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HomeMy WebLinkAbout1512A _._... _.,_�_ ... _µ_ ..�..__ __ _..._ WpRKERS'COMPENSATIOh bECLARAT141N .. .. . _ - - � ��`� �' '" " - ' ' '� ' � � i he�ebY atfinr +ha• i hove o Ce t f.c;a•e -• . �,•.• ,; ::: . . ' . ... - � mswe.or n ce•hf co•e oF',Norke:s Co r penr: „� .-o .� n,,::+ar.: � , -,. n certiiie c the,rs�•o�f;Sec.38Q0 �aa C.�`1�Z1C� '��,^a�a:•. n e�• f"1����i.e�'l i�L/� �4✓R �GRiY\��.�,. . PaLcv N�i���J�'�/ c"i"CnmPony.�_".____"'.__'-_"_ ?'s . ,.. . _ . r�Cer+�i+gHYb�'"sn�ebYfurn�shed SEWEIt - SEWACE DISPOSAL �.�enrfiad copy is f�led�+i�h.her counry l�u�id.ny inspec��on COUNTY QF LOS ANGELES BUILDING AMD SAFETY depart�ner' ..:ee.s;srya:�.:y^.�_�...��'?�ti�S': �:�.;b�' ..-..%rww� �...R.;a`:. ,. . . ... _,....,.....,� . ....,,... .�„ . . �»,.,.., ..,mw. :.� . ' .. . _ .. .:...„ ' Dair���Z(]/�.�App�i:on��x'�G�_1_�,xl-----___.. F4R ApPUCAiJT TQ FILLl1+! �. � � COPINECTIQN DATA � . 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Buv �;;?_l1 is --ae„t3 , ne,ss cna Pre{ess�cns Cotre.t�nd my(:cer.se�s�n fui��arce a^+d - '��"�' - ��� � effc�• �;;n'�a.i�:w ' � :.•.�.�ci.c�.:N:.R.er-: A�7,1 �7Z,1 ��'F?'t���l��_C��TS�. �` '..ice�seNumCe•Yt�Yg�! t,c.C:eass.._�Jy" ,..:�:�: 8225 �iee�hw�w� �rs �3�.+SF�:�t�"i�F � .,...•. � c�n�•��w�I'reeman `u�« 8j20 86 � `t�s�t�Loma ,_-,r L41980- �29 ,.Y.�-v� ..��:�� ,fr�_.. . ..�y:tsyF:'?��... ___ _._._ v �_L___�_ 'I{ aG � '•,n c �7 �7 _�I��n e�xr.-nor under Ser.�.,__—._of�i•e L,A.Co. ,}.�5.n^ t �8# ".:S'. v�4 �� �_���_._. : F�,imbm.g Codn 4r.d.'o•Sec..___-�_.._—_oi Ihe �•i 7ESC4!oT Oh OF�.vOR{ _ - 'in:.S �".-. - V �i:!.,c(Sir:E<:.:lut."f'11G"(: --����-��- „n'= � 6 &o.C:�e far tne{o;!ow��rc�reosan__ " }m r�,.tse i 3.� �Q t p�Z� VACIClA ION ._.__.,._.� k.4:r ran�K cl tn.:.^•[r't:R r+.q. . ; .....__1?U}e� - YAV`:F`Rn\r:iG � Signo'���r,.-'__�_._, .' . . . ,���f't`+crs'Ac,��<�7��;T� _ __ — ._- � _. 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