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HomeMy WebLinkAbout0955A T_ m,.,.�_.__._ __ _.--- .,__._ ___ ____.___�_ . � _. ._,_ . . _�_ .�::_ _ , � ....+ :_: .� . _ ._ . , . . .. .. ..:�.... ��'7fiA642D.....-,_-� 4 � . .. ...���vvvyyy ,.._�...�. . . ;,_ ..,...� . ,�... - ��10RKLRS C0�4PLNSATlO7�D'�;CY-A'RATION APPLIC�-1 ION FOR PERM�IT ..� � - . . .r -�GE 808(&80) .. . . �� . _~. ' � �� I hereby affirm th.�[ [ have a cert�ficate of consen[to seif - SEWER—SEVIiAGE Df�P(�SAL� insure.or a certificate of W'orkers'Compensation Insurance,or . ,... . - -- ��"` '��-"�� � 'tif�ey cgpy�t e e, t Sec.3so. Lab. ) � _ COUNTY OF LdS ANGEtESt�� �BUILDING AND SAFETY . a1°��s,`,.c<yc.5�s��` ..a.0 �� �u�%.'�- .,. . .,. , ,.,�...�.., .,�.-,. � _ Po1Tc, o � ompan� �� � � I FOR APPUCANI'Tb�FILL IN CONNECTION.DATA � Cer�fied copy is hereb5' rnishe � ' � ��� � � -���` 6U�LnING STATION � • �� oEVTM . �� Certified cop>'isfile tui in pection ADORE55 �-�,3'�J L13:T�0:1C,.'' L�uY' �i'S�1V:�. / . �.... . .de rtment. D1aJY10YiQ �c"33" wrvHo�E wePeseroce r, /) uPeew ' P� �_ LOGALITV TS.�/ L WER I � DBSC Applicant T X C}�Y3T�J. TVPE OF CONNECTIbN' -���� LENGTH FFO ..,.'. '..:. ......._. . . CROSS ST. -... ":'.,.-... s Y. CUR6 ... .. ..._, ..y .P.L. M.L.TO P.L. ."'�ERTIi`ICATE�OTI�.`7CEN"IP7 OY FROM WORKERS' '�� �- -' � CO�fPfiNS.AT10�i�NSURANCU . L,L��E'Y1 '" P.c.vo. ..,_�» -.. .' '. . � ..,, _ . .. ... OWNER �'�• i .. CO.IMP.NO. JOBNO. ��� . ......,,:. .:.: . _..__. . ..__._ ..9�_ , ._.. MA,� � '(This seciion need not be completed if ihe work involved HDDRE55 rRunk PERMIT NO. � ROAO PERF11i ND. � � ' by the permit is fox one hundred dollazs (5100)or less.) �F,oao� .rvE se.,E �oRe.��erR.� o.*E p _ :. :. :.,.�.. . '..::,-,.. ...:-::� '.-.:::�..,;.. � ...... CITv TEL.NO. a T w w eq nr we . ... . .�. ..._:. . ... ... . . .. U . I certify that in the performance of the work for whrch[his �Eca� � perir3it ig issued,t shall not emplo)•an}•per5on in any manner oescaivr�oH �or no. ,,,,__ Hwv,oa ST,4YI�ENIN6 � ... ......., v . . so as To become su6�ect to the Wurkers'Compens�tion Laws. - - .. _,. .....,.. ..r,.. ... . . � � �� ' ' , . ".., . -:" . ' ' ', BLOCK TRhCT , . ,,,,,,i STATE ENCROHCHMENT� � . .. - .. ....... - . . - . . ._. .,.. . PERMIT rv0. .. C.) ��Ilate Applicant �.oP e�ocs. _ - - LL7 .,_„ N . � . . ..... ... _.,.s.T_....�..,�.,:.:�:::�-.:..:,-:...� . , . 512E OF LOT NOW ON LOT...... -.... � NOTICF�T0��1'F;PLSCANT�If,�after makmg[fiis Certificate of - � � �--' ""'-�" .. . ...._ ,..,_.._..,....... S� F.xemption, you should become�subject [o the R'orkers' use OF . CHqRGES r � � Coiripensation provisions of the Labor Code,you must fotth- eu��o�Nes . ._ ,,, ___ .,„ _ - .. - ._ �with. comply wi[h such [�ro��isions or [his permit shal] 6e corvrancroe=+ri}JE'Y'� �. 1"��UYlSOi1s �Y1C'. cONNECTION CHqRGE FEE deemed revoked. ... .....�.e...'.`'.' " " - . . �' ' '' �� LICENSED CONT2ACTOR5 DECL.4RATION A�ORE55 �� ""G �' �I.-+YIO±.l REIM6l1R3EMENT FE£ �. i hereby aftirm that T am licensed under provisions of Chapter crcv ��S'C'P_�OYa TEL.NO.��J�9����y STeicT No � o� sseo e. � 9 (commencing K�ith Section 7000)of Division 3 of the Rnsi- �/ ness and 1'rofessions Code,and m}•license is in full force and srw*e �Lq. l f�" �P �M+P%s� �,:/.�.�-P--f ' effec4. �.iceHse No.����=1 c ss -- � �r/ OESCRIPTIOfi OF WORK FEE / � �o�HE�,.�,��,, '�� FINAL ) �� VA�IDATION LJcense:Vu� e � 1ic.Class � • � — _ f oaTe {�"/� � ewewsrevF�e r Contractor � Date 2 oiow'o oa ...,......., F1NAL ���... ! ❑ ' " sA�s.-s,EM`,'� BY �Ia;;: I am exempt from the]icensing requirements as[am a omr�o�ac�a�e�."ow licenstd architect or a registered p ofessional engineer w . �actinK in my professional capacit}� (Section'9051, Bus= wOE` ,iotE ' �- inessandNrofessionsCode). , a�R�ow�.ceir�,nov,aoo's�--� . . . . ., ., . urew,owoisrosw4 ' ' s[Wew sY§TeM._..,,......_ ..,..... ...-. ..;...,.,. ..::-._..�.�-..�,..:.r.'..�:......._.:.:c'_ _ ... � �. . . , iic.or Reg.No:-.:�..... . nxte ... _.. . . . ,.;;,�. .w :..� . . ;:.. . . ,,... . ... ., � ���.�. . HOME OWNER-Bl71I DER D6"CCARA7�'C61�f� � ..':�,..:.t. ..... ., ..... �.a C),5,�j{; ! hereby affirm thai I am ezempt �trom the Conxrac[or's �WNEf��$ Permit t ` �� 6 Licensa Law'for the following reason (Section 703t.5, Busi- AUTHORIZATIDN TOTA9.FEE a #� ��• •�� �%cm, <52% � nesg and Professions Code): - � � e 2'2,5 Q ; � I, as owner of rhe property,will dn tHe work and the *e rHe vve�~c� er+. �E� , • •r`�2,rj O� � structure is not intendtd or offered for sale (Section SIGNE�THIS +s__ 7044,Business and Professions Code). 2 , _,.....�... �ER=w�E t 209�81 ow �� ;. _ CONSTRI;CTION'T.F.Y4DINZ`,".�G�'F:R�]1..,.•�.' . wooaess . _ .... ...._-.,, ( I here7y affirm that there is e cons[ruc[ion lending aeency - - � for [he performance of the work for �vhich this p2rmit is � �ssued(Sec.3097,Civ.C.). � .._. . .._._._... ,.,.-.,.. ._.......-._.....,,._,.._......___...,-.�._-.......___«._,... ...M... . .....,._.. -,.,..... ,,�_..:. _.._... . � en ers:ame . _.. , . ..........-....,.�...,,_<....._.a .. ., . . . _ . . r ' ,__. � . .�.. ,�.. . .. .. . . .. . . . ._. - ti.,�...,.«. ..,�,_.,,..«.._. _._,�A..v......,_v......�d.�....e._... ' Lender�sAddress� �I� f [c.�rtify that �ce rr d his applica[ion and s[ate that thu � � alfoce inform tio is c re t u ree[o comply�vith all C�ur.ty ! o dinances d [e la s la:ing Plumbing and Sewrrs, �a h reb� ze r v[ives of Hiis County[o enter �. e ab �e- ti zd � erty for inspection p�rpuses. - - - --�-� ���"��^'-^'-'"�'�` , . .., . , . . .. . �� �� SEE REVERSE POR EXPLA?QATOI(�Y�YX�G�U.SG�������'�� ������ �� � ..., ./ " , . . .. .. ✓ -•e of Permittee Date� � � , � � � , i �. -�,�.,�,�.�a...,� � � �i` ..fi,,.. �.. � ' �; ,.°�" s,_m,'". �F'.w �.j...S�` ��e i`, r ;'3 t.�&`s - .. . . .. . . �... . . ... .. ��a..o.^�,�:�r' :p� .a - . 4 ilVSarc7t3�'s n10T�5 v�v:iE�-BUIi,T3EI2 DECLR�S'7'IQN . APP�OVALS "�ATE � iNsaeCror�ss�on�nruae ' �'� � " � _ _ 3 3�ere6y aBPicm that 1�am eretnpt from the Cont:�:c4or'� . . ...___ . .__ ... __ . ,......__-__._. . .. . . .. NEW HOME ELVER - �.`: ��.� ' � � � '. � - .. . � . � ,.. . � L'icer.se Latv fe? f'�e Pol[or.ing re:son(Secrier 7037 5 CCNPlECTA06!TIOhA_ ' ' �""-. ... .._ . . . � � d if CG . _ __. .... ��� . .,.. , . . n . A4�s ess .nd PrJ xsions CodeJ, An' citY r. sui�oiNc oa wo�K - . :. . .. aw�ec <equzr �,a perwrr ao co.�etYeect, d�zr Ampso e. SEPTt�T,4NK SEEP,PI-(S) .� . . _ _ . ............... _ -_ . _'"_'_"'_..._..'_'_'"" d8f91 €Y[, 9 an st`ustur.Pn r i0�t4 �5[f 2. n y o h � � i' c2 oz.r�Ge y e o s anc AND/OA DRAII�r:��0 ' ' �- � .. � 3rSC ekk:re$ th�appl�cdnt�for sacF permit to flte a - ; .. .._.. . ..--.� _.. __'..._..--� - - _ ._ . ' _ .•� , ...,.. . - , . ._ - . .. . ,: --�--- sign�!G��!ater•r.eat !h¢i he is :'icer.sed p�arsuanr to the � .. , � ,; ._... ... .. : . � CESSPOOI❑ DRYWEi�L�a- : � ��� - � � � �� � . '" prov:��:orrs oj the Co:atruc2or's l.fceiise Ca:v(C'hpnPer 4 . _.._._..—....__ . — . ALTER,RE7A7R,sElNER�oR-�--�- � - - - — {'t•omrn2ncing w3rit .Secrion 7Cv0/ of JivisrcJt 3 ef the SEWAGE�47fSPOSALS'YSTE.M� . __ ` ' ` "' ' ' I3t;a•eneJ� 9Pld PYof2S8ioi:S COlt�f O! th.0t Ite ?S e;.:eir,pt � __ ' __ ..._..-r-__- , OISCONNECT PLUG Anlo � . 1?�ere.,fram.a�vl rhe?ws�is fo:the allegcd exemp:iort.Any A6ANDCti HOUSE Sc�h�ER � - � 'violCFi'JN O�Secticn 7031.5 hy any app(rcanr fora�sermi� BACK'FILR S�cPTiC TAiI'RS��Y`"'-"� '�--' ' � � � ' �ubjec;s the ap�licanr ro a civi?p�ezad:y oj:mr more tfran SEEP;PtT(S)L CF�PDOL$�' . �. � � "'-'".." . . ..__ --...,_.__..._... ..__.__„-._. . .. .. ...... . .. � - .� .. . . five 7�:..�sdred�of!¢rs(.SSOOJ.: . . . .. . . . . . . . .._ .__ . . � ..v-I.'as ov�ner�o;the p,-operty wi31 do tlie wmk,arzd . ......_,.. ,.. . , . ;--._ -... __._.. ...-..----..__.-._ ._-. ..... .. ... .. . . -t3ie sir�cturc fis nnt i:tSen:lefi or oftered fot saie. - ��.:.�. ...,_.... ., _,..:� . . . � . � � ,,.:. ..:,-.c�� ���"� � - (3ec. 7C4.t, BasinEaa end Profe.ssio�s Cadm: The Co�' .._.. . __.._.._. _.,_._..__.... . _._ ._..... ._ ... _.. . . ,., . �_ � � - - - tractcr'4 L%csr.se icw does not�ar�pty :o n.^. osvner of . , -. ..._._ ._. . � . .. ... . .. �.� ..... . .._._..._..__. ._.... .__.. . .._...... _ - _ _._.. ' .j;ropeny�wh,o�utlds or imprc�ea the:_^on.and wF:v does - . <�.-•,:.�.:. . . _ .._.. ____ ...--- ..--.--_._..__. - .---..__ � ��� .such jv9rk hirnself prorided t8a; au�h i�r�roaenrenrs . .; .`,.:::� . ,. �.:��.�.. -�..,: �.. : �:-� .. .---. ..--_-� � - . . t�ir.tended nr oSfered fcr.sols. IJ. howe�rer, ;he � . . ... . . .. �__._...� .......... ... .... .._.. _ . _...._.. .. '�.. a. . are nc .. .� .... . ._ . .- .. .,-_,_,.-,� - - - .hrai . � d wilFin awP yepr oj _ , _ l�irzg a= 9r�proverrent is sol �.-.,,..., -- .-�- r:,�,,.: .. . . . .. .� ,^�- � ,.... .�..._._--- .._..---.--.._.. ._.....�_._-_- __:.�".:....--�..-_ _.. ,-�_ compl2tfon. the �n�ner�'vuilder.wi77 ha�e the 9urdea , .` :"�. ... . . ..:. ' °... .�_ . :..;�-.��. . .......... .. . - � . .�of prccing rhGt he dtd r.ot buiid o;imn.ave fcr!ite . . , ... ._ . . : . �- �,,..: -.:. ..,., . . ` - .. . ', � - � - ,nurpase o,t�sqle.) � _ . . . . .. .�.. . ., . , ..-_ '� �'- � .... :�-...�._� .. ..., - a ex.,n�x uh - ; . .. .. . .._....._. .. _,. ._. _.__. ._ .. ^` ' '. ` 'am �r ,der Sec._� .,. _ _... . . ,_ . _. ". . , • : , . :., ., _ --. ,, � 'e g��.�.fnr this reas3r.�.� .... . _ ...... ,:. . , ,. : �.,.: � ._ °�ate - -- - _. . _ _ � .. ' _ '. . _ . __ . _. ... � _ . . . • Owner . . . . _..___.:_...._ _:__.._ .... . . . .. .._. � C�aOf1�RE3�FCT0�'SP�0T�5 " ' � � . . . ..� .�. .. � .. ... .. ,. �, .. ._._::_.._ ��.. .._ . . ... :. ' _ . . . . ..- .; _.�_--_�._—W�' .-. - � ._..� � � . . . ... .,. :1 f�..5��.r• ' � __ �3....-�-,...'._',,:7._ ................_.,.,. _:. ... � . . _ , . .... .. � G n'?.'l. ' _. . :5' :4 . . � . . . . � ,..... . ^. . .� . rJ . .�� .. '__� , ' i U�Q� i - ... ,��, _. � ., . . ' . . .. _._. . . ... ' �.� , � _ . .._..._ _"" . _ . .. . . .r�" . . � - � ... . � � _. �; � , . . ; . ., . . , . .. q S. . - , .. . . . . .. . ., .. � �_ .. . . .._. _ .f �, ,, , __. ...,,...__...:- , . . . . � . .. . . ,. -..'.:,i f;..� ,/