HomeMy WebLinkAbout1442A 1870A (8) ._ _, . __ .____.. .,_ _ .. . __,... , , _ .. _
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� WORKERS'COMPENSATION DECLARATION � � � . . � � F � � � � �
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or alcert�ifiedccopy 7hereof(Seke,r3s$C�om�p�enC iio ��5�a��e` - � APPLICq,TION�FOR CflMBINAT101� SWIMI4AING POOL PERMIT
I he eb affvm Ihoi I hav�a certificote of conse to ,
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/-31/��QJ �r(�y�. 'e� /'����.� � •/�� 16 2'6 � � -� ' t" 1'ti. Y,3T.GRasta� +r.i.-c. _.�....., . _
7 V ' " �Z'^��i'� �I�.l'YY\,E3'1ti+1 GE�75;3`0c` � .. . y ..• ... , .
Po ic• o ,. n any COUNTY OF lOS AHGELES BUILDING AND SAFETY
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CerYfied copy is hereby furnished. ^�-� - ����- � - �
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. _..sw.wn�,ye,,.,,uW:;� BUIL�ING ..."'. ..
• Ce�+-4ied co s tiled wiih rhe count buildin p FOR f\PPtICANT TO flLl IN . p't,.,.`�f� �' �
py� y g ins ea . ..�,., , AODRE55
� tion deparfinen! BUIIDING '"' � - � �� -- ""'
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'Date1 �����J.1Applicanl � / �,_" AD�kE55 � t.S j . LOCALITY . � �<, . Nrt. .,�,.�,�,�„:
. .�.�.. . � NEAREST
CERTIFICATE OF EXEMPTIO R ^A WORKERS' ��TY j� . Z'P CRO55 ST. -
.,��j�/�..�SIZEOF � ASSESSOR � �� ���-��"
� ' COMPENSATION INSU ANCE ,r_, 7RACT ✓'t'T�3-L LOt '� � LDT NO. I MAP 600K PAGE PARCEL
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(This seefion need not be aomplafed f 1he permif is for one � � - TE� USE�p NE MAP ��/ " '`��'"'-����•`
hondred dollars(S100j or less.) OWNER y NO � �. � 9C.-J NO. � T y�� S
I ce��ify ihar in Ihe performance o*the . �or which this �. {�YdQ� SPEGAL �"� '�"`
permit is issued,1 shall no��m lo on erson�n an��manner ADDRE55 �
_ P Y Y P Y � s b �s � CONDITIONS
so as�o become s�biecf ta the Workers'Compe�salion Laws. � - ��� '' � n� � -''�'�'-'- -�� -� D�STRIC7 STAiISTiCAL'C1A55�" TYPE PROCESSED BY
�, � . CITY 'Y\ ��Z.IP �� � CONST.
Da�e Applicant ' ARCHITECT O ' "'7E�" ." ' ' ' '- C1A55 NO.
NOTICE TO APPIICANT: If, after making this Certi{kpte of �� ENGWEER � � �i� ��1Q�N0.'��{� ,
Exemption; you should 6ec�me��subjec� to the Workers' 7J �,� ! !f� VAWATION. . . .
Comoensotion provisions of the,lo6or,Code,yoo�must forth- ADDRE55 ]1� [ � - - �� --
wlih romply wlh such provisions or ihis� ermit zhvll be �`� /� VALIDATION
deemed rewked. P CONiRa.[TOR Q._ y� �x7� No.��1�f c� ' ; �(-�' �
(com enc n I'hD CONTRAGTQRS DECLARATION n �� - ���� IIC. �`'�
LICENSE ;: qDDRE55[7C � � . NO. I
I hereby offirm fhat I am I<ensed�nde pro �sions of Chapler 9 �
LIC. -
� g Sec�io 7000)of D s on 3 of the g sin�ss ., �ITY ���'���� C1A55 ��,� �� (�4.2 A
pnd Profess ons Coa rte a d e fe� ❑ESCRI7TION OF VJORK � �'�"' -� �' ' ' �
n' Y .. .. ... .,..,,. .._
� � - . . ,../Yc.-+ *j ' . _. ... .. . .,..... , . � FINAL ► '
Con�ac o�mbe. _ Dare lass�Z�.�_ SV+IMMING POOI DAiE �� G, }
e.an �ceose n u o
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�A�I.. � �—f `�-$J SP/� yr.� FiNAL . . � e �U.v,C<J O.
�.V�� 54.F7, ! By o � U
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I am exempt under Sec SIZE � � ' �+��V�c� �
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ELECTRICAL �7 i �-�S
6-&P.C.for this reason � �
Ce F-
.._ Date: „.,,.... .. „ , . � . - Q� � W
. .. ..._..... ... ..„_,-,.....,�-,,...�..." Steel 8 Conduit Bondin �/j'.,� ��y �
Sign 9
❑tu�e ._.....,...,._.;.,.,..N,..,M1 „..,,.. Condults,Conductors,Equipme t rf''��� Z
SINGLE FAMILY � , ��g,y �
HOME OWNER$UILLIER DECLARATION � PLUMBING 1 ► �
I here6y affirm ihat I am exempt from the Controctor's License���� ��
La❑w tor ihe following reoson (Section 7031.5, Business and � P Trap � [—'( � /
Professions Code1: 11'1'1 , � i /
Gas System y�� 'µ ��•
I,as owner of the propery,will do the plum6ing and A ri-5yphon � Id\I � �{,y�.a �t'��
ele<tricoi o k.I,o y emptayees w�th woges os rheir � ' � -
sole compensation or a I�censed co t actor w II do oll MECHANICAL � � �j � ---�-i �i 7,C p.
oiher wo k q�d the s uclu is no1 nte ded or offeiacl �� h�����+M�
for sale(Seclion 7044 68P Code� '���� "" �"� Swimming Pool Heat r � �Z �+� � �s c o d s�
CONSTRUCTION LENDING AGENCY jN��Cl�'` �C1��� � � � 7 ra�G C�
I hereby affirm Ihat:here is a consl,ru t on le�ding genty for ppp�ICAN7 � �� � � ,T ��G�-y<�
rhe performonce of the wo k fer wh ch rh.�s permit is issued N0. ° ° ' i�J�, 'rJ'J S
(SeC 3097.�V.�j. : . '. . . (PRIN71 .. . .. ►
Lende�s Name l�7,2 C!"�.�.
...... . .._.............._:.<...,....�...:... . AODRESS
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lender's Address / p�--'��
' P.C.Fee 5 �'� Permit Fee (p�. � L
I cert fy rhat I ho e read th s ppplimt on and srate�hat�rhe~ �� �- -
abovr ir,fo.mat�o is corred�I ay ee to ompiy wi h oll County � issvance Fee �o �'g��
ordinonces and Sfate Iows�relating to bui�ding, elecmcal,
. .... Inves�i � n Fee ...........`�.�� I .. . �. .•
me<honiml ar.d plum6ing canst.uc!ion,and hereby authorize ga�o � �. 1.,:�
represeNariyes of ihis Co��fy �o enler opori ihe above- Taial Fee! }
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mentioned p perry for inspectlon pvrposes. �- ��� ����-- ��� �..��,... .
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,q� -e af 4upbc��r or q�er� �Da�e �'�'�"'�� �'"'" �'""' SEE REVERSE FOR EXPLANATORY IANGUAGE
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� . _.._, _.......-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
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- . _..,,..,.._..., �-. -- ---. ...-.�.-.. --.._'.---' . 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-
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SEVJER for's License.Low cioes no!apply to an owner of proper�y
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� �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%-
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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
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SEIF-CLOSING ,. " � .. ... ..._�
GATES � } - � ![JSPECTOR'S NOFES
SEkF.L'ATCHING
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�I ROUGH WIiWG I '- . ...... .._ . .
i FINAL E[SCTRIC � } �� �1•� ' — —
�
I FiEATER(LOCAYION E VfNTj ,
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�GAS lINE TEST �
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'.PQOL OR9'.A1AGE ... � .
_zm9Tr� hiM'..^y��,F4Pry:i..;v.i:-!�qrl?..
�P-TRRP
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