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HomeMy WebLinkAbout1528A ; bVORKERS'COMPCNSA7i0N UE('lAR.�710FV APPLICATION FOR PERMIT � � I hcrcby crffirm Ihial I fxrv�o carlificat� ol con=enl to scif � insure,or a reriilicate of Workr.rs'Com�.�ensntion Insurnnce, HEATING - VEIVTILATING - AIR CONDITIONFING or a«rlifir.d copy Ihcrcof(Sec.J800,Lnb.C.) 76A36:C �f l31Fi�RIV IU!NI� � acyNo.__.. Company_. _.__—...._ ( Cr.rtified�opy is he�eby fiirnishPd. COUNTY OF LOS ANGELES BUILDING AND SAFETY � Ccrtifi�d copy is fil¢d with the county bviiding inspe�.- FOR APPLICANT TO FILL IH! �tutuWG �;�„��p�,�„�,,,�„�, nor��,et;s 303 S DIAMON..U. B �PRINI f).4 TYPF ONLY} .'._——.. .1_ e..... )� _�Li ... .." —___.... .... _' —_ "_' '_ L(7:'.ALtiY�X/7YyVy� Date—_...'_.__...Applicam lti,•�C� �7�I� F' N(). IYFE()=APi�LIANCE OQ fC7UiFi.1ENT FE'I. .—..—_ ....... ._�..._� CERTIfICATE OF EXEMPTIOEV FROM WORKERS' --�-- -�� -��� �---����-- - NLARIST COMPElVSATION INSURANCE CRnSS 57. (This section need nof 6o comploted iF fhe work involved by __.—__ ��`:kl'IIO.V UNIT_811.1_.:_.__ _� piSl4ic'i tii). i�aU^'c55;D uv fhe permie is for one hunAred dollars($100)or loss.) � ^ �J I ccrtify thal in thn prrfonnonce uf the work for which Ihis Alk IiANDI WG UNII,CfM__.. . / / /�7 ����. . ....__'... ....'--'._.... ...."' "_' ` perrnit is issued,I shnll nul crnploy�ny person in any � ..f_�•Gf rcuinnar ._—. ... .._.—' __._.._.__ � ROI!F.R,13TU—.... _"' so as to h�comu sub�nct to Ihc Workcrs'Cr i r.nsMion I�rwx. _ ... ___. .._ —....... � _..... _ ..._ :.:-i-F:?��;n�s nn*r irvsr�e,:iou'ti!'JI;IJ;�IURP � '��1._�� 1 co:,n��u�ssok,eTu.. ._3/4 HP_._ 1 0.00 eoixai�--... .._..._ .. --- •----- Date ....—. . .....— ......._._ ._.. ._. —..._ . ..._ ��.+� -9-�3./�3E�n�F,u«�,�.. —.... NOTICE i0 APPLICANT� ;(, aficr makiny iis Ccrrifirate o! vc�Nninno��svsiF;,s �'��+�'�� _� • F.xwnplion, yuu s4ioold become 5ubject Ip Ihr. Workers' " �-"��---��� --�-- Compznsntion provixions of iho Labor Codr.,You n,��x�io.iF� ----i vnvoenrroi cc;o.ev- --- --- VA�IDATION - with tomply with such provisions or ihis permit shall bc � .._ ._ .._.. ......_.�.. ...__ ._......— CIP.P.II1CCIrevoked. fIIRNAC.I� lAU._._..—C;RAVI7Y.. LICFNSEDCONTRAQOkSDECLARATION �i00R _itiU__... --_.... .. ._._ __.. _..__ .. ._—__.... .._ _..._. I IIP.fP.I)y(�PPIlRI�ItU�I 011l II(f?I1SY,[I URf�P,I provisions o(Chnpter 9 hhAfl.K: :'�U:'iVfNlll U__... UNIT_ (comrr�uncrn�wilh Section 7000)01 Division 3 u(Ihr BUSineSS WAEL`____'.-.. . '." "'""' rond Prnfessinns Cnde,and my licrnse is iri fi�ll lorce ar:d elfecl. � 'd�y '—_' "--.. .._--...... __ '_ __ �� I.icenseNumber— �q1�1 ..._Lic.Clnss���Q — F'� � ...___—__..._._ ......._ 19C _' __ _'... .'__ � I � C�nlractor__' ._._ _.�ale_.,_U/�/R�-- i— � . ._ _._......_ �VAI • - . . ..._. ... .__—'... � i nm exempr��nde��r.c.--------._._ — Plcn check fec� � ---.. ...-- - -- -..... .. 8.8i.C.for inis rcason___' ---. .... . ,�: PERMIT ISSUING FEE S � —_.._ .._� .._Untc:_..,.. ..... ...._--__'.._ _......._ . r ,.... .�— TOTAL FEE z0.50 Signal:rte`----...-- -��- - OYVNLR 13Ulif)FR DF.CLnRATION Fe%rk�i'FHt:+E'%�%�F�IC�NI I heieby uffirrn th�t I nrri t:xu�ripl froiri Ihn Contrnaor's Licr.nsc ...-- -...... --.......--...--- taw lo�ri�u following�e;rso��(Scd;o��7U;s7.5, �us�nass and hn"•+.i L & B REP'RI.GERATION CO•�_„_INC. `' i �=i f:f'� ���i�s;��,��,r�d�:): �� --- - - --�-- nouur ss — i.: o �� �.: o �.,u ❑ I. os o�•�ner ol il�ic property, or my r:mployces �it%i 1006 F'S. EDNI� PLACFI, �{71 .....�----.........�—_._........_ ....... I nqoe,��s d�u���o�„,��,,,,.p�„��i����,w.,��i.fn ii,.,,..,,,��t.�,-,nd eirv re1.Ko. I o •:L i):;•ii � ii,e si���w�� s�,������«,d��{�,�nP�ed ro�+�i��s��ii�,� CUVINA CA.R1 724 (81 B)91 5-29 9 m s ?044.Bus iP s nnd Pir f ss.una C:ode). . �� c , � o�'""��._ALL NATIONS SALES -.--- - '�•; ;C'', I,as o�,vner of ihe properly,am eadusivr.ly coNrar.tinq - --._. ,_, vvilh lir.=nsed contraUors'o censlract ti;e piojecl(S�o- ''�.�I! noourss 0 .1 C-�i',� �1Of1 7O4A�BUSIYICtiS CIIIfI Pf0{Pctilp115 c:o<�el. .-.----22.7..._�`VALLEY ._F3LVD. _--_ CONSTRVCTION LFNDING AGFNCY ���TY ALHAMBRII CA. �E�"'v�'(818)576-E39 E; I hcreby aflirm thnt therc is a;.onstruction lendin{3 n�ency for Ihe i>.=rlcirrnance iif Iho work for�a�hich Ifiis prrmil is issiied ('()NINA(;.I().l' (S�<.3097,Civ.C.j. ._. ...��i—B_�B.�.Ci.���._ CU r.•� — nor.uts:> 1.006 E._.,_ li;DNA_PLACE. �}A IPi'�CP.f 5 Name—..._—. ..__. --.._. ._—� . _ _...� . (II� i�,�aP�s ndd,�s,...- �--- --- �.. :._�INA.,_.��1._._91 724_:___`�$).91 5-2999 srnrr uc:. I cerhly ihi.ii I huvr, fE?(I(I�'lIS upplicntion ancl sh��r,that ihr,: ;i;:iNSh n'O. � C:ASS C3H nbove infunn<:�tic�m is<orreU.I ayrce lo comply with all Cnun;v ordinnncos a d Sin7e li�wc relaiiny iu buildin9 renxtruciion, rinr.l 4iomby r Ihorir.c represnntatives o`tius Counly lo r.nte•r q�on�h�<d o r�incriiion<+d�'oper'y for insnr,ciiun pu��imses. SEE REVERSE FOR EXPLANATORY LANGUAGE - �1� —9.�__� ..?(�IVi'C.�I �)?li�n•l'll�AUt•iil 7f�1�� i i I j I I � � � � I , . � � I II � ' �� . i � � l , � I I � � . !�'I . . . i � � i � , ;� '•.,� i � � I �� � , � . � ,� . �_ � ; ;,� ... � � � � � kZ .,r, � w , � ; �o� . . � j 1 � I i" . I i ; ' � { � i I ; ' � , ; ; � i ' ' � } � 1 � � .' 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