HomeMy WebLinkAbout1512A (8)WORKERS' COMPENSATION DECLARATION
I hereby affirm- -ha- 1 have a certif,cn•e ci :n••+•••"
insure, or a ceaificote of Workerti Compens :
n certifl th s;of ;Sec. 380% .. C.`
Policv N� �r/C)nmpon5'.__'_-�1lIld --------
rI Ce -4 4s6f A .by furnished
Cerhfind copy !s filed with rhe county budd•ng Inspection
deparhner•
Date -8/20/$6 Apphcon' _ r._eMC1n__ _
CERTIFICATE 'OF EfZFiOePTIbWhibW-WORl2 0s'
COMPENSATION "`�5'.'.r•CC.r
'Thrs sen caoneed no, be completca • • r. involved by the
Herm'• Is far one fur :. .'~Fess.)
I cor•,fv rha• i•t •••t• :>••• :,o•k for which this
Pmmit su
-s ised. .: • '^'son in any manner
so oS la oecomo .. •• r.. L•.::. •r .II '%Mp—Sotror Lows.
Do•r_ Aauhcan+--_
NOVICE TO APPLICANT- If, crier mnkmg this Cer'Ihcaie of
,At .mptran. yor, shoule ! - ,• , .: r : to the Workersr
ipensaanr provisions c' „• ri V, you muni forthwith
.nply wish such prowsio•Is or •ms par,,. -snot! be deemed
rooked.
;ICENSED CONTRA(TORS DECLARATION
' hereby offrm Arc- ! am ' racier orovis'ons of Chapter,
9 !commencing wul, Sec of Div'slon 3 of !ho Bur
nese one Professions Code. and my license is in ful, force and
orf ec'
;i:enseNambe•__9,74887 _I•r.0:osb__C34
Cont-artarrreeman !)nfe 8/20 86
-I I nm exemar under Sec. __. of the L.A. Co.
Phmibmg Code ard.'or Sec. , _ __ ----of the
B 8 P. Code for the fo:low'rig reason_
Date
Signal.rrr.._
OWNER .. ._......
I herr. by nff'•.. BUILDER DECLARAT16N• • •,,,e
Low far the -, .... co,... ...
�/•1-do,' Cade.:
I, as owner of the orooer+y, or my employees with wages os
'heir sole comoersuhon wuI ao the work and the strueivra
is not •n+ended or offered .tor sole (Section 7044, Business
_ and Professions Cade.'.
as owner of the proper+y, am exclusively coarmc•ing w,th
APPLICATION FOR PERMIT''
SEWER • SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY,
FOR APPLICANT TO FILL19
CONNECTION DATA
its: I_.44 a ',t=—.
r•iI::N
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RE
MET
•,FARTS- /q�f�[`\{
51 _J•.�_LL.3 �_�
r -FE CF Wt49:CeC%
FwCiTN
M.N.f4^.SF
AL'tiDFI GRP
Nc
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a:All CR'si PO Box 3329
'RL IK EERY : VA
FCA^. =F•!'' W
Covina c� NG 818/967-95 4
�
tt"eA`. VER EA F.'Arl"
RTCCR: 'NFTR 1C. FTC
pESCR •:Jl _ .0" \(: — G �T
BLOCK -iA^ 35754
._.__ NO..r ::L. cis
,
(:R ST .Vi^.FNIN
-TArEFN:R0AC1V1N-
IFRI NO
- -
NCX1 Ol lC"
upon the above-me•laoned prove -,y fo• Inspection purDOYes.
oK �.MR BE MAN CONST.
l•a.cl rrAR?: [
A::FES:_A 8225 Beechwood Dr.
HF •H7i.RSF•ALl irF
„w
lta Loma L_ ,r, 1980 29
= — — —714
i' C NO ;i L= YAR R::CFSSF!
Ra
Rt
AL Ajr
//
L
\•,1 2ESCRIRT ON OF w'OR< -
-
_
a:),.FrS~r.E<:.ONlrc'InG-C -_T 17 �0
'Jh lI-%1MR _
.;A•: )J
C f� •' ��
VALIDA ION .. ._
0: C rA+,K FI tr+A,^^.[ r • CR
- SAN: ,.F ^.RA Nr r,C _
i;:..SE �r+i
s CNECT,%
CYFCT'\C t7 — --
= •E :•t AI; 5•-%, SAL _
r lA.
try
1
::YIM't AM- CIA. %.„WW
.:: CRFLC',S'$EFPr•riF^IT ^RANT,!:= —
!xIN ',E,% -X1 ?R•'ArL_ rn.l'.a'F
i 5 1.2 A
.. iri,A•'. ^R ABANDON 40656-
'.L•CR 1n ,S^..SAI 5 sTrV
o A r
V
I'w x[7.50
OWNER'S Permit 5 1C50
� r [' 2 7, 5 01.
AUTHORIZATION TOTAL FEE 2' 0
i' 8.2 9 H b
licensed connoc,ors !a cons rue •ne proiec:Sec^a': 7044,
BJsmess M,d P. ofes6wa Code).
1 HAVE AT '-I ;; ''ATF A C;i\TRAr pr••.! •1•[ ICRFIN lA'/.F') ,pyRgC r,^.R -(
CONNECT'-EAB.^•Yk:X.4'RIM, FXc•NG ^'Lli, lf:"CTgE;JP
CONSTRUCTION ! FISDING'AGFNCY
Qp
I horeby offlrrr rho' !here Is a conmr:rctior .ending agrnry
for he Performance of -he wo•K for which :his
53'v[G LCIS 'AY OF
'AWN
permit ,s
ssuL•d ;SBr 3097, Civ C)
.0 �"�:,'L-/
T 7 T
lender', Nome__. _...._—_.__. ._..
� �
AC'JR=Sc_ . J
Lender's Address _ _ .,
• ` �+ "', ^`,•' -~-' .... .. ......... _....,,.....:.-.., .......... _.. .. ........ .... .; -.
I cortify that I I-.ove read 'l:Is aPp!Iconon Ona s•o•e •nal ter.
above mformnLo^ is corrar, I agree •a comply with o!i Couny
ordironces and STo•e laws regu'ntmg P:uinbing one Sewers,
and hereby au'hort/e remesem.-.,es of 'ms Coumy !n onto,
upon the above-me•laoned prove -,y fo• Inspection purDOYes.
Signofuro of Perm nee Dalc
SEE REVERSE FOR EXPLANATORY LANGUAGE
W
x
__`�
Business and
Which' _ county
require$ a Permit to construct, altef� improve,
demolish, or 7opair �kv ,d issuance,
signed 4jatc.�';t bo 4consed Pursuant to the
`(commencing with Section 7069,1 L -j' i>WWon 2 of the
Business and Pr#miows Code) or that be is exempt
"""-io=
'^v` ^^— ,'
Ell, asthe owner ofthe pivpertywill do the work, and��,1`4.'structure is or intended or offered for sale.
(Sec. 7044, Business and Professions Code; T7--'�anw
tractors Liccuse Law does not apply to an &, , of
property xbr. builds or improves thereon, and wba'do"
sucA work L4,uclf p�vjide.d that such improvements
of Prooixg Abai , 'i4l ."P. 'w improve for the
lur
�.
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