HomeMy WebLinkAbout1346A 1347A _. _ .. . _ . _ , . . .: _.. . . _ � ���jj} WORKERS'COMPFNSATiON DECLARATION- -� ._ �. � � ��- �� I�� . ;.� ��' -�t I hereby affirm ihot I have a ceffka�e of conseni ro self APPLICATION.�.FOR COhA�I.NAtION SVN�I�MMING P00!�P�R''����4$Y..`:�. •;��. insure a a certificote of Workers Compensallon Insurance, � or a ce t�f�ed copy thereof(Se<.3800,��.1���� � 6 zos � � � �� � �� -� � � � � � � �� ' ?�2'�O .a��-(?CP��-�'-C��Es;e[s-aai "' Policy No�-_; _ Cqmpany - COUNTY OF LOS ANGELES BUILDING ANb SA�ETY Cert��ied copy s hereby f�mished . . .. . . ..... . . ..:.,,.a ....w.�,.»,-,.f.-..,....,.�.,...... .y.....,,., w,_ ..,..., . ........ .. . ...._., � FOR APFLICANT TO FILL W euaoinc�a��3 " '--� Certified copy is filed with,th counly b�i(ld��a9-��e�o- ADDRESS fion epart ent. ` J/ BUILDiNG L£�CA[-G,!// , r.••��C ADDRE55 �o�a� � LOCAIi?Y Do��� App�icont � NEARE5i � - CERTif ATE OF EXEMPTI N FROM WORKERS' CI7Y ZIP _.,.. ,._,... CROSS ST. . ._... .......... � COMPENSATION URANCE $IZE OF � ASSESSOR . TRACT LOT- LOT NO. MAP BI�OK PP.GE PARCEL {Thia seNion need no1 be compteted if 4ha permH is�for one TEL -{ ,/� U OY,E MHP �J�l 2 � NO.d� lS���6I�'Y' ��' �L� NO. . !/O 'Jo'Z' hundred dollars(5100)orless.) � OwNER .�U�'U �,.. 1 cerl fy tho�in ihe performon<e of?he ork for which�his �p.�n SPEQAI , , ' permif is issued,I sholl nof employ any pe son�in any monner ADDRE55 `T--� .. . � /o� CONDITIONS . so as ta become su61ec1 10 ihe Workers'Compensalion Laws. � � � , 015 R:CT SiATIS7ICAL CLA55� -����� T�PE PROC 5C�e� � CITY- Z�P �� �� � CLA55 NO. 2 CONST. -Dale ApPlicant ARCHITECT O 7EL. f NOTICE iO-APPLICAN7� if, ofte mak� .� this Certificote ot EtvGiNEER� �' '�J'�'�"' NO. �.'�..c� U'Z�l� �`" �/ . Exempfion, you should-become subiect lo �he Workers' qDORE55 ('J ' "J- �,y� 2LUg- YREUATION Compensation provlsions oi ihe Lobor Code,you musi 4orth- . . . '� /T/'�,/-1 VALIDATION . p v w�rh such �p Te�. �_� � , . ..__ . ...... . with mm I provisions or ihis ermit shall be CON7RACTOP. /�iF� .NO. �1-� S � �r deerqed r.evoke�. . - LICENSED CONTRACTORS��DECLARATION� ��-� �� ,.�IC.�2 , 1 hereby affirm lhat!am licensed u�der p ovis�ons of Chopter 4 AODRESS�._lj�j'� ._-Ge LIO.olS���. f .(commencing with Section 7000)of Divisian 3 of the Bus�ness � �'�Z_ „[� CIASS (.� ��"'� � I� 3 a(�p � ond Professions Code:d�d my license Is in�full force�and effecL DESCe:aTION OF WORK� � � ,.1 PINAL License Nu er ��'� Lir,.Class`�� SWIMMING POOI DAlE ► �j:o o w e 7� a, , Contract � Date � SPA . . . � FINAL � � s o(fl 9,J 9 U r a �,,, � � . . sca.Fr. 7� . � ar. I om exempt under Sec. SIZE LL e A �J,C 9-c.� . . .. . . . . . �� O 8.8P.C.for Ihis reoson ELECTRICAL � - �''��� . � 2,�,�j-�(� W Da1e: Steel 8 Condult Bonding �� J�1� /R N � Signniure Conduits,Conductors,Equipment � SWGLE�fAMILY �.c a e e'e 3 — HOME OWNER-BUILDER DECLARATfON � PLUMBING ► - . i hereby affirm+hat I om exempf from�he Conhador's License � �� 7 5.S��% �Law for�he following reason(Se[fion 7031.5, BuSiness and p_T�ap � . �Professioni Code!: � - � Gas Sysiem . ° �' � 7 5.5�v � I,as owner of ihe pioperty,will do ihe plumbinp and An�i-Syphon - � � electriml work.I,or my employees with wages os fhetr . . � 2'L`�-g� so�e compensafion,or o licensed coniroctor wiil do oll MECHANICAL� . other work and the structure is not intended or offered � tor saie�Sedion 70A4 B&P Code).� Swimming Pool Heater - CONS7RUCTION 1.ENDING AGEN�CY � ������ � ��� - I he�eby offirm tho"here is o construdion lending agency for APP���qNT 7EL � +he performance af�he work.for which rhis permit is issued (pRINTI . NO. ► �ISec.3097,Glv.�C.1. . . ...... .. �ender's Name ADDRESS _. !e�der's Address ' p.�,Fae 5 �/j � Per i;Fee !(P U � �G' . I cerlify tha�I have reod rhis applimtion and sta�e thot rhe m a6ove information is correct I agree to mmply wirh oll County Issuance Fee �� � ordinonces ond S+o�e laws rela�iny �o building, eledriml; . mechanicol ond plumbing construcrion,ond hereby authorize In�esrlgano�Pee � ese�c!�� s of !hi o� � �o enter u on the above- Taal Fee �� < <j �m, -on pr eriyf r nspectio purposes. � � ... .... .. _. .. ,. ... ig w. f appl-mn•o� ye�r Dai SEE REVERSE FOR EXPLANA70RY TANGUA'GE'���'- .. ���PLANS70�APPLlCANT".'.... ""...".. .":��"' : . ....��IRJSPECTOR'S�lYOTES.: . �. . .�.. . . .," '.-'....'`.� OWNER-BUILDER DECLARATION. . � 7m � i ��-�Returned -���-' �-"...- ",^`".' ""-°�, heroby aff rm tnai I om e emp�°rom the Ccn�ractor's . '-' -- ���� � License Law fo �'he follo q e�+sr (5 7031.51 --- - Approved .. . "� - � ��-�-- . � Bos'rness and Professlons Code:Any city or co�nty which No. Dote �No. Dafe requires o permit fo construd,alter,improve,demolish, � -�.-..,•,-. .. ..-....,-..-. . .-.�-.`.^..-- :,:��brrEpoir any structure, pnor to ns issuance, ❑!so re- I ' � quires fhe applicont forSuch permrt to file a signed stafe- I � ... . . . . . . . . .. �.`...'^..... . '°.,.",.^ �....-.-...^-.....,.-.�..,ment fhof he is licensed pursuanf lo the provisions.o(�he � i � Coniractor's License Low(Ghaptor 9f(commencing with ii , ��� � � - -��--��-------�------�-�^---�-�- ' Sectlon 7000)of Civision 3 of Ifie 9usiness ond Pro�ev Lsions Coo'eJ or ihaf he is exempt fherefrom and the basls .. . .... "..... . .. .. .... . :.'..` :. ��. �.-. � . . . . .... ...�-�• .,;:�.-: for the.aNeged exempfion. Any viofation oi Sec�ion � � � � 703L5 by any opplicont!or o parmit subjecfs The appli- INSPECTION � � �� INSpECTOR:� . ��-�� T ��- ���•� canT fo a civil penahy of noi more thon Iive hundred LOCATION � dol(ars(5500;.).� I / � � -' �-��- -��•��� ���� ^��-=� ❑i,as owner of ihe property,or my employees with �STEEL 8 PORMS� - wages os thelr sole compensa�'on,wlil do the wo�k,tlnd ��- . ., . '� ' • �"���'�-� - -�-� �� � � � ihe structure is not intended�or offered tor sale(Sec 70441 -UGHT CONDt117 i �' � � � . . Business and Prolessions Code:The Con�racfor s License BOhDING � ; ��� ' � - ���"�" ''''�"""`�"' "" "�"'""""��""""" tow does noi ppply fo an owner of property who builds or �� � � improves ifiereon,and wh �d es such rk bimself or � � � . ��- - � ���-<- � . ihrough his ow� employees o owded that such im- .. . ._.._.. .-.,.,. .... 1"'-- —'�" � � provemeNs ore nof �niended offe ed f sale. !f, - � . � � ' �� - ` ��-- however,?he SuJd ng or mprovemeni is-sold within one . i. - � �- year of camplehon, rhe owner-builder wrll have tbe '� �.CQNOUIT �'„i �� ��.--�,:�� ---<.._,., ....,.,�,,,.,, .....� burden of proving�hat he.did not 6uild or'rmprove for the � � �� ' � � ose of sale;. - GAS LINE .,. purP � � . . �' .. � . . . , , . . . . ���� ' ��-� ���-���--° �.��'- �.I,as owner of'he property,om exdusively con- ��i WpTER LINE _�, ��� ' i-oc,;r.g w�'h I:cc^.sed contr�c,ors�o consfruct'he prajec' • . � �. o � � �� - � -��� � - �� �� ��� -�-��-.--��� � -�� i5e: 7044)Busmc-ss ord Professions Code�ihe Contrqr � � i SEWER �� 'y�� i . � � tor"s Licensa to•ro does not apply�o an owner of property I• ��� � -�-�� � � -� -- •.v.��.- ..�-�W.�� --•..-,�. who buifds or mproves thereon,and who confracts/or L� � such pro�ects uirth v conirottor!s)fitensed pursuanf fo �� . . � . - �he Confrac%or-s L cense Law� � .. ' ��ANf TI�SVPHON YALVE � r . - ...,.. ..�.. -._.�,....._- - . � �����-���*�- -�-��������❑�:am exempr���der Sec. .B.&P.C.�or this j E[ERRIC WIRES . . . , . ,...«.,.s .-.n:, .....,...� .,, . . _ FENCE(NEIGHT) �d[ �e Date _ Ovne ... ...,._,.:...:... .. . . ., . .. .. .. .... ....... . .. . ..'" .. SELF-CIOSING � � . .-•,.�.....�..-.,. GATES ('SELF-LAiCHING� �NSPECTOR'S NO4E5 ,:��f %�z� �l/�' . _. . ... _.,r.�„ ,... . ., . , -- �GH'NIRING I `✓� . , .. .. . . . . .. -.,. ...._ ,.�. �i . ,.. . �D � . ..:.. .,.-.. .�,.».. � FINA�IC /�'� . . ...... .. � . I ._... _ . . . . . . ... .. - . � .- . . ,.. ... ..... ....».,,-.,.wry^..,. ., .. . . .... . �. ..:..., .. . . . _ ... . . . . . . .:.. . . . . . �HEATER ltOCATION$V.kT) ' . _. . . . � . ... �. . .... . . .. . .- .:,... ,........... ::.�__.._ ... . .., . GASIINETEST � � - „ ...,� ..... . .... ...... . ... . .:........:. �POO?DRAlNAGE � .. ..__.. ., . ..,_ ...:. — . .. . . . - I P-TRAP � . . .. . .. ... ......_. ........,..s� ,�,:._....,,... . �.—___' �..,��. .,,:......,.�.,,,,.........,..� «e,,:.'av::..�:..�e�,,.,.,. , . .. ... .. . ...... .. .... .... .. .. . . ...._. ........ . ...... ....: � .�.. �...� . � .. . .. ............,.. ,,.n�.,;.... . .. . . ... ...� . . �. - .. .