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HomeMy WebLinkAbout1572A 1573A (9) __. __ _ __.__.., _. .. _ _ __ _. __.._ . .._. . _ ._ . __ __ . .. _.. ---- insure,oi a cerfiiimte oT Work TION D �'.:'. '...�� ' ' . . •`..c , . . . . .�' WORKERS'COMPENS ECLARATION �� � ' - � 1 hereb aff rm thai I hove o P � � YW�Pb�Y55241 � •Great Amero setf APPLICATION FOR �BUILDING PERMIT- �, certificate oi tonsent ers'Com ensauon Insurance, �'_ or a cenified m thereof Sec.3800,Lob.C) ` ` � -- � - ���� � ��� . . .. .. " _.._., .. ican Plan 2S GOUNTY OP LOS ANGELES ' ' BUIIDING AND SAFETY PolicyNo. � -Company � BWLDING C � � O Cerrified copy is hereby fumished. FOR APPLICANT TO FILL IN nooaess o�s'� C , !'A Certified copy�is filed'wiib the county b'uild�ng inspec- ' �-" gWI�iNG � ��� tiondeporlment.' ' A�DRE55 20839 East Boulder Lane D6te.. SZ-Z2-H6 qPPliwnr .. T$C Wf1l.,,Lyon Co..... ciT� Walnut . . . - -Z1P � 91789 ��,iirv . !�, . `�' RTIFICATE OF EXEMPTION FROM WORKERS ��� " "' � - NO.OF BLDGS. - �-- ' nIFAREST ce size oF ior 3,800 SF M in.Now oN ioT 0 ceoss sT.-- - -- -_.___ _ _.. _-. . _. _ _ _ ` �� � � �� COMPENSATION INSURANCE � � � (This setlion need not be compleied if the'permit iz for one - - rxacr �43760� stocK�2b800 LOT NO. � p'�ESSOR ,, ' -'' '� ...- hund�ed dollars(E100)or less.) . • • MAP BOOK'� � �AGE' PARCEI o,rMER T}IE WILLIAM LYON C0. No 833-3600 use zoNe r�w.P I cerlify that.in�fhe performonce of the wo k for,which this �� ' ` 3 � � 0. ' permi�is issued,I shall nm employ any peison m any manner , � � - ���- ---- SPECin�-.�- - ---- - - - - - - �- - - so os to become su6jecf to the Workers'Compensation laws. ADORE55 19-COT O PBCE�P Ld28--�-� --�� - - CONDITIONS � '4 ,, , . ,, , aTv Newport Beach, CA _z�a _ 92660 _ .._ _. _ ._ :a , <.., -- _ . _ _ . __ -. .._ . Date� � �. . .APPlicant � ARCHREC70R . 7EL ' � . .� � r'�OT�CE�TO APPLICANT: If, ofler making�lhis Certifitate of ENGMEER Hales-Langston ND S4]-OHG .-DISTRICT._. G U7 TYPE .: .. _. ..FI2E .. . PR SSEDBY.. � , mplion, you�should 6ecome�subject ro �he-Workers' 3 CONST.�-�f� ZO � µ � ampensa�ion provisions of�he labor Code;�you mus�fonh- qDDRE55 77� S. MBin St. Ste. 105 Ox'Hn �� - - ---�!� - M with comply.wi�h.such.provisions or this permit shall be - - 7Ei � deemed re�oted. , Same As Owner sTnnsncA�cusaFicnnoN APT. C oo. :Z � ' � `' '- ' ' COMRACTOR � NO. , �.�_ _. ,._,. _ � UCENSED CONTRACTORS DECLARATION�- - -- � � �� - �- -�-- - ��C. -- �--- CtA55 NO. �� DwEll.UNITS'_L_ �, I hereby affirm that 1 om licensed under provisians af Chopler 9 ADDRE55 NO. , (commenting with Section 7000)of Division 3 af the Business and ..__ ... .���, . _. .. � ��R�P ' � . __._ ., .__. .._ . _.. . . _.._.. . Professions Code,and my license is in full force and effect. CI7Y CtASS � -BK--� ��: � �- � �" " � �VALIDATION '-- � � ." . '�. Z�GBOS ..,',. � B-S.� ..._ 5�.Ff. NO.OF NO.OF CHECK � . ' �iCens@ Number - �� � - LiC.CIo55� � ' SIZ STORIES FAMIUES ONE � . � � � � . . - - -, _ VALUATION . ._... ... .. . The Wm. LyOR.CO SZ-ZZ-HG -- DESCRIPTIONOFWORK - NEW s y OOO contractor ' oare . ❑i am e.empi unde�Sec. -- Sin Le famil home constructio ADD -a , �'1 5 7.2 A - �;� . . . , . . ALTFR , - B.BP.C.for Ihis reoson _. .. � RE7AIR .❑ ..s �.- . .-. ...-.' ____. #� �.�-�G�._ . . .._ . .. . --- - Dale: -- �.. ... USE OF � DEMOL ❑ . _...._ E%ISTING BLDG. . .��. . .- �.�.'z(�'!.'�3..... -__..$ignatufe � .. . ... . ... . ........ ._._..�� � APPUCANT , TEL. . FIP1Al .�c=.' PRINT TF1Q William L on Co.No. 833-3600 �� .�7 ,_„e_•�47.2 . OWNER-BUILDER DECIARATION ___ _ ._. .. .._ __. .._. . . . ... . . .. _ - DATE'. .... .. ... _ . .. �I hereby affirm ihot I am ezempt from the Canhactor's License ' � Low for ihe following ieason�(Section 7031.5, Business and AooREu FINAI � � � ' I 2 J��-H 6 � ..Profeasions Code): ...._ .__ ._.... __._..._._-.. _. _ . eae N BY _- - � - : . .. ': � I, as owner of the property or my emplayees wilh . . . ADDRE55 � '� �` ���.< , �� 5 7�J A "�... ' __. . . _ ._..._..... ': . _ _ , . wa9es as their aole compansation,will do th6 work ond ip�q��tv ' •� i . #• • • •.�•�� � � - 1he slrotlure is not IManded or offered for sale(Setlion . '�� . '---�-�704a,�Business and Profassions Code).� --�---� �---� enOvwG �- ' - - -�-� � '� - TEL - �- - - - - - - - - � I,as owner of Ihe property,om exclosively conirocting CONiRnCTOR ' NO. . .'���, ��-� � -'� � 4 2��� '. ; , -wirb�licensed coNroaors ro construct�tMe projeet j5ec- '- . _. .... .. __ ... . . _�-.��. . :.'_ . ..__- .:-.. tion 7044,Business ond Professions Code). tooeess � � , �.. � • •4��.U�u; ', ..-_.. __. .. _REOUIRED ..70TAt SEiBAC � � ' �-�' . . . . .' ' YARD HWY. . ......_r'-.�^. �: r-.,.,,. . �SG . - CONSTRUCTION LENOING-AGENCY � SET BACK CROv.LtNE WiOTH' I Z.3�� I hereby affirm Ihm there Is a construction lending agency for FRONt � - � ' ��he performance ofihe work for which Ihis-permi��is Issued -. -.-- v.i... ... --... . - . .- ..- .. . -. . . . - -- -,.". --.- - � --�--- --...- (Sec.3097,Civ.C.J. Si�e � '� �. � �� • m .__._ _ _'___.._ . .. . .. _� ._,.. . __ . P.L. � �� _ . -. � .. . `, ..._.._ . _ � �ender'sName Continental Illinois Bank ' ^ � LDMA Ref.X � � � .. . -..-- ---. ... . .. -. . �.- P.GFeeE �� PermirFee � - . - . �.. .. . - Lender'sAddress 731 Cn. l,a Salla St.� ChiCB O /� � . � �� � _1 certify Ihat I have read Ihis opplimtion and state.7hat the ... _. . ._ -_ ..-. - . ivuance Fee- , �SV �OMA PiC M ���� , ����� � � �-= ��-, a above Information is mrrect.I agrea to comply with all County Invesrigation Fee � _. �� ' g ,ordi d State s�e ' g lo building.consfruction, ___ .___ - Totol fee� . �IDMA Perm.-M � �- � -� � � u hereby aui 'e represent� es of this County to enter , � up n t bo �!P honed pro e t for inspection purposes. ,�,��'�� f- �� ' a _ - -- _ .... . . .. _ �3.—Od. _ .. --._ _ -. . _ _ _, 4 � � 2-��— SEE REVERSE FOR E%lLANATORV LANCUAGE � �- ' n �-�-�" S�gnaWreofAp icon orAgenl . ..- - Date � '-.. . . . - . - . . '. . , .. - . . �1 � _. . ,.. _. . .. .. _ .. _- PLANS TO APPLICANT � INSPECTOR'S NOTES . i, OWNIiH-E3UILDER D�CLARATION , I hereby aftirm thaf I am e.empt{rom the Contractor"s To: � - RNurnod� � � � ' lkense`Low for� the;following redson:''(Sec. 7031�.5) � ��` ' " � " ' Appioved ' �Uusiness and Profcitiont Codc:Any rrty orcounty wbicb , No. Dale 1 No. �-- Do�s"- .. � ��� �. . ..� . . . . � � . �� ,reqaircr,a pervrrit to roxstruct,altcr,improvc,�deroolisb. � _ , . , _.._orrepairanystructure,friortnitsisruance,olsorequires - ' - , . . . � tGr applicane for sucG permrl!o fife a signed atntement ,. tGa��ic is/rrcnseJpurruant 10 1Ge prox�ixions nf lGc Con- , ��i;�;,'� � � tractor's I,icense Lau�(CGapeei 9J(ronrmexciag u•it!Sec- . . �=\.. . ' - �.. ._'� ...,' "'� __ __._ �.. ..�_ �....:��. . Uuiiness nnd Prn/essions r,�„7000/�o,�.;r��n 3 J+u� - I . . �, ��� . � �� �-'� CodeJ nr'tl�ae J�e i�cxempt 1Gerefrom and tb�e batis for tbe .,. .. . '__ . . - ..___ ...__ ._._ . . . . ,. __. � . . . . i -- -�.'-- • _-:__.'�'Raqu�red`:' .�..Dnfa Recelvad �.. ..-.. - .- '�'. . �--�� � � �- -... . - . . .-.. ars(y�lirantfnra�rnria rubjar7s i!eapp!cant�o a ci�il Approvab Yai -No or Approv�d . , . . �:fenally of nnl more.tban Jive J rsndred Jo!(ars(ES001.J:� - '�� -�- ., ���� � - � � �� � - �- - ❑ I,as owner of fhe property,or my employees wifh Water Certilica�e ... .-. �- �-' .�•• � �. .: � .. . .� .... __ ... . -� . ._ -. ..'.'_ ._'.-__. . .wages as lheir sole compensation,will do Ihe work,and ' '� �-� � - ���---� - ' -�'" - ---- �--- � � the structure is not intended or ofFered for sale(Sec.7044) . � Heahh Deportment._. _ .... .__._. .. .�_..,���1 _. . _� ------. - .. _� . .. =- ....�-��-� --.. . . �Uusinest and Professrons Code:TGe Contrartor's License ' , , , l,au�does na1 afpl y to on owrser of property wbo builJs . � . . i.- ,..�. Fire Deporlment . ._._. .___. _ ..... . ._____ " .. -_ .. .. . __ .. ..�_ . ��.�_ __ _ _ .._or imfrores tGcreon,and u�l o doctsutG u�ork Ginrseff ar :. ,-�. - . .. � � ' ..:.•_.�.'- .,�...:.."�.� ' � .. � .. � .. tbrougb7�u oum employces,,hrorided tGut sucb.im�,. - Groding � " '��-- ' - prrivemenit are�not inlended ar,of/ered fnr sale.� � . " " .ts..'. �:�! ' _ ;i' - . �i�,� , -� bou�eirr.tlebuJfJ;,rgo.improe���nenthsr,fJu�nLino.. ..�.. . . . . � .__. .-_-- . ... . , � . . ,. -: . . Geological - . � . � .,. . . ' �ycar nf�m rlelron, tl c��wner•bueldcr u•i!1 hauc�ibe � - � � � ��� �� �� burden oJrrnving fGnf Gc did not build or-improrc fnr i � Pedestrion Protec�ion .':-- . . � �-� � �. . ... . . _ . ' �. . ' 1Gc pu�ose of s�leJ.� .. ..,-. .. .-..1 . (Fence)�(CanoPY) - .. . . . : :... ..�� '� . .--- � . . ...-... ----.. . .- -.._ . .-. �, .. ❑� I,as owner o(the proper�y,om exclusiJely cONrac� . "� ting with licensed contraciors to consirud tha project(Sec. ;. ._, . Special Inspeclion� �- ' � ' -- �--� ��- ��- � � �� - - - - - � 7044),➢usinesr and�Professioes CoJe:Tbe Conlructor's (Conc)(MasonrY)(Welding) � . :: �.. .�.. .�. •... ___.:�.. _. .� ... .. •__.:_. ._ . . 1_;.�; ., ;. .�,. l.rcense 1 au�dors notarply to an oioneroJpmperry u�bn � ' -�-buiGls or imJ�roves�t!ereon;and u�GoYontrscls fnr sucl Lot Drainage � � , \�•�. � �� .� � _.. .._.__. . _ . . .. . . _.. . ...._ �rojrcts-u�ilb o mnlrador(rJ licenrrd purruant 1a the (�A . . ... .'• '... -- � ' . . � .� nnlractors .rcensel. -. . . . ... �� � .._ � �-.. . . - , .. �� Parking � . ._._... ..�. . .._. .. .. _ �._..__... . _ . _ _ ..I.! � auJ ..I � . ❑ I om ex �pt under Sec- B.BP.C.fo �ihii ,.. reoson . . . , _. . �-'-�---. _.__ . _... . __.. . _. --- --.. . , .. . Dole Owner � , ��.� ;..., �. . ���' � �.,r_ ;�� - , : ,! ��.i.l i i � �,�.. '� �� ___..._._ ._-�- . -' . - - - ... ... . . _ . _... . .. ... . � ._ • . .'-- _ .._. �.._-.__..... .i .., ... .Approval�� Date �-'�lnspetlor's Signaturo� . . � i . � - INSPECTOR'S NOTES � � locaiion— . . . . .. _ � _- -�ti.�.._. . .. . (Setback 8 Yards) - -.� .. . . .. . . � n _ _. t.. Foundations' :. �. . �� ..� , �. .. . . � ..� .. , , _.. _ .. __ ..._.. ._ ... .__..- . _ . Slab� �� �• '� I �.. :.�• � � . ,. _ -. ' .' . . . . ,�. . � � Frame � . . . . - .. ... �� . � � .. . . . _ . . . . � .. ,. Energy Insolalion � {� V'`�� � ..:._ . ___.1.�.L. . .. . ��. ._ .�.___ . �__ . �_ ._' ., . .� ,. ..� . , . . . . . i i � Lath/Drywoll- __ _ . ..._. ...._ . _. .. ..._. _... --�. - - . �� � . INerior . _ . .-_._ . . . .._ __ . , . • . . �. . . " la�h-Exterior ' . . ... . . . . � . - � _�r.;'. i '.._ � � . _ , _ .. � � . �� . .. ' �� .�\� �'��; � . �._. . . . �. . . _ .� � House Number- " '-" ' '' � - '�-" -' ' � , . �� , � -- ._ '_ _ ... . . ♦. �..._.. _ �. ��. ��� �, �, � �..n Correct&Posied `..' ",.. -.- • . �.�..-_-._.. . . . .... . . . . :� ,-:�. . ',� .-�.` . .-' .. .._ - , Final- � --- -- -- - __... ��.. _ �_ . . . . . . . . .. . , . Enter on Fronf . . - __i___..___ ___ .._ _ ...''.- �,... . . _ . . . , ,. . � - . . _ , : ., �.� ,y �:,� . _ _ __. ,! , �a , ". � ,;