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1649A (9)
.�r,;��' "� ,`W�K�TS't277v�S5ft�S,ti``1'I�`��'�',`�'S`YO'lil a��-�. ..,�� . ,.,..,..c�.:,:a ,.u.uW,,,.��rv ;s...�-3......�d....,.an,�b....�.,.,�w�z...P.,,......?�� . � ..,,,_._ _.... . «.,._..... ,. .x,..t� ..,x �.: .«. , -.:. ,.�:. . ,: 9]aDQ2 DPW 3/B")_ ., ,:. )c� � 1 he eby affirtn f6at"(have a certif mte of consent to self �� ' � � - � J j � insure or.a certifi<ate�of Worke s'Compensotion Ins4ronte,or� J°�d20 �� " " � � 4a�.-� '` a�'ertrfred copy thereo�j5'ec `38�1��p6 C) � - GE � PolicyNo=��Company � i ":a'JM'�>ecAJ @, ... , . BCB - ,�. ...... . . ..... . . . .< . ,... .....-r. : - py�y�^ �(p�"� g�y� r.a.a.u...:,u..m,....w......�.,�.:.:.....A«...,,,,«�.. ....o-_..... . A S�w���`��d�l�`��� P�(Ci�; �'i`�1�``" . .. , u_ .;. �r ..>, y���AV�VI��V3� .�.tuxd. . . „�� ❑Cert f ed cppy is lyereby furnis . - � � � '; � „�n, . . � _, �v w;;� ,t..�-.�.�.. _,...w .....-_�__,�;-._.M�.>_ .s..__��,k:,��..� Certif�ed copy is filed wit -e co ty bu Iding in5 ec n �� C��1�T�'���.'�S'}��.'�"�aeL���V�-������� mmN M�1,11��(N'(a'/(��$AFE'� � depar eM �. . .�� . . " . , . . . , ' ;._ Gats✓�3 ` A hcant � � �. . � ,.,...�,r.,. �� . _ � _.-.. .. . .„._.. �y!��� PP � FQRAP�lt��1T771"45�F'i4Lft5�""`'� f�i7� CONNECTIQNbATA�_� � TIFICATE��'SFEXEMPTfON FkOMC V�bk�C��Y2$ �� aui�otryc ' ..;,.*� :_ td1+�l��NS'�1TC5N"9�(�Y`Sfil;$1rlt`�' � nooREss � � srnr�oN ,`ai oev,rH �' f,'-`�'�' ` - x.,...� � �.� , .�,� �� � � '�(This section need not`�e completed'f t�re woik invoi�y`e�y t6'e . -� ipcnurv �� -�.- ��: '@, .�� Nw.NHo�e RFCEaen� � ;��. p�rtn t s{br one hundred clollqrs,($100)dF Vess) -�: �� � . <. NENEEST �i?.� e � -__„ _ .....:. TYPE OF CONNECiI�f.�.. •.....•- �lENGTH FlFOM - ., 4_.��, ,«, .�.,,. .. , . - .,. .v_ ._:, ..._2 � ,� I cernfy��that m rhe perfarmance,of r�ie_work tor whc� ih's ceosssT, � r cuks ' g� Mt Toa.t. �-7a . � p'artF r is iss�ed 1 shall not employ any�serson irt ony marrner - - ��: sp as fo 6ecome su6�ect to the Workers Compensat on Laro�s �� ' �`� P � o �y ,r�"`°�""' ... .�'� �+ � r..s•y J y.e-,Y :, OWNER i - - CO IMP NO.,. JOB"WO � /�t.,s�.i- s ��� ADORE55� � TRVNK PEkMIT Np ' -RDAO PERMIYI�fO:" , . . .�<. - .. • , , ��Date ' Appi can� �� . .. , �' '�. � � ' � � >.u:....,� , , , NdTICE TO 7YFsP7.1C�"(Y`it' att"er�maTc�,ng"ili.s�ar'Ticpfe o'� cirv �� � Te�,�h 1 �. �: � n WnivE F . .7NSTa"No`.�: ' onh,_. AF'ID VIT R EAS NENT 'RECORD � Exemp�wn you should 6ecome su�i�ect to the WOCkers � L��� „ ., .. _.. . ,_ �_,, , . '`tompensof on prowsians of ihe La6or code,you mqsf for-lhwitk � oE�a ptiz�rl �ior hio � � Hriv oe st:w�q�'vwc - � .�-"2ti'mply with such prcfvisiarrs ar�this permit.shall.�.be deemed � � .. ..��.�- ,. . � � � � � � � :, . � e�ocK���r ���.eatr" �" � .�_ - - r��ked � . - srareervc�zok'crir�i_ ._. ,.. r. _ , _ '�" ""'' ""^""�1° PFRMIT NO 1',LIC�NSED�dNT�2ACl`b'�'��t�'�A,Yip�`�1"""` , sizeQF�Q7 � N�'aKet�s . - _ .� � � nrow v�or ..�n ss ahd ProfessronS,C de�and��)1 aeD el$s n ful I{"�eopter . USe OF. �"� .�.. �' !�I I. / v2 ��� �,-�� � . ., 9 �'bY we�s� ° eUIIDINGS �-�' ; . . ..` .. ' CHARGES., „ � .. ' . . . . anc���' . . ... . .._.,�. ' CONiRFlCTOF �{„f�+ 'CONNECTION��HAI2GEFEE'��`� ��' " '�� �e{fecf , ,-_ .; � i.,,F � LICenSE NU,m . LiC CIaSS���� ���� ADqRESS: - �.REMBURSEN�E T FEE` -- � - 4.-��� .�COnt�aCf '^. . DOf6 �I�"'.'�` �«i"� ... �� . �..:. � . DISTRICT'Kf0': GROUP� A1`AP-.. ' '�.����PROCE55E6'BV"' O � y . �� ' CITY. �iEL NO , � � U , Y� i am eXempt under:Sec_ � „�_at the L A Co � ii c�5�� �.��� , .ctnss� �}� '�"y�' -p 6��� CJ'... ..� <. � . �� ,��. �, �+-,. � �[,.--, -�J � Plumbing Code and/or Sec N ' of the N� DESCRIPTION Ox WORK'. FEe' � . � �� � �- _.: - �,� ' .'��; � ��. ..., .'�• HOUSE R C(YNNEC,f,iy'G'f(5.�" .._, ._:,,,..._ OA EL . . � � ' .. . ,y'" �L-" � �... :. .�. ,. . B 6 ode for r e following'reasan Puauc�a '' �< —" �'�,�,,�� VALIDATION'���,� .�. � , ,., . '. '.,SfPiiC'ANK:SEEPAGFPIiOR '� . . }"' . . '.�-� �. .. ' � Daf � .. . P.IiS ANPiOR ORAINFIELD.. .'�` ."" F hAL . .. . . � � '. . MOUSE6EWER'C61�NFC7YN�i4.� .. ._ . .gy � , - � ' - '�� +�IYATE DISPOSAC 5V5 �� - .: Sgndfure � .,� � �CON�v�C1a�6i7ioNAt �UG Oa' "" �. - � �' '�� �� � '; bZGt�FR BU"I��ER DECLARAT(bN :. W��TOHouSE;spWER �� �� � , , ' OVFRFTOW 5 fAGE PlT DRA�NF F.6 �� L�n n �. �,. . . ».o- ..,.._. "�I hareby nff rm that Y qm exerirpi�ram the Contrqctqr s L ce se �exrN. cessaooP'�[sevweu,Mn�e1� , y`.' 'Law for the fol lowing reason.(Secto�r 7631$"9wsnass a�d.Pr"o .:u*ek,aePaiu oa"r,gn NOU@E � � � � � � 7 Pess ons�oi3e f _ ` , senrea Ott l7 sacsa�sv5iErn...' #a � m n� �l . �: �1 as owner of,thz,property,or my employeeawith wages as ��� � � . �. � � - � � �' their sole compensahon,will do�he work�ond the stiuclore �� � - � . � - � ( e o 2 7,5� :, � .' is not�intended o��qffered forwsofe(Sestion 70A4 B�slnes8 ' ' �' "` ""� ' �� � . �. . � andProfessions�ad�e`S" ,: :. ."_ ,� OWN�IZ'S" Permrt 5 p��. �.- . a a e2�'],�JrQc� �. �. ��I as owner of the p operlY,am,�s�clusrvely mntracimg�wVh AUTHORT�AYT��N fiOTi4l F���. ;9� Q,-,��6�-��5,7� licensed tqntracto�s to con5fruc}fhe pro�ect(Sechon 7044; i H,qy£Ar`r17i5 pqTf.o�"CONy�#CT'Cq�rH'n(E'HEk�iN'FAr�Eb,CONg�a� r{TU� � � � � � � Business and P�qfass�ons Code-) � coNNEer rH6a6a"ye D¢5'Cz�F6"E�CrSYIYS'�"i3Vaft�aG"7q"Y�+"�`p��[f�SE!�t+€�""`° . � - ��� CON57RlICTlO�L�N'DfM1'��At''�i,�t�;�l�' _.�;".:•.• � .- �y � . . . " �I hereby a�ffrm fhat there s a construchon�lending agenc�`"' ���µ SIGNED7HIS ��' DAYOf" � ��a I � . � � - � 'for the peeformance of the work for wh�cFi ths permt w ��O��OR �� . � , � - � OWNERS AGENT �-- -�issued(Sec 3097 Civ,'C) �� � .� . �. - � � ' . . ; �, � - , . . ... . .. ,,. . �_. e „ - �. :nRoxess�- ' k � .�Lender s Name -� .- : �. � � � - ' �. � - , ' ,,,......: + , .,��h, .. 1, ;f .s, . . ,�l. ,ti =, ys � . . _ . � er s ��dress -� � � � - � .�,. ..;. ..._. ,�._.,. .:.<........:....� ,...;;w. ...,.>a...-.� .,.,m..�;.: ... .,....�.:: ..._,,....: . ._....._.,�...� . _ .. .. .. , ...�._ ,_..:. , .,..y.. r.e�,. ,.v,_. `, I certify,1 t I have read th�s'appl mhon'and state thal the �� �.. � � � � ' � abOve�inf mqf�on iscorrect I agree fo comply wrth pll CoVnfy � � � - � � - � �� � � � � . � � - �- � �� �.:.ordmanc-��and State�(ows reguTating Plymbing and SeWers, . .. . � �.. '.�... . ' ...:.�.. ._...... _..:.-.. -'and her�� y authonze'�epres,enratives of this��Couniy'fo.�,entei� " "' �" ` �� "^;' � " ' � ' ` � �� ' � - �� � � � � - -upaq-t above�-me � ned� e�y for-inspectiort.purposes. .':.. : ....'. .". ..:"::.. ' . ..-. ` .�:. . ,. .`' . `c . .. . . .. \:_.'. � r . _ . �:.) �� . ... ._ . . . �. D--.��'=�'''`)° SignatureofPermitf� �s^ Daf� .. SEERfYERSEFi)R�E7CPCANATOYCVT'ANG"G7\�'E•`.`."••....•�`_..« ....,.�.:,.,..»,..,. „_..�M.,_... _,._..._..... ........._�_...._ __.....�.. ...._......__.._...>,:,, - F },,.. ,�, ,t t . .. . ".�aw��' - � ...��,��.,a.,d:, . , ,. ., ._ : 'T �? �^� `�` „���res�rs rsorEg _,bi�V�E�,��Td,Y)fER�U��T,A�9T��➢1� ._.�,��n ,,. ... .., :... � �.��_.a,.� ,.._,� w .... ,.... �-�AP�R��YAaS -' od� � ��rsr[aoR s-icnwru� " ". . ._. ,. ..., �� Y herebg affi m eCa����ame exempt'fsc�m ffie CcxnxraF.?mx s,.� .. PIS � �:�.a ...,. T.,� �� . `"i,acense d.aw fas che koYPo�v3n reasoaa(Secseau 703L.S, :. NEWHOUSFSENhk � ..; • L, ... . .., � .. BZtSi9te4S �lb�Pi"Q,f3S5R69l5 G(f�¢t8 A9D� GY"fi�$/Ot FOJe9YEy .. � .�..'� P.._.'.� .. _ . _..._ . :...... ..:,.�, �, . . �_ '_. .• - . �rvN[crnnoinonfnt ... :.,..,, , , . . : b :,; , ' :' ,^- `°'whsc�requires n,perrma2 eo cotAstt'uct aPPer,..am�¢wsze. . eunowcoawog� . .,. ;� , �� �. �. ._y. ' . .� . h. demao8esb ar rapsesr�^sy sSratceu�e,.$eor Eo§js:�xssaaczace, SEPTIC TANK,SEEP,PiT 51 _� ... . .�� ...� � ( ..j& , . r-" � :• -.'.. ,�"`�"`�=ako �e ssxrsa ¢b¢ ica vr'.susb erars4fi��ta dTe a�. anioroR o&nwsi=so _._J. < ' .,`%; :, ,.,,:: �.e � . sagmed�2ateantend t��ke as laerased pax,rsuavat to 8�`^.e... . _._ ... . ..,,_.�_,_..Mw-.: __.. �,_ :; ._�ww.. ,. _ , . . . ce seooi t'] nevwEu❑ �N ,. • .. . _ .x- x�- `��`'�s�orrssdorar of tfie�ora�ac8ors Zicesaa�7.asa(C6 t��`9 ""' _._.. .._._ . . � _..._ ._..._...���._ ..___ ._ ._... _.._...,. ��, , . .. b�:�.- �..�. . .=���� .- - ALiER,R.PAIR.SEWER,OR :�' — � yt, ,rM�dH���3n�✓'tf148 2CtfPtF IOOO o �JYv,iSiOA. 6 � Hl � stwnce oisaosA�svsr�n E • � . . - . —'—` "'«"'S"`` �� ` .. �$�'usaress a��'Profassdm�es CodeJ ar tr5.at be i.s e.r t�- . . Ascor�NEtratuc arao ��—�,-���—��-� .� ._. ,. : .. - ..� .: .� ibereJxe°aen aind ehe baszsf�ar tke aEleqed en'e�%aQ�aon,�'�-. � ,eaN�on�+ous6sE�a' ' . �- .�;�, `��� •^:,°^ �. -,�`."`�'-vsolatfoito 5ec'Seon7632.5y�-�raat it Tscaoaa ora ermsa . �GKFILL SEPTIC T.4NK5❑ -.:.� ._.__;.�,. - _.. .,.,: �2- � . � .f . `y "✓'�..�• f p . en . - . � . . . -snhjects S�,ct sppldsuxit#a a ris,�dl�e.arw'8�of nnt�eaaore tban�.- 5$P.FI7(5❑ CESSPO�5❑ : . ' �� ` - ---- . . . 6 � .... �o ,.�. .� . ...._. ._-•- -�-•--• „ .,.,. �n^e<«^^'*"w .n :. .l'84)8 . �'S��3Q4��P . , _,. . �� , .,� . , .. . : .� lit�4'SPd i'i'7 r _ ', r � ,,,�-, � . , gqCljiO(t8A't�9Vt1g(�04Y1C,�CrOR�GfSID.Qj' : i: �. . -��""""'� ., .rw«-,w,+..i.,gs...o a,y�.{..�,. p - ,. �R .:. ....�.�.__ . .._.. ,_ _ti °. '� ���s�xfse�omu�ot fntended or of[erea foc sale .... L ah ae t�cente u �,_, � .; . - .. .,,„�t a�; . . .�,�Sec 7044��Hazsamess ana 73irofesseons�si3ci��&Ae�iaie- � . u� � � , . ;„._... ._ �_ _�.... .�.�.-�. :.�. _ ' . ��.. ' . `1 `v-��.., . : ...:,„ ,s"``=-�s �eray�0 5ut�ra°oes'tsmt ra�¢7��F�ars-.nauram¢s�mE. _ h ,..� x�v� •.. , ;; r ... _ _ dmprovea tbereora.a9sd w�io�'a'es':'. , �, : _�:- ...,_. _ ,—. -.. . _` ',. -�; �sh wov;kr'havazs�df�5a'ovsded Bd+rs'�s�ecc� �ove�nents �. ��. .. _;. ,..., .,.�..:�.. .�.: . . _-� . � ., ,_ :. .., __ �:_ � . ' . .� . � , . . . ` � .: "'`'�hrs not issteserde..a or offareek}orsals f, ouiev�r, ibs� r �.-. � "�. ."""""'"' ."","."T�,��";�'�"`�;Sttt�daaa,�or sm�rarieiiie�a�E az s'o'd'd��watbi�a otia ym.ar of_ . �.. .. �� '- -.. .. . .. .. ,<� .. . � ,-,,- . , ... _ . .... . ,-�-�. �. ' '�� ��..-aa t '� > �� � ' � _ ' rmp8¢asori avrnes�brsaIIder evsld�'av'rs er5e burdesa....... : .. , , -,�.. , ,. �o � al�¢ ' �� � � - _.��"x..„` �'+` -- �evc �� ' aoe&eeaPcl at�.irtapsor�¢fos tb�� �- �-- ._ _.._ . : . �� ,i . ..1' .,. ' ._ � � 4 - . —- - r ' . �— . . �... :,• ,; '�._�_ ., �_._,_ . ,.. . C. _ . _,. , w.+...�.-'rw-,-^.w.^.- � -_.._. ,'•,c'�^a ,-^.-`+R a .w..w .� o��l 9ig t 8 - . DtLF�O&k Of 9AQT¢� � $, � 'e 3�� 1 ' T s�e�e�gat under S�cµ � � 9 ' �- �— �.-�r-�---,.,..� ,,w ��,�� �.��, , _ , �,� t�4 `f�r' ��c�� for tku5 reasu�n. 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