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HomeMy WebLinkAbout1257A 1258A (6) i . � . . . . ___. �.-._ . _ . _.._. .... .a... __ . .__.. . . .-- '_.. _. _ ..... ....___.. ....' -_ ' _'. . .__ . _ WORKERS'COMPENSATION DECLARATION ' " . ' �,� '�, ' � '. - . '� ,�. I hereby a(6rm�hot I hove a ceriificote o��o�5e��,o se�� -� --��� �-qpp��CATION� FOR BUILDING PERMiT �---�- -�- insure,or o certificate oF Workcrs'Compensot�on Insuronce, or a cerrfied copy the.eof(Sec:3800,Lab.C.) "" -- � COUNTY OF LOS ANGEIES BUILDING AND SAF TY WCP6255241 Great American Plan 2CR ' Poli[yNo.. .Compony . . ..- - O. Cerrified copy is hereby furnished. FOR APPLICANT TO FILL IN bUILDING /,j'�� �L ADORE55 r/(/ � �� Certified mpy is filed with ihe county building�inspec- - -� BWLDING . , � "fion depo�tmenf. '� ' ADDRE55 Date 'Applicant '' y.. ..- CI7Y ZIP . ... �p('qttTY 12-2-86 � The Wm. L on,Co. Walnut 91789 ' CERTIFICATE OF EXEMPTION FROM WORKERS' ' � � ' - � - NO.OF 8LDG5. -- � -, NEAREST_.._ � �,.�,,., , .., S2EOFlOT3 HOO SF Min. NOWONLOT 0 CROSSST. � � ����COMPENSATION INSURANCE � ' (This sec�ion need oot�be completed if fhe permit fs for one --� -- - - - - � - ASSESSOR. , . . . ' ' ' hundred dollars(E100)or leis.) .,� , ,. TRACT BLOCK LOT NO. hWP BOOK � PAGE� PARCEL owNeaTHE WILLIAM LYON C0.- N�33-3600 usezoNe aaP I,cenify tho(in"the performance of�he work�(oi wFiich this �� ��� } permi�is issued,I shall no�employ any person in any manner _ - SveCini-� . - - a e�s•Compensanonlaws. Aooaessl9 Cor orate-Plaza -- - coNoinoNs 'u t naeHrteaor�tales—Lan ston Te�. -__..._._ so os to ecome su 'ect to t e or aTr Newport Beach, CA ZiP 92660 � Dare ,.. ..•"APPIiwn1 � .,.,, ....,... .___ . . O �I,)TICE-TO APPLICANT: If, a�Ier making��h 5 CerlifiCtlte of ENGINEER b' NO. S�L]-OBGZ� DISTRIC� GROUP TYPE_ FIRE PROC ED BY_ .F .I mpfion, you should bemme subjeU�lo fhe Workers' � �CONS[`.//' ZO E � � .npensaiion provisions of tha Labor Code,yoo mustforfh- qDDRE5S7�� S. Main St. Ste. lOS V - with comply with such provisionz or this permit.shall be -��--- TEL. STATISTICAL C I TION . CONDO. Z deemed revoked. .�....�,.�„ ... � .,, �. : .�.,.,' . CONTRACTORSBIne AS Owner NO. � . , ._ _. . ._ . .... / LICENSED CONTRACiORS DECLARATION�..c•,l, -� -- - - -� --� - - - - - ---���C. �� � -- � - CtASS NO. DWELL UNI75� . 1 hereby oifirm Ihal I am litensed under provisians of Choptel 9 AOORESS NO. , i (commencing with Section 7000J of Division 3 of 1he Business and __ . _ _ __ . .. . - . �i�, . ,_ _ SEWER MAP Professions Code,and my license is in full force and eHect ❑TY Cuss - aK �--- - • VALIDATION�" � - �. . Z�6HO� �� B-S. . . . SQ.FT. NO.OF NO.OF CHECK � � . .. . . L([ense Number �LiC.Closs ' S1 STORIES �� fAMItIES ONE � ' The Wm. ,L on,Co 12 2-86 ---- __ NEw_ � vqtuATi���N�>>>\ . . Confrpcfor ' y Dafe OESCRIPTIONOFWORK ADD s��`"- — ^ ❑lamexempfo�dersec. , - in le famil home constr ction A�TER � , : =1 257A ,. ,�• _ _.., , _ 8.8P.C.for this reason . . • � REPAIR . s -- -� ." .��. . .. . -.- .��i• • •-•2� .. ' - -- -- - Date:�- - USE OF DEMOI -.`. + . E%ISTING BLDG. - -- ���2�L 7,2�J ' �-�-'- APPLICANT TEI. � � ..Signafure �-��`...���-- - . . ... _.� �� � FINAL ' , ' OWNER-BUILDER DECLARATION PR� W' : N�" - ' DATE� '� -- - -..__•.•247.23� �-1 hereby affirm that I am exempt from�he ContraUor i License � Law for 1he follawing reason(Section 7031.5,Business and ADORFS$ F�NAL " � '� � �2� g—g 6 _._- ------� P�ofessions Code): � .'-. .... . .". __ _- . R BY . . . . . ._,.__ . _ . � BUIl01NG z� 2�j�A � I, as owner af fhe property, ar my employees wifh ADDFESS _ „_ , ,__..,, ' _ . ._ __ . . wagesas iheir sole compensation,will do�he work and � - � � � �',the strocture is not intended or offered for sale(Section ��`��TY ' , ' - ��, � • • :• • � ... , -- �- 7044,Business and Professions Codej.�-� �' ��-'� -' - MOViNG- - --- -�--- �- - -TEI. -� �� -' -- - � - - I,as owner of the property,om eatlusively confracting CONTRA[fOR NO. . � '�, � � '� � °[j 2(x Q Q' � �-- wi�h licensed coniractors to conslruti the projett(Sea .. _ . - .. - - - -----....-- - --�-' -. . - :' " "�- .- � . . _ .: lion 7044,Busine:s and Professions Code). AooREu ' I � •4 2��Q�� ', ._.__. .REOUIRED TO1AL SETBACK � ! p - -"" ��-CONSTRUCTION LEN�ING AGENCY'- --� � 5E7 BACK YARD HWV PROP.LWE WI�TH . . I Z,� 9-H V I hereby alfirm Ihot there is a mnstruction lending agenq for FRONT ' " ' -the performance of the work for which this permil is iseued � - v.i. -�- �-- - - -� --� � � --- - - - � ���� -- � � - (Sec.3097,Civ.C.). SIDE _ �= ��,�� � • m _.._ _ P.L. . _.._ _ _. _ � . ' . .. .. � lenderiName Continental Illinois Bank I � !L7 y� �n,�,Ref.« -- . - P.C.FeeE- ' T4,a . -� oe.m,F�e� 5 - , � - . - , - Lender'sAddress231 So_ l,a-�Salle Rr_,� Chtcago � ���-'� ` � I certify thot I hove read this application and state that the ___- -_-..._.. . _ . .__ . IxsoanceFee � - � � LDMAF/CN � - - �-� - � -� �- � above information Is carrec�.I ogree to comply with oll Caunfy investiqation Fee �O g _ardinonces and Stota laws ieldting fo building construUion, __... . --_ ._ .... . - . -. To�ol Fee � -LDMA Perm.X - � ���- -• � -- - � and hereby avthorize representatives of this County fo en�er , � upon fhe above-mentioned prpperty for inspection porposes. ' - • o _ . .. _ . . _ _ . _.. .. .. . . . . . _ _ . . . _ ._ . __. . ._...__. . .... " �,.,-.�_�.r� l s � _ � , -- - -Signorure of Appl�mnt o.Agem- �-� -- � ...���. SEE RE�SE FOR EXPLANATORY t N OASGE � . „ .__.-O'� � _ . __ . � PLANS TO APPLICANT INSPECTOR'S NOTES ..O\VNiiR•IIUILDGR.DECLARATIDN I hereby affirm�hat I am exempt irom the Coniracfor's To: � Rofurn�d � . ' � � . � ` "License law�for the following�reason: (Sec. 7031.5) �Approved - Qusiness and Profetsions Codc:Any oily or county wl itG No. Date � No. • DatQ �� ..� . �. � . .- � . .. . �;1`. f;�-.�" :;reguiresa(�ermittamnstruct.alter,_iniQrove,:demolisb, _ _, , _ .nr repairanystructure,prior to its issuance,ako reyurres . ' . � � - . , . . .. ., -� ,.. , . U e applicaxt for surl permit M j'!e a signed statement tGal be is ficented pursuant m ILe pronisions of U e Con- , , � � : ���, � [ractor's l.irense!aw(Chapter 91(�on�mencirig u•itG Ser= �- � � - trnn 7000J of Dii�ision 3 of fLe Uusiness and Professinnt . . . . ��... _�.__ i ! -" �. . : '�''�. ; �� � � ... . . � ' �.. .. . . _... _. _._... I�:{,.�. • _•CndeJtir7Gae(re�isexen�t!lerefrorreand'tbebasis�orlbe ___ _ t�_.�._. � ' ,. ' - •Rdquired : .�Dete�R�e�iwd� -.. .�� - . - .- . � - � . , _ e ___ . onya/+plicantJorapermitsubjeerslJeappliranttoari�'J Approvals Yes �No ar Approwd , . r.,,. , ` :\� -�Qenalty oJ no!mnrc t5an jive hundred do!lars/SSOOJ.J: . . . .. .... � � - ❑ I,as owner of Ihe properly,or�my employees wiih ' -' ' ' i �" � '� • _ �- • �--• � wages as their sole compensation,will do the work,and WaterCertificate- . � -.. �.' - : ._.. ._ ` . . . .____ ' .. � . .. .. --- - � � the struUure is�no�iniendod or offered for sale(Sec.7044) , Healih Departmenl -• . `. ' �� _ . ..__.. -__ .-` -- , .. ._. - ��,:; . ='.,:. • ., O,Qur does no!appfpstonan ou+e:TGc Coneractor't Lirense � ` . L ncr of property wGo builds ' Fi�e Deparimenl .. . � - - - - _or iniprovcs t!rrrun,and u�J o docssucG amrk bimse Jnr . . . . .. . .._ - _ _ _. . . _ � � ,-,� , �t� .r_�., � � ' flrovgG�Iis oum cv�p[nyces.J�roriJed lbat suchyim� � Grading . � �, r " � __ ,pms•cmcnes rtre nnt rnteaded or offered Jor sale.' � . � ' �' ' ' '• -��;� .��� � ��,; �-� . - bnu•e�Mr,tbc burfding or inrpronernertt it snld u�rtLin� Geolo9 ml - � . _, � �yrur of ronipletinn, tl e oeemerbailder wil!/avc 1Gt � � � . - ' �� '��� ���'' burden oJpmnrng tGa!be did not build or imJirove fnr � ' . , ' . _____ __.__. .'_ _ __ , ... _. .. _ ' . . Pedesfrian Proteclia� . . . \.: �� � � � , t!c pvrposc ofaafeJ. . �. . . .. �.: .. (Fence)�CanoPVT � ; � . -.-.... .- .. .. _.. ._ .._. . ' . ... �" I.asowneroflheproperry,am�exdusiJelymntrao- ' , ' ling,with licensed tontraciors to construcr Ihe project(Sec. Speciaf Inspeclion � � - -� � ' � �� � - - � --- Uusinest anJ Pro ess ans,Caile:�_T Contractar's . --- 704C) Ge '... • _ .... � (Conc.)(Masonry)(Welding) ; ".'.. � �. ,_ . I. - _ _ . _. -_-. C.G`'�:.:.'.'i - I.icense-I.uu�Jocs nof arf�lY to an ou�ner oJproperey u�bn ��- - � '�--buifd.a or imprnecs tLereon,anJ u�l�n7nntracls j r suc! ` � "- / ' ,_t. � prujeets-u�itl�a tnntrac[nr(tf�liccnseJ parsuant to !be : lot Droinage ' - • . ,.__ . . .___. . ... . _ ._— . �n � . . . .. . _ ...Cnnlruclor's l.rcense�Lau�J.- � " - .._., tl porkinq � ..- . �. . ._' '_ ' --- -- �- - � ..,' ' _. . . ❑ I am exempt under Sec. ,B.BP.C.for fhis � � . � reason --- - � - --� . , .. . ,.,; . __.____.._. . . _. _ _ ._ _. _. . . Dale Owner _ . � :.._ � : �� ,. � ,.,�� . , � . . ' '__.' . . . _ __ __ __ _ 1 �,. � f Approvals � Dote Inspecmr's 5lgnmurb.� . . . - . . � � INSPECTOR'S NOTES � lotalion— � (Setback 8 Yards)� �� J � � � . - �� � . . Foundarions�, . : �I .� , . . _ .. � . ...•. , , �. . �. . . SIa6'�, . , . i /,2.�T� !� - ... � � ' Frome � Z�/�� . . . . , . � . . , . , . , , , , Energy Insulation � _..._ ._ . - . ._- . _ _ _ _. . �. . � . ; . ... . .. . . , . ., Lath/Drywall— . _.. ..._� .... ------... .. . ...... . - Inlerior --�i----..-. .—_ � � ' � lalh—Exterior' . .• � � . ,. ��n�� i I . .� . . -- - . . . i',.... . :._ . . : :- House Number— .._ . .- __��..L. _�•-._. _ . ._. _ �. , • ..1;�. �_ _ ._ ,-> ' _ ._. .,'-� _._ i I' . .,. .,..__t�.. . Corred 8 Posted � � ..�. . � Finol— ._'_._...____ . .. . . .__�.�...._� �... _.... .. . . ., ..... . __._ .._ � ___ _ _ _'_ .. . , .... ,. . „ ..... . .. Enter on FroN �•/� P, �`�� � �� � - ., . _ . . ... �� . , . . C