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HomeMy WebLinkAbout1243A 1244A .. _....__.... ..__ . .. ...— �-- -___... . .. _.... _ . ---_. ...._-- � - - - _ - - - Y WORNERS'COMPENS ,...• ATION DECLARATION A P P L I C�:� �'�. . � ..� .. ' '�,, . . . ....... " ' I hereb affrm tha�,I have a tertificate of�o�5e��,o 5e�E - ATION��FOR BUILDING �PERMIT ��- �-� insure,or a ceriifica�e of Workers'Compensa�ion Insurance, . _.__ .. __ . . - . ...-- or a ceriitied copy thereof(Sec.3800,'lob.C.)'' ' COUNTY OF LOS ANGfIES BUILDING AND S ETY � ' WCP6255241 " Great American Plan 3AR Policy No.- � Company - BUIL�ING '�/)� � �� Certiiied copy is hereby furnished: •. . FOR APPLICANT TO FILL IN nDoseSS�/�/ � �� Certified topy�is filed with 1he�county 6uilding inspec - BWLDWG . -flon depariment.�" ` ' ADORE55 Date 12-2-56 ,.Applicam .� Ttl2 Wm..Lyon Co. aTr Walnut ziP 91789 iocAutr ' � ��'CERTIFICATE OF EXEMPTION FROM WORKERS �'" " ' � - �ND.OF BlDGS.�-� � : � �: NEAREST . _ _ _ ' SRE OF LOT 3 800 SF Min.NOW ON LOT O � CRO55 ST. � � � -�COMPENSA710N�INSUR.4NCE'�� -• � (This seUion need not be camplefed if fhe'permif Is�for one -� � -- -- - - - -- -- � -- ' ASSESSOR , . '- � � �^- - , hundred dollars(E100)o�less.) . , , , TRACT BLOCK t07 NO. ' µqp gpq('� PAGE� PARCEL '� owNea THE WILLIAb1 LYON C0. nio833-3600 use zoNe rno.P /� ermit is issued,I sholl noYem lo an erson in o � I.certif that m ihe erformance of the work for,which this NO. V � ' ' �,Y Y p P � . . P Y Y P ny manner -... . - --SPECIAL �- � a so as to become subjecf to the Workers'Compensa�on Laws. "- ADDRE5519'COT' Ordie �P18ZE1' - � � -- �' ' CpNDIilONS � ., � �Q .• , � , . , , aTr _ Newport Beach, CA Z1P 92660 _ _ -- - - - .� ._ - a 4ote'� �- '' ' '" 'Applicant - ��� � ����� ARCHITECi OR TEL. DISTRICT GR UP TYPE_ .FlRE P ED BY �OTICE TO�APPLICANt: If,'oiter making�thiS Cerhf�cate of EN�iNEER Hales-I.dn Sto❑ No. 547-0862� imption;•'you�should bocome�sub�ect�to�the�Workers' � ^ CON T.. 'Z ompensolion provisions of the Lobor�Code,�you must forih- qDDRE55]]� S. M in � - -- ' �. a P Y .P ..... P .. be � � �TEI. S7ATi5TICAl ClA I TION � / APT. CONDO. 'Z wltM mm I with:such rovisions ot�Ihis� ermit,shall deemedrevoked. �.., ;, • - •,� �. ' ,..� �ONtRnC70riS8fi2 AS OwRet No. - LICENSED CONTRACTORS DECLARATION � -�---� --�- � �� �-��---------� - -UC. '--'� � ' QA55 NO. OWELI:UNITS r I hereby aTfirm that I om licensed under provisions of Chaprer 9 ADDRE55 NO. �yyER MAP � � (commencing with Seclion 7000j of Division 3 of the Busineu and . _ . _ __ . ���, _. ._ � Professions Code,and my license Is in full forte and effeU. Cltt �iASS � �eK �-�� �: � -� � - '��- VqLIDATION � � ' � � � � . S�.FT. NO.OF NO.OF , CHECK , ' � � SIZ STORIES FAMILIE$ ONE � ,:,�. . ; . �. LicenseNumberZ�6801 •'Lic.ClassB-1 VALUATION .'. . � . . The,Wm. L on Co. 12-2-86• - -- Ne,v \ ' "' - Y � DESCRIVTION OF WORK (J CoNractor Dala ADD ; l v ' �1 2 4 3 Fl � . ❑I am exempt onder Sec. �- � � � �, � , , , . AItER #�� • • •�� ' B.BP.C.(or fhis reason _. _ REPAIR � s . . .- . .. ._.. .__.' "' . . _.. ' _.-- --.- . _ _ oofe:- , use oF oeMa ❑ _ � •2 7 6 6 S EXISTING BtDG. . . ._ . -- APPII�ANT TEL. . 2 -Signalure � -- --� � � � - � - , � FINAI � • •2 7 E�G 8 0 OWNER-BUIIDERDECLARATION PRIM NO. _ ..DATE --- - - -��---� .- - �- --- � - � --I hereby affirm ihol I am exempt from Ihe CoNracbr's License - � - � . '. � 2� (�^$(� Law(or�he foliowing reason(SecFlon 7031.5,Business and nooaE55 FINA - ' ..Profezsions Code): '. . -' ' � '. --... . . . eE N `By ���,-� . ' . - . � . z� 2 Ll.�f.�� BUILDING , , . ' � 1, as owner of ihe property, ar my employees w(th A�DRE55 , _ . , �" '.` � , . wages as their sole compensaiion,will do�he work and � � ��- - ��� , - � #• • •�• •� � tha struUure ia not intended ar offered for sale(Sectian ��"��T� , ��� � � 70a4,Business and Professions Code).- ' - �- MOVING --- ���` �' �� - �' ' TEL: � - � -� �- � � -- 'I •4 7 5,5 0 � I,as owner of ihe property,am exclusively contracting CONTRACfOR No. . _ ,_ . ' --wHh licensed conrractors ro consiruct the projett(Seo- -'- - � -�-- ' - - � � �' � ' '-�- '- . ' ������J.7�J�0 u� �ion 7044,Business and Professions Code). n�oae55 : ;''�,'� ; .. : . . REqUIRED TOTAL SETBA K ` ' :" 1219-86 " �'-'CONSTRUCTION LENDING AGENCY �-"-' ' �- sei BncK �YAeD Hv.�1' PROP.LINE WIDTH � ' � I hereby aNirm that ihere is a consnoction lending ogency for ikONi - � �� ���.J- ��� � ' __. ' .�'' .. . ., , . _ r -the performance of the work for which this permir is issued -v.�. - - ��- �- � - - -- -- � --� -- - � - --- � - � (Sec.3097,Civ.C.). SIDE ' � ,- , ; ., � .. _. , � m __ ._ . . . _ . _..._ _ . P.L � _ . '- ___ _ � ;• .. �„ . . . = lender'sName_Continental Illinois Aank +1 / 4 ` � _ _. _ . . __ . _ __. . . .. . . . P.C.fee S� al� (o U -��5.00 LDMA Ref.M . .:. r PermitFee ��-- �'-� -- - � - Lender'sAddress��1 Sn- 1•a Ra11F Cr_� ('hirg�.0 . �. . -. �, � I certify thm 1 have read this application.ond smte�hat ihe .__. ._ .__. . .. . �-- Issvance Fee �-SO��- LDMA P/C M- � -�-- - � --- � -' .. . _. . .. m above info�matian is mrrect.I agree lo comply wifh all County ���es��ya�ion Fea � ' � g _.ordinances and State laws relafing to building construction, , io+ai Fee �75• 5��� ' LDhu Perm.�M - �- � � - _. _. .. _. . ... ..--- --- -� --'.- 'c-. _ ...� � and here6y authorize represenfatives of this County to enter � � � upon the oL o�e-ment�o�ed property(or inspection purposes. f,'� �D0 .f..']a 5.p0 �. �. � � ... _. . . .... _ _ _ ,. . , _ _ _. . . _ . .. .._ .... c ._ _.. . . ..__ ' _ __ ._ . . a (�`F �� � ! /slkti _ � n SEE REVERSE FOR EXPLANATORY IANGUAGE . � I � .' 51gnatureofApplicanrorAganf " -' _.......Dote . . . . .. . .- " . _. ' -� -' .. . .._ . . . . . :._. . . -: .- . -'- -OO� PLANS 70 APPLICANT INSPECTOR'S NOTES � 0�5'NF:R-DUILDF.R DECLARAT'ION - I hereby affirm�har I�om ezempr from the Contiactor's '70: - "� ' Return�d � � � ' � � � - � License law for��the.following reason. '(Set. 7031.5) "''- � � Approved ''Uusiness anJProfessiunt Codc:Any tily ortuunly which No. Dale �� No.' ' � Dafe - • � - �� � �� '' � �. � �� ,j�- , �requires arcrnril.tn Cnnslruct,alter,�improve,demolisG. , \ , _ .-�orrepairanysfructurc//�riortnitsissucarc,a&orequires , � . - .. • . ... � � , t/c aQ/+licant fnr tucG f�ermit tn filc a sign¢d slatevren! tLat be islirensedPursuant to tLeprovisions of tl�c Con- ' 1 � � -- � �`i . � � � traclnr's I.icense l.aeu(Chaptrr 9J(cummencing witb Sec- � .. ,. ;,,., . .. ' � ����`�- �- - linn 7000f af Dirisinn 3 of tLe Basrness and Pro�essront 1.. . _ _ "._'. ` , .... .+ ,� . � , � , �' �� . '��__CodeJ or 1Gat Ge is exenrf>t lberefrom and tbe 6Dsir for l5e _ . . ._ ... -, _ . _ ._ ._.._ _. _ ._ ._ . _._ _._ ._... _ . , aUeged�exem/rtion.Any t�ioJation of Settion 7031.5 fiy .._._.. . Raqufrad -Date Reealvad �• .-.:- .".. . .'�.�.� .. ��• '' � ."T�_ �"._ <- _'_. _ aqy�flicantlnrprerneitsabjeels tGe a/r/ificarst to a eivr! ApproJols� or Approvad . , . , � �peaa ty uf not morc than fine Gundred dollnrt(d500/J:. � � Yes No _ . _.... . . .. - -- - -.- : �'.-'� . -. -- , . - - - � I,as owner of the property,or my employees��with Water Ceriificare - ' -'.�.� � . ._._._ �. � ' ��_ . .�t_ � .. � •�.. . _�. . �wp9es as iheir sole mmpensotion,will do�he work,and � - ' -- - - �,�� the snucture is not intended or ofFered for sale�Sec.70a4) '= Health Deporlment '..� ... _ � -_ : _� '. ..'. .. . ._ �----- - ---. _ .. . _.. . ... . _.. . Qusinesi anJ Pr%3sions Code:TLe Contractori Lice�se � , f.uw�docs not app y ro an oumer of proprrty wLn builds � ���, .., ;. .. ,; r.,; .,,�� . Fire OepartmeM - - - - - -- . or improe�es tbercon,and wbo docs sucb work bimsclJor ' ' � - � ' �� � - , r �� � � �• . tGrnu,qG�/u o¢•n.enrpinyees,.provrded tbat such irrr� , \.. �.. . i_ � . Groding . , � - � �� " � prorrments.,arr not intendeJ or,offcred/or ra1e.� " � ` ,-�� � � -'� .._._ . , , - ,. -� boa•ener.lGeb��ifdirt,qorimproecmentisaoldwrtGinm. ��\ Geological�� . . - ,� ._ , � , , , . �year of�mmpletion; 1Ge owner-builder-will.bave�tLe - . . . .... burden Jpronin,q tGat be drJ no!bueld or im/�roi�e fnr , , �-- � - _ ` . , ., - .. ..._ . _- '-- - - --— - � - - t6e purpoie ojsa(cl. , � - _. . . _ PedeslrianProlection . � , . . . _.. ��.. .�. �.:� �:.� . (Fence)(CdnoPY)... .. � ' � -�' '-�' � .'_ .... . . ........ .... . � lin wilh licensed contra corsto tonsirucf ihe ro'ectnlrao- .� - ' ❑ 1,as owner of the ro ert am ezdosivel co , ... � -. . ._ . . ..._. .� . . .... . . __._ . . . 9 P I (Sec. Speciol InspeUion� � � � ��� , 7044�Ousinrss anJ Profertinns�Code:_Tl e Conlractor's � � ��' � � License 1.am Joes nnt a l Jo an omnero r ert, u�Gn (Conc.)(MasonrYllWeldin9) ; ��. , � - .. � � . �. ': . ' _ F�: iC.; _ . PPY JP„PP v� -�-� - � ` "-�buikls or im/�roves 1Lereon,-anJ u�ha tontradi for sutb GLof Droinage, � ' - . ._. . .__. ._ _____. ._ . . hrqeets-u�itb a mnlractnr(sJ literiseJ/�vrsuan! to the OA ' � . - Contrartnr's Licensc(.auJ..... . . ........ '-, -\ i Parkin9 . � • . , ' - . .._ . ... _ .. . . __ . _ __ _ _ ' . . _ . _ ❑ I pm exempt under Set. �,8.8P.C.for 1Fii . . . . ' • . . . ._ _.._ _ __ _ � -. . . .� . . • � ` . - , reason . ., ... , . _ ._ . . _" _ _- �_ __'._._.__� ..._._ , i - , Dale Owner ' . n . . i � . , _.. .... . . . _ . :' _ . . . _ . _ .. Approv6li � � Date �InspeNor'o5igoalvre. . �. .. � , . , . . � -. INSPECTOR'S NOTES Locatfon- � i . .. _ _. .:'... . . (Setback&Yords) , - � � � - �� - - _..- - - �. . . . Foundations �� r� ' , .. .. .._ . . .. _ ___.. ._._-.___ �.. . S�ob . �:...c/ f� _ . . __ . _.. . .-- - --- --- , . . ,, . � . . . . . Frome �� . . . .. .. . .. . . . , , - . .� . . Energy Insulation ��� �-�� � . . ,�.... ... . . � , . .. , Y � � . . . .. ._ ____ _�. __ . .__._.. _ _._ . Loth/Dr wall- -. . ..T -. .. . . . Interior -- -� - . .-- . . ' � i Lath-Exrerior . � .. . . . .. .... : . . , i � . �� .; . . �� . , - „ � ..�, . c_ ._ _ _ ... _ _ _ . " � . . House Number- '._ '__- ' .. _.__ _ .- . • . _ .__... _' .._._ , _ . _.:.i. .. ,,�. . .._ _ , .. - � ' Corred&Posled ' ' � �� .. .- ;. � � _ � Finai- "_.. ..___-____._ . -__ c ._ .. .. . . ___. . _ _ � , . � . ._ _'__. . .. � ., , � . En�er on Front ' � � � � . . ,. . � ' . . :-F . . .(,.. . .. . . ., . . . .� .�1..- _ , . . . . , , ' . ' ' ._ ' � `�\i . .� . .