HomeMy WebLinkAbout1153A 1320A 1321A . _ . , 1`l�'...... ' 1
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VlO4KER$'CO:lFFNSATICN DEC�, . ION � \ j � '—� � ��"+ 1 '
I hereby affirm iho�I have o«�„�,«���oF�(a�s����a sP�� APPLICA'TION FOR COMBINATION SWIMMING� POOL PERMIT
insure,cr n ce��ificele eF Workers'Cr.m`ens I�e�Insura�ce,
or o certified ropy thnrer.f(Sec 3PP7,Lnb.C.') �76n:^o
LV�f��—=(s"L ti Cfr �y CE-fi75q1/81)
Pol�cy o. Compn�y.../ �'PrL�N�� COUNTY OF LOS ANGELES BUILDING AND SAFETY
� Ce��ified cepy is herr.by fu�nished. � �
,e � FOR APPLICANT TO FILL IN Bu�ic�:c
,�Cerlilied ce�Y is fi,.d w�'h ihe county b.''dirg irspec- ADC=FSS Q� �
r�on de;.ortm=nl. � L•UilCinG /7L �
�J��� AD�RE55 L//4 LOCA(ITY
DoieJ�J App��[anl NEAREST
CERTIFICATE Of E%EM,PTION F40M V.'OFKERS' CitY Q Zi� CRC55 5T.
COMVENSATIO'J INSUQANCI: TRACT 3S3 OT�� LOT NO. � MAP BOOK PAGE PARCEL
(This�eefion naad nof b�eompl�l�d if th�p�rmil i�ior ona ret. use zove MPP ( '
hundred dollan(SI00)or I��t.) C'•':M1FR Q n0. n:0. S ,
I cerffy ihat in ihe per(ormance of th�wo�k(o�whfch�hfs S?ECinl
p�rmit is issued,I;Fall nol employ ony person in ony manner �DD�r55 � E U CCNDITIC':5
so as�o becom�subletl lo the SYorkrr5'Compenso��0�Laws. — DISizICi SinT15TICAl CLA55 �Y�+E PROCESSFD BV
CIiV (�t/ ZiP C�
D��n qppliCant ARCHITrCT C4 r TCL. /-}.� 1 Q C1A55 A'O.�,
NOTICE TO AF;LICANT: If, n�icr making this Certiflraro of
ENG'!vEER f', , NO. g �{ppr/ �
Eaemplion, you should bacome subje.cl fo �hr. VJerk?rs' �/ � L`f�✓t � v VAIUATION
Compensa!�on�revisions e(Ih?la6M Codo,yo�mus�Forth- nCDAF55 A 1 � VALIDATION
wlih cor�piy w��h soch p�o��vor.s or ihrs permii s�nll M ! � / �p t � a S S 6� Q
deemed rev^krd. CC�:iRnCiCRLt��J�t�'(J �
IICENSCD COtiTRACTORS DECLARITIOY ��/J�1�_n ����
ne^o�s LZ,SU �/ �,..No. 3/9
I hereby offirm ih�i I am licensed undrtr provis�ons of Chap'cr 9 ,� ��� S ' �;� � �Z�(i
(co�+m�ncing wi'h Sc:��c�70nJ)ci D�v�s�on 3 of Ihe AIISI�f?55 �iTV �C,/ ' ClASS . , y
ond Pro'ess�nns Ca.Jr.,ond my Ucrrsn is in(u!I(orce nnd r.i(rtct. ' CEXRi-;ICN CF VrC�K ,! • • 'C�
�F�j FINA O �� ► O
Li[ense N�mber Lic.CI s� S:Vi".:•.'•:G I'OOL U �AiE �. ��e •�`j.C� Q,
Co�t.ac�or �a��.L✓.� S^� � FINAL .. � n e •(:�^ ;i.i �
�O.FT. � dY �J
� I r.^�ea�mpf urdc•c^�. S�ZE � L(i�'"ci:i a
� y^� N
9.RP.C.icr ihis ronson ELCCTRICAL 5�,��\J z
Da�^; �
$�eel 8 Condui�Bonding a�` �q�
5��7no�wc Condui�s,Condudo�s,Equipmenl �
SIVGIE F�M1�ILY . �����
f!0"'E 064'NER-BUILDER CECLARATION GLU:lBING '
I he�eby a'!irm ihoi I nm exempi frem:hc Conrra:•c%s Li:ene� � . �
low fo��hn{ol�nwing rcosen(SecEnn 7031.5, 8usir.css nnd P T�o� �
Professfc�s Cede): Gas Sys�em �
� I.r.e ow�er ef!�e F�cper�Y,w��l do�he plumbi�g nnd M�i.Syphon
ele:�rical wo•k.I,cr my emptoyees wi!h war,es es ihe�r �^, �������
solc comp�nsatlon,or a Irce.nsrd co�lroc+or will dn aq h�ECHANICAL ;;o • o , .� �
ottier work and ihe shuc�ure is no�irrended or offernd �-}.. �
fcr saic(Sec��on 7C4a BSP Cod^). Swimming Pool Hcatc� tx� .
� •C[:t�'l)
CONSTRUCTION IFNDING PGENCY � ,.
I hereb offirm ih�l�hern is a conslruction Inndin a.enc for � � �=`��`��%=-
Y 9 9 Y AFFIIC�NT / Tf.L. G
the pr�fo�mance of ihe work for which ihis permi�"s issurd (P�1NT�/����,'�'p ��XI'�/lr N���7�� � ► (1�.� :—i;f
�Sec.3097,Gv.C.). l
Lrnder'SN�me ADDRE55 J � /J � fja/Q/� �
lend��'s Address P.C.Fne S �y� Pr�mn�nn �l.�i �t . . • . .
I ccrtify Ihal I hnvr.reod ihis opplicolion nnd s�a�e that Itirt � . • —�
abeve iniermalion is cr,rrcU.I agrea io mmply with oll Cconiy r 6 �� . �;;
ordinnnces a�d S�a�e Inws re�o�ing lo building, elrtcbical, Issuance Fee _ � *
methnnical and plumbing cons!ruttion,and hereby authorize ����vi;���on fee � "' '� �
represcN�eive.s of this Counly In entrsr upon Ihe abovr.- ToinlFen 1 � � s� � r � , .
meniio�d . .rty fry cpr ion pu.poses. _
� ��}{
S�c�aro��c ann��ra^�n.^?^^i ��� SEE REVERSE FOR EXPLANATORY LANGUAGE
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