Loading...
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 „`°.....,