HomeMy WebLinkAbout1223A 1224A (6) insure,or o certific ., , . . , ... .. . .._. ... .._.._ . ...._. _._. ._ .. ...._.._ .. ...- - — -._ ..... .. _ . _ .._.-.- '-..__.. _ . . . WORKERS'COMPENSATION�DECLARATION � - "� � � � •� � � �' . ...,. �. . . .. ... . . , ,. . .. �...... . . _. . . . _ . I hereby offirm�hat 1 have a certifitote of�o�=e�<<o se�f �APPLICATION FOR ,BUILDING �PERMIT - -��� ' a�e of Workers'Compensat on Insurdnce, or o tertified capy thereof(Sec.3800,Lab.C.) ,�.,...., ..- ... . . . . ..... � -. .-. ' . . -.. .. . . WCP6255241 " Great'American Plan 3B COUNTY OF LOS ANGELES BUILDING ANO 5 FETY PolicyNo. Company� � -� Q Certified copy is here6y furnished. '' . FOR APPLICANT TO FILL IN Bu��D�NG/>f1 �• ADORESS�/�� O� Certified copy is filed with Ihe county�building inspeo �-� BUIIDING � tion deporlment� - � � ADORESS oo�e `12-2-86, APPi;ca„� The.Wm. ,Lyon Co. arr Walnut z�P 91789 i�,iiTv . �` ��'CERTIFICATE OF EXEMPTION FROM WORKERS' ' � � -- -� -� � NO:-OF BLDGS. � � NEARESS �-��� � � -� � �� - - - �� � � ���COMPENSATION INSURANCE" �`�.:-"�� S12E OF 10T3 SOO SF Mlil.NOW ON lOT '�� O CROSS ST. . (This�section rieed not be-completed i{Ihe�permi�'is tOr�One ' TRACT BLOCK � l0T NO. � /�ppsgpq( � � pAGE PARCEL lPtenify ha'rlan�he perfo�ma PeY f tYe owNEe THE WILLIAM LYON C0. N�33-3600 use zoNE /�%.sP .. � ' ( I00)ar lezs.) . . � � wark for whith Ihis �� � �a ermit is issued,1 sholl not�em lo an perzon m any manner - � -"` ��A � aooaessl9 Cor orate Plaza ' � coNoiiioNs 0 so�as to become su6�ect to the Workers Compensation�Laws. � '� V , ., .. _ . ., .. �..., ., _.. . . ' arr Newport Beach, CA ZiP 92660 -- � Date � ' ' APPliwni - . ., . .,, . . . . .__ .. . . . . .,_. ��J !"'OTICE TO APPLICANT� If;'afler making ih s Certificate of ARCHITECT OR TEI. .DISTRIGT._. GROUP NPE , '-FIRE. . PROC ED BY... � ENGMEER Hales-Langston Np. 54]-�86�. CpNSL� Z �mp�ion, you should become�subjec� �o the Workers' - � �ompensation provisions�of the labor Code,�you mvst for�h- qoDRE55777 S. rfain St. Ste. 10S OLBn e� - - -- - �- with camply.wilh such pravisions or�this permit sholl be �- �-��� 7EL ; STATISTICAI CtA I TION �, APT. CONDO.�� ? deemedrevoked:��� ... ... . ..:.:.� - � �. ;-;.�,� COMRAROaSB[f1E AS OwIIOL NO. � . .. . .._... . _.. �. _ . _ .__ . _ LICENSED CONiRACTORS DECLARATION - � - - -�� - �� �- -� � LIC.--� ---- - - - � �55 NO. DWEIU UNITS I here6y affirm Ihat I am litensed onder provisions oi Chopter 9 ADDRE55 NO. , , (commencing with Section 7000)of Division 3 of the Bosiness ond ._ . . _. . .���, . .. ��R�P ' � . . . _ _ . _. . . ....._ � . Professions Code,and my license is in full force and effect. ON C1A55 � - "'---�"'" � --"- -� �" � �"�-VAIIDATION - -� � .,., ._. . . . . . . � �.�,, __.. 50.FT. . NO.OF , ...NO.OF . . . _CHECK �� � licenseNum6er2�bH01 - ���_tlassB-1 51 STORIES FAMILIES ONE ' "" � � � , . , ,. . . ,. �..., .. ..VAL O�� . � .__ .- - - � ' � T]1Q�WR1. LyOR�'CO � : � iZ-2-Sb . -�- '-- OESCRIPTIONOF WORK � � " � �- -��-� � NEW- �� + , ' Contracror Dme � S l '� ' AOD ❑Iamezemp�under5ec. '--' iTl le Eamil -home construction AITER ❑ , ; � ��� - S ' �122.3F ' B.BP.C.for�his reason .. � .._... REVAtR. . .... ._�.. "'.. . . .� .. . .� _.� "... . . . ... .. .. ._. . _. .. .: USEOF ❑ ' _..#• • • •'Z� � �DO�a: E%ISTING BLDG. OEMOL . _ .__ . .. ._.. . $ignafufe .. ' ..-.. . ._... _..._...._.. .. ... . . '' "- APPUCANT TEL. --� fINAI ' � � •2 7 Q 6 a : , OWNER-BUII�ER OECLARATION vRiM No. - -.DA7E �� -- � ----- � . • •- ------ -_- , __._. -1 hereby affirm tha��am e:empt from the Contractor's license qooae55 � FINAL� �� 2'7�6& �� . .�.. '. .i. U Law for the following�reason(Section 7031 5,Business ond � � � ..Profes5ionsCode):_ _. .._.__ _. ._. _ ...�. . _. . R .By .-..�,) __ ,. .. .. . . _'2'� 9-8L5_.,:, .�� BWIDING . . . . . � � I, as owner af fhe praperty, or my employe(s wdh _ L�l STSY . . . ......._ . . . �.. ._ _ - . s,� •�,Z�1 A ._.. / ..__ . . CONTRACTOR. ... ._ NO. � . . . �,.,":. ., --"� Iasowneraf�hedP�rofet �amexdusverlsalonhacrinn .. .- MOViNG - --� TE�.. . _ .... .._..__.__�..:''.' .- � -- _ ,� � •.•..•.• 1_�. �. woges as their sole compensmion,will do tha work and X P Pe Y. Y 9 ' .� . , . __.. _. . . .. . -��- with licensed com�anors to construct-the pro�ect(Sec- A�RE� - ' -" �� , .-�; �. 4 7�.5 O'- �, tion 7044,8uziness and Professians Code). ---•' , :�-� '�- '-� '� ._ . .__ REOUIRED-' YARD-� HWY' �TOIALSETBACK .._ . ._.... .. . . _ .__ . ' �. �:•� i_�.e47-550? .-� CONSTRUCTION LENDIN6 AGENCY ' �� - sEt BnCK DaOP_uNF WiDTH. . �; .. �,1� �,., ._„ �� I here6y affirm ihat there is a construciion lending agency for FRONT ' �'-' - �-. : � �2� (�-'�(� -tha performance of Ihe work forwhich this�permit is issued --- a.�.� -�- � - -- � -- � --� --- -- �- �- '� � - '� - - '"�'" � "� . (Set.3097,Civ.C.). SIDE . �.... . . `� _..__. . . _. . _...__ . . _ ._'__ _ .._ _ _ P.L. __ .. _ . ._ . .. . �� . ._�__.:.._.. � Lender'sName Mnhinontal Tllinnia Rank � �� - � . ^ LDMA Ref.R � � ' _ .. . . . . . . . .... . . ..... . __... _ _. � vermn Fea . D � � Lender's Addres5�11 c., i., c�11 o Ct rti;�a�o P.G Fee f'� ' , ' .. .-- `; � - . � _I certify that I have read this application and state thal the - Ivuance iee � �•Jr8 � IOMA P/c M - - � � �- - , a above Information is correcf.I agrea to comply with ali CoVNy Invesng�ion Fec � .� � � � _ordinances and Slote.laws felaling to building Construction. . .. ... ... . ...-. -_. . Toml Fee . .. .�'�-...'. 'IDMA Verm.�X : . .... - , ., and hereby authorize reprezentatives of this Counry to enter � � � .a upoo Ihe obove-mentianed property for inspection purposes. 'f .... . . . �.35�� �--.. ..- . _.. . � - ' -_.�. . ._. ._�__._ ._. _ _.P. . ._.. _ ... _ . ._.. ... .__ � _ "'_._..._. ._. _ . . ' .. o /ol..�nti�(�.�LZ((�i�!�� __ ��� . . SEE REVERSE FOR EXPIANAtORY IANGUAGE , ---... Signature of ApPlicant or Agenr �-- -- - Dore-. .. . . . . . . ... � • , .n . . .. .. .. _ _. . _ . ._ ' _ ._. . __ _. . .. ._. ._ . ..__.. ._..:QQ 1 � PLANS TO APPIICANT INSPECTOR'S NOTES , ONNER-DUILDER DECLARATiON , I hereby affirm�ha1 I om ezempt,from'the Contracror's To: • ' ' RNurn�d � � ; - , . '. � . "-License law�for the,following reosoa (Sec��7031:5) ' � ' ' ' � ' �'Approved ' �DusinessandProfessionsCoJerArtyrilyorrountywbicb No. Dete ' No. DaN � � • .. .. . . . . reguires a perneir rn�onsrruct,altcr,d provc,demoJisG, . , __-.�orrcpairenyserufturc,friortoiesissuanic,alnorequirei ' , . �� . �. ,. . -_ , , . :r�ar�r�an��r.suoG permit to filc n signed rtatement tbal�e is licenseJpursvanf to fbe/�mt�isinns nf!Ge Can- '�, ,:� � - 7atlor's Lirertrc Law(Cbaf+ter 9J(rommennag witb Sec= . - - tion7000/ofDieision3�ftbeQusirtessonJProJestiont „ �. `. � � �i • � '' - � -� � •�'� Cndef drlfiat Gc'is rxenrpt!!erefrom artJ t!e basis f rlGe . , . -,. . .. � _ ___ . _...___.._. ' __.. _ _. __. _ ._ � _ _. _ . ._.. �. _ ... . . . . . _ _.......�. !1 d - ' A 'k' S ' 7031 S b � a cge ex-emJ�hnn. rsy wo tron of ection . y , � Rqqutred� '.Dafe Roeoivad�, - - -- - -- � . . . .. • �-. . any applicant for a prrmit tubjectt Jbe aQf+lican!lo a trvil I , . . � ., � . . . ' A{rprovnls- Y�s No or Approvad ' - �. , . ,. , - penalty oJ nnt rriore lGan jive!unJreJ dollors(SSODJ./:� __ .'.L_.__ __ . _. .,.. ..__ _.__ . _.�1. . ❑ I.asawneroithe properfy,o�my employees with , . , . .. . , . . Water Cerfificole- - � .= ' �;'�. ....' � _..__'. _ . . �. _'..:.. . . : . . . ..�.. . . � waqes as Iheir sole compensation,will do 1he work,and � - -- � - �. the sfructure is not intended or ofFered for sale(Sec.7044) _ F{eahh Department...��_ -._ '..- .. ..: ." .._._;_ _ . . . ._--. ____. ___.. -.•.. � ..- �... .. .�IIusrnest onJPrnfessrons CoJe:Tl�e Conlracfor's Licrnie � � l.aw docs not apply ta an oa•ncr of prnperly u�bn builds � Fire Department.._:_.__ _ ..__ _ '_. __ .' . -.._- _. _. --.-. . �... _�.�.� ._ �.�_.� .. .. impro� xself or or �es fberenn,and who docs sucL a�ork Gir . � _��- - ' ' ���tllrougl 1 is,oa•n employcrs, (�rovWed,tba!sucl-im-- Grodinq _ � � , � , , . �,.prorementt are not intended or offered for sale.,.� - � _,.. , � � � -� , ���Gou•coer,lGebuildingorinrprovemeatrssaGlu�itGinn�. ' G ological . � , . - , � .,. , . . - ycor J romplceinn, the ounervbuilder wi!!lmve eGe - � ��� - � � burden oJ prnning f!at 1 c did nnt burfd or impmnc for ,, � _ .__.__.___ ._ _ __ ..._ . Pedestrion Proteclion " ��� � � � 1Ge pnrfiose o/suleJ.� . , �+� _. . . ... .. , (Fence)(CanoPY) � . -.� .. ., ...��� - --- -�-- �'�--- - -�- - - - � � - - - - � �� ;, ❑ ��I,as owner of the property,om exdusively coNrac- , ��ing with licensed contrpaors to consrrud�the'projec��Sec � '• . '. :� ' .. . ....- - � �-- '- . -- ' -- - . . . � . �044�U�nr�and�Pro essi�ns'CoJc. T Con ractn�s Special inspettion -- - � . -� + s � f • Gc 1 (Canc.�(Masonry)(Welding) � � � �� ;C� .�cen:e u� ors nn1 a/�rfy en an o¢�neraf/irofierly u� n � - '-"-�- - - �- - � � � � � � "-"builds or imrruuct'tbcrenn,and wGo ronfracls for suth ,. , lotDroinage . ._ �� .�..�, ,� �..� � . � . � � .. p�ojcots�u�ial a cnnbaclor(sl�literiteJ purtt�anl to lbe . � _-- - -_ . _ . ... .... - , -� Cnneractor's Lirercse I.au/. -- - --- � Parking .,_ , . ., . . . . . . .. . � _ . .. . . ,-. .` -�....-❑ Iamexemptonder5e[.'. . � 8.8P.C.fp'�. r ihis r - _ _._._ ._ ._. . _ __� . ... � .. , . „ , ' reason . i �. , ,,.. . ._._D . . .. . .... __ .---- -'-' - - ,-, '. ' . \ , , . ale Owner -,.. . . . _'_"" _ � . � _ . - APProvals ' ` Dofe .......Inspector'i S�gnaluro.... �� � ' ,;�; INSPECTOR'S NOTES ,� Locolion=" � .�. 1 ' ' � " -� (Setback&Yards) � � �- . r"'- '�, Foundaiions ' �... � . . �� . .�� . . . � `. . , .,;. ;o, . . . ., . Slob� � .. a� p . ., _ ., � . . . . . . . . _ Frome'. . . . 1�f . , � . . . . ., , . . .. Energy Insuia7ion, u hP� �� ____._.__-__ _ __ _.. _ .� . .-........ . . . . . ... . . . , . .. � .. _ . , _ � �( . . .. . .., LmhiDrywall— .. ----, _. _ . ...-_-. ___� .. . . . - Interior - � --- -'..-.. .__. : : , . ., tath—Eaierior _ .... � � - - � � ._... .._�. . ._. :. . .I:;.:..�... , .. _ , . - , Hoose Number— , - _,. _ ... . _ __ . _ i v• ,... _ _. .. . ,. . ._.. ' , . , . . . . , - Correct 8 Posted ' � ' � � � Finol— _-. ___ _._. _ ______._ .� . . . . _ _ ' ' '. .. . .__. _ .._ .__ Enter on Front ' � � � . � . . - � . .r�, . -. . . . .. ,. .. . . . ,, . . . • i, . .. . �.('` :f�_\' ,'`` '