,�,:, I,a�c does nnt apply ro rsn oumer nJproperey¢�Go builds „ .. ,. ._,..�,:. - ' � Fire DepartmeN__.,._ .. ...__. _. .� ._ . . ��� � - - . � - - � - ��- or improces lbcrcon,and a•Go does sntG u•ark Gireself or � . - ... �:. .. '(, . „ri. � � t ���-:;r.,, � tlroug! bis own emf�(nyces, prorided�ldr6t�-surh im. � Grading ' .� , � . - prorrments.arr not infende6 or fJered fnr.sale.'~ � � " "- - ��� ,-�,� �,;,,�,; . ; ��'( _ ���boa�ener,tfiebuildingorimprovementisaoldu�itGin.. � Geologiml��: �."�-- - -�. �..: -.-. . ���� •I::��.'. •� . �.. year of�cornpletion. Me ownerv6uilJer-wr!l:barc.tbc - ' � � � ' - " '�" ' '�"' ��� barJen oJpmt�ing 1Gat be did not burJd oi impmvc fnr i _...__.. . __ _._.__ ._ .__._. __. ,. . : . � � -� thc pu�ose�f saleJ. PedestrianProteciion..- ..:.-'. �.. . . � . � � �❑. I.osownerofihe ro�ert "amedu'��: (Fence)(ConaPY) � �, . � ._� . __. ._..._ ... __...__._. ..... ..__.._._.. __ .....�._ . . . . P P .Y� siaely contrac� � . ling with licensed tomrocton to conslruU the projeU(Sea P P'��-�` ` � )044 6utrness and Prn e:s'ons�Coder TGc Cantrartor'a 5 eciol�lns e<lion_-. : .�..:.� _. ._.. .... ... .__ .. .. .. ._ . .._ . _... ) f (Conc)(MasonrY)IWelding) � .. - � - .. i .. . ..,.l . License I.au�Joes nnt apJ�fY to an ou��er nJprofrerly u�bo ' � � � � - -� � " � ��' buifds-q/improveslberrnn,�and-u�lo"contructsforsucb lo�Oroinoge .,� �)�,.]�`� ,. i',.� , . ' . , � . �.-...-- - .. ...' --.i.'. .--- -_ - . - Cnntractnr's License Lau�l�J ._nsed pursuant_to tbe ;�t � o ect.r'u�t!a mntracto s fice�. ._____ , . �j/� Parkin9 .�. r ._ �� � . . _ ... ._ _'_. ' _ '. . -.� _ . . .P.._. __ �. -� . , . ! i -�� ' ❑ 1 am ezem t under Sec �,6.8P,C(or iFis 1 �� • � o . . reason ... ._._. __ . � . ,- . . � ,_ � . .. ._ _.. ' , . . . Date . . ._... _ ..--O ner . : � �� . . .. . . , � . � . . .. .. _ .. . __ �rADProvols' `� Dala -�-- InapitlorsSignofurQ � . . �.. .. . . ..., . . � - . � �� INSPECTOR'S NOTES�� � � � � Location= , . � i ,..-..;. ,. . ... . . . .. . .. . �� (Setbatk 8 Yards) - . . . - (/ , -�� , . . . .. � , .. ,.-� , . 2� - _ - ,.. . Foondaiions � ' �" ' � � , ._."_..._. _ ._. .. . ..._ . . . . Slob� � �� . ... . . ... �. Frame . �r vl� r"'�._-/� . . . . ..- . . . . . . . . . . . . . . � . , ., ., Energylnwlation ��� ._.��, � ��-�-: .�. _ _ ....�_.' . _. ' ._ _.... .. .�. .. : . , .. , . . . . �. Lmh/Drywall- �y�� -���. -. .�..-__.-.._ . .--- - . . . __.. __. __- . ' . . .. , . . . -INerior - - HD _... --� - . - , "- � - � . ,.�.c�.. . , Laih-Exterior , � . . � . .. . . _.. -. . ' . . ' ... � ' . , . ' � . . C:, c- ':� ,.�^-, c�t�. :-. •�, NouseNumber- �� �' . • '.-�.' . . ' . �• .-. ' �, . � . � _ _. .._ .._,••_.. . _. . ' =._.'.,:. �.�� .�..! '. .� :.... . !i....� Correci&Pos�ed � � - � � \;� i�,� � � � � �- final- .. _ .._ . .. _ ,._... ... . .. _ __ ._ _- . . _ . __ __ _ _ -__._._. ..__ __. ... Enter on From - �'�:`1 �.t�-Cr� . . .. . . � � . . .. . . .. . . ., - - . .. . , .�. • � �. . . . ... .. �. . ., . . . .. .. .. .. . ., .. . . '.. � � �, . ....,. �� •' - � ',! �:.� . � - i �