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Home My Public Portal About9549 GARIBALDI AVE_Sewer__ DEPARTMET,Cr OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL Z DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX. COUNTY ENGINEER BUILDING ADDRESS 1 `r ekpy414F�ICANT TO FILL IN LOCALITY ��fr BUILDING 1 rt NEAREST r� ADDRESS _ �} +1 / i?! CROSS ST. LOCALITY y, �ro DISTRICT NO.' '-SERIAL N0. ----PERMIT NO. NEAREST t:,. A .1— S CROSS ST. RECbIVED BY Ready for Inspection DATE ISSUED OWNER f. k_ `_-t E•�/. 1/i P - MAIL 4" ADDRESS USEZONE OCCUPANCY MAP BK PG CITY TELAO. L� �/`�� ° `• CONTRACTOR i i`/ lya f f� CO.IMP.NO. - ADDRESS .' 'fi j_' JOB NO. CITY - ' TEL.NO. j' I '`.i.y d TRUNK PERMIT NO. ATE O REGISTRATION NO. _ COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NOP .S r• / ATE ENCROACHMENTg � ^ ,j' `� RMIT N0. BLOCK TRACT '. _+ _ /y�j INDUSTRIAL WASTE APPROVAL SIZE OF LOT{` N0.OF BLDGS. CHARGES .4._r.j NOW ON LOT .r USE OF BUILDINGS CONNECTION CHARGE FEE s` ` NO. DESCRIPT113N OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER @ $ 3.58 RECEIPT N0. DATE I BY HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 Is CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. I "r_-DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM 1.00 CON N DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATIONY DEPTH / CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE U=RLOWER TYPE OF CONNECTION LENGT&H FRQ*r OWNERS PERMIT ; 00 CURB .f._ R-L.- M.L.TO P.L. AUTHORIZATION TOTAL FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS.___L___ DAY OF_.. - 19.x.-,( NEW HOUSE SEWER L OWNER OR " _ CONNECT ADDITIONAL :� OWNERS AGENT...... .._ -____ BUILDING OR WORK f •' —' / SEPTIC TANK,SEEP.PITS) ADDRESS.. .. •_.. .......___-......-... AND/ORDRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL❑ DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESI ENTIAL P OP RTY. BACKFILL SEPTIC TANKS E] // 4e? 171--, � - SEEP.PIT(S)[] CESSPOOLS SIGNATURE � �` , '� ' � � J . OF PERMITTEE-___-.__.__._!_-_...... ___. 76A642A 663 7/53 DEPAIC22 EENT OF COUNTY ENG( IUM SEWER—SEWAGE DISPOSAL 1 DMSION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LO$ AN(TEI.FA IOTQBUILDING U I LD 18 [i �7 WILLIAM J. FOX, COUNTY ENDINR d CANT TO FILL IN LOCALITY ADDRBUILESS 9NG 5 7 C--,4,e +4..1 J CREAREST OSS ST. LOOALITY �'- [ p CJ—4 DISTRICT N0. IAL N0. —PERMIT NO. c NEAREST A S 9 CR088 8T. -u f��/✓ l' RECEIVED Y Ready for laapaodoi DATE ISSUED OWNER ��[) "!��{�iY/NlOfi' g_/ `J! <14 M AIL /� p � J— r ADDRESS rycS / Ci--�i1�/ f USEZONE OCCUPANCY BK YAP PG CITY TELNO. ka,::3 _ � I CONTRACTOR�/ (7 C 00.IMP.NO. / 9-77 � ADDRESS 7� / 4 L JOB N0. CITY L TELNO. 13l'— TRUNK PERMIT NO. ATE REGISTRATION N0. COUNTY ROAD PERMIT NO. DESORIPTIOY LOT NLEGAL 9p d r $- ,u 7* 'j �9'�� TATE ENCROAOHMENT PERMIT N0. J-� dyw,4-� BLOCK T r RACT WEE APPROVAL SIIE OF LOTM-,O/ .k,l,3C'70 pOW ON LOTS AROES USE OF BUILDINGS �.�-/rid' CONNECTION CHARGE F NO. DEHCRIF'TION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 9 i us RECEIPT NO. ATE BY HOIJSE SEWERN 0 PRIVATE DISPOSAL SYSTEM IJO OCNNEcyr ADI)ITIONAL BLbS.OR EXCE OY RECORDED WORK TO HOUSE SEWER 1.00 6 V ALYIER OR PAI NG NO, TE BY SEWER OR DISPOSAL SYSTEM IAO ISWNN CT AND ABANDON SEWER AND OR DISPOSAL SYSTEM LID hCONkHffr0N DATA PITS AN0ORDRAINFIELD R 2.N STATION 3-F- /�, DEPTH r SPECIAL DON (TIONS ONLY 2-80 MANHOLE REFERENCQ LOWER TYPE OF CONNFJJON LENQTH FRdii OWNERS PERMIT ; 00 ;r CURB _km—m. Y.L TO P.L MITI—IORI7_ATION I TOTAL FEE 1 HAVE THIS DATE WNTRAOTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER �,/ f� 516NED THIS � � DAY OF 14,Lt NEW HOUSE SEWER S OWNER OR CONNECT ADDITIONAL OWNERS A NT BUILDING OR WORK ADDRESS BEPTIO TANK,SEEP.PIT(&) AMD/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- OESBPOOL❑ DRYWELL CA TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLUMBING AND SEWERS. SEWAdE D18POISALSYSTEM I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AMD/OR LICENSED AS REQUIRED BY OS ANGELES COUNTY DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT IAM THE LEGAL OWN- ABANDON HOUSE SEWER ER OF THE ABOVE�RIBED EIMA P P SgPrTIO TANK8❑ al NATURE ,�y1SEEP.PIT(S)F] OESSPOOLE 0 OF PERMITTER WIDRKERS'COIMPLNSATION DECLARA-60N I hereby affirm that I have a certfflcate of consent to self Insure, Ivx a certlflcate of Workers'Compensation I nce, or, 7eAstm a ll ry iI . 2 thereof (Sec. ab C ) 0°°Q 81I APPLICATION FOR PERMIT y� Policy N p__�_...,713�L`f�` ❑ Certlfled copy Is hereby furnished. I . SEWER - SEWAGE DISPOSAL [a-(Irtlfied copy Is filed with the my bulldln p Irmpection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. c Date !1 4—?!q Applicant FOR APPLICANT TO FILL IN CONNECTION DATA ION FROM RKERS' BULDINQ CERTIFICATE OF EXEMPTION COMP94SATION 1NSUPANCE ADORW 9S 1 'de J_ (This section need rat be completed If the work Involved by theLocAurY —� n L� MANt E 7 CU uFPER permit Is for one hundred dollars (;100)or less } '` I oert-tfy that In the performance of the work for which this C. G L C T 4 rDTYPE y OF. CURBp u � TO P.L. so permit Is Issued, I shall hot em lay any person In any manner . Pc to as to become subject to the Worker'Compensation Laws. OWNER Al Al 42 e- "T C0.VMNo roe Na MAIL TRUNK PERMTT NO. ROAD PW_M1T NO. Date Appllcgnt ADDRESS �— NOTICE TO APPLICANT: If, after making thls Cgrtfftcate of T�No. AFFDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE Exemption, you should become subject' to the Workers' LEGAL Compensation provisions of the Labor code, you must fpithwith LAT NO. I,Wy OR ST.W1DENrNG comply with such provisions or this petmlt shall be deemed revoked. -BLOCK TRACT STATE CJ(3OACHM"4T LICENSED CONTRACTORS DECLARATIONrrpq.oor� PERMLT NO. SCM OF LOY Ndw or�. i hereby offlrm that I am licensed under provlsloca of Chapter lig of 9 (commencing with Section 7000) of Division 3 of the Buss- EUSAINGS CHARGES nea and Profealons Code,and my license Is In full force and effect. CONTRACTOR! NTRACTOR jr LJcense Number 3 �L LIc Class C 3 sb ADORzse- I �� d O I�.... /(�—'� ;,76'0 P MAP BY V Contract�/,,,,+ � �.0., � tTd.No. ' � Bx Z❑ 1 am exempt under Sec. of the LA.Co. i1�tSE NO L iSb �' O NO. DESCRIPTION OF WORK I�.JJLL C ' Plumbing Code and/a Sec. of the RNAs ts7�i JT HOUSE�CONNECTING TO Ll DATE VALI AT'ION d jB. $ P. Code for this following reason ' UBU�sEwat "TA/N&S� PR OR RA yy PftS At•D/OR DRA24$D - S3 Date HOUSE SFAUZ COMECT1NG TO BY Sl�naturo CONNECT ADDMOKAL BtDO.OR !OWNER-&JILVrR DECLARATION WORK TO HOUSE SPA" � 10 I hereby affirm that I am exempt from the Contractors 41cense EON. ACCT.0 Law for the fgllowing reason (Secton 7031.5, Bulsnep and Pro- Sa REA1� ABANDON HOUSE fesslons Code): - yam '2'7.W ❑ I,as owner of the propelty,or my employees with wages as- .?Jvr 1 ITEMS their sole compensation, will do the work and the structure Is not Intended or offered for sale (Section 7044, Business and Profewlons Code). OWNER'S Permit $ TOTAL, 27.50 ❑ 1,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FSE QECK 27.50 licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE'A.CONTRACT vvtTH Tlf FAN diAAl® TO '' ' ' M�y•y Business and Profealons CT Code). COrrETHE ACNE DES R SED EXtST-P1O,DV0ELLJ TO Tlf PUBLIC SeMR.+� ■w -CONSTRUCTION LENDING AGENCY — I hereby afflrm that there Is a construction lending agency 51 -NM THk5 DAY OF 19_ for the performance of the work for which this permit.Is oMOR WNERS I1 1�'�if Issued (Sec 3097, Civ. C). ADDRESS ��30 11�: Lender's Name 42 Lender's Addrea L certffy that I have read this application and state that the above information Is correct. I agree to comply with all County ordlnancps and State laws regulating Pfumbing and Servers, and hereby authorize representatives of 4hIs County to enter upon th bove-mentioned property for Inspedloh purposes. /{� Slgrwturo of ttee SU FSVOM FOR tiMANATORY LANWJAWI •�WORI ERS'COMPENSATIE)N DECLARATTON - I hereby affirm that I have a certificate of conseht to self Insure„or drearttficate of Workers'Compensation Insurance, or �°�� A LLLi�� a certlfiW c hereof(Sec. 3800,�°b G) ,JM,�. '9,. '�,eRl APPLICATION FOR PERMIT Po l ltl�Ndp L m pa oy lrjk ” Certified copy Is hereby furnished. SEWER - SEWAGE DISPOSAL [E'L Ified copy Is filedwith the unty bwilding Inspettlon COUNTY OF LOS ANGELES BUILDING AND SAFETY . departrbent. Duro L l Appllcant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION WORKERS' BuLw4G1 COMPENS4TK3N INSURANCE ADD— -0— -5 '4 Z� � Dir (This section need riot be completed if the work Irivo(ved by the Lim L �' MAMipE REQ W ILMNERpermit Is for one hundred dollars ($100)or less.) TYPEI certify that In the performance of the work for which this STT, G OFpermit Is Issued, I shall not employ any'penon'in any mannerYP.� �LQRGrH P 1 to as to become subject to the Workers'Compensation Laws. ayypgR /rM/I/O A! C B N co,LW.NO, Joe NO. Date Applltant A L1 L� T�PBW NO. ROAD PERMIT NO. NOTICE TO APPLICANT: If, after. making this Ceritflcaie of APrDAVLT wAlVEi EA.'FA18lr JJJ rtFcrorrfl. No. DATE Exemption, you should become tubject to H,4 Workers' LES Compensation provisions of the Labor code, you must forthwith DESCRIPrtoN LOT NRO, HWY.ORS wMENIxi comply with iFuch provisions or this permit shall be deemed revoked. BLOac TRAd STATE EN(YJOACHAYNT LICENSED CONTRACTORS DEcLARA-nON HERAUT arg of LOT oN Lar I hereby affirm that I am licensed under provisions of 4hapter ustof 9 (commencing with-Sectlon 7Q00) of Division 3 of the Busk rsusorRos CHARGO nese and Professions Code, and my license Is In full force and effect. p G CONTRACTOR CONNEC rJ CHARGE FEE License Number 3 4�L �r5 Llc-Class `�- 3 1 sp y �� II t� O Contract4j4t ' d#4 0 /1 V:47 = TEL.P40. '3'j�(. O DrSTOCTNO. � Mw BY U STAIE ElI am exempt under Sec. of the LA Co. NO 3 �, a SS (� J �r 5� OY `3 Ci Plumbing Code and/or Sec. No. DESCRIPTION of WORK FE{ the oa HOUSE SEWER Oaa•EaDATE. VALIDATIONTNo ro DATE. � B. &P. Code for the following reason PLRIUC AN( pIT HTS Aro/OR DRAINFgD MAL Dat ,HOUSE SEWER CONrECTNIG TO BY $Ig nature aX44Ec.T ADDRTtorX BLDG. AV owNER-BuCDER DECLARATION WORK TO Hous SEWER , 1 hemby affirm that I am exempt from the Contr�dors License .1111.=DWU MANHOLE Lqw for the following reason (Secton 7031.5, Buliness and Pio- OR AW HOLM fesslons Code): mRES 10 ACCT.0 El 1,as owner of theproperty,or my employees with woges as 17441 .1► their&Qle compensation, will do the work and the structi6re 27.50Is not Intendpd or offered for sale (Settlon 7044, Business permit f 1 1TT[Jk7 and Professions Code). OWNER'S ❑ I,as owner of the property,ant exclusively contracting with AUTHORIZATION I TOTAL FEE �y Iltensed•contractors to constru Cl the project (Settlon 7044, I �iAvt AT THIS DATE A wn �y �y+��[' +2 H THE n5sN i�AAS®cwmACToR TO .. I V 1 FL 7.50 Business and Profealons Code}. CbMECT Trf ABOVE DESCRID®DaSTNG DWE.LP4 TO TA PUBLIC SEWER. �y CONSTRUCTION LENDING AGENCY CKCK 27.50 �■50 I hereby affirm that them Is a construction lending ogency SIGNED THIS _DAY OF 19_ for the performance of the work for whrch this permit Ism Issued (Sec- 3097, Civ. C.). ADORES: �y�L i , i `gyp Lender's Name 000D-0W1 1ALy�21/887 tender's Address- - - .. 6924 1 AM 10 3 I certify that I have read this appllcation and stat that the above Informatlgn Is correct. I agree to comply with all County ordinances and State laws regulafing Plumbing and Sewers, and hereby authorize representativea of this County to enter upon)-lisabove-mentioned property for Inspection purposes. Slgrwturo Perin Date SU INNUM 1'0111 E(PLANATORY LAIiO•UAW WCF ERS'COMPENSATION DECLARATION I herby-gffirm that I have a certificate of consent to self Insure, or a certificate of Workers'Compensation Insurarice, or �� h a Cer"fi ' thew r-thew C'j— �'D�WV. APPLICATION FOR PERMIT � Polley Company°.�T,T�.•iJ.r.�-- r �s ElCerttfled copy ts hereby fumishid. SEWER - SEWAGE DISPOSAL [�C�.ertlfied copy b filed with the co my building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department- Date 0-N Applic nt FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF IDTA PTION FROM KERS' ausnrNG / COMPENSATION INSURANCE Aoosaf3s �{. STATION ✓$Z- DEPTH 6 (This section need not be completed ff.the work Involved by theL fi MANH # 00 UP � permit Is for one hundred dollars (=100)o? lea.) I certify ttwt In the performance of the work for which this �_LS ST.—I -j 4 IV / A&L TO P.LFROr permit is issued, I shall not m loy any person In any manner Y- sus P.L ✓ M L TO .L 3 0 so as to become subject to the Workers'Compensation Laws. �OWNER AJ N 60 G C,-I-r CO.LW.too. JOB No. Date Applicant lc1 Ll,e° i�.D TRUNK PQWJT NO. 'ROAD PerAvrNO, NOTICE TO APPLICANT: if; after making this Certificate of aTY TEL No. _ 7 AFFOAvrr wArvlst F1SEAhENT ufooRD.irisTrt NO. DATE Exemption, you should become subject , to the Workers' LEo.At Compensation provisions of the Labor code, you must`forthwlth DeSMPTKN LOT NO. HWY.OR ST WIDENING comply-with such provlsrons or this permit sball be deemed r, revoked. u TRACT STATE Er Ao-WIBtT LICENSED CONTRACTORS DECLARATION NO.-OF aLDG&' PExAur SIZE OF LOT .NOW ON LOT I hereby affirm that I am licensed under provisions of Chapter USE OF e 9 (cgmmencing with Section 7000) of Division 3 of the Busi- sUsdria5 CHARGES nese and Professions Code, and my license Is In full force and oOtrtcTaN CUARGE FEE k effect. �3 � dr License Number 38 �� LI,_Class `, O �l ,.d,� sure DISTRICT NO. GROUP MAP BY U Contractorf El LIG .I am exempt under Sec of the LA ETA Co. P. Lkam No3 4 nAas (�' Plumbing Code and/or$°C of the NO. DEKZFTK)N OF Ham SEWER CCt*&:CTTra TO FEE o� VA DAT(ON B. & P: Code for the following reason PUBLIC SEWER r Prr OR PrtS!ETA DRAJrFELD i FNAs Dort � . ° roLrs_sEwss terra To ev Signature 7 r CONNIECT hDOCr ONAl .OR _ OWNER-BUILD&DECLARATION WORK TO HOUSE SEWER , I he affirm t =ROW oRAlJ�en _ hereby hat I am exempt from the Contractor's Ucerr" ocrN. MAraran 10 Law for the folrowing rea*on�$ectoo 7031.5, Buisness and Pro- REPAIR OR AM14DO"NOlrff feniors Code): OR DiSPO&4 SYSTEM AMA ❑ 1,as owner of the property,or my employees with wages as 3307 27,50 their sole compensation, will do the work and the-structure Is oot Intended or offered for sale`(Sectloh 7044, Buslnen 1 y M and 1'rofassions Code). QWNER'S Permit 3 _ ❑ I,as owner of the prop ,am exclusively contracting with AUTHORIZATION TOTAL FEE /7�/��.�/- � erty licensed conowoors to construct the project (Section 7044, 1 HAVE AT TFO DAR CT DHEREIN A OWMAW 'H THE NAMED T¢ 1. ECK 27,50 Butiness and Professions Code). COWE-c t TI¢ABOVE DESUINp DUSTING DWGLM TO.THE PUquc SEMR- CONSTRUCTION LENDING AGENCY , -. _. C ■00 r hereby affirm that them Is a'constriction lending agency SKAm THis DAY OF 19_ for the performance of the work for which this pe-rmit Is OW11& OR Iatuod Pa.-, -3097, Civ. C. owrIRs AgedADPRESS 000D—W01 11/21/89 Lendoes Name 6929 1 AM10141 Lender's Address 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 Sewer, and heauthortze representatives of this County to enter upon th ye-mentioned properly for Inspection'purpoles- Signature of FW.M. Data t@ V"V FOR DPLAP ATORY LAN6UAQ.41 WO.RKERS'COMPENSATION DEC TIQN I hereby ayTrm that I have a certiflcate of consent to self Iruun,.or`a if of Workers'Compensatlon Insurance, or 7&4.61M n �S a cer*W thereof(Sec. 3800, b.G) ¢°°°�.�^�� APPLICATION FOR PERMIT Policy 17pgeL nnpan Qs ❑ Certfflgd copy Is hereby fumished. SEWER SEWAGE DISPOSAL [{J'Cr tfied copy Is filed w,lth the my building nspectlon COUNTY OF LOS ANGELES BUILDING AND SAFETY department../ `� Date j/—/�Applicant FOR APPLICANT TO FILL IN CONNECTION DATA C1 RTRTIFICATE OF EXEMPTION WORKERS' COMPENSATION INSURANCE I = ,k STATION ,"1 82 .5 STM' TT' (This section need not be eompletbd If the work Involved by the �p�Rt3� Wpermit Is for one hundred dollars (=100)or less.) NEAREST QTY G LG C 7 I certify that In the performance of the woT) for. which this ST. C,7' L#I Y. OFCutin P.L. MSL TO Pr L t � permit Is Iswed, I shall not employ arty pecton In any manner so as to become subject to the.Workers'Compensation Laws. O MER AJ `JI GL co.LAY.No. JOB Nb.toe No. Doter Applicant ADDRESS 44/ L `✓ twtm? w r NO. ROAb PaLwT NO. NOTICE TO APPUCANT: If, after making this Certifltate of crrr TEL rip. .2 ,'�Q/ / ArroAvrr WAIVER r�.s�reaT REcpaD.utero.No. DATE Exemption, you should bbcome subject to the Workers LEGk Compensation provisions of the Labor Lode,you must forthwith DESCRTP KW LOT tap. HWY.OR Sr WI)ENIp comply-with such' provisions or this permit shall be deemed revoked. UOCx TRACT STATE eaCROACPAVW LICENSED CONTRACTORS DECLARATIONNO.OF 6DG& P6RMR NO. SIZE OF LOT NOW ON LOT I hbreby affirm that I am Iltensed under provisions of Chapter USE OF 9 (comrritncino with Settlon 700%of Division 3 of the Busl- Bu CHARGES nese and Professions Code, and my license is In full force and , a LARGE� d effect. mNrRAc.TOa License Number '64�4�i,/,7k Lic.Class G 3 (L/ /� ky r ZL COntraCfar LR7 "�^�/�''�' re f 4-10 CTTY TEL.NO. � -1 4 6 DiLTRICT NO. QROUP MAP 6Y r �f� z El am exempt under Sec. of the LA.Co.. �NO. L G 9&M C 3 (p No. DESCRIPTION OF WORK Plumbing Cede and/or$ec of the ANAL W HOUSE SEWER CONNECTM TO DATE SEWER _ VALIDATION. IL B. d,P. Code for the following reason w MTAr➢C,a OR r� PTTS AlaD/ D"RAIMR rA HD / HOUSE SEWER COtlfCTr4G TO BY . w 51gnatur1e f CON41 C .ORWOR OWNER R DECLARATION OV8 O SEEPASEWHi , GE I hereby affirrrr that I am exempt from the Contractor's License r=- Law for the following reason (Secton 7031.5, Bulsness and Pro- ALTat REPAR OR Aa4 DON HOUSE fenloh$Code): OR D[SPOSAL SYSTEM ❑ I,as owner of the property,or my employees with-woges as void T their sole comperrsatlon, will do the work and the structure Is not intended or offered for sale (Section 7044, Busmen Fermll f 3307 --.27 and Professions Code}. OWNER'S ❑ 1,as owner of the property, am exclusively contracting with AUTHORIZATION1 TOTAL FEE Licensed contractors to construct the project (Section 7044, L HAVE AT THIS DAR A CONTRACT WITH THE Iia NAMED CONTRACTOR TO T J Business and Professions Code). CCNrECT THE ASOYE DESI MED EXTYrRaG DWELLING TO THE PUKK SEWER •._ ■r CON$TKKMON LENDING AGENCY y' 3W7 27■50 I hereby affirm that there Is 6 construction lending agency SrN®'TH1S DAY OF T9_ , far the performance of the work for which-this permit Is OOWNER R Issued (Sec 3097, CI v. G} AM CT TOT 27 Lend ert Name OECK ■ Lenders Address . 17 certify that I have read this application and state that the '17 above Information Is correct. I agree to comply with all County ordinances and State laws regulating Plumbing and Sewen, and hereby authorize representatives of this County to enter1 Upon a v entfl�oneadperty for Inspection pur•po3et. 7� r 6M 1 AM10:38 Date Permittee ate M111NOW FM D(M.AP ATORY LANGUAGE