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HomeMy WebLinkAbout1211A 1212A (6) -- _ _ _. . --._ . . - . ,.- . __ �... _ _ ...___. _. WORKERS'COIv1PEN5ATION DECIARATION ;� a� •_.-,�._ . , �., � , ,, .. , ,.. � : , . . . . . � . . .:. � ._... .--... _. . .. .� _. , I hereby affirm ihat I hove a cert�fimre of cansent�m se�f qpp��CATION FQR��B�UIL�DING��PERMIT � �� �insure,or a certifim�e oi Workers'Compensation Insurance, or 6 certified copy�hereof(Sec.3000,Lab.C.) �" - �- � � � � �� � . � ._ __ . __ ` 47CP6255241 Great American Plan 1BR COUNTY OF LOS ANGELES ; BUILDING AND SAF Y . PalicyNo. Company -. . � ' � Certified copy is hereby furnished. -� _ � FOR APPLICANT TO FILL IN BUUDwG ❑� .. ' � AD�RE55 X Certified copy�is filed wilh�he tounfy bvilding�inspec- BWtDiNG fion department. - � � ' ADDRE55 � , � oare i2-2-86 � APP��ca�� . The.Wm. Lyon Co.- - aTr Walnut ziP 91789 ��,iiTv � �CERIIFICATE OF EXEMPTION FROM WORKERS`�� " "�-� -- �- � - NO.OF B�DGS.- � ��-'. r�nResr_. - -. __.. . . ._ :._._�' ' '"' �COMPENSATION INSURANCE � �- SiZE OF�oi$ 800 SF Min.Now oN ioT 0 Ck055 Si. . (This section need not be'complered�if the'�permit�is for one � - - � � - - ! ASSESSOR. � '� '� - � �� - I hundred dollars(5100)or Ie53.�� , . - . TRACT BLOCK l0T NO. � M,qp gppK - � � E PARCEL owNee THE WILLIAM LYON CO c NoB33-3600 us�zor+e nv.a • I,tertify that in the�performante of�the work for which this Np, � �' � •} permit is issued,I Shall nol employ ony person in ony monner � ADDRESSI 9-CO SPECIAI � ry - ;O so as'�o become subjeU to the Warkers'Campensa��onlaws � � �-- -"'- - - - � -- CONDITiOnlS e�' aTr._Newport Beach,.�A._ zir . 92660 . _. ._. _. . � _ v . im tio , . . . . . .. . ._. _ .� Date � ' ..._., ..App(icant.._..� �. . ....... . .... � ARCHITECT OR TEL ' � !`0 �"�OTICETO APPLICANT: If,�after making this Certifimte of � NO. S�iJ-O$6Z - DISTRIGT... G UP TYPE_ _. .FIRE . SSEDBY . F_ P FNGWFER }[ales—Lan SiOIl � n, you should become subject to'Iha Workers' �- COt�T.� ' Z �� .ompensotion provisions of�he Lobor Code,you musr forth- � AppREu7�� . � ,• �� '�.a wifh mmply with tuch provisions or this permit shall be -� -- ' tE� � " �" " '����" ��� - y� deemed re�oked.., .� �, �.�„�� . �.., � . . �oriraacroaSBme As�Owner N� . $TATISTICAL QAS N APT. C NDO:" LICENSED CONTRACTORS OECLARATION ' _ . --- �- - �`-'� � ---- - --� ��-- � . _ ._. _ .. . . ...-. _ __LIC. . . -. ...., QA55 NO. DWEII.UNI� �� � I hereby aff"vm fho�I am I�censed under provisions of Chapter 9 � nDDRE55 Np. (tommencing wilh Sec�ion 7000)of Division 3 of Ihe Business and . ._.._ . ��� ___ _ _ SEWER NWP , .. � Professions Code,and my license u in(ull force and effect, pTy cinss � ��-- � ---� �- � -- � --- ' --� � - --�� . . .. . � gg. p�. � VALIOATION' . . .,. �... . . �. SQ.FT. NO.OF NO.OF CHECK liCenSaNumber2768�1 ' . ��-Li[.ClossB-1 $IZ STORIES FAMILIES ONE � �. �. ... , � �� � YALUA ION � ' � I am exem rtl. L on.Co..., . . 12-2-86 . ._. ._ . __ ._ . NEW--� . -.,. ._ _. _ . . ._ Co� a�ohe y . DES�RIPTION OF WORK s� /,�� Date ❑ Plunder5ec. � . �,. . . � ADD � lfi��� {�CJ � , ��� ' l _ _.. _ _ .. � .. .. . ALTER . . B.6P.C.for this reason � �� , 3 � . .s .. . . __. _I. . � ..-_ '�� 2�,�`A � . . REPAIR -'-' ' ' "--' �ate: E%ISTING BIDG. �EMOL ' � �• • � �2� � __ ._ . . ._. ._. � �� USE OF ' . . _.. _._ _. . ._ ..._.__ _ . .SignOture - .._ _. . . _ ''." -. ' APPLPRIMT TEL. : 1 •Z 2 Jr.S� OWNER-BUILDERDECLARATION N�� - --0ATE`�6���-�--� ' ' ... __. ��I hereby offirm thot 1 am exempt from the Contractor's Ltcensa A��aEu �� �-;.�.� �� • •2 2 5,�� � Law for the following reason(Section 7031.5,Business and . FINAC'-'-�' �{�� , :` "Professions�Code):. . ... _. _.. . ._ __.... _ .._. :__. By . �_ (/-l/ - -.. �. ' .`�2� 9-8 6.. - �� BUIIDING , � � I, aa owner af ihe property, or my employees with � A�DeE55 v� wages as�heir sole tompensotion,will do the work and ' � � - '�� ,�.�- � � �\` '� ��� -�� _ the struclure is not iafended or offered for sale(Settion �OC���tY •�� � ' ,, .. . , � 7044,Business and Professions Code).�- - . _... . MOvwG -.. . . ..-.. ----. -. .-.. .TEtr-..-.. -. ., ,- - -- . .... . . . ' y{• •? --- CONTRACIOR NO. . � . . `1��; tt _� I,as owner o(the property,am e.dusively contraclin9 � -- � ��..� .�..: .. \. � •3 9�Q��Q .. - with licensed contraUors'to construct�he projev(Sec- ' -. _. . ... ... .. .........._._ ... . . _.. _. __. _. __ _._. ---. . . _._ „ _. _ . . _; lion 7044,Basiness ond Professions Coda). ADoaESS �. . , , REQUIRED._ ..TOTAL SETBACN ��-�' - `� t"f � �3 9 a 0 0 c=i� �` � - - CONSTRUCTION LENDING AGENCY��- -��-- '�'��- YAaD Hwv �-- �- - - �- � � - � � -�-�� -- - -- .._ SET BACK PROP.LINE WIOTH'� I�� �_0'4 . I hereby affirm that there is a construcrian lending ogency(or FRONT " -� - ,���,: ' o� -��: .' J,.1 , -ihe performance of the work�for which this permif is issued � � -v.t.-- � - � - � • . ._.._ .. . _. i ..... .. _.. ... .._ .. _ . �Se[.3097.Civ.C.). SIDE � . .� . .- ° ._ ... .'_... . . .__..__ .__ ... _ _ . . _ , .. P.L _. .... � ..._,...._ .._ . '' r '�', _ . .., . iender'sNome—Continental T_llinois Aank . , _ � 3 '�- -- ' � �-� -._. ..--'- � - - �' ' ' - P.C.Fee S a s-. I� -� Permtt Fee ' .S D . IDMA ReL N ' .__ �__._ . .- = Lender'sAddress237 Sn_ T.� Rallo SY.� Chira�0 � . -. ; ,. �I t _Ltertify.that 1 have read Ihis applitation and state thot the . ..._ _.._ . -. . -Issoonce Fee 0. 'rj0 ---- IDMq P/C N -- -� .- . . -. �-_._ � above informofion is mrrect I a9ree to mmply wifh oll CouMy I esiigairo F e J� ' � ; _.ordinances and Stote laws reloting lo.building construclion, __.._ . _ -- Torol�Fre U.Qd �-� �'� �LDMA Perm.�M- �� � �� '�' __. ._.__.._. ._._. _ ... ...._. . ._ .. _. ._ _._. _. � and hereby authorize repreaentatives of ihis County 10 enler . - ; upon the abova-mentioned properry for inspaction purposes. � , �� ! . _ __. . ._ .. _ .. . _. . _ .. _._._...__.__. _ ___. . . - _. __ . _. . ...._. . _. _ _.....-. _.. ;_._ .__. ..'_.__. ? �n,1'- �. � /�s�X6 . SEE REVERSE FOR EXPIANATORY IANGUAGE � � � . ..� _SignawreafApplicanrorAgent .. �..-_......._. Dafe_. . . __ . .. . ._. _ ..__ ....._ .._ . ._. ._. . . _ ___.._ . _.__. . . ._ . .__ . ��.__._...__ . ... ...__ ______- O I i PLANS TO APPIICANi INSPECTOR'S NOTES OWNFR•DUILDF.R DECLARATION I hereby affirm Ihot I am eaempt from ihe Coniracior s To: � ��� R�turnod. � � ' , � � Licenze Law�for�the�folloviing reason:'(Sec. 7031.5) � ' - �"- "� � �� Approved " IIusinessdndPrJ,:ton:C�J�:A�yneyo,co��eywbfcl� No. �ale � No. � �- Date��� � � ' . . . ' � . '. . . �: _,reqaires a pernrit to ronstruct,alter,inrprovc,den�olrsb, _orrepairanystructurc,/,riortoi[sissannre,alsorequires ' � , � � �� �� � � ,�•. ,, , , . � ' . tGe applicant for sucG permit to file a srqned slatement "1 . tGat Ge is licensed pursrsont to tGe proursinns of.tl e Con- , ' ' � -� �� lractor's License Lau•(Cbapler 9J(commencing a•itb Sec- , . -- tion 7000J f Divuinn 3 of!1 c Business onJ Professions � �� ` � � �.� ' � + �._ � '� � � �%���• �� __:�.. •'���CodeJnrtbatGe'ieeiemptt6erefromanJ[he6asisf rtbe �,___ .� . _ . ,. . . _ _. _.. _ __ _ _ _ . _ . ._ . .. ._ � � a!lrgeJ exemfi�ion.Any violntion of Secliort 7031.5 by � .�, '�' . . � Reqvired . ...DnfeRaeaH�d -� � - - =-�- --� ' ..�- . '.' . - . - - .. an.Yaf�Qlirantforapern+itaubjertstheapplrranttoa�icrl � ��Approvals � yas Mo or Approved f� . .. - � f�enalty of aol nrore Jbatt Jire i�uttdred dolfars(SSOOJ.J:, ���''�'" �- � - - " � - ' � - ' -- ❑ I,as owner of the property,of my employees wilh _� Woter Certificate '-' � � ' '� � � �� � � -i . __.._.__.�-.�._ _.' " _: _.•� � � . . � woges as iheir sole compensation,will do the work,and -- ----�� � � - -� � �- - � the slruct�re is not intended or o(fered for sale(Set.7044) ��. HeaNh Depanment:-�_ . � .�-. �- --�-- - -. ...__. .__ ._. .. � .. . . _.� _ . Prof�ss . ___ Businest ani! ions Code�Tbe Cantrartor's Liacnie - , , � = , Lau•Jnes not apfr y tn an owner of f�ro/�crty u�/o bui/d� � Fire DepanmeN _. . .. -- . . _ � -- - - � - -- ��!-- --- - or inrproves 7l ereon,and a�Go Jocs sucb u.�ork bimself or ,' .. .. , . . . . ..� ` - ....,�; • ,.� . . - , througG�Gis:ou�n em/�loyces,�Jrrovided t!6t sucG im-' ' Grading � ' ' �' , - � prnvcmenu ure no1 inlendeJ or of�red fnr sale.; - •-�-' � � - , hou�c��¢r.tbebuilding.oiirn/�rorementirsoldu�illino.. , � � � - � � � � C C����' ' � 'yeor oJ mnr�fefrort, 1he owner-builJer u�ifl�,bane�tbe Geolog�cal'.� , -� . .. .. � - - . _. . , � , - - �� burJen ojprnving lbat bc drd na!build or impmnefnr - P . .. -' _-___. .._.___. . _ .. . edestrian P�oleclion� " - - _ .- . tGc purpnse'jsal l..;'" � „ . � . � � �ing❑wiih I censedreofnvoct�s lo coas uclCihe projean(Sec. (Fence)(CanoPY) . � .. � . _ _. _. _ . _____ . .._ . . _. . ;. P P Y. Y � (pecio;I(nspection �- � - �� � �— � - � �� � -- -�-� - -- 4)Business anJ Pro ess'ons CnJe•T Contraotor's 704 f i Gc � Conc. MosonrY)(Welding) - ' ' ' . -- , - . . . _ . ...t,�.: , l.icense Lau�does not ap/�Iy to an own`er oJf�ro(�rr{y a�bn , ..., � � � -- builJs-or"irnpro�+es�SLerenn,and u�bo conlracts for suc� -�-� j " '. . ' .; . � projects�u•iN�a rontrxlnr(sJ�licenseJ pursuant tn 1le Lol Drainage � .. . ., �� -,... • . .. . _ . .. --.. . _. _ . � . � CnntracJor's'l.rccnsel.ou�f.'�-� - � - . . _ _ - . . . ��, Porking . � , .. ;.... __ .__._ _ .. . ._ � . . . _._-- - �- . . ._ � � � ' ; � • � ❑ 1 am e:empi under Sec. ,B.BP.C.for�thrs . . . , ., , � . �... . � , •.- �" �. . . , i . reason_ __ . . __. _. . ,_ 1 ,. . .- . . „... " Dafe .__ . .. . . _ ._._..--Owner ; - : , , . -. , �: � I . : � . �, . ,... . , , . _ . ____.___ ._ _ .._____._ _. . _ � . - Approvols '- � Dafe � �Inipecfor'a Signclura . . , _ � , -� INSPEQOR'S NOTES � Lacotion=" I .' I ' a� ... .. . . _"_ _...:..` . (Setbock 8 Yords) � � - , �„ � 'r'�- Faundations-. . .. � � ... .. ., � � . . Slab.., . .,. ` ...r�� � / �C.� � ----- --����-. -�--- ----. . .. _� . _� � . . ., . . � . .. � � . . . _ . _' . .. . � . , I Frome ' . - . . �� �` .. .. . .. . � ' -. _ � i. . � - • . , Energy Insula�ion, � � . � ' � . � �":...� . . . � ,�.. �, . .. . , Lath/Drywall— �(1 p I — .! _ .. _ __._._..�_..._._. ._. .. - . � . . � Inlerior d ��-��" � ���-- ' � ' Lath—Ezterior , . . . . .. . .. � " . , . _ . . . � .__ _ I�_ . �. _ _ . � .. , , ,.,-.�- � � .. . ... HouseNumber— •f : �__. . _ _....ti- .. '____ . ..'_. .:_c-.. __- ._ r . ' � ,' i_;�.:�'._ .�.1.�_ �... i� ... . , , Correct 8 Posted � �� '' • � �- � �- � ..^. . , Final— .-.-- ____ '__. . _____.. .�, . . .� , . . .._ .. _._._..___._._ _.. . __. . Enfer on FroN .� A 1�• � . . ' . . , . .� . � . - . � � . . .. . � - ,.. . . . _. - i, _- . -... ,