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HomeMy WebLinkAbout1768A wea�as•cort��nrsarioN occ�aar,�r� I hereby affirm thot I have a carrifimte af coasent lo salf jl ��inwre,or o certifica�e of Workers'CompenusHon insuronce,or '�^�"o U °fa��-��tz�3`�°�`d���b��� "B���R`"""'� 14PPLICA71OiN FOR PERMIT vou ❑Certified copy is hsraby fu�nlshed. SEVIIER • SEWACE DISPOSAL ❑Cerrified copy is filed with ihe caun�y building inspection CGUNTY OF l05 ANGfLES BUILDING AND SAfETY depar me �. Dote � +� Applicani ' � FOR APPLICANT TO FIF.L IN CONNECTION DATA CERT IChTE OF EXEMPTION fROM WORK€RS' euuoiNc COMPENSATION INSURANCE ADDRE55 STAiION oEvrH (This seclion need not be completed if the work involved by the i�i�T� Mo.NHoieReveacNce uwER permit is for one hundred dollars($100)or less.) I cartify thot in the parfo�mance of the work for which ihis ���55r. rvxorconr�aioN �EIv6THFROM permil is issuad,1 sholl nol employ ony parson in any monner Y. Nae v_i. w.t.r0 P.i. so as io become subject�o the Warkere'Compensotion Laws. owrvea CO.irotv,No, ioe No. �'�0'�� iRUNK PERMIi NO. RO�O PERMIT NO. Dote Appliwn� nooaess Q ) , NOTICE TO APPLICANT: If, ofler makin ihis Cartificate of _��-j_sl wFvionvir WANFR cAsemt�r uF[oRo.wsm.nio. onrE 9 CIiY TEI.NO. /7 � nption, you should bacome su6jxt to the Workers' �EGn� ,ipensation prov�sions of the la6or code,you must forthwi�h oescaiarioN ior Na � � nwv.oa sT.wioenir�c comply with such provisions or this permif shall 6e daemed revoked. �occ iRACf S1AiE ENCRO.KHMENi LICEN5ED COWTRACTORS DECLARATION r+o.OF&W5. PERr^iT r�o. I hereby affirm thaf I am licensed under provisions of Chopter srzeOF�Ot rvoworv ior us�oF 9(commenting with Section 70W)of�ivision 3 of the Busi- suimiN�s cHna�ts ness and Profassions Code,and my license is in full force and ¢FfBCi. �p-f CONTRACtOR � CONNECTION CHARGE FEE License Number J I�7�Lic.Class � _ �Rtv.aBup Nr FEE �7��( � .�, ADDRE55 COf11fOC10I 1�� � - 1@__�� � ^u . „� �..y, DiSrRIGTNO. GROUO MAP Pqp�E55EDBY � :IiY I�J4/�R TEI.NO. .J'�I BK PG � ❑I am exem �under Sec. of the L.A.Co. srnte uc. p V P II�ENSE NO. C1A55 V � Plumbing Code and/or 5ec. of iha No. DESCRIP7tON OF WORK ree �iNAi Q .aus�s�wH+coNNecrinc ro onrE '/ VA�IDATION � B.8 P.Code for�he following reason � � vuauc sEweR .Gf � ;�/ �7 w C TAfi4i,5[ A flT pR p„ VITS Afip/OR URAIN(IELP FINAL � Oafe rqUSE SEWfR CON1�ifCtING i0 8� � �.�_ Z PRiVATE DJ SVSiEM $iynafUlE CONNECT ADCIiIpNAL&OG.OR ► OWNER-BUILDER DECLARATION woea ro Nousc SFwea OVER LOW 5 ECAGE V�iT,pCAINFIELD I hera6y affirm that I am exemp�from 1he Coniractor's License txrN.,ctsbrooi,oRvweu.ru�nr�tq�e l�w for the following reason(Sec�on 7031.5,Buisness and Pro- nirex,aePni�oa ngnnboN Nousc ��OI19 COCIC�: SEWER OR DISCOSAL SNSTEM �J I,as owner of the properry,o�my employees with wqges as fhei�sole compensation,will do the work and the structora F 1 7 6 8 A is no�iNended or offered for sale($ecfion 7044,Business - and Professions Code). OWNER�S Permit 5 g?,�G� $`• • • q .� O ❑I,as owner of ihe property,am exdusively contracting with AUTHORIZATiON TpFAI FEE E�� licensad contracrors to consrruct ihe project(Sec�ion 7044, i HavE nr Tws onr[n coNrzacT wirN THe H[aEiN NnMeo con�.�tactoa To � " e�L 7,5� Business and Professions CodeJ. m�vr�Ecr THe c.eovE ocxaiaFo exisnrvc oweuiNc ro rME Pue�.ic s[w[a. CONSTRUCTION IENDING AGENCV � ° ` � c. L.r.O=. I hareby offirm thot there is a consvuaion lend�ng agency SIGNEDTHIS DnvOF �9_ for the parformance of 7he work for which this permit is owN6a5 a�eN* e 2.[F`C��l issued(Sx.3097,Civ.C`.�. /� / C't'.nTih F3�T19 1�,! Aoo»ess t,e�n1dgf r/'s Name a L�d ei s A�res� r . O� ,,�f . I certify}hat I have read is apptic �sfate that fhe obove informotion is correU.1 aq.ee t comply wiih o!I Coonty . ordinonces and Stote 1 s reguloling Plumbirg ond Sswers, and he eby outhorae asemorives of this Counry to enror up e above-menfi� d _ppsrty fo�inapection purpoaes. � ` r � $ignoWre Pe fiinee Date�� S�i IkFVERSE FOR EIRkANATORY lAN6UY18i � __. __ ._._ ___--------- ��� � � crs+:�Ft�-�?t�,�ra���,.�:i�rr� . _ ....� � ..�.,��..- -- -_.�... _.M_.__� _� . . - .:. +��. .:_ . -I "•►':s+y„.; . . . I ix�..o-��:�Rk�H:#�:+�1:nn c�a�.yri tnr;-,c tne('u�ii.r�hw'� ' -_- ____ , .__.. . .... . ._... _ __.._.__.________.__-. __. . __ .._. ___._� . . _. _. . . I .. . l�t.n.a I.:i�r fur 1#te k�linwi�w re�rn(9¢cre�xw 7Xd1.5. �...�_ ._______.._.'_ _._.�._,." .____... _________..__._....... - - L.'r:.u�css r.+:.�l7'rol:asiur.t Cnrir�::ln��u!t a'cr,!uK9 H�i�€A __....... ..___.. _.�. ___._ __.___..._ ..__._____ : . .. :... 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