HomeMy WebLinkAbout1418A 1761A (8) -. _� _...__. .� . _ _._ _ _. _ _ .
WORKERS'COMPENSATION DECLARATION ry'
I hereby offirm �h.,�� ha�e o�e,,,f,�o�e o<<o�5e�<<0 5e�f .APPLICATION FOR COMBINATION SWIMMING POOL�PERMIT �
insure,or a cerilficoie of Workers'Compensation Insurance,-
or a cer��fied wpy ihereof(Sec.3800 Lob.C �6A208 ' ' -� �
y�/���q CEB�6�3/84)
Policy No��Compon COUNTY OF LOS ANGELES BUILDING AND SAPETY '
- � .�ertified copy is hereby furnished. '
✓•' FOR APPLICANT TO FILL IN BUILDING
�ertified copy is filed with ihe ty building inspec- ADDRE55
�tion deparfinent BUiID�NG a
�, ADDRE55 (/ / LOCALITV
Dat� — � Applim NEARESi
CERTIFICATE Of EXEMPTiON FROM WORKERS' Uir • Zia Caoss Sr. _
' COMPENSATION INSURANCE 1� 512E f ASSESSOR
TRACT lS� l0T lOT NO. ' � MAP BOOK VAGE- PARCEL
(Thia ucefon n��d not b�compbf�d if�h�p�rmN Is ler on� TEi. ug zonle Mna . .
hundrod dollan(5100)or I�as.) ' � � OWNER NO M1) ' NO. � ��
I certify�hai in the performance of the work for which�his � 11 SPEGnI
permit is issved,I sholl no�employ ony perso�in ony manner ADDRESS � CONOITIONS
so as lo become subject io fhe Workers'Compenwtion Laws. oi tRiCi SinTRtiCnt Ctass TVPE PROCESSED BY
CIN ZIP CONST.
Daie Applicont � ARGHRECT OR 7EL. CfASS Np. (�
NOTICE TO APPLICANT: If, a41er making ihis Certifitate of ENGWEER NO � �O �1 11 C� d
Ezemption, you should become subjecf to the Workars' f` YAlUAT10N
Compensofian provisions of the Labor Code,yoo�mos�forlh- ADDRE55 �(^! � . VALIDATION
with mmply�wifh such provisions o� this permif Sholl be CONTRACi NO. — s V
deemed revoked. �
LICENSED CONTRACTORS DECLARATION - UC.
I hereby affirm thot I am licensed under provisions of Chap�er 9 A���� A � �/1 f � � �
�commencing with$ecfion 7000)af Division 3 of Ihe Business CI7 /� LASS (�
ond Professions Code,and my license is in full force and effet7. DESCR ION OF WORK � r--h
►�!I FINAL, �7 ,
License er Lic.Closs�� SWIMMING POOL 1�1 DATE� ' ��`.U� , a
�� � �� i�f
`�.`-�✓i�.YA SPA - � FINAI , � . �� 4.�.�� U (
Conlrotlor poteL�— 50.Ft.
!Y
� I am exempt under Sea SIZE � � �:• • • •L I �
B.BP.C.for�his reason ELECTRICAL - � � �
Dale: 9 B '�� U V ! - �'� �4 1.b�_ �
Sieel 8 Conduit Bondin d
'Signature Conduifs,Conductors,Equfpmenl � ' `!4 I.V.�c� Z
SINGLE FAMILY . � � f�
HOME OWNER-BUILDER DECLARATION � pLUMB�NG ,► � � •(1 Q'/•O 7—F5 S
I hereby offirm thot I om eaempi from the Contrattor's License �'`_�„� \1
law for Ihe following reason(Section 7031.5,Business and 8 CS�) ����x`
Professions Code): - P-TfOP �
Gas System , ,
� I,as awner of the properly,will do ihe plumbing ond Anti-Syphon
electriml work.I,or my employees wilh wages os their . .
sole compenaation,or a licensed controcfor will do all MECHANICAL
other work and the slrocture is not intended or offered � - - � . ' �
� for sole(Sectfon 7044 B8P Code). Swimming Pool Heo�er Q - �
. CONSTRUCTION LENOING AGENCY � .
1 hereby affirm that there is o construci�on lending agency for �ypp���pNT TEL. � s'� ��� �
the performonce of the work fo�which Ihis pe�mii is iss�ed (pRIM) Np, � -r . s
' (Sec.3097.Civ.C.). ., �
Lender's Name - qppREss �° v
Lender's Add�ess � , ' � . � � ° 1 5 G.5 0
r.e.cee s 1 ve,mn Fee � � ' �1 5 G 5 0�
I certify 7ho1 I hove read this applicotion and 51afe thof the , , '
above info�mation is mrreu.I ogree m mmply with all Covnty � lasuance Fee
ordinances and Sta�e laws relating l0 6uilding, electrical, �O � � �� � �9.C� —�a
mechonicol and plombing construction,and hereby a�ihorize Inves�iganon Fee , r �O
represemarives of Ihis County to enter upon the above- Toial Fee �
�ion erly for inspection purpases. � � �
L� �_�a-- g�
� S�gnot�re o AppLconi or Ageni ' Daie � - SEE REVERSE FOR EXPLANATORY LANGUAGE �.
' � PLANs 7o aPrLICANT � � � � � INSPECTOR'S NOTK� � � � - � OWNER-BUILDER DECLARATION,
To: .Rvtvmcd . � I he�eby 6f£irm_that I am exemp�from,the�Contracror's
Approved � '.Cice�se Lqw.:Tor�,�he following reason,i5i'_. �7031.5)
� Bu`s(nesi and Profess(ons Code:Any cily or coun�y whith
No. ❑ote �,�� No. � �. Dato . ,� " - � �� � � "" � � -��� � requ�res a permil to conslroct,aher,Improve,de nolisb.
, ... \,..: � � . ♦ , . . �� _ __ _ _ ___„ � or repofr any sfrocturc, prfor lo Its Issuance, also,ke-
� • ���` �� - � quires 1he apphcon�ior sucb permll fo/ife a slgned s�a�e-
. __ . . �. _ ._. . � . • ,�.��� .� �,-��., �- . � en/Ihdt he Is licensedPu�suaM to fbe provislons.o(Ihe
' � �'��C���� .� ,..�'� �-�Canfractori Llcense�lcw(Chapfcr 9)(tommenUng wifh
�-- , �- • - � - - � -- • • � - - � �� -,� Sectlan 7000)of D'rvision 3 al fhe 8uslness and Proles-
stons Code)or}ha�he is exemp�fhere/rom and fhe 6asis
- - � , � - (or;the.alleged exemption. Any violorion of Secnon
INSPECTION . . DATE _ INSPEGTOR i � ' " �� 703L5 by any oppliconi,for o permi�subjcr�s fhe appli-
conf fo a clvi!penal�y ol nof moro thon live hundred
� LOCATION ._ .. . ._ . . . . : . _'_-� . �,;�.'�;-..-,'`..`,.,.�% ���`• - I dolfarz(S500J.): � .
�, ` :0 I,as owner of ihe property,or my employees with
STEEL 8 FORMS � nJ � woges as their sole compensation,will do the work,and
IIGHT CONDUIT / � - - -. ,{.`�� _ ,`�, ' � �- the strutture is nof intended or offered for sale(Sec.7044)
-- Buslness ond Pro�essions Code;76e Confractor's Llcense
eONDING . ' ' �� , '1:,�,� '�4'J.�`�\�." , �_` �,\,, • Lawdoesnofopplyfoanownrrolpropertywbo6uildsor
� '- • - � � '� lmproves}hereon,and who�doez such work'himself or
� -� �`•�-�`-.,,� ��.�.,• : ' fhrough h!s'own employees, 'provfded fhat such fm•
" ' ' j��� - provements are nof Infended or oflered/or sofe. !(,
' ,, , however,�he butlding or improvemen�Is sold wlfh(n one
CONOVIT - ' `t "� ��`� 'J��` � � year�ol complelion, the owner-builder wrn no�e���t;e
__ .. _ _, � . . . .burden olproving thvt be d!d no�burtd or improvo lor fhe
GAS LWE �/ , � � � � ,pu�po�se of safeJ. . �
�'' a I,cs owner of;ihe pro�crty.�om eacluslvely mn-
WATER IINE ' � �rp�fing with licen!ed conlroclor5 to,conslruct 1he projec�
� SEY�ER � � ' , .',(Sec,'70d41 Business bnd FroicSiions Code:,The�onfroc-
� - ' � ror's Llcensc taw doez nof opply to an owner ol properfy
�� /�7�� .��'; _ _ . _ _. . _. . . ,._ . . _. _ who builds or Improves fhereon,and who confrods lor
� �IV" - ' �� � such proJecrs wi�h o mntraclor(s)ficensed pursuont lo
� � � ' '-� Ihe Confroclor's L(cense law).
���� ,
� A�TI�SYPHON VALVE � " � ❑1 am exempl under Sec. ,B.8 P.C.for this
ELERRIC WIRES � � . � . ' �.reason
FENCE(HEIGHT) Y � - � � Dato Ownef
GATES `SELF-CLOSING 1 / � � . � � INSPECTOR'S NOTES
SELFIATCHING J �
ROUGH WIRING ,� �. � .
FINAtELECiRIC `.�,�J __ ' . .. _ . . __- .. , - , '
HEATER�LOCATION 8 VENT) lJ " ,.•�•�. f�i.l t. ... , ' �� - � �
CAS LIYE TEST / " ' r . ' � . . .. . ' - - . . . .
POOI DRAINAGE (Z,J .- , -. .. _ . . . . .. . . � , . , . .
P•TftAP . , .. ...
d