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Home My WebLink About1393A 1598A ._...�___.... . _.... .. .._ .. . � __... / _ � . w WORKERS'COMPENSATION DECLARATION� � �/�f}`� �t-' i �' r � �yereby aff��m that I hove a �e�f�f,�a�e of consent to.self APPLICATION:_FOR COMB,INATION SWIMMING �POOL PERMIT � insure,or o certificafe of Workers'Compensatian Insuronce, or a certified mpy ihereof(Sec.3800(((Lab.C.) �gp2og � � � � � � n��[� �� CEB%6(3:8V1 Poli<y No..L�L7-7 jCompanyi COUNTY OF LOS ANGELES BUILDING AND$AFETY � Certified copy is hereby furnished. ((� FOR APPLICANT TO FILL IN BUILDING � �� Certified copy is£iled with ihe munt 6ullding insper ADDRESS �� tion department. .� BUIt➢ING p RDDRE55 � . LOCALITY. Daie�!_�'��Applimm��o- ��"— NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SITY IP � �- CROSS 57. GGG `� S/�26IL� � - COMPENSATION INS�IRANCE �� t „� �- SiZE ASSESSOR TRACT LOT LOT NO. �� MAP BOOK PAGE PARCEL (This secfion�need noT be complefed if The permif is for ene 7EL G �/ USE ZONE MP,P f�undred dollars(SIOU)or lesa.) OWNER NO. '"( `7' No. I cerlify ihot in rhe performance of the work tor which this SPECIAL permit is issued,I sholl not employ any person in any ma�ner AD�RESS CONDItIONS so as to.6ecome subject to ihe Workers'Compensation Lows. � � � DISTRICT SiATISTICAI C�ASS TYPE PRpCESSED�BV � , CITY ZIP CONS� �pte � Applicant � .4RCH1 T� TE� � ��D "„ CLASSNO. � � ^� � NOTICE i0 APPLICANT:,If, after making this Certificate of ENGINEER NO. �� `\ Exemption, you should 6emme subjett to the Workers' YALUATION � Compensation provisions of ihe Labor Code,you musf forth- ADDRE55 p,Ao� with comply with such provisions or this permit sholl be �TEL. s /� l�j'(.� VA6IDATION deemed revoked. CONTRACTO �NO. - � �� LICENSED CONTRACTORS DECLARATION �� ADDRE55 I hereby affirm�haf I am licensed under provisions of Chap�er 9 /� ��. /� S (mmmencing with Section 7D00)of Division 3 of the Business CITV N� CIA55(�� and Professions Code,and my license is_in full force and effed, . pESCRIP710N OF WORK '!'�� /l � � FINAI License Number`Tl LiC,,Ciqss�'v�Z SWIMMING POOL � DATE ��I� �� , �� 3�Fl � Coniracldr�_.sz.�P'Tay�3 �---- Dafe�- �- a � SPA � FINA�`-�)M�i+yf i m a�Y.�C/ U. ❑ . . . . . .. . . . . . . _ . SQ.FT. . . . �BY �.o�fi�i'�'1✓ I am exemp�under Sec. � SIZE ce o e�i-:(i;�'j� a'. B.BP.C.for this reason .,. .. . .. . _.. EIECTRICAL IJ��R� (�.�C�'-'� `&ZS FG� �`':�t:`R�i � Date; �' . . . e GnW:. (�KI��I�/L(f' W Si nature Steel 8 Conduit Bonding �- 9 Conduits,Conductors.Equipmeni sV�L � � � SINGLE FAMIIY - HOME OWNER-BUILDER�DECLARAiION PLUMBING I hereby affirm�har I am exempt trom the Comrotior's license Low for ihe following reason(Section 7031:5, Business and 8 -_i „r.�;� � Professions Code): � � � � P T��P . � Gas Sysfem . _� � I,as owner of the proper�y,will do the plum6ing ond Anti-Syphon .; c s a o�; elechim�work.I,or my employees with wages as their sole compensation,or a licensed conirpctor will do all MECHANICAL � `� I !�1�'v�i other work ond�he siruclure is not inlended or of,fered for sale($ecfion 7044 B&P Code). Swimming Pool Heater � `" " ' ' �'�'�%� CONSTRUCTION LENDING AGENCY , �'�,"j '+ �-"�'j` I hereby affirm ihat there is a construction lending ogency for qPPLICAN7 TEL. the performonw of the work for whi<h�hrs.permit is issued (pRiNT) �NO. � (Sec 3W7,Civ.C.J. . Lender's Nome , . ADDRE55 Lender's Address / `�'� ��.r� ' ' P.C.Fee S Permir Fee 6 �L'S P V V I certify thot I hove�eod this applimtion ond state that fhe �!� � above information is correct.�agree to comply wirh all Counry Isso ce Fee �v,�^ ordinances and State lows relating to building, electriml, �" . echonicol and pium6ing ronstruction,and hereby authorize In�es�igorion Pee ��, 5 a representatives of fhis Coun�y to�enter upbn fhe aIJ0�6- Tobl Fee n�Pe,1y for' spection purposes. � . (,.____ �:-`�; �� Signoture of�Applicanr or q9em � oare" �� SEE ICEVERSE FOR EXPLANATORV LANGUAGE, . , , PLANS TO APS�LIClsN7 " - " INSPECTOR'3 NOTES' ' "`" ' "'�""'""i ON/NER=BUILDER DECLARATION 70: ' Raturned � � , I here6y affirm fhoi I om exemp�?rom!he Coniracror'.s - � �Ltcense Lavt- igr.ihe, fo{lowing�reason,;($ec. 7D31.51 -�—i-- Approvad � Business and Profes3ions Code:Any cify or county wFich �No.I-• �ote �No. Dafce . . - requlres a permit to construct alter,improve,demolish, r— , � _ . � � , . "br'repair any�slructure, prior to iis issuance, also-r I ' �,. � � quires 1he applimnf 1or such permii fo 4ile a signed state- �I - • � . . . �. .. , + � , � � ment ihat he is licensed pursuont to ihe provisions of the - � � � � � ° Confractor's litense�Law/Chapter 9)(<ommencing wi�h � � `�' - ' � � ' „ - ' . .._,.. � Se<fion 700D)of Division 3 0�fhe 8usiness and Profes- � • � � srons Code)or fhat he is exemp�lherelrom ond the basrs � . " _ for The alleged exempNon. Any vlolof"ron of Seciion � � 703I.5 by any applimnf lor a permit su6jecis�he applr- INSF°ECiION�..� � � UATE i INSPECiO - _ , , can4 to a clvi!penalty of not more thon five hundred i LOCaT1UN �f' � '� � do�fars(5500).)� STEEL&FORMS � � �'�4'.'� . j� , ❑I,as owner of t�e property,or my employees�vith wages as iheir sole compensoron,will do the wo�k,and �:�GHi[ONOUii -r �- - ' ' the siructure is not Intended or offered for sole;Sec.7044? � � � ..�a.-� �� ' . .. Buslness and Vrafessions Code:ihe Canf�octor's License 'BONOI�iG� . � .r� • � , !ow does nof opply to an owner of praperty who bvifds or � � improves ihereon,ar,d wfio does such work 6imseN or � 1 ' fbrougF his own employees, ,orovided tha/ sucb im- �—' ' ' ' � � � � ' ' � " � provemeNs ore not in!ended cr oHered /or sale. If, � , � - . `. ' ' -- - howcver,ihe bui!ding or imorovement is sold within one COKDUIT �� _ - �� ' year of mmplefion, flie owner-buifder will hove the ' ��`-� �� ._ , _. � � , , . - . burden oi proving thot he dld not build or improve for 1he GAS LINE i�-J(�� .purpqse o1 snle!. . , � � • �..G I,cs awr.e/.�fi�t�e�proper'ry,'a+n exdusively con- WA7fR LitiE i ,� - ` t:oc'in9 w:`F Ilc�fi=e^cor!r�cto�s to consiruct the project i ' y � . � � iSe:,�70<41 8us�ness ord Professions Coder 7he Con9rac- . "v��R ��_�7 ,_�l � -� for,�License Cav,daes nat oppJy fo an owner of properly �� x ' .,, � who builds or imp�oves ihereon,and who cont�octs lor wch projects with o contracfor�s)ficensod pwsuon7 to � ��he CoMreceor's License Law1. I Ah1TI�5YPtiON VAt`JE � � � , ❑I a:-��exempt�nderSec.--.B.&P.C,for�his EL&CTRIG WIRES �eascn FENCf�IIEIGH7) �U= Dafe— Owr,er ISEL:-CLOSING � � ��"E' `SEIF-[A7GHING� �, INSPECTOR'SNOTES � l—. ,�'. !�� . ��<� �ROUG&1 WIR!NG �L}..�;�. �+��' 7! . �. . . /�N • �PINRL ELECTRiC � �— � I HEATER(LOC%TION�VENT) CAS LI7dE YESt . � ' � L---_ �'✓�. J�13 �Fao�o�Aiunc� �` ,--- �P T3RP ... .... ,....,....,.�.....;...w. ,.., .: - ... . ..... . ... .....: ....�-,. �.....:�t.,«^ '