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, ,� �a�� ,; . ., ,WOR'kERS Cd�NPENS,�,�A'7iON�D�ECI'4�+.RvnT�R� �� �� �. ,. .� ._....:; . . ��'y'.':,.,' � . . . . . ,- ._ � , ^ � , a'fl'-^ ,: 92 0002�%N 3 87 , . �µ �.1 � g,•+^F= �o-n, nw K^ �.'- , �I hereby aff rm that I..�avg a �ertifwate of.consenf to se(f ..,.,, ���420 - .�.,,.�..«..,o.. , ,..� -insare or a cefl f 4ate of Work rs Com{sensotian Insvra�ce'�or -�� �eoe � � ' �" � . .... . .. �. �� 1S "o'�ertified.�c,o,''py p)pfie�reo��'�Sec��3��`�a G _�� � y'9� ��- �f /�►pPLICATIt)N���FOR�-�P�.RNIIT 'PDI ry h�o.��Company ��� , .. ' . .. � .. �„ - ,�.. s ,�..r,� .... -. �. . . � ��ce„r ea������s i ea W,h,r,a'��n�v e�,�i � a', '. " ��WER -SEWAGE DI'SPQSAL._ , , , ..� .. ...a Y � .� � . .. " " 'CdUNTY,OF LQS ANGELES BUIL�IN, G AND S71FE,�Y � - py' ding inspec'fion � . . . . .. .._ .. ; . ,r�^+�.. �,� �., . _ : �...,.,.n�,,,,.... .department. � � � ' � � � �. , . � .,. � . .. _.. .e-,..... �. . ._n-. .._,. ;Dare�_�Applicant FOR APPUCA 1L IN �AT'L C�N,NECTION QATA _ �y ��+ � . � k�m. �. L�RTI��CATEV�� I�N�F�2��*A�AV�R��YYS BUIL�ING -NTTOFIa� f. � ' DEPTH�. ._ ....�. :.(Termiesrforon'eflUndei��0���$1bU 0 455.� 4�vB�„�Yfhel.� FOC4LITV � � .... ., ,'.M__..,v.Y ,.,...`.,.,.,.«....,...,: MANHOLEREFERENCE .r.�•!� � � . . . PPEY2 COTV�nI$ �VJUK��C� � AOORESS C✓r LOWER � ' p . . � 3 ... . NEAREST..:. . . TVGEOF'CONNECTION... "." .: �NGTH FFOM .� .. .,,:. .1 ceri fy that n the performance�o��he w9Y�,for wh�ch�ihis cao55 s=,. - v cuae P i ��: M�io v� � �,-�j . .'p'eFmii i; Ssued I shail.not employ any person�n pny mqnner -� - � �� -- . � p�,NQ - � �so`ds io become s�6�e�t to the Wo kers Compe saN�on Laws , owN�R"� f , �. - co iMv No. �.. - ioa No �Y ��� � y «�-� s „ `� �� .'. �� 1�� TRVNK PERMiT NO � j.ROA�r'ERMIT NO �. }�M . � . ,. . _�,..�, a '��ate APp�COnf - _� . AD6RE55�..�•��� .... +�� . �NOTIEE TO A�PLI�ATf� If OfiB(_.mpkln xiYtiS C f1�CZ1F� oP +� AfFIpAVIT-�.'WANER EASEMENT, REfiO,RD`1NSTR NO � DATE _'" u..._�: .� J . P,� ;;., Citt � . ..-. . . TEl N I � �p . . 'Exemphon, y`oo `sho,pld qeco,me! sub�ect to ehe„illorke s ., iEGta.; � ' -��" �- � -� ' . � .��Cqmpensdtior provisSans of rhe Lo6ar,cq,de,.you must for{hw ih , oeSCaivrlota �aTNo.' � � - _,.,�_. _. .__.._.,..L.... _.__._. �''c6inply wlih such prAyiswns¢r this permit shall,be c�egmed . e_�K..� iancr -SinieENCR WokN{N� . . HWY ORST �.::re�roked � � � .:. , ._ ... �' OACHMENr , ,. , • . .. .._ . � .CICENSF�t3 C�`ON7R/�C�'0125 aE�C'L,�k'ATPON � . ` , ` - rva oF e�iG� "'Y ���- �-�- PERf NO � . ` _. ,- .r e:_ ,. : SIZEOF lQT �. NOW OIJ[OT . � G' � �. . . .«.�.,.,.-....x�...,«.,w.w _. �. , 'I he eby aff rm t�hat('�m I cQ�sed unc�er�rov�s ons of Chppter � use oF� " "" " � �`- �'�'' "9�coJnment ng with Sedion 70D0)of Div`�sion 3 of ihe,�usi , eUuoin�$� � ���CNXk�ES`"�"�" �� � -- -:ness pnd Piofess o�ns Gode,and my licens,e is.in fuU fo�ce"and �,,,,_, � r.�-������-�•�•-m -� ��� ��- ' -'`"--"�' `"-"'"'-"`""""'""""' , ",eS��BCt . .,." , �i ,. . . �.��. '" CONTRAC?OR � '"' CONNECTIONCHARGEFEE .. . . . � , �jIa /�,.y _.� . �. .,. .. :.. _-._..._v. .._�. �._--..._._-w..,....._.� . } �L C@Y15E�lllYfb2�,JSJ��h V LIG C,IO55 � ��" - ADDRE55 ���� REIM6URSEMENT F�E .O � " � ��.•� � ,/}'� .``� ., •, V.. :\ ' ��+ . �OISTRICT NO.�'�. GkOIIP. ... 'MAP..`-. ... PROCESSED 85".�. .�COntfaC}Of � ' e �+� "4*C�+�� CITY � � � iEl.NO � `4.,. �'� � ` '"�Q I am exempt�nder8ec � � of iMe L A Co � �i� po Q� �cl/ss - �{i . � °� �"j BK r , � • ..• �.�� $;�,.?_,.. {�st4 „�' NO � '6ESCRIpT10N�fWORK. FEE`-� � ."�`."' . . . U .� J l/, �� PCum��n'g`"Co �nd/orSec�" ofthe � :. �...: ... '�zAm . FiNA� : � �. �y . m ..- Hbusesew�a,coi:NecnUyro.... , �"l e,� oarE �� VRLID�KTION,. � .. r � RU,BIIC SEWER �°; ' . �_ �. ; � &P.�� ode for t E fO��pWI1t9-Y8050f1�__, , ,.,, ..SEPTICTAhK$EEPAGEVITOIX� �; �� ��,� � FIhAL -� � . ' .PIT5 Afv��OR DRAYNFIE�D " � _ BY � � � • � .. ;.. �—Z . . ' HO�SE SEYvER"CO�N�CTING 7D'.•.,.. ..•.•'..•- � Pk1VATEDI9PCY5;411'SVSTEZ,1 ' ' '-" " r""" �'� $IglIP � � . ' . ...CONNECTAD ITIQNAl6CDG OR:,,_ •..»-••,• .. ... ... -,_... ....-_._. ........ .......... '- OWNEk 6UILb�R DE LARA710N ' -- � woRK To yod�seweR �� .� .. . .. �..�.�, kro'-s;h'.. �^�+;.. OVERFLOW SFEPA�E PIT,6RAINFIE[D � �I hereby aff rm�t"{iat(�am eicempt�ram ihe�antra�tpr's licgnse exm,cesSvoo�.:oevweu nnwni'a� - ^Law for the,�tollowirig r,"e'a`son(5eSign 7031.5;�Bu�sness and;Pro � urea aePar�oK'na Nooy'r+ouse, � � � � . .-�f,es}sions��ode) - � "� sewEa oe oisrosa�svsrEu . . - . . _ z{h,��L R . - '��1 I as owner of thq,.Property,ormy employaes with wages as � � , -. . . ,. .. . . � . -� -.--�*�a�c � s�'� � :. � .. � iheif sgle eompensat on w II do ihe wo k and the struciure � w �� � � ' , ,..,. , � rs not in}ended or offered fory��le,(Secii6n 7Q44 $usrness - . � � n. ,. " and P o#esspns Cotle). . OWNER"� Permit .. S L�. �`d 't ° �'G%C�� ' ; >»�,. � ,<;_, _. ., . _ = -- - ❑I as owner of the property am:exclusrvely contractfng with AUTHORiZATION TOTAL FEQ_ �_ m m ;��E' f censed COTt�aCiofs t0 Co�nShuCt thC{sro�ect�Secf on 7044 I HAVE!+T 7HI�DAT�A C�FTRACT WfTH iHE HfREM��N"AME�C6f5TRAC�bR i0�' . BusinessandPXg,�.gsgonst�OG�e] CONNE�i'TNEABO�E6ESC4lBED�X19Cif]`Q9 ELCENGfiQ"Y4�'pU�1�C^yEW�_, . ' ' � ft���_� ( _. - CSTJS7RU�TI�fJ�ENDI�J"G A�"N'CY � � . tF ��l hereby aRirm tFar r{�ere s a const uctio�.lending agency SiGNEqTH15 ���� oAY"O�` I�� ► -�- .�=for the tformance�of ihe work for wh ch this permit`is owrveg oe,_ _ �. ,q� ""-.„ ' _ .. P� ......... .;_ ._. O'NNERSaQGENT .� .- . .. .. .. . . . .. . '� ssoed�{Seq 37597 Cv C f � �� � - ' '; .F ,r .. � .: ADDRESS�.. . '�'Lend9r s Npme - ., : . . . . ... , � _ . .._. . . ... .. .... ... . .. �, ..; - .�:+ � � � � , d �' �^�nT^^���,�'".� . , �Lender s A51d ess �- �,A ,,,. er� ihal I��ave�iead f���s appf cahon�anc�`s#oie t'�at�ihe - �r.� `�� - .. . . � ...���aboVe-. formahon is.Sorreck i.agree to�mmpfy w�ih aII.,Gounfy � � - . . � ...�. . . .-� .; . . . � "�." . . � ... . � . . � �ordina� es and Siqie„Jaw;„regvia�ng Pl�mbi.ng qn�1$ewers,-�- � � - - - � �� -� �� � � - � � � � � � -and�h�reby auihorize��repres ntatiues of th�5�.-�County"ro'enter . .. . . ... . . .. . .,:. . ..; �::.., . .�.-. ._.,. ,...:.,. :. .., .. .. ,... . . � upon e above- io pr periy fof insp`ection purposes. , "� � � ,. . �� ..,� . ... .. .. � � . . . �_.. . . c -.... . � .�:.�.. . . .. „�. .,.... . ..', ... . _ . . . .. .. . ;�, Si natu'reofPerrhYt'tee Qale p' V� S�ER�ifERSEFORE�CFLFyNATd�iY��ANGU9,G,E , , . � � _ ___ g #� .p '' ...,r,. -� �. ' : I. . . .. . . . , , . , , , �I� �I., ... . . . . . .. .. � � � `z`" ' a�.�- � ' � s�- � IIfSPECTOk'S PI9YE$ . ��- .. . . ... , ...,., ..... . � � »,,� ...,c _t7 ,. 8�7�1f;I3$�2-�k.'Gi.�.�F�'F�i�9L�T � _.�� ,�:;�., .R� .���- ,. ..�..a ., ---_... ::- � -. . p , .�� A��R�YA�.S DATE . . INSffttOR'S SIGNATURE . .. . . .. ._.. .�.......,I IfEfCb'�'f9Y{fY1Fl SIlflT�"I8[Ali @YCETY�E SSOffi 2II��(�.U114t�CiQ58'�.��. � :_ .,_..:.: .. ., . , 'Ntu�Housesewea� . _ � . , .. . . ,.." . . .,�;License�Laaofae�:the�¢o31ow3n�.¢easott(Seat%on:703T.5,.: U . . .... . ... . . .:...:. .:.,... . . . . . . - - .:_ _�: -_......_ .:..�. , ... ....... .. Business amd Pro,y`esszas€s �advlr Axi,y cv ��oa�county GOt.1NEQ ADDITION�L - � - ' 0 � eu��o�r��oa�voa� ,,.�-. . `�,-. . . � � , ��.;.., . +��: . , . ; ,, .:� .-wbicb xagusr�,r rt 9�ee;!fatia�ta ca�s;arsce.'�tCt�ar.:sm.+¢Y,o+�ee,..-:� � 'sevric 7aN�,sEEQ;PiT�s) .�. .... =�- ��;---Y--� - - <. -�. ��.. ..devno7rsb,,oa repafr ayc�,�a2rxcCu�+zP;'prsor;6o ita issuance:... . uaoiouoenwFiE�n. .:�. .' . �. ',�' ' � `�.�: . � , ... :.. ������ pro�iorss�of l��C�,t��r�.€zcezese�L w� . ' �€Co fa7e a - � c�55p0o�O oevweu❑ . .�sig� saater°renE fd�uE dse ss diceresed uvsuaaat!a th¢ . . AITER.REiAlR SfWEROR „ . '� ,'�. .� :�CS�D�+169''�',.: � sew.a�e�isvosa�svsh,u , , .. .. �_: �' � .F.,_�.,_r'�� "- ��fcosnrvaennng vit'Ed�Sactaon �OOOi..�nf ZJsnuxun 3 0,f tb�'. ..oiscoNHecrrcucnta� � ' -.'. . . _. ._.. . .��-.:. ���' .-.: _ .. ,�:. . Business�.a9rd 7'ro,j'esrioms CodeJ or zbae be,-'u orerape.. . �� � �asnNooNHouse seweR.-. � - . . . ,. -. � ' . .. '^���� „l ,.,.:. .�_ tberej`ro�si�ibe basec�ar tbe al7eged exem�iafon.A��ii . aacrcF�4isearieTa�isp . ..._._.... ._� . . .�` .•,.��.., , .;, ' ; . ..��r�4olationo}',Secsiose7P?31.5�63'�YdPPPeeniatf�rupsomit. . SEEP.FIT 5)❑ ���5 0 �� � .-.� + -��:.��� .> �_ s � � � . T'°? .. .;:` ',a-'-, ubj BSe dreon�to a cdmil;oesalty of a�o&roaore than� _ ._.; . .. _.._ . _ _ �. u, _._ ....�ve ba.cdre doAars(BSOU)a ..-. .� . . � � � � L7 L,as�al�nwaer of�ehe�proPe$e,p�i11 doi}te�wotk,aad'.. '...._ ..,_..� ... ..... ' ._ .� _._. �, .�;.,j .: ' . .>,the�sieuctu're is nof intended os oftered for saYe: � ' �� � ' . � . � �> .�:� :' ...-" . _.. .. , �,„ ':� ,=� .�_�' trartnr�tj•-Ps�sirsnass'an�P>ofes¢eoscs Car�'a:'$be Co�u�. , .,,. ,. _r .� ' � . . .:_ _ . � � � irrerese Larv;does�co���¢Ir 81°to�a numer of.: �, .. ^, , x�.�- �:�sau�b ruror��$lrue�orwvaded e�a�eeeh�ssae d wbo iloes . _. _. , . _.�,... y n� , ..., , ,.. � . _ a� ��nz� . , ...are»ca anS¢�cd`erd gr afferz�ygr sad�.If,botusv�r. she�... - ,.._- - . ', .._ .�:8raslds�ag,'o�dmprovee�ent u sokd.wishfn nsia y¢ar o, . . ...rompdetioii, the oumenEse%T3'er wdEd'bav�e'tlre bur�e�� ..�, ,� , .. , � . _;� .. ... . .�:_ . .. , . :. . . .- .... �-��3��^d R.,', - - �� o}¢rov;sg�tbot ba d'ul'saot.bulld or%r.cpesove jar th¢���' . . ,� ��� ,.. � �. , .. , , ,r , , ' ,., .�- .;? . . � , �. prtrpase ojsed¢J � - �s " � _i � Y�; a�9i e'xemgse i�et Ses:_ _, _ � �&1s:C.fos eP�fs reagon�_...,..�:.a,__v ., ._ „ , , ,, _ . _ . r.. ,. . :, t � . - _ . � � ., , , � � �� - ; _ .� � . _ , . b . .� .._. .....�. .....�i,.:.. .�...... . ;... �.'._... ..... . . . . _ _ t_... . ._. ..� '— :. _� � ,. , : _ . . .. - . . . : � �� . ' '... .. ...::,..�� �:.. _. � . . -�- . ... r ,- . ��.t0'��—�—�....-,<;,„.... . .- . . ,;., , .. . , ... . .. .> .... ._ ..„ . , . . . . .,. ..:a-� , . �� �. , r, _ _. _ � .�.. � . ..�.� ::=r' ;� - , �-� :: , , : ;� ,_ .. OwELR'' .., -. . . . . ._ . ..:. �,,. � • ;.:�, , :y � ... .�..� _. , , . _. . r:.. r7` ':;;:�. , :�:. . 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