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HomeMy WebLinkAbout1602A 1951A ; WORKERS'COMPENSATION DECLARATION . - ^- � I hereby�affirm that I hove a.cer�ificaie of consent to 5e�t .APPLICATION FOR COMBINATION SWIMMING POOL PERMIT �� insure,o�a certificole of Workeri Compensa�ion Insurance,- - , wq�rl�fied copy thereof(Sec.3800,lab.C.) �7en2oe - , . -. . . . -. - . l� fl CE876(3Ba) . . � Polity No�`��1�� Company � rA1 Ifi' � . . COUNTY OF LOS ANGELES BUILDING AND SAFETY �. � [errified copy is heraby furnished. � � FOR APPLICANT TO FILL IN bURD�NG �/ � Cerfified copy is filed wifh the county building inspeo � ADDRESS ���. CLE�}�L CE_{G✓��A/� —�� � tion department. � BUILDMG ,.��,� �n � -SIn'1 S ADDRE55 2 7 L—)}�'L ZGZ—_✓� �-.�✓� LOULITY /ln N� Ch�L � �ate �' Applicont�< , I�p� CI7V NEAREST 1� 6ERT ICATE OF EXEMPTION FROM WORKERS' ^ n � LP CitO555i. qN I�' COMPENSATION INSURANCE 7 S�ZE OF� A$$E$$pR TRACT l0T LOT NO. hWV BOOK PAGE' PARCEL (Thls s�cHen n��d nm b�compl�ted H th�p�rmN Is lor oe�� \ tEi.�i� U5E IONE nwv f"-. rf � hundr�d dollan(SI00)or Ins.) - OWNER �7�/F ,,�)$ )d �a0. b(OD�1�/ pp.. ��,� �j T'��. - I certify that in the performance of the work fo�wh�ch�h�s . � ��iat . .._ � ._ . . . ... permit is issued,I sholl not employ ony person in any manner aooaE55 5R��-�= � coraoiTiavs� -.. so as to become subject lo the Workers'Compenwlion laws. , . DISTRICT STATISTICAt CUS$ � � TYPE PROCESSED BY � CITV ��"�-'� ZIP � CONST. � Dore ApplicoM � � � ARCHITER,L7� - TEL. - '/ .ClA55N0.^� , NOTICE TO APPLICANT: If, ofter making ihis Certifiwfe of ENGWEER fSe•f.����71.$ N0.�3�vOZ�7Y 1 J Eaempiian, you should become subjecr to-�he Workeri qDDRE55N�u/PC/�'L/!)� p�l'V VAlUA710N � Comperysation provisions of Ihe Labor Code,youmust forlh- (\ �^ / . YALIDATION with comply with such provisions or this permit shatl be \ TE�� 7� 3 ��`��7r� deemed�evoked. CONTRACTOR�[�u��l�� !-c9fJ�S -NO.Ci �G�r]3 . LICENSED CONTRACTORS DECLARATION O p �' 7 UC. . ��� �� � - � ADDRESSIp/b S•S7 �C �CYi-e NO..S�UDGU' I herebyaffirm ihal I am licenied ondar provisions of Chopier9 �� f �� �- - -�� � � � �- � � � (mmmencing with Section 7000)of Division 3 of the Business Cliv N�1�1�/��/ Cf.� �'lZ�t7�o MSS-G,S3 � . - and Proiessions Coc1e,pnd my licensa is in full{orce ond effe[t �XRI7TION OF WORK .� �'�1 6 0 2 A FINAI . �1 � � License NumbersZ-00(o� Lic:Class CS� SwiMnvNGVOOt . . . ... . � DAte L - -. • . c / �rN/i`�-�aL��1rr ��� `3 . Cono-ocio�E�l E�-o i�V E�vv�s Da�e �-1�_/'-f fi 5 P A �' FIHAI I • 1 [6 5 7 , a . . 54.fT. /�/ .. _ � .Y .. . _ • } . I am ezempl under Sec SRE lc 7 a � 2 t��,J%c=i O B.BP.C.for ihis reason EIECiRICAL ... . . . .. . . +i .. . . U I 0 9,1 5—fi& a Dafe: ' . .� . . . . O 9 $real 8 Conduit Bonding - 1� ' . . . I--' ! � S� natore SINGLE FAMIIY Condoifs,Conductors.Eqoipmenl V '� W a ; HOME OWNER-BUIL�ER DECIARATION P Trp , -S �� � � -�� ' � � - ` �. �- Z PLUMBING I hereby affirm that I am e.empt from the Contracfor's Litense _ taw for the following reoson(Secfion 7031.5, Business and P � I/ �� �� � 9 rj,� f� Profesvons Codey: Gas System . . �, . . • • e •v. . � I,as owner oi Ihe property,will do 1ha piumbing and Anti-Syphon ✓ � �° ' I . eleciriml work.1,or my employaes with woges os their . . .. . . , , � � - , -� -� �_ � •��a Q�) sole compensanon,or a licensed contracior witl do all MECHANICAL ofher work and�he shvcWre is nor iMended or offerad - - ' . . . �3� '�a G v 0 for sale�Sec�ion 7044 B&P Code). � Swimminq Pool Healer - . CONSTRUCTION IENDING AGENCY - � - � � �1 9,2�—�j�2 � 1 hereby affirm thot fhere is o cons�rocGon lending ogency for ApP��� TEL. � � � � � - - � the performance of the work for which this permit is issued (FRMT) , �,n�,S . . r,o.L3YuG•i3 , �Sec.3097,Civ.C.). . . . __.. . . _ . .. �lender i Name N�,����/-�l.�� ADDRE55 S�I S�: 7'i�CG/�F'� S�'�e5 . .. . . .. . _. . .. ._ . Lender's Address P.C.Fce S ` Permit Fee � - - �- � - I cerfify that 1 hove read this opplim�ion and s�ate�ha�the � � obove informo��on is correct.I agree fo comply wiih ol�Counfy iesv <e Fee ) ' ordinances and State laws relafing io building, eletlricol, � � mechanical and plumbing construct�on,and hereby nuthoriza �^�esryaro�Fee � �� � � � �- - represenraiives of�ihis County to enler upon Ihe above- - TorolFea � menfi�d+ roperty� or in`pection purposes. . . . . . . .. . . . i �/ls d"L" ,-.(� �/.��� "� I S+gnarure of AppGmn�or Agem �o e SEE REVERSE FOR E%PLANATORY IANGUA6E � ;�:-:.�..�-- .. .. .. , , , , . .. . , . ... , . �� �PtANS TO APPLItANT --• ••� � ' � � �� � � J-INSPEROR'S NOTES�• � � �' � OWNER-BUILDER�DECLRRATION � � � „� . I hereby affirm lhat I om exempl from the CoritmUor's To: __. Retornad.. �' � � - Licensa law�for the following �reason�'($ec. 7031.5) , , . . .... . .. . ...... :.. . . .... .. -- � Approved Buslneii-andPro/easionsCode:Anycilyorcou.i�y'whkh __"_" .. . . ..._ . No: �-Dofc—'_._.No.- _�__.Doto -_'_.__-.. .__.._._ _.. .,. . .....�. . .._ __ .. __._......_ . . . . � requires a permii ro mns�ruct,al�er,Impro e,demol�sh. . . . . . . _. , .. . . .. , . ��.,,.- , .. .�... v ,. --.__ ....._______._._.__._ : .___�_ -.• - ..._.. � �" or repair any'strucfure,�pNor la I)s issuonce. also re� , _ _'�'_ . . ._ . .._�._... _........ .__'. ____ .__.. _ ._. � - � � � � quiresfheappNmN(orsuchpermi�tolJfeosl�nedslate� '__'_....__..._.....__ .___.. .'_:_',._.__.._. _ � . �. . . . . . ._ .._ .._.._._... ..._ _. .. . ._. �_. . � .. .�._ .�� � men�fhot he Is licensed pursvon!�o fho provislons o�fhe � � ---Coniracf�r�s Lfcense Low(Chepter 9)([ommencing wlth ' �- � - --- -. ..-�..-�. � -. . -�.-- - - � . ' . . . . - ._-.� .. - . � •.-..- -.. - SecUon 7000)07 D vie on 3 ai tho Buslness and P ofes- . i � . . A .� � . i i . r � . .i.;,-.;�-� _ �•-. • ' .= � - �,I I�r - 'i:� �. slom Code)or Ihat hc is exempl Iherefram and the bbsis :� �� - �� -��� ,_ -.. , � -�; , - for�the alleged�,exemption. �Any violayon o1 Seclion �-.INSPECTION.__._.__.DATE-_ .....__ .INSPECTOR � �``�. �' '�:'.' �-' .� � . � �. ..' . � . 7031.5 by any applicoN,/or,o permir wbjecrs 1he appL- . � �� tont fo a eivil penalty of,nol more fhon iive hondred tOCATION.___-_--- ..__.. ._-- -% ' _- - _-_.• , ��•.. , � .� ,� dolfars(5500).): : , . . .� .,, �, : . . .... . � - .�. .. ❑I f h I "th , , . • ,as awner o f e preperty,or m em oyecs wi 57EEL8FORM5 � ,�,�.� .. . �.�. . - Y P - � . _... _...._,__ ._ _ .. .. .._.. .__.... _._....._ woges os Iheir sole compensal on,will do the work,and t�GHT CONOUit �,� � � ,.,`;` �� ---the stmcture is nof intended or oftcred for sale(Sec.70A41 . , i .. ; ,. . ;..,.��-..,. �.� . .__ ____,....._.. _.. _�..' _'__' . . . . �:.�..� �..• ' . e .- .-..... .- . - --. .... . ... .. . .. . ... __ . _.�' � •.Buslness ond Vrolessions�Code:iho Confrocfar's llcens � BONDING � 'i., � � ��'�f��"�' ��,� .. � � 'Cawdoesno�applyloanowrterof.properfywho6uildsor i � . .�., �.�. .�-... , .... . �,. .. ' . . � . -- � - --------- --- � - -- -- ---� - Improves thereon,and who does such work h�mself or . � � � . � � , ,, . �Ihrough hls'own�employees. provided fhal�such Im- � - � -" � - �- �-� - �� provemenfs ore no! fn�ended or oire.�d�ro; s�re. n. S ' � � however,thc bWlding or improvemen/fs sold wlthln one � _,. � .. . .;..�_ .�. �. [ONDUIT � � ' �'ye6r�ol compfMion, Ihe'ownerbuildcr w1l1;lovo Ihe � � ' - , - �- � : � •�- �• ��� �� �burden o�proving fhor he did no�6utld or�mprovc ior�he ----- . _.__ .- ' � _ . . . ,., GAS LINE - i ... .. . . ... .. . .. ... .__.. _ ; :.. , . . �'�Purpose o/saleJ.� , .,....:. . , . ... , _,� �� ., � _� . . - .,. . ; � .�.�I,as owner of 1hE qrpper�y;am,excluslvely cOn- '� WATERIINE ,�' � ..___ _ . ._.. _.... .. •.:;.: ,:� ; .. ` .-.. . .� � : ��� traciing-with Ilcensed con4a<�orz b mnslruU ihe projec� - SEWER � ' -' - - (Sec.7044)Business ond Proiessions Code:7he GoMrac , i.... _�_._ __�_-__ , ., . .. . .. tor i Llcensc Law docs naf-opply fo an owncr�of properfy � 1.._.._._._..."'.... . ......._ ... ... _ __. .___.___ .; _._ ..� . . . who 6uilds or Improves thoreon,and.who tontratfs(or i � � ' � �� ' such projects wilh o confracfor(s)litcrtsed p�rsuant lo . . . � .'Ihe Canf�acfori Llcense-tavi). ' .. ' . � . . ' ' "._._ _ '.._ _ .' .. ._____ .. . _ __ .. ANTI�SYPHON YALVE � ❑I am ezempf under5ec. ,B.,R P.C,for if�is ' ' �.'.1 �: ��_ . .. ,. . .._� - _..___—.,_____._._ _ .._. _ .. _. . � ELERRIC WIRES r¢ason FENCE(HEIGHT) , .,• � . . Date . � ��.��..'Owncr �. . . . . cA7E5 �SEIc•[LOS�NG � � � � � � � .W SPECTOP.'S N9TE5�. . . SELF•LATCHING i ___ . . . . . � . . .� , . . ... . : ROUGH WIRINC :_ .. . . . . , ... .,. . :.,,'�' . . . � FINAL EIECTRIC �. � '� __.. .. . .. _ _.________ .. ..___..__.. .. _..:_'. ...._.� . . . � � . ,t\ 1 , �_.., . ...:.... ... . . _._.... ..... . _ ... ...�..,.':. - .... ... .. HEATER(LOCATION 8 VENT) ..:. � .. .� . _. . � GASIINETEST ' � '.., •:�. . '. . ',... � . r i . _ �:�. ; ': ' POOLORAINAGE .� ' ' , .. ..' �... ' � . P-TBAP . '..�"�'J'`�. 1�'� ""' ' '..... ._...- .. .._..�__� . .. . . . . ,.. .. ,. . . . .. .