Loading...
HomeMy WebLinkAbout1225A 1226A i , __. ._ _ . .._. _--_. . .. _. ._. . . . __. _. _._ . ..._._.. ___ _ _ __ _ . WORKERS'COMPENSAT�ON DECLARATION . � . '�- � . ��� I hereby affirm thar I hove a certiiicale af�o�=e�,,o,��f -- - qpp��CATIQN �FOR BUILDING PERMIT -�l insure,or o terlificotc of Workeri Campensalion Insuronce, . .. . . . _ __- . __. . ___-� or a cerrRed capy'ihereof�Sec.'3800,lab:C.)' ' COUNTY OF LOS ANGELES BUILDING AND 5 TY Pai��Y�CP6255241 compony Great'AmericAn Plan 2B � Cen�fied copy is hereby furnished. FOR APPLICANT TO FILL IN auuo�N� ADD2E55 S ' aCerlified�Copy is filed with�lhe covnty buildfng,insper � - BUILDING . . . � tiOn deparlment. AD�RESS Doie lZ-z-$6 applicanr The Wm.: Lyon Co. aTr Walnut ziP 91789 i�urr � ` `CERTIFICATE OF EXEMPiION FROM WORKERS' �-'�' � S�ZE OF LO7 $00 i NO.OF BLDGS.- � -- � �-�; NEAREST .- - -. ... . � � � ' � � COMPENSATION INSURANCE��� �� �� . NOW ON�Ot � CROSS ST. s . (This setfion need no�be�comple�ed if ihe�permit is for one - - - � � . n55E55ott , , -�� ' hundred dollors(5�00)or less.� ,, ,._ , iRACT BIOCK LOT NQ � MqC BOOK�� � � PAGE�� PARCEL owNeaTHE WILLIAM LYON C0. ni�33-3600- us�zoNe ti+nP I.certify�ho�in�he performonce of�he-work for which�his NR � �� � �} permit is issued,I shall no�employ any person in ony manner - - - - SaECint- - �� ��-� - � ���.a -' ADDRE --"."..-. .----'- " -' .... CONDITIONS O so as to become subject to the Workers'Compensa�ion lows. � � � . r . aTr Newport Beach, CA zir 92660 ' . _ __ _. __- Date ..� .. . 'Applicont � �' �"`�• -:� � � �� �TICE\TO APPLICANT:if, oher moking ihis Certificate of ARCNI7ECi0 7EL. _DISTRIC� �UP ttPE FlRE . P EDBY � _ _ EN�iNEER �iales-Lan ston No. 547-0862 cor�sr. e �('j mprion, you�should become subjeu to�the Workeri . , � .mpensation provislons of ihe Lobor Code,you must forth- qD�RE ' .� . ' wfth comply wfih such provisions or this permi��shall be �-�- � 7EL. � STATiSTiCALCV.55i ON � � l APT. CONDO.� Z deemedrevoked. ,� ���� � � � ..,-. coNranttoaSame As Owner No. - � .. ..._ . . __.__.. IICENSED CONTRACTORS DECLARATION - �� - � � - � -- - --ii�.�- � -- � - QA55 NO.�DwEIL UnliTS� ' I hereby affirm that I am licensed under provisions o�Chapter 9 ADDRE55 No. ' (commencing with Section'7000)of Divisiod3 of the Bvsiness ond .. _ ���. . � ��R�+P � •� - � ' � �, _ . . .. .. _.... . . . ........ __ . Professions Code,and my license is in full force�ond effect. Ciiv CLA55 �� -�BK-�- �� � �� -� ��� �" �- " VALIDATION �- �� � . . . � ' . � ' � ..._ . SO.Ff. NO.Of � _..... NO.OF "_ '. , _CHECK : ' . LicenseNumber276801 LiaClasiB-1 � s� sToaies Fnnniues oNe . . . ... � . VAIUA�OW . ;...�. ��.12.2.... . .. �'he Wm. Lyon CO. ,. S Z-Z-H�7 -'"-' OESCRIPTION OF WORK "'""' " " NEW -� ^� Controc or Date Aoo � s / 5 A ❑I am exempr onder Sec. . . . . . �-- -_ • • _ .___❑ . ,... _ �. • ..�2.� _. � .� .� . . , . . /� ALTER . 0.&P.C.for this reason . (!/p� REpAiR. ..j- .__. _ .-_ � . _ . - ... --.. - _ _ . � useoF ; I •247.23 Date: EXIS71NG0lOG. DEMOI _ .,.. .... _ -I herebyaffi . . __. .. . . __ _ ., .__-. AVPtICANi TEL �, : • •'��t 7�2.3 � Sign6ture � vRtN i• No. FINAL �r�, �'.. OWNER-BUILDERDECLARATION � -0ATE-� � • �� -� ���- � _ _ 'UYoi _._ r219-86"_ . rm Ihat I am exempt from Ihe Contracror's Litense ,. , ,. , Law for the following reason'(Seclian 7031 5,Business ond ADDRE55 FINAL���{ � �� � - � '� �" _pw(esslons Code): .._._. _.... .-'- _ . .__... ... " _-. =0Y �V"`- ' `��- � `-�� � . ���� 2 2 6 A - . � em la ' BUILo1NG . . . . . " ... .. I, as owner of ihe property, or my p yees wifh A��RESS ��.� � � � '�� �wages os their sole compensa�ion,will do the wo.k and `� ry , ��� _. � �,� "�-� �he strudure is not in�ended or offered for sale(Section �'� _�_•.4 2��0 -- - 7044,Business and Professions Code). ....- , ..' ..- - MOviNG ... ... ' .-- - -- � TEL:-.. .. . -.- -. _. -. -.. -... .. . .. . aI,as owner of the property,am exclusively coNracting [On1TRnCTOR - NO. ' � . ,,r`. . ' .. .' U . ..wilh'litensed mnfmctors to tonstrucf the pro�ect(Set- ... ADDRE55 � ... ... .. _.. . . ._. _ . _ . _. .. . . ....., \ . _ •.'�{2��Q . tion 7044,Business and Professions Code). �� f . ,_, � :�. �2� 9-8 b .,'� ' . -._ .._ REQUIRED .TOiALSETBACK .. . .... . - . .-.� --CONSTRUCTION LENDING AGENCY '-- " ' - - vAso Hwr �- ��� . � �I hereby affirm thot there is a consHuc7ion lendmg agency for FRONT ' � `` ' �� '�' � � '�� � SEi 6ACK 7R07.IINE WI�TH � ` ( _` '' _ -tha perfamance of the work for which�his permif is issued -�-- �7.L �-- �-� -� �-- �-- � �- -- - � � - - - � ----- - - -� (Sec.3097,Civ.C.J. SiDE � � �,r,::.'.� � . . - � � o .___. .__.._. . _ _ __.._., .. P.L. " ' � Lender i Name �`., o..r�1 71 1; t� a�„U . . . - . .. . . .. ... -_. ._. . _.. . _ i _._ .._ _ .. . i . a , IDMA Rel.N � . .. . __ . ._.... --- P.C.Fee S . .....Permir Fee - .SD . . - . . .-. = Lender'sAddress���Vo-r-da-Sti-=�e-S�.--�--^�'t1g0 f� ? -1 certify that.l have read this applitotion and state that the ..__ . � Issoance Fee . 5 V �- �-� ��MA P/G M.- .. --..... ,. . . ..-- ,. .. , above informotion is mrrect I agree to camply with all County Inmstigm�on Fee � ' � � ; ordinances and 5�ate laws lelating to building mnstruction. .... . . . . . .. ... iorai Fee - ��o.� t�Mn aerm.M -��. .- . -. ... .-��. - . "-�..,.- � � and herehy avfhorize represantatives of this County ta entei �� upon�ha above-ment oned property for Inspecfion purposes. � �r� ,t,� � . '� /.�... __ ._ . _ _. .. ..__. _. . J � ; /`'�q` �. �p��, L��� . � . .... _. .. SEE REVERSE FOR E%PLANATORY UNGUAGE_ _ _ .'.. ... . .. ,... ..._ . .._ . ._ - . ��r/ E7 .Signoture of Applimnt or Agen� .. . . . �a� . . ..- . . - . ... -. _ _._ _._.._ ._ _ _. ._ ._.__. . . _. � __ _ _. _ . . _ ..._._ 0.i . PlANS TO APPUCANT INSPECTOR'S NOTES , OWNEiR•DUILDHR DECLARATION � 1 hereby affirm ihoi I am exempt from the CoMractor's io: , � � Rotum�d ' , -� , � � License�low fo/'the�folloviing re6son. (Sea�7031.5) ' ' � ' � � � � 'Approrad � - BatrnessandProfessioruCoJc:/Inycieyorrountywbrrb No. Dale No. Dulo'�� � � �•-� -.. . .. . .. , .,. ,.requires a/�ermit to ronsfruct,aker,improve,demolisL, . . - -'..orreparranystructure;prior[oitiissuancc,akarequires � � : - � „ ,, i i,., ,,,. , tbe applicarst f r sucb permrt to file a ai,qned statement , tGat Ge is lirersreJparsuant to tbeQrorisions tf lbe Con- �', , . � �� � tractnr'sLicense7.au�(CGaptrr9J(con�menringu�itbSec- � . . - _. . :..... :�.',�.��-� :_.`: . :.�.: ... _ 000 D ' G li ' � �dP ' . .� ��'� , � �� ' ` . . .., •.� ��'.� . � .::.':'�� . 'CodeJ or tbat be�ia�exe�!tLerejrom and the bacix for t!c ... .._ . . ' . _. .. _. _. . .. _..___._.'_.......__'_.'..__ ._. . _ . . . _. '.'_ _ � � - a!leged exem/�tion.An,y i�iolaliort of Section 7031.5 6}� � � t Requind�. � _: DutiR�eafvod- --' --- '�. . �.. �:..' � ' �: c:. ' �- . :� �-'.� an,y JplrrantJorapermilsubjetJtlSeap�litanlf�a�ivil � � � Approvols � ' or Approved _ penu ty of nnt more tGun/ire Gundred a!lurt(SSOOJ.J:�. Yos Na ' r.�. . � �.. \t� . � . . ------`� _.�_ �.�. _ . . .._ _. -- � � � ❑ I,as owner of the property,or my employees with . Water Certificate � " �� :� ; � �. _-,- .�_� . _.•. �. _ � ,:�_ • •� woqes as their sole compensotion,will do Ihe work,and . - - -- - - ' �he svucture is nm imended or oifered tor sale(Sec.704e) HeolthDeparlmentl:__�_ _ . . _ .�_'.: _L� :_i_ � . � -� - ..� � . . -. � BusinessqndPrnJessionsCode:TbcContraUor'sLicense : _ _ ......__. .. _'-_ _. � � . . . Law dnns not appls�o an ouner af property wbo builds ' r . �.< ' :..� .�. ., • - i, � Fire DeporlmeM __, .. .. . . . _ .. � -�- -� �- �- - - . or in+J�rours 1Gereun,end a�!o does sutG urork bimselJor � - ..-C . � , tbrougl�l is.nwn�emplayces,'provrdeJ tbut suc5�ine. ,,. Groding� � � � . � . -prnrrments.arc not rntended or,nffered for,.sale.. ' " ., � ti i� , bou•evcr,1Gc buildinq nrirnf,rovementissold u�itbin o.. Geolog�tol�- � ��- . - � � ��,ycar oJ completion, t!e owner•6urfder wil!-bavr tbe , � � � �-� � burdrn nJpmring Jhot J e did not build or improne fnr . . . _ ._- '�__ ._'.._ _.__. .. _ Pedestrion Protecfion.. . � � . . . ' tGc pu posr nf safrf. ' . . . . , (Fence)�Canopy) ,. , --- -- ----- - - --- -- --- �-- - ❑ I,asownerofiheproperty,amexclusivelycontrat� ting with licensed conirocbrs to construct Ihe project($ec. '' � �' � - ��� - �-� -`- ---- - - ---- - --� 7044)Uusiness and Professinns Code:Tbe Contractor'r Special Inspection � --�� � -- � �� ��- - . . �Conc.)�Mosonry)(Welding) ' � � � �- . l.icense I.au�does nn0 ap/�!y 10 aa oumer of prnf�erly uGo �• � � -� - ' - ' �---- � -- `�"� � � �-�builds or impmvea'flerenn,and a•!n contrarts for sucL "� Lot Oroinage.. �, '� '.. � ':.�•.. ''� + � . .. o tradors ocense I .. --...._ .. ... _ . . projects u�itl'a rnnlratror(sJ licented j�nrsuane to ahe . . �:.� . , -._._. .. ---. .'- -____ . . -C n 'L' au/.- . Parking' • r . m :, .. . ....... ......_...... ...,-�. ... ` . ... .,.._� _ . . . . - -. , ..�,. ,,. � � � ❑ I am exempt under Sea ,B&P.C,for this �" � .- � ... �. ; . . �� . , . . . , ,.. i` • � � - - . -___.. _.. ___. __._ _ _. . ,. _ . reason - _ _.. ___ ,__ ._._ _ _. ., . .. ' . . . . Dale . � . �. . ..- Owner - . �, , : . _ .___.._ __. . . ' _. . . �. .. . .. i. ,. . � . . �, �. . . _. ' � � " .� � . . . . ..,. . . Appravoli �, � Date �Inipetlor's Signoture. .. ... ..� .. .. .•��.•. .��, . .. . . .�. .. i.,.. � � INSPECTOR'S NDTES. � Localion— -- .�. . . � � . . (Selback&Yards) � - '�-�----�-.-._.... . ._ .. Foundmions ~ ' , � � � � � . . �, , , .�, . � ,_. . _. . . .. --- -- -_ � . „ . . . Slob. � �'v � "'� . .. . , ..e . _ ... _. _ . ... . _. _ ..___ . _':. . . .,, .. , . �. Frome� _. � .�.. I � a �'1 ... .. . . . � .. . , -. , . Energy Insulation �( i � ,' '._:. _ .____.__.'... ..._._ _ __ _ ..__.. . . . , , ,.. , . , �..r - . . . , .. „ : � La�hiDrywai�— ' ��yr►sa, �� , _..._._._. _ _.. . . _ .. . . . -- -�- � . . INerior •,4"�'V: � ' . . ._ " . � Lath—Exteriar . . _ . � � � . � - _-:.,,. . . . . i r.-. . .. . .. � � . . . , . . n_• •., , . .. .. , , . HouseNvmber— ... .-.. --. __•.._.�.. __._ �_ ..� . . .� �... _ ,i '. . Correct S Posied ' � � ` ' - . . . . �, . . ...� ., � : „, , Finat— __ '_ _ ._ . _. . _. . � ._. . . . . _.. . ._ , . _ . _._ .. . _ _ __ . _ Enfer on Fronl � ' . �, ..: ��..:�� � . ....��� .. , . ' �