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HomeMy WebLinkAbout1247A 1248A , ,,. . __-- _ _ .._ _ . .._._ .. . ._ .._ ._.. _ ._..�._ . ._. _ _.._. . WORKERS'COMPENSATION�DECLARATION . �� ' ��� ' '- � � � ��- I hereby offirm thar I have a tertifiwte of canseM to self _ . • insure,orocerlifita�eoiWorkers'Campensolion��s�,a��e. �.�_�_.._ ��APPLICATION �. FOR���.BUILDING�� PERMIT�- �� or a certified copy thereof(Sec.�3800.Lab.C.) �- ' �� � ��- -�- �-- . ._ .. _. .--- - �WCP6255241 � ' Great American Plan 2BR COUNTY OF LOS ANGELES � BUILDING AND SAF TY P❑olicy No. � Company � . . . . .. .- BUIIDING � � � Cen'rfied copy is hereby furnished. FOR APPLICANT TO FILL IN ' ADDRE55 �l � �.Cerlified wpy�is filed with Ihe'counly building inspec- � BUiIDING ', � �`fion deparfineM. � ADDRESS ZO$Z7 E 1� Date 12-Z-H6 � �APPlicant ., TF1E Wtit: .Lyon;Co.� � aTv Walnut ....- - - �� 21v ....91789 � i�,iirv , �' � � �CERTIFICATE OF EXEMPTION FROM�WORKERS' '� -� - - - NO.OF BiDGS. �---- nIEAREST. ... - -- -- , � � � ��COMPENSATION INSURANCE � .. SIZE OF 10T3�SOO SF Mltt. NOW ON LOT O CRO55 ST. � . (This aecfion need not be�completed if fhe permu ls for one -- - � ASSESSOR.,�,.. � -- � � -�"- "" � � iRACT'. BIOCK LOT NO. � MAP BOOK .�.;�. hondred dollars(5100)or less.). . . '�- � PAGE PARCEL - - owr�aTHE WILLIAM LYON C0. N�33-3600- ' e zoNe �P _ us I.cerlify,lho�in�fhe performante of fhe work for which this NO. • � -} permit is issued,I shail not employ any person in any manner . � ��- -� � SaECiAI��-�� - -- ��- so as to become subjett to ihe Workers'COmpen50�ion Laws. � ADORESSI9 CiO L OT8te P 1828 -� "- "' '--" CONDITIONS _ V '. • � . arr. Newport Seach, CA Z1P 92660 - � Dole ..�� :��. . ... APPlicant � �... . ..,. ... .__. . . . . . .. .. .: . G ARCHITECT O TE�� .DISTRICf ., GROUP TYPE .fIRE 7� EO BY. �TICE TO APPLICANT. If;'a(ter moking this Certificate of ENGINEER �IaLeS-LHngStOn No. 547-0862� i im iion � o� should become�sub'ect'ta the Workers' CO T' 'Z empensation provisions of the labor Code;you musi forth- ADDRESS��� S. Pidin St. StC. lOS Or�n e� �� - -� - � ,y wl�h mmply with suth provisions or Ihis permit shall be ---- 7E1. , STATISTICAL r ATION �/ A . C�NDO � ''2 deemedrevoked. -� � ���.� .�� �.��� �, . ..�,' ... SBme AS Owner ! ' CONTRACTOR NO. - � LICENSED CONTRACTORS OECIARATION- .• ���. -- - - - - � �--� �- � � � -- �� -� LIC.--� - M55 NO DWE0..UNiTS � I hereby affirm thot I am licensed onder provisions af Chaprer 9 ADDRE55 No. . . , I (commencing with Section 7000)of Drvision 3 of the Business and . .___ . . : - �LIG - . __... ��R MAP � . _... _. _ _ . _. . � Profesiions Code,and my license is�in full force and eHecL CiTY Ctn55 � ' �BK." "�-�:" , "�"- - --�"VAIIDATION ��`-�� �. ..�.. ZIGHOL ,.,...�,.. , ' S-1 . . SO.FT. NO.OF ._NO.OF _. . CHEIX ... . . . � Number �� � Lic.CIasS "' SI STORIES FAMILIES ONE �-"' - � lice i a'The wm. .Lyon.Co .12-2-86:' ___ N�,v vnwnnoN. _.....• _- _. � -' OESCRIPiION OF WORK "� x/l/� �' � �r �� Contro[for ' � Dale App � S (,J(,JV � �� 2 Q.7 A �"' � mexemptonder5ec. - - i❑ le.Eamil -home construction ALTER ❑ , . ' #• • • •21 �� , B.BP.C.for this reoson _. � REPAIR -❑ ._.. . . ..... _. � . -- -- - - -� �� •��. _. .__. . .... . __- __ .Date:. . . �� USE OF DEMOI ❑ . . .I •2 U 7.Z J � EXISIING BIDG. ... .- - �-•2 4 7�2 J�. : ..'--'$i na1Vf0 � � -.. ......_...�.. ... . _. � APPLICANT TEL. fINAL 9 PRIN he William L on Co. No. OWNER-6UILDER DECLARATION . . _. . .___ . . . _ _ .. . .. -.DATE . . _.� -_.-. -- -....�Z�"9-H(�-.... �I hereby affirm Ihat 1 am exempt from ihe CoMwctor's License . , ' � -• ; Law for Ihe following reoson(Section 7031.5, Business and ADDaE55 FINAL - � : !; p '� � -' "Professlons Code): ... .... .. . .... ....._..._._.. . ._ _.. .-' a N By � � . . . . . .���2(1.c°i-A.. ". BUILDING �'� I, as owner of fhe pioperty, or my employees wilh _._ ADORE55 . . - .. ..__ . .. . . #. � �.-�� � - � wages os-their sole compensation,will do the work and � � ' � � . .�� � - • . . the structure is not inlended ar offered for sale(Setlion �����TY � � � � � •�l 2�i.�� , - - 7044,-8usinessandProfessionsCode�.� --��-� � � � " MOVING� -' � � � - - �� "TF�•� � ""� --�"� - -�� � - - � �� . . . CONTRACfOR NO. . . ..,._, -. ._ : � S'��.. I,as owner of fha property,am exdusively contmcting ��� -,� - �l 2 6.��c> �--with�licensed comrac�ors�o-construct the project(Sec- . . .. . .. . . . .. .. ... . . :-. ... _ �`.. �.__. ._ . .... , � . lion 7044,Business and Professions Cade). NDDRE55 - � � � .._• � 2� 9_8 6 .: �, .... _. _ .REOUIRED YARD' HWY TOTAL SETBA K .�, '.' - ' ' - .- ... --CONSTRUCTION LENDING AGENCY�� ' ' � SET BACK 7ROP.UNE wioiii� � � .. , �_- �- �; , . I hereby afflrm that there is a consrruction lending agency for FRONi - "'"- " -' � � � � �� . . ,., y, -�the performance of ihe work for which ihis�permil is itsued � -P.L -� - - � ��- �� - - � -� - "- -",� �-'- � -� � " "-- �" -�-"�- ($ec 3097,Civ.C.). SiDE � .. . . . �. g .. . _ . _ . _ P.L . _ .._. . ... _. . ._._._ -.. .. _. . ._..... . ..._ .. � Lender'sName Continental Illinois Bank . . ., $ IUMA Ref.M � . .. . ... .. . . _ . Lender'sAddress�37 SO. La Sallp St.� Chiegg0 P'�'FeeE 7. e1. PermirFee ��S� � ' � "�� i � ' .. �.- � . � I certify that I.hove read.this applimtion and stota ihat�he - - ._- - �-. Issua�<e Fee� �O.J��- �DrM P/C N -� �� �- --� - � ��� �- — � above Iniormotion is mrrect.I agree to comply with oll Counly InvesYgaiion Fea � � � , ' g ordinances and S�ate laws relaring to 6uilding.mnstruction, _ . _ . .-. . . - . 7o�al Fee �� � .�� - LDMA Perm.N � � - --- --�� � �� �- --� � - � ��-� � -. u and hereby authorize representatives of this County to enter � � upon the above-mentioned property for in:pettion urposes. �-7S^ . -- . �'.35'��a � ' i - . o ._ . . _... _ _'_ ... . .. - . i ._. .' _ _ _._- .-. .__ i.' a �F �_ Q�j�' s SEE REVERSE FOR EXPLANATORY UNGUAGE � � � ^ i � - ... .. Signolure af ApplicaM or A9em . .. . pole...- . ' . .'. -.. . . - ... . ._ . . . . - . - ...: . . - ..' -. .. . ...�O� OMNIi&OUILDF.R DHCLARATlON PLANS TO APPIICANT INSPECTOR'S NOTES �^�.�� . . � . � I here6y affirm thm I am exempr-from�he�Contractor's To: .. .. ,, ' Ratum�d , . ' ' . . . ' 'License Law'ior Ihe following re6san.�(Sec. 703I.5� " " ' ' Approved ` Butineas and Professions Code:Axy city orcounty wGicG No. Dote � No: ' -+�Dats � �� - -� ���� � �� �- -- " . �'. ;•r¢quires a pemrit to eonstruct,after;improve:denenlisG, . . _ , , . --.orrepoiranyroracturr,prror to ih isruance,aCco requrres - � - , .' ' . _. , , ! . ' . . !Le aJ�plicant fnr sucG pern+rt lo/i!e a signed slotrment , �"� .., . ,lbut be is licented/+ursuan t lo lGe provisians of!be Con- i �' ,i., � � t� � � lroclor's l.icense Lau�(Clafiler 9J(comnirniirtg wifb Sec- , � , . linn 7000J nf Dirisio�3 of t!e Dusiness anJ Professions _ �`.. '' . , 1 ; .,. i , . --� � •' � �_: ' ' �. ' '�'_�Codcf 1ir tl at bc k e.Xem�+t N�ereJrom and!Ge-b¢sis for 1Le , . ..._._ _ . __. �. : .__: '- � . ..� . . . . � .__.. ._ . . ___ ._' . . allegeJ exern/4ion.�Any,rin/ation of Section 7031.5 by __ '. . Requtrod'� �.DataRvcoivod � .�. . . . �� � -�- � --- � " . .. - an.Yaf�plitantjnrapern�itsubjedstGeaQplrrantMaeioi! � Approral� -.Yei' No or Appravad . i., � • , . � �Tenafty o�no/rxare thun/i��c!undred do!lars(SSOOJ.J:, --� -''-- , � ' ' �- - � - ❑ I,as owner of Ihe properfy,or my einpioyees with _ Water Certificofe - . . .... � - . _ . . .. _ ... . � � . . .. . �wo9es as their sole compensation,will do the work,and _ - - ' - � 'Ihe structure is nof intended or oifeied for sale(Sec.,7044f '�� Heohh Deparlment�_ �.. � � :� ! _. .; ����--��--- �- -- �-=- - - �� � � ._ Dusiness and Projessions CaJe:TLe Contractor's License � � - I.au�dnes nol apply to an oamer of property u�bo bui(ds . Fire Deparlment . , _ . _ - � - or inrprot�es tl�ereun,and w�n does sucG+uork binuc%or � . . '��,- � � _ , . tGrougl Gis oam e�xpJnyces„f�rovrded thai suc! ini: �. Grading� � � � � prnrements nre nnt inlexded or ofJered for salc.;� ' ' ' - _, � � - �,��� -�Gourncr,!be baifding or inrprovement issold u�ilbin m. Geologicol ' , �� . - � . . , year af conr/�frlion, tGe omner•builder u�ilJ bave fhe �� � � '- � � burclen oJpmning 1Gat Gc JiJ rsot build or improveJor � ,.. _.. ..__. ..__'_.__. _ _... _._.. •.. _ _ _. .�__- _ Pedestrian Croleuion " - " . �. � ..' . � . tGc purpoae q/tale). ,,-. �. (FenceJ(CanoPY) � .-� � .-- - -- -=__ ___.._ _- - . . __� .- � ; " 'Q, I.asowneroftheproPerty,omexdusiJelytonrrac- . - Hng with Gcensed conrraciors io construd the project(Sec. Special Inspeclion - -� � �-�� � � - � - ---- "- 704E)�ISasiness and�ProJeasinns.Code:.TGe Coxtraclnri (Conc.��MasonrY)(WeldingJ ; � . .' ..:" . _.J_.. ._ '. _._:._._'._'.. �..5\�' ,: �..:`�_ l.irense"Laa�doesnntapplytoanoumc�rnfrrof�crlyu�Gn, , --� --�"builds or ini/�rones!!crcon,and u�lo tonlrno[tfnr sutG , � %� - � mjects�udt!'p rnnfrurJor(sJ-/eoented furs'vn6t to tLe lor Drainage �_ ., �.__.-. _--- —- - ._. _.. . C P , � _ ... -� Coxlraclor's Licemsc Lau�J.�--�- - � � , ; Parking : � a . .. , � , .� � . . ' . - -- . . . . _ . _ - . . . , -❑ I om exempt under Sec. ,B.BP.C.fo�this . . , t . ' '__ . .. . . . � � . . .. � �- � � . • reason ;, . . ._ ... .. ..._. .__ .__....... .. . .. ._.. . ' • Oare Owner Approrais Dote Inspactor s Slgnafura � . . . , INSPECTOR'S NOTES.� Localion— . . . . . ...____.. ` (Sethack 8 Yards) ;. � - � - � - ��"- Foundations ,� � � I `� � � ' , , . . � ,, . . Slob , -- -� -- - �- � - -- � . . .. � , Frome � . � �, '� .. . . . ... � � . . . �„ Energy Insvlarion �•� - � . .. _• _ .. .� ...'.'__.'j_'. ' .. _. .' _ _ -.__ . . . � .,. lalh/Drywoll— -. .--- - - -- .. . . i �- - , . . Interior "----" " - "' ' - Lalh—Exterior � .. � . ' - . �� �. .� . ...- � � _ . .. .. � . r� .., . .- ,. HouseNamber— . .,..-..._. .:��. _. ._. . ��. . . �� .. . . ,. � ' . . .._. . . � ' . Carrecl8 Posted � .'4 � ��� -� �� � ,. J. ..- � � . ��.. -. Final— _-_.... _._._...__ _._ , _'. ` ...^ . . _ . . . . „ -. . . . Enler on Fronl - � ��� � �� �, ..... . , . . . . . � . .`. :�` (.•. �:.�,. - . ,.��, � : � . . .. . , ... . . ' �, t...�.-• 1. .. _ � '�.._.� . - '. . ._-- �