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HomeMy WebLinkAbout1568A 1569A � �- , , ;. . ._.._ _ _ . � . . __ ... . ._.. _. __. :. _.----- - ___- . . WORKERS'COMPENSATION DECLARATION i . .�,„. � . ... .... . . . „ .._. . ---... , 1 hereby offrm.that I have a.tertfimte of�o�,e�,�o=e�f qpp��CqTION��FO�R�_BUILDING� PERMIT Insure,o a certificate of Workers'Compensalion Insuronce, or o cerhfied coe�y thereof�(Sec:3800,�lab.C:) . : ... . .. - . � . . . . ... . .. _.. ., ... ' WCPbZ55241 ° ''� Great American Plan 3BR COUNTY OF Lp5 ANGELES BUILDING AND SAFETY � Po❑I�icy�No. .. . . Company . � . . . - � - ` . . Cenified copy is hereby fornished. � FOR APPLICANT TO FILL IN BUILDING � . . - - A�REu a��3 �', � Certified[opy is filed with Ihe munly building�inspeo- BUIIDING ��lon depanment:'�� ' � � nooQEss 12-22-86 aa The Wm. L o Date n ucanr.. . y�ri Co• aTv Wa lnut � ziP 91789 . ��i,Tr - � : '� � -LERTIFICAiE OF EXEMPTION FROM WORKERS'�� - -�� - � NO.OF B�DGS.- - - � NFAREST ._... ..... ....__..._.. ._..,.._.. '� � - � 'COMPENSATION INSURANCE� , � SIZE OF LOT 3 800 SF Min.Now oN ior O '� CROSS ST. � _ . (This�seciion need not be completed if the permit Is for one --- - --� -- �-�� � - � � -------��� /�Es50R � - �� �• . . hundred dollors(§100)or less.) .. . TRACT BtOCK l0T NO. Mqp gOOK � " PAGE VAR�L owNeR THE WILLIAM LYON G0. No.833-3600 usE zoNe n+no � 9� I cerfify Ihat in the performance of the work for whlch�this NO. �� (/ � ' �--- �y permil:is issued,I sholl nat emplay any person in ony manner i �- -� � �- SPECIAL��- � ,-� --� � - �- so as to become 5ubject io ihe Workers'Compensotion Laws. � ADDRE55 19 COi Or8 CE�P 1828 -'" - -- " � ""� CONDITION$ �� u , , ,, . , , . .. cin Newport Beach, CA zia 92660 _ _ _ � oe Date ' � � � - Applicant .... . � .. ... . � ' ARCHrtECTOR � �� �' '��� TEL. � � O � �C7TICE TO APPLICANT: If,�ofler making this Certificate of ENGINEER Hales-Langston No. 547-086 DISTRICT G OUP. NPE _FIRE R ESSEDBY.. � ��nption-�you should become'subject to the Workers' �� 3 CONS� � ZO W mpensof on�pravisions of the Labor Code,yov must forth- qDDRE55�]'] $. Main St. Ste. ]OS Oi -� �- - --""�� - �-- - _ -�n' LICENSEDCONTRACTORs or;this•permit shall be � ---- '�� de medrrevokedh's�ch�provision , S8[II2 E�S Owner TEL. . S7ATISTICAL ClASSIFICATION ' A T. DO. y GOFITRACTOR NO. ^�-/ � S DECLARATION� � --. . ...__. ..___.._. . .._.__ .._ .. _ .UG .... _ _. . _ C1A55 NO.� �� DVJELL.11N1T5� I hereby offirm thor I am licensed under provisions of Chapter 9 ADDRE55 NO. � (commencing witb Secfion 7000)of Division 3 of the 6usiness ond „._. ��� � SEWER MAP ; �:-�� :. . �� ; . 1�. ... ... , ,.. --. ..__ ... . ___..._.... ... . __... ._. . . . fect. CITY ClASS . . _. . . ..... ".: -.. -._. . �VAUDATION--- ". Pro(essions Code,2�68�icense is in full force Bndlef 8K � � SO.FT. NO.OF NO.OF CNECK ' . ' Ucense Number Lic Class � SIZ STORIES � FAMILIES ONE . _ , . . . . �� TYIE'.,Wlfl..�LyOT1��CO ,.•..�'i Z-ZZ-S6 _' . DESCRIPTION OF WORK __.... _. ..._. ... _ NEW- VALUAT�ON. ... . _. . _. ._ '__. .... Conlraclor Dafe � s �5 OQO� , ` ADD . _ .._'_. _. ❑I am exempt under Sec. - Sin le fami L h m c n � 1 qiTtR ❑ „ _ , B.BP.C.for this reasOn . . REFAIR ❑ ._f. .._ __ _.__.� _. .: . .. . . _ .__ .__ . .. . �._ . . .. ._ _ ___.. . .. _Oate: --_ ...; USE OF DEMOL ' ' . .-"�_-� S�8 A EX�STING BLDG. - _."__Signature 9 ( _-._ ... _._.___ � ..�--- A oRE55Tt .._. _ NO. _ FINAI�. . �� ^ � -- .. ._��• • e .�� ; OWNER-BUIIDER DECIARATION � -OATE� I�i "/ -�-- � � --�- - �- ���-- �� -��hereby affirm thot 1 am exempt from Ihe CoNmttor's Litense BWLDiNG � B �.. .. �� I 2�.�b� . Law for the followin �reason Section 703I.5,Business and FINAL� � �� � 'Professions Code): � '..""-. . ...' '� "'"""� N � Y � �. • • (�(j� � '� I, as owner of the property, or my employees wilh aDDRE55 �� „ ; „ � �woges as lheir sole compensation,will do fhe work and �� � � � � �� ���, ' � 2 3� -�� � � � the slructure is not intended or oifered for sale(Se[lion �aA�iTY ' _ "-;� ' �- ' � — -�7044:8usiness and Professions Code).-..-_... ._.-._ ..� MOVING-. -. . .... .. .. . .- TEL. . � , . . . - . . ' �� -� � � �-�-5 f^9 A _.-'. � 1,as owner of the property,am ezdusively comrocling �aNiRACfOR NO. �� '• . �-- _ �,.� � �t . )-. , -�� .. - �. • • • ��, � -with licensed confmcrors lo construct the pro�ect(Sec- -.. ADOREu.. .-. . .. . .. . -.. . . . _ . . �. .. . � � _ � ..-- -. lion 7044,Business and Professions Code). � ---- -- j�,' � +-� _. ..._. ._. REWIRE� .. iOTAI SET&4 K . _ . . .` � �4.7 5 5 D. � CONSTRUCfION IENDING AGENCV� � � SEi BaCK �YARD� HWY- pROa.uNE �� WiDTH, � � � � - - � -'�� - . �� ��1 I hereby offirm Ihot ihere is o consiruUion landing ogency(or FROtdT ' - •[j 7�5�� -�the performance of-�he work for�which this permit la issued � -a.�.--- .-.._ _- . _ . - ... .' - .-. _._ .. . ___. . . .__.� - � ._- �.�' . -_. __. . _. (Sec.3097,Civ.C.). SIDE '� �2 3��-g'(�' � � .. w __ .. __. _..__._... .._..._. .. __... '__ __._. .... __. .. G.L. i ���• 1� . .. Lender'sName Co7ltinPiltal T11inOiS Rank �j � � . � $ .' '___ _ .. .. _ ._.._. .._. ._ _ .. P.C:Fee S- �/ . Pe.mir Fea- �: IDA+A Re(.M . . ' .. _ ... ' = Lender'sAddress 791 Sn- i.� $�l lo_ R�hjCB('O ' � � � � . I[erifncah�a�lb reaws r'elaf�iP''lo"build nWco'n5hu�clionY . . Invesi�goi�onFee .- ...- ...._. TotolFeeFec - /�-� LDMA Pe mxM��.,l.�v.- .. � . � � ' > , ' , 4 a ove inform tion is corc ree b wm I Ih oll Count ' � � ;$ o d her authon represent i s of th�s County lo enter � o n 1 e a o - tioned pro er (or inspeclion purposas. . .y�.��!'a�...___ . . .T�'�t�Qa . � . . � � . . . _. _-_._. _ a ��� SEE REVERSE FOR E7(PLANATORY LANGUAGE � ' - ' � ..': . : . _. . .'•._ ..:, _ ..... . .'Q•i SignalureofAp �conlorAgen� . . . .._�.... . . .. .. . ... . ... . ._ . .. . -. _ .. . . .- . . . .. - � PLANS TO APPUCANT INSPECTOR'S NOTES . 0�5'N8R-DUILDER DECLARATION � I hereby affirm thal I am exempt from Ihe CoNrattor's To: � � RHum�d . � � � � ' . � ; � license��Law'�for the'followng reaso ` (Sec.*7031.5) � � ' - � �� ' � � 'Approvod � � ° � '`��BurrnessandProJessioniCodciAnytiryorcounrywbicG No. Dota �� No. �'�Date"� � -� - .� - � �� � ' � requires aQennil to construrt,al0er,-in�prove,demolish, ; .. . .. , . . , . _ ...or repair rsny structure,prior to i!s issuante,ako requir¢s , � �:�n � � ' . . . . �� , !!e appliran!for surG permit lo file a sigxed statenoent ` " �� �' ,, lbat br it licenteJp��rtuant!o tGe j+roa•isinnt of Obe Con- � �,_� 1ratlor's License l.uu�(Cfia/�ter 9J(commencing witl Ser- -` -- , tion 7000J of Divisioa 3 oJ Ibe Business anJ Professioxt ' '" � - '�� �'' "� ' 'CoJeJ or•tGat b�is exrmf�t fberefrom and the basisfqr!)e �_. .____. _.. .._ ._ .. . ��.�" 1 :.-._ . . __. ��.�. __ _ ..__ _. . ___ .... __ .. � - . . . . . .. . . _Requtrad ._.Da�e RacaHed�� � -.. --. .�..-. �: .'.� ��' _ ''.� � . c S_ ._ . . . unrv ahPlrcon fnra per iitsubjects rhe aJ+(+fcant�o a ti�i! , _._ ._. _ _._._. .. � A rovals or A roved� - � .. � penalty nJ no1 mnrc�tban fioc bundred do!lara/5500).J:, PD_, : . -Yei No PP _'____f ...._�_.`_ . .' __�..j '. :.__... ..' �.�\. ��_-. ❑ I,as owner of the property,or�my employees wilh Woler Cerfifimte �-�' � �� ,`�. � � � � � ' �� '' � . �+oges as their sole compenso�ion,will do the work,and .� . -- ., , ._.._ __ _.._.. ._. . ...-... . ___._ _.�._. . _.... . ��, . . . --� ------�-�-�- -'--" --�� '- - �- ----� - " the strutlore is no1 intended or offe�ed for sole(Set.7044) HeaNhDeparlmeM_. _. . � �. � -�----� - . -�" '�� -'-'- � - �� . _ . Uusi essanJProeiionsCode:T Cantractor'sLicense _. _ .___: ._. ___ _. _ " I s Gc � . . .� Lnu,does no!afJ�ly to an oumer nf pro/icrty v.�bo build.c .,. ., .... . .. � Fire.Deparlmenl _.. .' - � --- --- -� - -��-- ---- -- -- or rmprores lhereon,and wJ�o doesssscL u•osk GimseJf or �� .-. ' .--.. . . . . ._ - ... � .� � :�. . .tl>raugl-his own emQfnyecs./�mvrded�lbat sarG irn- . .�- -.. , ...._ ,-. _ , , -.�,��._ i:�;'e.. :�:-..'_-..' - Grading.. � � - � , proremenit�.are not intended or_offered for sale.'— ' �� : '�:., ' -��' _ .'�.'.- �. ,. � _ - ... ��_ � � � '� . :, �, „ ,., � .. . Gomever,ibc build�eg orimprovcrnenJ is sold u•ili�in c " Geological �' - ..�_.... .'� -- ��� � �� .--� - :-�=-- .��:�i .•. � ,.� r ^� � ����1. �car nf tompfetiort, tbc ownervbuilder u�i!!bavc�tbe S • � � \ � � .. ��'���`�� '�� � � burden nf rmcing lGae 1 c did not builJ or rmpmne fnr PedesNionProteUion . ..._ .:�..,, .. `,,.. �... .'... . .`_ .__ _.. .._.._ _ __ - r .. � :. ... ,�..� _ tl e purpo e"of ialeJ. �Fence)��CanoPY) ; � .� - ....-. -...--.- �:-�'� �� ling❑with I ce sedreofnVac�tors lo��am exclusivelyconirbc- ' onstruct�he�projeci(Sec. Conc. ,Ma� ,. . . �.. .� .�. ..._ , ..�. '. ._ . . _. ._. _ Speciol Inspection�-� � �� � -� � � 7044)Uusirtess anJ Pmfess r Cor1c:�Tbe Contractor's ( )( sonrY)(Weldin9) � . - �- ..�: �� ._ , ..-. ' .-�:�- .. �.�._ .. ;�:.`::��:.. l.i�ense Laiodocs nnt applY en an ouroer ofpmpertY u�bn , - �"bailJs or imprones 1Lcrmn;�and uJ�b�contracts/or sucG � LotDroinage .� (`�( r� �c� •;�,' � �.. _-_ __..._.____-_ .._.__ ..._.. . .._. �mjects�utit�uconsactor(sJlr ..ed�purr_ . - ! � cens uant!o thc . . . ' - nntratlor's I.icense Lau�J.�-�- (�il Parking . �.... . . ._ . _�. �.___ _.___� ._ . �...�.. ... _.___-__P._._ ._. _.. ., , ..,:, , . .' . w " - � -❑ I om exem i under Sec. ,8.8P.C.for�fhis , . _ __...__... - - . ____ ..... __. . ... .. � � . , � reasan . . .. , . _.__ .__.__.__. . ..___..__ _.__ .._. � . , . .. ., " ' - . . Date Owner , • � . . . �..��. . _. _-.' _ _ .._ '_ _ _ . ,. . : =:� .�.,. . f:._;.. �. ,._ao . ; :.J I I.. . .: � , � . - . . ' Approrols � ' Date Insp6ctar's Signatoro � - , � , . .. . . . ... . ... . . . - � -� INSPECTOR'S NOTES � - Locotion- . - �.._.... �.... . . . ... ... . _. _.'____ _ _. , � . �Se�back 8 Yards) .��� .. . ... .' ...� . ' � '� Foundations� .. . /�. . � � �. �� �. � � .. � � . ..� .. . i Slab, �-� �i�E �� . __ ... . . ._... ....r _, �. ,. ... ., . . .. , -. Frame- , t - � � .. . . . . � . . _.. ' . . . . . , . , . . . . .. , . Energy Insulmion �'G-`T .� ,_._ ' . __ '. '_'.:. . .. .......�_ �. . . ' . . .. � _ . � ... . . . Lath/0 ywoll-. � ---- -.._ ._--... _.----. ..----. _ _._ _..� � . , , . � . . Inte ior �.�•:: � -. _._ ____ � � . .. . 7 _._. .'._. . . . Lath-Exterior . . . . . . ...... _..._. . __ .. . . .. .. .. � �� � . \\ .. . \' `.. ... -- . HouseNvmber- .. -...:.. ,�".:,:.�... _. _ _ ..,.. .�.,.,-.-. ..., .:. _.. � .��:'_:�. '' r 'i� _. ...... .... ... _ .. ,.. . ,._ . Correcf 8 Posted � � � � � � � � . � .. .•. ...- � � . . Final-- ..�._. . . . _. , -. .. . . .. _.__. _. . __._.____. . ..._---�-' � �.. . ;. � � , . . � _ _., .. .. �.:.. ._� �.- .. . . �. . , .._.. . . Enter on Fronf . . .._.. _.�. . \-�.�.,:. � � ;, . , ,�..�' - �'�, i .. ._. ---�:� . -� .., . .�... _ . � ' . . .`\ , , . .. . . . . . . _ . . - . s.; -�' " � . �. . .. . . � _. . . , ._ 7_ l�. _ .