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HomeMy WebLinkAbout1277A 1278A ' I here W vm-h CO MPENa ceOificae ofcopenf� . .,. ..._.... ... ... _ . . . . .. ..., , ' .. , . '° � � i .APPL�CAT'I4N FOR -BUrLD1NG PERMIT � insW'e, o cert ic e of Workers'Compensa��on Insur ce, 3- 9Y`o te/Yifie c l reof(Sec:3B0O lob.C.) .. - - -- � .... , COUNTY OF LOS ANGELES.. BUILDING AND SAFETY •�Polic N ' , .�Company � � tifie o y hereby fum�shed. \FOR APPUCANT TO FILL IN �1LD1� a. ' AWRESS Ce tifie py s filed wifh the[ounty building inspec- eUItDING �tio de e f:�' ..... .. . .. . . AD�RE55 G . e:�... . Aqplicant [RY . .. '� . ZIF LOG�.LITV + � � � 'CERTIFICAT OFFJ(EMPTIONFROMWORKERS` - ..,...�... ......._ .._.._._....+,�a�e�etucs�:--�----------��---= WEAkFu-.._.... . : � � � � - C MPENSpiION INSURANCE-'.'..:-" ......�� SIZE OF l0T NOW ON LOT Qi055 ST. .."_-...._._._"_._____.'.:_..._..._—_..._._....._.—._......__.... ` (ihi aection ne nat�be�wmpleted it Ihe permit is for one �-' �-' -. .-- ---......------- ....------ ��� - . . . � � . .. . . .. . . ....... . hVf1 Bd do�� (f100)o�IeSs.)�: - � -�.� .. . iRACT BLOCK l0T'NO. /�qp BQq(' PAGE PARCEI - - . . TEL. �qpp I.tertify fhat in the perfo�mance of fhe work�for whith fhis OWNE � � �K'I 1 p�p.I� � � permll is iuucd,�shall nol emp(oy any person in ony manne� , qpDRE55� ���• v - CONDITIONS � . ... . ..... . � sa os-ro bacome subjed fo�he Workers'Compensulion Laws. V :. .: . nrv.� _..... _ zie_ ..G _. _. oe Dote .` .. .�Applicont. .. . ... . .� nRCHITECT � TEl . .O. ,,. NOTICE�TO APPLICAkT:-If, aNer�makiny ihis Certificote of ENGINEER � NO� ��. �J DISTRICT GROUP TYPE FIRE BY G j� emption, you should 6ecnme subjeet to-Ihe Wwkeri � 1 CONST. ZONE �,,,.�mpensotlonprovisions of the Lobor Code,yoo musl�forth• AppRE55 Z 4+ • # � �. �� wilh�comply with such pravisrons or:Ihls pe[mi!shoil be -- � �� � 7EL. ��� � 57ATISTICAI C �IFICt� AP7 CONDO.� Z daemad revoked,.,�' - �� � � . • . � � CONTRACTOR NO. �(�,( � �j� LICENSED CONTRACTORS PECL4RATIOFJ .` . . .LIC. -. ��:`L�� �.`-'IIwELL.UNtT51� 1 here6y affirm thqt 1 am IiqCns9d under provisio�s of Chopfer 9 ADDRE55 NO. � (commencirg with$ection 70D0�of Divisio�3 of the 6usinesi ond __.. _ ._ � . tIC.�� ��R� � �. Rofeasions Code,and my license is in full force ond effe¢. Ciir C�ass -�� � " � VAIIDATION � �" � � � SQ.Ff. NO.OF NO.OF CHECK - . licenae Number .. � � Lic.Class � SiZE S10RIE5 FAMILIE$ ONE - � � ._. ._. _. . . ._ .._. . , . _ VAfUAT10N _ . . .... DESCRIPf1ON OF WORK . . . �w . �GL'� ,�y�y-� � . Cqnlmcto�. . � Date � � � /,, � ❑ S 7.I :J�CJC:C_J � '..... .. �I nm exempt under Sec. .. . . . � `��L �.- � .. . AL1ER �� C�I.7 P B.BP.C.for this reason REPAIR s � . .. ._.. _. . . USEOF � :,..'.`.��.. , . _... ,�• • ! s� � . � ir.� EXISTINGBLDG. �� � c '� ' .. Si nat�rc �• APPIK'AN7 • i � TEL . Gn FINA� � I L J%.� � 9 PRINT VN w �Z 5 -J-� � NER-BUILDER C �nannoni . - /� -�/- - _.�. :_��i�'?. _ . ... , . . � 2 S�.t s s... 1 hereby oHhm ehat 1 am.eocempt a»tM Contrw.+o�"s License AD�RESS�_-7-� �.l� Y�i.�CU: E'` kJl�li1 '� � ., . tow fw the following raoson-(Settion 7031.5,Business and /<. - - �- FINA. ..,- ...'_ ".' .... • y''; -ProfessionsCode): . ._... ..__ _ ...._._....._... . _ PRE E _.B�.. .. . . . . �c.�C.��'"�56 � ,� BUILDING . . �� t, as owner of the property, or my employees with qppRF55 ,.___ ' _ s� C�,O_A , wpges as their sole compenaotion,will do Ihe work 6nd .'...' _�.-._, _.,..---,_...._-----'---..._..__._,.,----._....'.--- .... ,... .. .,.., � �- �� ',. - l � tocaurv � � p. .. . . 1 � rhe structure is not intendad or offered fw wle Seclion � 70M.Bu7inex�aMl�?rOfesaione fode) _... _ MOVING � TEL 2.�2�x�� Q 1,as ownar of the m CONTRAC70R NO. _. , � - , P P�Y,am ezclusively coniraUing .....- ` - . � �... with ticenud eontracron to eonshue�rhff�poien(Sac-- . _. ,. . ....._ ,_ .. . .,,.__.. ... _ ,.... _ .__ _._ . � . AD�RE55 '. ..�.. .. ' .G C�O O o tion 7044,Busineu and Professions Codej. � '� _ � � �- ----"�""ZONSTRUCTION LENDING AGENCY - �gpcK vaco HWV � "7OT p�pp.iiNE wimH� �� �� ��� � (Z.L 2-S f5 _ I hereby affirm that ihere is o construction lendinq ogency for p�� - � � � 1he performance of ihe work fw which fhis permil is isaued � P.L.- � (Sec.3097,Civ.C.). SIDE �- � ' P.L. . . . . . ' Lender's Noma (y�� , eT �pAdq Ref.N � ' � � 0 �ender's Address -� P.e.fe �� Permit fee d« ��J � ' . > {j'� I cenify thar I.have+ead this opplimfion.und Sfpfe iFMt.ihe tu�ance Fee �JV• ���P�f M / a o6ove infpmation is correci.I agrea to comply with oil Counry �f� /�/ . � g prdinantes and State lam�el.atinp eo buildiny,con;truction. _. /v ro�.� � ,1�.� ��P�m:� . � . � and hereby awhwize representa�ives of this Counry ro eMer � upon t e obove-me ioned property for inspection p�rposes. , . 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