Loading...
HomeMy WebLinkAbout1546A 1904A (9) IWORKERS'COMPF�SATION CECLnRATION � 1 herrby nffirm,F,�, ��a�P n ceniiicate o��o�,P���o sr.lf APPLICATION FOR COMBINATION SWIMMING POOL PERMIT � Iinsore,or'(�ce���hta�e of Workers'Compensa��on Insurante, or a cr.rtilied cepy thereol(Sec.36Q0.Lab.C.) -Enac� CEe76�7/fl�1 voGcy N U����mpa�v ����r�/� , COUNTY OF LOS ANGELES BUtLDING AND SAFETY � Crtified copy h here6y(um�shed. � ' ' FOR APPUCANT TO FILL IN eu•iowc errified copy is filed wiih ihe counry building inspec• AODRE55 t o�depar�menl. BU�L�iNG �- �l� (� /� .4CCRE55 � � _.1. .i.-I'-Y� V LOCALITY Da�e t/r �l Appli[ant f7-UC '�l%'1r'ZZ�.'� D, n _ NEAREST �� r'i tiv d;;/ caoss sr. O � �. �CERTIFICATE OF EXEMPTION FROM W04KER5' ��TM � �� 511£a " ASSESSOR COMPENSATION INSURANCE TRACT�i��S lOT lOT hO. � MAP BOOK - PAGF VARCEI (Thit s�cllen n��d nof b�complN�d 11}h�p�Imil i�For on• �. � j N � TEI.�^ USE 20NE NAP � Aundrad dollon(5100)er I�s�.) ONN f11 V^�-�-=1v—+-�c-�-la NO �� �7i7 NO. I ceriify tha�in�he perfe�monce of�he work For which ihfs "� SaeCinl � � permit is�ssued,I sholl no�employ ony person in ony monner PDDRESS �, � � CO�IDiTiONS so as lo become sublecl to the Workeri Compensorion laws. � ^ /� D!SfR�CT STAlIS7�CAl CLA55 fvPE PilpCE D BY ' c�n �--�' f Z�P �� ClASS NO.� GO�vST. � pate Applico�� ARCNIiECT OR � TEL. I NOTICE TO APPLICANT: IF, o(�er moking Ihis CPrtliim�P of ENGL'JEER �, y4� !� � NO.�i i�� '�Y � E.r.mp�ion, you should bncomn subjed �o the Worke�s' l ' ��� , VAWAT�ON Compensonon provlsions oi the Lobor Code,you most fo�+h- ADDRE55 1 (�i i� • . +.L�_ s��Q VALIDATION wiih comply wiih such provisions or rhis parmi�sholl be �«'�3 � � decmedrevoked. CONiRACT04�: f `_--_ 1-s / ,'1�, �NO.'.y�-:"' � _ , IICENSED CONTRACTORS DECLARATION /i ���' / nDDR:55� ,Q � �!�: h0.� ��� S I hcreby offirm ihal I am licensed under provitiont of Chopter 9 � ���. _ (commenc�ng w�+h 5^cnon 70(101 ef Divrs�en�oi the Bus�ness CiTV , C�A55 � " _'� �`�'.�`1'i nnd Vro(ezsinns Code,ond my Gcrnx is in fuil iorce nnd eHetf. �K��cT�Ov wCae y _ -7' /-C" � FINA , liCenSe Numbe.r�`•���� lia Clasl�� SK'INM:NG GOOL �7 O�TE / v • • c C(1 '.Z.L.�� /"� Y�� � I'„ /7/I%.i'"'+ SPA � L�1� FINAL � � �n'„ i } Controc�a�, \ 'Daie SCj f!. ��--y1ri / eY _ O� � I nm expmpl onder Sec ! '� SIZE JIJ��' �•. ' `� .. . "`- O U Q�.� J- �.. � R.BP.C.for this rr�son ELECTRICAL � Da�e: � S�e.el R Co�dui�ea�ding V Si��o�ure Conduits,Conductors,Equipmenl . W a SINGIE FAMIIY � HO"d.E OVlNER-BUILDER DECIARAT10N PLUMBING ► Z I hcrr,by oSfirm�'�ot 1 nm ewempt from Ihe Comrotlor's License � � . Law for the(ollowin3 reason�Sec�ion 7031.5, Business and p.Trop �.o(easiors God^): � Gas Sys!em � � 1,as owner o(�he praperly,will do�he plum6ing ond Anti•Syphon . elechicol work.I,or my employaes with woges os�heir sole rompensai�on,or o I�tensed connactor will do oll MECHANKAL o�Fer wcrk and�ho strucWre is not in�ended ar oFfered icr sale(Section 7044 BRP Code�. Swimming Pool Henter � ,:� Q(i[.i'� CONSTRUCTION tENDING AGENCY ' _ I he�=6y afi�.m ihat ihere is a constr�crion lendin9 agency tor APPIICANT � �Fi. �:e • • o .�j the performvnce ot�he wo�k for which ih�s pc�m�t is iesued �pp�Nl) ��1� 1� ? � �p, . , (Sec.3097.C�v.C.). ) o tl � • � JO��� lende�'s Name AODCE55 Qr ^�-ti n_Ir LL ,� • n � ,, .:n` lend��s Address p.C.F�e S O Fermu Fce I `'T�Qv C�.r F-"•`; I c^rlify�hol I ho�e rcad ihis applimrfon ond sia�e Ihat Ihe try rt obovr,iniormolion is correcl I egrer�o comply wiih ofl Coonty � Issuance Fee lv�V ordinonces nnd Sia!o laws relo!ing to buildin�, electrical, , . mec��anical and PI 'nq cons}�uttion,ond fiere6y aulhorizn Im�s���o��on�rn .0 O ' represen+a�ives th' unly to nnler upon the a6ove- Toinlfee J _ me��pm erty�r injpettion pur�eses. // l C �� / / _-3,. /s+g�oru.e'ncni�ca� �r nq•oi � �aid - SEE REVERSE FOR E%PIANATORY IANGUAGE , t�.��1. �1f., � � P � ~ . . ._ .O O �o (1 D n p 'f1 p O •Gl n. �(�i i � � � � �o � (1 S � O M n y � x � � O O i"'� � O . ' . z O � y D Gl r ^' �° s � m =� � �� O Y N � -� > Y �n � _ (� � Z 'Z' �o� � O b T i �^ : in C � n �' D � ^ -�i ]o �n N O jy Z L �' 'y O y N � (1 Z �w � N C '`' � � f. � rn v � � G1 � y,r eh O .+p m � ' � �� h � 2 �. \ '1 — Z in y�y 4,' � �- _ �.� c c, � � � �x a :� ;.- C �, ,� �` - . .� . `"� 'j`�� � = <�. �- = 5 _ n � y � • `� � `1 ' e c' y �., � ti \; j `� ' � ' (� ' � N � `` � � � � m � � \ o � � \ . , A . a �' K \ ' . •\` d 1 . N • � � : � . Q ' A . N z • o . � �1 � - � m � • � ' ' .` . . ' . _ . .. •I L O p-� 1 . w N(1 . � � ' � Tco� � � ° � % O �-o `_'� N = ° jc ^a ='� ` - ' q c � =.^ ;N^^c � c 1 o av f �= n`� �— o v Y � � . � I �^ c: ' n `o � r. _ �_1 o �. � o � c N.a _�; ❑� o' tn"� fl� � + _o ,�, v r� I � I �> � n Z' C� �U��J _. O r�.', � 7'N � ` O -in C� C..�Ci �� r O C ; C . I I = ; N �� n i.' _ °'° r y� N _ c N _ o "' _ �-°c� =� ,�;=�+ ; C ° f ' � � � o n �' `'^ �Z: c '. � n ' c n' v� � - r �t; n �o � c � o�..'�ai � r w v'< � v _ ? I � ' o ' ° r G -c '�.i J tr'-�. ° i:U �.l ' '• �v T.4.=C= � C ^ ' C+ = r-j.'- � ' �. � _. �.' - 1 r 7 r°- ^ � C 2 G [+ A -�J'. �Z !' C O N �=, � n U � C..L' � � � �' - � 2 r� � - y l: ' i: " _ `l N �. f. - ft � �' v `� ' .� C�.% I i I ` ' '- _ .. N '' � .T[, y C � c _ ;; ^ O ci_C � � w �^ �c � �. ., � i � ' i c � c �' n � �`�� = �'`c c � �° ` `- ' '' ` =yt '" � f� `•' " �3 c � N � n . =.e � �, �:.�y r. � , Y ' � n= ��. I . - �J � �:. o o ' ❑ 'o �c c r,. �. �°`, %c � r, v �• i� t�n T� ' c r x' . I m �. j 'o y 7 r. a .. .. . f n C :� C � � �• � G L.2 P �' � � L? .. � r r ,-.+' C � , ` "' C' �" . . � ` O � � n ^ C; Q O 'S i�• O �- t_ '� � .+ = C �C: � . I I I' � F .;' , .. � ;N: Y � i o s`V �� ' S: o � _,ci �' ' .'c x = c ^ � 1 ^ � � I i I l N � I' O C ` _ . � � 4 '= C� � ^ , G � r T' � { � f Q :,.' � V, ' - �c o C `� � ;,��f .�. � r' v c_-�^� � : �c.� r� � I {1 � I � � m i - [�� n - _ ��= _ : � � � : �, �,c � r c_ c N o _ r. c ` ° i; C 1 I V' i 1 �? � Q c N i � �^ � C u f. �� V N C C C' i.� ` � C _..� ��_C �� � c [:.� C; `� � u__ : .., � e •3 c �n ^ lj �' n �r I I 1 r, �� o T_ � o c F�� ��'� i^t i> � � �i�n ; n'^ � �- , I 7 .�c -r=� a� = .�. =i, : • -^'„ '. 7 4 N��.�` O .TJ C - M �N y, � M f ^J�`� O G W � n N � f1 n f. �' � „C n C a' C'� �-p �• 7� p , 1 � � C O 'R'� p C 3 f'`• {��f �� 2 fL2: _ j•, �� � C y �:� I 1. _ � � O n _ C "" ' �" _ _ � ' _ ✓ . � r � r - .. . � { � � i c i: n �' ? - — � � % s- .... - -- � i ' i I ._._'�. � - �;� . _ . � . . .