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. . .s d� .�..�„�Ab%-��•. � �. e.u.�h� »w�a�-m�,.K.s.�., aaww�..�:.� , . wa,wu.ea�:a,:.�i yr� �n�, .3 � - .,1 „�.'� �. . WORKERS COMi'ENSAT1dN�E�LARATION �- - y �ppyya e� ��'' � ;���:,� xr�-�-�.n . . , . :. .. ..� . :: .. . , ..: , . I hereby n'ffvm thot I'have a certi�roate oi eansem to self .,, zbqbazo - � -. insure or b[erhf cate p��70,r�Cer'�'�ompensation�'nsurqnc$ ce eoa : /�p�L�/"`A�f�� ':����'RM'T ;.. . , »w.�- - . - a tertified e� �ihereo=t�ec��ab C.) �� � �� .�_ , t'1! \rl1 ��,x *am,,,M„�� �,�„ g � ',Policy No�Gompany . ...��. �� Os :. ` .. . . . .� . v.r ._,�, xN�.� .-_, .< S�W�R SEWAG�E DI R ��►���� �. , �UILl'�1NG AND SAFE ,��Cert f etl topy is hereby firrn shed . ' S ,� � ' � �" � COUN7Y bP LOS,ANGELES „ � '�,C'ertified copy�s filed w�th the,ntpuni�building ins`petlwn � �� � � """'*"""' "'"�``'�'""`'°""""' ,de art ent. t �y CONN�C TY »��„ti.„„,,,t.. .Dat�'�APPlicant �� �. , . �F�I�AP�����`���,.�.�„�,�.�a` a�a� a�+ L�-�.. . .. �,� oti-.�M / ' C�ERYt�1CATE bF EXEMP710N FROM WO KERS ; , eUiidtNc'.' �.STnnoN ,�- � c� � � ' C�N�d�YV����I�Y�RA� _ A�DRESS� ; .. . ,. ,..... � .. �c �EPTH t T,x.rY`-�^a wt .. . �, �� } . _ MANHOLE REFERENCE � � -(Thas sertiQ;,n,n,eedn,xoi be<ompleted i the wor'Ic invo��ed;6y the �aA�iTM.�r+ . . . - � �� ' .. ��pe�rmlf i's for one h4n„�fPe�o,��„la,s($100)or less) NEAREST" "�"""` '"� �' �� '� ""�"-� ��� � M L�7o„D' " - �- , TYpp OFCO ERfON'"' OiN �-'I catify t`Fi6t Iri ihe performance�,of the w�k fo�r,�„wh�'�cfi,ths � caoss57-.; . v cuke � Z' : . ..:,�. ,.....� .u�..��«,.,s� ,�. � _.. . ec.' 23`""" � '-��erm�t s issued I sha�l.not employ any person in any mc�nner """ . � . co.inna No : � � '.s0 as to bec�,om%es,�ub�ect to the Worke s Campsnsb�w lavds ,,, owvea - . �.� �- �' � MAIL «�, :.;«<..� .`• p � ROADPER �NO`II �"� .. ; - ;s '� ii ti �„�". �"... s �': � n.onREss G.� . '. � a�eMirN on f' � ; ,RUNK .:pa"YC � ApP�IGC�nf -. � -_ . �. .•:. ,�,�� :. .w AFFD'S�7f7� WAIVE SFME ... . � ' - � � T6L NO � '. -. p Eq NT RECORD"MSTR'YJO T NOTICE TO /{PP„L��AN�' If qNer r�»`ak ng ihis Cerhf 4ate pf � �iT� - -;Exemphon�� yoo sho�ld become, sub�ect to the Wor(cers tEent� " � � ; `�"� " ' Lp7ND HWY ORST.WIDEN�NG .�,.�Compensqrion'provisiq�s of ihe La�,e�rc�ode you most fprthiv fh _,��;� oesceiPriON ,,,,,: „_,„. �,;,.„,. „�,�„,,-„ . . . -... . _�.:-. >.�,z� . , _ . , . : . .__. .'co`,mply�with such,prov s o�s csr,�t�i s pi'r`m�t shqil be deemed .,;. g,.ocK. ia��r '7(,�� � "� � . � sra7e eNGkorier+m�NT`""".""``°`""'"""°`"�;'`�'"' . ' 'r�voked . � �. �. � . . ...w ^,,y.�. _ � � «�..�. _.w.. . . �,.�..LfC£NSE6 CO YRAL'1'bR5 I��CL'71 ATION �. -� size oF�or �. ow cNl'b�s _ . �„� �w,.� ts§�+�.aa PEFMI`N0.,.. � `l�iereby aff rm that I,�m�ce sn gend�n�er provisi�ns nf�hapter �se'OF" `""'"���"" � ""��`� � �` � � . � .- �Ge�'.: ��_a,�.x..,.,„�� -,9�comm�nang with Sed on 7v11�'of Drvia qn 3 qf the�Bus ��: euitowGs .,.� , �, „ - �=:�rV�§a{+d professions Code and my licanse�s�in full{o ce and` -„��- coNn+Eaia�cnaite�Fee .�.. .. y ..<+�.�..=,a�Wm>�..w�- sw,ox ui� :. .. , CANTRACTOR �: ,.,.,�.,, .«.:�.�w+u�' .. 3Q'�t3 t t� � � ,9 g�eCi . m . . . - •- �� EIMBbRSEME �.LicenseNumb,er ic Class�_ ��. nooRess.. � � R NT tfE ,. ►� - .-.S- �' p � "'•",`•>, DISYRICTN(3� GRW7 /�fq-p.."". :PR6CE5$EO��P"`"" .U... ° � J /� ,��� /q p� <�ont�aclor�- , r.G'1.L$�Ote crtv , . Tet No r � g� °� ' Q �+ �- STATE � 3J��Kl�V lIL ��� � . �_ � -? � r� ��[� I qm exempt underSec_.,.,,,,___�—of ihe I.9 Co � uceN No �,. knss _,ry�LLMA .. � li . ofthe �_•�; No - ��SCk1PY.ffSN�15 tlFi�'.""" �','"""F`"T � � Fltiat ." ". . .� �.��- �' �� _,s ; .. .�,s „ P(umbjng C"e and or 5ee. � .„m.,�,,,�w n�,a��, pouS�sey;��1;7N„ d�� -„�".�.` .�.� �,� oarE � t � YALIbA�"TIbN_.�__._....e...a _, _,F...� .,, � :�,...� �} ,.. , • .� � " ; ..PUBI'CSEWEk - /-i� N 8 8 P"`� de for th fo,llowing ce6son � �'�"' . . �' """"`""""'" � - SEPifCTANK,SEEPAGE PI70R "� - FINAL ' ' ' , ,.._ ., .... ,..�M - ,, .�-x�,�� ' , 'PITSAfdD/OROkAINfIE16 " ' � � D . ...,. � NOUSE�S.FV7E�CUNfJE�CiM�TO_:' "u;e�+" . .. BY ��M . . �. . :� � �vR1Va7E 015 Al5 5TfM � w.�'s _ . ......��.,,.;,. «.+. .,�.�..wr.�+.�,:a„<.��._r,o-�-..:.-,.o..n:.,.:._.. Signat e . � � NNNE r atia�D7�(y,�`btiSG b1F � _ ... � 'w4RK�ROt75E SEWER ,'- ' WNER BUIIDE}�DE�C`L�ARA"�' �,,,�,,� � n � . - - . _.. . . � �OVERfIOW$EEpA�PR qR INi)ELD ,; � I hereby q�firm that I_am exempt��rorn t�ie�Conlractor s ,�,cense ,�� �Ex*N ce5spb9��huWet�rvwNr+o[e . � AlTE2 RE7AIR OR BANDtlfv H'JLSE � " s 7 �h� �.aw for Yhe 4ollowm �reason Secton 7031$ Bmsness and�"Pro �.SEweR�OR�iSP65�5v5iEm1 � '"' � . .�$o �e�'� �,. � �. 9 ( .. :; . . . o o.. �. fessians Code� � .: ��,� ` ,, .. . ''� . . . . .. � ❑I,as ow�er of ihe-p operty ormy employees w��h woges as .' .�r ,„,�,,,. , � � ._. . ihev sole compensation w II do ihe work�and the strocture Nµ . - � 2 5L' � a� 7. is nof�intended or offered for sale(Sectron 7b44 �uslnesi � ,o -O�NE�5 Perm�t � � /��r .�.IAa � . .a � `°G 7°,��-c i'. . . ahd Profe�s,s„ons�C,�o,de) AUTHO$IZA"170N TOl'AL F, ���";�` ca� ❑1 as own�r of the�property,dm`excl�swely tanlraCt ng with �= . -� . � fl.L£?..'"'.�7 . ..... f�censed cont'ractbrs to Consrruct the pro�ect{Seclon:7044 r,nvE nT Tr+is q��g ��¢�N�1,,R�p.���`5��6wE�lH,��aT�NE�uaCC�w kTOR to . _ � Bus ness and'�ro ess�°'ons"Code�`"� ��� � coNnEGtiHeA�"tivfq�cqi�4.EX„ - ��,..* . � �CO�STFfU���10�LEY�DINGAGEKIt`? 6AYOP ��� 1 � � � ._.,,, ¢ x.=�v av�n»�+wa� r SIGNED THIS . � ' I hereby�ofhrm fhat ihere is a con fructron e�"dn ng agency �NER Oa,- (-� . �. . � � � for the performance of the work �o w'}i,.ict�n��s per,mit is owm�6s Ac��"`�"'"� - _...�:. r ,.., h,.., ..�. ..�._..,w-.�'. . . � . ssue��(,Sec 3097 C; C) nooRESs • � �. � � . � . � tender°�s,Name ��� �"" "�'�"� '� ' '�"' s -�� c = :; .,. . -�� �i ;t � s 'i .a w' 3a .' ..: �.#�� �` er�„Address _,_, � .�.�rv., � �, ww�, - .�.,. r I ce ify�lhat I F74v,e,,,;rea t rs:apPica on'on 51ae at 1 e . .. , - .�Y .W �'.- _�. . ... .. aF�Ov informat on is corr,eai. I p jrae to clomPly with a�l�',C'ouniy� . . . . . . .. . . .. . ordi nces and Sig}e law5.�megulating Plumbing.and Sewers, � �., - � and heceby aoth rize'repr' �atives ot t}�is Cquunty tB enter �. . , �. � 'up n ihe obov - �nti ;pro erry forinspection purposex._:. :�_ , ., :_,- ,. .. „;. .,,_..... ::. ... ....:........ �;.�..._ � . : .. __.... . .. .„ ; f / ^ � ^ ._. . . .: , . . . �� fl � o.s*���.x�:�w�a�u.-�":�'-�+�are.-".SEF B`EYk9tSE,fOR,E7(PLANA76RV IANG�A�GE . » ., _. . W ,.,.. .... � � . ,�,SignatureofPermittee, Oate . w ...x,rn...a,v.,w..�,��, ,,..., ..,.._..,. �. .»..�-, .�,.�_.,..�..-.�. ..�:..,, .� . . k � �,:;,t s � . � �Pd ..... .. ,.�;�a.,.,�._.�....x�-rcr�, '�' �+�.�,�+ �-�. . . ,', ., �.. . .sa � .' �„;: � t���er�a�s,�ao��s �,��14��dEt�-�T;131ER i7�CF.A�'�"IQlW �_,.._.., .. .n,�,,� ,„,„,,� . �..�..: _,.y„ . _ R��, _,.w.� ,: A�P�O�lAi$ a;arE ir�sa�croa�ss�nu,rua"e ' � .... . ... .. . . . , .��-�: a F.�.�a,..:d here6q a£firm that'-Lara rzemgifi from eh�e�Csmf=a�Kap"a' �eu°No rec o°a�wo�icA� .___. -�� , . ., ..:� , . ,.,, .,,. , . , _..- . �,. ,., reason p'$eciiox 3'D31.5..- . t�w House sewea � .,_:i,icense i.aw foz�tEie�foHlbvring .,' r=�_ N- ....�., � .�business�:a+ad Prefess4ott.e�a„'��;.Bx,y csey-.or eou�tq"•. - � �SEPTICTAPIK,SEEP,PIT(5) _ .... .. . • . . . . .WLJICIJ,fY,+�f2S 6 f169�tjit l0.f'OfiSy°'i'F9C'� ��{�pi BCM�9'O4Nt.�. .� . �.tioiow�tq�NFieto � . . : .�� .- - . . . -:de;.rsvdlsb..or refic�r any sir.sctwra prior`to if`,c r,ss+wo�te,��- �ss?oo4❑ � �oavrreu ' ..,":. � .'�. �;'� ".�; ;' � ; .�t. ako seqsesres tb a/splrcans for-arecb � . : ... . l7 , . , ,- :- '--.,.- sagsaed &a � ec peayaei8 Eo,fiSe a��. m.:,., ' _.._ �� . . ..... s .., . . � 4..� ,,... . , s..• e%&$kRi�`s'e dacans¢e� asss:s¢scb'to tne.� . . -,aC�it.tt�bnia.sev:�aoa'—.. _... .. �"�- � .. . �. " . �..: ` . ,.,. .. i� ,,,,... . <_ .,�. �o�rsaonsyo}`Ebe Cosi�$racRorfs Licatue F,atti t`Cba�Eer�.9._ . se�va�e oisaosnt sVs�m ' .�. ' �, . ., . :�. . -�,... . �i..�comsmsnciwg wlYh 5ectsoaz 7600)�af�Jivision 3 af t6�e�. � �7)SCONNECf PLUG'AND _,'� � �, , .. d6nNoohHou:,�SEw�tt . .. . .. ' . �. -� f � ,.,�,..,: .....dYsesirsess w�d Projessdons �adep::or tbat he'i.t e.s�¢mpt. encur�ei sferic raNxs❑ � :�` �:`§'�s �"` ,Y,-yb�'e.�fr'wic�h�ad�the basr,'s f,or&be„atd,e�ed ea�m'itian.�ny.�. � �Er,vrels�L]' cessPoois❑ : � ,, .- _ ... ��violaciaa�of SecEicmt Jb3I S ar�ta,3�op d'sccsatforu�emaaB. �...... �..r - _..,'-„ , �,.;„, p . .*.,, � y . .:subje���8be a��lfcaret.8o a�penud y of xioa more t6�¢n . , ` �� :�. .... , .., .. . �. ... �fiv��e ndred edmd8mrs($500).: ... . � ' -, � ' , ' , `... , . .,,.. .., �.�.+�.s+. �s._.,�. T,as'rh,ea�wme�r�o�chepxopeee9wiifdothearor&and:.�. �.. . . _-,...� � .� .. . -''the stru¢ture iended er offered fok��salr�. � • . 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