HomeMy WebLinkAbout1352A 1447A ' . � _ . .) ..__ .._.._."_' _ _ . . . /
\VORKERS'COMPENSATIOy CECL4RqT10N � `�., /�
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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�
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