The URL can be used to link to this page

Home My Public Portal About9032 CALLITA ST_Swimming Pool__ WORKERS't7OM,S:EN�',ATION DECLARATION hereby �Firmilhcil I have r ce'ii amp of consent to self APPLICATION FOR COMBINATION SWIMAING POOL PERMIT IlLlll insure, or o cdrtificate.of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) I 46A20B , ��//LI[[��[[//�� CEB76(3/B0) Policy No.g2L7._Compony _ COUNTY OF LOS ANGELES BUILDING AND SAFETY OCertified copy is he furnished. . _ R ^ ,Certified copy is filed with the aunty building inspec- FOR APPLICANT TO FILL IN -- ADDRESS �dJt tion department. BUILDIN Q ADDRESS 7 - LOCALITY Q Date;�7 I —.�S7 Applicah - NEAREST ql( 61'Z11 -CERTIFICATE OF EXEMPTION FROM WORKERS' CITY. ZIP _ CROSSOR COMPENSATION INSURANCE SIZE OF ASSESSOR TRACT LOT LOT NO. MAP BOOK PAGE I PARCEL (This section need not be completed If she permit is for ono TEL. USE NE MAP hundred dollars ($100)or less.) - OWNER NO. NO. certify that in the performance of the work for which this - / SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS CONDITIONS so as to become subject to the Workers'Compensation Laws. DISTRICT STATISTICAL CLASS TYPEPROCES ED BY CITY ZIP I CONST, Date Applicant - ARCHITECT A - TEL i_ lIt CLASS NO..—)NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER `, N V Exemption, you should become subject to the Workers' - VALUATION Compensation provisions of the Labor Code, you must forth- ADDRESS J - with comply with such provisions or this permit shall be TEL. -631,1129q •5 (� ©0c,�_� VALIDATION deemed reCT4(11 revoked. CONTRAOR .NO LICENSED CONTRACTORS DECLARATION LIC ADDRESS O. hereby affirm that I am licensed under provisions of Chapters $ (commencing with Section 7000) of Division'3 of the Business IC. CITY CLASS and Professions Code,and my license is in full and effect, pESCRI ION OF WORK /� e [^ _ FINAL /JL License Number?/4y9� Lic. Class, SWIMMING�POyO�L yy f J �3 DAT ` SPA .�r[/r /^ l BLY / D Contractor Date a 27�� Q FIN O SO. FT. ❑ 1 am exempt under Sec 512E B.BP.C. for this reason 2639. 8A Q - ELECTRICAL -. # • e • s '2 - Date: I�1 LLI Signature - -Steel 8 Conduit Bonding - _ - I a : 6 2 4 8 Ll Si 0 Conduits, Conductors, Equipment - 524806 Z SINGLE FAMILY . - Q �,2 6 8 7 HOME OWNER-BUILDER DECLARATION PLUMBING 1 hereby affirm that I am exempt from the Contractor's License - Law for the following reason (Section 7031.5, Business and p.Trop 6'J 9.9 A Professions Code): Gas System. _ 1, as owner of the property, will do the plumbing and Anti-Syphon r # ° ° O's, • .3 electrical work. I,or my employees with wages as their _ sole compensation,or a licensed contractor will do all MECHANICAL _ I e 2 2 a 5 O other work and the structure is not intended or offered r,� for sale (Section 7044 B&P Code). -Swimming Pool Heater - FPZ1 ° - 22 Q 5 05 CONSTRUCTION_LENDING AGENCY c ' I herebyaffirm that there is a construction lending agency for 1.26=87 9 9 su APPLICANT TEL. the performance of the work for which this permit is issued (PRINT) NO, (Sec 317, Civ. C.). Lender's Name ADDRESS Lender's Address P.C.Fee$ N qtv Permit Fee I certify that I have rend 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, Issuance Fee mechanical and plumbing construction, and hereby authorize Investigation Fee - L representatives of this County to enter upon the above- _ Total Fee menti dproperly for inspection purposes. `17 ` S ignoture oMpplicam or Agent Date SEE REVERSE FOR EXPLANATORY LANGUAGE