HomeMy WebLinkAbout1277A 1278A ' I here W vm-h CO MPENa ceOificae ofcopenf� . .,. ..._.... ... ... _ . . . . .. ..., , '
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'° � � 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. , . ' 7��'�„ .
/� _.. _ _
� , l 2-/�-8v 5EE REVFRSF fOR EXPtAN�ORY IANGUAGE��� �
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