Loading...
HomeMy WebLinkAbout1522A I ':r;?�iK�4� �":':'"%ti.�:.^;�.::'.'.!�s:.'��,' .. . . .„ . , .. _. . .... _ ...�..- . .. . .. . . . . ..,. , itierebv o.:... ..:.. .... �.. ,. ,,,...;...�.� ::: ..;...�r•... .:: r.:.' . .. . _ [''�I insure or�]cer�i(i:a'e ol Wo�kers"Compr.nsof:on Insuronce,a• '6n641D� � � � , ,. _ !I a ce..c..-!'-.^.,�,.�...�,:r'Soc 3800,La6 C.i ;Y y�e,Q�;,g.o., . . .. � � .,:,,._ .. . . :_� .��:�;?�:..:,F�.�,S�ec --- �sew���A s��A���R�P. . POL<;\,��11 ":�panY_St.._�una.—.--- �., PE�MIT� . . . - ,,...:: 'o'sdt �Idepar!ment D SAFETY Cr.�t�iiea cop��s fiied wirh���e coui��y ouiic�i n�rispecriar. COUNTY rJF�OS ANGELES BUILDING Ak ,,.:;,;»«<:-�.,�........,...,,,. ,:,:,...,.,.., . . 9+.-...�...e.,F:,'«'"F.,v'�:.+��i::w. �[�s.:..:s>," ,:a;i::tii,:wV`� Dc�°c_H�ZO.�S{Appi¢ant�r@e��,._,----- ., FOR APPLIC!!NT TO��ILI fN CONNECTION DATA ,. N.�. . � CERTIFICATE OF EXEtir1PTi \ C �!�'RKE�I2'S" - � 3.,r�� g ---�`-- "" COMPENSATION 1,,4 ' :.cca-ss��� C. . ...(J£'� "�y�..l'� __ '�♦ � . . �,This sech, ,� ..,rr:�•��,:.•.� •- , irvolvr.d cy!he •- �'� it � • 't��'. -, 'T� 'p/�� Ya\-t,^.�Rr . � . ' :'�'E4 AEITI'IS ..�. I , 1 , ' ::....� —�n��2�"1iL- .. . � ....r ._'.\'F4 •�..11�y �___"' i�F^"-��'�^.NVi;'Tn\ z so ns''o n�mr�e sdbier�io��,p.� �f hc wo K inr whirh'h�s � � `k�`r� ,.�yy5� t5��:- �UG[�i} _ r , � -..+F pe�m'�s is¢uea, snn I o amnloy ony pe.son,n any�nonre�' ---- --- = � ' � �.� . � ,VJorkers'Con:•ensahon Lnws - " • � . a AIVDEN GRP " "� �a'��' ,, . o;.�ia 1 . . ,. . .. .�. ;��. .;.;n�� , ,o:;v.:. ��:Ri':.� PO �JX��._ 'd:`:<F�iti•"V^ V(`l;:F{2'f��\::.. ,. Dale_._. _ApplicaiY . . _ ..� . � NOTICE TO"A�FrP:1CAN7��If. af;er mak�n..�lhis Cc�hrim�r. of ,. ' S�8�Q -�.f'?AV' niV�F' FAg[':E��; R!�,^,R.^.•.N�;+,:;..� _��n�,W.,N 9 r Covina -F:.•; 67-954= .��mplo• yo, ..��,,. : . �,•,� .��. •o the Wor�cers' y ��J � np�nsa �i�, �.:, � � ; � ,r you musiforrFw�th DESCR�'iION �oruc � ..:n.oa5r.wioE+UwG.___. .,. , . ...._ ,�:,.._. —_�{�174 . _ ... _.._ � . ..___.,..... . nply w i i s�cF DrUV SiOnS cr h s per n:;shail bc deemed _ fe�0<et,� 3lD:k R.t:l _ 5'i�TEENCkOACi(AFENT ' ,.. ....... .......�r, �.... ,...;w.mi. '.^0=G!):.5 'f<Mli NO 'ICF.NSED CON7RACTORS DECLARAilO!���� s,Z�p ,;i nc�m^r.:c+• �tiereby n4firm•hot�em�i�C�ISPd undfv prn��sicns o�Chootr.r — � " ~ 9!rommerrir c,....., rn^.1 . `v-r�� . ., e:..a .. . ...,.._...,., , :,.s,uw.,> g wn . , o� Drvision 3 0� thn Bus'' �..�,:�;,s l�'. @3 , .. ..., .. :-ad:-�s ..M...�. � .�.. r.ess n�A P•ofessions f��:�.� ;;.:....:I,cens•c n v�full force ond ' — --'--' - . .. ... c�fert 34 ,-��-�ti:�;� 'r�F�A�'�L�.GI@:s_T.__ ::;��_�.-�,,.,:.�;.:« - - � ��.�-,s�N�mb�:.--474887 �,�c�,�ts_ � pr� ry�.�. � • - � '- .1�DRESS (,�G�BVe�chwo�d Ll• __ ��r�a-kc:...,:\•F'e , . _.• �,�.w.r�wn, v co��r:oro•__��c?inan _nare._��2Q�.$�— :.�r ��Qm�.v h. v;:�—/�v-•erc-i Jlcl�'�/�n,^, ::GC:.' •::.I' . w..s,�iC:�KiE�a�w.i q� BK PG Zo -'I om nxemo�under Snc '';�.� q7 — � ol�I•,�L.A.Co ..�v:t�:: 'Y! $s�j _�„5�ln.�j� v�� PlumbmgCodecnd'o.5ec. cfthe '�"' i;5C4�PT�OtiC�s/OaK �tr . . ... -- - ~ —' :�n<. V ' � -(:JS'.�c�S'.CO��'^T�Nc�a 1 p cn-F � VALID TION .a R 8 P.Codr.ior•nc�ol{ow:ng roason .. ""F'•-" _� ���'Z�-��a- '...,^".^-..y __ - c �ti r.nn,-.,-.. rn,—.:,n.<s � „u ��n ���/y p� ? _ . ��a!e �'SF•.i 3Y:A\i.r: '-� 1�- — i'J.`�.:�•:i�(N:C i�I�N.'a�C .y -k�rc'f�SP••tin "�r � / � I , $ig�oture_'___' ...............,.,............. ,x.�.4MSn'v�rc�.v� ^^\Vc^'A�.:inC�A�3•G:J4 —� ► OWNER-BUILDER DFCLARATION ^'::'`:'^"�.:.i`'".r�' =q"� rJ C�G A. �e=er::r.:::.,pc•.�._Jvnmfirt� I he•r.6y offrm rhe.'I om r.xrmpt from ri�e Cornrocfor's License �x:�� i=FS�Co. ec��.�.. ,e.n+�Cs: !aw`or Ihe fo'lovnnq�eascn;Se<Ic�%03�5,Bu�s�ess and Pro- n':a e���>n�2.�:ne:,�C.^,ti rG.:s[ �. a � c ! U •rini0;io�•sCode'� :r.aFuox,`;=esn tivs�v, " -r- -- — ( o.�2 7.�G !.as owne�of'hc uroF�rty,o�my emplcyP.r.s wi'n wo�es ns � lhev sde compensonon,will dc ihe work r.�o ihe s:ruc�u�e ry�.:J�u — �s::o��mendeq or oif�red fnr soie I,Sect:on 7044,&�s:ness permi} 5_�� y nnd P�o+essiors Cade' OWNER'S I ns owno•of•he �''Oe4 2 ' p .��._9 fG(� �� � � proae��y,am o.- • •;.;� „ h AUTHORIZATlON TOTAI FEE "- IiCP.nStlCI C(Jrltrt)C:O�S't)CO^S'IU:.1" � „.. ., , . I HAVE A''H:S lGi-�:71'2��' T:."�1'I��:�1:'vil�!\A•l:,^,::':\'iAr�::4 ". g�lSIf1C55 Cl��d PIniC55�on5 Cotic' CONNECT -F P]C'iC:if.Y2iiE.^.[x�•��-;:/.f!.�'•[;`�I'�.IF�:ihfl CONSTRUCT�ON If.NDING AGE�vCY � ']. �'€- , i ��C•eby cff�rm �no' �F.ere is a cn�s���<fior Iei�diny aar.nr,v -�'�f^1�+15 !-' � '�v{OF_ � y +or �ne ocrfnrmance oi i e work For v�iv�n �hi� perm�t is \������'�`��.�- �eyyl __-t-���E„� n < ISSJCO jS2: .;C'91.CIV C� � '� "�'� J i � fender's Naine :;`•e•y ' � _�� . � �" 1:�.' .�1_ Ler.dcr's Addreas . .,. . ..... ,. ,,. �,;,;,;,,,,,, ,<.-�..�.��..r�.. �....:�..:a,.:.��.�,:.m ....,.... ...,..�.-...,.�...,.�...,,.. ,... ..,. , . .�. ... ,. . _�_ . a.� . _. ,.. ... � � � �cerl�rv �hnt I have rend '�,�s ap,�Lcahon �na s•n�e 'r�r the . . . aoove vi!orrr;orion i;:orrn.c;.' . „. . �• •��II Courcy .c-.��.,,�, `:........ , ordi�nnces nnd Stale iows , . �•Sewers, and iie•eby ou'ho:�ie repre:... . . . . . Ir,entnr ��oo���4re cbovrmenhoncd oroperry!or�RSaPC�Of.��YFIOSER CJC,�'v� ,�l�l.tJ�L4._,,,_ r�_"'�l.j_�_� S:an����r�P�ri•,�;�ec �r.t� SEEREVFRSEFORE%PLANATORYLqNGUAGF .. . .' . .. . .. ,., .......,�.� .... .. , . ,. ., . . . . .,.. , ..:s�,,.,�.,.,,...�.�.w.u� �.,,.,� . ,�,,,_�.�,.�«..r.. . ,,.,..�.,., .. ..� . .. ....� . , ... ...,,:•:.,.s.:..:.�.,.wy..__.,�._.... . , , . ., �-�,.. , . . ,,. : .,. , .. ... . . �� . . ...�..: . .,.:::..`...._,..__s._....,...�.,... . •�.•,.w...�..�.�..�....a� . -�-----__.. _ . � ft�sP�txo�'s vt�Ea...___...__._...._-----•- ��i'F.R-?3Y;PLL3��.;if:t::a,tid�A'�'F��h;; ,.....__,.....�� ;,...�. . . , . . . .. .�..,..,�,.._..,��.�=•s.,m,� . ` ' ,: ,...... APgRl�4'/'it"s__ �aTE NSGEGfOR'S SIG�AIUk..� _,_�_..___�_____.� - f�IICl'�9j'hlFv�•M LStSC:..�...:"..f'M1Y'e�I':��.�,'..'i c.,.ra�tor'.c '.. � ----'-- - Lieense Law#ar:be -'-�--�'` :.�?i r.!a+�::r.a:��.,V.rrt 7G'i:.`i. NAV�iWSE SEWER i � ' $nsmness aad��ofexafons Cor1eJ:.�4ny city ar county -'--'A.'--` � --'---'-'------'-'------ --- wuNPn.�oorw,r:ni �-- .. wbicb a'eqx@res a pe�mlt tn coxs��ucvt,aTPer,s�tprovr, , nUIL���G UR YI02K I �R9Rh1lSb��J'!'.":�A::;Y'GEIS,'y 3�9YdC$ibB'8r Y••�.$O�{5&1YN�AiCf� SEv!if.TANK,iFEP.PIi(5-'-� -__ --._ . 4If0 r.gxlre> Lhe �ypixcc��i .:rs•rrsck`;fs:�::: io fs9e e RND/C��RA!NF�FLD . C.=55FiX)i.17 DRYY:ELL(,J-_"--' ' - ..,,.. . . . . ., .. _. .... -,.. Sfg%¢�S3GICilE¢9S L'in:i.'.:::..:'-t'.:Sd:3�.G�.'_:M^!:2 YO $j1B � I _ gmv:t�xcrns o,!3Y��CL:.::rcet:wri:.ic�s�w::>.a:t;C`iiup:er 9 AIiE�E,2FPpIR.5F�NEA pR -� 1 . .. . � �Cn1R:X.'E:iC.Y'k,'UJ46�t fPC:iJYt i(piii�,�J,9�:1:!:iJR?C`:�/¢ ,.,��r...�,n•.r.�l".c.-.. . . . . . . . . . . .. .... .. .... .. . .. ..: ars �:n';m.s f ..: e' :!F,� R mp _..:__.. .-----'-�--'......._._..� -'---'-'-'-�- -- � -' -- . . . .. . ....._._ _.. _ , awd '��� .� � f � tbere6r» �� Sbch�isfor ,t l�,r �a�_.-?�io.-�e A.�:� . �.:: '-'-'� '-"---'-�--'- --. .,. _..,_. � - - `.� �: , , . ...... . _ , '�io eio � 'u 703Y.5 i ...:� �.t i:�r,o.r r.• . ._. ,. . ,...� . , OAIX l�Sk If�fANi."U � : . . �3 �3 r�f0 :' l:�ri . . 1 ' � � -- sabjeces t3ia appdiumx to�aurT pe�edty of wat more tban a vT��n �E �o�s L I I �e ------------- ---, _�__, �._ -..,�� - ��•••s �, fioe bttads'erd dotPars/,$S�J.e .. . , .. . �„_ y �ID,as rhe awner 5f aSe propcteq miiI do the wor��and , , , . .. '��'• � ,t�e sttsxc�ae�i;.snt isocended or offered 4ar eaie. . . ' __ rYnu 7'J44. B�:.t:x,v�.;:r,�atrofe,sriows Code: $'N`�^�mt- ._..,�..,-_.� . ___._.__ . trer.For4:.i:e...::s i.ww r]iir-�e8 a�ply to am oa af ' ._,_.. proparty�uc 7i:ai0ds ar um,praares thereor.crwd»��m,?cs; . , ----_�___�—. , . sucF work himsei'}'pravided tEsi ssub ar.i,9rr;:Mmens Qf¢It0%:?.G3Y!/dC[�M'iyjCTC��OT S6�¢.�f '/lC8UC1[T.:tJ_3s ' - .•i: , }'i6:1�YR�' i.Y%97;°ifrUi.l,6�a:wY'SO�WiEbYR U18E�'BOf'.y . � com�SdetA:rt, 33ic ou,:se�brel;dur soiol:b%'u: e:5;; beasdeat . �- - - -_- . � q`r,>nadz,�r.ba�t hc.d4?:�ad b:.'i:4 n�.°w.aerw�r!C:-Pbe — � '_^--�____ P'�nsc n j a»:R.) - --- ---- . . > ' . � ;� . , : ' --- 1 air:txeue�st u�d�>;a��..-__._-------.–. - , . - _. "�.': , .. ... , ._... _._._..__ �� , __�__._ Fs&�.�:.iar i`ii:���astm---.--...---- - -------�----. . �a£e.---�-----.�._.__..._.__. " _�_ _.� �....�..-. �f}�'4iL';�__.----- --'---.__..._.. a.R..,-..�._,�-,_._,-. _.�-.........-,—.-,_.._.,� . ,. . . (!!SP&C?O?'i i�OTES '