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HomeMy WebLinkAbout1782A 2132A (10) i _ . -Y- -- .,.. .... ,_ . ..�- _ . - .. �,.4.., - _ _ _ .._ ._ .�_ �. ._.._ ._ ,,_. I'' ,�,. ,�...^-...,�-_ , . . , �..._ . r �..� ' �+;. n �.. � ' r N� :� _ � � � WORKERS'COMPENSATfON DECLARATION .��. j � � : ' ':-- ' �� -� � -���. ! insurebor�of�ertifho'te of Worken'fCo P�50;o°,`��s��a��e` `.: � APP�ICAt10N.�,FOR�-COMB�NAT�ON SWIMMING�P40L�PERMIT -� � � . or a certlfied Sopy thereof(Sec.3800,Lab.C.} 7sn2oe °-� �• �,� - �° ���-�' � � `�, ' - �' ' ' ' � �� `���' ' " ' '�'� - � - + �etJ LS 'cee�s tsiea� Policy Na��(a_Company-� . . �/ ......COUNTY.OF LOS ANGEI.ES_. �.,�.: BUII,PING AND SAFEiY � . ���Cenified copy ia hereby furnisRed.- � . ' � �� � � �� �� � FOR APPLICANT TO FtLL IN sunoiNc '' • .�Cenifled coPY is E�led wi�h�h�eounry botlding inspec- �"'- '.. .. Aooa�u '� �'" - � . tion department. � .. �� BUILDING � - , �, � •• .... ADDRESS� � .�. .� . _ .� •. ..-_ . IOUtITY ' . .. AI� .... . � Date��Applicant ��� .�. � � . . NEARFST � - . �'-CERT{FICATE OF E7(EMPTIO ROM WOR RS` .' ��. Clry � .-.. �.ZIP.,, ���. . �,-�'�.� CRO55 ST. .-� 1� . .. . , .'_ � .SIZE Of .ASSESSOR � . .-.,� � .. .. COMPENSATION INSURANCE .. iRACT_� IAT. . �� lAT Np.. � . MAP BOOK � PAGE � PARCFI - , , � 'Qhtc sMion-need not 6a completed N!ha permlt Is For ena . .. .7Et. n uSe zOtae -��NNG �...��� , ��.... � �I � 6undrad doUcrt(5100)�r lass.) . ". .� �... OWNER � � �NO. �O,^4 K...� NO. ���� ��. . �I�certify that in ffie�performance'of the�work�for whicN this�� � /7 ,�.r� . - �•� �� S�E�A� •�'��� '��� ' �� �� � � � � . -'�Permil is iuued,i aholl nof employ any person�in any manner ADDRESS l�l'�1 K �C{ CQNQITIONS . .� .... .� 'i.:� .. ao as fo becoms fubjeCf Po the Workers'�Com enspfion laws:� - � �-DISTRIQ�-� 57ATISnCALCUSS � TYPE. �� �.� PitOCESSED BY� � , � . . � „�,�.. � � QTY - �V^ w� T17�� ��Io , � "_ . CANST. � Date�_)� � � C1A55 NO � � _G_L_LL.�APPIicCnt � ARCHRECTOR .. . " h�:" . . ,f, -. �• - ��NOTICE TO ACPL�CANT: If, pfter�ma g lhis'Certifi e of� � ENGINEER �� ���v '�� �� � � , ���Exemption, yoa should�become:a jeU to fhe.: orked-�- � -'��� �� � -��� �� ��� � � NAIUATION . . . � � , ,Compensation provieions of Ihe Labor Code,you mosl forth- � �DRE55 �� � ' � .VAIIDATION �- � �_ wilh.tomply wifh.suth provisions or �his parmrt s�all be . .. .. ... -.�. ^�..� ` �.�f.�i r� ' . i . '� �� ��daemed xvoked; ��'-.�. .. .. . GONTRACTOR . . .,, I, � � LICENSED CONTRACTORS DECLARATION ` � qDDRE55� � �� � � � � � � � 1 heroby affirm thar I am licensed Vnder provisions 4F Cfiapfer 9 ��� •�:S��' �-�" -''�' ' ;�� ���' ��� i � � � (tommeacmg witfi SecNon 7000)of Division a of tbe.6iuiness--� ��n, � 1„���JO�, t"'��a q,qsg � � - � � �and Professions Code,aml my�icense is in fu�l force and effecf.�� DESCRIPTION OF WORK� � -� �,/ � � � ��� ��''2 A 7 � � [� (�i FINAL (f� Contro Number�`���0�� Lic:Closs � �SWIMMING POOI � �. ....�. � DATE ` ��o( ' �� �.#���. �.�?�� { - y.� ��. j . +!� . . . � i - Q�. � Licens ctor/�V�LOJ!O A C_ Date�_..:�.L2:� �_. SPA . .. .,... .�. � � �FINA4 . ..� .�. .. -. '��� a(1 r1�7'' (� � � . . .. . SQ.FT.. ,. . . ...RY ��'7J . 1 am exempt under Sea� . �. . ...SIiF . .. .... . ... . . .. ��i . ']� � 6$P C.farl6is reaaon,�� ;. . . .. . �ELECTRICAL .�.���. . �. . . . . �d�� �I,,Q� �'. . .. �4,1 b"-8�7 � � i . . .. Dare: � � � � � . � . .. . . ' S� ndtu�e .` . � �..�.Steal&Conduif Bo�ding. . . .. B .. . . , Z��(.5. : . � �� � t (al1. � . ._ .:. ..�. .. :. . tors,E9uipmeM . . ,-•��_. ._ �. � . . �. 2� 9 Co , . . �, �, _ SINGLE FAMILY . _ ndults�Conduc n . �� HOME OWNER-BUILDER DECIARATION , , p�,UM81NG , � � � ' � -� _ � � � I hereby uffirm�ihat f am�ezempt from�he Confraciar's Lkense . , � � � S ��� ' .. .. .,_. .� , � . i , tow(or�he foflowing reoson(Section 703}:S;�Bvsineas and P-Trop � � f � Professiona Code): -- ' . ,.._ � . �Gas SY=fem�.. . , y .. . _ . _ • # ���� � � 1,as owner of the p.openY,will do�he pl�mbing and Anti-Syphon ' ' � .. �... �` eledrical work..I,or my employees with wage�ps ihetr ��' � . .. . � , � �I ..._.._ . �... �. _ .. . ....... ... . ,. .� � . '� sole compensation;o��a licensed tomrottor will do all . �MECHANIfAL..-. .��. � ... ...�:.. . 2 3 . . ' .,.�... � ' � � other work and the shoclure is not Intended or offered ' � � �- ..�---7 ' ��- �' ' � �" �� �� � . � � . fo�sa�e Secli6n 7044 88Ptode. ' .�. . .. .. ...{�!� ' . . � - . ( )� .. . Swimming Pool Heater �. '`'f� ,,.7.(� : '� �'�� j,-�A' {i . . CONSTRUCTION LENDING AGENCY .._. . --..- -..... . .:: �-. .--.' ��I /�T/ . . #•�i r . � : . ; (hereby aHirm ihat there is a tonstiotlioa lending agency for �-APPLKAM� . . . �� :' . ' ..-� . . 3 � .��. �, � ehe performance of the work for whkb-tM1is permit is i:sued . (pRIM)� -�e~ ' � �..NO +�-G, p I , ��Sec.3047.Ci4:C.j. .. ... . . . . .. . �.:. _ . : � . 9-ZS»�O 7 ...., ..l • � 6���� '; �. . , 1�::.Lender's Name ... ADDRE55 �eha C CiC. � �./✓'�1�, .:.. ....,: �.. ...' . . . . . -�►]LjJ��J,o L1 c�a, ��. t Lender's�Address �. . . .�..J�-�.rZ rQ .._...� _ � ��Q�G Jr�8 7 '' �� ��� ..,., � V.C.Feef- �.� Permitfee . �.., . ... I . : ., ,. I certi4y thaf 1 have�teod fhis vPPlicotion dnd�tate�hm Ihe � . , . ' {. ' ' �� .. ,.. . . . � '. � above infwmation is mrrecR 1 a9ree to comply with oll County.--... ...er"". 9�.� , ... Issuance F�a�� � ��Sv � ��.� . . , ' PeneQntatiyes ot forins ecflouo orooseshonthe obove- .. ImstfgmlonFro ...... . - .. 7o�alFea :,� �..�� .. '. . �. . .. � j� � . -M Y P P� Y P P P_ � . _ , . � . . . . I ,, ,. � �/ r.�. � ' sig u�e App mbr aqant � Doie �'� �-"�3EE REVERSE FOR�EXPIANATORY LANGUAGE�_ � . . , i � � . �`.' . � . . � � . � . ., v - , ._ . _ �.-...�,r ---__. _- _ _._ . - � �— --.1. _ , -. -. w _ _ _� _,,•- : � , e �, ; ` _. - ` , _ _ _ _ � � � ��PtANS TO APPLICRNT'�- � � � - - ' ��-1NSPEQOR'S NOTES��' � ��� � OWNER-BUILDER-DECLARATIOh1� --� . � I Itiera6y effirrp]hat f am e ehipt fr'om 1F�e�Contr6ctor's 70: ; . , _. �.Be}nmed_.,. ..�,,„: _.�., � . : . � ��� ��Uiqqqs�:{q�,1#o'r�he.:fallowing,t}eosoly�(Se<.,,7031.5) r .... � � -� " ��Approwd � �'��� ' ' � � . P �-Business and Pro/essions Code;Any.tity or counly w+Ich� � ND:. . .,.... _poie.,:,:...._._ o .._. ts_._. .. . ......,,�....._. . .............. .. _ . , , }� . , R? . . �. ��� . t�,Q .�. Q,� . ,+.. ....�".�� reqofres a perm���ro coosfryct,alter,improve,demo isM1, � � .. .. y, .-:�y..ii•'�, _.;. a �. � � _ - er ny or. ce � � �" repalr C �cirucWre, prl to Jis�Issuan ,�oho-re- .. .... .. . . ..._.. _ .....__. .__ '_'. . .... . .. .... .._ ' � +,�` • ?,. � ..�� quiresiheopphctlnffo�suthpermlltoltlaosignedslate- . _......__..._ ._._.._.. *- .__�-:• ... . � ..--_.,. ;�_�. �.�. . . l ... ,.. mmtthaf`be.isllSensedpurauonito+�6e�pr�v�}ton3ofthe � . ' .." ,+ ��. " � `..--. .�. •'-.l �1 ,•--. ` `.'..r_ , _ -....:SeN cn`�t700011of DIWsi��rChaptor 9)(comrrienNng'wlth � ...--... ,.;..... -- .. . . - ;;� . . . . -, .� � ) 3 oi the Buxlness ond Proies- . •t � � slons Code)ot?hot hels exempftherefrom and fhe bosls ..._...... ' .-..- .� _,. , .� � . � ��.��1 �.�,.. . ;.,:���' t ,=.,1..�i r .�,.'�� { _.� ....7031?5 by'anp appllcanptor a perm t,subJec�s he o�pJ� � � . ..INSPECTION ._- bATE. �.,.�_WSPECTOR, S, -._ �� � � ,;., nt,Ao dYi�penalty of nof more ihan Itve hun red ;:\ ; iOUttoN. __,. _ _._.. D-7_,p-7 ,�y-�A � _� . i .11�1� f�ltl��� l +1,[�, , : ,.,: ...�dollara(SS00).):.� ::�,.. �' . .. '.., : ,-�,.. . � � - �' '- V, /v�/ ' � ' � �.-� �^ ��-1� �❑'.1,cs owner of the properry,�or my employeas with �. ST€EL i FORMS , . � . .�r• . � ;.. � Q'-q� . � . .. .�...���_!�� .:�__ � "".:�. .'�J� 1'�•. ,�,` 1 ��' . wages`d5 Their sole fompensation,y+ill c�o J6`woo�C,and �� uGHi CONOV�T '-� 'f ?� � - , -r-..; e sYrotNre Is. inlanded oa�bfferbd for sele�Se�..7044) �. . .., .,. ,..:. L'1�-7 ��j,/� ,�. ..� _�._ _.`._�. ----�'—.. ,-^-�._' . � �� einbt � iheCoMractor's,L�ecnse.._. - i -`Business pnd Pr fessions Code; sOrvoING ' ���� + ,�' '`..-;"%' `' `3 , ,7 ,. :.I .•'y ":(.t °`�'kdD . °PA�loanownerafpropertywhob�ildser l . "-lmprdves lbeFeon;�ond whd does s�cF�work�h�msel(ar � . . .. . - . - ,. } j.; .-7�'�'' -;r � - �iKruugh'hls'own`�employee�, 'prdNded fha! such Im- , ,.� � } - � � ���` provements are nof.in�ended or of(erad fo�`�ea/e:�lf, � ' � . , 3 . . . � 1.,� ` _i�:;t.;)- ;�.o�_._�� r�.:Y....�'r _ ,. f . , howevor,�iKe bulldfng o�tmprovement is sold wi�h�n one ' ti ,. _ '. CONDUIT . � !f}-f6 � � ! �-- . � �'yebl'of mmpleflon,.the qwner-bullder w(II-'h6ve"'INe � - � � � �+ �� i �. � �� � -;'bufden of�`roving that�he dld nai 13ulld or improre/or Ihe , GAS LINE � I� ��`/ ' ..,, _,.__^ _ _. _�. .... .. ,. " �, :.- ^ .;..., _..�Pur Oe of saleJ \ �.. :-. . � � I:as owner ofl�h ' � . ' � � � . � � �,pl�6per��m excloaively con- ' � , WATERLINE�' ' - . .�.. � ._ � � �-��� �. � j � 'Irocting with licansed�conir9Gors to cons}ruti the projeU - . . , � . . :,.; . . { � ^.�Sec*.�7p4id)��usiness d�d,Pr.t�les@;on�¢o�e\Tha Confrec- . �_._-�. _._._ �.._ . .._ . .., ,.� SEWER -�� - � � . � � �-�er`s�f�eanee�taw dees no��dpdty.io an owrteFof property � ..- a �..._ , '' ���� ' � . � . - � ,_.._.._ . ..._ ._.. � __ �����• ..who builds.gr_fmprove;fh�reon;and-who confroeta lor � , . �, .._. _ _ . _ _. _. ... . . . ._.. _... . . , ; � � such pro(ecfs wllh o controcior(s)hcensed,pursuanf lo � ' � . , ', �, � ' ......� � ��'fbe�C6hlrodor's-Ucen3E-L61ti).'. �` ., �...: . ,. . ,_.. . .. ..� . . . . . ; , .. _.__�._ .._ _-_._. ,.P_. _ ___._.. .. _._ . � �; ANTI•SYPHON VALVE. �� �'� �, `�. f � �--, � � � �� ; ❑1 om exem 1 under Sec, ,8.$P,C,for ihis ,. ... .,.. ,- � __.._.._,. ._. ,.__ . _._.. .....__.... . ... �-. ELEttRICWIRES � - j � reoson '. �. � . � 'r � .�,.� . - .i .. ., a ,. - . FENCE(XEIGHT) . . .. � � ..-.Date ��wnec � � ,.,.a GATES �SELF{LOSING 1 . + _. . . � ��"'� � � ' � � INSPECTOR'S IVOTES a ... ' SELFdATCNING r P � ' � � � � , . , . _ .... . ; . .. .. , .. r , I ��e� � � , � . k �.��t�i� f . , . � , �� ��.�... � ,-,�� ��, � � � RoucHmRiNc . ' �f'd1 '�_._ �� . -,�...-.,�.�,:.- . . .,s • - � � . I � FlNAI ELECTRIC ' ',�'`� `�` '. � � �.. . _..__._...__. � ' . , . .. . , . _. _ _ _ , , � . . • _ . . `_. ' _ �t�. . . � � � ,.',.._ ..: c C". '.':,e�3 �5�� _;�,. �- �s{; \+ � � ��-�u._, t . .',.. . , -, ,� . , . ; r :,tl ' .. _ � - . . _ , _ .. _t`•.�., ... � . -HEATEA(LOCATIOR i YEN7) . ;. � ,.., � .•.. . . . � . � � / y� �� �...'_ ... . l.�, . t . � ' � GAS LINE TEST . JO I7- . _ .�. .. . . ._.. _.._ . .. . . � : . . . . . . t �. PODLORAINAGE � - ' ^� � ��� ���. ." . �.- - � , , _ . `� ' _ . - , . . �i- r� .t:.. �,. , . ...__. .:..__' "__.. ..� _._. : .. , ' . ... .1 I �� .�,.:,, , , . P.TRAP . . � . .. . . . � � . . . . . . . �� . . ' . - . . . - . \ �. '�`�. -\� '...� ..S'-'�° �\ ., , , . � . . . � . .. . ..... .. . ..r :.,.. . ����, : ,.