Loading...
HomeMy WebLinkAboutNo Permit Number (2200)WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of o t consent self insure, or a certificate of Workers' Compensation InsurancetoAPPLICATION FOR COMBINATION SWIMMING POOL PERMIT or a certified copy thereof (Sec. 3WO, Lab. C.) 7yAZDB WS (I1 /81) Policy No. —Corn TERF.MnNm TNT]F.MNT_ COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is hereby furnished. Certified copy is filed with the county building inspec. iC Lion department. Date Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE CisThis aac►Loo road not he completed if tlo pai mit Is for one dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number 319018 Lic. Class C53 Contractor. WALNUR POOL�ata 6-30-83 1 am exempt under Sec. B.&P.C. for this reason Date: Signature SINGLE FAMILY HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and Professions Code): 1, as owner of the property, will do the plumbing and electrical work. 1, or my employees with wages as their sole compensation, or a licensed contractor will do all other work and the structure is not intended or offered for sole (Section 7044 B&P Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws relating to building, electrical, mechanical and plumbing construction, and hereby authorize representatives of this County to enter upon the above - mentioned property for inspection purposes. FOR APPLICANT TO FILL IN BUILDING 33O ADDRESS u BUILDING ADDRESS 1330 LOCALITY catJj�' CITY WALNUT ZIP NPAREST CRO55 )F. ' G //'/ sQEOF TRACT r3fOr� LOT LOT NO. ! 0 asSF-!aL ryly`��BCIOOK PgGE PARCEL TEL. NO. —/JI NE USEOWNER /0 b L I pP ADDRESS ] 330 S . RED BLUFF SPECIAL CONDITIONS CITY WALNUT ZIP DISTRICT STATISTICAL CLASS CLASS NO. TYPE CONST. PROCE ARCHITECT OR TEL. ENGINEER NO. ADDRFSS ] 36 r IMSKELL AVE t VAN NUYS VALYATLON _ $ 000 $ VALtDA716N CONTRACTOR WALNUT POOLS NoL. 596-7647 ADDRESS 2 450 GOLDEN SPR LI%GS DR WALNUT 319018 CASS C53 CITY FINAL ��''Li='�` L a • Lt ).:: DESCRIPTION OF WORK ® SWIMMING POOL DATE ,'_' ® SPA Pq FINAL SQ. FT. !YSIZE 4-)o - -. ELECTRICAL Steel a Conduit Bonding Conduits, Conductors, Equipment c PLUMBING Trap « Gas Gas System Anti -Syphon MECHANICAL Swimming Pool Heater ® APPLICANT 7�.ND (PRINT) WALNUT POOLS .95-7547 'ADDRESS 21450 GOLDEN SPRINGS DR a - P.C. Fee f Permit Fee/�}o--- Issuance Fee �� Investigolion Fee Total Fee Signan,re of Apph—, or Agem Dare SEE REVERSE FOR EXPLANATORY LANGUAGE CL fr. V cc u z I=a= \�\%ek\{\�'[} e-0:;7 �#ƒƒ )�/\f_&}>/.k 02�f°° °L0 °�'` [ref#% -,D \ =�fE%$[S�I�0 «. 'erg%+| [(\�§&-�» a7a%i� /\�\�(�k��C2 ƒf§/ }�%ƒ� |/ §§o $% -0\e E a§ { �2§,u`- o 0 u,%a �G §e)3@ 1 0m030�b »! 0k af� |§o a- u£e<_#E M|s�2�e§»Zt,&� 00ID 0 .13t2a'=0E C2 �)§@��e:/:);±o&, =o��° $�k� \(} y�X. 2- ._a� \[3u0x r °a !ƒ±-e. o _-� ` _§ `?rk+:\2!!�- I[)=`0Qc;£z ss%/\§a \ m x- ro =�]t»\� 0o0°3 J rV w0 s6, SIg0J`E § - �o-��� #e:a QZ0�»&,°n 2/.-w ±)- IrLco ®m«(\\tk${ -0�r® [ E %«±©00)>» \"�L0 o� CL �/L_� n o%§\&at3c ak�E-t r0—Z !ƒta--a:L §£t 2G+2■��»�°�°�`"23 / t0ƒm2/elf§%t\/k%|/H ƒ/\2() O 2 - ��ift|�42a \{/\'&EOm ®`I|\ƒ§\®\\2)\2j$ f -0 2ƒa�a=>0�