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1253A 1254A (6)
, . --.-- ..... _ ._. _..... __ . _. _. ,._. _.. .._ _ _ _.____ _ ._.... _ . _. . _ WORKERS'COMPENSATION DECIARATION -. , � � .., � :. . , _ :�� _._. ..._... _... ' ' , : -. .� .� . I;here6y affirm �ha1 I have a certifitafe of mnsent to nelf � � �� � msure,orocerlrficateofWorkers'Compensotion��5�,a��e, A�PPLICATION-�FO�R-���BUILDING� PERIIAIT ��� _ _ _ _ _ _ , . or o certified copy thereo �Sec.3800,la .C.) � � � � COUNTY OF LOS ANGELES � BUILDING AND SA TY �� �- �- ���� � vou�yNoCP6255241�omPa�Y Great American Plan 3AR � Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BuitoiNG p ❑, . . . . .. . ._ ADDRESS Q X � Certified copy�is filed with the county building�inspec- euuDwG ��iondeponmenL��� n�DRE55 20815 East Cliffside Lane D6�e' . 12-2-86, .'ApplicoN �. The �Wm.�.Lyon Co.-.. aTv Walnut . .. . .... 21P 91-789 �.. i�,uTr � -� CERTIFICATE OF EXEMPTION FROM WORKERS' -' -��-- -� � �� NO OF BLDGS. � � �-- � NEAREST.--,� .._ . ._ � _.�_. � �� COMPENSATION INSURANCE�-'- -�• 5¢e oF�oi 3,�800 SF Min.NOW ON lOT � � CRO55 ST. (This section need not be completed if the��permit�is for one - � - -- -� - - � � ASSESSOR ��- � -- --�- � hundred dollars�5��)or less.),._ TRACi L� ](jO BLOCK 2OSOO �LOT NO. SL Mqp gppK� ' PAGE PARCEI ' THE--WILLIAPI-LYON C0. 'E�833-3600- use zoNe tiwP � , I,tertify�lhot in the performance of the work for which�this OWNER �� NO. NO. ' � �} soas to become sub'ect to the WorkeY Pefson in ony manner -- �-��-�- SPEC�n� � - � � � � � .Q ermifizissued,lshollnotem�lo an . - -- qDDRE5519-COL' orate Plaza �-�- � � n Compensation Laws. �� � � CONDITIONS � � , , . ,. arr. Newport Beach, CA Z1P 92660 _ � . __. . __ . __ . u Daie - � ,: ..� APPlicanl . .. - .��,� , . -- . , pG ARCHITECT OR � TEL. O �'OTICE TO APPLICANT: If, ofier making Ihis Cerf fic6te or Hales-Lan SLO❑ S�L�-�862 DISTRICT GkOUP_ TYPE .fIRE_ SED BY_.. ENGINEER g NO. �� � mption, you�should 6ecome subjed �o��he Workeri ro T�� z aJ .�mpensation provisions of the Labor Code,you must{orth- qD�RESS��� .S. P1ain .St.� StC• 1�5� Oran e ..�. � 6. wfih comply�with such�provisions ar this.permit shall be �-- ��-- H deemed revoked..�� � , .' '�� ' S8m2 F15 Owner TE�• - STATISTICAL I ON � APT. CONDO. '�Z . �... .. .. �� �.�.���" GONTRAC70R NO. ' . .... . . _- LICENSED CONTRACTORS DECLARATION..� . - -�- -� ��- � � ---- -� - --�---�-�IC.- � �-��- � QASS NO. DWELL.UNITS ' � I hereby afiirm that I am licensed�nder provisions of Chap�er 9 ADDRESS No. (commenting with Settion 7000)of Division 3 of Ihe Busineuand .._._. . . . UG .-- _... SEWER MAP . ; . . .. . .. ;: ___.___ __...._ . _.._._.. _ _._.. Professions Code,ond my license is in full force and ef(ecl. CI7Y � CIA55 � BK -�-� - - - -� - - --VqLIDATION � -� SQ.FT. NO.OF NO.OF CMECK License�Num6er z�b8�1 � Li[.CIa54 B-1', '-"- SIZ STORIES 'FAMIlIES .. . ONE � � � , � . .. . '� , The Wm. L on Co. �12-2-86 --- - - - -- --- .. New_. � vawanoN - - .- -_._ _ . .._ Y � �� - �� . DESCRIG110N OF WORK' '"' s �110U Contratfor � Date ❑ (J , ; �... . . . �I om exempt under Sec 1i1 le .famil -.home construction A°o � _ _ ___-_ .__. ...__ , � AITER � , �(a� � s_ _ _. _1 -- . _. - - -- - �. B.SP.C.for Ihis feasc�n , � � .. . REPAIR � 2 J�.J A _ .. _. . -. r - . . Dale:' ..� � EX STOING BLDG. . DEMOL ❑ J� . � Signofure � . . . _ ... . -.' . .. ACPUCANT . TEL. '� FINAL .� . .. . r�• • � •`�1 OWNER BUILDER DECLARATION PaiNT The Wi l liam L OII CO.No. 833-3600� _.oaTe- � ' _ . . .. _ .. ��_ . ._.'- ..._._. .-._., -I hereby affirm that I am eiempt from the Controctor c Ucense � � - ��� �- � � - � '2 7�i 6 8 ADDRE55 � .. . ,,.. �� ..• . �� • . Law for the following�reason�(Secuon 7031.5,Business and FINA ' -'� � �2 7�6 8'= � 'ProfessionsCode): � -.,-,*. , . ......_....._...__....� ___.. q .. 9Y ' . . . -�.. .._-. � . ..�'.-. � " ' euaoiNc ; I, as owner of th'e property, or my employees with ADDRE55 -�� : ' � , �2�'9�-$(,.� -woges as their sole compensalion,will do the wwk and � � ` -�,� - ��� � '- ��' the strua�re is not iroended or offered for sale(Section ����TY ' � �- . � -` '� s� �ra 4�i . �7044,9usiness and Professions Code]. �-�- ����'- � � -�� MOVING�- '�-- -�---����---- - ----�'�-TEL:- '. � � ��� L .. _ ._._ .... . . . .... ._ . . � I,os owner of the proper}y,am exclusively coMracfing CONTRACTOR NO. �- � � ;' •_ , ` ' #�� �� - - with licensed contraciors-to construct the project-(Seo- . �.. - .. ._ .. ... .. ---.. . ... . ... ... .. .. . �.'- -. `�- ��. . • • •-. .-. - lian 7044,Business and Professions Code). ADDRE55 �% . - • -.- �� •4 7�j.5� � - - .- REOUIRED... . 10TA15ET8ACK � ._ . .-. �' � :___- -�-CONSTRUCTION LENDING AGENCY �� - - �� ' - 5Et B/+CK � YARO` HWV' vROP.twE � WiDiA- � '�� . � �-� - I hereby affirm that fhera is a construUion lending agency for FRONT . � � ,' � ��'7�J Q�� ' -Ihe performanm�of Ihe work forwhich this permit is issued �- --P.lr-. .- .. . -.- - � ..._._.. .. ..... .__.. . . ._ _ . _.'�_.,.. . .' �-: . '. __ . .... (Sec.3097,c�.e.�. soe I 2 1 9-8 6� ^ _ _ _. . -_ _. __ . ._ . . _ - : ,: . � Lender'sName �ontinental Illinois Bank P��� � � � � � ��� � -� - � � �// LDMA Ref.M � � �-" ' � $ '.. . . - ._ .. .. . - _ .. P.CFeei. � � ��S-_ P lFee�-'!(OS. _ . ___ _ __ __ . - Lender'sAddress_9a1 Sn. T.a Rall� St.� (:hiCd�O , � � � � ���� � J cenify that I�have-read�his applico�ion ond s�ate that the _. -.. . ._.__. .__.. _... iss�o�ce Fee�-�� D.SD�� LDMA P/C k � -� � --�� � aabove informotion is correa.I agree b comply with all Coumy tma:ugmion Fee . � ' -' g ordinantes and Stare laws�eiating lo building mnstruction, , __ __ . _._ __ .___ � Tmal Fee-�� 7.J S��- � LDMA Perm.�N � - - �" ' u ond hereby authorize representatives of ihis CouNy to enter ' � � � upon Ihe above-menf aned repe ty f inspe nan purposes. ,�7.S- .._.,. __ ,.__ � �'• i u _. _ .. ._ ._ _ _ . _' .__ ._ .... _. . . .._' _ .. .. .. .. .. . . , .._ . _ . � _��� ��(f� � g6 SEE REVERSE FOR E%►UNATORY IANGUAGE ' , _.. a � � - SignaroreofAppLmntorAgenr .. . .... .. .Dma._ ... ._....__... . _. .. .. _ _ _._. . . _.'. ._ . ._....'__'. ._._. _..' . _. _. . . _..._ ,OO� PLANS TO APPLICANT INSPECTOR'S NOTES ,�A�VNIiR-UUILDEiR DECLARATION I hereby offirm thoi I�am ezemp�from�ihe Contractor's To: ; i � RNurn�d � . • - license�taw'for the'following re6son.� (Sec. 703L�5) " �' ` ' � � � Approved � � ' ` '" "' ''� Burinrss and ProJrsrront CoJc:Arsy city orcauney wfiicG No. Dafe % No: � Oafe - •--...•�.. -- .. ��. .. .. , .� , .,!'. t:-regnires arermit to conatruct,altrr.im/�rave,denrolisb, , ., - -arrepairqnyslructure,fnrorMrttissuance,a4orcquirei . . ... - . . . . ' ' . . ., . ' _ . fLe a/./�ficant jor sucb f�crmit to file a signed rtalemenl , -[Gat Ge rs licensed punuant to tGe procisronr pf tbc Con= , ���:.;' , -- .�-.�-. , .'i�,' � lrattor'sLrcensrLaa�IClapter9J(commencinga•iti�Ser- - - --- " - -- , fion 7000f of Divition 3 oJ 1Ge Qusiness and FroJesaions ' -- � . ' �� � I". _ . .. ' .. . . . � ` ' '�-�' '�__�_CodeJor[GatGcis�exenrpltGcrefronianJfGebasisforthc __: _. r�. _ - �... ' _ '.. . �� ,__: ���._. � _ . . ..__ .._.. _ . _.- . ..__ .__ `_.. . allrgcJ exem/�tion.Ars,y vioJalion uf Section 7031.5 by : , ' ' .. ' �..Raquirod__: � ' ' .'.-_. �- . . -.-" . . - '_' ' .. - � anYapplicantforapern�itaubjeclstGeuppficanttnaaio�il ,.n, . ` . �Approvals - —Dafe Reesiwd : �� i� • ena![ o not morc lban ive Lundred doUars 8500J./: � � ' ' Y�a �No or APProvad � . '�--�I. . . `. ' h Y � f ( � :,. �. .� , � ., � � . ..,.. ._... ._ _.. _ _ _ . �--� , . -- I,as owner of the property,or my employees wilh � Waler Certificote � .. . '� . '. �.. .� - _ . . ..__ _. ._.. .._. . , .�_.. .. _.. . . . wages om�pen as their sole c sa�ion,will do the work,ond - - - - -- �tha slrocture is nol iMen ed or oifered for sale(Sec.7044) ' Health Departmenf �`:_� �-'� -i. � �' .. ' -._..._.. - _ _ _ _ . Qusiness and Prnfcisions Code:TLe Contrac0ort Lirense � . ____ _ . _..._ . ___ - � �- � � �;�' , , ,:;,��,,; �- .� . . I.aw daes not applp!o nn oumrr of properry mGn b�ilds . Fire DeparimeM _ __.. . _ � - � - � -- �-- -,- --- or Inr/�roc•es tl�crcon,and u�ho doct sutG uork Gimtclf or � .. ... - ._. .. -�.'.,-- . .. . � �--tbrou b-Lis oum.ent 1n ces, rooided�lLat sucb im-,, . _c: . �. - x r r r � Grading � ' '- - frooenrents are not inlended or oJ/crcd Jor sale., � - � ., ,. , .� ,����, i�' � . �(� , ��. 1 n¢•ever,t6e bui(ding osir�roucme�t issoldu�rtGin n�_ ,_ __ _ . .. _._ ' . .... . __ ° " � - � Geolo9icol � � , _ _. , , , �]'car r�mnrplrtinn, 1Gc�otuner•builJcr wi/1 baor !be � burJen J/rms•in,Q tbat Ge Jid not build nr imf�rove for � ._.._. ..... .... ."._ '_ .. _...._ _ '. .. ._:.:.. . Pedestrian Protec�ion " . � �_ � 1Le/�ur/,nse fsaleJ. � '. (Fence)(CanoPY) ' . ------- � - -. ..- . . -. . . .... . .-.--.-�..�. , ��' 0 �I,as owner of Ihe propeny,am exclusively coniraN - , ling wilh licensed contractors lo constructlhe projeci(Sec. Special Inspeclion " _ . . .._.-._. . .... .__ _ _ . _ _ _ _. _ .,."' . . . 7044)I3usrnett artd Professions CoJe:TGe Contrattor't (Conc.)(Masonry)(Welding) � � _ i � 1._.y.`� � Limnse Law dnet no1 apfly fn an ouvicrof prnperly u�ho � - "- - --- � -"-builJs or iniprorrs lLercon,anJ u�6o"tonlracts for sacG GLot Drainage . .._ �.. . . :.: . . � �-- . . . '~.. . . P 1 �(l Q �nl to (Le � . ' ' .... ... . . . ..:, . ... .' onlractnr'sJLceasetl.anf. s uense rsua ro ectc 7' u C ; Porking . . ' - -- '"- � �' � . � ❑ IamexemptunderSec. ,B.&P.0 forlFis , , ,. - .. .. . .___ � . � . - . reason • , _ ' __ "_"_'_ _ ._ _._. __� .. _. , . *� . i , - � , Dale O ner '" . . .. . . ,, r, i. I __ ', ' _ . _.. .. . . � . Approvuls� � Date InspeHor's Signalura, � . �� P f'"��. INSPECTOR'S NOTES �� localion— .____ _ ._ ___ . - . . . � (Selback 8 Yards) � [�� � � - - .. - .. r . _. ._. ' .. . . �� .. . .� _ � . . Foundalions � j " .�. , Slab; , . �� � : ,t G2 � � �'' . � ,. . ; �, .. _...... . __ .._..._..-- -- --�--�_- -.. . . - - . . .. .. � ,', Frame- � . , - � �'� ,Da`i � . - __ . .. - . � . . � ._ . , , � Energy Insulation " ' ,' .'. _.. �_.. __.._._._: .__'_ . . ._ '.': , , _ � ... '' .� Lath/Drywall=�'., 1 --.._. . _ _ ._ .'-"'-_-' '.'-.-.� ."'- --.__.� . , • _.. IMerior - ---`-� - � - . I ' � - Lath—Exterior . . ' ,_ .' � - . . . ,. ... . � ' I . I _ � _ ':�r_,,. _ , . , . .... � .., . , ....-;• House Number— . . ,.. ._ .'.. . ,<__ ' . . ...... . ..... . .� . .. , . . __. . ___ _ ..._. . . � , . -_._ ___..__ �,;., , . CorreU 8 Posted � !�.� ' , � Final— _.. _. ._ _. .. . _.�.___._._.�._._ .. . . . _. .__._..... .._.'.__._...._., .• „ .. - . , Enler on Front ' � _ . - - . . � . . . .. •` � - ' . ' :, ,. . . � . � . ., . . . ' _ ..�: ,5� - c. ... . .