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1646A (9)
�: . i. -. , �''T ' . � WORk@fIS Cd�A�1�6AT Ot�DECLARATION � �`�" �` ��7� - �'3 �x � T �^�` ^ 9T 0002 DPVJ 3/67� _ ' " _ . . . . �. ;���I hereby a11 rm that_l;hpve,a ce�(,ifiGat�,o�.coqgg,nj,�,�,o,�,asel,f�,,,, r��aq� , ' . . - . ..,._ ... .._..- _..., _ �_.-__. „_ .. ..�. ,'ns re or d carhf cate�of Warkers'Compens'at on Insuran,�e,or � c��g .� p - •� -. . , . . . ' 'a certifiedtcopy"iheireb�f(Sec 3BdD,Ld6 C.) . . -' -. : � ¢1PPLICATiON.:�O�..P�I�NIIT . , :'Pol cy�o�a.�CorrtpanY �..�^^ .s����a.'+YG7 . Us �; . .� ... .. .. .., . � _ .. .. _ , ,, :.. .�___.. ._ ...,. ._...... ,_M SEWER SEWAG@ QtSPCSS/�►L ,",,�Cer�f�ed�opy�s hereby furni �ed. , � � � -� � � "`�` COUI�iY OF�,OS ANGE,[ES m , , , BUILDIN�ANO SAPETY ��Cenified 5opy is filed with he'co nty buiidin ins ;"ion y ,�..,...»n,...,�..+�.....«,...._.-«.._...------. ; department. - � -� ' .. .. , _ . �.. , : .,. -..-+ r�' .�� .. ... bafe AppUcan � POR APPLICANT TO Flll IN,_._„ , , ��� CONNECTIQN DATA � � �p �. `� � � �� "c' . . ' �, 4TATION � . .��EMH g , � � CE IFICAiE QF EXENVPTION FROM WOR RS euiwir� � l ' � � � COI�PENS"�."TrOIV YN�[1�RA�E. . drtoRess�:�� I�-�.rv � A",�' , , � .�(This sechon n¢ed np1 be ca,tnplete�"�t"�e work nvo[ed�y rhe ����' . � �. ria.NHo�e Re�aer7Ce -�� '°ER� LOCALITV Z- r LO R ;p�rmiT is forone hund�.ed dq[lars,j$lOD)p les3) � - - - � _ N�necsr rv�oFcoe�uErnoN- �N�rHFdoM � "I certfy�iha� inihe perPoimancc�iof'the work fpr wh�ch th�s` cRo555T.� v. NRe' " � _ nn�ioa'i' `"p`�inv t s i4sued I shpll nor employ any�p'erspn n any mann�r � ' �. �,_ . ' �- � - ��- '� ' ' '-6:c No ...., �_,.,..... , �:.'so css tq 6ecome s.u6jecf to th@ Wo�kers'Co,mpensation Laws __ oWNER.��' � -- `� � � - cc inna:��No. � • ���og Ho _.,� -a r �k �z � n -� ti,, �-ow �� a�aa ��' �� �§ -� . .. " .-_r.. _ . +.�� ( : n* q ��,. _ �IL _ '�� ..� �' .._,f. TRUNKPERMIT'NO �'�.. � ^-ROADPERMtNO.�.^ �• ��.Date Applicant � '� .. "' Aooaess �. . . . -^ . .-. :, ,;;� „;: � „�j.��- . m�� aFFibC;VR" WAIVER EASEA1ENT- RECORDINSTIi,NO.� �AIE�'� '�NOTfCE T'6 A�P'PlICANY If after�making'this Certif cate pfm� ,;. crtv. � i¢t;�:No � � . .., ..�.,._ . � .,Exempf oi`s; yoii"�s�ior�1d 6ecome sub�ect to ,ihe�WgrJcers', , �aA� - -�--- . --Com ensptiop' rovisid�s of fbe Lpl�6r code, ou most forYhwifh � oESCk�nON ' toiNO " � u.,.. f ... P P Y . . .. ;._:, .. Hwv oasr w�oer�iti� -.�" � :. - ?'comply with such prov sions or fhis permit.shail be deemed ;` � �"-� -"""` '"""'"'""""'""""`""" � � .. , ,`Y2�okeGJ - � � BLOCK-. TRAfT � ' 'STATEENCRbACHM,ENT �'� ''' ND�F'��D�G`5 PERMii NO � � �,.�-IIC�VS�D CbfJTF�,A�79k�D�CY�F�P.71Q'�'+a!,,.y � s � s¢e oF ipr, � NOw oN�01 r,. . -�r _ ___. _. �. I�ereby aff rm�t�iat�am,i censec���nder provisions of Ckapfer ���' ��E o��,� � . ��� - -- -�-s��•• -u.�v�^-.�^-- •^��••.. � f"��. � � �'����com�encin' with�Secrion 7000 of Divsion 3 of thef,Bu i '- suitoiN�s � ��� � � -'� - �� ��-� "�� �NARc6s' ' "- �"�"""�� 7 9 ) 4 _._ �"-ness pnd Profess onsCode and r�y license is`tn fuq force,and ��- . : ��� <-�- - �`- ' ' '�-' ` ' ' ' e`�'Fect . ",�,...: .., . ': coNrRncroa �„ . ,� 'CONNECT(ONCHARGEF�E ,' ��. "' 1g� ' � `�'Litense Numb . �.d/� Lic.Class � -✓�� ' ,. . .�..� . � . REIMBJRSEMEM FEE , ., .�... � ..�..�. v-...��.�' , . . ... .. .,.^-�--r-,+-.—^r_• y ADDRE55'. .. ., .:. ,,. ... , .. " �'" ' - DISTHICTNQ: GROUP�.�. MAP�..;". . �PROGESSEDBY:.. � . ��Canfrac#o Date�/"e? %7 �� CiTv�„' ,- �� 7El No - '.�� BK PG f -[�1 am ezempt under Sec � � o�f�the L A Co uceN o � " � {.7�Q _ cuss �`� ��� ��� �� -��; , d � - ��" r r�� � 1°�'�°"� " DESCRIPTION bKVJpRK � � - Pium6in �od /orSec. '� ¢ffhe � - ff� �FiNA� � � LL ,,: s . � Housesecr�q.c4Nu,��TtNc7o: oa,e VALIDATION � ��- B 8�P�Co for ili toflow ng eason - � Pu9.ic sewez -, � � '=�- - .: .� .... -..� ..�.. , . �,... •.. . SEPTIC iANK.5EEFAGE'pIT OR • .'"•'"�_"."`..�` . . �.� . . D � � �- � PITSANp/OR.�RAINFIECO " . FINAL � � ? -. �' �� �� �NOUSE`SE ER 4DNNECTltJG TO°- ..� .•"'« BY � _. ��� Y .: ' .. . .PRIVNI'�bfS�SAI S�lSTE1v1. � .: �. . . . . . .... , ........_ _..... ............ ... ............ ..._ : $�JntltU� , . fONNECT ADD 1{7NAL 9lbG,dR. '' "'�"�"" � �� OWNE�2 BUfL E �ECLF��ATItll� woRK7oHo�5E:s�vex ► ___ � � - 2,.�-.�.aK':.��e F '-+�+'�� � OVERFLOW 5 EPAGE PIT,DRAINFIEL� ,I hereby affirm thar�dm exempt from the Cpntractor s License _ �crr� ces3vFbo�;oevwe[t`MnNHo�e � � . '�"Law for the tollowing�reason(Setton 7Q31.5,"Buisness an,c�,qPro „ , .. � �14tER eEPAIR"Ok naANobru H6(15E '"""""' � � � � - � fess�o�s Codej�: ; s�vea oa o�sPosAi svsr�rn , _ z 1 6 U,�A � , , �.,.,..._ '� � ❑I,as o_wner of th,e,��ro ert or�m em Iq e�� � N�� . . . P P Y, ���'Y P Y es wifh wayes as . .. _ ��, - }�c-e a e �.(�..: . , '. . � . .....,....,- their sole 4ompensaEion wiil do ihe work and the sfructure �� - .� � . �" .... .w: . �s nof�infended pr_ptferad for sale(S�ct dn 7Q44 Businass � � -�- - . � � m a���'�;.�"j O � - � and Professions Cgde). " OWNER'$ Permif � 5 �.. »_.. AUTHC�RIZATION iQTAL.��. ...... ,. 2:. :G � e o 2 7r 5 U exs. _ . : ❑I,ps owner of iha{sroperty,am e�4clusively contrqciingwith � . . . . ' I can5etl mn�f'acyprs to cansirUcJ t�le pro(ecV(5EC�io0��79A�4, ��ry,qve AS;n15 oA7['A CONTRACr Wrty TM€ E,R'EI�7 haMEO eqNTRACP6R o � .. ' �;t. . � ��� BUSIne55 dn{�PfofE55 ORS COde. �� CONNECT THE ABqVE OESCRIBED,E%IST!NG�\^YEII�G YO YZiF"715��(C 5�V1�K` �" � . i (�G���.�7'� . ' � _...., «.�.�..e . . . ' �ON5TYtU�Ylb1�1"'[.Eh�DING AGEIV�Y � ., � +� � :. _ � . . - ,��I 6ereby�affirin that=lheie ys a construc�ion.(ending a�ency SIGNEP,tHiS�DAYOF ���� �19�!� 'fo� ihe; erformance-of ihe woik fo� whi,ch this perm i is - �NEeOR '- . , . , •. P ,. . �._ • � . ._: �OWNERSACxEN7"� . . . = iss�ea{$ec 3097 C v C) - ' �` - � ,� ; , k � .; ADDRE55 � , '.��Lender s Npme � � - .. ._. ... . . . ... .. , ,. . ... . . ,. , . � � .'' �' ^ � :: : s x x ..v�"�+ �� Lender s Add"ess - ��- � '� "� - �.,�. _ wt„s�. a_.�-..... � ,u .,--.F. .,,�._. 5 � ,.;-d �� .� _, .. . _, ��u ,z....: . �,.;. .�_ .. ,.., _.: .�.�..� . ,� ..,rt. u n :� ... -;. .,,' cer �-t�iar I'�i"ave;read th�s'6ppLcation�and sta�e thqYthe �. ., .` �" � `... . ., -. . . ,_ .. , �. , .. : � ,. . . . ... ... , . . ., . . . ,. . _ ._ aboye-.i,formahon:is-gorrecl:I_agree�io comply w�fh ql�.Cqun,ty � . - � . , . � -�'"� ordman es and S�ate,Ipws regulating Plumb ng and Sewers, � � � ��� � � - �� � � � �� � � � � � � und he��,by authoriie represenlgtives af{lii,s Cqunty to:'�'nter����-' ' ' ' �'�� '-' ' � ' � � ��-� . . � '- � -_ �� � � � � ���: upon 1 e above-m.�.�ione rty for in5pedion purpn s.-�� . � �. � ' . �.� �� � � , � - �'� � - � - .� - � � - �„'�~,�,V. � . `, � �. ..... ;. � .. . ... .. ..: ; ��,., ,....� _.,-_ . ... . _ . ._ .. . '�� � SignotureofPermfIIee, �;,,.:.� D-� - � � 5EERfVERSEFOR�E,XpLANATORYCANGUqGE;,;.. . � � � " ' �� .. � -' � ��-�. .,_„ ,. ._, ;,.� r..,::� _ ...:.: � � � ,�.� _. � _�� ��� �� �- � v�.. �.,� �.K_ �: �, � �� � � ��r�'s��c�oe���c��� � cz��z�ii��x��c°�..��;izc�rr,� _ ,,. . ,. �r . ., ri = .: s ._�. �,. --�-_ _ .�, _ _ � ;� �.� di��ROVALS ... oa�"- iNsrECToa's sicwnrtiii�' ., .��_ -: i � �. ..,......_.:I hereby af5irm thae Y am exemptfxom ehe-Coaeraetoa's � . r�wwousesE++we� �y Licsnae I;amv ior ahe£cllosvia�seasau,°Se�aav�a 7037,5,. . '" ��- -�� ,.:�_ . .... , ..� -. � .��ttsaae.ss..cxd Prof'essfons'Goda1:tflay,rity:.�:ar-couxty. .'.. . _ . . :�.._ . ;QJNNECTADDITIONA! .,�.,T,< :�, . . 1UD18CIJT af2 � „. -.�. . � • , � �'�. s� e.r»aa&So cnsdsEssace a%ter,...5an ve,:... :BU�ID�NG OR WORK �"' ,� ' � " ' �- �� P'� . F� - - 'searic raNK�s�a pir�s� - - - _:-'demciPds,or reFaar a+y,y strxs�zuioe,::p�ao't9�ss rssusnca,.�. 'APoD/ORqRAiNF1ElD • . � :. :., �. . , .:. 1 '� �n q�paj 8 . . � : � ." � •,. � ' . sz e���roecaat`ESwe�be�S3'cess cb �s�rs¢st-�8o flTe a - � [ESSPC70l.O ~DRVWELL[J ,. — . �_ ...— S'`� . SP,d]S%f,S%eeY$$4 Llle . ,. ' . .�.. _ �� " �' + -. � �,: - 1H'a��s?l che Cotelpiactor"s�T,ii�gocso i,csm jCbiaptes�9�-� . sewaceEosPasai`svstEro ' �.'�c ..�. . . �.�_ .. -� `z .—. :, fcmmrcaesaeaa,q zvsal�Sectiam 7D00�-�of Z}avac^.oea 3 o}"tbe����� � � .. . _ � _......_��.,� i�.:. - . 915CONNECTPLUG'iWD , ... .. ...� ' •'"_ ,..-. .� _.._,. . .;:. `:, ':. `��.��'�aee.`rs�a'ra�'k'rof¢sasons Codef aP 3hat 6se','ds ezerotpt.' AenNooN Hous�sEw¢R . � ,... '.�- ,.'tfierejrojn axd ebe biiabs!br alse�atdegeid exenspkor..As,y:. � encxfic�seanctxwKsp _.. �..,, ..�. � , e • . ,� ...viodateor:ofSectdon703t.5�bystsy`ayplara�d,fora�erambt. ��ea;rir(s)❑�..«sseoo�s Cl. . . . .�.� ._. . ,...!,�-�..�;.,�:. �-...�.� .. sab'arze sbe a [aeaaat to a cssril enadt . - ,a � 1 AP�� P 3��i�ot riscrre ehaa� �f€oe bssasi8red�od:ars($30Gj.: , . � �' �°'�, a � �uy.;;,� .-:�I:as�xhe awner of�z�e y ropercg w4it.do.he.wbsk ana4--�.�. . [ ;�,� . , ;_ .. M. _. .. . „ ' . �.;. .�.�,...,;;��. . � ._:..,. . . . . . .,. .- " ..:. . ;;_� �Ebe srnncwre is um�zneended oe offes�eF fos sr�@e • . . r., . .. , , ,�; . ` � .,:�:, -:. .� � . :.�.,., '"°, ^. , '���(Sec 7044;'Bress�iasr�md�rrifesse'oaa�Codse�,�Tbe�o�`�. . �, �..: �_ � .. . ��. � ;.a :.��. 4 "' .,:: . 't. `-."ttactar'a Lsceoaa��`.aaw�:�doas neht-.�P1+Xy to mva'��oumer of s - '. .. . ...; .._..: .,_._ _... . . ._,�_ " _.pso�{ierdy;who bA�cidds or#mpro�ves slreraon,axd suho�¢e.;�. .� .,:,,�... ...s ; :._ _ . ,.. __. . ._. . ,..:, .. .,: . , :., _ . -`. � :.�susis wor�'hdmselj'�iraxrided�ibas'saccb�lrsa»prot�ernents�. -. , .� -. .,. ..; _.. . :: .. _ . .. . . raa¢me'esided or.effered jo `.•Fe Yf,bbtivevzr s$e�. . . � 7 . .:r ,_ ��,: ... . �;.. . .;:;_ - - butklasng or im$roveoiieRt w��a�weabs9a`asie ear - . . .�v�. �.._.. .._ .._._... .....__ .�..: . _,., _ � . .;. .,'. , ,.., ,.., . . . Y, �; . ,r, .'. �.. _ ��,���.,. , ... ���.. _ ,. .�. , ..�-..:, ' � . � �r.nissprdetioaz, z�ie �uitae'r-3iuildee' ws'1l"J3a'vz'affie buideaa . ::_ .. _.: . . :: _ ;,_ . . ..:. a : . .:a{provt�:::8bat&e dlyd nos,bssild or ivragsrova.asov 8dse�. �- •_ -....;_ _ - ::�, - . .'� �: ,:; . -- � -� . - �- �. . ..'. , ., �,. ' �" f��ase o sale.l �" '" r� I aren Exemgaa diri�er�.�, � .: . r ; , :, w.,,_ __ ,: . _:,. _.% :; '_ ::;. - , ...:,,,. - . � _.. � , t�g&��,�.for�tais se�son� . , :;_ ; _ __:. ,Y., , � J� ` � . _ .;,: ._ . . . ., . .. , . �:, . -_�:. �.-_� _..,.w. ., �-: .,... . �._ . . ._ � - ' . -- � . ' ,. , .�,. , .�,. _ �r:�,. . - . , : . _. . .._- _ . . . . _ ,.. ':; . - - � . : ._z� _._ .,..��.. � . . : . . ,.:� �,,;, n. , �._., . :..�. . .':.:. ._.:.,� __._:. „.._.._�....� _�.;., _ ._ _ . _�.,. . _ .m_�_ � ��t�.,_____ ' . ... . .. . . �IIfA�. - . . .,. . . .. .__,. , . . . ... ,.. .,,, u.: - -t _.,: ,.. � IhdSd`�C1'tiR'S NOTES - � � ' , . _. `-. - . . . � . . . . ..� .._ .... . . .. .-z c o s �a:�.. . . . - � � - . �� . � �� . . . . . . . . _ ._ . . .. j..�,a ..� . ...� . �.. _ _., _. ._._ _.� . >. ... m . , , _- >- _ ; �" :.. .....:� .�.._.� .�....� .. � .. . .. .. . ., � ,.., �- . _ �-� . . .� . ,r,. . . . ._�.. _ , - � ._ _. .:.:..e . . n��.. ....>.:_ �,r -.S . ..� .,, -. i ,-.> ,-� ,,, .�.� ., e . , .. . . ... ..� ...:�,_,W. �- �:... �,�--�. � .., � .. . ._. . �, _....«..,.�_..K - . .. ,, µ,... : i ...� . , . . .� , . .. '.: .-. � .... :. �. ..: �: t �:. ' . -..aa4 ....d3 iA:.e�... . .. . .... .� ...... a,. .. ' ' �.9,$. k�'�.a J q,UA�P`' {„� .�9 J'. 4> e; '�'. . . . . ' ' _ ., ' ,., . f. ._.. ... . . . . _ . . . . . � s . . , �- . . . ., . .. - . � . . .W....ti,.t.» ��„.,..�........;,�.:.;p.. ..»,,._�,..�., . .. . � � .. ,7.+ . ' ��