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HomeMy WebLinkAbout1574A 1575A (9) � . , ... . � ___. .. .._ _. . ..._. _ _. . _ __ _ _ —..__ __ _. , ,.. . __ . ..__ , . . . . _.... WORKERS'COMPENSATION DECLARATION ' ��•�;��' .�� . � --- ��. , . . . . . � _._ . _,. _... " � . . ,�. .�. . ., . ,,:�.. i�he�eby ofiirm that�l hove a certifimte oF�o�5e��,o 5e,f � qpp��CATIQN��FOR�.BUIL�DING PERMIT -�� - ���: insure or o cer�ifim�e of Workers'Compensolion Insurosce. or a cerhfied��bPY�thereof(Sec.3800.lab.C.).', '�. - . .._..-.` . - ... . .. . - . "WCP6255241 Great American Plan 3C COUNTY OF LOS ANGBlES '. BUILDING AN�SAFETY . . ��:�,�;J PoiicyNo. . . . . Company .. . . .. - . � Certified copy is hereby fumished:..�• ' ., . FOR APPLICANT TO FILL IN BUILDING ,/ AD�RESS D�7I �� �' Cerlified topy ie filed with fhe couniy building inspec- -� � BUI�DMG . , , tion Ceporimeni. � � ADDRE55 20841 East Soulder Lane � Dafe• 1Z-ZZ-S6.Applicant� Tt10 Wm.�Lyon Co.� arr Walnut. . .�. . '21P 91789 ' i�i�n � , '" ���'CERTIFICATE OF EXEMPTION FROM WORKERS' -��� - �-- � �� � NO OF BtDGS. - ��--�---. N¢qR¢Si. ... .. .._.. ___.. . _ . . .,.__... �. . � � � ���- COMaENSATION�WSURANCE-��� � . size oF�or 3,S 00 SF M in.Now oN ior � ' CRO55 5T. (Thi:�section�rieed not be[ompleted if Ihe parmit is for�one �� ���-- -- � � �� � -- - --�' ASSESSOR . . �- - �� -��-�: ' hundred dolbr5($100)ar IeSs.� . . . TRACT /y BLOGK 2 Q LOt Np.� µqP 600K " DAGE PARCEt � THE-WILLIAM LYON-00. TE�833-3600 us�zoNe nwr I teriify thai in the performante ol fhe work far which lhis � �WNER No. No. D�—333 �� � - �!} permit is issued,I shall not employ ony person�in any manner -��-�� -- SPECIAL.--��-�-- --- - - � - �- � ��-�- - ��a SoaSlobecome�5ubjeCitOlheWorkeri Compensafionlaws. ADDRESSS9 COT orate P19Z8� - -� � - -- ��� �-- CpNDITIONS V ;... cirr Newpor[ Beach, CA zia 92660 � - - .. _ _ _ _ ._ ._ . Da(e .. ..., � .. 'APPlicant � ., . �. .. . ... . .. . _ . . . . ... . _. _ . .: , . �"�m ARCHITECR OR TEI. DISTRICT . GROUP TyPE FIRE PR ESSED BY_� � TICE�TO APPIICANT: If, ufler moking this Certilimfe of ENGiNEER Hales-I.angston No. 547-0862 ������ Z� �mplon, you should become subjec� to�tha-Workers' ---��- 2 . �mpensation provisions of the Lobor Code,�you mosr forth- qboaES5777 5. M3in St. Ste. 10S Oran 0 — :J - - I �a. wilh comply wilh such provisions or.ih s,pe mit sholl be -- -�� � ��� -- -��N deemedravoked. ; �. � -. � . - , :.,}. .� SaRle AS Owner �. TE� STATISTICALClA55IFlCATION � ' APi. C . ? .. .�•. .� .� CONTRALTOR NO. � .... __ _ _. . UCENSED WNIRACTORS DfCIARATI�N-�.• •.• __ .. ._. .. _._ _ .. .. . ._ ....LIC.... ...�-�---- . �u NO.-..�O DWELL UNI7S �I I hereby ol(irm lhat 1 am litensed under provisions of Cbapter9 ADDRE55 NO. � (commencing with$ection 70p0)of Division 3 of the Business and ... _-. _._... . . ____.___-__.-• � SEWER MaP . � . ��. . � �' _UG--....._ _ ... ProFessions Code,ond my license is in full force and effeU. Uri CIASS �� ' '�-" '�� "-����� - - '� --� "" VAIIDATION �--�� � .. ., . � , BK. PG. . . . ,.�., �,.� . . ,.. . ..'. 276BO1..,� . ., . .. $-1 , _ . SQ.FT. NO.OF... . . NO.OF . ... CHECK - . - ., LiCense N�m6er -Lic Ciass '� SIZ � STORIES FAM�UES ONE �'� � :' ' .':� : , ,... �. . ... Tt10�.�1T111...LyOil CO....�. �Z-ZZ-Sb '__." OESCRIPTIONOFWORK . .. _.._..._ _�.__. ._ .. NEW .� . .4 ... __ _ . .. .. _.._ . . .._. ALUATION Conlroctar Dale ❑ S S�Q� , ' � � � . . ... . . ADD -.� . �Iamexemptunder5ec. --- -- Sin le�famil �home� construction - - � - �� --�- .� . .... ,., . . ,,.: AUER � � . � .___...__._.. , 6.8P.C.for this reason .-_- � f -- . ..---� .-. . .. . .-L-� rj 7.Q Fl. . REFAiR , ._.. ..._._._. . _. .... _.. - Date: ..._.� �� USE OF DEMOL � . EXIS7ING BLDG. ... . ..-#�.�• • �.'�'� � - 5 gnature ... .. ..._. . . -. ._. .. . .- . ._ APPUCANT . TEL. F�HAI � � . `. OWNER•BVIL�ER DECL4RATION PRINT TFl2 W11118f0 I. OT� CO.NO. 533-3E7DO� DATE �] ��l�. �-� - - ---�- --�----���27�6 b�3 � � -�-1 hereby affirm ihat I om exempi from Ihe Contractor's lkense ��� � ��-���� �� � �� - � � - � � � �� � � �� � Law for Ihe fallo ng��reason(Settion 7031.5,Business and AODRE55 p�Np��'` "� ' ' � � ��2 7�6��_ `ProfessionsCode7 .--____. _. _.. . .. _. _.. . _......_ N By ._ , . . . . � -- BUILDING . . . - .. ' � n.'Y 1 _o L ; �, os owner oF/he property, o�my employees w8h AooRE55 c.� o� wages as the r dole campensotion,will do ihe work and � � - , , �� i LOCAUiv - � ' � �-^>� -- ihe svucture is not iNended or offered for sale�Section . . � � , - rJ 7.Jr A�� '- ---���7044,-Business ond Professions Code�.- - -��-�-�' '"-- MOVING ----` -�--�-� ��� -�- ��� TEt: -���-� � - � - � �� � � -- -- � I.as owner of the prope�ry,am exdusively contracting GONTRACTOR No. � .• _ � . . ,� .,... .. . ,'., �• • • • 1. .. - �with-licensed conrractors�o�constroct the project(Sec- --_ .. . . . --- - -._.. . . .. ._ .. . . . � .. _ . : .. � ... . ' _�. _- . .. tion 70d4,Business ond Professio�s Code). A���� ,_� _, - . �.: � I •�7�Jr Q .. _" ' _.__.. REOUIREO . TOTAl5ET8ACK . .. ._.._.. `~. .w ' ' �_� ��. ��CONSTRUCTION LENDING AGENCY� �- -� - � �Sei BnCK � YARO- -NWY pROP.(INE W�DTH {� •U 7�S O c=i � I hereby affirm tha�there is a construction lending agency for fRpNT '�"��r�-� S�-' 1,�- � � � ��the perfvrmance of Ihe work�for which Ihis permit is issued - - �v1:- -- ��--- - - ---- - -- �- -- -� � '-�� - - � �se�.sosi,c�.c.�. s�oe j � 1 23 S -R 6 $ ..... .. .... . .._..... _. .. .. . ." '_. .. _..._._ P.L '..� ._ �-,<. . '. ._ ... ._. .. .. . __ _ . ..._. Lender'sName Cnntinantal Tllinoic Rank . �.�-�' � i- . � g tDMA Re1.N �� � � _ . ._.. _ . ._. . . . .. . .. _ . . P.C:Fee S- ' Permit fee �. ~ ' -- ' -- - ... . - lender'sAddress 9"t1 Sn io C�77o-Cr f'FhiCdgO / �i ' � �. �, r . 1 cerhfy thot.l hove reod this applimtion and stofe fhat the . . _ . . _ _._ .._ iisuance Fee�- - � .� IOMA PiC M /�s`�_�C ' . '---- . _ _. ' orma i ' correct. e to tamply with oli County Invesi�goiicn Fae /y � ; � o inances and State�la relatin fo building Construtlion, . .__. -. .--. To�a1 Fee ��/ �- Q� tDMA�Perm.�M ��. -. . ..'. . .-:..':=�.�-.� ,. an here aui epresent f Ihis Coonry ro enter � . � i v �, up n Ih o -men oned pro erfy f r inspeclion purposes. _ ��� _ _ '_f..?SQ�-- ... '.. ......_. ._ . .,. __._. . ; , O!.. . .. . . __ ._. .....__.. . .. . . _._. .._.. .. .. . . .. . .. . 1'� - � SEEREVERSEFORF%►LANA70RYLANGUAGE ' ' ' � � ...__ Signa�ureofAppl antorAgenl . �...._. .Date .___._. ..__._ .. _'_... .._ _ _-- - .. _.....__ . ._.._ _.. . .. . _.." _. . . . . ..�. .. . �p� PLANS TO APPIICANT INSPECT00.'S NOTES 01YNF:R•OUILDEiR UCCLARATION , I�hereby affirm that I am exempt,irom Ihe Com�oaor's Toh , Raturnad�,•'-., �- � ' • � - �L(cense Law-toi the��.followinq reason��(Sec.���031.5) � " � � ' ' " - �Approvad '' Dusiness anJProfessioni Code.Any city orcounty wl ich No. Dote � No.� :`�.�Dafa :.'�.�':: '. .� � ....-� �,-. '.';. 1�:'' •.;' .:� .;;:reguires a pernait lo aonstruct,aller,imf�rovr,den�olisb, .or repairany structarr,prior to its issupnce,also rrguires - .�,,,. - � . .. :�,i : . � . � . . tGe applicant for,suol perneit to Jile.a srgned statement � , ..lhat he islrtcnsed pursaant to tbeproidsians af tGe Con= , ,��� - , � � traclor's License f.a�v(Cbaf�ter 9J(commencing mith Sec- . �, , ,.. ,�; � .:.�,� �. . --'"---�- � - "- � ' �"��� � �-"��" eion 7000/of Dieision 3 of tbe Dueiness and ProJessians ' .._:___: • 1 >.. �, '. .�.�.: .. ..... ::. .._______ _. .... .. �� ' • .�_ CodeJoriJalbe'ise.rempttGerefromandf5e'batisfortLc __. _.__ .. _ . . . _ :'' . . ._._ � � � - � a!leged exemption.Any violafion of Seclion�7031.5 by ' �'-.- ' ��. . .:.Raquirad��,, ._+DofaR�adv�d ---��- �-.. -. . --�'•."." .���.'. �- �- ^.-..---.�_.:_._. anyapplicantforapermi[subjectttl�eapplitanttonrie�i! , _ _A ._ . ..__... . . P��ova1s or Approved , .�-penally oJnnt more tban Jioe iiundred dolla>s f8500J.J: �'. �-� � Ye� -Mo ... . , ....: ._;� : _ :� �'. .��� . _._.__ -___. . . � . _ . . ,.,. .. - , . . -- ❑ I,as owner oi the praperly,or�my empfoyees with Woter CerYfica�e .-:.:,'�..,.. � . � �. .. .._ _.. _... ... _._ . �:. �._ . ....__�. _.. .. wages as their sole compenso�ion,will do Ihe work,ond . "--"�--- -"--- - --� -- " -�"�-"-" -" - " the strucfure is not intended or offered for sale(Sec;�7044) Health De artment . _ ___.._. ._ ''���-:�� .. ..,� �--��- ----- � ' - � -- - - - --- --_ - � Qusiness and Pr Jessions CoJe:�TGc Contrac(or's License . P . ..._. -.-.---._.. - � - � I,ou�dors not apply to an oa�ner o/property wbo builds �i. ,��. Fire Deportmenl___ . _- . _.. .___._ . ___.._ __.'� ' -.�------ :.� . _. �-.:.. - . .-.---- ..or imprnues ibereun,anJ�uGn dnesautb work bimself or =: . ' . ,:;�` . �.. . �': ,��� : ��..,,, -. .�.--:.,,�. ; �� .� . .'. fbroagb lis�ou•n e»rployces,provideJ 1bat�tuch�im�� � Groding ' � ' � �� ��-proorments.arr not inlen6ed or,ojJcred,for sule.� - .� , �(��; � �Lou�erer,tl.rc building or imJ+roe�ement issolJ�dtGin o. � Geologiml�._ , � �.. .:.i ��.. `..--�-� ,,-,�..�. �,- ....- :��....�. .� �'�. year oI rorx/dceion. 11e�oamer-builder.urfl�,bave.tle �' �� � • '� ��� �" '�" � ' � -__-�;; bi�rden nf f�rnring 16at hc diJ nat build nr imprm�eJnr , __. ._ _-.._..�:_�._ ._ .._.. Pedestrian Pwteuian �.�� � . . .. .... �.. . .. . � tLc parpose of salel.'.'. ....... .;. .,. (Fence)(ConoPY) � . � �.,�� '.� .. + ... . :. -. -.---�- �--.----. - - --.-.._. .. .-� � , �..��'I,as owner of Ihe property,am'exclusively conlrac- _ - iing wi7h licensed coNro<�ors to construc�the project(Sec. ' SPeciol lnspedion .' _::.i.'__.. _ _ .._:_ ,___ ____.. .__: ___ _.._.... .. __ ._ 7044).Duseneas arid Prafessions�Coilc;Tbe Corstructori . . . -.. ..;. ..';�.. . . .:... .. .. .-:. .... . !...-- -' . �.-. .,,: :: • .. .. oes nnt apply�o on ownrr ojrroperty u•hn �Conc}(Mosonry)(Welding) � � ����` builJscrinrpr�irrs��lberenn,�andu�Go"controctsforsuiG .�� ,• -"`j .. � ' /�r jects�wie!a mntrwomr{eJ licenseJ p rsaant fo !be Lot Drainage � ( �' . . ..___ ._. . ______ _...__ .. __._. . . _�. . , �.•� �...,. � .� .. � '. �Conerareor's I.irense-LuuJ.-- - .... � �.-.. .. . .. . . . . - • '_-i Parking . -� � _.._..._. .'_.__. __. __._ � .. _ .._ ._.__.___ . - .;..�,:,�.. ��:r.:��:� �, . ❑ I om ezempt under$ec. 8.8P.C.for fhis � ' . . . �, .. .. . . . .... . . .�, .t .., ,�:..' � � , � -,:. , �,,, . . ' - . .. _ ._.. .._ _ � reoson � . Date.. . ._ . _O_w e-..._... _ . .._ _ '._ .. _ _ . _ ..._ -�Approvals Dota Inipector's Signa}ure,� . � .. . ' � ' INSPEC?OR'S NOTES , � � Location- .... . .. .__....... .. - : (Seiback&Yards) : .. / .' . _. " .:.'.�:�. , . . . . . ., . . ,, .- ,�.t-. Foundations . /� � : . .-., . . '�...., . .., .. - . •,,. f. . l. . . . ..� .. ...... .. .�. .. . ' S�Gb� ,. -. r ,. . � q�„ ; -. _ . . . . . . . i-/. .. . ,:� . . ��.��. ... , .;': _ Frame . ' "U�� '� .. � � . � . . . .. ,..,.. -.:,. . . . , �, . . . . Energy Insulalion� ' �Pn �� �.. : � . . � .. . �� . � .. . . . . ... . :.� _.,.. .. ... _. ...,.._ .._.__. ._. _ : . , 2�( . _ . � .. � . lath/Drywail-. I __ _ .__-. _.-___._... _ � � ��:. .� I. ----- -_,----.__.._._. �- �Interior -_..__. .._..____. .. . ..: ; �. � _ . .�_,: ,�. lmh-Exterior . ...� .. . . .. . . . . .. . ._. . :�..'�:: _..':..:!1__ . . ' -.... .... ��., . . . � ^r-.. .�• � \- � ,__. ._ . _.. , �.. . .. .,� ..., . HouseNumber- ,. -_.r. ti_�.,_•.._..._.__. . ..�;.�, .-. ..., �_ . . . Carrect&Posted . - .. --_. .' .�_.-.- .. ._� I!.. .... ... .... . . ._ -i ,�" . C. '. �. .',� � . - . ffnal- ...._.. _".___. .._. . . �. .. . . ,.. __ . _ _ _ _ ._. ' _. ..___.... ENer on Front � ��� ..�.� .�.,.... .. . . -- � .. -..., ".t'^\,� . ... : . ... ..�. � � _. �.�..,.�. .. . . . . . .. ... .. � �. . . .. ..,. ,. .:,�;:..� . - � . .. ..� ._ . . . .. .. . . ... ...,. � . . . � _. .,. a , � c C,. ':.5- ' •\-. -.:l.�y� . .. .,.. � , . ,. . . . �� , . . ��.•. < i. r� k S � �_,/ .\ '� /'