HomeMy WebLinkAbout1013A 1077A �� ,..,�__�_ �r..,� _ _ -_ _ .
- COMPENSATION DECLARATION � � �
i hereby affirm rhat I have a certifica�e of consent ta self ,
��S�,e,o�o�e�,�f��a�e of wo�ke�s-�ompe�sa�;o���=��a��P, APPLICATION FOR COMBINAT10N SWIMMING POOL PERMIT
or o certified copy thereof(Sec.3800,Lab.C.) 76A208 ,
�E-875(11/B1) .
Poli�y No. Company COUNTY OF LOS ANGELES BUILDING AND SAFETY
� Certified copy is bereby furnishad � -
Q FOR APPLICANT TO FILL IN BUILDING
Certified copy is filed with the county building insper noDRE55 S��
tion depariment. 61111DING /�r
ADORESS �O� L�/�� S/ . LOCALIiY
Oa1e Applimnf pn , NfAREST .
CER?IfICATE OF EXEMPTION FROM WORKERS' CI7V /p7/'✓JUN✓ia �.Y+�ZIP CROS55T.
COMPENSATION WSURANCE SIZEOF ASSESSOR
TRAGT l0T l0T NO. MAP BppK PAGE PARCEL �
(Tbls a�elbn ne�d noT be compbTsd fF fhe permit is for o�w 7EL USE ZONe MAP
hundrod dal�an(SI00)or leas.) ��OwNEz ��nJ 'r ��G7 NO. "/.S'�y n10. �
I cerfify fhat in Ihe performance of Ihe work fo�which this SPECIAt
permii is issued,I shall nof emplOy an rson in any monner �ADORESS O:s� �U�r 5•/ CON�ITIONS
so as to 6ecome subject�0 7he Wor�ompens DISTRICT STA7ISTICAL C1P.55 TYPE PROCESSED BV
9 �-/,'�� arr �l-4n-to�� lh2zia coNsr.
�Datd��Applican �.GG'-�T't"' '�ARCHITECTOR e TEL. �w���
NOTICE TO APPLICANT: If, aft� making ihis Certificafe of ENGINEER rNAR - ft Rr'�SNO. �36-Q�� �Q �, -
Exemption, you should become subject �o the Workers' VALUATION
Compensotion provisions of the tabor Code,you�must forth- ��ADDRE55 VALIDATION
ith comply with such provisions or this permit sholl be � �L)�J S /-W1S"�NO. s � ��
�deemed revoked. � ' CONiRACTOR
UCENSED CONTRACTORS DECLARATION /� ���� y��^7 - -
ADDRE � /c:.�(/�"r S(�C �PNO. �
I hereby affirm that I am Iicensed under provisions of Chapter 9 f . � - � �� `�`h
(commencing wilh Section 700D)of Division 3 of the Business ��, �p ���tp,ss�-53 i-;� a � �f '
LITY � � r
a�d Professions Co�3����r�s6 is in ful)force and effecf. DESCRIPTION OF WORK ryNAI /7 �` �, c, : 0.
License Number / lic.Class� SWIMMING POOL � pATE �• � ► ' � �-�� r u
❑ _ OC
Caniracfor/'�� ��_" Dafe C��7 O� SPA FINAL r. . . ..,..:�t �. 0
OS�.FT. �j V
I am exempf under Sec 51ZE 't5 SY �`^'= ,—f�'' w
B.BP.C.for�his reason EtECTRICAI S �� � �
Date: (�j '�-S4��
S� nature Steel&Conduii Bonding ,�.t,
. �9 Conduits,Conductors,Equipmenl L� .
SINGLE FAM14Y [ �,:1 C�7.��i ..
HOME OWNER-BUILDER DECLARATION PLUMBING CS�.1�n9,-�111-�
I here6y affirm that I om exempi from the Contracror's License � ,� [� f'o c o c r.�
Low for�he following reason(Section 7031.5, Business and P_T�aP � �d'�`—�' �
Professions Code): Gas Sysfem . � .� ° I E;�.�1�l
� I,os owner of the property,will do ihe plumbing ond Anfi-Syphon p . _.,.,.,_ .
electrical work.I,or my employees with wages as their °� �i b;;��;�i::�
sole compensation,or a licensed confrac�or will do all � MECHANICAL
other work and the structure is not intended or offered , � � � �'��—��' �
for sale(Section 7044 B&P Code). Swimming Pool Heater
CONSTRUCTION LENDING AGENCY
I hereby affirm thot there is a construction lending ogenty for 'qpp�ICANT , ��]n iEL �+
the performance of the work for which this permi�is issued (pp�NT) !l2 j/S�%�-I�''�'jNO. `?����a ► � .
(Sec.3097,Civ.C.). / n
lender's Nome . ADDRESS�L� 7 �/✓CS��� ��.
Lender's Address ,s�,/— � �
�P.C.fee S � Permit Fee J (?
I Certify that I have read this applicotio�and state thof the q ' �
above informotion is corted.I agree to camply with all Caunty issu ce Fae �`'�S� �
ordinanc ond State laws relating lo building, elechicpl, °" �
mech ico pnd plumbing consrruction,and hereby aothorize �-���esngm�on Fee //�• U�
rep sen tives of Ihis Caunty fo emer upon fhe a6ove- 7orol Fee k� �
�io ed proper r pecf n purposes. "
�-.� ���-�- G'z z—�S
Signo�ure of Applimn�or Agen� �a+e SEE REVERSE FOR EXPLANATORY LANGUAGE �
� Pt�'.CtS 70 APPI.IZAN4 � IIVS� 4 NOTES OWNER-BUILDER DECLARATION
To: q,y��� . , � , I hereby affirm rhot I am exempf from the Contrc<lar's
A rQV� License Law fior the foilowing reason (Sac. 7091.5)
PP 6usiness and Proiessions CodA:Any city or counfy whicb
No. _ �cro Pfo. � Dota . requires a perm�t lo censlruct,alter,improve,demolish,
. � . � . or reppir any sirucfure, prior}o Its issuonce, olso re-
'� � � quires the ooplimnf for such psrmif to 11fe o slgncd stafe-
. � - � - � � ment Thaf he Is licertsed pursuont to the provisions of fhe
� � - Confrocfor's License Law(Ghepter 9)(rommencin�wHh
� SecTion 7C00J af�Ivision 3 of fhe Buslness end Proles-
sions Code)or ihaf he is exerr�f therelrom and fhe basis
� � � . - ior 7he a!lsgod examp#ion. Arty violWion ol Sec#'ron
IP�u57'�CTIQFS � � DATfi INSPECTOR � 703L5 by ony opplimro far a permrt subJrcfs�Me ap�ti-
{ tanl to a civU penolfy o�nof more ihan flve hundred -
L6'�f.710K I � - - dollaB($5�0).)'
------ � I � ❑I,as owner of ihe properly,or my employees with
STEEt&FpY,k> . -- .. � woges cs iheir sole mmpensatlon,will c#o the Npark,r�nd
� ihe slrucWre is not intanded or offered forsale(Sec.70b4)
IIGHT COMDtitt�� ��Y•�r- -'-� � 6usiness ond Prciesslorts Code:The Conirodor's License
60�:ElCC i. _, � Low does not apply ta an owner ol property who builds or
� � impraves Ihereon,ar.d who does wch work himsslf or
through his own employees, provided thof such im�
� "'--'---"—� provemeMs ore nct intartd�d or o(fered for sole. H,
'� � � . however,t6e bu'rlding or ImprovemeM is sold wi�hin one
i COKDUIT � � year eP cumplefioq the ovmer-builder wi11 h�ve }he
. . burden of proving fhai he did nof bui7d ar improve!or fhe
CAS LwE ,_j,L Q � purpose of sole). '
❑ I,as a.vner of Ihe property,am exciusively mn-
WAT4R LIr:E —'� � trac+ing with Ilcensed conJracrore to construct iho projecl
� -�(Sec.70d4)8usiness pnd Pinfessfons Code:�.7he Contrac-
SfNfHc tor's License Lcw dees noi opply lo an owner of properfy
'� � � who builds or improves fhereon,and who corttrads(or
such prajects with a ccn�rocror(s)licenssd puasuant to
� the Controrto�'s License Lnw). �
ANiI-,*�YPHO^:VP.LV: ��
�I am exernpt under5ec ,B.8 P.C.for th�is
ELEGTR!:1M1'I�SS !..`--- '� reason
FENCE(kEIGHT) � Dote Owner
GnTes ISeLF-Clos�rac � � IMSPECTOE'S NOTLS
�ssiF-�arctiirr f
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avc�ri uv�x�Nc
FIRAI EtECTk'.0
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'.. HLA7ER(LOLlATiO!�1�VEPJT)� �
GAS LI^J'TEST . .�e,�ZZ,� � � ' '
POOt D;f�ItSAG:
P.YRA.^ I . . . .