HomeMy WebLinkAbout1359A 1835A (7) , _
� :- _.._>_
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 � �
��
m
. p ;S J
, q.0 /�j`.
� G v � ,`pY � .
` C�« O O =6 V O ...
y � O E O � �p_Q � a M U' �'l� .
�p O.y. �... �d�
, 'O L� d' �-�p� ,C.� C > � �U t � �' _
t in N C � � 3 � M1 u 'j '^ j N s t > 'in y L� �'D d a
O'P.•-
m; m o '� o_� �s ,;N� E ,� 3 _ ° � :,�- ,m o ar w
����Nr�,.� ; -O y 4 � . y o d . pt O�p�:' � K v�ci.cL C .Y � . .
=- oY„oa+amv, m.c r;�os.xa"' o3 � m �,�,�o ? d p
� O p ui� �n C � -G D � L'O v� G � u ' .
:An>m o m o c c�° ° '" .��.. Es°�o =3'o m,� v-`oo o.;°�'n o ,n .
o � a - ' o
o " n� `�'' ��E MD ° �D r� � a p� .�->o d ���.Sn 2"`� °;`�o o " O
._s�« U �u y a p �- �c ° ° �+ £ � m o.'" Q m �.,o m a a�u� N C U
Zs .oQNm � w�> °1_ ° 3m�od °"� o � L a��9o+° ,°� m 3 y .
O`rQ �o �E � o+.o'm � i,E � =o o d m�° m v °-o '-�°"o �'c.ab"-� N °, N -? O Z
. � O � 'T�'_ r- 'R..'d L Q d.- 0-d O O ?�L j_N E L t s O O� N O p u ¢ .
� � �r`-�... .c o �c 4. n' o � � c-6 V o ; o C p ,- v . o E
4,� fl"_,II'4.O d �t G d C C O- 6,"�O C C'O 0.._ � � �� d N'O fl-� N � % . .
A u� v� ° r. �V`, m° "" ° s � � � o o d� � o� .'c m t 3 E �'� m
. pC d o ° � a� n.3 0 � E c r � c m �, � ` .�--�m �y`p.,�-..7 � o = � � . '
V c�a i+ 6
�� Q �.N�� Q1 N� y�M Qf 41 V = � a) p 2 O Y �.G Q.� N y�L m.N ✓' 01 � . ' .
'� O p u �•p• C bl �L m ��a„ �C ✓' C G � �"y � 6 L O n'"��. �i� d� � � C� O d � .
� � d � cuca ,c�'��oo_'``� •` �'pot� � ` "o °'.."' u�o ,,,� s� o a
� � p 'S"'m T a'�. 6 � ,V Q Of �+>O� L O O C N t y N..- C N .C N O � d 0� O ,
� �, � ,� o aP �-ti
`� t � r¢�J$� G ° V ��- a� � o >rny � -61a� a.r o �,o3N .
ziE ;� o.00�'z;orad� oLC] a�,c3o,00a Tp '�.' = '"r. :
O � a-D o �+o.�{', c v r'^. , o r.n y � o E'� o-t
7.J N 4, 4 N� a 0 C � O O 7i j�p-� . ' � .. � .
� �"� �' �y C C V p p 0 V� � ..
. m N C� � Cl �CI O1 „.r
s � ' °' o �E��
1m �
... �.° ,� y .
' ' , �, °
. ` � . � r ��
�
Z , '
� • �y,
6 �
Z _ + �,
. ._ °.
,
:�.
� � . • :,.. . _, : i . -
� � .,, �
�,
'.; '
�
'�
� �'I
� ��
. � �
� � � � .
a '�u "�y✓ `, r`.
� . y
�� d . :", . �n - . �. - �,
Z �
t
�, , 5� .
, / n c" W
,• � �� �v �
Zm ° ��'` � t� 2 ' W
...• 4, t O y� --s'� t_,.._� ,`- t9 Z 0 �
� 'F �G� z j t j o: .�'i+ Z .
v ;
}i aa. o�t C' y �Q � ar ° W p o,
,!, � � j S j J K V p� J J M;
� � o z, � � � � T 1 a Q o- o.
� p 3 w � Q = u
�� Q .. a
� Z .) W � � W Y K � -
_ �, O, � Q � . � ,. C,. Z '^ U Z "L
W � � i- W W l7
.} � . � � �- � 7 ? ` � q W �' .
;� � Z o a�'e " a o � 'i a
' `. � u
\ Q W •v �
J� �
J
0
� r 2
,�i
„`°.....,