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HomeMy WebLinkAbout1602A 1603A (9) .___. . ._ . _____ .. _- -- ... _ _._ . _. ._ _. ._. _ �_.__---- - --. WORKERS'COMPENSATION�ECLARATION " �'� ' ' �� � � � - -•• I hereby affrm that I have o cerrificate af�o�se��,o=e�f -�- -�� �� APPLICATION FQR BUILDING�PERMIT - �� ��; insure,or a certiFimte of Workers'Compensotion Insuronce, , ._ . �. . . .. ' ' - __ .__ '__.._.__ or a"certified copy thereaf�Sec.3Boo,lab.C:) COUNTY OF LOS ANGElES ' BUILDING AND SAFETY 'WCP6255241 Great American Plan 1AR PolicyNo. � �Compony � -�- � O Certified copy is hereby furnished. '�� FOR APPLICANT TO FILL IN BWLDING c ' '_/ ADDRESS c �r � Certified copy is filed with��lhe county buiiding inspec- �---- gURDMG ti0ndepartmeM.� '" � � � �� ADDRESS 20831 East Can on Rid e Road � � � ' oote .12-22-86,q�l�mnr .The Wm. Lyon Co. �iTr� Walnut ' Z1P 91J89 ��,iiTr �,.�� CERTIFICATE OF EXEMPTION FROM WORKERS'•� '' �� - ' - � - ' NO.OF BiDGS. - - �. nIEAREST��- . ' � � '' �COMPENSATIONINSURANCE �� " ��� SiZEOFLOT3>HOO SF Min.NOV70NLOT � ' CROSSST. � (This aettion need not be�mmpleled if Ihe permit is for one -- � - -� - - - � ASSESSOR , � � �� - '����� hundred dollan(5100J or less.) . , „ . TRAQ L� ] BIOCK 0 LOT NO. 0 MAP BOOK �AGE• FARCEL ' - owNea TtIE WILLIAM-LYON C0. No833-3600 use zoNe �P pa _ I certify t�at in the performance�of the work for�which)his 3 .3 �a permit is iisued,I sholl noi employ any penon in any mannar � � - - SaECint- --- � �� �- � � - � --� - so�as to become su6ject to the Workers'Compensotion L'aws. " Ao�aE5S19-Cor or2t0 Plaza - - coNoinoNs � . . ..� � �u , • , aTv Newport Beach, CA Z1P 92660 ---- - -.- ,a Date "� . .. . . APPlicant '� �' � . „._ . . __ _ _ . __ . _ _. .i �. .. TICE TO APPLICANT: If, after making ihis Certificafe o4 ARCHIIECTOR�;ale5-L8I1 SCOR TE�' S�i7-OH6Z .DISTRICT.. GROUP TYPE . FIRE PRO(�SSEDBY_ !O ENGINEER P> NO. CONST. ZO V � ��mptian,'yau should became su6ject�to Ihe Workers' , , �. W .mpensation provisions of the labor Code,you musi forth- qooQE55777 S. Main St. StC. lOS Oran fl �_ . ..� - .�- - - � d with comply�with such�provisions or this permit sholl be deemed re�oked. Same As Owner tE� , STATISTICAL CU4551FICA710N L/ APT. C oo. 2 �., :. � : � COMRACTOR NO. ._..., ClA55N0. �O �DWELL.UNITS�L ._ ._ ._ - ` LICENSED CONTRACTORS DECLARATION -- - � -� � -- � -- � � --����: - -- I hereby a(f��m that I om licensed under provisions of Chapter 9 aDDRE55 No. (commencinq with Section 7000)of Di�ision 3 of the Business and _ _ , . , . __ ��� _ SEWER MAP � � - ' � - _ . .. ._. .. _ , Professions Code,and my license is in full farce and efiecf. CITY CLASS � �"-'BK �-"���- -{ �-� �' --, -"'-' �VALIDATION�� � �� , � ' �' � ' '� 50.FT. NO.OF NO.OF _CHECK � - '� ' ��� 512 STOftIES � FAMIlIES � ONE�-- LicenieNumber Z76$Ol .Lic.Class B-1 ' ..., .;, '.,. . . • � . The Wm. L on Co 12-22-86 � vALUATION .•. • Y ,,� -' �ESCRIPTION OF WORK -.. . . -. .... .- NEW- .s �y ,. ._ .. ... ' �� . CoNractor Dbte � lQ oV(� 1 6 0.2 A'� AOD �I om exempt under Sec - S1❑ le fami 1 home-construction � -� : � ?-�'- . � ALTER B.&P.C.for this reason _ � S � � --� - - REPAIR . _ � ..__ _...... .-._.___.- __.. _._ -. useoF I •225.81 Dale:' - - ExI571NG BLDG. DEMOL ❑ _ """ . .. ._._" ... �-$ignalure �- -' '--- .. _. . ... .... _ � � APPLICANT TEI. FINAL �' : � � �2G5'�� `_' ' OWNER-BUILDER DECLARATION PRINT W' ❑ C .NO. $ - 6 _.DATF - ---�- - �- ��--, - -�I here6y affirm that 1 am exempl from Iha Controcbr's License � , �-� ��� � �� � , 3�-�i� law for the following reason(Section 7031.5,Business ond e.00kE55 ryryq`;,�. .. , , ' � r 2 '.Pro(essions Code):.. ... .. .......... . _.....__. _... ._ RE :.Ey. �� ,._ . ,. � f - t� b Q'��} � . � BULLDING ; ,-. ; � "' I,ns ownei of the property, or my employees with ADDRESS . � -• , • � �• • �'�.� � - r "--wages ds their sole compensa�ion,will do ihe work and - - � - - - �-�� � � �. ' � - � r - ihe structura is not intended or offered for sale(Section ����TY ' � ' �_e.3 9 O O p ' - - - 7044,-Business and Professions Code).---- --- htOVwG - �- - - ---- -' �TEL� - �- - � �--� �-----� - - -' ,_ CONTRACTOR NO. ' ' ". .�. I,as owner of fhe properfy,am ezdusively confracting :-. ,.j��. ... �`• '�- •�O O�Q S�.. .. . � � �-with licensed comroctors to construc�the�praject��5ec- - ��� - -- ' -� � -- '�- � � - -� -� -�� � � - "on 7C ONSTRUCTION ENDING AGENCY"- 5E7 encK aROa.uNE W io7H�. �� '-, I 2.3� -8 b-'� ' A�DRESS RE UIRED. YARD' HWY' '"10TALSETBACK . . . _. ..'_' ' ' � ' _ ' '_. _... .. I hereby offirm Iha�there is a mnstroction lending agency for FRONT �-�`�-- , � ; '�- - ' ' " "' �the performance of tha work for which this permit�is issued � P.l.-� --- � -- �-�- - �� - � --� -� � --- �--- - � �� � ��,-� `-�-� � -----� - (Sec.3097,Civ.C.). SIDE ' ��: ' : ^ V.l. ' __... _.__ . :�_" . ._ ' . m _ . ._...... ._.. .._. _ .. . _- ___ ._____ _ . . _ _ _' __ - _ .' _.__. � Lender'sNama Cnnhinantal Tllinnic Ran � � _.. ...,. _ . . ._ ... _ ..._... ._. .. -. p.G Fee E �' Permir Fee LDfM Ref.N � • ' _. - Lender's Address f fi i ' /� , � � � � � . . � .I cer�iiy that I-have3ead�ihia a paication and sta e that 1heCa O insoa�ce F�e -�0. �L/� �on�n ciC M �- � -- � �� - � _.g q ..."'__ _ . ... ..._ .,. a obove iniormmion is I ogree to comply wilh all County Invesrgai�o�Fea � ' ' � g manc te lows re ting to building consiruUion, iarol Fee � . 'LDMA Verm.N . ��� ...� � .. . . . ._ _ . .. _. . . . _ _ _ ._- _ . __ ._.' .... ._ __.. ._-., d by aut orize repres tives of this County ta enter 0 o the v -m ntione ro erty for inspection porposes. ' .. _ ' _. _ . . . . _. _ _. ..._ ... __ .. ._ ._ ... . .. . ._ _ . __ __ _ ... _ __ . a � ,o �� L�Z'� SEE REVERSE FOR EXPLANATORY UNGUAGE � , � � � ._- -Signoture ol A aant or AgeM -. . _ . . ..Dare .. .--_. . ...___ __ .. __' _ .. ... _ . - _ - . � _.. . .._.. .. _ _'_. _ . ._ .. . _ .t � PlANS TO APPUCANT INSPECiOR'S NOTES O�i'NER•I3UILDEIZ DL'CLARATION I hereby af(irm thoi I am ezemp�irom�ihe Confmcror's To:., ''. t.� . . RNurn�d �. ' � � ' ... �� .. , , .'.litense law ior the��following reaion,.`(Sec.��7031.5) ' � - � �Approvad � �QusrnessunJPr%siionsCode:AnyriayorcouxtywGrcb No. Date ` No. - ���'OaN�.'.� �� - � • - � ��. - ;,� �;;requires a permil.lo rortslruct,alter,improve,demolisb, , , __.or repair any ttruclure,Qrior lo iti issuance,o(so requires ' � . �,\ � �� � � •, . : . .� , � - - � , !Ge a/�plicanl/nr sutb Qermit to/ife a signed statement !L¢t Ge ir JicenseJPursuanl to tGe pro+�isinns ojtl e Con- , �„ \ , � fratlor'sLicenaeLau(CIa/�ter9/(conrmrncinguillSec- - - " - , tinn 7000f nf Diersinn 3 of tGe Qasiness and Pr%tsinns 1 . . , � ... ..�.;.: � . ,, � �,.,, � . � �. �: �' ` ' ' ' `_' CotleJ or 1!at bc is exemfit tGcrefrorim ond tGe basisJm�be , • .. �. ._.. _ _ _ __. _... _._ . _..-_ ._ __ . . _. _. _ . _ �-. .�...-......--�---- .- . _.-. .�. ... . -- - ...�. ollegeJ ea�emption.AnY vinlation of Section 7D31.5 b,y - '- . Requirod' ` ".`-DofeRoeoiv�d� � -- -- ' . .-- .. ..-' ._- ' -_ , anyahplicantjnrapernrrfsubjectstbeappliranttaacivil ' Approvdls� or Approwd �.penaJty of nnt mnrc d�an jive bundred doJlars/5500).J: � .:.....� :-Yef No ,� , . . , , . . . .�,. , . . .,,. . , „��� �. �- �-- --�-- ' - --�- - - - -- ❑ I,as owner oi Ihe property,or my employees viith � � �.. '. , , ,.. . _, . Wafer Cerfificale `��.�-. ' - '�,� ' � _._.�. _._ . _ _ _ .. .. . ... _ . ;..wages os their sole compensation,will do Ihe work,and ---�--�-------� � --�--- -" � ��' �' � the slrutlure is nol IMended or of(ered for sale(Sec.7044) ' Health DeparlmeN _ ._.. ___. __ ._-� �_ __ .-_� ----- �- �-�-��-- - - - �--- � . � �-� � � Basincrs and Prnfcssinns Code:�TGe Cnntraotor's Licercse ' �� -- �� - � �I.nw docs not app7y tn an oumer oJproperty wGo buifds �� � � . .. �„ ,-.�.. ��,����, � Fire DeparlmeN ._ _ . _. .__- . . . . ._.__ - - - - � - or imf�rot!es ebercon,and u�bo docstuc!u•ork Gi»rseff or . - . . ��::: � i � _ . .- . tl�roag! Gis ore�n em/+loyees.:prorideJ!(iat�sutG•irny . Groding� .. � � '� ' " _ pmncrnent.c,arc no0 intended or�o/%red fnr.aule„ . , � �� , �(����� � � bou�ener,1Ge bvildirtg or imQrouemertt is sold urtJ ix o Geolog�cal � - -- - - � -, - . � . ... , ,. ' year nJ tornJ�letion, fle au�ner-builder wi!l,bave�tbe � - - � � burJcrs oJ pmx•ing fbat be did aot buNd or inihrore Jnr � . '' .._...--_.. ..._. ._.. _. _._.._. . . . ' " � �' � � ���� � tGc�+urf,osc nf saleJ. Pedestrian Pro�etlion '---.� -.,�,. . �.. .. � . . �, . ., �. ... .� ..� .. ��:.'. � ..-. . '. . . (Fence)(CanoPY) ,.. . .- .-.- -._ ...__ - _ '___._ . . ._. .. ._'. :.`.. ' � ❑ 1,as owner of the properfy,am ezdusively contrao , . ring wiih licensed contraciors to consnua the-project(Sec. .,....._ . .. . . - -�----_. _ _ . . . .- ---�- - - � � . . , . . Special Inspeclion-�� � _; � �- - --:: •' � , � -� 7044)Dunness und Pro es.amns CoJe. 7 Canlratlors f Lc (Conc.)(MasonrYl IWeld�ng) . �� � .. ..�� _ __.. _.!_ . � ._1.. �... ._.; �_.:.. . Lrcercae Laa�does nof a/�/�ly lo un�ou�nrr nJproperty u�bn � '. •�.� � - • � � - buifds nr im roves�lbereon,-onJ u�ho tontractt for sucG � �•` •� . . � /�rojects tui!!a[ontrartor(sJ�licenseJ parsuan! to!/�e Lot�roinoge: : ,l �� .�: . , _.__ _ ._._ _ .. __ � , �-I •, � ._ . ... .__ _.�: ; �. "'Cnnlraunr's I.irense/.au�f. _ .. . .. - . . . Parking - , . �� ' , . . . . _ _ . . . �. . � � � -❑ I am exempt under Sec. ,B.BP.C.for this i ' � � . � . reason_ .___.._.. .. . ., Dote ..� .. . . . . . . . Owner�� . . . _. . . '". ... , ' . . . . _.. ::.. _ _ .' . .� , �Approval� � Dafe �Inipec}or's-5fgnutura - , ,. , - , . . - � INSPECTOR'S NOTES-��� �- lomrion- . � r. .. n . (Seiback 8 Yards) ._._. . _� _ .. ' . .,. .. .- � ., � '��-- Foundalions - . : . .� .. ..�,�� .. . . � . �� . . � Slob I� . . . . . , Frame _. . � �`� . . . ,,. . _ . : . - � ' . , ., .� , . '� .. J Energy Insulalion �„S�/1 ' ""_ _ ..___...___._ .'_._.......__'_ "_. .. ...__ ... , . _ . .. , . . ... , lath/Drywall- .. _. _... .-�- -- � -.__ . . -- ---- � --" . �. . . . ..__ _ � ' � �.� '.. � Inlerior ���-���� � �, '. � i ' Loth-Ealerior . � . . - . . .. ._-.__. ..�__ _�..___._„_-.t,.. � . . � ' :•�✓,<-' \Ll'_'�, :' ;� �. Hovse Number- .:' • �.. .• ."••_ ' . . _ . .. , , .. _. ,_ �� _ . . - ' '._ ;-' ___ _. _. '___.._ .. . . _ , . Correct 8 Posted .Y . . : � . �.�.. . . ... . �. .. . : . � : .. ' � ` r '� �; .. . _ ' , Final- _- ._ ' _.__'.. .. . . � �_ . _..... .. .__. . ._______ .______. _ .. . . , , ... , , Enter on Fronl �� . .., . , . � - � . . , � �- . .