Loading...
HomeMy WebLinkAbout1546A 1904A IWORKERS'COMPF�SATION CECLnRATION � 1 hereby nffirm,F,�, ��a�P���,���;«�e o+�o�,P���o sr.lf APPLICATION FOR COMBINATION SWIMMING POOL PERMIT � Iinsore,or'(�ce���hta�e of Workers'Compensa�ion Insurante, or a cr.rti(ied cepy thereol(Sec.36Q0.Lab.C.) -Enac� CEC76�7/A�1 voGcy N U����mpa�v �`���r�/� , COUNTY OF LOS ANGELES BUtIDING AND SAFETY � Crtified copy is hereby tum�shed. � ' ' FOR APPUCANT TO FILL IN eu•ioin+c errified copy is filed wiih ihe county building inspec• AODRE55 t�o�depar�menl. BURDiNG �- �l� � r .4CCRE55 � ,� J.:1� .rI'—Y� LOCAIITY Da�e t/T cl Applicont P7�C 'rl�i'1/�Z�.� _� NEAREST D._ n � tiv d;;/ caoss sr. O �� �.�� �CERTIFICATE OF EXEMPTION FROM WO4KER5' ��TM � �� 511f a " ASSESSOR COMPENSATION INSURANCE TRACT���S lOT lOT hO. � MAP BOOK � PAGF VARCEI (Thit s�dlen nod nef b�complN�d 11}h�p��mil i�For on• _r. � 1 r � TFI.�^ USE 20NE NAP � hundrad dollon(5100)er I�s�.) ONN f11 V^�—�-=1.��'+-�c-�-la NO �� �7i7 NO. I cerGfy tha�in�he perfrnmonce of�he work For which Ihis �� SPECIAI � � permit is�ssued,I sholl no�employ ony person in ony monner PDDRESS �. � � CO�IDiTiONS so os lo become sublecl to the Workeri Compensorion laws. � ^ /) D!SfRiQ STAlIS7�Ul CLA55 fvPE PilpCE D BY ' cin �--�' f Z�P I� CLASS NO.� GO�vST. � pp�� Applico�� ARCHIiECT OR TEL � I NOTICE TO APPLICANT: IF, of�er moking Ihis Cnrtllicaln of ENG'NEER �, � !! ` NO.�i'l� '�Y � E.r.mp�ion, you should bncomn subjeU �o the Worke�s' l , ��� , VALUAT�ON Compemonon p�ovisions oi ihe Lobor Code,you most fo�+h- ADDRE55 1 (�i i� • . =.C�_ S�^Q YALIDATION wilh com�ly wi�h such provisions or this �lr.rmil sholl be ��TRnCTO4Y: f � � + ,l�, 1 NO.�/7�J—:�� � � O , decmed revoked. - � ' IICENSED CONTRACTORS DECLARATION /i ���' / nDDR:55� ,Q � �!�_ h0.� ��� S I hcre6y off�rm ihd I am licensad under provisions of Choprer 9 � �i�, _ (commenUng w�+h S^cnon 70(101 ef Divrs�on�oi the Bus�ness CiTV , C�A55 � " i_� r�'.J 1'i nnd Vro(ezsions Code,ond my I�crnx is in fuil iorce nnd eHetf. �X�;ci�ON wCar y _ -7 FINA Z\!?��,T �— " .r • • c C:l l�Ce�Se NumbPr � l�[.Clasl�� SK'INM:NG VOOL O�TE � ► , �I/ / /-� . � � � • .p '. Controctor�^t�� I , L��'Daie I=1}/I%�i'"'+ SPA FINAL •. ." , �- � � sci ct. �S-�� er - O � I nm expmpl u�der Sec. f SiZE C'�., J— ,'l � 8.8P.C.(or this rr�son ELECTRICAL � �a�e: F" S�e.el R Co�dui�ea�ding V Si��o�ure Conduits,Conductors,Equipmenl . W n. SINGIE FAMIIY � HO"d.E OVlNER-BUIIDER DECIARAT10N PLUMBING ► Z f hcrr,by oSfirm��ot 1 nm e.empt from Ihe Comrotlor's ticense - � . Law for the(ollowin3 renson�Sec�ion 7031.5, Busi�ess and p.Trop P.o(easiors�od^): � Gas Sys!em � � 1,as owner o(�he praperly,will do�he plum6ing ond Anti•Syphon . electricol work.I,or my employaet with woges os iheir sole compensaiion,or o I�tensed contractor will do oll MECHANICAL o�Fer wcrk and ihe sh�dure is not in�ended or offered icr sale(Section 7044 BRP Code�. Swimminq Pool Henter � ,:� Q(i[,i'� CONSTRUCTION IENDING AGENCY � _ I he�=6y afi�.m ihat ihere is a construcrion lendin9 agency tor APRICANT � �Fi. �:a • • o .�j the performonce ot�he wo�k for wh�cb ih�s pc�m�t is issued �pR�M � � n0. � ► �se�.309�.c�.c.>. � ���r �J ; , ,� � • 1 5 n�v lrnder's Name ADDGE55 Ql ^n-ti n_1 r Lj_, ,� . ., � �, ,:��` lend^r's Address P.C.F.e S O Fermu Fce I �7.�'.v`�' ��,r F—"•i' I c^riify thol I hove read�his a�plicorion ond sia�e Ihat Ihe /� rt obovr,inlormollon is conecl 1 egrer�o comply wiih ofl Coonty � Issuance Fee �v�V ordinonces nnd Sio!o laws relo!ing to buildin�, electrical, . . mec��anical and PI 'nq cnns��uction,ond fiere6y aulhoriin. Im�s��go��on�en �O ' represenfa�ives th' unly to nnler upon the a6ove- Toinlfee _ me��pre ert�//r injpettion purpcses. // l C �� _� / / _-3,. /s+g�aru.e'1�cni�ca� �r nq•m / oaid -� SEE REVERSE FOR E%PIANATORY IANGUAGE , t�.��1. �1f„ .�- O .O • r _ —� . p � ^, .O ' ' O '� n` � � A � . n L > Z o �n � p Z � (1 � � i �C 70 $ ,�,� � ,� Tj Z n 1` C y 2 � -- ! en ^ v� ..� � � A Z �. "� � A. < � Q -'-• � � � n .�.� . . . ' �O (/ ` q G1 = � . Z � r � 'd O 4� � r t N V� � A z �:�; ' 7 � � N ' J + 7° C� io T'" � , � �w D -� ._ �� ..� 3 Z � D (� i.1i a0 T� `(�• � '. D O �� � �+� �,j b F 7 � O �� J ` � c A � w M � - • � 7 D � _ , C c.���� P G. �►1 2 /.. �� t. - O \ � - ^`•. ._ ,. .�"'�'.- 1� L �'.� �X _, � ' • � �\ �- � i _a- c-" Z �, �. � C <�• \ , . � � � � . \ �� ��\ �. O °� �� � � � A o. \ . \ \ �� .� \ ` � � \ � . � � , , , � . . � , � . . ' N • * 0 . • . .�1 • . N ' . ' •' . - . . ' � O ; p " � . • {f(1� C S.1 �.� :: . .. � � C� p�' � y�� A < <' �s. o ° _. N Nv N v ` � a' o � : _ o ' � ...� -.nn �, �� n"` i„� n� �, �3T � pO ~ �'; C, _ . � 'D � r. o p Q ZJ `G � .. .� a N C C,C �y tl i: C„ 1 : ' + lT O ��� " +. C..� P Q �tl < O�v� � C -' N C� .f.�_�C�N n"l: � 1 �.. , c- ' . __. C N�t� `� O C O ry J = �. �' � f. O O(1.j f. O v I".u v N � C �' w% f^ G u; � ^��Fc�.�� O, w` N .^oc � ;"� o<c���=CQ � � n Y _ c.�c _ �,' ' i c� D o c_� t. f - N. o-_ 'y c. —� ::: . z. . c o,» ; = ° rN c G° . ' ' _ - � ^ V c•L'G t' � � ', C, ^ v q F; ' r' �K J[T^ f C'C d �f� � � i� n C v�� r r � �. �^ �' '� 3 C ' , I . J N'N O �C f r+ � ' y � �_Y, .;n ` C = n T - � � ...^ (' . ° c ' ' ^ " � £ �' " z r ` 3v�' oE= � cni. r � � . ' � = � °.Y ' f_ -..: . �: � ' �7 ty � i�C � t:.�} t. O ^. �J � W f1 ,.,. 4 r. ". F 1 r %`> �N'C ,� C �T`=•i � O 1T C �G�i 9 > p " �-(-'_ � G P �''C:^ �) � 'I � ' �C �j C r 7 � � , t.,• 7 �" � Ci 4 O f+i C: G � 'C l � �'C' -- =•G C. � � � .'C � �. i - � f G .. .. C' Y " � r'. = .: G y n G �� ti � j '^ o �- .. � % G .: ', .r 7 � � . m (' ' C: Cr7 .'. ^ Q'O � - y='O ��V �. L �=C C� « ^_Q%'� � O_M j'"��; ^ J f'i ? u � � c���� �� �. � i. 7 � n 4 ^�. c c� � � C � 1 � ' � ; q ..� t � � s V �. �: ° c 'c n�.=' "�cic � ° � c a c 'i.^ �r F ', ".' �; ° Y '_'-' ° =�� ': �-" � � v < U` _ P O S; � t/� ' ti-;; w L,R '. ^ � U f. �n � c p r 4, � � 1- , I ' � 1 O .I ='i_j� f1 _ p' (: `^ C ` ���c. C Ss : y- ? C 1�n v r. ;^. ���= C O � i I `= 'rN , r.',' ^ � f c�` 4 F�.-� ^ S, �� ...i� -o i;; O N o� .�c i . I ,I ,' � � i r :'� �• �,'T� 'V ��-� �-C u�; C ' G �.f .'O 4. C N i L� J II (' tr�'...r -��i ��,'� O .�� N C � C r t T..�; 7 Z ^ ��Y �; y T r f. - � I � � y .... � _ .- ,�. - . f 1 "-L; ' P' Z G O � ij t O � '_.C n + t„_� i.�` t I� �•�'�' ". .. �n C �C O'C�c •�.� � C f�_ C C� � �. : - I 1 ' C: 'C '� - . .. n n 1 { = n C C j ? r n 1 �. �N � � _ , ' ` ���c i ' �_� � �