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HomeMy WebLinkAbout1797A V�'ORKE45'COV.PEhSATION DECLARATION � , �=reby alfirm tha� � �av�a«�,;f;�a�e of�o�.e�„a.�,f qpp��CATION FOR BUILDING PERMIT insure,or a certili:a�e cf 1'lerkers'Cer�penstion Insurancr.,or a cnrfifi���opy thcrecf�5=c.?300,lob.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolityNo. Company � Ce�+�fied cepy�s hcreby turn�shed. FOR APPLICANT TO FILL IN �U!LDING � �� � Cr.rtified cepy is filed wiih thn coun!y 6uild�ng inspec. 9Vi�C�t:G •)/y} ^7Z� / (/p[`p �C�>CSS �b�� f�on deport�nent. � ACC+"E55 .�LLV /L {.��//�� ICCALITY SJ ,. �E�F(ST �� �r Daie �rpl�cam aTv ���D�/z ,a�r0 zia CeO555t. CERTIFICATE OF EXEh+.PTION iR01.1 LVORKERS' No.CF E�LCGS. n55E55C4 C04tFEN5�Ti0N INSURANCE SiZE OF LOT Noa�Oa�Ot l.`AP P.CCK PnGE PARCEI �This srclion need no�br compleled if�he permi�is for onn / i IU'.! a+.q: t� h�ndrr.d dollars(SI00)or less.) iRA�i ntGCK LCT n0. �1 NO. f d`�. ,� 1 r Q iEL S.FCiAI � a I ceriify that in the per(ormance oi ihe work for which ihis ���'��R �" -S�Q NO�q�-� 1-(� CCN�ITIGtiS Q r�il i5 i55ucd,I shall nol Pm IC n �'���+'CI GVCUP IYft F!RE f70CES�E��Y P^� � y y p^�son in any monner qppqE55 �� CONST. Ip��e V so es io Mcome sub'r.ct to ihe Worke�4 e�.r�sotien tq.ys. � C 3 �' n -�����.. urv `� ziP CZl � � '��c��i o Dnrr._ npplicam ry �lGf� :f/�IIpI!CALCLP55'FICAIiOY n�r. coti.�o. —I NOT� � AFPL CANT: If, n(ier moking rhis Crrtifico�n ol �RCHiTFCT C� iEl. w fze.T.p!ion, yoU shoutd becomr subjrCt 10 thC �YCrkerS' FM1(�!\�FR Np. CLASSNO. D':':ELLUNITS_ a Compensa��on p�ovisions o(the labor Ccde,you musf torth- y iih comply with such pro�isions or �h�s perm�t shnli l;r. �C:pE55 SEw:u:�n�� z d^�m�d revckr.d. � / TEI. — LICFNSED CONTRACT025 DECLARATIOY CCNi�nQCR i ti ,�,.Z��4n033a S75 FK. �'G• VAIIDATION I hereby allirm�hcl I am licensr.d under prov�sions of Chnpirtr 9 ADC7E55 / ,(� ���� • � 0 """ � ��0• VALUATION (commencing with Srtcbon 70W)ol Division 3 ef thn.Bus��ess ond �/-'^ Q '�G Prnfr,ssions Cod�,and my Iicense is in(ull force nnd r.ffecL CiTv �CCCI / � 2[/.�/Ctn55 d/ S .> SQ � . NO.CF h0.OF CIi:CK icens^Numhrtr Lic.Closs_�_ Si2E STO�!ES Fn!t.iI�ES C!:� Conlrocbr , q' y{�p�p_��'`'`_`� CESCRICTIOV OF LVCR¢ 7�.%�} NCv! � S I o^i e:r.mpl(rom Ihe lice.nsing requir.mr.nrs os I or�o , � LL�l—eh_ c � C✓,�vtL ^eo -. Ikens�d nrcharc�cr a regis�e.ed pro�=ss�o�a1 er^ineer n!7ER � FINAI � // �� � e;!ir.g in ry prcless:onal ccpncity (Seciien�7051, � y DATE �p � . Bus�ness and P�oless�ons Cede). ' _ �`-�a'R ❑ USE O� � FINAL E%�ST'NG°LOG DE:'pL Lic.cr Reg.No. Date ACPIICA'�1 /� TEI. BY � _' �'`'�t OYJtiER•9UIlQER QECIARATICN fPp�tiT) � ,��1p, �/ I h?reby affirm ihol I om r.zempl frem the Conhacler'S Licensr law icr ih=following�easan(Seciion 7071.5, Bus�ness ond ^D�:[55. � ?? (Q�� PfOfl!SSiOnS CO(I!:�: OBU::UI!.G I, as owner ef the prcp^riy, cr my employers wilh pC:;cE55 wo�=s os�Feir solr.compenso��cn,will do fhn,wark and _q t 7 9 7� the s!ruclure is nol i^!=nded cr cifered fer so�e�Sr.cticn lOCnt�TY .704A,Cusin�ss on�1 Pro(essions Code). , .a•pV�NG TEL. �l� � � � �., � I,ns owner of ihe p�operry,nm e.dusi��ty con•.acfng �nNTRACTC4 no. � with licensed con•r�ctnrs ro con�rruct�6e p•oj=ct(Sx- A^�.F55 � • �O�,J� iion 70aa,Buslnnss and Frofessions Coda). - . F'kL'U'GCD iOTAI SEIt ACY FRO'.1 E%ISi. CONSTRUCTION IENDING AGENCY SEl RnC[ �AQ� H'��� CAq� I�P<F 1":�DiH ��� ��7 S O F� I hereby alliim thot ihnre is a tons�ruciicn lending ogrtncy For �G��;�� the perfo�mnnce nf the work(o�which ihis permit is issued a� 0 3 0 9—8 2 (Sec.3M7.Civ.C.). S�L`f r.i. Lrtnd^r'S Name � P C.Fcc S rP.m��Fe„ R,DO lender's Add�rss � �cerlily Ihat I hove rer.d ih�s appt�mi�on o�d s�o�r.�hnt ihr. bw cr.Fe� Q Qabove in(ormotion is correcL I nprre�o comply wi�h oll County Inves��nm�on Fro � �� ordinnnces ond$�ole lows reloting to buddmg cons!ruc�ion, Te�ol Fno � � .sQ and heroby a horim represr.nmtives cf th�s Coumy to enrer ^ upoa J e nF r.-meNinned�'Cp�r�y for inspocticn porposes. � / / /�3`/ 4 � � �F[�f. �,� � SEE REVERSE fOR EXPLANATORV LANGUAGE ' 1 S��no�u,e ol..;pl�co,.i cr Ag.�i p�'e . � � � � � �, I 'J"� o� n c � o o ° c n c o n;n f.� ` �! � � � '" -� 7 U � � _. � �c o r. � L` C �; O I�O C � :� �\ 4'] a . ? 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