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HomeMy WebLinkAbout1607A 2204A (9) -,,-.--*.,�r-�, �„a�.�... __ ...,., , — -- .. _-. ..._ .__,,,:�. .., . . � .,;,,, -c�.. . �,, ` , _ . , . . "k:..��, .,..,.- Q; . s.TION DECLARATION� 1 he�,. --�.w.��ti�e o certificore of consent�0 5e�+ . APPLICATION�FO�R COMBI�IA'�18i�`�`I�YI�A�IA������C����k��:..���,���� insure o a�tificate of Workers'Compensa�ion Insy,{ance,� -� or a cen fied�ropy thereo4 SSec���800,l b.C.) � t6a20B . . ..:. . . . -CEB'6(3�84� �cy'��'�P��� Compan ' ��i �i-•�'�: COUNTY OF LOS ANGELES BUILDING AND SAFETY �rhf ed copy is hereby furnished + . . .__. _...,.... ... .,...,... , . _...__ ..,... ... . � BUIl01N6 ' Ce���fied copy is tiled w��h the unty buildmg inspec- FOR APPLI�ANT TO FILL IN no�aess-�� � �, hon department. , . /�//� . BUILDING /J,/ �J� / y� � ADORE55 c7C�` � , G+��•��'�"��- / LOCALI7Y - � Dofe ���� Applicont �' � '�� NEAREST .�� t CERTIFICATE��OF�EkEMPTION FROM WORKERS' ���- CiT � ,'it�G'. .,� i.Zla CR055 5T. � COMPENSA710N INSURANCE �� ��� ��� �{ �y S2E OF ASSESSOR-� � TRACi ry� ,�p. � LOT LOT NO.�� MpP BOOK � PAGE PARCEL . (This secfion need aot be complNad ff the parmlt la�for one � �" �� NO. �i.s u5E ZOr7E MAP !c1�. h�ndred dallars(51�OU)or��less.) OwNER� ,� t.t.r}.y���C� :.2, NO. d U I certify thot in the performance of�he work-for which this � / ,9 - � SPECIAL � . permit is issued,I sholl not employ any person in any manner . ADDRES �t � (/ � . r .�/- CONDITIONS . so as to become subjec�fo�he Workers'Compens6lion Lows. - �DISTR�CT SiATISTICAI C[A55`����� TYPE PROCE55ED BY . �� � Z�p CONST. . • ' . .. . �� CLASS NO.� . ^� � Date Applimnt - ARCHITECTOR� NOTICE TO APPLICANTr lf, affer moking this Certificafe of ���� ENGINEER �- -d M..21 Na �36"��-4 � Exempnon; �yod should-become� subject ro �he Workers' qDORESS /� .� ,-�`!�" . d �rti� VAWATION O� . Compensation prowsions o4 the Labor Code,you musf forih- ' ' A TE� S /��}�� VAIIDATION . with comply with such provisions or this permit sh611�be CONTRACTOR rt� O�`"�!� NO.6� �3C�cf deemed revaked. � .. . �� 9 LIC �y '/�! � LICENSED�CONTRACiORS DECLARATIQN�� � � � . qDDRESa�c-.�-Z3 .a /cC.L-�L NO:oE:�/y�-�e: i hereby affirm��hat I�am lice�sed under provisions of Chopte�9��� � . ��� s . (mmmencinq with Secrion 700D)of Division 3 of�he Business.�� ��T� E�.���'.y: CLA55�(.3���� �oad Prafessians Code,and-my license is in f�ll force and eHect. OESCRIPTION OF WORK � ���L/ry� FlNAL l/ ► Li[ense Numbe�Lic.CI055 ����� � SWIMMINGPOOL � �ATE '�q��" - > �- / - � :��t / it � ConfraUor � �J �a}e� SPA . . . . � FINAL � � 0 � SQ-FT. �(J� gY /�3.� fr � o e�� U SIZE � � I am exempt�nder Sec. ' 1 a "j R� � O � B:&p:C.forlMis reason� � - ELECTRICAI � - � ~ � U Date: . . . . ._.,. � . .�?.G� � I�.i - Steel 8 Conduit Bonding �, � Signoiure .�. : . �-" Conduits,Conducrors,Equipment � � �'��`� Z SINGLE FAIv11lY �- �� ,:,,>: � HOME OWNER-BUIL�ER�bECIARATION � ��� PLUMBING , ► � . I hereby affirm�hot I am exempt from ihe Con7ractoi s License � . Low for the followi�ng reason (Secrion 7D3L5, Businesq and P-Trap Professions Code): Gas System . � � I,as owner of the property,wiil do the plumbing and , Anti-Syphon . electrical work.I,or my employees with woges as lheir . sole compensation,or a licensed conrrador will do ail MECHANICAL � other work and�he srructure is not intended or offered . . ry � 4or sale(Setllon 704A BRP Code). � � � � Swimming Gool Heater � �� CONSTRUCTION LENOIN2'i AGENCY � � � �� �� � � I hereby affirm ihoi fhere is a ton5huction le�ding oge�cy for .qpp�ICANT TFL ����..2 U��� the performance of work for whichYhis permit is issoed (pRINT) NO. � ► ��s a�m e 's,.Z, � {Sec.3097,Civ:C. g�7, � Lender's Name f'='��'�v�-�' AODRE55 ' ' r ���G L Lender's Address s �, � U � ��.`1`C� � P.C.Fee S � Pe�m�i Fee � I�cerlify ihat I hove read this application ond state thallhe ` . (�0;j '�_8 n obove informativn is correct I agree fo wmply with oll Coonty Issu <e Pee i �� ordlnonces and Siaie laws rela�ing to buiiding, eleciricol, ��„vest� r Fee an � � mechonical and plumbing_mnstruciion,and here4y authorize 90.:°" . . 1 rep� se��a�rves of this oonty to enter upoa the obove- ?o�ol Fee 1_� . _. . . ��m�ioned p�operty/r n pection purposes. � , . �%\..^i /°�'.0/ /l�"���✓t��i` �� . . .. . ���r�y� _:_��.��j'. S�qnotara of App!canr or Ageni Da'e -SEE�REVERSE FAR EXPLANAT6ftY LANGUPCGE ('/ � .�. � `:.� '. ' ..� .: �.�: `�. �.� ����,' �. .��� . . . WNER BUILDER DEC ARA O PLANSTO�APPLICANT -�'.:.- `.'�"`.'....�"_ .. . .fNSPECTORSNDTES � � :`......"""`".� � � L. �� TI N.. . � --��-- -�- --�•-- •#��•-•��^e•-�^ I hereby offrm that I om exemp�from 7 ,Gan;r7ctor's To: Roturn¢d � License Law for ihe following reasor,-(Sec. 7031.5) _ Approved � ����-���---��� � �-•-•--- �-��-•�--��-�-�-����� Business and Professions Code:Any city or couqfy whirh �No.I �Do!e� - �Wo. . Da}e , � requires a permih io consfruct,alter,improve,de,molish, � . . ' .. . ..,__...__,,,.�_„..........................�,.„....,._.„..,,.:.�ror repair ony strucfure. prioreo its�issu�nce, also.�re- I �I . � � quires the vpplicant for sucb permit�to Pile a signed stafe- . ,_,._._.....___,,.._._._,._...�.......�_......�..,...:,.:.:..menf fhat he is licensed pursuoni fo�he provisions of the Contrac�or's Litense Law(Chapter 9)(commencing wiih . � 1' ... ' . � � �-----------�--- ��-����-���-^Sec�ion 7000)of�ivi;ion 3 of}ha Business and Pro¢es- . � sions Code)or thof he is exempi iherelrom ond ihe basis .__. .. ......:.... ____..."'_' ,.,..,._._ .:_,.:,,... „. .:..:..., .. .:�;;;,,,.,. ._....<. -...,,...«m, � . .:�.iar ihe alleged exemption. Any vlolaticn o� Secfion INSPECTION �DATE" INSPECTOR �� � � � � � �703I.5 by any applicant tor a permiF subjecis tho appli- . � � �- ^� � �canf�o a clvil pena/ty of not more ifian li,ve hundred tOCaiION� . . � . - dolfars(5500?). � �� ' � -�-� ��� � � � ❑I,as owner of ihe praperty,or my employees wiih ..., � " � wa es as their sole com ensaYon,will do the work,ond !STEEL 8 FORMS : ,J � � � 9 p � - _;, � � ----- �.^,�--�•� �-•�•.�--^�^-. ���.-thesiructure'snotintendedoofferediorsale(S .70441 LIGHT CONDUIT.��.�., , � ��� . t{fi � � � . � - . � 8usiness and Professions Code.The ControcPo ,ticanse .. _.. ._ .. . .. .. ._._.. ..,...:. , � �� �- , � � ��- -� �� �� ��-�--�"MMLaw does not oppfy to an owner of properfy ho builds or - BONDING - � � � � � )mproves thereon,cnd who does such.wo�k himseN or �.:.....__.. —' . . ... .. _ . - � . . . .._.. . . _....._.,__..,_..._..,. �,..-,:.fhroogh his own employeee, provided ihaf such im- . provements ore nol intendecf or offered for so/e. H. . . . � . .,---•,.-. . ,-^.:•�-.....� rW°'�.�;...-.°�.�:'•=bowever,the 6uilding or improvement is sold wi�hin one . . � � year of complefion, fhe owner-buNder wifl have the ��CONDUIT � � ���--- � � -��-•��^�- ��-"'^�"" -�°"'�-burdenofprovingtbaifiedidnotbulldorlmprovefor7he GA5 LINE � % %� ' purpose of scle�. � /� ; � -- ��-�- -•-�����_��� + --�.-��� ❑ I,os owner o4 ihe proper:y,am exclusively mn- WATER LINE - �-ac:ing wFh I'�.c=nsed con'rpctqrs�o.construd the projeG , / � .. .. . .. . ....�...... ..•-........��..�..om�•.-�-:•:•::.•-�-:f5e:.70s41 Business and Professions.Code:�7he Contrar ' SEWER lor's Licenso Law does nof opply ta an owner of properfy , . . . . . . . .�.....-.....-.--^--.a�.--�-..-�-.,-�+--^---W��.-•�^-:who builds or improves lhereon,and who conirac's for � � uch projects wilh a coniratfor!s)Ircersed pursuonY fo s . . . .... ... ......_....._.._.:- . .. . ,the Confrocbr�s License Law;. \ IANTI-SYPHON VALVE . ......_._..._._._,_.�..�........�............._......,.....:..-_...:..,. ❑I am exemct ur.der Sec. ,B.&P.C.for this �ELECTRIC WIRES recsor . . . . ... .,..... ...., .. - . FEPiCE(HEIGHTJ Jc'e nwne , . .. . ..,._ .,. ... .. . ._ GATES SELF-CLOSING � �y' /�e lNSPECTORS NOTES �SELFdATCHING� f!�rb ( _ . .;�..._ ,._ .. ..... .,..: . . :,...M..�„�..,.�.�wM,-. ...:..,.�,...... ' - „�:..:a.,�...���.�.a.�.w-.�.,�.•Fo-...er.+�'��w��.� i ��/ ROUGH WIRlNG � �.:..�k J�-//G�'.,—•�....� _........ ..,....... - �.- .:,. - :av+au �c,r...vn..nn „w.��an...... .� FINALELERRIC ... . ...�.... ,V.�.�,T.rw.,.. .._-..e.,,.,. ._...,...x....,,..�.�..s....w...,n.-w�-raw�«,.�,.w«a�.�i,„..� . 1 � �,�,�/ Gf�'S��/'✓ � i2 �� ._........._....._..-._.....w_,..,_...................._�.�.._. :,.:.....n�.., .....,,..r,.......a.,.,�4,.;.�...:..�..._.._»,.,.:�,,...,.. . . _.._ .....V�....+...,.. ... . , . HEATER(LOCATION$VENi) � �... ._..._, . ,... . . ,.. .. .. „:� ,. : . ..... IGAS LlNE TEST' .(�r snea'ru..n M,x...,..,.,...�...m..... ........�x«c...,,.,.._.�a.c.�.,�.r�..,��....Wx.a..�- ..,,..,...:....� I POOi DRAINAGE ...,..�«,.._,..:..,..,....,........»,..,.,... .. ;— P-TRAP � . . .. . .:. .. . . .. . . .. . .. .., ., ..,._...... ,,..n,.r. �.......:... . .......... ......:........ . �.:.w��..+p+A..�»,,:M..�w..,h�mmiwwv,n.,:,,.. ....:,..� .