HomeMy WebLinkAbout0966A 0967A �- _ _--- --- __. . . _. . �_:_ . _ _ __ _ _ �. / WORKERS'COMPENSATION DECLARATION �( M N g� `�j �j /./I hereby affirm ihar i hove�o�e��,f,�a�e�f�a�5e���0 5e�f .APPLICATION�FOR COMBINATION SINIIW�NG��OC�RNiI'I' � � l! nsore,or o certificate of Workers'Compensoiion Insuronce,� or o cer�ifi d copy Ihereof(Sec.3B la ,C.) �sa2oB � � - �� � � cee�s tsiea�� �:y�OUNTY OF LOS ANGELES • BUtLDING AND SAFBTY PolicyN Compon . ,. - � „ � � CeHi ed copy is hereby furnished. �, ` • � - ' - � Cer6fied copy is filed wiih ihe cou ry ild�n ' c- � �FOR APPLICANT T0 FILL IN'�' ' AooREu tion deparfinent. BUILDING 1 ADDRE55 - LOCALITY , Dote`Q^�Applicont NEAREST CERTIFICATE OF EXEMPTI FROM WORKERS' � � ��ry �Z�P �� CR0.555T. � � COMPENSATION URANCE SiZE OF ASSESSOR , TRACT LOT lDT NO. MAP gOOK � PAGE� PARCEL �, �Thi�s�cfion n��d ne}b�compl� iF fh�p�rmif Is for on� tEt. USE ZONE� MA9 . . . . . . . . , , �ndr�d dollers(5100)or Ins.) OwNEe NO. No. I tertify Iho�in the performante of the work(or which ihis . . � �qq� �� permit is iss�ed,I sholl not employ any person in any manner ADDRESS � CON�ITIONS so as to bemme subject to the Workeri Compe�5alion LawS. � DISTRICT� SiATISTI�AL QA55 TYPE vk�D 9v � . � , � QTY ZIP ' �, �ONST. . ._,� CLA55 NO. � . ' Date Applicanf WGMEER 7EL - r - NOTICE TO APPIICANT: If, ofter makinq Ihis Cerlificole of �� N � , Exemption,-�you should become subjeU l0 1he Workers' AODRESS YALUATION Compensation provisions of the Labor Code,yoo must forth- _. ��L�' '�'`I - VAUDAT�ON � . wi�h camply wi�h such provisions or ihis pe�mit sholl be CONTRA OR rEO. U deemed�evoked. � - LICENSED CONTRACTORS DECLARATION � ` �� � . I hereby atfirm that l am licensed onder provisions o1 Chop�er 9 ADDRE � C\ � O. �� s +� � (commencing wi�h Section 7000)of pivision 3 of the.Business � �� � � � . ' � . and Protessions Code,and my license is in fuil iorce and effetl. � M QA55 `.' �� . ��. DESCRI7TION Of WORK NNA� �. , License N�m er' tic.Clps� SWIMMING POOL . �.. ._ . DATE-. ��O. , , . . . • � }:��, SPA a Conl . Da�e�Q�. . FINAI / � ` O . � so.Fi. 1 i'1 ar . ''(; , ;;r`; U I am e�empt under Sec. � SIZE / L.J � . - 8.8P.C.for Ihis reoson Daie: EIECTRICAL. .. . . . ' ' ��ry l . � ` ._. .. .r+ c . i, � , _. __. �J � : :c.�:1 � � .. � � Steel 8 Conduit Bonding ��� � � �, � . ' � ' � LL' � SignoNre � Conduils,Condudors,Eqvipment - - - � . � =" =� N � - . $INGLE FAMILY � . . . .. . .. . . . . . . . _ . . � - : . �.:� _ I c z HOME OWNER-BUILDER DECLARATION pLUMBING - � � I here6y uffirm tha�I om exempt from the ControUor's License . . ,. ., � � I O.G G—C 7 -Law for�he following reason(Sec�ion 7031:5,Business and p_Trop � � . Crofessions Code): � Gas System _ _ ' . .. , l :=C ?t}1. � � 1,as owner of ihe properry,will do the plumbing and Anli-Syphon �� ��� l rl`}��j_ ' - _ eleclricol work.I,or my employees wi�h wogas as iheir _, . . .. ..,1 . ,. � .. . - ' � sole compensation,or a licensed contmctor will do all MECHANICAL � � � � � � ^ � or , o�her work ond Ihe strutlure is not intended or of{ered . . !�L7 A'`���.. _.. . � d � �C.�„'!) . ' for sale(Sect�on 7044 B8P Code�. � � � - Swimming Pool Heater � �-� �- � � � .,-f� c , �; CONSTRUCTION LENDING AGENCY � � � \O ,��� - - �� - ' ` �'�- �� I hereby aNirm thaf Ihere is a construc�ion lending agency for AFPIICANT. ... .. TEL. � ... . .� _ . . the performonce of Ihe work(or which ihis permi�is issued. (pp�M) . NO. - � ' (Sec.3097,Civ.C.). � . � Lendei z Name ADDRE55 . . .-. .. .. .. � . .� . . . .... � ( r'.C''�—� ,' Lender's Addrezs � P.G Fee E S� �/ Vermit Fee �7�� � � - - � - I certify thot I hove�ead this appliwtion ond stote that the � . � above info�molion is correcl.I agree to comply wiih a�l County - � � ' lasu ca Fee ��T� ` �ord�nonces and Slate laws reloting fo building, electricol, - � \, •hanico�a�d plumbing conslrucrion,ond hereby aothorize ���eeuga�ion Fee a^ 8�o� ��� � . � - . � �- -- � r �ntorves of his nry o enter upon �he above- To�al cee � �� 'or erty nspectio purposes. � ��� � � . \\ � - ` AppIImN or AgeN � SEE REVERSE FOR EXPLANATORY LANGUAGE � �� ' ��; ' �r � � �- �;i [ �s �. f�1 � � � �a � i' y � ° c � 4 � � �A 11 J�' � . . . . ' . , . . , � � �i $�ro L k.w� �I'. iw r�� ��'�y�� �y� . . . . .. . . . .. . . . OWNER-BUILDER DECIARATION ' �� � PlANS i0 APPLICAN7� -� � �INSPEGTOR'S NOTES �� � � � � �I he�e6y offirn(�that�l am enemPt f.am.the,Contr6ctor's To: ' ,Rotumed. . � �" ' . . . E t �`(���'� � l�QnsQ Lav�-f or.nhe followinqvr�a:on`l5ec. 7031.5) � �Appraved �1Buslness ond Prolesiions Code:Any ciry or'cpunly which No. '� �alo--� '- tJo. , � Dofo;�"r " -�" " - "�?Q� ' " � g ' '�� requlres o permif ro const�uct,aMer,improve,demolish, .. . /.�� '..!���.J ... J;'J'-/ L,� �, ` .��. ' . .. ._._. . . . ,,. . . ___ ' �:or-rePalrpny struciure�.prlor fo lls isxuonce, olso re- � r / � , ( '� �,� f� -� �—� � j quires 1hd oppllcont for such permit to iile o signed sfo�e- � . , . ._ .._.__ .__ ..� -:.� •,. •..-.�y�� . . .. ._...�- •.: ��.__a�y.!�� r.,�. .. _.i - _ _ ``'rPe�Yf,haf he is�tensod pursuaN fo�h�pro��lonsbf the -.�r , f �' ,�—.� . f_I� ' . F '- �Con ractoriYl en'se'Cow(Chaptor )�(om n�in9�wt�h � ..� ,. - . �: . � ' - --�, --.. •_- .—4-....., - ✓.� . - .- � '- -. ... ----'-- - . - .•. -� ... . .: Secfion 7000)of O�vlsfon 3 of}hn Business and Profes- � . ... ' � sions Codo)�or fhol ho1s exempl fhereFrom and the bosls � - � -- -- � � � � , � . - � � � _for-the.alfeged exemp�lon. Any.violafion of $ecfion , INSPECTION . . DATE . INSPECTOR �, (` ���, �. � 7031.5 6 an a L`can�!or a ermu sub ects 1he a I - ._� i , 1^<- / �f � Y Y PP� P I PP'- � �- • , � canf fo o t7v(I penal�y of not moro than live hundred �ocnnow _ _ � � � _ .-�.��r;.� �. � ��dolfa�s(SSoo).): �� . . , �� . .,. . . . ��.�..❑I,as owner of Ihe properiy,or my employees with S7EEL 8 FORMS;, ,, . ., . � _,__,_._ .. ,` _�. �. . wages as Iheir sole compensotion,will do the wark,and IIGHT CON�UIT � )•: �� �, , � ! ! `Pi �, , ---ihe structure is not Inteoded or ofiered for sole(Sec.704G) - � �'�.-��i�� ,(�,�����%! ' �-'��� �9uslness ond Pro�esslons Code:ihe Conlracfor's Uce�se eONDING ' -��� � ( '' '/i ( 'i � . • lawdoesnotapplytoanownerofprapertywhobulldsor , ,ry,'��\1.�, � ���.�v t. ._;�)j; � . ��mproves thereon;and who does such work himsol7 or . � L��Ju -�.-1 � .t �"� � ��- N- � � -lhrough his own employees, provided }hot such (m- �-�{ 1.F+'� �"'"� -�"U,:J .�� �"�-.'�` - � provements are no� 7nfended or of(ered for's6le. If, � � (�`.„J ,�;i �:,.n.,� • � 4 however,the butldin or im rovement 6 told wiffiin one .C.(� /_. _1.J C.e�..���-�.._ 9 P . CONDUR vY(�..�,.� �� J 4� �� ti � "7 ' year�ol compleflon, fhe ownenbuilder will have fho .-- v . _ ��._�_,.^. _, _, _- ..buMenofprovingfhothedldnof6ulldoNmprovalorihe CAS UNE�V� ��l �J�� , 1'.. --. . �pu(pose of saleJ. . . . . �"-r_ �, . . ���as owncr of t�.pro�ert�'�-�m extluaively con- WATER LINE ' . _ • � � ,�-�. - � � trot�ing with I'�¢nsed onr oGo�s ro con«utl�the projecf SeVJER � , ' . . . _ ' `�c.,��4Q)�Businesr.�pd_�rp(es,s i�s� „�e�ffie Contrac '� �� �� �'�� -- � "� � �6r s II ens�Low does r(ot 5pp�j>io d�wrieruf properfy . � �� � �, � . .�� ._. . ... ._ . �..• �` . .who boilds or improves Ihereon,and who eonlroch tor __ � such projec�s with o confracfor(s)(icensed pursuanf�o � -�Ihe Confracfori Lfcense tow).-�� � � i � t , .. . � . . . . . - AhT1�5YPHON VALVE Q ❑I am exempf underSec. ,B.&P.C.for lhis :-. ELECiRICWIRES I . �}. .. - . . � .. „ .. .reason . .... .. . . . FENCE(HEIGNT) ' � ' Dato OWner � SELFdlO51NG �� GATES (SELF•IATCHING� � ��� � � INSPECTOR'S NOTES� . � �Li'J _��.. .�.. , . . � , . � . t � ROUGH WIRING � � . , - � � �{ FINAL ELECTRIC ' .... ... . .. .. ... .. . _ _. it . .. . . . . . . . . • r ._. . ,._ .._. .. .... ... . . ..'_. .. � HEATER(LOCATION 8 VENT) �: � � i . - GASLINETEST ' � - '- ' '---'-- - - ' - '- -..- . .. . . . POOI�RAINAGE P-TRAP .- . , - � '. . _ . .... � ', �\ � � . . _, ..... _ . .. _ . _..._.. .. .. � � ( 1 / - � ' l '<' ��(J� � �f.. J \ �',. . �. . . � . . _. 1 '