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Home My Public Portal About9547 GARIBALDI AVE_Sewer__ "WORKERS' COMPENSATION DECLARATION I`hereby'afflfm that'I have a cerilficate of consent to self In3ure, or 6 certificate of Workers'Compensation Ins pr 76As� LLLIIL Pal` r3o6 0°;Lab C-) .�l CE&M(V."I) APPLICATION FOR PERMIT ompo ❑ Certified copy hs hereby furnished: SEWER - SEWAGE DISPOSAL [9Certified copy is filed with the unty building Inspection COUNTY OF LOSAMGELES BUILDING AND SAFETY department. pate- //*//-99 Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION RKERS' sDtNG , COMPENSATION INSURANCE ADDRESS -r� �d A L O/ �A11Of+ ✓e2►� °STM C (Tfils section need not be completed if the work Involved by the LocWrY 6 � tnAAo-tar R -7 TYPE OF COtR1FCTK)N d4 UPPER permit is for one hundred dollars (;100)6r less.) I certify that In the performance of the work for which this sr, t L� Y Y. CURB P.0 ��roPL t permit is Issued, I shall not empploy any person In ohy manner P.C.40 so at tp become subject to the YKorkeri Compensation Laws. Oyy� n/I AJ Dt fJ 6 L' Af# CO.LW.No. Joe NO. Date_Apphcont ADADm:�s O e L,r TR'1NI(PHtAYf NO. ROAD P13twT t10. NOTICE TO APPLICANT: If, after making this Certificate of Te S,a - N�A� WAtvtsr EASEMENT RECORD.1NSTR.NO. DATE Lxemptlon, you should become subject to the Worker` LEOAL Compensgtlon provlslons of the Labor code,you must forthwith pgCRprlgr LOT No. M,y OR ST.WbENNp comply with such provisions or this permit shall be deemed revoked. BiOOK STATE ENC OA03- NT NO.OF BIDOS • P5bW7 NO. LICENSE)CONTRACTORS DECLARATION 'x- SUI OF LOT Now ON LOT I herel7y affirm that I am licensed under provisions of Chapter UE 9 (commencing with Section 7000) of Division 3 of the 13,sl- BunDtNGS 0� ness and Professions Code, and my license Is In full force.and effect. CONTRACTOR L(t CONNEMON a-v rE } License Number 5 P 4e6`J r LIc.Clan; M, ADDRESSL G REIMBURKMeNT FU CLO Contracto to 'f±l µ` aryIf 01 AJ TEL.NO,•' '13'3: D DUTRICTNO. OROUP &W IN U STAT! LIG 5Jv V V ' `� / Oel I am exempt under Sec. of the L./t Co' No. 8 6 CU4S5 FEE Plumbing Code and/or Sec of fha NO. WORKRNAs/ VALIDATION LU HOUSE SEWER COtN{rwG TO DATE B. &P. Code for the following reason PLBUC SEWER T SEEPAGE PIT OR PnS AAD DRAJAF13D Ac6at° HOUSE SEWER TO By PRIVATE sl'�Slgnature CotAIECT ADornONAL BLDG.OR i - — OWNER-8LJI R DECLARATION VKWTOtKXM WED I hereby affirm that I am exempt from the Contractor's Ugense ��'Low SO D"M&NICU , Law for the following reason (Sectpn 7031.5, Bulsness and Pro- A1TEtL AB�MOUN 10 fessions Code): aEwEr2 T. ❑ I,as owner of the property,or my employe"with woges as their sole compensation, will do the work and the structure 3307 27■50 is not Intended or offered for sale (Section 7044, Business Permit f 1 1 and Professions Code). OWNER'S ❑ I,as owner of the property,am exclusively contractlnq with AUTHORIZATION I TOTAL FEE y + s�� licensed contractors To COnstru� the project (Section 7¢44, I HAVE.AT nits ATE A OOtJTRACT WRH THE HEREIN NAhVED OTRACTOR TO �r Business and Professlons Code). COt4MB-7 THE ABOVE DESCRIBED EXTSTM DWELLING TO THE PLIBUC 1e0AR MCK CON.MLK-nON LENDING AGENCY 27■ 19_ I hereby affirm thattru there Is a consctloD lending agency � OWNER�SIGNM THIS DAY OF ,- , .00 R NER for the performance of the work for which this permit Is OW Issued(Sec 3097, Cly. C_). . Lender's Name ADDRESS Q00D-0041 11/21/89 Lender.Address 5927•-.` 1 AM10=41 I certify that I have read this application and state that the above Information is cotrect. I agree to comply with all County ordinances and State laws regulating Plumbing and Sewers, and hereby authorize representatives of this County t6 enter upon t bone-mention property for Inspection purposes. Igr ture b ermlttee Date SM RWVRU FOR DTLAHA`01IN LANOUAGE WORKERS'COMPQJSATIOf4 DEC1ARAT1C N I hers ?m that I have a certificate of consent to self by.. . Insure, or h certificate of Worker'CompensMion Insurance, of :a.certiFled py thereat(Sec. 3800 Labe.) �°° 8,61, APPLICATION FOR PERMIT Policy _J2Q341L,�Company �ND�cs?�t►/ �N4�tiw'rT� �, c El Certified copy Is hereby,furnished.. SEWER - SEWAGE pISROSA4 S2T-ertified copy Is filed withthe unty building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date,//- /�`df�. Appllcant ;ZlFOR APPLICANT TO FILL IN CONNECTION DATA CLPTIFICATE OF E)MYPTION RS' eusBLNG COMPENSATION INSURANCE 0,6LD1tit- STATON 38:z .$ DOTMT b (TMs section need rpt re sample;($if the work Involve_d by the LST, �� C �i 7 µ UPPER permit Is for pne�hands($dollar (;100)or kits.) NEAREST 7YtT OF CONNECrON I certify.that-In the pet'forrrnance of.the work for whlth this L [G r Lj� 4U4GTHFROAA r permit Is Issued, I shall not empploy any person In any rnahner Y- Cu Rs V.L, M.L.ro PA_ so as to become,subject to the Workers'-Compensatron tow►. p'c NO. . �'� �oAJ - L1 t cL o co.W.P.No. ape NO. - MA1 L l Date, Appl Itbnt ADD'REfS L l i@, ,C✓A TRUNK PERMri NO. RW aszrwT No. NOTICE TO APP1JCANT: If, after making this Certificate ofcry L - A>anAvrr wAivet 2 srr t+4. D�iE Exemption, yob should b*come subject to the Workers' I MAL Compensation provlslo - of the Labor code, you must fgrthwlth_ D tpN LOTt4O. • HWY.oR ST.WDBN RJG comply with such provisions or this pwmlt *half be deemed rgvgked. TRACT STTIMIetT LIc!ENSED CbNTRACTOR5 DECLARATIONUZE# +40W.F LOT l hereby affirm that I arr,licensed under pravisiohs of Chapter bSE OF 4 (commeWhg with ion 700¢) bf Division 3 of th4 6Ltsl- 4 nese end Proferilons' e; and my.license fi In full force and , effect. co� ooNNpznoN MARGiE TEE LlcenmNumber 39'4 C -7 I 11c.clots G 3 L 1 C Contractor Data „/L: �, Tg. DWR4CT NO. GROUP � MAP PROCESS EY ❑ lam exempt Under Sed. of the LA Co. N. a�r*s G SIV d Plumbing Code and/br 56cof the NQ' /MON OF VPRK Fp; RNAL �J e3 HOUSE sEwEiL IVG ro DATE 'O VALIDATION g. $ P. Cotte for ih4 following reason_ Puea}c SEWER MU/ JNFI PST OR Dafe PITS/ DRAIt�FlH.D BY i HOUSE TC Nry6TE QDM56L RMM �kz 6Y /5lgnaiL,re aWT T�oorrlOfJAL Q�(3.C11bWNER-BU I DECLA OIC WOtaC ro t iousE� L hereby dffltm rhat I ons exempt from-the Contractores LicensExTtr Prr F 10 Law for the following reason(Sectors 7031-5, Buliness and Pro tiTER REPAIR OR ABMDON FKXM fesslbns Code): �^�OR o SYSTEM ACCTA ❑ I,as owner of the property,or rpy employees with wages os fheir sole compensation, wllldo the work and the stmcture 3307 27'50 Is not Intended or offered for sale (Section 7044, Business e and Professions Code). OWNER'S' Permlt . 3 1 rTM ❑ I,as owner of the property,am excluslvily contracting with AUTHOJt1ZA11dN TOTAL FEE TOTALZ7.50 licensed confidctors to construct-the proleot (Section 7041, I HAVE AT MS DATE A CONTRACT WRH r}* I NAMED COtfMACTOR To (��{( Business and Profeasions Code). cOfTELT T}f AsovE bEat1B®3Exs!MNG DysELUNo To THE PUKK SEWER.' QECK 27-50 CONSTRUCtION LENDING AGENCY - , .[� I,-hereby a#Irm that there Is a construction lending agency 0.F IS DAY 1�,,_ OR for the performance a# The work for Which thL permit Is = Issued (Sec. 3097, Civ, C). ADDKM 0400-O001 11/21189 Larder's Name 6926 1 AM10:40 Lendees Address I certify that I have read this application and"statb that the above Information Is correct. I agree to comply with all County ordinances and State laws regLllating Plumbing and Sewers, and herebuthoriz• representatives of this County to enter /upon e a ve-mentioned property for InspeGtlon putposes. Signbturq 4ffPemltt6e Date M WVM&FOI[DGLAMATORY LANdUAO•! ~WORRS'COMPENSATION DIECL ATION- t) hereby � KEIrm that I have a canificate of consent to self Insuro,-o certlflcate of Workers'Compensatlon Insurance, or �� N t� _ r TJ 3900, Lab C.) t9M„�'"I ` APPLICATION FOR PERMIT h- D.�XI� 7 o iTy p \) J 0 Cirtifled copy is hereby fumisbed. SEWER — SEWAGE DISPOSAL --/ s 5J'Cef1[f1ed'copy is filed with the my building In Ion COUNtY OF LOS ANGRES BUILDING AND SAFETY department. Date //-/s-19 Applicant r FOR APPLICANT TO FILL IN CONNECTION DATA CERYIFICATE OF DCEMPTION FkOM COMPENSATION I NS U RAND C' i(' 43rATION 'i'82—C DEIm 6 1 (Thls sectlon need not be completed If the work Involved by theLocwTY L F � o oPret permit Is for•one hundred dollars ($IQ0)or los.) n , GUS P,L ��ToP-L FROM I tettlfy that In the performdnce of the wdrk for which this ,T. (� eiy' 54VP Y Tref#OONNECTK)NtENGrt permit Is Issued, I shall.not employ any person In any manner I O so as to become subject to the Workdrs'Compensation Laws. P.0 Np. OWNER CO.µw.NO. -10e rib Date , ApRllcahl ADD SS - TRUNK PBZWT NO. ROAD PERMfr NO. AFF1PAvrr V KFl m E}SEhSB•IT wcORD.INSTR.NO. DATE NOTICE TO APPLICANT:- 1f, after making this Certificate of - t,10 - Exemption, you should become subject to the Wgrkets' CoMpgr)Wlon provfsloni of the Labor code, }fou rnL)&t forthwithVM M comply with such plgvlslons or this petmlf shall be deemed � � wWY_atsT.}vmaRiNo reVOked. - fAOO( TRACT STATE g43nACFWfNT - .. . LICSNSMCONTRACTORS DECLARATION rb.OF LOT R/M PE !T NO I hetdby_affirm That 1 am licensed uoaer provlslgr►s.Of Chapter st 00 LOT NOW ON USE 9 (commencing with Sectibn 7000) of'Dlvlilon 3 of she Bu sl- � CHARGES ness and Pcofbrilona Cgde,-dr)d my license Is'ln full forcepnd effect. CONTRACTOR CONNECroCN t}IARGE FEE License Number 3 LIc.Clap_�,,�,�.{rs¢ _ - ADORM {� COh Date t! �/ Q ( TEL.NO S DISTR$C7 P EMAP BY 4 n , ❑ tarrr Exempt under Sea of the LA.Co. STA 1 L PlunSbing Code and/or Set Qf the NO. DESCIRJEnNOF YOORK FEE RNAL B`$ P. Code for the following healon b +i CON 1ECTrNG TO DATE t. VALIDATION d P”A / IE DRAJND - F> ldi Date HOUSE SEWER C0rai{R+4 TO tiV Signature, 1ZCt011ECTVtU193.Q1R OWNER-BUILDER DEC�A IQN 70 HOUSE Swat , I hereby affirm that I am bxempt from the Contractor's LicenseOVERFLOW SEEPAOEF 14 Law for the following reason (Becton 7031.5,$Maness pad Pro- REaAiR OR AINION HOUSE fesslons Code)i Ll 1,as owner of the.property,or my employees with wages as • . " their sole componsatlbn, will do the work and the vWucturb - 3307 ' 27"50 Is no}Wended or offered for sale (SectloPr704A,Business 1 Yfi�-y� and ProfesslonsCo¢e). OWNER'S' Permit. f [� I, as owner of the property,am ixciuslvely contracting�vlth AVITIOMAtION TOTAL FEF - 27 0 licensed contractors to co Rstruct the project (+Section 7T44, I HAVE AT TI EIS DAT1 A CONTRACT HERSt?NAME OR TO BviJness and professions Code). CONNECT TV ABCNE DEfOt]EE)F7QST1TDWtiLING rb iH!PUauc (+'ECK 27sG CONSTRUCTION LANDING AGENCY , Q .00 I hereby affirm that there Is a tonstrudtion lending agency SIGN®THISTDAY 6F 19_ for the performance of the work for which this permit Is OWNER oR Issued (Sec. VW, Cly, C.> OWNERZA`� ODOQ-0001 11/21/ 9 Ler-Kfpr, Name Lender rAddrea 69Z 1 AM10=44 I cdrtffy that I have read this application and state tart the above information is correct. I agree to comply with all County ordinances and State laws regulatlhg Plumbing and Sewers, ar'dherpby authorize repre"ntatives of this County to enter n upoabove-mentJoned property for Itu>&0lon purposes. - 'Signaturprof Permittee SHMV U POR DPLAlIATORY LANGUAGE WORKERS'COMPEN-WK N DECLARATION I hereby affirm that I have a �ertlFlcate of consent '0c o self �nlure, o'r b certificate of Workeri Compensation Iruura11 or b `°r" , f (�` �°° `) /, '}�, ,,, `�" APPLICATION' FOR PERMIT y� Panty Company �ir�A f ma ❑ certified copy Is herebyfumiahed. SEWERSEWAGE DISPOSAL Oc.ehifled copy Is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date -14 9 Applicant 9FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF BSYJ TION PRAM KERS' OULgNG r COMPENSATION INSURANCE ADDRESS6,411 srARON 3 8�,ti DO" G (This tectton need not be•completed if the work involved by the rim t + µy}ptp Rgg�•C �C O upper permit Is for one hundred dollars (;100)or lass.) I certify that In the performdnce of the work for which this l(!d TYt{of WL TH FROM ' Y. QAtn P.L. ✓ M.L TO P.L y V permit Is Issued, I shall not employ any person In any manner P NO so as to become subject to the Worker'Compensation Laws. dyeAR ao LMP NO, X>B HO. MA E � TRUNK PSM7 NO, ROAD PERW NO. Date Appll4ant NOTICE TO'APPLICANT: If, after makI.rly this Ceftiflcate 'of say 4WAVIkO Tti No. �a AFHDAVft WAVER EASEMENT .NO. DATE Exemption, you should become subject to the Worker' Lr GAL Compensatlon provldions 6f.the Labor code, you must forthwith DI�TgN NO. KWY OR ST yy�NG comply with such provisions or this permit shall be deemed revoked. LaOac TRACT STATE�oAcruAeiT LlCErrSW CONTRACTORS DECLARATION NO.OF N DGS PBWrr NO. SLA Of LOT NOW ON LAT I hereby affirm that I am licensed under provisions of Chapter USE OF 9 (commencing with Section 7000.)-of Dlvlsloh 3 of the BVaI- Nc3s CHARGES ness and Professions Code, and my license is In full force and (`,Crl•Ei'TFON a uLR FEE effect. •" aoNTRACTOR �. License Number Lk.Class C 7 �+ ADDRESS at. I I 1 — Sr9 _ O D<7TTFKT Na GROUP MAP PRoa BY U Contractor aTY No. ^moi ❑ I am exempt under Sec. of the LA Co. �' tp /`� 841678 Plumbing Code and/or Sec. of the NO. DESUIPT10N OF WORK FE ANAL 1/ Foo _ rqusE SEWER mra,Ecrrrx3 To DATE B. 8 P. Code for the following reason uc se�ETr VALIDATION CL MgAGE PIT OR 1;r 0 HOLME SEWER CON ECTNO TO By A _ Signature. CONNECT Apprnct4A1 ww; OWNER-81.1I R DECI ARATION WOM TO HouSE StMA I hereby affirm that I am exempt from the Contractors Licanap EXTN. MAt4-KXE Law for the following reason (Secton 7031.5, Butsrwssand Pro- t1TER �AJR OR ABANDON rro)aP. T■ fessions Code): sews2 ❑ 1,as owner of the property,or my employees with wages as T their sale compensation, will do the work and the struchrre7 �•+ is not Intended or Qffered for sale (SecfJon•704A, BusinessPertnit - : = 1 11CJh7 and Professlona Code). ' OWNER'S ❑ IV 1, as owner of the property,am exclusively contracting with AUTHORMATION TOTAL PEE TU& 27. 5G licensed contractors to construct the project (Section 71044, 1 HAVE AT TMS DATE A,OONTRAi7Z WrTH TFE I NAMED OR TO7•r Business and Professions Code). corrtcT TFf ABOVE MCZMU DUMNo DWELLNO TO Tri"UC SEWER .' CONSTRUCTION LENDING AGENCY , .00 I hereby affirm that there Is a construction lending agency SKC' THIS DAY OF 19— for the performance of the work for which th11 permit. Is ow04ER OR -- . Issued (Sec. 3097, CIV. C-) owNERS Acrid ADDRESS OQ00— 1 11/21/89 . Lender's Name b 1 �I11:41 Lenders Address 69M I I certify that I have read this application and state that the above Information Is correct. I agree to comply with all_County ordinances and State laws regulating Plumbing and $ewers, and authorize representative! of this County to enter upon th bovo-mentlon rty for Inspection purposes. 1gnature of Ittee Date tib RiVEM FOR DO•LAPIATORY LANOUAOR