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1748A 1979A (10)
_ _-.__ _--- _. _ �Y,ORKERS'CO�v1PEN�ATYON 6EC�AAATIdN : _ .. � . .. . .. .. . " ��' ...' �-. . � . � � -. � � .;oy affvm thaf I have a certificate of consent to sel`insure �_ � ' � ' ' -�� - �- � � � � n. �cerhficate oi Nlorkers'Com"pensafion Tnsurance Or a�cerEified� " ' �� �npy;he�eof«�.�gno �ab�,. . _. .._ APPLICATCON FOR COM�f�V��fi�`��VI�`I`�1���P0(���`��I���;(,'� . . 76A208.. ; .. .. :. . ,.,� .-: .__-:.. r . . 29 6018bPW�9/88 ':. `": � ." .` ` ,:.' �" Po��cy No ' Company '�' ;, ' ` � � � -�COUNTY OF LOS"ANGELES ���� �`� DEPIf�iTI�I�NT OF i�0"BL"fC Wb1YK5``" �� ` ��� � � � � � _:, � , � Certified copy'is hereby furnished ` - ` ' ._ .� , �. � „,_,.. _,. _ ..w,..: _ � Y,;..,,._.; _. ...BUICDWG ... .. .....�.. ...»...... . ___ . . -, ,.. . � iied copy.is filed vntfi�th u fy`ti`ifd'" inspec�io'n de-�` FOR APPLICANT TO FILL��IN qOORESS � d p2rtmfent �. - � BUIIDING� C� -� � r Date 4lt�APPlican., ' .. ADDRESS�` S� � LOCALITY ,,�� � ' .. . NEARE97 "' "'"- — � - .CERTIFICATE OF""EXE1v1P`110K�`��#ONT`�1GdR�'�'" ""``� CITY � p„� ZIP � � ,,,�„CROSS&T. � V{, � COMP�EN5A710N INSfJ�YAhYbE " SIZE OF .� a-:AS$ESSOR`� ��� � . TRACT,��(f$" LDT � ��� !OT NO ',;:MAP BOOK - ' � PAGE : PARCEL (Tfiis"section nee�`no(be ComP7e�ted"if'tlie p�rmitTs�"�r on'e`�`�� ..�-. -;�� TEL � �USE ZONE MAP � � � c=--. � hundreddollars($i06)orless:j��- '�� ' OWNER ���� � NO � NO ��J ���� I certify thaf in the'perforinance bf the work��for�vf�icfi�tFis permit�� �'-��� -� ���- SPECIAL� -��- '� � � is issueo �shall not employ any person m��any manner_,§o as�tn A�DRESS��� ' � � � �CONDITIONS ' ��� -- � � � become sublect to tite Workers'Compensation Laevs - ' ` . . DISTRICT STATISTICA�CLASS '�TYP� PR CESSED BV ��. -� .. -. CITY . .. Z(P. .. ..; _ CLASS NO: -C Oate" � �� Applican{ ARCHITEGT OR -' ��� "TEL ' "` - � �� ENGINEE,R " ' IVb � �� � NO710E TO APPLICANY If aff,.r�:maKng this CerTilic2ie�of`�7[emp-"� _g, � tion,'you should��become su6jeot to the�Vl�orkers'��onipensatioo.�� - ��-� ��� - � � �� � � ����� prowsibns of the La6or Code,you must�orthwth comply'�wi}h`s�ch�� AODRESS .- - VALUA nIO�N^� � � ' - VA'LI�ATION�� � � � �� � � prowsions or this permit sfizll be deemed revaked ���-- � ` TEL. $�j� � �y/� � - � LICENSED`CON7RACTOV2S DE�L`�ARATION "� .� CONTpACTO A " NO. �0 (J(� � � ... � p:�.� ., . ADDRE55 -,�� LIC .-. �� � . , ...... I hereby atfirm that I am licensed under romsions of Cfiapte"r�''�. -1 �k✓. � NO $ � �1 7�8 A � a (commenc ng with Section 7000)-bf Diwsibn 3�of the Business and CITY &,/' � � �CIC � Professions Code and my license'is n fulT"foice anc�"e�'�ci`�.'�""` �� CLASS � . - #.� • • •2 T � �`" '� �^�.�y DESCRIPTION OF VIOI�K ( Licen5e Number l '-[� Lic.Class - � , -FINAC� � (\'` �! ��7��.�.2� �. , ,.�t .. �.- SWIMMING POOL - � DATE -� I���B L�� � ContractorY�lue�cY'.,�q��S15 oacg���.:, sPa. . , ..�... .. .._ ��..�Q'� FiNa - . �7 5 1�.2�� �OO . � so Fr �j/�� �,,� 0 U,1 7-8 9 U � I am exempf under Sec �� : SIZE �:� (� B� p Vlx- � � . � �B.&P.C.for�this'reason� , ' �"" �" ` ': ELECTRICAL .' . ' .. . . ... .. ... . . ". � . � . . � � - ,_ �ate .. . . � . .. . _ . � _ . . _ . -�Signature :- � � Steel&Contluif Bonding � " ' � " � y Conduits Conductors,Equipment � . � SINGLE.FANfILY� ' ' " - ' � � � �- � � � � � HOME bWNER-BUrLbER DECL'ARATIC�N - PLUMBING � � � ; " - � � , � I hereby affvm that I am exempt irom fhe Contractors License Law - � - � � - ,r.._. . for the follow�ng reason(Section�903i Business an$Fru#essCons �� p-Trap � � �* o� 9�(�A� � Co��de):_.. .. _ . _„, .. . - Gas System .' . _ .. �z, � . I as owner of the proper4y;will�o the plumbmg and electrical ,�^,�,..� �� -#-e;.a'�:.�'�� Anti Sypnon� S_.� ! . work I,or�my empldyees unth wages ae 4heir sole com � � � � pensation;or a licensed,confractor vu,ill dp all other�woik and � MECHANICAL�� ���-��- " � �� ��-�"��- ����� �'- , � �. � the structure is not intended or offered for 5ale,��(Section-'"�. � ,; - - . �- -�� ' �� ' -� �� � � � � - � -- 7044CON 7RUCTION�LENDMG`�;GE15�Y'"�"�"'""' ""' � Swimming Pool Heater � - � - � �`:�e�2 b 3� _ �o..._ _ ._ I hereby affrm t}iat"thereis"a construction ending agency�for the" �. � � p�eVfoCr j ance of t�e work for whicfi tfiis perinifis issued`jSee 309`�;�"�. APP PRANT) • � pL � ( � ��6��O�O:U ' q1�.2Dw 8.9 Lender's Name - � � .ADDRESS� � � � � � �� � � � h Lender's Address � � � � ��� _ � �� - . P.C.Fee 5- �S-� �Z @ermit FBe��� � � - � � I certify that I heve' is application�'arid�5tafe�t�iaY�lfie`above �. . . -. _ C _ information is�c -ct gr e to comply wRh a0 County ordinances�� . . . and State la' eia' to ilding:elecCncal,mechattica7 and plum6ing" � ISsuance Fee��- �°�• .a � � � constructi ,�an� authorize representatives of thi �County to� Investigation Fee � �--��������"1.�- � � eh r�up n the -men66ned property�!oF..i pecti .�purposes. �� � Total Fee � 'L" � � S .. ture of AP ca � -gent te � �SEE 12EOER'SE P6R EXP�'1CNAT6RY�i�ANGUA�E'",". .._.,._ . �... . _,.... .,...,... . .._.:.. _ .....,. >... . � �, � ,� � � � ��� ,__�;�� �_ -=��—_.`._�-.w� �� , ,��-.–�. � ___. . �" ;.� ����s�c��-�G� r.n,v �._ �n�s�� � s var�� _ ' �7VSr�4�;�-E+!C e�.Ft..�Er,�rsR�1`tc)�7 -., _._ ____ —�_.__ �.<__ _�_ �„� , � � e rrc�d � � .. 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