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1647A (9)
� - � - , , NlO�KFRS �nMi�NSatibTt 6E'CC�aR;471�N ' ` ` ,��' _ ` f � - !N,. ,. F �°" ... ^` . 92 OCO]DiV/3/8� ��'�� . 'S1. '`1 heeeby a�#fi m thoi�I have a certihcate of,.consent to�If�, __,., �b�a�p . . _ nsure,or a cerhfica�e of WorkQrs'�,Compenrqtion In;u Cance or ce'eoft � � r � /y r �p. `� ���- � ��- ��- �� ^� - �a certified 2o thereof(Sec 3800,�L"ab C) �- �. � . .._� A�PL��r`A�'4�,N I•oR_.PCRIYI�T � . .Pof�cy N �ComptrnY .--7"`�'�,�-��'f3.�iL7 -. �s : ,.�,, , '�` �+ ... . .. `1--r .� .._ ,�, ,.,_ �. ,..,_.; . ,»._ .; ... ,. --.., ,..... '.. ,. ..;:�. . �. . C .:. _ �.. ' ��L.�Cerhfied copy ts hereby furnis � S4��R , .,��"YYAGE ��S��JAI, _._, , � . �'Cert fied copy�s filed w't he co nry buildin ' spe' COUNTY pF LOS A►dC�ELES BUIIOING AN,,Q,�yS,�,AFETY , '. t depart ent �' .� �. � � � Date Applica -s�^' FOR APPLICAA('T 70.FII,I IN . ,,. ,, , � CONNECTIOM DATA v � ��E OF�E�PTION F OM WOfj,��S Y �. eun,oiNc� '� . . �� �. sTAnoN J�... oevrH ��a �_._ . ,; �r+ g,� �- }COMP�N dT'�i�"fN��RA"?JC�� ,s .` ..., . nooaess' � Y R �?W".. .. ' .. . �'_(T�l 558CtlOn eU n01�'IE C0�11p�2tE[� �t}te WOf�C iIY4o�Ve[��Y f�le � � MANNOLERFFEREN�E ��7f �PP .v ,,'p�i'M t s fo�one hundr�d dollars($106)or less) ^ � ����x�/^� �'� � � -... . � '"pet5ni�s i'ssved,i sha I not emplo.Y ony pe so�n n�any manner�•�.. � c�b5 si,A C7�Y�}� .� � .� �..� - rV-v oFcpcuR riot�- i �.c.� ��qohF'�� � . "� �„ ,"so as to becor�e sub�ect io the Workers COmrJetT54f1or1 ldw5 , , ., qN/NFR� ' � �Cp IMP.-NO.� JOB NO �7Q� � nd� ,a; y ��e. 1�1 � �'�aiF�}.+ 4m��k.���yai'%^+-"i.�s.+;+h�is.f`k<i §"'� ,='a� AOtlIEESS��yv ' S � TRUNKPERMIT'NO ' �- R0,4DPERMITNd:�� •.~ . ."'Date��Applicani - . - . � : ' N�7��E TQ ,�f�,(C�,(`fT �f pfiBl�,mOk11t .}{ti5 �fftl{jCaf2 of, ' '" '- � QFFIDAVIT � WANER EA$EMENT RECORO INSTR.NO.. ��+��.- � ... ,_..-�. 9 . ciTr-�.� .a:'�No'��� �.� . .. "'i�Exempt on;: yo� shoold becomE su6ject',to thE Wockers' tE�A�- -' y . . ���� -�� . ,�. . . __,.. .�.,.........�,,., ........u_-,. ��c�o�m���w ih such� rov sionshe�Labor �dmit�s u musr fqrihwith �. oesceicrioK � �io1 Ho.` dS,,. .�,... , . .� ,��Mi No ��oen�iHc - �... . py p p hall be deemed �'" �]" � _... .. ` EVOItEfJ � � ' BtOCK., TRAR , ^(Y� SrATP ENCRDACHMENi � a ���L�C�NSE�CONTRd�7C31�5 6E�LA�'A�'t�y� :< �� � No`o'�e��s _. � . _ . � ,� , ,� ga,s afuv n.y;w.�r. :tis�+.^•u=5. k' --.� . . 512EOFLOT NOW IXJ LOf .� '�f '��C`` r �I Fereby affirin lhoi'`�om'�censed�u�der prows�ons of Chapter use or�- "` `�� ' ' -� �' '�`9 "d - .�.. _ :...�.a . ._.,.-.-,s . �„--�,��. � ''"���4�commenang'with�Sechon,7000)of Didsibn 3 of„the.�Busi, ,� ;;; eunoti�s � �- � " cAnac,�'S" ""�`�""� - ""�'"" "n.yess aHt!Professwns Code,arvd my license is�n full force„and ,.� -- ��' - � ������ -'""""�-� "-""'"�-"�-"��- ; :�6Yf6Cf. � •-• �T ... , ••+��. . CONTIX.SGT(7R .. CONNEC?ION�CH RCrEFEf' ' - . , - . .._ �1. lcenseNumbe Li< CIa55 � �.7� REIMBVRSEMENTfEE y ADDRESS- . ���� ��7 �ISIRICT NO.� GROUP� MAP""" '� PIFOCESSEp BV��� �� -�Contacto _*�Date.��:-e.._Z��. , a�v �� �,[,! YelNO ,. . Ly . ..«.�t-r SiATE ... , " .:. , '.- "tIC y� . Q . �,Ll I am exempt under Sec�..,;_of the,L A Co . uc6N5�No. � . aass �U.. dL""1� �`'P,�- - ^ c . . °>��' �,f,�,�,„�,w.a.�-st '�q %r .> tio DESCRIPLIONOFWO�FA; ""%E`�' . � . .._ .� n � m: B�&'pn9�od /0 5ec. oitfie -� . FiNa� �.�.�. r - rio�sps�Y7E coNnEcnN�ro , on� � VALIDATION �„, ' ' 'C defor-th follQwingreason � _ PusLKsevu�� �. ^^-�� �� . ,._ . . 1 . , t.-'�""- �-"-'�--�-�-��^, _..> '.SEPI'IC 7ANK$EEPAGE PIT"b$ ��� ` � � .� r.:� ..P175ANb/OROA/CINIEtb . . .., FINAI �":, � ' . . �.. ,.`' ��. O �� ..." . :'HO�S,E SEWER,GDNhECTWG TQ; '�•»• .'�", . BY '. PRIVATE tlf SkL SYSTE ` ,�,,,', �' $IgnatUY . �xa�� ' CONNE<T Abqli70�7A1 E�IdG OR � ' . . - . �� . „....��..:.. .. .� ... � OYVNE�E�UILDEYRyDE���Q�XITYVIY � - -WORKTOHOUSE'SEWER �', ,�..,,a,r4. ,� ¢ �. �QVB F(.OW FEppGE plT DRPJNFIEI�' � � �I hereby af�i m thai I am exempt-�am ihe C`oni"iacto's Ljcense � ;exrN r.�ssroa oRrwett ma;NHote - � �•� (j.(„'�A . ' :�Law for the fo6owmg ieason(Secion 703J 5.Buisness and Pro ��� '?ire,keeae DR'���'RN HOuse "'" , �� . . � ..fessrons�ode) . .. . sew�aoaotsaosa45vsreM _ .. � � � � � � �f�o o m..7 . . w -. ...��.. . ... � ��. ._. M.». .. : . . . ., 0 �,. �I as owner of the propeny,or�my employees with wages as -, __� . , � �, :��. �. Ihgv s'oIe com�en4at on,will tlo the work;and the sir,ticture �,y � � �� � �� � � � . �. . � e a_2��. 'rj Q � p . „,.._._. � . : - �- - is not�mtended or;offered for,sq�,e(SeaUOR 7044,$us ness �� �-� -�� -� � ' ' � ,.--: �and Profess ons Code) ..�,. . .. , : 01�NE�f�$.- Perrtiit E�� �"-(`J� . � e o o����']���J Q� �-. . . ❑I as owner of the prope ty,am exdus vely contracting with AWT}1CS�1Z/ITI�PI TOTAL FEE . "" � Lcensed co frad rs to const`rv,t ihe ro'e W Nn �Co'rvR1tAc'rbR r0 . '- - � Q 2�-.� �� � Bus ness and Professions Gode} =ct 5ecilo'h 7CWA . 5O EDTHISAmovE� p wiH tye�Np�E . . . ,: P 4a � �.aS� P I ( �COEn�zoqiuGor+��nrc�ot+5�8itt.`SEwEa_. ...`:: . .. . �I here�b"�affi m tl�at��O IENf�' G AGENCY �_ � CCSNSTI� 1�° ` y f�ere is a eonsirud�on�lendng agency . ���� �- - � �. 'r fo the erformance`of the work.for which tb�s' ermd_is owNez:oe . , , . . � , � P . P OWNERS AGENi ��- - � �' ssued(Sec 3097 Crv�.C) � � � � � � r.: . '_, .,.. �,:.: . . ._ .�,:, nooxess, .. . � ; Tlame �` e_ ` �-,.,,x,�. ,' . ,. .�,c; ' '�.e ��:a, ^` r��sS�-„a� ',g.' '�t,t"e . . . . .. . . .._ . _. J Lender s Address �� �� '� -- - :: � � � ,. ..y ,__.,_ ,_, .,�,„. .. ,:; .�._,.. ..,�.:� ....__.,�._ ._...�,.:F , „�_._.. ._ ..__ �__... _ __..._.._ , _. ..: _ �.�... �- ..,_ . 'r� certify-thot I have�-?ead t(ais��qpphcatiort-�arrd stpre,thpf the �._, ..._ � -ordia�j�.formation As.cprrect i a�ree to Comply wdh all Cpunty � "- '�" � " '� � . � �� .. abov'q es and 5taie laws reg�ulot�ng Plom(i ng and$ewers, � . � . _.. , ,��. .. :�r. . :. �... . . . . :;. ...,._... . _... ...., . _ ..... ; .__ - ��. .. .�..,. _.. _,.,-..� .. _._.,.�.- -... ...�__- . ....__. �-and�h reby autho�ize�repr senipiives of ihis Copnry'to�ent'ei' "" '"'-�� "'-�°"' -'"� "" - � -"�"�-'' - � upon be.gboye � -nti��- � praperty for,inspech n�.purp� es. . . - , . „ �� - . .. � _- � . ,',' . a ..; . �. �.8 �:. �.. .. �. . .. � � . � � . �. .. . . .�, . . . . . . . � .. ^ ~ $ignature of erm,iftQ � fe '� ' � � ' SEE REVEASE FOR:EXPLANATORVYAM1fGU¢GE,,,, ,,, ,,. � �� � � - � � ,. . : ; ,,�{,r � �, . ., , - " r .;� r, ` . s € sa "`� ft�asPE�so�'s�s�t'Es , __. �,7Girlei�,�� I�I3��2.13E��.1��'�d�1V �,• .: „ M ...�� �. ���.,x._ � w .,, . . : � . �.�1������� DATE� ')NSPECtORS SIGfvASURE _ � I Btl^t@I➢y.ffiSES£11]Yp02t-T'RE31�XE4ZIj4Y SYOd1 LIlC C6A2C0C$Ofi'':'� . � xsW iaouse seur�a �.. .:. ` �: ' . - License:Ii�w f<�s 4he:follorvd seasos(Sertioaz�p31.S,.:� . ..,.._ . � .. ��...�, ... � . _. � _ ussn ..arad�'r esssovas Co�er:Any ci nr cossnEy . ._... & ssr ,,.t . . COtdNECT ADDRIONAL � . . -: ., •. .:. ./.r"?'= " '" . ' .4UJ]DCaI.i'@ 9{ZA88 VJ �" . �6UIL61NG OR WORK� � ..;.. .;.-. ;,. . .':- . :.. . ... 4 .�¢t'ni&d CU,CO'f�,�+P%St tdYts9;.-'zamjrroy¢,-�_ . . ,�. . ��:��demoPssb,.or, cr usr,y_ era�ctrsse> xoe so s:s'ac.csearace,. . •9YFfKYANk.SEEG.PI'f{5) T _. �,„ � praoiozuza�mFiei.o. alra r�k¢ire tbe aplhTesmts2 fbr sear,dn�s�rosx2`ao,�lde¢�� � � �tessr,00[C. �qzvu�st p��� . . .sigued statewa�srxe�.tbaF�dve a Sseea�serd par,:scmms �o aXse.�. .` _::_ _:_.. . ' � �- - , �� � .- .. � "�� :. � prowstcvat oJ°tl�e�Coretrac�sar''s,Eecesas��w(Ch¢,p2ea 9�.. i1t7ER,�af9ANt.5EwEROR . .,, . .- . � :.. �. . !'cosr�aoae ° �ui3tb�'estao» 7000)�oJ l�'amiasdoia.3'o e$Q� - SEWAGEOISFOSAt5Y5TEM . , „�'.• ..�: ,.. :. .`.�'. .'.r ,. :.. -. „ ,!BGY�Q' �J . . � 'ascoN�cr�rcoc�nNo _ . ..�, ... ... � .� . . �. . . .. .::� �usi�cs:s ar�d ProJressv.o�.d GbdaJ�or Sh�e d.�s-'as exempx; �;ae.anecora wouse sFw�t ". . �. . ,�. . . �� , : ' `t,5zre}bovn aud Ebe Sases fa-Phe'udds�ed ox�p�,'tsora..4n.5`..: . . �aaeKffttserrtCrnrmsp= -.... _ ..- ��. :-.�- --� ..^. :- ,.�'�-'; ,,.. �: . ,,�:.. �.:veoda8faaoj5ectsoasj031;5�.3'cRyre,�+pdisaesifas�apertiade. . � s��,virls)CJ cessrvoous❑ -�.� � � �- .�. � ..` ,:. .� � � _., :,_.'� ��. . . swbpecu ihe�ap¢id�ruats aa g ciatd�z�sssrsCry of ravt�minre ebau...,. .. . ' �: : ''' �_� `�" :. '�." -� y 4::. r ,�i:.L s s ,.�` ,�lvs��*d�e wn'e�r�r3�shepropct:y��iLida`th��wor�aend�� � � ❑ . - _ —�- -:z � ' ��i#i.e strncxute rs sKcc isatezc8edor bf#eec�cd fa�aaie. .. .. . r__. _,. .. . . ..�._. _.,;. ..- �,,a��., ;. � . ..� ', .�, <,v�,A� .{'Sec 7C44�`Busassesa Mud 3'to`fesismes L'o�ei'�23se Caa--�� � � :� :_" ". ..- .._....�.� .: � � . . ~ . .:_ . .. �w., r .� .�.,�. ' � .��estmds�Lsceaae Law'�oes n¢E�rsPpd+y io an:o:vater of�.�-� . . .. . . . �� , ._, . .. . . .:. '' •._ _. _... �. ....�. P��Pee°ty wFio duilds ar ir�rara�Ymves Sberemn.tisrd we5o does�. _-_ _ ._ _.._- _ ... -. � � r ... . ` .:... ,. _ ��.' _ �.. ,,. .__ ... :; . ;' ., . . � _ ��. , .�.�. .� : _�..�, * �� �'�ldsmg ort��ro�s�es�aoFrt`,.:tusehaas�a9ieey��$o,�" .. _._. , ... .. ._ . . _._._. ._ . _ '. . :..—. _ .._ . �. . . '� a " ��. .�..iovn¢7eE�oma,`sbe'.-oauraai+�bv�iFder��i,vdY!�'dve��'xXse b`urdetn; .. . . �� � .:. -� „ �� . . . _ . . . �.�.___. ._.:. _ ....�._.. ., . .:. :::< .. __ ._ �.�.�_ . :.�., .,;�' of,}proar,iy�g...ehut be��di�8 xaP lr�sfld or dr+mpsove fos�dhe� . � E�._:._ ..:_ ' �-.r.: '.. - .' _.;.- . . .:. �- ;. �' ,�..� _ . _ - :.pu'rpose;�vf-sraXe.p . .. . `I�`�X�ffiipY�iYig(�E%$E�C: y ' � 3- � - � ., � . �.. -, . . . �.," . .. . . ! .. .;. ....�..:.. :...... ', . . . .._.: .. ..,> ... . _ r_., ..: ..._., ..._ . ..:., .. 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