HomeMy Public PortalAbout10952 FREER ST_Sewer__ ECDLARATIONJ,,,,,_ 'QDMPE114SATIO-N
Ism that cycw0ficate of consent to If
Ours, or a.csrtlficcr itrs/CampensatI.n
I
moan �b C m MOM(EV.a APPLICATION FOR PERMIT
-cn �fled ropy Is hereby ftirnlshed.
SEWER - SEWAGE DISPOSAL
Certified copy Is filed with the county build g Inspection COUNTY OF LOS ANGELES BUILDING AND$AFETY
part 1.
e t'^
t
liccn FOR APP CA TO F1LL 1N CQNNECTION DATA
CSFTI I EXEMPTION>ROM WOR}CLRS WrW
NSATION 1NSL,IRANCE Ams
(This sectlorr need not be completed If the work Involv*d by the tocALrrY MAN-W 2
permit Is for one hundred dolrars ($10(Q)or leer.) Or
NEARM I certify that In the performance of the work for which this Y. T Curet P.L Mo PL,
permit Is Issued, I shag not employ any persgn In any rronrtef
so as to become sub ect to the Workers'Compensation Laura P'C-�'
Pe OWNER ODS YNP.NO, Joe NO.
_ NO. ROAD PBLW T NO,
Date Applicant
NOTICE TO APPLICANT; If, after making this Certlffoate of AF4DAvT wAjVw NSEMBJT RECO(.INSTR.No. DATE
-Exemption, you should became sublett to the Workers'
MAL
C.ompefsWlon provisions bf Jhe Lobar code, you rhyst forthwith t iPTDN tJO. IY OR sr wDEN NO
comply with such provisions or this permit shall be deemed
d.
revoke
STATE ENCROA„CRW1•{1 .
LICENSED CORACTORS DECARA
LTION tis.OF PST
NT
SIZE NOW ON Lor
I herdby affirm tFtdi I am licensed under provisions of Chqpter uSE
9 (commencing with Sdttioh 7000) of Division 3 of the Busi-
nessand Professions Code, and my license Is In full force and
a CONNECTION C LARGE PEE
*gnlib^A Llc,Class j� � d
40
Aqwpw- oatortP MAP PROCESS®BY �+
STATE arc
El �
I am exempt under Sec. oO
f the LA Co. LKy,tSE NO CLASS r
Plumbing Code and/or Sec. of the DES�RIPTION OF WORK FEE ANA
HOVEE SEWER ODNMC11NG TO DATE /8 ld VALIDATION IL
B. $F.Code for the following reason =MWEP AGE W
PETS At.D rJ�D
T Date t-OUM gWH2 CONNECTING TO eY ! _ X
Slgoature ooNrTEICT .OR
OWNER-BUILDER DECLARATION DECLARATION woax TO-'OUSE SEVAR
I hereby affirm that l am exempt from the Cohtractors License
Law fqr the following reason (Secton 7031.5, Bulsness and Pro- AlTat REPAR OR ABANDON
fealoha Code): 5EW62 OR DISPOSAL SYSTEM r� r�� •-
QI,as owner of the property,or my employees with wages as _ M07• ... _. f(.,JV
their sole compensation, will do the work and the itrtrttura ITEM
and
Is not Intended or offered for &are{Sectlon 7044,Business EM
Pbrmit = i I
and Professions Code). OWNER's
❑ I,rn owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE TOTA 2-7 .50 r�yy-]7 cc�y
licensed contractofs to construct the prolect (Section 7044, I HAVE AT THts BATE A CONTRACT wrTH Tw NAMED OR TO �� 2 .50
Business and Profeaslors Coded tonrfcr TrE16ovE DESCJz eED ovsrsvc�DweJJNG TO T}E PueIYC SEWER
CONSTRUCTION LENDI NQ A CG04CY �Gt ED DAY OF 19-
0 9� •
00
I hereby affirm that there Is a construction lending agency
for the performance of the work for which this permit Is OWNW�� `
Issued ($ec.3097, Cly. C_). s
ADORFss �" 9/ 6/89
Lenders Name 5514 1 i AM Q8:33
Lenders Address
I certify that I have read this application and state that the
above Informations correct. I agree to comply with all County
ordinances and $tate laws regulating Plumbing nd Sewers,
4dndhereby authorize representatly f this Co t enter
ve"mentionedgnature of ttee SM 6VM&PO!OTI AMATORY L"GLIAM