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Home My WebLink About4292Ath ORKF,RS` COMPENSATION DE'C;L,ARA' ON 1 hereby Affirm that + have a cc tiflcate of co sent io seff hisure, or a certificate of `Workers' Compensation, Insurance, or a certified copy thereoi' (,Sec. 3I00, Policy company--- C,.tea"iec3 copy is to icd,r f"r:,;3ts,-cf, Certified copy filc d Oith e c county building frf.,Pectsoai r' ooirt r`ie Ci t. Date_ �_- Applicant CI,I''TEL'la A3 i (IF N f" f/1I1 10N L'idsit'NOR l;l€"S' I . MPI',I ,f,a ONJ rNtiUPAT`dCP'. ('phis section need not be completed of the work involved by the Permit is for one hundred dolhvr ($100) or lem) I certify that in the performance of tb. work for wlf°s_ch this y r `nit is issucd I sat H not ca f i. y any Person ria agy manner stea as to become Subject to thu, Ihforkus'Compensation Laws. Hats:...- -- Applicant NOTICE TO 1i r " CAN C if, afier rnaking this C"a rtificat f Sreiri,tifm, you should bccoi; e subject to the Workers' Compensation provixions of lho Labor ode, you i USt fr rtb with coinply With stwh mr Msions or tif.s permit shaft be deemed revoked. LICEN P -CONTRACTORS U,1,E;:I,Eva"tATI=ON Z hereby afihril that I ii pica €.c@ underparcvisicfrf sa Chapter 7 (comme; 6ng with Section 7000) of Envision 3 of ?he Busi- nes,s :and Prote sons Code, via± nHy tice.'i;,a is in fretl force and P.ffect$ O_)I51'I'' OF LOS ANGELESBUILDING ND SAFETY DI` I ICE � 9 � • � Y FOR Lair iCAN F TO 3i_L IN LG, ALi Rr 4 L SCRiPTION V.,0'7`z40. oI (gyp 7 "4 3 e Dr V 5. jUSE OF �'` ' �R L�--.� nr L Aa.:...REss -Ty �'�btA_`�6"-,.� -Z 13 APPLKIAT�ON FOR Contractor _ _ r a"c S lS--L E. f a In exempt sa iris the Hconsing ; puf en,a fats as I am c_ licensed arch;le:rt or a registered professional cn,ircea- I-sp-- =zn:cauacting piaracyp r fessit n'd capacit (Scefion '1051; Bus-- 1v'XIe"'INN in ss nd Prof ssia r s C ode):L ' E:S-.E'P3' RiSc.. <DI 3=.i4G t.s L,Qf:, orY"t`.'.g. No... __. ___—._._...m_._._ IJ pit E;„„u_.._.._ t;EC.,.t';.-CAi ON I hereby affirel ;h.€ I tiara exempt fr ;.If fi c Contractor's License Caw for the foUo,,rl€ig r a;on (`icclion '1031.5, ilIW- ne.ss and Prorc i o f:i 'Code); jI as of Drier of the, property, will do the - o `. and d the structure .'s no! hiicnded or offered for laic, (Section 7044, Business and Profesi` cars Code). CONSTRUCTION LENDING NDING lrGrNC Y I hereby aifir n thaf t[ ie is a construction tending agency for the €serfcannancc, of the %vori< ror orhich fflis poerl-nit is issued (Sec. 3097, C;iv. eC.). Lenders Name - Lender's Address______ i certify that I have read this ap>ptkmc i)n and state that the above isrf©rri`irriora is correct. I agree to <,onfpiy ivatl sail 4�ounty ordinarfees and St ?e Laws i.:aaop to " =a adirg nonsSa'° LQ"" and hereby aui,toriae sefi e vntufves of Uass County to ender i} a atie ab® e a eeI`soo , 2 flre per'8y fc. H"S"0FCti4343 Pu'€ c.scs. Signature of Perrrittee Bate NO. OF Er X iSVNG BU§L,DgNG;S ON 01' AND USE� SPACES PROVMED PROPOSED USE OP DUILDENG {L. si, 'EYc'".ms EELO`P NO OF STG a=_E. PROPOSED IAAXx of-c. ISSUANCE FEE ^- "rOTAL FEE EE i?EYP:RSE, FOR EXPLANATORY L,ANCIUAGE NEAREST c tc S sa. Ca STPkC` NOG -s t,�a.,�p 'r P' .—. _ E OCE.ss 'B BY^0NST. €k ---r "ti As' N§C FPFgV p�� STATE MAJOR SECOND LOCAL il>Z: ZC3 C5C T oo'u L;:1A. 7., Ci7 hS t3ETtCN OCCUPANCY GROUP OCCUPANT ILOAD EXIT HARDWARE, No Spec, Ifnowl. EJ Panic P,allivi;a El Ncs. or Exits i PACES ,r2 K _i 3i3 C ' LIMITED TIME USE _„----" DATE DATE FINAL, APPROVAL iNSPDCTOR'S SIGNATURE 4292A t I �110,50 110,5oo-)