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HomeMy WebLinkAbout1213A �O ""°RK��`°"`,p�'T'°�o"',"Q°�,°'ti �PP�IEATIOtV FC?R Pl.UIUIBINC PERMlT � � I I-iereby affirm that 1 have a certiticate of cansent to self 76P.6e7A � � � j insure,or�q certifl4at@.a�Worke[5'.CQmpEnsatinn.lnsurance._ . �gF7(FtEy.;O/81).--- .. . .. - . .. . t . . _. . ,._._.- ...__._. _..__. _•___ --. . . . . or-a certified-coPY thereof�(Sac.380Q:tab.E.}- -.-.. . .....�.... . � ... .- �—.. GOUNTY pP tOS ANGELES BUILF}FHG AND SAFETY 5a � �rs�No. ��n� c t►c t7t n.� 3 Cerrified copy es here6y furn;shed: dl�-� � . . - . . . - WR APPlICAM TQ fltL ItJ(PRINT OR TYPE) - BUILDING.� R I e�tiHed��cepy-ufifedw�i6the-county..bviidi��inspac ADDRE55 a�- 1 �-� tiondepa�finent.� , t � �NUM66t fIxTUREORfTEM � � . . . . - I �`�."��- ir,ant � �/ .. .. C-C.�. lOC/iLIFY .. D�ta A�f' �`-l�-:��-� WATERCIOSET � � . . . . ---- NEAqESF � � - _,.._.. CERTIftCATE-t?F�£%ENIPTfO1V"FROAr�WORKERS` .._..._ ��--SATH�SUB. ,__._._ ___.----- - - -._�_.,,�:- CROSSSi.--- - - - f -, -+��i't ..--___._ . ..---- _- . --- --CQMFEFVSRTfONiNSURANCE �-- - � � .. _. . � (Ukas:sve+ioa uoad woe i.sowpl�►.d u N�s wxk inrotwA bY�:-- sNov�tEtt ' owr�Eiz � - - --- - - -.. - - --- ---- ----- --- -- - - _ . �� ihA pe�ait is iw�oe��undnd�alFars(S48@j or lais.) - � � M� _ - . EkVATORY <t_.ADQRESS-._ _ ._ .�l _ e ._�. ___.._. t eectify tiwt en i-he pevE+�mqntessf#he�+aerk-€�rM«#iieh t#ris -- _ -- --- - . ---... -. pB�rmif�s tstu�d,_Yshaltnotem�sto�on�rpe.so dny manner � "fy�- $t� :: l'�„� �-� CfTY �� f � � �p�p. - �. ._- So tts:lo l�eco�ne.-sub�ect ta tl�e Wwker�•C mpensation laws � DISt#WASHER .� . ��_y�� _ .. � :�.. .���_.� 1 ,. ._ . . -"' CONiRACT9R 'S'�.r�r `�. ... .... ___ - [ku}a- 'a��J 4ecKhrr.at .... - . _ . LLQTEgSYSpSFffii __ _ - . -. .� �CE 7Q APPIiCANT tf,-after muking Hr�s-Certifrcate of . . . �� a[7FSRE55 . -. .. _.-� a ptian. You�'should becpme sub(ect lo ibe-Wwkers' � S�M1`�lNGPQQtREEgPIOR. -_ - G�.�npenscftionprovisionsof'�hstohorCode`you�musf#orth- `�- - -- - - -� ��` --� ._. . �� � ��,,._. ' ... _ _ ��� � �� � o ' m �° " � a .c zt. ��� �,d M;O 0 �in O 3 ��'� b O[ �e � b D�.„ ,�C [.�C . . . ,. � .. , �, . ,J� . � p � ,m 0 � � C,D-w N,C-C O 11 Q w 7 O � - ' . , � , . . . . �*�y, p '�a � C � t C� O �' O ` '1 y.S p�1 C-4"m�,,,,,,�� . . . O .&,..�._ r � . �. , Z m �Yu0000E "' ° om"� r&^ ~ � c �,s�� Eem p '�- °,` '°' °.ocoo-°o oom3� � � o � t. .« , �. � OCU � ����`•N� '� N �.:L�O � O� � � OWO ' �' � ��T ° a. �'':C a � � > rm ',3mV o � o�moay � �7.. u Q Q°, Q � a>c � m �,� �,E `o �;� c o �5.0 � � 4 « ' _ o rn ..o ` `a o a... < a� °' o '�i� u"� m � m o � o Q m a n; o� o.. tY x �t L `o a �s o E a o „� a� .a u �.c �l� m c c W 3 0 � �y 4 �.,� x o o,� o--d� o a .q—m. c m� o E—° � " � `z3 � „ �a� ° �vd � ' �':cr �� d.^ o m 6� o � �,o �..i �Yl m m �= °1 o m ', m„��. � �°,. ..� '� o � � ... V n O.ir�w. t d ��•c k V O � '��c y p 'a 'O,C 01' m yl � w,.. _� d w`�:B � c o o °' a ati `m'o m'p , o� „= ° � ,r_� Z ' So 'E �-_n �o�� o4' ; c = o '" �im � ; a � s ' 3 " � a � >.a•--...�a a, a.� • a !' �...� ,�i•.,o a`i � Q. � _ O `o3c4y,�r`$m� o "v��,io,Wm „ � `o�-o `o E ,o � � a N „..`L a or. o �� ov�,� �� m� �Zs y.a�° K ' U i F` �� n m m ah'= o cv.Fv? = Cp ,•.'.n� 'e'vo o �� v a � ..ymv 'n •o��` � m � uz �t�c= - um�a"'��oma�� a�.. cp a 3 r tt �m� m o 'vEu°h �°� $v° �ti.° 3 3�E o °c — . m [� C� i,,_, � - �i:' , r-� � O � Z , a "� � � � a N a ' ..� 4.. ' . .r ..� ',..� . -�.� ..� .+�,4 _ . . � . Y 1' �,, . I ' � I � Q � a�r y , � Y�'�-.� . V1 " . e�U..}' � . y , . � " ..-��� . ...r � N. � - � . . 'O A-i k" , .s+. ', � Z �$ .• �-��' �� . .. . N _ V � � ' . ; � 1�..�, . . W � � � �I„ Q 0 a" 0 "C. It',:. . � . � O J � � II;� ' . , � . . ��.1 � � � . . ._. h ' � w � � W l� (�' - , . . I�, oYe � .. � aW' W �A \, . j O Z . � � o �, � �,1 In m S 2 . O `�'0 Q LL � . " Q u'S a a- Z q Z u~i � . �Q � i',,. . . . ' w � a � 3 m �-" J u�i�. � 0 � N N F- �Vl . . � Q ¢ Z� Z . - � o�c aV' � � a� U' � u. �.. � .