Loading...
HomeMy WebLinkAbout1746A . • �, WORKERS'CO'J!FENSATION DFCLARAiION ... ........ .. . . .. _ . . . ... . . . . . � ' I � " APPLICATION FOR �I'�DINC PERMIT � ` .1 hereby afiirri thot I have a,cenHfco�e of consem to se�f_ . ..._ _...... � � .im��e;or o ter�llica!e o�Wo�ke+i Compensii�n Insurance,cr a ce�rr�ad copy rhereof(sec.3800,tob.C.). ., COUNTV OF l05 ANGELES- BUILDING AND SAFETY Pplity No. Company �.� BWLC:NG � � a� Certiliad copy is hereby furnlahed:� �� - -� � FOR APPLICANT TO FIIL IN !•^DRE55 ��S •.�"��-�"��L � ' � nCenified copy�s Cled wi!h the ccuniy building inspec- BU'IDING � t _ � 1 !� ��on depa�irner+r. ' � ' ' a�oaE55' S C �MA LOCALITV `+li^..-��1 47rr �.� �• �. • �, . . . .. � NEARfST ` �• 7 1 . . . .�Do�e � � Applimm ' -� - Ciiv� WiV� - ��2�v � Crt05557 CsJi�;, ,�7 ' ��� CERTIFICATE OF EXEMPiION FROM WORKERS' � NO.OF BLDGS. ' A��+' ' �•� � '� " COM�ENSATION INSURANCf � � �� � SIZE OF LOT . .. . NpW pN lpT . MAY PAGE PARCEL I � �(Thii seciion'need no�be�romp9e�Gd if the pMmif is fp one 1RACi.3� /.� BLp[K LOT NO � U�� / . �P r�-(i-„���s' � hundred dollars(5�00)a lect.l • � �i SpECin� „ y I I cert�fy�fwl�n the periormonce of�he work(or.wnich�his.,_ _ O'r.'NER �f� ►r' NO ��0��� f01'�1ilON5 Q permit�5 issued,I sholl nol employ any pprson in any manner qppRE55 � �C���� 7�- D!STkKi GROUo Cv�'r FZ� GR')OCESSF.D BY � ' so os�o become su6ject to Ihe Wev�k�n'Com� nwtion Laws. . .V� �� �3 % -��- �f � . - ( i � I! V acal�/ � • " � .. �'• / CITY�\��Y�� ' 9aie � RpPlicanl �� �- • .� Z'P S7AflSi!CAlCLA551HCAl�ON � AVT. CONDO. W 'NOTICE TO A ICANT: If, efre��maling el+�s Cen icMe of- .. . ''��U�i� ' -'-'. ... ..- . . i�..... - �� .. _. � �f�emp+ion,�yo� ahoub become aubjet� b �he Workers' �+INEER �� CLASS NO�DWELL.UNtt$ y ' Compr�sn��on p.p.��s:ons of tha IaMr Codr,You+nust forth- ' ���� . . . . . . . . S�Wxo MAn Z , .wi�h wmply w:�h sueh prov�rona or thia permit shall be , . deemed reuoked. � . . , . ... . �OMRACiqt K] iEL. .� �. �. YALIDATION - LKfNSED fONIRAGLQRS.,JD�EGIARATION '/��{,�'., ir[.. • . I heraby nH�rm thot I am IICMSld V.ryc1{�lOY�LQS�S O��+.ypllf G. ' AOURt,1S .S'�S . {�Nl�,`' - NO ' � � V VAlUAT10N � � ,(commr.ncing w�th SecGon 7W0)o�Diwslon 3 of ihn Buainesy ond �K. . � , Aofessiom CoQe,and my I:�nse is�n iull force and effec�. ,,, , � 7V ' C�'2 f !7 P � , yn Fl NO.p NO.O� CMECK � :�}tcaMe�Numbe.��__Lic.Cfoss�T_�� � �� Z�� SiOrtRs vauu�ES ,�^ i , J ��� � NFW �. f I ��ConrraUor��MAR#.S� ..- �(s�.n..�e 5/1"/iT'L .. OESCR�Pi1ON OF WORK . ,.. . ❑ � . � ' I am eRbmP�i�m�rhe li 'roi u q �r�� . >>iCT •L�A� A� / ��❑ ,tC o8ce yireman�j 03�am o � Si . . . Ilcensed ar�iieci or a reB�s�a�ed professional ertginRr, ... . . . .. .. . . AIiFR � FlNAI /� .� �ad'yg in �`y profest�CFa� coDaS�t.Y (Seclion 7Q51. ' REauR O DATE �� � � � B�sinesf ond RO�ssiona Code). �� !"I FINAI . j &OG. l.] gY ,'1, Lic or Reg.No.��_Oa�e���. � . . .. lEl . . r� �,•,.(,n ; . _ . owra�e-�cmoee o�einan„oro�- � - �n — 3 6 /h( �(j(� ' I hereby a�f�rm+Iw�I cm e.empi from rhe Co�hocror's l�ce�e � � lS/Oa , `6� '` �('��`��J:... • . •,� � 1ow for rha Fo.Uawiag�easnn(�euion 7�p(i�.5.8�si4ess o�d r Rofessions Cada}� � . A a t IF_ , ff��eZ�W� � � • �j.',�,;j ' ..fl �1, as owner oi ifie�P�aPe�Y. cx my�emp�oyEes w��h-. ' .f�DPREDS�S -. . . � � ^ __ _ I woges as�heir soie compensaaon.wJl do�he+.w4 ond . �-�.�-'� `':: !.-',�; . .- . . rhe orucr6*e y�o�imended o�offSredfor svle(SettiOn �A`' , . � � ' . . 7044,B�tinefs o�Raiesaions Coda). iEt. Q:i.�.��-�G .. I,os owner o4 the properry,om eRclvyirely cprnrvc�mg �� � � ' �� w��h licansed connanon io mnatruc��he Pojan(Sec- .. . � . _ .... �w��7W�k 8u��nen ond?rofs�siom Codei � - a �u .- . . � CONSTRUCl,�MV IENDING AGENCY . �,Bpa yqRp f�wr TOTA���IVHAC�FROM W fH , �I hereby oifvm�ha ihero n-a construcnon lend.�ugeeqY fa ' FR(YJ�' ... . . . ihe pe�formonce oi r6e woh for which rhig perm�i�s�ssued v t • � e _ ISec.'3097.Civ.C.). . . .. . . . ._._ � . . . . . . . P�i. Lender's Name _ . . . . . .. . . .. ,... � . .. . . . � , ' P E.Fee S iPrmii F�. ,:Z�. � , Lender's Addrass , _ . . .. . . . . �� I ce.Gfy rha�I haae read rhis applicallon and s+o�e rho�rhe issua��e Fae p-s� � • , } i � above iaformp�pn�s mrrqtl.1 agree lo comply wilh OII COun!Y�. .. � .. . . . . . . . .- - � � ordlnonces and SW�e laws reln�i�g�o bu�ld�nq co�strucfion, Tr.��l F� ✓'f• SQ . . . ', � 6nd hereby a hori:e represen�a��.en oF thls Coun!y Io en�er .. . . . .. . . . .. � ' y�eTM�g a v .men�ie�'$roD�M.!Y Sor inipe�rion purposes. �. . , � , < ' � ' � �• �' ' ' � � SEE REYERSE FOR EX►IAHATORY L UAGE 4p�o�ure o�App��roM � � ro • . . • ' ' � . _.. .�. .., .. . �_ ..AN6 . . .... .. . . . . . . . . . . . , I �. . . .... . . . .. . , _. . . .. . . ._. . . . ,_.... � � �•'�� `'�1 _ _ - � ,.. _, _. l ._- . 1 ; .1 1 a � ^ � T �.<: C.'� 1'�' .. ' .. . r� C [)� � `.:• � 1: . 1,, � " c��' � '^ �' �j,•.' ° C n ,� `' �O r - _ - {.r,' � Q n � ^ L�� Q A � � . _/.;Q . ��__ .+ .. r % � .:�� V O�� ,' � � i• � D •1 'j Q �� T � . � • � �'' o `r�.� ' � �� c , G .3 n .1 c �' i ', ` � � rn „ n' ��� c`°�� •.. o �zM : y ? � v -. r�.. [ r c � � � c. c: c zs �i J , i: c� �. ''•, , _l ' ) { ,,,..� 112 T c T? � t: � � 'S ��' �= 7- <i C� O � p ,.i n . , �� V. ��� � C ��, ? �O � . v s' � �7 O . . , ' � �, ^ 'r'�n rn :,-{ % _ '� ,� C: � ,1 < �'� ' 'l Q •a ry� .ri, �(1 4 � � N . �• ;' � ,S' � , •�c C o � � � •:' -i� i . ^ - -n' •� -�1 �t , ` . �j �C� C-,• � O ! '� 6, � ` � c � i � �^ y y p r �� - 1 ; n ' �� ', � .t� m T, ,, 1 `� . . . 1 h � '` r+ �i , t� , _i '4�O ' \. ^j'1 � . ���� ' 11 _-�-�'�� � � '� ,' � ` `� � �— . . ' _ !1�1 tv 1 �, 9 � , _. � � .� q U . '; i . ��t.N ' • � ' � +- � .1 0. ,1' t �I:� . • . ' C i• . ,,. U ` ; F� `. ,� '�`� • ,� ' �__'-1 � �1 . p �' � ' � , ' ','r _ 1 1 t 1' , ,�,4 _ . � ��� • 1 . } , �, • �- = ' . �1 1 �. . , . . . ' 4 ' r� �- �- � .. , i: s` • .. :1 ri 1 _ .1 1 �.. _ . � I . '/ , t � � ' '�" � 1 , ` t _ � � �, � /� ' � ' . . �` C__ � `L � O . ' . ', `' _ �'11 T`;r` 15• 1 � �n • ' 1 ` . . . - � . ', i , � �t . . ,`, }' 1 ' • _ '" . , . ' l: ' �� . � . ', . =,, ';�, _ \`' . ;, ;'v '! . , A . i `1 '4 1 - . + . !r -�`� .1 , � . 1 •t 1 ' - . . '� � 1 1� � ' .. ` �� �:, � . , r,� 1 ' � ► . � . : ,. . � . w � :, �.���a:_,� � . : • . + ^n^•f^ ^ n. f N •- '� � . •� �`i. c ia �'1 1'c.:.�.�.�"�N_��:�,y'� �, r K 0 � . ' . . .. T J /� G N n _ w��^'= _ �, s. T: R ^j • '; 'J O'� ��p cY.¢y C r ,e r `C"wN...Y4bT� ...�. �� ���r�.�^ ry �f, f� . �.. ' e� V .�. t,^,� e �' R.x+-� n �n �^� �n �'^T. .��F �-��^ �.�.. � r � D p� �i y �, y`.,� r �v' f' .S N 3 .. 3 ... C `� F 7 .+�...� 1 • ' O � V� a�y��a _-v-�, i 7 e� a ?�� r, o �.�-,.'...�-..,,� � � ...: � � ' � O N • . 1 w n �� i ..�^' vr a' �w �N.-• � � C C �^��� G N�r w �. e. � � N„Y = �-n, '�3 a . ^ � ti,� � ^ -t _ ��r K � =:r. ,.. 6 �^ p x ,� � � r' � ' ' C �' �.: 'i tn'� C r. � �� O'V. �t...` Y p �• N'�'t�'' � y�� n �. . , � '. �' .� � � N ,x,�Ay �w.� . F ^'Q Y . i�'p c: m �' .-n..+._y �„ �.a� .r'.. .� .M S C �' �� i• � O'� % n '+ 'l'��w C�' .i �6 N , :� . , tl ,� 4 t= :'. � 00 C �G,�. �� q'cb..C..T C�'! - t. .. c F L.�Y X (, � , "� " ^, � � 3a ya � � c � .. r.�.°-.''� "•�.'' _ ;; � C E '�/ • .� ,3'h � x �.C ��,�-a^ i�S..i �Aj� er�'-.'"'.o<.�� Cp«.F"y✓�'-� Zr '� � � " ...���A �� �', `�c ~ ] O =' A L..n. r� � ei C y��,r,"y^� .r'�Y, ti ...�.• " � Z � .�a � 9� '��� �3�<;• Wq�.� «'�.�x's ? c,;�•� � �.x,e 1^o=. "e. �-1' o : y . 1/� -. A y M�N" , }• i' � Z'' ,O� a:f^ O ��"....�L': .�. .�. N 4 A .- 7 S ►� .�• •O . . .., - yG L,y s O C..6' �t.' A � 3 '^ =w � `�i � � A �;A n: �� � � { ~~�q ('��;,.3 F-w n S..'^ i�. •?.r O � �n�+ 0. .' J ' • � . . � � p' F�'�n� n � x�.ta.��3 i o.0`� ^^= �.^..'e.� ^��` i_i, :. �_� �'!. g '�� s ' g u `' p" -.3 c a = R ^�a°...^ � �•v•�� {^.�' S,� »t+-x�i��t �, r c �'� " Z , "�� �.�•.n �� '�"' j,� +� 7i'!i O `�- a � l n'� r .��' n - r'p t�1� '�. • • p ; � { � =.- .5i � a t,;i'. •��4.� a��:,��� � �"^.�:�S'. . `�, u� . .� ���?.�'v``. �Xa, c� �" �N v'r. � c.r+n�T �:`"." � N 'N �'�� ^ t% � �" L � G w�'^ C � 7 � . �'^ O -e `'�-t p ��S ^�.� � �:O O f.�r���" �. i � . .� � . . °~ °° �, � '� �_ ^ � ;: „ .. � . -- . n s �.� = r � � � ��o�' � a',�. f �1i . . , � �, � �� ���' •��,] • ,t ;�� 3..�t n N !1 _ . T � � ' r 1• ! �� � . '