HomeMy WebLinkAbout7634A 7766A (19)WORKERS' COMPENSATION DECLARATION hereby affirm that I have a ce' Comp of consent to self APPLICATION FOR COMBINATION SWIMMING POOL PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800 Lob. .) 7s?2o9 _ CEe1e 13!BA) Policy N pony COUNTY OF LOS ANGELES BUILDING AND SAFETY �L' 3 r —1Certi Certified copy furnished Certified py is filed with }h county buil g ec- ti n depot ment. Date Applicant CERT ICATE OF EXEMPTI N FROM WORKERS' COMPENSATION SURANCE (This section need not be completed If the permit is for one hundrod dollar. ($100) or less.) I certify that in the performance of the work for which this per is issued, I shall not employ any person in any manner so as to become. subject to the Workers' Compensation Laws. Date Applicant NOTICE TO APPLICANT: If, after making. this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Numbf .: �'Lic. Cla s Cont C-S^� Date I am exempt under Sec. BAP.C, for this reason SINGLE FAMILY HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Low for the fallowing reason (Section 7031.5, Business and Professions Code): ElI, as owner of the property, will do the plumbing and electrical work. 1, or my employees with wages as their sole compensation,or a licensed contractor will do all other work and the structure is not intended or offered for sole (Section 7044 B&P Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Ci, C.). Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State lows relating to building, electrical, mechanical and plumbing construction, and hereby authorize representatives of this County to enter pon I e above - mention op y for spec n purpos S,gno0qf Wlic,nt or Agent ate FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS n LOCALITY CITY ZIP lv NEAREST CROSS ST.✓ y / /,',� �j OF TRACT vri 1O 3 LOT LOT NO. MAPBOOKPAGE PARCFL TE USE�p NfE AP G, �77 OWNER I< ! ll O O ✓ SPECIAL ADDRESS �fU©V COND 'Ci, DISTRICT STATISTICAL CLASS TYPE PROCESSED BY CITY ZIP / ( CLASS NO. CONST. .� 0 ARCHITECT TEL ENGINEER N ✓a• ADDRESS ' VALUATION S VALIDATION EL CONTRACT R _N i ADDRESS b _ _763, A sTM CL CITY SS ^S ' 1: FINAL • • ° • 21 !�—�`/ —/ DESCRIPTION OF WORK �r�I'—�--///yyy SWIMMING POOL DATE ) • • h 5, 3 7 SPA FINAL r SO. FT. BY l- .�- o u e 4 � 3_ SIZE G4.22-87 ELECTRICAL Steel & Conduit Bonding Conduits, Conductors, Equipment f,,,D S (� PLUMBING ► P-Trap f 7 7 6 6 A Gas System' ° • • s ♦ 3 Anti -Syphon+ MECHANICAL It 1 6 3 O Q Swimming Pool Heater ° ° t 6 5. Q 0 04,28-87 APPLICANT TEL. IPRINT7 NO. ADDRESS P.C. Fee $ E 17 Permit I -one Issv eFee /d Investigation Fee / 0 o Total Fee SEE REVERSE FOR EXPLANATORY LANGUAGE fi. u V O w C N z PLANS TO AFFLICANT INSF0906kiti 14OUS To: Returned Approved No. Data No. Doh t i FINSPECTION DATE INSPECT R LOCATIOIt STEEL IS FOR?n LIGHT CONDUIT 180N! 't)IfJG V CONDUIT -I ± L.' GAS LINE / 7.J� WA WATFP LINE SE�YEC. ANTI SYPHON VALVE ELECTRIC WIRES FENCE (HEIGHT) GATES ++SELF -CLOSING FSELF-LATCHIN ROUGH W:IHNG FINAL ELKTRIC i HEATER (LOEATION ti VWT) GAS LINETEST POOL O�AINAGE P'T`AP OWNER -BUILDER DECLAKAT ION I hereby affirm that I am exempt from the Contractor's s License Law for the following rea-r,.(Sec 7031,5) Buslness'ond Professions Code: Any city or' county which requires a permit to construct. alter, improve, demolish, or repair any structure, prior to ifs istsucoce, also re quires the applicant for such permit to file a signed slate-. ment that he is licensed p--rf to the pr—ui ions of the Contractor's LicenseLaw(Chapter p) (cemmeneing with Section 7000) of Division 3 of the Business and Profes- sions Code) or that her is exempt hi —from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the apply cant to a civil penalty of not more than five hundred .dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec 7044) Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own empfoyee, provided that such fm- provements are not Intended or offered for sale. N. however, the building or Improvement is sold within one 1 • year of compfet-on.. the owner builder will have the burden of proving that he did not build or Improve for the purpose of sole), 4 1'I, as owner of the property, am„exclusively can - trading with Ilcansad contractors to construct the project (S c. 7044� $ sines and Professions Code 'The Contrac- ter's License. Low does not apply to on owner of property who builds or improves thereon, and who contracts for such projects with a contractor($) licensed pursuant to the Contractor's License Law)- ❑ 1 ant exernpl under Sec. , B. & P.C. for this reason Data Owaer INSPECTOR'S NOTES