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1638A (9)
��I hereb a(firm thai�Fave a c � Y�k ���.� �.- � rv�^,e���:� �i1A .,�r;� � �n���N'��^� _ � � ,w �m ?�c€���'�-"4� u xN z'�irs�,�.�+-p.^7�'#5�',y�*'°�y»'cc^'�s�'-�-��.,c,,�.�-^"�°k�-.:�'��,"�a.�:3-� ;�s�t�p . � -WOpKEa5 COMPENSA�{�D�C�k�2ATION � �C/ , ��- u"A4 60b2 OPN^3/6� � "; �, , . .} . .'. �. ' Y @f1�ICQiC Of COf152tt1 t0 52�T," .eY. ]6F642� �. � .� • . . . .. �� Po�iry'�o. �Company'� ��i�� �zfsJte,ar CEBCB � . . . . .. ... .... �. . nsure orn certif mta of Workers'Compensation li�,sura�s . a c�rtified�cb y ihereof(5ec�'"38?�0`Cab C} �� A P�r�/^�T�w� ��b,��'�'X"�It ' .f3 �s n ■.�4. � .. 1� G �ra , . .wF � ,._ T-� .. .. , _ �_ � _v. ._. _ __ .. ____._� .. _. . .. YA/ e� � h v iy � �.. �Cert fied copy s hereby fum she � 7 111f R , � - o„�.-,� . . . �.. .. . . . ,. ,_. . '`,�Ce r�fi,ed mpy s ti,�ed with- e cou bu.ildin inspe ' � COUNTY OF.4Q5 ANGECES, BU1(.�SING AI�TQ�SA�E„�TY '"'' ' "' ' depPrt nt . : '. , ^ , ""^ . - Dataj" nppLcan ' FOR APPLIC NT Tq FILL IN y¢� CONNECTION DATA " �'�. '`"" ��. C�EbF EXEMPTION FROM YdC5R1fERS �a..� euitDiNG ' � srnrioN oevrH ��� " '� Cb�NSA�fI�'SNY'�JSURI�`1C�E" � ,"� :. notisess ���^ ..'� .:.. . . � . ,_�., .�.a.. .��.-;.. ... .� , u> . .-..� ... - .. ;; CTf�ssec�'onneed or eEompfa�@c�i�theworkinoled�y+he � -- : vwNHoieReeeaeNce ��'J � ,= permit is fo�one hundred dollars{$1�0)or less) �� �o���'r- ` � �� .iowea- � : „ -. .�....,< ....�,c:. ...,.a_.., .«,... �.: � ' � .. " . ' TVPE Of COnNECTION. ...� IENGTH FROM -y "�"::'` , NEAREST . I cert fy tha7 n the per�orroancs'of ihe wor�C�or wh eh th s ck055 5r. � � Y. cuQe P � rn�To vl; .G�1 � - "per}'�1 is ssued I shall nol employ any person in any manner � �� � � ��dc No � 'i'sa as to become sub�ect to the Workers Compensation Lp s ati,�_ cc innv No��. ioe No � ��... �� � + n .:z � y .. ��^ � R.. . /.,,7 �'... :" ��z t - ° � < %" ` - �'�� @ TRUNK PERf�AIT NO . � ' ... ROAD PERMIJ NO: � .t.� .�, pP "9 F , r-»�.. '� ADDRE55'� .: ., �.' �' � - � - AFFIDAVIT� WAIVER�EqSEMENT ��RECf/R0`INS7R;.iJO: OP:TE "'��' .ba�e A� licant _ `"E OTmp�l nb"fC�PULIC'Ao Id(beaome sab ect 1�i.o�"�"'e`rti�pre oF.,. . :: .: . _,. . . „-�. .a.,��. , - . crrv �. � re��.N . ,ke s' 4�cA� . . . �� ..�` .- :�... . ._ . ..�.�Com�fensaf on provisions of ihe labor cvde,yb�mUst_forthwith oescRiPtiON �orNo Hwv oa 5i.�w�oENi�v� � �� � � � � - �� � ' .�`oorrr`ply with such provisions or�th s permit shall 6e deemed --�` ` � �- � � � - � � �`.fG3Volted . .. . BLOCK �' TRACT " � yTA'E ENCROACHh1ENT . . ... .. , t C1C�NSED COTlTRA`�.'�'OI25 d��CARA�it�t� - � � nro oFaioGs aeaMirNo - � � � � , ���. � : , s¢eor�or Nowo'�rior a�� �...,�„ � �,- _, - ^ �,h� ��s..� , I Kareby af�m thor I'am license�Und�er provis ons af Gh�apier > _- - - _ - - ' �.. `'-"9�comm;enang witk�Sectio �T(19t7}of Drvislon 3 of ihe.'B�si- �,, auiioiNcs � � '" � ' � � cHnzces: � � � ;'tjegS arYd„Profes5iorts Code and my I cen3e(s�in full�torte and �- , --�a- �•��� � � � � ef�eC� , � � CONNEfTipN CHRRGE FEE���` ' "'�'�' "� �"' � �1,cense Numb ...� .,„ L` .. .., �. �� ADD ES5ETOp" . . . . .. � ;, rt - IC CItl55��a��,_ , � RE MHUNSEMENT FEE - , � - o� ..» . . .. . (k.. ' „ +� . � DISTRIC�NO. GROUP MAP ' ' �PROCESSED (�. � `,�Confmcf � Date //J .�z. .P`/� urv . re�No '^ J � STA"E'� � '°� �� ���uc �"�,� � .�i� .��= �-, r ,- ❑I am exempt under Sec � 6f ihe L A Co � UCENse �J� �p Hn55 a�-- �-� � � �� x - .: r. .��;.� .�;.-:,� } ,;.� ..: �-. . ` Plumbing� " � �a ��� 'DESCRIPTLONOFWOkK �E�� ,. � ��OfS�eC Of1he ,�� HOUSE EWER,LY7NhECT�NG�TO�- � f CATE` . � � VI�LIDATI�IN � » { :: B &P�:.Code for thC foll�wing�reason . ..�:. : �pueqC�ewEa... " -: , , (,�;.'�,�,��- . . �.�;.... 'SEPTIC TAMK"SEEPA�E PITOR = ""' "" � , .. , ,., . . . '. ..,. FINAL �.. ' � � •, �.. ., , � •.� ' . " PlTS AND/Oft�tiRkMiIETU,` .. - _. , �- � � � �-^-- . '. � HOVSE'�WFR���`1NECTtyG TO.... . '-- . .. BV . - <' PRNATE DISPOSAI SYSTE ' �' �"Ls�L„J - ' ' $IynfllU 6 � 'CONNECiA�01T10NA[ �CJG 0� "'"`" - � - � �� � � � •`< OWNER BUILDER DE�fR12ATIbN �� � -woaK�oNous��sew�x � '"�:*. .#.. � OV6kFl6W SEERAGE PIT'6RAINFl4L0 ' � � �� - - �I I�e�06y af{vm f�hat I am exempt��rom��ie�ontrqcfo7's ti,Gense� � BuiN. CeSsvbO'4-bRYWF11,rtnnNHOYE � � � ���'law for tfie following�.reqson:(Sectoh 7031:5,Buisness dnd Pro- . �-A�tea,RePo.iapp�aanNooN NbuSE ��" � ` . - . - � � =f95b10f15,�OdC � , ,SEWER OR DISGOSAL SYSTEM .-. �. �� L�O� : r-� .,.� � �. .. .- _ .. . . _ . . _ ._ . . . {I U � , LI I as oy�rter of the�property,or�my employees with wa�es as � ��- theicsole eo,�npehsation,will do ihe work:and the stNcture � - � . ���s a ��.'�.�+.. s noi,infended o-�.of#ered for,sale(5ectio�,7tl44,Busmess � - andProfessronsCgde). ` OWNER'S Permit s C�(' i � v���a � ❑I as owner ot iheproperty am exdus vely contrac(ing wrth AUTMORfZA7fON TDTAL FEE � � a2"7� �^C,i � � - I ce�sed contracto�rs to eonsirNet the pro�ect'�SecYron='7tld4`,"'�`�""' i Hnve���r iy�s oaYe�'A coatRACT 4NITH ritE HEREiry NntJ�Eo G6N7kACi'ORT9" � b e o-Q 7,Ej Q� � � E BU51ne55 allC�P�ofE5510n5 CO(�B) � CONNECi THE ABOVE DESGa�BED E%ISTING DWpLUNG TO THE PVBLK SE,'.VER - � � �� ',> 49NsrRCrC7�z��lfri�piNc A�el;u"c� ` �� 'n-__�.,.,�. _ t� � I 0�?6-8 7 `�� Fere�by off rm t�iat there is a consiructiomTlend�ng�bgency� SIGN�D,iHiS oa�l ig . � � � -for the performance' of ihe�work fqr which this permit s owNee.oa ' "- � � ?� ssUed($ec 3047,Gi�,C) ���� � � . owNErzs AGEH � � ` . `:s „_.. .::',. ...i. ..:. .... ..::.. .v. '-.::� ADDRE�_ " ".. ... ,..._, 'Lender s�Rlaine � ;.: :, {, :I`'� �„ �; :.. ,.rJ: � .. . � . ., � ,.�Lende s Add ess � , . � .. ,.,. '� , . _ „ - k,. .,r,. � ..,, . . ..,.. »._ ,._,.�. .. .... . .., .s. �. _,..�- ,. �,.. �. _.._.......��,a. erti fiaf�l�have-read this�:applicahon,a,nd state t�iat ihe � � � � �� ��'-� ��Y,LL " µ�� V._....� ��'��-� above�in �rmai�on�is correct�I agrea to comply wirh all'Covnty� � � � � - ��, � � � � � � � � � _ ;� � � , . .' ..�.. . ., . ..,,. . .,... .�.._ .. ��:. �. ordinonc s and$ta�e�laws regulqting Plumbing and Sswars, � � �� �� � � ��� �- � ' ' � - ..... . .:. .:.��.,.,. �.... .... �.. . ._.. _._.. ...... . -and her� y authoriz'rapresentatrves of�thi�s'�Counl'y to_enler �-- �� " ��- �" '� � . -��--��- ` upon th .abpye-m 1'�rte y for mspeclion purposes.. � . , ���' �-�� -� , . � �.� �� -`�� � �-� � . � � 4; ' . . . . . . . . . �� . . . . . - � � . ..r ,. ,... . . . _. .. �. ,� ` �. . �. . . . . . � S' nciture o�Parmif,[ � . ` • ..- `SE�E RE,VERS�`FDR��YpL%CYJ T V`CAN (} GE;.". :' �:.. , :� . ....'. "... ... ".-- .. .. .�g .. � ae Date. ' .,k,z , �., ..A�'R..� Cz IS , _. .. . .. . � . _ _ � .,; ,� - n. � .. � � , .< < _ _ � ; k �: �n b'�ws�Erro��wa�s _ __ OWNE?lt B�IT.IBEIt 7���L!ld2.t1'T'IOI�T �. � . .... , ,�.,_..,. �__ , _. _, . . ' .. ��9���b��.S�... DATE''. . INSPECTOR551GNRNRE �� �. ..�.. .. � ' I}tEY@�]j��Stmt$$184I_�ffil 2X@mCt{POm Y�Le�EDPlt1$CkOS'S-. wew House serr�a � . :`::. c�-.. � -:::. : ...= 4�. ,��. .'... .. : —- �.-� :Li�euse Y:ri�v�oq't6e��fq3tocving setisoie lSecE41:n 703`2.���-�...-... rae ��-''�^-"' ... . ,... � � �� .� ::: .,..�'9ar4ness.oxd'Proj�;aio�a.c Cocdef:�vay.ciey.b;r s�nx.,iy . _... � , . ._--`- ---. :�. -«.. � CUNNECiAODITIONpI� ; . . � . . .�;,; ,.�,.'e� ,��.... :�. ..••• . .-. -�..•- ..��Rl12tiC�t PBQS6Sf45 R�I82Y3Lt$t0 6018S8PK6C R�LCP::.,S�jSPOfl6i.:: . BU�t�1NG OR WORK ..• , � ..•,, :, d .;.�. ... L � f •&F' ��... .. .. `� �_�d¢mo u$.or re is ava.s reeeFure>. nor o a�-�esseconce: . . . SEVTIC TANK.SffP.PRIS} . . ... .- � .� ._:... ...:.:.., �_. ,...;_.. . «..R�CCO 1B P1tY68 $ fi �CC696E• �� AND/OG DRAINFIEIG . �� ...�-. c, .,,. ..... ;:. ..e ', • '� s`j,:. 3. _;.�, . .. .,,:.... ,r,..�Lu Of{X��C�MS'AUCLOP���i�pT.tiPU r�@,�{IB q •,''.� cesseooi D �Rvweu p ' � Cbap �"9 titiiR.Revn`i�:s�ao`R.�._ . . ..�--. � .: ."� - � - � : �� , .(commeencsng wxab Seitse�a 7600��of.Plcsmsaosa�3 aj tbe � �FYJAGE DISPDSAt SY5TEM ; � . '. ` P=** �.�•. ^." � �. .- `"....�. '7�usrrses`s�snil Profess!ons vode�or Sbat be'�e en;am6t: D�SCONNECT PLUG AiJD ' ' �... . -'�"..' ... .. . �.. . �� � t � n'enN�Sou HousEse+n�R .-� — -�.;:.--F--- ..:. ��.3$¢rejrom arrd tbe basss3�or 2be allegad�.xevnjr�Foax,Aas,y;. � .BAQSFILLSEPiIC�TANiCS❑ . • `�.,'• ..:=,. -.• ` " � . �'B�YOIQSdOP'O,JS8C&SOPd7Z�>�:.S�ti%f*�tZ�Tf&'6P8S�09'afeBf'i388E .�, - � sEEe�vrt s)O c[ssvcots C7 .. . ..�. �. .� ...�� . .� -. sssbjects&$¢�rplecaat�s u vi[fieraa8ty oj�aot mora thas�� . .. ....... __,_ .. ._..,: _.,, . .,. .; -.�,�„a.» �. � rcr -�-�`•� . '��•�. -.Jiarebundier�dollars($50n1•... ,... . . , b '. , .,.� ,. . . , .. ' _ . - � . . r :: �,; �. q -�•., u. 'a: t -� -�- ��,[�L,as Yhe.oavnes of the pxop�8g*�w`sll dn khe�work,aard. . v . � < , �..,_ '�^x-#---�-��--�—� � _ �. ,..�, . -,.�� �. . . ,_ __ _ .�_ .._ .._. _.. -. ` the sssuaaam is aot�iriaeadect�or oifexed fos�s�ale. ''-,� �. �", ,�� . � , �<:...� . ;.� � �`; '�'��. •.: .. .'(Sec. 7644:'�us:rces.s�r�e"�safsssiiins Cc�¢::Tbe�oss»-�. ;. ,t, ::, .. . _< _:._... ..... ., ,-., � - � -,;��, . ' - . `"�'�2°�actoa�'s�cea¢a�Luw.uTaes no'3 i8,pg�ly io zcvt;�oumer`of.. � . . . � .- . ., • : fi :-. , , . . ' pr rty wbo fsmsJds armnprooes 8bereora,a�ad av�o�does��� e ,. _, _ _.__,� _... . . �� , s b eoot�''Sr»eself,gtr5airdei�`'d�8 aaaeb dmprcwemeraas ..� : .:_ �--..., .,, . � .-; , :.�., .,..._. :.�.'� . �.. �_ . . � . .� .,. e 6eot�m'texd�d oP-�aff�rEd Jo�le If Xro':a�ver 2he _ � c., .: . . . . ..: _._,. ...,,,-� ,.�ar'��r . . . .m.,.__ _,� .. s�ng or¢cnproti�n�dena`u so �.uxx6iu oiav ea"r�oj,,... __� . .. . ._: �� . .;., _ . ..:_ . � ;: ,.,� ::,�. .; '; ._ '��sompdetfo�s,. d3�e'oqvsaer�bual�ler'wsfd ba've'�tbe burd�eai- . . ; -. . . - . ., . � � , .,,,,.�. . . . �.. - . =' ._,:.,�:..�. „.'-.� n".J.t;'.;k , _.;'_ ...�._.af.�vdng''shat ke.ilsd aoe baa_Id.o�dcnpPove,�*or'1be.. ., . �.__ . . . . :., � , � . �„ .. . .. - . � ,_.. . . �.: , .�.:. _ � ..-�nrpose o¢sale.) - '� � �� s.';. I�ux�x�mipt c�naler S�c� . Y • . _ , � ` _:: _ < ._.'� ; �.' �&P.� €or e�ais r�asoas_=____�....�....,,_.. � . _. ___ �.�. _ �. , ., . . �- , „ ,. ,..: .. � � y. : . , , . ..: . .u,_ - ., .,:,. - _ I3atc . . , � '. � � , _, � � _ :, .: . ��, _.. � - y�. � _ �_: _. . „ , , �waer' m�..: _,..._�». .,;_ __ ..,..j�- .�� r..m. .,�.::: -,�-.�.-;�: ._....�.� . 7 p ,: w . lPiS9�EfBAR'S NiD�'.ffS ' � �. .. ..� . ., .. :, � . . . - :.. ..�,_ .... �,.�>... „�..w,�....4«,«�.�.+<,-� . .., ._ �„,�- � _ - � , , .,. .., � n a,�: --, :� --.� � � . .., . � ., . ._.� .-.:.. ..� _..,-;�.��.,,. ..�,:.:.,..�»�.,�.....,�....v,..� �. . ._ � .. . . . . . . . ,� . � �t . -^.�.R,y,2.-:..�„�,y�..„,.„„wa��sre*�,*.�.', w..«xm�a�•,., ,�.�iN"" r*,� � .r,^K..-,�., - � ..' .: ,:.<,j - � .::5 .�. u..., . ... .. . . �.. , �:r. ' . �. � � p . .. .. . . � .... '.,,� ...: .�..,r ..�.""pY".�,,,.�yf�� .. �.w..„«�w,�.�...�,.���»�.�.k..a�...,�.,,,..,�„�,,,��watTi,,:, m.p,w�+r+*wr�«,'�%�.;m,.��,...�..,..<,. c� ry.j� ., �". '.' - . .� �_ . ,., .. a ,�..� n- .e « .�.-'+ex^- �.p, �.�.,".. _ .,M;V - ..� ;> -.i ___ . . .. -:,�b.. ..,. � ., - - �-=�-.�� -.,ru.,...�;:�� ,� _ ,-, z��p�.+.„ . ._.�_ . .._�,�,�.n .. �. . ._ , - m ' �"^`..�. �, Al. '. .A..d' �_k h ',:.. . c�� .� - . ,. .,. .. � � � �." �'�- 3y,.,�a��4- ... . ......,. " � � . . . . . wm«»,..«w.. ..,...�..� . ' ' ,'�..�.� .. . .. - . � . ,,:> , .. . . . . � . . , . :� . . , . : ,�� �,- . :, -. -'� �- .. .� . . .. ... �...:.. , ..,...�..... _. .,.�.�.�. _�..,.._.�-...,..--,»�e.�. . .w.w,.,,�s.. ' _ . . ,� � .. , t.r�s�x_� " ; �.. .._� . . .. . ... .. . . ,-. ._. . - .. ., ..,.�, ,.,....... �,,..».7.,..-,. -...:.._....��.,�rr,:r-.-•...-r-«.,.e..� :. .:_, .. . . . . . , , . . �-; ., . . ..:.', ..,:_.. _,.�,,.'..,,. ..�...,o....,m �..,......r.a,...:...«-�.. �' ""?�'.