HomeMy WebLinkAbout1334 SUMMITRIDGE DR (8) � ' WCr;KERS'COMPENSATION DECLARAiION
I her iby affirm ihat I h�ve a certifimte of consent to self � � �
;�s�r�,or a cerlifimte of Workers'Compensation�n5�,a��e, APPLICATION FOR COMBINATION SWIMMING POOL PERMIT
or o tertified capy�hereof(Sec.3800,LobL._C.,)a / '7en2o6 � � � �
Policy No.W�'a3Lb6'{'�"ompany ✓�/7G� /�l��hC CE87613/en) � �
COUNTY OF LOS ANGELES BUILDING AND SAFETY
�Certified copy is hereby furnished.
� Cenified copy is filed with the count buildio ns ec- FOR APPLICANT TO FILL IN BURDING �y�
tian deparfinenf. y 9� P 3�� ADDRESS ��-�" LY-a•
BUILDING / L�j• ' T_
��.OV PP ADDRE55 /�� /%/yl]-F.i6 f/I� �OCAIiTY '�•
Date A licant �ii
y NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CI7Y �QYJ�pr7� =7Q✓ Zip CR0555T.
COMPENSATION INSURANCE y SiZE OF ASSESSOR �
TRACT ��'S{p v LOT LOT NO. MAP 800K PAGE PARCEL
(This section need nof 6e complefed if tHe permiY is fer one C���tpgN/4 QJ�nyON�T88k. US�ZONE MAP
hundred dollors(5100)or less.) � OWNER � �y� NO. -(� �v� NO. �1�� '�
I certify that in the performonce of ihe work for which this /��,.� p SPECIAL
permit is issued,I shpll nof employ any person in any manner ADDRESS �.�4¢� �.+Ic.�� l�li+i�;{ ��l�PG�
CON�ITIONS
so as to become su6je<f to the Workers'Compensolion Laws. DISTRICT STATISTICAL CLA55 TYPE PROCESSE�BV
cirr C�/5�0 B�'• ziP '?(oZ¢ anssrvo. coNsr.
� Date Applimm ARCHI7ECTOR . TEL / )
NOTICE TO APPLICANT: If, ofter making this Certifimte of �NGWEER ���<j NO. -�'f.9�' J 4 ��
Exemption, you should become su6ject fo the Workers' Ap�4F� ��0�. -�/-�G!}G/q ��fY. VALUATION
Cornper�saeon provisians oi the Lobor Code,you�musi forin- � �� VALIDATION
with comply wifh such provisions or ihis permit sholl be TE�� s /i��0��
deemed revoked. CONTRACTOR ✓�' �LL'�'ING• No.� +8$/I
LICENSED CONTRACTORS DECLARATION � /(� `'��t� NO.�w"�O�
i hereb affirm that I am licensed under ADDRE55 � S �Y•
y provisions of Chapfer 9 �,��1�Y ��� s
(rommencinq with Section 7000)of Oivision 3 of the Business� � CITv Qt-+1+re/*--� � CLA55 G-s3 � =o,�,'� f�
�� and Professions Code,ond my license is in full force ond effect. DESCRIPTION OF WORK '
A `,�(�71., FINAL
�' License N'umber 489'Z(v� Lic Class(-'�5�✓ SWIMMING POOL �(/h�/� ,�j/�rJ,[�{!��{ pATE �-�[._�� {6 a o w w��
, , ! c� a f� �� " L�
�1 co„i�a�io,�7'L4�J�en+945��Date 5�'.3•o� saa Stv�ssr�i.VEj f3�'X_ Q FINAL ��"
p� F O
� 5�.FT. � flY L�Y� ° ° : (?L s'L.l�=� U
� I om exempt under Sec S�ZE a
8.8P.C,for�his reason ��!�.Q v'�t%li �
ELECTRICAL
Date: U
Signpture Steel 8 Conduit 8onding � �.�2� A.��� CWL
SINGLE fAMILY Conduils,Conduclors,Equipmant ,B'C..� �f G
/
HOME OWNER-BUILDER DKLARA'ION PLUMBING , ��gS�/� � �
1 hereby affirm ihat I om exempt from the CoMracior's License sC. Iv
taw for ihe followinc�reasan (Section 7031.5, Business and p-Trop
Prafessions Code):
d � GOS SVS�P.T � E' /.�_ � n -
i � I,as owner of Ihe property,will do�he plumbing pnd Anfi-Syphon �`��yr��.xs `�~ �
A eleciricol work.I,or my employees with woges as their '`C�,L�
sole compensation,or a licensed mnirocfor will do all MECHANICAL
other work and�he structure is not intended or offered
for sale(Sedion 7044 B&P Code). Swimming Pool Healer � �
CONSTRUCTION LENDING AGENCY
I hereby offirm ihot there is a construdion lending agency for APPLICAN7 /�� �� 7EL, y/ �
ihe performance of ihe work for which Ihis permit is issued pRINT S `�v�i�:.J�,
(Sec.3097.Crv.C.). ( ���ET2 OWAIS�RL'� No.(p39 88//
.Lander's Name ADDRE55 f�v"✓ �r4'A.+��'/F��+q�:+� i� "' �� +� A s,j
Lender's Address /� � �j� �^� � `''�� ..1�(�!
P.C.Fee 3 �T3 Permil Fee V
I certify that I have mod ihis applimtion and state that ihe `� �'.'j J.(i U i
�; � above informotion is correr.t.I ogree to comply with all County ,n �, " '
' ordinances and Stote laws relating �o building, electriml, Issuonce Fee V Q�,�y-,p 6
mechonical and plumbing mnstruction,ond hereby authorize. Investlgarion Fee �
(�: representatives of ihis County to P,NP,I upon the ❑bove- Toral Fee
 me Iioned property for inspecfiorypurposes.
� Signoi�rr of Applimni or Ag�/ 3Date SEE REVERSE FOR EXPLANATORY LANGUAGE
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