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HomeMy WebLinkAbout1608A 1609A (9) i� - ._ _..- . .- --. _ _. ... .._ __ ....... _. ... .... .__ . -. . . _ _._ _..._ ._ _..._ WORNERS'COMPENSATION DECLARATION � � � � � - J .. ..-. �. ... . .. _ I hereby affirm tha�I have a certiii[ate of.consent to se�t � �-APPLICATION� FOR .�BUILDING-�PERMIT� � � � insure,o�a certiticole of Warkers'Compensation Insuronce, . 6�6 cernGed copy'�he�eof(Sec.3800,lob.C.) ' COUNTY OF LOS ANGElES � BUILDING AND SAFETY WCP6255241 - "" Great American Plan 3AR " PolityNo. � Company BUIIDING ' Q Ceriified copy is hereby fumished. _ � FOR APPLICANT TO FILL IN ADDRESS o2�Fl � � Certified copy is filed with ihe counry bJilding�inspec- BUIIDING , � �tion department. '' . ' � : � ' '• A�DRESS � ,The W -- - Oate�'��12-22-H6Appli<ant m..LyOn Co. aTr Walnut. . .ziv 91789 ' ��,uTr � . . � ' CER7IFICATE OF EXEMPTION FROM WORKERS'� - - � -- � - -NO.OF B�DGS. — - -' nIEARESi._ _�. . . .__.__.. ' _. -. J S� �� � COMPENSATION INSURANCE � � � ' SIZE OF lOT 3 SOO SF PSlil.NOW ON LOT O � CRO55 ST. (This secfion need not be compteted if the permit Is(or one - - - - ASSESSOR .� - ''� ' � '� � . .. � ... . -- . ' � , PAGE' PAR[EL ndred dallars(E100)or less.) .� . TRAR BIOCK LOT NO. /�qp BppK � . '�'� � TEL. USE ZONE OP � P�certify thaf'in the performance�oi Ihe work for wh�ch this � owNea-TNE-WILLIAM LYON �'i�. No.833-3600 . _ . -. �a � 333 �'rmit is issued,I shall nor employ any person�in any manner qDDRE5519 COL OL8 tC P Ia2A -- -� �� � - CpND17lON5 so as�o betome subject to the Workers'CompensatiodLaws. - ��- ',V ,, , • cirv Newport Beach, CA Z1P 92660 --.. -._� . ._. � Da1e � ' Applimnr ' • - . . ..- �. �- � - " � -- - � ' - O ARCHITEQOR TEL .�ISTRICT_ ,G UP TVPE, _ FIRE PROCESSE�BY . F- `�.�OTICE 10'APPUCANT: li, after moking�this Certificale of Er�GiNEER t{ales-Langston No. 547-0862 T mption, you�should become subject�to�the Workers' - � ' CONST. ZO E W ,mpensation provisions of the loboi Code;�you muv farth- qDDRESS��� S. Main St. StC. 10$ Oran � ��-- � - �n' with Comply wifh Suth�provisions or this permit shall 6e - -- iEL � STATISTICAL CU+SSIFICATION � � A . C DO. Z deemed revoked. ,� �. � ���, , - ' ::��. � � CONiRnCTOR Same As Owner No. , _ _ ... . . _.... : LICENSEDCONTRACTORSOECLARATION�:�� � �•� - -- � � -� --- - --� � - UC. -� � aAUNO.�DWELL.VNiiSt I here6y affirm fha�I am licensed under provisions of Chopter 9 nDDaE55 NO. . , � (commencing wilh Section 7000J of Division 3 0(tha Busineu and ._ . _ ���__ � SEWER MAP , i � �. ... .... .-� -- - - ._ . . . . , Professions Code,and my license is in full force ond effeU. CITY CLA55 -" BK '--� � ' �` � -- � ' �" "VAIIDATION�� , � � 276SOI � � $-1 . _ SO.FT. NO.OF NO.OF _CHECK � , ' licen3e Number ' ' 'Lic.Class � . Si2 $TORIES FAMIUE$ ONE � . • , .. �� . - � , VAL TION . _ . . - . . . . � The Pm. Lyon CO. SZ-ZZ-SG DESCRIPTIONOFWORN ' NEW QO , _ Cantractor Dale App , S � ' ' � ' �lamezem tunder5ec. -� - - Sin le-f2mi1 -home �constructio , � ��'�--� - �� � -� AtTER _ .� _ . ... ' . . :. 8.8P.C.for this�reason . ._ RE7AiR - s -- -. . . --�.. - -- -. -__ . . ._ _. . __ ._ ._ _ ..__. - .--___... " ' USEOF , �� __.pate: - ' E%ISTINGBIDG. DEMOL . ___ _ _ . . . _ . . ....._.. . . - APRICANT TEL. . � y, '�� Signature -- .. ... - - -- � � , FINAL � 6 Q.�,� OWNER-BUILDER DECLARATION _ _- -__PRiNT . _ . _ . . . NO. - _ . DATE _ _.._'-_ __ _--_-_ . -._ . _ __ -�I hereby offirm that I am exempt from the Contmctor's License ADDRE55 FINA ' " ' '' ' I �� '` '°�� � 4 Law for the follo.ving reason��(Section 7031.5,Bosiness and � , � _ . . . _- 'Professions Code): _.`.. _ �--'------------ --- N y . .. . _-. I � •2 1 fi 6 8 B W t�ING �, I, as owner of Ihe property, or my employees with ADDRE55 �_. -., . . _.__: �i`� i �' ; � wages ai theii sole compensa�ion,will do the work and - , . ; •Z 7 h.h.P�_ �he atructure is no�intended or offered for wle(SeUion ��`��Ty ' ' �� "� - �� 7Q44,Business and Professions Code). ��� --� -- '" � - MOVING`-- � � - �- � -TEI.- ' ' ' � - - - C,: - �I" f ' - _ 2J� C.0 � I,as owner of�he property,om eaclusively toniratling CONTRACTOR NO. �-, ,� � -'�,...._ • r� �(�9 A ' with licensed contractors ro construct the projett-(Seo- -- - ----. .-.-. .. - ...--- �. _. . _..... .'� . � � � �- � ''� . lion 7044,Business and Professions Code). ADORE55 ' .. �_". _ e ---"- " - �- CONSTRUCTION LENDING AGENCY � - � � � SET�BACK YARD' HWY' TaTApROP UNE WI�iH ^ \ ' � � � � � 1 I hereby affirm Iha��here is a construc�ion lending agency for FRONT ' '-'''� ' �%'�:j�� � •(y 7�rj� -ihe performance of Ihe work for which Ihis permit is issued - -� v.L - � -- � -� - - -- - `� - - ----' �' -��- , (Sec.3097.Civ.C.). SioE � ,-t;.�3:?�;`� •(j%ti SC:� . ^ __ � m .. .. . P.L ._ ' ' ' '. ' _ _. . ..'- . . _ . . . . _.... . . _.' ' ._'__ . _ � Lender'sName r�ntinantal Tllinnis Rank , � - - 7.G Fee S� . Permi�fae � LDMA Ref.M � - � LendePsAddress 2.31 So La Sz��e �t-, �h�cago �' � � ' � ' - /� �T�7 .. , _. � _I cenify that 1 have read Ihis applicafion and state�haf]he ___ . .__ __.. _... .._. . __- -- issoa�ce Fee /C/. �- LDMA PFC M /�`�'^�-- , . ..� --- .- .' .. '. . � a ve' mal' is torrect.I agree to comply wilh all Counfy Investiga�ion Fee l'� • g mances and St e la ra a lo building consiruUion, ,,,___, __ __ .. . --� Total fee LDMA Perm.M�%-'`�'� , �� � � G o d here uthori e epresentati f ihis County lo enter i � u n 1 ab e en ned prop ( r inspeUion porposes. �,y�� ._.�O e-�.J . �_ ' .'_. .'_' _. ."o _. . ._ _ . . _ _ .__ . ._ / O/J. ... ._. __ .' '_._ _ ... _ .. . _ . � �-L'L-C,{ SEE REVERSE FOR E%PLANATORY LANGUAGE �� , , _' '° y , __. . . .. �QQ i � ._'_'__' . . ._. .._. .�._''__ " rA � - � � Date .. .'_ __._ . ._'_ . . . _ - - -Signoro.eofApPlic -...--. . . .- - � ' Y - PLANS TO APPLICANT INSPECTOR'S NOTES ,, OR'NER-I3UILDER DECLARATION , . I here6y affirm ihot I om exempl from Ihe Conlractor's To: Rot�rnad � � . � � � � Litense law for the,following reoson:"(Set. 7031.5) �� �-� `� � " �Approved "' QesinessandProJessionsCoJe:AnycityorcountywGicL _ No. Dafe � No. ��'��Data ���- - ��- ��--�'�. �.:�,. � � � ��� � � . . regurrcs a f�ermif to cortstruct,alter,iniprove,demolul, . . . .ar reJiair nny slraclure,/�rior!o its issuance,also rrguirea � ; � �� ' '. � I� . � ' � � . tbe applirant jnr aucG permit to fife a si,qned s�ntement . tLat be is licensed pursuaml lo tbc pronisions of tLe Con- � . �,i: ; • -� � - � tructnr's Lrcense Lau�(ChRpter 9f(tommrncing a•itb Sen tinn 7000f nf Di�tisinn 9 oj1Ge➢usinest and Profetsions �_ __ __.,_, _ ____ .•' . .. ` � ... _.. ' .. � '.' .__ . . .... . .•.' ' __ _ ' "_ CoJeJ orYGat!ir it rxrmpt tGere/rom and the basis/nrlhe , � � � a!leged cxemption.Any viofation nf Sectinn 7031.5 by �,,. ... , `, . . �. , � A �rovals . . . ' Reqolred DataRaealvad�,�,� -.. - . � .,-�� •; . -� �� - '�---- . _ an_YapJ�licantforapern�rtsubjectstbeapplicanttoacioN � PP or Approved ... � , . . , ; : penahy oJnot more tban five 1 undreJ do!lnrs(f500J./:, � � �:Yes No __ '_._. _' . � . . .. . . ._ . . -. ❑ I,as owner of the properry,or my employeei with -� Woter Certificate �`�-`:_ �� . � �; __. __ • _.__ � � � � _ - woges as Iheir sole compensa�ion,will do the work,ond . .__ . _._ _ ._ _. ..__ . . _.._ ._. __.: ... .. .- _.___.. . .. ihe strud�re is nol infended or offered for sale(Sec.704a) � Healtb�epariment.. _ . _ _. _..� �.�__ i _ ' - -- - -- � � ' � � �- -. ... �_. . Businest andProfessioni Code:Tbe Contractorz Licrnie , ' l.aw dnes nof af�/ify to an owner of J�ro/+erty wbo builds i , �. •� .. ,, .._, . .,,_. .., .. . _��� . ., ' Fire Deporlmenl.__.,.---- __ . _ . . -� �- - - �- - --- - - _ _or imrroves 11 creon,rsnd u�Lo Joes sao6 u�ork bi»rself or :.:- ' ..'�� - : ��� ` . ;_.'�`.: ' . .� � . � ' �' � tGrougb Gis ou�n em/�loyces.,proeided tbat asscb�im- ��• Groding � �.J;' ".,'.� ; �'- _ _ � ' � f�rnrenrents are not in(endrd nr offered.jor tale. ` ' •,I . i i'. �('` . ��bo¢�crcr,tGc building or impronemcnt is sold u�r!!in n. Geological � � '•��,- - , �, � -- - , , ^"year oJ m�njrletinn, tl e ou�ner6uilJen wi!!bave 1Ge +. �� '��i . �. ,+'. �'� .. �::'. . .��. . . burJen oJprnvrng fGat bc JiJ nol builJ or imf�rni�e%r . . -. __ ..._.. . ... _ .' ' Pedeslrian Pro�ection '.--. .. `�,: ��. �� ��-. �. . : ._ . .. . tGe purpose of safeJ. �. ', ,- . . . ..', (Fence�(CanoPY) . ... . �. ��. , � . ' ...-. . .-� -�-.., .. ..- - -- �---�--'-- -"-- -'" '� - �� iing❑wifhlce sedreonfhacors��con VucfClhsivelyconlrac- i' e�projed(Sec. Special Inspection`' i �--� -- � �� � � � '� - - - � �.-� -"�"--�--";--"- - -"-_.--- 7044)Uesinest and Prnfessions Codc:TGe�Cnn�ractor's � (Conc.)(MasonrY)(Welding) �� .... . � . : __ ___. .__ . _� ..__ ___ ':_�. .�'_.� ' :T i . Lirensclamdocsnntapplytoano¢meroff.roperlyu�h� 0 � � ' �� "�'6uilJs or rmfro��es 1Gerenn,anJ u�l�o corttracls for rat� ( � LotD�ainage � `, '�(�� V . :___ . _____ _. .. . � Projrt0s-u�itl� a mnerucror(sJ licenaed J�arruant to !be W \_,'.,_ � , .. ._.. .. .. _.� . . , . .i ---�Cnntraclnr's I.rcerstr l.auJ. � � ----- - � . .. . . . . . . .. . - Parking . , - - - - -. _. __ _ _. . ..... . .. .. . . _-� • . '.:���.: � �! : � ' ❑ I am ezempt under Sec. B.&P.C.for Ihiz . .�_�reason _ ._ .._.'_' •, . . ,. . . � ; , ... .•... . .. . . ._. _... . ._ .. _ ___... ...' __ .___ .. . ' Da�c __ Owner ___ _ �:�.��.',:. � . .. _'_._.. , . � . _' _. . _ � _ . .. ._. _.. . � . . ... __ _. . App�a�o�s� , Date Inspactor's Sfgnatura t - � " '- � � � . . � INSPECTOR'S NOTES . Location- � � � . (Setbock 8 Yards) �- -����----�- ���� " . . --- - , Foundations ' � " ' ' � ' � � � ., . _ _ " __' _ . _ _ _ ._ _ . . .. . . � Slab � . , , �J . � - --- - . . . . Frame �! , , . . , . ' . ' .. . . . � , . , . r � Energy Insulo�ion . �� 1��� : ��-�::. '__ .. .�_ � _' _ .�. __ : . . �� . . . . . .. . � Lath/Drywall- lae7y'�!-si ---'.. -- ---- -- - 1--- ' � ,. . . . . _-_ ___.' _ ___ _._. . . IMerior ��V.-'."[ "'�'1.___.. . . : .._ .. . . .. Lath_Exte�ior� I . . , . . . . .-. . .� .- . _ - .� .. .,-., : �� �� � ;�. , . ___ . ._.���.�.. ,': \ �...� ,.. . . ._ . _ ,__ ._. '-.' ,' ^. ..._ House Number- . ,;� _•. ._•'. s �..___. __ ..,_�. �-.��\'-._._.. .__ ,.� , . Correct 8 Posted . . ;, _. , . F `\� . , �-i ',��;;_ ..._._ ��..r..' .:. �._� ._. . . . � ._. Final- - - . . . . , � .. � . , . ,, .._ ___ _ . ..,. ._ ..._._ ____ ' _'.'-__ ` EnteronFront `c-�. ' , . . . . . .�. ' � .'- . . . , , . . � . .. .- . .-. ' -.t,. ... ... . . _, , . , ,