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a.�,+��wm , e+r�. ;wu�s�t �x a�.m��rw ,«r r� �' . _ ..,.. -. t .�- . �� » �nr ,:te � &� `�cF7`t�§ �r`n �tt� r^= , s^-._�: . »7e.r:v*�:-+�,.,.:a.�^-s[-^��'�.'n.•w .�..sa�i:�»� _ . ...;,.+7. „ , ,. s,��,.. �. `� WdRKER5 C6YJ{�ENSATI N DF�k'ATIO� / �� �� � � � v-.. ._, .� ;� ;. -y�.. , i �92-0�2'DPW 4/87 „ ., � . . .[. � .°��1 hereby afFvm �hat I have a cedif cate�'o�consent to selF � � , � �� � �- -� . ' nwre ofa t�rtifimte of Workers Compensafion lnsu"iance,'�r"" '"' ���BP�. � ' � �, W � a cartrfied copy there'of[5ec,'35bctS-r,C�ab C.) ���r--� ���f 1�X�/+►�"Cf1"�'f Y'�ITClfi`�!`r� "` " ..P�o}IiSY Ne1�1�.�°-�-E��CompanY-:�/����,f-ZLA/�,"�_ ...�. ..00s .. � �+ YL��,�r pt'd� cV��(�x/+S'VIy[�i 8.r'C�cIC�(ITYM ... ... ., .._....... �� LJ Certified copy�s hereby furn �_ed. . ....� .. .�.� . JEYYCR '..�GY•P1�7� �IJ�r"�J/1L. .,y:, ... '� .x�„�.s. , :.:. . � . Q Cerrified copy s£iled wir tlie co nry 6uildin inspe ' n GOUNTYAF LOS/CNGE[ES BDTCD°ING ANb S�CF�,71i'" "'"""� ' "' ` , department. '�� � � � ��� .- �: ..: ..._,,._.__. ':6ate�Appl�c r FOR tl4PPLfCANt TO F411 IPf •-� . � CO PeY�5A�1'dN lY�5t7Rq'1�C�" r nooaE s srn � CONNECTION DATa(__ , . .,_... , ' � �E I ICATg Of EXEMPI"fON PfFC?M W(SRKERS � _ .. . . . . - . .� � p � '7n �a-�� p - .. „o� ?�-� CEPTH�. ..:. . .,..J .rsM,. ...- ....' , 'Y 7his seci oo need not�6e com�eted�ihe wor�C i vo��ed b ihe 4�� - - i uPv a� � � � P � n Y LOCALITY � �uHOtE REfERENCE � ' ':p'�rm t s for one hvnd ed dollars�.($Idb)or tess j �� � � — . . . � � „„ „ OWE - »"a _ NEP,RE5i- � � �T'YP.EOFCbhNECTIQKI- �� lEN6THfROh1� � :- -.�. .�u.A��.,,, . ' . a� � - �,.a: : I cert f rhai in"tFe r�ormanee of ihe woJ��or w�ilc`i this cRasy.sr � � � � � Y Pe eYm f is i soed,l,yhbll not em }o an " � Y� ���- cuee.-� a� m�`"i'o v,:i' ���P � - p Y Y Per56n in any mpnner' � � , _ .:__,.. >._.. 'so as to become su6�ect ta the Workers Compensat on Laws. - �- ' - - .'. ' . �P:c No , � "� � �� .� ;, �,�- OWN�R," { � Cp IMP,NO.- :108N0 ' y .,, � . . � . ' ..�. :�b�s,ate � �v A(pplicant _sh,a� � { �dRE55�, � iRUNKPERMITN6 ROApPERM�JNO:'��' . �IV�T�C� T� A�rL��A� f{ a{tela ma��g 1}]I5 4E!}��ic0�(E Oi �3 �� " �'°1.+ ,7'/°�,�� A�f�pAV17�- WFNER EKSEN£NT RECOR6 IN$TR NO:� �AIE._ ��,:�xsmphonj you sho�ld� betome su6ject-:to tha VJockers' � crv _ t'e.��n 7 � ��If A � om en'saiion'FoNisYons of the lobor code,�ou musr forrhwith �E�� ,� � . , ..� P P ,.,Y DESCRIPiION �OTNO � HWY.ORST.1h'IOENING �: ' '- "� ' � ' � ' '--.comply wrth such provis�ons or.this permit,shol) be d4emelJ � � '� ' "" - � �:IL'VOICCCJ � BLQCK... -TRA�T STATE ENCROti�HISiENT ., ." ..`..` . " . . ,..'....... .�.i 'tG�9 'Z� ' k dr 'SX 'ce'a&�Y5�k ,. H NO CP BLDGS ' PERMIT tJ0 . . . _ ; a >,IICENSE'b`CONTRAC'�TU�2�DE�CL�A�;t`IOt� � _-_,: � ., . -- . �. +.a, . .�.�,... nr., „ .� : SIZEOF'lOT . . NOWON'iOT'. '.. ,r ,�I hereby aif�rm that I'am I�censed-unde provis ons bf��iapter useoF-- ._�. �.. . � i E� � ��G' ; ',9(commencing with.$ecton 70�`,0)of Dv'sitin 3`of the:Busi- '_ e�i�p���s ' � '"' - aAR�Es>� - � . � -- - ' "�+ess ti»d Prpf�ss ons Code,and my(icense is in full fqrce'and � �- t � � � � - � � - `^' C�BCf . � . �:-.; `. ' .' ... .g ....: ' CONTRACTOR . - CQNNECT(ON:CHARGE fEE . .. ' L cense Number� � � LiC C�ass �.."' 4�_ ,_� qCpRE55. , . �.�_ � . � REIMeURSEMENT FEE . , ,_, p- �' �, . .. 1 - J'� ��^^`�� Dt$TRIC�NO. C-ROUP�� M11AP.' �.'-PRdCESSEb'BC'�""'" �onffacfo , DQtE�,,;.��rZ� CITY iEl NO T1/ Y J j � BK PG .. �... ''�l]I am exempt under Sec � of ihe l A Co iiceNS_�o ��- � - c nss � �JC9 �.�� �� � �� . O �_ a '�.; .< ,,,;'y x��.�5�;�-x:t�� �'»;,�s:t..�."s ' � NO.� � � DESCRIP7'IONOF WORK�� ��ree ' � �� �- :, Plumb�ng Code.and/or 5ec �of the ���q�a d�� o.are� r}c - W� � .HO�Sf SEWER CQNNECT NG'TO"' �i '' ,- ••,,••- .PUBUC SEKcR�. . � ./� . �, . VALIDATION ..a._. � ; �Cod for.t�efollow�ng�-rsason , . .s��r�7pNKseErn�eProR � � ' � � - � � B 8P . �y, . -PRSAN6/Ok"DRAINFIECD . ' FINAL �� '.. 2- . - � � .HIXISESEWER"CONM1IcCTINGtO� ' BY � � ' � -� PR U iE 615P0 AL SYSTE " � " - � $gnafUf � � .: � CONNEC7 ADDIT1I�NAL BLDG:'bR' . � . . . . . .. .. . . . .. . ' a OWNER�YJf[D,.E"R CGRRA`T1Z5N � woaKroNousEseWErF'�' � � . � Yp a�:wy � ':OVERFLOW$EEPAGE PIT,DRAINFlEI,D ' � ' �' � v .,s +,,,.a e....�a-, m�x.� ..wn� .„� ., . ��if�e�ly aTTlfm iFta}�O7Y 2XE11lPP tYD�I'�111@(,011tfaCtqY 5�CBItSB 'E%T��CESSPDOi.DRYWEII,T1ANHp('c � ' � � � �� � � - � �� - - .... ., _ _ ..... ....< r low fo th�fol,lowing neason(Sector+7031'S�9uisn�'ss tlnd Pro � :a�rEu",RE�nra eSZAs� Oor7 x'oUSe � - � �. .. . . - . . � :.fess ons Code). �' .,� '��' � �SEweR Oa biS�A�9v57EM''' ' � � - � - ❑I as ownar of the��property,or my employees wrth wages as � rheir sole compensation,will do the work�-and the structure �� � � � �� �-.� (3�3,Cj�A'- is not.intended oi:offered for�sale(Serfon 7b44,Busi'riess` � � � � - . an��lrr;ofessronsCpcfe) � � �` � OWWEI�'S-` Pe.r!T�it , E � `}�b�e s s � a . . , ,�❑I pa owner of ihe prop�rty am exclusively<ontracting�w th AUTHORIZATIOI�I TOTAL FEE � �� � � �ICBf15QC�coMtactors to tonsiruct the project(Section�QQ4, yqVE��P'THIS DATE�A CONTRACT WITH THE F{EREIN'NAME6 CON�CTOR TO�� � � O�0���,��-� � �� BVS n253 qf1CI P OIPSSIOfYs GOCI@� -CONNECT TH'�ABOVE DESCIEI�ED E%ISi1NG QWEL!ING TO THE PUBLIC$FJrEP : conlsrkticri�3N�eNurrr�n�e�cv �'"` » �, : a • �2 Z 5 G� _ � .. . . ....,,,. < .,.,. ,�- .._u �.� SIGNED�iH15 �,_DAY �� , 19� � - ';�YiereLiy affirm ihat �here is a consiruction IenCI ng ogency � ER�Oa ► - .(Q,'�O.r��j`� �� :�for '�he performance:of ihe work fo� which this permFt is °'�H -�*�- -�- � . � ,.. . , . OWN,ERS��ACyEJ� . . , r:issued(Se� 3097 Ci'v.-C) ` � '- � . . , .. . . . .• a r,�e .�,.i .-.���.F _,.e -�,.� - _-,- -� wooRess � `°"Cender s Name � � ' �� « ra " _.;: ,�' _-�,�' vF�� ,g .i .�a�-�a r'm����'s`akr 6 C �. . . , . . Lende s A�dress �, �.. N 4. .��„ .:�a. .... ...-:. ..u.,'-.�,. ._. -��.,..,> .-�_ . ,.,_-.: i.,. .,,.,..�, „ a�P cerfif��thot� have read ihis appMicotion and sYat�e tliat�itie " � � -'��`" , �' .� v �..-__ " ��ab e i,.,.ormation'iscorrect.J agree to comply w th oll Gounty � ` �+-� � - � � � � � �� - � � "dinanc s and Sta)e�laws regulatmg Plumbing antl$ewers, � � � ' �� � - �� - ' �� � - - � t�r.-� nd her".. ' �_ . . . . . , . . . . . , . y„authouze representa(ives of thi's County to`"enYer ,"� `� . ,,, ,,;;opon�rh,pbove-mentioned.pro erty fnr iospecfwn purpo ea � � ' , � � � �� , � � � � � ,,.'. . P... � .� �.: � ..� . .. J , . . . . . . . _. . . . . . . . . � . . "^'��� ��-SignaPoreof ermitlee � Da �..., ,SEEREV�ItSE�iOR'EXPIANATORY6qNG11AC>E�� �� " � � - �- �� � � -- "" � � e'- a r 4° �'�:i �` '�, !c Sfl�C'�O&'�dJO7ES . u , w.....�:_� . < r ,; . . _ �:; C9�7EI��'S7�.DER�`9��'1,Akikb'�C�14 � , _ ..,, ., j.,„ ,.. �.��. .., �.x w , ..,.�, _ ..... _ � , � �.��p��'�p�L§ �onte � �Nsvccroa's sicNnruae` - .. . . . _. � i her¢by af4sm taat E-am�xe�ngz fm�a the Conersceor's-.' ,. Hew House�R � �,`..._ �. ":: . ,:: . , ,.. . Lacense L�iv far r�e 4ollonnng rea�ae��Seceaova 703;i.�s �� � .. .... :.- .,U�sb'enesk' and Professsomas Cmdepe.Any ceSy ar rnunfy. � — .�... > � ... . ... , ... , __•_-„_,_ ..._._ :. .. . , . ,.. ._ _ -_� . w�nea nminorva� ,f: . ,.: , -.�. �. > - LL � :. _ ._ : .,.. i . ..wbu�reg'€iires m per�iiiit So m�s.tr�ac�s',¢.'ber.''ssn}iroye,� � 9UILOINGOR WORK' . �'-' � �' ' ' - �VTIC iANK.SfEF.PIY(5J .--�_....__ . _ ... .' , � � -�¢61E6j:dile 6C Y 49T a93y SSCUCtPbYe�bPAO!20�II$S_8S,s8tWACC� , . .. ...;;..... ..7...s.p_.,n .....,_._. ,..h..:..�.....b�0�m 2L1P3�3���t%'d9{�•y�..> �_ . .[ . � AND/ORDRA�IVFlELO .. �'�' ��: . �':, .. .., . .,:' .- ...y - � . Q . . l5�! 91P.E5{X'�i'il'ET?t&18��ltB,p3T8 6��-. . . .�...T._. .—r- ,_ ._ , .. _ � �:�- � �. taSea7aexra ebme'I�e ss,l.c�msed�5xrsradva�so S+Se : . � � ceuvooi O �-oenwe«�� � ,�:�;:. � ,.a - ��... . ;�.: -: .. -...-., �<•:w._......T... s%8ne�f s , �-- �;, - ., �K.,�rarraas`osae'of zBs'e Corassucto`m's L'ireias¢f,drv.(G'&�Ear 9' , _.,:._�_ _,. � aihe;�n�aiR,seN€rsbe , . ....-' ` . � ........ ..-..::� .._.. : � �.Prnm-menisiag witii�.Seitfoma 7600J of Dfvi�ioss.3 o_p'abe: . s�wn�eoisFvsn�svstFnA . .. _ - - . ._. ^—�— .° ,;.; ;` � .6,_ ,_,.„.,.�.� -,._,.,��yne.��datd'1'rofeasdors CodeJ'�op ShaE he=is�eem¢t'��. - DISGONNECrPWGAfVQ . � .-'. . .-.. .._...._. _, - . , . ... . ASANDON FIOUSE SE�k, � ` '- -EF)8f&f`YON3¢SIL�$I96 A[L585)XN'th$tlbI¢R'U�e3C6fFd�SW9F lS3F�1,. ... xAc�i�k se�r+c TaNecs p :�� = . ",µ•tu'tzo�s of':�ec�aa�7Rs t 5�iy"aesy"p7t asa.<`fo$'a pier"va%a- � seeP,�ait s ❑ cess'roo�s C] ...; , ; �`� ... �; s bjects ads�a�plsewnt to�c�ccaC�iem�y af raot ro^.ore&han�: . � - - - -�. � ��,�kr...R,c�,�.,...�y..'� � ,..�::.��v�ridrea8 doltars�f�'S00J.: '� - . . ' k-{5- � ->' --.� � <� ❑E,as tlae rtawnee e#xhe pcaperty will da the wor�,and� . .. , ,. . ,,_ ,. ,r � ,� . .._, � .��� .x ,_. ; . �, � '.. � ,.. --- , ,.., ,.._ �rr?,.. : : tP�e ssruce+sere is ao2 anaended or o�ered fo�s�?e. ' �., _ _. _. .. -� ..:. ., .;: . ., :�. ��.. , . . : ,� ; a.� � """"rr�c�s�'lu�sase'�La:v�o"es ssoiaapply t�"uro�"��wrt�"o�-. .�.�.,:. ,».aa.. , . . , .. , , ;<� �.��.,__ :.. ,_ „ �.3 y_.�._ ...-. .�,_. .�... �,.�. �propm¢y uibo&udkk or lml5s�oves�thereoea.a+md�v�io idries'. � . -_,;., ._ .�:.. .:: _ . .._..,-. � . , "" ", sxeeb ti"or�"7asm"ase��oriie$ed S�a:seccY�"s'mpirovesnents _ . _ _ ._ �xot eretetrded vr ojjsrsd jor sada Ij boaii4cer tbe . _. , . . __,: _ :__: � ' �. _ _ . _ . . .. .,._.-. ..�,.:. ,., , � �. �� � -,. � ._ _ • _ �'aldesag ar"empe�ooevnexe ss sord''.w�tbe�t'ox¢�yaa�a�'� r _ ;`' � r.,. � :,..ti �' �r be` �,,,_Y.�_ ` `�srorcepleE2on, daie row�sei*&uildei•antFl bre'v�tbe" . ..........�. •'': � : � ��o,J pro_visag.,ebos ba di�raoa beasYd.or�€sre�rraeie f . .._,�_ ..� ,._,. _.. � ... . .,.. :__ ......_ . : ' ` � � � � �.n :;.t ;r: ' , ,' r�os�bf saJe./ , - �: � : �. _. . ... . .. . . . .. . .;,-.....�. ....:.. ...,._ .-�. _ . ....:`. ....... . . .. . ,,, .... . - ' -- ... .,., ,„-........ ,,s.� , .. .,r .._..�,. ..,...,._.::� .,�. � ,... , . ,y. .. , "' . , . � , , ..,,. z ,. , . . _. k� :. ;F.: ''as;; . , a- .a - I��ii@ffipt t�dea'$� � �� �"� � , � � 3 >' ., _ . -� w J �.,_ .. 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