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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 � Z Q o •- --� r . _ _.`—��, 1 m pv ....- t �a � . � � ! z � + � Y ; ' � b u+ a Z' p, 0 I2 � 1 � i m � � � m� � C � , 2 7! rn � t p i � y 2 � "� r,,, � � G �n Ai ' ta i_ � � p N m �a. � m '� � . 1 -0 G [t {,d ��tf Gf m r G�-.'":� r=�n g Q '� � �� ''' ' et a w � � � �',n G1 .`-o Z •3' jtl �r � � i^ � m� � ,��, G - x�i� . 1 7 m A Re � rn'r^ pq„ r� ' � ..1 �v q � On r I � ,ni O n' � o � ' � � � p ' �Z �` ` T W � . i "� � S 2cs� th = ; �' '� n ' �" 1 "'i C� ,n '&' p�`'s, , �-: 1 a A g zt�. �. �, z._ ` � °" '' � � � � ,- � r � ' � ;. a � �� � � �y . � � t ,� �O �' � � O , A W t. C- fi. � � `�. .5.+ " -� `i `r� �', � �k ^- � � � , F� � m *fi Y�. 25� .. f � � . .I « .+' � �h. . ,f V� _ ' .;, . '.r � N rr - ' � r.. 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