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HomeMy WebLinkAbout1209A 1210A i _ , „ _ . _. .. _ . _. . . . _.. . . _. . ._ _-_ , .; _ . _., _ _ __ _ -- . WORKERS'COMPENSATION DECLARATION ��� �' . � .. ._... . ... .. . . . . _ . �� ... insurebor�afcertifca'teofWorken'1Compensa�lonlnsurancef APPLICA7'lO.N���FOR BUIL�DING PERMIT - -��,�� . - - _ _ _ or a cenified'copy thereof(Sec.3800,lab.C.) ' COUNTY OF LOS ANGElES j BUILDING AND S FETY WCP6255241 "Grcat Amcrican Plan 1CR P�o�licy No.� Company - -- -� . _.- .. Certified copy is hereby fum�zhed.. � . FOR APPLICANT TO FILL IN eu��oiNG AD�RESS Q .Certified copy is filed wilh fhe couNy building�lnspec- - gUItDING � �tion(jepartment. � ADDRE55 oa�e ' 12-2-86 APPI;�a„� The Wm..Lyon Co. �iTv Walnut ziP 91789 ��,tin. ` � �' ICATE OF EXEMPTION FROM WORKERS' ��-� " -��- - � NO.oF 8ioG5. � -� -�- �. N¢a.ae5i- ' . ,, SIZE OF lOT 3 HOO SF MiTI.NOW ON l0T O ' CROSS ST. . CERTIF ' � �� ����COMPENSATION INSURANCE '"- � (This seclian need not be completed if the permit�is for one --- - - � ASSESSOR " -- - ._ . __ _ _ ._ _. _.... _.. _. _ _ � hundred dollars(b��)ar less.) _, . , ., , . TRACf BLOGK LOT NO. L1q0 BOOK AGE PARCEL ' owNea THE WILLIAM LYON C0: No833-3600 use zoNe rtiaP _ I certify that in the performance of ihe work for which this N�� - �a permit is issued,I Eholl nof employ any person in any manner __,_, , _ . _ _: -- SPECIAI � - so as to become iubject to�the Workers'Compensation lows. ADDRE55 �- - "� "� CONDITIONS . � �V , � . ciTv Newport Beache CA _ziv 92660 _ . _ _� i O Oate� .. APPlicant � ��""�. . .. ._ - . ,/�OTICE TO APPLICANT: If,�affer makin this Certi(icate of _ ARCHITECT O � TEI. DISTRICT . G UP TYPE. ._ �_fIRE . PRO �BY s ENciNEER �iales-Lan ston No. 547-0862 � ao G j �mption, �you should 6ecome subject m��tha Workeri � 2 .ampensation provislons of tha Labor Code,yoo most forth- qDDaE557�] --e/-- -- � � - -- -- W • 'a wlth comply with..such�provisiona or this permlt shall ho --- � � TEL. . STA71511CALC I ION AP7. CONDO. � deemed revoked. , �� ' � . . . '� COMRACTOR SHfI12 E�5 OWi12T � NO. . . LICENSED CONTRACTORS DECLARATION ��..��� �- - -�------ �- -- -�-- - � �LiC. � �� �- -� CtASS NO. DWELL 11NIT5 � I hereby offirm that I am licansed under provisians of Chapter 9 ADDRE55 NO. (mmmencing with Settion 7000)of Divisian 3 af Iha Business and .. ._____ -.���, . . � ��R�P ��� � - " �� _ . . . _ ..._...._' _. . . . Professions Code,and my license is in fu0 farce and�effed. aiv . Cw55 '�� �BK---� � ---��� �- � --�----- VALIDATION ����• ..... � . . ,.. .., ...._ $p.FT. . _ NO.OF__ ,_. NO.OF. CHECK ' . . • LicenseNumber'Z�6S01 � �i[.ClossB_1� SIZ - STORIES FAMIUES ONE � �'''���� � ' . . The Wm. LY071 CO ' S�L-Z�HG " ` ' ' DESCRIPf10NOFWORK - vA UAj-ION �7'1 _ CoMractor �o�e yEp � StQ(.(J �(�C_J r 1 2 0.9 A � �I am ezempt under Sec. � --�� � � � � , � � " .. ' ' "._ ' . _ ' ' ' � J ALTER . . #• • • •`�� � _ C 6.6P.C.for this reason a ' �� REGAIR � -S- . . ........-'�.. . .- -.. - - . . _. ._ . . ___. .. _. . ........... ...._... Dote:�� USE OF � DEMOI I : . J •2 2�H� EXISTING BLDG. '--. ...- . _ . . .. _.. _S9oow�e _ _: - nPcucnNT iEl. FINAL • •2 2 5 8 1? ' OWNER-BUILDER DECLARATION PRINT ' ' NO. _ ' DATF - , _ .. . _ . ._ ._. .. . . _. .. .. _ . . _.._. .. . -I hereby af(irm ihat I am exempt from ihe Contractor 6 License � ' � 2,� 9-.Qi� • . ldw for Ihe following reason(Section 7031.5,Business and ADDRESS FINAL' ^� � � ..Professions Code): .. . . .. ._. .. _..... _ _ .. By . V '1. . . "-'n� 2�.�A -, BURDING .,.� � I, as owner of Ihe property, or my employees wilh ADDRE55 � _�_ _ � � �� � � ' . ., wages as iheir sole mmpensation,will do tha work dnd � ' �` ' �� . �'�. � , . � � ihe structore is nm intended or otfered for sale(Setlion ����tY � '- � �� � � .. . 70d4,Bosiness and Professions Code) . . ".."- .... -�- -�� MOviNG ' -�--- �-- ---......._....". . -' 7E1. .. ..- ' . .. .- -- ..' . . .- .. . -� •7J 9 Q Q� �-��: � I,as owner of the property,om exclwively cantrocfing coMenCiOR NO. - �, , � • � - ; - � with�licensed conuactors to consiroct the projett(Sec- "� "` qooee55 � ' "O� ` •a9a; tion 7044,Business and Pro(essions Code). � . '���, . - � . --� --CONSTRUCTION LENDING�AGENCV �� �' �� ��"� �� -��sEQ�e�a.Rc�� �ARD �Hvn TOTApRO�iiniE wioiH �� � - � ��� �21 9 8� I hereby affirm Iha�there is a constroction lending agency for FRONT � r �)' � � � ' - � � � . ._'-�.,_ , . ..% . -Ihe performance�of ihe work�for which Ihis permit is iesued - -P1: -- . ... . . .. ..... . .. . . . ._ .. . . . . .--. -.. . .. . r..._. ..-... (Sec.3097,Civ.C.). SIDE �. ;�� �'I �J� � � g __'__ 7.L ' . __._ .• .. , . .�. ` ..._ .. _... . _ . . . ... _. . _ '_' . .__._._._. . _ .. _ __. � Lender'sName � r;,,n„r�l Tll;.,n;c Ra„k . _ / _ ___ $ _.._ .. . __.. _. .. _. _ _. . _ _ .. . ._ ' P.C.FeeE_.7..�1s.�l�' Perm�Fee 3 rs� - IDMARef.A �� _ .... .. . ._ . = Lender'sAddress.��.} c.. .., c..ii,. c�����ago � � � ' � -I certify that I have read thi:application and sfate fhat the _ .__... . _ . _ . ._ .-_..�,,,,ance Fe� �-��0•Jr� --: �hw v/C M �- -- �- - ,- � - � �� � a above Informafion i:correct.I agree to comply wilh all County Investiga�ion Fee ' . . . ' � ..ordinances and Stale laws relating to building construclion, ._. .. _ _ . . . _. .. -._. 7mal Pee�- �- � . - --� u and hereby au�ho�ize reprasemotives of this Coumy�o enrer � ������ - ��onu Perm.X - -- --� �- - �- --� � upon the o6ove-mentioned roperfy for inapection purpases. � ;. - „ ._ ./"� . _ �. _ ._ .. ._����� .__ . .__...__. ._ . . .._ _. _ . _ _._ . .. . _ _ _ . . . _ a L�L� ���� /J/S/}(� YLANGUAGE . . . .. . ---__ _ ^ y_ _r__.�.._ . , . ._ Signalure of ApplicoM or Agen1 - �`.�ate . ... . ... .... . . __ ... . .. . , .._ .. . . ..__.. ._. . . _ . . .�I .. _ ._. ._.. ._ . _.__. .__'.__. _.. __.� SEE ERSE O XPLANATOR � PLANS TO APPIICANT INSPECTOR'S NOTES 01VNrR-EIUILDGR DBCLARATION ' , I he eby affirm�thot 1 am exempt from the CoNracror's To: � � � RNurn�d � � ' , � ' - � ' -License'law�'for the'(ollowing reason.- (Sec.'7031.5) --- � "' � ' ' �Approvvd � Du'sinessanilPro�essionsCode:Anycityor�ounty,wbrch No. Dofe ��• No. ��. Data�' � �� �� =�� �'��� �� ' �' �'�•�. :.�: ��,�� �. �� �,�reguires a permit to oonrtruct,alter,inrprove,demolitb, . .. . . . 7rcp6irany tructure,priortoiti;.ss'uance,alru'requires ' . . ,. � . , � ,. . , ..- the applirant for surb permi!Io filc a algned statement that Ge rs lrcensed pursuant to tbepmnhions of tbe Cdn- i . i , , '• -� ,.� - „',� ,.� �� � tractor's License Lau�/CGa�ter 9//tonimrncin�mitb Sec- . .... . �,�.::� � ... ., ' -�- '"�" "'""� " �'" "`-"'"- �`` �� -" -� lion 7000f o�Drcisinn j o 1Ge�utiness and rofessions `"-"' ' � '; `�. .� .-.� '�'�.�\ ', _ . _ _ _ _ _____ �ci:.�.. . ."_?CnCeJnrlhatLcis�exem/�ttbrrefromandthebnsuf r1Ge � . _. �: . . = . �� ... . . '___ . _ . _ ._ .. -" � '- ���- ' - - - a!leged exem/�frnn.Any uinlation nf Section 7031.5 by �� . RequGod' -, ...DoroRoe�ivad -; ._ -.��...-.� '��-. �,-•"�� :`� �..,; �,�,' e . . anyap/�licantjorapermitaubjeetrtbeapflicantMaeie�i! � � Avorovali�-'-' Yas Na or Approwd � , �� penalty of not mare tban fine Landred dollars(SSOOJ.J:� .. � '.� .._..._ . :.!_- ::�..:Ci:`-�'�_-- � - '��.��,... � � � ----, ❑ I,os owner of the propery,or my employees with . Wo�er Certificote--� - ' , � � - � wages as their sole compensa�ion,wiil do Ihe work,and . - �� � � � � �� �- � � � � - ��� - � �Ihe structure is not intended or ofFered for sale(Set.7044J , .. Health Depanment_ _... . .�. ' .' ' . _ _� --�---— - - � -- - '� '' -- �' ' � � '-'-� '� - . . Eusiness and Prnfessrnns Code:Tbe Confraotois�License � � . �. I.au�dnes not ufp(y!n nn owner of yroperty wGn builJs ' . . ..,, ... . :..- , , � • �. .I- �:r .• Fiie Deparlment _,�,._ , . . ._ .-.-_- --�-�- - �- ---� -� � - - -- � -- or imf>o��es lGereon,ond u�bo does sucb u�ork Gimseff or , , �,: • , , �„; � ' . -lbmugG hu ou�n-empJoyces, rrovrded tbut iuc!�im-. Grodfng � � i'"a pmvements arc nof intcrtded or offered for tale.,. �� - - - _. , . ��� , boura�er,tbc building or imf�rot�crnen t it sold u�ilGin n.. � Geological -� .�.� � �. � , �. ycar f ronrpJetion, IGe ownenbailJcr ui!!baur tGe � � ��� ��� ��� �� 6urJcn Jpmving d�a!bc did no!build or inrJr�ioreJor , � . , , . __- ___ . . . . _ _-_._.__. _� - _ - Pedestrian Profection �-- . ' . . tGe parposc o/saleJ• ' ' .- . ; (Fence)(CanoPY} . .. .� ., � . .. . . ..... . - . . . .._.._.__._. ..... _.._.._. ....'. -. �❑ 'I,as owner of the property,brrm.eKdusively conirac- ' iing wi�h licensed contrac�ors to�consirud the project(Sec: ..,�.. - .� .. ._ _ '. :_C. .._. _. . ._. . . . . , � ., Special Inspection- . �, 7044)6usiness anJ ProJessions Code:Tl�e Conlractors �� (Canc.)(Mosonry)(Welding) � � � � _ . � �._� .� �- ; L crnsr Lau�does no[opply tnan ou�nrr ofpro(rer{y u�1 n � - - - � � - builds-or im�+roi•es tGcrcon,-and u�Gn tontracls for such _ Lo�Drainoge " � � � '' , - , _ _.. hrojects:u�itG a mntracto�(sJ licrnsed parsuant!o tbe � . . , , _ , �,� .. . f_.__.. _. . _ . . . - Cnntractor's Lirensc Lau'l.._... . � __._.._.._ � ' -� Parking . � .. .� ;:, "�. `. - � . .. . .;.. _. . :.' - ,... .-- :.. � , - � I am exempi onder Sec.�. .. � ,B.BP.C.for this _ _ ❑ .i . . .. . - . .. _ . _ . . . , . _ . . . _. . .---. _ -- '� - � � -�. � .�„ � �, I � reoson �.�. ; . . ; ,. ,. _ . . ._. .'_ ' ' '._ __ .. ."""' . � '- I .. : , . ' , Date ..Owner . . '�• -• . , ... .. .. .� . ..r i � .r.� _...._ ___ _. . .___ _ -t.' . ' � . �. " . ._ . .... � .. . . . .. . . _:.:�i. . .. . .._'. , . . �Approvals�� � Oate � InspoctorsSfgnatora. � . � INSPECTOR'S NOTES .� . , - Location- � � . -. . (Set6atk 8 Yards) - - ��"` T , . - Foundations ' � � . .. . .. . , . . , Slab � � '� � . Frame , f _. � � ' . . . . . . .. . . . � . .. . � _ • ..�, Energy Insulaiion �'Z "�� � . . ;- - .- '__ .._-- __-_�... .._ . ,.. _ . . . . . ..:. ... . � ' i Lath/Drywall- �s -_. � .-' .._..-- � - '-�... ... .... .. . ' , ,- � . . Interior �(D� ._e^�--��.. . ' . . . .. . _ Lmh-Exterior ' .' -. .� " �. ' .. ,. ' . � .. . � . ...:" . .�. � .. . . .. � . . �.�i r � . .. ..� _ .. House Number- . .._. ._ . :._,-_. . . � .• .-- �. .. _. . , .. . _._ _._ - _._ . , � . . Gorrecf 8 Posted '� ' - �••�. : .. ... ....� . � . . . . _ ,•,.-. , . _ Final- ._.____. . __..... ' '.._ ._. .. .. ___ .. . . , _ . ... . . _ _'___ ...._ _". ._ _ _ . ' . Enler on Front . '• � � . . � . �� . . ... . . . . .. . .,� ., . .. .. . . . ,r��._ .. . . _ �.