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HomeMy WebLinkAbout0959A 1238A WORKERS'COMPENSATION�EClAkA710N - '��'RMIT � � 1 Aere�aff��m that I hdve o�e�,,f;�a�e of�o�=e�,�,se —� � ppPtiCAT14N FOR BUILDING tAsure,or a cerfiFlca�e of Workers'Campensa+�on Inzuronce $UILDING AND SAFETY . -b�o cerrfed copv ihereos�Sec.3�eoo lab.C.) COUkTY OF l05 ANGEIES . P�olicY N .�ompany���3%�+lr� BUnDtNG 2 .2�- L+7-e�t� �• Cer�ilied copy is hereby��shed. `� fOR APPl1CANT TO FIIL IN ADDRESS �errified mpy is filed with the<ounry 6Wlding Inspec gVitDIN r ���� V/' ��IiO�nQ d�eporl�me.�nl. ADDRE55 . T�'�D e�S'rr-f��,�J ZIP l lIX'/�LITV O¢te Applico�� �x CITY NO.O`eLDGS. . NFAREST - ERTIFlCASf OF EXfM4TION FkOM WORNERS' - � Now ON Loi CROSS 5t. �I�I$� � SIZE OF tOT /�SESSOP. pARCEi -�COMPENSATION INSURANCE �P 6� PAGE (Thls eeaian nead no�be mmpfe�ad ii the permit is br one - O.00x lOT NO. J . hundreddaHars(EIOO�orfess.) tRaGt J ��T5�, uS�QE � �J— . I<er�ify Ihm i rhe p rformanca of 1he work{o�which fiia �wNER � �� ��`� SVEC�At p , ( • (}O CONDITIONS (� permil is hsucd,1 shnll no�amploy ony person In any manner q�,oR[ss2� Z' ' "`� ���' � � � ' so as to 6ecome subjec�to the Workers'Compensation taws. /��y PTY �/�"��u�' `� IIP �� L fIRE PkOCFSSF�eY 0 �� ' TEL. DISiRICT GROUV tt7f , F— AFP4iconl �^ . �p�.y�T. ZONE U AkCH1TER0 ,( G J/� NpJ ��=-7 p 1 W NOTICE TO APPIICAN7:If,atfer mokin9�lhii CCrtifiCple of ENGMEER � �" _,�(r� Eaempfion, yov should become subje<� to the Workers' � • " g � (an Compenso�ion p.ovisio�s ot rhe La6ar Code,you mua�lorrh- pDDeES {AC� APL CON�O. irh wmply ��h su<h provisions w Ihis permit sholl 6e . �Et. S7ANSF�CALCtA55if1 nON Z deemed revoked, tQ��Rp� '' NO. ���NQ�DWEl4 UNi75�— . IIC.. 410ENSE�CONTRACTORSDECLARATION '?i1�(,t�Q � I� No.3� -�U SEWEAAMP "' 1 here6y oM�rm ihot I qm licertsed under provisivns af Chcprer 9 no0RE5Y T ��� VAUOATION � (commencinq with Section 700D)01 pivisian 3 of the Busineu and " �u��� �{/.., ��p5g BK. QG. - Pro(essioes Gode,and my G<mse�s in full force and eHetr. " [rtv �HECK ' -�1� � 50.sT. ^+a.oF a"aMi�s or� VALWflON . . llcenseNum6e���yL�qL� (Ic,Cloas� S�ZE STORiES . �'(� New y �lA �� , �09�a9A Conir��y���_�'ir�+Dal OESCRIPtiON.OF WORN A0� ❑ s 2 3 � 1�'1J ALTER �� ❑7 am exempf under Set. , ��p RFPA;R s � �•LF Ci.S S ••�''�' B.BP.C.for this reason Dat�: USE Of �Ma • • FXIStING BLOG. .. )El. FI13AL � •4��&� Signorure AFttpR MT a0. pATE O g���c�i 8 OWNER•BUADER DECIARATION FINAL 1 ha�eby affirm tha�I nm eMemp�bam iM1e Conlronor's Llcense low for�he falfowing�eason(Sec�inn 7p31.5.Business and ADORE55 6y Professions Coda): ,. ❑ 8UIl01NG , • . 1,as owner of the properly,or my employees wilh AD�aESS , wages os their sole compe�sallon,will do r6e work and i���TY � . . the s�roaure i:no1 lntended or olfered for sole(Seciion TEL . � - 7044,Businei:crtd?refessions Codej. h�OViNG NO. � � i,as owner of the property,om eaclusively controainq CONiRAC70R . wi�h licensed mMrodors fo<onslroct Ihe pm�eU(Sec. ADORESs ' M1On 7044,BuSineas bncJ Pro{esS�ont CodeJ. (OSAlSESBA% ' �y�OTH � ��C�8 F� RE�UIRED .YARD M� PROP.LINf ' . � CONSTRUQtON LENDING AGENCY SEt BACK . 1 hereby ef{��m that there is a consrruvion lending agen<y for FRON7 ��•••'� Ihe performonce o�Ihe wo�k!o+wblch rhis permit is issued � ���� ' . •�$a C . ($ec.3097,Civ.C.�. S40E ' ' . P,l. Lender s Nome � � )(Q r IDNJ�ReF.k , •. f O�O�U j i.C.Fee S T�U• d, 7ermk Fae � tende�'s Addrosa � i,.,,o„t,fa• � lD�P��N 0 8.2 9—8 8� j t cartify tho�1 have road thii opplica�ion ond sroro Ihat iha obove Informorion ie co�rect.I agree ro<omply wlrh all Counry i�wsiipm�on fee Q �pMp O��m.N � ordinances qnd S�ote law>relori lo bulldlnq con�truclion, imol fu and hero6y oothor pres�nt vet oF Ihh Counly fo en�er �- . � � . � uhove- o�ed p etl mapection purpoess. � � `�J�� 6f!RN[RS[!OR�SlIANATORY IANGUA6F � 5pnor af Ay anf or Afl�t pp� . � � FlNNS TO APp�I�ANT - � � To: . � . �INSPECTOR'S NOTFS � 6�\N1.H.IlUILUItk UltCi.nn.•.,.,,. � � ' ' Returned � , i hnre6y aff��m�I�i�n I am eKemp�from the Con��a;�or"s No. Oa�� .. .�NP7�ovad ticense lnw lor�he follow�ng r.�;o�. (Sec.•:?OJl.S) No. �Ooro . . . .. � . . . . ttrszinesx ttdI nJrsrinttrCndr:An,�Pnnn nunhuGi��.. .. . � -. ., ' � .�y�� p�rnnca,�u,n,r.�«r,�n�.,t,np., �d��n��t..�,, - � � . ,. .. , - rrpn� i rrra�t�uc.prior t��iu i s� t ti�aLvn rryui . � .- _ .- . ' ,. .. �. . , ..��� , ._�. ' , N,e appr�ounr Je.:od p e e /Jr u s,enrd io�ermen� .i t5ae!,e�s 7wcnsrdp�r e r rl e pr��ust.,nr oJd (, � ... ' � � � t � �j J ti4Cf��Y'S�.it'ChfC�,��[•((�� (�I ���tt�rrinlfnlihCll!I 5('. � . � . � � �\ . p � tiorc i00fy j U� �m i of�he Ouslnrss unJ Pn I s s . ..AyProvo6 R uhod. - p - .. . . . .�.. C'� ' .1.� . Cndc/nr U t 1�is lrcmpt t!erefrmi�unJ the F�is�/ �!c BQ nta Reealv>A�� - � . nNeRrJ exrmrhnn Any vinlahnn nf Sernnn 7(��!9 Fy �'. Yns No orApproved.. � ..- . .- . ._ � unyuppLcune�mnperniitauhjerBllnappLwnetl �it . ��i^_r.Cc�i�f curc� .. .. : ., �� . . . ...-- - - .. ...� ' .. p�nuliY nJ nnt nmrc l6mi/irc L��nd d A�11urs/SS40)J: " . � _ . � + . Lj 1,as o..ner of rhe properry,o�my cmployces wi+h ' Healrh Depertmen�.... - , '.'' � .-'��:� . �.�..: _ — , . . . ,_ .� woges os ifie��sole compensmwn,w�ll do ihe wod,and - � ��,1' � �he s�ruc�wc is nai iniended or o#fered ior sate(Sec 7044� R.e Deporrmen� _.... •. ...,, ,�;.; .� . _ �.�.. ._.�.... .� � B iners J Pr Jassi�na Co ie•T hc f-�+nerai ror's Lueacr .._. ... � � �,�.. .i' ��t �J��: r arpt.ra�n�,u�n�,nf p.op�.n i�r,��q��rd, G�odnry ti.�� • \, - � . mjr, tf anJuJnJue.xx��rhu�nbb�n�ml(nr �.� . . � 1 _ . ' ..UrrnuR6��f errcplq��ees.prn d J that su.L�v- G�olo9 col: . . , � ,� pr r nr its� r¢ nnt � d d r /f d J .sn7n. !J, � - � _ � I -�1 e er,rLnbvifding( ) n�. [. rl! t�inr,nr � , Pedesmon P,orec�ian . . - -- . - t��>�n/innrpfrtinn, th�. ou ner 6 ilJer+r�[I bm r�[hc ' (fencel(ConoPY) . . . � . .. _ . . . ....�� Fur�lrn n(froi in�1Fa1 Irr�liJ nut l�vil.f nr iv�Jrrnx•i•frir er,�•p�j,��s �f..�r�l. Spe��nl Insp«.ci�on � . ' [; 1.as�owner of thc properiy,om ercius�vely crnfroc� (Canc.l IM4soniY)1Weldirtg) � . . � �- . . . ... - - . .I��g wn/r licon�ed conf�octors fo sans�ru•i the prolec+{Sec. 1oi Oro�n � : . _ )Oad)Unsrnerx unJ I r(. ns C�Jr:'!'bc Cnntra<t�r's oqe - ... i .- - _t _.. _ , � _I,rnns�•7r�vJ��<:nnraJ/h�t�a +rn�rnJp���pr.ttu•L,i � _ . ... hw(Js ur irnp.o�rs ft rrr�n.�nd iri,�.r.i,neraca Jo+ noh Pprking . . ... . � . . .- -� � 'Y� , - - .-- . _ ':h��jrr`f«rrith a ron(�o�{r(s)li�•e c�l f4rsuant tn eGr � . � �:,i .Cnnirnee � 7.iernsr l.um�). �� ' i -� . , . , f � _Cl i o �mP,��e��s��, a.ac.c fo��h;s . . ; � . , .._ � _._... .. � ` reason .. . ' . ... _. ._ . . .. . . - ° � � � Oa�e Ow+� AAP�ovuls�.. _._. __ _. . _. ._ . - __ . ier Date � - .._.. • • _. ... _���.- . . Inspo<eorsAgnaluro � . . .�� " ( ' � . -. tocar�on_. � . � .. � �Serbacl 8 Yar�is? ...-.".... . . , . . . .i �. .. .. , � 7N3PECTOR'S NQtFS .. fo�ndni�9ns ..�.....' -_ I .. . � _ ...._.. ... .__,... .�._..__ ! , . . .�. . . Sta6, '- �.._. .. . . ., : .. .: � Fran " ' -. . . .. . Energy Insuloi;an . � . - ` . . . .. . . . ., . . ....:..___._. . . . .. . . ' Lnfh;Drywall_ . --'... __ .... �._ ._ . ._. .. . .. Inter'ior .. � , . .. . .. . ... . . .. , ...� . . � . � .... ._..... . . :.� LOth-Ealeri9r� � . . . � . . ' Ho�seNum6er_ ........ _..._..' � . . , , � � . .. . . .. . � ' .- ...:_.___..__ .. ._ ..._.._.._.. � Goneo B Posied � . . .. ..._... � , Fi�ol--� . � ., '- . . _ .. .�, " Enre�9n ;. ....__. . .. .. � � , ,r � � __. . . ."' .... . . . ..... . . . `1 Fronr . � �� ' ' �' . . . � .... :ti.� .�� .,,. ., . . . . . . � . . � r'\.:.. ..1",`,�� . .. �...,`,�! . ` ,L, .'.1,.