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HomeMy WebLinkAbout1519A , .._ -- ----�. ....._,._.. ..._......, _ .. ..._.. , . . .,... .. _ .._�..,..._. .. �._ - ---- - - - - -- --- _. . .. ..... . . . . ... ... -- ._. IYR � NSA710N DECLARATION . � ^ . , . ,. . . . . . :.. � APPLICA,TION FOR PER1Vil I hereby a certrc cate of consem to self - � � � � � � � � � n5ure or c " • ' ,',rs'Compe:tse�lo�I��sJrance,ar 'eA6X26 a fe��r i•o .,•,,�: 300,Lob C: .:E BOB IREV BiBi) .� , �,. ..� . . . . Poi cy No . ......;,::�''---- �t. Funu ---.....----- �s '(�^���-,�f . �'�,���hnebylurnished SEWER - aEWAG� DISPOSAL I11L CCI'II�Fd copy �s���ed wnh rhe:oun:y uu��ding inspeci�on COUNTY OF LOS ANGELES BUILDING AND SAFETY � tl1f10lfTCn' o�,e__$�_2Q�'f.Z.�i�oam��...F.rE?J9aX�__._ FOR APPLICANT TO FICL 0N CONNECYION DATA ` ��w CERTiFiCAif CF FXEMFTION:°RCAA'WORK'[RS' n�,��;; . , . e -'-"-'-'--'--'- — . . 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