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Home My WebLink About1442A 1870A ._ _, . _� .____.. .,_ _ .. . __ �.. , , _ .. _ . _,�-_. -_ ,. . . � WORKERS'COMPENSATION DECLARATION � � � . . � � F � � � � � . . -__ .. .. . . � ��s�,e o�a ce��PFca(e of Workers'Compensatio ��5�a�e" APPLICq,TION�FOR CflMBINAT101� SWINII4AING POOL PERMIT I he eb affvm Ihoi I hav�a certificote of conse to , , Y ce or a cenified co 7hereof Sec.3800 Lab.C.1 � . -- ��••�- .R,.,�.trm«�zryx�� ,,,��,py�..�., .��,;,;.;,._,,,, �:;,�-.... ,,.�.,.:..... /-31/��QJ �r(�y�. 'e� /'�� •/��- 16 2'6 7 N ' " �Z'^��i� �!/.l'�E3'Lt.+1 GE�75:3`0c�. � .. .. . ' ' � Po ic• o ,. n any COUNTY OF lOS ANGELES BUILDING AND SAFETY ❑ � ,. .. CerYfied copy is herehy fumished. ��-� - - .��- _... '.�. . ._.. ..,. .. �.,._..�. . _..s.r.n�e�m.u..W.;� BUIL�ING ....-. ... • Ce�+4ied co s Filed wiih rhe count buildin p FOR APPLICANT TO flLl IN �'..`�f�f' � � py� y g ins ec• . �,., , AODRE55 �P tion deparfinen! BUIIDING c� � ��- �� " - ""' 'Date1 ��J.1Applicanl � / �,_" AD�kE55 � �t._/ j.. LOCALITY � � �" , 1N�, n'.^,��: . ...... . � NEAREST CERTIFICATE OF EXEMPTIO R WORKERS' ��TY j� Z'P CRO55 ST. - � NCE .,��j�/�..�SIZEOF � ASSESSOR � �� -��" ' COMPENSATION INSU A , __„ 7RACT ✓'t'"75N-�L LOt '� � LOT NO. I MAP 600K PAGE PARCEL . ... . ..,._..:. ........... (This seefion need nol be aomplafed f 1he permif is for one � � - TE� USE�p NE MAa ��/ " `-�'"'-��•` hondred dollars(S100j or less.) OWNER y NO � �. � 9C.-J NO. � T y�� S I ce��ify ihot in Ihe performance o*the . �or which this �. \ �YoQ� SPECIAL �"� '"� wark t � pe�mit is is5ued,I shall no�employ ony person�'n pny�manner ADDRE55 c j � [� ,j j CONDITIONS so as�o become s�biecf ta the Workers�Compensalion laws. � - �� '' � � -''�'��-'- -�� -� D�STRIC7 STAiISTCAL'C1A55�" TYPE PROCESSED BY �, � . CITY Y\ .��P I� CLA55 NO. CONST. Da�e ApplicaM � ARCHi7ECT0 . • �fiEC� �" ' � �� " { �, . • NOTICE TO APPIICANT: If, ofter making this Certi{kpte of � ENGWEER � � �1 NO. - Exempti�n; you should bec�me��subjec� to fhe Workers' 7J �,� ! VAWATION, Comoensotion provisions of the,lo6or Code,yoo�must forth- ADDRE55 ]1� [ � - � �� -- wlih romply wiih such provisions or tFiis�permit zhvll be �`� �� , ; /'� VALIDATION deemed rewked. CONiRA[TOR ' (�_ h � C�%; NO.�1' (�' LKENSED CONTRACTORS DECLARATION � �� IIC. � �..-. I hereby offvm fhot I am I<ensed�nde pro �sions of Chapler 9 �'� ADDRE55� � . NO. � ; (comrpenc ng uh Sec�io 7000)of D s on 3 of the Busin�ss ., �ITY ��'�� C ASS �C,� � n pnd Profess o�+s Coa ce a d e fec� ❑ESCRIPTION OF VJORK '�"" � ��7, . . . � � ��'�'.2 n ' r .. ........_....,,. ... Conlracbr f e.an �ceose Dafeu o.��..'.�` . �. .f... . �...�. � . �I.0 I• FINAL ► � � SV+IMMING POOI �LSa DAiE � G 1 )., a c �cense Numbe�__�L c Qass ..�,....._....... .. . . ,, o .n . 1��/♦1 ... ��-f �-�J SPA yr.� FiNAL .. ....... � e �U.v,C<J O. �t��— _f � 54.FT, <''� . . � BV r. � •. f U I am exempt under Sec SIZE � � " ' �+��V 9 c� � ,.._.. ... ..... .:.. . ELECTRICAL �7 i �-�� 6-&P.C.for this reason � � C�j F- .._ Date ,,.... , . . . .. � U ..._..... . ... . �....:. Steel 8 Conduit Bonding �,� �� Signoru�e , . __. � Candults,Conductors,Equipme t SINGLE FAMILY q��✓ Z HOME OWNER BUILL�ER DECLARATION PLUMBING 1 ► �G.�,y�p Q 7 I here6y affirm ihaf I am e empt from fhe Conirocto s L cense �� LaOw tor ihe following reoson (Section 7031.5, Bus ness and � P TraP � [—)( � / Professions Code1: 11'1'y , � � i Gas System y�� 'µ �� I,as owner of the propery,will do the plum6ing and A ri-Syphon � Id\I � �{,y�.a �t'�� ele<tricol o k.I,o y emptayees Wfh woges os rheir � ' � - sole compensation or a I censed co t actor w II do oll MECHANICAL � `-� � =i �i 7,C p. oiher wo k qnd the s�utlu e is no1 nte ded or offei�iJ '� h�p�wJ�F+� for sale(Seclion 7044 68P Code� -'�� ""� �" Swimming Pool Heat r � ��Z/�(' �+� � �s c o{ s� CONSTRL'CTION LENDING AGENCY I/�/V�v� �J�� I • 1 I�j,.{i G I hereby affirm Ihat 7here is a conslru�t on le�ding genty for � —' - � � G./G��<� rhe performonce of the wo k fer wh ch rh�s permif is asued A��ICAN7 �NO �`�� g 0 ��5�S (Sec 3097.C v.C). ' . : .'... . i,aeiN71 .. . . ► Lende�s Name l�7,2 C!"�.�. ..... . .. . ........._:.<...,.........,...�._.,.> AODRE55 lender's Address / p�--'�� ' P.C.Fee$ �'� Permit Fee tp�. � ` I cert fy rhat I ho e read th s applimt on and srate that rhe^ �� - - abova irfo.ma��o is corred�I ay ee to ompiy wi h oll Counry�� issvance Fee �4 �'g�� ordinonces and Sfate lows�relating to bui�ding, elec�rical, . .... Inves�i r Fee ...........`�.�� I .. . .. .• me<honiml ar.d plum6ing canst.uc!ion,and hereby authorize ga�on � �• 1.,:� reoreseNariyes of ihis Co�nty �o enler opon �he above- iaial Fee! } _ .. . ... mentioned p perry for inspectlon porposes. �- �� -- �� ..��.... .. .......�p.. .. . .�.s..�.:..�, �H•.,� .:, ...�, _ . . . ^` � � ��_z . _. - .�..:. .....,..„ ,.� . .; . . �qn -e of AupLc��r or q�en� -� �D�e ��"�""'��`'"'" �'""' SEE REVERSE FOR EXPLANATORY IANGUAGE - v _ .� __ ,.� ;-�,.,�, �..�'- _ � . _.._, _.......-w.... I .� :.,., . ,: . : � .. :...-n:. ,.. ..;. .., ."' OWNER BUIIDER DEC ARATION .":..:,.�r. �� PLANS TO AVPLICANT lN5PECTOR'4 NOTES�. � i�Yo: ' , �— Retur d ' � g�j_s I heroby arf m thai I am ezempt om�16e Con�roctor's � Approved � " 7 l ns,,,rr_ fo_ th f lo ng ea or. �5 c 7031.5) Wc. Qa!e No. Dpte Business and Professions Cade.Any ciiy or coun�y which �/C�y requires a permit to construct,ofler,improve,demolish, or repoir any s;rudure, prior fo lts issuance, also re � '3 t'�`G „�,p quires ihe applicant for such permit to file a signed stote- I ._ � menf that he is lirensed pursuant to fhe provisions o1 ihe � � � .� �� Conirallor`s License Low(C(iapter�9i(cammencing with � I , � Secfion 7000)of 6lvision 3 0l ihe Business and Prolas- , : � . ,sions CodeJ or f6ot he is exempt therelrom ond fhe bosis . . . ... . ,........ .,.,. . ...._ . . - . _..,,..,.._..., �-. -- ---. ...-.�.-.. --.._'.---' . ior the al/eged exempPion. Hny violation of Secfion � ' 7031.5 by ony appfirant for a permil wbjec�s the opplr INSPEQfON �.�.. I DA7E ' INSPECTO,: - � _..._..__.. .,._...: ,. -...,. �� _.. ��canl Po a civil penally of nol more than five hundred LOfATIOtJ . .. 1 %� ' _ ' ' " dollar(5500).1� _ . � . . .h,�.,.....,� � . . ; ,: ❑I,as awner of the praper!y,or my employe'es wkh STEFL F.F6RM5 ' , .� � � Jy '� " , ;_. �, _ ,_ wpges as fheir sole comoensation,will do the work,and a i� ' � � the stru<ture's not intended o off red ror sale(Sec 7044`, LIG}9t CON�UIY ��{ � 7 / - ' � :�!„jl 1!i .J � (' f'' � ,,.,,,�, Business and Prafessions Cod,:The Controrror's Lirense eOkDING � '�- � ' � �Law does no�opp(y to an owner of property who bvilds or �. ... i �� F �%� improves f6ereon.cnd who does socF work himself or � ._._ _........_,..�_t�.�,.-�,��Ifiroug6 Bis own p.y . _ em lo ees, nrovided fhat such im- - provements ore nol Intended cr offered for sale. 11, _ . however,the building or imp�uvement is sold wiihin one I��ND�tt ��,year bf mmpletion. fhe o�.vner-builder will fiave tfie __ burden of proving thai he did no�6ui fd or improvb'for ihe I GAS IItJE ,purp se af sa7e;. � ' 4—�— [ I,es cwr.cr af tne praperty,dm ezdusively con- �!4'ATER LINE troc::ng vi�.'7 Ilcensnn. wntrncbrs'o consiruct ihe projecr �'��Se<.�70441 Buvnass ard Pro/essions Code:The Conirac- . .__........._... SEVJER for's License.Low cioes no!apply to an owner of proper�y _ . _ . ... ...... . � �mho 6uilds o mproves ffiereon;and who mrtPrac'rs/or ri , I such projects wrffi o controcior(sj fitensed purouonh�o - �ih�e Conhracfor's Licensc LrnN%- . ,...... .. . . ....� ......,....._...__��-.._—�_...._.�_:..... . .. AN7I�SYPHON VALVE [�I am exzmpt under5ec._ ,B.3 P C.for th�s .ELEC?RIC'n�3RE5 - . .,.•.",....•.,'". . . . .. ..._...... reasor _ �FENCE(HEIGHTj - ' :_..:.�Da!e Ov{ner ..... .. . ....... . .. _.... SEIF-CLOSING ,. " � .. ... ..._� GATES � } - � ![JSPECTOR'S NOFES SEkF.L'ATCHING ' .,. ... ' . ... . . ,, � . , . ; .... ;'.� �..�:.:�:t_..:,:...�.,..:.ne.::...,.�..a..m.n.I :,.�.,..�.....�,��. � �... i, � � . . ' '..• � ' v�n:i �r� � �: .. .. .r. � � .. ��.._ ._..... .. .....:......-r..�..ie.y�c � .: ....,.�.�. . �I ROUGH WIiWG I '- . ...... .._ . . i FINAL E[SCTRIC � } �� 1•� ' — — � I FiEATER(LOCAYION E VfNTj , .. . . ... ........... . _ ..��:...<_..._.»„�.. ...........:..:. . _,.:�.. ,...:... ..:.... �GAS lINE TEST � ..�,. ,...... ... ..... ......_,..,....,..,.r..:.r,m.,r.m.v,.,...y„w. r ,... .. ..: '.PQOL OR9'.A1AGE ... � . _zm9Tr� hiM'..^y��,F4Pry:i..;v.i:-!�qrl?.. �P-TRRP . .......�......... ...... :..�...::..,,.e -:........; , .......,. �:x �.� i <i'^:.'�. x :-`. '-.:.. . ... ... . ., ... . . ....,.... .-..,, �..�,.. ,...;. ..e::- ,�t.„se'�„'