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HomeMy WebLinkAbout1596A 1597A (9) Y ... ' ., .�_.__ .._. . _ _... _....._ _ . ........_ ... . . . _ ... . . .. .... _ .... _ ..._ _ _. WORKERS'COMPENSATION DECIARATION �-�: �"": .�. . � �� �. . . ' �.. ..� I:hereb uffirm Ihal.l have a certificole of�o�5e��,a,a�f --� ----- -APPLICATION �FOR .BUILDING� PERMIT�— ��,�� insure,or a certifica�e of Workers'Compensoiion Insurdnte, or a certiiied co �iheieoi(Sec:3800.Lab:C.) .� ' . ... . . _ . . ----._ .. . . `� ` WCP62�5241 Great American Plan 2CR COUNTY OF LOS ANGELES BUILDING�ANO SAPETY , POolftyNo. � Compony . .. C Certified copy is hereby furni:hed. FOR APPIICANT TO FILL IN ADDRIESS �OfS��S G r �'4 .Certified copy�is filed with tha couroy building inspeo -� - BULLDING � � �•� '�tion department.' - � ' A�DRE55 20815 East Can on Rid e Road Date 12-Z2-86 APPlitant TtlO� WID. LyOtt Co.� ci,.� Walnut .. . ...Z1P. . ..- 91789 , ��,iiTv — ' •' •�CERTIFICATE OF EXEMPTION FROM WORKERS'- - � �� - NO OF BlDGS.� - - - -- NEAREST .. _ _ . ..� _. . • _ _ .. _ .i � - � � COMPfNSATION INSURANCE � � � 92E OF l0T 3,800� SF Min.Now oN ioT � � CRO55 ST. ' (This section nead noi be completed if the permit is forone --- - � � n55E550R � , � � hundred dollars(E100)or less.) . . ;, TQACT 43760 6lOCK LOHOO LOT NO. 9� MqP BOOK PAGE PARCEL • - owNea TFiE WILLIAM LYON C0. No 833-3600 ' use zoNe �P a_3 } I certify thot in ihe performance of,lhe work(or which this . - � permit is issued,I shall not employ dny person in any manner _ - SPECIAI - , -- - - � ��-� - -�- a' so as to become su6ject to Ihe Warkers'CompensaHon laws. -' AODeESS 19 COi orate-P laza - conromoNs ,u , , aTv_ Newport Eeach, CA Z1P 92660 _ _ __ __ . � Dafe ' . ' .' APPlitant�� '.` . .. ��� � ��� ARCH17EQOR 7EL . . . .�O �TICE TO APPLICANL•�If,�afler�moking Ihis Certifimte of ENGINEER klales-Langston Na 547-086 .oisraicr GROUP iYPE. _ � FIRF PROCESSEDBY_� mption, you should become sub'ec� �o�the Workeri - ' - �J' CON5�7. / ZO � ..,mpensa�ion provisions of ihe Labor Code,�you must forlh- q00RE55��� S. Main $t.� Ste. 105, Oran pG_ �- .-. _,!!- _ :y with comply with such provisions or this permit shall be � - TEL STATISTICAI QASSIFICATION : APT. C DO. ? deemed ravoked. .� ... � ;� . , �� ���,� S8n1e AS Owner � CONlRACfOR NO. ' � _.. .. _ .._. _ LICENSED CONTRACTORS DECLARATION�.� �, ---- -----. � � - ---- � -- - UC.- � nA55 NO. � DwEu.UnlitS � 1 here6y otfirm thql 1 am litensed under provisions of Chapter 9 ADORE55 NO. (commenting with Sediod7000)of Oivision 3 of'the Businessand ,___. _ ��� SEWER MAP � _... _ _ '. . . .._ _ " � Professions Code,and my license is in,full'force ond effect. atv CwSS -BK: -�- � �- - � � VALIDATION � - -� . . 2768 ... OS � � ,..B—S ,.�, . SQ.FT. NO.OF NO.OF CNECK ; License Number ' Lic:Class� ' Siz $TORIE$ FAMIl1E5 ONE '� � � .. . � i The Wm...L on Co. 12-22-86 NEw vatuniioN -- _ ._.. Y � . OESCRIPT�ON OF WORK .. Contracfor Dale�� ADO � S �� OOO . . � .. �Iumeaemptunder5ec. - � S1❑ le .famil -home constructio � �. � , , -� - --�1 59.bA�-: � AITER B.BP.C.fOr 111i5�ea5on .__. REPAIR- S - - .� .- ._ ... ._.� .._.�. • . .?� -. - .. useoF _.. _'._. _. I •247,23 � ' DOte: E%ISTING BLDG. DEMOL � ' "....$i nature� ". .._. ._ ...__.._. .. _ • ' APPLIUM 7EL. FINA4 '� � . 9 vaiNT The William L on Co.No. 833-3600 �2�� _ __ _ • •2Lt'],2.�,c=, . OWNER-BUILDER DECLARATION .___,._ . ._ . . . .__ .. . . . . � DATE —I hereby affirm that I om ezempt from Ihe Contractor's ticense . , taw for the following�reason(Section 7037.5,Business and ADDRe55 FINAL \� �� - . I 2 3 1-8 6 � . ...Professions Code):. . _. . . ... . .... . .. . _ .. . _ ..BY . - . -.- . _ _ � . . �. � Bl1ItDING 'S,� .r7 9.7 A . �� . r 1,as owner of Ihe property, ar my employeas with ADDRE55 ' ' � , , . . . . . __ waqes as�heir sole compensarion,will do the work and ��-' • . ' the strudure is nol intended or offered for sale(Sec�ion ��`��TY � �` '.� k' � �1 -� '- --7044.Business and Professions Code). . . . - �- MOVING �-� --. ._ . .. TEI. -- .. . ��.. - _.' - - . . . . .-� �'.; � I,ps owner of the property,am exclusively controcting COMRACrort NO. '� , 4 C Q� - whh licensed contractors to construct the pro�ect(Sec- .-.. .. . . . . _ . . ._ __ _ _. . . -, . ..- . . . � ,�' S '. lion 7044,Business and PrOfessions Code) ADDRF55 � , , � . . ' •4 G h�Q _ ---� �-"-' - CONSTRUCTION LENDING AGENCY ' �" "-�-" - �sE�aACK " vAkD HWY- T��ApROTPiinKie wioiH � - - �-� �� �- �� - � z'3� —�E " I hereby affirm ihot Ihere is o construclion lending agency for FRON7 "�,k 4 . -' ���% � -the performance of the work(or which this permit is issued - -- a.i.-- - .. - . ��-.. . . . .' .. . .. . . _. . .. � ':i+.; _ . - . (Sec.3097,Civ.C.). SIDE ! , � g _ r.t. -�..- � C�w�_��y � Lender'sName Continental Illinois- Bank . , � J/ IOMARef.N . __._ . . = lender'sAddress ��y S�- �•� �a��A St.� ChiCagO v.C.Feef 7� �� �� , � Parmit Fee- • � I certiiy that I have read this apPlication and stare that�he .. . . -.--' . . . _.. ... .. ...- is.w�ce c�� � IU•VV � LDMA P/C R � ,- . . - . .� � . .'.".' �. .. ' � obove informotion is mrrect.I agree b comply wifh ali County i,,,,e:ugauon Fea �. . g inantes .S� aws. ming to buildmg construction. .. __ . .- ' _ _." '- To�alFee '----- -- -- u and hereby oui rize represe iives of this County to enter �`g apo i ab ent oned rty for inspeUion purposes. �y3� _ ._ , �,c..?t-QO _ B _ _ . _ .. _. ..... . .. . _ ._ / N`� � IDMA Pe�m.M� .. . ... . . . . -.. _ . .. _ '� � ^ � SFE REVERSE FOR EXPIANATOMY U�NGUAGE ' ' ^' O -' - Signaturo o A�Plican�or Aqem —� - '' Da — '' ' '- '-. - . . . . . ' . . . . _ ._ _. . . . ' ._ _ ' _ '. "".. .__._._ _ . .. .._� - r i J 1 PLANS TO APPLICANT INSPECTOR'S NOTES . OWNti&SUILDER DECLARATION , , I hereby aifirr*m tho(1 am eaempi�from the Contraclor's To� ' R�turn�d ' � � � , � ' Li[ense LCw for Ihe following reason.�(Sec. 7031.5) - " "� � i Approved "- � QurinrssrsnJProfessrnnsCoderAnycityorrorentywLrcl� No. Data -� No. � Date ' . . � .... .�. . . . ... ,- .. : .'. .. , . . i. requires a permrt to wnslrurl,¢ftcr,imJ�rovc.demolis{, , , .. orrepairanyStrutture,/�rinrMitsissuance,alsoreguires . • . , �' ' � - � . . ., . , . ' .. - !be applicartl�or tuch Qernei!to file a sigaed slatement - , [Gat Gc is Ircensed pursuant to tbe prociainns of tGe Con- I,��n '��,i�� „ . � . � - �, truclor's License Laeu(Cbaflrr 9J/aomniencrng u�it!Src- �' - - linn 7000J of biidsron j oJ tGe Dusiness anJProfersinns I -': �.. . �.�:�,'.; . � ��. � . . .. -. � � � . • ,�' CndrJ or'tl�at Ge u rxemp!tLerefrom and the busLa�orlbe �-- .- . _ .__�___._ _ _.'. __._ ._ ._ _ . _ . ._ . . _.._ . _ _ -__. _..._. ._ ___. _ _ . . allrged exemption.Any niolatron of Section 703I.5 by �_, ___ _ . � _Raqufrad�, ' ', . .. _ ._.____. � __ ' •�.:. : '��. ." _ � ._', ony�plirantjorapernritaubjeclstbeap�licante�onril Approvols �afe RecQ�v�d j -Yes No o�Approved�� ' , . . ,pena 1y oJ nnt mnrc 1Gan finc hundred ollarr(S500J.f:, � . � - - - � - � - - --� ❑ I,os owner of the property,or my employees wiih . Woter Certi4iwte �� `. � -; � � `� _. � .wages os their sale compensalion,will do rhe wo�k,and . , . . .. . .. .. _.. .... . . . ._ :. , . . . . . �----�-- - - � " ���� ' ' � the struuure is nof intended ar offered�for sdle(Sec.7044) Neahh Depaitment_ ,... ,._ ... _ .`_ ... c i . . - . .. . . . . _ _� .. . .Dusiness ond PrnJessioris Code:TI�e Conlraclor's Lirente . . , . ' . .. ,i'•-, ' �:, � I.aw docs not apply to an ou�ner oJ property wbo buifds • Fjre Depariment _._ . � -- - -� - � - or irrrJ,roves tbercon,and�oba does sacb a•ork Ginuclf or . . . _. ._.. . _. . _. . ,. �� �;,, � . ,. . .. lbrougb !is ov.�n employces,.provid¢J 1Lat iuc/�im_ Grading . ., � � � . ,pronements are not intended or of/ered,fos sale., � � � , - - � , . , . . �;- . -bnurt�cr,tbe bai(ding or im/�rovement is sold u.•itLin a,, Geologicol� - .� . � . -., , � , . , � yeur nf cnmplelion, tLe ownenbuilJer mill baoe the � - � burJen o/proring fGat fic drd nnt 6ui1J or impronc fnr i � . . . ...__ ___ _. _ . ___.. _ ' . . , Pedesvion Pro�ection - - ' . . . � - tbc purpose nJsalrJ. - . � . (Fence)(CanoPY) � .. ::._ � . . ._- ..-._.-.. .- .. - ..�---�--� -- -' ' ..❑ 'I,osowneroflheproPeny,amexdusiveiycOntrao ling wiih licensed comroctori ro construcf 1he prolecr(Sec. "' - --- � --� � -"- �� -� � - ---��--- -- � �-�--� 704a)Buairiest and Professinns C�de:TJe Confrnctor's Special Inspeciion ., �- � � . ' ' � (Conc.)(MasonrY)(Welding) . � .. . - .. .. � . . '._.. ._..._ . ___ . .1 1!'.,.��� i'�i'.. I.irenrr Lata�does nnt a/�/�Jv to�an ou��er ojpropertY ul o �n � '� ��� ., --boilJs br im o es 7Lerco nJ ss�fio cnntracts for sscl /�r r n,a s W lot Drainoge �!�,'_.1 ���•` . ._.. _. - .. .. _ . . _ . . . . %�rojecfs-u•ith a,mnbattor(sJ lrcensed pursuant!n,t!e 1 1 . � -Cnntraclor's I,icensc lauJ.- - �-------� _ ,., � , V . , , � � ' � ...... . . _ . � . . .. ,. . Parking - . - �.., ..- .: , , . ._...__ _.. ._ .__ . _.. .__.._ __._ . , . , , ❑ I am ezempt onder Sea ,8.8P.C.(or this . . • reason - - - . - � � � . . .� � , , .. .... . . _. , _._._... - . _ - ---- : . , ',.. . . Ddte Owner Approvals DaTe �Impecfora Signofure; �-' �� , � . INSPECTDR'S NOTES � � � �� Lomtion— . � � . . . . � (Selback 8 Yards) „�} -"�—� � - - ' . . � . _ Foundotions ` . .�`- .. � � : .. , . � . . Slob � ' ' � ' � F�ome (� p , . . Energy Insulation r]�j� /f'�/�.� '' .. __. _ �_:_� . _. .__.. . . ' . �.. , . . ,. . ,. , . ., , \7 v v i Loth/Drywall— - --- '-. - - ... - ... _..._ _..._ .. .... . Interior -- " ��� -�------ � � � � " " � ' Loth—Exlerior . ' . . . ' � , .. , . .. �� � . ,+ ` , .,.—� �^`. � ,. .. ,.• HouseNumber— � , � .. ' . -� _-- • . . .._ ..._ .:.-__•_.__• '_'.. __ _. . ...•. �.�.,. ... ..�.t I:.. .; _. _._.L'___' . . ... Coneci 8 Posfed ' �.-�ti � - � „ Final— _ _ ._ . . . . .. .._ ...__. . . _ _ ._ .. �. ._ : .. . . ... . __ � , �. , .. : . .... ... ..� ,. Enler on Fron� "'\ \(. �;� . .� . ' ,\. � "' .. . . , , . . .�.. � -..- _ �,