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1155 SOUTH DIAMOND BAR BLVD (42)
_..__._ .... - _ _ __.. .._...__ � WORKERS'COMpEN5A710N DECLARATlON rlyl hereby affirm �hat I hove o certificat�e of consent io self �.��, �������� ��� �������� p►E�E'�A�T �� � � � insuro, or a tnrlificule of Workers'Com nnsohon fmurocce, or o cenrfied cupy iher9o£(Sec.3Bo0,iao.C.) ��p�4+ti'.TY OF t05 ANGELES� 9111LD1ldG AMYL1 5A'FETV . PohqPs�. Compony ' n Cahified copy Is hareby furnished. �' �"��� g��i�.��NG � / � � FOR�,P�����,v, ���'I�I rI�n\- ADURE55 r �:r s ���� �� � C`1 Certified copy is filerl with thg counry building inspac- �gU4�ING / �����--� �`�^����-�.yrriU,( ;� '"-j �--E tion dnpartme�nl. ;$i A01]RE55 /f��,'v,'—�r' TT �- :^--�r �.�I--i=1�.-ad��l OCALITV ,/� �" �y / NEAREST Uata Appl�cont �"`CiTv 6 1 /( iP 4. uD555T i .:���=Y_�ti�D���1�-_.____�1���;:� -�-�"� � � CERTrKICATE OF FxEMPTION FROM WORKEeS�� � +; NJ C'F`'BI.�GS. :,.ASSFSSOk� , CUMPENSA7'ION INSURANCE i�'.''l��'SIZE OF LOi rvOW ON LOT %�`j MAP�OOK PAGE PARfEL This saction nead no�bn cum ieled if Ihe ��--_�'-�t'd USE Z��NF ,MAP � ^j,/��+ ( p permit is for one �7gqCT BLOCK l T '�O J „1.r�✓ hundrnd dollan l,b1G0?ar lasa.) yy�. r /'G l�� 7 yyy'._ f.��^� SPECIAL � ���, N N 4���•n CONDIf10N5 a„ 1 certify lliot m tha pnrfarmnnta of tht� f whicF ihis O NE��Y..tp,�fJ� �y��"i ��� �" �El•/•�.r permii is issued,I shall npr emol�y any rsor i u y manner � ` i;:, DISTRICi (;NOUP TYPE FIRE PROCESSED 8Y � so us fo boc,�fm su6jen ro the Wur:<nr�on ns yo"!�s �ADDRE55 ��,���_"�„?�(.���-�,S �� �� , CON�T. �" ZONE C: � ( y-, �p��7 /' �_ �/ . . � ��i CITY �7SlW ZIP {'W � k`7-_'_ ._---`�- Da�9 _ApPliconl ;� � ��Q---`-'-+-^-� �+STATISTICALCLASSIFICATION+ APT. CON00. O NOTIC TO A 'L CANT: If, ofie mo � � �B { .ARCHiTECi Ok•yy�------ y�. 7EL� � .___ � 'ENCINEF���/(// NO��� �_�q55NO..�DWELI.IINITS_ �ui,{ E em ion, you should become jea �he Workers' ;•.: ,��-7r� /_ a Compnnsation provi5iUn5 of rhe L r Co ,you musl forih- ;"��qUDRESS�hn,�.QSS�,/�FJ_�___ 7+ SLWLRMAP Z with comnly with such provisiOns or 1 is permn shal! 6e :'. �y+�a� deemed�evoked. "� ��,.} '�? ^ . ��CUNTRA(Tl]R , , C�(,� Nn. :• dK. v�, YAUUATION L�CENSF.D CONTRACTORS DECLARATION �s''�'q�*"�'�"1 , ��; 1 hera6y offirm tho�I om licensed undnr provisions of Chcptar 9 ��n'D E55 1�-Y._ NO. __„_,�,2� VA:UA7lON (commencing w:�i�Sec�ron 7CKA)of D�vision 3 of ihe 6us;ness and �^ ,� y Prq4ossiqns Codo,ond my licensa is in full force nnd nffect. '`�'CITY �ASS F{ s �7y��F.(r�' " � . �SC:.�(1. NO.OF NO Of (:HFCK :. 1��?� LicenseNum6ar lic.Class__,___ ��t$��t �StOR!ES � f.4M;I.IFS � ONE �' ['�; l..__ �� S *„, ��,4 .zi.5 Fi COn�/uctbr _pa�o ��DFSCRIPTIONOFWORK �`�F/t� NEW �;�-� . }'�^p/-"-7-",� � l ' /�—/—'� �Aoo �...,';'� :i Ir. . . .i 3 ❑1 am exempt undnr Sec. __ �:;�.�1,(1.,�_/L1��7�.iy[.._,_C�.'.L__�!�_�.�ALIER '^'� F!NAL "'' �lf���l,1 Ci�J i C�� �� .- .� ,�r:: 1 v .2 5.U G H.&P.C.for fhis raason � y y OpTE ilL"FAIR r�;.,��,� '_ Dafe:_�� ii''USE 01" � /' FtIVAI "� �:.:. u c`i <,�EXIS.TING BLUG G� / L- Dt�yr)I. L.'l��i ' �'�, —.l�L�'��. /+ Si noture a'APPiICANT TE:��l �'`; gY ` ��rE� OWNER-BU!LDER DECLARATION ��._'k'�"T �� /�� �'4� � f 1 0 6—�;f, 9 r � �o i_�/'�1<':�. �.o�� �ya �=��'�� I hereby affirm Ihat i nm exampt from iha Conlractos s licnnsa � ._� ��y„ Y (�-1- �P+ f-d�G��;���i''j¢-2 -`ADOAi:]5 C p,J �'.'+I � Law for�hn following reoson(Saction 7031.5, Businass ond �;�,,,,,.,,�,s`,y„<.� ��(f,�y�N,(,�,i��o �-/ u"",,�^assfona Cade '� ��`+S'�,.- -. .. � y '� ` "��� 2 ]L• �� ,rer::;[Nr ________.�_____ ' �' � e:ituiniG �ri I, ps owner of Ihe properry, ar my employees wilh �c.ADpqE55— � /,C�� f�� woNes os rheir sole rompensation,w�ll du Ihe v,:orA or!d �:� � Ihe struciure is no�imanded or oiFared fcr sole(Section `���,�,��-4�_TY : 7044,Businnsx and Frofessions Codn). :��MWiNG 7EL �~�i � /'/' ��'r�C,��� � I,os ownnr of Ihe propeny,om exclusively coNracung ,ry� N1RaCTOR NO. �.' C/ A/� w�th licgnsed contmcbrs lo consrcun�he projocl(Ser �'`aDDRtSS ��� ,�!r/-��"' �ion 7p44,Businnss nnd Professians�ode). �-. ' . - -- ��, � ` i��i`�-�.�,�%). CONSTRUCTIQN LENUING AGENC;Y S; R`p�IiRCD yARO NWY � fOTA;�iCTBACK FROM EXiST. '' J / 5:f P..i1CK FkOP.I IN' WI�T!i '� �/ �,�- ! �/j 1 hereby offirm it�m thnro u o consiruc�ion lai�ding pc�ency for +;�FRON�T`����� 'x �'---^'� /�,,� `1� the pnrfwmanca of thn work ia which ihis perm�l is issued '�,' P_�.��j�� j ' -" �� /�/� _ (Sec.3097,Crv.C.j. � '"'� S�oE � -� i�.—'._.�i J� % � : tender's IJama '.� �•�,� ! . r,�WD ��.I�� I.�lH'(S �R R�D P- A�oJ0.���` :�"=- . .. �`3ffi4�- R �° � `Y? �. �"=' " ti .2,ti`�.- �' K� sJas FncH � P-a� µas veaTiw�'iou ��s� `;c c Fdb x S'- Pa,m��rtd `� ,-, - Lander'sAddreu_,_ ;;, - } r._.��,.�.� �va,y�'.,�.�� � 'TI ,'.�J PRev�D'E {rJ Gtl.�i/µiN.�OCC. � I cerfify�hal l hove reod this opplicalion ond swfe�ha��he �iea�,onceFnu �`i� a obove informouon rs mrract I agrae�o comply w+th all Counry ir�invesnga�ion Fea ��'� .SHoW HoW o'f-{�,I �� �q�E �' ��[HE�T�p� Tlfe Wqy,�. � ordinuncns and Stat lows relanng to bwlding connfruction, $��iol Fe� �,p( �Y�` Y1 anJ herebyy wh�r e r��resen�aii�e�of�his Couny ro enter , ���7^�. '�XI����FY �}G�rf �11f � 4JAt..� p.Cklo(i��p Ls1 '�}& � upon t yqbtive- en�i ed P parry for inspdd i qp�s. \ �o� �j}� f" f"� / �a°�Rn"'� & SP�.��Py tc�o lt� �.n,�c.t�ofa ,/� � ��jV � SEf REVER5E fOR FXPLAPdA�ORV LANGUAGE U�Ekt�If� �"�EEp� � � � M �aME& pr����F � �, Sig a I`ypi'�u�Apa,n� Dare � ,. . ,......� . . .... . , .,w . . ...._ . ._. .... . . ..'____.._ � ��� �P. �Db(�REASIRxl�i.�'�,'?� 32"�t SEF t;�D s'f���.. . .. --a- -----_..-___,.__�_,___� .,�