Loading...
HomeMy WebLinkAbout0973A 1142A (9) 17 � � WORKERS'COMPENSATION DECLARATION !� � � I hereby off��m �ha��ha�e a certilitole o,consenl fo seli ;. APPLICATION FOR COMBINATION SWIMMING PO4t PERMIT inswe,or o cerli(itate of Workers'Compensation Insuronce, !' or o c d copy thereof(Sec.3800, 6.C.) _ ',' 76pZoe � � � - - �� (j��y1�, j' .�CE8�6�3(L'3). votfc !_� '�L�`�pa�v " �P_,—.��x3�—�--`� .. . COUNTY OP LOS ANGELES . BUILDING AND SAFETY � � � Certified copy is hereby furnished. f� /l � �' BURDWG err�fied copy�s flled with�h nty 'Idi�g�nspec• _ FOR APPLICANi TO FILL IN ADDRESS �� lJ 11� tio deportment! , BUILDING /���JO C�' �-yn /tiU 1•. \ LOfAtITY .� AOORE55 O� � JrVv/i-� �,1' '�./ Date ApplimM li {� Q NEnRESi - � CERTIFICATE OF EXEMPTION FROM WORKE ��TY' � m'6�Q V�T'-' Z�P' . CRO55 ST. I 512E OP ASSESSOR COMPENSAT�ON INSURANCE Tqp�YV �pT LOT NO. • MAv BOOK PAGE PARCEL (Thi�socfioe nsed not b�eempldad if th�p�rmif ti fo�on� i / ieL 2 USE ZONE M/P ��-3�7 � � hundr�d doliors(5100)er La�.) . OwnIER f C..d�� NO. ��J � NO. I certify tho�in Ihe performance ef thn work tor which this � (�n� �/� y-� " � . SPECIAL. . � � '� permit is iss�ed,I sholl noi employ ony penon in any monner ` ADDRESS (i�"V��� ` C.l l.�i N CONDITIONS sa as to become subject�o�he Worke�s'Compensa�ion laws. I ^��{I!f1 DISTRICT STAi15TICAt C1A55 ' TYPE PROCESSED 6Y � cirr /\rv��Y Z�P CONST. . D CIASS NO. / Date Applicanl - . ARCH�TECT J..�'�i� NO S�G�C�r..� � � � � NOTtCE TO APPUCANT: If, after moking this Cerlificate of ENGiNEER ' E�empHon, you shouid.become su6ject to rhe Wo�kers' ; AD�RES�b(v�LY� G"� V�wATiON . Compe�sofion provisions of Ihe lobor Code,you musf forth- � TE�� � � � ���� YAUDATtON wilh tomply wiih svch provisions or fhis permit shall be s ` deemed revoked. CONTRACT QD S NO. _ � LICENSED CONTRACTOR$DECIARATION ���' - ADDRE S �� s� I hereby ofiirm Ihof I am licensed under provisions oi Chop�er 9 ���. C (commencing with Secfion 7000j of 6ivision 9 of the Business ��n. � (f,� CLA55 . � . . ond Pro�ession e,ond my i[ense is in full forc � ffect. DESCRIFTION OF WORK 1/`r �Q �'j1 NNAI y , � �097.3R license Nomber `�+ l�c.CIoSs��L�.L SWIMMING POOL DATE � �.7 " . ?�. .�r, ,� /� `` �S .� $PA �"CQ o��o�� � . F . �• • • •`�� 0 . Con�roR���'-� `'�`1Dn�e '. �.FT. [� � e . . 1 • •4 9.0 9 . � .1 am exempt vnder Sec. � S�2E v�' � • e A.9,0 9` t�— � � 8.8P.C.for this reasan �.�; EtECTR1CAl- - � - - � � ' �• � W � Date: �-y� � -.. . . . D�12�]�8� ' 0. Steel 8 Condo�t Bondiog - }y�.� � � (A ' Signatvre � Condui�s,Conductors,Equipmenl �_,J � � " Z . SINGIE FAMIIY . . � ' HOME OWNER-BUILDER�ECLARATION - } p�UMBING � ' . , . , . . I hereby afFirm�hal I om ezempt from ihe ConlroUor's license �__ . T _ taw(or ihe lollowing reason(SeUfon 7031.5,Bosiness and r P-Tra . . Profess�ons Code): : � .� 1 Gos 5 �em - � � r� _ �114.2A � I,as owner of the proper�y,wili do the plvmbing�and � Anti-Syphon • . ' electritol work.I,or my employees wi�h wagas m their , _ . - �i• • •.3 sole compenso�ion,or a licensed connac�or will do all �-MfCHANtCAL ` � alher work ond ihe siruUure is not in�ended or offered � ��� � ' ' � � � • � �]�rj n ' for sale{Seuion 7044 88P Code). ' -' �Swimming Pool Hea�er CONSTRUCTION LENDING AGENCY \ , • � 1 J.Fi O u 1 hereby offirm thoi therr,is o construc�ion lending ogency for App���qNT , � ' ' the performonce of ihe work for wh�ch�his permi�is issued (pRIM) � O Z O 2"'b'rJ -(Sec.9097.Civ.G{. ,�,,,// - ` . .. . . .. . tender's Nome • ��~ aDDRES � �-- 2� ��l _ .. . . Lender's Address P.C.Fee E � •� Permii Fee ��.� ' � � - . I certify ihai 1 have reod ihts opplicofon and state Iho1 ihe � � � � ' I obove inlorma�ion is correct I agree to comply with all County - - � -- � - Issuance Fee Q��� . ordinonces and$ta!e laws relating to building, eledritol, . , . _ . s me -al and plum �ng constrodion,ond here6y authorize'`� ��°esr�gation Fee � . `a ' resenta es of.l�i�s ounly lo enler upon Ihe a6ove- ioMl Fee V � . . � r eNioned p� rry for� spection purposes. , � , � / CE,�:t��.� � 5� o���e o�n p�i�onl or A oaie . � SEE REVERSE FOR EXPLANATORY LANGUAGE � _ � -�=��!� -J U.� � �� ` � './ � .���'� ts � z � . � o 0 ��-: � _ �, o ��� 7�� m � . n y s �= � � o -� �n � y v +° o Z �. r � �. '^ o z �o p z v P ^` m ? � A 2 � � o r ^' o 70 � n ni y� � � G �n a �p O m �n A. < 2 � �o G� m y C� N = �z O " r� O � . �0 0 y J r .y � " � � � „' � N � ,"�i, G' 2 -�c O Z �i jO T T D • t . N q � `�p tv Z }n � x -� � � n n � �� m o O .. �i [�,n � q m 2 Z G1 - qi . � r o, G� - M c n G "� p a > Z o y � � e y ,1 �, �, q _. • �,J' ,'�D ` Q < .f• A O r 4 �` ' �� . .. . . � _ � ' 1 � ' � - � , N • , � � . . � , � � . l . � �. � _. � o � m � � • v,n3 c y � . � - �, , ' Q n VQ C 0 T�� + ' � C j y� (� . . ' . r"W S Q ��_. �n O p � O M N f9 6 ' . �,,,[ S�?3 � w N rL1 a v,T(�� n a? • e a p D_. � � o � ° p� a' N �� oII.? a„`o ° ov ' f -' �z ' �^ � O N� . ,p CL G Q � � O N �Q ►V���C O v O N q�O � N �' . 0 0 � ." T° ��' �� n �'� `° S '" � ° ; s� o<�� o �� «�. �3•° ° gR, . � o o� v� oa`.^.ou „ • �T�.a � mmoc,..�. w °,�o o �,._ op. � J :D 7 C• l� A L�. �.,� O T y� N O �N < ��D� �+O M � i' � 0 M � � . —�.a.� �.=,p � 0 3 � o o eov° � o o m e,��o � m � � o o a G ' ° � N a p � .-° �c,m�`� �.��° m -a o o �w � M p M�° e N N o 3 � `� �•f f � � m~� oa:o � oo = m' � `s . '� 3� Q� f� cv �,o° xA . 3 �.T'3° o� � o q? `�° 3v �-� Nm�� oo? aos�� o ; Q�•� d o m °- "o � 3 3 ...o n � o y� v.Cl v_ � o � �,.o o S .a� -m� �-f o 0 ov °� � � �3 o m �., �,�,' Z � � o � 'a7cc • a.o3n.m ° mao `� 03 o� a - - �'� oop � 3 .c T N ' .+' �V � r� �. � p'O CL`{� �� O�' j't O W [a�"' O ' p 3 � m f o � o o ; a : �.� o � o -+� 3, < � ? =�3 ,� a ni ^ � if ° �v � op ,. O° mooN�oeo £ ° ° No �'� ovmcoo . '� O ' . � .^ ' y � j'�=.'^ �O'3 c c o C'1 a�3 S C a p � N a �.�'� Z jO � 'o � ��' `-'`'� �°-im � ° °-� �� 0 3 '�^ 3 < ^ �9 c n o ' � =? O N n fl O..� .l-fli �. .� �, O W . �n 7 � p N '^7 !� ¢.7 . � � . Z -n o.n �n� � ' I O -. N rJ 0�C O fl T� � v� �p,� n O � Q C .0 +1 O . O O O N d'_ ^ B O m d. .� d 3 p � . _ ' �^ N �-� m� n 3 f.�-..°'r�-°_ir f-°� T m v+� �� o �o °.�.� g - ,v� � = v o �-o Nmo � c m o � v� • .� �oo•�T� �Q� o ^.� c ^ �x£ �ro �o� f.� � msT�N 's o � � . . � � =�v n19 " o m � �'r°_a NQ' � Q� , � _ C� � c o ��°`<` ., o �30o m �a .. o � s � . - . O � N� O n ? W m (p ' rt O „� � . . •._�.��� . S O . N