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HomeMy WebLinkAbout1352A 1447A ' . � _ . .) ..__ .._.._."_' _ _ . . . / \VORKERS'COMPENSATIOy CECL4RqT10N � `�., /� \. / - [3 1 here6y alfrrm ihat��,���o���,;,;«,��,«�,e�,,o self app���ATION FOR tOMBINATIQN SWIMMING POOL PERMIT - � insure,o•a certificotn of�Ynrkcrs'Compensclion Insur�ncc, or o certificd cepy thr,ren(�Sec.3900,lob:C. 76A7_`3 1�7ss'�Y � fE�275�11/fll) aol�cy No. Company �-C�-� COUNTY OF LOS ANGELES BUILDING AND SAFETY � C^rtified ccpy is h��eby fumished. . O Cr.nif�ed te s fNe:i�vl�h�.e count bv�ld�� ns FOR APP ICANT TO FILI IN au':o:�� 1 y , rv� � r e� nAc- �noeess lia�de�crtmcnt. /� J � ACCRESS W�D� � � %-� r iocnun Da e Ap�p icanl ' . — �AB�ST J � CITV 21P CROSS ST. CERTfFlCATE OF EXEM.PTtON FRO!d tVORKERS' �q Siie oc n55E55cR COMPENSATION INSURANCE TqqCT �'z�+ J lCT LOT k0. MAv BOCK PAGE PARCEL (ihl���cfien w�ed nof bv compl�Nd if Ihs permif lo for one �EL. L u5E ZONE NAP hundrad dellori(5100)ar le�s.) Ov;NF4 NO. �����G+�� nlo. 9"�r^ �3 I ce�fi�y rhol in fti�pprlcrmnncr,r.f�h�wMk(or which Ihis permit is i55ur�1,I sticll ncl em�loy ony perzon in any manner /+DDGESS SaE��a� COv�ITIC"d5 so os b 6=come subjrU to!he Wwke.s'Compensnlion lows. D�SIR�Cf STnTiSi:CAt CLn55 irPE PROCESSED BY CRY �� � ZIP /Q CLASSNO. �� CO'JST. �o'r. Annlimni AaCH•TEC7 7F�G� �� NOTICE TO APPIICANT: I!, qqrtr making this Cr.rlifim'e of fNGiNL NO E.emption, you sheuld become sublect io �he Wo�kers' / ,(/� � VALOA710N Compensn•�o�provisions ef ttie lohor Codr.,ycu must fcrth� ��C�SS/�O� �sz,1 Z �,/�ei wiih cemply wlih svcb prevrsinns er �his permll shall be iFL s / _�� VALIDATION � d0�m�^I revCGed. CGNTVACiO Iv� h0�<< < LICE�SED CCNTRF�CTORS DECIARATION ��C. �Aerr.b aff�.m!hn�I orn licens�d wder nC^erc5 � P/ h,J?Sa�S'rJ ' y provisi�rs ef Chaota�9 � (commendr+c�wlth SeUion 7000)ol Drvision 3 of ihe�usmess ���� ^r� "� �a�i, n�d Professions Code,nnd my license is in full(or�r.vnd efle;L dT 1.4l.e�y..�,s C1n55 CS'� , . . ��� � � �i � C::�CR'PIION CF lV0?K �� 'FINAL �� O u:����N�Tti ���� t�c.u��s3 SV:IV.�.�NGroo� l�J" • Z/ld'li ► � , .„�� `'' D11TE ^I(,�'/ OC Co�i�a<ic Dn!r. �nA U FINAI e n e � '" � '� � � SQ FT. ::l.t; - lJ w � � 1 om evempt�nder Sr.c. Si2E �� BY �;�.� ��—t5 J 4 N B.RP.C.fcr this rPasen ELECTRICAL � T Dote: �,�, _ $ir�noture Stenl 8 Conduit Bonding �_�_�_ Conduils,ConduCors,Eqoipme�� LCr SINGIE FA:^IlY H0.'E 0�'�tiFR�CUIICER CECL..4ATION ?W!'.61NG -/ " 1 hPrPhy o�fir •hm I am n�rmpt from�h�Contr�clor's LicenS= Low(or il•.r, fcllow�nq rcason�Seciian 7031.5. Cus�ness and P-Tr� � .,� '�.7 fi FI(:�C!<i(1^5 CCA^�: � �� • /' GCS$y5'CT ' - � I,oe owner of�he p.ope��y,w�ll do i4c plvmb�ng ond M�i�Syphon � ::e • ..e .J eleCri�ol werk.I,or my cmplcycos wi�h wnges as iho�r solr.compensation,or o litensed mnheclor will do all f.".ECH�N!CnL � ° � G�::O� ah=r wnrk nnd�6..s�rociwe is not in�endrd or offrreA � �-y/� fcr saln(Sec!icn 70d4 BkP Cede). Swimming Pool Heaicr u • • I (`��!(1 u CONSTRUCTION LEND!NG 11GE�CY , I hereby o(firm thor iticrr.Is o cons!ruction lond;ng oqenty for 0�,� �—�,�i� ACMICANi �h�n^�{o�mn�cr.of�he wo�k!cr whirh this pe�m��is issucd Fqi iEl. ISe[.3C97.Civ.C.). I NT) �O. ► lcad�r's Namc nODaF55 lender's AdAress P.C.fen S '3�' O � /'��� Pnrmu Fne 1 cemfy ihnl I hove rcod fhis opplitofion nnd s!n�e ihot the abo�e informai�on is ccrrcU.I agrce�o compiy with�II Caunty �p.� nrd�nonces nnd Sln�e laws relatinq to building, electricnl, Isiunn<e Fee mcchonical�ed plvm6ing consk�ciion,ond hcreby outhorir� �^�'s•�qnr.nn frn /��, 'l D rrprosrnlolivos nf rhis County to rtnter upon the ohove� To�d Fee � mCI1Ij7�Pd�f'C�^r 'n5 �iOn�,r.�eses. / ,, -7-/t=-c�'.'T �,5. i,.,��ce9i,«• c,n9eni � Dn�r. SEE REVFRSE FOR F%PLANATORY LANGUAGE j� ���� � % � \ . � .. - _ _ r' r � '� � —�-�'. � O \..J'� _ . � �, � ' O � � � 1'� ' � _ ... -� � ' '� � �- ,^ Q' U M � � _ n ' �: )� in �j • O �! (� ; n � � i: ,-r�i c .'�p .�' a_ n I` � C ' � �_� � � � n n T r � _ � a . 'a p > T� ', � N �= `' ti ' ' ��1 O I i r�- }. � � n r ` � �T h; �- � ' ` �' : �. � !l � , n f: y1 V' � I I ' �1 '—.-:� �J t! m r . 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