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HomeMy WebLinkAbout1207A 1208A (6) , .., . , _ _ .. _ . - � - _ __ .. ... _. _ _ �_._.. _ . _.. _ ... . __ ._ WORKERS'COMPENSATION DECIARATION . ' �-=-- �- � �.� .�• �. 1 hereby offrm ihpt I hove a certificate af�a�5e�,�o=e�f � - ��� �qpp��CAT14N-�FOR .BUIL��DING� PERMIT � ��� insore,or a certificate of Workers'Compensafion Insurance, or a certified copy rhereof(Sea 3800,lab.C.) COUNTY OF LOS ANGELES BUILDING AND A ETY voucyNa'�CP6255241�amPa�Y Great,American Plan lA � Ce�tified copy�s he�eby 4ornished. FOR APPLICANT TO FILL IN eu�t��t�G AODRE55 �� Certified copy is filed wifh the tounty build�ng inspec- � - guuoiNG � IiondeparlmenC � AODRE55 20842 East Cliffside Lane � oo�e .12-2-86 APPI��o�� The Wm. Lyon Co. C11V Walnut Z1P 91789 , ��i�Tr CERTIFICATE OF EXEMPTION FROM WORKERS' � � -"--�-- �- ��NO OF BlDGS. - - � NFaREST� - .. -�-- . "' - " 'COMPENSATION INSURANCE SIZE OF l0T 3 r$OO SF M1R.NOW ON lOT � � CROSS ST. (This seUion need no1 be completed if ihe permit is for one -- TRAC7 43760 � eiocK ZOBOO lOT NO. (�� �ESSOR , , � "--" - • � hundred dollors(5100)o�less.} . ,� ,, ,, MA7 BOOK PAGE� PARCEL owNea THE WILI.IAM LYON G0. No833-3600 USE ZONE I certify that in the perfo�mdnce of the work for which�this N�� �- permi�is issued,I shall not employ any person in ony�manner __ _ , ,: ��-� - SaeCint - - - - ti so 6s to become subjeet to the Workers'Compensaiion Laws. a.00aES519 COi Oi8t0 Plaza�--� ��� � coNoinoNs ,V ' Newport Beach, CA Z1P _ 92660 ___ _ a . . � , . ._ aTv _. _ Do�e� � ' Applicant � � � ARCHITEQ OR � 7EL. � � � /"OTICE TO'APPLICANT: If, aftei moking Ihis�Cerlifi[ate of ENGINEER Hales-Langston No, 547-0862 .o�sre�cr GROUP TYPE .... FIRE _ P DBY . ' � �mption,you should become su6jeU lo the Warkers' ` � CONSj.�,� Z E W ,ompensaiion provisions of the Lo6or Code,you must(onh• qoDRES57�7 S. Main St. Ste. 105, Oran e V � wifh compty witfi such provizions or Ihis perm�� shatl be TEI. i STATISTICAI C ✓ TION APT. CONDO. iC [I@eltlfClfEVOkCfI, . . ' '. .'....'• . ^. ''.� ' CONTRACfOR SSIRE.' AS Owner NO. � ... . _... .. LICENSED CONTRACTORS DECLARATION -� �-��- � - - � - �- �---�i�,- �--- - CLASS NO. DWELL.UNITS� . ' I hereby afiirm that I am licensed under provisions of Chapter 9 noDRFSS No. (commencing with Section 7000)of Division 3 of ihe Busineu ond . ... .. . ��� _... _ ��R�`P , • ' ' � � � Professions Code,and my license is in iull Torce ond effect. [ITv � C1A55 ' �'"BK--� � ' - -�, - - VALIDATION � ., .,. .. . .. . . . . .� ... . _. 50.F7. NO.OF . . . NO.OF_ . . . CHECK .. LicenseNumher2�68�1 ��' LjC.,CIp55B-1 � SIZ STORIES FAMILIES ONE . ", " . . . . , ... _VAlUAT10N; ". __ _. . .. , .. ..�� 2 O.�I A � ,The Wm. Lyon Co. 12-2-86 - oescairnoNaFwoaK - NEw � � Contmcfor Da�e � ' �, ' . . ADD � s , : , �J• • • •Z� �I am ezempt under Sea �-- S1❑ le -famil home construction � � �- � ��. B.BP.C.�for Ihis reason . . .M1• . � . - REVARR ' S. . ` .- ";"-" - - " � �"� •2 2 5'8� . � ._ _ . . . .. Date: - - USE OF DEMOL � ' EXISTING BIDG. - � - - -•2 2 5 8 1 c=i � - -Signature �. . -_ .. �. __ .. .._ . . - - - AVPLICANT TEt. ' FINAI . vewrThe William I, on Co.No. 833-3600 1219-86 OWNER-BWIDERDECIARATION . , . DATE �-�-�--�� - -- ------- - �-- -� -�-� I herabyaifirm Ihaf 1 om ezempt(rom ihe ControUor's License qDDRESS � ' `'� � ' � � �� 2�,$A ' Law for ihe following�reason(Section 7031.5,Business and FINA . ..Pro(essionSCode): .... . . .. . -"---" � -'. ..- _ . , � I, os owner of Ihe o ert Y P Y BUILDING ' . r � . . - � � . #,• • • • • � , , pr p y, or m em lo ees wilh AODRESS _ .___,. „ _. _ ._ �..,. .' , wages as their sole compensation,will do the work ond � � •3 9.0.0 0 �� � the srrvcture is not intended or offered for sale(Section ����TM � -� � -7044,Business and Professions Code). � " - -'" "' — MOVING" ' '��" � ' -- " �TEL-���� � . , -'"�- - � '- • •3 9 Q O x ..' � I,as owner of Ihe propeny,am exdusively comratling CONTRACTOR NO. .,_, .` `�\ .. '' � �`�' - with-licensed contratlon to mnstruct the project-(Seo ---. .. . .. . .. .. _ . . ' -. . .-- .... . . �" _ �� ' 1 2,� Q-..$� --."��' fion 7044,Bwiness and Pro(essions Code). ADDAEu " , i . , ' - , �.,.- r.� . . �� i .. _.. _._._ .REWIRED . .YARD HWY tOTALSET6ACK -._. _. ... _. '_' . . ._' __.__ '._.' . ' . CONSTRVCTION LENDING AGENCY��-� �� "-�-� Sei BnCc va0a.uNE wi07A �� �• I hereby affirm Iha�there is a construction lending agency for FRONT '� ' "f: f� ��-,i�' ' ...i5ea 3r097,Civc�f the work for which this permif is issued �-" SIDE ���� � _�-� '� : " - ,-�....-_. .__..,.....+' .- .. ..._ - . � � � - - -. . f-" � 1 � i m .._ _... _. .. . __.._._.. _ . _.. .._. _._ P.L. -. � lender's Name •on i n n a] T l l inoi Bank .0 4 C tonna,aer.x ' 8 . ._' ' __' "'. . _ . . . .._._ . .-'_'- P.G Fee S' J .[J Permil Fee - � .'JD ' ' -- t'__ . . _. = Lender'sAddress 7'�1 Sn- T.n Ral la Ft,y Ch;cago , � � .I cenify.thm I have read this opplitofion and state that.tho ... _. ._ ._. . . _ . . ... Iss�once Fee�� .5�� ' �Drnn P/ON�"--' ' '� - � ' ---' - a above informarion is torrect I agree to compiy wilh ail County love:ngauon Fee �1 ; , - � g ordinonces ond Stofe laws relating to building construction. '-,_ ,_ --- . . . . Toial Fae Vi� �IDMA Permr N�--- - ..__- ..- '_-... _.._. . . ._ . . u and hereby ouihorize representatives of this Couny�o enter � � , � upon Ihe above-meMioned properfy Tor inspection purposes. . . . .. _ _ ..._._.__ . . . .._ . . ._. _._ - __ _'. . . '_ . _._.' _ . ' - . a '.. /� _ _ ,. . ._ . ___.. ... _._. � I�G� �/i � �/_L/�/f/� SEE REVERSE FOR EXPIANATORY LANGUAGE � � O' _ b"Signat�re of Appl con�or AgeM '- '- '�� Do�e— � -.- ..- .. . _ . . . ' . ' '-'. _ . . . ._. .. . . ... .�. � _ . . ' ' ' _'.' ' _ ' ' . . PLANS TO APPLICANT INSPECTOR'S NOTES 01VNF.R-BUILDER DECLARATION I hereby offirm thot 1 om exemp��from ihe Controtlor's To: � � � Roturn�d � ' � � , � � License law for Ihe following reason/ (Sec. 7031.5) ' � �� �� 'Approved ' ' UusinessandProfersionsCodr:Anycitynrtountywbith No. �a}e No. � : `Dafo::'�' � - - . � �..� � � ��.. ... �,;, ; requires a pernil0�n�onstrutl,a!ler,lmprovc,.denmlisb, _.or rrpair any structurc,frior tu its issuan[c,ofso requires ' . . V � " . . . . . . , t!e applirarst for setb pernrrt lo Jile a siFneJ statemen[ � � lLat Ge is liccnseJpurxuant ta tLe proriiions o/tbe Con- f ,',� -'., i ' , . . lrartor's l.icense l,aa�ICfia/�tes 9I(romn�eneing u�rtb Sec- � - - - - - lron 7000J of Uroirinn 3 njthc Dusiness and Professinns ��-' , � • � , '�'� ' . ��-��.� �. . • "' CoJeJorlLalbeisexenrptlLerefromandtGrbatisfortbe " .�.=�- , `Rpulrvd � : ��D teRecaivod .I - � - - - --- �_ arclyapplirontJnrah rnitsubjcctstbeap`1'cant�oatr�7 � r ., � . ,. ���� �Approvals �- � � � � pena!{y o�not nmre t4an/ive bunJr¢d dollars(SS001•J� � � Yos Nc or Approwd ` , . . . . . -- - �- - � -- - � � � -- - - . ❑ I,os owner of 1he property,or my employees with Wa�er Cenificate. ' . � '�" " �'� ' . . _ wages os�heir sole campensation,will do the work,and , �,_. �� . ___. . . .. . . � - �-� - � �� � �- � ��ihe s�ruclure is not inlended or offered for dale(Sec.7044) Health Deparlmenl ��-. '�_ . � ..�._. '"- _ . � ' - -. - . __... . , Dusrriess oxd Projes3ions Code:Tbe Cantractor's License � ---... _ .___-- .. ._ . ._. .. �. - �' "- -- - � " �� � , , /,a¢�does no1 a/�ply to an ownrr oJ proJ�erty a�bo bailds � '� ��.: .,. <:..:,v°. .�.�.�; ' � Fire Deporlment _. __._ __ ' ��� --� -- -- -- - -- �-- - - � or in+pro��es t!ercon,and te•bo docs sucl�¢�ork l�inuel�or --- - -- � � � . _ .- ,.,i_.-.• .;�,:� . lbrougb /iis oum r»+pinyces,pwrided t1�dt sucG im-.� Grading '., ," � .� �� , . .. .. . � •.• pmvrnrenls arc not inOcnded or offered/or mlr.;� - ' �� ' - Lou�r��er,tbc buitding nr imrrorement is solJ�ritbin o>. (�� , � �� _ • . , . , _ _ . ' ' . -- � � � �: �1 .c � . .�: � .� ' - Id ! l ." � � ._. _ . �. _ . -� .-� . year of tomplrliox, tbc uumenbur er wi!bane�t�e Geologiml�-,, . � . ��� -�� ' � - . burde�nJ proving JI at 1 e did not build or imrrnrr fnr , ._: .... -.. !. . , . " .'.__ _. . . - tl O urpose o/rafe�f�;' . . .. ' .�. Pedestrian Prorect�on .. ,., � . -. . .. - " � � � . �Fence){ConoPY) � ' . . � ,• � .. .. .. . .-._ . .. ____ ._.. ._ _ _ . .... � .. .proPerty,am ecclusively conlrao- � I,as owner o Ihe � , � ��tinq with licensed contractors lo tonsrruct fhe projeU(Set. Speciol tnspeclion�� � - � � ��- � - "- - - � � � 7044)Business and Prnfrssiont Codc;Tfic Contr¢ttor's . . . - � . :� � . - � (Conc.)(Masonry)(Welding) - � � - � , � l.irense Lau•does not a/+ply to ar+ou�ner ojprnper�p u�l�o � � � ' ' '- �� �-�- - '� � "' .. -� builJs or imfroocs�t/erenn,anJ u�bm m�tracls Jor sueb � Lol Droinoge• � ' / ' ' � . . . . pmjscts-wiJb p tonlrarinr(sJ litrnteJ'pursaant to tGe _ . _ i. ,�� • . , . . .. ".- ._. ...Contractor's Licente i.au�).---`....--��� - - . _. _ . �- ' . . �" - -..._ _ . _ - - ^9 ... .. � � _. .. �; - � ` - ". .•. � {1 '. ... . .. .❑ IamexemptunderSec. ,B.BP.C.IorIFrs Parki . . . . . � . � , .. reason - - -. _ . ., � . .. .:' �. . , - �. '. . . _. . .. _. _ '__ .._.._.. _.._. .. � � Date Owner � � - � � i . .. . ,.( �. . r, , .. I � . ... . ._. . . . ' .. : . . _. ., �APProvcli'_: Da�o � Inepectoi's Signalura� � .. .. .. , . INSPECTOR'S NOTES � � Locailon— . � '. . ' (Setback 8 Yards) �'` - .. �.' " "�� � �. Foundations`�� I � .. , �� "� .. .� �� ... . . , ---- --- - 5�ab�� �� � ° 2��[/ � . _ -.. , . . � . . . . . Frame i .. � i1� � - -' � , . . ..l.. .. '-i Energylnsulafion �U�.i1 �,/`/\, , •.�...'�'.-_'_ _ _.__ ' _-. _' .�_._. ... ._. ''� , ;..., . . . ' �. �.. � ,.. V_} . _—`� - --_..--.._.. - . _ . ..._ --- -.. _' Loth/Drywall— -�1� ,�Y-. - '- --' . � . . .,. . Interior H' ' Lath—Enlerior � .. . � � � . �- ' � -� ' ''� '---�� ' . � �V ._"_ �. � .� �� i ^., f'�I . . . ..._. _. __i..:l _.. .� . ... ' � - Nome Nvmber— r.� -.._ ...__ . . _.�_ ... . , , .,,: �:.:.. .. ... .. . �.._ . . . . Correct 8 Posted � � ' - � , '.� Fina�— ___ .._.__. __ _._ . ._ �_ . , __ . __ ._. ., .. . . , , . . . . .. _ .._... _ . _ . Enter on Front ' ... _• ' ' .. .�� . ' . �_ . �� . .-... �� . . _.. -....- . . ... . . ," .._, . ., , .. � , . . . ,_ , .,. ... . �� ,. �� r\'- !�:.. .