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HomeMy WebLinkAbout0955A 1341A (5) _ _. .. _ _ _- -__ .. ____ _. ._ �___,---.___.�________�,___ _. � - --.J---. j %� WORKERS'COMPENSATION DECLARAT�ON ' ' � I hereby afFirp tha�I have o certificate�of consent ro self ApPLICATION FOR COMBINATION SWIMMING POOL PERMIT �j insu,t�,or a tertdicpte of Workeri Compensation Insurance, - or p c rtified��of Se�3800.Lofq_C.)/1�- 75n20e � . . . . . ., .. . . (�. I'� cee�s�ie+� � Polfc mpany �V � � COUNTY OF LOS ANGELES BUIIDING:AND SAFETY ��/C�ertiiied copy is hareby furnishad. �"�1�� � � ' � ��� �y��`-ertified ropy is filed wi e ou uild ng inspeo- � � FOR APPLICANT TO FIIL IN - . qpppE� S� � �.C 't' ! I n d porf ent. BUILDING /1� /'� �, /7 � A�DRESS S�O �-Gi _(�O l�`C�"J� IOCALITV �t�Fj O F-n-- �A�`-' Dot Appiicant n� ^p , CERTIFICATE OF EXEMPTION FROM WORK S' CITY A �L�J 'JI'+I-� 21P . -� CR0559T. � �%� , COMPENSATION INSURANCE TRACT 3I J-�-' lOT� LOT NO. Q .- MAP BOOK . PAGE PARCEI (ThI�s�efion nNd not 6�compbt�d H th�p�rmi�b Fer on� • TEL. u5E ZONE MAP,-.- .. ..i�O � � �undr�d dollan(SI00)oi loa.) OWNE � / NO. NO.- � � I cerlify thof in the performance of ihe work for which this /' l� � SVECIAL� -.� �� � - permil is Issued,I sholl not employ ony person in ony manner ADDRESS �S�u ��I..�.PQO'� Lf' 1 . CONDITIONS so as to become subjec7 to the Workeri Compensalion Laws.- �r � DISTRICT SiATISTICAt QA55 TYPE PROCESSED BY CITY �\ �1.l.PN� r.�V ZIP ' ' CONS7. . . Oate Applitanf - ' - ARCHITECTplt TfL � �� {/� .ClA55N0 NOTICE TO APPLICANT: If, ofter making this Certi(icate of ENGiNEER � ��L�S No.��� lV '�� Q, Exemplion, you shovid become subjecf to Ihe Workers' p� � - - �� VAlUAT10N � ' � Compensotion provisions vf the Lobor Cade,you musl iorih- AD�RE55� �-t G �" � � . __ .yp��DAT10N wilh comply with such provisions or Ihis permit sholl be tE�� � � � Sq�c� �� deemed revoked. COMRACTOR C�_ NO. _ IICENSED CONTRACTORS DECIARATION � ���� � '� ADDRE ^JUYk P10. I heraby affirm thal I am licensed under provisions of Chopter9 ��� f-- � � � -� --� � � � � -� - � - - (mmmencing wiih Section 7000)of Division 3 of Ihe Business CITY Vti P� MSS - ' � - and Professions C e,and y itense is in full iorce and effecl. pE�RIPTI OF WORK � License Nombe lia Closs FINAL . �Q 9�5� SWIMMINGPOOI . . � . .. � DA 2����� ► �•a • �G J Conlractbr � SPA . . . . . .� FINAI . ... . . } SO.FT. Q/]C_7 . ... . . ' . 6Y . . . . . I e °G G.Fi� O � I am exempt under Sec. �,7+V SRE �T{ . V �. . o E L',e� �; U B.BP.C.for�his reason Dare: ELECTRICAL � - - . . . �' �.C.� .. �5�.'�. �-- �_..0 2.1 ,�-.8 8 � S�eel 8 Conduit Banding � -� � � � ' U Signolure � Conduils,Canductors,Equipmenf � � - - � - � - W SINGIE FAMILY . . _. � ^ p - 4 HOME OWNER-BUILDER DECLARATION pLUMBING � ' .�1 � � � Z I hereby affirm that I am exempt from the Contractor i License . . � ►� � � ' � —' law for the fol�owing reason(Section 7031.5, Business and P_T�oP � � , - .�" � � . Professions Code): Gas Sysrem . . . . ; _� .. . � . � ' �� � I,os owner oi ihe properly,will do ihe plum6ing ond AntiSyphon � electrical work.I,or my employees with wagas os iheir . . . . . � -� � �, � � � �- � --� � -- � sole tompensation�or o licensed coMrocror will do all MECHANICAL � . other work pnd the strucfure is not inlended or offe�ed � - �� � � � � � � � � (or sale(Section 70�4 B8P Code�. Swimming Pool Hea�er ._ . . . . � . . . , . . . _. . <� 'J�«� �i� CONSTRUCTION IENDING AGENCY � I hereby oftirm that there is a constroction lending agency ior AP��� i TE� . . . . .. tJ s s s .�.3 Ihe performance of the work for which this permit is issued ppiM , . NO. t � (sec.aoe�,r�.C.� I(n o � � , _ I ' 1-b a C 0 lender's Name� ���-�` - ADDRE lo I_� � �� . � . . . . . . . � ` • 1 6�.00� lender's Address p,[,Fea S �[. Permit Fee I � � � �� - � - 0 9.p^c-8 8 I certHy tho�I have reod ihis opplicaiion and state�hat ihe -� obove informo+ion is correc�.I ogree to tomply wifh oll County � issu ce Fee � � � - ordinences ond Sra�e lows reloting fo building, elecfricoi, � - ' mechonical ond plumbing conslruction,and hereby authorize In�euiqm�on Fee �n � � . - .. . . . . . . .. . . . represe otive f lhis Counfy 10 ent r upon the above- Tmal Fee meNione ro or inspeclion p s�. , s�qna��.e o nppu<a�i .aq�� � oa�e SEE REVERSE FOR EXPIANATORY LANGUAGE � , _ ,. . , -�PLANS i0 APPLICANT �' •� � - � �� INSPECTOR'S NOTES � � - ' ONINER-BUILDER DECLARATION ' ' To: ,Ro�umcd„ I hereby affirm��ia!I om cxempt from fhe Conhacb�s � -- - License Low for �he following reason (Sec. 7031.5) '..-. � . -�•,..,�s ..,;.. ..� _ . .. ... ��Approved --Buslness and Profei{ions Code:Any city or counly w61ch No: _.__"_�ate_',...:__.No: __'_Oato._..�.: .'_.____.':':'�.. �...__.......-__�� -.if .'�__.. . __ � ..._ . , . �,�� l 1��� reqv7res a permil fo consfruct a17er,improve,demolish. �_._..�______—_ _:_ _ . _-.:__. __� _. ___� '_"'_ .. __. 'or�repo:r any s�rucfure:prfar lo i�s.issuonce. olso re -. \_ _ .f„ � / . . }�T.N � r� quireslheoppliconHorzuchpermifroflfeasl�nedslale- . , :, , ..,� , �. �, .,., ---__-__.____ __. . _—_____._. ._�__ . � � - � � � menl ihaf hels licensedpursuonl fo the provislons of fhc . _____ - ___ � . � ' � ' � � � j - -�Confractori llcense Low(Chopfer 9)(commrncing wllh '_._____—_-, . -_-__ -�- r.��.-__-_.____ ____._ 1 _- . __ _ -- 5 _i .,- -- --��-- -� - Setllon 700D)of Divlsion 3 0l tho Buslne a ond Proles- i � � slons Code)or lhpt he ts vxempf fhcrefrom ond the basis „-,.._� , . : .,. t ,. . , '__ .. ___ . . ____ _.._.__._. � � .� � � - - -� - -� . - �-- �� � - ---, , , for Ihe.alleged;ezemp}ion. Any viololion�ol SeUio� , . . . . - .:. .. . . . ,_JNSPECTION _.-.___ _'DATE__ ..—__._INSPECT r> � � ' %'. � ' '. -, 7031.5 by ony appliconf Por p perm+!�sobjoc�s Iho cppli� „ eonf,lo a Nvfl pcnally oi no�,more fhon Jivc hundrnd " " .. . ' ' -� .- ; � _' � , : �; . dollars(5500).):, .. .� , � IOCATION__ '._�_.. ._"' ' -'. . . , . . , . .. .. STEEL 8 FORMS . . j .'�''( /, ������ � � ; _ . _._ _,__ _ _ __ ,'_____._. .�__ . , ,._ . � wage❑s as aheir sole compen�sal an,wrilfl do helowork,and uG�ii[oNouii � I � � . - - . --- �he struUure is not inlended ar offered for sale(Sec.70A4) ,... . , , ._'__.'__._'.._:__.__ �.,,. � . �. � .�.__.:,_....._.... . _l._I_ '_�-_ .. _ _. _ _ � .,HusinessondPra/essionsCode:ThaConfradnr'sLicense eONDING 'a ' ��� � • � . � Lowdoes not apply lu on owner ol properly who buifds or '""-" "" ' �� � � -�� - - ' Improves fhereon.cnd wbo docs such work himself or _..___�.__ _ _. .. . .. �� �� f �� ' ' , � , . 'fhrougfi his'own'employees. provided tha� sucM1 /m- �---� --��� - - - - " " " � �� -' -- � provemenls are no� infended or ollcred�for saJc.'1L i � . � - howeJer,�he 6Wlding or Improvemenl Is sold wlfhfn onc �D � � _ .._.. _. _.. . - _.'_� . . . .- .._ - ' ycor o/�comple�ion. ��hc owncrvbullder wili have Ihe COHDUtT ; . �6urden ol proving 1ha1 he did nof bvild or improvvlor Ihe GAS LINE j � ��- �� -.. . . _ . . .�. - � � . purpos�o/sole). . .. . . . ' � ❑ I,ps owner of the properly,am eaclusively con- WATEB UNE ' �� � � � ��- -rracling wi�h licensed conrrnctors io conslruct the projec� •"' _'"_-_. _'_- . � . .� � � . . (Sec.70a4)6usiness ond Prolessions Code:The Contrac SEWER � ._ . ....__. ..__ . __; . ' - � ' . -�ror's Llcense Low docs not oppfy to an ov+rter of properly , .,'� :.. .._'...-.__..__: .....-_"� ___ _._..._ _ ._ . . .. . .___ ____who 6Wfds or improves Ihereon,ond who controtfs(or ,- wch projects wilh a controctor(s)litensed pursuoN7o . � � � - � --��he Confrottor"s Licensc La�vJ � ' ' � ' __.., , � ANTI-SYPHON 4ALVE � ; ❑Iamenemptunder5ec ,8.8P.C.forthis � ,.., . , 7 _ _.._ _ _.. _ _ . _ . ., ELERR�C WIRES reason � � � FENCE(NEIGHT) .. � � � po�e � Owner,�� GATES (SELF•CLOSING � .- ' . ' � � INSPECTOR'S��OTES \SELF-LATCHING � � . . � ... � L ' ... . . . .. . . -. .. , ... .. i. . .. . .� � . . . . ... . ROUGH WIRING 1__ - ..�.t..-�, � , • � . FINAI ELECTRIC � , � �. ___._. ____ _". .___... __. .. . _....._ _ .._' ' ____ ' I. ' ' . �� . �- i .,. . . ,. '. HEATER(LOCATION 8 VENT) ........_.T. . -..•R. ., ' ...., :. -. ..��. . • .. .... -. b-�-'S1 � ' . GASIINETEST - ._ .. _.. _._ . . ._ __ _ . _ _ . ... �, . . �.,. , ' .. „ , . . , POOL ORAINAGE �. 1; . ,' ;i . � � � ' . . . P-TRAP . ! .. ' . . . . ... , _