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` WORKERS'COMPENSATION DECIARATION � . , '�.� I hereby affirm Iha�I ha•�e a cerlifiwte of�o�5a���0 5e�f . App���ATION FOR COMBINATION�SWIMMING POOL PERMIT ._� insore,or o caNi�imle of Workers'Compensotion Insuronce, � �:� or a cer�ified copy thereof(Sec.3800.L C.) ��5n2ao. . . ... . . . -. . . .... . . . .� . . . . . :... ...�. .-- . . ' . : Policy�co Ypan � cEe�6�3ie4� FOR APPL CANT O FOSINNGELES eunow� BUILDING AND SAFETY. . Cerrified co is harab furnish i ' Cerhf�ed copy is f�led w�ih fhe counry buJ mspec• � A�oi+f35 �� tion deparlmgnL � . BUILDING I �� .Da�����.g� � ADDRE55 ALITv - �L_b.[(r_APPIicoN RESi ♦ "� � � - CERTIFICaTE OF EXEM O FROM WORKERS � � ��TM� "- - ZiP cR SS si.- R - � � � � COMPENSATIO SURANCE �� � SrzE OF �. ESSOR , , . . TRACT . LOT . lOT NO.._ � MAV BOOK. PAGE. VARCEL (TAts actlen n��d not be eempbt�d if/6�p�rmN(t ler on� .\ iEt. . u5e ZOraE - MnP -� ._.. .... .... ... . .._. -_. ._. .. hundnd dollan(SI00)or Ins.) owNER r�0. - NO.� I certify ihot in�the performante of Ihe work'for which fhis -�. ...�... 57ECiAl . ..-. --r. _ __ ___ ... _. .. _ permil is issued,I sholl not employ any person in any manner ADDRE55 ' ' CONDITIONS - so os lo become subjecl to the Workeri Compensalion Laws." -� . DISTRICT � STAi15TIUl C1A55 � TYPE - - pRpCE$$ED 8Y . . � . CITY ZIP ' :� CONST . . ' Dafe ApplitaN . �: . . ' ARCHITEGT .(Y ".. . . TEI: -. . . ` G1A55 NO. � ^ � . . � 'NOTICE i0 APPUCANT: If, after making this Carrificate of ENGiNEER G N 1 O � ���. '�� �-� ��.- Exemption, you should become subject to the Workers' - � -� --� � - � � :� � VALUAnON ' �; -. �- � Compensafion provisions of fhe Lobor Code,you�muse(orth- AODRESS _TE ..�'� . . .VAUDATION - � � with compiy with soch provisions.or �his permif shol� 6e - ' � � deemed revoked.� . CONTRAR ' �' ,., . .. . . . _..____ .... ' . •dICENSED CONTRACTORS DECLARATION " ADDitE �� ` llC. �+ , � I hereby affirm that I am licensed under provisions of Chap�er 9 � . � 1 - �� � �-����- � � - �- � --- - - � - (mmmencing with Secrion 7000)of Divislon 3 of the Bosiness ���' �' � � �''�� �� � � !'� .l''"� .. . . Cla � ' . ......_...�.,_. , � .. . and Professions Code,ond my license is in iull force and effect . ' �� � �-` -� � , ��S� . DESCRIPTIIXJ OF WORK . .. . FINAL . - License Num - lic./Clas�_ SwiMPniNG vOOt ....... ... . , oATE• _ . ► . _. . . � � ` /j� .� �►'y� SPA � ..._ . .. ..FINAI . _.. .. .. - . Controc�o, .�:-.`��n� Dafd_i_.��. . . _ � . ..�Y . _.. . ,:. . . � , f.. �.Fi. �,, : ❑ . . . 512E .. .. . _ . . . .. . __ . ' I am�exempt under Sec. ... . ... ... . .;-. `. �. ��. O . . . � - � .. .. U 6.6P.C.for this reason . . . . .. . . . - . . ' �. • � -�.-~- .... ELECTRICAL _ . . . . ..,___._._._ � . . _... .. ._. _....._ . . . ._... � ' �' Da�e: � _ __._._... _. ��, ..!�. , . _ . . ... ... . ... . . . Q 5 noiure � Steel 8 Condoii Bonding . . . -. . .. . ,. . �"" . 9 Conduils,CondoUon,Equipment � � . - W . . SINGLE FAMIIY . � -. .. . _ . ._ .- . . .. . . .. . . _ . , .. � . N HOME OWNER-BUILDER DECIARATION pLUMBING � ���►� - " � �- �� �- " ��" ." -�- ' � � - , i hereby affirm tho�I am eaemp�(rom the Controctor's License . . . _ . . . . �' / . � ��'�' - � z � Low(or 1he following reason(Section 7031.5,Businass ond P_T�aP � ��,� � �� . --� ,�� - � Profassions Cade)� • � Gas Sysiem - . . .... . . _. . . .. �'. � ._� , ....�. . ❑ . .. . . . _, .. — I,as owner of Ihe property,will do�he plumbing and ' AnliSyphon ��4&8 R electrical work.1,or my employaes wi�h woges as their . . . . .. - ... . . ...�....�. .� .. .... .... .-.�- . .. aola compenwtion,or a licensed con�roctor wlll do all MECHANICAL �� � - � other work ond fhe slruUura is nol fMended or offerad . �/ .. . . ._ ...._ . .__ .. ..._. .�• • • � •3 � � 1or sale(Section 7044 B8P Code). � -�� � Swimmin9 Pool Heater � � m � . " , ___ . I •'i 3fl00 CONSTRUCTION LENDING AGENCY . . � � �. ' I hereby affirm lhaf there is a ronslruction lending agenty(or APPUfANT � �1... � • .. . -.. . ��, . _�:.. _..-_ •.o.� �j�.p U�_., . � the performance of the work for whichThis parmil is issued �PRIM� . � Np, �� , ' (Sec.3097,Civ.C.�. ._�� . . . . .. ._. � . .. . _ �.. _ _09.b9-88 ��� tender's Name ADDRE55 . . ._ . . .-.. . .. ... . .. _. . . ... . . ���- I . ..... Lender's Address � p.C.Fee f Fermu Fee � `� � � � � - ' � �� - � � 1 cenify thal I have read this application and s�de ihaf ihe �(�� � � �, ��' � obove informotion is mrrect.�I aqree 10 mmply with oll County � � issuance Fee -�.l � '' ��' ��"���� ��� '� � � �� � ordinances and Slate laws relofing to boilding, electricai, '� .� �� " mechonical ond plum6ing tonstrucfion,ond here6y outhorize Irnesngotion Fee � �- - � � � ��'"' -- ��� �' � � ��--� 4`�g representa'ves of Ihis Co ta enler opon the obove- Toral Fee _ ; � �� menti ed rop for i peclio uiposes. . _ . �� '�. �. �r'� �� Sg ar e o1 00�o.Ape�i ' Dara � � SEE REVERSE FOR EXPLANATONY IANGUAGE��- .' � � � `\�/ � . �'. � -------- r _ . . ___- . .- . .. _ _... . . _._.. . .. . . . � . . , . �" „ .C']: ":ii'. �.. . . , ,., � .., 4... .(� . r.-�.:= i� c�,r•. '""r,. �...'.�, , .. .., . .. ... ... ,.. ,,.., � . =pWNER-BUILDER DECLARAT :� ...,. i �` -�•�PLANS TO APPLICANT ' ° ��'INSPECTORS NOTES�-� � �- ' ^ ION � � . � � '� To: . .�._,_ Ratumed_ . , .,,. ..r:•,-_�,- -: � -. ..,., �-.� . � � ���L ensaYlaw�othah�l_;fmlle^m�plr rom�4`Seonf7031 r5) f . ._ .... . . ,..,. .., . . . -�`� "Approvad �� � ��-BusfnesiandGrofcesionsCodciAnyci/yor_�oSnry'which Na�' -':�.---Date'_".- NoC�'-„Date .,. ..._. __''.. .... .__., _.__._. .__._..__._�.__.__ e u(resa ermifloco".. .. �. . ' ' _'_,.. ... - _. . ,. . . . ..t , , .� � ` . =�. ,. . . �- ,,,. - . ,..� ... ...-- � � 9 P ns�rncf,aHer.imp�ove,demolish. } -.:. . . -..•.- '.-_�. I•_l--.?� . ._•_ _ ._ .. ._... _. . :.._ . . _ ` i -'�'or repalr.any-sfrurlurc.-�prior to lls Issuance,cfso..ro- ._. .... .._..._... 1 ...�'.. ..+. . . . . - . ... / �.." - .' , j .i� . , . '•. � - -, �(,-' -.• ' ..:; qulreslhcapplicon/forsuchpermlHolileaslgnedsfafe- .---- -. •: ---' . -'.-..+_.. __ ..,:,- .-.�_�___.;.J •�;_" -.t_ � ._ � ment fhct he.is licensedporsuanf fo fhoprovlslons�ol fhe .. .r . .. . r: .�,�J • ". � ;,, - ; . - -.._ �....•._� ==__.'.. � .-Conhactor's Lkense�Law(Ch6pfer9J(rorrrmenting�wl�h f- �-: = �._ -_ ' ,.:' : .'___..- - — t,o e�sr��s:a�d r ores r - . . ..-------- .-.-.... .--...-- -"- --.. . Secflm 7000)o1-0Ivislon 3 0!I I � -,,�,� � - . ' � ;", ,..,i - -� � �� slons Codoj or fha�he�s exempt therelrom and therbazrs . . ._. ._ .. __. .__ __...__.__. ...�__ .....,.__..... _. .. _ _ ../ ; . -- ;-- '.. �� or.t e.,alle od exem flon. n v7olafion al�Secfion ,.���,# h. s i. a E! r- �INSPFCTION____.__DATE:__._____MSPECTOR � . : � . ��.�� .- i�� � . 7031.5 by any appllcanf!or o perm�t:subjac�s thnappli� � >,.�� cont.fo.a clWl penolly.o(.,not more,lhan five hundred IdCATION. ___ '._r _. .... ...:, � ... • ..dol7ars(5500)) .,.�. ., i.. r. �.. _. . .. STEEL i FORMS --� � 't � .. ...-,_ _____....._.. _____ __.____._. . _. ___... ._.____ _; .....,wage�s as Ihe Wsole compensation,wi11 do thel work,a'nd � _the structure is not intendad or ofkred for sale Sec.•7044 IIGHT CON�UIT �i � "� '. 1 �� ��.�. . .i:itt'.�� ..�,. � � '.�'r t L ...7 _.. . ( ) ' . .�._...___.�.�..._...__ ..� , :_�.. ..._. .... .. __.... . . . _,..i-1�_._._�1��__•.•:_ „'1_..-:_ ,�.:_�' ; �.:. ..Businesf ond Professlons Code:.iho Canfracfor's Licen:n BONDING� � �� � � > 6+C�� .I:��� � :. . :��:'Lowdoesnofopplylo�anownerafpropertywhobuifdsor " �"""" ' -'�- ' --��--- � � -�"'�Improves�fhereon�,���and wha does such work�himself or -..__ . ___ . _ . . _ --'�^-� ; ' ,�' �: r ) ���"'.� >� . �`.. � .- � . �, . � � IhrougF"hR'owri�'emplayecs.'provided thal'such.Um � -` � - �"- � r` ' �-�-' 'provements ore not Inlended or oNered lor�sale.��If, � ` ��.��� � L,.��. � howevcr,ihe6u11ding��orlmprovemen/Is'soldwllhinonc CONOUti . . . ' '.`.. _ . .. ; ._` �, �`,.. �,..�he awncrbuifder-will have�1he D F �„ . , �... . � .., ,:, borden o! rovin � � 4, � . L , __ p g4hathed�dnotbuildor�mproveforthe ,� ear o��om !el'o _..._ ' ..___ I .. ; purpo❑sc oQsofe^ .. . . . GAS LINE � �-�! � . . �. - r.. .. ��..., `� J � I, s o er of the,Pioperiy,dm exclui vely con- WATERIINE ... � .__.:.�.._ ..�.__... .�. i . .....�„.:.� i � :... . . . _ ._ . � . �._ ��'troci ng wi�h+cc�nsed mNradors b<onstr�ct the project i - �.._ . �.�.. , � � � SEWER - � � �����' "--��� � � j�i.ISec.7p44),8vsincss and Prolessions Code:-ihe Confrar � � �� � � �- -rori�llcenselowdoesnotopp'ly�toodoiv'ncrolpropeity • ...... . .... ,. •. �.' � � _ � , �� � �� who 6uilds or Improves Ihareon,and who confroch fo� 0��..- �i�"--._,_ .. _.. _ . ._ . ___ _ ___ -- — , — _ ._, — `� such projects wlfh o contracfor(s)liCensed pursuonf lo � -� -�-= �-��he Canfractor's Ucense Law).� ' ' ' - � � .. ' , ,. . \ ._., ANiI-SYPHON VALVE. ' �. � ' -- . -�'- ��`��---- .__.._.- '-._ � : ' � , - � _ � ❑I am e empf unde Sec ,B.8 P.C.for this , .�,. , � L! � .::: .._� ,,....,. _ ___'....__. .. . ._'"' .... .._ ELERRIC WIRES . l.� � � . . . . . � _ v '_' . ..._.. �... reoson . � � �'I , � _,� , .�'-i ..�;,.. � _ , .._ ...�;.. ...�. ., .,... : iENCE(NEIGNT) . F �; ' � � . Date ,.. . ,Owner ... .. .. . GATES �SEIF•CLOSING � t } � . ..-. . .. .. . SELFlA7CHING 1�'��; INSPECTOR'S NOTES".-��; .�' ,�. _, � � . .. � . . � ._. .__� - i� i -.,_. . I _ � . , . ,. -.: , '_.__ ; �.,., ,..,.�.. i-... ,.:..� . ROVGH WIRING � ._.\' ... . ,.,.�. . _ .•.. . . ' . . . � FINAL ELECfRIC � � �. ___.__._. _________. ._�.. .�..� .. . . . . .. ._____-' ._'_ ....__._. . ; , . ..c . � .. . .. . , . . . .. .. , ,.. . ...... ..�,.,.. ,..�. , � .r�. i , . . .... . ��., ...., . „ ..__.....__.._..._.._— _.__.._._ . "- '_"'___ ._-_.'_____. . . . . . � . . .. . _,. .. _. . HEATEk(LOCA710N8VENT) ..-.-......._... ._._._�e.._.�._ ...._.._.__........__.__ ' . .'�.' _- , _ ..._.._.. .... . j i . , e . . ... -. : `_' . GASIINETEST ._ __...:..r�.. :____...__' �,.._ ________._. ._�_..'.._" ,.. .�, .,. . . ,,. . . ,.:,�. I..,..,... i,..'. ,.. .. I 1 � � .. . . _.. . . � POOI DRAINAGE s � .,�� :.i ' � � - ,. . P.TRAP ; ' ... . • , ,i.... . ,.. . . .. � . . . :� ,. . ... . . � .. . ..,. .. ;.... _ ., . ......._.�. _ ._._.. �:�.._�.._......_, . ."' ._........_.,..�....�. . , . .`. ..' . J —ar�, _ r 1. , ` - 1` / 1.