Loading...
HomeMy WebLinkAbout1509A.., a.. d� COMP,EIVS5A"'lib'N"t5l"�iA� , I hereby ,0- •- •• r I have a certificate of consent b self i W +'Cr•^m^4 .n -:r Insure oratrr•IVal - - - "Ad4so - - .. . f tWork, a..; : car 4eof � ;;;} �',t. --. sOs ;REV 8!811 /�'�y. ������� . . .'4.'µ'-•�'M..A. ".-aA'fluA»� Gii'C.yi.C.'.:J.Y:.eJ:.-.i^i:.�y:. �:... -. Pollry Noompa. F7 �r• Ceranby furnished : Mi� SEWER • SEWAGE DISPOSAL Cer4fiad copy. s Mott wrh -me cou:n bwldin p, y g .nspeciion COUNTY OF LOS ANGELES BUILDING AND SAFETY acpar•m n• V ..»• .,.,,.. •.. wrcH-'y.i:: ..'Y, �''.."7^s•::`:C^ ,C't..;, _ .. ,. Date _... 8�20j_�*;leant_ ,Fl"eem2A FOR APPLI ZT TO FILL IN, CONNECTION DATA CERTIFICATE OF FX°:• -`"a rn';•: :'.:"t<: i. COMPF.NSAT',-% • 4.,4A.",'.° �,/ n. -- A — ' Tans section need ' no• oe completed d -he work involved by the • • ,:rrvR aMnl.L; ;r. ;'0p1 P•i.35.? 1J EF " .;. ...,.F which 'his the work for ,ny person ri any manner lm :�: .,.••; \E:•?: e- ` ,� [A$a t' �t[s� '--�'k�`� ,ver Cr :.'7\\-: t1^N J.N,^,: =KJp f C!.R3 ;• I t6 u . so oBto P.CO sube r ' . he Wor4 ; .c to t en' Comoensnhon Lows _k ANDEr`x Gj1p Dale__ .Applicant___ Ya' T� nr� VTr• qq r'�1•)QE`� pQ 'L_33 . TFJ%7713n r•1a ;CA! %=4:.111 NC ..� •., `7. •-VSTR NOTICE TO' APPLICANT ')F,' afor alak.ng th'r : t, �OP111 1:. ,u 818!967-9� )'• fA:'I AA vK: A�FVF VQF.:--, .} L':.IE rj�.e'mpllan. you should become subiec' 1; Tpersa•'nn prov•-Inns of the Lane, code, 1::. ^' • •'- oESCF rr C\ ,^"N;7 � L.s -•' .,nciy wdh sucn Provls.ons or •ms prnnr , ... NwY OR ST. WIO1;Nff•Id""" revoked G O:x iM' LICENSED CONTRACTORS DFCLARATIdIJ I hereby affirm that I am Ircensoo under proves -ons of Chapter fnS ON 7- ;commencing will, Sect -on 70001 of D.vwon 3 of Inc Busi- St.9 S,nL=\�: �;x1Jge Res. --- y-��AQ�;$ -,ss and Professions Coo. and my Ncenso is in full force aria — - - - nrfec' ;:t\ A,TJF FREEMN CONST. o\\•f me:,:Q;;F:rc ,s 71 �A L'cprse Numbrr__yc A8_a7_ 1t Cass-_ AL]F:'.SR.-`.•tuiSfN.r\':EC _ O /��}� Contractor y,4 Un!e 8 LG1525t_'}.� •[ QMr� -„(7�� �QQ(�� [� SFQ^� NO i::l ys: aQ: �re5.7 ev S,J I ori, exempt l,ndel' SAC..___- __ef'F1e L A. Ca. -�. 7 ,..,e$ (! 7j 4 P.unb•ng Code and • or Sec h NT7 .�JfSCR'PT:CN OF WORK - - nn -f --J._._._� .__. a•• V B 8 p Code for The fo'lowmg rrnson__• .. •ii.Ix $':vF: C J\\i:' MG 70 L.S:' q.•rrR -AN, aF=-;,;L s- :;r L 1'•: i 0- — _ ! 2r_ VALI hL` A\) CG 3RA'\'IF.L : \n S.gnalun),—_—.._ �_ .. . .....•.,, OIDFR DECLARATION ' „,.•z,.. �F. •,.:omr:i.-_ a cr. ;:F -� -- M 'K I hereby atfRm thatat I am ex am exempt from the Contractor's License - ^RA,\r h•.tQr n Sr ---ACF Ir”x^, ;:$}:.•,x), _"1vAr van".1%.- !ow f-• •! : ',;"owmg reason (Secton 7031.5, Bulsness and Pro- _ _ A 'AR R: -A R ?i AeANLCA hoar. D ,K;SA. i'S-E.L' ` AG „ J k� I os owner at the property, or my employees with wages as e A ° i th.,r 3010 compensallon, will dr' ", •. •'•r sfru; cur. Is --a,Iniendeo or offered for ::: ,. .. ..: Busir:ess ,y P,afess,ons Cone OWNER'S Permit S ZQ J© I o7 T Iand IJ I, as owner of the property, am exclusively contracting with AUTHORIZATION r TOTAL FEE 1 27150 , „ ? 9 n x ,.conbr:d contror•ors to ronstrim ,he project .Svc',on 7044, 1 wAVF AT Tu 5 ^ATF A ",^,N -3A:' AIT- r-! -Ir RF'• Y4:'=: 'DViiA;-' d 11 Business and Praf.sslurs Coria:. :::r...r_"•Ir •ip:,sF pfd:Q•ELn •x S \G Thr IN i :^. T.1r +,:G .i 'FWfQ C \ p fi CONSTRUCTION I ENDING AGINCY 3 I hereby nffn.n• ;hat aha:. is a con,imErior• 'a••d,nq agency for the 5•GNF[)7rf,5�1 7Av ;AN -?:1s �.a— oerfo•mance of the wore for watch :his pernut •3 �_� �.� :n1Ni:b A;•: h'C��_ .1!{/•+'�r' `-C%"� issued (Sec 3097, CIV C ' —✓,�„ _. Lender's Name. _ Lender's Address-- ddress_ ••, r• ~~• m ,.Rat, v,r.,,. 1 certify -hot I have reoa •his opplicohor and state Ihot thr.- 1 above mfo•mation Is correct. I agree •a comply •wrh o4 County ordinances and State lows regL.,a•rrg Pnnnbmg and Sewers, and hereby autl•or•ir rip:escrow-vas of :tas Courtly :o enter upon -lie abovir-menironad proper•y `or -pec -:on purposes. Slana•urr Ircrmn:uo Datc SEE REVERSE FOR EXPLANATORY LANOUAGf- •