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HomeMy WebLinkAbout1566A 1567A i _ �_..__ _ . _..; : . . _ .. __. :,._ _ .; __ . __ ._.. ` WORKERS'COMPEN$ATION DECIARATION . .-. �' �: . . . . . ., : . . . . . . . . . .. ._ ._ _ . ' _. I hereby affirm.lhat I have a certificate o,mnsenf to se�f � � qpp��CATION FOR�-�BU.IL�DING PERMIT �� �� ��� . insure,or a certificale of Workers'Compensarion Insuronce, or a certified copx�rhereof(Sec.3800,Lab.-G� ' ' �-�-�-" � - � . � ' - � -- -� - --: WCP6"195241 ' Great American Plan 2AR GOUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. - Company - BU4�ING Q. Cenrfied topy is hereby fumished. FOR APPLICANT TO FILL IN nooaess o���oZ C�' � �� ,�Certified copy is filed withlha county bullding inspec• ' - ewtDiNG � " , � `tiondeportment'� � � .400ae5s 20827 East Boulder Lane i Do�e 12-22-86 Applicon� The'Wm.,Lyon CO... CITY Wa lnut Z�v 91789 ��iRv ' �� �CER7IFICATE OF EXEMPTION FROM WORKER$' "� -"��-' ' - " ' NO OF BtDGS: --���- � NEAREST.-. . � � SIZEOFLOT 3�800 SF �Min.NOWONLOT � CRO555T. �� � � ' COMPENSATION-INSURANCE� �� �� ' (This seclion need not be mmpleied if�he permif is for one - "� TRACT 43760 gt�CK QO$0� lOT NO. $2 � MAP BOOK�� �� �: : PAGE PARCEL hundred dollars(E100)or less.) . �. ' owNeR TFIE WILLIAM LYON C0. No833-3600 us�zoNe No? 02 .�'�3 > I.cerfify thof in the�performance of the work for which this � ' � ��� � a permit's issued.I shall nol employ ony person in any manner � � --� SPECIAL . , so as ro become iu6ject to the Workers'Compensatron taws. � Aooeess 19 Cor Oiate Plaza �oi s r ei c� G a O U P NS � �V CONDI710 ❑rr Newport Beach, CA Z�P 92660 � Date' .. . i.,� Appli�anf` . . . ' .. __ .. . ._ ._ . . _ . . _. - ._ . . . �O A R C H I T E G T OR TEI. NP E __.. �F I R E- .. P R S S E D B Y . .�� � �b TICE TO APPLICANT: If,'ofter making lhis Certificote of }la les-Lan ston 5 4 7-0 8 6 2 - ENGMEER g NO. / �mptian, you should become sub�ect to fhe Workers' -- ' � CO�ST ,ZC�E • . .,N ,mpensation provisions of�he lo6or Code,you must forth• nooRe55 777 S. Piain St.� StE. 10$ Oran �3 -�-- `� wilh comply wilh.suCh�provisions or this permif shall be - ��- TEL STATISTIGiICLHS5IFICATION APT. CO . z deemed revoked. . . � �.-,• , . • �� � - mNrRaCfOR Same As Owner No. � ._c..� � LICENSED CONTRACTORS OECLARATION .�� � - � - - �-��� - � � - � --�-� -�-� UC:- �- � --- - CLASS NO. �� OWELL,UNITS=Y_ . I hereby offirm thaf I am licensed under provisions of Chapter 9 ADDRESS NO. ��R�P , , (commencing with Section 7000�of Division 3 af the Business ond . . . . . . . . . . .... . . .. . ...LIC. �- '.. . . ' . . . Professions Code,and my license Is in full force nnd effetf. GITv CLA55 - BK- - ��: --. �- � � � �"-�-�" -YALIDATION - � � , , � . .Z�GHOl � . , . � B-I 54.FT. NO.OF NO.OF _ . CHEIX � � ' . � � '� �"' � . License Number Lic.Class � ' SiZ STORIES FAMILIES ONE ,-. . � : �' . The wm..L on Co. 12-22-86 _ _ r,ew vawnn�(o/N __ . _ _ _ , Y � �� DESCR�P(iONOFWORK-'" 7 O O Contractor pote App S . . � . �I am exemp�underSec. Sin le famil .home-constructio , � " -�""- -" - '"�" '�, � . ,. . .,.., . . .. _ AITER � :� . � .. ::. . � -� . B.BP.C.for this reoson ' ..... � REPAIR .� ..-f..... _. .. ...:..... . .. - ..�. -- .. .-- ._.. -. _ . .__ _ .. ._ oa�e: use or oennoi .-. _ �1.5 Q b_A-__ EXISTING BLW. . , - ._Signoture � ... . ... . _. ..._ � . -.. . nPruCANT , , TEL FINAI �/ � . vRinrr The William L on Co.No. 833-3600 k• • • •21 OWNER-BU1lDER DECLARATION .. .. .. _ . ... ._ . -.DATE � 'I ��S .... . .. _ ___.._ .__ ._..___...., -�I hereby affirm Ihat I am exempf from the Coniracror i License .. , . .�. ' � •2(i�,��J � Law tor ihe(ollowing reasan(Section 7031.5, Business and ADbRESS FINAt-` Professions Code):. ._ _ . .- -. ...'.--.. . ...". ... . � . � �Y ' � -,' • • (4 7.�J czi �. . . BUIt�ING - : 2. .. '. . wa es s thert so e com eosahon,w�'I do the woik ond CONTao.CTOR NO. . .. ._.. ..' . .'� r.� � -�,��j�,� . P P Y. Y P Y _ .� ^�6 � tbe stroaure is nor imended or o((ered for sale(Sect on tODUTY � - -� -70d4,Business and Professfons Code. � - --" MOviNc ��� - ---�TEI.- - � 'J(�,7(� .�-' � I,as owner of ihe propertY,am exclusively contmcting ... _ - � ' .�.`�•: . .' �.... . � .-.� _ . - with licensed comroctoro�ta construU the'project(Ser � " � - ��- " �� ��� lion 7044,Business and Professions Code. REOUIRED. i07AL SETBnCK ' ' f` � � -��� - " CONSTRURION LENDING AGENCY ASeT BncK YARD HWY' pROP.uNE wIDTH' - � � � �� _ , I 426 I here6y affirm ihot there is a mnsfruction lending ogency for FRONi � ' '- �'�� Q z(x = -�he performance oF the work forwhich this permit is issoed �-� -v.�. - _.._.. . _ .. : _.. _ _ _ . �`_...:_.�' ...-_- •.• �Q�... . �Sec.3097,c��.c.�. . P�oe _ . ..._. ..� ��-- 1 2 3 i�—8 6 .._ ' / � LendersNam Continental I-llinois Bank � � �r � � • i . _ .. . ._ I✓•S LDMARe{.B � ..'_ ' .._ ._ � LendersAddress 9'i1 Sn_ �I.a Salla Si_�� CSiCago P-C.PeeS ve.m'�Fee ' . ...I certify thaf I.have read this applitation and state thot fhe .. . - lavonce Fee -IV•J� G � ��hV+PiC N �.JJ o2-- '- - ' -�- - - � _ _ ' � obov ' ' n(s agree b tomply with all Counry Invesr�gar�on Fea �' . .�� ' � � ' inances and e_laws re ing to building conslruction, .__. . . - Toml Fee - . � � d he y aN p ives of this County ta enfer � •Q d� ��OMA Verm.N�� �- - --�- - �� - �-�� ' � rize re f85 � � on f e b e- tioned r r y for InspeUion purposes. ,1�4.C-�� f-4 e^l1R � �' . . _ . .'_ _. _ . ..... .. ... ..._. .... _. T /VJ C(�lJv .. _ .. .. _ ...__._ . . . ... .. _.. ..' _ L'�„ SEE REVERSE FOR EX►LANATORY IANGUAGE .� _._ S�gnatureofA IimmarAgem ... . ___ Doie. ..:.. . . . ._ .. ... _ . ._ ..... _".._'_ ' �. _.. . .... ... _ , . _ ..__... . . ._. . _ :� 1 i ! VlANS TO APPUCANT INSPECTOR'S NOTES �,. OWNF:R•FIUI4DER DECLAAATION � ( I hereby offirm�hat I om-ezempt irom�ihe�Contmctor's� .To: . RNum�d ' '��- � . � . �� ' License Law�for the following reason:,(Sec.�703I.5) - " � `" ' � � � - "�Approved ' ' �Qusiness nnd ProJessions Code:Any ci/y or rounty mGicb � No. Date �� No. ��� Dale��'� �-�- � � • - - � � •� � � , �requires a/�ernrif M ranslruct,aJter,improve,demolisb, , . . , . ._. orrepairanystraclurc,priortoitsissaancc,alsoreguirc's � �' . ; �` — - _ . � _ � .�j 1Ge apflicnat/or such fcrmil to file a si,qned statement „ . tLat bc is(itensed pursuant to 1G¢provisions of tLe Con- . �:i;:�„i ' .f i�:. .. ..i S`:.. . � � � traceor's Lraense Lau�(CGapler 9J(con�mencing u�itb Sec- '. ' � � � - �, -"�� , tion 700DJ of Oie isinn 3 of!be Dusiness and Professions '�' ' ` � � �� + �� '"''� ` ��-' " CnJeJ orTGat 1 c is exempt 11 erefrom onJ tbdba3is fnr�Lc . . •. . �. , � , : . ' ', . _ _ .. ._._.. _._._ . ._ ____ ._ .._. . _ _ __ __._____... _.. . _ . . .._. - a!legeJ exemffioa.Any vrolation of Section 7031.5 bY � � .-� .' Rrqutred.._.` DateRaeoivad ..-�--� - - � -. -' �"-.�'." -' � ` ... ..". ... _ onYapplicuntforopernritsubjeatitbeappliconttoockd! ;__ .,--� ... , . �, Appiorols YQs No or Approvad .;` � /�enafey o/not more tLran Jrue bundred doflars(SS00J.J:� ..,. .: :� . .. �� .. . - - �"- --""- � �-�"-� --"�� - "� -� -" -� - ❑ I,as owner of the propeny,�or my employees with Wa�er Certificote �,�_ :�.�-� ' ' ��� ...'. . . . ��..�_ . . .. �._.. __ ._ . ... . .: wages as their sole compensation,will do the work,ond .. ��----��-�- -�� -- �� - ��•-�- - � -�� Ihe struclure is not intended or offered for sale(Sec.7044) �� Health.�epariment_.... ...___.__ ._ . ...:...!_.. _._..__... ...-._. .--. .- . . - � .�. .... _--_ . .. .Buaineis and Pmfessions Cnder Tbe;Contiatlori License � - . __ , , . ,. .. . I.au��docs not apply to aa owncr ojproperiy u�bo builJs . :., �. •� ..:�,� � �� ��.. Fire DePonment ._..._. ._._ _.__._ . .- .-- -- _ .- . .- . .. . -- --- -.:..;- ..-'... or i>npmnes t!ercon,and u�bo does suoG work GiniselJor _.�:�;� ;�, � , _ � � � �lGrouqG�bes ou�n cmfloyees, proviJed lfiat autb im.�_ . �� Grading • _ �- � � . . pronenicnti are not in�endeJ or J/ered for safc. � " . -_ . ' . _ . . `�([ . . . . �Gou�e<•er,tl e building or inoproeement is sold u�itGin r,. , , , , . ... .�.i .,.� . �. ' - � -`--- :- .. ---- �- -� � � � ''�ycar�nf rompfe�ion. !be owner.bui(dcr aif!Gavc�tfie Geologiml �.. . . � .. . . .. . . . . � , � � barJen of proving tGat be diJ not build or improve fnr , .. ..__.. .__ �:. . - ---..._. __.. . .. . ._. ..��.:. Pedestrian ProteUion.�.-. . . . ... !!c purpose of taleJ. � .. � . . .. . (Fence)(CanoPY) .. ,. � � �. �� ��.;�� �. -�� -- _ . . _... _-� ._ ._._. __.. __..____.. ._- _ .._ . . ,.. ❑ I,osowneroflheproperty,amendusivelyconlrac- � , �inq wifh licensed controUo'rs to construct Ihe'projea(Sec ' ' ' �� �' � "� -� � —�----�--- --- ----- -- ---- � - � � 7044),Dwinest ond Pr�fessions'Codc:Tbc Coatrnrtor's , Special-Inspeclion�� � � �- - - � • - � . (Conc.)(MasonrY)(Welding) '� . . . . � . - _.._�. _.��....i.. _. ...,.. _ � .. ��:•.�r...'.-1_. l.imnie Lau•Jnes nnt a/.ply to hn ou�ncr nfAro/irr{y u�Lo - �-6uifJs or iroJ�rot�es�lbrrrnn,-and u�l o tonfracls'/or surb � Lof�rainage � �. 11. ._ ••; � . .. , ';_�... ... ... --. -.- -----r - .�- - C �r actnr's Licensc l.au'1•�l - . Our u .. __ _ ctr'uti�l a conerooeo s litensed s ant to tLe y�..__'� �'� - nnfr � ♦ �` Parking . . . . . _,. . � � .. ._. _ ... - � � ,.. . _ _ . ...__. . "_ '__. . .__ "_.'_._ _. �.. ' : i., ❑ I om exempt under 5ea _ ,B.BP.C.forihii . � �, reason . � r _ . . _.'_'____ ._. . . .. . __.._ .... . - � � Dme Owner , .i '• � . ..' . _� .. �� . : � ..__ .._..' _ "._ _ . _ . APProrals � , �ate � Inspador's Signafure . . �� - � INSPECTOR'S NOTES : Locofion— . .� .. (Setbock 8 Yords) � � � - � - � - � � Foundations' �� ,: 1 A� ` .•: _ ._ ._ � ,. . .. �. ' .. � . .. . . . b., ��.: . . ... � .�. . .. . Sfa6 � ` . . . . . . . . ,-�`� __. .. . .._. . . , .. ✓. .___. _ _�. -..._.._.._ _ _.__.... -_ _- .. .. . ,. ,,.,., '�. i Frame b ,�^� �^`f1. . . .. ... . � .. ... .. .... � . �.�� . . . . . . .. . � . , G - ' '' . _ .. _ ___.: � '. ..._ _ ._.� . ._ � . . . . . . , _. .. _� .. Energy Insulalion � � — , . . - ._ , . . , , , . ,. , , n Lath/Drywoll— . ._. . ._._ .-. ___ . _.__.,_ ...__.. _ . . . .._ " � . �Inlerior i... . i .___ _.._. .__._ .. . . . Lath—Ee�erior . _ . ' � . ' . _ . .� .. . � � _ . � . . __ _. . .. . .. . ��.'. c. . , „ .�- �. „ ,.. .. House Nomber— .,. . � ..._ . , •_•___ ... �•.-..� ,�.� � - . __... r., , •,�.. . .�.:_. ..i 1..�. :� .. ._.. . . ._. ... ,. Correct 8 Posted � '"' � i''�\ � . ..... . , ,.. . � . . Final— '_. .. .._ _ .. �_ .. _...- � _ _ ._ ._.... . ___.. ._ _. . . _. , .� . .. . .., . Enter on Fronl ' � C' �\`- . '. �� _ .. ...� _"p . .. . '__.. � .. -' � ' � '. ... . . . - .. . . .. f 'S"� .i��..t � . •.�i