HomeMy WebLinkAbout0907A 1039A ,, - r-�-: - -_� _._ . _ _ _ �/��3� _
WORKERS'COMPENSATION DECLARATION �
, I hereby affirm ihat I have a ceniiicme of�o�se���o,e�f .App���ATION FOR COMBINATION SWIMMING. POOL PERMIT
� insure,or a cerfificate of Workeri Compensation Insuronce,
or a cerrified copy thereof(Sec.3800,Lob.C. �sn2oe � - � � .
CE876�3led)
Poliq No.�,�Company . . COUNTY OF LOS ANGELES BUILDING AND SAFETY
� Certi(ied copy isQereby fornizhed.
� Certi(iad co Is filed with Ihe coum bu7ldfn �ns eo- - FOR APPLICANT TO FILL IN bU1LDING
PY y 9� p ADDRE55�I�
lion departmenf. , BUILDING �
ADORE55 IOCALITY
Date���7 Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' ��TM� � ZiP CRO55 Si.
-� COMPENSATION INSURANCE � 1 51 E OF ASSESSOR
. TRACT� {p LOT LOi NO. �� Mqp BOOK FAGE PARCEL
(This sMioa ns�d not bo complN�d N TM p�rmtf 1�!or on� TEL USE ZONE MAD .
hundred dollan(f100)or Ips.) OWNER� NO. ��O Pp. �� `
I cerlify thoi in the performance of the work for which this SaECIAi
permi�is issued,I shall not employ any person in any monner ADDRESS d 0��l CONDITIONS � ' �
so as io become subject to Ihe Workeri Campen5ation Laws. DISTRICT STATISTICAI CIA55 � 1YPE PRp�E$$ED BY
. CITY ZI� � � CONST
Dale � Appliwnt ARCHITECT TEI. � `^, CLA55 NO^ ` ^�
NOTICE TO AVPIICANT: If, af�er making this Certifimte of ENGWEER V .j �j
Exemption, yo� should become subject fo �ha Workers' Y�tU/�TqN
Compensotion provisions of�he Lobor Code,you must forth- ADDRESS ��
wifh comply with such provisions or Ihis pe�mit shall be � TE. S �// S � VAUDATION -
deemed revoked. CONTRACTOR .NO. — �
LICENSFD CONTRACTORS DECIARAiION uc.
I hereby offirm Ihof I om licensed under provisions of Chopter 9 ADDRESS � NO s '
(commencing wilh Section 7000)oi Division 3 of the Business ���' A �r . �
ond Profess�ons Code,and my license is in full farce ond effecc CITv CWSS L J . .
oEscR,v�ioN oF wo �0 9 Q 7 A
Litense Number Lia Class � FIN� (/' ►
� SWIMMINGi00L � DATE ��/
I '.r6 SPA � #. • • •2� o..�
Confraclar pote� p
� 50.FT. sy A`� � d •J�2.V� V
I am exempl under Sec. SIZE �
6.8P.C.for this reason � ELECTRICAL � �OJV� • ' •5 Z.�� � �
� Do1e: � . O H.2 O`8 7 �
9 � S�eal 8 Conduit Bonding � e �S��q �-
Si nature SINGLE FAMIIY . Conduils,Conduclors,Equipmenl � Z
� HOME OWNER-BUIIDER DECIARATION � PLUMBING �_�.\�
I hereby affirm Ihm I om ezempt from fhe CoMro[ror's license . ,�nl!'1.�J-l-h �
Law for Ihe following reason(Section 7031.5,Business nnd � u� .
� Professions Code): P�Tt°¢ � � � . . �
. Gas System .. .. . . .
� I,as awner of the property,will do Ihe plumbing and Anti-Syphon
, electricol work.I,or my employees wi�h wages as their , . , . .
� sole compensation,or o licensed coNractor will do all MECHANICAL � �� � � � �
other work ond�he s�iucWre is not intended or affered . . .
for sale(SeUion 7044 88P Code). Swimming Pool Heater Q ` � L,� O�9 a
CONS7RUCTION LENDING AGENCY " �
I hereby afiirm ihot�here is a conshuction lending agency for A���Nt TEL � �*• • • • •3
the performance of�he work for which thiz permit is issued (PRiNT) . �.�p, �
($ec.3097,Civ.C.j. , � • 1 8$,0 O '
, Lender's Npme ADORE55 - ' � �'�- -
• •� �aoo�
- Lendei's Address p,C Fee f I Pe.mn ve� -� � 0 8 2 5--II 7
. I certify Ihot 1 hove reod Ihis opplimtion and stale 1ha1 Ihe - � .
obove information is correct I agree lo compiy with oll Couny � I:s�ance Fee
ordinances and Stale lows reloting lo building, electrical, - � - �
mechaniml ond plum6ing construclion,ond hereby auihorize . invesugoron Fee �y'��
represenia� oi thi•( County to en�er upon the obove- io+ai Fee �� �-7�/
i ned e y f f inspeciion purposes. - �
' L�0� � 75/ _ . . .
a
S�g�a�ure of Appl�co�i o.Agenr oo�e SEE REVERSE FOR EXPIANATORY LANGUAGE .
- PLANS TO APPLICAN7 � ��� �� � � INSPECTOR'S NOTES� � �� � �' OWNER-BUILDER DECIARAT10N .
To: .Rafurned �� � I FZereby.qffirm that I�om exempt from ihe Contrador"s
� - � � � .� ',L'iSensp' lqw��fo�;ihe fvllowin'��',.rcas6r�`{��c. 7031.5)
� Approved � ��6uslnessondProlessionsCodo:�!nqNfyorcountywhich
No. � -Date•.t �� � No. Do�ai:: . .. . ... _. . . ._ .. . . . .....__" ..._....__,
� . . ,. _, : .•, �, ..
requires a permif fo tonsfruc�,olfer,Improve,demolish.
• � . .�. '�1�.�,1.� � .•�� . . _ .� . _ .. .. � "•or repvir ony s�ructure, priar to Ifz Issuart[e. afso}e-
. � " �\\ �,����, quire�fhe ap�6canl for such permit lo file o slgned slote�
� .. . . . . . .. ... .. . .. . �- - , men�}hat hcYs limnse��ursuont to Yfiq provislorts of}he
� ' `����� `.'3 �i... - ,"��, - �� ConfratfoYs Ucense Low(Chapfer 9)(tommencing with
.-.- . . . -.. . . - . . `.�. �-..�. ..i.� - ��.� . �.,... .... - Secflon 7000)ai Olvision 3 0l ihc Buslness and Proles-
�� � ' � � sions CodeJ or that he Is exemp�lherelrom and the bash
- � - � - t � � - � . � for.the.alleged�ezemptlan..Any viofofion.of Setfion
INSPECTION - .'DATE INSPECTOR�` '�`'`•��\� �����-'`�-� '��'`��� ����'�� 7031.5 by any oppfimn�,for o�permu su6�ects the applr�
� . � - conf,}o a Uvif penalfy o1 nof more than Ilve fiundred
tOCaT10N Z . . .. . . -_ ``\.�l �,� � � dollars(5500).): _ . .�
� . . , � ❑I,as owner of the property,or my employees wiih
57EE�8 FORMS � weges as lheir sole compensotion,will do the work,and
LIGNYtON0U1T � ,�.�,("•'-;��.� :`�.,�,t.'"�.',.\� �� �=1�^ � _ , � 1he structure is not intended or affered for sole(SecJ04a)
8usfness ond Professions Code:7he Confroc�oi s Lfcense
BONDING � � � ' �!�'' �\'Y't;•. 1.`t.`� • i' r,\�� �2awdoesnofapp(ytoanownerolpropertywhobWldsor
� - 1��i"�`r�'�`���,•-�• - - � "� �"��� � � � �� � tmproves thereon,and who does such work himsol!or
� ' - . ;.\• ..�,,� ..i_,_��.,�.�, , 'fhrough hfs own employees, provided IhoT such�Im-
, ' � - - pravementr are nof lnlended or oHered for�sale. If,
. - ... . . • � �.�. . .
�-� �-.� ..�� . ,� ., .���.r', '_ however,the buildfng or ImprovemeM is sold w(fhin one
CONDUIT t ,�--.\ -yeaf o�complefion, 1he owner-buildcr w�fl hovo fhe
. � - -• � �ti ..__ . __ - -- burden of proving tho�he drd no�butld or improvo lor ihe
GAS LINE . , � p�rpOso of safe). f �
E ='[]I,as owner of tqe�roper{j�'om exclusively com
. WATER LWE . . . . . . •'�' � . . . _. '. _ _ '
_ trotling�wi�h licensed mnire�ctors fo conslruU the project
�-}'-(Sec:�7Q44)B,usiness ond Prolesslons Co[�e;Th�e Confrac-
SEWER � - . ��t������•��•.`.�- "- " � .� �or'i Llcens'e!ow doer'noYdppfy'to an owner of property
� . .. . . . _ _ . .. , - ... __ . . . �'who butlds or tmproves Ihereon,and who controcfs!or
� such projecfs wilh a conirodor(s)licensod pursuan�ro
' -- � � , '��the CohlroUor's ticense Law). � ,
. � ' ' . � ' _ . � . .... _
n�71�5YVHON VALVE � � ❑I am exempt under Sec. ,B.6 P,C-for this
� EIECTRIC WIRES reason -
FENCE(HEIGHT) � Dafe Owner
Gq7E5 f SELFCLOSING 1 � - - �- -- . - INSPECTOR'S NOTES ' �
�SELF-LATCNING J
ROUGH WIRINC , .. ., . . . _ .
FINALELFCTRIC /S� � . . . ._ . . _. _ .._..
.. . . ... ..... . ...... . .....�. _.. , . _.
NFATER(COCA710N 8 VEN7) (l .
GAS LWETEST . ' -'-.'. . -.. � ' . •'. ' .
POOI DRAINAC[ � S �� _ . . �
P•TftAP
�'.. . ... ,..��..i I�.•