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HomeMy WebLinkAbout1525A __._ .. ._ .. . IWORKERS'COMPEN5;4TIb73'D�'�L�CR,�'IbN,.....«..,.w,,.»-.»«....,,..,...,.,..,....�..��..�.».....�,..-.�»*,._.,...,,.»..�.,.M...�.,........,,.......M..,._..,.�.........�......._..,_..-,..,��..o..._......_.........,.�.,..,�._.,._.�..,....,..:....�m.�,..,�...--.. I hereby affvm �hot i hovn o ce.rtifica:e o� mnserf ro seii . . - � � q} i�s;;re,cr�:er:ihra;e of Workers'Comnensoticn I��su�antc,or '�a42D, . „ , � - li a rr.r,�fie �� • or i5ec :!c:N.St..C 1 UT�i .��eos IaEv Bieu 1S �o,�cyNa.=-- Compa•:,._..--. P'-' d ----.— s �PIPLICATIUN FOR PERMIT . _e����,������h�'ehy fumished SEWER - SEWAGE DiSPOSAI �Ce�iif�ed copv�s 6ied wu��rne cov�ny budding insperlien COUNTY OF LOS ANGELES BUILDING AND SAFETY aeparmea: ,. ,.... : ::r.. . . ,. . . ...�:..'l �:.�,.H:..i�.::..+r'�.;r:f+.r•,u,�r.e:7:.w"„�u ���kx�k:lr p/ ^�:;S�e Date_.V/2�/$�UPlmm__FTEPIQ8.L1 l . ..._. . ...�.,.. ....,, — .,. . . ,....., ..,._, _ . . . .... ___,. . , —_. '... -_ '- "'.-.... :.�., .. ... FOR APPLICANT T�F�li W CONNECTION DATA ,,,� CERTIFICAIE OF EXEMP710N FROfv1�WORKERS' �„i��;,,�. � � � � � " -"`�- COMPENSATION'NSURANC` ncoe�ss .� . . @ . �.....,.. s�r;:n� „"_'-...�t�T�...c••r-;••:,,,,_,,•,.','.,a��..� '—.' u•_.�� �T6is sca m�need uo�oc comple!ea�f Ihe wo.k invoivno 6y�he ��.-� �••-.v`�L �•,�.�-�ci[tc:[-.., •,• permit�s for onc huntlrr.a dullors;5100'nr less 1 '�"'"� --' j , � DI� �AR . . ,........�. _..__.. .- - n:.�4-s: - .e�:��:�;. ..'. Y� _ 'JC+_'���..�_+!�'�+ _- I �r�l��fy �hat �n the}�e.r!ormunce oi the wnrk }o�wh:ch tE.ly .ki:fii;= i�rl. �� �'�� � . • . .. : .. permi•,s�ssuea,I shall�:r.t erv�p:oy ary perscn:�ony manne.r - ��_'— F- so r,s to become subieU:o the Wc�kers'Co^�or.risa�inn L�ws ;�yh_Y___ pnT��,T �.;-f� — „� .,�\` ;:;; �� 4-[„U ftlY aA9.._ �.L . d � . . .,.,. :.. _.. .n. �� .i?oX 3329 -1:...K��«.:,-.� uo.,c�Fa��.•cr Da'e__ •-APpLccN'___._ . . . ' _ NOiICF. 70 APPIICnn�7 :< nknr ma4ir;g �h�s :�.,r..;.r:., ;' ~.YY—_'- h pc . ,... . �.`-e �tiap�;,r•,.,...ercoz-insT.��nr� �nr.=. . ,. ' ..���...,. :,�. Covina :�v��i18L961�JJ41 �r ' �..' .. '. oecome sublcU lo .�. ',,..,.,. � .. � ., l:C,:. . •�.� .� � . •:���:f.�(1fJOl C(I(1P..YOU R1US �Of�l1W IF� „'�;'2.i.^,N .^�Iv:: .__ .. . . . .. - --- �---- -t•�ORST WIOEIJING � ply w � suc� orov s�cns or•�i s perr^; sna be deerred 3575} ��� �' evxeei ei;:K �ecc yn'�r�c4c�.c��:+F�' .,......,.,�.,�, e��.r�..�:::.� . . . __."- _'_'__" _'_ r.4•:If\�� LiCENSCD CnNs`�,4CTC5Ft�D�C�ARA710N� �� c��r,.�cs _......,.„,...w,,,� �„�,w.a�ean, s:°�,�:C: nO..,^,n p - 1 hereby ofhrm Ihn'I cm.�:ers��:d��nde�p.ovivons cf Chr.pbr t,—�--- 9�cornmencng wi'n Sec,�on 7000:o�D�wsion 3 of rV.e Busi p,,,�,.y::y �"lj'I�s� ���• _ . ...,wYfi,.,..�......... x.rvawia.eiltl� ness and Professrons Code ;mci my!icwnse:s m eail farca ond ---_--- �--- efiec• �7A pp�J /� ^ :o�-aR:'^¢ �!�i���eQ�.S.mia—. _ ,-o�.r�•:n..r.-n3;:==', ....w.v.e.nxr�a�.�.v r I.icensC Ni.i'1lJel�1-7U.o!___:1� C.�oSS'..."'_Y�'L�_ aCCF-4 iE':?..kcF:.�f\-�C; d 822�I3_eechwog�—l��r/ -------- ., , .,,.�, o Cor.�roctor__FT�eT=3Xl__Uc�e_.S�2O FS� ,,,� Al�a_�,oma_ •_.v� LZ`_tl��Q:.�-�� "-ut:Ho 'saCi:= ...- ••..•�^xr.e5s['�«� V �� i am exer�p!u•;tler Sec.____'._ _'o't�,e L.A.Co .�a�F Tf 7 Y88� � .�� . ._.�',,. Z r���:...,. -�`�.�s C34__ C j o ?;�ri6�ny Coae m�d.or Sec _cf�he ����k���vV O''VJORK rtr - .L—�_ � at� _ . .. ... . . , v�,:; -__-'_ ".i"I.i k i.0'uM1F:'".\�_.. B 8 p Code for�4•r fclbwmg reoso•: , ri';',`i v.�r �. d ` l O_ �7 �}/ VALIDATION .�. .. y :..�c .r."Efn^.�: �O' ab y ::.... ... i��F\.:.".i':1hI1J•'�]"u � �IM1A: . ,... ... ..........._«Dntc___-_ _ ' ' � ' �;:..ti-:::'.:FS C�1'�i4:"\'-^ � 'y �.1�J 1'G,nl='::.'::i: iY5?'I. S�G„atu•n-- •-'a:.:._., --___ _'-'_�-"_ ---'— ......... .. .. ... . ............. �,,,,-.aoai e.�: ca � OWNER-BU:LDER DECi.ARATIOn ,r-'�.:;;�`-'`,��^;� � �hereb af`I.m.he�I nm exemP''rom,re Ccr�t.oc�or's lice�se —�`�`.c:,i[�rn;;�' -::n�4 r� � � ,'i �O 2.J�� Y %iN ,CSSr,^,::: .�4�:.F�. �A\.I::;h � Law�or�tie rol!ow��g.eoson iSecbr.7037 5.B.:�snexs ontl Pro -�l�°�, ' "-'+'- — - '<LF>V i:A.:�.V�I:::V-::l'Y w•�-.mns Codc': �'v_;;';s•5��sr.v I - --- — r,ov ea � O� i,as ow�er of�r.c proper�y.n•my eRip'oyces wi'n wo9ea os '�•ci�sole ror�pnnsa�ior,will oo itie work and ihr,s�r,i:ti�ie .j.<: ��J,S`^,, .s nol i�•re^ded ar cit're�r.d�C!S�I!�SP.C'�(M 7C44,Busi�ets nnd Proiessio^.s Cc�ic. Q�1�/NER't Permit l(�'15� ` .. .��J+�,:,U L.1�,as owno�ot rhr.orooe�ty.ar�e<-'..;..�.. ., AUTHORIZATION�TOTAL FEE � � � .-�� ..., + ..:::..�� Grt h:���rsed:ontrac•or�ia;ons+�:;c•.....�.':��.: � `.•.. — - 7:�?S� k.;U,�f�••�i f) ....,, . . , ..�, ., ..... i HAVE . ; ,,,.. '., '. . .. . ,:;� Business nnd Professiors Codr:. cordNEc �..�. ��"' •�• • � ������ " '� CONSTRUCTiOh�'CNC�NG AGFNC� �� � , I ne�eby a'rf.r�� �ho� •'icrc �e e con5�r::cr.on 'endinq aaercy :�:(+M1=UT�.�S_�� ', vCf-� .� I:'r� for the performance o� �he vmr,c for •,a�•icF 'h�5 oermit ;s �•'�"���° �M—.c,� , �ss�,ed;Sec 3097.Civ C• ]:.M2!,tC?N'��•_�_��1�'^� _ � �jti. n..v._�,� -� '- �-t-� ���'' - ' Lrr.dcr'slQarrr._._.___-__._—' ....._.....,..,.. ..n.,�...,._,:_.,.,,.:.�, • � LenAcr's Address_ ,«.arr.q.•:....s...,��na��.�,�..a'..�.....,...Y:�n....n,w...:,:.i�.,:-..w,.,,...r..wn.,�....,.-w_....N.-n.rw�.n,..,..w,,.�....�....:.. --._'- ._. ..._......_,._..�..�..:....-......+•.,,..�:..;�:x,c....,s.-,..ew.....w.w.newau.�..�w�w.s+.��w.+Irw v.v i ce�tify!hof � havc rn.oci 'r i; nF�llcnlicr ona S�OIP'I::1' �hC above m+onnoho�.s co•re<•1;agree ro r,nriply wi�l�oll Coun'y ordina�crs ard �•...:• � � .�.. �....,,. : ....�:��ond Sewers. ... ��:. , . , . . nnd herPby o;,th�� � �� , • , � . 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