HomeMy WebLinkAbout1114A 1432A _ _ . . --- -- -- --- _ _ -
_��,_.
WORKERS'COMPENSATION DECLARAiION �-�� , C�t7vt�� {�
1 hereby o(firm that I have a cerfificate of conseni to self II
insure,or a ceriit�core of Worken'Compensarion��,�,a��e,- - � APPLICATION FOR�COMBINATION SWIMMING POOL PERMIT - � �
or o er d�mEy he ec7( ec.�800,La6.,C.) � 7saaoe�� � - - -
��j I�`w���{� CE01617/84)
Polky No. Compo�y COUNTY OF LOS ANGELES BUIIDING AND SAFETY
� Certified copy is hereby furnis ed. � �
FOR APPLICANT TO Flll IN BUILDING�,�?���Q��DOD
Cerlified copy is filed wiih ihe county bu�lding inspec- AODRESS �
�ion deparlmenL BUILDING p ��� � �
AD'�RES ALITY ^
Dafe�Appliconf � NEARFST , �p�� �
CERTIFICATE OF EXEMPTION FRO WORKERS' CRr .. Lp . � CrtOSS Si.�MI�-f� �/�/�� �
�COMPENSATION IN E TRACT��s7p l07�F lOi NO. O . MAP BOOK PAGE . PARCEL
(Tb(f s�Nlon ns�d nef b�compl�f�d tf tb�p�rmlT It for on� TEl � USE ZONE M.4v . � -
hundnd dailars(f100)or bss.) � OWNEa NO - NO. � � � � -
1 certify tho�in ihe performance of ihe work for which this �/ MO SVECiAI ... .
permil is iss�ed,I sholl noi employ any person in ony manner ADDRES �/ �tl�' CONDITIONS �� �
so as fo become subjecf to Ihe Workers'Compensatian Laws.�� DISTRICf 57ATISiICAI CLA55 TYPE 7ROCESSEO BY
� CITV ZIP .. , CON T. A/^,�/
Oate Applican� ARCHITECT R TEl /O ��A�N�''�J7/� Mns-t//✓�
NOTICE TO AFPLICANT: If, aRer mnking Ihis Cerlificore oi ENGwEER NO. -
• ��Eaempnon, you shouid 6ecome subjecr �o �he Workers' Y�LUATION '
Com ensa�ion ovisions af the lobar Code. ou mus�forih- aO�aESS �
withPcomply w'ih such provisions or ehis permir sholl be L. j/ - �- �, VAUDATION
deemed revoked. CONTRACTOR NO.
LICENSED CONTRACTORS DECLARATION �� '
I hereb affirm that I om licensed under P �OaESS �
y provisions of Cha ier 9 ��� S . . ,
(commencing with Section 7000)of Division 3 of ihe Bosiness [�TY ClASS �
and Professions Code,and my li[ �e is in full(orce ond effect. DESCR TI OF WORK �j.�, �,//
y�� FlNAL /�j
license Number-� Ol� Lic.Class� 5winnMiNGroO� �I.-1l oeT6 '�(-C!� ' ► ' � -� ^:� � �.�A y:
�] a
Con�rac�o���I�� Dafe��/ SPA ' . - � �FINAI � ,' . - �c o• •2� U
O � SQ.FL .. ., . _. .
1 am eaempt under Sec. 5¢E... BY . ..� o •.�9.0 9 Lr
B.SP.C.tor fhis reeson � . . � m < C�, O
ELECTRICAL � � �{���(L'y� °U G�J� V
Dale: � �- � . . . . .
Si oNre � Steel 8 Conduit Bonding � � (1 ��q� . .�D�2 7-$7 �
9^ Condoits,Conduuors,Equipmen� 0� � Z
. 51NGiE FAMILY . . . � . .-
HOME OWNER-BUIL�ER DECLARATION PLUMBING -,� � � � � � �
I here6y of/irm�hat I om exempt from the ContraUor i License -
Law for ihe following reoson(Setiion 7031.5, Business ond P-Trop � � - -
Professions Code): � � Gos Sy51em � � ��,,�� � . . .
� 1,os awner of the properry,wi11 do Ihe plum6ing and AMi-Syphon �_W YI�(���_� � , -
eiectrical work.I,or my empioyees wiih woges os their . ,_. . - G`� V . . . . . .
sole compensalion,or o licensed confrador will do all MECHANICAL J�3�� .
other work ond the struUure is not intended oi offered � �
(or sale�Seclion 7044 88P CodeJ. Swimming Pool Heater � :��A a 2 A
CONSTRUC110N LEN�WG AGENCY . . ni� �3 3
I hereby afFirm Ihot Ihere is o convruclion lending ogenty for APv(iGM T/[L � ' �
the performance of the wo.k for which�his permi�is issued pRiNT V�O� /� � - j � � 7 S Jr�
(Sec.3097,Civ.C.). � . . . . .. . . . .
lender'S Name ADDRESS . . . . .-� ° � �`�'`{"��
Lender's Address p,e Fee E �} ve.m�i Fe� � 5 - � , D 9,G�"a 7
I cerufy Ihm I have read Ihis applicotion ond stote thot Ihe , , � . �, �
above info.ma�ion is mrreU.I agree lo comply with all County � �O' ' . . � -
ordinonces and Stote laws relafing to 6uilding, elec�riml, issu ce Fee - -
mechanicol ond plumbing construUion,and here6y autho�ize �^�esrqaron Fee -- �- � � ..
i
represento�ives of Ihis County to emer upon Ihe a6ove- Toral Fee _ � �
menrioned properiy fo�inspecllon purpOses. � . ��
5� e oF Appll<a�l or nye�r Date -� SEF REVfRSE FOR i XPLANATORY LANGUAGE � .
PLANS TO APPLICANT - �� �- �INSPECiOR'S NOTES �� � OWNER-BUILDER DECLARATION �
I hereby afflrm�thot I om eaemp�from the Gonrmttor's
To: , Refurnod .. . . . � � � License-Law for �he following ieason {S�c. 703f.5J
-�Approved Buslness and Prolesslons Codc;Any clfy or coun�y whkh
„ �--� � No. , - Dufa - � " -� " �� - .� � ' �`-�� ' � � - requires a permif lo cansfrud,oller,lmprove,demolish,
No. '�afe
�- � � or repair ony slruUurq prlor 10 Ifs Issuonce. a�so fe-
� � � � � � qulres 1he opplkont/or such permR�o lilc o signed sfo�c�
. ._ . . � . � ._.. , .. .. � ._ ._ , � . . '�menf that he is licensed pursuanf lo fhe provlsions of fhc
� � � - Conlratfor's�Lkense Low(Chopfer 9)(commencing wi�h
- - - - - - � � -- Seclfon 700D)of Divlsion 3 of Ihe Business pnd Profes�
� � � sions Code)or}hat he is exempf therefro ond 1he bosis
� � , . . for fhe.alleged exempllon. Any vlolatian of Sec�ion
1NSPECTION ..DATE INSPEGTOR � � +� � ' •� 703L5 6y ony appliroN for a permi/subjads the oppG�
�� � , � canf to a tivil penolty of not more Ihon five hondred
tOcanofl ' � �. ' ..�� i. .' . dollars(5500).): . . �
. �� � �[]I;as owner of the p�operty,or my employees with
STEEL 8 FORMS � � � ' �� WageS a5 iheir Sole compensal�on,will do the work,ond
.. ihe sirudure is not intended or ofiered for sale�Sec.704a)
� IIGHT CONDUIT � -''f� � � � �, � . �� � �i � � .., - Business ond Prolessions Code:7ho Con Vacfor i Ucense
eONo�NG � � � ' � . . � , , . �Lawdoesnotepplyfoonownerofpropertywhobuifdsor
- � - � �-' � --� - � improves fhereon,and who docs such work hfmsel(ar
� . � � � � , , through his own�employees, �rovided fhaf such im-
' '� " - � � � - - provemenfs arF „or m«�ded a offeredYor safe. I(,
� , , , , • hawever,ihe building or improve'ment Is sold wi�hin one
CONDt1i7 - � �- yeor�of�'completion, the ownervbuildci will havo fhe
. _ . . - . . . ..,-burden olproving tho�he did nof�6ulld or improve for the
GAS[INE . . ' ' ' ' Purposr of sole). � , -- . -
� . . ❑,t,as owner of-ihe property,am exclusively con-
WATERIWE � . . trocline�with Ikensed�con�rnciors io mnstruct tF�e projec�
SEWEa� � . _ . _ � � - ' .. . . � ' �, ��-lSec.70d4)Businezs and Prolessions Code:The Cantrac
���ror's Lkense Law does no/apply fo an dwner ol property
�//:, , _ , . . . _ . , - ._ . .., wha builds ar Improves Ihemon,ond who confracfs(or
V � such proJec7s wi�h v ronfroclor(sJ licensed pursuont fo
. � � . ` . " fhc Confrador's Ucense Low). ' - �
-�. .• � _. . � . .
, ANTI-SYPHON VALVE � � ' � ❑I am exempt under Sec. ,B.8 P.C.for this
ELECiRIC WIRES �, fea5on
FENGE(HFICHT) � ' Da�o Owner
� CATES (SEIF-ClO51NG 1 ' ' � INSPECTOR'S NOTES
lSEIF•IATCHING/
ROUCN WIRING [t`{ � - � �-
FINAL EIECTRIC '/ . .. ... .. .
... k . � .. . . . . . .
. ;
.'.. . , ..,.. t . . .... . . .. . . ...
HEATER(LOCATION 8 VENT) _ �� . -
GAS LINE TFST / � ' . r . . . . � .. . - . ' ..
'r,�,�nv�
. POOLORAINAGE �I._', - ' . . _ . .... . . . . . . .. .
p-7RAP � � � . �: .
.� � .. l i . . . ... . . .. .._...
� � ' � .. � . . � . •
I
�