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HomeMy WebLinkAbout1359A 1835A , _ � :- _.._>_ 4 WORKERS'COMPENSATION.DECLARATI4N - - - . .... .. _ .-_. .. -_. -rt` - � - . ��...' ___ insure��rao;cerfif��e7•e4�f�lNorke�srtEompensatioolnsumncef" - - � _-. AP���A�IQN_FQR C4l�81NkTtOM SWlMAI[!NG FOOL PERMIT� or a cerfifeed capy ihereaf(Sec.3800,-Lab..C,) ..- � 76a2oB �--�. -' .- .. .. � I , ���ry� �J �� �u N� GESl6 S3/841 PolicV�N��t�J�,y�����Y v�t4 .. Ct3UAiTY OF�OS ANS'rElES -_ ..__BUlEOU+IG A[+IQ SAf€TY ---__._--, � Certif ed copy is here6y furnished � �- `-� _� - --_ . -- .. . . ..Certified c 4s�f�fed w�ih�ihe coun buiW' +n�. -�QR�1P��[��ftdl�Q ft�L-�1 '.-� - BWLDlNG ..-/�-� �- � • .. ..- . - opY !Y_. � sPec' ._.. _ _,_ __- ADDRE55 � V�J -� F�C!�,}.. �.lion department:� . ... . ., �.-: BUlLDING � . - . .. .� aooRcss 4 b .0 (ri .s�•[ iacaurr [�I --1 K• � Da�e�/uiPi'rco � . G . � CITY .ZlP �AREST �CERFtftCRTEOF"EXEMPiIONFROMWORF�RY� -�- - - 7 CROSSst'�. - � ��-- -CQMPENSATIOPI-INSURAMCE y�+ SrZEOF qS5�55pR - - � 7F1is NC/ip�1 1fi�d Iro}jy��q 7RACf ia�� � LO7 FOi NO. MAP BOOK PAGE GARCEL [ plef�d H}[�parmff is Eoi on� rA ha�rad ddbn(fTW�yer Iess.J- -- . . . .. own�R!`• i C H�.ti �!. _� usf zor� � .. ,�3„3� .. 1 cenity ffiat in the perfwmance-of the work for wFith ihh � - SPEGAt - permit is issued,i shafl nof employ any person in a�y mpnner ADDRE55 - - ��� CONDI7ION5 � -�-so,as to become su6jecf to fhe Wo�keri Compensafion Lowa �- �` � � DISTRiR STRSfSi1CM1l CLA55- - 1YPE PROCESSED BY - C17Y /— DP ( � �� ����. � CONST. . �Date Applicam ... ARCHfiECf OR -� 7EL. 7/ ' ! NOTICE TO AVPtICANT� ff, after moking ehis Cert�fimre of E���R '4� � � � Exemptian, you Should become wbjecf to the Workers' - VALUATION . � Compensafion provisians of the Labor Cade,you�must.forth- R��� �� (� ; with rompty with such provisions or this permit shall be �t�A� � ThEpL. ���� s i7 YA1WASi0# � deemed revoked. � . . V I - FICENSED COMRACTORS DECLARATION- � E�� . Iherebyaffirmtknt.t.amlicensedureder�prevrsiomafthapter9 ADURE55 �O NO. - � . .. , . . (commencing wlth$ecfian 7060)of Division 3 of the 8usiness - �� ��' �� '� ' S � � . . � - � - � ond Prafessions Code,ard my�license is en fuii fwce and affect ��n . .. �ffJ.�{L"3G -_-� WORK F�iAt � . liceme Number������' C�ass ��1��� . QATE ► . � !�il 5,9 E{ �: sw�nnnwc roar Con1.o��oC��NTtl/ZS+ x!f��� ����f �'" � F�Nwi #•• a •�7 g o �.� s� E am ezemp/under$eC. - 5�� F • •�E.�'J �` - 8.8P.C.for this reoson �� .. ..... . . _.-. ti , � a � . ELECFRlCAI - a.o e..G c.'�t, be�e: � W -9 Steel 8 Condui�Bundir�g �- ..�y� Q� (i Q G�-�-� d � Si naNre � �� � Co�uits,Conducton.Equipment � z - -SI FAM{LY - �J . HOME OW - 7LDER AECtARATIpN PLUMBING .. o(,5��y � . � - i hereby offitm thot 1 .exempl from Ihe Contmctm's License �9 ' , . � -�� Law fo.the following reason(Sechon 70.3t.5,�Bosiness and P.T�aP r-�t n�� ► � Professions Code): - . Gos 5 stem � � . ..�.. - . - . � �c � I,os owner of Ihe property,wiFl do the piumbing and Artfi-Syphon �1 �J.v A elechim[work.1,or my empbyees witb wages as their . . � - T+ •�• �c3 sole compensotion,or a lice sed ca t actw wilt do all MECHANICAL � other work and the strudure Es not mtended or offered ... .. . _ � /� � � � ' � t Q��,5(�' for wte(Setfion 7044 B&P CoBe)- � -�- - Swimming Pool Heater + � CONSTRUCTtON LEND(NG AGENtY �- �i �����0� I hereby aHirm thei fhere is a construUion lending ogenq fa pPP41�T �, -�J � . �9'��.,_�� the pedormance of rhe work for which this permir ia issued (PR�M) Y 'C NQ- - s�5' .� � �Sec 3097,Civ.C.). p . . . . lender's Name � A��REu 'C y � lender'S Address � ��-ry . pQ � . P.G Fee f �74p ��� Permii Fee �I - � �cerfify Shos 1 hove read this appficoiion qnd stote thot fhe . . above irrfwnwtion is correcF.1 agrteYo comply wiitr oll CovntY . -f('J. ,j'v � � ardinonces�ond Sfa�e ws reMating ta building, etectrimi, �uuanc�Fee � mechanical and plu ing construction,and bereby authorize �^�������on Fee . �n O r� represent "es o �his C enter upon the o6ovB- - Towl Fee V J _ menti o ry fo � ' n purpozes. � _ --�=��6 �� u of ty,plKom«age�r pote SEE REYfRSE FOR EXiLANATORY IANGLIAGE � � �� y C ._� t� V N O O E� G�� Q d � d� O L � . C � '" "'•L N "� °� ;.�� � a-° , 3 �^ �� °'t.,o s �� m a U° a° � u Q . a c � t`o ;o $Y«o °'amvim � a°1io " „�' E � '" � si ?.�c� m c � a i A ^ � m v m c��� .c'L T 3 Y- o-c '- ;_ ° �� .��° � a °8 !i' � C� C O C C ZI O W � O'L Y O.��" tl � v~. �0� 'C ap . . �• � �,"' o u o 6 a�N�m o c :"_ � �-.�c m � 3 .c o 3 E x � m•.� ° m . h V�_� Ol C M .F N 0 � � E O O « � � ✓� '` m N� �'t � . 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