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HomeMy Public PortalAbout4931 HELEO AVE_Swimming Pool_7/26/1989_" WGRKF,RS' COMPENSATION DECLARATION e' ' L- 4 -31- 9 �� I hereby affirm that I have -a certif{cote of consent to self Lip insure, or a certificate of Workers' Compensation Inswonce, or o cerkfiedtig thereof (Sec. 3800, Lob. C. } Policy No Company Certified copy is hereby furnished. Q�eertified copy is filed the county building inspec- tion departmrn}t. + C�� Dater " ) Appli��11��- CERTI CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) Icertify 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. APPLICATI N .FOR WMBINATION SWIMMING POOL PERMIT 76A20B CES76 (3/94) s Ca(0��c��to��(C UNTY OF LOS ANGELES `7q 3 I FOR APPLICANT TO FILL IN HI,JILDING �� n �� _ ADDRESS J fj t r CITY d 1r�� pr11 ��J . 'I } ��j ZIP 11 SIZE OF aJ TRACT LOT LOT NO. OWNER }�� y t ;rua,AI p NO. ADDRESSh{y CITY ;1 9 4rrt 9/-e (11 - f es ? ZIP INC��AN�� 5 FEtY , eolwc6rllull lot/ 1/_3_/1,17 BUILDkNG ADDRESS ' r P�� LOCALITY NEAREST CROSS ST, ASSESSOR I MAP BOOK j PAGE ) PARCEL USE ZONE NO,��}I k O U SPECIAL 1 CONDITIONS DISTRICT iTATISTICAL CLASS TYPE PROCESSED BY f 23 CONST Dat- Applicant ARCHITECT OR / TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. Exemption, you should become subject to the Workers' VALUATION Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be\ TEL. S VALIDATION deemed revoked. CONTRACTOR 'i4 `��" -NO 1,-L/ ����/�� 'fir i/i l ��j O V LJ LICENSED CONTRACTORS DECLARATION ��t ��, NO. '2 ADDRESS K ` 1r7rrv��lD to '4 t I hereby affirm that I am licensed under provisions of Chapter 9 "'���� LIC. (commencing with Section y license of Division l of the d effect. es CITYC (j_ M _i .J,' (4N ,-, CLASS (,1-5-3 and Professions Code, and my` license is m full force and effect. DESCRIPTION OF W0_ RK License ber -/r ������1 Lic. Class Q--1 \�� SWIMMING POOL FINAL. SPA SQarc��arc�� �� DATE���� ��nI "Secl���� r 1 a��\ _ I������t(,Contractor �� "+"��Date n--r�� JFINAL1 am exempt ,deSIZE ��+a I ; !'�� BY [ J B.&P.C. far this reason ELECTRICAL ��j )I Dat - Signature SINGLE FAMILY HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): j, as owner of the property, will do the plumbing and electrical work. I, 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 sale (Sect.ion 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 Namv Lender's Addr-� 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 re sentatives of this County to enter upon the above. m n Toned grope nspecti gqpurposes. Signa, of Applicant or Agent Steel & Conduit Bonding Conduits, Conductors, Equipment L�� PLUMBING Trap. Gas System Anti -Syphon MECHANICAL Swimming Pool Heater APPLICANT (PRINT) TEL. NO. ADDRESS P.C. Fee $ ��J 9J Permit Fee Issuance Feev O 6 Investigation Fee 233 r O Total Fee SEE REVERSE FOR EXPLANATORY LANGUAGE 74 LA MOM1 7/26/89 a7 4684 f AM I I : j I ! O U 1 0 V - to Z 23 ACCT.It 3307 q.9 7 ACCT,� ,3:07 333 �% 00 2 1 TEM" S. TOTAL 428. 95 ( CK ��aV.7��" J++ . tJV MOM1 7/26/89 a7 4684 f AM I I : O fU 7 c O U1 b tr 0 7' O C� 3' O O VO 0 �' (D O m n T ci N r' s O in ri -- 0 4 ti < O ti D Z3-0 O' '* in 0 0 �. :s � m ❑ a o a b tr" V ❑ N o 3 w c o N c^ ❑H a +„ r) 0 7 Y o m Q O� j y- Q G O. O '� q p O Q N n g q O Q NF F T 0, o n IDa m m obm Qm r4 w E�U xm C) @Q 0 0 v 0 �� (11 D 3 a 3 aN 7 m - a 0 o m o a `c b b 5 -DO d. ID �c 1n C d a p 'D O Q_ O N 3.(D o O tq o 3 7 0 np A n T [ + H q ID rp N r- O C n Q ID - co '1 'r° p 0.j S m m° 0 0. �', '3p o' b+ 7 b Z3 a C, = 0 3 fm � � O ti� O�-� 0 "O 4 a 3' 7 CD 0' 0 r7 Q 7� ''. � O x w nc S i C O - m 0 N ^ ° ti b 0 ID - b a O O O 0 O m N 4 a � a O 7 N µ x :U 0 0 3 0 0° f. m V, �" ,a 0 y o 0.� mo O 0 nb M 23 Tb m o 3 3 O m 3 a 0 0 0 o K m 3 o ff m m +� :3 ° 3 m o o 'D 40 0 n, 0 a m m �b o a —3 c 0 N. n fD 3 0 3 D 3 o 4 N a Q 0 ,b C 7 �, A 7' N 4 N N U Q ' 7 O (n O 2 n N O 4D N N O d j 0 r0 N a a n 0 i1 c b rl N 3 r n 0CD7 N T CL, 0 q p `[ V 0 On N 7 16 7 m 0. rqG V F 0 Q b n a' O �O.. N O O6, Fr :10O :I- rD 7 �. lh w O ti `C 0 n (DCDN +• 3 O N