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__. . ._.. ,_ ,.�, .. .,.�� ��.Qaw ..�,� �.n�. � � ,: . WORKERS'COMPEN§RTI�N D�CLARATfON � � . � � � �� ,. . .:.,-. �' :, , ; . . .. . '� � 92-oD9Y4FW7i97 ..,��� � . �I he eby affirmi thai I have a certfitp}e of�Sonseni t4_self .,, , �bAd4zo � � � ...._, . insnre or a ceriificate'of Work�rs';CompensbHon Insvran,ce or ��e � � . - �i � . ,, _ ,,.. _. . . ' "'a certrfied�,c � there�(�e< 3806;�La6 C.) � � � � � . /�'�]�- [ �p PolcyYJ {ompany ��f`,K3?� �HV'/3 Ps r ����+����rC�rri11�1�CO��r�, �O�,�C�'1 �C�Cervfied c0µy is kereby fom�she . � � � � � � �. �CrYGR _�.SG�rAG� ��SpQsAI �_ . . �Cert fied copy is filed w�th t cou y buildmg inspe o ,COUNTY CfF COS AWGELES . ,, .,T BUII�DING„AND„xSAfETY �� departm en) - � � �- - � D'ate<���Jr._Z��APPI can µ� ._..__ FOR/�PPLICAN7 XO FILL IN....... G-/f—/_,?+� CONNECTION DATA ,_ .. CE IFICATE OF E�XEMPTION FROM WOR�(,Ef�'$ � �` euu�irac f' - sranoN "�•� [- � �PTH ���� .., : .�..... , '. - COISI�EI�1S/�'O�I-IN$�'�R�C.� � ,�� �" AOORE55 F �' ✓ . J . ... . .�. n � '��his section need no�„�e 4ompizted if the work inyolveci liy ihe .. �o�A��T�. �� .�� ,� � r.uruHO�E'kEFEaENCe � f '-. ' -`PPER- >> .��petm r's'fqr one h�ndced dollars,(5100)or less� � , NEAaEST�. ���-'� . ` "-•�-��� •-'-.'--` '"•.-"'"' T�a�o��qNHEcrroN'- •""'""" �N�r"ri Fr�3nd`�t 7� � � ':�Serrnit s�ss�ued,1 she I not am fq�an���ers rk fo[whi�1�)h s,. .�; ceoss sv. � . . . v . cuae �� P�) M i ro r i. ', _,.__ :„ y -, �. P Y Y P o,n in 4ny manner . ..- . . . p�C Na :'. .... `. ''�`•�sa as to became sub�act ro the WQrkers'Compenwtion Lqws. owNER'..'` "� �, "�� ��'� ' " �' '' - cb ima Nc.:: � �oa No � �� .�. �. �� � � �:' .•"" ' •': k � r" : ADDR�55� !:. �TRUNK v�RMIT NO .� ROAD PERMIT NO.����• ^m� �. . :,DOtB�Ap�JI Can) rc , .. ..; r �-� � � ^�' �y` '� qFFIDAVIT� WAiVER FASEMENT RECO¢0 INSTR NO. DATE� ,„,_�NQYI��TQ FiPP'C�CANT It af�er.mnking rh s Cert"fieaie of . arv ��� � t�No #'4/� � " / � � � � . �..,.,_.,,< � ,- �xemption, you shou�d become, subject�Xo the Wqrker@. „, ,�,. �A�� .���: � -�� � -: , _ �;Compen�dtion�prb3isions of the Lqbor_code you must 4orthw th .. oeSCRiMioN' lOiv4 - � HWr.o45T w�pE��Nc .. ; �. _;� � ,. ., .�.. . ,.. ... . ...� .. . . .. . •�s=Lgmply v(ith suc,h pro��sions.of,�yi,h s perm�l.shqll}�e LJq��med„ . � . . ..__ _,...._..,,,.�..� � /EVDkEf� � . ; BIOCK��: T�RACT .. .; SiATE ENCROACHIJ�ENT , � ?L1C��1SE�C'�9Nf�A�TORS DECIA"�kdTIO�Y '�� , ` �-` . .. na OF BlocS . �... �RMTNO � ... . . . , ,._ . .. � S„��� . r ,,.- � u..� a - SIZE OF LOT NOW OYJ LOT �^ � -7�` ' . c a.. a�� ' .� ` � `I hereby affirm lhoi I am licensed under,provjs ons of�C�i�apter �SEOF'-� " ��� `_"""' `.,"`,"'""��'" "„"; '� �"�. J`r`> ��� , ,:9,(commencing with�.:Section 70,00�of�rvis'ion 3 of,ihe.�Busi-„ ,_.,�,;; � -gunoinics �� - � � � ' � � ����s'� ��' -'��- " , ��ness and Profess ons Code,and my license is in fqll force,and, �� - �-� �� ' ��'�- '-�� � "� "" ' ""' "'"' ""` "'-""""".. ,. .,.�w:_.,.E ._.. . � 7- , . .. . . �„ ��. 4'f�Eti ' � �� CONTRACfOR' '- ' CONNECiION,CHl�G�FEE , . . , ., � _. » . .��. . . . ,.. , _ ,....�.,.,. .,.,.....-,....,. S� ":�L censeNumb �"��� .Lic Cfass,"_ �.�.,�. � .�'�Y<� .� � rzEihnaua5er�neN- . .... ... �., nooRess = '�. . �� � , ,� /y}� ' .' 1 ".^.'j �,."'"•" ."�.'' P15TRICTN��. GROUP � . -IGffHp"""`""� ....PROCESSED�BY ..Contract -Date .L_L__— Ciiv � iel.No @ff � '.....r� ,.� a..: � STAZE :�. . ..u� � . � "� /� - O � IJ I am exempt underSec � � of thQ L A Co � ucENs�y I�}. ('� � c:nss .. - ��✓ r�� ��- � r � Plumbin Cod d ^�`�� �� � NO 'DESCRIP iON OF WO4K' FEE'" ''"` '" ' ��� � U�. . - g' "/or�'ec:. _". '" '`ofthe � . - Na� .. � _ , •� - �- riou�e sew�a coNHccriNc ro_ �� onle ,��. �VALIDATION� a, -" � B 8 P�C e for �e following reoson � -p�uni�pR . :. �� �� ���� � . ... .. F Q _ . �. SEPTIC TANK.SEEGAGE PIT.OR'. . .„ ••�.,`.. � �- •, �.. ...�_ _ . _�* . . .- . AINFiEI� ���. . . . - _ fINAI ' -+- . �. �HOIJ5ESNVEICCOIJNEC It�GYC� `" �" R : ,. � 'PR W�fiE 615PY55/CC SWSTEM . ., ,'"� ' S gnd ure . .. . `CONFlEi:T ADDItIONY'l BLDG OR •• ".` n� .. .. .__..,.. . .....:-. .. ........ ... ............ � OW�JER BUILDFR,QEC�ARATI'QN _ �woaK ro HOUSe seweR � mo_...£.: %� . . ' ;��lC7Y�'9EEP!{�,E M7.ORAINE�IEID - ' , e . . .. .... �� I hereby af�rm t(�at"��gm eXempr from 1�ie�antrac,tot s Li.Gense,. ExrN.,'cEsscoaC oevwea MaNwoLe - � � � � :- Law for rhe following reoson(Secton 7031.5;Bursness and Pro ��n.'iER`RePnIR"oa neallooN t-K�usE ' " � . ` fessions c'odej: � . � . sewekce_arscosn.svsr�ti _�.." .. . , . . . . � . �.1�6�G.2 R� ��. . _ r. �. . , ,.. ,. ,_..� �.,- - , ;� ❑I as owner of the��property,or my employees with wa�es as � , . . � � . , . " their sole compensatian,w�ill�do Ihe work and the shucture �.-. � ��� �� �����������u � � - � � � _ ,. � .. . �• � ea Vl� , - ��.intended o pffered for:sale(Sechpn 70d4,Bvsaness . � � -� � � �. . � ❑'SQ�or'oiessionsCbde) ' : OWNER�S PerRtit $ /(�. j� s a . and P """ AUTNORIZATION TOTAL FEE " w er of the property am exdus yely contractingwith - ` � (� � 2��a `"q ` I�cense�confracfors fo consirOct t�e projeCf(Sechon 7�44, �� �HqvE qr'rHls DATE A CONiRACT WRH rHE H��N rvAME6"CONTRa�TOR,r0, � � �, a a •_��(,�`r V ' .... Eus ness dnd Pro�LSS1of1S Code) � CONNECT THE AQOV�DESCRIBE�,Ew%ISTING DWE[LI�yG TO TFlk"PU$�CIC S�Vie,' �� � ' CONSTRUC710N CEi�DING AGENCY ' � � . � .. . . � P.O����-8��� �� - � r �` I hereh'y�a4fr'�ri Iha1�T`�ere is a oonslCu'fio`h'lending a�ency" s�C'��TR�'��DF�YOf ��c 19� � � � _ v_.. ' ; for fhe�� erformance.of the wark.fo .,h�ch th�s perm 1 s owNEe oa , . I . �, P . ---...,- OWNERSAGENT� � . �� �5iued j�5ec.$097,Civ.C}. . . .,.' . �.-. � ;. Lende s Npme - � - : .,..,,_ �ooa ss , e �^ ; s�'� � � I�rerf��iha reshave�read this-a�� �� �. .� .. �� . . , n._ � . >. � . .� .. . . �, .,,.,. . �...,.�� �.�m�,-t„r..,n.�-�»»;.. � ,� .„ . ..,.� . ..... .. . .,..-».. PPlrcahon and store't}iot f�ie �.....� �...�,�..,� ..��....:: ....... ...�... ...,..,.�:. ......�,�:, .�, .,�.. �.�«....<. .. .. �., .....� ,r......M. ','- Crbo��e inforrt�ollon �s��torrecf.I agiee to comply with all County -� ' � � " � - , " or nances nd State�laws regulating Plurs7b�ng and Sewers, ��: �. � ' . ' ' �. ' � � � � - � � � � � � -� -� -�' d hereb a�thorrze:representatrves of this Co`unty'io enter' ' "" " � :� �� �� � � �� "� pon ihe ove men�" ed �for irtspection urpo-`s � " `� � � ' - �'` ' ' ' ` -� � ' - � �- �-- -� : r `"" .�2�-�*' � � � �SlqnntureafPermiktee , � � Dat� . � SFEN�VERS�FOREXpIANATQRyIFjNGS1AGE�, � ' .. '�. "„ypez �,"�'' ���; �z�av ��.-� � :` .��" p�CTOR°Si��T�3 . t �. , ,>.,,.,; o �; • . . C3`adtV�2�31.'ILDF[8 d3E�I.P3R�""R"YON � �, -,x.�,» � . ���� ,,.�...,� �M. ... __. _ __ __ .... ..._ . �P�R�Y,AL3 � ._ . onr� -� ir�sa�aai�s��sicronni�... .,: . ,.�.�. -.....,Averebyaf£irmthatIgmezevupefrarsth�Cunerarto�'s.-..��. . .... , ._, .....__. � �wwousesewea�.. . ...... ., . ._ ,�' .'. .. ..` :':. ':. . . ,:...:Lieense��Law for�d�e:following season(Sectson 7031.S,t'�,. . .... __... .___ :. . .. . .,., . ,.,_., �. ,.. . ..:.. .. ._.,..., .. �r_Basi+se.:s.;and.Professioaa.; Cod'eh iisy s£sy.,r�r rctrx8y.:�. . ' CONNECT ADDITIONAL - . �.�� fUllZc}l P¢ [TfS a BfHi{L$p COp3yC/{C$lLI:�:.:Sroa Y6 ¢n':�. . Bl11LDINGORW6RK ".' .:" � . '.. � " . .' ,'.'� , . ' . 4??� P- �' Y . SEPTIC TANK.SffP.FR(51 . , ... :..' . .. , * x' .' . . .. ..�..�CEMOIf3Slx OT PCJlWT O 5$YPt4CibP¢a,P�'09°tG4.,d8S.SSS'AdRfiG¢�. }lN0/OR 6R41NFIEL� " � � - ,-:, ,,. ' .�.:. „, ,.. ,:,.. . ,� .:r. ,, :,. .. ,,�. a.(so.regudres £Is.e,aDhlisaret far,sucb.peivrsas so,fSke.a... � . -._:: � �.. •` .`... , , � , s' ed s3a8etnem#tbat be r"s Jscer+se�b rs€cea2 t�� Ehe. � CESSPOOI❑ �DRYWELL❑ �� �.;� , - . . ' , ', �,, rv -. � � .'. tgsa .. , .. P� y �ALTER,^�RE9AIR,SEWER"OR ' ._ . •�11f'oULStOf4S�O�CFl,¢GG18�SptfCSOY'S LPC�2�'A,/.Sa'L�1L 1Cba�$9r S�.'- ;r +, . �SE4VAGE DISCUSAL�SYSTEMS ��... . . . Y �.., . � ,. .• ..,_._�e ...(CODM£168iBC8#�4VtLd7,S¢CS409a TDOOJ;J Z�BBJP38d98�O�$JIR... .. twnNoma nouse sEweu '� .. ��� .s '�.-,.a»_M ��a"o�giad ProfeaaXons Codef or¢Kat dse as�.xeertp:" _... �coNqEc7'mu�allo . ... '�.. , . . , . _ c�ed ene bcac?s jor a6v¢Id.¢ged ezevm;ptzox �An.✓... . .. �nanu sevic rtiNxs p . . ...viaZaxioa o�5ecsracs 703Y 5 by atty uppTscacs:rtJ'or a,pnmszsia .�pr s)❑ cessvoots O'' .- , � . , . - . . ' � ' . _srabje�sa dhe applfeaat to rs cdvil peaaalty.of+sat sitare shaae .. . ,.._... . ._._. _ _ -. '-- _„-.�.. _ . . . ; , . .., ;�.:,� e.� ,�..- ..' '•, bttxdred dolPan. .00 • �'. . . , �', -:!!ve -9�S J,. �� s '"'�, -;. '�� �T�'.-'�^�-�u - . .�I;`h.s-th�Owner aff eh�' r � �_. �- . . ' ,*.,.� ., _�._�. . . . ... . ., r ..------"`=•'----•�-,'�=''"—�---- � P aPertS'wz31�d ch�vrrork,azid' �,:.., ,. ., ..:__. .. _� �.+�. . '... . : , . . , ,. �`che strucaure xs not ustended M'o£€ereti 4ae'sale ` ..: . . ,• ',.'w -. , __. ., '�:;` ' ... ';, �'�, ' ;/Ssc: 7f144;�Bus3r�esss'undPeofessao»`s`Codse:�',SeCosr��� � " � . ..-.�. . _ .:." ': ,. ri"" � � •. . -..��3raiMr'r"Leceros¢basv tdnez xo£-ap,jily Eo�ari'�owve¢r o,�` . ... � .� ...�. � � „ _„ , t, ._.. .�__ - .�._ , :, .. .,, .:� . .._., �`_ ._ � ,:.-.;: ' ,._.:� � � r' . .�..�yroperPy,wbobrmil�sor,impiravrs.z&ereoor,¢i.�wbo.d"o"es� . . �li.:�; . . ;:^ .. ,'��. .-.�._. �.�_ � .:� ` .'._;. . " ' � .�:ssacdr.wvr�-hdmselJ'�ra�etl tDiaG�sra's3� ssr.prooemaeosts � ;.._ __. ,r,�,... . i..., .� .,: `" , i are riot rease�ed or'v�f�red}or sale Yf,X�t�.¢vover."tFie .� -. .:.: ; ._._ ; . ,. _:. ..- �. , ildsug�or in¢pronerir�ut ss sold�.unt�sa'r�'�yeas�of� - � � . . � , - . ��� . .�. „ , -. ._ - _ � ; �..;: . .......... .. . ..: .. . ..' . .. " ,�, `:: .... . � �.. . ., .� ,... - S b��did-n�busddBdor.m�hrar�e.¢or�� i. ' ,... ".�6ee '' � �ca»apre8soos, EX� , . . .... � y . , ". _ '. a. Of.pPOvsrig 2aJG _"'_. .. ..: . ,.�.:.. : . 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':�. � ,.;:�. , .:. -.�. - .-� . - c . i��.�. 7NSPECY�1�'S ffOT�S _. - .. - � - � . . . . - , .. . ., .. . . . ;. -. ..... _ . ... . _.. ,, . , , ..,. ,. ��, . _ . . .�� . . . � ;�; . .. � a-:�� � - - � . �.,, .. . - ,,..».;.::�.,...K...,,..�. . .. ,. . .- . . . . ._ . .. z. �-� � -„ ;..;, , �, . , . � .... . .. _. , . . . �. . . . '� .. . . _ � <._ .,�,; ., .. _ � , ; r ,,a x..m. . �:. ... . -: . .,� � . ...., .,. . :. _ . �' ... .. _.' __:�... . . _. -.: .-. �. . ._... . ., . . . , - :. � :�.� �.. '. w:y -�.. " ' �.., , ._ �. . . . .. , .. .q . .: �:.. _. ... ,� � .: ...� t ` ' .. ,i:^y ..:... ..,.., .. .,,,,�., , - , . . . � y, :� -':i� _,_;�>�:. r;_.� ,_w. ,. ..,.. . ,.r .. .. ', w, ..y �w M., ... . ; � .+^P � _ ; . ` .�. _ i ...,. :. . . . . ... ...... .,i a.-,...�-..... . . ,......, n . ..,�...rr..n� , . . , . , f..... ... .......... ..,. .. , vv..e...,..i�.�. . . .. ' ; - . .. . . , . d._. .� . . ' '- . ' . . .. . . ., . :..... .:, :� �.M...m,w,�...'�.—o«.....e..,._.._.L::x .._.... ,:..�.,.«� .. .��„�...-.r..�.-. .;mm-a ...r_.1'.,:r.e,..... � • •. '� �. . ��..' ._,�.��usv w..wu.n,vs. w..nwvrnNrin ra��..�w.e+.srw.�--m:.b .�<..�.:.»w-mw..c{M . ' ... � �.� , . .. . �. . � . . . . . ._.. � .�.- _ � .:. �.�: ': . . .. . .:- . ,,:, _.... ' . . ....i. �. �.: , �:!.C .t. . . �_. .,.,. . -.