Loading...
HomeMy WebLinkAbout1175A 1597A �- , _ - _ ._.., _ >,;., . :�� � ,F� 2,:; �. . ._.,. ,� . .� ... . _ '�" �WORKERS'COMPENSA,T,I,QN,DECLARATION V he e6y aff rm that I haye a certificate of consent to self p msu e,o,�o ce�ificaf�o(W.orkers'Campensafion Insuronce, APf LI T��� F„�.R �,OMB�NATIQN SYI�IMMI�IG,..P401..��ERN61T � or a certi4�ied copy thereof jSec 3800,Lob.C.J � ,R�;2ee .�:u��.:."� � .:.�.<" .. � -�.... .,.,... _. � F i...;+....,..., �� 'EB]'cj3 34 � � � � Po�cy yo��l284 Compon�_State Comoensatior CS�4lNTY 8E LOS ANGELES � Cert fied�opy Is hereliy(�mrshed- _ .._ .,.r .,,.:. .>.-..,.-..-.,.•.•,,..,. ..,:..» ��1.ILA11�G..9ND_SAFETY ,..:..'. ..,:� . .. . : . __... � FOR APPLICANT TO FILL IN euaom�Y` - �- Certified copy is flled wi±h.the couniy building inspec- ADDRESS c3436�Robinbrook Pl. tion deparimem. BU4��NG , . .. . ... . .... . . . ...,_.. ... .. .. �::��.� ... ADCRE55 4 Robi bro Pl ko4ru�rr..Dlamoncl Bar ..,..�,are„ nppi«anrTOGJn..&..Gountrv.Pool ,.., , �n.:..a..,. .-,. . .....,. , aer . _ , . ,. ,... . arv Di ond B Y' ZIF NEA s ' �w c ao� � . . .,CERTI.�JCATE OF E7SE,yNPT10N FROM WORKERS' 7 G CROSS S7. /0}Mo.� Z, �. . � � ,C.OMPENSATIQN INSURANCE SiZE OF ASSESSOR � � TRACi 3�OE)3 !OT tOTNO. 2� MAp80pK PAGE PARCEL (Ih s.section need.not be completed if the per�(t is for one .. . ., . ��^�<��: : • ��-••�• �-• � � TEL. USE ZONE MAP ���` � "' `"� � � . .. . hundred dollars�s�oo�o�ia.:.) owNeR i�orman Hobbie No.8b1,-01 69 rvo. I cer�ify tho�ir the perfo.rmqpce,of.the work 4or which this "�'�'"'� � ^`�' `^""�-" " '- ���� ��-�••�— ��—� � permit is issued,I sholl no1 employ any person in any mpnner ADDRESS ! CONDI?IONS so os to become subject Io.Ihe Workers'Compensatlon Lows. -- � •"��� � "" ' ""� � �DISTRICT STA71STICAL CLA55 TYPE �PROCESSED BY aTv. �iamrand 3ar z,P 91765 CONST. Da,fe . ...APplC,ant... .. NRCHITKTOfj.,.. . •"'. ....� V ..TEL CLASS NO. ��"-" ` eNc�NeER iown & Country Poo7n�. 5g3-7578 �L� 3/ , � NO7iCE TO APPLICANT If after making thls Ceriificme of , ,... ._, .u�aa.-� �,,.-...., ..,.. . . . ... .. . Exemption, you sho�ld 6ecome subjec� to the Workers' �" �" '-"�" � i � yF. Womensafion 1 y ADDRES 1 VAlUAT10N :`-= p provlslons of„he Lobor Code, ou must forlh- � Ti Gare Ave. Pomona �,A. lh comply with su<h provisions or ihis permit sholl be ���- �� ��' � � � 7EL. VAt�pAT10N deemed revok=d. CONT4ACTOR^ s Q _ y� S ,j ��� ---f;—�*-c—v o,'� ,I NSED,CONTR, i, R5.DECLARATION _ . ;;.,.,a.� . .A�.4 uc., , � I he e6 aff� .t ar i am I�<ensed under ADDRESS 2��0 N . G2re a've. No. 183275 .e "��"�4 Y ^�.h P�cvisions of Chapter 4 ,,.:. ,��,. ..... � �:........ .. ... ..... . . . s (commencing with Secfion 7000)of p.ivis�o,�3 of the.Bosiness �ITY 9 C A55 m � ��'�:L`:� and P ofessions Code.and my license is in,full.force and effecl. DESCRIP7fON OF WORK � L cense Num6er �g3275 L<.Class i.-53 SWIMMiNG POOL ('iUt11 Ye V F�NA� J� ����'�'�"'�'j� _ , . ,...... � DATE/fJ L� �� ► . Or..` .��r4'IaF+oTnwn & ('rn�nf�r �Pa+e .� scn Gtlrl�t2 ❑ Fi at� so Fr c�j .. . _. �SIZE 530 � 9 '�—"'i n I am exem 1,u_ er Sec � ..4-!: ...,,..,,. ,P 2�,. ... .. . �c� a�' se e— � ...... .- � B 8P.0 fo,iks eas�,n ,.,_._., _ � ELECTRICAL "^ ' . ,.. . ..,. .. Date: � y.�`� C.7 /V W � ,Sfeel 8 Conduii 8onding i� p„' S g�fure,. ,�,� � „�.__, . ' Conduifs,Condocfors,EquipmeN � v1 , SINGLE FAMILY �"z 2p�/ c:,� v�,.,1 n, Z HOME ON[NER,B.UILDER DECLARATION 6 PIUMBiNG �� I hereby offirm rhat I am exempt from thQ Co�tcacror's Lfcense j , r�� 6 � p-r Law for�he following��reason(Section 7031.5, Business and g P T aP � ' �� Professions Code): � Gos Sys�em � � �^L� J. '1 ❑ . . .. . . . . . . . , Ul. I,os owner of�he property,will do ihe plumbing ond � Anti-Syphon eleUriwl work.I,or my employees with woges as their , . '�? �V�� sole compensotion,er,p.licensed coniroctor will do all � MECHANICAL � ' ��£�� � o�her work and the s,t�;qcfure,.is,not intended or offered x �;r��,..�rJ �or sv�e($ectio�70d4 B&?Code). f Swimming Pool Healer �Q , � . , � F ..:. . . . .;. ' .. . .. CONSTRUCTION LENDING AGENCY 9 � � - � Iherebyaff'rm)hotthere.ls.oc,onsiructionlendingoqentyfor - -��-- W;*-=•.,«. •�........... . � the erf,ormpnce af the work for which this APP�ICANT " 7EL. � � � p , permit is issued (pRINT� (Sec 3097,Civ.C.j. �. , '. � ::,:r. � �.;.,a...:.. . ...-.,_.,.......... . L�,nde's Nome . {AD�RESS � �, . ., . . �R,. ...... .. - �— . .. lende�Add ess , ,_ . ,_ . �V,C,pae E �°�``� ver i Fee -" "��� �I cert fy�hor I have read rhis opplication,pnd stale ihat Ihe �- � �.. �� �� -� . above informorion is correct I agree ro comply with oll County j �/�,�'""� . ordinances.and Stote laws reloting to building, electriwl. , _,_, Issvance Fee - mechaniml ond plu ing mnstruUion,.and hereby authorize i��esr�gdnon Fee � � � � . re enta!ives o' t�s County �o en'er upon rhe above- 7oiai Fee ��-�'r.� d enri ne prop or inspeUion purposeS. �� 's,,,��:;;;�f}„� „�S e;�::<'.. . .,.. '. y. �`� ."?F�'�-�'..�r.— .. . . , . L..__.�: `7�� r�-�" � � S�g�awre of n acm��o.Ageni � D+e SEE REI(ERS,F�QR EXPLANATORY LANGUAGE � _._. _ :.�...... .. . .....:.. . _., .. .F,�. , , ..v.�.._. ,.,, ., _. . _ . , . .. . . ,_. .. -.�. . _ w.�..;� � �_ . ....,.__�.4����....r �...,�.� .-� � �4��.�. , ,� .� �� dtlM d� .,.,�a..�xt„�.m.s.�a{3�§f` —� . � ' � � � � 3�VNiVNO i00d�'�. _:. . . .. ..; �x,� �-. .,... . : .;.. :..., � . ... ..—. ' - ,. -� *.�n "'31 3NIl StlJ . . . ...._ -_—_ - - � ._. _ .,�... . � 3 - y� ..1 - _.1. �,••-...•-,•. � • ,.•-.. ,,..,..,.,, ,t�.,,,�-'�� �',(1N3R$P�O11H�07)831tl3H� , _ _. ... ... .:...�.�.. .u.:.ata x-..<.:<sSa�i,. .. . . . ��..� s� 'a .,.., . .'.i'C�n`E�.�� �_.W,.-�4.ki'. � ' —'—� ii',a.." � �n.. ;. ..:..... ............�..,,�.- �. ��rW„ , 31NAJ313lVNi3� ,�%s. � . . . .. .,. . ._. . .. . - . ,... .. ...•.. ,. .. . �. _—_—_y ...._... ,-.e.. .. , .,.. . .. � :s;'f:I1M N9f70JM;, . . arci s�.wwn.tnem.a�'yayU+. .kF+:.;.;... u:a�i�:}. r3pv{tl�.>'s.¢x�sw:',... N 5�a +w vs - ^ � 1 ......�,. ,.,w,.�v�+u+rw+aae...., u+^rn�•�1R5v . . ...,. . :Y». +A. 'sni!4�w. F.._ h � ' —i . , �-�'xy� I s3ioNs,aoiS3asbi _ ..,_,._........... . . . ....�.�_ '_., .:_..-.,. ...-.".� -:. ,�`: (`�NIH31tl1d13S� sa��� � �.., .w.,.:. --� �n�boi�a�as I . -. .--..-�•. . . Q o cC ' '- (AH'.JI3H)3�N3i ..��. .v: . . ;. . osoa� . .,... . . ,_>�.,�,.,P� . - ..�.;..�. .. ..-,.:,r:.- . �,' . � 53i1M�IA1�313 ._ . ...,.,,,.,.. . '" ';,.?, . ... . ...., � . siy�,o}���dP�g' �oagiapunlcwaxawo�� "-.�,' �a .: ... . ... ,. � � 3A1§'A NOHdASi1Nb I _. _ '(mo�as �i�s,�o;�o�yuo�ayy ' � I oa yunnvnd pesue�i�(s)ioFoo��uo�o yym s��alad y�ns � � � � � � � � .—�---1 . �oy s��w;uo:oym puo'�ba�ay�s o�dun�o sp��nq oynn an Al�ado�d;o�eurno un oa 61ddo,ou saop Mo7 asua�i7 s,�oa ' �-'� '�"-"�""-�-•�-�<��`���' - � . ao�fuo�ayl:apo�suorssalo�d pun ssaursr,9!6hOL'-aSJ � __ ����5�' ' �>alo�d ayl l�nµwoa oy s�oi�o�.um F',asu�>:J y;�.a�6u;�o�; .., .. ,M .. , -uoo A�anisn��xa wo'G;�acwd ay�.yo�aumo so�� J � - -g 3P�I'I m31dM� . ,. �ja�os yo asod�nd . ' � . � % � �;� 3N17 Syg� ay��oy eno�dw��o ppnq you pip ay�oyy 6uino�d}o uap�nq �� � ay� ano4 Ilrm �ap��nq-�aumo oyy �ao;ia;dwo� �o �oa6 ... . . ...... _...:.....:.....:......:..:�«.:�:�:,:,..::a�.�::...�.: .. i' LItfOYO]�I ,. �_J auo u�ya�m p�os si yuawano�d,w>>0 6uippnq aya'�anaMoy ' ' - . ........... '�� �a�os io} pa�ayo�o papua�w �ou a�o s�uawano�d � - �� �" " '. �� � " -wi yons 74y! Papino�u 'saahoidwa umo s!4 Y6no�y7 �._. �� .. . . .�_� . � • i �o��aswiy��on�yons saop oym puo �uoa�ay+sano�du�i . .._..�..•. . ;.�.�,..,^��:=:�.i:^v_'_' . � _ ..... . . �o spjinq oym 6��ado�d�o�auono uo o;.(�ddo jou saop mo7 � " � ,�N�4H09 asua�i7 s,�opniFuo�ay1�apo7 suorsse�o�d puo ssau�sng -�-' " � ..�_ �.:,�:�-�..:.:,.�......,..,.._.._. -_r ...... . ,.. fvbOL'�as)a�as�o}pa�ayo{o papua+xn'�ou si ampn�+s ayi '�+��� � 1iOeNo7 tNh;i puo'��om ay�op Ilix.'uoilosuadwm a�os nay�so sa8om . . ' .. . ' "'-.._"."._'_'..-.-_��."..�,.._. . ..,'��'„", ' . � �; SWa03$133AS yaion saa,Co�dwa Aw ao�6�,ado.d ayy�0 laumo sb'�r� . , � , . . �;'(OOSS)vnUop.. . .. -...�-�,�,.R,v�.�rr...,,�.,. .,.... .._� ,, � � wouv^.o� pa�puny any uoya a�ow�ou yo 6��ouad�rnp o o/;uo> .�, � ddo a s al '-. ..,.'. ..�•-:+'rt:,G;nacp.x�^ot`�-.: MOl}7dSN1 ......"..� 31tl4 IdOi1J3dSNl -!I 4� �� qns y�w�ad o�oj�uaoqddo Auo d4;'lEOL �-�.�.�•-.•-.... . uo��>eg yo uoUo�oin iuy vo+ydwaxa pa6a��o ay+ �o� � � � -•� -� ��� ...._:..�.,._...�._..._.. s�soq ayl puo wo�fa�ayi Idwaxa si ay ioyl io(apo�suo�s . .. . . . .,.�.. .. . , .,s,,. �-su+z.w.,,.,....,}7.i,:r . .. . � �sa�o�d puo sreursng eyy�o g uoisinr(�io(ppp�vo�y�eg yaim 6unuawwoo)(6��1do4J)mc7 asua�i7 s�ofno�{uo� . . .... . .........................�......,.�«..�:ae�wa,w,�e_..�,M., - . ayy�o suoisinoid ay{oa Fuansand pasuaoi�sr ay soy;auaw �- a� - - -ato{:pau6is o a��f o!vw�ad y�ns�o�yun�qddo eyy ra�inb 'M" � 'r,r'' s,�}"a}.:� $%�a� .� � �� . . .. I -a os�o 'anuonssi s�r o}�oud �a�na>n��s Auo�ioda.+�p � ' "''� �� I , � J 'ysqowap'ano�dwi va��o���n�ysuo�o;�iw�ad o sa��nba� -"���'"�' �� " � '� o _—i _ y�iyr.�.(+unoa�o�(�p 6uy:apo,�suoissa�old puo ssauisng � - ' � i e � � � a;Q •oy� a;ad I y� ' ' "" panwddy (9'lEOL ��as} uosoa� Suimo;�o} ay: ioy MD� asuaoil :�•`••�""�y •.�.•.•y�,*, .... _ ---__.---'___ . 1 io�oo�.uo�ay�wo�;�dwaxa wo�:oya wq;}o Aqaiay �, " Pawn{oa I .,M,� NOI1H21H1J34 213011f19 J3NM0 � ""�S310N 5.801�3dSNl � -: '`1NV�IiddV Ot SNVTd '" '� �-�� . �� . ,,.,, .::.....,w . . -«..,,W's° ay&.�ba�•ia'�, ,,,�a,.. — ,.. . . ,-.... ,. _ ' .'.':.;f�,..� ... `�"� �;�6f�s��,.r�YdP.,Lw . . � ..,s.,. . . � . �.'.�..., . . . . ��. .:.-J.