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HomeMy WebLinkAbout1616A 1955A (9) ...._.. - - _ _ ._, ;_,.,v;. -�. _ _ . ..��w WMPENSA710N DECLARA710N � � `'� .,���-- � � � � � � � � I hereby piiirm Ihot I have o certificote of consenl lo self � ��� inwre,or a certificoie of Workers'Compensation��5�.an�e, �� -APPLICATION FOR COMBtNAT10N SWIMMIN�,POOL PERMIT - or a ce�li(ied copy thereof{Sec.3800,La6.C.) _ tsnzae � � - . . . �' . . • CE8I6(�/BJI � - . Poticy No. Company COUNTY Of lOS ANGEIES BUILDING AND SAFETY � � CeAiSied topy is hereby furnished. � BUILOING � Ce.rHied copy is filed wilh Ihe coumy building i�tpet- POR APPUCANT TO Flll IN qpppE� 2,2 �J�(�..�, �.0 � tion deportmenl. BUIIDING /' \ 3 . - � AODRESS Z j� I.YPC� QL IOCAIIiV. . Dote - ARP���a�� �t NEARLSi � CERTIFICA7E OF EXEMPTION FROM WORKERS' C�Tv �io—n,v,,.�L / .—ry� Z�v Ce055 ST. - � COMPENSATION INSURANCE � p�( S�ZE OF ASSESSOR TRACT f.�I�3 LOT lOT NO. MAPBOOK PAGE 7ARCEl ..(TAi�s.ceion n��d not bv compl�f•d it th�p�rmit ts fer on•� iei. u5 ZOVE. MAP . ,` �hvndr�d dollors(5100)or I�ss.) OWNER ��� NO.s7�- �Q� t NO. 2���7 , -1 cerfify tho�in Ihe performonce of�he work for which this ry �I � SPECIAL . . . . pe�mN is issued,�5ho11 noi employ any pe�son in ony monner ADDRE55 r/4Jt� l.Ye C K I(J ' CONDITIONS�' so os�o become subje[I to Ihe Workers'Compen tion Laws. ,,/ DISTRI[T S7ATi5iKAL � 55 - iYFf PROCESSFD BY ��ry �,.y..ru�t /J.tr 210 " ' CONST, Date��ApplimM - ARCHi7ECTOR TEL. - ClA55N0.;�� �`''^` NOTICE TO APPLICANi: If, olter mvking ihis erlifiw�e of ENG�NEER .C. Y� N0�,3Lb2.$�/ !J � \" , Exemp�ion, you should become subjec� �o �he Workeri �� � VAWATroN Compenso�ion provisions of the La6o�Cade,yav musl forth• ADDRE55 �OZZ C�i.— �� , 6��•�eNG�s✓�-- �^ . . VAl1DATION .winc �omply with soch provisions or �his permit shoil be /l / iE�� S f J �'7iZ� � deemed r¢voked. CONTRAC70R` L/h.0 �a�l -N0.6 0 Q(r/ i IICENSED CONTRACTORS DECIARATION -I ���' � , ' 1 here6`q offirm that I om licensed undet provisions of Chpp�er 9 aDORE55 0 Voti,� -.er� NO.���fL��2 3 (mmmen6ng wi�h Secfion 7000)oF�ivision 3 of�he Bostness ^� � qC. � � ond Prhfessiom Code,ond my litense is in full force and effecL tlTv ry,�..��t�H. Ctn55 C-� /� DESCRIP710N OF WORK � ���/)� HNAL ticense Number�2-s72-3 li[.[lossy SS SWIMMMG POOL U OATE .. . ��6�,6{� �, �2�,�. � �-' ,eohs-{-Lc.;�p.�ofl -y 3#' �I o o Q.z� a. SPA � fINAt � � � aCoNraUo Date 512E �33` � .. . . er �{� . . �.e .E 3 9 7. a so.Fr. 1 am exe�npt under$ec. � ..� B.BP.C.for ihis reoson � EIECTRICAL . . . .. . . � e c(�::�'�/� F;� oare: . 09,�4-86 t;a Si norore ' �Steel 8 Condoi�Bonding � �. . � 9 Conduits.Conductors,Equipment • �� ' SINGIE FAMILY - � . ;-s� HOME OWNER-BUIIDER DECLARATION PLUMBING , �" � � " - I here6y offirm Ihol l om eaemp�6om Ihe Conhocror's license . � . _ .. rrr---���fff � � . �Low for 1he follow'mg reoson(Secfion 7031.5,Businees ond P-Trop' � � .'y� �� � Professians Code): - Gas Syvem . .. e � ... . ,. � - � 1,os owner of ihe property,will do the pium6ing and Anii-Syphon'. � � etectricol work.t,or my employees wirh woges os iheir . . - �� � � so�e compensolion,or o licensed tonfracror will do all MECHANICAG - � � mhe�work and ihe so-ucture is not intended or offesed �. �.����_��,` - � �� --� � � � for sale��5eclion 704d B8P Code). Swimming Pool Heoter � � � CONSTRUCTION LENOING AGENGY . � � � � � ����r�5�p�� .I hereby otiirm Ihat Ihere is o consirucfion lending agency for qFPtICANi TEL - ' '� � � �� " . Ihe performonce of Ihe work(or which this permil is Issued {vRINT) � ;� �` N0. Q QG/ , ��•o � •e� (Sec.3097,Civ.C.). ' . . . - . . . + tendei s Nome ADDRE55 Z!{O �+R! ✓1�.J.�� JQyJ� . . .. . .. ... . �.°L�G S.rJ� .Lender's Address �1� �\S � . .� . . e e��5,K t7� � P.C.ice S �) Permir Foe 'I�terlify Ihnr I hove read Ihis app�icofion end staie that tha� � �� O 9,� ��b 6 o6ove inio�moiio��s correct.I agree to comply wiih oll County �� Ism <e Fee '.� ordlnonces and Slate laws rela�ing to building, electriml, mechaniml and plumbing construction,and hereby au�horize Invesrgaron Fee . �. � . � � - . representotives of th�s County ro enter upon the above- ToiolFee Q . _ . . . . m�Y ed pr p r�y fo�inspeclion purposes. . � . . . UZ � ^T'U b , . S�gnmore o1 n�or agenr Dare SEF REVEitSE FOR EXPLANATORY 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 !- .