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HomeMy WebLinkAbout0971A 0972A . . WORKERS'CO/vtPENSFC710h7 DECLAf:ATYbN" . ` .. -__ . .:. � _. "'"""' '-„' .•"'.' ,_ .... .-<'\' >....�_:... .,�...,...�..:.. ...,.e.�,� ...�..�..w _...:, _a..�.......... � . ,..._..�-...�....�..6.m,,:. . . ...._. nsure;or a cen fita�e af Workersrt't co�e�ot conseni�to selt ' " ' � ��� ` APPLICATION F�R C`OMBtNA'��fil S`VV�i��II�����C�F� II�T`'���.���� I here6y offi.m thvt i have a ce . _ 'Com-ensat on Insu ance, . �or _ c�r� a -ihe e f(Sec-3$0� a C.i �� '*-r a2 s -. .. '. . . - ( � �CEd"c�3 B=` � PoI cy� G� � mpo�y ''�'`�`��` COUNTI�aP LOS�`AN�oEIES" BUILDING AIJD SAFETV � Cer+fied ropy 5 ereby fu nished._ . . � -- • �' � � BUILDMG � � - _ .�._.��. ._- FOR"APPIICAN7.T0�FI�C'IN �. A�oaess 5Si• Cert�fied copy s tiled'w�•h�he,w u Ird.ng�nspec ' ' � . � � . )iondeparlment�. . . �/ 1 BU{l . " ' ` � '�: � _'. � � _ �,'k- nooza_ R> . , �u'��f�:.... iacnurv . ' , , D61e i' ..-U . pphmn�.__ .. ... �. . . - _ NEAREST ' �� CERTIF(CATE Of EXEN'iPTi�ON F�tp1U'S!`Vb`iZ1ZERS' - � �T � _ P - CROSS 51 , � /J _-�SiZE OF - i ASSESSOR . COMPENSATION INSURdNCE �"`�� � _ TRqQ .{ -�pT .., LOT;NO, ��� - MAP BOOK � PAGE.. PARCEL . _..�.: .__.,_ . � > ' __._ .. {This-secTion need no}be complated�if Ihe permitJs for one <.��� /�� ,�- .�:,. TEC USE�ZONE--.'- MAP �� .�d1� -.� �. . hvndred dollqrs-(5100)or�ss.J � � - OWNE � V ' � Q: '�� �'.�J NO. � � I<enify�ho�in?he performonce of the work for w6ich this�� � -{� � - � _ , ° y SPECIAI ��.� . . . pe�m�i1 s issued,1 sholl noi employ ony persQn n ony manner A6DRE55 'I� � . -i��J'�rr.-. O..b��7 _ .CONDITIONS . .. �. ...-��, so os�to become-subject tolhe Workers'Compensation Laws. �- -� � � • � ' OISTRICT STA71S11CA(Cll55 � T�PE - PROCESSED BV� � � CI � CS, �_ � ����.. ZIP rv• � _ CLR55 NO . CONST Date . APpLcar�t '. .; ARCHITECT`..."• ...�j.��� ' ' ) 7EC. -. ,�,.y__� �t'. . . :- '�4 NOTICE TO APPIICANi:If,�ofter mak'ng th s Cert ficate ot��� ENG)hEER-. ,l P t ` . � V ( _ Exempton, you-�-sh uld. 6ecnme subjecf fo ihe.Workers'�� " /�6 �- �� � ,� r" - VALUATION. � . � � 3 Compensat on pro sio�s oi the Labor Code,you mus'forih- A��RE$L'`� . ` . . . wi.ih mmply w�th such. provisions or th s perm i shall be�� ,,, � „J -'� N�. ��-5J�4! f �~. ��(3 '"�"— YRLIDATION . deemed revoke�. . .�� CONTRAQ- .U„�--.ti.7 [.SC}� . _ G.lZ2 . . . � � � LI�ENSED CONTRAC70R5 DEC'CARAYfOfV` � " �� � - , { ��{� ���' / ADDRE55 . � . .;`.-+ 'lL�3"- NO [- . . I here6y offrrm that I am I cense�J u der orov�s'ons of Chapfer 9 � ` �/ . �� � ��� � �.� . S� (commencing with Secfon 7000)of D�v sion 3 of ihe�Business �� .��?� '�,r (\� CIASS - ond Groress ons Code and mylicense s in�Tu�l force-nd effect - � - �. -- � - - � /� ' DESCRIPTIOfV OF'�PYOR7C�"...� ��}^�-�q FlNAL� - ��, �- Lice�se Number� � Lic.C�a55�� � SWIMMING POOL � 'L�,i'. DATE � - � :� ► � Co .ti � : ...ate�� �O� � SPA .... .. . >. .0 ..;...._ ., -._.».`� FINAL '2�O�7,,� A, O J{ ��--��(�,O _._:._ , .�- . r-^�'.—'- � 5�.Ff. {�-� .-- @Y ' . � �� .. : 4 ' . - . . .. . .. . I am exempt unde�Sec. -SIZE . �g.Q a e 2� O. � B&F C for-.i6 s reason � ..� ELECTRICAL .. :.: .: .-�� ..... .. � � .�J/) , � ,�.p`�'2..&2 I W . . - � . . f.�s✓ . _� .. ._. , Date - . �,f� � � -�� � � � � � Steel 8 Condui�Bondi.ng tv���� _,/ � -�... .-�6 a 5�,£y-j-� N ' i7!! .?' a` • - 5 gnature -� � - - ; � Condu ts,Conductors,Eq�ipment �. 4__� „L p' � ' � - �Z � � SINGIE FAM(LY � � } � - � HOMEDWK7�R`$OIIDE'R"nECL�RA`�l0'�I_,-..��� •�.� PLUMBWG � ._. . . ... . . - . ����.��-8 v . I hereby affvm tha+I am exemp�from�ihe Conrracror's t cense -� . : . _ , � Law for 1he following reoson (Sect on 7031 5, Bosinass ond - �p-Trpp �--� - " ' � - - ProEessions Code) - Gas System � � I,os owner of the property,will dn ihe plumbing and -� Anti-Syphon _ � � - � �C��'�A elecirica�work.I,or my employees wifh evages as�he�r �-� .�. . �' . . _._�_._ ..,_.__.. ._.. .,�.. . � v o'e e j � �� sole compensaiion,or a licensed controctorwiJl do a0 �� MECHANICAL . . .. . ^�.�� otner work ond rhe str�ct�re is not te ded or offe ed ' - - � ° }-F?F5,(j J � for so�e(Sec ion"7044�8&�Code).-� � �Sw mming�i�ool Heo'ter��� .. . � �CONS7RUCTtON IENbING�AG�EIVCY �- -� '�-� � � ��� - � a ! ��.Q O�i I hereby offirm that there S O CO st ct on I ding ogency fo �qpp�ItANT,- � � - F1 . - � � - � � � ihe pe formonce�of ihe work fo f ch'his permif is ssued � T � � . _. , � _ P (PRINT) .�� CS�� �� I�/6,�E'i"H�J r,Sec.3097 C v.`C i / -' _ , . . .„. ' . �p . . _ . Lender s Nome �f f� //� C.JdA vt,� �d� - � � , ..'AD�RE55 j� . - �7 X`4 . � "' - . �- . ���� . . . , !ender's Address - -� -�� ' '" p,�:Fee$---�0-�0�,-�( - Perm�r Fee • �/'�� � � I certify that I have read this .pplimtion ond sfaie that rhe � -� � - �. � �. above informmion s correc',Iagree ta complywith olfCo�niy���. ijj .J� . ord�nonces and S�ote lows elat�ng tc 6 Id ng, eleci icol, . tssua.�ce Fee . .� �-. �.� mechaniml and pl rn�ng consr d on;.�o d hereby o th r¢e .- � �°�1O^°Be . �fQd QQ � - repres oh es f �h s�Counry to enter upan ihe obove �� � �-ioral Fee V O men�¢�/op�rty f mspec�on purposes -_ ` �� � - �. � . . � �� �/ G ,� ._. � �.. ._,..,. ..:_.,.-,. ., . _._:::.. .�..,. ..__..>........:.. .. ..:..: :.:�. T � ���� .. .. .. � : ,.� ..._. .. ._ . _ . � 5 n e of�AopFcon•o Doie .. . . SEE REVERSE FOR.EXPLANATa`RY L'/1TYdU�kk�E`:�..;ru'- ` ���F�LANSTa�AFPLTCAk7���`- - '"":.:""..'�'"".� - .. . �{tISKQ�'S-PIOTES � � `:.`. . �"."."'.' ". -OWNER-BUILDER DECLARATION ..� . - --- - � - � -� -- '���=� -�- I hereby a!+irn ho I om xempt�from the Controcior's To: , . � turned . � � . Lice se L 'w-s rhe follo q reasan (Sec. 7031.51 - Approved - � � � � ��- gusiness and P fess one.Cvd Any city or county which �Na.I -� Dot• � Dqte � reqoires a perm+io cons}rutl ok r,improve;demolish, "� , � . - . ... -_..T,.,.__._, _ .-__ - ""'o�'reooir any��sfrucfore, prior fo its issuance, olso re- - � �^ � � quires}he pppii<anf for such permit to fi71e a signed sfafe� - � - � " � �- - --- � . � , �� . . ._. --.. mertt tbat he is hcens.ed pur;uant to fhe provisions of 4he � - - � � � - Confrpctor's License Law/Chapfer 9)(commencing wiih N� � v � � � Section 7000)oF D vision 3 of ihe Bus ss and Protes- sions CodeJ or thot he is exempt iheref om and ihe bosis � ____ .�-_ .__..._.. �. . . t ...-.. -.....-.. .... for ihe,.alfeged exemption. A.y violabon.oi.Secti.on � INS �CTIOY - � �DATE- INSPECTOR �y E S �f / 703I.5 by ony appfimnf fo>a permrt sub�erts the appli- .� - �l /�� � . caM to-a c"vil penafiy:of no�.more,than frve.hondred LOCA,TION � ' . . . J�/AT_4 -�� �,�y� . ..... -�dollars(5500).;: -. . . :. ..... �`-Y�"� -�� "-•'�'---[�,��I as ownerbf ihe properry,or my employees w ih S7EEt&FORMS ' �� . -� - wag s as fheir sole ompe sat on,w I do ihe work,and �� - — :� - - �- �-�-�� � " � � � - }he-sir ctu e is not n�ended o offered fo saie(Sec.70441 ,uGHT Ci ONDUIT I . �j a ` 8usrness and P�olessions Code Th_e Contra<tor's Lrcense .. ._._.�._.__^___„� • _. _...... .:..... . eONDItdG � � � .- -- . . � _� - -- �`� �- --� !ow does not appfy io an owner of property who bu�lds or � � �" � _ � _,,, � - Improves ihereon,and v+ho does sucfi work himself or � • {i �' �. �� � � � - ��-- ---'---- �through his own employee-, �rovided that such im- t—'-- _ ;, ; - provemenh._p e nof intended or o{lered for safe If,� . , y .. .......... _>w i �� : � ..__...-.... _,.�:�.a � ._ f � � ., � - � "':`"' ` . ---�-� however,ihe SuJding or improvemenf's sold wifhin one_�- • �p— ��;�,; � --- ��-- �- year of completion: the owner-burlder v�Jl have the.. _ � �,CONDUIT �:.,,ii i . . . . . _ - ... - . . a.- �. � c� - � �-=-'��'�--•;L-�-=:h- _--�-'��+�-�__,.. burde I proving tnot he did not buildpr lmprove for the � GAS LINE ,� S �j:� �� �f•`._.�- ..� .- .. . .. . pu pose cf sal . . . ..: . � ' -�-�� -��F-..�:;;:❑ I,as a rer cf lhe oropert am exdusivel mn- _ �.�:�. _�.,..x. y, y . WATER LINE � � - . � - recting wi'h I�c�n�ea c roctars Io construct ihe project � cr . . . � ... ....�. .._ .:�• ... -...-. --_--_..- -•- --:_- .—r.xa-..._. _.�._!Sec 7044;Sos- ss orid P fessions Code ifie Controc- �SEWER � .. � ror's Lirense Law does not opply to an owner bf�properfy � -� - ' � � .� ._ . � . �-�� `�_- - ` �-wh builds or improves fhereon,ond wBo contracfs_for . _, such p ojecis wrth a rontraclor(s)licensed pursuant�o . . ' � � - . ..� . .�. -.- . . ..:::.:6e Conirador s License Lowi. . i�ANTI-SVPHON VANE .. :.. . . -,...._ ...---.., .:�.--, ..-....... �I am exemct under Sec ,B.&P,C.for�his �. �ELECTRIG WIRES .. . —' . ..�• Ey..+ .. . . .. ...... ... . . . cs � . .�. ___.... .__�,.:... .s.�s-_.-�.: ,....,:,,...��irae3+aae*.x-a�. . .� . .... `.�-.n.. �.�,� ��F�r.i:� . . FENCE(HEIGHT) x.� ';'� � Do;e__ Qwner _ _ � . ......_.. , .._..,..e,. _.N...:.-....,.�. ,a,�,.:-... ,� ... ._._ _.. . SELF-CLOSING. .-..'.... . .. �GATES (SELF-LATCHING� . . . . � . IWSPECFOR'S EVOTES .. .. . .. . — _ . .. . >,.....- .. .,.�.. ..a.:�:,.< .> ...ar:<.c�-s;...- ' . .., f.. , .. .. _ ._ . __... _ _.. ... - . e�sr +�`.�8.�� ... s4"--f+__� . ��. . - ,i...r.*�m-sa � _—. . . . c, �_ . ' . . . ...,_...< ...:.:_.uvs..rtnm-R':n-'.rri�.u...z+w�.eae. � �. . . _ _._... .�ta� ' � t 1 . � - - - '�'[t- : . � ROUGti WIRING " �- " - -� -� - �� - �� ,-- f4� ,J > __......�.� ....�-.......-n., .._. _.. � �_ , r_ .mait-k,^_-'. ::� .._ _ . - 7 � � � ~. . ... . . - . . . . LFINAS ELECTRIC � � . . .... __._....__'___ ..,,,, ...�..T,. .s:;.��v���.s���s�x3�sa�:-rs.�����t' ,.ry,e,��#,.' `- . .. . .. :_. .. .. ..__ .,.v.. _ ., ..... ..: t.._ .- �. . - . .. . I , . .__., . �. .�* .:. : .. _ ,.. , ___,._ , .... .-.. .. �- � .e-. _..._._ ...,_,t�_ . . � HEA7ER(LOCATION L VEM') �� .. .. . . . . . . � . , � , . , _ . _._. ...._-.,:.-�..,.:.,. +K«, � ,. - � _...... ...::a � GAS LINE TESi a � �'�_i �•--- . . . - . . , _ ..__ ,..... ..�... _ _ _. .. .. � . - - � ».....�,_,. .s..�..,:�. U.s..�Km:.;..3-sw.�-�,�.-�:.�r-�� -a.:'�m'a.v.�u�:.��.`. POO!DRAIiJAGE . . . .. ... .. ... .. ,. ,__.:.;;� . .. . ..sa' r�,cz,a...: .. � i P-TRAP . . . � .. . . . ,__: . . , . - .�. . •�. . — . . � - .... ... .,....:—......--...n.,.-_z-�...v,.,..,.reaw�a.F-x,n,,�, ..:.:._ _.__...,-_;. .sfi.a._.....:� .._-w-SNY"LY.�_ .,.,: ...,:,,.