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HomeMy WebLinkAbout1245A 1246A , . ,, , .._ _---- . ._. . __.._.. ..----_ . __� _. . _,_ _ . __ .. _ _ - -- - ---- - - WORKERS'COMGENSATIONDECLARATION � '� ' - � " .�.'. .: . .��; '� � � _ �.. . , . ..._. .. . ' ... _ __. . I:hereby attirm that I have a certificate of.consent ro self APPLICATION FO�R BUILDING-PERMIT� � inwre,or a certiiica�e of Workers'Compensation Insurance, . __. ... .._- - � � .•,', or o certified copy thereof(Sec:3800,tab.C.� CQUNTY OF LOS ANGElES BUILDING AND FETY "'WCP6255241 Great'American Plan 2CR Policy No. � Company -. - � �� ar� r � � � � FOR APPLICANT TO FILL IN BUILDING (/ ��•� Ceniiied ca s hereb fumished.�� nDDRE55 p�� ' / � aCeri�i�ed copy is f�led w�ih�he co�nry butlding'iriipeo ` - BWIDING � ; , �ti0n CJeportmenf. ' ADDRE55 Dole.,.�,IZ-2-Hb �APPlicont. �.T}18 Wt11. .Lyon Co. c�T� Walnut ziP 91789 ��,�iTv : " CERTIFICATE OF EXEMPTION FROM WORKERS ' -"- -" " NO.OF BlDGS. -- -- - -: rlEnResi � . . . _ .. _ ... ... � ..... ._.. . . � ' '" � "•COMPENSATION INSURANCE �� � � SRE OF LOT 3 HOO SF M171.NOW ON LOT CROSS ST. �, (THis sec�ion need no�be completed ii the permit is For one -- TRACT BIOCK LOT NO. " � �ESSOR . _- ,- '� �� � � � handred dollars(E100)or less.) . . . . , .. MAF BOOK PAG PARCEL , ' ' owNea THE WILLIAM LYON C0.- No$33-3600 use zoNe mv+P �33 so as'to become'sub'ct orthe Worke seComke�S�whith this �� �� � Y P permit is ssued,I ahall not employ any person m ony manner _ _ _ . � � SPECIAL-- - --��-- � p Otion'LawS. AODRE55 - CONDITIONS . , � �v �.. , . .., ... . _ arv Newport_Beach, CA_ nr 92660 _ - - --_ . _. Date ' ,... .... � ''Applicant . ' . � . � . ',- :� ARCHITECT OR TEL � �pTICE TO APPIICANT: If;�affer�moking this Certifi[ate of _ ENGINEER Hales-Lan StOTl No. 547-0862 DISTRICT _ GROUP �NST. !ZpN "P� SEDBY_... . mption,�you shou�d betome subjett to the Workers' - � .ampensaiion provisions of Iha Labor Code,�yov most forlh- Ao0RE55 ' ' '' - - a wiih com I p p . � .. .. . � p y:with such rovisions or this ermii shall be � deemedrevoked.',�� , .. . � . -. • � S8m2 AS Owner TF�' � STATISTICALClA551 �/ APT. CONDO. 2 CONTRACTOR NO. ' . . . _' ' _ _ , . LICENSED CONTRACTORS DECLARATION,��� � - � - -- � �-�- --- ii�. �-��--- ; aA55 NO. DwELL UNITS �, 1 hereby affirm�har I am licensed under provisions of Chapter 9 nooRESS NO. �yy�R MAP (commencing with Secrlon 7000)of Division 3 of the Business and .._ . ___. . . ii�,. . ' ' ' � � " � ._ . . - -- --_ . . _ Professions.Gode,6nd my license is,in.full force and effect. CITY C�A55 ` ""�"� BK-"- ����- ��-" . -- �; yqLIDATION� � - � - 50.Ff. NO.OF NO.OF CHECK , licenseN�nibe'r2�68�1 ' lic:ClossB-1 si STORIES FAMIUES ONE , .. . � ,... . . ' ' . ._VALUATION . . i am ex Pm. Lyon Co.., .12-2-86 . _ oeseaivrioNOFwoaK _ - . New .� �v - - . . _. The Contractor -Dafe s '. . , � ADD � em I under Sec. . . . . ._ ..-- � ---� - .. . . . -. - . . „ . , .• • . ALTER ❑ . , ' �1 2 4 5 A ' 8.8P.C.for this reason __ _ ' REPAIR . . S --- -�- � --�" -� �--� " --...""' - ".. _ ..______'. .." '_'_ "_ .. ._. . USEOF � ; � {�• r •2� ��Date:�� DEMOI � E%ISTING BLDG. . .. _.. . -. $ignatufe �� . ... . - .. . . .. ... ' � APPII�R NT , NO. � fINAL �� i � •P 4 Z 2 3 ! OWNER-BUILDEROECIARATION - ��DATE - �-�� -- -'�- �-�� -I hereby affirm tha�I am exempt from the Conrractor's License � � - - � � -� - � - , • •�Q'],2 J�, ADDRESS -�� � � law for the following"�reason.(Section 7031.5,Business and FINIµ ,� ' �' '�� � "' �Professions Codej:.... .�.�_...,...-' -__.__.. _._ ._... . __ N .By v�� . - . . . .-►21�9=8 6 � . �.. - . .. _ 6UILDING . _' ' 1 I, os owner of the property, or my employees wifh AD�RE55 ` wages os�heir sole compensation,will do the work and � " :" �� . � �� 2�1.'b A Ihe slrocture is nol inlended or offered for sale(Settion ��"��TY ' ' - I , . .��. -- 7044,-Business and Prafessians Code). - �-- -�� � -���-� MOVING- -- � - ��� - - -�- TEL. �- - - - --� -- - '��r• • • • •� --- � I,as owner of the property,am exdusively tontraUing CON7RAQOR NO. - - � � � . -with li[ensed coniractors ro constNct the projeU(Sec- —� AppRE� - "-" -- " - - - �� - �.. , - - - ' 1 •4 2 Q�Q-- lian 70E4,Business and Professions Code). � �"-�---"'� ' � ' � - - - -� -� � -CONSTRUCTION LENDING AGENCY " ' �---- -REOUIREO yqRD Hwv ��OTAL SETBACK . ._. _. _..�.._... ' �'_?'.'1._._• •_Q 2(j O O c=i � SE/BACK PROP.LINE WIDTH I hereby aHirm thot there is a mnsfrocfion lending agency for FeONT � � -�--.---� . '��'.��i�_1� ' � Z� q:_8 6 � �the perfarmance oi the work for which}his permit is issued -� -P.L---- �- . .._ . . � - - �'•'�' , �I __�. (Set.3097,Civ.C.). SIDE _ , ' ' ,. � .,,�'. , .. , ,,• , • .. m ._. ._ ._..__ _ . . . _ ._ -- ... _ ... v.L. . . . ...'. ' --- -_" � Lende�'sName Continental illinois Rank . � P.C.Fee E - Perm�i fre� � Is• rj� �OM4 Ref.M � - �' � _ _ - LendersAddress9'�1 Rn_ T.a ^1alln RY_� C'hirg�0 ' � � . � _t cenify that.�have read this application and stare that the . -- - - .. - � tseoaoee Fes ��.S�- ' -ion.ta.Pie k _-- , . -- i .. i a6ova informotion is correct.I o ee to com I Ih all Count �� gr p y wi y Inves�lga�ion fee / �'"� g _ordinances and State laws relating to building construction, _. - - Toiol fee nZ�O •OC7 - � LDMA Perm.M � ' � -� u and hereby aufhorize represenfatives oT this Coonty to enter � , � upon the above-mentioned property for inspecfion urposas. .�...7 JC _ _ f-3$�Da_ ' . ._._..� _.._._ _ __._.. .. '-- - -� p -- -- / ,o ��¢[„�.�1�,� � ��p SEE REVERSF FON E%PIANA70RY LANGUAGE , Q � � � Signoiure of Appikont or Agani-.. .._'__._...Oare__. _... . _,_.. .. ..- .... .. . .. .. .... . . . . ' ' _" ' __. ... .. ' _" ._�_. . .._ .. _ . ._ .. �.p i � PLANS i0 APPLICANT INSPECTOR'S NOTES ,.A}t`N8R•BUILDER,DECLARATION � I here6y 6ffirm that I am exempt irom the Comractor's To: . R�furnod �� ,�- �- � . � � � ' � Llcense Low�for �he following reason: (Sec.;7031.5� --' � � ' � - � ' ' Approved ' � ' pusiness and ProJessrans Cnde:Any.-ity orcounty u•bicG No. � Da1e � NoJ �'�Dofi � •- - � � - �.- �. �.� - ;..requrres a permif 10 tortsfruct,alles;improve,deneofitG, . � o'r repair any structurr,priar to its issaance,also requrrer . � � ' � ' �" , „ , , . . . ' . tl�e app(icant Jor rsscJ permit ao jile,a si,qned statement , 1Gat!�e is lirenred parsuan t eo!Lc pronisions of tLe Ctin= � . � . . . � �� tratlnr's l.rrense l.au�/C/apler 9J/rnnrnirncixg�uil5 Sec-' , ;` •_:;r• � ..�:. . ,. ....� ;.... - � "' � -"�"- '�"-- ���""�- '��- -- tinn 7000/nf.Die•isinn j of tbc IIarrrsess anJ Prnfessrons ' '� ' � � ` ' ' ' � � : �'-���� � •� •r-' CodeJortJatGciicxerupetGerefromund�bebasisfortle , � . . ..� , , . . _ . _. _...� .. ... __.___. _.._. ._. �. _ _._ _ _. .. . .. . _ . � --� ---�-- ---'-- --- -�� � -� � a!legeJ esemptiort.Any violalrors of Section�703l.5 by , • � � .• '�.� �� ..,�Required �, + .. .. ---__ '"._. ._ .._•�'�'' . . .. � . . ' anyaphlkanOjorapernrilsubjectstbeappliranttaarivrl Dale Recalved ' � Approvals� . or Approv�d . . .- . - fanalf}'of nnt morr tlon jire 1 undreJJollart(SSDOJ.J:, . ` ,Yes No ' ,-, , , .. .�'. ' ` ' ___, ._. ._�: .. . .. . . . ._. . - � ❑ I,as owner of the properly,or my employees with Water Cerfifimte�- � � - � �� � - wages as their sole compensolion,will do the work,and ' - - .._ • . _.__ . ., . . . ,_ . , . .. __ .__ -- - - - �the struclure is nol intended or oifered for 3ale(SeE.7044) Heahh Departmant�...� ' '`'�' � � ._�� . �=•� �. ... ; .� �. _� . __ . Burinesa dnd Profcasions Codc:Tl�c Conlraclor's License ' "" ' ' . , , . -,. , , „ l.aw d��:„�e applv e�a�oum��of proprrty wbo builds --- ,;� .;�- ,. .�. .. .. . Fire Deparlmen� - - -- - - � - - - - -- -� --- - - or im/�ro�rs tGcrron,und u�bo Jocr tucG work himself nr ._ _ . __ . ... . . . . . . ... . _ . _ . , . --� �� ' • � ' ���:: ' � 1GrougG !u ou•n empinyeer„/�mvided lGat sucG,i»+._ Grading ' t�" ' _ ' .'� � .:Jrrnremenls ure nnt infended or o/%red fnr ia/e.�� � � � �� � -- �,�`�� _ .bnu�encr,1Ge duilding or imp�ou¢menl is sold u�it!ia o.._ � Geologiml �.� �' , . 1� � � , . - „ year of eom/�letinn, t1e au�ner•builJer.u�ill�.baoc�tGe - � burJen of pmning tbul/c Jid not build n�inrproec fnr 7e�de�setriaCa r�oleclion. - - ',.� . .. �.....- ,.. _'_. _ ... .. ....__ _.. � _ ' ��. he property,am�e d ..�. , ,. . .. . . . tl e parpose of salcJ. ( )( PY) ' . . _ _ _. _ . . � � ❑ I,ds owner of t usively tonrrac= , Nng with�licensed contrauors�o conslruci-the project(Sec. •`�"` � � � � �� -- -----�� --- -�- �- 7044)Businrss and Pmfessiorss CoJe: Tle Contiaclnr's $peciol Inspeclion� � - -- -- �-- - � I,icente Lau•does nnt o l to an ou�ner o ro er{ u�Go � �c v>� e� , . . . - -' _ cc,•:�. .� ; . --. r Y Cont. Masonr Weldin rr Y IP . U` - - � 6ui1�ar"imfrnnes�lGcrcan,�dnJ u�ho eontracls for 3ubG Lof Drainage •. - � � . '.• " � � - .... � . hrojettr�u�itfi a mnlraclns(rJ Jicensed pursaan� to the - �-� - - �- - --- ��- - �-�-- � - Contraceor's l,rcensc Lau�J..._- � Parking ,.. . . .. , .. . . .� .._._ __ . ....: . _. ... _ . . - � -- - ._. _ . ..- i- --; i.-. i -- - . ' . � -❑ 1 am e,cempf under Sec. ,B.&P.C.for�this .. , , . ._ .....__ ..... .._. _. . • �,. � j , . + - , _ reoson _ _ _. . . - . , _"__' . __ ._.. ._'_ ._ "'_ . _ . . .. " , Date Owner , � , . . . � �; � ------ -- - - � - . ,. . " . . . _l. r � - - - .- . � �� Approvals- � Date - �-Inapatloi s Slgnatun ... . _ . �,' , _ , "� INSPECTOR'S NOTES Location= � - . . ' (Setback 8 Yards) - � � � � ��"' . foundations , I� �- � . :. .. � '�� .� �... Slob �J - � -- -. _ ._ . . _ � ... ._ � ,. .. .. , � � . . . , . Frome . � . . . .. .. . , , ,.. . '� , - . . .. � , . �.� .. .. . .. ..... ... . Energy Insulation U �� � - � -- � --" �- � -. ' . . � - .... , . . . . , . . .. . � � . . � . . .. ..,, Lmh/Drywall— . -'-._ •--. .__. .- -- -. -'-'-...,--'--�._..._ .., � INerior ti�""� �-__ ._.- � � � . ..�, • Lath—Exierior � . . , � - � , .. � . . ... . .. . ' '_ � ,� .� , . , , . - .�. . -. � .. , ._ ._ ._.,. .. , House Number— - ,. - �-=' .�_-.� � _._ .._.�_.. • . ._.._. . .'� � ..,_ • _- '---- � .,� .. , � Correci 8 Posred � � •.t � - �-�� . . . �� ~ . . ._.... Final-- .._. _.__.. .__ _ . _. .. ..y_. � . , . .. . _ . . .. . � .. _ _ . . ' _ '_ . . ...: , . � � � , i . -r r , .-J r. Enter on Front � - .. . . . . � , . ,-�. n. - - . , I