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HomeMy WebLinkAbout1249A 1250A (6) --- -- ._ _ .. . .. . . . ..._.. . . ._... . _.. . _ .. . __ _ _ ._.._ .._ . _ .. WORKERS'COMPENSATION DECLARATION . - . � . _ � , . . . . � - . .. _.. ._.. . � �'' .. . � I hereby oifirm fhot I hove a certificate o�tonsent to self qpp��CATI��I� FOR BUILDING� PERMIT - �� � insure,or a certificate of Workers'Compensotion Insorance, or a certified copy ihereof(Sec.3800,Lo6.C.) ' ' �'�' �- � - - � � __ ._ __ .__ . : �,y7CP6255241 ' Great American Plan 3CR �OUNTY OF LOS ANGElES BUILDING AND SAP Y� Polity o. �Company -�� � � Certified copy is hereby furnished. -�.��� . FOR APPLICANT TO FILL IN BUILDING � � . .. . . . AWRE55 . Certified wpy is�f�led�with the county build�ng inspet- BUILDING 'Flondeporfinent. � qo�RESS � Da�e 12-2-86 Appli�an�_ The Wm. LVon Co. aTv Walnut zic 9]789 �ocnuTr � CERTIFICATE OF EXEMPTION FROM WORKERS' ��� "" - - - - NO.OF B�DGS.- � �� - - NEAREST . - - -� • � COMPENSATION INSURANCE '� � ' SiZE OF LOt Now oN l07 � CRO55 Sr. (This section need not be tomplered if the permit is for one -�-- �- -� � � ASSESSOR . r-�--� � � hundred dollars(5100)or less.) , TRACT BLOCK lOT ND. Mqp gppK�� � PAGE PARCEL ' TEL. USE ZONE �P � � I.cerlify Ihal in the performance of the work for which this OVJNERT}IE W N - � � � } permit is issved,1 sholl not emplay any person in any monner .• �� � SPFCIAL � -- ��0. so as to become subject to fhe Workers'Campensolion Laws. - ���� ADDRES -''- -"' ' CON�ITIONS V . . � crcr Newport Beach, CA . zia 92660 -- � � � Date APPIiCOnf ' ' '�•... .-. .... . . ARCHITECTOR TEL. ., � l"QTICE TO APPLICANT: If, oGer making this Cerlifica�e of DISTRICT G OUP iYPE_; .. ! FIRE P ED BY � eNcweeR Hales—Lan ston No. 547-0 2 implion, yoo should become subjecl to the Workeri ^ CONS.i , � _ompensolion provisions of ihe labor�Code,you must forth- qDDRES 1 � W � wilh comply with such provisions or Ihis permit shall be TEI. ST�STICAL CLAS ION �/ APT. CONDO.�• � Z deemed revoked. '.�, ,' � CONTRACTORSdR12 AS �Wi12Y �NO. ; � UCENSED CONiRACTORS�ECLARATION � � ---� � - � � � - -- -- l�C.- .� . - � C1A55 N0. � UV�LL.UNITS - I hereby affirm Ihat I om licensed�nder provisions of Chapter 9 AD�RESS NO. (commencing wiih Section 7000)of Division 3 of the Business and _ . __ __, _ , . ���__ . � SEwER rnnP , �, � � � Professians Code,and my license is in full force and effed. CITY QASS � BK - - ��: - �� -- VALIDATION - � License Number �"� ���� � S ' --- - 30.FT. ._ NO.OF NO.OF CHEIX � � � � �`. 276801 ' �Qy�- ' S1 E STORIES FAMILIES � ONE , ' � ;-�� � I am e. .. . .. . � YALUATION � , NEW �,R • he Wm. Lyon-Co. 12-2-86 - - oescairrioNOFwoaK &] r�/► 1 �1 249 A Confrac or pole ADD s S v�^-� � � � xemplunder5ec . . ..-. - . O , � -'-�-• • •.�.'Z� .. ' .. . . ALTER , � B.&P.C.for ihis reason - .- - REGAIR � s' - -" ' -'�-.....-( -� �-- � •-2 7��i 6$.... �_ .. . _ -� Daie:__. _ � USE OF . . . E%ISTING BLDG. DENAL ❑ - ' '. ._ .• .2 7 G b&�- ' .. ...Signature� . .. -.. �.- ..- -.- . .. APPIIC{�NT . TEL . . � �� FINAL OWNER-BUIL�ER DECLARATION PR� . . NO. ` -DATE � ..--_' '--.''� - - . �� 2� 9-.g b_--_... -I hereby affirm�hm I om exempt from the ConimUor's License � �-� -� � Law for ihe fallowing reason(Settion 7031.5,Business and ADDRESS � FINAL � ' '�� ` " �r'-'� 2����fi _..Profe:sionsCode): ._..- - ' -.... ._._-.,_. _.. . ... . . , BY . . .:� . - -. .- � BUIIDMG � , tj• • • • '�. . � �, as owner of the property, or my employees wi�h q�oRE55 ' wdges as their sole compensation,will do the work and � � `�AiiTY , ' ' , ���.�4•��5� the stroctore is nat intended or offered for sale(Section , '�'� ' — 7044,-Business and Professions Code). -� - - ��- �� � MOVING-- - - - - - - � � � iEL. � � -- - � �'; -- - _ -- - )� _ � � CONTRACTOR NO. . _ � �4'I J�J�O,c�. 1,os owner of the proper�y,am exclusively contracfing - with licensed contractors ro construcl�he project(Sec- - qpDae55 �� � � � I 2� G�=8 6 - tion 7044,Business ond Prafessions Code). . , . , - . . RE0IJIRED. TOTAL SET6ACK ' - -- -�" "�-CONSTRUCTION LENDING AGENCY�"-� -"� ' ' SET BACK YARD HWY pROP.UNE Wio7H� � - � � -- ��� � - " 1 hereby afiirm thai Ihere is a consfruction lending ogenry for FRONT � - � ' - � '" -the performance of fhe work for which this permit is iesoed - -- - �P.L - �--- - � -- �- -� � �- �� � - �- --_.. . � (Sec.3097,Civ.C.). SioE •.. . . � , . �,� ;: ��;, a _ '_._.._._._.._ . _ .. . .. . . .._ _ P.L `.) , .-- ' ..,. � Lender'sName_�,...-��z;..,.�.,.i �ii:..,.x.. ., i. -_ . .. .._�_ . ... ' ' . '_. D $ -. _ . _ . _. . ._.. . _.. .. . - v.C:Fee S- "Perm t Fee � 5. LDMA Ref.N � J_ . _._.. - Lender's Address , -��-� "..�; � .I-rertify tha�1 have read�his appliw�ion and state that theag� ..__ . . .__ . - i»uance vea - ...�D.S�—��' �DMA PiC M . . _ . ..'.. . . -� �'� '. � ^ above information is torrecf.I agree lo comply with all Cpunty Invesligafion Fee ' � 3 . ordinances and State lows reloting to,building construttion, __ �-Torol Fea- --- S•.S� �nnn Pe�m.�M �-�' � � � . _ . ...._..... ._. .. � - - - - �. _ . ._. i and hereby authorize representatives of fhis CouMy to enfer -' �- -� � upan the above-menliO�ed proparfy for in5peciion purposes. _�75.d 1 . -,- . -. �'35i�p..-, ' � e '_. . _ " L�S� (J '_____.. . �) /� - - . — _ ; _ ___ ._ _. _ .- o (X�1M7�L`. � SEE REVERSE FOR E%PLANATORY LANGUAGE � ' ! ' .'" '.Signatura oi Applimnr or Agent. -_'__._. ...Dafe.. .. . _ . .. . - - '_ ' ' '- '_...._..�. _ ' . _ _. .. _.. �...._ . .._ ... . .. �.i PIANS TO APPL�CANT INSPECTOR'S NOTES „ 0�9NER-BUILDBR DECLARATION I hereby affirm ihat I am exempt from the Canlractoi s To: Rrfurnad , � - ' , . ' ' -�-titenie�low for the following�reason. (Set. 7031.5) ' '` '� -� ' Approved '� BusinessandProfessionsCode:Anycityoreounty_ulicb No. Date � No. � Date � �- ' ��'� � -- � �. -. �. reguires a/rcrnail lo tanstsua�,al0eq imJ�rot�e,demolisfi, ._':or repair arty stru"ctu re,Qrior tn its issvanre,also reguires , . � - _ � � ,, � . � , � tbe applrcant Jnesuob permit to Jile a signed statement � ., tGae bc is lirrnsrd parsuant to tbc frn<�isinns of OGe Con- � , . , � � tratlor'sLimrtseLam/Cbapler9f(torxmenringadtbSco- � - tioa 7000/oj DiiJsinn 9 of tbe Uusimess and Pro/rssions ; ' " . . -� � '(I� � :,��.��.;��.'. : .c,;:CodeJ or tLaf be is exempt el errfrom artd tbe baris forlLe • ��. :•. ..- � � __ . ..._. .... .___ _ _ __ . _ _._ . � � "" - - � a!lrged exemptron.Any urnfAtion of Section 7031.5 by , ._ . .� .,-� ' Raqulrod . '--.DaleReeeiwd -. �l___.-.�- � ' ...�..' "� ; �:' .' . _� anyap/�lirantfro(�ernritsubjetestlea/�Jdicanttoaeiri[ � Approvals Yos ryo or Approved � . . , � penaltY o/nnt mnrc�Lan Jive finndred Jalfars(SSOOJJ: � - -�-' . - - ❑ I,as owner of ihe propeity,or my employees wifh . N%oler Cerfificate � � ' . .. .-_ _.. .. . . . . •�� . . _, , wages as their sole compensation,will do the work,and �- -- - -- �� � --- -��� the shuUure is not intended or offered for sale(Sec.7044) Heahh Department . � ' . .� ' �' ' • .� � � �� � .Business unJProfessioris Codri TGe Contractais License _ . . _ _. . :.... . , . - '' " --- I.aw dnes aot u/�J�Jy to an o�uner af properly who builJt ' ' �� � � � ' �� � � or im/�roves lbemurt,and u�bo does sucG u•ork Liniself or � Fire Deparlmenl _. . _ .- - .__ _ - - . . . _ .. - . -. . .. � , tGrougb Gis ou�n emJ�lnyces,�Jrronided tJ at iacG�im� ' Groding� - �' � � . . Qmnen�ents are nat intended or,affered fnr salr.. , •.� � . . - ! ! - .•' ._ � ., imu�encr,tGe bueldrng or impmvement is svld u�ilbin o.. - � - -- -- �.-��--- �� - - �: � '�� �� ' ' •" � ' � � ear nf c npletr rs tl e ownerbuiGler u•il!bauc !be \�'�.\ � .v or 'n � Geological � " . . _ � barJen oJ prorirtg lbat br did nol build or im/�rone for ( I " � '�.,,.,_' �-. . . .. ...� . .. _ . . . -'�� - - tlOurroscofsaleJ. „ � . . -..,, � Y . Pedestrian Proleclfon . �. . . , . . Fence)(CanoPY) . . . -- . . - .. --- - . . � .9 P� P Y� . P I Ico(roo-. I,asownerofihe o eri ame.clusi . lin w�th Ltensed controciors to conslruct the� ro'ect Sec: � ��-� � �---� -��- � --- --- � �- � ��--- - - - �� -7044)Uutinciz and Prn/essinns`Code:TGe Contraclor'a Special Inspecfion 1 - . . .. . . '� .. .�, � . � , - , - u, o (Conc.)(Mosonry)(Welding) �� �. � �� ; ,, rense l.au docs not appJy!u an ouner o�r��r rty G � „ Li e � � ... _.�� �. -. ..."� ' -" --�='' - ' "--buiGls or irnprores-ll ereon;und uJ�o ronlracts for sucb Ct ,... . _ , .�i � LotDrainage � " � ' .•.. .� . _ _ . . _. Qrojcrts witl�..o toatraCfor{rJ litens¢d Jrursuant �o lbc � . �� � - � � �Cnnlrrsotnr's l,icensc fawJ: � - � -�- ' , . Porking ' ' � � ' ' . '•. . " ; . . . . . ..� - ❑ I am exempf under Sec. .0.8P.C.io/this '. , reason--� ---- �--._.. .. .., � . ; ,. . ; . __.._ . ._.___ _,.__. . .. . . � Dole Owner -� . , � . . '_ ..... . _._._.. _ _... . .._. . . .. _. � . � . . . . . , , . . . . � . . ._. .___ .. .._ ...� �Approrals , Oata Inapedor's Signdfura " - ' . , , , � INSPECTOR'S NOTES � Lotation— ' . ' . . � (Se�back 8 Yards�) ' -- ������' - ' • . � - Foundations � " .� " . .� � . .. � �. . ' Slab ' f,�,� �� . . . ... . . . . ;_ -- i � i ^� . , . ... � . . , . Frame . . .. - . . , .. , , . �.. Energy Insulotion 9,y;1 . . . ._. ."� -� " - - . .. � � . � -.. �� � ,. . `. . . . �V �om/�IyWOII— Z (�"--� � _'__" ' " _ _ ,_. ._ _ Interior �- -�" . .. ' '�, � • '�- � lath—Exlerior . .. , . . . .. � . � . , � . , i_ �r. ...,�r1 .. ,. � � � � House Number— . �.�.. ._._ '__ .._'_. . . ....:..,. .�..� . .., . . , __ _ .__. ___ _. . . Correcl&Posted ' , . >> � � _ � .-�t.,' -.�, . . . �. Finol-- __.-__ ___ _ _. _._ __ . . __._ _. . _. _. .__ _______ _._._ . . . . Enter on Front . .•- . , ' � �� '� . , . . . . -.( ,l' , . � , .� . . . � ,.. . ..... . ' ' ' ... . �\ :�i.� . . . '_-, ..