HomeMy WebLinkAbout1424A 1575A (8) _� ._ _
'`� WORKERS'COMPENSATION DECLARATION -
I hereby affirm �hat I hove a certificate.of consenr to self
7
insure,or a certifico�e of Workers'Compensation��s��a��e. �-��� - APPLICRTION. F.O..R COMBINATION SWIMMING POOL PERMIT ' .
or a certified cooY thereof(Sec.3800,Lab.�C.l 'Sq2oe . ."..." .'. �.""' .- "'•". ..^_,., _M.,_...,�,.�.....n�:..+e_......���.... ...._,,., . .
a '�<y rvo.�����Cor.,paoy � �`a-a,�.aa COUNTY OF L_OS ANGELES _.,BUILDING AND SAFETY t ` ,
Certified copy is hereby 4urnished.
FOR APP CANT TO FILL IN " BuiioiNc a ���
Ceriified copy is filed wirh the c building inspec- ADDRESS
tion department. BUILDING g '
� RDDRESS '�J LOCAUTV
Da�e� ��"�pplican NEAREST
��7y ZIP CRO55 ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' SiZE OF ASSESSOR �
COMPENSATION INSURANCE , � � , TRp,� 1� �pT LO7 NO. MnP BOOK PnGE PARCEL
(This section need not.be<omplefed li 1he permit is for one TEL."-' US qN MAP ��^
hundred dollors(5100)or lesa J OwNeR No. �-� f�/'� NO. '��r�7"
I certify�hor in ihe performonce of ihe work for which this , SPECIAL
permih is issued,I sholl not employ any person in ony manner /+DDRESS '��iv�� CONDITIONS
so as to become su6jec7 to ihe Workers'Compensafion Lows- OISTRICT STATISTICAL CLA55' TYPE PROCESSED BY
CITY Z�P �� CLA55 NO. 7 CON57.
Date Applicanr � ARCHITEC70R . '..TEL....2�`..��L?`�. �[.i � f
NOTICE TO APPLICANT� If, offer making this Cerlificate of ENGINEER e N�� O �
Exemption, you should become subjec� fo the Workers' VAWATION
Compensation provisions of�he Labor Code,you most forth- ADORESS �. TEL VALIDATION
with comply with such provisions or Ihis permit sholl be ��NTRACTOR NO- ; ����'6 '
" deemed revoked. �
LICENSED CONTRACTOR$DECLARATION � cp` lIG ��
nDDRE55 C_ ; - ,
I here6y affirm thot I om licensed under provisions of Chopher 9 N�� f ' �' L'��R.
(commencing with Section 7000)of�ivision 3 of the Business . ��iv CLA55 -p �,
ond Professlons Code,ond my license is in full force,and effect. � � � '���' � £�� �
n ' DESCRIPT ON OF WORK FINAL LL��.
License Num6er��—����Closs�� SWIMMING POOL �,�.f DATE 6��,�-6 V ► I �� �=�' 1.E',J' a
Contractor
. �� Date ��I�[^YC � SPA LJ FINAI ���c- '(�. i.E�S c.TS U
. . , ,... _.. _.
� I am exempl under Sec. , SQ.EF7. �O .. .. BY .. . . ��"f G-�`�� O
. _ . . ..., ._.... .. , -. .
.. .. - . , � � ' � 4-,
6.8P.C.for this reason . ... . _.. ,...... _.... .., . � '-IECTRiCAL ... •` C„)
Date: ,}/1 � W
Si nature � 1 Steel&Conduit Bonding � �/a„p_ ��, _ j �'],j q �
g .._...,j Conduirs,Condoctors,EquipmeN I%I %-""' ' ' � z
SINGLE FAMILY ... ...��.. ....- J y� iF e 3 c'c c�j -"
HOME OWNER-BUIlOER�ECLARATION '' ,�_pLUMBING Z„S.J�p �
I hereby affirm thar I om e.empt from ihe Coniractor's Licen;e , � � � c ; �i„�V
Low 4or the following reason (Seclion�031.5, B�siness and p-Tra
Professions Codel� � P ? ` '"�n=�-�
Gos System < : 1,�,j�,�
� I,as owner of ihe proper�y,will do the plumbing ond Anti-Syphon
electncol work.I,or my employees with wages as�heir � ��'%,C�i-'O O
sole compensation,or a licensed contrador will do all � MECHANICAL . .
olher work and ihe structure is not intended or offered �(
for sale(Secfion�7044 88P Code). �� ~ � � j�,, Swimming Poo�Heater �J
CONSTRUCTION LENDING AGENCY ?
I hereby affirm that fhere Is a wns�rudion le�d�ng ogency for �" '�- '�"� '"""'"��""`'""'
ihe erformance ofi the work for whlch this ermit is iswed k APaLICANT TEL.
p P (PRINT) NO. �
r5ec.3097,C��.C.1. .. —_ :.•. - .......;�—,��•. .
Lender's Nome , , _, _ AD�ftE55
Lender's Address r Q .
... ..... . ....... P.0 Fee$ Parmlr fee �
I certify ihat I have read lhis applicotion and s�ate thot the � � ' '-� "�""'f,
above informotion is cqrrecl.1 agree ro<omply wilh all Counry Issua�ce Pee � O • ��/
ordinances and Sra�e laws relatmg to building, electrical, ... ._
mecha � nd pl�m6inq constr�dian,and hereby authorize �investigorion Fee r ,�_
re resenta i this Coun:y to enter upon �he above- ioml Fee f \ O � �L�
en ned prop.rty ection purposes. , . f�� �
Sianowre of�npPGmn�ar Ageni � Z� SEE REVERSE FOR EXPLANATORY LANGUAGE .
�
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PL4NS TO APPLICANT - � . INSPECTOR'S NO4E5� �- - ' UWNER BUILDER DECLAR.4TION---� �
�-- ' hereby otf m Ihot I m exemp from ttie Contrador's
�To: — Returnad L�cons l °or th f I ow q� son (S �031.5}
F'— Approved Business ond Professions Cod¢.Any afy or couMy whfch
�No. Dote �PJo. Date requires a permif fo consirucf,aker,Improve,demolisb;
I , j or repoir any structure, prior to ifs issuanre, also re,-
_� � quires the-opP)iccni for such permit fo tile a signed stafe-
� . - - ment tfrpi he'i,s licensedPursuant f,o�the provi;ionspf t6e
� -� Can}roctors fiten3e LoW jCSopic�`9j(co�irhencing wi�n
� - Seciion 7006)of Divlsion 3 of the Bvsiness ond Profes-
`�` � sions Code)or fho�Ae is exempt therefrom and 1Ae besis
. . . for ihe alleged exempf!on. Any violaficn of Section
WSPEC710N�� DATE SPEC R � - 7037.5 by any applicaN?or o permit subjecis ihe appli-
tanf to a clvil penoliy ol not more than live hundred
lOCATiON { , dOI1q�5($500).):
STEEL E FORMS C I,as owner of 1ne property,or my employees with
wages as their sole comper.sation,wdl do the work,and
�.iGHT cONuu�i p the structure is noi inlended or offerad^or sale(Sec.70a41
� L - Business ond Professions Code�ihe Conlroctor's license�
�BOkpiivG � � L'`� � � Law does notapply ro an awner of property who builds or
improves thereon."and who does such work himself or
! - . ._: , through his own emptoyee:, �rovided thot such�im-
- ' ' provements are no� intended or eNered for�sale. 1(,
, . ., however,Ihe Suilding or improvement is sold within one
CPNDu�Y i �G���-�� � ���G��, yeor o! comp7e�io��, �iie owner-bvilder wiN hove fbe
. . , . . 6urden o(proving fhot he did not build or improve for the
GAS LINE ,,.�"���� '� purpose of sale;.
,_�
. C i,es owner of ine proper�y,am exclusively con-
WATEP.IINE � Iroc';nq w�"r i�cen�ed conirnc'or;b:onsfrucf ihe project
'SEW=_e ' T�,1Ses.,7�e4}�8usiness and Professions Coder The Contrac-
for'i Licensa Low does 60!apply fo on owner of property
!�1__ , , who 6uilds or improvos�he�eon,and wfio contracfs ior
�� ~ �„R � uch projects wi/h o controdor(s)licensed pursuant!o
�� Ihe Coniractors Cicense tow!. '� ���
AHiI-SYPHON VALVE [],am exem�l unCerSec�--.B.8 P.C.for this
EL&CTRIC WiRES ]
� fBq50f.
FENCE(NE!wHP) . patr__ OWnef
_.._...,..._,.....:.................:...-.�...........� ...,. _,...
�GA7E5 �SElF-Ct0511 G 1 1 INSPECTOR'S NOTES
SELF-LATCH N j ' . .,_ . _. ......... ...._.............:...,_.,.�...:..,,..»....<: W .
�GH WIRiNG
j FIiJAL ELECTRIC ' "
� _,
�HEATER(LOCATION 8 Y@N7)
�
�LiYE TES:' �� �� � - '
�POO�ORA!N6�GE `
!P.TRAP
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