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Home My WebLink About0093A 0904A (4) . - -- .. ._ _ :._ KERS'COMPENSATION DECIARATION \ ( IY(��`�J I her i� that I hove a certificate of consent ta self ` � . . . .� ��S�,E ��,��o�e of wo�ke�=Compensafion��s��a��e, APPLICATION FOR COMBINATION SWIMMING POOL PERMrT �� or o certifled copy fhereof(Sec 3800, a6.C.) �an2o5 � - � � � . � CEB?6�3i8u1_. , . Policy Na7a��.�9Compa�y COUNTY OF LOS AN7'aELES BUILDING AND$AFETY � Certif�ed copy is hereby furnished. - - � � -- � � ��- � � � . � �� FOR APPLICANT'TO FILI IN euuoiNc S � Cerrified copy is ffled with the c ty building inspeo- AD�RESS `t'o7n department. � - BUILDING / S"Z}^�J/ �� _�,,,_ �DDRESS � LOCALIN Date Applicon - NEAREST CERTIFICATE OF EXEMPTION PROM WORKERS' CiTY ZIP - CROSS Si. COMPENSATION INSURANCE"' ' T2ACT �'j�J� SOT OF LOTNO.S� MAPBOOK PAGE PARCEL (This secTion need no}6e compleYed if the permlf is for one TEI. USE ZONE MAP i �r ��q hundred dollars(SI00)or less.) OWNER�� NO. NO. � � I certify thaf in the performance of the work for which ihis SVECIAL permil is issued,I sholl not employ any person in any monner .4DDRE55 CONDI710N5 - " - so as to become su6jec�to ihe Workers'Compensation Lpws. DISTRIC7 STATISTICAL CLA55 TYPE PROCESSED BY CITV ZIP CONST Dote Applicant ARCHITECT�QR7 TE� _ t� CLASS NO. � NOTICE TO APPLICANT: If, after making this Certificate of ENGiNEER�,f NO Exemption, you should become subject to the Workers' �/ VAW�5710N Compensation provisions of the Labor Code,you musl forth- ADORES ith comply with such provisions or rhis permit shall 6e 7E n . s /�H VALIDATION deemed revoked. CON7RACT0 N �( rW LICENSED CONTRAC70R5 DECLARATION LIC. ,r I hereby offirm tha�I pm licensed under provisions of Chapter 9 ADDRE55? o.y� �r a s (commencing with SeUion 7000)of Division 3 ot ihe Business �y LIC. /�� ❑nd Professions Code,and y license is in full force and effect. CiTV � f 6 CLA55 CL. 3 � `yI�+Q� DESCRIpiION OF WORK FINAIJ^— r/� License Num _��lC�—L�Lia Class C.S—'� SWIMMING POOL DAT.I l��—a� � � ,: co�o-a�r Da�e � ��""`�"� sP" � FINAI ='�v 4,3 A U ❑ " sca.Fr. g I om exemp�under Sec. SiZE BY ?1 o m�� B.BP.C.for this reason ELECTRICAL �1�l �� I � e �G�;7 Q- O �..7\ g� �� Steal&Condoit Bonding /1.'S�`�� Qe�_�, �__,., °`��U�j 4-� Si ature Canduits,Conducrors,Equipment � � O�� 1 � 7� � � $INGLE FAMILY � f' � R'� Z HOME OWNER-BUILDER DECLARATION PLUMBING ►�� ; ; I hereby affirm rhor I om exempr from ihe Conhactor's License , � : Law for fhe following reason($ecfion 7031.5, Business and P_T�aP � `. , Professions Code): Gas Sys�em ��• ' ' � I,os owner of the property,will do�he plumbing ond Anti-Syphon � ' °�,s d electricol work.1,or my employees wiih woges as iheir � sole mmpensa�ion,or o licensed mnirocror will do all MECHANICAt � S o�her work ond the structure is not intended or offered ��{ � for sale(Secrion 7044 6&P Code). Swimming Pool Healer y_} CONSTRUCTION LENDING AGENCY ,�,� �Y � I hereby affirm!hol Ihere is a consiruction lendinq agency for ��`L v �' the performonce of the work for which this permit is issued APPpRANT� NO. - (Sec.3097.Civ.C.;. I � S-r}c o o � ��5,' Lender's Name q�DRESS �, � °�� ,v� Lender's Address {�, � � (�. ~ " • „ .�>a � L rI� �i;i�� P.�.Fee$ v� Permir fee �;? � I ertify thot I have read ihis applicotion ond state that�he �7 u,O, �.,/ abo�e informo�ion is correct.1 agree to comply with oll County `O 4 a ordinances and State lows rela�ing to 6uilding, electrical, Issuon<eFee me<honical c nd plumb�ng construUion,ond hereby authorize invesrigonon Fee � � �� represe��1t�ives of this Co�nty �o enler upon the above- Torol Fae mentione pTrpe��y for insoection purposes. - - - � `,.-�r-�:1��'_��..._._ �7. h��`_'� �s9�o��.e or np�r�o�,a�qge�� oa�e SEE REVERSE FOR EXPLANATORY LANGUAGE PLhNS TO APPLICAkT ' � ' INSPECTOR'S NOTES� ` �� "'"""'�''�'"'��'�'�NER-BUIIDER DECLARA' ��(�� ttw,�r { I hereby qfficm�hot I am e*emp�from �he Contractor's Ta: � Rofurned �(} (j �Sj`� jp+C��. Gf� Y `�+5'1 l �2 "' �'cen�e,Lbv. .�or, 1�he follow�ng reasen lSec 7031.5j Approved � � 8usiness and Pro�es'sions Cade:Any city or county whicb Na. '�..Do'oe �� Plo. Dafa� �� Q� O 2p,,.,.� requires a permit to consirucf,olte�,rm�rove,demolish. �.�y._.. , , � , �. � ,.•� - or repoi�ony structure. prior ro i�s i suance, olso��re� 1 �� - quires the opplicanf for such permif to file v slgned siale- ' , . `;. , : '♦ .� . , ..:. . .� . -`� � � - � � -��-��.,':. •. : .: � � . � - . -. � , . ? meni that he is licensed pursuanf to the provisions o(1he I .-y,.� K ��' . S,' Confrertor's Llcense�Law(Chapter 9)(commencing with . -. . . . , Section 7000)of Division 3 of tho Husiness and Profes- I �� - sions iode)or tha�he is ezempf iherefrom artd the basis —i— - � - � - � for the.al7eged exemption. Any violation oi Secfion I�15?ECT!ON DATE lN$PEGTOR � ' � 1,"�: 7031.5 by any opplimnt for a permit subjects 1he oppll. . cont to o clvil peno!/y of not more fhan live hundred —� n ' y dolfars )� LOCR7IUN •�;ti,..:•..:� � ''Z'. (5500.`� , � ��,; . ❑I,as owner nt ine property,or my employees with STEeL&PORMS -� �� . ��ti wages as iheir sole comper.satwn,wiP�do the work,and IPGKi CONDUIi F � � � • � ; �`,.� the siructure is not intended or offered r`or sale(Sec.70d41 . . .� Business and Pro(essions Code:The CoMrector's License �BOkGING �r T �J„ ' � �. `: v� � ; , ; ' �' , ` Low does nof apply to an owner of property who bui,'ds or ��-�"i-� improves i6ereor, cr,d who does such work himself or. '— � `�- �� . - �� ihrough his ovm employees, provided�lhat such im- ' ' provemenis are not �„tP„dFd or offered for sole. H, � . �� .,•�,ti��• , ; , � �,�Z. �; however,t6e buiiding or improvemen?is sold within one !—�` ��:�i� year of comple�ion, fhe owner-builder wlll have the �<OkoUti -�� , . _ ".��; �, ' - �,. ��-, �hurden nf proving thot he did not build or improve for ihe �'GA5 LINE �i� � purpose of sofe!, -' ' � ❑ I,as ownc:of theprdperty,+oin exclusively<on- i VJA7ER LEhE _e J /f �� `troc�ino v,i'F I:c�rse:�conlrac'o�s lo consirucf the projec, �—= � - _' ' ISe:.7Ddd1 Busin�ss and Professions Code:7he Controc- ISEWER � ._,.�� i� _ � .L� �o�'s Lirer,se Law does nn!apply to an owner of properPy � �,, i.`.; who builds or improves thereon,and who contracts ior surh projects vnth o contractor(sl licansed p�rsuoM io the GorcFrador's License Lnw�. IP,N71-SYPHON YALVE � ,rr '--' '' ' ❑I am exemp�unde:Sec._____,B.8 P.C.for ihis I P�ELF.CTRIC WIRES . reason /41&IGHTI . Dc'c'—_ Ow'ter ___ Gr;z'es �setr-CLOSiNG ) INSPECTOR'S N6TE5 � SELF�LATCHING � . . . _. __— . . . R'SLJGH V91R!NC /E;�� •�� f � .. . FINAL ELECTRIC ' ' • .. ._ ... - ._._.. ._ . . 'HEA�CP.TPCN 8 VENT) � .. . . CA5 Lltif TE57 l�6 d % �� -. . ..-- � �... .PCOL ORAlNAGE . —�— . . ... .. . . �P'&A'�- P '