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HomeMy WebLinkAbout1442A 1870A (8) ._ _, . __ .____.. .,_ _ .. . __,... , , _ .. _ . _,�-_. �.. ,. . . � WORKERS'COMPENSATION DECLARATION � � � . . � � F � � � � � . . -_._ '. . . . � 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 , Y /-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 ❑ � . CerYfied copy is hereby furnished. ^�-� - ����- � - � ._.. . .. �.,._..., . _..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 '"' � - � �� -- ""' . ^. _ . � ._.. , .. - '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 . ... . ...,._..:. ........... (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 _� a c . ... � ,...�„' .........`. ,, � �A�I.. � �—f `�-$J SP/� yr.� FiNAL . . � e �U.v,C<J O. �.V�� 54.F7, ! By o � U � ... ..�.-� . . I am exempt under Sec SIZE � � ' �+��V�c� � ,...... . .. ,:_. . 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$UILLIER DECLARATION � PLUMBING 1 ► � I here6y affirm ihat I am exempt from the Controctor's License���� �� La❑w tor ihe following reoson (Section 7031.5, Business and � P Trap � [—'( � / Professions Code1: 11'1'1 , � i / Gas System y�� 'µ ��• I,as owner of the propery,will do the plum6ing and A ri-5yphon � Id\I � �{,y�.a �t'�� ele<tricoi o k.I,o y emptayees w�th woges os rheir � ' � - sole compensation or a I�censed co t actor w II do oll MECHANICAL � � �j � ---�-i �i 7,C p. oiher wo k q�d the s uclu is no1 nte ded or offeiacl �� h�����+M� for sale(Seclion 7044 68P Code� '���� "" �"� Swimming Pool Heat r � �Z �+� � �s c o d s� CONSTRUCTION LENDING AGENCY jN��Cl�'` �C1��� � � � 7 ra�G C� I hereby affirm Ihat:here is a consl,ru t on le�ding genty for ppp�ICAN7 � �� � � ,T ��G�-y<� rhe performonce of the wo k fer wh ch rh.�s permit is issued N0. ° ° ' i�J�, 'rJ'J S (SeC 3097.�V.�j. : . '. . . (PRIN71 .. . .. ► Lende�s Name l�7,2 C!"�.�. ...... . .._.............._:.<...,....�...:... . AODRESS .. . � .. . _... lender's Address / p�--'�� ' P.C.Fee 5 �'� Permit Fee (p�. � L I cert fy rhat I ho e read th s ppplimt on and srate�hat�rhe~ �� �- - abovr ir,fo.mat�o is corred�I ay ee to ompiy wi h oll County � issvance Fee �o �'g�� ordinonces and Sfate Iows�relating to bui�ding, elecmcal, . .... Inves�i � n Fee ...........`�.�� I .. . �. .• me<honiml ar.d plum6ing canst.uc!ion,and hereby authorize ga�o � �. 1.,:� represeNariyes of ihis Co��fy �o enler opori ihe above- Taial Fee! } _ .. . ... mentioned p perry for inspectlon pvrposes. �- ��� ����-- ��� �..��,... . . . ., .. ...� ...,., � .;::: ...,.. ��.__—���-t�.y. `�— � g—$iSS� , .,._.�, . ,.__...�.. .. ,q� -e af 4upbc��r or q�er� �Da�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'�„'