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HomeMy WebLinkAbout1153A 1320A 1321A . _ . , 1`l�'...... ' 1 �, � � /J . . � ,__.. _ �, � �,. , . �__.., � 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 . � . ! . . —.-�.-�--�� -- — � _ �;— _ �_�o -- - "� p n � �: = � �%' ,I' I -- � : � �. �� �+ r' � O I � I � 7 � p n 4: � -- � �+ rl n i =-� '" -'�''. c � � u �0 .r� ' C% � • G N II5 �I T 1 ' f: '�I � ,1 '� C � �� 7 Z� r n ^ ! w � � ��• 0 !. _I � { r m � � �� LT V. 1, � � I � . 1 v: O - y � � NN =' ~ � j ' 1 I I � . 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