HomeMy WebLinkAbout1515AWORKERS' COMPENSATION DECLARATION
I hereby of h r` Tsen' to self
t
insure, or a ce >' s.:' I surance, or 1"6190
n :.e" r,::'1 CE 808 (REV 8,'Br )
Po'( ,,8'T�'7 nti. Fund .��
ysipy•', . , M:,y turn shed.
44
Corl,fied cony s tiled wnh the county building Inspa :,on
depart rent
Date86Appl'can: Freeman
CERTIFICATE OF txrAX I0WrR0 X N/ORiZFRS'
COMPEN5ATION INSURANCF
ITh Is soc- on neva no: be completed ,f -Ile work �ri,olved by the
oorm't ,s For orc hundred dollars 151001 o• less '
I certify -ho, n the pe fo once of the work for which 'nis
prrnnt is .,succi, I shall ! person r any 'nortner
so as to become I..ws
Dine___.—_ADPl,carn __---
NOTICF TO APPLICANT: If. at— •rnak,ng It- Ce•tt'cate of
mp"'. you ahoulc .1:..' to the Workers
F 'pens t— proves 1 .. ..' you —s' ;a.
thw,'n
.... .,Div with Su,tl p avrt!O^5 or '•,.s perm,! Shull be tleemCd
evoked
LICENSED CONTRACTGR:S DECLARATION
' hereoy ofKrm tho' 1 om hcensea „moor prowsroes of Ct'op•er
9 ;cor.;menung win h $ecr'a, 7M0: of D—son 3 of the Bus,
ness and Profess -o, Code. and 'may l,cerise a ,n fuil force arta
effect ��
License• Nnher_�e4QB7__Lc Class____Q
Cor.ra;tor_Freeman
7 I em anemp: under Sec of rhe L A Co
p:.,rhb ng Code and or Sec of the
B 8 P. Code Tor eke follow ng re, sin-
OWNER -BUILDER DECLARATION
hereby at'.,rrn t1J 1 I am axemp' `tom t6= Can'rprtor's l ire^se
!.ow `o he follow"hn reason ;Se—n 7031 S, Bu, snoss and Pro
,._
I. at bwrher of -l".. p.,.;
their sole cornpCeSa
APPLICATION FOR PERMIT
SEWER - SEWAGE WSP®SAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
CONNECTION DATA
..
fJ"0 1 ViJ_�=i
_
`JP=F4
rv. 719_. x,8_
:,ANMO.r RF-CREIC"
7Y
rs
1 as owner of the orooert Om a%c'u5'VeI ' raring w'•�
Y' Y can•,..-,.
AUTHORIZATION
%T__
d
�
,..Nix 1U1DEN
�c
J:n r..•,�(�
(]
>nIts, PO BOX 3329
-.I..h<r'FR•/'\(:
ROAC aRV.T N:.
Civina 818/967-9541
AFFIDAVIT WAVER EASEMENT
RECORD. INSTR NO DATE
`+
so
r:ri'RP• „� O" NO
hWV OR ST. WIDENING
'
35754 ....._..
r.- ENrRUAr.i:aEN-
.. .. .... .. ,,._.._.
No
SIZE OF LOT NOW ON LOTS
for t1,e errorrnonce .of 'ne work which •rvs
P PCfm I' ,5
.: _RS .:/:Fv��iw'1• �'cF iii`^.`•- �t".�
6'SE J'A:.: Sing._ I�es.q�__
issue d '.Sec 3097, C,v, C--
:ON -SA:. -CR FREEMAN CONST.
ADDRESS 8225 Beechwood—_---
SL: RSEV.CN1 °K.r
:AltaLama ;. ,:,7.14/980-4429
]ETR CT NO CRO_=
:,' • RO:ESSED d'
_ _
1 c'; Ey ♦;J 474.887 Q 34f.
PK
I certify rho' I !Tawe read 'n•s opoli<a• ana state 'nal •ne
NON DFSCR'RT-DN 01 WORK "_F-
;'OenEc'F1nG'C
N _
Ca*�.
VALIDATION
`C e.nK .-I FRnr_F P -CR �
Sl_�^_
h h:•L
'. CPK '!1 SCAT E
(?A SE=RAfs f' LRP NF"%:.]
r I -1.5A
h -N
L'k IR
6R n
—
rx 2750
,, -27.50
O
U
z
W
z
.1 iritenned or . • t.... .
•r •„
OWNER'S
Permit s1 1 x50
r_
1.
_
--
0 8:29`-86
1 as owner of the orooert Om a%c'u5'VeI ' raring w'•�
Y' Y can•,..-,.
AUTHORIZATION
TOTAL FEE �2
�
hce'hsed cont'.:'.:'.. I.... ,.. ..
'. .' '.
HAVE AT -. ;1• ;A1r : ^'nTR
n;- • TIF •L \ NAYEf.^A;
BIJ 51r'C55 ped " •
CONNECT THE �.�;:,''-^'SCR'5FD : XISTIN',INC: " I \,� :^.--r I':.?r' $:'.l'rR
CONSTRUCTION. LENDING AGENC'
SGNfC iHIS_ A
11,0raby afhrni Ila; Ihe•a Is a cor,Struc•,mt lending age^cy
`o
�4X
for t1,e errorrnonce .of 'ne work which •rvs
P PCfm I' ,5
.: _RS .:/:Fv��iw'1• �'cF iii`^.`•- �t".�
issue d '.Sec 3097, C,v, C--
_ r
n-rFsS-4�-
Lender's Address_—
I certify rho' I !Tawe read 'n•s opoli<a• ana state 'nal •ne
above ,nformotron 's come:.; agroe b corny y will• e.'! County
oydrrtances m'd S•oie laws rea,Jla'Ing Ph—b—ar,o Sewers,
and hereby a !ho-rzo ropresentol,vos of this County to er'tor
upon the above-meproperty ibr nsnecnon(�purposes
S'gnot,rre of Pe, r...Woo Dato
SEE REVERSE FOR EXPLANATORY LANGUAGE
INSPECTOR'S NOTES OWNER-SUILDER'bML'ARAMN
I he.'*!Jy affi.Le] dIRS 1 21--. L=Sn-,t fil= ChP G0W.Wt.Mr`S
License Law foe Ate ichom•I-g keam•, S-ri.z 7031.5.
Business and i""'fe), Any clay or county
which rayr-'re, a patnaet 'o COMOW4 alter, improve,
d.woku;, *:- m-piir --V svwc., issuance,
also mavims ihr qp.U-..t for such J,.,mit so fide a
signed r.wtapjast tura: he i% Incensed I,:: t to the
provisions If lbs Covemcf6i-s License Law (Chapter 9
Business and Professions Code) or that be is exempt
(commencing wish Section 7000) of Dk*iox 3 of the
violation nj b.C&3. 7031.5
[I L as The di :tie gWopeliq qn!"ic, li.e Wolk, AILZ
the stracluee 4 not :uc.LAje.i or ca!e— hu sale.
(SC. 7044, Business and Prof—i6as Code., W—Ir4n-
traetors ..icebso Law does %of %dPly to an v,, , of
PmPerty who, baiids or improves and who does
such work himself provided that such impmvemenn
are net int"asd or offered for sale: If, however, the
builditV — improvement is sold within one year of
complefi,n, the ownev bvilder, will ham the burden,
q( proving that he did not build or impmiv for The
Purpose of sale.)
I ain exewpt w,derSei-
13 & P.C. for xbis reasmi.
APPROVALS
DAT_F INSPECTOR'S SIGNFTURE
NFW HOUSE SEYMR
CDNN&QI DDITXDN�-
BUILDING OR WORK
SEPTI IAk-r, SEEP, PTSD
MDIOQ DRAINFIEID
CESSPOOL 13 DRYWELL [I
M.TFRIZIT.�;. ;.;ER OR
SEWAGE D-SK)SAL SYVEIA
MC INECI PLUG AND
2
ABANDON HOUSE SFWLR
-M
BACK
St PT!C TANKS 0L , 3L ==Laaza�% _.
L, --, J,.
INSPECTOR'S NOTES OWNER-SUILDER'bML'ARAMN
I he.'*!Jy affi.Le] dIRS 1 21--. L=Sn-,t fil= ChP G0W.Wt.Mr`S
License Law foe Ate ichom•I-g keam•, S-ri.z 7031.5.
Business and i""'fe), Any clay or county
which rayr-'re, a patnaet 'o COMOW4 alter, improve,
d.woku;, *:- m-piir --V svwc., issuance,
also mavims ihr qp.U-..t for such J,.,mit so fide a
signed r.wtapjast tura: he i% Incensed I,:: t to the
provisions If lbs Covemcf6i-s License Law (Chapter 9
Business and Professions Code) or that be is exempt
(commencing wish Section 7000) of Dk*iox 3 of the
violation nj b.C&3. 7031.5
[I L as The di :tie gWopeliq qn!"ic, li.e Wolk, AILZ
the stracluee 4 not :uc.LAje.i or ca!e— hu sale.
(SC. 7044, Business and Prof—i6as Code., W—Ir4n-
traetors ..icebso Law does %of %dPly to an v,, , of
PmPerty who, baiids or improves and who does
such work himself provided that such impmvemenn
are net int"asd or offered for sale: If, however, the
builditV — improvement is sold within one year of
complefi,n, the ownev bvilder, will ham the burden,
q( proving that he did not build or impmiv for The
Purpose of sale.)
I ain exewpt w,derSei-
13 & P.C. for xbis reasmi.