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Home My WebLink About05_12_1986 - 20948 MOONLAKE ST WORKERS'COMPENSATIONDECIARATION ��'� . � � �I� G� � I hereby affirm thm I have a cerrifico�e of consenr�o self � ��,�.e,or a cerlificate oi Workers Compensation��5�,a��a,� APPLICATION FOR CQMBINATION SWIMMING POOL PERMIT or o certified copy thereof(Sec.3800,lab.C.) . • '76a2oe - - � � - - � � - �� - � � (3l8�) Policy No. Company FREMONT INDEMNf�'� CpUNTY OF LO$ANGELES BUILDING AND SAFETY � Cerlified copy is hereby furnished. � � � � � - - FOR APPLICANT TO FILL IN eunowc Ceriified topy is filed wi�h the tounry building inspeo" ADDRE55 tion deportmen6 . � AooR ss� 20948 MOON-LAKE --- �� iocAun -- � Date Applimnt NEAREST� CERTIFICATE Of EXEMPTION FROM WORKERS' � ��ry ��-' Z�P � '� CROSS SY, .---�- ` � � �� COMPENSATION INSURANCE � SiiEOf , nSSE:oOR . TRA LOT LOT NO. � MAC BOpK PAGE PARCEL (This s�el�on n��d�no1 b�eemplN�d R 1h�p�rmif ts for on� iEL � llSE IDNE nn�ta . I+undred dellers(SI00)or leas.) � � � OWNER ELLIOTT No.595-7664 .. - No. � . � I certify Ihot in ihe performante of the work for which this �-�- . � SPECIAt -�� - - - permil is issued,I shall not employ any person in any manner AD�RE55 �I($ CONDITIONS � - so as to be[ome subjed 10 the Workers'Compe�safion laws. .-�ISTRItt STAi15TICAL CLA55.''. TYP PROCES BY arr WALNUT zir - c Date . . . Applimnt � ' ARCHITECTOR . .- .. L . � . �SSNO.�f� . NOTICE TO APPLICANT: If, after making ihis Certificafe of ENGWEER FARRELL T. MILE�.994-6278 C ! Exemption, you shouid become Svbje[t to�the WO�kers' ADDRE55 7],3O HASKELL AVE VAN NtJYS YAIUATION '� , Compensation provisionf of the Labor Code,you�mus�for�h- +, . . .. . . - VqLIDATION -� with comply with wch provisions or this pefmi� Sf1�II be � CONTRA�TOR � � �NL �] s deemed revoked. � . - . � - LICENSEDCONTRACTORSDECLARATION. - - qDDRE5�14SO"GOLDEN SPR- ��319O�.H � I hereby ai(irm ihat I am litensed vnder provisions of Chapter 9 �� S , ' . � -- � � � �- . .(mmmencing wiih Sec�ion 7000)ei D�v�s�on 3 of the Business . - GiTY WALNUT� � � QA55 C53'�-� � and Professions Code,ond my license is in fuil force and effect. oeSCeiv7iON OF wORK � License Number 319018� �- �;�.eia�s CS3 � - FINAL �j. , � SWIMMING POOL DATE 7/7r"D � WALNUT POOL� 5-12-86 'sPa - _.. _ ..- } _. J,,. a Controdor ate . FIN/L �Z l�J.O A� U . SQ-FT. py � QI om exempt under Sea � � �� SIZE- - � �- � � � � �� . � �}�• . • •2� -� Q B.BP.C.for this reason i EtECTRICAL . . . . . . . .. .. . . . . ... � a •(1 9.�C) V � Dote: . - . .. W . $i noture � . Steel 8 Conduit Bondinq . ... .. v . ••• s(,� 9(}�_ � 9 Conduits,CondoUors,Eqoipmenf Z � SINGIE FAMIIY � � - � � - . - . �� 0 1� :>_?b _ HOME OWNER-BUILDER DECLARATION PLUMBING I hereby offirm that I am e.empt from the Contractor's license . . _ �`"/ . . =2�j.� �1 . ' Law for Ihe fallowing reason�Secfion 709L5, Business and , � P.Trop J �.�� - � Professions Code): ' Gas Sys�em � . - .. . . �T _ .. . . � �_�:e o • s'.j ' � I,oe owner of the property,witl do�he plumbtng and An�i-Syphon � - �N� G� electrital work.I,or my employees with woges as thelr. . . . . . ._.. ��- � . �� ° � ��`-`� sole compensation,or o licensed contractor will do all MECHANICAL .-� -„�x other work and the struttura is not intended or offered. � ,r� -- ° ' � � -::'--� � (or sale(Sedfon 7044 B8P Code). Swimming Pool Hea�er � j � � . CONSTRUCTION LENDING AGENCY . - �•z� '- �'� I hereby affirm Ihat�here is a construction lending agency(or qpp�ICAM ��, �-- �- � �L � � � � the periormonce of the work,for.which�lhis permil is iswed .I, �pgINT) WALNUT POOLS- �595-7547 , ��, (Sec.3097.Civ.C.J, i . . - . .. Lender'sName - ADDx�51450. GOLDEN SPR.WALNU� . y.. .r lender's Address �� - /n � � `�_ . P.C.Fee S • � Permit Fea l,�' /� � ' I ceriify that I have reod this opplico�ion and state that the � , . -'�`�, _ - . obove informotion is corred.I agree to comply with all County � - - � , � ordinances and Siale laws reloting �o building,�ele[tricol, Issuonce Fea � . . mechanicol and plombinq construdion,and herebyauthorize, ��es+iqaron Fee _ , _ . -� �� - C',�/ � � � ; � '.�:. I�,�. . � representolive5 of thi5 CooNy �o eNer upon fhe above- �� Totol Fee i , , �. � � - memioned properly ior inspeUion purposes. . ._ . . . . . � ... �� .. ._ .. _ _ _ � . 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