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HomeMy WebLinkAbout1235A 1236A (6) .. . .._...._... _.__... ... . ..�...�..�� _. . ..... ..... ..�..... .__ . . .. _ ..r .. .". _. '."__ WORKERS'COMPENSATION DECIARATION . � " � ",,' . � ' �' "�`'•�'`- '. � . . . . _ .. . ...._._.._._ . ..�. . , . . � insureborafcertif�a'teofWakers'rCampensaYonlnwrancef APPLICAT_ION .FOR�,BUILDING PERMIT� �� or a cerlified coey�thereof(Sec.3800,Lab:C.) ' � ': �- � ����� - � - . � •WCP62S5241 Great American Plan 2B COUNTY OF LOS ANGELES BUILDING AND SA TY . PolicyNo. Campany � , BUIIDING �.� a Certified copy is hereby furnished.� FOR APPLICANT TO Flll IN ADDRESS� � �,Certified copy is filed with�he coonty building�inspec- " � BUimiNG tiondeparfinent.'�• ' ' ADDRESSZOSSZ East Cliffside Lane "� 12=2-86 �. The Wm: �L on Co.� Walnut 91789 Uate". - Applicent y CRY ZiP LOCAIITV ' ' CERTIFICAiE OF EXEMPTION FROM WORKERS � 5¢E OF�Oi3,S00 SF Min.�NO.OF s�oGS.� �� - nuaRe57---.-� - � � - - -�-- - �� �� -� � � � � �COMPENSATION INSURANCE ' Now oN ioi � Cz055 5T. -� (This section need not be compieted if the permit is for o�e ' TRACT �V3�GO BLOCK ZOHOO LO7 NO. G3 MqP BOOK ' ' 7AGE PARCEL hundred dollars($100)or less.) . ; .�. , owNeaTHE WILLIAM LYON-CO.. N�33-3600 USEZONE �'^�+P a— . . . ..- , I[ertify Ihat in Ihe�performance of the work�for whith Ihis �� ��' permit is issued,I shal�not employ any person in ony manner 9 Cor OT8t2 P1828- - -- ���- -- 6PECiAL - � d so as to become subject to Ihe Workers'Compensafion Laws. ' ADDRESSl (� '- "" ' CONDITIONS v ; ,.,. , .. . ,.. , � � • arv Newport Beach, CA zia 92660 __.. ._.. - -- - _ ._ . _. . --- ,,O Date., . � '.:... qPPlitanT . ...�. �.. ' ARCHI7ER0�� � ���� " TEL. �OTICE TO APPLICANT. If;after making this Cerlilicata of ENGMEER �[ales—Langston No 547-0862 DIStRICT_ .GROUP NPE _ _ _ _ ' FIRE. oROCE ED.BY �mplion, you should become subject to the�Workers' ���--� �a�5' Z N `y .ompansalion provisions�of tha labor Code,�you must forth- qDDRE55��� S. Main $t.� $t8. 1�5� �YBII 0. - N with comply with such provisions or this permit shall be � - TEL. �, SinnSiKAIC iFi TION AFT. CONDO.- Z deemed revoked. , :� - �,.� � CONiRnC70RS8fie AS Ownet No. . . , . .. .-. �� .. _ . . . I._ - �. -'._� . . _. . .. . __ . - - --, ClA$5 NO. DWEIL UNITS � LICENSED COMRACTORS DECLARATION-� � -- � - � � ��� - � -LiC � , I hereby aifi�m Ihaf I am licensed under provisions of Chopter 9 A�DRESS NO. ' LIC. .. . . SE4JER MAP , .' . � (commenting with Secfion 7000)oi Division 3 of the Business and . .._ _ _ . . . . ___. . . _ . _ Protessions Code,and my license is in full force�and effeU. Ct7Y C1A55 � � BK- ��"� � - �- � " "-�� �VALIUATION �� � ' Z�6HOS ,.$-1 � .. 5�.FT. NO.OF NO.OF CHECK_ '.' �� Li[ense Number � � li[.Closs ' -�' SI STORIES FAMILIES ONE' ' .. VALUATION_.. . --. - . • The .Wm. Lyon Co.. _ 12-2-86 . -. oescairrioNOFwoeK - "Ew- � Contractor Dafe � App � S �I om exempt under Set. �- li7 le famil ��hom construction A�TER ❑ , - . � B.BP.C.4or lhis�eason .. REPAIR ❑ s -- _ __ . _ • - — _ __ __.__.___._'....... _ . .Dafe:. .__ . USE OF DEMOI ❑ . E%ISTING BtDG. - � -�- �1 2 3.5 A--� '_ - '-'S�gnoiure'` ' " - APP�vRinNnT he William L on Co. NEo.833-3600 FiNA� OWNER-BUILDER DECIARATION _ _ . . . _ - . -. . __ -DATE� � �� �-- - •� - ��- �� ��2�� -�� -1 hereby affirm Ihot I am exempt from Ihe CoNractor's License qDDRESS FINA�r_�'�_� � , � � � � � •2 4 7.2 3 Law for the follawing reason(Seclion 7031.5,Business ond _ . ..Professian3'CodeJ:. . .. _ .. ._-'_ ...._.,.....Y" -- k BY �./��`� . . ,.. ._ . BUILDING , • •,2 4 7.2 3� � /� I, as owner of the properly, or my employees with nDDeESS . _ , . � . -- . - _ woges as their sole compensatian,will do the work�ond �OCALiTV � � � -` � � 2.� 9-8� : the structure is not intended or offered for sale(Section -- 7044,Business and Professions Code). �' -�-- � "-- MOviNG --� - -� --- -� `�'-�--TEL' - - '-' '-'� '-� - � �- - �" �" " ` � 1,as owner of ihe property,pm exclusively mMrocting CONTRACTOR NO. ' �,' :�, . ' �� "_'_ _'__. ._. __. _.. .._. ...._ ..._ .. ' - ' _'! �' -�--wNh licensed coNroctors to consirucl the project(Sec- qDDRE55 � � � #� • • • • � tion 7044,Bosiness and Professions Code). � . � � .'__ _"__" . REOUIRED YARO HVJY .TOTALSET6A K . .. _ __ .._ _._ .__.._._ . .._, _.. _ " . . CONSTRUCTION LENDIN6 AGENCY "" � Sei snIX VUOv,twE � WIDTH" � I •[l P Q O O �� ' 1 hereby affirm that Ihere is a construction lending agency for fRONi � -ihe erformance of Ihe work for which ihis ermil is issued -- -P.L - - - - � - '-� �- -� - - � - - ----� ' � - P P ' � • •�12�i��� (Sec.3097,Civ.C.). SioE _. '�� , .. . m ____ ._ . _ . _ _ P.L. . .. _ , __: .1 �..� � = �e�dersName Continental Illinois Bank 121 9-86 . � � LDAM Ref.N � P.C.Fee S ♦ .Z Permit Fee �S. SD -----' �� = Lender'sAddress23� So. La .Salle St.. CIl1Cag0 � , ' �� � � � _Lterlify fha�I have read lhis applimtion and sfare�ha�the _-.. --- --- .--- --- --... �,,,,o��a c�e �a'sp- -ior,w vic N -�-- -� - - � - �- -'- i above informalion is mrred.I agree to comply with all County Invasngm�an Fea L' g ,ordinances_and State.laws�eloiing to huilding construction, .._.. . . _ .. _. . . -- -� �- To�ol Fee '7 �.� � LDMA Perm.k� - � � � and hereby aothorize represenlotives of this Counly to enter � upon ihe above•meNioned property for inspeclion purposas. /��UV _ •�.,3si D � �. -� - --��--�-----� -- -- - . � - �-� : Q _.__ .__ _ / _- - 7 ^ �w�..� pi� /.2./��{6 SEE RFVERSF FOR E%PIAHATORY UNGUAGE � , O' _.. __Signorore of ACPlicanr or Agen� . __. . . .� ___. ._ .. .. _. . ._ .__.. _ __ _ _ _.. ._..... . ' � .___ _ -.. PLANS TO APPLICANT INSPECTOR'S NOTES , O�VNGR•DUILDER.DECLARATION , , I here6y aifirm that I am exempt from ihe Conlractor's To: Roturnod � � � . � � , F�� � License Law for�the,following re6son:�(Sec. 7031.5) � "' " � " ' ' � Approved ' '�Dusinrss and ProJcssiont Codei Any city orcovnty whicG No. Date ' No. ' •��Date�� �. �� - . " � - . - . .. ,,. ' � requires a fcrmil ln tonstruct,alter,inprove,Jrmolisb, ,_ , . -. orreparranystructurc,/�rimtoitsusuanrc,akoreguires, � , � •� , - . , � . ._ ,. . ' . the applrcant for such permit m JiJe a tigned sta[enien! - tbal br islicensrd f�vnuanl to tLe�rovi.vinns o�!!e Con= ...�,1 -.'�i:.�.. t•; � . tractor'sl.icenaelnw(CLaf�[er9J(comireencingwi[SSen � ,,.. ;; . ., . � �� - - - �� �-��� ------���- - �-� �-� . tiore 7000J of Divrsion 3 of(bc Buriness and Profesrions � , � � � ��� � :' ,.� � "� ' ' �" '__' '� � '�' CodrJ br t!at be ii exenipl tGerefrom and the basrsjor tbc - . . . __ _ . _ __ _ .... .. ._. . . .. ''_ _ . .- __._ . _ . _ : . .. ..-'_ _ _. _ . . . . . , . . � ��' ' �- ._, �.Requtrad. � - _. . _' ', . ". .'_ ��:, ".`� .._ _ '. . anyapplrcantfora�miesubects b appl�an���od�,! �._, - ... DaN Recatv�d .. . Approv6ls Y•' . Na or Approved . , . .`�,; fenalty of nnt rnorc.Nan fre bundrrd Jo!lars(55001.1:� . _ � _..'_'_'-.' ',,,... _;. .'...... . . . ... . _. . ❑ I,as owner of the property,or my employees wifh Water Certificate� - - � � � _.___. . __ _ .. ___ _._ _. woges as their sole compensation,will do Ihe work,and - -- - '" - � � � � -- the strucluie is nol intended or offered for sale(Sec.7044) Health Deparfinenl _� ..-, ! � . � .:.�. -.�' '. ._.._ �. --� � -.. .- - _. ... - . _ BusrnessandProf�isions�Codc:.TGc�Corstractor'sLicente - � .. , , � ._ , . , � Luw does not app y to nn oa•ner of property wbo-buifJs Flre Deportment_____ . .__ _ , , - - -- - - � - - or improves tbereon,and tuhodoessur6 work bnnre f or . , , . , � � � ' lhrougb�his oum emp7oyeea,'provideJ tbat tutb im._ � Groding _ � ` ' i � � pravemenls are not intended or,offered for sole.-� , , _ , ,- , - ; �,',, , , ;\; � �bowever,thebui�dingorimf�rovementifsoldarlbirsor.. � Geological '� '� _ - ._ _ _ , ,year oJ rompletion, !he�ownenbuilder wr!!bave�ebe • � � � � burden of prnving t)at be did not build or lmprooe jo'r PF d csetriaCano�ectian ' ,-� � ' ',�- ";' .. . -. ,., - '.: ----_ .__..._ - _-- -� the❑purpote o/saleJ.�.'ep operiy,am exdusive ( )� PY) . --�-. .- - --'� ----�- I,as owner of fh � ly mntrac• ling with licensed mnlracrors ro canstruci the project(Sec. Special Inspection - " �-� ' - - - - � -"" - �- . 704d)Burinees and Professions'Code:_Tbe Coniractor's p� (Conc.)(Masonry)(Welding) . � � - � - . _ , , ��� .. , , License I.aw does no!aJ�f�ly In sn owner oJproperty wGn � "builds or�improvet fberenrt,�and�obo conlracts/or surb W projects'u�itb a contracaor(sJdicenseJpursuant tn tbe Lot Dramage . . _ _. _ .. ..... . _ . ' _' ' , � . � Cnntractnr's�Licensel.au�J.--- - . . . , � .. .. . _. '- Parking , . . "_ _ _ _. _ . . . . . ._. . . __ _. . .. . .. � - , , . ❑� I am e.empt under Sec. ,B.BP.C.for Ihis � . . .. . � . - - -- --- --�-,., , . ,� , , . r -. � . i , ,.- ; reason -. ' . "__ '_ .'_ _. .. _____ __"_'-'_ Dote Owner Approvols _ Dafe � Inspector'�Slgncturo....._ . . ,. . � . � � INSPECTOR'S NOTES :' Location-. . (' , . . . . . . . _ .._ .... .. _� (Sefback 8 Yards) : 7J - • - --- � , � � -� , ' :" Foundalions � � j /� '� � �.! . .�. . �,. - . �� . . � . Slab .. . . . � 12�� '' . . _. . . � . � � . �. � . - � � Frame : . , , „ . ... . . . _ . ..- - . �. . ' � . . . . . . .. . . . . .. Energy Insulotion ', � � � - , . - - . - . , , , . Lmh/Drywall- • 1Qc�-. _'-'-.,'-�-�--'- �'----'--'-� --._..._'- -..__-�-- ' ' - - Inlerior �r/f c��•�- .. '--' -�- . •_ .. , - - lath-Exlerior . ' ' . .. . . . �� _ �. .. _ . . . , � . , . ...,�� . _. ._ . ,.. � . ..-� ,_.�. . ,... , �. . HouseNumber� . . .-___'_. __� �'._- ___.. . ._. _.. . ..,• .___..:.. . . ".L.� �..'.-:..'�� �.� ;,�' .� . .: ..1��a. '. Correct 8 Posied � - .F,\ � �. . Final- . ...- -- - .... _ .. _.. . .--- -.... . . �._-� --- ---- - --� -- - , ,. _ . . Enfer on FroM . . . . � � ... .. . •, .. . . . . .' � _� . . . . ' . �. .. - •.- �. - . .