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HomeMy WebLinkAbout1604A 1605A (9) i . . . ._ _ __ __ _. .._ . ... __._ .... . . .. --- - ._ .. - WORKERS'COMPENSATION DECIARATION � � ' • � „ ,;, -- �� .. , .. .. , �..._... .. .. . . �� _- - _.._ � tie�eby affirm Ihat I have a certificate of consent to self qpp��CATION FOR :BUILDING PERMIT � insure,or o certificote of Workers'Compensotion Insurance, or a�certified cop thereof(Sec.3800,Lab.C.) � '"" "" "�'�" -" -- ' " - � �- �---- " ' WCP6G�5241 Great American Plan 3CR COUNTY OF LOS ANGELES BUILDING AND SAFETY , „� Palicy No. Company - Q, Cen�fied coPy�s he.eby iom�shed. FOR APPLICANT TO PILL IN BUILDING �� � �. . . , ... . _ ADORESS . Ceriified copy is filed with the munty 6uilding inspeo- BUnDiNG '�tiondeparlment. ' � ADORESS 20835 East Can on Rid e Road .. .., '. .. � . . . . . Dme 12-22-86 aPPpcom .The Wm. Lyon Co. ciT� Walnut - �ZiP 91789 io�urv ' �'CERTIFICATE OF EXEMPTION FROM WORKERS'�' ' � - --�� NO OF e�DGS. - -�- NE.aREST. - SIZE OF LOT 3�HOO SF Min.NO'N ON l0T � � CROSS ST. � ' ��� ' - `COMPENSATION INSURANCE��' - �� � � (This section need not 6e'comple�ed'if�the permit is for one -� �- -� - - �--� - � - - ASSESSOR . � - � -- ----� �- � I cerdtifd ha�'an 1(he�erformance of�the work�for�which rhis - " owN a��THE-WILLIAM KLYON C,�. `nj�S.3313600� ' U$PZON� .OP � � � �AGE• PARCEL i Y Y P permif Is issued,I shall no1 employ any person in pny manner SaECIAL� - ---� --�- - - - - - ------- -- �0- so�as to become subject to rhe Workers'Compensation laws. � � ADDRESS 19� COL Oz'ate P 18zH - - - - � -- - CONDmONS �V . • aTv Newport Beach, CA Z1P 92660 � Dofe' , : �. . 'Applitant " � � ARCHITEQOR TEL. �. � .. �. . . . .-.... ,� ^ TICE TO APPIICANT: If, aNer making Ihis Ceriificate of Elales-Lan StOII 547—�862 DISTRICT_ GROUP_. TYPE . FIRE .. , PROCESSEDBY _ _,� ✓"� ENGMEER g NO. CONST. � ZO l mption, you should become subjeU to�tha Workeri - 7 J�� , . .mpensation provisions of ihe La6or Code;you musl(orth• qD�RE55��� S. Main $t. $LE. 1�5 Oran �. _ _.✓. _ [i ._y tnc �omply wuh.s�ch�pro�is�ons or �ha pe�mi�shall 6e .. . 7FL. STATISTICAL CLASSIFICATION APT. C oo. '�Z deemed revoked.,,, � - Same As OwneT � � ,,,, UCENSEDCONTRACiORS � �� COMaaCrOe NO. �� � �in� , _ �./ . _ OECLARATION. � . - .. . .. . . ... ._- � ... _ tiC. -. . CwSS N0.1L�DwEIt:UNiTSL.L� . ... . 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRES$ NO- � (tommencing with Settion 70W)of Division 3 of the 8usiness and _ __ . , _. ___._ _ . . .. �IC. . . . SEVJER MAP . - Professians Code,ond my license�is in full force and effect. CRv cw55 � - -�BK -�- ,�---�- -�-� -� --yp��pATION �- '�" ' ' $O.Ff. NO.OF NO.OF CHECK � Licen'seN�mber'2�6801 ���tlass'B-1 ' srz STORIES FAMIUES ONE � The Wm. L on Co.. 12-22-86 NEw_ vqtuaT�oN, _ __ - — _ Y oEscaionoN oF woaK s b Contractor pote � O ' , . . ' ,. ADD ' ❑i om e.emp�under Sec. Sin le famil home constructio ' -- - ' . . -- A�hQ �� � . 8.�&P.C.for this reason . . REPAiR ❑ s'- --- . . .- ._ . -'._ . `.� ��(y� __. . -- �� ---� -- USE OF ! . � - ��Dale: - E%iSTING BLDG. DEMOL ❑ _ _.._._ _ . .. .. . . - APPIICANT TEI. . � �'-• •'• •'�'� - s9nawre ' - ' vRiNr The William I, on Co.No. 833-3600 FiNa ' � OWNER-BUILDER OECtARATION .. DATE . .-- -��- - -- � - � �I-•�2 7�G b�j-- -� -�I bereby aifirm ihat I am exempt from the ConlrocloPs Litense � ' law for ihe following�reason(Sec�ion 7031.5,Bosiness and aDDae55 FINAL � '�� - - - � � x � �2%F68� , 'professions Code): -'-..._. . . . . .. ... .. . - vkE EN 8y ' � : �' . - . . . - : �— - eunoiNc - , . I 2 3 1-S_F� �, as owner of the property, or my employees with ADDRE55 . woges as their sole�compensation,will do the work and - ,.� ' .' ' r� (��.S�A � � the strvcture is not imended or offered far sale(Section ����TM ' , — - 7044,�Business and Professions Code). --� � �- MOvtNG -� - �- � � �Te�.�- -� � � � -� '�� - - - - - ��----- f� CONTRAC70R NO. ' .�. . �r• • • • • � � L1 �•ps owner of the properiy,om axcl�sively confracring ..,_`.. ., . . _. .._. _ . '. . . ,'.- � � - --� -- ' � --with licensed contractors�o construct the project(Sec- qooke55 � • tion 7044,8usiness ond Proiesstons Code). �. '�. _' ; � �4 7 5.5 0 � . . _.._.. . . REQUIRED . YARD HWY. iOTAt SETBAIX -".. .._. .:. . �.- , .. _r_ CONSTRUCTIONLENDINGAGENCY ---�- " � SETBACK PROP.�WE �WIDTH ' •„U�.7J5Ox. I hereby affirm that there is a construcfion lending agency for pRON� ''. �`i,�;�, � � � -the�performance of Ihe work forwhich lhis permif is issued � - 7.L - - - - �-- - -��-- � -- ` �2 3� ^8 b� (Sec.3097.Civ.C.). SiDE '- i::` :t-�, ' � - m _'________ _. . P.L. . __..' "_ - . . • �' c. . .� ' . � Lender's Name COII ln n 81 T 1 1 ❑01 Bank .� t�j� � �ptitq Ref.if �. �- � � $ P.C.Fee S Fermit Fee�y�� �- � � '-- -- - Lender'sAddress ��1 Rn. T.� Ralla Sr-���Chi�g�p ��� ' � � � ' � J certify.that I have read this appiication and stale Ihat the _.. Issaonce Fee IDMA P/C M � � �- � - a bo ' ation is correc agree ro compty with all Counry Investigation Fee � � g inances an te ws re 'ng fo building co�struction, _ . Total Fee IDMq Perm.M -� � �� - ---- - u �d here6v authori represent i es of this County lo enter � � opon d�e ob e-m nlioned pr er for inspection purpases. )..y`�.�.s1 ����/1-y� � m _.. .. . ._._ _ . . . ._ ��[/V C/CJ ' . . _. � ._ _ ._ . .. Q _ .._ _.. _,_ _ . . ._ ,o ' �Z L?� SEE REYERSE FOR EXPIANATORY LANGUAGE . � - --S�gnaNre of Ap licon�or Ageni . -..Dote'- . . .. - . . - . - . - : .- ...- '- -' . . .� ' -' '-� �� PLANS TO APPLICANT INSPECTOR'S NOTES � 014'NER•UUIIABR DECLARATION 1 hereby affirm thol I om exempt irom ihe Conlrocfor's To: � Rofumod „ - ' ' ' �� ' � � Litense Law ior the following reason. (Sec_7031.5) '� ' " ' � �Approved � � � �� � . � � � �QusinesrandProJessronsCode:AnyeityorcountyieGidi No. DoTe � No. � 'Dats `•� � ��- �•�`�"�' ' - " •�� � ��� ,,.,. i� ., _ , :.rrguires apernrit to rnnttrucl,aller,im/�roeerdemalrtb, _ .nr reJ�airanystruclure,Jrrior to ils ittuqrsce,a/.co regqrres � � ��� ' . ! - -� � . t!e appJicanJ for aue!f�ermit to file a signed stalement ��:�..,-� - . _ . . . . .tGat Gc u licensed(�ursaant fo tGeQrovisinns o/!I e Con- '- � , , Matlor's Licenre l,aw(CGafter 9J(romnrentrng wif5 Sec- .. ` i , , tinn 7000J ojDi��isrnn 3 oJ tGc Busrness and ProJessions ' _',_i..-,' ,' � .: . .� . _ . _.�_ _.. . _._. .. ._ _.. . ' CndeJorkfiaticirexenr/�ttGerefroinaudtGebatisfortbe i_ ._ ._._. .___.__ _�� . . aIleged esem/rtion.�Any vrolation of Setlion 7031.5 by _ ___ � _ _ _ Requirod�'_ . Dafe Retsired - --� -- - �� -- -- � - --- ' anY ap/�ficant fora perreitavbjcols tl�c applicant tn a civil i Approvplz -;Yes No or Approved � , ,, , Qen°1ty of not morc�than fio�e Lundred do!lari(8500J.J: ;, . _ �� , i , � � -" �`- " - " � -' "" -' -' - - ❑ I,os owner of the properry,or my employees wifh � .�..� . . ., . , . . - Woier Cerlificote �, - - - '��' � + _.._, _ wages os iheir sole compensation,will do the wwk,ond - �. , ._..___ __ _._' __'.__. ... . _ � �� '—�--�" -�' '-���-�`"-'��' �`-- �-"� � - � .,_,the struclure is not intended or offered for sale(Sec.7044) Heolth Depor�ment ._ _ . __.. __ ':��. ._. .__ - -� - � ---- _.. _ .. Uusiness and Projessrons Codc:TGc Contractor's Lirense � . _� . . .„, . l.axu dnes not npply Ln an ou�ncr of j�rnperty ul o bvildr ,- Fire�epertmenl. ._. _ __ . -_. . - � nr inrproves tl�rrcun,anJ wbn does sucb work Girnself or �� _ . . ._ ._.._ . . ; _ ;��� � . .,� �. � i. tbroug! hrs orun �,�rployces,�pro�dJed 1Gat sucl im� Groding • ' � - I -�pmvenrexti arc not ineended or of/crrd for tale.. - - � . . : �,��.. � �- . � bowencr,tbe biarfdrng or impronemers!is tnldwitGin o. ' Geologitol �, - ' , -- � . .. . . . . . . .. .. _ Year nf tnmple[rnn, tbe nu�ner.builder wifl bauc lb¢ � � - hurden oJQrocrng 1Lat be did not build nr inrprooc Jnr PedeslrianProtection - � . Ibepur/�nse�ofraJeJ.� - �� � - � . - (Fence)�CanoPY) . � �f .. ..";� �; . �- - .. �-- ----��- --- -- - - - -. --_-._-- ..' ..,�',❑ I,azownerofthepropeny.omexdusivelycomrad , -ting with Lcensed contmcton b constioc�the�projeci(Sec. , . : . �� ., � .. .. ._ . _ .._. .. .. ._ . _ . _ Special Inzpetlion--- ' --- - �- -- � :' 7044�.Qurinets and Pmfessrons Code;.Tbe Conlrattor's (Conc.)(MasonrYllWeldin9) `:"� �"�' -'� - � � - ' . . � : ..._ �.�: ._ . .. ,.. �. .. l,irensr�lawdocsantappfytoaann�neroJprnpestyu�bn "�'�."��" � - � --��-� . �"burlJs nr improees tl ereon,-enJ u�Go tontraces for sucb o Lot Drainage (\�,.^ ' _ � .. _ ___ . .-.___ . . _ _._ projcats�u�it!a confmcror(sJ liacnsrd pursuant tn t1 r - Conlroctoh Licenm l.au�J." " " ' Parking , -� ; . "_ _ . ,..� . .. ----- -- --: .. � :• . : , . � � - ' ❑� 1 am ecempt under Sec. ,8.8RC.for fhis . I _ reason -- . -_ -. ._.. . . . . ., , .. . . . , . . - .... Date . . . . _. _. _._Owner - -- _ Approvals Date - Inspallor's Sfgnaturo _ . ' �� � ' INSPECTOR'S NOTES��' � Location— . � . . ,.__._______"..._.._ _. (Setback 8 YardsJ'� ,E--�—�_�� � � - � . Foundations j . /�` � . ��� � � ���'� �� . . , ' .. ; „ � � . _..._ ._ __.__ .. __... _. . _. . . SIo6' . � � : ���1' /�ji " ._ . . ._ . . .. Frame . , �, . _ .. _ . . . . � , . . � . �, - .. Energy Insulation �� C 71 2^� � . �:' ,-. . __. . -__ ___-._--'- ....� _ .. __- _.. . . J�JV � -� . . . � . . Lolh/Drywall— � 1 � : --- �..-_ .__._ . . ._. _..__ __ ,_ . . , �� ., Interior „t�� �� � �--'- �-- � . � . .. , lath—Exlerior , _ . , ,\\,.. '. . ' . . � . , .� . .. . . , _. . ... . . �;�•�. ... �. �..��. . .. ., House Numbe�— �� ��` � ' ' ' � � i ��-�� � , . . .. . . ______ . . .. .. . ...._. .. . .. .. . ... Correcl&Posted ,..--.. . � �� . . . :- - •_ ...� � .. .- . �� ,- Final— . _. . .. .... _ .__ ', �. . .. ._ ' � . . En�er on Front c•'- - . . ���'�'•`; �� � � � �� �� � . . � . . . .