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HomeMy WebLinkAbout1227A 1228A . _. _ . . ._ . .. . __ _ ... .. ._ _ . ..-- - � _... -.- 1NORKERS'COMPENSATION�ECLARATION :'. ` � ' " � - � • . ;.- ' ,: � , ... . _� .... _ _ .- I-here6y affirm that I have a certificate of consen�ro self APPLICATION FOR .BUIL�DING PERMIT�-��-� ���, insure,or a certificate of Workers'Compensation Insurance, or o certified copy thereof(Sec.3800.Lab.C.)' ..� _-. .. - .. .. .. . - -.- - . .._.._ ... �1CP6255241 � Great American Plan 3C COUNTY OF LOS ANGELES BUILDING AND PETY �,,: ,.. Polity o. ��Company - .- - - - - - � Cenified copy is hereby furnished. �. FOR APPLICANT 70 FILL IN Bu��DwG a . . �� ..__ A��REu X .Certified c'opy is fi�ed'with'the county building inspeo gUiLowG � tiondepartmenl:� � � AD�RESSZOH3H East Cliffside i.ane Dale �.1Z-2-H6 APPlimnl TIlO Wm. Lyon Co. CITY Walnut . ...Z1v 91789 , ���iT, � �''' - - . . - . - ' 'NO:Of BLDGS. � ' '. NFAREST. - .. _ . . I... .�. `CERTIFICATE OF EXEMPTION FROM WORKERS'�� ��' Srze oF i073,SOO SF Mirt. NOw ON LO7 � � � �COMPENSATION INSURANCE ' � �� • CR055 ST. � (This SeUion need nol be mmpleted if tbe permit is for one - TRA� -- � �- 0.SSESSOR ' ' ��� -' � hundred dollars(b100)or less.) . , 4 � bLOCK LOT NO. MAP BOOK PAGE' PARCEI , ' owNeaTHE WILLIAI�l LYON�CO.' N'g33-3600 usezoNe M4P ^ I.certify ihot in'Ihe performance of the work for which this � ni0. � �� } ermil is issued,I Sholl not em loy any perion in any manner �� -�-�--- - SPECIAL - - - P P orkers'COmPen4ati0n LawS. � � AD�RE5�9 COI' OI'8CE"P13Z] ' ' - � CONDIilONS �u ao os to become subject to the W , , New Ort BeflCh CA 92660 Dafe ''� ' � APplicanl .�. .• ,. ; � ._ CITV.._. .._p._. _ . ) __ 21P ._ .._. . • ..�.__. .__ , __�._.-___,_,. __. . .. .� .. . '.OG ARCHITECT O TE�� ..DISTRICf._ GR P TYPE . .FIRE. PROCE D BY-. . � /+�OTICE TO APPLICANT:�If, a(ter makin9 fhis CerliRcate of ENGiNeEa ��ales-LangSton No. 547-0862; � � - ( :mption;'you should become su6jett�to�the�Workers' - � , ro�T� � Z .ampensat�on provisions of the Labor Code,you must forth- ADDaE5777 S. Main St. Ste. 105 Oran e' with.comply wiih soch provisionz or this permit shall be -�- - �- - � � deemedre�oked. � . ; Same As Owner TE�' STATISTICAICIAS ON APT. CON�O. Z CONTRACTOR NO. � .. .. '_' . . . .+,L/ ..__ _ __' _ UCENSED CONTRACTORS DECLARATION� �."•� --��--- - - � ��- � - -- -�-���.-- � � ��- � CLA55 NO. �� DwEll.UNrtS� I hereby afiirm that I am licensed onder provisions of Chopfer 9 ADDRE55 NO. � (commencing wi�h Seaion 7000)af Division 3 of ihe Business and .-_- _. ----. _ .___. . . �iC. . ___ � SEWER nMv , . ... ,� Professions Code;and my license is in full force and effett. Cliv Ctn55 �� �""BK;�' �- '---��� ----��-��- VALIDATION � - 50.Ff. NO.OF NO.OF CHECK � ' License�Nuriiber2�68�1 'Lk.ClassB-1 si E STORIES FAMILIES ONE ' . .. -.. • . . ..VAIUATION�7�: 7 A The Wm: ,Lyon Co. , 12-2-86 • - oescaiarioNOFwoaK N�- � S S l.C..+�/ -� `� 22 CoNractor �Date , � � ' ADD .�• •.• .2.T': �Iomexemplunder5et. � lTl le famil home c nstruction A�TER � ' � �� �' � �� '.. .. � , .... . / . EPAIR � ..s... _ .. . . .._'_ "' . �I •276.6H .. � 8.8P.C.for ihis reason _ _ l.r - , -- � . .. " - . _ Datei"_ .._ � u5E oP oEhtOL � , EXISTING BLDG. ❑ �.,Z��6 8 U ""Signature ._ ._. .-. . . . �� APPIKANT TEL. FINAL • OWNER-BUILOER OECLARA710N PRiN ' ' No. _ �� � • , -- . -DATE .. ... . ...:....._.��Z� 9--SG' -'_. -I hereby atfirm that 1 am exemp�irom�he Contractor's license -- - � f � Law for Ihe following�reason(Section 7031.5,Business and /+ooee55 FINAC_ ��`r��_ ' ' � ��2�.�8 A � '-Professions Code):-._.. ... . ._�._ _.. ..._ - eE N By (�/1J --. . . ..- -..:- -',� . . BUR�ING �_ I, as owner of�he property, or my employees with _ _ apoeess � � _�_ �• • . . •� _ _ wages 6s their sole compensotion,will do the work and `��TM , � ��., ; . fhe structure is nof intended or offered for sale(Section ' � •4 7 5 5� � . . 9044,-Business cnd Professions Code)..... . . . ..... MOViNG... ... .. .._ ... TEi. .. - . . .. -. . - -- • . . . ... X� 1,as owner of the ro ert am exciusivel coMrac�in COMRACTOR NO. ' P P Y. Y 9 . ��'-�.�.' '.� .,:. -. •ArI�SO� � ' -with licensed contractors ro construU�he p�oject(Sec- .. . �.-. .-'� . ..� . . -. . ..-. . . . . .. . . ' . .`.'. - . . .- . , tion 7044,B�siness and Professions Code). ADORE55 _._ . ;., � -���-� - �-CONSTRUCTIONLENDINGAGENCY �" � � -aEOWxED YnRD �HWY ��TO1nt5ETBAIX . . " � ' �2'�.9 _8.6 ', SET BACK PkOP.IINE WIDTH� � I hereby a(firm Ihal there is o tonstruction lending ogenry(or FRONT � --�--- . {_,�"�.j"� ' ' � ' •� _ ....� ' , - thc�performqnte of the work for which this permii is issued �- �P.t. � �- � - - - �• � � �- � --� � - - � �--= - --- -- �-���-� (Sec.3097,Civ.C.). S�DE . � ' .:i � � .,, '. 1 t�, m _'.'_ . .. ._ _... .._ _. .. . ._ P.L _� " v . �. � Lender'sName Con inPn al Tllinois Aank p � �� � � $ - - '-� ' - ' P.0 Fea E .(00 Permn fea 5, ��Ref.k ' -� - � = Lender'sAddress2�1-SO-.-La_$a.l-1.F_—Gt.� r}+��8g0� , � ' �� � � T � .I ceriify thot I.have read�his applicat�on and s�afe that the -�. - h�uonce Fee i v �DnM V2 N �- - -�- � -- � ' - --. .. .. . . .... .. .. . � above informofion is correcl.�agree to comply wilh all Counly Investiga�ion Fee '� ��' g ..ordinonces and Slate laws relating lo building construdion, __ _., _ ._ _ Totoi Fee - - •S�- �LDMA 7erm.N � - � � . . . .. . . ' _' . ... . ' ' _ ._�... _ u and hereby authorize representatives af this County lo enler � � upon Ihe obove-mentioned property for inspection purposes. ��� ��� s5T , � � . � � .. _ . ..... . . _ __ . _ _. . _... . _ J.�'[il/ � � SEE REVERSE FOR EXPLANATORY LANGUAGE ' � � ��.,,,,,__� 6 ' -_ ''o, _ .Signo�ure of Applicom or Agen� - . .. . . a�e' - - ..- _ .. ...... . . .. . . _. .. _._ _..__ _. _. .. .. ... ..._ . _ � �PLANS TO APPIICANT INSPECTOR'S NOTES AR'NF.R-BUILDF.R O@CLARATION , I hereby affirm that 1 am exemp�from the�Cantractor's To:. " Rafurn�d � � . � � ' � . � � Lfcense�Law for the following reason: (Sec.�7031.5) � � � ' �� ' '� 'Approved � jJusrnessandPr%ssinnsCnd¢iAnycrtyorcountywbicb No. Date '. No.' � •Dafo� � � � �. . � -• , � � ' ' . ��requires a/renni!to ooms[rucl,a[ter,in�rove,denmfisb, , .or re/miranystrutturc,p�inr tn i!s irsuance,a(soseguires -, , � � ' . , , . , tbe a/�/�Iicant jor sucb rernri!!o Jife a si,qned atatement " - .1La!be is licerssed pursuant to tGe pmt�isinns nj jbe Con- � . �. �, i;; i;,;„ , . , lratlor's License Lau�jGfiaj�ter 9)(comneencing mrtb Seo ; . . � ,,'�i::_.: . � ,. , .. .. �. •.., . � � � " --- - - �- - - - -- - „tinn 7000f oJDivisinn 3 of the Busrness and ProJessions � -- - � � � � � �� �"' ' � • �' CodeJ nr thot be is�esenrrt Iberefrom nnd!be bruis fnr Jl c ' ___ _ .J . _ � " .- � . ..- _." _ . . -. . _ . . . . ___ _ .. . __. ._ —. _ . . � - - a!legeJ exemptian,An,y vinlalron oI Settion 7031.5 by : � � �' � Raqulrod ._. . DaURaceired�� . . - .' .- - � . " �� �' ��'� . .. , . . . onyapplicanffnrapemrittabjeclttheaf�Qlicanitoa�ini! � � Approrali or Approv�d . , � J�enalty of nnt morc tban�'ne hundred do!lars(Sf00J./: -�.�Yos No � .. . , --' -�-- . � -- � - '� - -� -- ❑ I,as owner of 1he properfy,or my employees with Wa�er Certificate�� ' � - --� ' wages as Iheir sole compensation,will do ihe work,and ': �-. . _ . ._. .. __ . . _ .� '_'. . . ..� _ --- ---" -�� --- ---- fhe structvre is not intended or ofFered for sale(Sec.7044) � HeolthDeporjment__:- .�.�. :..�.�J �� ._.�r'.� .._. _ . - - �--� -- � - - .- . . . .UasixersandProfessionsCodeiTbeCoxtractor'slicense � , � I.aru docs not apply to an ouroer of rroperly w��builds ' ` :'� . :, :r.•,;. .. �,- � ��. Fire Department. . . _ . .. - . ._ . _ .. --�� -� ����� ,-- - - �--- - - -� ___ar imf�rot�et t4ereon,and u�Ln does su�G work brmse!/or . . - ,.-C '� ' r �n,:,!-;.�,I: �. - - � tGroagh�bis ouro-employces, Qrorided tlat}ufG nn•' � Groding � -� j,�:, � � � � � � � �, � � ,, �rn��emenls arr no! i�0ended �r offered f�r sale.� � - . . ; �.� � - , �� nu•rver,lbe bui(ding or improvemenl istold u�ilGin or. . . ...... _. � Geologitai , . � .. i _ , �year nf rompletion, tbc omner-builder�n(ll,bao� !be i �� � � - burdrn n/pm:�ing t!a!be did not build or inrprone%r .._ .____ _ _ _ - PedeslrianProtection '-'.' - . ' .-� ��.• �� . . '� �� � ,� , � .- _._. ... . . . _ . .�. tGe purposc nJsalc% '� ' . (Fence)�(CanoPY) . .. . ..��, �. . -'--..--.... .. . -'-... -. - . . ..':- �; ❑ I.asownero(Iheproperiy.om�exclusivelywntroo- „ '� ting wilh�icensed cantrotbrs to construct fhe projeU(Sec. h�, Spetiol Inspeclion'� �. .-- -� -� �� ��� � �� � ���� � � - - - - 7044)Business and Prnfessinns Coile:�.TGe Contractor't ' - ' � -�- - � � l.icense l.tru�docs not a (y eo an oumer o ro crt u�bo � (Conc.)(MasonrY)IWelding) �. .. . , - ' . i.._. '�_ ...: _. l.�.._:�..1 i , b '!d n -nJ on rr l� r v � �- -''-- " --u or imprnres tbcrco ,-n u�!n c lracts for suc! lot Droinage ' ' � � � . _ A1OIrclo�u•ith a rnn�mctor(sJ�licensed�ursuant tn tLe . � . " �. .. �- . . .-..- -- �- --CnntractnriLicensrl.auJ. - . ..--- ..� —� �� '.: . r Parking . . - . - . . . - . . � . ❑ I am�e:empt under Sec. ,B.&P.C.for'ihi's _ .. .� > � , :� .. . � '- �• .. ;�.� � , . _..-----. .._. ._ ._,,,. � �.- ', : � . � � � reason • �.•,: ; . _ _-- .. -- �__ _ .---. .-- -.-.-. -.__- . � �. * . . .. Date Owner , . , . , . . . . .,. . . . ..' ._ ._ - _ _ ____._ .. . .. , � . � ,�.'. � , ,, i,..:1 f .._ Approvals Date Inspec}or'c Signature . � - INSPECTOR'S NOTES � � Latotion— . _ _ (Se�back 8 Yards) � � � �- Foundarions . � � � , � . .. . � ... , Slab . . ? . � . � - Frame _ . I:: I !c7"� � • . . . . . . .. . . . . . Energylnsolalion �.�� l,ti/�_ -._-_._ ._ ... . __'. _._.. _._. -._ . . �. ; � . .,, �. .. , Lath/Drywoll— �g-f _ __ . . _.._.. ..-__.. �. -, - '-- . Inlerior -V� �-^�1. . ..� � I , � � � ' Lath—Exterior . .. . . �� ��,r:.i.�:; ' ..'i:'". . .. . ... • � . . _.. ,�.! . .,-. �. .. HooseNumber— .. ,. . ..�_,��•:<....... .... . .... . . . .�. _ ._' � .' � , , , � . . ... Correcr&Posled � " ' . -. ✓�-- -... � . . . .. . ..._. . ., .. Final— .. _ . .._ ._ _.�.-•� _. _... . .. . . . . � . � Enler on Front - ' � � � � ��_, -��� . ,. � . � � � .. . � �� . .. _ ;c , . . . . , ,i , . . ..