Loading...
HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (29) . ..� - � . . :. ,:-.�.�_x�._ �.,.�..�::..�. ....:. .. .........�.:. .brE.-.v.sear .as-w#'n.x�. a,st^t.,e,-.,.,.`�.t.e..,.,..i�t K,.t..s-r,�.,z ...,Y:.._,.�,4i�a...+.s^�:.. I.Mx..a;,,esai�. . . . x4_ ...a r. ..,n... ...._,.-.. . � ����RKERS'COMPENSATION DECIARATIDN � � I here� c ..n rhot I have a certificaie of��consent to self � �EAEa2o - � . insur�"or a certificate of Workers'Compensaiion Irisurance;a ��3�;REa•�,s� ,qpp`ICA710N FQR PERMIT a certified copy thereof(Sec.�3800,Lab C.) ' Policy No. ComponY� .._,....._._.. ..,... . . . . SEWER - SEWAGE DISPOSAL . . ..::.....:.......: ...w.v.:_..m._..:_:..,�. ❑Certified topy is hereby furnished. - ❑Ce�tifed copy is filed with rhe county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY dePartmenf. . .. .. . . , .. . �. � ._... _.. .. _..__.. . . . __ Date � � APPlicont , . FOR APPLICANT TO'FI'LL 1Nt " CONNECTION DATA � ��` � �CERTIFICATE�OF EXEMGTION FROM WORKERS' �- wnow� �AT�pr,� f/� pE� � � � - � COMPENSATION�INSURANCE '� ^o°REu � �~ S u .. (This section need not.be tompleted if�he�work.involved by the ��q��TV M4NHOtEREPERENCE .}� u�R� ermit is for one hundred dollars($IOO)OY I@SS.)� � NEPREST ���-������" ������� iYPEOFCONNECiION P IENGTH FROM O/ I ce.tify that in the performance of the work for wh�ch th�s caosssr. _ v. cuea v.� M.L.TOP.L. permil i@ issued,I shall not employ any person in any manne� � -���� vc No. so�as�o become su6jeH to the Workers'Compensation Lows. OWNER ` h1 '�v CO.IMP.NO. JOBNO � ...., l�.'., . ^� ( � . ... ........_...._.�. �Q/�'� �f/�� DORE55 ��'"r' �~ T�-�V.$f,')S TRUNKGERMIiNO. ROADPERMIiNO. Date '� '�`-' . ..APPIimM�d�P-fy` .._. ... AFFIDAVIT WANER EASEMENT RECORD.INSTR.NO DATE NOT�CE TO APPLICANT: If, ofler makinq this rtificote�of �iTy � ',r,�;� rE�No. ��2-UCSv�� . Exemption, you sl�ould become_ subject 1a ihe �Norkers' ��� � ..... Compensation provisions of ihe,Labor code,you most fo�thwith oescaiarioN �oi No. � "" -- ""-�'�" ����� � -� _ HWY ORST.WIpENING comply wi�h such provisions or this permit sholl be deemed � '-" ��' � ` '� "-""`� ^ _ 10vOkBd. BIOCK TRACT STaiEENCROACHMENT .. ..-......•'_.-.-'_...,....._. LiCENSED CONTRACTOR5 DECLARATION - No oK"sC6G5"""�"i;""'-°"-�' ffRMir No. .,�,. . S12E OF LO' NOW ON LOT �.� ' . . ..... ........"`.. ... . . .....................-•...,......,. I hereby affirm that I am lieensed under provisions of�Chopter uSEOF - - -'-�� ,-...�^-.�--.__.__.:,._...._..,_. 9(commencing wirh Section7000)of�Division 3 of the Bosi- ewioiN� - cNnR�Es�� �"'""'�'�"""-�"""`"".":"". ness and ProTessions Code,and my license is in full force and � - �- ��� - �- �- - ef{eCi. '�} (j�¢ �I [ONiRA��OR- � ��t��.Q� CONNECTION CHARGE FEE �C��6J� C..'��� ._ . . . . ..... . ........`. . - License Number Lic Class qD�aES � � d REIMBURSEMENT FEE � .. . . . . . , ... :. . -�y` �^- �/,y'�^�' Conira[fOr�,N� Date �i^fS�L^ PTv yJn TEL.NO /!�G�`-��J.� DISTkIRNO- GROUV MAG - GROCESSEDBY � � . StAiE �-, � �LI[ . p . .. BK FG � ❑I am exempt under Sec. of ihe L.A.Co. u�N!No. CtA55 �.. —�7� ,� 0 . . _ _ _ _.. ..._.__. .. Plumbing Code and/or SeC. _ � of the v NO' DE CRIPTION OF WORK cEE FiNAt � � ' ~ _ ...-... , .. . HOUSE SEWER CON TIN � ; DAIE VALIDATION 4 B.8 P.Code for the foBowing rEo50n P:1BlIC SEWER _ .. _ ..,.. ....,-. .... ' $EviIC iANK,SEE�AG T OR N ' " '"' -' ' ' - '- GIiS ANDiOR OftAMfIELO gY°'� �L DO�C MOUSE SEWER CONNECTING TO � � - � �" . . ..... . ......_.. �...<.- ..�::,q.,�.....:y,,.�A.;:.�,...,. PRIVATEDISP SALSYSTEAI . . �, an,ca ., ' Si9rlatU�2 ' CONNEC•ADDITIONAI BL�G. F �, h a , - - �...........�.............a.........,....,,. ,,.:a: WORK TO HOVSE SEWER t t � OWNER-BUILDER DECLARATION � ovER=iow seePn�e viT,oani io �I here6y affi�m ihm I am exempt from the Contractor's License exTN,,cesSaooL okvwe�L nuNt+ote law for the following reason SSecron�OSI.$,BUi5�B55 OOd Pf0- ' AITER,REGAiR OR ABANDON NOUSE ' fe55iOn5 CoCIB): SEWER OR DISCOSAI SYSTEM d ❑I,as owner of the property,or my employees wi�h wages os . .............. their sole compensation,will do rhe work and ihe strucwre . . is not iMended or offered for sqle(Seciion 7044,Business and Profess�ons Code). OWNER'S Permif S �d (� ❑ I,as owner of the property,am exdusively contraUing with AUTHORIZATION TOTAL FEE Q ' , licensed coMrociors to construct the project($ection��44, 1 HAVE AT iH15 DA1E A CONTRACT WI7H THE HEREIN NAMED COMRACiOR TO BU5ine55 On(}PrOFgS5ion5 CodeJ. CONNECT THE ABOVE pESCRIBEO EXISTiNG DWfLIING 10 TNE PUBLIC SEVhR -�'6 Q��3 A CONSTRUCTION LEN6ING AGENCY I hereby affirm that �here is a consfrucfion lending ogency >�GNEDTHIS OAYOf 19_ , �e m a e � () for 7he performance of the work for which this permit is �WNEROR � o � JWNE25AGENT _.,.<-.....,-.e.....,•� I b50 issuad(Sec.3097,Civ.C.). ��- -� �- � � � Lender's Name /+OORE55 � c y �^S .__ , 8 , _ _.,-�._. �.,. �.:�.,. _ . :�.,�...... . . ........ ...:� _. �� Lender's Address - � � � �� � 0�� �_�� I certify fhot 1 have�reod this applicafion and s�ate that ihe �� � above informafion is correct.I agree to comply with all County ordinances and$fole laws regulpfing Plumbing and Sewen, and hereby authorize representotives of ihis County to emer upon ihe above-mentioned property for inspection purposes. lU'i�✓,��-��� �—lSz—�3c7 Signneure of Permiftee Date SEE REYERSE.FOR EXPLANATORV LANGUAGE ' "' . . ...........,_.. . ... .. . ... .. ........ .. . . . , _ , ..:�.�., — . 1�s?��s'C3�'s tv5�Tg5` --�- _' _ Ca4V1\`ER'•P:LTIi,DFS2.�ECLARr4T�t3'.ei�: E� h5 ECTQ4'S�5�!.4iaR- ' 1�IC[l'GV:iir41'i9!d:1,i!((RRl CAL`[R�1f f�t'(1[31 if1E(.ORLf:iC(!3i'�S - ���RCSV.�.�.5___����--�� � _ . . . -- -�---"'--- - d,ice�sse Lu« :a:r thc rol3a�.in�, :easru fSe�!inr; 703P S, Nev✓HCUsesewea, �_l. . .� � _ — �_ . Bu�inose artFr I'rofesnraris Cndel:.+�.,4 cih nr eorir,ty w•lridi CONNECT ADL`i!O�AI... I .. � ., ' . '�:.. ...,.. . : .., _ ...� .._ . s � _ e . �euiWn�e.woee' .. .. .. . _ , , ' u.,. Ye.¢uaree a pen rrC'n^o�r.,�r��Cd,rlFar rr.pro�r.delao[i.�n,�r __._�� , ... �` . • repair anv iirur,t�u'e prim to:t.i istaanr,e,alsr re?r�irra Iire - ,r 5 .'-.-. ' '�.�'1' '� '--�:. - ' . ;�. ....... . .. .. efiplr�anr jor�rrck pesrzeit fn file a.+rRned stale:trrul tFai he n� $E?il�TRNK 5'FF, ,,. _ , _ , ANOi^q:1F>Nc����� _ . . . � . . i �_.._...-_� " - . . C�c'O()S.,C' DiVWEL'_]_ ��_ . .. .. ..: ..' .. "' ' . , �' -._.. . . , _ . . ..�!__`.. . ����y cce�s6d pu��srnt! sa rtf pror:unxr n 1 a :onlracrn�s � r ^ . . . . I. '_ — _ . . � ' -_- ---Y L�cease 6.ax•iCnupee�9 lconrmerscvag wt h S�hnn.{SOG)nf � - �-., � - . .� ' kJiv%�.r,�.3 n(!re 13�s:ie 5s��¢d Pi (es imtt Codel w�Ilru7lie is area ua�:?e senee.iz _T - _ , � r r r e r. �q Sewa;E�Dsao�atsvcl��a � _ .. errv:p[tlterefrrem and the hnsir fnr�[Fee u le,scrf esem.p(ian. 'DISCCF\EC I:Gan.� -J . . .. .'` ,.. ....... ... . -�._ � _^— _�__ ' J{ A_x�:inln.tint+oj'�ecrio t 703/�by any upplrran.Jorapermit aenNxn�c�.�5ew¢a ... ... .:.qqc yR� � u p ir } f .�e_ ire th �i e —._..�.-.-� - . . . sa:K, <�:tik�J , „ --- -5[t^.r. s�C CEssaoO:s�J . . . ..... .. � --J- � , , o��c,and s�tbierfs the ar�pUrmA tp a nf e utr,p':•.i��zr handr��d�a/enrs(tio0pj�,: V - ...._�-.-- _,_ � . ---_ ���. , ..., � _ . . �.. •� . - � . . i,�i, ;e Vwne:oC the proDeriY�;;i:3=i tiie�n • _. . ... ... . . _., . _. ._:. . . as t ` ' . ...-. .� _ __. . ..__ ... �. . ., . � ;he s.r:!chirc is not i�tended n:otfered fo:va3c. . ... . ._.._ . '.... . . .. _. . � �- � ..... . .... . .. . ... . . - . - .- . ` . . ... . . , , .. . - . {Sac_7�41,flusi�;zax an.d Prnfisciarts Ctrde:7�ke Conir�etar's �' . . _. __.: •_� ..___ _..... �. � . . - .._ "__ _' Lice;zse!,:+w does r+n:¢ppi�•to an n�vner cf prn,prrt}�x�hn . . . . . - . . . . . .. .-. ..... .-___.—_ ._--- . . . � � �b+d/d..�or i:npr,�ser there0r.,ar.:d wkn dris>a'��t1i v.�or'k 5im.seff .i� �. .,:. � .,., . '�. � .. .�. .. � ' yrnriderllhat sud;impms•etner.t,s rtm nnt h,[ended r.:cf.j?md ., ... ._ - ,� ..� .�. : �.' .: ' _ __'._.. _' - . ,- - - .. . . - �- - � So:.en�..If,T:ssvn�•er,the bratslirg or fm.prrremr?>t rs so!d .,, . .. ,.. .... _ . .. ' - -� -. - -- � _-._. � � __ _'___'_4 — witFxi:=:nteye'arrzf��'utr?plelinn.thenccr,er-SrtJderxdUf:r.vethe •.. � ...�, . . ,"_ . .__�"___�,__:_.�_--- -. . , , _ ,. . ._. . _..-.. � � L.eMen nf previn.g thaf he dti naP%>+r,'!d o+'riukrnrr jor+ae -.... . -, ...._. _ . .. . . . : .-. _.... . . .._ ... . .. . _ c n, : ,... ,.__._. _. ... . . , , p n _ .,. . .J�._�.. - '✓,r o e o r e.! � � :: ..�.� .. ,.:� . .. .:.,�. � . . - - . . . . .. ._ .. . .. . . • . .,, _ _ - y'-a,n excmQt under 5ec,---- ��_ ----- — _ . ._ _ , -- ;_:.. . �,.. _ _. . .: - . : :'�.'..-.. .:�,.' . .4 .;. ..i :- � �'i. .'. .: °-, ---- ----__--� ... .. - —� .. .. $ cY-Y.i:.for ihi�a•eason'._ ._., ' -- ------ , ----- i)uFe _f=-�__-----•—.�.��._, _�-- , . .. :. ,. : ... Z3une. ._ -- ---- ___ __— ; ,.. . ;: _,. .: z�=�=c€�a'�wores • _• _,z , < � ... . , , - '' _�.�__ �: .., . --.�._�. — , .. , .... ... .. . :. ... .. .. . . .. ,,. .. ......... ..... .... . . . ";; ... .__._. r , ___-_..----�-- " , . ,r � ,_........ -. '- ' ". "�9