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HomeMy WebLinkAbout1096A 1267A , WOfjY.ERS'COMPENSATION DEC�LARATION � r ; � � � ' ' , . '_�.��� '�"��". � � � I hereby�;i'� 1}�at I hove a cerlificate of mnsent ro self � ,�,�,;:.c:a cer�ifimre of Workers'Compensation��=�,a��e, - AppLICATION F�R COMBINATIOM SWIMMING POOL PERMIT or o cerrified copy�hereoi(Sec.3800,lo .C.) . . 7snaoa �--.- . ...... . - . :. . . ._. .:.: ..- -.. -. ... _ ... __._.,..._"..--. . ��1r ro/l _' cee�e(area) _ - - _��Polity No. L�-n����CompanyM ' �- � _. COUNTY OF LOS ANGELES .__. , BUILDING AND SAPETY � � Cer�ified copy is hereliy iumished. - � �—�/ fOR APPLICANT TO FILL IN BUILDING �/� Ce�tified topy is filed with� coUnty building inspec- - - � ADDRE55�� ' -- � � � tion departmenr. . � euuoiN� ���' nooaess � ivcauTv '�' Date Applicanf� � - � NEAREST \ � � � �CERTIFICATE OF EXEMPTION FROM WORKERS'� � ��TV . 21P �� � CROSS SL \ O��� . ' �� � COMPENSATION INSURANCE t, 512EOF ^[� nS5F550R . TRACT �13�3 LOT LOT NO. 'G�� d� MAP 600K PAGE PARCEL . �(This socTion n��d not ba compl�f�d ff th�p�rmlt fs for o�r 7E1. USE ZONE MAP . h�ndred dollen(f100)or I�s�J � OWnIER NO. ' NO. - - �� I cer�ify thot in the perfarmance of the work far which Ihis � . SPECIAL . . . permil is issued,�shall not employ any persan in ony manner ADDRESS � CONOI110N5 so as fo 6ecome su6jecl fo the Workers'Compensation Laws. - � � -OISTRICT STATISTIG4L QA55 TYPE pROCES5E0 eY � � . CI7Y 21P �� CONST. Da�e Appli[onl ARCHIIER O 7E1 - Cu1S5 NO` NOTICE TO APPI�CANT: If, after making�his Certificate of ENGWEER NO. 'J - Exempfion,�you should become Subject to Ihe Workers' � � VALWTION Compensalion provisians of Ihe Labor Code,you�must forth- ADDRE55 ��, VALIDATION with comply wifh such provisions oi Ihis permil shall be � � --• TE�� ��. . S�. , � deemed revoked. CONTRACTOR NO. IICENSED CONTRACTORS DECLARATION � - ���' �� - � � I hereby offirm Ihat I om licensed under p�ovisions of Chapter 9 ADDRESS -NO. f (commencinq with Seclion 7000)o(Drvision 3 af 7he Business �- CITY QA55 ' ` i � � � and Professions Code,and my I cense is in full force and effect. DESCRIFiION OF WORK ` � . License Number � x�/�^' r��__ FINAL . �, Lic Class SWIMMING VOOL - ... . . . OATE ''���' d �. � G fq .. :' '�� � - FINAI . � O Contrador .-.aLl��� �ote SPA - .. . _. O U � � I om eaempt under Sec: �O�C� �EFT. _. . . .. . ... . .sY � . . .. �� Q ,.�7�} � 1 � : B.BP.C.for this reason ELECTRICAL ��� - � � �� � � �� �� �� �� �� � � � ,'�2�3 � F'" . �.. ._ .. �_ .� Pi�.7F W Dme: � --�Steel 8 Conduit Bonding � -� -- � � `�. ' ' � a Signof�re Canduits,Conduclors,Equipment ' ���� l � � � • • •Fi Q.7 Jr'c�,� Z _ . SINGLE FAMILY . . .. _ _ . . . . .� . • �O �� . HOME OWNER-BUILDER DECIARATION pLUMBING ' ,' - ' ' _ �� -O��2��S H I here6y a£firm thal I am exempt from Ihe Confrocfor's Llcense , . . , � . . � �• Law for the iollowing reason(SeUion 7031.5, Business and P-Tiap � � ' � � Professions Code): : � V��% (\ � � � • , Gos Sysfem l . ' , �� . . � � I,as owner oi Ihe praperty,will do the plumbing and Anfi.Syphon .. L- --/./'1 �l�"t_�4 ' . . �. � eleclrical work.1,or my employees with wages as iheir �3���J -.. . . . . . sale compensafion,or o licensed comractor will do oll MECHANICAI � ( v� � � other work and�he s�r�cfure is not intended or oNered - � �� ��C-�1�}iGf_ . .- �.��2�i 7�1 , � for sole($etlion 704d B&P Code�.��� �� � Swimming Pooi Healer � "��� . . � � � ,CONSTRUCTION LENDING AGENCY � � � �� � c`� � �hereby affirm ihar ihere is a construction lending ogency for AVPLICA TEL '� �-' �� •2��,5 p the performance of 1he work(or which�this permil is issoed (pRWT) . NO ► ' �� (Sec.3097.Civ.C.). � � .. . . - �� - • �e 2 C G 5 0 u � .Lender's Name ADDRE55 .... � .. , QE31 -88 � lender i Address Q �.� � '� _ � .. P.CFeet O� Pe�mi(Fee� 7O�.C/J' - ,. • -� � - I certify�he+I have read Ihis application ond slote ihot Ihe � � � �t •� � � a6ove information is correci.I agree lo comply with all County � � � � Issuan<e Fee ��<S� . � � �� ordinonces ond State lows relaring to building, elecniml, mechanfml ond plumbing consbociion,and hereby authorize �nvesrigocon Fee � .� - � � , I- . represen�atives of lhis Couny fo enfer upon Ihe above- Toral Fae �(�•� � �� -;' - . � . . �+�d prop ly for inspection purpose'(�'si� . . . . � Signorure of Appiimni or ngen� .. Daie SEE REVERSE FOR E%PLANATORY�IANGUAGE, � . � - � � AlANS TO APPUCANT � � • � � tNS�ECTOR'S NOTES � � ' ' �OWNER-BUILDER DECLARAI ION� `' - ,. � here6y offlr_ Ihat 1 am exemp�from the.ContraUor's To; . Roturned . � � �icenso-�av:���or�,1117e;following,�[e6soq;'�(3ec.�7031.5) �� �Approved � � . �� Buslness and Professlons Codo:Any city or counry�whlch � No.. '�i� ..I.Dotc� J.� No. -.. Dato _ .._ _- _. ... .. . ... _ . . . . . .._._ . ... . . ... ._ . ���� � - requlres o permif to tonzfruct,alfer,Improve,demolisM1. , -��._.�,"a _ .. . ! �_ .. _. _ or repolr any sfructurc. prlor fa!fs Iszuante, also re- -���_ -�r � i �.,, , �,� ��� qulfes 1he appflconi for such permi�,�a/ile a signed slofe- --� - �� . - � +...,- - - �•�- - � �---� � - menf Ihp(�e li Iicensedpursuahf lo�ho provisfons of�he � � ---- ��-CanfroNo�s Lrcense-Law(Chopfer 9�(cbmmencing wilh � , , _ . - Senlon 7000)of OWtslon J o/fho Buslness and Prolos- �� � - - � • � ' � slons Code)or thaf he is oaempf fhcrelrom ond ihe bosis �- . . � for fhe alleged�exempl7on. Any Wolalfon of 5¢clion .INSPECTION-- . DATE� � -�INSPER R � � � ����' ' 7031.5 6y any appliconf for a pormi�subJects tho oppli� mnt fo a civll penalfy ol nof-morn Ihan�five hundred �ocaTioN _ _. .. ..-�_ - . . .. .- -.'').'j�;.. '- "� . dollars(SS00).): . _ . ..... . � - �'0 I,-as owner af the property,or my employees wi�h S7EE�2 FORh75 � � wopes as iheir sole compensation,will da ihe work,ond ucHi CONouiY�� - � ' 1`�`� -�• � ��- �^'�-�.'�� ..�•�; �----the strodura is not infended or offered ior sale(Sec.704a) � '�-��J 1 ��- � - � 3�� ��� - - � Buslness and Prafessions Code:ihe Gonfrador's Llcense BONDING " " *' / •'� '��� - Lawdoesnofapplyloartownerofpropertywho6Wfdsor � _ - V{lJ �.��.J '�'���v .. ����'•.'��._ _ ���mproves Ihereon.and who does such work blmsel/or ��ai,�;��. ', , _ _ , :I,):' �y �t`._ -� . ihrough hfs own employees, provided fhaf�such-Im- . � provemenls are nof infended or oHered for zale. II, � �t�...:; _ .�s }�1._:;.)�.,r � - howevcq the building or Improvemen�Ia sold wifhin one CONDU�7 0., .�:s � - - i J l ' yeor of�compleHon, �be owoenbulider"wtll hova the �,� ,� a ��,�__` burden olproving fho�he did not 6utld or Improve for the CAS IINE : � , � ` ` . .~. ` � �. purpasc o(soleJ. .. - .� .. � . - . ., � 0 J,as owner ofJh��pcoperl�am ezclusively com WATER LINE _ ._ .. � � rracting wilh Ircensed confroUors to mnstruct ihe proje[r SEWFR . � � � - � _ _ . ._ ,. -�-�SeL,70J4)6usiness and Pro{essioni Codr.The Conlroo - � tor's'C1�ense Caw does not Cfpfy7o 6n�ownero(properfy : v ��=� .._ ._ . .. . . �r..,, _ � who 6uilds or.improves f6orcon,and who mnfrocts/or ' suc6 projecis with o contraclo�(s)litensed pursuanl to � , � Ihe Confracfori License LawJ. � ' � . . '\ � .. '. . _ . - ANTI•SYPHON VAIVE � � , _ ❑I pm exempr underSec. ,8.8 P.C.for�his FLERRIC WIRES � �� reoson ' FENCE(HEIGHT) " � ' Dote Owner GAiEs (SELF•CLOSING � , - . � � � INSPECTOR'S NOTES � 15ELFdAT[HING . . ,... . , I'. . .� � . .. ROUGH WIRING �� `� � � . � . � �. � i1NAL ELECTRIC ' .. . _ _. ... . .. ._ ._ � " . �,:C.'j �:� � r.'�i�11 . . . . . . , , . �:.1� .� . •,;,.(�..,�� . .__. . NEATER(IOCATION 8 VENi) rY :.:�1'.' • . . � _ .:.`i•I�'�..'•.,�....I: ..__... , .. GAS LINE TEST / .- ' �_ _.......'...... ._,-.. . ..:...-` . ' . , . . 1 ., . . .., . , . POOL�RAINAGE ' ' ' .�.. � . . .. _. . . .._. - P.TRAP . � CT-�' . . ,. . . � . , } `,�. . �i� 1. '-�(', �`q''; � �1