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HomeMy WebLinkAbout1570A _ . ,.,_.,. .�.:. , . �u,... .,.:,:. _w.. ;.�, d ��t:.:,e� ._� �.� _ .. . - � .t�7,�. _ �..�._m._ ; ,. .,,.. �. �.�. ,,. ,y .,.,�:�_ .. WORKER$'COMPENSATION DECLARATION � � I here6y afRrm �hat I have o ceS�cPte�und�nt to self... . .. . ..:.'". .'.`. ...... ..�����'�.•. . �: . .... . .. ...... .... . .. � . ._.. .,.. .... . ., ..... .. .. insure,or o certificate of Workers Com ensoiion-`insu�ance,or """ �enaaso � �� --� o einf ed to y thereof(Sec.3800 Lob C) CF.BOB,REV 6/B�j ATION, FOR PERMIT Pol cy�No. Company • �s „ /� . `�r p . .. . ..,.._..:. . ...__.. ... . .... . . . ❑Cetfe co is`fiere6yfumished. � SE•1�ER • SEWAGE.DISP(�SAL �� `��� � �Cert f ed m � py is filed with rhe county bu�ld�np inspection COUNTY.OP LOS.ANGELES „ BUILDING AND SAFETY, ;"��deparlmenL . .. .. . . . ,-............, . . . a POR APPLICANT TO FlLI IN Dafe�- E�I?O�SFb I mnt_�' �__�'T�QIRe.TI. � ..'•'... ON D „�. �.• .:, C��YIxI�J1TE OF�XEIN6TI($N FR�/J�WORRE'�RS� � � �- � euaoiNc -�� '�� �� -• � Fl-- - CONNECTI ATA � '. ..COMPE'�JSFiYlO}J 7N�UR.4�t�E �. . , ..:....'..' ' nooRFss � 1��(/( (� STnnorv DErrH��� ���'��" � � � . .. .. . .. . - (This�sect on need not 6e comple�ed ii}he work inJolved 6y ihe .. -.-.`... --�... .^..•. . _.__ .__..,.,_ ..„.,,._,�.,,.v� IOCALIiY �^ANHOLE REFERENCE permit s for one hundredMaollars,.($100)or less.) iowee I �eYfiT t{lOi in,ffte NEAREST � TVCEOF('pNNECTION� ^ ^ y performance of the work for which this cko55S. / 'S � ���� ��.-.� - �.,��T���W�"����� :u peFmif s�issued,I sholl not employ any person in qny manner , �� CVBB P... M.�To p,l, `.�, 'y .._�n., .. ............ .....,.... ♦ ��?'� OWNER y�y6YDY�N GLI� • `.•�'� CO.IMF.NO. -. -- J09 NO. 9l�Jj" sa ps to ecome sub�ect to ihe Wo ke s'Co pensation Lnws. r o:c.`i3"o"`"""➢ � �.:.�,.5 . . ,�_�._. :.; �,:,: ...,_ _ - .. .., ..._ . .. .:,.-: . ... ..... ...... f .... r�w.n ,.-,....,-�.„. ...........,,... ,. ,..:,.:.�. . ...._............... ...,,_:_,_.�-:,<.._..- TRUNK PfRMIT NO ROAD PERMIT NO 661e � APPlicani �� �.:: . � � . nVDRE55 � � 'L . __. � � ��� � � �� � �� � hFFIDAVIi WA!VER EASEMENT RKORD INSTR.NO. DATE ...�.. _ .... . NOTICE 70 APPCICANT If,'�ofte��making��ths-C'e`r"tifimle of � pTY �ovina ,E:.No. 8is 967-9541� � -,�:npt on you shovld become subjec to the Workers' . . . . .... . . ' .ipensahon ov s.ons of the lobor code, ou must forthwith LEG41 � --��-----��-----...��.w,.,.:......._�.,_...,.,�...,.,,,,, p� Y �ESCR�PfIOr.i � LOTNO. _ wmply with such provisions or fhis.permir sholl,be deemed �- - . . �;wr oasr.wioeniN� . . � BIOCK 'RAC� SiATE ENCROACNMEN' ........-...-,•..__..m_........„.,,,,,,„�.,.,�_.„_„„, re OkQd � ., �. . .,.: PERMR NC. ��` � No b�atoc5, �,,,, �CICENSEDCONTR'ACTORSb�ECLAR�.TIONµ 5¢eOF�or NOwrtiio •��-�� .,..�.� � _... . . .�.. .._._,.-....._......_..�...,......,.. I hereby aff rm that I om�icensed under provisions of Chapfe� � � Use or � "' "" -"`�^ -�" �����^ •M�•-��-��,-� 9(commencing with SectionJ000)of Division 3 of ihe BUS�- BUIIDINGS S3-� • �'�.C3 -"'cHn'r�"Gf3"""'"'""""'""'°"""'""`"^"'^""�^ nes!'and P ofessions Code,and my license is in foll force and � �. - . . _ .. . ,_.....u. y,,..,...^.µ,�_y.A,� §ffect: ... ... ._...,.. .. ;..:�... ._ . . . . . n y .. A � � CnMRACTOR Fre eman k/Qn8 l�� CONNECTION CHARGE iEE LcenseN mber 47`t'g87 �-� Class C34 qG �-�� y� � �y�� � - � a )p/ ,:.. :,-. aooeess SZf,J BP.PrC11WOOd SyJL-� REIMBURSEMEMFEE , Contracto� Frg�g�� Dote ��$�ZO/L70 ��ry �.�a -I,oma iEL NO. ~/Z4/,7GJ�-4429 DISiF�CTNO GROUP MAP"�'��- PROCESSED'BV4� O "� . .�- '�;• :.....�., :_��. ,. . ... . .:..'-: .... - '� ' STAiE op .... .,.... ._. ,.. . ` BK PG e . C I am exempt under Sec, of the L A Co. 4,',4, '7 � -�����q�;/•�50 x�•4 /�ro . .�: . � � -. . ��N�HWSEDESW'R'CO HECOINCOTOK ...._ FEEp55 v�� ...,�.._.� YV ..... � Plumb ng Code and/or Sec ���" � �' of the -_ .-._. _,.... � ` . .... ..,.. oare VALIDA, ON � 8.��8 P.Code for�he follow ng reason. `. . '� vVa.0 SE',vea ' 1 a� t/`2�-�� N � ' . ' . SE C TANK,SEEPAGE GIT OR ' ' '' � ..• � � � � DOfe .�' �, •..�. � ' PITS AND/OF,�.FAINFlEI� ' � FgIN4L �' � ... ...•-- .:,; . ,,s..z.... ..,,..�,..:.,.„�....T. F07USE�[WER CONNK7ING TO . .. . . .•�.• ��' ,..-. ; �. ' ; PR�VA'EDISP(�SpL5Y5TEM . . . � �Signotu E .... ... .. �..•v. �.... CONNCCT ADUTONAL BIDG.OR ' �•._•� . . . .. .... _... ....... ...... ........., �` �'� -OWNEa`BUILDER 6EClAR�A,�ON ' �-`"- wo¢tiroHewEsewea , � �� ' - �� � WERFIOW SEEPAGE olT�RAINFIELO -"� "' " -' I�hereby aff rm thot l cm eiiempi from flie Controctor's Licen;e � ` � exin�. ce55aoo�,�evJ.�u nnnnHote Low for 1he following reason(Secfon 7031.5,Buisness dnd Pro- raree REPaie Ok nBaNDGN HOUSe �� �� '��"-^" • r.�- � ?"�"-�pM1S COCIC�: � � SEWER OR OISPOSAI svs*eM � '-�- f .: i,O A ,J f,as�owner of ihe proparfy,or my employees wifh�woges as �;;° c y N f (} their sole compensation,will do the work and the structure �� � ' ""�-'�'"" �is not�Mended or off,ered,(or sale(Section 7044,Busrness � _. . .i � ���i ��. and P ofession"s Code1. " OWPIER'S �ermit y . .Q I,os owner of ihe propeny,om eadvsively coniraciing with AUTFlORIZATION TOTAI FEE � '� " '- ° %'�;.� ,_, �licensed contrac�ors to const uct 1he project(Section 7�44, I HAVE AT THIS DATE A COhikACi WITH iHE NEREIN'NAMED CONiRACTOR�O ":BUslness and ProTeS5f0 5 COdE� �ON.'JECT?HE ABCVE DESCRIeED E%ISTInTG'D`tiEiL!N'v TO7RE'F()�!IG SEWER. "'" �i`r V �'�� ._ . � ��- CONSTRUCTION LENDMG AGENCY ' "� � � � ' ' �� - � I hereby dffirm�that ihere'is a consfru[fon lending oge cy � � SIGNEDTHtS -❑ OF��__ > >q 86 , for the performance of the work for which this pe t is rn�'tiEaoe � � issued(Sec.309>,C C) - �wNERS AGeNr j, � lender'sNome ' � �� � � � . ''A�R955 eBCY1WOOEi_1 .��3 037TI18 , . . .� . �. . �,:.. .,..., m-... . .. . . . . . - , �:��. ... , "r;m»� °tx.e��vhRh k id.r'+� 4di: .'�.E. r,:. Lender's Address . . . .., ,..._ , ., .. .., _. .., :,�t�r- ��- z::,. .,.,,.:_ ..,.- . . . ..., .. ,.. , � . ..�. . �.:,..., .....-.._. : ..,_..,..,. ,. � ....,.,.. � . � . . . � �I�certify that I hove read this applicd7ion-dnd state�fhaf the �"^„" .'. � w...."�.•. •...:......s„_ .�...., ...,...„ � � ' ......... .. ... ._ ...:.: ...,..,..-: :...... � obove mformafion is correct.I ogree to comply wifh oll Couniy � � - � ' � � � � . , �� � ordinonces ond Sfote Ig�wS regulatinq Plumbing pnd Sewers, �and hereby authoriie representatiaes of this Coun7y to enter � � �� � � ��Ihe abov enlioned property for inspec o pur ses. gna�o�mit�ee �'bq{����� SEE REVERSE FOR EXPLANATORY LANGUAGE �' . .. ... . ..�.. ... . . .... . . . . , .. ,. ... �.... . .. ., .. � .. .. . . .. . , . ,. ._ , M,�;_,. �. _. ,,,.. � �:.> ;-,,._,.. .. .. , ,,, , ,. ; , , 9WSP�CtoR's NOTEs �`i�itT�3Y-7BTJ�.]d��17�CL�F'cAT`Yi'�TrT -s.;._.-M.r..M.,�.-....._�..._.�. Fi�PRO��LS i �ATF 't. .�P$PECTOR'S SIGWTURE . . . .. .. .................�......... �I7EPEzJ�LLSElYTPl i�l$Y��m e�czn-.@t frr,isp uz��^unxract�?s Liceevse 3.am fmr e�i2 3oSlowing reasase/SecBio�a 7031.5> NEVr'HOUSE SEWER . ' . .. BPbsisies'�19"�.td � __.—. ...�._...._...._..._......... �P�uJ:sB.eoai L'oldei: ?8y ect�or rofraaty CONNECT ADDITIONAL . � tYLJiCki v�eqra?s�rs ss psm:i£da towsPrrca.-k m4ter: srn3trr+ve, ;y' BUItDING OR VdORK ... . .- .-. /�¢pgpXpSb,or:s��er�ie bray s�rzct'4j�rosi(i3'FGT,8o aSs$sseseidCE, SEP71C iANK,SEEV.PIT(5) ...... G�^O T9y'l140'YS E%Y ApIfY�SC{4ln4,F(Y!SMCaJ�iQCPT'6�t0�sd¢a ANU/OR DRAINFIELO _ ......... asgned s8ste»aesss 33as,�s:'s e�car�ed�sassuvnt to ki�e e cess�oi Cl wzvWFu❑ � ' 1hrouisiows of xJ�¢CanSt.rcc8o✓s Lues+se 1'.aw jClrapear 9 !s. ¢ ,,¢ ' P1TER,REPAIR,SEWER OR "'!' ...... �COrifHdB9EC:9d�4Ui6i SCCYY098]��iF��f 6,�d�`JYYASf6R 3 y C�S¢ _<ewace oisvosni svsTEu " . �sexi+�es;mvl�'s�ofessrosR.Cude{ar 2uat he zc exe»ad: ,.. AG ;, DISCONMR il1:iW AND . . S�gge�POM�.'Y�'.`��ie S65iS fe3i'f�J2,?!Y0$C!I B.R.'E4IYQLSOfi.IiC�y' .. ABANDON HOUS[SEWFk ....... _..... ... -'��.�ilJ .. encxFn�seanc raHxs p - uiolatxon cf S3c3aosi 7z3 i,S 5y a�,��,�dirana form eermit � ��'::•- SitP.�'li S�❑ GESSPDOLS O . . "— '' . LI:YdOTR EGA69 . ,� .. �tl&ar�3�t7f11 ae7•a zj:nf m ',: .. ...�:. ... , ,. ... . '.:��.,L �.:_: :: � � Wt!`1f�DQ$1G=W6Y1i�81A� - .... ._ . . .-..... . . . .. .. . .'. . ffnel,83t�0wIlCY E�C +x�oagh.lY, , ., . . . ...,� _�� . .� .. . � � . . . . . _ � .. .�.W ;W.. ❑ �T � �: - '- ;.�-.� � � � , �.��., . � .-;7?.v,�;.i xhe sinac:uer.-:�nat Yan2endad ot ofierecl fari sa1e. .�._ . . :,,,:._y: l8ac. 7U44, Busssters�xd Professions�ox{sr?: `ao: �... - ... - , . . ,�. tsactor's L° . � �ao�au�sn# ffiy'ta o• �ss,� , . . ' , ._. .. . . . - �., s�';:: . .� �.< , � . , , rcerse.(� app � =: _. . >:, i , psoper+✓y wbo buetds oa in¢prrwas zhereox.�axd wbo dnes . ... . ..........��W ' , :.. ... `.- �� ... . ._ ... . .. . . _. .. . . .. � . . aru:b wosk be�selj,¢raviaerd t&a8�c&anta5raaemaaess .:. . .. ... . ._ ..,. .. . . . . : �.... . . � -. ; . � . .,� . ..�... .:�.._.........�.,,,„..,,�.. are ao8 iritenda.d or a}ferr�fop sade.If 3ot�evet, 3F,e .,.>v bzssfding or crss�s°ovemertt:'s so[d wdabr'vF�,s:a year of _ R '� -� ��� ,., ._. . . .. ....... . _ . . -. .r...`. �. .....__.... ... .... ............ rc3mpPetios, slie rnune�beait"2er widt Save !�he Tiarde» .. . . . . . ._.. ._.. ..... ... . . . . . . � • -�.......�- .�: , , . ,-•:- of pyrr�riwg tbn�3se dsd uat Sati7d or#sat�raua faf tbe - - :.. . . . ,.. . � , .. _ . . ... . . . ...�,�....., puy�yos�af�aPe.1 ; _ . .. � ..., - —.. _.. _,' : . _ -; _ F.��t_8�t��`��i II€Ytler'��C ,....--._�.�, _�.�, _ �� .�._,�.. ��z P.�,ftse t3xa�s��ana , , _ _ ._._..�._�. . , . ..,:. - . : �. �.� �.... _ ,_ t, , , _ ., x _ .. ,_ -. ,.�.w. . ___ .: � .� �_ <� _ _ l�x� �:.,` , ., ...._._. _�...._ ._ . ,.,.... .... ,. .. �. .. . __.._ .., .,,,...� . �_.. _ . _ __ Owx`ec.�. _ :.4,,,...;���.�.�,. .........-.. . . , . �. i?+7SPECYA&'SPIOLER ... . ... . . . . ��....... . .,b,...=,W�...�,.�4,.-��.�.k,.s,:..........„..,�.�;,.e.�..�.��-�...::�.x.�:.:�«�s:st:.z_?�x.t�.:ays.�nra�aaa:���...,�. 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