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HomeMy WebLinkAbout1819A 1820A i5'COMPENSATION DECLARATION - � ;a',e of wo ke 5-'�om'��5a°o���s��o��e` APPLtCAT10N fOR-COMBINATION SWIMMING POOL PERMIT •y fhereof(Sec.3800,loh.C.) � �e�zos � � � � � � � - �� �- � �� - � - � CE078(9/8a) •� Company� �`�'��`� COUNTY OF LOS ANGELES BUILUING AND SAFETY �py is hare6y furnished. �.topy is filed wi/h ihe counly building InSpee- FOR APPUCANT TO FIIL IN �DDRESS �S�! �e � � �37 :,artment. .. BU�LDING r/rfi ADDRE55 d J a IOCAUTY .. ���,Applicanl NEAREST -^ERTIFICATE Of EXEMPTION FROM WORKERS' . ��TY � Ziv . CRO55 St. COMPENSATION INSURANCE rRAn 3//'�j �OS�F lOT NO. � MAP BOOK PAGE PARCEL . ��i�cNon nMd not be compbf�d if fh�p�rmit I�fer oe� 7EL. USe 20NE M,4P . `L - . .�d��d dollen(S700)or I�s�.) . � - - OWNER ../C��t�� NO.t�I!'�'.713 NO. T' �� ��ertify fhar�in the performonce of ihe work for which this . SPEOAL �� permi�is issued,I sholl nof employ any person in a�y ma�ner AOORE55 CONDI710N5 so as fo become subjec��o�he Workers'Compensafion laws.. � � DISTRIC7 STAnStiGai C�a55 irae 7rsOCE55Eo Br . . CITV ZIP QASS NO CON57. Date APPlicanl RRCHITEQ O�% /�� � �Tft. �� NOTICE i0 APPUCANT: If, after making this Certifimte�of ENGMEER j�J�G[•c 7 No .���oz�� �1 a � -Enemption, you zhovld bemme subjed lo �he Wo�Gers �- " �� V71q1A110N Compensation provisions of 1he Labor Code,yov must forth• A��RESS �/OZ7..r /��/�� . . VqUDAT10N i1h comply wilh such provision5 or Ihis permil shall be � � TE�' S ��—�`�\./ deemed revoked. � CONTItALTO .NO��J 3' LICENSED CONTRACTORS DECLARATION � ` /'_ ���' ADDRESS cJ3a �CX/�-o N0.3SUISTJ � f �'S .1 hereby offirm fhot I om licensed under provisions of Chaptar 9 � ���, ' - � , .(commencing wiih Section 7000)o(D�vis�on 3 af�he Business�� �� - � � � nqSS �.�� �-. _ _ �L�,yo . � ond Professions Code,and my license is in f�ll force ond eHad. DESCRiP7iON OF wORK � " �SZ�'�S�CJ -C�� I �1� FIN����� ►. :.`.�� ��.C/A ' �license Nu er Lic.C�ass SWIMMING POOI L�-f-A� DATE / . a Gj��`��p-/ SPA' l=J FINA �r n < •'o'z� O Contmcror Date�J-�1 Y �,FT. . . . . . � _��� V . ❑ er � 0 •5281 � I om exempt under Sac. SIZE B.&P.G.for this reoson � ELECTRICAL � �. "� �� � ��4'S�.�1 � O Oo1e: g �r� �/J r �i 'n.,n 9"Pi b � Steel 8 Condoir Bondin � ��y .�✓ p" � Signorure Conduiis,Conductors,Equipmen� � � � � - � ' - . Z . . SINGLE FAMILY � .. . .. . - - . .. - ' �L/� . - — HOME OWNER-BUILDER DECIARATION PLUMBING -► 0 b - 1 hereby affirm Ihot I am exempt from the ConlraUo�'s license � .. . . . .. . . . . . � law for the followin9 reoson(Section 7031.5,Business and p_T�aP �� , � � �� �2�Fl Prafessions Code): � � .Gos Sy3�em . . . � . _ - � I,ns owner of 1he property,will do ihe plumbing and Anli-Syphcn eiedricai work.1,or my employaes wi�h wages oa Ihair , _ ��c o r e e j sole compensation,or a licensed contractor will do oll MECHANICAL � ' � • � �j�.Q Q olher work and Ihe structoro ie not intended or offered � � � - ' . - � �' - � � Por sale(Section 7044 B8P Code). Swimming Pool Heater � „ � • -.:•E-„-.'� a„�� ��Q�� CONSTRUCTION IENDING AGENCY� � � . - - . � I hereby offirm thot there is a cans+ruction lend�ng agency for qpp�ICANT . 7EL � � �'��9`8 6 the performonce of ihe work for which Yhis permif is issued (pRWT) NO. , �Set.3097.C�v.C.). � '. ... . Lender's Nome ADORE55 ' ' ' ' - � -�- � � ' � Lender's�Address �-� � ,�7�� � . - P.G Fee E SZ��I Fermii Fce ��'� `� I cerHfy�hai I hove reod this opplimrion ond sfate fiot ihe , r � ,. •• ` . . . obove informalion is corre<L I a9ree lo comply wilh all Counry- - � -"� " -" is�va�nce Fea �u� `S�� ' � ordinances ond State laws reloteng to building. elec�ricul. �n.eer � Fee . ' -.. . . mechanimt ond plumb�ng const.uction,and here6y avthorize 9piO" -. . . 8�'('J � �epresentotives of ihis CouNy �o enter upan rhe obove- To�al Fee menli ed p�ope�y ec on purposes. �. . _ . . .. . .._ . . . i�, � � poie , -��SEE REVERSE FOR E%PLANA70RY LANGUAGE '�� P[ANS TO APPIICANT � INSPECiOR'S NOTES '� OWNER-BUILDER�DECLAR, To: Refom�d � . .. . , , I hereby offirm 1ho��om exemp�fror A rov�d Licensa Law for iho.foliowing reasc _ PP _ , . _ __ ,,_ . , ,_,_. . ... .. Bu:lness and Professions Code:Any cl�y No. --Doto� � No. �afe � . .. � requires a permif to consfrucf,alter,Imp, . .. . .---.. . . . _. . ' oi repvlr ony s�rucfurc,prlor 10 Its lss� � •" �- ' - ' qoires fhe oppliconf for such permif fo(ile c - - - - . ._ . . _. . . . Tnenl�lhofheisfitensedpursuanifofheprov. Controc�or's Liconse Law(Chapfer 9J(iommE - - - , Sectfon 7000)oi Divlston 3 of Ifie Business an. � � � � ' � � ��•� sfons Gode)er Ihvf he Is exempf fherefrom and ih. � , ,for the alleged exempfion. Any vlolofion o! S. INSPECTION � : .DATE" 1NSPEC70R � - � � 7D3L5 6y any oppllcanf(or o pe�mt�subjvtfs fho o� canf fo o clvil penoNy of nof more fhon tive hundr. LOCATION .. .. . - 'flollars($500).): '. .. , • ❑f;as owner of ihe properfy,or my employees wi�h 57EEL 8 FORMS . ' � � woges as their sole compensation,will do the work,o�d ❑GHT CONOUR � . . , � - � � , . - -tha strotture is nm in�ended or offered for sale(Sec 704A) , - - � -�- Buslness ond Professlons Code:ihe Conlrattor's llcense BONDWG ' � . .- . - � � - � , � Lawdoesnolopplyfoartownerofproperfywho6uildso� � --- � - � � -- �- � �'� fmproves Ihereon.and wFo does such work hlmseff or � /--/"`-'--�- • � , _, -. Ihrough hls own employees, pro�7ded thaf sucb im- � , - � � " - - provemen6 ore nof ln�ended or o(lered lor'"safe, f/, ��. .. . howeveq Ihe bu11ding or Improvemen�fs sald wl�hln one CONnuti '�• �yeor of'completion, ihe owner-6utlder wil!have �he ��^�� � � _ . . . . � . . . burden of provtng fhof he did nof bu7fdor Improve tor Ihe GAS IINE ' ' ' ' � � p�rpose of sole). - , „ � , ❑1,as owner of Ihe.properly,:am exclusivoly con- � WATEe qNE � __ �_ ., . � � 1rotling with Ircensed contradors�o conslroci ihe project � {Se2.�70�e)Business ond Prolessions Cade:The Contrac- � 5£WFR ' �- �-,�;�. - ��"t��or i Llcense Low does nol opply fo an owner o!property . . . . , . .. _. . . . . � _ . . who 6utids or fmproves ihereon,ond who contracfs for �such proJeds wrlh o tonfroctor(s)licensed pursuonf�o _ 'the Cvntrodor's LRe�se Low). - ANTI-SYPHON VAIVE . . ❑I am exempt under Sec. ,B.&P.C.for this EIFLTRlC WIItES � rcasan � FENCE(HFIGNT) � Date Owner 4qTE5 �SELF-CLOSING � -� - . INSPECTOR'S NOTES - SELFdATCXING ROUGhI WIRING , 0�., i ._ � . . . FINALEIECTRIC 'jf'> �Lr—�-- . _ ... . . _ _.._..-. , , , . , HEATER(LOCATION 8 VEN1I . .�... . .. � . _...- . _ . . GASIINETE57. �p ---. .. � - ' . . � '. " . , , . �� .. POOL�RAINAGE . _ ' _ .. . __'_ _ . . . , , � P-TRAP . . , , ., . \��_ `, �