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HomeMy WebLinkAbout1348A 1821A �- �_....._�...__,.--�____.----__. _.._-- �------{--�__ _ _ . -_ .___ _ _ WORKERS'COMPENSATION DECLARATION I� � � �., � I hereby affirm fhat I have a cer�ifiwte of consent to self ` ;�5��e,or a certificole of Workers'Compensafian Insorance, APP_....,rION FOR COMBINATION SWIMMING POOL PERMIT � or a certified copy thereof(Sec.3800.Lab.�C.) 7 .76n208 . ' �...� . .� . _.. ...__ ... ._. ..; . . �,,�,�I. ,� CE-875(11/81) . Policy No.Ll�Compan�� 7'-a�� COUNTY OF LOS ANGELES BUILDING AND SAFETY �, � Certified copy is hereby fumishad. � � � ' fOR APPLICANT TO FILL IN' � ewi�wc ..y� �� ��� - ' Q Certified copy is filed wilh ihe county building inspeo-� - - A�DRE55 �3���i'77"�'E�" � � � tiondepariment. BWI�ING +� �-. � - - �y��� ,-� _) Q'� ���? ADORE55 �I'��� � � .�' .. LOCALITY. !7'� . � Dale�_I�I�Applimnf , �� � q NEAREST /, �� � CERTIFICATE OF EXEMPTION FROM WORKERS'� Citv " � Zia /��4 S� - GRO55 ST. ��� /"�+ � �, � COMPENSATION INSURANCE l�9� SRE OF. a55E550R �, �, . � � TRACT'��+ LOT LOT NO. MP.P BOOK VAGE FARCEL , (Thl�a�c}lon nwd not 6�mmpided if IM p�rmH b for ono � TEL. USE ZONE MAP. '. hundrad dollar�(f100J or I�ss.) OWNER NO. �4/ NO. ��� -j�-� . I cerlify Ihat in the performance of the work for which this � �^ SPECinI . . . . permit is issued,1 shal I not employ any person in ony manner ADDRESS �""�� � d�7 T� CONOITIONS so as to become su6ject to Ihe Workari Compensation Lows. � ' � � � - . , OISTRICT STATISTICAL CV1S5 , TYiE PROCESSED 9Y . LITY ZIP Ctq5SN0.,.. ' CONST. - Date AppliCanf � ARCHITECTO -� �� 7EL. . �p �, ��l ` u� NOTICE TO APPLICANT: If, after making Ihis Ceififimre of ENGiNEER NC+�' �(7� Exemp�ion, you should become subject to Ihe Workers' � pDDRE55 ' ,(�' VAWATION � Compensation provisions of the Labor Code,yoo-mos�fortb• � � VALIDATION ith comply�with such provisions or this permit shall be � COMRAC70R � c� �-N� s �• deemed revoked. �- � � LICENSED CON1RACiORS DECLARATION � �� qDDRE55aSSC� �NO..�,Sa�.i.s7 ' �. ' . I hereby affirm�ha�I am li[ensed under provisions of Chapler 9 ��� S - �, � • , � � (cammencing with�5ection 7000)of Division 3 of the Business � �� . C�� ��3 . . . R� J Q,8{�. 0. � �and Professions Code,a�d my license is in full force and effed.�-�, DESCRIPTION OF WORK ' ' � ' � �� .'. . _. . . � FlN �� ► $i• • • •'L� V � license Number��� Lic.Class SWIMMING POOL DA r]�(�//�f' .� � p � I.• •528.1 p Coniraclp�`"'�y�{L�' Dafe,�[7� SOA ' . "' FINA '� � . � H ❑ so.Fr. •5 2 8 1 � u I am exemp��nder Sec. SI2E � � � �y ' � - 8.8P.C.for this reason� p O.2 O�--a�l ��� � ELECTRICAL . . _ . ... , . � �t,�/ .?.S��lo J Z � Da�e: � ppp . .� Si nature . . .$teel 8 Gonduit Bonding � � �����_�� � � - � , � , 9 Conduits,Conductors,Equipment , . . SINGIE FAMILY - _ . . ' � � HOME OWNER-BUILDER DECLARATION PLUMBING - ' � � � I hereby affirm that I om e:empt from ihe Coniwcror's License � _ � , . i� . Law for Ihe following reoson(Section 7031.5,Bosiness and p_Trop � � �� � � Professions Code): Gas Sys�em . . _ � . � . . ��� . . . - . � I,as owner of ihe property,will do 1he plumbing ond Anli•Syphon . �, electrical work.I,or my employees with wages as Iheir .- . , . � sole compensation,or a licensed tontratlor will do all MECHANICAI - � � ', �� $Z� A . other work and ihe slrutture is not inlended ar offered - ,� �. � , ' � � for sale(Seclion 7044 B8P Code). � Swimming Pool Heoter . -� � � I ��, � e � #1• •3 � CONSTRUCTION LENDING AGENCY � - . '�, � � - - � I hereby affirm Ihot there is o construclion lend�ng agenry(or qpp�ICAN7 TEL. - - ' �'' ' . � ' � $$•�� � the peFformance of the work 1or which this permit is issued pgiNi � NO. � � . (Sec.3097,Civ.C.). . � � � , � - .. . •_c � (j$,�Q� . lender'S Name pooRE55 . . .:. ,��O� ..a(� , Lender's Address P.G Fee S S�!•�O /� Permit Fee J� Q � - � � � � - I ceriify thot I have read this applimtion ond slafe thot ihe . . , , , . � � - � '� above informalion is mrrect I agree lo comply wilh oll Covnfy � " � � � Issuance Fee � �� � � ordinances ond S�ate laws�ela�ing to buiid�ng, electriml, �� mechoniml and plumbing ronshutlion,and hereby outhorize �r�esugat�on fee . /��� �� � � � . �represenlalives of ihis County �o enier upon the above- Toml Fee � - . mentioned roperty for inspedion purposes. � �� � � � ��. � �' � � ' ��r .P-� �-/-��-f ' ' Signotu�e of Applicani or ngeni ome � SEE REVERSE FOR E%PLANATORY LANGVAGf '� ' � � . ` PLntls7oAP?LICANi ' � - '~iNSPECTOR'S�NOTES' ' ��� � OWNER-BUIlOERDECLARATION � To: - , Raturnod „" - �� ,� , � '� � I hereby affirm 7hat I am exempl from the Conlrac�or's ' A roved 'licensa.Law�'for:thz following�reoson�($ec 7031.5) _ .. . ._ . :• '`��:. . �. . �_,, y PP Bvslness ond Proless�ons Code:Any cily or county vihlch No. �- � Oafe - No. Date � � � requlres o permit lo consfruct,aller,)mprove.demollsh. __ . . ., _.. . . '- _.. �. ... _ .- 1 � .'�� r-! �'or repair any str�cf�re, prlor fo tfs'Issuonco, afso re� � -� �,,./; a"+�tf� qufros/heopplican7forsuchperm(itofileaslgnedslofe- _._ .. _ . . .. _ _ _._ -_. . .. ` __. ._ _. .. . "n,---- .� � '- � - menl�hat ho is li<en ed pursvanl}o e provlslons oi the s th � � � / �\� •--� ' �Confrottor's L(censo law(Chap�or 9)(commoncing wlth � � - , . .. Seclion 7000J o(Dlvfzlon 3 of!he Businoss nnd Proles- � ' - � �� � - � slons Codef or fhot ho Is oxempt fherelrom and}he basis , for�fho alfoged cxcmpflon. Any vfololion oi Sor}�on --�UJSPEGTION � �-DATE�- � INSPECTOR - • ',,`•�'-- - � 7031.5 by any opplicanf lor v permlt subjecfs ihe appl�- , � � canf}o a tivil penaHy of not more fhon flve hundred IOCATION _._ . .�. _ .. . �.._._� �- . _ _ __. _.... . . .��''.:'�%�J ; -dollar❑s Iso�oowner of ihe praperfy,or my empla e ` y es with Siee�a coents '�I�1 (J.J�� _ _-_ � � . - - -. - - ' wages as their sole compensation,will do the work,and , � 't'� �, ,., � Ihe strucfure is nol infended or offered for sale(Sec:7044) LIGHTCONDl11T ' .. ... ........ �,_�' ^" "-�-�� . , ._-�'`��:'� �"'-"' .- B�s(ness and Prolessfons Code:The Confracto�s Llrense � _. ...._.. .. .... ........,. � eoN�iNc ' � ' " , - .���, -� � Low does not opply to on owner of propertywho butlds or � ' - ' ' . -� - - improves fhereon,and who does such work himseH or �� � � ,� � , , ,. , _, . ., . Ihrovgb hfs own employces, provldrd lhat such !m- ' � , .. _ . . , ._. � � � �� provem,enfs are nof Inronded or oliared for sale. 11, �� � . . . - .,_. ._ however,fhe boilding or lmprovemenf)s sold wifhin onc ' � ycar o/compfefion, fhe owner-bullder w711 have fhe CONOUii � ., . �•�-� . . , burdenolproving�holbedidnotbulfdorfmprove(orthe i � cns tWE : , - . . ,�i , � � purpose ol safeJ. , . . .. I � , , ._ _ ❑-I,os ownr.r af the�propery,•am exclusively mn- �, WATER L1NE '� . � � � . .. . , Irocting with licensed coNrpctors to constrvct 7he projecl '� . . _.. __. � ISec.7044)Buziness and Pro(ezsions Codv>7he Contrac SENIER ror's License Law does nol oppfy fo an owner of property -�� C! f �.✓ � . . . --_ .-. .. _. . - . who buflds or improves}hereon,and who conlradz for such projecfs wifh a conlraclor(s)licensed porsuanl fo �� � - ' � ., .,_, !he Conlrocfor's Licenselaw). ANTI�SYPHO!7 VAWE • I . -, _ _. ❑I am exemp�under Sec. ,8.8 P.C.for this �ELERRIC YJI:tES reoson � FENCE(HEIGHT) L�„_/ ' Oa�e Owner I GkTES rSEIF•Cl0$ING 1 � R�SPECTO^nSNOTES � � . �SELFdATCHING/ ROUGH YlIRING •��r°" r �� . FINAL ELECTRI^ - - � . . . . . . . . .. .. ._ . . .. .. ,....._' >{FATEF(IOCATlO}7 L VC�iT) � � GAS IINE TEST � .- . . . � -' ' -- "' . . .. - ., . � . . . POOL ORAINAGE ' . . . _ � � � � . � � P•TRAP , � . � � . • �