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HomeMy WebLinkAbout1316A 2203A (7) WORI ��.111QN DECIARATION� ' �. �+� 1 hereby of(ir� �c,a ce:�ificotP of�o�se����o,�e�F �APPUCATION FOR COMBINATION SWIMMING POOL PERMIT u insv�e,or v n kers'Com ensotion Ins�ran a`, "� or a cei�i'e c .i�5ec.3800, ab.C.) � ��7gA20e � - - I ��s/,� ` �CE976�718<) - � Policy o. Compon - ��r COUNTY OF LOS ANGELES � BUILDING'AND SAFETY � Certified copy is hereby furnished. ' FOR APPLICANT TO FILL IN BUIIDING �errified copy is filed wi�h fhe county building Inspe[• ADDRE55 v�� �I � ���£f-G+� lion depar�ment. � y� BUILDING J.� G" � (' . (� ��a/�/�� ADDRESSpc�7 ,,,( 1 /Z�.�Il�vt LOCAIITY � L Date������_' Appliconl L/ 1--/ NEAREST CERTIFICAIE OF EXEMPTION FROM WORKERS' CIN L�(. 121P CRO55 ST, - COMPENSATION INSURANCE aY�S� 5¢E OF ASSESSOR TRACi LOT lOT NO. MAP e00K 7AGE PARCfL (Tht���eHon ne�d nof b�compl�Nd�f fh�p�rmh i�fn on� iEt. uSE�N� n�wa ,��_3 7S hundr�d dolluri(SI00)er I�f�.) . ' OWNFR ( NO � r� nq. I cerliFy fho�in the performonce o1��r which this ��/- � (��� SVECiAI permit is issued,I shall nof emplo�a�� on in ony manner ADDRE � � .QL ¢� O"�� CONDITIONS so as to become s�6ject ro the�or s'�wpensation Lnws. ^ - DISiRICi StAT15TI�P.I CtA55 TYPE PRpCE55ED BY /� CITY J Z�P C1AS5 NO. CONST. Dofe Ap 'anl ARCHITECTOR TEL. � NOTICE TO APPLICA . If, atter moking this Certificme of ENGWEER NO. y,�,� �� Ezemption, you ould become sv6ject to �he WOrke�s' � " yAWATION Campensotion rovisions of the Labor Cade,you-must fo��h- ADORESS�I�n2 . � ��� A . ,e� � tEt. �t VALIDATION with comp wilh such provisions or Ihis permit sholl be �ONTRACTOR !Ll- !`Z`G�-/ �� �,..33l�'PJ s f��v deeme evoked. � UCENSED CONTRACiORS DFCLARATION LiC. 1 hereby oifi�m fhat 1 am Gcensed under provisions of Ghopter 9 ADoaE 3 • !. i 0.���//��- - S � (commencing with Secrion 7000)of Divisien 3 a1�he Business CITY iy � -yv�i MSS C��� ��� v�.b� and Pmfessions Code,and my license is in fpll Force and effect ��R���ON O�wORK ��-�-7�/ � License Number �3/�� lie.Class �-S3 SWIMMING POOI LJ pA E` � ► #' � � } 'G� . _,Op-/ I • •G0?_l! a. Conlrocfor . - �'�"�✓ Do1e �s J-E� SPA - � FINAL II� T � . SQ.FT. S Y � ' ' °�%G,C u U � I am exe pr onder Sea 52E �c ZC� " O B.BP.C.(or ihis reoson ELECTRICAI � � �- � � G�'2���� V oa,�: p, �n nW. Si nofure Sfeel 8 Cond�it Bonding � / , `Q_� � , , 9 Conduils,Conducfo�s,Equipmenf r����ta� r NT z SINGLE FAMILY 'f - — HOME OWNER-BUILDER DECLARATION PLUMBING ► �J �7 t"Q/a ' � I hereby o{(irm thal I am ezempl from Ihe Controc�or's Llcense �r'�`���(� � . Low ior the following reason(Setlion 7031.5,Business and P.Trvp � � , Prafessions Code): Gos System � I,as owner o(the property,will do the pium6ing ond Anri•Syphon elecrrical work.I,or my employses with wogas oe�heir _ . . . . . .. sole compensorian�or a licensed contracror wili do all MECHANICAL o�her work and the strvcture is not intended or oNered - . for sale(Section 704d 88P Code). Swimming Pool Hea�er Q � � CONSTRUCTION LENDING AGENCY : 2�2 G.3 A I hereby a(Firm thal there is a mnstruction lending ogency for ' the performonce o( work!or whith this permit is issued .�, A�(PRINT) NO. ► jt• • i .i� � (Sec.3097,Civ.C.. Lender's Nome ��{� -'�� , ADDRE55 , � °L� a 0 0 . Lender's Address � � �O� ' `�� �n�u � P.C.Fee f �p._. Permii F<e - I cerlify thof I hove reod Ihia oppiicolion ond srote�hvt the �p.� 7_a b obove informo�ion is toneU.I agree ro comply wfth oll Couny ' - � �� G�ua�ce fee , � � ardinances ond State laws relating to building, etectrical, � mechaniml and plumbing consnucrion,ond hereby ou�horize I tnvesrgoron fee - � - � epreseniatives ol ihis Caunty �o enter opon ihe above- � toial Fee �lioned propert��mspeclion purposes. � ' �i�„�Tl�c l.if.�.�—t/ ,��5�� `\ Signaiure of Appli�anl or agen� Da�e � SEE REVERSE FOR EXPUNATORY LANGUAGE � � �-__. � - " a _ . - z o 0 "' r - . Y � O . � ^ O .�s, em' 7'� 2 .+ w `i Y Z Z O O � q o � � r G � Z 2 n � D e^ "� a C Tn � r^ � �1 � p � % '' ro . A �� a M �?, � "� � ' Z �y . 0 5"n t+ s � � � ,z xy p � m L O ^� C^ Z O r ^ Z � � '� o ,�,. � � 2 �-+ ��"�' a � q �I'�! � � y �o � ! 7e � � ` '^" L O c � vo � � � » p � �p e� � ' y� ^ f� �, ^ o n t�� �J�. ��� a' d 'p �' . y �', ?. Z� ,� s.� �!'�.�'j � a o. 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