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Home My Public Portal About9237 LOWER AZUSA RD_Sewer__ COMPENSATION DECLARATION r;,,,t r have a certificate of consent to self �� ate of Workers'Compensation Insurance, or 76n6a2D ;' r c 7opy thereof {Sec. 3800 ab C.,} CE BOB rREv.8/81) APPLICATION FOR PERMIT policy Na ' L�obogtompony ??C Y"" ��"G1r ', CP�s ❑ Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY deartment/. � Date FOR Applicant __ FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BunDING 23 p .', r STATION DEPTH COMPENSATION INSURANCE ADDRf.S$ Leer- �, ' (This section need not be completed if the workinvolved by the m MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOCALITY LOWER NEAREI certify that In the performance of the Work for which this CROSS SST. TYPE OF CONNECTION LENGTH FROM L permit is issued, I shall not employ an Y- cuRe P.L M.L.To P:L. p p y y person in any manner so as to become subject to the Workers' Compensation Laws. OWNERZ11 CO.IMP.NO. P.C.NU, MAIL TRUNK PERMIT NO. ROAD PERMIT NO, Date Applicant NOTICE TO APPLICANT: If, after making cae othis Certificate CITYJ'CA TEL.NO. AFFIDAVIT WAIVER EASEMENT RECORD INSTR.NO. DATE Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. HWY.OR ST.WIDENING comply with such provisions or this permit shall be deemed �j revoked. BLOCK RACT S j STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION NO,OF BLDGS. PERMIT NO.y ^ Ji [ SIZE OF LOTvyk— NOW ON LOT I✓W�, I hereby affirm that I am licensed under provisions o. Chapter USE of 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS `r 10 CHARGES ness and Professions Code, and my license is in full force and effect. �L y CONTRACTOR - '" CONNECTION CHARGE FEE >- CL License Number,3018i j8,1i`{y41 L Lic,Class j / ADDRESS r REIMBURSEMENT FEE CL CantraCfo�/I/�/(.! t lA t]f' Dote�I`/ �� DISTRICT NO GROUP MAP SSED BY V CITY' /, STEL.NO. STATE UC. BK PG Z ❑ I am exempt under Sec. of the L.A.Co. ucENSE NO.6 — CLAsS -is ;/�,)� 2.:'1.- � Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL y � V LU HOUSE SEWER CONNECTING TO DATE / VALIDATION a PUBLIC SEWER _. �- > B. & P. Code for e followinq reas0 SEPTIC TANK,SEEPAGE PIT OR / Z PITS AND/OR DRAINFIELD FIN atP. - HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM \ Signature s CONNECT ADDITIONAL BIR -� WORK TO HOUSE SEWER "> OWNER-BUILDER RAO OVERFLOW SERA,D PIT,DRAINFIELD I hereby affir that I am exempt from t Pit ctor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE Law for the allowing reason (Secton 1 Isness and Pro. ALTER,REPAIR OR ABANDON HOUSE fessions Code): SEWER OR DISPOSAL SYSTEM ❑ I, as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit $ r'�� j 2d ❑ I, as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE licensed contractors to construct the project Section 7044, 0 p I ( I HAVE Al THIS DATE A CONTRACT WITH THE HEREIM NAMED CONTRACTOR TO �"' � ® ' � ��+ Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING SO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY I ° " 4 3 5 1) _ I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19OWNER OR " li. 7, i lJ , for the performance of the work for which this permit is OWNERS AGENT issued Sec. 3097, Civ. C.). Lender's Name (,1_L// ,Q� ! ADDRESS ( ` = c Lender's Address t-i P'7 8 ran I certify�Ial,.I,,have read this application and state that the above iron correct. 1 agree amply with all County ordina c and State laws regul g lumbing and Sewers, and r by authoriZ represe ve of this County to enter upo t e abov -m ned p r for inspection purposes. Signature of Pe. ee Date' SEE REVERSE FOR EXPLANATORY LANGUAGE / , - w WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self 'insure, or'a certificate of Workers'Compensation Insurance, or 76A647D o Policy Sep 3800-JabLia ' ''va. sOBiREV.B'e" APPLICATION FOR PERMIT Polio N om an ❑ Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY deportment. Date 1/40-9f,'Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESS y `4^ STATION DEPTH (This section need not be completed if the work involved by the LOCALITY j�yy rd MANHOLE REFERENCE {J jt `3. L)./-`� UPPFR permit is for one hundred dollars ($100)or less.) LOWER I certifythat in the performance of the work for which this NEAREST TYPE OF CONNECTION LENGTH FROM P CROSS 5T. +' Y. CURB P.L. M.L.TO P,I. permit is issued, I shall not employ any person in any manner P.C.No. so as to become subject to the Workers' Compensation Laws. OWNER J CO.IMP.NO. JOB NO. MAII. - f TRUNK PERMIT NO. --17YROAD PERMIT NO. Date Applicant ADDRESS 6 ; / AFFIDAVIT WAIVER EASEM NT RECORD.INSTR NO, DATE NOTICE TO APPLICANT: If, after making this Certificate of CITY / TEL.NO. Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. Gr HWY,OR ST.WIDENING comply with such provisions or this permit shall be deemed ,y // revoked. BLOC F_jRACT y STATE ENCROACHMENT A NO.OF BLDGS. PERMIT NO. LICENSED CONTRACTORS DECLARATION SIZE of LOTS 7 ` <' NOW ON LOT I hereby affirm that I am licensed under provisions of Chapter USE OF 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and effect. CONTRAC`1 ,_ ff / CONNECTION CHARGE FEE >_ CL License Nummber3o/. Lic.Class—_ f7 _ ADDRESS ^� r REIMBURSEMENT FEE COntractoif &1*7 ✓ u" - Date.- —'� CITY f'j•� TEL.NO. — � �.3 DISTRICT NO. GROUP MAP 7ED BY V ,— BK PG Z ❑ I am exempt under Sec. of the L.A.Co. LICENSE NO. - CLASS / � �� "1_. t Plumbing Code and/or Sec of the NO. DESCRIPTION OF WORK FEE FINAI -T VALIDATION HOUSE SEWER CONNECTING TO DATE E -- -Y - ' B. & P. Code for the following reason PUBLIC SEWERSEPTIC TANK,SEEPAGE PIT OR N PITS AND/OR DRAiNFIELD --- Date HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM i 1 Signature CONNECT ADDITIONAL BLDG.OR ' OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT.DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE f Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessions Code): SEWER OR DISPOSAL SYSTEM ❑ I, as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or Offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit $ ❑ I, as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE w licensed contractors to construct the project(JeCYIOn 7044, I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONT ACTOR TO (b 1" ' Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY ° ® ° I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19_OWNER OR for the performance of the work for which this permit is OWNERS AGENT issued (Sec. 3097, Civ. C.). ADDRESS Lender's Name 9) Lender's Address - /Y? I certify that I have read this application and state that the above inf motion is correct. 1 agree to s omply with all County ordinan and Stat*regu lumbing and Sewers, and h y authoriz ## this County to enter upon'tifi above-rpeninspection purpos�s. Signature of Perm, Date SEE REVERSE FOR EXPLANATORY LANGUAGE r WORKERS'COMPENSATION DECLARATION I`hereby,offirm that I have a certificate of consent to self insure, or n certificate of Workers'Compensation Insurance, or %�A542D o certified c��jj��jjy they f (Sec.pony Lab v.) `E$aB IRE ,8/8) APPLICATION FOR PERMIT Policy No.1"wv050�1Company Beaver Insurance ;�,5 ❑y Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL {�Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY d��a/110 Date /186_ Applicant.__ _ FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESS 9237 Lower Azusa Rd. STATION DEPTH (This section need not be completed if the work involved by theTempleMANHOLE REFERENCE �c dt '` UPPER permit is for one hundred dollars ($100)or less.) oCAu?v city ty Y- 3 5 1 LOWER I certify that in the performance Of the Work for which this NEAREST Encinita TYPE OF CONNECTION LENGTH FROM Y. CURB F.L. M.L.TO P.L. permit is issued, I shall not employ any person in any manner P.0 NO. so as to become subject to the Workers' Compensation Laws. OWNER Moran Properties CO.IMP.NO. JOB NO. MAIL Date Applicant ADDRESS 45 E. Huntington Dr. TRUNK PERMIT NOY :-- �., ° ROAD PERMIT NO. NOTICE TO APPLICANT: If, after makingthis Certificate of Arcadia CA 818/574-1670 AFFIDAVIT WAIVER EASE. NT RECORD.INSTR NO, DATE CITY TEL.NO. Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DESCRIPrION LOT NO, 27 HWY.OR ST.WIDENING comply with such provisions or this permit shall be deemed ^y po revoked. BLOCKBook 42 TRACT Pages 93 a 94 STATE ENCROACHMENT ., LICENSED CONTRACTORS DECLARATIONNU,OF BLDGS. PERMIT NO. X_11__-: - SIZE OF LOT 1 .446 Acres NOW ON LOT V I hereby affirm that I am licensed under provisions of Chapter USE OF 9 (commencing with Section 7000) of Division 3 of the. Bust- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR Fullmer Construction CONNECTION CHARGE FEE y. License Number 301814 �LJc.Class B1IL ADDRESS 22632 E. Golden Springs ##280 REIMBURSEMENT FEE O Contractor Date Fu 1 lmer Const 11/10/86 CITY EDiamond Bar,, ,, 714/861-6633 DISTRICT NO. GROUP MAP CESSED BY u . . ❑ I am exempt under Sec. of the L.A.Co. STATE B-1-301814 C' B 1 �y BK PG o p LICENSE NO. CLASS .,'�C1 �f,Jt 'Z,. 145 Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL HOUSE SEWER CONNECTING TO JDATE �="'/- VALIDATION'-' d PUBLIC SEWER -f Y, B. & P. Code for the following reason 7Z SEPTIC TANK,SEEPAGE PIT ORAPITS AND;OR DRAINFIELDDate HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ` Signature CONNECT ADDITIONAL BLDG.OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE Law for the following reason.(Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessions Code): SEWER OR DISPOSAL SYSTEM ❑ I, as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNERS Permit ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE ^ , licensed contractors to construct the project Section 7044, ON P I ( I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO Business and Professions Cade). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19_ for the performance of the work for which this permit is OWNER OR slued (Sec. 3097, Civ. C.). OWNERS AGENT 0 s 7, ADDRESS Lender's Name_ Lloyds Bank of California j ` 8 Lender's Address Branch I certify that I have read this application and state that the above information is Correct. I agree to comply with all County ordinanc s and State laws regulati � Plumbing and Sewers, T , and he y authorize r, presentSyi eof this County to enter upo >�above-rrfentl pro rt for inspection purposes-., gndture of Perm if! Date �..„SES RYER$R FQR EXPLANATORY LANGUAGE Si Ar'