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HomeMy WebLinkAbout1616A 1955A . .-....�... _. _ . _ ._... ..^��l�yt.+�r -i. - ._ . . . � .. ..��w WMPENSA110N�ECLARA710N � � `'� .,���-- � � - � � � � � I hereby oiiirm Ihat I hove o ceAifirote of tonsent�o self ' ��� inwre,or a certificoie of Workers'Compensation��5�.an�e, �� -APPLICATION FOR COMBtNATiON SWIMMIN�,POOL PERMIT - or a ce�li(ied copy thereof{Sec.3800,Lob.C.) _ isn2ae � � � - . . . �' . . • CE8I6(�/BJI - . Poticy No. Corripany COUNTY OP lOS ANGEIES BUILDING ANO SAFETY � � CertiSied topy is hereby furnished. �� BUILOING � Ce.rHied copy is filed wi�h fhe couny building i�tpet- fOR APPUCANT TO FIIL IN A90RE55 .2.2 �ii.cs^�v �t'L � tion departmenl. BUIIDING /' \ 3 . - � AODRESS Z j� I.YPC� QL IOCAlI1V� . Dale - Applicant �t NEARESL � CERTIFICA7E OF EXEMPTION FROM WORKERS' C�Tv �io—n,s,.,.OL / .—rL� Z�v Ce055 ST. - � COMPENSATION INSURANCE � 2�"j 52E OF ASSESSOR TRACT LOT l0T NO. MAPBOOK PAGE 7ARCEl ..(TAi�s.ceion n��d not bv compl�f•d it th�p�rmit ts fer on•� iei. uS ZOvE. MAP . `` �hundr�d dollors(5700)or I�ss.) OWNFR ��� NO.s7�• �Qb t NO. �'3��� , -1 cerfify tho�in Ihe performonce of�he work for which this ry �I � SPECIAL . . . . pe�mN is issued,�shvll no1 empl0y any pe.son in ony monner ADDRE55 r/4Jt� l.Ye C�C I(J ' CONDITIONSr' so os�o become subje[I to Ihe Worke�s'Compen tion Laws. ,,/ DISTRI[T S7ATi5iKAL � 55 - iYPE PROCESSFD BY yA�,�/—y[ CITV (.�l-��'+-��t !J•'�.! 210 " ' CON57. Daten_T�ApplimM - ARCHITECTOR TEL. - ClA55N0.;�� �`''^` NOTI�CE TO APPLICANT: If, olter mvking ihis eAifiw�e of ENG�NEER .C. Y� N0�3Lb2$yI d � \" 1 Exemp�ion, you should become subjec� ro �he Workeri �� � �� -; 6 G VAWATroN Com enso�ion rovisions of the La6or Cade,yao musi forth• ADDRE55 IOLZ Ctc� t-•c+�eN ts✓C.. P P /l ♦ /� tE� . VAl1DATION .with comply with soch provisions or lhis permit sholl be � CONTRaC70R l L/�C !'t•a�l -N0.6 0 Q(/ s �� �� � deemed revoked. .. . . t IICENSED CONTRACTORS DECIARATION � �/ ���' � , ' ADORE55 O VOw -.e+� NO.���LS`�Z 1 here6`q offirm that I om licensed undet provisions of Chpp�er 9 ^� � ��� 3 - ��� . �� � (mmmen6ng wi�h Sedion 7000)of����sion 3 of ihe Bostness Citv �,c..��t•H. -� Ctn55 C-S� � � �� - � and Prhfessiom Code,ond my litense is i�full force and effeci. DESCRIP710N OF WORK � L1cen5eNumber�z-s72-3 Li[.[lossy sy ' HNAL + ��(y},(�� SWIMMtNGPOOI Q OATE � `��C�, ► 1-� ,�o�s'{-Lc..�p.�w�) -�I 2�' �o o c r z 1 a. SPA � fINAt � � � CoNracio Date SrzE �3}` � .. . . er ��� . . �.e e��9 7. � aSO.FT. 1 am exempt under$ec. � ..� B.BP.C.for ihis reoson � EIECTRICAL - . . .. . . � e c(��:�'�/� F;� oare: . 09,�4-86 t;'a Si norore ' �Steel 8 Condui�Bonding � �. . , 9 Conduits,Conductors,Equipment ' �� � SINGIE FAMILY - � . ;-s� HOME OWNER-BUIIDER DECLARATION PLUMBING , �" � � " - I here6y offirm Ihol l om eaempl 6om Ihe Conhoc�or's license . � . , .. � � . �Low for�he follow'ing reoson(Secfion 7031.5,Busineas ond p.T�ap, . . .� -� . Professions Code): - Gas Syvem . .. � ... . ,. � - � 1,os owner of Ihe property,will do the pium6ing and Anii-Syphon'. � � eleclricpf work.�,or my employees wirh woges os Iheir . . . - �� � � so�e compensolion,or o licensed tonfracror will do all MECHANICAG - � � o�he�work and ihe structure is aot intended o�o(fered �. �.��`:; - � �� --� � � � for sale��5eclion 704d B8P Code). Swimming Pool Heoter � � � CONSTRUCTION tEN01NG AGENCY . �� � � � � ����r�5�p�� .I hereby otiirm rhat there is o consirucfion lending agency for qFPtICANr TEL - ' '� � � �� " . Ihe performonce of the work(or which this permil is Issued (vRINT) � � �` NO. 8 QG/ , $�•o � •e� (Sec.3097,Civ.C.). ' . . . - . . . ' tendei s Nome ADDRESS Z!{O �+R! ✓ty-�� 1Q��+ . . .. . . .. ... . �.°L�G K.rJ� .Lender's Addre:s �1� �`S � . .� . . e i��5,K(��, � P.C.ice S �) Permir F¢e � 'htenify Ihnr I hove read lhis app�icot�on end stoie fhat the� - �� O 9,� ��8 6 o6ove iniormoiio��s correct.I agree ro comply wiih oll Couny �� Ism <e Fee `.� ordlnonces and Slate laws relo�ing to building, electriml, mechaniml and plumbing construction,and hereby authorize Invesrgaron Fee . �. � . � � - . representotives of tbis CouMy to enter upon the above- Totof fee Q . _ . . . . m�Y ed p�p��y fo�inspecfion purposes. . � . . . 0 C '�F'�'�o S�gnmore o1 n�or agenr Dare SEF REVEitSE FOR E7(PLANATORY LANGUAGE . ' ' PLANS TD APPti[AN7 � lNSPECTOR'S N07E5 � � ' -OWNER-6UILDER DECLARATION'� � 70: , ` Rolumed , . I here6y af£irm�fiot I om oxempr from the Contracror's,- . Approved Ucense law for the following reason (Sec ,7091.5) 8os��ess ond Professlans Code:Any city o unty whlch No. Oate "-- Ne. -Dafo �. . � � - -.� � � � �- � �� reqWres a permR to construct,ofrer,Impro e,demolish, . . . . _ _ _-. . . .... . � or repalr ony'sirucfurc.prior b tfs Issuanre,also re qut�ez Ihe oppllcant far such permtt ta 7ife o signed slafe- . . . __. � .` . .. .. ._._ __ •� . .. , � � �� _ . ment Ihat he is Iiconsedpursuartf to Jhv provisions oi Ihe Conitoctor's License Aaw(Chapfer 9)(commencing w7fh - - - - � - � . - - � Secflon 7000)ai OWfsfon 3 0(tbo Bus(ness and Profes� ' � � � � ' sfons CodeJ or thaf he h exempf Ihere/rom ond Ihe 6asls . . !or 1ho affeged oxempflon. Any-vlolaffon of Sedlon . INSPEC?ION - -OATE� _.INSPEGTOR . "��' � 7031.5 by any applimnt for o perm�t subJetls}he apyli� ' � � � � canf to a Nvil penoBy o1 nof moro}hon five hundred L000.ilON - --1 ,�'j �-� - ':��.- �� •'J ' � dollors(5500),): . � . -.. - ❑1,os owner of 7he property,or my employees with STEEC L FORMS , i,�,'��. f �- '�� - � wpges as�heir eale tompensallon,will da the work,and �� � .��� � , �. • � the atructure is nat intended or offered for safe[Se4 704a} ❑GN7[ONOUIT �� �� . � " -' � � : � �'�l�1 . � Buslnass ond Pro�essions Code:Tfic CoNraclor's Llcense aoNoiNe ✓� � , ' ' � ,-. . Law daes no�appfy io an owner o1 p�operty wFo 6wlds or - - � -� ��-� ' � - � � improves ihereon,and who does such work hlmself or � �� ' � � �� , , , � , _ .. , through Ms own employees, provided thal such Im-- , � - - provemenls o not IMended o offered for sale. fL ,. . ,.�,,�_, . � , however,fhe bui�ding or Improvemerola sold wiihM one CONDUI7 (��l(_ < - �,p1'�Jf�. , � yedr of compleflon, 1he ownenbWlder will hove fhe �r'�, � . . . ��6urden of proving thot he did not build or lmpruve for fhe GAS UNE,'y�C, `:''� � � Aurpose ol�sale). � ' . ' � � (02C'�;C, . , .. � -.❑1,as owner of(he,property;.om exdusively con- WaTER UNE ' - � �racfing with i�censed con�ractorz�o conslruct 1he pro�ec+ SEWER . - � ($ec.704dj-Buzincss and Pra(esslons<ode:�The Confra<- - - tor's 17censc(aw dacs no�opply ta an owner of properly � . . . .. . _ � . w6o 6uilds or lmproves lhereon,ond who coNrocfs,-lor � svcb projetts wi�b o controtror(s)lirensed pursuan!�fo � 1he Confrocfor's Lfcense CowJ. - . •y ANi1�SYPHON YALVE ��2��.� ��^� ❑I am exempt u�der Sec. ,6.8 P.C.for this �.^,v' � Et4CfRiCWIRES • � . . .reoson ... .. �' FENCE(HFIGHT) ��/ m r�:i`/ , . � Dale Owner GATES (SEIF-CtOS�NG � �- �' ' . . lSElf.IATCHING� 4 INSPECTOR'S NOTES FOUGH WIRiNC - � � FINAI ELECTRIC Z�`j� (�.� _ . . . . . �.,. ., . HEATER(IOCAl10N 8 VENij ' �� ¢- � - . . ' . .. .. .. � . .... GAS L�NE TEST � po �� . .. '.l� . �_ . . ''' __. . .�_. , .. . . . , ... � . .. POOLDRAINAGE 1 S�'�. �_1"` ' __' .. . . . - .. . . P•iRAP !- .