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HomeMy WebLinkAbout1251A 1252A (6) i Y . _ _- - _.__ _ _..._. ._.. ._ --- _ _.__�_.____. _ _.._ � _ - ---- — _. insure,o�oaeKERS'COMPENSATION DECLARATION ,_ ' � �� . . . :, . . � : , - . . __,_. _ � . . I hereb off�m,�of��o�e�o��e�,�f,�a�e�af�o�5e�„o,e�f � ���-���APPLICATION� FOR���-.-BUIL��DING- �PERMIT -���--��� ' ficole of Workers'Compensation Insuronce, oPp cer'�d y th r of(Sec.3800 La6.C.) � '` ' ' � - �- --- - -- - - -� �GY���52�! . � Great American Plan 2AR COUNTY OF LOS ANGELES BUIIDING AND 5 FETY PalityNo. Company -. . - ' Q Ce�tif�ed copy�s hereby turnished: . . FOR APPLICANT TO FILL IN suitoiNc / ADDRE � � Cenified copy is filed wilh the toonty building inspeo- �-� BU4DiNG _ . �tiondepartmenL �� � � ' � AODRE55 20819 East Cliffside Lane 12=2-86 ' The Wm. Lyon Co. Walnut 91789 f � � Da1e'� ApplicOnt U7Y ZIP �ppe,��Ty � CERTIFICATE OF EXEMPTION FROM WORKERS' - " �� -"-� "3 �500 SF Min.NO oF B�DGs.-�� � � � ��� r�qaesi��--�- _. � � . - �-' � � '� �-��COMPENSATION INSURANCE -' Si2E OF iOt � NOW ON(OT ' CRO55 ST. ' , (This section need not be�tompleted if the permif is for one - - � -" ��' -� � TRACT 4376� � BIOCKZ�SO� lOTNO.-�53--- ' ASSESSOR. � . hundred dollors(E�00)or less) � . - - �P B� � " � PAGE PARCEI _ THE.WILLIAM LYON CD._ TE�S33-3GOO. : USEZONE ^no.P I ceriify that inlhe performanco of the work for whichlhis OWNER No. p�p _ � 0. perm��is issued,I shall nof employ any person in any monner pDDRE5519 C'OL'POI'8tE' P 182fl .. . _ __. . . .. . -" � ' ' SPECIAL ' - - - - � me su6ject fo Ihe Workers'Compensalion Laws. CONDITIONS 'V fla e ro beco , , Newport Ueac , CA 0 ... _ - -..---- _. __. . � Gir ._. .. LP_. ; . , .. .�a . , . . ... .... _... . . _ _ ..._. ._ .._ . � Appiicant � ARCHITEQ OR TEL. �,O �""'OTICE TO APPLICANL•�If;�aiter�making this Certificote of Hales-Langston 547-0862 DIS7RICT GROUP ttpE .__ _ .FiRE PR EDsr .. , m Hon, . ENGINEER NO. � [ONST. •Z N G � p you should become subject to ihe Workers' .umpensofion provizions of'1he Labor Code,you mustfarlh- qODRE55��� S. Main $t.� $C@. 10rJ, Orange� ._� �a wHh tomply��wilh such provisians or ihis.permit eholl be �- � deemed revoked.. • ., Same As Owner TEL. STATISTIG4l ClAS _ ON APT. CONDO. Z '.'-� ...".'. CONTRACTOR NO. � . . ' �'/" '._ ._ . ..._.._. �.� UCENSED CONTRACTORS DECIARATION� � � � �- - � �- �-- � - �--�-� ���. -- - �-- CtASS NO. DW¢lL UNiTS � I hereby aNirm ihat 1 am licensed under provisions of Chapter 9 nDDRE55 NO. ��R�P (tommenting with Section'7000)of Division 3 of 1he Bvsiness and . _ ... .._ __ ._ __ ���, . _ ' �: � � '- � . Profeuions Code,ond my license is in fvll forte and effett. GiV CLASS " "BK:�-�- �-��� -.- � --' - ��� -"-'-VALIDATION� � � � � ZJGHOS . � B-1 � � SQ FT NO.OF NO.OF. CHECK _� . . . ticenie Number' Lic.Class ' Si�4$G 477 STORIES 2' pqMiu¢5 1 ONe •'...:: , � The wm. L on;Co. Y2-2-86 � vnwanoN _ . _ , Contra�tor ' . . .� Y� ..� Date � � � DESCRIPTION OF WORK . . .' . . .. NEW S+-� T�, � . . . � / U [J ❑�ar„e.empf under sec. ingle family_home .construction ADO' ,, _ _ __ ., ._ . __ —_ . /� , . ALTER p p� 2 s i a 8.8P.C.for this reason �•,T. REPAIR ❑ 1 "-- �-- . . � _ . . . - -.. -. __ .. .._..__. .. .. ...___._ .. ._.. Dafe:.... . � USE OF , #• • • •�� EXISTING BLDG. DEMOL ❑ __ _ _ _ ,.. . . Signalure . .. _- ... � . .-_ . _ ._� . .. . iEt FINA � •2 Q 7���J . APPUCAN OWNER•BUILDER�ECLARATION PRINT he William L Oil CO.No.833-3600 � ..onrE�� � � � - -.. _. __ _. ._ _. ._ -I hereby offirm Ihof I am exampt from ihe Controc7or's License . - , _ 2�U.I,Z�J= � Law for�he following reason(Seaion 7031.5,6usiness and ADoae55 p�N � �� � �� � .. " �.-.�.- .- � . .: -.�,. `ProfessionsCode): - . . . �. . �._.. ...__... _...- R N BY � -�2.��9-Pi�J ��- . ��. . .. BUILDING ._.. . �. _ ..__ ..,__ _ __ . . � 1, as owner of Ihe property, or my emplayees wilh AooRE55 __'���'2�J�.2 R �woges as their sole compensation,will do the work ond ��� � , �. , . . the slructore is not intended ar offe�ed(or sale(Secrion IOCAUiv . ,-, - �� .� � � ' - - 704d,-Business ond Professiom Code). -�� � � �-� �� MOVING�-- �� -� � �- �- 'TEL.- - - � � - � ,��� �� �- - - - '��#• • • • • � - fXl CONTRACTOR NO. ' . . � '..4 n�O Q U I,as owner of the property,am eadusively contracting _. �_� - � .;'. �-�\� - .wi�h licensed contractors to consvuc�the project(Sec- ..... . . .. . .. . . ..... . .... ..- . .- . . : � . -.-.-� . c - . tion 7044,Business and Professions Code). ADDRESS ;� . ��' . . ... . . E�IlIREO .TOTAL SET6ACK . . - ' . . �- �.4 2.6 O.O�._: �CONSTRUCTION LENDING AGENCY � � �- - - SET BACK YARD HYJY ' p�70C.LINE WIDTH � � � • 1 hereby aifirm that there is a mnstruction lending agency!or FRONi � � . . .� �2� C�-8 a � -Ihe performonte of Ihe work for which Ihis permit is issued � � -P.L - � � - - � �� - - � -� -- �� ��-- -- � �- -- � - (Sec.3097.Civ.C.). SiDE . - . : .' . . � m ` Continental Illinois Bank P'�' ' � �' - -- -� ' - Lender's Name � � ' �� $ aboverinfo�ma�oo s corretto.1 airee bcom e wi h•all oh�Cago.. P C Fee S �- I.�3 Permit fee-' •5 .LDMA G/G M.- -- - �.-- '� -� --- ' -. '.�. �.. , � 1 cartity.that I have read ihis applicaiion and state that the .. __ - hsuonce Fee �b.S�- �, 9 P Y Y Inveshgalion Fee .`� � ' : � _ordinonces and State laws relating to building construction, . . � . - � Tota�Fer-�� . � - LDMA Perm.N � - ... ___ . ____._'. _.. ___ _.._ _ �'_ u and hereby aothorize representatives of ihis County to eMer , � upon�he a6ove-menrioned property for inspaction p rposes' .. . . .. _ �7 J!'�. . .. . .�,�r . . _._ _ _.,_.___ _ ...._. p _ ... . . . _ . .. . __. r _.. ___ . _ . . '_ ...... ^ �y„« C . �� � �� SEE REVERSE FON EJ(PtANAiORY IANGUAGE , �� a � .. .'_ SignaWraofAppliconforAgenl. ' '.. . _ '_Daie. . . .. ._. . . . . .. . . .._. . _ .. _ ... .. ... .. .. ......__. .._._ _. ... _. _ .. ._. ..:�.i PLANS TO APPLICANT ` INSPECTOR'S NOTES .. O�YNGR-BUILDER DECLARATION . I hereby affirm thot I om exempt from-the ConlroUor's To: R�Wrn�d �. - � � '`� , � � ' � � � ' License�Law�for rhe,following reason. �(Sea�7031.5) -- � ' - � � '� - �- " Approved ' ' AuairsessandPro�essiontCode:Anyrityorrounlyw6icG No. � �ata � No. --�Data� , � < . - ��� 1�, . .-. �•.. �.� , . . , r.requiret a permit!o construri,olter,inrproec;deniolish, . , rehairany seructu�e,frior i�ils issvance,a�o requires � . - . '��i.!' � � ' . , -. . . fLe applicant for suthQermit to file a si,lrned stntement . . tLat Ge is licensed pursuanf to!be f�mnisinnt nf fbe Coe- � � � ! ' �ii; . "IL �i traclnr'sl.icenseLam(CbaJ�fer9f(commentingwitlSec- � '�t� , :,;:r: : .�.. � �_�;,. � � . , t _..._.. ;_` ._ _-.. _. _'.._._ ... _ . -. _.. tion 7000f of D,reitron 3 of tGe Dsssiness and Pr%ssiont ..... . . .-„ . . ' �. ��. • .�� ' ' � �- - .� � � - � ,-� CodeJ�or f7�at hc is exempt lGcrefrom anJ t!e batrs for tbc .. _ .: � . . _ . .. . __. .__ ._ _.._ _.. _ ' _ .-. _ . _ _ . . _ .._ _ , � � - , - alleged exene/Ninn.Any vinlution of Settion 7031.5 by . ' . . Raqulred - pateRecaired � . . �. � . , .. . � . .. „ , an.Ya/�/�ficanfJnraJicrnrrlsu6jertstGeappficanttoativif � � Approvals ,-Yes No or Approvad � ,. , , penalty o/nnt rrrore tLan five hvadred dollars(d500J.J: �-- -- � - - - ❑ I,os owner of the properly,o�my employees with , . . ..,. .,. ��,. . i, Water Cenificate . '� ... . ��'� . •:' ' .._ . ..�_�_ -__..__._.. _._ ��. .�_. . wages as iheir sole wmpensalion,will do fhe work,and � - - --- - the struaure is not infended or oFfered for sale(Sec.7044) . - � . . . ,. ;.� , , ,, , ,,, ,,,,, , Health Departmenl _ .,� � .'_::� '._ �� . �.-:: .. ._ .' - .�-- � - �- ._.__. �.. _... Uusiness nnd Prnfe3sions Code:Tbe Contractor's Lrcense � .--� . � . .., �� . . � , . fafu dncs nnt c/�/�fy!o an ou�ner of property u�l n buifds � Fire Department ___ .,_ _•.._ _ . . _ �. ,�- \;:,, � ,� ---- ^ ��� - - �� or inrprones tbcrenn,and u�Go docs sucb u�osk Gimself or . - . � ..,_ , .. . ., tbrovgb l�is oa�n empJnyees.'provid¢d tliat ruc! irn� �� Groding � � '� . i , � , pmnements arc no1 intended or oJfcrcd for salr., - i3,' " . . _ . _. r.�:� . . ��ll . bnwcveqtLebuildinqorimprovenrentissoldutitbino�._ � . , � , �. — � . ,. . . _ ., Geol6gital.- ..- .. .. -� : , ," ,.:- • �.•� �, �1'car of romplclinn. tbe owner-burlder�u�i!!bavc lbe � �� - �� � � burJers of pmeirtg lbat be drd not build or imfrovc f r . �. .; ' , .'. .. . _.. __._ . _.. . . _.� . Pedestrian Pro�ection ��' - � � . - tGe purpose of salef. � , - .. . . Fence Cano � � � -�� � � � - - � � ❑ 1.as owner of the ro en� . ' � )( PY) �.� ... -�- - �- "- �� - . P P Y,om efidusively contrdc= �ting with licensed confraUols io�consiruct the projec�(Set. Special�nspeUion� � ... . . . . � . ._. . _ . �.. _...-� ,�:. , � - �6uilJs rimfr i et!be�on�`anJ u�e:t 7be Contractor's (Conc.)(Masonry)�Welding) � � � arr.v ou�ncrofyropertyu�bn . . -.. .. . . . - - bo confrocJs for sucb lof Drainage " _, _ _ , ,_ _ _. ____ . _ . _ . projects u�itl a cnnfrdctdr(sJ'li[enseG fursuan! !o tl�e �� ` , - - -nntrartar't I.icensc l.aul -— _ _ i , C W Parking' _ _ � ❑� 1 am exemp�under Sec ,B.BP.C.tor this � x i r. , ., ` ' fC050� � ' "" " .. ." _.___ "_."_.' "" . ._. . . � � � � Date Owner , .�.... .. �.: . - �. . � -�'�- . .U:� nc. - ,.�� ir ,. "� ._—. .... ._.. __. . _ _ . .... .. . Approvals � �� �ate Inspeclois$ignnfure . . INSPECTOR'S NOTES � Location— , �, ' � ._ v. ` ISetbock 8 Yards) , � � � . . � '-" Foundations f� " . �. . � .., � . � � . . Slab . � � - ��.. . . ,. .. � . . ._ _ '..' - - ...—' - �- ---. _ ,. � � � - ,. . �. Frame � . i�/ . .. . . . : � ' , . , � . � .. .. Energy Insulation { t � ' ��''..____ _ . .�.__ . _ � . � - . . .... . , . . . tath/Drywall_� � . ..._—.... _-_ _. _ . . . . � - --� � . Interiar - - - - ' � , . . � . - i Lath—Exterior � . � . .,.,. ,..�,.�. . �--. . ....�.. . , . . . � ; _ . . __-_ -___ _ . _ . _. . HouseNomber— � _ _ .. . ..._. ._ . _.. _._.. _ . .._. . __ . ... .... i ., .___._ _.-, � � ., Correct 8 Pos�ed � � � � . r. . � Final— ... .__....__. _ . _ ._. _ - . __ .. . . . . . . ._ _ _ ._._ .___. _ . .. _. __ _. Enter on Front � - . .. � �/ t'�' _ .... . .� ..