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HomeMy WebLinkAbout0973A 1142A (7) �,; . � WORKERS'COMPENSATION DECLARATION !� ' � - [� I here6y off„m thar I ha�e a certilitote o,conzenl fo seli ;. qpp��CATION FOR COMBINATION SWIMMING POOL PERMIT �� inswe,or o cerlifitate of Workeri Compensation Insuronce, i' o�o c d copy thereof(Sec.3800,(� 6/�.C.�)�} ',' 76n2oe '���p y L�r.l�+W� .�CE816(3/eal. . ' ' , - .. Potic a� COUNTY OP LOS ANGELES . BUILDING AND SAFETY � CertiFied copy is hereby furnished �_/ �c/ -� � ' , �ertlfied co s filed with ih nt 'Idin ' � �' FOR APPLICANi TO FILL IN BURDING �r-7 /t l� Py� y g inspec• � ADDRESS �io deportment` � /'� ^' ' , � U I AOORESS d�7 O ��y�l�� QV�•� ' LOfAUTY ,� Date��Appli[ant ' m61�4-1 �!-1� NEAREST . - � CERTIFICATE OF EXEMPTION FROM WORKE I qTY.1'�j( Z�P, . CRO55 ST. COMPENSATION INSURANCE I TRAC4���v LOT O� LOT NO. • MAP560pK PAGE PARCEL (Thi�sacfion nsed not b�eemplNad if th�p�rmif ti for one 1 / iEL -7 2 USE ZONE MAP (; ' hundred dollors(SI00)or 1���,) . OWNER f („�dD-1� NO. /7J . NO. �o}3J7 I certify thot in Ihe performance ef the work tor which this � ��� �/� y� ' SPECIAL. permit is iss�ed,I sholl net employ ony person in any monner `. ADDRE55 (f"-�l�+� � �,yV 1�lJ CONDITIONS 5o as to become subjecf lo fhe Workers'Compensalion laws. I �.�{�/{� - DISTRICT STAi15T1�P.�C1A55 ' TYPE PROCESSED 6Y . . - � CITY �YV��/}/ ZIP CONST. Date Appliconl - . ARCH�TECT �'�� � �TEt. .!'D ��ASS NO. � , NOTICE TO APPLICANT: If, of�er moking this Cerlifimfe of ENGiNEER NO S�C�C�j � _ Exemprion, you shouid.become su6ject to rhe wo�►e�: ; Aooaes�b(lJ�O�/"�i'�/J v�tuATiON � Compensot�on provisions of Ihe Lobor Code,you musf forth- s YAIIDATION ��` wilh tomply wiih svch provisions or fhis permit shall be / TEL/';_ � � j '`,�` �� deemed revoked. CONTRACT dpLS� NO.l � ��`.v . LICENSED CONTRACTORS DECIARATION S LiC. O` ' - • I hereby ofiirm Ihof I am licensed under provisions oi Chop�er 9 aDDRE , _� (commencing with Section 7000)oi�ivision�of�he Business . ���� � . ' ond Profession e,ond my itense is in full forc � ffect. � ��TM v� CLA55 � � -� � i /�/ DESCRIFTIONOFWORK ' ' ' ' ' license Nomber l.J Cc.Class��. HNAI � �� ► � �0 9 7.3�} ' SWIMMING POOL DATE �: /� l ��,, �� � �-Cd�Sb g� n- Con�ro�� �-U l�DolesL�_� � SPA F . {�e • • •`L� O . ❑ so.EFT. � - " I • •4 9.0 9 � . .1 am eaempt vnder Sec. 6.8P.C.for this reoson � .�� EtECTRICAL- . _ _ . . . , • • °4.9,p 9�% O '� �( � ... . . . W . � Date: � D�1,�6�8� ' ' Signoture S�eel 8 Conduit Bonding - 1 YI � Condui�s,Conductors,Equipmen� [/'� SINGtE FAMIIY i !'—� � � - Z . HOME OWNER-BUILDER DECLARATION � p�UMBING � � . . " I hereby afFirm�hol I om ezempt from ihe ConlroUor's license � � , . , , _ law for ihe following reason(SeUion 7031.5,Bosiness and p-Trap � . - � . - Professons Code): : � .� 1 Gas Sysrem ' - � I,as owner of the proper�y,wili do the�plvmbing�and Anti-Syphon � - ?� � Ii.C A ; electritol work.I,or my employees wilh wagas as their � sale compensolion,or o licensed conlraclor will do oll MECHANICAL � - ' -- � � � � � ii° • • • •.3 olher work and the siructure is not in�ended or offered ` ' ior sale(Seclion 7044 88P Code). � -' �' ' �Swimming Pool Hea�er � " ' �Lfy�yI � • � 7��J n CONSTRUCTION LEN�ING AGENCY �\ ( � • � %�.J�` I hereby oHirm ihat ihere is o construciion lending ogency for AP7lICANT V the performonce of ihe work for wh�ch ihis permi�is issued �PRiM) ' �7��2„�b,5 -(Sec.3097,Civ.C.�. . ` � , lender's Nome ��� aDDRES L �.- `z e_. ��� . .. . . .. . .. . Lender's Address �,� . � . P.C.Fee E � •� Permif Fee • - � I certify that 1 hove reod ihis opplicofon and state�ha�ihe - - � obove inlorma�ion is correct I agree to comply with all County - . ._ ' ' . � � ordinonces and S�afe laws relo�ing �0 6uilding, electricol, IssuanceFea Q��� me "al and plum ing constroction,ond here6y authorize'`� ���esr�gation Fee �J ^ �. , . _ . �¢ resenta es of.lFis ounly to enler upon Ihe obove- � � ToMI Fee J .J V . . � r eNioned p� rry for� spection purposes. , � � . . / 4��`���� . 5� ot�re o1 n Prco�t o�A oa�e . ' SEE REVERSE FOR EXPLANATORY LANGUAGE - � � � ��-2��i'�-:��� .. �� U.��� ���r Y'' r. � �-�-��i � � p ; = 2 � o �, ^� D � � n n � .- � ,- z -� "' 9 p v, y � C „�� n n z . � y vp, z z � rm.. f�1 - - - o 0 � p Z z m 2 �' m � �'n � � .- O � -=i �' -Di . D m ^ � .� • � �i � . •- M � Z '�O w p -+ p n ..-� � S 2 . � 2 O Z Z . 2 �* n �+ �`o v�v� Gl O rn . 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