Loading...
HomeMy WebLinkAbout1426A ,_ _ __- .-�_ -- . ___ . , _ _ _ _ ... ._ _ _ � , . - ---- - WORKERS'COMPENSATION�DECLARATION . I hereby,affirm Ihai I hcve a ce ffica�e of consent lo se�f " , °��D002oawaie� � insure,'[i�a certi4icate of Workers' ampensotion Insurance,or . �6ae�zo, a Scclified�co�y��ihe�reof(Sec.3800�,�"�b�., �������,'�'���� . C80�,'.�- � . APP�LICATION'FUR PERMIT PoYI�'4�3����rS/mE'R{�anyS�N1���iC�u�cs�-c+--i �: SEWER - SEWAGE DISPOSAL �`` ❑Certified copy is hereby5umi5 ed. I' . , . . , . , - - � ' . � ' � I�Certified mpy is Siled wiih thE counry building inspecrion. �' �. � COUNTY OF LOS ANGELES - BUILDING i4ND SAFETY ,, ' ��tide�P�o��mep1.q �I� .. : ' I � r � . , . . , op+e�� C _Applicam���_if�gG��� FOR APPLICANT TO FILL IN CONNEGTION DATA ER7IFICATE Of EXEMPt10N F.ROM W S� � &JILDING � � � COMPENSATION INSURANC nooaess � srnrioN �f.��. , o¢vtH�� . (This section�eed not be'completed ii the work involved by the ' �`� � � � �vvec . LOCAIITY MANHOLE REGERENCE �-�'7(�G IOWER � ��, permil is(or one hundred dollors(5100)or less.) � ' - I tertif Ihar in the� er(ormance�of the work for�which Ihis . �^aesr � rvveoFmNNEaiori LENGTHFROM ' t� Y P 7. , 1 . CROSS Si. Y., CURB . . .F L , ML 70 V.l. ' permil is issued,1 shail qot employ any person in any manner � r.c.No. �� so'as to become�su6ject fo the Workers'Compensation LpwS. � pWNER �i/� � CO.IMP.NO. JOB NO. �� ' I', ��:',. . �I �'�� � �'v I tiun . Da� _ ADORE55 TRt1NK VERMIT Np � ROA�VERMIT NO. �NOTI �TO APPLICANT:IIi. affCl�'iTakillJ hy ertificate O� , �ITY �1.N0. AFFIOAVii WAIVfR EASEMEN7 REGORD.INS7R.N0. OATE � Eaemption,,you.3hould i become'�subjecr �io j Ihe Workers' � ieGnt Compensation provisionsIof Ihe Labor code,you must forthwilh DFSCRIGiION LOTNO. HWY.ORST.WIDENIIJG comply wiih such'proJisfons orlihis permit shall'�,lie deemed � ' fEVOked. ' � � I�� , . � I�� � �. � � BIOCK TRA�f STAtE ENCROACMMENi I� .LICENSED CONTRACTORS�ECLARATION: ' r+o.or eiocs ccarn�r No.� S12E OF tOT NOW ON LOT 1 hareby afiirm�hai I om��icensed�under�provlsions of Chopier � - use oF � � 9(commencing wi�h.Section 7000),of Division�3,of the Busi- auimiNcs � � .o+aaces ' ness'and Professions Code,and m�y,litense ii'�in fu�l farce and . ef{IeCi. ' . I'�� . . .' I/�'�' .�I CONTRnCfOR�, �V � CONNECTIpN CHARGE FEE � . . . License Numb �Uc.Class ` ' � � REIMRVRSEMENT FFE �� � � a nooa[ss C0�1lOCIO / � I' D01Q �p DISiRICT NO. GRpU� � MAP��' PROCESSED BY V ., . .�. . .i � �O�.I, CITYC:��f'Y/I/�,Q TEL.N ' BK GG'. , , Z ❑I cm�exempt under Sec��� �' 'of the LA.Co. ucenis[No. ��y3 anss f 0 , p-- �1 '� 1/"T O �' - ' � � '� NO DESCRI7ilONOFWORK vEE ~ ,Plumbing Code�and/ar Sec � � � of�he �. � �uva� � , � U I I 'i HOUSESEWERCONNECiINCTO on�e , C�. � �� VALIDATION W B.8 P.Coda far the follawing reason � � vueuc sewez p-J �"� . , a . � �� � . $fPti�IANx,SEEVAGE Vil OR � . , ' . ' , I i I � PITS AND/OA DRAINfIEtD fiNAt ' - Z • DO1e I � �pUSE SEWER CONNECTING TO RY ' �� '�� . il . VRIVAIE Ot5VO5Al SVSfFM . . S19nOfU! �Q � CONNECi AOOIiIpNAI BIDG.OR � �' '� � OWNER-BUIIDE�LARATION � � woec To House sEwea . OVERFIOW SEEPAGE Vli,pRAINfIEID I hereby aifirm that I amlexemp�fram the Contmefor's License exm,cessvaoi,oarw[u,n,uNr�pc ' /� [.,(� ' LOW(Of�I1Q{OI�OWIfIQ fE030f1(SBCiOf1 7O3I.S,B1115l1E55 Ottd PfO� � ALIER,REVAIf!pR ABANDpN HOUSE � ��.4 Z.V ry fCS510t15 COdC�: , � � I!' � i � SEWER OR DISPOSAI SYSTEM ❑I,os owner o{the properfy,or my employees with wages as, ' � � ' �� � � � } � ', their sole compensotion,will do rhe work arid the stracmie � �b � I ���7 J Q is no�Intended or offered for sole(SeUion 7044,Business � �' � , and Prafessions�Code). � . i : OWNER�S Pe�mit S O ,� ' �� � , �' AUTHORIZATION . � � ` •`=7.5 C` ❑I,as owner of the property',am extlosively coNracting with �'�, TOTAL FEE . ' , ,� IICC�SG(�COI11tOC10f5 IO[OfIStfUC1 iF1C PfO�CC1,�SCC11011 7D44, �HqyE Ai THIS DAiE A CONTRACf WITH IHE HEREIN NAMfD CON1 AC1OR TO O g G 7`��3 ,B�siness and Professi'ons CodeJ.�;; I ! � I ; CONNECT THE ABOVE DESCRIBED E%ISTING DWfIIING TO THE PU2lIC SEWER. ' ���� �I ' . � CONSTRUC11ON LENDING AGENCY i I � : �. I hereby affirm Iha�there is�a con'sfruc�ion lending agency �" S�GNe�iHiS DnVOF �iq_ � . for �he performdnce of�the���work'for which this permit'�is' � a"NEROR ` .. I issued(Sec�3097,Civ.C)� I �, , i�j owN[asnceNl . il' , ' .' ' _ , lender's Name ' ���� '� i . aoosess '��� Lender's Address��' i .. ��' � � � I,,1 :��I���'�' � . .. . � , I cerlify�that I have read Ihis applicaiion and stare that the '�.� ' � � '" ' - � � a6ove information'is corr'ec1.I agree to�compiy with all Cauny� �I���� ' � � ordinontes and Sfate laws'regulating Plumbing and Sewers, - ' ' " ' ' " �' and hereby aolhorize represanlatives of Ihi{Counly to enter I�,''�, � . � / _ upon 1he a6ove•meniioned properry for inspecrion purposes.' � ��.,I - � � � ; ��� �� � �� � � � � � I�I ! I , . , . . . .. ���. .. .. o erm�ite � . � Date SEE REVERSE FOR EXPLANATORY LANGIIACE I . 1 � I, — ....�*'+s✓ __ �. --,---�� • – ; � �� � � t ior., ,SpiP f_ . o..o . j o n • INS�iCTO.".'S NOTES 2 0°o V o 10 � •. � af�� f,r�I�ION�' �. �o 0 APPROVALS DATE INSPEROR'SSIGNATURE �� � ���fb.�0�[�y`) :1 ,Q�:t3tFtCCORtfattOf�S � r+cwHovscs:wes - � L,. �'y,�°io°'tio°r.e f< � L`y oa�aSrction 703f.5, �., mNNECfADoinoNaL . . . . � IIu`., J3O.f:rojessi 4 V.� t,��,o�O�or rounty BUILOING OR WOaN . . . . . :wht E\ x}er a pen�•�/ �+: ��oo $1 in:hrovc, � '�-demolu�,o'r repmr�aay y.`fiLctJ� � o ''P .ssi�ce, SEVTIC TANK.SEEP.PIT(51 � . \ [� �n AND/ORDFA��JFiElO - .��--� ♦-•, Rt50 I'CQNlIlS tfJC a�f�Jit¢nt JOt'S'.^��0� d�' .10 fi1C 6 � i\`,i'�...^ > .�y;l l:�-.�. �.:�..'cil�� � �y . I eFss000;❑ carw�u❑ ` L , s�gned statcne.et tbat 1 c is liccr.se�0 .eant to tGc �� .j.:��...,�.,�'�. �;�;..,;;�,' �,-.. .;��4..�'�.l, � provisior.s oJ aGe Consrcctor's Liceri. aic(CGapfcr 9 i j RRR,RCGAIR,SEYhR OR � � ��� - (�O/nmCT.[Yxs u•itb Section 7000J of Lk�isior. 3 J tGc � $EN'AGE D15op5Al SVSTEM BuSinets and Projession.t CodeJ or that Lc is fXC.pS � aen°o"oN Mou�sewca - � fberefrom anJ tFe basis jar t/c a!lerrd exemf,fior..Ar.y BACKF���SEPiICTANKSO ' � • ����'���!'�'._..• i'\;:�� � violatiorsofSectior.7031.5byanyc4plicnntforapermit �a.vrtisl❑ assa�7ot5 O `+�� -. srebjeeLt Jhe apQliear.l-to C eietilpcnalt�,�i�ot morc.tGar. � . •, .• •. , -, • .� '_• - .=ajiemYwi+�reeiduJlars(t5001•:. . . . �.' � ' . � �❑I,astheoa�nerofthepropert}•�:illdathcr.ork;and � � - - '' '""' " '- the strueture is not intended or offered fo:sals � � � " . � (See. 7044,IJusinert and�Prdj tsions Code:Tbc Con-' - �� --� - lrnctor's Liccr.sc La�r docs r.oi c�fly to on ou�ncr oJ ' � Qroperly wGo builds or lmprores tbereor„end u•1 o doet , � � � . tucb wark bimrelf proaYded tbat aucL in:f.rorcntects ' , _ . . . . - ure no!intended or offered for sc!a If,boc•cerr, fbc ' .._ . _. . . _ _ bssildrng or impronemen! i.r sold¢�if6ir nnc yccr oj �� t � � romQletion, tbe ou•aervbuilJer will Gen�c tbe burdcr ' � ... . . � � ' •• •-��1 '" � � of,proving,fbat Ge did not.burl;i or.imfrouc far tbr . . .-. • _, .-. � _ . .i � i�. . . , Drrfore of.rcl . _ � . � � . . . _ . .. . �... . , _ , , , .� � ,�.;,., . Y.:.-... tr � �. � - ,,, c .,� • '`Y.�� ..r C am exc�pt nnder�5 - , , . .. . . . - --- 1� �-••' �,'�. �;�� B&P.C.for this teasoa _ :� I Date`� _ _ __.,___ ��;�� -...,..__. Owner` . � INSFECTOR'S N TES } � � . � . � � , o a�� �, CP w e�e W rT �.� C��SSnS ' SC'��` I �—� S�c4� , - ._ _ - -�-,'!�'- ��