Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
10_29_1984 - 21015 PATHFINDER RD (4)
I � i WORKERS'COMPENSATION DECIARATION . � � � � I hereby offirm thot 1 hove a certifiwre of ca�sen� b selt . . . }l - insure,w a certificate of WorkO�s'CompenwNon Inauronce,or � �6^6'l0 - u � °` ' ` ` �9wese.tern Emp10Ye1"5 �E�qE��� APPLICATION FOR PERMIT Po��-����`Y����Y ❑c��r+�a�aPY is hereby Fumfshed. SEWER - SEWAGE DISPOSAL �]Ce.nRed co�w�s filed w�rh�he counry 6u��d�og��sPecnon COUNTY OF LOS ANGELES BUILOING AND SAFETY �deporimenr. � , . Do�e 7 n_�U.Ad na,n�am �ee'S; PJ tIID1il OT— � FOR APPLICANT TO FILL IN CONNECTION DATA �' . CERTIFICATE OF EXEMPTION fROM WORKERS' p�µpr.r, /_� COMVENSATIONINSURANCE �noktss 21Q15 Pathfinder Bld B ST�Tw� �`tZi �� C� " ' (This section need not be completed if the work involved by tha �N�qEpE�� I permit is fw one hundred dollars(=100)or less.) . �outiTv / � s, i R I certif �ha�in�he erfwmonce of the work for wMich Ihis ��ST T�ocO��o�e��Tq� ��TMiyp� Y P cxoss sr. v. curtp v t. M.i.ro v.t. permi�is iuued,I shall not employ any person in any manner � ' w rn�o become s�bject to the Workers'Compenwtion Laws. �R �p�r.p „p: d9 '_ oa,e nm,i;�a�, "",',� 21015 Pathfinder '���R�T^q. R°"o°�"'T"°. NOTICE TO APPIICANT: It, afrer mok�n this Cenif�cote of . �rciwvrt WAIVEA e�s[�rrt Rctaro.nata.rao. w.r� g CITV TEL NO. � Exemp�ion, you should becoma subjeU-to the Worken' �• � ' Compenaation provisions of�he labor code,you moat fortbwi�h �x��ip.� �orNo. Z � � HWY.OR ST.WIOENING comp�y with such pro�isions or this permit sholl 6e deemed M i f�VO4ld. .. - . • . . lLOCK TRACt �-!.J���Z STIIIFENC50ACHMFM . UCENSED CONTRACTORS DECLARATION NO.OF BLDGS. fERMIT NO. sae a ioT r.aw a�iaT d/ 3 1 hereby affirm Ihat I am licenud under provisions of Chapter 9(tommenting wilh Sedion 7000J of Division 3 of the Busi- g�jip�r.rGS comnercial �,,,,,�5 - neas ond Profnsions Code,and my license is ie foll force ond . - � � � cor�aioN a�ccc�c I �f«�.e r,�mbe. 3081 Q6 u�.ci� C36 ��ce �����,+.� i � • DKiR1C7 NO. GROUv IN,► iROCfSSED!Y d ' Co�vac�or Lee s P]�mhinome 1�-29-84 ��n. �i� � � n v � ❑I am exempt under Sec. of fhe L.A.Co. t��iE,qE ra0. 3OH� Cin55 � �3 � ✓ ' - Plumbing Code ond/or Sec. of the "p� �������'�''�RK � r�w� � ', O ��R cornYcrn�io o�re VALIDA J�I�7 A � � B.&P.Code for�the following reason � � u� . . . . _ . SFVfIC TANK.SfEVAGE%T OR FINAL � �' � PRS AHD/Ofl DRAINFIEID y Do�e �+ousE snv�v carmccr�Nc ro °`' /'�YA' `� • • • � � Z %tIVATE DI VSIE � siqnoiuro mr+r�er�oo�Twwu e�ec.«e I •�•2 7.5 0 OWNER-BUILDERDECIARATION womcro�ousts[w[a . ; ti I heroby oRirm fhof I om eyempl from�he ConlroUor's litenee ' r.x�ivR�Cessapoi,�xi'vE�iRi��i u�a� �• •�•2 7.5��., ' ��� Low for the foltowin9 reaso�(Secro�7031.5,Bui4I1R4S On/I P/O- M7ER,QEo�iY pF A9ANppN 1q�5( � � � feuions Codel: �"'F°°R°1$°O5"�sr�"` I �.Q R-3 Q , ❑1,as owner of fhe praperry,or my employees with wages as their aole tompenwtion,will do�he work ond the atroduro � � ��is not iotended or offered for wle(Sedion 7W4,Businns � and Professions Code). OWNER'S �ermit f t Q ❑I,os owner of�he property,am excluzively contractiig with A�HORI2ATION TOTAL FEE Q licensed comractors to constr�ct ihe projact(Section 7041, � i�n,.,,��r rHis w.re�coraiawcr wrtH r��nu rau�+�o coNTq�croQ ro ' Busines:and Professions Code). coNrwcr r��sovE o[scR�e�o ex�sr�owEiur+c To r�a wx�c s[w[R. i CONSTRUCTION LENDING AGENCY �� Z9tI1 OCtObOP 84 I hereby affirm fFwt there is a consirucfion-lending agency ��THIST DAYOF 10_ , - . � - for tbe prformo�ce of �he work for wbich Ihis permit is �"{R OR �xi��s«.�,c,..c.�. ,,�u`'�'4 ee ve. o. on e, i lender's Name ' lender's Addross � � i I cenify thot I have read Ihia opplicoHon and atate that,the .� � above informonon i:wrrect.1 agree to comply with oll Counry � , � ordinances and Sro�e laws regula�i�g Plumbing ond Sewxs, � . � �nd hereby authorize reprasenla�ives of Ihis Counly fo en/er � � { oon fh above•mentioned property fw inspection purpoms. - I � 10-29-84 � g olure of Pxmiflee Dofe SEE REVERSi FO�E7f►tANATORY UNGUAGE j i f _- ►-- - - - - --- , - -- ---- . ---- ------ - _ , . . .. , _.. .. . , � ' . . . � ._ ' • i �� � �g m� '�"' '� �� co 7 ' � . - ; � � .. ' � i i . i ; o n �`Zn �T 'U C� �Z i . � _ r . • Zc om b �a i^. ° D ' :i •i i 9 r� - a a,� n D ro � � i � �� �p fl ZN �� � . i : j - i �'� t � � . i ' , . ~i ; . , : ,: � �;, ;,;�, ��; � ,;,a o o p , ' ' : � ' I, i, f _' 7 �D tn^' O ^ L . . — . • � i � � c.❑ �O �p �� �- 'F � I ' , ' , ___ � I , N' � i� N _. � ' ' � ' ; ,�` ' 1! ' ' ; ; - ` ;o � , , i � , f � � � i ' ; �� '�°- _ _ _ l � � � --- � � � � i �� ' � ,� � � , �� p ''" � ,� ; � M 1 _ ' ' � � � � � � � '- . �' �. �"^ � . � I i,. -- ' � � t_ ., � L - ' _� , ' � � _ � � � I . ' i� � � � ? �. � � : -- � � • � ; � � - � ` • • ' ;i ± ' ; ; � � � ' _ � c , . . . , • ,. ; ,-"i � �j• �. . . . i ,. . , . . , • i { ' ` I ,. ' .. . ; ' ' I � . �: � , , - i i - ,. . {. , ___.... , ,_ ! i_ _; � ' I I. -� . s�' � ,� , � 'j�- -- i. I , j 'i , , I � . � . � � - . � `� , � i ?._ � _' _ �, � ! � _ _. i _ I ',I � if . i . ; � � . : ' � � �� 1 L � �j � I I I - ��. . i � . ! ' �� � �� ( � , � �, . ' � , . . �1 . .i. 1 `i � I i I ' � i � , �' i ; I ,� � Z. . � � ! I I � - ' '��°" ' , � �: � j ' 'y ! � ' ... . . _ � i._ }. F . � - � . - � N . .. . ', 1 I� .� �j 1 � I `�� +r- , i, , f, _ � , `. . � � �. _y I �' i I � , � j i „ + C ( - I' - ; � i;' � _ � : ' i , � � �. � I � � • - - ' � i_. , _ �. � .i • i � i � � '� - _ r c • � _ � c- ' c - ' ' i - : �. ! � _ . i-'. i- . �e'cx �a o-�. � ti A C;.'ra � v �P"'. i .. � � , � . C; � ' �" �►r � 1�^.,,' , C ,'+� n tn❑�. �P�`' .�0�. G-� ..°.�^C e .a � ._ .. .. , - i i � L7 , �t.] c a = � ��~ v� �� " �� o•'^ `" 2:�'�•� � F � - . . . � . � . . - ' � I ' � � � 'e C_.0 m �; '� O» t�� a .. �3Y'� C a...in r � '� � � :�.) � 4-�,.� I c �h �. n c...p'C��: a C C"i' 1 i - , � , � r: i �.. �%� �,-� +. � �. I ^� i ;t �'� � x ^ a^' � ��F i '^? c• �' 7 - . � � I C`. ,r: ��c c �y'° �� � a a �. i ^ ti a.< ` , t,,, i - � ,� m^ � � fi_c �..:N� F�,�o ��a � � � 4' ..: �� .. .. , .- t� � `� .. ( , � I ��_, b �-n_rt �� _��.,:T o � t.s p n'�' ti,4 . a '�o -o _ �i+ � ' '_ � C ` .h c .: Q �`."".t = O H ^ � r�i � '- i . - . . . ' � y - G _ _`� ,o.`,o a-^'+ C"-p'a, .i c ti b-na .�^- L" '- , . ; ' , � - � � , ! `+ ��Z] 1 ti l. « C �O •`• h-�p'-,,, ^ �•O ►�1 . I . � �'. ,G �.•'- �= �'d ,+„� •- q vo�`^ ; �^j�•� h c'� �" � ' i - . ' I' � ,f c.° a= a`�c �" M1 .c..,c° °.c ° � � � � c.:;., c.�- .� �o a A.= � L� � C: �, �` . • .� �. j �� fS �. " L'O y O�C Cn -�"' O ` � y. �+ . - ' ' - � '� , O .r,. � � z.'�^.S ''.� �'b�P'^ C� �.A " a .,0: ^ -C - � - - � , - . . ^ �. �p �A O��C�/y �y " � � � , �„ . .. csa`c n o ' 4 �� 1n ���.o'o,.`a� Cn�c �_; . ` � - � � - - �� � � - . ' � °�n ., ���s n�S �`'C o?' '�' �o `�° N n- n �.. � I _ � ' - , �' - - :c a" � N � ��_ �''e A.M ='`,�;�°�:'° 7 ✓ .. _ � , ., c - .� .. �. � . - _ ,- i ` � o.+i� c � ^�n o y�,�a.`c c ii:... x � _ . „ `. -� ^'•4 �,��;n � -D�: sy n � m�ti � :. � . c� �� : � .1 4" •_ � .. � n o w .0 ,� � _ � � " . . . � ' � :; Y � '� s� n n 'c �4."� n"' 4 c f` �- .. .. . . . .. . . -• -c. 4 0 o n �.c� � ° c �R o'c ►� .. . . - ' . � . � • _ n��� O`�� ' C �A `ke �V i 1� �C �:i� -.�O , , . " . ' . � : ' � . , ' , .. C a �"�.�� '".��' ' r ``�� r�„p� �.w r.,..F C rC, �.�• ... • ' . • ' , � . - �� � T O. � `1 `p'.� ; � _` � �..� ' . .. . . ^ -• �,,_n �.1 � � � p ii� ._ . . . . � ' . . .. . . . _. .. - . � . . . ,.. .. . ._ . , .. �.� d C L�'s O H _G IC N�N h�i0 ti .�" V+ _ � '