HomeMy WebLinkAbout1135 CHISOLM TRAIL (6) '. " . _ _ ' '. � \ ..
WORKERS'COMPENSATION DECLARATION \V �
� he.��.;of!ir►.�hot I have a ceni{imte of�o�5e���o self App��CAT10N FOR COMBINATION SWIMhAING POOL PERMIT
insure,or a certJicofe oi Workers'Compensotfon Insuronce,
or a ceruf�ed coFy thereof(Sec.3`Lab.C.) 7sazoe ' - - �
Polic N �G Com an �p+�0.'rn^"� CEBzep/Ba)
v �— P Y COUNTY OF LOS ANGELES BUILDING AND SAFETY
� Cerlified copy is here6y(urnished. : � �
FOR APPUCANT TO FILL IN euaoiN� }' �`� G
� er�ified copy^�s filed w�th fhe county building inspec- nooke55 t1�
lion deparlment. �- BUILDING �
a1_�.�� AODRE55 I ���iS L-�� �CQA\� LOCAUtY �L\�D ` ��-�
Dote ' App�icant NEARE57
CERTIFICATE OF EXEMPTION FRO WORKE ' CiTv ` � A✓J� �.i1 �AQ.ZiF �I l 1.�'S C�z05557.
COMPENSATION INSURANCE h Si2E OF ASSFSSOR
TRACT 1 lOT LOT NO. MAP BOOK GAGE PA CEL
(Thfi s�ctfon nNd nol be compbNd if�h�p�rm71 t�!or en� �, �Et, uSe ZONE TnnP
� hundred dollers(f100)or I���J , OWNER �� � � No. ����9 �_� No. - ! � 3 �� �
I certi(y�hal in Ihe performance of the work for which this / {- SPEQAI _
permit is issued,I shall not employ any per5on in any monner ADDRE55 S�J T��5��Y� Q_�-aL 5���-L CONDITIONS
� so as to 6ecome subject io the Workers'Compensafion Laws. I -�� DISTRICT STATISTICAL CLA55 TVPE PRp�ESSED BY
�ITY � ��� � F�Q ZIP �1 �4 � ' CONST.
�ple Applicanf AR[HITECT OR , TE� 1Q QA55 NO.�` �
NOTICE TO APPUCANT: I(, pfter moking Ihis Certifimle of ENGINEER NO.
�Exemplion, you should become subject lo ihe Workeri � C-�.. VAIU 710N '
Compensotion provisions o4 the Labo�Code,you must fo�th- ADDRE55 . ,
ith comply with wch provisions or this permil shall be TEI. t� � s � �. � �;� VA��DATION
deemed revoked. CONTRAGTOR 1 � a S �C .NO.Ef.��O'�Z , � �
UCENSED CON7RACTORS DECIARATION ^ '• � ���'� � '-� . �
AD�RE55`.�J �S 11� ,.S JP_ 5� NO..� � �
I hereby affirm fhat 1 am licensed under provisions of Chopler 9 t ��� f . . �
(mmmencing with SeUion 7000)of Division 3 ot the Business ��7V C l-��n1� C1n55 G'.S 3 � •
and ProfesSions Cod�e!,ond my license is i�(ull force and eFfecf. DESCRIPTION OF WORK
LicenseNumber �7���7�( Lic.Class �-_`° � SWIMMINGPOOL- , L� FINAI � 9//
Cl '�t�rJ o��3 l�X- � •7 z o q� }
�A.�IN/ .��-d�."7� �5 $PA �C_I� FINAI � � r . U
Contractar � Dare . � i
sa Ft �(SQ sy - • �
❑ I om exempt�nder Sec. S�ZE
6.8P.C.for Ihis reoson - ���� ��� U
EtECiRICAL . � ��(�j S
Date: ^ J q ��`� W
Si ature Steel 8 Canduif Bonding . . d����D 1. OC\--�/�U� � ,
9" Conduits,Conductors,Eqvipmenr e - . �N Z
SINGLE FAMILY �
HDME OWNER-BUILDER DECLARATION PLVMBING , � �
I hereby affi�m�hot I am exempl from the CoMmctor's Ucense - .
� Law for fhe follawing reason.�5ection 7031.5,Business and p.Trap � � - � -
Professions Code): Gas System ?7 9 a$A
I,as owner o(the property,will do Ihe plumbing ond AMi-Syphon
� electricai work.I,or my empioyees with wages as their , �' ' ' '�3
sole compensation,or o licensed tontroclor will do all MECHANICAI � '
other work and Ihe strucfure is not iNended or offered . ' � • •2�•�4
for sale(Section 7044 B$P CodeJ. � $wimming Pool Heater � � � U
�CONSTRUCTION IENDING AGENCY - ' �?1'�ll
� I hereby a4firm iha�there is a construction lending agenty for pPPIiCANi TEL � - ��1 2�-8�i
�he performance of the work for which this permit is issued PRINT � � � - �
�se�.309�.c��.c.�. c � 2 eR rvo. ��.Y'Sr13 ( �
Lender's Nome n l -�7 9 4 9 F
- ADDRE55 �rl-��\. �l\S ��� �J, �
#. .'. .g
lender's Address - p,C.Fee S Permir Fee W�N � �� � • � 7.�]Jr Q
1 cer�ify that I hove read this opplicotion and state thoi Ihe /� ' ' '
above informotion is correct.I agree b mmply wilh all Ca�ny Issuonce Fee 1 �,] - - � � � 7�S�_
ordinances and Sto�e laws relafing Io building, electricol, .
mechoniml and plumhing construction,and hereby oulhorize ���esYgonon Fee � ��1�� . - O�.2 O_$�
represen� tives of this County to eMrr upon the a6ove- ia�al Fea � � �
menf� roperty for inspection purposes. � '
.— �z�� %'Sr'
S�g� �ro f Appl�oni o gen� , Dore SEE REVERSE fOR EXPIANATORY LANGUAGE � .
P1AN5 70 APPLICANT INSPEROR'S NOTES OWNER-BUIIDER DECLARf�710N '�
To: Rotorned�� . . , , , i hareby offirm Iho�-�am exempl frorn ihe Coniractar's
� �� '-� � � �•� � ' - License law for'the,fallowing reo:bn'(Sea 7031.5)
_Approved ._ , __„.., Business and Professions Code:Any ci�y or�munly whlcb
No. Datq No. �. Dato . � . requires o permi�fo construct alter,;mprove.demolish.
- , - - �-- --- � �- � - �� or repalr ony sfrocfure. prior 10 i!:issvance, also re-
� � � � quires the appfican�lar such permi�to lile a signed sfale�
. . , meM fhal hn!s Ilcensed pursuonl ro tFe pro'vislons of�be
� ' ' � � " � Co�«atlor's Llcense Law(Chopter 9)(commenNng wlth
� Se[fion 7000)01 Olvlston 3 0l Iho Business�and Profes�
- ' � - ' slons CodeJ or ihaf he fs exempf Iherefrom and fhe bosls
. � � , lor ihe olleged exemptlon.�Any violaflon oi S�clton
INSPECTION - �ATE- � � INSPECTOR � - � � " 703I.5 by any applitanl lor o permll subjetfs/he appH� �
� � , , mnt to a�tfWl penaky ol not moro fhon (ive hundred
LOCAt10N � ' �� ' ' � � ' dollors(5500).): �
, , . ❑I,as owner of the property,or my employees wirh
S7eeL 8 FORMS '. - . � � � ' -� ' woges as their sole compensmion,will do tho wo�k,ond
LIGHT CONDIIIT . � _ ,�' � � _ � ' �he strucfure is not intended or offered for sole(Sec.7044)
� � � �� Bustness ond Pro/essions Code:The Confroctor i Llcense
BONDING �� � � lawdoesnotapplyloanownerofpropertywhobWldsor
� - � �- �� improves�bereon,ond who does such work hlmsclf or
' � "— . . tfirough hls own employees, provided �fia� such (m-
� provemeNs are nol fnfended or oHered for sofe. If.
' ._ _ _ howevrq the bW(ding orlmprovemcnf is sold wfthin one
CONDuii +�r� � year of comple�ion. �he ownenbuilder wtfl hava 1he
- - - �- - . 6urden of proving�hat he did no�build or�mprovo for fhe
cas tlnE . �- �purposc ol sole).
_ � . . ❑I,as owner of�the property;�am exclosively con-
WATER IINE � ' ' . �rocling with licensed cantraciors�o consfruct Ihe projec�
SEWER �. ' • . � �Sec.7044)8usiness and Prolessions Code:The Contrao
� � � � for i Llcense Low does no7 opply fo an owner o!properly
�- , � � who 6uifds or improves Ihereon,and who confrocfs for
such pro�ecls with o rontrvcfor(s)licensed pursuonf fo
� . � �he CoNracfor's License Law).
�- ANTI�YPHON VALVE � , , , , ,. _ �I am exempr under 5ec. ,6.8 P.C.for this
ELECTR{C WIRES reason
FENCE(k1EIGHT) . Oa�e Owner
GATES �SELF-CLOSING 1 - � WSPECTOR'S NOTES ' �
SELPtATCHING J
ROl1GH WIRING . � �� �
FINAL EIECTRlC .
NCATER(LOCATION 8 VENTJ ' �-
GAStINETEST - -' � �
POOL ORAINAGE ' ' � ' _ .. .' . ..
P•TRAP � . . . .