Loading...
HomeMy WebLinkAbout1237A 1238A (6) , ,,. . __...__ _ _.. . _.. . .. _. _ . . _ _ ._ _ _ . ... _ . . ._.. WORKERS'COM7ENSATION DECIARATION � � �' '� "'�� '� �� ' __. ` � �APPLICATION �FOR BUILDING PERMIT ����. I herehy affirm thar I have o cer�ificoie of consent fo self insure,or a certifica�e of Workers'Compensation Insuronce, . _ �� or a cerfiiied copy thereof(Sec.3800,lab.C.) '� �� - - � � �� � � ' ��� -� -- - WCP6255241 Great American Plan 3A COUNTY OF LOS ANGELES BUILDING AND 5 FETY ' PolicyNo. Compony ' BUILDING � Cenified copy is here6y fumished. ' . FOR APPLICANT TO FILL IN ADDRESS / h� _ � Certified copy is filed wi�h the county building inspec- - BUiIDING , � 1i0�departmenl: � '� � '' � ADDRE55 oare 12-2-86 qppl�car,r -The Wm. Lyon Co. a�v Walnut ziP 91789 ���iTr • �CERTIFICATE OF EXEMPTION FROM WORKERS' '� -��" NO.OF Bl�GS.- - - - µEaaeST �-� �- - - � �` ' COMPENSATION INSURANCE " �- 52E OF lOT O NOW ON LOT � CROSS ST. - , (This setlion need�not be compleled if the permit is for'one -- - --- � - - - � - �- - -- - p55E5SOe . �" � � h�ndred dollars(E��)o.less.) TRAR g�aK LOt NO. MqP BOOK E PARCEL TEL ' USE 20NE �P � . I.certify that in ihe performance of�he work for which ih�s ' owNeaTHE WILLIAPi LYON C0. �N�33-3600 p�p. — } permit is issued,I shall not employ any person in any manner � �- ---� SPECIAL �-- • - a' so os to 6emme subjecl lo the Workers'Compensation Laws. � �-� A�oaES �- - " ' - � - "� CONDITIONS �. '.O ori Aaal�co�i nrr_ Newport.. Beach, CA ziP 92660 - - ' V Date� � � � � qRCHITECT O TE�• .DISTRICT. GROUP. TYPE _ FIRE_ R SSE�BY_. CE TO APPLICANT: If, afier making this Certific`ate of ENGiNEER �lales—Lan StOlt No. 547-0862- rnrur � zor� �G ��:mption, you should bemme subject to �he�Workers' -� " �W .ompensation provisions of the la6or-Code,yoo musi forth- qDDRE ' ��- ' �- �-- � "- p y P -� TEL STATISTICAL C TION APT. CONDO.� Z wi�h mm I with such provisions or this ermit shall be �-�- � deemed revoked. r . , � �� � �., CONiRACTORS8i02 AS QW7ICY NO. �I' - -' _ - - .. . .._. __.... LICENSED CONTRACTORS DECLARATION � - ��-� �- � � - - '' '- � - � uC. - -� - � �u NO. � OwELI.UNITS • '� I hereby aHirm that I am licensed under provisions of Chapler 9 ADDRE55 NO. ��R�P . , ' (commencing with$ection 7000)af Division 3 of the Business ond __. . _. . . .__ . ..... ._ - _ iIC. �- - - --� � _ , � Professions Code,ond my license is in full force and effect. CITY C1n55 " BK.' pG. �. �VALIDATION `-• , . � .. .. .... 50.F7. NO.OF __ NO.OF CHECK � .. . . , ,. . LicenseNumber2�6S01 lic.ClassB-1 51 STORIES FAMILIES ONE . . , . . . _ _VALyJJJQN� `.:� _ . __ .. _.. .. ._ _ ,The Wm. L on Co. 12-2-86 � oesceiPrioN oF woeK - N�"' ' �l �>���� �1 2'�7 A "� Cororac�or y Date Aoo � S[�� 1..�_.v , , . . . .. � . �I am eaempf under Sec. ---� AUER � �� � � �2� 8.8P.C.�Or Ihis reason . � � , REPAIR � .S. . .-� -" - -'- -�- -.-.- . . �� USEOF � � �27�68 -_.. _ . __ .._ ._. . -Date:.. . . �. �EMOL ❑ -_ _ ' EXISTING BLDG. ' ' ' ' "� - -_....Signature. .".._._- . .. . _- ��.�.�: .._ A7%ICAN7 TEL FINAL . � • •2 7�t 6 Pi c=.� I OWNER-BUILDER DECIARATION PRINT ' N�- DATE -- - __ ' � - �- ,--i2i9-ae-- -I here6y aifirm thal I am exempt from the CoNrattor's License ADDRESS FINAI�/� :, � � � � � law for ihe following reason{Section 7031.5, Business and . - - : - - �� 2�j,�j A - ..Professions CodeJ:-. . _�.-- _ . .. ... ._ _..._' --- R N -!y Y v`-" . . . BUILDING �__I, as owner of�he property, or my employees with . noDaess - , _ . , - -. , - ; �' ' ' ' '-� � wages ds iheir sole compensation,will do the work and � � , � - � . -� . . the strucfure is nof Intended or offered for sole(Secfion ��`��TY - ' .' ' _�_ . ._.-., -- -�7044,-Business and Professions Code).--�- - " � MOviNG- -- " - " �-- - ' -7EL:- �- -� - -�. - � - � �-- � - . 4 i � No.' ' - � � 7v50= O. I,os owner of fhe properry,am extlusively conlracting _"._ COMRACTOR .. ... . . . -. . - .. . _ ._ _ .��� .. . .(Jn ,5�_C,C ' with licensed contractors to construct Ihe praject(Sec- � . �G `t3 ti0n 7044,Business ond Prafessions Code}. � ADORESS ` �, � ,',� �_ -- CONSTRUCTION�ENDINGAGENCY SE�BACK YARD' HwY - ���Apg�Tp�jNE WIDTH. � , . � ' I here6y affirm�ha��here is o construction�ending ogency for pkONi _ , _'_ . __ ihe performonce of the work for which this permit is issued �-- � V.l�. -- - � - � " -- - --�' --� " -�'� - � ' � (Set.3097.Civ.C.). SiDE ' . • . �'' � � � -- '. m _... . _. . . _. a.i. � .. . .. _ . ' \'" ._.� '_ ._ ..- - .. � Lender'sName �'n r; nr�1 T11; n�.,4 �� \ c� IDMA Ref.N � ' n�'. .. nn;c_ .. _ P.C.FeeE-v� �o GermlrFee�� J. ,._- _.... .- . . - . �, - lender's Address�'t� c,. r., c..n,. c« ��.�ago � � � -I cerlify that I have read this applimtion and state.that 1he ... _ - luuonce fee O SD ���P/�K � '" " �, � � � above information is corrett.I agree to comply with all County Invesriga��ion Fee g _ordinanCes and Sfate laws reloting to building consfrucfion, _.._ . . .- � �To�ol fee �� 7S S'� IDMA 7erm.N � �- -� -'---"'-""- �' -��- '� �' u and hereby authorize representatives of this Coony to eMer � � upon the obove-mentioned proPerly for inspecfion purposes. . . �-7 g" . .. . . 1'3Sr�a . - ' - ' - -.. . . . � ,a /� '_ �J"/'��I _' " _ -.._ . _.. .'" _."_' "" a ( 'M.1J C .!//� �I�1� I _ SEE REYERSE fOR EXPUNATORY UNGUAGE � �'_... . . . . . �� " ' 'Signature of Applicont or Agent _ . -' _ Da�e' ' '"- . . _�._. . _-. . .. . ..__. . � .. -.. . ... _ ._ " '.-... _'__ . _ ._. 1 PLANS TO APPLICANT INSPECTOR'S NOTES .. 015'NFiR•IIUILDFiR OGCLARATION - 1 hereby�offirm thai 1 am ezempt from�the Controdor's To: . � � � ' Rotvmod � � � � . � ��License Law�for fhe��following'reason: (Set. 703I.5) ''' - Approved -� QrerinestandProfessionsCodc:AnyriryorcounJywGicb No. Dafo No.�� " t� �Dale- �� � � �.�� � � �• � .� - i�., regwires a permi!fo tonsbucl,al�cr,impros•e,demolisl, . _":orrepaircnystructurr,priar to i1s issuancc,ako requimr . . � , � . • � ' . . � .. tbc apQfirant fnr sucJ�permit to Jile a si,Qned stafemrnt , lGat Ge is licensedpersvunt ro tl eQrovisions of!Ge Con- - . . �-,, . � - � lraclor's Litense Lau�(C�apter 9J(commenting wi1G Ser-� - - linn 7000J of Dieisinn 3 of!he Dusiness aad Pr%srions � �" � � , � � � � . _'����' � � ••"���CodeJ or tLat Gr'u exemJ�t tbereJrom and the basis far 1Le � � '_.��, � _ i: : �.. ..• ' ; � : .. - -�- - - - � -- - - � --_.-- -� .. . . _ � - o!leged exemption.Ars,y vialatron ojSection 7031.5 by , : : � :�'. - . .._ ._'; '.: Raquirad ..'.DafaRewfved -- -�'' .`. . •'� ��� _ .. . -- . - an,Yap/�litantfnrayrrnri[aubjectstheapplitanttoacivil !)': Approvals � ym No or Approved . . - , ,, . „ ,., -�Qrnalty of nat more lban Jive 1 undred dolJprs(lSODJ./: �.• . .-- .-... .-� - -.•. '.. � � -. -: .�--�. - � ❑ I,as awner of the property,or my empioyees wilh Woter Certificate,� � ' - .. ... . wages as thei�sole compensa�ion,will do the work,and , .• . .-. .. . . . � . . .. ,� �- � - -- - � � � - - � � � ��he structure is no�iniended or offered for sale(Sec.7044) Healih Deportment'_� • - � � � .i � -- ----�- -- � � � �--� ��----� -�-�-�. . . : .. .� Dusiness and Professions Code:Tbe Contracror's Lrcense _. _. _. � - �, I.au�does nnt appfy to ars owner of Properly eul�o buifds -� .. , � ,, . .. ��� Fire Departmenl _ . ._ _ � . . . _ _ � -- � -- � -� �- -- - -�- - � nr imJ,rot�es tLer¢on,and wl o does furb urork bimself or ' - '� tGrough uis ouro eraployees,.proi�ided tbat ruoh im� . Grading •.� "'. '•.�� �� .��".� .�-,," .. � _.�\ �� ,-�rnnemenls are not inlended or ojfered/or sale..,� �. '-' � � ., -`\1 � '.� n«•ever,tbe burldingorimf�rovemenl issold«titbin an - _ _ ._.__ .__ _ _... ., .. . � , ,.� .• .i .•.-.'i, . , � _ . . Geological i - , , . . � . 'year of rompletioa, the ouner builder wil!bave 1Ge � � � � � �� � � burden oJpmving tGat bc diJ not build or improncJor Pedeslrian Pro � � ��... .... � .� �..� '�'� I:. _�. lec�ion . � � . � 1Gc purpose of ralc% � - (Fence)(CanoPY) � � ..� ' ., - �---� -----. . ...-. _. .--� --��.-.-. ..-. ' ring❑with Ike sedreofnt a corslotcons roctCthe projeU(Sec. Speciol Inspeclion�`" � � ' �� � � �� -- -- � � - - � - - 70d4)13usiness and Professions:CoJe:TGe Controttar'a ���� - � „ l.icense Laeo doet nnt a 1 to an otuner n ro cr{ a�hn (Conc.)(MasonrY)(Weldin9) � -_- . ----_.-.- . . � �;: . . hh y Ip P v . � - � 6urfJs�ur'impruresUcrcon,-anJulnoontruclsfortuc! � Lot Drainage j . , �.• ' ' , , ' ' . _, .. __ .._ _. .__ ._.._ �.._'. ._.. -' .. Ca�neractnr's l.ir�ns�iauj•f�) �c - .. --.- _ �. !'rnsrd p��rsuant 10 tGr N va�k��y . . � ;, . � _ ..., . _ _ . _ -- � , ^ . l ❑ I am exempf under Sec. ,B.BP.0 for�thii . ,.. . � . _. . i . . .•.. ._ - . , ' ., . _. I � � reoson..._ ._ . _ ._. . _ . � _- . -- ... - -- - - - - "- --. . . - . � ,. Date _����Owner....-�_ Approvals � Date �Inapector i Signature����� , . _ . . - INSPECTOR'S NOTES-�' ' Locotion- ' � � � � � (Setback 8 Yards) ; -. . ... � ._ ." � .. .. � ''-`'.. � Foundafions- ��.,r �1 � . � � ��� . � . �� , . .... � .. ., Slob- Frame ..C�d �. . . . - _ , . . " . . - . .. . . . . . . , Energy Insulation .. - .. �.. .� . . � .... . . � ... . .... � . . . ._.__ _._ .___. . _. ' '_ . , i .. , �� . � � lath/Drywall- / �,.� ,. ------._.._---- ---- --�--�� - i � ._.. . , .____. . ._ __ ._ __ ___ - , Inleriar l ���— �- -'-- � ' . Lalh-Exterior .. . � . . . .. � . . . . . . � " . ... . ..�.I � .. ... ..�..... ,.__ � . House Number- . _.___.: _c . '__._. ._... .. � .� .�_..,.:� . . .. , .. • .. ��, Correc�8 Posted ` � : �� . •. -., , . � - . .. . .. , . Final- __._..._.. . ..... . __ _"_' ' " . . . � _ _ _ .__ _.. _ _____...__._ _. Enter an Front ' . - . . , . . ... •�. . . . '1'. . I , ' - , . , ' , . . . .