Loading...
HomeMy WebLinkAboutNo Permit Number (3) 1'lO4KER5'C0:4"�FENSATION DEC�ltRATION II I here6y nf(irm that I havc a certificote C(cOnsenl 10 5e�, APPLICATION FOR BUILDING PERMIT '� insure,cr a cerlificale cf VJerkers'Compensiion Insurance,or a ce�rlied copy thr.reo��Sec.3600,�e6.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. Compony ❑ Y FOR APPLICANT TO FILL IN ACJDESS �I / �' G'� Cenilied ccpy is hereb (�rn�shed. � Cerfilied topy is��led with the coun�y buildinq insp�c- ^UILO:NG �^ µ� licn deperimem. AD�4E55 � !f/ (/'/ IOCALIN r �;FARCST ' Datc Applicanl CITV �j/l��/� ZI� CRO55 ST. 'V'��f Q. CERTIFICnTE OF EXEIAPTION FROM 1VORKERS' NO.C'CLDGS. A55'SSC2 COMPENSATION INSURANCE SIZE OF LpT NOV!CN LOT f IAAP GOOC PAGE PARCEL (This sec�ion need no1 be complered if the�ermit is for onc USE ZCrvE �.+nN r raacT Z t� / ocK �oT no. ho ' � — '� 3 hundred dollnrs(S100)ar less.) } TEL �/ qq 5�'EGAL d O'liNER � NO�'7�/I � CCNDITICNS I ceriify ihot in�hr.performance o(�he work fo�which Ihis � permit is iswed,I sholl no1 employ ony pe�sOn in any monner D�S�RiU G.OUP iYVE NRE PROCESSFO BY so as to b�come subject lo Ihe N/crkers'Compenso+icn Laws. �cee�ss � 2 CO�'�y�� Z04E � Do�e APplicanf CITY Z17 $IA�ICAL C1A551F CAiION '� API. COnDO. O NOIICE TO AFPIICANT: If, oirer mnking this Cerfi(icnle of ARCHIiFCTCR TEI. �y E.empi�on, you should 6ecome sublP�� �o the VJorkers' ENGiKFFR W NO. CLA55 NO. DwELL.UniiS o. H Compensation p�ovisions ef the Labor Code,you must ior�h- „G^:Ei; st•.•rEK�.+.ap � wilh comp�y w'Ih such pro�isions or this permil shall bc J TE� — deemed rr.voked. VALIDATION CO!JTRA�TCR /1/Y'J NO. eK. K',' IICENSED COYTRACTORS DECLARATIOY UC. � I hcrwby alf�rm+hai I am licnnsed under provisions of Choprr.r 9 ACD�E55 ti0. VALUATION (commencing with Sr.c�ion 7000�of Division 3 0l the 9usiness and LiC. Professlons Cede,and my Ilcensr,is in Full force and eilecl. Ciiv CLA55 5 5(l.F n(f '�O.CF NO.Of C�'ECK � License Numbe.r Lic Class Si7E G� . STC41E5 j FA�e!LIES O�F f�RN 5 ConlrOGlOr DO�e DFSCRIPTICN CF YJO4K ❑ _r�,�,�', ❑ AC'� � ... t,: .. 1 am e.empi from ihe licensing requirements cs I om a /O � �,� � ���� 'licensed erchiiect or a regis�ered prefessianal engineer „ /LTER � FINAL y� � ocfing in my professienal cepo:ily (Se�tion 7051, R� DATE . .DA!4 � �y, ,r, B�siness o�d PrcFess�one Code). uSE C� G� C=:'.OL FINAL ��� ����r Ex15iINGBIDG. /�')G.. ❑ BY _ Lic.or Reg.No. Doic nF.LiCAVT TEI. ' ' `� ' . � O\VNER-OUILD'_R CEClA2ATICN �����T� ��' I here6y affirm iha�I om e�empr f�om ehc Con+raaor's l�cense � . law for ihe foltowing reoson(Seuion 70�1.5,�usiness end pCD�E55 Prcfessio�s Cede): i5tv; . � . . . 3UILD'Ir'3 � , .-:i _C: I, os owner of Ihr properry, or my empl0yer.s with ACD5F55 woges as!heir scle ccmpensr.tion,will do ihe work ond �p�ALITY � the etruc�ure is not intended o�o1lered for sole�Seciicn 704d,6usine!s ond Profrssions Code). h�OVING TEI. � � I,os owner of the�rOperly,am e�clusively co�lraclin� �ONT4ACTO4 NO. � � with lice,nsed centroc�ors lo mns�ruct ihe p�oject(Sec- qCC.E55 . rion 70=a.8us�ness and Pro(r.ss�ons Code�. CONSTRUCTION IENDING.4GFNCY ftEUUi:FU yn�D HVfY TOfAI SEIfiACK FRO'A ExIST. ' SEI P.ACK GPCP IIN� 1VID7H I hereby affirm ihot there is a convrudian Iending o,ency for FkUNi ihe perfo�monce ol the work for which this perm�t is issurtd v L � (Sec.3097,Civ.C.). sioe v,i. \ lender's Name Lender's Address P.C.fes 5 Pcrmil Fne � I ce�iify thot I have reod fh�s applicntion and staie ihat thr. iss� rn ven �� � ebove In(ormotlon is conecl.I nqree�o comply with nll County �,,,,ps„�a,,o�Fee n� �'7' �- �rd��onces or+d Sroie la��s r=lai�ng io b�ildinq construc��o�, ic�ai Frc �/• S � and hereby au�hcri:e rr.prnsr.niaiives of th�s Coun+y io eni�r upon ih obo•�-n .ntionr,d p•�erw -._sp=U�on urposes. � � � SFE REVERSE FOR EXPLANATORY IANGUAGE $�Uno�.re 'AFF��conl o p•nt •��/� �� q� Gf�iJ /.� � �e� • � %- o 0 ��� �. . � : � '� � c ^T o ; � � a o � nv �n- `- `� � ✓ � ' r o �, o o a o Q � 7 n, y:� 4't � v0 ,�r,J' '^ Z�'. Q x• O n Q � !; a � C :�i r". � 0 :�-` 4 O 3 n c N q �f�.'�� SS 7 �a p� r' ? 'ry L� . +p r„ '^ p c -�-�U : p ',^.� � 'o ► �c , • r � � a er � U fi' y u ° a <, o � p ... (�S � ` `� 3 / o F7 v � ct n ✓� � Z r. ? � v� �C �� ;i �o � ��o � � � ` �� o � -� ' �,f7 % !',,,,C 7 ��-" P �ar,. � � ' 'p � 7 Lo�� f� .O p �' �' it�-„ P� .�. y�U -^ -c 3 � ° G: .t -;� . ° � p O tF ' O ;7 D �p � C • � �:r. 7 • � r s, �' i:-1 (� � �• �1�� �fi i.. .�'�� O �.r'. fr rl ✓ ,' G G� }C ' Q O �t O r � ' �• � � � ' o� � ' �, y / ! � ro � : ; �m � : � y i � op � o / L', � e� ; a � � G� ' ��� w . . 6 r Ly P � C � � � f . � S . a � A . • N . � •f' 0 � , � N ,� ,.. r,,r �y a N n T � � t��� U �C �� F.3 �l� y � [. ' � C �.N..f rJ .+�L^G'}� �`;r!y �"t~.'�"J t' N N '.�Q/� v L.-' = M• H N 17 u � �C O 1n r. .s �P �p�T, e-K n c a ^ �� a � �:�,� �,o t-�.F a M ^_-7. �y �M' A� rl� �� � " x ° N c p +� ^ ,,,, n ' M N ., ` j ..- C .p. ." ..s"i£ � _ 3�0...' n �� M p; t sv � :•`=•« v.c� :'�.� �r a o � shN..M _� o �? a �.�n��i.,� O,� �=•.: MC� ^N ^ '^ T� G N � �S� H`-�•C ': N � 'u� � O „N � ' � C '^ Q �• G a � ^ � � G O O C•`C,� C b��p '-. .a.�� y O e' H L'n « o O 7 C� � a N,..._ = v, 7 � �`r:. «.c• � e' � �r:. ^ c ^`� ''' =2 � C��`��` � Cl � �.� �^ � � ' o v� . � 1 w � � «.: o a .-� % t c` NYu'� �o" � x°•:Qc �� 3e G ::r�^o,-`� '= � �,�.�,r'.,' �'`'�"' -,�-.t ' - ..., " ,� 3 N � :� x �?�`-4- oc M.'��w f1c-7 o e�.° ''�'y � " ° �+`av n • � � ;� �c � n n t�C:.�n � � i..� q o ._�^, G'1��'n�.':�.�"' N "':+ i C. ii n""'�'Y N�9 0. C��N O" � O O � � N : C H�'O i; ��" „_'h'•p a � N ;� � o °'i�.°� o c..F. C t--� F'� "+o �{ �. " ' a ? � � "" ? ..? m U' `�`' o z 'o ^ w� � c� M�,� r. f ° ' �' V+p „ ? x' �-. � S•► a n n n `-� c r n� o �` ' ° 'a f1°'s 3 �'� ��-[. = C�::S O � �, O �'' -�-r n° n c " &.,s::n c ° o a'< c"-,� .e�a r.« �. a n � � a�� � � � O C N � X i�^``,ea C'.J .. O A C''O e� t"Y p ti-'„' �.' � ' �: N �y s^_.� � ,.•�. G-' s"F. : i. %y 3 N 4 ` �""yy�`"=� ^`r U a. � * �„�t � ^ 9 »-.r F'n � �, r, � o� Z t`� �' � � C � � �4 T."� C i-p � GW i^ t+wi q y r �,..L' i U O � � C~+'=��� '� �.C..`'^ Z -t N�L N C �-�•�n �L-- - .. N O - 1 ��� � J V....�..� � =O M�� F N Op �� y^p ^�. C�_.tN.u� ti � m c `.; o �o -.c �s cF �� xnoo4-`r-v ,�', '^ � .. �^ v � � " � n o r r1a ?? ..:."'N y�3.�"' ... :.�ti L^ .. � o c 3 c L�r,... n 't t'' �' �+.C+` �.i � � � �- C C � ti C r _ n` c �.� � '. T ��� �• 'u� r