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HomeMy WebLinkAbout1594A 1595A (9) WORKERS'COMPENSATIONDEC . . _._. . , .....`. .._...., _ ..... .. . . "' . .'_...__. .. .. ._.___ . ... ._ '. __'. _ .. .._. .. �� " IARATION . . . •' . �. -_, . �� . �� 1 he�eby affirm ihat I have a cerlificate.of�o�=e�„o se�t �- � -� ��APPLICATI4N FOR �BU.ILDING �PERMIT��� ---�, insure,-or a certificate of Workers'Compensorion Insurance, _ , . . ._ . . . _.. __ _ ...... or a cenH�ed copy�hereo �Sec.3800,ta .c.)- ' COUNTY OF LOS ANGELES BUILDING AND SAFETY WCP6255241 "' Great American Plan 3AR PoticyNo. � � Company . ... - , � Lertiiied copy�s here6y,furnished. FOR APPUCANT TO FILI IN eu�to�NG ADDRESS � Certified copy is tiled.with�he'munty building inspec- ��- -� BUILDING . � 'tion tlepar�ment. ' - ' ' A�DRE55 z0 I 1 oate 12-22-86 APPIicaM ..,TI72;WIII. Lyon Co. arv Walnut Z1P 91789 �ocnurv � '�CERTIFICATE OF ExEMPTION FROM WORKERS' � � � -� -��-NO.OF BLDGS. �- -- rrEnREST � - -�--.•� � • SRE OF l0T 3�8�0 SF Min.NOW ON LOT � � CRO55 ST. ' ���� •COMPENSATION INSURANCE��� ' � ' (This section need not be compteted if Ihe'permit is for one -- - - � � -- - �-�-- � /+SSESSOR_ � � - � , � �� ' hundred dollars(5100J or less.),, , .. TRACT BLOCK LOT NO. � /.Wp gpq( - PAGE PARCEL � ' TEL. USE 20NE PN+P Lwrtify Ihat in Ihe performante of�the work for which lhis OWNER�TtIE WILLIAhI LYON C0.-No833-3600 � : ��� - . } permit is issued,I shall not employ any person in any manner � �----� SVEGnL --- -�. � - - -- �- � � �- so as to becoma subject�o the Workers'Compensati on LawS. ADDRESSS9 COT' OL8Cf''P18Z8 - -" " ' -' - CONDRIONS .. v an Newport Beach, CA _zir _ 92660 � - - - ee Date �� APPlicant � . : �.. . . .- ARCHITEQ OR TEL .. 'O TICE TO'APPLICANT: If, afler makingYhis Certifimte of ilales-Lan StOn 547-0862 DISTHICT. G OUP 7yPE .FIRE _ PR SSEDBY.... � ENGMEER g NO. ��ONST 20 E lmp�ion,��you should become�subject �o�Ihe Workers' �" � W ,,mpensolion provisions of ihe Labor Code,yoV musf fOAh- ADDRESS�I77 S. Main St. StO. 105 OCBn e v\ - � � �- �"' wilh comply pr ' this permif shall be ���� w'th suth ovismns or - �N deemed ravoked.�, � , ' � . � . S8[IlE !�5 QWIIE'T TE�' STATISTICAI CLASSIFICATIpN � APT. CAN �Z � �� , � � � COMRACTOR NO. . - . � . _._ ._ ._ ._. . . . LICENSED CONTRACTORS DECLARATION .., .-�•� � - - - -� - - -� - -- ��C. - - � �-- C1A55 NO. ' DVJELL.UNiTS 1 here6y of(irm thal I am licensed under provisions of Chapter 9 ADDRE55 NO. (mmmencing wilh Settion 7000)of Division 3 of Ihe Business and _. . . . .. .���, . ��R�� �" � �'' Professions Code,and my license�is in full force and effed. CITY � CLASS " BK--'"" � ""-� "� " VALIOATION �� , � '; , � S(].FT. NO.OF . NO.OF CHECK _ ' Li[enseN�mber 2�68�1 � - Lic.C�assB-1� �� SIZ � STORIES FAMILIES ONE � � � � The Wm. L on Co. 1Z-Z.Z-86 ---- - - NEw VAWATION _ . .. . y � " DESCRIGT�ON OF WORK - �O O O Cantra[tor Oate ADD � s �� _ __ �. . - . ❑i am e.empt underSec. - � Sin le familv-home construetion- � ,' � . .... AUER , -� •:' B.BP.C.4or ihis reasan � .__ REPAIR-� ' S -.. .. . . ... . ' �'- -'- -����J 9.��F� ' - � � - - ��Dale: " USEOF DEMOL � exisriN�eioc. -- - - i.-• • • •21 - -- _ -"� SignOtUlB � - ' APPUCANT TEL. FINAL -7y�f'� . FRINT �'7 pG-1 ...�'.�.27�1�]a.... OWNER-BUIIDER DECIARATION _.. - ___ _w. .. . . NO. _.-. . .� OATE �� . � . . - . - . -I hereby affirm thot I am exempt from the Commctor's License ADDRESS FlNAL�� - - � z ; Low far the failowing reason(Section 7031.5.8usiness and •2 7�.���' 'Professions Code): . ... ... ... .. .... __. . - . .- . R � -. Sy . . . � - -. � BUitoING ' . I 2.J� -Pi C) I, as owner af the propeny, or my employees with AD�RESS � , _ _ wages as their sole tompensmion,will do�he work and � i�i�rv . , � ' �.:+ ' . � �� rJ 9.�A � � � Ihe srrut�vre is not inlended or offered for sole(Sec�ion � 7044,Buslness and Professions Code). � -- -"� ' mOviNG �- �-- '�' � � �7EL. �- � - - - �- --- ' '- - �-- - � I,as owner of the properly,am ezclusively cont�aciing cOraienQOR No. ..�,. .. -.�� `,�, .....��_ $� • s • o • �. ,. - with licensed cantrocton to construct the pro�ett(Sec- � qDDRESS ' � ��•4 7 5 5 0 tion 7044,Business and Professions Code). � . � ..__.. _ _._ .REQUIRE� .TOiAL5E7BACK I ... _' _ _. . . . CONSTRUCTION LENDING AGENCY ""-' SET gq�K YARD HWY VROP.�WE WIDTH - _ . •��Li%�S„O z I hereby atiirm that there is a constroction Iending agency for FRONT " '�'t ' '�•%"�� ' � .� � -the performance of ihe work for which�his permit is issued � � � P.�. - � � - - - � -- - �� ^ �` � � �^^ ��7 —86": (Sec.3097,Civ.C.). SIDE � � } J t'�,�'� , � w _ __" P.L. _ . _' . _ '_. . . . .. _ . _ . � tender'sName Continental Illinois Bank /y $ _ . .. _ .. . ._ . .. -_ . . . _ . P.C.Fee S� �/ . Permn Fee - . LDM4 Ref.M _ _ _ . ` ._ _ = Lender'sAddress 791 Sn_ l,a SallA St_r Chi�ggo �7 � - � �'� � I carfify that-1 have read this applicafion and sfata ihat the . --. _ _. -.. . . ---. � iss�wnce Fee� -�Q�SQ � IDMA P/C M ��aC , - � �- Q obove i ation Is coRe ree fo mmply wifh all County Investigmion Fee . . � inances an te ws relat g to building construttion, _ - - Torol Fee - - � u a d her auihor representat� es of ihis Coomy to enter �� � � � - • ��rna.Pe.m.M - � - - -�� ---�- �---- -�- � a on t a o� -m ioned pro rt for Inspection purposes. �'��"'/T�•, �-q�s� � I '� 'a _. ._ _.. . c�U _ . . .. ... __ ._..___ __' . ' _. _ Q _ .. . . . ^ .- SEE REVERSE FpR E%PLANIITORY IANGUAGE ' - � SignatureofApp'mn orA9m� - . -.. Date . _ . _ . . . ... _. . . ' . - _ , . . _ -..' '-. . O'� � PLANS TO APPIICANT INSPECTOR'S NOTES 01VNIiR•EIUILDER.�ECLARATION I hereby affirm tKai I om exemp�fromlhe Contratlor's To: - Returnad , " � . � � ) � ' �� . License�L6w`for'the,following reason.; (Sec. 7031.5� -'- � ' ' "" � ' � ApProvod '� DretinessandProfessionsCode:Anycityoroountywbicb No. Data �� No. � ' Dato����-'- �� �-�- � � -�� "• -� � - � ,;�requires p pern�it!o onrtsfrucl,alteq in+prove,demolisb, , . __.orre/�airanyttructurr,/+rlortoiRtruuance,altoreguires �_��•. ,����, , , .' � .. ' tl e ap/�litanl for sucG f+crnrit lo frle a aigned stutement � , .,tfial be ia liressed furtuant to tbeQronisions of t!e Con- � � � I�- i �. - I I",'�� trartor'sl,iceriseLam/Cbnpler9J/tomm¢ncingu�ilbSec= � - - - - " tinn 7000J aJ Uinision 3 of tGe�usincra and Profesnion.r , _... _ . . . . '.. . . .. � ` �':i11 ' .�. ��I ' ,.• . . , - • �, �" " CndeJnrtGat/ciscxempetlrref.on,andelebaihfortbe - � '.- � �_ _ � - . . . . ._ ._. . . _ .. .. _ ._ .._ _ ._ . �_ . .. . '- ---�- ---__.< ,___ . ._ .. _�.� . . , aflrged esemptinn,Any ninlation of Section 7031.5 by i ' . `�..�:. . Raqufrad,'. _ . . � � ._.. ._ ' - -� ..'��. . "� - � . . ._� � _. . anvapflicanlfnrapermitsubjeatsU�capJ�ficantfoacitdl ---�- �Date RaceWad ' Approvalf Yes No or Approv�d. � . i... . , t .• /�enolty oJnnt more lfian fine LundmJdallarr(SSOOJ.): - - �" - -' -��� '- -- ' ' -- - -- - ❑ I,as owner of Ihe property,or my employees with Water Certifico�e ' . ;� � .., . . . . . '..---'.___-'_ _. _. __.- -. .-_. ..__. .. wages om�pen �� � as Iheir sole c sa�ion,will do ihe work,and --- -- �- -- --' �� ---�- ' .,,ihe structore�is nol�inten ed or offered for sale(Set.7044) .. . - Healih Depariment_ . ,. ._._ _'_�_ _��-�. ' ._ . .. .%. � ------- --�-.- �-- - �- �� - -� - Dusinest anJ Pmfessrons Code:Tbe Contraclor's License � . I.ma docs no!apply to art o¢�ner of pro/�crty u�Go burkti . . . . ., . , ' .. , �.��.!_. .. . .: .. .� . .;�; � Fire Deportment .._. _ ... . . __. .._. � - -� -- - - �� ,- _ nr improrrs tberran,anJ ud�o docs sucL u�ork bimtclf or , � ,._��; � � . i �, , tbrougb bu�oum enrpJoyces,provided lbat sud� im; •� Grading � "' � ' prorev�rnts are�not inlendeJ or ofJered fnr sale.� � , . ,,.� • ����; . bou�ener,�Ge buifding nr imJ�rooement is m!d wiebrrt o., '� � ..: -.'. ,..-. �-- .. . . ��... . .. � :'.: .�, ear n/r mpleL n l/e ownerburfder w(!have Ge .. Geo�og cal�.�� �� . , , _ . . , . � ,.., •Y o 'o . � i t • � � -�� � burden oJ/irnt�ing tbat Le did not build or int/nore fnr , ._._.___. _ . . ._. . __..___ - . Pedeslrion Pro�eciion �,- - � . -���- - IGc/iur/�ose of sulef.J� � . . (Fence)�(ConoPY) .... . , � . . : . . ---.--.--. -'�. .. _ _. ... _.__ _..___. ❑ I,as owner of Ihe property,am exdus�vely toni�aN , ting with licensed comroc�ors to�constroct the�proje�t(Sec� � .,,...� . - . . _ ..__ . �.. ..- - -. . .- - -. _ . ._-- $pecial InspeUion -- _. . .. ' - - --�� . , . �. : ofess Cont ac � „ � 44) usrness an r 'nnt u e: r tnrs 70 i �e (Conc.)(MosonrY)IWelding) '.. � . . . � .. . ..-.�._. �. ! . ' .:._ , ..•:�:;_�, '� , .. l.icensc Lau•dors not apply to ars omrirr oJproperty u�Gn , -� � � ' -bui(ds-or imprones iGermn,ans u•Go conlracts Jnr suaG Lot Drainoge � ;•.�,•� f`� �,-•��-�. . . � . _ .. . pmjrtti u+itb a rontra�ior(sl'litensed pursuant 1n tl e ,., .. • . '_ . ____ . __._. . . ��`ppp ` . �i --� "- Contractor'sLrcenseLaaf.---� --- - �� -� . . � Porkin ' � �J - " • �'� . � ,__ . „-, -- - � � --. .� . . .. . � - re�n I am e:empt under Set. ,B,BP,C.�(or�l6is 9 _ . r . . . �. ... . _ : . � __. _._._.. _ _ .. ...._ ,.� , Date Owner . . ' � .. .. .._:. �. , . ,. . ... � . . ,�. , . ..�.._ . . . _._ - . .. _ .,_._. Approvols , Date �� Inspector'i Signa�urd- , ' . � _ �� INSPEC70R'S NOTES , � Location— , ' (Sefback&Yards)' -"��- � �- - .�� . ' . . . - . . i�'- Foundaiions �� � f� , ., .: ___.. -_. . ------ - - .. �_�_: � � � .:.� . � . . , ,.. 5�ab , -:. , y�` �� � ; � Frame � . I / � . .. . - . - . � . � . . , rr Energy Insulation �� /�a'� �JLl � . . . �•� .� � � . . . . . , . . , . , . . _ _ _� _ __ _ .__.. �....._ ,, .' 1J Lath/Drywail— � ', - . .-'------- ---- .._ _._._ _ . . _ . . Interior - -- -� - ----�� '-""'- , � � Lofh—Exlerior .. � .. � . . . . ' � . .. � � -_. . . . , ._ ., .. ... . � �`�%•C. Ho�se Number— ... ...• ,.. .r.....__ � . . . .. _. . � ,- . . , _.__... ._ ,� . .+ ..� ..__.. , . . , .. . , _._.. ...: � ,.. _ i. _ . : Co�rect 8 Posted , . .�� > .- � ._. ... .. ; ,, Finol— . _ .._.. ._ . .. .- -�- � --- �-- — - -'------- � . � . Enler on Front � . -- ��•,\ � � � . � . . . . . . , _ . ..- � . - .