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HomeMy WebLinkAbout1217A 1218A _ .. .. .__ _... .. __. _ . . .._ .. _.-- -- -_ _... -- , WORKERS'COMPENSATION�ECIARATION ' �'�-� � � ��' ` ' �� ` � � �� �. . � �� � _ _. .. ... . .__ - .. .. ._ . . ... .. .. ' . - I here6y affirm that�have a certificate.of�o�,e�,,o ze�t qpp��CATION FOR BUILDING�� PERMIT� � ���� insure,or a certificate of Workeri Compensalion Insurance, .__... . _ . . . .. ._' _ � .._... . _. o�a cc�r ied mpy t erea (Sec.3800,La .C.} COUNTY OP LOS ANGELES BUILDING ANO FETY PolicyNoJCP6255241 Compony Great American Plan 2B a Certified copy is hereby iornished: FOR APPLICANT TO FILL IN Bl11lDING ADDRESS a �Cerlified copy is(iled with the tovnty buitd�ng inspea � � BUILDING , . � "tion depoAmenC � � ADDRE55 ❑ � D6+e -12-2-86 . qPP�;�a�t The Wm. Lyon Co. c�Tr Walnut Z1P 91789 iocs�uTv • . .. ... . ._ . NO.OF 81DG5. ''. NEAREST- ._. ... ._.. ' "' �- - .; ' CERTIFICATE OF El(EMPTION FROM WORKERS''�� � � SRE OF LO7 3 HOO SF M1A.NOW ON�OT O CRO55 5T. ' � � � �COMCENSA710N INSURANCE � ���� (TFis�section need nor be compleled if the permil b for one � � - -- �- � � -- �� --- A55ESSOR � -- -`�� �� ���� ' Ilundrecl dOIIaf3(S�W)Or Ie55.) . TRACT BLOCK LOT NO. Mq7 BOOK �'� PAGE PAR�I owNea THE WILLIAM LYDN C0. No833-3600 USE ZONE tiwP I terlify.thot in Ihe performance�of the work for which�this N�� � ' ��y permit is issued,I shall not employ any person in any manner qDDRE55I9 COI' OZ'2Ce"'P 1 flZ 8 ' �--- � "' '' SPECIAL � - � `� O ���� -� �� ��� CONDITIONS so ai to betome subject to the Workers'Compeni6tion Laws. " oa� . _ , . atv Newport Beach, CA . ziP 92660 _ __ __ _ �_ _ - . v • . _ � e ' � Applicant � ARCHrtECi OR TE�� .DISTRICT . OUP TYPE .. �.FIR O SED BY___ 0 /+�OTICE-TO APPLICANT:�If, a(ler moking IhlS Cetlifi[afe of ENGINEER Hales-Langston No_ 547-0862 - coNs E ��G ! '•mption, you should become wbject �o the Workers' � ,rmpensation provisions of the Labor Code,you musf forth- qDORE55777 S. Maitt St. Ste. 105 OCan e - � - �W with comply with sueF provisions or this permit shafl be � lEL. , STATISTICAL C TIO � A . CONDO.'' deemed re�oked. connancroa Same As Owner Na 2 , _-- LICENSED CONTRACTORS DECLARATION . .���� - -�-� - � �� - - - -�� -- --� ----�i�.-� � � - �- M55 NO. DWELL LNi75 ' I hereby affirm that I am litensed under pravisions of Chopter 9 ADDRE55 NO. �� (commencing with$ection 7000)of Division 3 of Ihe Businesl and . _. ._____._.. . ���_.. � SEWFR 1MP . . � � � - �- � Y . „, .. . _... . _ . ..___ . ._... Professions Code,and m license is in full force ond etfect. CI7Y [U.55 "' �� �-- �-'--�' � �- � � ��'"' �� yqLIDATION - � � � �� � SO.FT. NO.OF __ NO.OF,._, CHECK BK' �'' Litense Number z�6801, . ���:�c�oss B-1 . . sa STORIES FAMILIES ONE . ,., . � . ' , The Wm. L On Co. , 12-2-86 _ __-__- _ NEw - VALUATID � ___ ___ ___ __ y � � OESCRIPTION OF WORK s Contractor Date ��" � ❑I am ezempr onder Sec. �- � 'in Ie-fami 1 ome cons truction A0D ,. � -=1 2-1,7 A�--�' . . � � .:'. i ALTER .'�: _ #•.•• •2-i 6.8P.C.for Ihis reason .._._ ' REFAiR-.❑ S..- ..- � . . .. ... ; . _ o,�e: ' use oF o�nno� I •2 4 7,2 3 ---; exisnNc stoc. _... Y .. '� ._ P _ ..._......__ . �� . ..-- APPLICANT TEI. � Signaiore veiNi W'. � , .No. $ _ pp� FINAL �-�„r.d, ' • •2 G 7,2 3 c=i OWNER-BUIIDER DECLARATION •-DATE ����� --��� �-- -� - � � - �-- �1 hereb aifirm Ihot I am exem 1 from Ihe Contractor's License � I 2 1�9-8 b - Low for Ihe(ollowing�eason(Section 7031.5,Business and ADDRE55 FINAb': .`� � - � , . � "�ProfessionsCode): . . ..- .. . ... -- � -" .. '. N -By/(/� . .. . � .� _. y-�� BUILDING � �-� 2�.S A�- �� � I, os owner of the property, or my employees wilh ADDRE55 _ . . . ._ ' • .,• . • '� ,_� wages as their dole tompensmion,will do the work ond : �-�� � - ` � . �� {� � � Ihe strucwre is not inrended or offered for sale(SeUion ��`��Tr '• ��" � ��� "' --� -7044,-Business and Professions Code): �� ��-� -� rnOviNG --- - � - -� - -iEt.-- - � -----�� '- - � - �� - " , ��- I � •(t 2�,�� - - � I,os owner of fhe property,am exdusively cpMrocting CONTRACfOR NO. �- ,�- ' ; � � . . . . ' .wifh�I[ensed Confraclor5 to constru[f the project($ec- - - ADDRESS -. .. . . ..� ' "" .. _ .. . �. ... . . ..� . . .� . .�' .. ' .`. ..� ��;�• �G'�Q���'� tion 7044,Business and Professions CodeJ. �- � \ y_ � �� __ _.. ... REOUIREO TOTAI SETBA K ...._�_ . ... . �_;�� � ' .� - �CONSTRl1CT10N LENDING AGENCY--"--" seT encK YARD��� �HWY pROP.LME wiotH� - - � - � I here6y offirm tha�there is a mnstruction lending agency for FRONT ._. _ . �:c C (!�, �Z.� 9-S 6 ,.,_ � -tha performante of the work for which this permit is issoed . . .v.L.. .. - -- - - - . -. ..'- -. . . . .. . .. ...... � --__ . _._.. _ .i_ ._ . . ..._. (Sec.3097,Civ.C.). SioE ' _'�:i-'�--���': . � . � . . • .. P , , , - m "_..._' _.. ......_. ... .. _. . .." '_ .L � � Lender'sName CnntinPntal Tl linnis Rank ^ - . .. .. . . _. -.. .- ..-.. �_. . . . __' . . � .. _. . ..' '_ '-. . .. . ._. _. ... ... P.C.Fee3 01 lS. D.... IDMARef.M . _ . - lender's Address Z31 Sc La Sallr—� �� .'^agD '� - Permit Fee , ' � � � ,� _I.tertify thaLl hove read this applimtion ond state.that Ihe _..._ . __ . _ .__''. . Insuance Fee. ..�0�5�� - �DMA PiC k .-. . - .. . ." ' - .-..: -. a above informa�ion is correct.1 ogree�o comply with oll County inresnganon fee �/�f� ' � '� i g _ordinances and Stafe laws.rela�ing lo building conslruction, ._. __ Toral Fee-7�eta��D - �� I�MA Pern,.N �--- -. .. . � . . . .. ..�� ' '_ _. .._.__ ._. .. . . ._... ._' '_ ___.._. u and here6y authorize representotives of ihis Counly to enter � , $ . upon the abave-mentioned properry(or inspection purposes. e�.7.,^ t.+3 5. . � ,a .. . . _ ._ . . _. _ . .. . _ .. _ . . . . . _.._ . .__ ._ _. . ._ . ._ _. _ . . _._ . . .___ _ .___.. a �iI/!/!µ/P• �'�i'J ra-s�r� SEE REVERSE FOR EXPIANATO0.Y UNGUAGE ' - ^ _-.- .SignoNre of ApPlimnl or A9ent.. .-- -�Daie - . ' . . . . . . _ . ._ . . . . ..._ �.. �- ' p i _. .. _ ..._._ . _ ... _ .._. _. � _... _._ _ ... . ..___ _' / PtANS TO APPLICANT INSPEROR'S NOTES OWNFiR•BUILDER.DECLARATION I here6y�affirm fhai I om exempf from 1he Confroctor's To: , � R�turn�d �. � � � � ' � � � '' License Law'ior the �ollowing reason. (Sec."7031.5) � � � - ' ' Approvad ' pusinessandPr%ssionsCodc:Anyctityortounlya•hit(r No. ` Date � No. . � Oati� �.. . .. ... .,..' .. , . ,. .. , , ��I;�. .,.reguires o permi!to tonstrart,a(ter,improve,demalrsb, � . ...-.orrepairanyairuiturc,f�rior to ifs usuanCe,plso feqttires �' � ' � � ' ' � � � � � t!e appfirant for sutb permi!to filo a signed statement � - . - . , . . ... . , , t!at Ge ir licensed pursuars!10!Ge rrovirinrts of tbc Con•, � . . - tractnr's Lirente Law(Chapter 9J(commrncrng utitG See- '` '.�� � ' !' ; ' ` � ' ' � `� . � •r;:- C deJ000�6rb��s���:e,petGrrnfromandt/�b�rs/nrtle !. .�:,. _ ._ . . . . ...-. -- . . __ . . .._�:�� __ . . .. . . . _. . ..__-._. '� . .�_ . __.��.- __ aUcged exemptinx.Any violaeion of Section 7031.5 by � ' . _ ,.Raquirod �'. . � _ _ . _ __- ''� �'.'_'. , .�.. .. . . ..'. .. ' anyapf�litvntforapernritsebjectstd¢af�J�licanttoaciaif ...--- "�A rovals � - -DaN Rac�twd; - �1 � � PP � or Approwd .. . . ;.� . ,. . ._ . � J�ennity of not mnre fban fioe Gundred do!lars(SSOOJ.J:. ..�. .: Yos �No -�--- -"�_�.. � . . '..�\, . - � - - ��-� �" � � - - � � ❑ I,as owner of the property,or�my emp�oyees with Waier Cenifimte� �,_ � � � �' � � � __ _ „_ � _'. ___.'. . . ' '-...... _ _ . wages as their sale compensation,wJl do the work,ond � --- --�- -�-� �he sducture is no�infended or olfered for sale(Sec.704d) � � � � � � . liusinerr and Pro easions Codc:Thr Con[raclor's Lirense Health Deparfinenl,: '._ �_.- .� .._.'. ._�i�-:._._.. . _._'. _.--- ... -.. .. -- .':-. .. -,�:- . �-�... .. -Lau�dnes no[a/+�,Y to an oa�ncr of J�roperty mbo builds Fire OeparlmeN__,__. ___ . _•. _. . _ ._ _ - �� - -. —� - � J� — � or impros�es tbercon,and wbo does suoL mork!rmse f or , . � ���.�. � . `.-. ����. - � �i - ' ,,.;�... .- . -!1 rovgb-7is au�n employeet,j�roviJed lbat sucb im�_ Groding� � � , � , � pronen�enls are not intenJed or,o/�rreJ jor.sale.� � , , , -.�i � --�'ti . _ bou�ever,tbe builJing or im/irovemen[is sold witbin o.. � �_ � � -. ..,._.., _.. . .._. .'. � . .. �. , � f p!t th b '!J � !1 G Geological � . - . ... � _ , ��yenr o com e inn, r.ownerv ui cr u�i .bavc r! e .. • - ��- �� �, burJcn of f�mving t!at be did not build or inrpmne fnr Pedesnian Prorecrion.�- . ' ..-. . - � -.._.. _--.. .--�-.__._._ ._. . __. _.�.i_. �_�. -_� rbcpurposenJlalc).� . � . � . . ,, ,. � � . (Fence)(CanoPY) ... . . . .,.�. . . � .-._..___.... __._._ _.___....__._.___. _. .�___�_:.. . . ❑� I,asawnero(fhe�pioperty,dm�exclusivelycon�rao , � ling wilh licensed mntraclors lo conslruct Ihe�projecf($ec. : .. .i.,. _ : . .. -_c: _ _ . .. . _._ _ . __. ' � . . . � Spec�ol Inspeaion�� - . � - . ' � � -�bu�lJs or�inr s��dnd Prnfes ns,Codee 7Ge Cantractor's h (Conc.)(Masonry)(Weldin9) . �� . . . . _ .�., i.__ _�._�.. _ _ ... 1\.;� �- l.icensel.amdoeeSol'appl�tnun�nw�er�fproperlyLco ��� -' "' ' � " p �e!creon and u 1 c ntratls jor a L lot Drainage . � � � ' - . . . �� . . pr jrcft u�itl a tnnlraclnr{if�li[onteJ farsuant!n t/e . .�, _., .. ; ...:... _.._. _.__.._...._ ._-... _.: � Contraclor's l,rcenic�%au�);._._ ..... . .__.. ' r. Parking . . . . ... ,..---. � . .. ..- - ; �, .,. ... . .. . .-I am exem r under Sec. . . ''B.BP.C.for'. , .,. :. -- '' E � �� a rhis � , . . . . . -----._ _ ._. .. _.... . . .. . , � � . � .. � � reason . . .._ _ ' . . :�.�. �. : - . . . . .� .._ _. - - - -'----- __. .__. . - �- '� Da�e Owner . ; _ .: „ , - .. ". �: .. . - . . . . ��, . . . . . . .. ...._ . � Approrali.��. 1 Date -� �Inspectors Signdtura .- � � � _, , - � INSPECTOR'S NOTES:, � � � Locotion— � , . , ., . . . . . ..' ______ .__... .__.. (Setback 8 Yards) ' - � /'�-. Foundoiions � .. � . . . . . . ... � . . � � . ; .. . _. . _ .__._ . .. Slab . : � .�� f ^ - - - �. ... . . . Frame �� . . .. . . _ . . ' . , , . . .. . . , . � . . .. . Energylnsulafian � li�(Jp ' —�. . ... ��'. _ ___ � .._.._! . ._ . ._�. . . � . . ... � , � . . . - ,� . � Lath/Drywal I— .-- ..--.... . -_ .- .-.. . . . . Interior -.�`�. .. . ..._. -- ----- , . " . , .,. , . . Loth—Exterior : _ . . .. . . .: . . . .. . . _� .. . . . . ; ,. . � . . . . . .. _ .._ .'.L.l� :...:..t�.'.. . �.�.�. HooseNumber— � . ._�.. ...._`� .�, `, . . � - . . . �. � . . , „ .: .__. __ _ ___.. _ .._ � CorreU 8 Posted � � � . . .. . .. ..•.. .. . . . � • � �-� � . Final� . .. .... .. ... .. .. .. . _. _ .._.. . ., , . , .. , - , - ._._. _. __ .;.. __.__. . ........ . , Enter on Front � � � �� � �