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HomeMy WebLinkAbout1255A 1256A (6) .. _. . . ._. ._ _. ._._. . . . . ..__ ... _... ... _ . _ . . ._ ___. _._ ._. ... ___.. � WORKERS'COMPENSATION DECLARATION . � � "�-• ' �- � � '� '` '� �� I here6y uffirm that I hove a certiiicale of consent fo se8 insvre,oracerlifimteofWorker5'Compensation��,��a��e, � ����-� :� ��APPLICATION FOR �BUILDING� PERMIT��- ��� or a ternfied copy ihereof(Sec.3800,tab.C.) ' ' � CpUNTY OF LOS ANGELES � BUILDING AND SAFETY WCP6255241 Great American Plan 3BR PolityNo. �Company ' ' BUILDING � �.Certified copy is hera6y f�mi:hed: �� � • � FOR APPLICANT TO FILL IN qDokeSS � aCer�ified capy is(iled wiih the to�aty building�inspec- BUUDtrvG � tion departme�f. � ADDRESS Date�� 12-2-86 � Applicon� ThC Wm�. .Lyon.Co. arr walnut Z,P 91789 , ����r � CERTIFICATE OF E%EMPTION FROM WORKERS'� " �� SIZE OF LOi 3 SOO SF Miri. NOw ON IOTS O : 055557. r �This settion need not be com leted if ihe ermit Is fo � � "COMPENSATION INSURANCE r one ASSESSOR "-- � ( P P TRACT BIOCK.. � - ... l0T NO. '� - MA.7 BOOK � .. FARCEL hondred dollors($100)or less.) � . . - �. ' - owraeaTHE WILLIAM LYON C0. N�33-3600 usezoNe �P I certify Ihal in the performonce of the work�for�whitH this �' O �a permit is issued,I sholl not employ ony person in any monner _ SPECIAL �'f ,O AD�RESS]�J Cor orate-P1 Z � ' CONDITIONS �.cy J so as to become'su6jetl b�he Workers'Gompensarion Laws. - , �V `� � New ort Beach GA 92660 - - arr. _P ' z�P _. _ ' a Dale � .. ., .. APPIicaM �. ' � , �. . . _... .. Q ARCHITECT O TE�� D1SiRICT. GROUP TYPE FlRE PR SED BY H f'S)TICE TO'APPLICANT: If;'aiiar�making thiz Certificate of ¢NGiNeeR �lales-Lan S[Oil No. 547-0862�� ro�;T,� 'z N I mption,'you shoold berome�sabject�ro ihe�Workers' -- - /� _ � W � empensotian provizlons of the labor Code,yo�mvst foNh- ADDRESS]7] . M ' ��� � - - n' �' s or this pe�miL sholl ba - � � •7EL � STATIS71CAl 5 ICATION A�. CONDO. ' �Z de medmeL'CE SE�DCONTRACTORS CON7aACioeSHfiO AS OW1lBY NO. � .� — PY P __.-�'/ DECLARATION . � - � �� �� � � - --� � � UG � CLA55 NO. DWELL:t1N1T5�L I hereby affirm that I am licensed under provisians of Chapler 9 AD�RE55 ' NO. SEWER M4P ' (wmmencfng with Section 7000)of�wision 3 of�he 8usiness ond _..._ . . ._ ..... __ __ . ___ _'. LK. . ..._ .-.. � � . . Professions Code,and my litense is in iu0 force and effecL CITY ' CIASS '� BK� - �;� � - � � � - � VALIDATION - - � ' � 50.FT. NO.OF NO.OF ,CHECK � � -' 51 510RIE5 FAMIUES ONE �..' LicenseNum6er2�6801 ���.ClassB-1 � ` ' . ., � � � NEw .� - YA ATI .. _. .-. -' ._ .- _ The ,Wm: Lyon Co. Z�L-Z-H6 � DESCRIFfIONOFWORK Contiactor Date . noo s� �� 2�5� �I om eaempf under Sec. AUER � ' . #• • • •2� � 8.8P.C.for fhis reason REPAIR-� - s - � , � (��.•2 7�.6 H USE OF - - " � - - - Date: - DEMOL . EXISTING BLOG. --� � ` o APPLIG4NT TEI. � � �2 7 U b C+V ---- Signatore . . . . . -._ -. � FINAI . . OWNER-BUILDER DECLARATION vei NO. _ . DATE- �--- -,� �2� 9 y 8 b �� -1 hereby offirm that I om exempt irom the Controctor's license , ,, � ' � .: .; . , , Law for Ihe following�eazon(Section 7031.5,Business and AbDRE55 FINAL/- � '� � �. -Professions Code):.. . . ` .. . . ....." . By U\./`/`� - ", - ���2 S.b�I � BUIIDING � :. . . . .. � . .. I, os owner o�the properfy, or my emplayees wilh AODRESS -��'\ !. � • • � �.�.� wages as Iheir sate mmpensation,will do tbe wark and � ' ��`�, , � � � � , the strucrore is not intended or offered fo�sale(Sec�ion ����TY ' . .' � •Q 7.5,5� -_ ��� � �-7044,-Business and Professians Code). -�� � � � � �- '- MOviNG - � � � - ' Tft. � � - - � _� - , � CONTRACTOR NO. , � O I,as owner of ihe properfy,nm exclu5ively conlracting . . .. . . . _..._ .... . . _ � �: ..'._'.'- ''. �_. . .-... '.-. . '4..7�Jr.�c=i • • wilh licensed cantractors to tonstruct Ihe projett(Seo- �- - qDORE55 �' � tion 7044,Business and Professions Code). � '. � � . �z,� 9-fj(��-'�� . RE�UIRED .YARp Hy� . TOTALSETBA K I . . . -. _-- . .. _. - . . .. .. _ '� - � CONSTRUCTION LENDING AGENCY " " �� -�- sei EneK PROP.IINE wiotH. , . . . „ I hereby offirm thot Ihere is a construction landing agenty for FRON7 ' � - � � �Ihe performance of Ihe work-far which ihis permit is issued �--- � -P.l.- � � � � -� � � -��� " � � ' �'- " � ' "" '. �-- � ��� """- - - --� - (Sec.�097,Civ.C.). SIDE , _ � .. P.L __ _ _.. .. . .. .. _ ._ ..__... . . � r . � , ._ _ . . _. _. _ ___ ". _ _r'_ � Lendcr'sNama (�on 'nPnYal Tllinoic Rank � � .. . .. �J . LDA1A Raf.A . . � __.._ ... - � P.C.fee S Zl Permu Fee- S•� "'�� .. __ .__. _ , . - Lender'sAddress.�i Cn- I.� S�llo �r.__ Ch,_,ag0 � : � J tertify Ihat.l have read Ihis opplication and stote thot rhe ._ . ..... _ _.. _. . . - Issuonce Fee � � �DMA viC 8�- �- �� -� � - � �� ��� mabove intormation is corred.1 aqree to comply with all Covo�y Invesrigo�ion Fce . � ordinances and Slofe laws reloting la building conslruction, _, . ._... .__.--- _ To'a�Fee----y7S.�J� � LphlA Perm.N � - � � � � u and hereby aulhorize represenmlives of fhis County fo enler � . $, upon tha obove-menfioned property for inspeclion purposes. 115 - , f„3.� ' ' _ �_,�� - . � '..___ "' . . . .. .__ ___ _ ._. _ ._ . T ._. .. . .. . �^ �ii,�.�..c_E'. t�Euvs _ _ - � a � 3'86 SEE REVERSE FOR EXHANATORY tANGUAGF � , � �S _-'__. SignaWre of ApplfcantorAgent _ . .. Da�e . . _.._.. _ . . .._" '. _ . ... ._ .. . _...._ _ _ .. ._ . _ _ __ _ .. __.. ._Q' � ��a-i � PLANS TO APPIICANT INSPECTOR'S NOTES ; OWNBR-ISUILDCR UECLARA'I'ION �� I here6y affirm that I om�exemp�(rom tha Contrattor's � license lave�for�the followin reoson. Sec. 7031.5 To: , � . RNurnad � � � ' � . .. ' � . ^ � ' .9� ( ) �' "� " �Approved ' � QusrnessondProJessionsCoJeiAnyci�yprcnuntywGicb . . . ...� _.. . _ No. Date � No.� � Date� . . �. .• � . .. - � � � � � � I.�i�. (,reqarres a/rermit!o tortstruct,aIlcr,ineprove,demofisb, " ��' � . . _ � , �� . -. . . . ,_.a ' �:�. .,;�.. � � tbe�J�lironl for surb�fcrmrt totfrlc�o signrd statement IGat Ge is licenred fiursuant to tGe prnrixions of IGe Con- '� � , '. , ,,, � , ;,;..�.� � �. ..... � �-�•� '. tractor's Lrtense Lau�(Cbap�rr 9J/comnirncirtg uitb Seo- _ -...,.__:.._ .._._ �,.._ ....:��. 1� '.- � .-_ trnn 7000J nf Dinision 3 of tGc Busrness arsJ Prcfessions ��� �� '� � � ' �t - '�'�� ' •`'� CoJeJ rir e!at bc'is e.rempt 1Gerr/rom and Jbe basisJor tbe l_ _ ' � ' .:.�� � _ _. . . - __. .._ _. .. - - � - - � a!lrgrd exemptiort.Art,y vrolation nf Section 7031.5 by . . ,' . Requfrad� . Dafa Recefvad- - - - --- . � . . . . - ' ` . , . . . _ an,Y afplicanf fnra f�ern�i1 subjects tbe af+f�litan0 to a cie�i! --Approrols�1 ,Yei No or Approvbd ;,- . � f�analty of nnt more t/ian five Gundred Jo!lars(b5001./:, ' _ - , J�J .':a.. - - '- ��- � � ��"� � � � ❑ I,os owner of Ihe property,or my employees with ,. Water Certificme- � � � � , ,. _ . ... __ .. __. _. .__ • . ' . � wa9es os iheir sole compensoiion,will do�he work,and � �--�- � �-� ��' ���� � � e stroci"re is n �'niended or offered fo iole(Sec 7044) '� Health Department -_. '• "�'. , : :_---: '�. . ._____� _ .._ . .. •- . . - , � . .. � Dusiness andPr fessions Code:TGeContraclor's License � � ,;, ���� -�, �� ,,, . „.,, �� ' law doet not apQfy to an ou�ner of pr�erty u�ho builds � Fire Deportment _____._ _ ... . .. ... . __._ �----- - - - -� y �- _ - - - or impronet 4erc<n,a d u�Gn d es sut tt+ork Limte%or t , n o II : . . ., -��� � ,,��..�:,_,. �i.,' . '.•�_.,•��.:. . , tbrou ! bis na•n�em !o ecs,. mnided�lLnt ssstL im� s � y o � � � Groding � - ' � "' -• ,pmvements_ore not intended or o/%red for sa(e. . � -- �" - , , , , ;;� � bou�crer,fGe building nr imQrovement is sold u�i!l�en o.. . i , Geological � ���..� -��� . � }'ear oj compfetioa, t6e oa+rser-6uilder u�i1l have�1Ge � i'�. - � ���� � �� � berden of prnuing tbat Le did nn!bvrld oi imJ�raue Jnr , i � , .__ __'.. _ ___...._._ _ ._ _.. _� _ ' Pedestr�an Prorection. - - - " ' � . � tl�e parpose of saleJ. . : _. ... . .... (Fence)(CanoPY) � . . ... �.. . � ; -.. - - -_- -�-.. - - - -- --�---- ......- �._ ' . ❑�'I,as owner oP the propeny,am exdusively mntmc, . . ling wi�h licensed contracbrs to mnstrutl the project(Sec. � Special Inspeclion � --� - "'-- - - � �� ' ' '-" � 7044)Uusiness and Professions CrnJa;Tbe Contractor's � (Cont.J(Masonry)(Welding) �,` ,�1 Licensrl.du+dnes nnf applylo an owner ofproprrty u�lin �- ' ��� � - builds or improra tbcrenn,artJ u�Lo tontracts for'tucb LotDrainage� ��_ � -" _ ' . . . pmjetts u�ith a tanfrxtor(sf JicenscJ f�ursuanl to 1be . ..._._ .___ . -_. ._._ __ . . --Contwrtor's Lrcense Inu�J.- --�- �-��� ,_ Porking� ,: : � �- �` �� � ' � . '. . �._ . ......•._ , �• . �.. .❑..I 6m eaem i under Sec. �._.. . . . . . , p . . . ..'8.6P.C.tor�this . . . , . i , reason..__ . ._ . . . . .. - . � . � . .. . Date Owner����� �� � :... . . . . ,. . . . . . � ; . , �, . "__ __ ._ _ . _. . _1 � . Approvali � Da�e - Inipector's Sfgnotun � . , . � � INSPECTOR'S NOTES ' � � �! Localion— � �� ... __' .. '"__' __.'' - ISetbatk 8 Yards) n � � - - Foundmions , f� � �� � � �. �r � - � . � . Slab ����iJ �/2 , . . � Frame�, . • � � �,`��';� �. . . . . . _ _ ., ' � .� . , ��- , . Energy Insulalion �. � .....'_._ '_ . " _ _'.__ � : .__ �. ...: . . . . ,, _ ..,. , � ,. � . . . � i . ' . � , � • . .. .. . Lath/Drywali— � �--- ---- -- - � - --' --__.._., ---� ----_: . IMerior � �-- - : � � ' .� ..: � . Lath—Ezlerior . . � . . . . � � . . _. � _ ,._. ,__ 1 L.:..._.-..__ . ._. . . � � . . � �i i ,-. . � � . .. „ House Number— �' - �" '--'� "` �-�'' , , , , ��� .. .. . .. _. .._.._'_...___. ..__ ...... , .. � • . . Correci 8 Posled � ;�-; , .... . , � . � -. � �, .-... .� . . .. .. .,, � Finol— . _ . __.'. _ ._ _._.-• .. � . __ . . ._. � �. , . ._ ._,-._. _ _ _ . , Enrer on Front ^ , � � � : � .. -. ., .. . . . ... - - ' �.�.. . � . , � . .. ' ' . : � . . . � � � ... _ _, , \;: . . . . ��.