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HomeMy WebLinkAbout1215A 1216A (6) „ . .. .. _.. __. _. . . . ..._ _ . . _. _. _ . .. _ __ _...___ .._._ ._ . ._ __. - ..._ _ _--� WORKERS'COMPENSATION DECLARATION -- �� � ` �- ' `' � ��• ' I hereby afF,.m that I have a�ertiiimte of,.consent to,e�f -��� - � � -� -APPLICATION. .F�.R��BUILDING PERMIT � -����. insure,or o certiiicate of Workers'Compensa�ion Insurqnce, or a certified copy ihereof(Set.3800,Lab.C.)” ��`` "�- � - � � 'WCP6255241 - ' 'Great American Plan 1A COUNTY OF LOS ANGELES BUIIDING AND S Y PolityNo. � Company - � � O Ce�rrfied copy�s hereby fumished:.�- .''_ FOR APPLICANT TO FILL IN BuitoiNG + '" A�DRE55 � Certified copy,is filed wiih fhe county building inspeo- - BUILDiNG . �tion department." � ' ADDRESS � 06re ,12-2-86 aPPltcanr .The�Wm. Lyon Co. oTv Walnut Z1P 91789 ip�uTy '" •'CERTIFICATE OF EXEMPTION FROM WORKERS"•� ��� -�--- -� " ' �' �' - "" NO.OF BloGS. - � �- � nlEnkeSi�- � . ' � � � COMPENSATION INSURANCE �� �� Si2E OF LOT 3 800 SF M in.Now oN ioT 0 � CRO55 ST. (This section need not be completed if the'permit is for one -- ASSESSOR ,_ ��-�'�- '- " �, hundred d011ars($100)or less.) - . . TRAQ BLOCK LO7 NO. � MAP BOOK�� � AGE PARCEI � � TE�' USE ZONE �P so as"m becometsubjeC�o�rmante of Ihe work for which this OwNeR THE WILLIAM �LYON�CO. No833-3600 �� � ; � �. . . ��, Y P permit is issued,I shall no�employ any person in any manner __ . qDD2e5519 COt' orate P 13z 1 - - � -� - -- CONDiTiOnlS a ' the Workers'Compenso6on laws. , , , , , , , ,,,,,, , arr . Newport Beach, CA ziP. . 92660 � - - - - - u Da1e � ' �� " �Applimnt � � � qRCHITECTOR TEL.• OISTRICT.. G OU NPE .FIRE _ GR EDBY .'G �`'QTICE TO�APPLICANT: If, afler making this�Certificate of ENGMEER F�ales-l.angston Np. 547-0$f12 -- I �mplion,'you should 6ecome`subject ro Iha Workers' "� " � CONS � O E _.mpensation provisions of ihe LaborCode,yoV must forth• ADDRESS]�] S. Main St. Ste. 105 Oran 2 � - - - � � � wilh comply witfi'such provisions or fhis pe�mit shall be � � TEL. STATISTICAL C TION APT. CONDO. ,Z deamed�evoked.•,•' �. '• �.� ���. .�' CONiRnCTOR S8[nC AS Owner NO. _ ___ _ .. -- - . � � --�- ClASSNO.�DWELL.UNIT�� LICENSED CONTRACTORS OECLARATION - � �- � � -� -- -- - -- � � ---UC.'- � � I here6y offirm that I am litensed under provisions of Chapier 9 noouE55 NO. ��R�P commencin with Sedion 7000)of Division 3 of the Business and _ _ . _ .. .. . . . . . ._.��C.-- . - � � Professions Code,and my license is in full force and efiect CITV CLA55 � -�BK�"---�-- -- "- - � - - 'VAIIDATION � i . Ucense Numb . � � ,,. . . ._... SQ.FT. _ NO.Of ._ . _ NO.OF . _ '_CHECK . r� J�A e.276801 ���,Class B-1 SIZ STORIES FAMILIES ONE z� G�. _.VA/WAT�ON^�., _ .... .. , . .,.•. _ � � � The Wm., Lyon CO SZ—L—SE7 DESCRIPTIONOF WORK "" '" NEW ' /�/n /y y ) 1'� #• • • •Q� COntractor Date .. ADD s llilY C�CJ�.! , � �I am exempt under Sea , . ... ... . � nL1ER ,.��. .� •�2 S 8�..�. . �.. .. ,. , .,.., , 6.8P.C.for thts reason . . , � � � REPAIR- ' s... . ........ . ... " � _ �_ .. � -� �22,rxB� c. . .. _. '_._" . _.... . _ . . . USEOF : --"�---�Oa1e: E%ISTING BIDG. DEMpL ' __ , - APPUCANT �ei. I 2�1 9-8 b" "- SignelVre.�.. _�� "- ' .'_"- _ - -.' � PRIN7 ' ' NO. ' FINAI ', . OWNER-BUIIDER�ECLARATION .. . _ _ _.. .. ._ . ._ . . . - _. DATE -��-- --' -- � - -��•�-�4� 2�,b"Fl '- . �-I hereby affirm Ihat 1 am exempl from ihe Conlrodor's licease . . , , _ Law for Ihe following�reoson(Section 7031.5,Business and ADORE55 FINAL � � ` ` �. . �{. .,. . ,1 "Prafessions Code): .. . ... .. ... ....`--' ._.._.... __..... _. . R N gY ' , BUIIDING � f', I, as owner of the property, or my employees wNh aDDeE55 _. .. __. .. _ ._...: . .. _ ._ _, � •3 9 Q 0 0 � wages as their sole compensation,will do ihe wark and -� , ; .Ihe strucfure is nol intended or offered for sole�Section ����TY � • - ; -� �� ' •3 9 0.�0 0 c=i ,_ . ' � ._ .. --7044,0�siness and Professions Code�. �------- �-'--" MOVING ...----- " ---" " --'� - � iEL.. . _ .._ .. . . � _ _ . _- QI,os owner of the property,am ex[lu5ively Con�ra[ting CONiRACTOR NO. ' ' . �.��- � 2� 9�8 6 --wilh licensed caniractars to-consVucf-ihe projecf(Seo -' '- � -�- - ' -"-- - � � -' -��� � - - � - - - ADORE55 � • �' . . tion 7044,6osiness and Professions Code). -� '"�-_ ��i_�' ���: � ', .REOUfRED. IOTAL SETBACK .. . -- . .. - . .. . _ -. . . �-- � '"- CONSTRUCiION LENDING AGENCY - --"--" -- -- SET enCK VARD- �HWY- pROv.UrvE WIDTH � � 1 here6y affirm lhat there is a construction lending ogency ior FRONT ��� " r�}!" ' ^ � � " � „ ihe performance of the work for which this permi�is issued ---- p.t. --.._ ._ _....._ _ . _ . .. _._ _. .; . . '".. � . .. .._ ..; _ .. _ . _ - - .., • �� . .._. : � . (Sec.3097.Gv.C.). sioe : - ��� ;'�. . . -- --- _..._ v.l. ---- . _.. __. .... ._... . m _' __.. _ ._. _ . __. .__ ._. ..___ __. _ . . - - - � Lender'sName Cnntinnntal Tllinnic Rank , , $ . . LDMA Ref.A . .. � . � . _ . _. _._ _ .'_ _ .. __ ._ _ V.C.Feef._�..`a- -. 7e..��Fee- 7 .��... '_ ... _ - lender'sAdd�ess $�� $q �,a �alle �K � Chi^ago `' � .I.certify ihat 1,have read this applicafion ond.stote�hot.the .._ . _ . .... ---��-- leeuanm Fee-- �• � � �� LDMA P/C N-�-- --- -- - - - � ���- �- �- � .c above iniormation is correc�.I agree to comply with all County Invesrgaiion Fee l� �' `�g _ardinances and Stale laws relating.to buildingmnsvoction. _._ _ . .._____ . _ .. Toral Fee � U.�� LDMA Perm..N . .- . � . . ' - i� and hereby oothorize representatives of this County to eMer ! . m upon the above-mentioned property for inspectian purposes. , __ _., . a ' /"� . . _ ... _ _ .._.. _. __. .. . . .. __' " _ ' _ _ . _ . ' ' ... . ..'_ ' . . ... i _ � ^ (r(/tiL�.aL.��f,({JG, �.r�"S�$L SEE REVERSE FOII EXPLIINATORY UNGUAGE �O 1 i a � �, -" - - Signature af Appiicom or Agent - - ' " pote ' ' .._.. . �.. . - I OWNER•OUILDIiR UECLARA770N - PLANS TO APPLICANT INSPECTOR'S NOTES I hereby affirm that�l�am exempt�frcm the ContraUor's To: � Rofum�d '. �' � . � � _ �'�License Law�fdr ihe��following rea3on:'(Sec.�7031.5j � � �� ' � - � - Approved ' Duairtess and Professioas'Code.�Any cily or rounty a�bicb . _. .. ._ ,. . ..... .... . - No: Dafe : No. : .Data � • ' � -- �- � � . • �.. , I ����� ,requurt a fernrit to tonttrutl,aleer;rmprove,denrafrs5, , , _ �_.or repairnrsyslructure,frior fo ifs issuantc,also reguires - . . . ' . , . ', . , ., . tJ e ap/+licant for.rucG Jmrmit ta Jile a signed statement �_ � , lLat be is licensed pursuant to 1Le provisions n/t!c Con= , �. ,��..; , . � lraclor's I.itense Lau�(C!eptcr 9J(comrnencing u�ilG Sea - ""� tinn 7000f nf Dirisinn j of tGe Dusiness¢nd Professions i � � •. `��i .'�, , ,, �� '�� � � �� '� • �� CndcJ�r tbat bc is exenept fl crefroin and the basisfar�l e .. __. ...�. - . ._ : .:�_ ._. ,.. - ,___.. -_� ._ . ___ ._.. __.._ _.____ _ . _ . __ . . . . . _ " , , a!lege exe�x�itinn.Any vinlation of Seclron 7031.5 by ' ' ' � Raqvlrad� ' DataRscalved.=.� -- -- � •���. .. . .. . anyaJrJilicantJnrapern�itsubjectstheapplicanttoarh�il , - aPProvals-`. .. � or Approvad� . .. ... . ... .. . ...... .. . .. , ___ _ .� p¢++alty af nnt mnre tGan Jive bundred dollarr(SSOOI•I+i � . � Yes\ No � � � ❑ I,os owner of Ihe property,br my employees with Water Cei�ificote - � � � - � wages os their sole mmpensa�ion,will do ihe work,and , � __ _ ..' ' _ ' . ._. - � �- ���- - --- � ' - � the struclure is not intended oi offered(or sale f5ec.7044) � Heahh Deporiment �, " - � � .. . .� . ...; .-... .-' -' -'._.. .. ..;_._ � - . .._ -�-. ��au.�does not apf! tons Code:Tbc�CoaOractor's Lirense _ usinrss and Pro essio , � .. �. _ _ , throu b'hrst�ten�en d ' �' b ' s . _ _. -��..,. � : :... , . :,. �_ Pfoycet,d ojpropert��u• o uiGl FireDepariment _.. _ _ _ . . � � � � P o oetaerLuorkbimselJor . I ' ' g ., prncided tlat,sut!.im� Groding , � � ' � � J�rnven�enls.are noLixlended or,offered for.sate. . - � -�,� , -� , �;; . . bau�ener,tbe buildrng or improvemen!is sofd u�itl in r.. . Geolog�cal . �� �� , ,,. ., .� , _ , - ,year oj�nmpletinn, tl e awner-buifJen u�i!!6aue�!!e � � �• - burden of pmuin,q lGat he did not buifd or im�rane for �.. P . . . . --. _. .... . ..._ ._--`- - � edestrian Proledion. : ' . �.. . lfir/�erpase of saleJ... . . . (Fence)(Canopy) � � - �� �.�\ ' ----- ---- --�� - � ---- ----�-� � � — �� . I,os owner of the properiy,om�exdusively tonlrac- _,�t " ` ' �ing❑wilh licensed conuoctois to construU Ihe rojecr(Sec: `� ' ' - -C. , _. . _ _. + --.- � - �� - - -� - �- - -- - - . 7044)Uusiness anJ Pmfessinns�Codc_Tfic Cantractor's � Speciol Inspection , . _- . _ ..'_ __" . - , . . ..._.. . ... . . I.icertic Lau�daes not a f tn an ouarer o ro ert, u�l o (Conc.)(MasanrY)(Welding) �,�;��: PP,Y f/+� /�, Y , . �.-��� � . � � ui Js a ini o es 1Lercon nd u�Gn t nlracts f r sucl lof Drainage ° • + '. • `� ' . ,'•, . . .. �... _ . . _. pr�JeclsluilLra mntracror(tJ�licensed j'ursuane�tn tl e _.. . . . . _. __ _ . ._ ___. .. _ . ' j . �� -Cnntrac nr's l.rcrnse Lau�J. � - � -- - , , Parking . = � �� . . . � 1 �i'.� .., :._" .. -- � � � ' " ��-�--' -�amezemptunder5ec. . . 6.8P.C.forlhis ,. ❑ � . . . . , . t_ , . - , . .. , . . . , . . . � ��.,,. � ' � � � e� , , . .reason ._. __ _. _ ..... . , . - . .. __ . . _ _ ..____ .. _ -___...._..._. _.__ . �- . �� 1 �ata Owner , .._. . :.,. � ,. .... . .. . ._ _- . _ - . .. _ .,., ,. . . : . ..._ ._ .. � � �- .�_. : t..; i: � . ,. . �� .. Approvols Dafc �� Inspecfor's�Signnturo . _ � �", INSPECTOR'S NOTES � _ . _ . . � , . _ _ .. . Locotion— � ' ' .__ "._ _ ._.._. _ � �Setback 8 Yards) ; /� - �� � � • � Poundaiions `� ' � -- �� � � . .: � �. .. . . . Slob . -- i r, i �02 . .. : . , . . . . Frame �� �i. . � . . . .. � . .�, .. . . �. .�.t.,-. , . . � Energy Insulalion � '_ '.I. . ...._ _ . _ ._".'__ ..J. ..._i ' '. , ..- , . , . . . ' � - lafbiDrywoll— rp� --!-- - --�---�- -- . �_._ -�- -------. ----, ,.. INerior -t` "'~'—'�-- --- � . .,.� , Lofh—Exlerior . . � . .. �.-. - �. ... , . .� : : ''..:�:.i..:_.)_'..:7:�I1._;:C:_.... ..,� ,. . ,. � . HouseNum6er— .: „� . __.._. _,�_'..._,,. ,, �. • �,-��- - r . . .. � . , - , � . . � ______._. _ ._ .__. . , . � . Correct 8 Posted '� _.... . . . . .. Finol— _ ... _._ _ _'.___ . .____ . . �._._._. .. .___._ . . . . . . . . . __._..._._._.. . - ..� . Enler on Fronf � � r . � � ' � .�. � . ..