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Home My WebLink About1592A 1593A (9)y TION DECLARATION here, affirm that I he -- - APPLICATION FOR .BUILDING -PERMIT ' WORKERS' COMPENSATION ve o�cerlificate of consent to self insure, or a cerliiicdte of Workers' Compensation Insurance, - or a certifiedco thereof (Sec.' 3800, Lab. C.) WCPCM5241 Great American Plan 2BR COUNTY OF LOS ANGELES BUILDING AND SAFETY Pa. icy No. % Company O�^ Certified copy is hereby furnished. Certified copy is filed with the county building inspec- 'lion department. T ` 12=22-86 Thel.Wm. Lyon Co. Date Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' ' I COMPENSATION INSURANCE-: (This section need not be'completed if the permit is for one - hundred dollars ($100) or less.), , I certify Thai in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. Dale Applicant OTICE TO APPLICANT: If; after making this Certificate of ^mption, you should become subject to The Workers' - - ,npensation provisions of the Labor Code, you must forth. with comply with suchprovisionsor this permit shall be -.. deemed revoked. LICENSED CONTRACTORS DECLARATION - ' � - - I hereby affirm that I am licensed under provisions of Chopter9 (commencing with Section 7000) of Division 3 of the Business and _.. Professions Code, and my license is in'full force and effect. 276801 B-1,` license Number - Lic. Class The'Wm. Lyon -Co. . 12-22-86 Contractor Date I am exempt under Sec. - - B.BP.C. for This reason - - Dale: - . _ Signature _.. _ _... .. .. ... OWNER -BUILDER DECLARATION I hereby affirm That 1 am exempt from the Contractor's License Low for the followings reason (Section 7031.5, Business and -Professions Code): _. ... I, as owner of the property, or my employees with _ wages as their sole compensation, will do the work and The structure is not intended or offered for sale (Section -- -- - 7044, Business and Professions Code).- ' - -- - - -` ® I, as owner of the property, am exclusively contracting - - with licensed contractor To construct the project (Sec- tion 7044, Business and Professions Code). - -' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued - -- (Sec. 3097, Civ. C.). Na Lender's me Continental Illinois Bank 8 Lender's Address 231 -So. i— So.l.a_ Salle St., Chi a. I.certify that I have read this application and state that the _ above information Is correct. I agree to comply with all County g oops'd- �d S lawsr Iing to building construction, nd eby aui Drize repres Lives of this County To enter FOR APPLICANT TO FILL IN BUILDING Q C ADDRESS COO D L • , BUILDING ADDRESS 20807 East Can on Rid a Road - Walnut 91789 CITY ZIP LOCALITY - - -- -NO OF BLDGS. - - SIZEOFLOT 3,800 -SF Min. NOW ON LOT O NEAREST - CROSS ST. TRACT 43760 BLOCK LOT NO. ASSESSOR MAP BOOK PAGE ' PARCEL OWNER -THE WILLIAM LYON- CO. No833-3600 usE ZONE - AN d r '.. ADDRESS19 Corporate Plaza- '- '- - - - SPECIAL.. ..._. ... _.. CONDITIONS _. ... Newport Beach, CA 92660 --- - -- - CITY ZIP ARCHITECT OR TEL. Hales 547-0862 DISTRICT G OUV TYPE FIRE .. PR CESSED BY - ENGINEER -Langston NO. - . _ CONST. -- Z/O�N , ADDREss777 S. Main St. Ste. 105 Orange -� 7�. Same AS Owner TEL' STATISTICAL CLASSIFICATION APT. CO NO. CONTRACTOR NO. --LTC. CLASS NO. Dd. DWEIL: UNITS ADDRESS NO. SEWER MAP - - .. LIC. - CITY CLASS BK. - PG. --- --- " VALIDATION SQ. FT. NO. OF OF CHECK _ _NO. SIZ STORIES FAMILIES ONE VALUATION _... _ .. _. DESCRIPTION OF WORK.._ _ _ __.....,... . NEW .. ®S ADR- Single familyhome construction REPAIR . ❑ DFMOL ❑ $ •- l 59-.2A USE OF EXISTING BLDG. FINE A"77W, •y T .. DAT7 / - - - - - - -- - It .• • 2 1 1 •247,2:3 APPLICANT TEL. PRINT The William L On CQ •NQ. B 3- 00 ADDRESS FINAL, L by - PRESENT BUILDING ADDRESS - - I 2.31 —86 ,• 1 9, 3 A. LOCALITY MOVING ._ . __ - - ... _ _- - TEL... CONTRACTOR NO. .. - _ .-.. _-.. .. _ ... ;. ,_ r'.i"' Jr -V-426,00 n e (j '2 f• 0 U 2 1231 s 6 - ADDRESS REQUIRED YARD -HWY TOTAL SETBA K _ .. SET BACK PROP. LINE WIDTH FRONT SIDE P. L. LDMA Ref. M ... _ " PC Fees J Perron Fee Issuance Fee /d•✓ CJ - LDMA P/CM �/ •/� --- -- Investigation Fee Total Fee - -LDMA Perm. M /3 - - - '- - po the ov entioned ro erty for inspection purposes. )c �C`�� fd�vS•Q� _ _ _' - a SEE REVERSE FOR EXPLANATORY LANGUAGE ^ I - Signature of A�Iicont or Agent PLANS TO APPLICANT INSPECTOR'S NOTES OWNI'.R•BUILDER,DECLARATION .. _ I hereby affirm that I am exempt from the Contractor's 10: Returned - ,. - license Low for the ,following reason. '(Sec,`7031.5) - - Approved Business and Professions Code: Any city or county wbicb No. Dote ' No. Date requires a permit to construct, alter,' improve, demolish, - or repairany slraclure. prior to its issuance, also requires -'II... -. , .. the applicant for such permit to file a signed statement lbat he is licensed pursuant to the provisions of,the Con- .t tractor' License Law (Chapter 9)(commencing with Sen tion 7000) of Division 3 of the Business and Professions . Code)or ?bat be is exempt therefrom and tbebasisfnr the alleged —plion. ny violation 31.5 by _-'Required ' - -Dote Received ---- ---�- --- - -- any appfitaniJorap�rnrit subjects the app/�ant�oacivil Approvals --Yed No or Approved < \ - penalty of not more lban five hundred dollars ($500J,J: . - - -- - - - - - - ❑ I, as owner of the property, ar my employees with Water Certifica_ to ' -� - ._, wages as their sole compensation, will do the work, and _ -- - _ - _ _ the structure is not intended or offered far sole (Sec. 7044) Health Department __. _ _ - _. - - _.: - _ - - - - ... _ -.. .. _..._ _. ._ Business and Professions Code: The Contractor's License ::: .: � ; •-.. ;. -, - - '. Lau, does not apply to an owner of property who builds Fire Department - _ . -..._. - - - - - - - - -- -- or improves tberean, and who does such work bimse%or through his own employees, provided that such -in,- - Grading - - -. provenrents are not intended or offered for sale.. I- however, the building or improvement is sold within c. Geological --, - - _ •--�-, , •.-- year of completion, the owner-builder will have the burden of proving that be did not build or improve for Pedestrian Protection -" - � ' �' - - '� - the Purpose sale). - - ='• p p /.. (Fence) (Canopy) •, .• - - ---- - - - - - - ---- -- - - - - .. _ ❑ 1, osownerof the property, am exclusivelycontroc- ting with licensed contractors to construct the project (Sec. Special Inspection' "- - - - - � - �-� - - -- - - ��- � � -;-��1--�- ---�- --�, - - -- --"-� - "` 7044 Business and Pro ), fessions.Code:.Tbe Conlrartor's (Conc.) (Masonry) (Welding) - - - - ._ -- _. -- -- -- --- License Lou, does not apply to an owner ofproperty who -------- - - _ builds or improves thereon, and who contracts for such Lot Drainage I'-tel \ i�._ -. .._ projects wilb a conlract r(s) licensed pursuant to the Contractor's License Law). -" -- - - --- - . - -' Parking __.._. ❑ 1 am exempt under Sec. , B.&P.C. for this - reason- Date _.Owner..__ - Approvals " Date Inspector's Signature -INSPECTOR'S NOTES Location— ' (Setback 8 Yards) Foundations - Slab Frame Energy Insulation - -_ .. - . _' ___.._.._;_. __' .• - .. , . - . Lath/Drywll— a - Interior t Lath—Exterior House Number— Correct 8 Posted- - r Final-- Enter on Front .. -.. ..