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HomeMy WebLinkAbout1598A 1599A (9) '� WORKERS'COMPENSATION�DECLARATION ... -- �-' � - � _ ' � :.. ... ... ...._. .. ...._.___'-'-- . _ . __ ..,`. . ...-._--. _. ..... .--.. 1-hereby affirm ihaf I have a certifitale of�o�,e�,,o=e�f --- ��-���--�-qp�p��CATION -�FQR .BUILDI NG �PERMIT � �,� insure,or a certiiimte of Workers'Compensotian Insurance, or'a certiiied co fhereof(Sec.'3800,'Lab.C.J" � � " ' " ' � � � -- . .__.. ._. WCP62��55241 � Great American Plan 3BR GOUNTY OF LOS ANGElES � BUIIDING AND SAFETY . Policy No. � Company � �� BUiIDwG a.�Certified copy is hereby fumrshed. FOR APPUCANT TO FILL IN AppREu 2, �; ' �[ ,Certified copy is fled�wnh the counry bbilding inspec- BwtDwG � � � u liondepartmeM.'� ' � " ADDRE55 20821 East Can on Rid Date-, SZ-ZZ-Hb APPlicant . �hE.WI[I.. Lyon Co.- aTr Walnut 21P ' 91789 � i�rtv �� � �CERTIFICATE OF EXEMPTION FROM WORKERS'�� � �- - ' � � NO.Of BLDGS:---- -- - r�nRE57. .. - � . S2EOFlOT 3�HOO SF Min.NOwONL07 O CRO555T. � � � �� -� COMPENSATION-INSURANCE � �� - � � (This section rieed not be completed if�he'permit is for one - � � -� - -- - �� � /SSESSOR. -- � -- � � -'� hundred dotlars(EI00)or less.) .. . . , � � ienCr L� ] BLOCK l0T NO. MAp BOOK � � PAGE� PARCEL � OWNER THE WILLIAM�LYON C0. No,833-3600 use zoNe r.wP . : - J . I.certif ihat in ihe erformance of Ihe work for which this �� ��oC l�o�- � � so as ro become su6'ect to the Wo�kersPCrson in any manner --- SPECIAI- ��- �- - - - - �� � � - isrssued,ishollnotem to an e aooaessl9 Cor orate Plaza ermi . .. ....... . _._. � ompensation Laws. �� � CONDITIONS _,� . !v arr Newport Seach� CA Z1P 92660 - - -- - -- - ;� NOTICE APPlicam ' �. ' ,� .�. -- - � ` . 'TO APPLICAIVT: (f; af�er making'�hi5 Cefti/iC01e o( ARCFiIiECiOR�.IaleS-L8tt StOil �E�� S4J-OH6 DISTRIC7. GROUP TYPE...- - .-.,fIRE _ . PR CESSEDBV . �� �+mption, you should become SVbjed'lo�'IheiWo/ker5' '- � ENGWEER $ No. ro Zo ,�� ,mpensationprovisconsoflheLaborCode,�yoomustforih- qDDRE55J�7 S. Main St. Ste. 105 OCen -�� - - ��`�� � � �a' with comply with such:provisions or Ihis permit.shall be TEL ; STATISTICAlQASSiFICA710N � A7T. C DO. �Z deemed revoked. . �. '. ,. •� � . - . . � CONiRaCTOR Same As Owner No. ' LICENSED CONTRACTORS DEQARATION - � � - -- � � IIC.' � - � CLASS NO. 6d DWELI.11NIT5�/ I hereby affirm thot 1 om licensed under provisions of Chapter 9 ADDRE55 NO. (mmmencing with Sedion 7000)of Division 3 of the Business and ._. . .. ..__. _ . ._ ���,. SEv''ER MAP , ' � . Professions Code,and my license is in(ull(orce and effect. CiTy C1A55 - �- BK-� �-�� ---�-�� �� -.� -----ypLIDATION , Z�6HOL ,$-1 .- SO.F1. NO.OF NO.OF . _ CHECK ... . ' liCense Number �� Lic.Class� ' SIZ STORIES FAMILIES ONE ' , - , ' The Wm. L on.Co..... LZ-ZZ-B6 .. -.. NEW YALUA oN. _ _-- . -. - - - Y � DESCRIPTION OF WORK- -' S ,�DO Contractor ��are , � . . - . . . . . . AOD � ❑iamexempfundersec. Sin le-famil -home constructio - -- " . . . . . . . ., ALTER � __�� Jr B.E.A_ . _; . � B.$P.C.for ihis feasOn ._ REPAIR s -�'-- " ..- -' -' " '-- � .... ..._._ . . _..' "` 'Date: . _" � USE OF �, � ' EXIS7ING BLDG. DEMOL ._ , �� • •�� . .Signature �� '- -"-"- - - � APFUCANT TEL. FINAL � . "' Painir The Wi 11 iam I, on Co.No. - (� i ' I •2 7 6 6 8 OWNER•BUILDERDECLARATION _ _ . .._ , __, _ _ ___ � UATE - -� -�- �—�---- .�� �-- -- ---� ---- -A heraby afiirm Ihat I om exempt from Ihe Contraclor-s Litense - � � ' � f �_ . Law for Ihe following reason�Section 7031.5,Business and ADDRE55 FINAL �' ' " � � �� ��L`'��' _..._.. . /'../ -Professions Code):... .... -".'--. ."'.. . .. �. . e .�Y (/� . . I 2 3 1 —S 6 �-� BUIIDING I, as owner of the property, or my employees with qD�f2E55 ._ . . _.__. . ._' " . - - , r � wages as iheir sole mmpensatian,will do fhe work ond � � _ �1 5 9.9 A �� � the structure is not intended ar offered for sale(Section ����T� � � � � � � . .- �- 7044,Business and Professions Code). . .._.. .. ' '.- MOVING - -' � - " � TEL.' - -.. -_ '. . -.- - . . . . �• • s . . � --�- � I,as owner of 1he properfy,am exclusively tontracfing �ON7RnCTOa NO. , � �-.- , `'7 ..�-_' - wIfI1 IiCensed COnffOC�OfS 10 fon5iru[t�h@ prOje[t(SeC- "" ADDRESS . _.. .. __._._ ._.... ._. . -"_ �', • ' .- .: "'_ -- � - I •4•��5.� -. tion 7044,Business and Professions Code). , � � .._... REQUiRED YARD HWV TO7AL SETBACK . i . . . .. . . _ ' . .. . •-�[1''��.��� ' � -" �" CONSTRUCTION LENDING AGENCY-- -�� SE7 BACK PROP.UNE WiDiH I hereby affirm thot there is a construction lending agency for faONi ' '•.��)'g ��� � � � � � -�he performance of�he work for which�his permit is issued � �- -e.i. - � � --- � -��� - .� ��2.3� -�i(� - (Sec.3097,Civ.C.). SIDE . . . . .� .^;.� �. . '� . m _ . . - � ---. . . P.L _.. - - -'- . _ .- ._..-I � . lender'sName Continental Illinois Bank $ LDMA Ref.M . '� " ' . _-.... - ..... -. . Permil Fae � - = lender'sAddren 231 So. i.a Sa11a�Rt.� l:hiCggo P�eFeeE . - - -,,,- - � _Lcenify thm.l hove read this opplication and state tha�Ihe . _ ..... ._.., _ .-.- Issuonce Fee -� . LDMA P/C N ��a- , ' a bove Iniormafian is cor . ree to comply wilh oll County invesrgoran Fee I �" ances an tat aws rela' to buiidin construction, '� /3$3_ � �' � 9 9 _._ _.. . .. . iolol Fee . LDMA Perm.k . .-- � . ..�� � u nd her by autho j e represe al ves of this County to enter , � on t e b e-m tioned o �ry for inspection purposes. ,r���y� . .. f t^� _ ------ ._ _ . . - . __' �[/ u. . . . . __.-_ a � L�� SEE RfVERSE fOR EXPIANATORY LANGUAGE � � --'- Signa�vre of A Ircan�or Agen�'-- - ' .- . . .pote - . _... .. . - .. .. . . . .�. -._ .` " ' -��'� PLANS TO APPIICANT INSPECTOR'S NOTES .-OVVNP.R•13UILDHR DECLARATION I hereby affirm that I am�exempt-from Ihe Comrocior's To: � �.'_�.�' � . �: Roturn�d�'.' �. � . ' `. � '� . . . " - litense low�for the;followiny redsan. (Sec�703i..5) � ' " � ` ' "Approvad � �Ousiness dnd Profesiions Code:Any�-iiy ortodnty u�!icb No. Dote � No. •= �Da10��•� � � �. . . -_ . .. �."� ,. , . ,, , ,;f�,rcquires u/�erneit M rnnsfruct,a!ler,imf�ro�e,deniolisG, , . .. rrc/iairanyslructurr;(�rrortoitsissuancc,almrcguirei i � .� _ �� ; � ' , , _ . . . t!e epplrrant for sucG permit to f'!e a si�qned sentemrnt , � , -,tGat bc it liccnsedQursuanf to tGeFronisions of!bc Con- . . , � i ' , . � tractor's License Lau�(C/aptcr 9J(coneinericing u�itb Sec- , . ,.� . . . .: .. ......� � �""� - '� �� - - - - , � " tion 7000J of Drrision 3 of tLe Qusiness and Pr%ssinns �' �: �,t,��.'�' '. - .:�-� . � � � •' '��''�� •`�'� Code/orYliatlicisezen�ptlLereJromand7Gebasisfor7Ge ' - - - - -�-- ,-� ---- � --- ��� --- -_ . _.._ �--- . . _---... - -. - .`- _. . - . �" -" � - a!lc,yed exemplion.Any riolation nf Sectron 7031.5 6y � �� �' 'Ra oLed� ` ' ' ' � ". � ..._� ,., ... . , ' anyaJ�/�licantfnraj�ermitsubjectslGepp lirantloativil i, i f � � Approvcls • •�• .. 9 , - ' Dale R�toivcd . . ..�..' � e� �-�-� , ena!! o not mnre tl�an iee Gundred doflars SSOOJ•J:. �� ' Yo3 Na or Approwd� - � � _ . 1 r : � �' Y' .� .l ' � .... , . ._ _ . . .. -' l _. . _. -,. . -- - � -- - - ❑ I,as owner of the property,or my employees with Water Certificale - , - _ wages as fheir sole compensalion,will do Ihe work,and � - — - - - - � -- - � , the strucWre�is'nol iniended or ofFered lor sale(Sec.7044) , _ . _... . . .. . " Healfh Departmen�_ ...__ _. ... .___ � _-���' .._ . �-� --�----�� �- ---- �� � - .._.-_ _. - Business und Prnfessrons Code:Tbe Contractor's Lrcense � � � , l.au�does not aprly to an owner of proQerty urbo 6uilds , ' ' ' .': ..:_�,'.•. .,. - Fire Deporiment _ _ . . . - � - - �� - � - � --� � or improvrs 1Gereon,and u�bo does such u�ork bimselJor . . . ... _. .__._ ._ .. _ . . - � � !l�roagh-Irs.�ou•n employecs,.provided that such im- Groding�, ' � ' i - - , - /�rnremenls arr nol intended or.ojfcred Jor sale.,�� _ - - � ��: , -�� . - bou+eveq!Ge bnildin,q or improrement is sald u�ilbin r. . . . � .. .� .. .. . _- � Geologiml . � -� -�'- � , .. � �. -� � .. , . . . , . . . -1'ear of tomQletrnn, 11 e nwner-buifder:u�r!!havc�11 e • � � burJen of/�mvrng lbat!e did not build or lmprnre Jn'r i . .. . __ .._ .... .. ..... ... . ... . . �..� .: . �. - -'- �bepvrpase'ofaafeJ.:' �., � �. � Pedeslrion Protection .. � � ��� ' �� (Fence)(Canopy) ���. �� '� . ' � -� �---�-- - -- - - ---- � ' ❑� I,as owner oi Ihe properry,'am e cluiively conlroc- ling with licensed comracb�s lo consrrucl�lhe projecl�(Sec. c�t� 5 ecial Ins fion " '' , � ' ... ....I-.'' _-_,.. . ... ��� . " "-� 7044)Ousiness aad Pro ess'ons�Code:Tbe Conlrnctor's _ _ _ � � v (Cont.)(Masonry)(Welding) � � . _ �. Litensc Lau•Jnes not afply fn on oumcr nJf�ro/�ertp u�hn � � � � - - `' -builda or irn rn:�es 1Lcrer n,-anJ u•Go-rnntratts fnr sud� r Lot Droinage . '�,• .• •'� 'r\ J�mjectr fl.�i!!a contractor(sJ�frrenseJ�purruant to 1!e . �, ;�" ',..: �C" �. . . .-__-_.___._. _. _. _. , . ; " Cnntrarlor'tl.iccnsrl.auf... .. .--�-- -- .. . _.' Porkin9 .. _ . , . . .', � -. .: ...�. .� - - - �-� --- �--.. . - .. - -❑ 1 am exempt onder Sec. �',B.BP.C.for this . . ._'. .__._.. _ ._______ .�__ __� �. . . ' reason � ' • . . '_. _ . _ _ _ _. _.___ ._. ._ _.___._. - . - , � . t., - . . Dale Owner , . �. , - . . ' _. ._ _._ . . _. _ . . . , . . . . � . . _ _ . _ .. qPProvals s Dafe ---Inspector'a Slgoalura �� . , . . . �.� � .�� INSPECTOR'S NOTES '� ��� � location— - _. . , . . ` . (Setback 8 Yards) � n� a . . . I r. ' Foundations � 3 c+� . . `. ..�� , ... .. . � .. . .. . - Slab �..�� � . . . .' _ . .�.. , . . .,. . � ' -�, Frame S2 � � . _'. ,. � � .�. .. .... .... . . . . Energy Insulation �1�� . . .. _. . _ _._. � . � _.!_ .� , , . ,' _. . I. ,. . Lath/Drywall— r� �^� '. .. _ _ . . _..._.. __ ,. _...._ .. . . _ . . Interior T/I -_ ..... . ..___. . .. __. : �::, Loth—Ex�erior � . , - � . . . , . ' . � _ . � . _ _' . • . . . . .. . � ,t,.� _.,., _ , , ,., , . House Number— . :_ :� �� -. . . .. '. .-•_ ' 'e_ __. . , � ., : . � ... . - � . �. --.. . �. � � - . . ..._._ �'�_.,_._...._.. :. , . . Corretl 8 Pasted � ' � '� ' . : . .. ...�. . Final— . __..._ .. . _ ... _. ..._ .. ._ _. . .. ' _____ __ ..._.. . EMer on Fron1 - � � � � . . . . . ; . . .( - . � � . .. � , � . ,