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Home My WebLink About1050 S GRAND (2) . __,_ ..____ _..._ . _ _ ._ .._....__—_, :_-, - --`� . ___ �,....____�_._ � WORKERS'COMPENSATION OECLARATION � �� ' insurebor ofcertif cate of WorkersrfCompen5p71011 If15Ufdf1 e"� . ApPLICATION ,FOR�COMBINATION SWIMMING POOL� PERMIT �� - or a cert�fied copy�hereof(Sec.380D, ab.C.) - �eazoe� -- - -� � � �� - - . �CEB76(3/84) volicy N�N��m3p�afny COUNTY OF LOS ANGELES BUILDING ANO SAPETY " � Certitied�opy is hereby iumished. , � � Q FOR APPLICANT TO FILL W sunoiNc �O$D • ' ' Certified copy is filed with the taumy 6uilding inspec� � � ADDRE55 tion deportment. � � BUILDING }� �// � /� �/D , . / . . ADDRESS //� 1- �� /7Lci��.�. IOCALITV - �l!.�. •� �^ ' �.Dale"� "/l� ApPlicant � � NEAREST � . �� ' �CERTIFICATE OF EXEMPTION FROM WORKERS' - CiTv . �� .��• 21P �� CRO55 SL - � COMPENSATION INSURANCE � SIZE OF ASSESSOR � TRACT l0T LOT NO. IMP BOOK . PAGE PARCEL -�(Thi�s�cfion n��d not b�compld�d tf th�p�rmit Is for oa� TEL. USE ZONE� At4v � � �� bundr�ddoilan(f100)orl�ss.) � �� OWNER uK '�S �/� NO.lB��/ NO. ' �/ ��-�/ 1 rerlify thar in Ihe performonce of Ihe work for which this /� A � - SPECIAL , -. � permil is issued,I shall noi employ ony person in ony manner ADDRESS !�.za p 'X'�� Sr CONOttIONS � �So as lo betome sublect to 7he Warkeri Compensation Laws. , - DISTRICT STATISIIGL CLASS TYPF � PROCESSED Bv ' . . �' dTY �.� ..�s �Jv/� ZIP �.Z�CP �� . �pNST. . . Dote Appli[ant � �,ARCHITEQOR �- � TEI. .�O � .CLA55 NO.,�_/ NOT�CE TO'1PPLICANT: Ii, ofler moking this Certificole of ENG�NEER NO. Eaemp�ion, you should become�subject to tha Workers' - - - -.' �� - � - �� . Compensa�ion provisions of rhe tabor Code,you must forih- �-'°DDREu , v�lU�iWH , , wilh comply wilh such provisions or this�permii shall be - ��- �f� � �s VAIIDATION deemed revoked. � � CONTRACTOR �c��r .�.Gj �NO.�J?7'S�� UCENSED CONTRACTORS DECURATION �. � -- - � - �� -� . . , uc. �, ADDRESS Np��.�foZ �J . I hereby affirm that 1 am licensed under provisions of Chopter 9 �� S /J�� -- �� - � (commencing with Secfion 7000J of Dry sion 3 of the Bvsiness � ��T�-��- ��-� � � � � - - � Rqu�_�j � " � � � . and Professions Code,and my license is in lull force and effect. DESCk�vTiON OF WORK - FINAL �8 6 5.3 F!,.;-:� �License Number � Lic.C�ass SWIMMING POOL � � � DATF� ► � � I �. ..�_t.:_, r - ' SVA _ .. . . . . � FINAI I .. .. .. .' �. ^Q.22 V . Comrador Dale � � so.vT. L� ev_ I pm ezempl under Sec. SIZE V � � • c •3(!,L'2� fY O 8.8P.C.for this reason EIECiRICAL . .. .. . . . ... . . .._ ... - - � Q°j.� 2-8 5 ~' a�a:�-��-�y e _ a � Si nature � -5teel&Conduit Bonding --� � � � � 9 Conduits,Conductors,Equipmen�. N SW LE FAMILY . -. - . - .- .. � � .� . . . Z . HOM OWNER-BUILDER DECLARATION � PLUMBING �� -�� R H 6 S 4 A , ' �hereby aifirm thar I am exempt from the Contmctor's License . . . . . � , ' _ ___.. � Low for Ihe following reason(Section 7031.5,Businest and P.T�aP �� . � � �{• ' •�J . ; . Professions Code): � Gos Sysfem � � - . ... . . .. . .,-,��...-, . . � I,as owner of the properry,will do Ihe plumbing and . ANi-Syphon � � �.° � ?�5� � electricol work.I,or my employees wifh wages os their .., . _ . . . sole compensation,or o Ifcensed contraclor will do oll MECHANICAI � � ° • � ��°�-' � olher work ond the ShoUure is not intended or offe�ed . . � � -�^ -�� ' .- ' , for wle(Section 7044 B8P Code�. Swimming Pool Heater �� 2�8 5 CONSTRUCTION LEN�ING AGENCY "- -� � - ' • I hereby aflirm thar rhere is a consrruUion lending ogenty(or � qPPIICANi TEI. -� --- � the pehormonce of Ihe work for which Ihis permit is issued _ �pp�M� �� - NO.- � - � (Sec 3097,Civ.C.1. � ". .- . Lender's Nome A�DRE55 � � -� � � - � ' '' .1��.... . . i r, ,.,. �[q� ; __"'.'..'_ _"'. . ._ __ lender's Address p.C.Fee S �T 10� Permif Fee ��S�-�� i � -� . . �� I certify�hot I have read ihis applimtion ond state thoi Ihe . �I� �� - �- _, obove information is mrrect.I agree fo comply with all County ' � � � � �O-� � . � . . � ord�nances and Swre laws relating to building, elecViml, - issuon<e Fea _ , .mec 'cal and plumbing construction,ond hereby ouiho�ize ��esi�gor�on vee .. . / �7.r � ."—T � �� , � -� re ese ratives of this Counry to eNer upon Ihe above- � To�ol Fee ��v � � m nli �tylo spection purposes. . . .. . . . .."—'� --'-�. . � ��—�� Si 'alvre of Appli�o�i or Age�� Doie � � SEE REVERSE FOR EXPLANATORY LANGUACE � � � � �. � _ �� PtANS TO APPLICANT � �� ' � � �� INSPECTOR'S NOTES� � � � � � ' � ��''OWNER-BUILDER DECLARATION � � To: . Ratumed.. . I here6y effirm�hot I om exempt from�he Comractor i � - Liconsn-taw for.ihe.fol�owing\teosan.,($ec. 7031.5) ��Approvad Bvsfness and Proicsslons Code:Any city or counfy whkh No. Dote :� No. � � �afe ;. . ..___.._. . ._......_.._..._.__... . ,.'. .., . - . . .__. ___.-.. 9 P P � � �� re ulres o ormu to construd,alter,im rove.�demolish, . . . . ....__. .__ '�__ .__ ' __ ... _...'_._'..._ _ .. ____ _ . _ _... • --..or rrpoir any struUure,prtor�o f�s Iszuante,�.also�re- -- � � � ' quires}he appliconf!or such permll 10 flle a Signed sfafe- . . . . _.._ .. _ _. .. ___ _ .. .. _ .__.. . .._. _ ., �.._ . ._. . ..:. . . � menf ihaf hels litensedpursuanHo�fhe.provislons o�}he�. . ' � - -�-- Confracfor's L}cense Law(Chapter 9)(commencirrg wllh�. � . - -.. .- -- ��----� .-. - . . ..-- - -- .. .. . � Secflon 7000)of Div(slon 3 0/�fie 8usiness and Proles• ' � � stons Code)or thal he!s ezempi fhere/rom and Ihe basls �....; . .� -..� , . . - - --� - ---- — - � - � � - � � (or.fbe olfeged exempllon. Any.vloletlon.of Seclion � � .INSPELTION � �� -DATE"� INSPECTOR ' ' " � � 7031.5 by any opp(icont!or o permlf,subjecfs Ihe appli- " cant fo o Nvil penalfy oi nol.more lhan iive 6undred � LOCATION ' � ' � ' � ' � � � � d01lors(5500).): �. � ' - �� - � , ,., ,. _ .� � ❑I f th property,or m em loyees wi�h ,as owner o e y p S7EEl8 FOeMS � �,��.. i - ' �� - � wages as fheir sole compensation,will do Ihe work,ond LFGHT CONDUIT � � 1 v �� .- 1ha strutture is not inlended or offered for sale(Sec.704a) - � � �• - .-� . - . -. . . � ' -- . ._- _` -_ _. _.. .__. .. -Buslness and Profeszlons Code�76a Confractor's Urense eOND�NG � - -- � '� � Lowdoesnotapplyfoonownerofpropertywhobuifdsor ... .. � �� ' � - -�-- ��' improves fhereon,and who does sucb work h�mseH or ' ' y ,- � � � lhrough his�own�employees, provided lhaf such Im- �. .- , ;�., �-.�,. , '� - � - � ��-�� -- �i -- � � --� �� -� provemenh ore not in�ended or olfered lor sole. 11, { � however,Ihe building or Improvemenl Is sold wffhin one �� -�� - � -� --�� - �-� - � �-��-"' � �year o!'romple�lon,��he ownerbWlder wlfl have fhe conouir L (f��S Gv,., ' __:� • - �� _ _ , burden o1 proving}hol ho d!d nof 6ulldor improve-(or fhe � GAS lME ' � 4� .. .. ... . ... . -' ' . .. - ' ' � purposc oi saleJ. ' � � - ' � . , , . y k�� . ❑ i,os owner of Ihe property,am exclusively con- � � WATERIINE ' �� - �� -��voc�ing wifh licensed con�rattors to construU the project , SEN:ER - �- , � � �� , _. '.�. �). ._._. (Sec.7D44)Business ond Pro/esstons Code:�7he Confrac � � - �--ror's llrense Law daes not apply ro an owner of properry � '-� _ . - � , _ , _ _ .._. , _. �„_. ,._ _.,_ . _ .. �- who builds or Improves Ifiereon,and.who controcfs for � � � such pro(ects w�rh a contracror(s)(icensed pursuanf to ; . - � � �fhe Conlrpcfor's License Low). ' ' - ' �� ANTI-SYPHON VAWE _ . , .. , � � ❑1 am exempt under Sec. ,8,&P.C.for Ihis I � ELECTRIG WIRES ' reoson . FENCE(HFIGHT) - ... • � Dote � � Owncr GATES ISELFCLOSING _ . - �. �15ELFdATCHING� INSPECTOR'SNOTES � . " ROUGH WIFING � . . ,. � - . , . .� , „ , FINAL EIECTRIC �' ' • � "'____ '__.__-__ ._._ . .. __ ... __.__.. , _ .. . ., , . . - � .� ��`1�. _. . . . . �._, . _ . ._. .. _._ . .._....__ ._ .' ��'. .. _ . ._._.. ........ . .. . _.. . _.. '�.-.. .� . . HEATER(IOCAT101J 2 VENTJ ' � � . . �. .� .. .. _... ..�. -. - � � fA5 LINE TEST ' �' —'.. .��. ' "- . ''�''�'. . _. . ...' " '_ .. .. ....:.... .. �. . , . . . .�il.-�' . � . il.., POOL ORAINAGE � ' " �� ' ' � � , . .. , . .. . �»� , � P-THAP � .. .�: �.. .. , � � �-t ._ . . __ ...._ --...� .. _ � -. . . . . ..,� ...,.,v ' . . !� • '