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 � � .' 'i
, , �
I � ; j ' ` i ! � � �� I : ' � � I � � � I I : I � � �
� � I I ' � I ' ; ' i i i I � ! i i i � � i
� .j ' � � ! � . � � � , ,I l ' �' �
i ! � I . � ' I � I � ' ' ' i j � I 1 � I
� i � I : i :
� 3 I � I I � . . ; I
, '.
� ,. I I i � I I j � I , I i � I ! i
I � I � ' � � I � j ' I � � � � � I I � i I
i I � i � I i . � � I I ` I I I i i � � � I
�I ' i I i � ! � � � ` i � ; � I I 'I j . � � � � 4
I i. I � � � I I . � I � . : � � � I i � � � ��
Ii' I i I � � � I � ` � � ! I � � ! ��
� � ' � � � I � � j � ,I � ` � � ; ' � '�
E � i { i ' . I ' I � � . � I I ' ,I ` I , i I � �I � �� � �i i��
I � � � I I' � � I '� I � � . � i 'i Ii �i � I I I � I :��
I 4 ! � ; I � � ! j �x�
� I . . � ' ' ` I .I � ' ' I I I I ' i� i ��i
I � ' �� � � � I • I � ' � . � ' � �� ! � I . I, °�1
� �
� � I� � � ' ` j �. l � ' ! ; � � I � II ; . `� � I �
1 I . ; � ' '� i i � � � I I. . ' ; ; ; � I � � 1 ; �. � �
i � 1 ' � ' i . ' I � � ' i : I � � I � � � ! I
� I I ; ' i ' � j � '. ! ; 'I ' ! : � i � � i � � ! � �
; . , � � . 1 � ; . j } ...� ; , j ; ; � I � � ° � �
� I � I � � � � � I ' I � � I I ,' I � I 'I � •I � � �
, �� I j ' � � { � i ' I I I � i i I ' 1 ! . I � ' . i i � .
�, �[; - - { � :� _ 7 O " l L �O li1 = C C O p .r , O y � } q � � ..'
`� n 9 n_3-' �^ : a � � 'C ^. 7 W� � n Y � � r _' O N
i - � � c a' . _. a� � e :.: n .� v - � �
r o . � . � � -. m 'm
� � -., - f i r� � n G n � .._r ' � •v ln "�O n h' w '� ,"-'�� Cn5_
G� . V.., 1 C � h-G ij O -. . �
� �^ j � r; ^ � r. c �u ���� �.-1 ' •-� ` ' _ q a^ - � �� O �� � _ fl "
: I ; � ' p�N � - 'LC j - �y ?.: V� Q K ��00 ' O C f
i j C�. V Q O �.. j�C O �:i � _�" . bi�� V �, j pJ U^ R.�" C � ,� .� �
� - O C - � ti �"- C N G.`C fL: � ' � `C
i } o ; 0 3 � �; c _ `a � �_ o `" ��• '3 �^ l
� � � c � `+. r : � . ro f ^ - � � _ �a � � � o ; _ :
i w' - ,- �� i� � 3 p �� � � �s � ?'C r, C =' �i ^ - _ '�"
7 _` �j -�~• . O �s � • �,°
I .. , i � � � e o � o ^- m c Q-�a p ° Q ' o.. c-c��i' � m :, _ m � c' o o - �
i „ ` v' V` N C v �.� O � O ri �. N � e - O_ " _- ��j�� r'n' C� � C N n � ? J ; �
. � I _ n �� �� z �- _ ==❑ �" o -p�•r. O _. ,� % t C � y �.'. �
I i c � ~ ^ , `� � _ ' T� � � �^. o y ��wn� ^_� c c•c T �
� i ; : � n-�.�sm;n 'ac° . �� �� ° � 0 3 °n�Z � ',' ^,... �� r
� ' � '` U � � '" --� �K � � ' � 3'Y. _� � _ a � - r.;.
� � � � 'c �c � 7 0 �" .. .Y ry i a �;a .�
i � I �•� 0�.3., � O � :0 � _ ' � N � = � � � � .,, _ = y i � C; r
i. a e. . � �ry <� a c n ,7 N' �I�J O C J7
1 ; � n a.� � u - - � �'n n.�_ .' o ° -• =. �' = = _ n"�.
i � " , � �5.^ - , �'�? �,� o �o �a._ ���e ? c.?. �y j�� - � 'l
i ..' I 1 O } r�•.�y �. G ,, C �j �� Q � T� � � .n :� O 4 O � ^ �^ 4 �
I n -� - .`= � '7 N 6 � '+ � : � � . n � ` 4 '7
� � O 7 =�^ "� � n �_ � � '� ��_ _'� � n c G '� �
� . �• I ^ -�' " � � ' ^ j b ^7' _ �-� Q❑ � : V=
j ; o r� _ � �n � o �% v+a z,;� � '<
� ' � ' • i g '_N.� '� •< a-� �;� ' j � • , o � .`o � c o : w
� i I i I n ' _. ^ '• ~ � ~ _ �� 9 - �� _. .
� �� ��c c c ��c' ° � �� � �� �c<• � c.,
I � � � ' �