Loading...
HomeMy WebLinkAbout1241A 1242A (6) , , . .. .. _.._. _.... . _ _. __ .. . _. __ ___ ...._. ._. ..___ __.. .. _ _. _ ._ � WORKERS'COMPENSATION OECLARATION ' �' '�- �- � ' I he . � reby affirm ihat�I have a�certificate of consent fo self .- '.'� .. .... . . . � .__ Insure,oracertifico�eofWorkers'Compensalion��5�,a��e, APPLICATION_.FOR�BUILDING� PERMIT -� or a certified topy thereof(Sec.'3800,�1ab.C.) �' � - � ' � � � � � � -- �--- - -� ' merican Plan 2AR COUNTY OF LOS ANGELES BUILDING AND S FETY WCP62552-�1 ' Great A Po❑Iicy No. Company - BUILDING ' Certified copy is hereby(urnished. FOR APPLICANT TO FILL IN nooRe �� Certified copy is.filed with�he counry building inspeo - guRDING '�fion deportment. AD�RE55 D6�e�`1Z-Z-H6 � Appli�ant �.�TYte��1Wm. �Lyon�Co. aTr Walnut nv 91789 � i�,�iTM - ��CERTIFICATE OF EXEMPTION FROM WORKERS' ' - - � " 'NO.OF BlDGS. ' -- -' '� NEAREST-� ,-�� -- � �- --- � ' � � COMPENSATION INSURANCE �' . 52E OF t0T � NOW oN lOi 0 • CROSS ST. (This seclion need not be�tompleted if Ihe permit is for one -- �� � � � ASSESSOR.:� - � hundred dollors(5100)or less.) . _. ,, TRACT BLOCK LOT NO. ' MqP BOOK VAGE PARCEL owNeaTFIE WILLIAM LYON C0. ni�33-3600 us�zoNe tiwP _ I.certif that in Ihe erfoimante of the work(or whicFi this �- � � Y P 0. permit is issued,1 sholl not employ any penon in any manner . ADDRES ' - '�� -�"' --' �" � COND TIONS �� so as to 6ecome subjecf to the Workers'Compensation Laws. V , arv- Newport,Bcach,_CA_ 21P . 92660 � � D6te -' '� .,. APPlican� .. . , . .., ., 0 �lOTICE TO APPLICANT: If, ofter making fhis Certifitate o! ARCHiTECTO TEL. DISTRICT .. G OUP NPE_ . _ -FIRE ..PftOC SEDBY ENGINEER �-lales—Lan St.0i1 r,o. 547-0862 CONS. � ! imption,�yoo shovld become'su6ject'�to �he Workeri - W ..,mpensation provisions of�he Labar Code,yoV mVSt forih- qDDRE �- - - � - - N with�comply with suth�provisions or lhis permit shall be -- TEL. � STATISTICAL QA$Slfl�'q710N �/ APT. CONDO. ? deemed�evoked. �� �. � � �.� �,. , CONTaaCroeSame As Owner No. _��i.� . UCENSED CONiRACTORS DEQARATION� � � -� - - � � - �� - �� -tiC. - ��� � -� QASS NO. ���� DWEtI.11N1T5 I here6y affirm fhat I am licensed under provisions of Chapter 9 ADDRES$ NO. ,., (commencing wirh Section 7000)of Division 3 of the Business and - - - . . .. . ... . . . . .. LIC. _._ . SEWER MAP i . . . Pwfessions Code,ond my license is in full forte and eHect. CIiY Cw55 ' BK --" �""�-�"-- � ---�� VAl1DATION - - ,. � . SQ.FT. . NO.OF ._ . . NO.OF CHECK � � �� -' LiCenSeNUmber276HOi "Lj[.CIai5B�1� � 512 STORIES FAMILIES ONE �' � �- a , .. P . . , .. . �. : . O ..�AWAT��N �._�...r ;- _..—__.- -� _ .- -- - .. The Wm.�Lyon Co. S Z-�L-S6' . DFSCRIPTION OF WOftK NEW �Nl ContraUor Dale S ' � aoo (.L.it.J 1 2 4 1.A . I am exem r under Sec. � � � � � __ AITER � #. 2� B.BP.C.�for fhis reason ._ � REPAIR-� . .S - ..... - - � - _ ._ ' _- __ . . ._ _. . . . _.. USEOF � � I •247.23 . � �_.__._ ____ _ .. . . Date: �- � DEMOL E%ISTING BLDG. �- � - -�-- . . .- - -- - .�.._-Signoture � �� � � APPlIG4NT TEL FINAI • ���7.2 3 c=i OWNER-BUILDER DECLARAT�ON PRtNT NO. - . OATE --� -- -�--- - -- _. �I hereby affirm Ihat I am exempt{rom Ihe Contractor's license F'NA� , , . . .. .,.., j �I 2,1_9.-8 6 Law for the following�eason(Sectio�7031.5, Business and ADDRE55 •.Professions Coda): .� ._.. .. _.. . . . .. . _. .. _. . R . BY. . . . . _ -- . �� 2 Q 2 A�'-� BUILDING •. .. ,�� ,I, as owner of the property, or my employees with _ , _ nDDRESS .. - -. , �.�-� ___ _.\�• .;. •� " � wages ds iheir dole compensmion,will do tha work and � �---� � • � � � � � � - �he siructura is not intended or offered for sale(Section ��A��TY �� � ' --- 7044,Business and Professions Code). "'' MowNG �- - - �-��-� iel. � �-- . '- �'- �.-� - --� ��.,. -�- ' � b�0� �- I •42 CONTRACTOR NO. � � ' � I,os owner of the properly,am exclusively controcting ' -' � _• •(1 2 Q���-- with licensed contractors to construct�he project(Sec- ' " " " �"" � - " ��'"�"-� ' ' �"' �"� ` � ' `-i� ADDRE55 { ��' tion 7044,Buainess and Prafessions Code). - .•-� . ;� ('Z� 9-8(�' REOUIRED . fOTAI SETBACK . _.. . ... I . . . /. '' _-_. ... '_ - ' -- "CONSTRUGTION LENDING AGENCY - ' -' Ser enCK YARD HwY PROP.LWE wioiti� i ' I hereby affirm thai there is o construc�ion lending agenty for FRONT � �/: ; �,.`� �` • " � � � � ..__... �'"'_ -tha performance of the work for which Ihis permit is istued - -V.L� -' ...--_.. _ .v .�. _ -- _ _ .. .� (Sec.3097,Civ.C.). SiDE _ .. r�. f�'.�� � ' . m _ _ _ ' .. . _ ._ .._ . . . . _ . P.L. ., e .. . . ._ , . ..__... _._.._ ___ - . ___._.._. . .__ lender'sName r,,.,r;..,, r..t T71;.,,,;� n�.,4 � �1 f S SO .. IDMA Ref.N .. _ ... ._ , _ ^ V.C.Fea E 'a .a J Permk Fea , Lender'sAddress.L� �e.� I�$ Sa��e 6e-�`�.-ago 1 � " - � -.I.certify ihat I hove read fhis applimtion ond sfala thol ihe ... iss�anceFee ���f�• J�� �DMA�/C M �-- - - --- � - a above information is carrect.I agree to tomply with all Couny Inves�igaron Fea � � � _ordinances and Siate lows relating ro huildin9 consiruc�ion, . . _ - - -- � Tatol Fee - a�o•�- -� tpMq-perm.N - ��- --� -- - -'�--- - - � -� ', and he�eby aufhorize representatives of this County�o enfer u ; � upon t/he'J obove-menHoned property for inspection purposes. .. r-7 S" . .r'3 S. ' _..._ ..._. ...__ . ..- .._._._. ' _. .. .-__ . - - � //AMnt�C, l�j / FJ,6 � SEE REVERSE fOR EXPLANATORY LANGUAGE , , �O 47 I � '- SignoNre of Applican�ar Agant - ' Dare ..' ' ' -' ' . -....- ' -'" -- . . .' .-. ."'' "'"" -. ... _ ...__ '.__ _.. . .._ ."" ' "_ _"_ . .i ' PLANS TO APPUCANT INSPECTOR'S NOTES O�YNGR-I3UILDER,DECLARATION , , I here6y aftirm ihai I am exemp�from ihe Contractor's To: ' ,� RNurn�d -' ' '''''� . ' �� � �' �' � . � �License"Law�ior the,following reason: (Sec. 7031.5) � ' ' �'Approvad ��Qusinesi anJProJessions CoJe:Arsy rily oroounty wGid� No. Dole . No.' �. .���ata� �- . .. - . . . . , . .�, requires a permit to�ronstrurt,alJer,inafrooe,deniolisb, �, . . .., . „ -:o�rrpairanyilructure,priorioilsissuance,alsorequires . . .. .i�_ ., � . . . .. .. . tbe applrranl jor aucL permil to file a rign¢d statemen! . tGar be is licenscJ pursuanl to thc provisions of tGc Con= �� " � . trarror's L.imnse l.aw/CLafter 9f(tonemrnting uvtb Sec- . - � . - - ` - - tion 7000J oj Drvisinn 3 of!Gr Uusiness and Prajessiont � -) , _ •, �: .� ��r� _���;_''_ � .<,;�CoJeJortGa�lersere�ttbemfromartdtbebarrsforlGc _ _. ... _ . _ � . . .. . . -- .. _ . . _. __ . _. _ ___ ._ -. ' � ,.. Reqvirod�. '��.Data Raceived-- . . .-- �. ._-� . •' ` �-��.; . - ..,. -- - Q^rY phlicaxf J�r a pern�ie s�bjeces the applrcant M a a bi! � �Approvals Y�� ,No or Approved , . , . � .penalty ojno!more'tlan five Lvndred Jnllars(SSOOJ./:� �� "- ' �"�""� ' �-�' "� �' �"-"� �� ' ' � � ❑ I,as owner of the property,'or my employees wifh . Water Genificaie : - _� � �- � � � woges as Iheir so�e compensaiion,will do the work,ond " - - ��� � � ', �he slructure is nol imended or offered for sale(Sec.7044) HeaNh�epariment . ', . �. � .t�: � :__. . . __ ..-. _. __ .. ... ._. . �� .._ _._._r-�- � "� . ._ ,.Flasincit and Professions Code:Tbc Confrbctor's Lircnse � _ , l.aw docs nol o/�ply to an owner af f�roj�erty m1 o builds Fire Deportmenl ___. __ _ _ _ __ _ -- -� � - - - -- - - - . or rmprones tbrreon,and u�bo Joes sutG ubrk Li»ueJor - - � � . -1Grovgb lis.ou�n emflnyces, f�rovided tSaF,sucG�irx-__ Grading ! ' ' ' , provements arc not intended or offered.far.ralc.;� ' - � , ; 1 � Goa�cner,!bc baildin,q or imfronement is aofd u�rtLin r.... Geologiml -.-� -- -� .. -- - � . ,,,--� -. , . . . , . .Year oJ�rom/+leiinn, tAe owrt¢r-baifder wi!/bavc-iGe . . . ` ' .. . , , burdew oJ provrrsg lLat be JiJ nnt build or improne for ._-__--. .__ _ . .. _....._ _. r!e purpase of sale). � Pedestrion Proteclion � �-� � - � ' ' '' .._ : .', _ ....� '..'..' . . (Fence)�CanoPY) •� . . .. � .' '� ., �; '� " -... .. ' -- ' - .-- . . .' ---- ----- .. '..- .= � ❑ I,asownerof Ihe property,dm exdusivclycontrac' ling wifh licensed tororactors lo construcf the project(Sec: Special InspeUion - . - -- -' -- � - � �� ���- - - - � " . 7044)Be�sin¢ss end Pmfessions'CnJc:T/e Contruttor's (Conc.)(MasonrY)IWelding) ,, � ':' . . .�� ...� .. � . . ,. , .�;�,_, .; . . l,icenscl.atndocsnotapQlytoannwrscrnfJ�rofer{Yu�Go � . �� ������ � � -- builJs or im/�roves"(Gcrenn,and wGn rontratls for srscB _�^ • . . � �� �. _ . . . .. ._. _... ____ . . . Porking 9e � __ _ __ _ _ �rojrot u�ltl� a cnnlra�tnr(sJ-JicenseJ pursuant to tbe s o� raina ont�actnrs Lmersse I.awJ - �C I _ . . . . . .._ _ .. . _... . ._ __.. ._. � , . � . � ^ ' " �° � . , . ' �❑ I om exempi under Sec. ,8.8P.C.for this , �'� , � ` � _ . . reason . _" . _ . ., .. • _. ... � . . . . . . -� . .. Date —_. _._. .. ..Owner _.__ � � :.�;". _.._ .. .. � . . . - .':.,.. '.��...': ..r.:: i: �:.'.:.I . � . - _ , .- _ _ __ _- ' ,Approvals�� � Data Inspacrors�Signaturo� . ' - = INSPECTOR'S NOTES � Location- � -- . � . ($etbatk 8 Yords), � - - . - . . - � � Foundaiions �f . . .' , . .. � . �.. ; . . � _. . ._.. ._.__..._- � -- -- -- , . Slob � �o� �?V � _-- ---. .. ._ .._ . .. . . --- - . . ' . ' Frame _ I �` . ' - � . . . . _ . - . . � .. � �. ��, . Energylnsulafion 1.+�']a. /_Q�_ � ,� - - :.._ ..' �"- - - � -- . . .. � . . . . . y vdl vV . i - �� - � . . . � � Lath/Drywall- �r ._ ._-...__--- . . . ._ --. . Interior ---�`-� . ' �' -..� .. . � .. . la�h-Exlerior " � . _... � . . ,. . .... .. I% - ,.. . .. . . .. , . � . .. •1._ _' ' �_1 ' . .. . , � . f�-:i�. House Number- . ' __._._'_._ .. �.• . _..._. .-' �:_ _-t-. �_� . . . � , .. . - __... __._ . . Corretl 8 Posted . _ . , .. . . . � . ,. . , . .. � . �,. . ,� .,- final- __ _. ___'._.___ _ _- - . - , ___ _. . . _._.___._ . ___. ._ _..._ ... . ENer on FroN , ' , � � . .'. .� . . ' � . � , . . . � . . .. .. .. � , S. . . � . '