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HomeMy WebLinkAbout1229A 1230A (6) . -.- -., . . .,_.. _..... . � ... __ _ _- - -. . _ .. . . . . -- - WORKERS'GOMPENSATION DECIARATION ��� � � � � ' �� '� : ' � I�hereby affirm Ihal I have o��e«,f��a,e of�o�5e�„a se�f �� ��- �� �- APPLICATION �FOR� �BUILDING PERMIT � ���� insure,or a certificale of Workers'Compensation Insurance, . . .." _._. _ .. _ ' - .• . . _ -: or a'certifed copy thereof(Sec.3800,tab.C.) COUNTY OF LOS ANGELES � BUILDING AND S FETY WCP6255241 Great American Plan 2C Policy No.. .. Company . . � - , - a� Ce.tified copy is hereby furnished. FOR APPLICANT TO FILL IN aui�owG ADDRE 1 �' Certified copy is filed wiih the couny building inspe�• -- BUitDiN� � � ; tion deparlmenf.� ' ADDRE55 Dote 12-2-86 -.qPP�;�o„�., The�Wm. Lyon Co. arv Walnut ziP 91789 iocnun � •- � '•� ���� � � -- - NO.OF 6LDG5. NEARE57 . CERTIFICATE OF EXEMPTION FROM WORKERS' SRE OF lOT NOW ON�07 � CRO55 ST. '� � - 'COMPENSATION INSURANCE � � ' (This setlion need not be completed if the�permit�is for one - -� -- � - � -- � - - - ' AUEUOR , .- --� - � hundred dollors($100)or,less.) � , TRAQ BLOCK lOT NO. INqp gppK � VAGE PARCEL TEL USE ZONE I certify that in the perf6rmance of the work for which ihis owNea THE-W I.I. " 'N - p�p, �� � ;�, permit Is issued,I ihall not employ any person in ony manner .__. ADDRESS � - ' - - � � --' CONDITIONS � � '� so�asYo 6ecome su6ject to the Worker3 Compensation Lows. V oa�e 'nPPu�a�r ' ciTr_ Newport_Beach, CA ziP 92660 O J'vDiICE TO APPLICANT: If, oiter�making thi5 Certifimfe of ENG NIEER � TE�' DISTRICf . GROUP TYPE . -FIRE _. GR ED 8Y . .;F �lales-Lan ston No. 4 - � cor�s. o e c� � imption,'you should bemme su6ject to fhe Workers' - W �mpensofion prOvisions of Ihe�a6or Code,you musf forfh- A�DRES - — - with comply�with such provisions ar ihis�permit sholl be �-- 7EL. S7ATIS7ICALQA ION APT. CONDO. .Z deemed�evoked., _ � �. .��. � CONTRaCTORSame AS Owner No. - ._ . �. . - - -. .. .. LICENSED CONTRACTORS DECLARATION . -- � - � - - - -� -�--- -� � � ii�, � �- - � CLn55 NO. DWELL.UNITS� � I hereby affirm thar I am licensed under provisions of Chapter 9 aDDRESS NO. , � (tommencing with$ection 7000)of Division 3 oi the Busineu and . . __ ... .���, _._ ��R�P � � ' � � .. . . . _. _ . _ . Professions Code,and my license is in full force and eHeU. Ciiv C�a55 BK- �" �: - � �� -VALIDATION � Contracormb�er2�6HO1 ',`DaelasSB-1 - SQ.FT. , NO.OF , , N0.9F _,,_, CHECK �- . ' ' ' $I STORIES FAMILIE$ ONE � ." . � VALVATION ' The Wm. Lyon CO. 12-Z-S6-•, " ' DESCRIMION OF WORK "' '"" NEW s �� �- �� 2 2 9 A ❑ , ADD ,_ 1 am ezempt under Set. u• • • •2� �. ALTER 8.8P.C.for this reasan REPAIR S .. . . - . . . .- - - ���2�1 7.2 J � .-. ._ __._ ..__ _ . _ ._ . . Date: ' '. USEOF DEMOI � � �. E%ISTING BLDG. --- •2 4 7,2 0� �� -� � SignOture '. . .. � � APMICANT TEL FINAL � OWNER-BUILDER DECIARATION PRIM r• NO. --.pATE�j .. _.._._.. � 2 1 9.-8 6 . . -I hereby affirm Ihal I am exempt Trom ihe CoNrpctor s liCense qDDRESS � FINA � � - 'R� 2��0 A taw for the following reason(Seclion 7031.5,Business and .'Professions Code):.. . . . �_.. ..... . .- .. � BUuoinlc By � . � . � � -:. �.• • � . � I, as owner of Ihe property, or my employees with ADDRESS _ . . . ...�� ._. _ •' • .. wages as Iheir sole compensation,will do the work and � -. � � •[G'Z�Q O the sirocture is not intended or offered for sale(Section ��`°TM ' ' � 704d,Business and Professions Code). - � MOVING - � ' � ' '� - � TEL. - �� ' - -- - . ; • • O� � I,as owner of�he property,am ezclusiv¢ly[ON�atfing �TRACTOR NO. -- �� � � '- : 4 2�O . �with litensed tontractors to construcf the projetf(Sec- pDDRE55 � � � �2�� 9-8 6 � �ion 7044,Bosiness and Professions Code). � �"` -� ' � � ''� - ' . . ,. . REOl11RED iOTAI SETBACK . - - �� -'�.�� -� ��- - -- ��� � ---�� �-CONSiRUCTION GENDING AGENCY � '� �- � SET gqCK YARO HWY PROP.LWE W�DTH I hereby aifirm that there is a constroction lending agency for pRONi -.- - -_ '� � � ' ' -Ihe performante of Ihe work for whith this permif Is issued - � 7.L — - --- �- �� � -' �--` - � -- , (Sec.3097,Civ.C.). SiDE __ , ' � � . , :. m _.... . . . .... . ... . . .. ... _..... _.._._ P.L. � _ � , ' '. . � Lender'sName rnnYinnnr�l 711i.,nic R�„L � �^ ^ �-��Jri�SO- IDMA Ref.p � � .... - .- .. . .. . - - " "' ' P.0 Fee E � � .[ ' ' Permit Fea ' ' ...... .. � -'-'-' '. - tender'snddress?�� ga, �,� Ss��e SE.� 6}rizago � .1 certify fhat 1 have read Ihis applicalion and stale that ihe _ . . . .._ . _. _. . . Ismance Fee- �• � - LDNW,P/C M�------- . - . .�.-� � �.. � obova informafion is torrett.I agree lo tomply with all County Investiga�ion fae , g _ordinances and State lawz relaling 1a building consiruction, .__. . . . .-. -_ . . ._ Totol Pee--- 4i•�a LDMA Perm.M �-� �- "' u and hereby authonze represemofives of this Coun�y to enter . � upon the above-mentioned property for inspection purpoaes. _ �i.7'S.pD_ . . . _ �.35.D� ' - � . ._� _ ._ _ .. _.. a . ^ �^�Q�����o /� SEE REYERSE FOR E%�UNATORV LANGUAGE ' O .. Signarore of Appikonr or Ageni . . ..Daie . . -. . . . _.. . . . ._. . ._ . . .. .� . ._ � .�.i PLANS TO APPLICANT INSPECTOR'S NOTES ,.OR'NEiR•�UILDER UECLARATION . , I hereby pffirm thot I am exempt fwm-Ihe Contracfor's To: Rdurnod � ' " � � � - � License Law'for� the�,following reasan:�(Sec. 7031.5) �� ' ' � ' '- � � "Approved � �Uusiness�and Professions Code:�1ny rity ortoenfy tuhicb No. Dcte '' No. � Dat�`. ..!�� � '. _ . . ' ,.. .. . .. .. reguires a permrt tn rnnstruat.after.rmprooe,demolish. . . " orreforrarsystrurturc,J�riortoi0sissuarscr,alcorequires I ' . - � . .. . • . ,. . .. . , . .� " . � tbe apf�lican!fnr sach fenni!to file a signeJ atatement . lbal bc is litensed pursuanf to tbe�ronirions njtbe Cort- � • , . - . �� traoloh I.itcrtsc Lau•(Cbapfcr 9J(comnirncing u•it!Sen � .. � � . _, ... � , �,� ��� -,. _. _:. , , . i ._ '- - -- tion 70001 oj Diorsion 3 oj tbc Busrrsess and Professions � . , -_�' . : '. ;. �' i.. . �.r . "" � '. - r�;':�. , . •.��� CoJeJort1a11�eisesemp[lLerefromandtJebasisJorlfie . . . � ._ . _ __. .. . _ - ' _.._ ... --. . _ . . - . . --... . - . -. .. - .-a(leged exernptinn.Asy vrolalion of Section 7031.5 by __ � � Raquirod 'Da}eRaeaiwd -.-. _ . . ._. � _ .. . . _ ... _. . . '. . an.YapplicantJoraprrnritrubjedstGeappliranttoacivi( . � Approvcls Yos No or Approvod . . , , � pe^°!ty oJ nnt more lGars five J�undred dollars(SSOOJ•/:. ' ._._._'..... �. :_ �' . _..__:..._. ' . . � �� `- �- � ❑ I,as owner of Ihe property,or my employees with . Water Cerlificate " !�� ' " � �� _. � , . . woges as iheir sole compensalion,will do the work,ond . � _ �.� :� ,. � .,�_.,.'• . . , . '-- -�"--"' '"�` ` �-� - ' � � ihe slructure is nol intended or offered for sale($ec:7044) ;' Health Deparlment __, _ . "� .% , � _�_. . _ .. �� � � - - -- �- •� �� --'- .- -���-.� -� � - - - .,,Business ond Prnfessinns Codc:T1 c Cnntrattor's Litense . Lau�docs not off�ly to an owner of property a�Go builds � , ..., -, ....,,. .. . Fire Departmen� .,_. _ _ _ � _. �_ ' -� -- --�-�- � -- - ---�-� - -- or i»�Jirot�es tGcreon,and u�Go does autL work himse f or . . . � 1Grovg6 bis-ouar emplopeet,proi�iJed,tbat sucfi i�n.- � Groding � � � ` � . ���. � -prnrrnrrnts are nol intended or offered fnr sale.. - � ` � '�•� � - � . . . , - � Gou•ener,tbe building or inr/�ronement issoid u•ifGin m. - - �-- - � -- � - - ' ��.�'' � yea>of mmJ�(etion. tl�e neuner•builJer wi!l.5ave�tGe Gealogical.- . � , . .. � . ��� � . - . burden of/�roving tlat Ge did not bvrld os im(�roreJnr v[. ' . __. . . . __ .___._-. .. Pedeslrian Proteclion . � . " fGc/+urQose of salrJ.. : . . , (Fence)(CanoPY) '� . � � . .__._. ._ _ _ _ . .... .... .__ .. _ . . _ �' ',�'-❑ I,as owner of Ihe properry,am'exclusively tonliar ting wilh licensed mnlrocrors lo construcf Ihe project(Sec. Special Inspection"- � � � l -� - '�'" ' � and�Pro eis'on.r�Code•T onlr tor's , . - � 7044)Uwiness r bc C ac . _ _ .. . .. .. ._ , . . � (Conc.)(MasonrY)(Welding) '� � � - . . � _ \� ,.i. Lirense�Lau�doet not afply to aii ownerofproperly u�Gn � - • --builJt or im/�rores t!ercox,and ubo contratOs for surb Lot Drainage. I . �, - :� - ':. .' ' : ..__ _ , /�rojects:'v�r1L a tnntructdr(sf.lirensed�pursuant tn 1Ge , _____. __' ._ _. _._. . . . . . . . ..^,-� 4 --�-Contraotor'r Licensc LauJ.�- -.... ------ �.._. Parking � . » . � . � �� ... . . .. . . - - - . . . . . . �� � �i _ � - �� � ; _�, � , ❑ �om exempt under Sec. ,8.8P.C.(or�fhis � . ,., .. , reason __ - . _ _ i �, � . ��. . . _.__.. _ . .._ .__. ._.. .___......._._ ._'_ Date Owner .. .. . , � i . .. . 'Approvals , Dote Inipeclor's SSgnaWra . �� � . . . ... .. . ' � .-�� INSPEROR'S NOTES ' � ��-� �� loca�ioq— , � � . • (Setback 8 Yords) ` f� � . - �. .. . .. .�. ; .. Foundations :: -. ._ . .___. -__-_.____.. .__. .__.__:_ � , ,� ,. .. ., �. ., SIa6 � " �,•�/. �/��- . .. ---- - , . ., . .. . _vrE� - . i ,�, i q i„ ���. .. . . . . . • .�. ... Frome �a1 . . _ . . .. . � . . . . � Energylnsulalion M1 f�� : . . . - __ _- -_ ,, __._. . . .. . . . .,,.. , . . , , . � �i Lath/Drywoll— �n�,G� ��� � --- � '---�------_ � ' .. . ' . . Interior W�.rCJI � .. ._ ' , . ._'.. . -;-- - - -- -� � Lath—Exterior , � " . . _ . _.. . . . . .. ... .. . . . . .. .1:... _.' . .._ . . , ' - � -.-� ^.���. . , .. r�.. ,_�.�. . ._ . ' ' _._ `_� _ .. �.. . House Nvmber— . ' �-- . - . .. __ _..._ . ._ . �, . . . Correct 8 Posted ' . � - �-. �"-. � -, . ,... . . Final— . .. __. ._. . -_•. ..� . . . � � . � . .._ . _ ._ - . ___.. -___. _ _ . _ Enter on Front � � � � � �� �� � �� � .. . .. � ... � � - , . . , . . ..' � . ;��