HomeMy WebLinkAbout1380A .,. „W.._ ,..,.. . .,
WORKERS'COMPENSRTfON���CCAkATIb'Rl � M` � �- ���� �I
I hereby affirrn rhai I hove a certifica�e of consent ro self w � -�- • -•• �=" ���"-^ � �x�^-�'u�a. '!:`'�:�'� -?� ""�'�"�;','.- ��
insure or a certificate of Wo kers Compensat�on Insuronce, MPPLICATION�-FOR COMBINA�1'�ONB'SWI�IUIM(IirG POOL ��RN9lT� � � ��
or o'ce�+;fied mpy thereof(Se<.380 'ab.C.1 , ^GF20B � �� ...
� . ""� C%8�6�3 da� . . ..,.
Polky No.��Company " COUNTY OF LOS ANGECES BUILDING/lND SAF'ET�/ �(� �����
�Cer+if�ed copy is hereby furnished. .. � .. . ..:- . -.--..— . . ..,.. :. ..;,:,.Q, /,,,,,�,,�, ,,,,, ;, .. _.,..
.,. ....,.,._.,.
Certified copy�s filed w�th the tcumy build�ng inspet- FOR APPIICANT TO noorze55 �'r (_(J(� l i �
tion department. BUILDING w
AD�RE55 � �� ^ � LOCALITY
Dote�.�APPlican � .:^ � ,
/ NEAREST
. ,.,__.. CITv "[ IP CRQSS Si. �,j
CERTIFIUTE OF�EXEA�PTIO�N FI�OM W�kkKfRS' ,, _ ... (� S�zE OF x� ASSe550R
COMPENSA710N 1�NSURANCE � TRACT� 'l �OT LOT N0. d� MAP BOOK � PAGE� PARCE�
(This seclion need not 6e complet¢d if The permiT is for one ' TEL �J$E ZONE MAP ;(
hundred dollars(5100)or less.) OwNEe No..� — � , ��i� NO. "C
I ce�+�fy thai in the oerformance of ihe work for which this �(.� SPECIAL
permir is�issued,I sholl nof employ any person in ony monner ADDRESS � ., . "0..i Q� CONGITIONS �
so as 10 become su6iec<<o�he Workers'Compensa�ion Laws. OIS7RI�T S?A715T!GAL C1A55��- TYPE PROCESSED 8Y�
. . GTV . .�,. ZIP ,.. ... :_..,..,:.,.,., , CONST.
Dote Applico � AR�HITECTOR "'%�/'������ 7E� �h CLASSNO�
NOTICE 70 APPCICANTk If. affer�making this�Certifico�e of FnGINEER � /� NO � '`J �..7
Exemption, yau should become su6ject ro the Workers" �l� �� VALUATION
Compensa8on prov�sions of the Lobor Code,you�must forth- A�DRE55 ! -^ �
with mmply wifh wch pro�isions or ihis permit shpll be TEL. /,'� � � VALIOATION
deemed re�oked. CONTRACTOR NO.��7 ���
LICf.NSED CONTRACTORS�BECLARATION���� ��� �"� LIC.
I hereby affirm ihat I�m licensed under provisions o;Chapler 9 AD�RE55 NO. ,�j_� � s
(commencing with Sectlon 70W)of Division 3 of�he Business ' / �'��
and Professions Code,and my license is in full force pnd effect CiTV CLASS J{�
�� C C � DESCRIPTON�6F WORK _
License Number.'`���-'�_.J� Lic.Class J � FINAL ,
SWIMMING POOI pqTE 0.
Contractor C��;f�e'L.— Date__x�A SPA . .. ................ ..........._... ..... � FINAL 7 � :�.G 4 0
� 50.F?. BY U
� I am exempt under Sec SIZE .. .,... �1 . ....._... !'+ ;� a �� ^ e a O
B.BP.C.for ihis reoson - ELECTRICAL � A�� J � (�„ �""
1 �� �52z31 U
....... .. .... �.Date: . '� LU
Signolure $�eel&Conduit 8onding �. -a S��q " �" ,��j��:� v �
� ""- "'"` Condui�s,Conductors,Equipment
SINGLE FAMILY. z
HOME OWNER-BUIIDER�DECLAk'ATfON� ���� � - � pLUM81NG y'���Y"�
I hereby affirm that�am exemot from ihe Connactor's License
law for the following reosor�(Sec��an 7031.5, Business and � �� ` �,
P-Trap
Professions Code)� � Gas$ys�em � �1-�y�
� I,as owner of the proparty,�,vill do the plumbing ond Anti-Syphon � ,
ele<trical work.I,or m•y employees with woges as thei� . . ,. . .
sole compensation,or q Ilcensed mnirqdar will do all MECHANICAL � ��(�
other work ond�he structure is not intended or offered lJ
for so!e(Section 70d4�68P Code). � $w�mmmg Pool Heo�er � <-��;�
i
CONSTRUCTION LENDING'AGENCV _^
1 hereby aSfirm thoi+here is a consir�Cion lending ogency for ��� � ������� [�` Q�
1he performonce of the work rar which fhis permi�is issued APP�ICANT � .7E�, � /"� /�.` ` ^ � � Q
_ -1 . (PRINTI � NO. S � �'. '� I L�� ( �� �
(Sec.3097.Civ.C... ' � � � �.% \"1 � �
Lender's Nome �---� � - �� �� "' qpDRE55 ,� GG �� �1.��
�� J
Lender's Address �� ' � " -��"' ' p.0 Fee S � :` Pe�m��Fee - .
I<enify thot I have read�his applicotion ond stats thor the
obove information is rorrecf.I agree to comply with all County
ordinon<es ond S�ole lows rela�lnq lo building, ele<irlcai, Iss� ceFee
me<honical and plurnbing constru<tion.ond he�eby auhherize ��Wesngo+�on Fre
e en�a�lves of �his Counry to en±er upen the above- imalFee
mQ�sti ed propert f �nsoeUion purposes.� ' �
! ;
, � �-y�J ... . . .. . ..... .. .. .... _,.... .,
.
_ .. ._. .. ...... , .. ...
s�qom�re o appu��.,+e.aqer� oo�e SEE REVERSE FOR�EXPLANAY`bRl��l7�NGlYAGE �`� " .
. . ... .,..y...,_, ,,,.,Rm:- ,�� . �,k..� .., ,., �
+-• . : .'i: ..�a� � .K'. •`, ;_4."�i.,.
.....,. ... ...:--.. ...,-. ..:... . ,,<' .',.,... �..'`—'"'�� .: ,� �
e__ .
�� PLANS'TO APPLIGANT��- �""'"'" "'�"°"" '���"-�""` �'"�IMSPECTOR'S N0T65 - " """ '�'`"' OWNER-BUILDER DECLARATION
� --��� ��,-»�,�•. I heraby aHirm that I am exempt from rhe Contractor's
To:, . . '' Returr.ed ��+����-~.•n�� ,Tf���W�.V."..������^�License Law for ;he fo{lowing reason (Sec. 7031.Si
� Approved . �.:.
� ,-��-,.--.w-��=<.,,.•,...-�...<-.....- ,-,-„Business and Pralessions Code:Any city or couMy which
,No. Date No. Dafe - � . • � requi s a permit to�tonsfruct;oMer,improde,demolish,
re
� � �� �•� � - ��� - � •��� --� � � ��-��.:. ..� p any structure, prior to its issuance, afso re-
.._ ........ :�.�.. -r-:or re air
�� quires 1he ooplirant 1or sucb permit/o file o signed staie-
� - �' - '� � ' � =� ' � -"'-•�•�'^•_���--�:-•�-•`�'- �� �� menf thof he is li<ensed pursuant to the provisions of ihe
� � Conlractor's License Low(Chapfer 9)(commencing wnh
. � �-�-----�•�--�--.--�r.�-:<.•.:x--.,-.....:.:..... ,Section 7000)of Division 3 of the Businsss and Profes-
L � sions CodeJ or thai he is exempf therelram and the basis
.. ...__.__.....,__.__.......... . .. . . _ . .
... . _.___.. . ___...._ _ ._ _.....,
� '� -- '--- 4.;for t e a ege exemption. ny vio ation o ection
INSPECTION � dASE ItdSPECTOR . � � � 7031.5 by any opplicant for o permit subjeds the appli�
- -�� ,.rr mnt to a civil penalry of not more fFon five hundred
LOCATION ,,... ..• , dollars(5500;.;.
+ ❑I,as owner of ihe proper!y,or my�employees wifh
,S7EE�M5 � wages as fheir sole comoensation,will do ihe work,and
LIGkT CONDUIT � " I � ' � ' ' ' ' ' . ��-� ihe siruct�re is not infended or offered for sale ISec.7044;�
Business ond Professions Cods�:7he Confractor's License
eON61NG � � � � � Low does not apply to an owne�of proper�y who builds or
' � improves t6ereon,and who daes such work himself or
I � � � � -�� ��.....,,.,...,,,,-.�„-.,,��,e,;,y;,,,;�.;-,;.� '..� through his own employees, provided ihai such im-
j � emen�s ore not infended o oflered for sa(=. If.
pro
� _ ' ��- - - �.- �. ....... .... ... . however,4he buiiding or improvement!s sold witfiin one
.
i � yecr oi completion. thc owner-bu'rlder will have the
CONDUI7
i � - � � -•�+^+.+•. •..*....�,+. „r,:,,.;.4 , burden of proving tha!he did not build or'rmprove for the
GAS IiNE purpose of sole; .
_�.� I,as ovmcr of the Froperty,am exdusively con-
�WATER l� .w wl•h '�.. sed contrcdors!o construct ihe projec+
-' i - ..� .,i5e��70na:Bus ness ond V�o{essions Cade:ihe Contrao-
'S"cW�i -R _,_ ' ior�s Li<ense Law does no!apply fo an owner o�property
..... � who builds_or_Improves thereon,and who contracfs for
� , udi projecss r+iith a ontrocror(s)licensed pursuoni fo
I . . �� � .���--. .. - +ne ContraUr.�'s License Lav{i.
ANTI-SVPHON VALVE � . ,+..��....+.n., .�- , , C�em exem.
. . , ... ., p'��de�Sec_�.B.&P.C.4or thls
;EL@CTRiC WIRES � ;eascn
FENCE(HEIGHT� �cl .. .•�.:�. �.p .�e . . .��
SELF-ttO51hG 1 �.: .. � . . ..... ...�.
- . .. , . ,.,.... «.:...
•�5 ��SELF-LATCHING f � ' - lNSPECiOR$P�OTES '
� . ..,. . . ' - ' , . .' , ' � . .
ROUGH WIRING ' � �����-������.��--�
61NA1 ELECTR�IC.- . -. . —'--
.. ........ ...._.....,.,_._____...
• � ' �' ..�...-_ ..__......._....,_...._...., -- . . .�:.�y,c:
� . . _..,,_�.._.__..� . .._. .. . . ..
Iw...A..., . , ,... : ... .- .
..... ." .� ;..�.N,�..�.. . ._. _ . .
i kEATER(LOCATION 8 VENT) ' . ., . ,a.... .T~Y . . . � .
i . - ... . __ ... .. . ._.,.,....-.->.,..n.. -- . „
UAS LINE TEST �-.. ... . :;•.: ...,:. .�.:.. , - �
�POO!PRAINAGE , __:,_.��—.,.._._...,.; ...---�. ,",:�..:�, ...;..,.,
; '. . ...... ..... ...........�.,�
P.iRAP ' ' ' , . - .