HomeMy WebLinkAbout1380A (7) .,. „W._. .,..,. . .,
WORKERS'COMPENSRTfON���CCAkATIb'fJ � M - �- ���� �I
I hereby affirrn rhat I hove o certifica�e of consent ro self w � � ��� � x�^-�'u�a. '!:`'�.�'� -?� .. „ , . ��
insure or a certificate of Wo kers Compensat�on Insuronce, MPPLICATION�-FOR COMBINA�1fi0N8'SWI�IUIM(IirG POOL �LRNIIT�� ��
or o'ce�ffied copy thereo!(Se<.380 'ab.C.l , �GF'euB � �� ...
� . ""� C-s�6[3 aa� . . ..,. - .
Polky No.��Company " COUNTY OF LOS ANGECES BUILDING/TND SAF'ET�/ �(� �����
�Cer+itied copy is hereby furnished. .. � .. . ..:- . -.-.,- . . ..,.. , ..;,:,.,„, /,,,,,�,,�, ,,,,, ;, .. _,..
.,. ....,.,._.,.
Cer+ified copy�__filed with the tcun.ry build�ng inspet- FOR APPIICANT TO noorze55 �'r (_(J(� l ' �
tion department. BUILDING + w
AD�RE55 ! �� ^ L� LOCALITY
Dote�.�APPlican � . . .:^ �. NEAREST
. ...,.,__.. CITv � IP CRQSS Si. ` �
CERTIFIUTE OK��XEMPTIOXI FI�OM WGSRKfRS' .,, _ .. (� SizE OF x� ASSe550R
COMPENSA710N 1�NSURANCE� ' � 7RACT� 'l �OT LOT N0. d� MAP BOOK � PAGE� PARCE�
(This sec/ion need nof 6e completed if The permiT is for oae ' TEL �J$E ZONE MAP ;(
hundred dollars(5100)or less.) OwNEe No..S - � , ���� NO. "C
I cer+ify thai in the oerformance of ihe work for which this �(.� SPECIAL
permir is�issu¢d,I sholl nof employ any person in ony monner ADDRESS � ., . "0.i Q� CONDITIONS �
so as 10 become subjec<<o�he Workers'Compensa�ion Laws. OISTRICT STA715T!GAL CLA55��- TYPE pROCE55ED BY�
. . GTV . .�,. ZIP..,.. ... :_..,..,:.,... , CONST.
Dote Applico � AR�HIYECTOR "%�/'������ 7E� �h CLASSNO�
NOTICE 70 AP�LICANTk If. affer�making this�Certifico�e of FnGINEER � /� NO � '`J �..7
Exemption, yau should become su6ject ro the Workers" �'l� �Z VALUATION
Compensai��on prov�sions of the Lobor Code,you�must 4orth- A�DRESS f -^ �
with mmply wifh wch pro�isions or ihis permit shpll be - TEL. 2 5 rl VALIOATION
deemed re�oked. CONTRACTOR NO.,��� a�+� L/
LICENSED CONTRACTORS�BECLARATION���� ��� �� � LIC.
I he�eby affirin Ihat I om 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 e4fect CiTV CLA55 J{�
�� C C � DESCRIPTiON�6F WORK _
License Number.'`��(-'�_.J� Lic.Class J � FINAL ,
SWIMMING POOI pqTE 0.
Contractor C����t-.- Date _! %— ll A SPA . .. ............... ..........._... ..... � FINAL � � :�.G 1'�, 0.
� 50.FT. BY U
� I am exempt under Sec SIZE .. .,... �1 . ....._... !'+ ;� a �� ^ e a O
B.BP.C.tor ihis reason - ELECTRICAL � ��� J ,� (�„ �""
....... .. .... �.Date: . .i � o �J C.Z5� `U
$leel&Conduit 8onding �. a S��,q � � , Y n-
Signolure � Condui�s,Conductors,E ui Pnf �J���� ' `� �
_._ ...._ 9 Pm.
SINGLE FAMILY. z
HOME OWNER-BUIIDER�DECLAk'ATfON� ���� � - � PLUMBING y'c���Y"�
I hereby affirm that�am exemot from ihe Connactor's License
law for the following reasor�(Sec��an 7031.5, Business and � �� ` �,
P-Trap
Professions Codep � Gos$ys�em � �1-��C
� I,as owner of the property,�,vill do the plumbing ond Anti-Syphon � ,
ele<trical work.I,or m•y employees with woges as thei� . , ,. . .
sole compensation,or o Ilcensed mnirqdar will do all MECHANICAL � ��(�
other work ond�he structure is not intended or offered V
f o So CONSTRU 7044�B8P Code).� � � Sw�mmin9 Pool Heo�er �� <-��;�
r � (
�
CTION LENDING'AGENCV �(�
. .......... _.,,....... /� (��
1 hereby aS4irm thot+here is a consir�c!ion lending ogency for qpp�ICANT � •TE�, .''J �/�.� ` � ��� �
1he perf rmonce of the work rar which fhis permi�is issued (pRINT) NO '� � Y L--� �
(Sec 3097.Gv.C.!.. . . � � �'� � `
� ^ `�-� �
Lender'sNomv �-�--� � � �� �� "' qpDRE55 ,� GL �1.�
�� J
Lender's Address �� ' � " -��"' ' p.0 Fee S �* :` Pe.m�i 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 reloiing to building, ele<irlcai, Iss� ceFee
me<honical and plumbing constru<tian.ond he�eby auhhorize ���esngo+�on Fee
e en�a�lves of �his Counry to en±er upon the obove- 7oialFee
mQ�sti ed propert f �nsoeUion purposes.� ' �
! ;
, � �-y�''7 ... . . .. . ..... .. ._ ... _,.... ..,
.
_ .. ._. .. ...... , .. ...
S�qnmoreo appuc�n,e.Aqe�� oo�e SEE REVERSE FOR�EXPLANAY`bRl��l7�NG11�AGE �`� " .
, ,..:_, ,,, ,R.: •-. ..�,�-+ - ..,. ..,..,. . � y � E'
�
.- ,��4.,�;-
...... .. . ...... ........�._.. ,. ....:... . �"'� .:...' .:` .',:,.i: _ ..'�'.,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 ' ' ' , . - .