Loading...
HomeMy WebLinkAbout0800A . �WORKI;125'C0147NL_VSATIONDECLAKATIOV �EAfi42o �;.�q„pp.�aC�AT�IO��N� FOR- PERMIT �) � � CE 808(2�80Y � `A A/�C p w ' :I hereNy affirm that l have a certiTicute oY'consent to self � �. .�. , Cj�W�,�-��y-d/-1 V G D�CJ f"�CJ/'1�- ' �i � ��insure,or a cer[ificate nf tl'urkers'Compensation Insurunee,or � � . � .. ... _,.�.. ..,,, a certitied cop�thereof(Sec.:tBoO.[.ab.c.) ; COUNTY OF LOS ANGFI..ES BUILDING AND SAFETY . ` . '. :�PnlicyNo. CornPanY . . . ____. � cen�f�ra�oPy�s nz��ns f���,;,i�rd. FOk APPLICANT Tb rl LL IN CONNF.CTION DATA _ �� BUILDING TqTfON DF.PTFi ! AooRFs= �g'�'7 __ /f !'�!�! l�l L �Certified copy is filed wieh the counry 6uilJing inspection u �— urrE t(I�P.�,1ll��1�f�i1y2i�1 df (D] LOCREiST ���� '�NFiOLE FErERENCE LOW R �D9IL•S�A'y�.4p��li��:in1_�L�.,�.+`�� :� NEA TYVE O CorvNE TION LENGTH F F C ROM y � CWO55 ST. �". CtIRB P.L. M.L.TO P.�. ' '�"- CCRTIFIC.ATE OP EXf'.\1YTION FR0611VpKKb;RS' "� _____ ...._--:___� COb1PENSATION INSURANCI: �;± r 'O'No' OWNF_R (L '��J CO.IMP_ _ JON _ Mo" O. (This scction need not Ue compieted if the work imolved �� a ❑REss � ' � rxunK PF.Rmrr No ewm�rvo. y,j:;�� by the permit is for one hundred dollars (310U)or lesv 1 c'Ty �R,,,, ,,,,n.��j g� ,��„ F�o„,,, ,,,,t ,EMF �oNo ,�„R.„ ,,,,r � .;�. i���di�'• � ,�:': 7 certitj�tha:3n the perfurmance of'tlic niorl<for which d�15 �e�wi. �„�• � . permit is issued,f shull no4 entplo}'an}'person in:my;nanncr eeiP �or ry ,.) ✓� wr.oa ST.WI�GNiNG .Q» . so ns to hr,enme suhJecl tr>the Workcrs'Cumpensaiion Li:ws. �i �-- -o ,,. � ._ — _ ��. - �LOCK TRACT�����J STATE fiNCROACHMENT �; � �Date_ Applican[_____ � wo.oF BLOGS. PERMIT rvo. __ ��j S F.OF LOT NOW ON LOT ''�"�'"� � _ � NOTICk'f0.4VPlJC.1N7:if.af'ter ntukin�ihis Certificule�P �, 1z --- � '� �,,;� . �;Exemptien, you should hecome subject to ❑ie {5'orkers' �.; �uE�oines � c�aaacEs �,�� � �Cumpens.ition prrn•�r�ons of lhe l.abm(.ode,Yon must fotth —_. � �--- .... - -----...— ----'--'�-�- i - 1 '`wtf en:ply wRh s�ch provi,;ion> ot this permit Shall h rR [�L//� orvrvecnory c.�aect c�E , `�dc med evokeu. �,, .aO�'��''���1�t��..l��... - �M ! f �}�r REIMaURSEMeNTFEE a � LSCF:15h1)(_'ONTRAC'PORSDECI..4itAT10N f. ooe�ss i �f �"'I hcreby nffirm tha[1 am licensed under provisions of Chapfrr ��i p � AI I r�t.No. �d�'�"I �!� srn����.+ �:Ro�� �K Mna v Pu�ess.:o ev 9 (rommencing�vith Sec[ioir 7000)of Uivisiun J of the Husi- c r L.� 1 F L f• r f> ness:md Profe.scinns Code.and my]icense ic in full force unQ :'srnrF uc�. }9 �r? .+'".� ��u�!,t�.� LICtNSE NO.��' ����_ CL 5 /f �C t- eifeM. {"`' 'I NO. �OESCRIPTION OF WORK �EE j VAI.IDATION ry/ /�� �[1 F'INAL � LiCt!:IVCNUiII 2! ���77�(C" I.iI:.CItl&S_._.� _ _ � _-nrvFcrinic'ra - DATE 'j� j -.�:;,` . Ha�sr.s w't�e r.o ssvtpc r / F ) py � r�ra o/o (�C�PIlNC#nf . a_6���4'TJBIf�.�_(.�� , : — oo --_._ FINAL /.. / [�.� ' - 7- BY .� �y {.:�K„�'�,�;� r� I am exempt frum Ihe LcensinK reyiiirements as i am e : �o f ; � I�ce�ced archi[ect o� a rceutered Pmfesston.il cr�gine r . oL�_ �' (' � .. . actinK srt rtxv prufesnion.nl c�p,aity (S2.Lor. %OSt, Bus -��+ iners nnd Protess�ons Code). - - --- o�,sr , � � Lic.m�Iteg.No._'_'.._ _.—Date�_�. . -_ .-.. ._._...—.._._ � _ _ ___ ___ ____ :', . . 130M1]E O1NN1:K BUII,DCR DLCLARA"110N + , � ' OWNFR'8 Permit s� � ��"�:% L-:i d�( �, I hereby ai'£um tn�t I am ezempt fmm [hr Contrxc[o - — Li�eose Luw for the following rexson (Section �oat.s, aus- ' AU7�HOREZATIt)N TOTElL F�E ,;' �' �(_� r' " w ` l U '�iese and Pro{essions;ode): _ � I. as ou�ner oi the property.wiil do[tic�votA and the o rwt.�oo�i�srwFa. "'�"o�F oEs�.+�dE ___ � o, e { '(F�;1 � . . slrucNre i� not i�tte��Aeil or offered 1'or sale (tiection . S��;rv�o rr+is owv oF' 19 7044,Ausines.s ancl t'rpfessi��n}C'o�e). --"— � e n �n 1 '!,`.(��.- . CONSPAUCTION LENDWG AGENCY " �ces.,�.r ____ _._ _ � ,� ��._8,� . �� 1 hereby affinn thaf tnere iz x construction lentling agency — -- - ��Por Ihe performanee of the work for which this permit �s � � . ii.s¢ed(Scc.3097,Civ.C.). � .: Lender's N.ime _-_ . . ��� Lender's Address i �i� � � I certify thai 7 huve reud this npplica[iun and stiite thut the � abuve informulion is correct.L agree to rnmply mi[h all Court>� urdinances oncl State la�+�s regulnting Plwnhing and 6ewers, and h�roby �ufhurire r esentn[iv s of this Comuy[u enter ' � upo [he ubovc-men[i �• property inspi�c[ion��urpoxes. �, �(�i� ' SLf(REVF.Ittil�:N�OR HXPLANATORY LAhGUAGC �" —_��� � Signxtu ,�. .�-_Date � �' � ��iy C� iT'm Ga tm �D pa ,I`L-i N `Oa�t'� � . m W m v, p2 x � '�x �O 1�'m;v O��-� O •T> ��!O �3,.,�.Z� � 'ti _ -,�� OZ`��'�'�r �➢ln➢�',�` �7J . . NN �C) 1N�11�1- �!DT,��'`�" �,Q -1 v➢ �Z�''� `� � �1-mo OC'��p7��� ,nrn�0-11� T� n-'i <nC < �n,-� 90� ,C�l� m� '�'� �rm�� r� ^�; i �-� �D�cn��m O�� D.� -Cm+r � l `, i oz�`az 't�n7y�r' ��1 O mo -� �N ,� m0 G 1 '�� U� ��� � i� ti-i � , � ' � `m � � 1 � � � � � .} � V i o � ` m � i `� � '�� �� z , � � o t 4 Z � ' vmi i c � 1 1 ' � ' � t � } t �; � t , � � �� � I t � t - ' - :� � �.... ' I .. � � � � . � . � . _. , , 1 , , I. . , .. � I � � ,�. � 1:, � . `� 1 . ��! � . �. , ��. � �. ; 4 ¢��. _ . � - -� � � �� 1 � � � ' N� ,i i � ' � � ` }. � �� _{t .}.� � , _ . , ... �y{{�� �"^ ry` s:� I- �m 4 ` •• � _ � ��y � y. I• . '. '� k( � � 1 � L . �'� '� � � { � � � i l 1 E � � J•s � : � ' Y �✓ ��",��� ^ � �~���p � n ='� t��u `—r',',� m ..� C � �. G�'c` m � �7 1 'CS ^c V1� tC�t2 i0 �� '"�^'� c'".. � � � p-a � -e sa <o � �>,..�..,y 'p • " Ya�. . Lt�O � fo �,Ou, 'y c' ��S�_' '' b O -� � v ' �,'� ..�7 :a ` ',�'',n �- Y "' � 1 'Q'OS3 �'"' � .� O `l(:'�t'-"" � S p '= R � ^"a �'C. � ..�c � . ►� � o ,p� `c`< " �c � � ��, �°•,a �4�..,s n � p� r' � Q' m � «' „_ r+. r s''c y A.�' -„ � ...''ts �"° .,. LTa ,.'t. , b y« . � � �n oc x � m �.O � trJ N � 4^7^.s o L � � � �."��?� '°��°` . � (P }S R ,,,,-�.�...Q,`5 N 7 iD a"a i:� te�s �1 S.'C Ia :0 w � � K ;�,P� ro ��s� � � c tO � : " : s� "° a.> 'n� a.'n� ��o v Lo'' � /' w,.h � �.._ <0'CS C.N �F.""ctb^ '' » J 4 �•�y' 'n v —•y '�� � y J.. ' Q � �, 's'J Y'=y°"'C1 a.i � r+tn �W v 3 C S� ' T � <p T ' ,,,, � � � ro ,� ti £ a 7 --p o .,,,_,, o n t0 .�.� p `'�k•M ;� � r; '� ss,s �y n " .. �,P.� o n `B,� !y� s' �;^,� c.� `� C�i m eo ^�•p t. � � � � � � '��U ry A.'Y � eo ti � 2 G • 3` .. �q.;,.,,,•• � -^'•v.i 4 � �;' � a „ e.'c ' '� � 5•`� '<Tc,:e � i, �` ro s '• � � t"' - � �o :s'� ^-n c�" �c '� w .. [/i c •- -��.o �� �c � '"' ���cs � ?^o ' .. ,,,. '��� r ir<~o �e z ,H,*c �' �`� c �x� 'c"''� �'-� a-�'`� ''� � � . 'c �c .� v, .. ,.y � � �,.-�i s'• . a tt� ��ro�.�,?�r� •�'�s p,A�j -a•n c+`--',p%� ,� � �,��� ' . - c^� ��s'� n o o ��� ��c a R N•�ti �� Q A��- o �� � ry W � ... < p R � .. _ � � a p �? r� `v^� .... � o ui� " �+a�`y r � � " b � pp��.�' � r CoptaW'�a0`^np.+ �On .. . � 6 �'t�o � � ';= C "" 3 }s`-Q.+ � O� .�,.:�' ""• . . � co m q �-c i� x �° .p <° � :�.co r Cc•,e ��v, ',' �crg � � �ro ('� N� p ,��, s-�C ;S ��' � ` ��� .:`a � � C C ti G < , y ^����y N�."�f � . .� � a . . �uia�yu� ' � �r:= �<..., ��