Loading...
HomeMy WebLinkAbout1016A 1394A (5) WORKERS`COMPENSATION DECLARATIDN � � ���I�� � insurebor�o ce.�cate of Workers~Compens�'on Insorance'f APPLtCAT10N�f4R CQMBINATION SWtNtMING� PQOt PERMIT � or a mrti�led copy therevf(Sec.3800;La6.C.) � �snzoa -��-------- ��� - - � � - � �I���/[�� GE8�6�3/842 �P-o�7licy No.i��u+-e--�-u-ompany . GOUNTY OF LOS QNGELES .BUILDING AND SAFETY . � Certi£ied copy is hereby furrtished. � . � - , FOR APPIICANT TO FILL IN BUILDING Certified.mpy is filed with the counrr��xtvyy building inspec- ADDRESS� � , t//i��on�epartmeM. x�1�'\G1\\�� BUVfDING �f ��PP �-` �'�'�'� AooRE55�!O locat�iv Date A licont K NEnREST -�- CERTIFtCA7f OF EXEMPTION FROM WORKERS � ��TM � �P - �Q��" � - COMP€NSAAON INSURANCE (7� $�ZE OF ! '455ESSOR . TRACT �(] [07 WT t�. 1 hVtP 900K VAGE PAREEL (This a.cNnn n.«I wot 6e comptNod R tb�pwmit is for one � �Et. u5E zor� nviP + l, hundrad dotlers(ikQQ}er Isss.} �� . OWMER N6. Nb. `� '�`� 1 ceraify that in fhe performonce of the work tw which this - ��� . permit is issued,I shall nol employ any person irt any monner noDRE55 CON�RiONS so as fo-6emme subjed to the Workers'Compenwtion LawS. DISTRICf STqTISTI�AL Clq55 , TYPE PRQCE D BY GTY ZIP Date Applicant . ARCHITEGf - — � TEt. �.((�.f�� ���.2 N4FICE TO APPUCANT: If, ofter making this Certificate of E�'��� � `�`�' "�`� ,� � '^"-'� � Exemption, you sho�ld become suhieu m the Wo�kera' � y�pqnpg " ' � - Compcnaotion pwvisions of the Labor Code,you-must forth- A�Eu ���.� --`� YALIDASlQN ith comply with such provisions or this permit.sholl be �� � � cj Q ��� ; #�3 deemed revoked. CONTRAC70 -NO. LICENSED CONTRAC70R5 DECL4RAFION ��� ���. fT �f n � q i Q - �i C���6 a �1 hereby offam fhot t om iicensed Lnder provisions of Chapter 4 � Y �d, f � . 1 (commenting witFi Setlion 7006)of Divislon 3 ot the Business ��n, �� .�- , t!a e +w�� : orui Rofess+ans Code,ond my Iicense is in fult force and effect ��R pF WOtiK - �� - - o - � Licanse Number Lic:CIo55St�� SWIMMING POQL � � hE`Z Si� � ( + •7 u 8�� j-;'~������ �p t a .7 4.fi 4� a -cono-oc�b�i � y Z-S'�a SPA � . _.. . ❑. . S4EiT. _.B�` Q�2 Jr Pi 7 � �f am exempt under Sec. D- � - B.B.P.C.for ihis reason �ta: .. . .. ElECTRIEAL � � - . ����� � � 9 � Steel 6 Conduit Bonding � �- (��,n_ �(�s$'b� d Si rwture - ' Conduits,Condutlors,€quipment Y��—N`n d` � z ' SWGLE FAM7LY � _ HOME OWNER-BUIIDER DECLARATlON �PLUMBiNG � � I hereby affirm thof 1 om exempf from Yhe Conhnttw's License � - -lpw for the followF�g reason(SetfiOn 7031.5,8usiness and P_T�aP � � � - Profession:Code): � - Gos System . (� � ,�� � � ,�(� - � � t,as owner of the prope�ty,will do the plumbing ond AntiSyphon r (�jp.J���t-�`��'�' electrim!work.1,or mp empioyees wiTh woges os their - . � ����� .. . - sate mmpensotion,or a lirensed cvMroctor witl do oll MECHANfCAI � / other work and the srrocWre is noi intended or offered / {or saie Section 7044 B8P Code. . " . . . C'7'1 . � ( ) Swimming Pool Heater- LK� - . . CONSTRUCTION LENDWG AGENCY �� 3 q�4 A I hereby offirm that there is a construction lending agency for AP7LKANF 7��. .. � �� � � . .3 the performonce of ihe work for which�his permi�is issoed _ . �pq�NT� pp. _ � � � (Sec.3097,Civ.C.). . Lender's Name . - ' •����a AODRE55 ,` ((�� _ _ _ .ti27550� . lender's Address ���(� � .('�'� . . � .G��&„8 7 V.C.f�S 1 S �mif fee \..J._� ... �cerfify ihat I hove read Ihis opptimtion ond stale Ihat the . . - above inEormation is mrred.I og�ee to comply with ol!COunfy -- . � ord'rnances and Srate laws relating to bailding, eledricol, - IasuonceFee- - � - mectwnica!and plumbing construc�ion,and hereby authorize Invesrigo�ion Fee . . - represe tatives of this County lo enter upon the above- � Towl Fee . menlione pPerty for inzpecfion porposes. � � - - -� �_� �-�Z�~� ( �graWre df AppNcant or Age.+t Dote -- SEE REVERSE FOR EXPLANATORY LANGUAGE r d� � � .• v �ro v � � • d m m � � � 'o 'ns N;:�' a� m 'vo.am avc ° OE- pw� o?�oy° � s �.� oo3po �oco.o � �� 3ti��jyuo= ;� � aoo-� ? o .c ^ � � °m � '�b w N r i N o m N„p � y'n 'a m d m U p,� m� (j � v.m, �b � °°� a�, �� ° N � 0 3vr-oso.'c o 3t o �-=`m o c � a � �.✓i'0 i c � '3.E n a c L= a.c� � 3'rs"'�- a � �ti � �°, a w3 "-O .c'L'%;p o „ o o E � � o m � y o y o �. c v N 3 E x � v"� o m ra �.,+r -..o'� a, ma� cM'o.� o ,,-o cd3a � � �, � °1 �v.;-C � S E�� E �= d in o y� E_�° o y-c m rr ' .a o ,,E � o 0 3 �, � o.o'� • ,� o� 5 m S . v v o j"° c . 'v io'°v c'v.u W Q "•-„m,�. � = � o a m m � a o ; a� a� � „ >o v � •� o e= p V n Q °' o '� `m�'c c o ` c m� �'^ ° o cE,�-a ,.�°.,o o °� o � �ai � � a� oa o.Q a.E m °� a� � ° avoc ° .a•o �' oo . w _ x 3a � ,o a�r p E o o a`o v �'v � � � c -o ��m °-a � . � � ,,0eua� oo � �r. � U_ wc � c o � o o � odvao-° '..�ooamo3 ,ii OE,oNNa„ 43cy �oo Qma�N °3o� Ev�m :��� �' o� c � a� � c�'j ? ° o o �T��,o ° •'-" �� � � E c o o b a� o� -�' °c c m ° � c O oW. m -�Ty " � �:. •�smu°_a , u° = '� oaE � o ov ° a� oo � � a _ � oi, c m x � o c a, `o c� Zt,,.`:'.:' _ 2o � eoa "am y °' ' �'_ � t �?ro � �, � "waa� ; , a z 3 ° ' h �- �"'wv o a.. c ° c Q Qo.3 m � m c-: � m c 3 E aEi E�� a E � � Ld -` 3 �, a odoo.aa•�?� o � a 3i x �s." � > °-" .' o � �`�� o • a, m o o - � ._, � „ Q �, � � �3•'c a c e,c N c.�°' o u c h,� �v c o� � �-�,o a� o= m N N � � E 0 o a a .` m onv ° �.o.`nv ° � � � h h � c � oL 3�v c-o a, o 0 �. � N '" p�� `u o .o �-- auNd a�.c � `w ° m.:. � a . o - a�'p� � m d P �N w �n � �❑ v � �v° o �' m 'y ° w o�}..�� �-''° °'�j � � L� � �� � � om ��000 °r � o �.`�c ° o °w� ��-ou� o'� ?� ° o --:�m o o-E u�n ., � u� 3 m _, a.c >..a q, ._ 3 � o � . s%` � . i . ,.',J . � . '�, — ' . .� ...+ . � ` x:w ' `�. � .. �..,..� � .. � i _ �* � f � r � � : ., � �, , ' � ��� .. J ,i �,� � � � , O � �� .,j_ �' f Z t. ,,' N . �- y t!.. . � �� � � N ii+. . . . . " 6 N ' / ! z �ti � � �, - �`.. J , j" ' r j) �. : , ' •' '.' . ♦ � �.- .i �� ' . V ` '� r .� _ .^ . � , , _ .. � �� .d�„- � ; 1. �.� � . � , O O � a ; °c � � � � � � � � ..:'...y � � � . . . ~ � . �..�� . . vb 0 . : o, ' 0 d ° �`~ Q oc _ n . � � ?+.i�� �k � 1 . � � . .f '0 �O 4 t � a - r ` J � a � {�� W 81.�:�,�� * Z= 'J 1t � O~ Z o�.0✓:!+ ' O � . �y, Q �J O W �c \l � . _ ` ." � L Q ' Z � S W W Z pC V M a � - C Z W N� �4, Z -�' � O {' = W ? 1 � � �y ? W �J ~ Q � � Q � F d � Z �y� . W � N •�r W � W W .�d Q d 1O� .W S I. = H F �- W Z F� .7 Q a Vl 0 �'. , �" �L � � J N � {O V CI � IWII � Q W 1WL G� OL LL L C� d d