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HomeMy WebLinkAbout1221A 1222A (6) \ , . . , _ . . _ ._ - -'-- - - -_ __...._. _ .._. _ ..._ .. _ . ._ _ . ..- _ -- WORKERS'COMPENSATION DECLARATION �.- �� �'. �-� � '- � ,��.;� �. � , �� I-hereby affirm thal I have a terlificata of consent to self � �^���� � . insure.orocerh(icateofWorkers'Compensotion��=��a��e, APPLICATION.��FOR .�BUILDING-PERMIT� or a certified copylhereof(Sec.'3800,Lab.C.) � �� � ' � �" ' � . WCP6255241 - Great American Plan 2C COUNTY OF LOS ANGELES � BUILDING AND SA ETY . P❑olicyNo. �� �Company . ,. .. . .. . .... .. _... . Cenified copy�s he�eby fu�nished. FOR APPLICANT TO FILL IN BUIIDING ADDRF55 � Certified copy is filed wi�h the munty building inspec- � BU4DING - • � lioddeportment. � ADDRESSZOBZD East Cliffsid Lane � Date �12-2-$6 ; Applican� .Tt10 Wm:,.Lyon Co.- . .-� cin, Walnut. . .. .. Z1P' 91789 . i�iTr � . � � ��CERTIFICATE OF EXEMPTION FROM WORKERS'' - �"�� " -"� - � -� NO OP BtDGS. � �- -�; Neqee57. --.. � � � � COMPENSATION INSURANCE - � srze oF ior3,8�0 SF Min. NOW ON l0T 0 caoss sT. . ' + (This settion need not 6e tompleted if the permit Is for one -- � � � � - �- � � � - �� -�---` ASSESSOR ' --- -- --� �� ` ��•�+'- hundred dollors(E100)or less.) .... . TRAC7 Q ] BIOCK � LOT NO. MAP gOpK - '� ' GE PARCEL � - owr�ERTHE WILLIAM LYON-00. -N�33-3600 us�zoNe n+nP � ; I certify tha�in the performance of the work for which�this � NO. - ' .} permitisissoed,lshalinofemployanypersoninanymanner ._. qDDRES$9-�COC OY&tE P182a � �-� �-- SPECinI��-� � �� � �--- ��0. . ._'_.. . . . � so as lo become subject to the Woikers'Compensotion laws. � � � �- -CONOItiON ,O ., aTr Newport Beach. CA nr 92660 __� _ _ �, � . . , . ... _._ ARCHITECT.O . ... . TEL.. .... .. . � ��. .' . . ��� Dole ' '.` '..�.�Applicanr- . � . .�+�OTICE TO�APPLICANT: If, after�makmg'Ihn Certificate a4 W-[ales-Lan SiPn S4�-OBE121 DISTRICT__. GROUP_ NPE . _ �.FIRE.. PROCE55 BY . � mp�ion,'�you�should bewme�subject to �ha Workers' � ENGWEER g NO. ro�,'�� .z� � .mpensationprovisions of the labor Code,you mus�forth• pooaE5577� S. Main St. Ste. 105 Oi'an E� Q"- ' , � with comply�with such•provisions or this,permi� shall be ��- �- � �.� � '� � �� �N deemedrevoked.,..�. •� ' � �� SBIIIf k�S Owner TE�� STATISTICAL TION � APT. CONDO.� � 2 � � � � � �' � � � �OMRACTOR NO. � � / IICENSED CONTRACTORS DECLARATION��. - � � �� �� � ��� -� � � � ������ � . ...� - . .. .._ ...." '' �' '-UC:_ .....- . .� CLASS NO. � DWEIL UNITS1�._(_ I hereby offirm thm I am licensed under provisions of Chapier 9 qDoaESS NO. � (commencing wi�h Section 7000)of Division 3 of the Business and .. .. . _ ���, . : ��R�`P ' ' ' � � � Professions Code,and m license is in f�ll force ond effeci. S�Y� � SrOa�S � � � F MI�lIES C`A� CpNEK �� BK. �,. ' � �DATION �� Y VAl 276801 B-1 . , � License Number �Lic:Class . -� ��" The Wm. L on:Co. 12-2-86 _. ___. _.. ...., .. ._ _. NEw vatunTi N Y oeseaivnoN oF woaK � ��2 2.1 A � CoNrottor � Date j ��-'� � ❑I om ezempt vnder Set. - iII le famil -ho e construction Ao� ` _ � , .2� . . _ . .., ALTER � - � B.BP.C.forihisreason __ _ . REPAIR 's --..__ . .. _� ._ � . .... .._. . . ._ � USE OF � � ' I •2�L 7.2.3 _ _ .Dare: _ exisnNc eio�. oerao� _ _. . �.2 4-2?_3�.. - APPLICAM TEL ' '� �. ..-Signa�ure . .. �-�- - - - - -� . . FINAL � . vaiN�Y'he William L, on Co. No.833- 600 i 219-86 OWNER-BUILDERDECLARA710N _ . . ._.... . ... . .._ .___ _.._. ._ ...DATE ...-.._ ...'.'_ __.. ._.__.._......____... - --I hereby atfirm Ihot I am exempt from�he Contratlor's litense � �z'�,2.�.2 A I law for 1he foilowing reasan(Section 7031.5,Business ond ' ADDRESS FINAL`� �� �� ' _ _. . . ____.. .. ..._ . . _� � "Professions Code):� --- --.... . . ._� . . .__ '. . euuowG �BY . . ..- -- �•.� �� . � . . • -' �-.� I, as owner of Ihe property, or my amployees with ADDRESS ' ' � ' ' - � , .._ ..._._. __� ... . .. . _.. i �w6ges ai their sola compensation,will do the work ond �� � � �. , ) •[i`Z(y�� - ihe strocWre is not intended or offered tor wle(Section ����N �� � � - � -� 704a,8usiness and Professlons Code).--- �-�- - �� MOviNG � ' -� �- - �` � �- � - �7ct- �- - � �- " � -��� - � � •4��b 0 G c=i � .� . CONTitACTOR NO � "' . . , - . I,os owner of Ihe propeny,am exclusively contracting t �with licensed[ontratlars to'tonsirutf Ihe�project(Seo- �' ADDRESS �. . ....'��' � '-.... . ���-�� � � - - - •. ��2��9-��� tion 7044,8usiness and Prafessions Code). - � S�`1 �,� I . .REG7UfRE0 .YARD- -HWY" ..TOTAL SETBACK . . . ... ._ " '. ' _' ._ ..__. __.. J � � -- -"�-CONSTRUCTION LENDING AGENCY � - ' - Sei encK PROP.LME WiorH� - - I hereby affirm ihat�here is a construction lending o9ency for feONT � �� -�� �.ti"`j�-'1���!! `� '- -' � "-.✓" 1 -.tha performonce of 1he work Tor which Ihis permit�is issued .... ..P.L . ___ ._ .._.. ....___ . . _.__.. ___ .. .. _. _. . __ _.....___ -r .._ . . __.. .._ _._.�. (Sec.3097,Civ.C.). sloE (����L;l�;� � � - � , .. m __ . . . ._ . .. _.._._ .__ .. .__ P.l. .. .... .. � . '_. ......' _. __ _. .. ..._' . .�.�'.. .. _: � lendersName Continentel Illinois Bank ' �^ ^ �f S.SD wrna aer.x _ _ .._ . . . .._. . _ ... . . .. i.C.�FeeE._.A+� •.1 � PermnFea .' _ , .. __ . . . - lender'sAddress?3� Sn_ T.a SallP St.� Ch�e2g0 �. � ��. ' ,-. . � 5' _.1 certify that 1 have read�his application and s�ate Ihai the .: . - � �ssuonce Fee . ----� lDrn.4�/C M -� -- �---- -�--- -- - �- -- � h^ obove infarmatian is mrrea.I ogree to comply with all County ; Imav�goiion fee � � ' � g ..ordinances ond Stale laws relating fo 6uilding constructian. __ .. . -.... Tmal Fee- ��[.�.....` L�nAq Pvm.M �-- ., .. , � ... .. . . . ._ . . _.. . ....._. .... ._.. .......... .'_ u cnd hereby aulhorize representatives of this GouMy fo enler � ; m up Ihe above-mentioned roperly for inspeclion purposes. .r.. ��D . �, . � � r _ g .__ __ - ^ L t,���( �a �� � SEE REVERSE FOR E%PIANATORY LAHGUAGE ' � -" -Signofure of ApPl�cont or AgeM.... . a�e.. . . . . . . �"' .- . .- .-. '- --- � - .�. .._.- .. ....'�'� _ _ ._ ._._. .__ . . .._ . ._..___. I PlANS TO APPIICANT INSPECTOR'S NOTES .O«'NF;N-fSU1LUER DECLAKA7'IOti I hereby aifirm tha�I om�exempt from the CoNrocror i To: �� - RNunied. �� �� � � - � � . �'license Law ior the.followin9'reason.� (Sec.�7031.5) ' � ' � ` ' ' Approvad ' Business arsd Professiunr Code:Any iily oreounty wl ith No. Dofe ' Na� �� -'-�Dofa'-� � -.. , .�. . .. ... -�.' . ., . _ . , �.� , , . �,reyuires a pemrit In conslruct,alter,imprnvg denrolisG, . .._,.or reJ�air any structure,prior M its issuance,also requrres . � . - � , , , , . . 1Ge applicaxt for sucG permU!o file a signed stalem¢nt , tGat Gc is licrn+rd jiursuan t to tLe proviarons of lGe Con• � , �;_ � , � � tratlnr's Liccrosc[.au�(Cbaptcr 9f(conrnicxcing u�itG Sec• ,., ' �" ""-'���""� -�- ��" -��- �������1 -�� , lion 70001 of Dierrion 3 nf 1!e 8esiness and Pra�essions ��� ��� � -" � "�_�CndeJortGatbe'hexenrptflere�romandlGebasisJorlGe ' �. . .'�` �.. : ..` -`.Requirud_ �. .���,Dafe Recd�d�- -. .._. - - .-. � .. . . .�... anrl aJ�Plican JOTQ J��M1li SLE�BClS[IJC applr arse��a rib! .�� � .. • '- __- . �� �� � �� � A rovdls -.Yad Na or Appravad: ; . . „ �,, - . , �� f�enalty oJ not mnre than Jire hundred dollars(S500J.):. PP � �-- - � � - -- - � �� --- - �-� - . ❑ 1,as owner of the propeny,or my employees wifh Waler Cerfificnte � ..� � :•� �����. .�-�.� . , . �,�� :� ,. . ..... . . .� wages as their sole compensation,wiil do rhe work.and .. � . ... . ..... ._�. . . .___ _. .. __ _ .._ .______ _ . . . �-------� �- �- - �-�� �'" � —--�-'� � ' the struciure'is no1 inlended or o(lered for sole(Sec.7044� �- � .r;..i ��� f Dasinesi and Prn essinns Code:TGc Contractor's License Health Deportmenl ..__ .': .��. •� . _..,. ._.. . - ___.-._. ___.� _ _ ..... _ . .__ _ _ _ . f . . � , ;',i , Law Joes not apply to an ou�ner o/properly wbn buikfa �' Fire.Deportmenf.__ ._. __..._ . _ _.._ .. _ . . - - - � �-� �-;.- ..�. ..... . �_�. �.. . . . imfirov on n Jo raelfor � or es tl erron, J �bo es tutb u�ork bin ,: ; . . � , . . .�:. :_�+�, :�'. u:..�,. : - . � ' tbrou�G cmployces.�oroi' � _ Gis ou�n nded tbat-�sur1 im•. ' Groding � � " . -�-/+rnv rertts arr not ' te JeJ r �j/rred for tale.. � .. ,. ' ���. . � "'' . � ' ' .. '�.. . � .�.:+'.�..�� .i'."��j .';-�.;.' '. c;.:�.�� �1 C�'i� . . . bnu�ce�cr,lGebuildingarimproecrnentitmldu�ilbino. � _._. . � ... ; � ._._. . __ .., . �-. . �� Geological ,�� -� �' ; .�, --.,; _,r� .. . . ��,Ycar o/rompletion, f!c-nwnervburldcr�mrf!bave�tGe - � '�� -�' � � . � burden of pmring tGat Ge did not build or improvr fnr . ._.. . .. ._._..�-�- .-_ _ . ..._- -- _... _. .. . .. ., Pedestrian Protection� - � . ibr purpore oJsaleJ. - _ . .. . ... . . _ . . :.., . . , , . (Fence)(ConoPY) .. �.:.. '� .,� '.. � , � ���' ._-... "_S.__.__ ..._.._ _. _.____. . ._.._. ::.�. , .. ❑ I.asownerofthepropeny.amexclusivelycontrao . �ing with licensed controctors b wnvruct the proje<t(Sec. - "-'""�� ` ` ' =" ��,-�, -- �-�� -- �- --- -- -. - Dusineti and Pr%ssioris�Code:..TLc Cantrartar's __ . . . �. . _ .... �. Speciol Inspectfon _. _.__ .. . . . 7044) . . (Conc.)(Mosonry)(Weiding) - ��� "' �- -� �- ��� "�� _ , L ___ ��� �� �� . ,�� � . LirenreLaaudoesnotappTytnanou�rtcrofpropertyu�hn � - � --' `���-`"-`"' � - � builJ3 nr,improves thereon,nnJ u�lo contracuforsuch . N LotOrainage; �= �' .-.. � � � �- ;,"-'`�,. ' � -� �...-'-------- .---.._ - .. --.-- .. . �Cnnlracu�itb a confractns{sJ'licen.ced�j�ursuanf fo tbe � . . � n tI ., . . . , . ' '. _.. ... loriLicenseLawf. ..,. ..__.'_ _. � �� : Porkirig ., _ --- -- . ' � i '' ❑ I om exempt under Sec ,B.&P.C.for 16i's . ,.�. � . , , I . . ... ...;. . •. � . ..... _.. . _ .. . .. �• _ � . . . reason .. _.._ , ... ., < " ' ,- � Dote .�... � .. . � . .Owner ' , _ . ; „ � � ` � ��,.�. .. . . -,. � . :. •. , _ . „ I I � _. . _ _ Approvdls .. Date ._..Inspeclor's Sig�af ra."-' . . . . . , �� i . . _. ..... '' ' �: INSPECTOR'S NO7E5 � '-� � � � _ ., Localion—. . .: ., 5�� ..-.. . � � . (Set6ack 8 Yards) �... .-. _.. _.. ._.. _ �.. , . . - _ . _ _. _.. . . �. , . ; E_� , Fo��ao��o�5 , �/ ___ --- _ __ _ � Slab "' .. " �l //L . . ,.. ...�:. . . .. .... . . . . . �l�a( � .. � . .. .. . � .._ .. .. Frame _ . . . . ., � . � , � � .. . . � Energy Insulation . �^ �..'.r,.I. .- -.�.�.�.:_.---- -'. .:. � _. �. .. �..� . . . �,. .. , . .. , Lath/Drywall- ..__.��___. ... _._.. . .._ _... . __ . . . �' � . _ . Imeiior ��!`-____.-__ I , 1 y . " Loth-Exterior . , .. . ,.: . ._ .... .. - . - . .. . _ ._ ��,.�,� , � I- _ - , .. ,,, . . . ... .• House Number� . . . .___..,,. _,. _._._ .. . ..�• ._. � � .. . . � .... . . ,. , . . : . .. Correcr 8 Posied " - ..I . . - , ._.�., „� i . .____.r. . _�� '.. �. . ' ... `��-� � ' ' . Finol- ...._.._...._ . .. .__ _._- . _ ,. _ _ . . _. . ___ _...___._.. _. . . _. Emer on Froni � . . . , . ,� . . ,.... ..,., .„.....