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HomeMy WebLinkAbout0800A . �WORKI;125'C0147NL_VSATIONDECLAKATIOV �EAfi42o �;.�q„pp.�aC�AT�IO��N� FOR- PERMIT �) � � CE 808(2�80Y � `A A/�C p w ' :I hereNy affirm that l have a certiTicute oY'consent to self � �. .�. , Cj�W�,�-��y-d/-1 V G D�CJ f"�CJ/'1�- ' �i � ��insure,or a cer[ificate nf tl'urkers'Compensation Insurunee,or � � . � .. ... _,.�.. ..,,, a certitied cop�thereof(Sec.:tBoO.[.ab.c.) ; COUNTY OF LOS ANGFI..ES BUILDING AND SAFETY . ` . '. :�PnlicyNo. CornPanY . . . ____. � cen�f�ra�oPy�s nz��ns f���,;,i�rd. FOk APPLICANT Tb rl LL IN CONNF.CTION DATA _ �� BUILDING TqTfON DF.PTFi ! AooRFs= �g'�'7 __ /f !'�!�! l�l L �Certified copy is filed wieh the counry 6uilJing inspection u �— urrE t(I�P.�,1ll��1�f�i1y2i�1 df (D] LOCREiST ���� '�NFiOLE FErERENCE LOW R �D9IL•S�A'y�.4p��li��:in1_�L�.,�.+`�� :� NEA TYVE O CorvNE TION LENGTH F F C ROM y � CWO55 ST. �". CtIRB P.L. M.L.TO P.�. ' '�"- CCRTIFIC.ATE OP EXf'.\1YTION FR0611VpKKb;RS' "� _____ ...._--:___� COb1PENSATION INSURANCI: �;± r 'O'No' OWNF_R (L '��J CO.IMP_ _ JON _ Mo" O. (This scction need not Ue compieted if the work imolved �� a ❑REss � ' � rxunK PF.Rmrr No ewm�rvo. y,j:;�� by the permit is for one hundred dollars (310U)or lesv 1 c'Ty �R,,,, ,,,,n.��j g� ,��„ F�o„,,, ,,,,t ,EMF �oNo ,�„R.„ ,,,,r � .;�. i���di�'• � ,�:': 7 certitj�tha:3n the perfurmance of'tlic niorl<for which d�15 �e�wi. �„�• � . permit is issued,f shull no4 entplo}'an}'person in:my;nanncr eeiP �or rv ,.) ✓� wr.oa ST.WI�GNiNG .Q» . so ns to hr,enme suhJecl tr>the Workcrs'Cumpensaiion Li:ws. �i �-- -o ,,. � ._ — _ ��. - �LOCK TRACT�����J STATE fiNCROACHMENT �; � �Date_ Applican[_____ � wo.oF BLOGS. PERMIT rvo. __ ��j S F.OF LOT NOW ON LOT ''�"�'"� � _ � NOTICk'f0.4VPlJC.1N7:if.af'ter ntukin�ihis Certificule�P �, 1z --- � '� �,,;� . �;Exemptien, you should hecome subject to ❑ie {5'orkers' �.; �uE�oines � c�aaacEs �,�� � �Cumpens.ition prrn•�r�ons of lhe l.abm(.ode,Yon must fotth —_. � �--- .... - -----...— ----'--'�-�- i - 1 '`wtf en:ply wRh s�ch provi,;ion> ot this permit Shall h rR [�L//� orvrvecnorv c.�aect c�E , `�dc med evokeu. �,, .aO�'��''���1�t��..l��... - �M ! f �}�r REIMaURSEMeNTFEE a � LSCF:15h1)(_'ONTRAC'PORSDECI..4itAT10N f. ooe�ss i �f �"'I hcreby nffirm tha[1 am licensed under provisions of Chapfrr ��i p � AI I r�t.No. �d�'�"I �!� srn����.+ �:Ro�� �K Mna v Pu�ess.:o ev 9 (rommencing�vith Sec[ioir 7000)of Uivisiun J of the Husi- c r L.� 1 F L f• r f> ness:md Profe.scinns Code.and my]icense ic in full force unQ :'srnrF uc�. }9 �r? .+'".� ��u�!,t�.� LICtNSE NO.��' ����_ CL 5 /f �C t- eifeM. {"`' 'I NO. �OESCRIPTION OF WORK �EE j VAI.IDATION ry/ /�� �[1 F'INAL � LiCt!:IVCNUiII 2! ���77�(C" I.iI:.CItl&S_._.� _ _ � _-nrvFcrinic'ra - DATE 'j� j -.�:;,` . Ha�sr.s w't�e r.o ssvtpc r / F ) py � r�ra o/o (�C�PIlNC#nf . a_6���4'TJBIf�.�_(.�� , : — oo --_._ FINAL /.. / [�.� ' - 7- BY .� �y {.:�K„�'�,�;� r� I am exempt frum Ihe LcensinK reyiiirements as i am e : �o f ; � I�ce�ced archi[ect o� a rceutered Pmfesston.il cr�gine r . oL�_ �' (' � .. . actinK srt rtxv prufesnion.nl c�p,aity (S2.Lor. %OSt, Bus -��+ inezs nnd Protess�ons Code). - - --- o�,sr , � � Lic.m�Iteg.No._'_'.._ _.—Date�_�. . -_ .-.. ._._...—.._._ � _ _ ___ ___ ____ :', . . 130M1]E O1NN1:K BUII,DCR DLCLARA"110N + , � ' OWNFR'8 Permit s� � ��"�:% L-:i d�( �, I hereby ai'£um tn�t I am ezempt fmm [hr Contrxc[o - — Li�eose Luw for the following rexson (Section �oat.s, aus- ' AU7�HOREZATIt)N TOTElL F�E ,;' �' �(_� r' " w ` l U '�iese and Pro{essions;ode): _ � I. as ou�ner oi the property.wiil do[tic�votA and the o rwt.�oo�i�srwFa. "'�"o�F oEs�.+�dE ___ � o, e { '(F�;1 � . . slrucNre i� not i�tte��Aeil or offered 1'or sale (tiection . S��;rv�o rr+is owv oF' 19 7044,Ausines.s ancl t'rpfessi��n}C'o�e). --"— � e n �n 1 '!,`.(��.- . CONSPAUCTION LENDWG AGENCY " �ces.,�.r ____ _._ _ � ,� ��._8,� . �� 1 hereby affinn thaf tnere iz x construction lentling agency — -- - ��Por Ihe performanee of the work for which this permit �s � � . ii.s¢ed(Scc.3097,Civ.C.). � .: Lender's N.ime _-_ . . ��� Lender's Address i �i� � � I certify thai 7 huve reud this npplica[iun and stiite thut the � abuve informulion is correct.L agree to rnmply mi[h all Court>� urdinances oncl State la�+�s regulnting Plwnhing and 6ewers, and h�roby �ufhurire r esentn[iv s of this Comuy[u enter ' � upo [he ubovc-men[i �• property inspi�c[ion��urpoxes. �, �(�i� ' SLf(REVF.Ittil�:N�OR HXPLANATORY LAhGUAGC �" —_��� � Signxtu ,�. .�-_Date � �' N '',p(�',Z c� iqm G�.m - n+7 W��Iz� N `'oa'r2 x 1i mC: Dn `ym��,v OC��aR' O •�' � �-xs� p�In7310 73..�;7�-i.� 1.'O _ � � .. - �� �m,OmIO p�➢�IO➢,N 1�7J ' N N T n �u'v i,� `�,D�.��'�R' .,`O<y., �Tl O'� '�7� � I TTI O� T 1y m�C. .(A' 71 ' � 7J O i", I t'� lmC qm`� '�_ ^Z., ;� �'�'N�'cn��m t7°'� D' -� m� {m,r �` ���. i cZ��Z `�np�•r o�l OT r"� ��O C 1 '�� �nN � ',m� GL7 �� I `v ti-i � i i ` �m { b 1 � 1 � �'' � � � � -�1 `I i m � � �� in 'I �� z ; � o ' � -� , 1 z � � � ; � � � I �i ' �' , � , � , �. � . . � ` , � , � . �. � � � t � S � � � '.... ` . 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