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Home My WebLink About1525A (8) __._ .. ._ .. . IWORKERS'COMPEN5;4TIb73l��'�L�KR�ii'I�N.......»..,.w�,.»-...«........,»«.,...-.x,..,�..�.».....�»�...�..-«-�.*»..�.�..............,....,...M.-.,_...�.........�............,:_.�-,..,�.....o......�.....�......,....,..,�._.,._.�,.,..,,.e:...,aa..f.�,..,�...--.. I hereby affvm �hot i hovn o ce.rtifica:e o> conserf ro seii . . - � � q} i�s�re,cr�:er:ihrp;e of Workers'Comnensoticn��su�antc,or '�a42D, . .. , � - li a rr.r,�fie �� • o�i5ec :!c7•'.St..C 1 UT�i .��eos IaEd Bieu 1S �o,�cyNo._-- Compa•:,._..--. 14-' d ----- s �PIPLICATIUN FOR PERMIT . _e��,��h�'ehy fumished SEWER - SEWAGE DiSPOSAI �Ce�tified copv�s 6�ed wu��rne coorny building insperlien COUNTY OF LOS ANGELES BUILDING AND SAFETY aeparrPe^,: ,. , ... : ::r.. . . ,. . . ...�:..;. �a,,.H:..i�.::..+r'�.;r:f'»r�,u�:!+:S:.w""�u ��kxn�l,�k:lr p/ ^ss'ary3�r . . Dote_.V/2�/$�ur��,__Freeman l . ..._. . — .,. , . ,.__, ..,._, _ . . . .... ----,. '...-., � , FOR APPLICANT Tt5 F�IL iN C.ERTIxICA7E OF�EXEMP710N FROhA�WORKERS' ' � ' " � '� _ ON � �;..r�;•.n riI�l��.�.�.��' � .. CONNECTI.,�.. ATA:,,:,..,..,..;,.�_..,, COMPENSATION'NSURANC` nf.oe�sS .�� y �,��pf 5��%�� ct°TD _—._ . ..�.... . .., �This sec!on need ua�oe comple!ea�f the wo.k imim��ao 6y�he • - DP�nlif�s for onc huntlrea dullors;5100'nr less 1 .�:�'..'r .,�.�,�+^.i[ti:[-.. __' ,. . �.. ...,.,....�..�....,��. ' _'""'.. _ "'_-_" -' nF.�4-s: yyy . -v�r p...;.,, .;': .. y.��'!"�+m=:+.�t+_+!ri�+ _ I ar�l�fy +h�n �n the}�e.r!ormun<e oi the wnrk }o�wh�.ch if.ly .ki:fii;=�l� �� '�� . . • . - permi•,s�ssuea,;sha!I�:r.t erv�p:oy ary perscn:�ony manne.r - �� '�� .�3Pf3�ifTOR��ShOYES .^._ .�.,..A iP��:-��11C.1�s'C..tC tp�\.i..:'3.S�ir�.�Ti:i� :��PR�VALS � JR1E '•"•�•IN514CiOR'S SIGYA7Ui�, �_.• . S jie:x.,q ai€:r.��hac I n..:a:.usue fra::.e'.r U,-.atraetox's .�__._�.._ . -- ----- ---- �-- -.. ._------- rocwtiousese,vEe �� ?�',� � ' �� '�s^Law fo: .h�?cl,cwin�_eas�u;:Sc�.'u,�x 7.032.$, —�-�';'� __ Draxlwuss nsstR 6`enjessznx.r G��s�. any ciLY ar-eoeanty COi1NECT AfNJ�•IONt.I � � .. . _... ... .._.. z�. ,-,:, � wbicb re e�iYes a ¢Pmid to rofav s,.nninr,ua woac ... '. , �... . -.. , " 9' A alter.svnprone. , SEiI C TANK.S�E'.'ITIS��.__ d�)D90TlAtL1r(DG'S��G{P 6i3N fi#i`MCEttTBi�xP�..8R6 lSSYbR9IIC6. ' AND/pRDRF�FlE.7 I �___ � ..` f9P80 :ef.diiY,"3 iY'Jd 6i�6j{C6i36�$OY SYG�i�eTmtP�'Q�t1R Q ""_�—"�_� 3i'UE:d�I(f7P.�Y.d�2Y :�eF�.i �k �.fCCFS'�.t:J�.'e4uAe' ttt /AC CESSFOO L �%tYWELI[] . --.'--"_""'_____" __—_—_ __'__ �5 , � ' ��'�� 5 jY!/�21AC.39�S OI Jl� � ..4:SY+v+FI.'1.'Y336•iwinU fv.d�11Ct� ALiER,RE7AIR.SElt4R0¢"—�--_� — "9 (Cnm3MfN�"Py? :,i.�.,`..1'.ei..i .'U�ii Lj��E::ihiuit S of thc SEW.4G,i)ISJCSAicvS�F.M � _—_ —____�___`_'____`___ ^ISCG!M1NiITPll1CiANu i /3.�s:r.ess �vu: hr,J'essio.is ia:;a/�r i3,:t Fx is xxempt , FEAti�T:HOJSF ScWER � _ � "._.--._—_--_ :'ixr��iwr...r.,u[Aa��.<:Yor '!'''!l.;.,rrJ..r�. ,rJ:.:x:.Lray xncx.,�.i sevr�r rnw�cs U � - —i--"-- - or.i!aitr,.:�j:;Wrtdcr.:'uSl.S.,. ..:,y..r..n:v:r.��:��n^:;�:..:m�[a � s�e=. ,;O�ss��-is[j ....1...�...�wo�.�r.� _�_'__.____ " _ sc�bjcc�s::��tf'tieFr:r t.i.e r.;. , .. , „ ....... __— !ru :K(:,�."7JYp • .. . � , ftG4.Sft4er .'s'US:Crd iJiUlrJ.: ' — _ �_�, Li i�8e.'i2l�'w:M'.:Ji C3it(+':vye:P/W:7i? �'wui6�RYe4 � .;_.:... � � . . .. .,. . . — :i � .�c � :". . . . .. � xh:sernc.uz•a iH un��i;xx�cLed ar uf6c,re3 fo�..nz:t. .._.._._ . `. '.... � � .. _.- _,_ 1S!!s'. %1/h'+, e9+:s��:.;.ix:tr.3 Y9�cjeS:iof.., CctJs:'3;' "cwa- � fiMICtGT"3 i, c�ntd i..�iU,�OYS ":•12 G�.Oij R(� ,413 Y 'Lf . �rcpae•ay wTio BttcAG�ir i�n,re»u�;r':ar¢.ir;:„nd u;$'o daet xssch umrk 6i»:sslf�ravided iFx.':xs..9 impr�i4'L'f:IRId:F � � . sre i�nd 3v:s.»ra6e�'o:��fered f:;r:�,;�.[f, Finvn:vcr, aba � . - � �• . . b�::dirai: n.• im�rovayne!el ts so'Iu'turt.�,ir. JMB.y3GY rsj " ''� ___._,_,___ cati�plssran, S.nr nc5acv�Eisider w�id 'c.:nr tbc hurrlsu � , � � np'prnviwx ti�af bc did eot BaiC:t r,r.insJrone for:5� � � �_ � � _ .aiu+pnsv oj�a7e.;7 . .f , ,. . . .... ,. • , . .. •- , -- . ..-.. ... .. -------- .. 4.aa��sea,r;;t u;,der 5fi: .�..._..,...._._..,__. � . ; .�.. $�Y�.�.ifsl':.�Ii.S t'�'i49i!:6.___._.._r..�._._.._ - .. . . .- '--- ..... .i�i�a4r._.__ .�.._._..+._-------- �r�,�.- -- - C�w;x�'��- --•--'------ ._..,.._.��_.�� .... ..... ....... � tE�iFECTOBK3�E6'fE5 ' ..�. .. . . � . .... ' .� - � . ... . , . . . �, .t � u•..-� • ,..,s_.�..�.-....,.--._._..._,.._.»......,:.. . • . . ., .�. .... �..,,,,:�-.......apr:....K..,.,,„.