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HomeMy WebLinkAbout0546A 0614A 1"10RKER5'CO:".FENSATION DECIARnT10N � I hereby allirm Ihai I have a crrfificotr.af�o�,e�,,�SP�f APPLICATION FOR BUILDING PERMIT insure,cr a ce.rYrficata ol VJerkers'Compensfon Insurance,cr o ce�rf�ed cepy ihe�eof(S�c.3?00,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. Company BUILD'NG ` l ���` Cer�iRed cooy is he�eby fumished. FOR APPLICANT TO FILL IN ae_a[55 3n i o Cerf�fied copy is filed with the county 6uild�nq inspec• pU'LD'NG T�n �rr � / lion�!!partmrnt. � AC?�E.- yL /G�I.�/fJ,rj IOCALITY (t""�'s-I'Tt�� �(/ A�. /�J� KEARfSf n / Datc Appliconl CITY IY'T ZIP / CRO555T. (�-.G.tr<�t1 ��a'�+'� ' CE4TIFICATE OF EXE:'�PTION FRO'+1�YO4KER5' /��. NO.OF RL�GS. ASSESSOR . CO."��.RENSATICN INSURANCE SIZE CF LOT I.Z�7C�� N^vW CN LOT / .".•AP P.00K PAGE PARCEL �This secfon need not be compleied if�he permi�is for onc , uiE ZC':E .'.a� hundred dalla�s(5�00)c�ie5s.� rener eioeK ioT no. � �/ No O 1 -33 7 } •�. s�euni a, I ceni(y thnt in th. perlormonce of the work c �ch ihis C:':�ER , y��f1,s ,p �"�3� Oe'�d CC�.�oiTiCnlS � pprmit is issued,I inll not employ o on i manner ��+ D:SIR:(;1 G40UP IYFE � F,G: P"O�ESSED BY �,J AD�Fi55 O�O ST�E/�L�O��c7(/ C01ST.�— Jt�s so as�o becc./.^.. o�� to thc lYc� C rr. �.i n Laws. ,/� /Q �a �/ V M1 ��� O 1 �l �(� CITY �/7� Z�P I/CS � � D(1'1! _AFJ�Ii[an _ SiAl15Il(;PLCLASSIF;CI�IICY AFi. CCNDp. V ARCH:TECT OR TEL. NOTICE �O A .IICANT: If, af!e� .�x�ng in+ Cer�if�ate of FN�:r:rr� r.0. _L �L Eacmption, u should 6ecemr. Suh�PCi i. thr. 1Y..rkeri CLn55 NO. � D�vFLt.UNiTS_ N Comp�nsc!ion provisians cf Ih=Lobor Ccd�,yc_ �crth- AD77f55 =fl•�!k r.'.AP i�h co�+ply wiih such prov�sions or �his p�r��� shall be — deemed revoked. v �- ��" eK. �, VALIDATION cevTanct e FS! w. LICENSED CONTRACTORS CECIARATION I h�mby o(l�rm thc�I nm lic�nsed�un<1=r provis�ons o}Chop!rr 9 AD�RE55 �O. yA�� �comm>r.ung w�ih S^Ulon 7000)of Di�isicn 3 ot rho Cusiness nnd ii� Professions Codr.,nnd my licensr,is in full forcr.end r.Hecl. CITv CLA55 5 S().FT. , h0.CF NO.OF CN.ECK License Number L�t.Class SiZE (70 StORiES Fn:1It�F5 CN� n���� ❑ S Conlro^.tar po:^ D�SCpIPTI V OF WCPK � I am e.emp�From�he I�censfng requirements as I am a /) �/ /�e.�� �C� � =:���I.6 n licensed crchi�etf cr o re,r��s•ered profess�onol eng�neer AITER � FI��AL �1 � acling in my prc(essionol ccpntity (Seciicn 7051, '��Ai� � DATE T �;� �� �l• e . •2 j Business end Prefessians Ccdr.�. USE C� � �«,�� FINAL Fxi5lir:G fi1DG. ❑ By I • •J 2.H O Lit.cr Req.No. Dale � n�•��e vT1 K�'�-� C�^�S n0. 3 ' J���C� 01"J1JER�BUIICER CECIARATION � �r ��� � I hrre.by�f(irm ihot I om e.empi irom rh�Controctor's License q��pE55 Q � EC��£ 1 � �.� �"�7� Law(or�hc following rcason(Seciion 7031.5,Business nnd Pr ss�o�sCade): �.�;��,; P.J:1 D.4G / I, ns owner of thn �,�eperty, ar my r.mployee.s wiih pli,^,efSS woges as the�r scle compensa�ion,w�li do the wcrk ar+d �OCnLiTv ehe so-uaure is no�inicndcA or cfierr.d for sale�Sec+ion 7044,Busin�ss and Prcfrssi�ns Ccdr). .•."Ovi!.G iF�. " � I,os owner o(ihr,properiy,om evclu!ively ton'rocting CCNTRACi04 NO. with licensed conimcte�s to construct�he praject(S�c- A�:R�55 �ion 704d,E�usiness and 7r�fPssio�z CcdP). ' r�6�.4� PF(;UIRE'� 10TA1 SFIEACK iRC'.'. �X�ST. CONSTRUCTION IENDING AGENCV SEi EInCK Yh�� ��'�Y FFC?.unE tV'nfli ` I herr.by nfhrm that�herr,is a canstruction Ir.nd�ng o�=nry fer � p;���;� ;;� � � ��1 �he p=r{ormance ol�he wnr4 fn�which�his p=rmii is issued �l : (Sec.3097.Crv.C.I. S�cE � P.�. �.. .[i 9.5 0 Lender's Nome 8 " P.C.Fee S —tt� r,.,m��v�� 1 .�C9 • • •q 9,,ri 0� � Lendcr's�ddrrss ? I cenify Ihni I hov�rcad ihis r.pplim�" and s!ctc thot ihc �,�� �v ,,,,,��p,,.,, � � �'� b-8� .' cbove inlcrrnaGon�ccrrnU.I agrer�,mm ly wiih�II Caon�y i.,,,ps��paano ree � � ordinonces nd 5� tc Inw lo!ing o bu ding ccnYruU�on. 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