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HomeMy WebLinkAbout1213A 1214A (6) , ,. , _--- _ . . _._. _. _... ..__. - .. ___ _ _. . _ __ ... __. _.. WORKERS'COMPENSATION DECLARATION ���' � �'�`-'� 1" ' ��� � � ��•': ' ... ... , ., .. . . .._ _..__.__ ._ .. . . . . . . I�hereby aff�rm that I have a certificate of consent to salf insure,or a cerfifica�e of Workers'Compensation��5�,a��e, APPLICATION. FOR��BUIL��DI NG� PERMIT � or o certified copy'thereoi(Sec.3800,Lob.C.)' ' ''• COUNTY OP LOS ANGELES � BUILDING ANO FETY � � WCP6255241 Great American Plan 1BR � PolityNo:� � Company � � � �BUILDING � Cert'rfied copy is here6y furnished.� • FOR APPLICANT TO FILL IN ADORE$$ � l OCertified copy i3 filed,wilh�fhe county building�inspec- BUIIDING . � tion departmenl.'� . AD�RE55 20811 Ea s t C1 i f f s i de I,ane 12=2=86 .,The Wm. ,L on`Co. Walnut - - 91789 � Date� Applicanr 5'. Crtv Ziv ioclwTY ' ' CERTIFICATE OF EXEMPTION FROM WORKERS' � � ---� - NO OF BLDGS. �-� -�� ' r�lenREST�-_-- �� �- �� --� --� �- - � � � ' ' -COMPENSATION INSURANCE�� '' � SIZE OF LOT3 rBOO SF Min. NOW ON LO7 � � CROSS SL _ (lhis sec�ion.need�no�6e comple+ed if+he permi��s for one --. .. -. .-� ---. -.-. . .. . ._ ASSESSOR .. .. ' . .... - .- . ' hundred dollars(;100)or less.,) . TRACi 4 � � BIOCK LOT NO. MAP BOOK �� GAGE PARCEL � • - own�eTHE WILLIAM LYON C0.- N�33-3600 us�zoNe n+nP - "' I certify ihat in fhe performance of,the work for which this �� '>' permit(s Issued,I shall not employ ony person in any mpnner . ' � ��� SVE��A� -- "�-- , n' so'as to betome subject to the Workers'Compensotion Laws. � '- Ao0r+E5519 COT' orate Plaza � --�- -� eoNoinoNs �. .- �, �� _ 9 aTr Newport Beach, CA zia _ 92660 ._ _. , ... _'oc Do1e � ' '...,. APPIicaM�. .� . � � . �. .... ARCHiTECTO . . . -�� TEL. . . �OTICE�TO APPLICAN7:Jf, qfter makin this�Certificate of ENGINEER �[ales-Langs[on No. 547-0862 DISTRICT GROUP TYPE_ FIRE . PROC EDBY_. �xmp�lon �you shauid became subject to�Ihe�Wo�kers' -- � .'rnpensat'on p�ovisions�of Ihe Labor�Code,�you must(orth- qDDRESS��� S. M2in St. Ste. I�S� Oran C .�. �� �NST-�/ Z e �,0. wilh mmply�wilh�such provisions or 9his permil sholl be �- � N deemed revoked. � . � � . � S8([18 AS Owner TEI. � STATISTIG4L CLAS I TION � APT. CONDO.'�� � Z UCENSED CONTRAQORS DECLAR cONianci0a No. _, �'CinSS NO. � nwELL UNITS � ATION � __., . _. _ .. ... ._._ ._ ..__ .. _ LIC.'_ .. .' I hereby aHhm that I am licensed under provisions of Chapter 9 ADD2E55 No. . � (commencing wiih Section 7000)of Division 3 of the Business and _... . . ...UC. - - ��R�P � � ... .._._...__ . - - - ..._. -- '._..._..'-_ , Professions Code,and my litense is in full force and effed. ptt C1A55 - � � BK �-� �� , �," - '" "-"�-VpLIDATION �- �� . .�..�.�, . -� . '... B._1,. . SO.FT. NO.OF _ NO.OF _.. CNECK � '' � �, .,�, . Class . �� . ��- � SI �STORIES FAMILIES ONE"--. ... . ': .,,...� . licenseNumber lic:,.. . . . � .._VALUATION _� : . . . ._. ..._i . ,, 276801. _The, Wm. Lyon;Co 12-2-86. -- - oeseaivrioNOFwoaK -- - � NEw � - ' Conlracto� Date App � S ' -' �I om exempt under Sea - -� �lII le -famil home-construction A�TER �� . , �� ----�--�L 1 2 1.3 k,•.�. � B.BP.C.for fhis reason __... + • REPAIR-❑ .S . ._. . .. ___�. _ � .. .'-._��--�_• •`Z 1. .- � ._. . ._ . __.___'_....Dafe: ..._ -. USEOF DEMOL •. EXISTING BLDG. ' . -.. -_.--. ...-. .._.... . - �. �.�.-.-.. APMICANT iEL. . "' I •2�,�I�� s9�ow,e _ _ _ ..- - - FiNa� vainrr he Wi 11 i am L on Co. No.8 3- 0 OWNER-BUIIDER OECLARATION _ _ __ _. . . _ -DATE � - .: �- --� -- ---- ��-�--- � -J hereby affirm that 1 am exempt from the Contractor's License �� � � - - , .... � '�2���,�� Low for ihe fallowing�reason�(Setfion 7031.5,Business and ADDRESS • FINA - � ' ` �'� �� '�Prafessions Code):..'. -. .". .""... . .'. . ..---- " N ��Y- . -.. - ' . . -, 1 21 9-8 b . BUIIDING ,-,_ � � _ I, as owner of the property, or my employees with qDDRE55 -���.�,..� • .• ' " � �' wages-ds their sole compensation,will do the work and - � \c� '` ��� � �� 2�.�l A � the structure is noi intended ar affered for sale(Sec�ion ����TY � ' � �t . .' ' -. ..7044,Bus�ness and Professions Code)....-. -... - - - rnOvnvG .. . . . - .. --� - iEL- .. - - . . .. . - . . -.�.- .�.-#• • • • •.� . . � I,as owner of the property,om exclusively contracting �Ora7anCTOR. .. . .. NO. �. .�.� :� . �. r � ... . � . � -with licensed coMra�tors la canstruct the pro�ect(Sec- �-. ... ... .. .. . .--�- --"- -� -... .._: �.`. � ' ' � .�. - , lion 7044,BVsiness and PrOfe53iOn5 Code). nDDREss . .,,�,. �- � �. --•_ ' � . �. 390�0 REOUIRED . TOTAL SET9ACK . -`.,' . � ---� ,- .�.' '� ••3 9 0 0 0 v � ' " -----CONSTRUCTION LENDING AGENCY � �- -��� Sei encK YARD' HWY pROP.UNE WIDTH � ' - ' I hereby atfirm thot there is a mnstruUion lending agency for pRONi �- � �' � �� "� ��� � �Ihe performance of ihe work for whith this pe�mil is issued -- - P.L- .. .... ._... .--_.. . - .....- -. . _ . . -.i � -.. --8 6 -.-. 1219 (Sec.3097,Civ.C.). SiDE _. ��, . �� ^ � . ...,... m . ..._. . _ . . . . . .. ... ._.. _ . . P.L � _. . _ .... .. .� . __.. � . ._ . . _ � Lender'sName Continental Illinois Bank . $ ^� IDMP.Ref.N , __ { Lender'sAddress231 Rn�.- T,a� Sal le St.� Chicag0 P�C.FeeE� '.c,S�� ' - PermitFee�- -�7 �,S� -" . � I cerGfy thm I have read this applimtion and state.ihot�he -_ .._ .-- ..__....... -._- i�s�a�ce Fee— .5�� �IDMA P/C k .- . .. . - ,-. ._ �.--. - � ..��. '��.-� a above intormation is correct.I ogree to comply with all Couny in�esrgaro�ree �`� `� _ordinances and$lafe laws relating to buiiding construction, __ _ . ._.____..._ ._.__ . —Torol Fee �•Q �' LDM4 Perm:N- --��- -� -� � � - �. ._ . ._.... __ _..._.. ._ . .. u and hereby aoihorize representatives of this Counry to emer �, � � upon the above-mentioned prope�ty for inspection purpases. . _.. .. , .. . � _.. _ _ _....__ . ......` ___ . _ _ __. . ._ _ _'____ .. . ._......_ .. .. . ..._ . . ^ �y�^ � y� � r � SEE REVERSE FOR EXPLANATORY LANGUAGE : � � O ..... . Signot�re of Applicanr or A9ent. . '_ � .Dale_ . .'__ .. .. . ..._ _. .... _ . __... .. : '..__ . . . _ ..._. __. : .. -_- -':. . . _._.. __�r � �a�5,$� , PLANS TO APPLICANT INSPECTOR'S NOTES .AWNER•DUILDHR DECLARATION � , I hereby afiirm fha�I om eaempt fram Ihe Confractor's To: j i� � '- R�turn�d � � � ' , ' - . Llcense law�for the following reaion:(Sec.�7031.5) - � �� � - Approved BusinesiandProfessinniCndc:Anytityorrountya.�hitb No. Date . No: � '.1,Dafe�::'.:.: �.'•: %".��� . ,. ...� �.i ';-,` '•;'.:, ;,.;.f ,.. ,!� �,.reguiresa/Icrnritfotonstrrsrt,altcr.imJ�rove,den�olisl, , , . , „ _...orrepairnrsystructure,prlortbilsissursrsre,nlromqurrrs • � "o. .. . . , :.��arrr,�a„t�or s¢c1 frermil to file a si,qned slatement , ,. tGa1 be is licenseJ pr�rsuonl to tGc proriaions of t!c Cbn- . '�r;t,I • '. I;' � ! I�,i� �. � � trartor's Licertse Latv(Cbapfer 9J(romniencing r�itG Sec- -- "� tion 7000J oj Dinrsion 3 of the Duseness artd Pr%ssinns , ..--..._ .. ' _..1 \ :._ .. . .. .. f;�:.l .. .('„ � . ��'� '� � -� � CoJeJ or 1La1 bc�is rsenipt lLerefrom and lbdbasis for 1!e '_ _ .. -�' .--'!� �Dute Recdvvd. �--- . _ _ _ _ _ .. _ _ __ . . . `--- -- .� .._.'_ �Raqulrallo� - - PP .._.. .- - _. U.��- . �.. .�'.�.' _._�'_ �_. anrY PP!'cantforaP rnrrtrubjecestheappl�ant�foaa�il 'Approvala YQs or A roved , . , ` .. �. Penulty of nnt mnre ll an fine!andred dollart(SSODI.f: a. �.:,�, �. , : . �- --� �-- -� �- - ���� - �� -� ❑ I,as owner of the property,or-my employees with . ,.,. .,�: ,... . . . ,., ...� . - l�later Cenificaie,�:. .... � ,�.�. - ... .�._.. .. � � , wages as�heir sole compensalion,will do ihe work,and � �� � � �the strutlure is nol intended or offered for sale(Sec 7044) • Heplrh Deportment._. -�"�-." �_� _��� � � � -._-._ _-- ---..' _ . _ ____ . _ ...Burinest and Pr fetsions Code:Tlic Conlractor's Licente � ' -') '-�,.�.. . � Law docs nol opplY�o aa owner of Jimperty wGo builds . ... , ., �:.,,;, � Fire DeportmeN ...__ . -���- � ---�-�-� -- --- - � ��-- --�--- - nr rnr(�roocs lbercon,and u�bo dors rurb work Gineself or . '_.._ .... . _ _ . . . . . . . .. . . � . . � ..� - �:1ir...'(' .. C;:_�.�;�i,.�,l_�, ��.�. � . lbrongfi bis oam emJ�loyees..QroriJed lhdt.sucb�im• Groding, , . �,, � � . Qmi�cmenls.nre,nnt infenJed or of�cred for sale.�~�� � " ' _ , , , ,, , \�� �bn¢•cvcr,IGc bui(ding os improvement it sofd u�it1 in k � - • ;. .,_�;� ' � , � . �;. ,__ e`. ,..� ,� . . Geologiwl � �, �-� �, � .� . ' , � , _ ��year nf rnmpletion, 1Ge owner•buildcr wilf Gave tLe � �� ,� �. .. .� .�.� . �... '.`. •' .' `. . : . _ burden ojprnrrng ll at hc diJ not 6ui1J or improre for .....---._--- .. . _---.. -._-- - - Pedestrion Prolection � - - -. . ". � tl erurpose nf saleJ. � . � � � � (Fence)(CanoPY) ���� ' � .. '� '... -. .-... ------� --_.---- ----- -�-- � - -�- .(; ❑ I,asowner'o{the propeny,�am ezdusively coMrat- . , ,.. fing with litensed contraclors b consfruct�he projecl(Sec. Special InspeUion"-- -- - " -�"" �- � "�-' � 7044)Uusiness and Prnfessinnt Code:.Tbe Contrdctor's � (Cona)(MasonrY)(Welding� , ' � - - -'� -'.. `'- � , � ' _ '�-,,'_.�i:1 � _.. Lu ense I.ma dors not upplY to an nwncr nJpropert,Y uJm ' � �- '� ���-`������ � b 7dr or im/�roves lbeseort,and ubn controcts for sucb •� lot Droinage ' "" � ' � � ,. . .. prrijerts�witL a oonlracMr(sf�litented pursucnt to !br . • ' � . "'.'__ __._ . .. . .. ._.. . _ . :. . , � , �, . � . .. . .. . ��j � "�'Contraclnr's/,icensc I.auJ.-�-�� ��-- ' . 1 . • ..... .... . .... � ., .-. Parking ' � . . . _ . .._. __ . . . _ _.. _ . . . _� .. . __._..... _. . .. : ' _., .. . � : . � '"� , � ... � - ❑ I om exempl under Sec ,B.BP.0(or�lhis , . ,. , . - n . . , . . . __. . _.._._ ._. .. _.,,. . �. ._ .. . .I � reason . �....: ; ,. . . _._. _. �. .._..____.__ ..__. __ ... � � � . �� � . � � . �o�e Owner � '... 'i. � ;� . .,.. ..., .. . . �� . . ..._ . — __, ,., � ; ,.._,' r.i f I - __ __ ---- --. _ _... . ,._- 'Approvals Date Inspactor's Sfgnaturo � � -. - � � �� -� � - � � �� �� INSPECTOR'S NOTES:� � . .._.. .. ... , Location=� i . � � . . . . (Setback 8 Yards) .. ..._. ` ,..: - .__ . . ._ _.__ . ._ . _ _ :� . ,. .�. . .. . ..� . Foundations � 11 �.� . _ ���..� ` .�, .�..�. .. . . . � . :. � 1 ' _..' __._.___. . _'__._ . . . .." � . . Slab. - „ . . .. . . . . . , ; , r � �--....---� --�-- _. ._ .._ . .. _._ . .`.: _ .. . . . . . . . . ....... . .. � i Frame . . . rRJ _. . , .. . . . .. � �. ., . . ,. . . . �� ,. Energylnsolation . ����.� . � . -'.. .. , .. '. . .. . . .. Lath/Drywall_, ,. : - _.. . __ ...--- -----._ . ...----. .. . __. . . . . . .. , Interiar L'��g'] [�J'�_-____.. .. i ___��- , ., ". .. .°� �. ., .. La1h—Exlerior . , , . .. � .. _.. . � � . . .. . . :..�' � . 'f' - . ' . . � . . . , . . � _ � House Number— �., �_ �� `-' i� `� "• '�•�'" � • _ ..._ . . __.... __---- - ._, .._ . � �... . . . . . .,.,,. - . ... . . . : .... . _,..�. :_.�._ , . _ _!_.. -�� �: Correcl 8 Posted � � �..-, � � . � Finol— ___.__ ._ _____ ... _.�__. . _ ...�__.. . . _. . _ __.__ ___- _'___.__'_._.. Enter on Front . �� � � . . ' . � .. . . .. . . ., � , . � � . .. . � � . . i1 . . . . .. . . .r l t� . . . _ . . . . . . � . . � - - .