Loading...
HomeMy WebLinkAbout1566A _ __ _..._. _ _ _ ___... .._. .. .. ._ ,_._._. �,.... � . _.._._,� �,_...._ _. ___,. _. _. �, _ �.... �_ ...,. :. ...___ _._._ ___�._.....__. __._._... WORKERS'COMPENSATION DECCARA7fON- � � � '� - �� � �� ���' - �� �� � � � � � � ' � ' � I hereby offirm thot I h6ve o cerhficafe of consent to self� - � � � � � � � � � ' � � �' �� � ' � ' 16AGa2D ...�. ... �-.. . .. ., � . nsure,or o certificate of Workers Compensation�Insurdnce,or� � � � � � � �� � � � � � � �a Eertified co� thereof(Sec.36d0;Lab C.) ce eos�uev.aisi� �"- � � � � , _ . .... .,�..: Policy N Company st. F,�,.a , , �_ �APP�LICATfON '�C�R��''`�l��l�� cC�Ay�y y. q �...�,... ..r �...., . .�.__., � ❑Certi ied py is hereby furnished. JEWER ' SGr�A�iE�DI��S�� ., ..... . . . . - .—,-�:,.�,.,_ . _ _.__-'.-------...___...,. ._.�..;._..._.:.,;,,:.:�_,.�� �. �Certified,co y g p • - � - py is i e w�th the mum 6uildin ins ectio� NT OF L S ANGECES "�`"��"` �`�"BUILDING N'63?CKETY-""'-`�"""""' `��' C.:s�..�.:department. . , ..... _...., .., ..,_...... - .... .. . ... . Dare��Q�_$_�Appliw t T�._R_o�roa�p� FORAPPLlCANTTO FILL IN CONNECTION DATA' --µ .:_.... �,: �. CEf�iIFICAT�OfEkf7vlP`fIQRfFR6A�`WOIFK��5'�� .... . eunoin� � C0141PEN5ATIONINSURANCE ��� nookess � �� I �J STATIQN pEP7H ' (This seciion need not be completed i the work i volved 6y ihe - � � Juaves 'pErmit is for one hundred dollars($100)or less.) �ocnurv MnNHo�eaernteNCe . �pyvER , `��f'certify iliat�in�ihe�performance of ihe work for which this NE°'REsr, �. � � rvfforCONNFC'IroN "��'��� � - �ENc7HFROM � .. CFO55 Si_ ' . Y. CURB P L M.i.TO P.L. ���permit is issued,I shall not employ any person in any monner� „„ _.. ...,__,..,,. ; sb as to become sobjec�to ihe Workers'Compensation Laws. owNER .��Ei� (�'�Q'� ac r�o.. �.... ...,-:.. .,.�.: . : ..� i .. .. �.'.. ' . ' .: ..�. . . . . Ci�.IMr.NO. OB NO. ��� TRJNK PERMIi N0. 'ROAD PERMIT NO � Date� - App(cant:� .. . ._ ... � � � nooaess ����X 332� . .. � NOTI�E��f� A'pP((C�i�`r (i,'�affer�making�fh�s Certificote-o#LL��� ������ �,�',a, LO117�.N0. '.S�.S 967-�g5�Q.�. AFFIDAVIT WAIVER EASEMENT qECORD.INSYR:'NO- DAiE CRY . ��'"mption, you should become subjecl to the Workers ��A� , � .+pensation provisions of the Lobor code,you must forthwifh oESCeiv7ioN' ���orNO: Hwv ORST.w�oENiNc �omply with soch provisions or this permit sholl be deemed � evoked. . e,ocK TRACi . . ...,. STAiE ENCROACHMEYT " ' � ""- " .,._.. � �Y�- IICENSED CONTRACTOR�DECIP�' ��'- -� �����'��'� No oF eiocs. PeaMir�No � ' � - ' RA710�%'..._. . srzeof�or - Now oN ior _. . . I he eb�affirm that��l�om I censed unde ovis o s of Chapter �se oF - . 9 (commencing with Section 7000�of Division 3 of the Busi- gur�oiNcs +"n�L��i• �Re� CHARGES � ness and Professions Code,and my license is in full force and T}��i ��T �T ._ . .._.._.._. ' �-' 'ef{eCi. � CONTRACTOR y`tl,1;I�.111Y CO�Y��• CO\NECiIONGHARGEFEE �, ��, LicenseNumber ��¢887 LC aas5_ �34 ADORESS g22 ..Beechwood. Drs REIMdURSEMENiFEE � o � COnifaCio�'. �Freemari����-�DO}e �8/20/86 DISiRICTNO. GROVP MAP ' PROCESSEOBY � � , . ,. . ��TY Alta Zoma . rE�No 7I.4/980-4429 ❑ I am ekempf under Sec � �of the L.A.Co. � �A� uC. �A gK ac Z �-. . . . ., ���ENSE N�.474887 ��A55 � �r � o - �Plumbing Code and/or Sec � �- � � of the h�� DESCRIP710N OF WORK � ��� cEE�� V �� ' '." - ' - ' ' '� ' ���� � -"•. HOL'SESEWERCONNECTINGTO '' ''"� TE W FiNAL . B.�8 P Code for fhe�ol lowing reason � � PusuC SEwER � �� oA L/-Z 6—86 VA�� TION,. _ y ' . - � SEPiIC TANK;SEEPAGE PIT OR . . . � pqte � PITS AtiD/OR�RAINFIELD '' FI'JAL � . � .� .� ...... FbU5E5FWEk'CONNECTMGTO.".._...".- . ........ eY ' . '�. ��-.. ... ..' ' . : . ... PRivAiE oI5PO5Al SVSTE.'N . $iynofufe ...,..... , �pNNECT ADb;TIO1JAl BLDG:CR � ' ' � _ ' '�� �"- ' " OWNER6UILOER'6ECiARATlb7�1 "���"�� - � � ' woaKtonouse'seWea I hereb affirm that I am ezem�f f om ihe CoM acror's License ?�RROw seeanc,�air,oanwFie�o , . Y P %'N„CESSPOOL,�DRVWELL,MANHOLE Low for the following reasOn($eCtOn 7�31.5�BUiSne55 qnd Pfo- ALTER.FEPAIR OR ABANDON HOUSE Z'��1on5 Code): SEWER OR DISFOSAI.SYSTEM .�5 �L � �� . .. ... . . ..- , ::.'.. ..: . i l;. �!I,as owner of ihe property,or my employees wiih woges as s p o o 'j L - their sole compensation,will do the work pnd ihe sfrucWre . � . � is not intended or offered for sole(Section 7044,Business � � �, �and Professi,ons Code). oWNER'S Pe�mit g 5Q % .0 ��%�;(j � � ❑I,as owner of ihe property,am exclusively contracting with AUTFBORIZA�(I�N T�TAL PEE G ��- -, - . licensed coniracfors io mnstrucf the proiecl(Sechon 7044 ' � � JO `' � -l ����!�� �HAVE A7 iF!�5 DATE A CONiRACr WfTN�T}IE�HEREIM1�NAMED CONTRAC�OR TO . .� : 8usinessand�ProfessoSCOde�. CONNECTTHEA9pVEDE5CR�BEbEX�STINY�'6\NfLL�fJ`U"YO`iTl�"OS16LI'CS£rNER��'"'-'� i:C jC �R� ' � CON$TftUCTION�CENDING AGEI�C�' —'�" "` '�"""'"" � L � . . I hereby affirm that there s a conshuction lend ng pgency SIGNEDTHIS 6 o YOF Aug I9 8V for the pe fo mance of ihe work for which this,perm f s owrvea oR - ssued(Sec 3097,Cib.C) owuerzs n�eu5 c% ,� �a�• Lender's Name Aooaess t 2�-`'C WOG� y � OIDB. Lender's Address . . ,- . .. .�:.�: ...-..-. . ..�. ., .. �..��� _ .., . ... . . , . . . .. _ . . . . ...� .._...._ �.....,�...._......_...,_.,... _...._..._ ,,._...__.._..... _,.�_ .._.,.,_..,. .. ........,,..,., ..�...... ........w...._,>.. _� ...,�......� . ...,�.�... � ,' I certify thdt I have read this application and slote that the above informotion is correct.I ogree to comply with oll County � � �'ordinances and State lows regulating Plumbing and�Sewers, � � � � � � ,. and�hereby avihorize reprasentotives of this County to enrer o the abo entioned prope forinspecYon purposes. �,'� �6t DP fi ����� ` ._.. _ __,.... ... ..._,_. .... . . .. Signot�re of Permitiea Date SEE REVERSEFOR EXPCANAiORY�LANGUAG€�"�'���� � -- .. . . .� .. .".':��... '...{�, . .. .. . .. . . .. ...:� . .. t.,:v�uc::��:ae.�o-o:.��+.wn..,ka'.�.�w.�w.. ._.. ,.. � .w . .., . 'i;k#F-�;Fc '.,-..��w•:�'n;.f4 . ,� .. .. :w....�m�.m..-.•,:.,�.� 'w�;�.an.,. a"`''p.yoq."vw.ee� ,q.�«.�q+.".":90.3 n..iks?V*?y-'.khw. 5r SP93PECTbR5i+HCaYk'�`'= � •�"••".,"". • �' � >. , . "°�- M' . +���1BXITI.T���E��.�'i"�'�31�; �� , .,�; �' .: . �^ �. .: .. .,..,.. . . . . . .._ . ..,z. ,. .�-... a�rFY�+y°M - - . . .. . . ._ ... . .. . ....�... :'�ppp4aW¢q? .. .. , . . .. . � x .. .. .. . ... AP�R���LS DAiE � INSPECTOR'S516NATURE _ __ T_ _' ' �j�gp�)r�}(iYRiZWd2A8fYs�XEYtaJ't,§4"GY6iA2�.UftRYHSYO:S°� .. ... .....,_,_,....�..�..., ..� License Lsw ior�he�FolEawin teasoa�Saa:Fon 7031.�, NEW HOUSE SfWER y"� I .- . �—._.,_,. Busdness aard X'sg`essiovas Cvd¢j:tFssy cf&y or raacasty CONNECT ADDITIONAL ' - - ' whpC�J Ksf85 G . n XE9fllYC PG CONdjtY'i6k.4a�88N 293d''✓POL3r '. ' 6VIIAING OR WORK . ... . 429MOI64y,.mr rejrufr 3ny a.rsrctunE,prbr.to�.as assc:¢+:ca. � �PTIC TANK SEEP.PITI$)"......... . . .. ._ .. .. . . , — .. . ..... S.�.... �:: APIO/OR ORAINFIELD . .... ... .. �.. qqy0 9'�yj'f'By • �.� —_ . .. . . 4� ,.�e,�peplacasaW for sa:ch¢ermaea 1n fe?a tt s4g�ea'ssuxsr�a�e a�,aa be+s Fscetued�u�s�uaar,s to ebe : CESSP00!❑ DRYtVEIL•[].. ... , —�—,*_-_-,_,«.-.,-,,.�__._.-..--__._�;__. .........., = Sl _.. . � pros�iseons v,p:Se CoxtracWr"s�,sc�;e Law(C°taa�rCsr 9 rs ' SEWAGEED SPOSAL SYST M — __ I[6riR�&¢96CLv3a'V.'S3BJ.S¢CASOfY 7d10CJ a!i7doesioas 3 of:�e ' DISCONNKTPUIGAND..- " - . Y��.•�_._.•— - � . . .SJLSL98Ct'•s and Pro}`essians Cadel rrr ana:b�i,.ax,zzr.ps : nenNooN Nouse sexers T :". '• . � ' — . ...< s,bere/ram urr�s.b¢bas�for tna r•ddegad axemp�ara.A:n�. . . .......:.......... . ..�:,,..:,.. '� BACKFiLI SEPTIC TANKS G� ., ..�-�r ... .. ...... ..+•... .. Y1jOI6$i069�Of:F6CLeDY.J032.5 by axy apPYrcantjor aper.xist . se�r.wr(s)p cessrcous❑ . _. . � ..-:, - . .. zsabj¢cts tbe pptic°�rsx to c cYoi.°pex�lty of nro:acws�e eL� � ,..... �--:"'^" ..,.»,:.-� ...:r,.,,..�.�...�. . . . _ . . .. � �.�. ,. .. , .... ,,.�.+���,>�, ......�......-.�.««�.�,�.'C:'ii^a ��1:;"' .,. . . .,�...,...... .._�e rs($�0�. . �.. . ... � :.; iwds'ed dodlrx � '�. . .. . .. .. .... . . . _ ... ..,. .. ..: _ . . ., , • , .. .,. ... �� Y,es t'ae awner ax e '���Ei do zhe wark,and .. ' �. -.., " � .. '�. . ��-� ....,.�� -" '- . � �..:�-_�.f�. ... .. ... _ .....4lze sYructase is nox ivaYe¢ded�po�s ffer�d for sa€z. . ' : .tL' ,.__�.. _ . . . . . �. _. .. .. _...._. .._ .... . . . B ' P �, C�•Tl��AN .:� . :,., ,.:.. . ...,.....;.....«,.... ..m...:.�........... ...w.ax.�.ks,.:.�SeE. 7Q�A4r Yfiiik85s 'pd. 81'l�63SioHS e. . . ... . . . . . .-. ��_;.:;' 1 ' _ � ¢tnetog✓s Licensr.,'aw does r.as,.aj�j:5�,�Sc�a oc_. 'o¢ . _. .. . . ..�_ _ . ... ' � ... �'{,,�• � - P�'oPerty us$o bmald�or iinp'ror�e:;e{;erean:xsnd whc+doss � �. '�t .... - . ..:...�.-.� � ..`....,."."`..."�"•'•.""'�"'"`••`a".."°'. :.",..`"...•"_tae�E wor� $imse,N 3rav4de'S&a�susb�ara�rava»a�eta . . ,.;, . .� �:. . ... .. . ..._. . _ .. ._ . . __ -- . . . ' � �ss�e aoE awter.ded er afferer8 far srae¢.a'f,bowezisr,t5e � . ,.: . ., .. .. . . . . � .. ...... ..... . . ,.: c�. ..�. ' ... . . .. ..� ..... budS�emg a.^sm¢r�ceasaer6.Fs soed uritSin v�y�r of . . . '�;-. ....,._ .. _. �,� . ... .... .. . � coanpletion, abe owsaev�Gr�sfu+es uiilX bave 2 s rdan .. . . ... _ ., ..._ . .. . ,.... � . .. . '. . .. .. . .`. � N.�..•. ,.... .,. � .•, _ ..,..'..��of�ov'ax�tbae ne dw apqt.besila ar lm,p�:avs.�or tbe � . ...... . . ,. _ .. . . _ .. . " � � .., _ . .,..�... :_ .. . -�.�-i .:. . . . . ... , ., . r�ls.1 �� ' . . . � � - . - , p n. � '•. S'. —... .., fMe 039 O .,.. , _ ' :. � C � + f�:�.� -, _.t�����.�iYil�i`f�¢➢Y3�1'.��k�-t'^---�.r• � ; ., r�^"" 5� � .t�.a♦ _ _�v_,. . . . . . . .. . ... ...... ....... .... , . . . . � -� .:. .. .. ...... . .. '. . . . . . , , '�' . , ' . ... .. . .. ..... _ i, ".:: . }� �$E�.�.fas'.thi�s�e�o�_____ _ ;� � '� , . .. _ _. -. .,�_.__ _ .,,._ .,. _. , . . � ... .. ` .,.:.. _.. _ ..,s__... .._�.. _ _ _ _._.. _.. _, . . .. fl?$$� _.,...,.. -.»., , . . � , � ,:. .��.., .�,..� , , , , ,,.,..:,.. €?r,v�.e� ,�,.._.. � .�. . R'.�..k-_._,.,,, _.._�...-�.. . n ' 4(VS?ECTOR'$PBOTES � ,n,...,a,�w..a..�..,.....:.n�. ,-,�r,,... . . ...... .-,..,. . . -.,. , ,. _, . ., .-v . . .. . ..._..,..�;...._......„,..„..,...,..,.._....._^-e,..,. ......,.„. . � ..�._._, ' . � . .. . ... . ................... .�.,......w �.: �..: _____..,.,.,.�..;...�.:.:,=..wa.;.: .:..:,.„-.wa..,.r:.,.. .„.'�[.:..__,xe....rab_.�r_.<.._. .�•.�Yrcr„'Y��.^M1..=ce..e'.Y:�;;2,I+L�^a.Y.�ux:;'"r��.ffi::.?§N.`�'.�.�.r j . . �' �"�.r-,r. .., .... ._. .... ... ....... .. . ._,... . .,. . ._. ., . . ' ._. .,,_,..,,... . ....._.., .._ ..n,..,..q,,�r.-bd'�',` .r1'u�'"p+n�•'-�"�'�l�b�+eilAYds'.t�d. ' .. , .-... . �- '`wa�..'�:... ._. ... ..�.. ,..,. ......� ,.. ».. . . .. 1 � ^ '.', �.:•' ;. . . .... .,. .. �....... ' �'s, r. - � .. . .. . � . . ., �«..,.a._....._......,.�,.m..o.a�. „«a;t�*'P^.�.xx.vm,�wHan*+rer«..�++'awer�+y.,rmm..-n,�,-.� a»,�dw...a . .,..h.., ,.z„.. �+,,. ., -.xw . - '..«... �.�..,�.�..,ra�� a. '... :'�,c�a.. ,...,:.�:... . � , ... . . . .. . � . .,..... .,.�,�.e ....,. ,,.m..>,s� �.... . �.._r,.� . >._ ¢�-1.,. , ... . ...:-a1.,�,:...x,i,.L.. ...�,t<.c _,,..� .t: � . . . . .,Fa �_..... ., ... ..., . .. .. . . .......:-.. , �f „ ��qr : 5F�'"a+9�.`.,e,�.?Kp"aNwo,;.w.�i�.,a,,,_a,-:t+i:s,�ve.1.+..t*„..c.+.a.9-,;�.',q, !- �.,,�:.+5?:i CiTln'� tS.,f,.__.�..� �r . ..ay,�; . .. .,. r,. . ' . . . .,.. ' . �... . ........ ... . ....„o- ---T— � � . - �r..s. _.�..:.�a ..,.�,_. k ��,.�::;a... .,:�.�",�...��.... �F+. .,.3..�r• ..�-� sx ,.-. ...,:.,..;... ..... ..v �v .,. . ... _ ,s.-..m..�..,H , ,., .._ .. . _. . . . . -w .. . � . . ...,_1...._. ,.�......,,..........�:.«,-.�,._ .�...�..,..�...m...,..�.�..�,-..�:.,uzk..,,...�.�d,s..�..�.,�,W.�:. a.,,.�..a��,:... ,,.m•��...�...v,.:::.�.a. ,. ' . , . -...�`�:,A,`!W d.z�i'r.S!;h 1.�,.. . � .._.. .._ _�......,....... ............. .,w...�... _.. _,.......,.:��n....,-....a.,,.,w.id���t-.'.�_. :. ., .>..'e.: ., . . :.-.JS...�q11YSJJ!T:fYr'YSb:'k�C�.d.l 'Y➢,�".'�..r + � -� . ,..�...:.,.. �;, ae .a e.,_�..+a �s�„ .. .. . ,:..... .,;_..,.:�........,<........... .. .,..:..-...._. ;.+,;::,..�>.x«..sw�.�:«rr�wti��a:-d.<a.�.:..w,.:..,..,,�:..:; -�:�..wa.x. .a..:�._,.;:�..,.:.s;u,:�.� .,.:,., . ' . - _.. . - .. `^2 �.y+�,..tpt, .. . . . . .............. �,.-..,...,,. ... .....,.�. , .,. .._.:...;...� .:;..'G:�:,. .,..>„u r_.. .. ,. . . n...� r. �. .. .. , r...v_.^`Mj^'�. af^�^+�^� . �¢�.� '......, ^^ , -�. '��%fiC�$ '4�..4y,v..NT`'Xf"�i.'fi.�:.-.�.'.. . ,. J ._ a ',y.. r