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HomeMy WebLinkAbout1513A (8) . .._ ... _.. .. . _ + .,.. . . . .. _ _ , �,:. ,.. .�: . ,.� �_. . � , . WORKERS'COMPENSATION DFCLARAiION � he�e6y affuri �ho; I have o <er'i{ira+e at mnsent co seif . nsore,or o ce�+trca�e nf Wo�4rsrs'ComFEnsa:on'nsuroncn,or ''•apny,r, , ����,,���,,�„y�� n ce.nf�ed 4�� p1 f5ec.3800,laCh � =eeos�uEv eiai) ' p p! `�p 'P % 9ol��y No '`�'",.��`�npanY. ."'�s �TIC�. _� �s ... .. , . �"R�i�`iA.�,CVp�6�r��ICr���'�(��Y���7\i�G�` y��+�h��''��`.+�' � ae,.�,�._-.,,_..., .� . .. - �Canef�edc`6tYv�s hRfebY r�rn�shed.� — _"-_ � +7F1��GA �7GYYHS,.?G�U/�1'1l�JA��•-.m��y_._ �•`"r;w� . y`.. , . . . , . . , . . . 'F.I Cerlri�ed mpy :s h'ed wnh�ne couny puJding insue�rmr COUIYTY OF LO$ANGElES BUILDING AIYD�SAFETY dc tmen . . ...._...,.�....a ..:.:......,:�s,-'__�.re.3"�-r':.:�'IYSw'.i�'G'i.'-'" .e�irlt"='."ifm::i;�;. .,,:,:i:.t',."' �vr'ei:'::,'. ��20�86 Fre > ." ; on��,.._.__._.._._n�p���a�,�_..----'�man . . . .... . . . ... ... ... ---- �c�"� O K(LL 3N'. .. FOR APPLICANT T CQMMECTI4N DATA CFRTtFICATE OP FXE/iM1PYION FROM WtSRKERS � �,,,�,��„ > > µ T --'!'- ����� CO�+APENSA710NINSURANCE ni�et'S5 �_����������� >"?���v :ta��- _ w�.......,..s+�w.�..-�.,� ;Th�s sectra�i need not!�e:nmo"rred,r r•,e woric�nvolved by tFe :tn �+- DTA F3.AR :.'�:ni.ci.:aFr�,�t;.t ' .�rrpa ,. ,. ... ...... �..,..v L::'l.Fk ocrrni�is for orr,h�ndred dolinrs(SIOUI or less.; -.- �. i cc�nf ihat .•i:he ^.En<ry- �-- Tva�t;:��'.,�tt:c.�n y pe�tormance of fhe wcsrk£ar wtuch th,s / y}�-y J �^y �encn-��eM ;4':5.<.S� �_..L✓��LG Y rUkn - .,I J I oor�;il��a iu�ed i sf+ali::o�a*rolay nny person in ar.v rianner `=-"��� - � . . .^� ^.- so ns+�bec�me sui>jec+��en�+Wo�kers'Cc�moenwnon Lm.vs JL� {,r.� 'c `.:� �7 �j x,.-�,,}� ::n-x ^c.:r rv;; r.n: ''"�� PO BQX 3329 _ �, ho�e_ __APPl�mnt ... . a^ca _nKa=:�,-nC .:n'>-_x.�n•:�c .. > M1JOTICf TO�APP!ICANT� If,��o�ie� mak!ny ihis �',r......,. �.f Y ' ' r{�18 �-9�a4ry, ' �,1• '.YAbfk �Av"A�N .'ONJ VS'�N:�••• •wn'�•,• n�+� p� you shou�d 7tcomP s �rr:- •� , . VOVlri�1 -t. �.o ��^m ron. .• �b;ec� �a ..�,� ':..:�.?+•1 r �rC:., . ' �o[�nsa+ion prG�'�si�ns>f the toi:c�cade.You musi iorthwiih :i::q eri^v �.ci ac: ...::oasr.widEN!N�' ".... ...' . ... . ...............0 ,,.nplv wnti sucn pravn�ons or rhis nerm r shsad ce denmed �" G' A 'Cvok@n i��.K -NAC" �J��Y "a'�+T'NCRCXC ENY'"..:•�.` •... . ' UCENSED CONTRACTQBS DECLARAT�qN �; p�;..�cs '=x�,•�-NO 4 7';.r tl% �.^.Ye f,LL'��}' i heroby affirr��+hn't am��censed��nder provmons oi CFa��ar .i—i — ^ 9 Ico�nrnencinc wrn Sec�ion 7000;nf D�viaion 3 0'�he Buii� ,-:�,i_�!n;,: J1Tl i�E',$. ;�.,parv:s ness and pro{ess�ens Code.csnd�.+y i•cr.nse�s�n F�I=torce emd - ��-"-".`= - r�r��� �7 :�,.•�:,-o� rAEE4iAN C�YiST. �::�.�_--::,:.;:,,.;:-E� . ._.w L:ter.seN�mbe-47�$��,�_:�t.Class_.��`�'__„_ r y iF'.�EJRS=l+fV'^ec ... � q/ ,;:ra_s> � $EEC,�11eiL1.O17.-�'..----��- O C.on'racror �ry��.,6'IP.1T1. Pate.������ �G".- s'�__ °-c . ... .,.n . Ji:��_.._ i �. ..-,,. .:...._ e�c. 'C9Y.... ... . .,......,.,.� ' . :s1�u :uO�ir^. . __...__.'�.1 �tFit:- �i' . . �2cre�z� �. ) PG Z i�:am exemo'undc:Sec.�_._ of•he I.A Co. t"}!L�,£y(�j� L jh j . . O ... � �.l-.»'._"" '."_ .. ._.._. ..» .____».;.:._. _ "�..__'"__. i." . � ..:,:"":,;..... ,.. ,...,i . .. . �... .. . � PI�rr��mgCodeand'c•Sec_ ni+l:e �- V ,___... _. ............_, . �. ' ...__.'"„_'....�_.._ , : :., .., ,. , ,-,:�u ��,_a.2 VAl1I}AT flh( ...,-�--•--� B &P Code s'ar t�p iolla�.vina reoso.,"_' .�.. ..' _ ,"�_.._ ' " _ _ "..`.,_•�. _.__.._._:_ p_, i.t __ ..-� . .__„=_Pare_ ' . ,,;. .� _.._i.. ` �j - . . .. . ,: •.. ', "_.�_.�_ _ , ..... .."'-...:. .;_.t"'"'.._ ' '. . . �. ..._ .._. - .. .......... . Signc��ro`__.�..._, .. ....... _._...�w,...... .,. . . ,. , , : , . ' ' F-. - "'-.. _ • y ' ' Z OWNFR-AtiltOER t�ECtARAT:ON �� _ . ...� :` _.._.:..:�c.0.... .. - -_.-"-"- E' " - - _ .. , ._. . � �. _ �,,, � ..�. :.. , �. ,,. . � . � �- - I hereny oFPrm fnn:I am exemp+i�em�hr.Co^��auor's;•cense ��� � low fo•'ne fiol!owia��8csan{Sec'en 7U3'.5,Bo�s�ess en�P-�_ . •'"'. -� - -. - ' - ..' -""'._ ...-. ...' - .. . .__. ;. ._. . ,.., � ._.�...�,-,' ' ,:.: ' a� r �„""•,ior,s Codet: . . . . ..., . ......_. �. ._. ......__. �z i J�!,�{� _...� ._ , ..___..__..,"_ "_" .t,as owrter af ihe�roperty,on.,«•..::::.n,�.:r.-..wages as , . ,,,_ ... ;;� n � n Y� �herc sole compr.nsai�o� w�ll +�.;�.„:.r.<.:.."..u�sfruciUre ' �s nat�iturdecl nr a+le•eti:or;;. . . "- r..: 3usinFtss Permi� � 1 �'�. �7 v,F�.' ard Pro.ess•ons Cocie• pWNER'S �..� � r�� as ow�er ot�i+e pruoerty.ar�exci�s�ve�y co^+�acrmg w�th AUTH'�RIZA7IQN TQTA�FcE ,*_�j �}(} �,�' •,, �j/j(�.3 I�cersed r- , . .,�,�the pro�er. 'Scrion 70dn, ,�.�:;,-�.:g, ::,r..:�rvea^n-.:.-;. ....,...,,..�„ ,,�,,.. F:cdC�^JA•:t^:::V'fi:.:!�R'.: Buvness�'CONSTRC7'CTION�� c:'"'-,..,•:r.;c�:e:=5ce�s=r.�x snvc�..__i tia�c ctu��a.r i'e:K ��7 .:. �, . .. � a�.29� LENpiNG AGE!JCY ' � I hr.rrby a?fvm �qai �he•e is o censt�;;c�;on lendirtg Ogency ' SIGNEOTHIS'�� 7��DAYp; � !9�. fo� �t,� perrormonce vf ��P wa�rc +or wt„r,h this permit �s �'���a,-_`�Y�p�..,, ti��t �„�,,�,.� :ssucd i,Sec $097.Gv C; ''`—Y-' "- — . .._-. [ander`s Nnme__.-_,..-__ ,�__..__�....� . . ,. '.<r.'• .. � - � iander's Addres=_� , _ . .... ..:. ... ........,.. ..,... .... ._ . ... .. . ........ _�.... .. .... . ........... . .. .... . .... I cerhfy rhn� I hr.ve�wad �P�s r.pp'i.�aa�on a,�n s�a�e �ha••�� .. . _. � . .. . . abpvo miormanon�z co!rect.I as�rce tu ccmpiy tvr+ti o11 Ccun+y ordm,onces ond 9o�e iows re�u'oting P�urnb:ng and Sewers, nnd here6y nu+hori�c represr::i+arWcs o`t�:s Coun+y ro un'Mr upon:no afyewe mAnnored prr.perty f�r r�spa.chor:u�pnsex �.�s:.3,7�+1J��!.. �'�' '�" � . , .. .. . . .. .. .. . .. ... . . .. .. . Siq•:U��rr Pcr+nitlpl' i� SEE RBVEftSE FOR E%PLANATbRV LANGUAGE � _iwsa�craxs wos�s � _._.._ .O{�NER-�CT�I.DEIt�71ECI.�RA°d`T41V . �'--'—'— .,,... . t -.._. �...,......,�.,....,..�..._�...n-„s.,:.���_.�.,.. •,, �. n�4�avn�s____._L_a"� I II�SPECTOR'3 SIGYATURE '"_' y C rereby:,::iru:ci�ac.i am�x::t:�:i ix<:ae ehe C;,:itractox'c Y-:-- r s� —' . ... .,... _ . ... ....... .. Ljcense Law ior e?�c Yo9:uwi:��:�awa/Ssr.ri;:r,7031.5, NEWHOUSFS`.W:^. '�'' .f .��=`_i BHS�#BSS astd Peofesslm�s CadxJ:A+ty dP�,�r or rnmaty '•• ••a, . .^.' H P _" _" , mhNea.�onricrdn� � , .�,._ . �..__�. ._.,;. , �..,,�,r�.-+�-�•-�...�.�. ...... . .. .aobicb re ire.e a parmit to rawstrv2t,._qYder, improno, ' BU'LOING D¢�YORK .�'__ �47iDI%d�J�s'St)t6�t"C93y SbP`YBC$AeW°��pf9pV'$O�iPdi 1558!(d'NC¢y scPnc TaN�srtP.virts� —'" � - . . _ . . �._.::.... ..�... _;;'� �:..; .-�-... .,._:alm rres th4 Gcaat� r satb• se�ta rJe a � ANUiCk�RM1vFlE.� ... .. _. . CO TBtftt� tt��'� lf0 �UB97Te f cEssroc�p nuvN:.�i � — . , ; siMne�acn�so�rc-wt ?Sa¢he ir dreestsed pursu,�at 80 8be I pmoisionr uj.:b�-�o>tEiwtto✓s f.icensa I_au�,'CbqAt��s 4 Aii[R,RFiAIR.SFWER OR . % iCf1.Y.f76&fl[Y9F�vnab.S:etdo»70fJ0}aj i�se�esir n 3 r,f tbe SiWA�Er);e„cOSAI,SVSTfN . . ._.,_.... ..,.....a.,.....,�.:.w...»+se+a . ' w.aa,.-... . , . . r3usine�.a�?r l�n-ofera°fnaa �adej or ek=F "r,s z:¢�rempi DIY,.Utih�Cl VLI:G AND � —_�� — � aanNoon uouse sFwek ._ aberefin�r.��w idie basis jor ahe adleged rxe�repdfoft.Any �—"'�. I .• . �"�Aw�•�.� •. •.(';. 1f0DliYEfu�: 9G'r'a�u7031.3 69d O CfC�!'at 09'6 6CHt4R 9ACKFILL SEPII^.?ANrS❑ 1 . . .. f ;�' y�p� J p SEEP,PR(!)❑ Ccc5PC�15 i] _'_._..___ _ .__ S4bEfCCti:FJ3.Yf�C%:�liJ3i.'..'+.t..YU4.ti(.'9T�i.:1'y 0�6&Oj fqOCB ffJfi/d •••'"�_ --; . , •— ,4va rax.:,'e[t..:nYa::a I,d7cJ3.: � �I,as�he owner;,f tLi_1'GeEY�y c�rsEi do the mork,aad • - � ' ��:� � tP�e cvur.i.nre�s uot ir.t�:,ded er airactd for sa[e. � pSea ?D4''' t�tavr.�a�r,J.Aro}rssrcas L::ds:7F'"�n- . . —...—.-- . . , . � �, tr'actor's Licen.�F La:t.e'oex aoE?bf�iy Ec�t�m �af _` _ properly eufia'&ui:ds a>imfirsvar:nr!eoK.azd wbq does - — . . . suru mor� �imteBJ g�rovlded b$ut sucb dmprovemettts :se n.nt swsen�ed or,offered j'or saTe.If,t�murever, abe � bseLiimq ur�:aiyrrovement ss aold wdabin dva¢ysar of .. • , .. co,n�la:io», :�-+ •;s;rnc.baiW.^• •...ri' Laoe tke 7surden ' � , , • o,Fproairg 1ia�na lid reni bniiu ��<•imprave,fot ibe _ • — ---- Asrposc f sak•.1 ••.. ... : .,.� �..,,gj ... ,,.,, , � , . :.: , .. .... . � I x���Sr uxcde�r�cs�.._�__.. . _ � _ ., . 8&'�.C.:trr t:ais reas«n_.�.._._.---- ':,�4 - . . . . . , __.. . .. r.eni2 ..._...._ _ _ ._�..� � -\ ,,, , . ... - �._...�_ � � � l�WA2L--__'-_--..__.__..�_._..._-'..� .�..�......�.___......,.....,...�...�-�..-.�..._-....' .. ..,,..�....r.' . ... . ... .. ... .. ... . ,. ,.. . � FMSPkCT�R'SyUOTF.S � " ,.;.;..w,.„;_,_,,c,:_,.�.,.,.. �,�. ..,.. . . ,,, . .... . , �. . . �..�__.�.__.�.�..�.........,.._....�. < < , . . .. .. . .,.� .r-w�. _ .�......_..�.��._""�.�'...__�.�r�..� �'_� -._......_-�_'_�.�_ � .,. . ... . . . �. ,....!�..,, ....- .....�..._»..,.. .. ..., . . ,.,,..�, . , � . . , ... .. . ..., ., � _.�..-_._�._.�_.._� -- _ . — ' . r ... 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