Loading...
HomeMy WebLinkAbout1770A !� - � . . WORKERS'Cf7MVE1dSA;��pN DECkAR�4�T10Vtl I hereby o4ftrm �hor I hove a cerHficote of co�sent�o »lf }� insure,or a ceftificote of Wwkers'Compenwtion Inuuance,w �eneazo � a�f ar ,teb , �EA°°�RE°„83� qpp1.ICATION FQR PERMIT P�cy N�o.����C� � ❑c���+���oPY is hareby furnishad. SEWER • SEWAGE DISP4SAL ❑Certified cop is filed wi+h the county bui�ding�nspection COUNTY OF LOS AN(iELES BUfLDING AND SAFETY departme t. �� I^' ��. Dale Applicam �%7 FOR APPUCANT TO FILL IN CONNKTION DATA CER ICA7E OF EXEMGTION FROM WORKERS' s�uoi�c ,"T COMPENSATION INSURRNCE ADDRE55 v s*n*ioN cearH (ihis saciion nead not be wmpleted if ihe work involved by�he i�iiT� ,twNHoiE REFEREN[� uocEk i pe�mi�is for one h�ndred dollors(f100)or less.) �q�sr T1'�EOFCONfJKTION �ti,h,iH rrtom I certify thol in iha parformance of Ihe work for which lhis [rsossst. v. CuaB P.i. M.L.70P.1. permit is issued,I sholl not employ any person in any monner so as to become subjec�to�he Workers'Compensaiion Laws. owr�ea / CO.IMP.NO. JOB No. ��� TRtINk FERMIT NO. FOAD PERMIT NO. Da1e ApplicaM Aa��� NOTICE TO APPUCANT: If, afier moking fhi5 C9fii{iCO/B Of CITY TEL.NO ` AFFiOAViT WAIVER EASEMENT RECO���NSTR.Np. DALE � mption, you shovld become subject to the Workers' �E�Ai npensmion pro�isions of ihe Labor<oda,you must fathwith �scwvrioN lOi NO. HWY.OR Si.WIpENING mmply with such provisions or this permit sholl be deemed ICVOk@d. BIOCK TRAC7 SiATE NJCROACHMENi LICENS€D CONTRACTORS OECLARAiION NO OF g�DGS veRMiT No. I hereby affirm�hot I am licensed under provisions of Chop�er s¢eovior wow oN ior 9 commencin with Section 7000 of Oivision 3 of the Busi- useoF _ ( 9 � gUIL�INGS CMAR('iES ness pnd Profrr,sions Code,ond my license is in full force and effBC�. ��9.�,� CONTRAROR CONNECTION�NARGE FEE License Number�J7L�Z7L'J Lic.Class � �ReiMauqs MCNr rEe f�,�� AODRE55 �. COn11aC�0����"rtT'»�8��_ � � DISiFICTNO. GROUG MAP PROCESSEDBY �' , �ITV TEl.NO. BK PG V STAiE ll�. I O - ❑I am exempt under Sec. of the L.A.Co. uceHse No. . cuss � NO. DESCRIPTION OF WORK FEE Q Plumb�ng Code ood/or Sec. of tha HOUSE SEWER CONNKIING 70 ' ,� onTi� VALIDATION u cueuc sEweR 8.6 P.Code for ihe following reason l vt SE IC TANK. EPAGE dR OR fINAI vli5 ANO%OR QRqINFIEtD l�at �d�e NOUSE 5€Wt�ll CONNFGTING ip BY Z VRIV.7E QIS SYStEM �' Signalure CANNECi ADDIiIONAI BLOG.OR � OWNER-BUILDER DEGIARATION wowc.o House srxEa OVfRFLOW SEE AGE Vii.�RAINFIELO I hereby affirm Ihat I am exempt from Ihe Coniraclor's License exrN..ces5voo�,oavv.�tt.mnNHo�[ Lnw for 1he following reason(Setfon 7031.5,Bui5ne55 Ond PIO- ALTER.REPA-R OR ABAN�ON HOUSE � 'on5 COCIe�: SEVKi OR OISPOSAI SYSTEM �I I,as owner of fhe properry,or my employees wifh wages as �heir sole compensation,will do the work and Ihe siructure - is nm intended o�offered for sale(Section�044,Business ond Professions Code�. OWNER'S PC�mit E �r> �� 7�.�A ❑I,as owner of the proparty,am exclosively conrracting with AUTHORIZATION TOTAI FEE � . o . � � 0 licensad coMroctors fo consir�ct ihe project(Section 7014, i HnvE ar rHis onrE n[oNrAnc*WrtH rH[NEriEiN NAMf�coNTRncroR to BUSIf1B55 Qlld��Of935iOh3 CO('�8�. CONNECT iHE ABOVE�ESCRIBED EXISTING D`NEIIING TO iHE PUBII<SEWER. � o a 2 7 5� CONSTRUCTION LENDING AGENCY I here6y affirm iha� Ihere is a ConsfruCiion lending agenq SIGNEO THiS DAV OF 19_ , • ,. o G 7�S C� for ihe performance of the work for which this permil is owHEaoe � issued(Sec.3097,Civ.C) / ^/. owr�as a�[Ni 0 2.2�—s 4 �t+en�der's Nam�t��[ _ nooa�ss Lende!'s��dr ss I certify ihat I hvve reod his applic tio and stata thol ihe above informofion is corretl.I ogres comply with all County ordinancea and Siote I s ragulating Mum6irg and Sewers, ond h eby outhoriza -presentotives of this County to enter u e above-m afi . ,r�pperty fw inspeciion purposps. �N — , ignafu/0 f tfee ofe SE�lEVfRflFO�EXR�1NA70KVLANGUA6E i �. ' �.�.�,.�...� �..�. __ __ _, ----- .�'•• ' ^`'`"^ e3t�v��A-�11E�B�CLABATH�i _ -v_.... � ..,. .�� . ------.�y._-- , _ .. — ,,, — �,.,,,� � ,s3r»�- e ..-., i �;" i ya�_..ss�s.�.;'. ` .__.��_ .. � I Ir.r.h�:�11R�w ttt�t I:ne�c>e;e}•f ft�w�rt#f'iwd�rn�!!w�'s ,. � .,_ ' '_'_ .__ _"- -..__ __ __ .. ._. _.... _ ._._..__ _____-__-__ � _: . . Liu i.e��- Lari fur ft`e 14�Hwwiryy��w f Yrrrtww TI9i#..f. �_ ._�__._..__.__. .Y__�.._�.._-�_._._:.`_______. . .. ..__.-___ .__ B:�u+x�.�s a..v'Prtl•ssi,�.s Cuw�i::Irri -or r�iw+l�'N�JpcR _ _. �•i'i _ ...�. �,. ... � . __ _.... �.. _....... ._._.� rrqr+i�.s c pe�nr;t to rtw,v:rwt.n(::�r,i�+rw'�.;u�d1�YA.�s '_ .- .__�._.—._ ..__.__._' _____..___'. .. . . ��� _ ..,-- � _._.._ -_____- _. ._ __ . ____..._. .._._ .. __..._. r:��,yw="<ury:�.rriH.c�Pri.�r tn its is��varrtw,i+hn rc��y�rw�s IRr - ..- a�,pt,"�.eu/iir c::cl.lur�re� 1 r fi7e tr siy�w°d ahw4:iw.+t 11YN{M ie . ,. .. r:._.� ' __ .�_ .. . .__...__ . ' ' . , ., -_ ......_.. __._._..._.._.._-' ..-__.._. _.__...__. _._-,.___.______.�__.__ /r �risFt�reer,a�ur!f tH U4r fi+nrr�..s+,� nf t!!�_ CAw£racter`c _...__.... ...�._ ._._._. .__.__ .__... ' ' . � � La i-w,v Lr�k�(€'fMNw�9/rrww+�+wea�F�ri�1F Sw�r:w if1M1{� ... �.�.:- ' . . � . � IHrr..ioit3rg`l.'!:[Ru:N.�s.n�wlP�nftt�.en;�r,�Ct�i4)vr'tAsiNMi.� 'r- �..._.... ..... . _ -__ .... . . _ . __ ._ . . . __. ...__� .. _. . .._' _'_ __ . 11-:�i a fk< !e�i.�fm tF� �k.r�1v erevw�Mvw, '' � . . . _.. ' _____ -__ . _-.__ _� _____—. .� � �S� (���.7LJ S ��ros��i.':�rut f.. a rsit e i �+. .:. ___ ._..._. ._ 4 << ! /- - W,,. ; . - . . � .. � /s[h.ujy�f �+:t lr u< <{�eawik r�nrti i�c«.�iRw�fwe .' — '.� • ._. __..... .. .._._. _ .__... ._.__... .._�— fFi.M(EI'tf tff.(1vl1 l5l(i{11. . .. ... � � . L]�..>-��a.� �.ttrr r.:thv ryrp�rt}�ui11 ht+tiw'�r+wk.�ri- � . . . . . --.._-.----- ---.... _. .._--___..----_-.-_. .___----- the w�n:fi:;-:ic n�+t ixk.v�dsA���ir�xrS�iw tiri�. . . � ;5.��.7M�t,Ikr•;ir�+.�w.tYre;4s.��e«u�C'u�fa�:Tfh('rrwfe�e�Ywr'�. ___._. __-_ . �.. _.___ .__...,_ _.... ____._�_.____._ LiicnS%[,n:;�k1es rkf uppfc to wr ow•�hr qjF,^rywf4 n. . . 1���ur i;wpri;��«���i.w�rr�N,r.sut w�hw uS�;•ti,5�x;�k���ru�n!a'aer;e., , . ............... .... . ........ _.._._... _...._._..._. _._-__-r-- /M'�i'lf�l!':.�ilip'.�'!H'�ilNtJXlDtFrK('IAtfSYe'l!(Hliff�'fM�F't:�lYli�lA�p� ' . f(�l'C[tiC.I��� (Y'M+'YYF'.fllp IMJL�i{�(N'Il�iaw�F'•iiE'r FC C.'f� . . ..____ H'(iHfilltl:J['ff�O�fr+i�..' .�1�7('l�N. 'ji":i�!'I'M'f(���#��!'/� . ...._. _ . .. .. . _ .. .. ...... . ... __ .....__ . _ . . - . Y.I�F'N!1(fY'Ul'.IN[/�f1 IMi(�.I liHl MYfII fYl'[PIgIFY➢4'i fUY lAC L , � ' .._.. . lKi S'�?!1 i �'' ____..._ . ..........."__. _....._._._. .___._..—_._.__—__y__---_ / 1�' .I.-vh::.� . .. " B!ltAt�tf l#tfYNF Y��IYQ._� '__.__._....__.___, _...__'__"'.__"'"'-'._.._._....__'""__' 1 aftt ; . � � _.__. _._. .. _ . .....___ ....___ _-.._... ____..'__'__-._. A!�l �.F'.�[7F 4�IP}I M!�liTf#FF .._.__-_ t . '__""' "_'...."'.___'.......__ . ._.._.__ "_'_._.=—__ " �!'—_"-"-'___ "_-'___.___"_-_ � � ...... .... . ... _.....- .._.__'_- __'...._.__- .:.. _.i....__. . � - ��YFIM+dF"___...._"__-"'______'_"_' - _..._......._ ..._...._ _ .__. ..__.._,..... _.._.....__ . �1•�'r`��9r'�:r ' . _ .. ..____ .___. '_'"__ .___...._.. ...__.._ .._._____. _.._.. ,.__..___:.. _...._..__ ..__.._ _.""_"_"__-""—__�.--"_ _..__.. ._____.._ ..__..._. _.__ ....._..._ ....... ..... .... . ..._... . _...._ ..,��.______'.�_-_ . I a ! .._..._._.._ .."_.._._ ._...__ ._....__ """'_'_"._'. "—____'_...._-. _..... ....... ......"__'_.—"_�—