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HomeMy WebLinkAbout1637A 2246A (9) i WOnKERS'COMPENSATION DECLARATION I hereby offirm thai I have o re�tilicafe of consent�o self � insure,or vi cert�ficaie of Workers'Compensalion��5��o��e, APFLICATfON fOR COMBINATION SWIMMING-PQOL PERMIT -� or a te f"e�d o�v thqr�q((Sec.3��C.} � � �76n2oB . . ... . . . . . . . ... - . . . c'�� ''b�p�f.xx t--� cee�eiaiaa� Policy No. tompany Tv . COUNTY OF LOS ANGELES BUILDING AND SAFETY � Ca�'ied copy is heieby . � � FOR APPLICANT TO FIIL IN BUILD�NG � �ific�copy is filed 'rh the counr uilding inapec- ADDRE55� — ti deparimenf. BUIL�ING '� AODRE55 LOr'..AIITY� Do Appticont � NEAREST / / - 1 OF EXEMPTION FROM WORKERS ��i �7�!> zir CaO555i. � y //�f�^Z/oL � COMPENSATION INSURANCE � n � SiZE OF - � ASSESSOR TRACT p.S lOT lOT NO. � MAP BOpK PAGE GARCEI . (Tht�s�cfion n�rd no/b�compbNd if�h�pnml tEl. USE ZONE - MAP � - `I hundnd del�an(5100)or lua.) � owNea � Ho. No. -���J � �JY I ceniiy rhot in fhe performonce oi 1he work for which ihis �/ — .. .. SVECIAL . . . . . . permit is issued,1 shall not amploy ony person in any monner ADDRE55 V WNDInONS 50 05 fo became 5u6jeU to 1he Workers'Compenwfion Laws.� ' �.y�n DISTRICi SSATI5TIG4t CLA55 1YPE PPOCESSED BY � CITV �I(.� ZIP CONSi. �Dofe Appliconf ARCHIT£CT I,� N� QASSNO NOTICE TO APPIICANT: If, after making this Certificote af ENGiNEER V ���a �l �1 � EKemprion, you should 6ecome sublecr to tha Workers' �� � � � - YAIUAiION � � Compensatian provisions of the Lobor Code;youmast iorih- ADDRESS . . VALIDATION wilh comply �Ih such provisions or ihis permit sholl be •Tf�� ; 1� b�(� deemed revoked. CONTRACTOR -NO. LICENSED CONTRACTORS DEClARA710N � � ���' � I he�eby affirm Ihai I om litensed under provisions of Chpprer9 ADDRESS NO. s . (commencing with Section 7000)of Division 3 of the Business � CIiY L � �Cl 55 � and Prolessions Code,ond my �.e e is in full force ond effec6 . � - I � DFSCRIPitON OF WORN fINAI - ' Li[ense Nu Lic.Class ��"'/ SWIMMMG GOOI DATE����l`�l5� , Contraclor e ��," S�A FINAL. . . . . .. . ,. ___('l113._ 51�.Ff. .. . . 6Y.. .�� . . . z� 6�.7 FI d p �f — siiE I om eaempt under Sec. p B.BP.C.for(his reozon ELEGTRICAI - � � .� r-. � � �� {#' �O °2 1 � oa�e: � .���� 1 • •4 4,0 9 � Si noture Steel&Conduit Banding � ' � •�e � x 9 Conduils,Conduclors,Equipment � e Q Q QO� W SINGLE FAMILY . - . �S$bq � ' � � HOMf OWNER•BUILDfR�ECIARAiION p�UM81NG - � �.�. . " � O Q.� E',—�}B 1 hereby offirm thpt I om exempt from ifie Conlrodor's licensa . - � � - Z Low for 1he/ollowing reason(Section 7031.5,�Business and P_T�aP _� - ' _ -�� - � _� - . � Prolessions Code); � Gas$yslem . r.xi:YQ . . � � i,ps owner of Ihe property,will do fha plumbing and Anti•Syphon �'�'� electrical work.I,ar my employves wilh wages as Iheir . _ . � � -- - � �. . . sole compensation,or a licansed conlroclor will do oll MECHANICAL other work and ihe struuura Is not inrendad or offerad � �• - � � ��- for soie(Sec�ion 70<I B8P Code). Swimming Pool Heorer � � . CONSTRl1GTION(ENDING AGENCY � � � I hereby offirm ihot Ihere is a constructipn lending ogency lor ppp�ICANT� TEL�' ' ' - the performonce o ih w rk iar which this permii is issued pg� � (se�.sov�,e��.c. � � ' "°. ` � -�2 2 G.6 A Lender'S Nome qppq � �'. i . • �j ' 1 J Lender's Address . /1�/� . , . J • � 7,��,5 Q � P.C.Fee S ,O oermir Fee �xJ � �� I ce�tify tho�I hove reod ihis opplicarion ond s�ote thor ihe � . o � r� above informafion is correct.1 agree to comply wf�h all Gouny . . . O .. . .. " Z %��.��? ! ordinanres and State laws relafing to building, eleClriml, �uvonce Fee . �'� � mechan' an p mbinq consrrucrion,aod hereby au+horize �^��sugonon Fee t-� �� � � � � ��Q,�%—8 fti repre n�afives of his County to enter �on the abave- To�al Fee � � menfi ne p inspeUion pwposes. � Si i�mn�o �� SEE REVERSE FOR EXFLANATORY LANGUAGF _. . . . . / gna�u.e AP7 . /�� , -. . .� .�'�n.:� .., �. .... � .,. . . . . ...�� � .. . .. . -:".., �..- � .... ..... .. . . .. . �. . .. . . '� � �•� PLANS TO APPItCANT � � �� -- � � •� '� lNSPECTOR'S NOTES • - � (" '-"ONINER-BUILDER DECtARATION ��.� • To: , �. .. . .;Raturnbd.. � �. - _ � _ _ I h e6y offvm ihot I-am�enemp�frcm 7t c Cqntrodor'a :.'�� � -. . .. ��. �, ,�� ��.. . , ,.,_.:::,. . -..�.,.,-, li�o Low�for the"follo in� c��s�� (S c. J031.5) '. .. "A rovad � _ _ ...: . . . . AP Buslness nnd Proiesslons Cod A f�ity o o ty�which No.- -. ._.._6a4e_.._ �_ No.-.� .�Oo1e ._._.._ _ .'__' ..._........_._. _.____ ,. ..._. . _..._...�.. ...__ _ . . i , � requires a permil fo construct,afler,�mprove demolish. � .. ,.•. -, c ., _ . - -• -.� .. .... ., . _._.�.., ..,. _.__.._._.' _.� '. '_ ' . _ �or repolr.any structure,�prior�io ifs issocnce..also ra��. ... ... .._ ... ._. _. ._. __ � �-� � - - � � quires'lfieappflconllorsucfipermiflo(ffeaslgnedsfafe� '. ' , ;' i 1 ',- -�.'� . � .. �__'.-_--._ ' '_:__. u•.__�,. _ .. _._._�._ _._ -.�. ...:....:- �. _ �...���,....,, _ . .menffha}RefslicensedpursuaNloffieprovislons�althe i �._.. � � '�i �-�-Canfracfori lltense Law(Chap/cr 9).(comme,ndng wlfh . . . . _,::: . . .� .-..________' _ �._..__ '___ �_—_"_. _ .. _._. ; � � -- - -�--- - �---� �--�-- ---- -� ;-. - � ..._ ecfion]000)of Ovis'on 3�af thv Bustness and P les� S i ro � ,,� f ; �i � �, ,j f _ �slons Code)or lhaf'he Is exempt�here/rom and tbe basts ! . . __.._ _ . . .. ., ._, _.. _ . ._ _. .. � �. . . . .__ _. - ,_ .-... .. - .,. , �f � � , _.-. �_ - - , -. . for;��c alfeged,exemplion.Any vlololion.of Sedion ,__..JNSPFCTION-__. �•DATE:_. ----_WSPECTOR �. ' :�5 � • ��''', .�-': • .i � �..7031.5 hy any appfimnl for a�perm�t subjects fhv�oppl%� � �. {��. � } � . r' l.J!' 1 ��dollars 5500.: hundrnd � - .,. � ,• ' � .:�:..�� , P . y�,��,,. SOCAT&OFORMS -." ' "-_.I-__ __�- ' ."__. 1 v. - , �... .._'.�_"_._. . ..._"__.._ .-. f '� ...,.. '� , canf}o�OSrOWSDIE COtnp�nOpGO�,WiII CJO�hC w�� . more!an ive , , � . ."��I rfy,or m em lo ees wilh ' � wages as their p ork,and - �- � � i.. � � . . � � � � ;., __.. the sirucfure is not iNendod or offered for sole�Sec.70d4) GGHT COIlOUIT ' �� ' '� . � .� �'.,�;. ''.. .; -:'���J; • � ' , . _._...._.. _...,,_ . , .. _ ..__. .__. ._......� � . . . ,_�; � � -�'- . .BuslnessondProfessionsCode:TheGontrodor'sLlcenae BONotNG ; ",;-:,"' . � , / � -. . i � - ���Lvwdoesnolapplyfoonowncro(properfywhobuildsor . ..., . . .... . ... .,. .. .. . i. _____.._ _ '; . '. : _. _ _-_.... � mprove ffi reon an wfio cf svc work imse f or _.. .. __._ , . , �. ��-- .... " ..',.,} s e . d oes h f - . 3 .-., 'Ihrougfi��his-own employees,provided ihal such im- " ' . ' ., .. � � . - .. . , � -' � � ' '.`��. .._-. .-.•' '�� �'..' ....-. .�.' provemenls ore nol inlendod or offcred-lor sale:'�If. � , �,.- however,ihe bullding or Improvement is sold wlthin ane - �� � - � --� ' � � � ��� � � ' �year'�of�complelion,-Ihe ownen6u�Ider wlfl have 1he CON��It �_.�<<� v --- . _ � .., , �„ __, . �,; 6urden of proving 1ha�he'dld nof 6uild or improvo for fhe � ___ .._ .__ .._ _._ .__ ... , ' GAS IWE � ' . .. . • . � purposc o(sale).',. .., .. : � �. . � .�I,.as owner of�he praper�y,-om exciusively con- WATER IINE � �� � � � � - ��rac�ing�with Ilcensed<ontraUors+o cons�ruct tf�e p�ojec� _ __' . ._.... _ � i � SftvEa �� ' � "� � � ` � _ . , (Sec.7044)gusiness anA Professlons Codcr I7he Contrao i � ��- � - � � --�Iori Llcensciow does not apply fo an ownvr of properly ; . ,,, .,,,,__, ...,.._.. . __ ...___ . ��., , .�, who buifds or improves Ihereon,and who confroch�for ..... __ . ..... ._ ..__�_.._____. _ . .._ . � � ' such proJecis wiih o conlroctor(s)Iicensed pursuaM��+o � . _ .. �the CoNracror's Llcense Cow).°� ' ' � � � � , �.,� • _..__ . '_.__ _._.... __ .. . AN71•SYPHON VALVE • � , � � ❑I om e pi nder Sec ,6.8 P.C.for this � � , .., �.� - ..�.�....- , ....._ _ _..__ . ._ �._ . . . . _._ .__-�. ELERitiCWIRES � �,f�' reasOn � FFNCE(HEIGHT) / � � � Do�c Owncr � GATES (SEIFClO51NG � � . . ` ., � , ' ' , . . .. �SEtF•lA7cHINc � INSPECTOR'S NOTES � - � . . . .. , , . .. . � ' '��r . � . . . 4 � �.. � � . /� y.� � .... t . .. . . '..... . . .�_. .. .. � • �.. ROUGH W7RING �Y , .� . _ , �, � .,i , . � � , FINAI FLECTRfC .� �. . � .-. . ..�r -.� • ��...�., . �. ,__. ._ _.._. _____-__'_.. _. - ' ' .._'_____ . _.__ _'_.,� . . . .. �. ., . ._.__. ..- - . . . � . /t. . . . � � . ..�.. � . . � ....; . ..:". �.._,.:._ .'__ _�..:-.'. -.;� � � �� HEATER(LOCATION d YENTj ' `-� ' '•.\ GAS IINF iEST �.� j_ . ..`.'. .' . _.�..�_'�.' . .__�_..� i , .... . . .. . . . �� . . , . � . . ' �, ^AINAGE j: '.� ._' �.i �.. . . ' i..... .� . . . ,. . ��. �.�.'� „� - , . ,,, '. / _ . .. ' .. � . . . . � . . , . . .. . . �i . � . � .�... ._� _... ......... _.. _._... .._.._._..: _..._..... .-. . . � �;' - ' � � . � . _. � � , �- - _' -