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HomeMy WebLinkAbout1590A 1591A ._ _.. _ _ . . _ _ _ _._... ____ _ . ... ._- -._ _ _ __ � WORKERS'COMPENSATION DECLARATION � - ' -" � ' '�- ' " � , , , . .�, . _ . ._. . . . 1 hereby affirm Ihot I have o certificare of�o�se�,.,o=e�F . �� �--�� APPLICATION FOR--BUIL�DING �PERMIT �� -��. insure,or o tertificate of Workeri Compensation Insurance, � or o cer�ified copy thereof(Sec.3900,Lab.C.) � �� � - � - � �� - - -- ----� Pot�cyNo CP6255241�amPo'�y Great American . Plan 1CR GOUNTY OF LOS ANGELES BUIIDING ANd SAFETY • Q Certified copy is hereby furnished. FOR APPLICANT TO FILL IN qpp�u a D r�0� �. '' i , �� Cerfified copy is filed with the counly building�inspeo- �'� BUR�ING , • �lion deparfinenf.' P.�DRESS � Dare 12-22-86.Applicam � TYie Wm. Lvon Co... .-� arr Walnut zie 91789 �pp,��n � . 1 ; -. . _ .. . ._ .._ . .. , NO.OF BlDGS. .. . ..- .. NEARE57_"' . �CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF lOT 00 Mi � � COMPENSATtON INSURANCE � .NOw ON iOr O CROSS ST. ' � (This section need nm be completed iF the�permit is for one � - - ASSESSOR ... r�" - - ' � - � hundred dallars(5100)or less.� , . TRA�T B�aK LOT NO. Mp,P gpq( ' PAGE PARCEL . TE�' USE ZONE NOP QpC✓a� } 1 cenify ihat in 1he performonce of�he work for which'this OwNER THE WILLIAM LYON C0. No.833-3600 . , permit is issued,I shall nm employ any person in any monner �ECIAL �- - - - - - - - � ao as to become subject to the Workers'Compensolion Low1. � ADDRESS " ' CONDITIONS � .. ;V , _ . , • . , an Newport Beach, �A ziP 92660 : � _ _ _ .. !m � �a(e� � ' Applicant ARCHREQ OR 7EL. � � �Q , �OTICE�TO�APPLIG4NT: If,�aTler malting IhiS CBrtifitole Of ENGMEER Hales�Lan SCOil NO. S�LJ�OBGZ �DISTRICT GROUP TYPE FIRE _ PROCE$SEDBY � / '-mption, you should become aubjed to Ihe Workeri --� ' GONS / �, ZO . w . ,mpensotion provisions of the lobor Code,you muil forth- qppRE55 � - � � �' wilh mmply wi�h such pravisians or fhis,permit shall be - - ,. � deemedre�oked.. .� , . � . ,. CONTRAttOR Same EiS �WROr �E�' STATISTICALCLP.SS�FICATION APT. CON . � 2 �� . , .' ' NO. �,e..� ' _ ' ' LICENSED CONTRACTORS OECIARATION �� ��. - - � � -- � - -- - � - --� - � IIC. � - C�aSS NO. -�� �OwEu.UNITS_L ' I hereby affirm lhat I um licensed under provisions oi Chop�er 9 ADDRE55 n10. , _ � ;' (commencing with Sectian 7000)of Division 3 of the Bosiness and .,_ . . . .._. - - ���, . . . . ��R�P ' � � Professions Code;and my license is�in full torce ond effect. ciN QASS - BK- - �;�- � VqUUATION - ' ' � SO.FT. NO.OF NO.OF CHECK . � ' li[enseNum6er 2�6801 �li[.Class B-1�� SIZ � $TORIES FAMILIES ONE � � . . � � . � , . � � �- • � VAIUATION . , _ - . . . _ .. ` 'TtIE�WIII. Ly011-�.'ri0. 1�L��L2.�H6 �" -- - DESCRIPTIONOFWORK NEW Contrattor Date -. . .. ADO s , � �I am exampl under Sec. . . . . . . - - . � , � z 1 5 9.�A, � AL7ER B.Bp.C.for this reason .. REPAIR � -"s- � . � - � ' �- - �i• • • •2�� - , ' - " � D010:' - USE OF DEMOL E%IS7ING 6LOG. - I •2 2 5.P,i ...-...Signalure �' '�---. .' - �- ' '- � APPLICANT TEL. ' FINAL ��y ' . `. OWNER-BUIIDER DECLARATION . . _PR�� '� N��__ �DATE� o�( • � �-�- --• •�2��S.K�� c=i � .I hereby affirm that I om exempt from ihe Contmctor's License � Law far ihe following reason(Settlon 7031.5,Business and ADDRE55 FiNn� � � '� ' _ I 23 1��=�8 6 . � '�1P-r-oltessioni Code): .. ..,..'.'- , .-". . _ ..,.. . . ... - R SY ._ _.... _ , - . _... /^�,� I, os owner af ihe properly, or my employees wifh AODRESS , _. ._ _ , � �.,. F.� F 9'.�,� __ ( � wagei as their sole compensation,will Ho tha work�and � ����TY ' `'`' � � , ��� � � � � � , the structore is not intended ar offered far sale(Section . ' ' -----7044,Business and Professlons Code). -� -' �� MOVING � - -���- � - - - TEL - � - - � - - �- - - - ' -- � � I,as Owner of tha property,om exclusive�y coniracting CONiRACTOR NO. � � . '��. ,��� : �' � •3 Cj Q Q Q �'' ,. : �, ..:� . „ � •' - -with licensed comracfors to canstrucrthe ro'ect Seo- � � - � -� � �- � - �""' " • � ��' � �� tion 7044,Business and Profession:Code)P � ( ADDRE55 _ , • •jO��Q� �,, REQUIRED TOTA[SEiBA N ... _ ..__ . - . ��- �'�- - ��-CONSTRUCTION IENDING AGENCY� -� � -� - �- SET BACK YARD' HWY pROP.LME W�DiH � � I hereby affirm thai there is a construction lending agency for FRONT ' � 2 J.��,H 6 . -Ihe performante of Ihe work(or whith ihis permi�is issued - -v.l.- � � ��--� � - � - - - - - - - � -�- � � (Sec 3097,Civ.C.J. SIDE _ '.-S'-,.•,(�,,= � . �� �- . _ . _ .. P.L _ __. '.__" . ,. .' '. __' "_ . ' � _..Lender'sName n,.�...,,...«.,1 Tii;..,.:.. u...,t. . � __ _ _. . . ._. . - . _ .. _. . -.__.. P.C.Fee S. _ Permir Fee IDMA Ref.N " _." , _ . lendar'sAddress-��+ �- �- �-+�- ^- ^'-`c8�0 /O•�D � ' � � �' _I certify thm I have read this opplicalion and stale ihat Iha _ _ � Issuonce Fee LDMA P/C M -- - �--- � - < obpve-infesaant�on is r agrea to comply wifh all County Invesiigoiian Fee � g _,rdinances ond te.laws rela' g to building conslruction, _ _ _ _ Toral Fee �LDMA Germ:N� -- � - ��- � - �- and h by ou onze represe 'ves of this Counry to enter � po Ihe v - ntioned op �y for inspetlion purposes. � � 1 �m _ _ . ._ . ..__ _ . _ _. . _..__ . _ . . . . . ...... . , _.. . . .... .. . . .... o � �` Z�2 SEE REVERSE FOR EXPLANATORY LANGUAGE � , � —". .. Signalure of A�{plicon�or Agen� ' --' � Dafe . . _. - . -!. . - � .'. .Q� 1 � -- _- - • - - PLANS TO APPUCANT INSPECTOR'S NOTES � O�VNER•IIUILDER DECLARAT[ON I hereby affirm ihol I om exempt�from the Contractor's To: t , R�turn�d , . - � . � ' . '� ' - License,�Law for���the'followin9 reason-'(Sek`703I.5) � 'Approred " DusinessandProfessionsCode:AnycityorcoNntywbich No. Dote " No: -����ero � � ' � � �� -•� �� � -requhet u Qern�it to consOract,alaer,improve,denralisb, , , _ '.:�orrepairarsystructutr,Qriortoits�i.siuunce,alsoreguires , .� , . ., .,., � , . , [be�plr�ant for such nernrit to file a signed rinten�cnt lGat be ir licertsed purivant to 16eQmvrsions of tl�c Con- �� � . , . � ' tractar's License Lam(CGapter 9I(rommencinq witb Sec- � ...-:. '�.'. •. .�� . :.�. ��:�..-..��. ... :'.��.'�. -.._ tion7000JojDit�isrnn3ojtbeUusinessandProfessions i - �,,-. • � . �� � . . .... � �.� ' r,,,' � . .:. CodeJnr tGat bc rs�exem/�t fGerefrom and lbe baiis/or JGe .. . _- _-__ ' -__ - . ._� __.._ _. - - - .- . . - . �afleged exerrrption.Any violation of Section 7031.5 by ' � ���� Raqalred.. . __• Daee Raeoiv�d � - . - . ' . �� ... . � '�, '-._. � anyaQQlicarslforapernrrtsubjectslbeapplicanl7oarivr! '�, � Approvolt- � � or Approved � p¢nalty of no!mnrc lhan f:'ve bunJrrd dolJars(SSOOJ.J:i � � �. Y�f Mo ' . .. . � _ �. . � _ � ., . _ -� - ❑ I,as owner of Ihe property,'or my employees-�Jlth . Water Certificote .-,C, � ' ' _. ._. _ _ . _ . ... . � . woges as their sole compensalion,will do ihe work,ond — -_ . _ __.._.---- tha strucNre is not intended or of(ered for sale(Sec;704a) . ., , F�eolthDepor�menf_ .___.._ -- . . - - - _ _._ _.. � - - - - -� - �� � --- -�- � -�•�� �- _, ButinesranJPrfetsionsCode:TGeContratmr'sLic'ense ' � � . ., I.au�dacr no!n/i/�ly to art ou�ner of property wbo buildi � Fire Deparlment . _._ .._ - _ _ _ . ._ _ , � � � � �� , or iar/rroves tficreon,and a•Go does satb mork Ginrse f or � - � tbrougG bis n¢�n emf/nyecs, provideJ,tGat-tutL im- � � Groding . ', � - �� ' j�mrenicnls pre not inlended ar oj/ered Jor sale.- �- . - , - � S� � �� Gou�encr,!be buifJixg orimprovemen!irsold a�ilGin n, Geological �' � � � . ��,pe�r of comrletion, t/c ou�nenbuildcr u�ilf Gouc !Le ' - � � � � - � . burden o/pmcing 7bat Gc did mt build or rnrprnne fnr � I . ' _ .... . _ . ... _ .._ . Pedestrion Protection � � � -� . tbe purpose a/auleJ. . . _. ' '� (Fence)(Canopy) � � - �--- � - - �-�-- �- �� -- - � � - _,. ❑ I,osowner'oflheproperly,omexdusivelycontrac- ling with licensed coniroctors to construct the project(Sea ' . .... . - . . .. . _ _ __ ..,i..___ __._. __ .__. _. -:� 704d)Uusiness and Profrssinns�Coile:Tbe Contractor's Specia�Inspeclion- � � � � � � (Cont.J(Mosonry)�Welding) '- � �� � � � _ : . �..� LicenseLatt�daesaolaf�/+TytoorsomnerofJ�ro/+er{yu�bn � � -�-� " �� -'�� - - "' -•``� ` - -��buifds-ar inipmvrs tbercon,and uJ�o tontratu jor tutb � Lot Drainage ' ^ �• � . .._ � _ - J�rojerls u•itL a rontroctor/tJ litrntrd punuurse to [be r � ', i' _. . . . _. . __-- - . ... . ... _ - --�- -- ' � �'',.�' � ' Contracenri Licensc LauJ. - � � � •_. .. .... Parking � . .._-. "- -.,... ._... . _..... .. _ . . . . . .... ; .. .• :� �. � � • ❑ I am exempt under Sec. ,6.8P.C.lor this , - . � ' reoson � _ � --�. . .. - . - .. ' . : . . . ... .. .. ._ .._. . .. ....... _... . ..._ ' ' Date Owner ,. . � . -,_ -�� _ . � . ' .. ..--_ .._ ' - -'--- - -' � .Approvols Dale �-Inspector's Slgnmun ' . . � - � . � �'� INSPECTOR'S NOTES ����- ' Location— . � � (Setbock&Yards) � - �� � � � - . � �� � ���- Foundofions . . . ' .. ' � , . • , -. ... . , s�ab �3c� � _- -- - . Frame �• 2 m � . . . . .. . . . . . . , -, . , . - . � . . �, . . ., �.., Energy Insulalion �� " . .. . ... _� _.. _ . _ _ . -,. . . � <..� , .�. .., . �. , . La�h/Drywall— . - -- �-- - -- - -�, - - -.� __._. -- ` . Intarior �`�" . .. .... . � � . , La�h—Exlerior , . . .. . . -��. .'! ' -� .. .�. - . . - � � .-�� .�'_ House Number— . __, .. ��. . ... ._. _ .-.�, ..._. . _ . . . , . . Corred 8 Posted � - - . � ���-� � . .• -. . .• • � " � ^ .. �. � ... , ,. Finol— _ _ � _. _. ._ ___. .. ___ . . .. .. __. _ '__. _ . . � Enfer on Fronf - .�.-+, � � � � . . .. �. � `