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HomeMy Public PortalAbout5617 SANTA ANITA AVE_Sewer__ WORKERS"COMPENSAIION DECLARATION 'i he,6by affirm ,that I have a certificate of consent to self 20-0051 DPW 6/89 insure, ('. a cer0icinte of Workers'Compensation Insurance, o, 76A8420 PQier d� py thareaf (Sec, 3800, Lab_ , APPLICATION FOR PERMIT d p SEWER - SEWAGE DISPOSAL Certif-red copy rs hereby furnished, Fi Certified copy is fled with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department y Date_�� - fAppI,cont,__ FOR APPLICANT TO FILL IN CONNECTION DATA CERTINCATE OF EXEMPTION FROM WORKERS' BUILDINGrr COMPENSATION INSURANCE ADDR; e '`r(' 1 srloaa DEPTH (This section need not be completed If the work involved by the L MANHOLE REF_R€NCE uPPER fey y- r permit Is for one hundred dollars ($!00)or less 1 LCaA,,i Y j4 G LOWER 14EAREST TYPE OF".:ONNECTION 'ANGTH FROM. I certify that in the performance of the work for which this CROSS ST [ Y CURB P L Mi, TOP L permit is issued, 1 shall not employ any person in any rronner LFGAI. o.C N so as to become subject to the Workers' Compensation Laws DESCRIPTION LOT NO �g co IMP NO Job NO BLOCK IRACr Data Applicant T4,'vK PERM"NO ROAD PERMIT NO ASSESSOR AFFIDAV T YdAIV'ER EASEMENT RECORD iNSTR NO DATE NOTICE TO APPLICANT: If, after making this Certificate of t AP BOOK PAGE PARCEL L Exemption, you should become subject to the Workers' NO OF BLDGS. Compensation provisions of the Labor code.. you must forthwith SIZE of L`OT l 5, NGW ON Lor comply with such provisions or this permit shall be deemed '� HW'Y OR ST,wIaENtNG p r p P EO or m atwrCgr ,. . revoked. BL1tLDINGS STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PERMT NO� �"_ �` e ��.�,,a�3��",a��t",7,� I hereby affirm that 1 am licensed under provisions of Chapter OWNER 9 (commencing with Section 7600of Division 3 of the Busi- 'MAILADDF;ESS / 4'(�*� rAl 0 CHARGES ness and Professions Code, and m license ,s in full force and f� /s� r, C!TV �_ % � _- TEL NO. P }'"Y3 iD 6i'"y" �� r CDNNECi ON CHARGE FEE License Number / L;C. Classy} REIMBURSEMENT FEE CON T.RACTOH6� ¢,���d�� D S`RrCT NO GROUP MAP PROCESSED BY ADDRESS � ! S`r J;G�FIV. BK PG Iam exempt under Sec. of the L.A. Co. r° p Y 13. 9 6 TEL .N F O Plumbing Code and/or Sec. _ of the STATE LIC FINAL C,7 LICENSE NO 3. � CLASS C-4'2-- DATF VALIDA I N Z B. & P Code for the following reason_ NO. 1 DESCRIPTION OF WORK FEE (Jl`""1 --'�' s 0 wo sE SEWER caNNEcTIVG Ta FI14AL p Date _ P.a.Ic SEWER SEPTIC TANK SEEPAGE°.T OR Signature - TS AND OR DRA,r F EiD OWNER-BUILDER DECLARATION HOUSE SEWER CONNECTING To PQ: A,f DISPOSAL SYSTEM I hereby affirm that I am exempt from the Contractor's License CONNECT AcG vO NA BDG oR Low for the following reason (Sector 7031.5, Buisrtess and Pro- INORK TO HOUSE SEWER fessions Code): OVERFLOW StFPA:iF PIT DRAINF,ELD - .. EXTN.CESSPOOL DRY W'Ett.MANHOLE 1, as owner of the property., or my employees with,mages as ALTER REPA CR ABANDON HOL,S€ _. ,EWER t7R DISPOSAL_SYSTEM - their sole compensation, will do the work and the strUCture is not intended or offered for sale (Section 7044, Business nd Professions Code). C_j I, as owner of the property am exelusively contracting with , F licensed contractors to construct the project (Section -1044, OWNERvS Permit $ Z47 Business and Professions Code). AUTHORIZATION TOTAL FEE to G CONSTRUCTION LENDING AGENCY I HAVE AT Trus 1,A-E A C3N-RACT w H THF HERE;N NAME NTRACT9R To I hereby affirm that there Is a construction lending agency CONNECTTHE ABOVE ES: TIF,EXISTING YWE,JNG TO THE.PLBLI('SfwfR „.. for the performance of the work for which this permit is issued (Sec. 3097, Civ. C }. SIGNED THIg DAY OF !9_ OWNER OR _ Lender's Nome 7NNE RS ACiEN? ADDRFF„ Lender's Address_ I certify that 1 have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Plurrobing and Sewers, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection p1,,rposes. Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE ;ORKERf' COMPENSATION DECLAR4TOON {� 'f hereb; alfirm .that I have a certificate of consent to self 20-0051 DPW 6184 u insure, 4 a Certificate of Workers' Compensbtion Insurance, or 7EA542D Ooier�ry fro thereof�(Sec 3"0 � APPLICATION � FOR PERMIT L] Certified copy is he�re'by furnished. SEr>r ER - SEWAC E DISPOSAL Cer11f ed copy is feed with the county building inctio COUNTY OF LOS ANGELES BUILDING AND SAFETY department _ CH' DateApphcani_ _, _ FASSESSOR FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' ING �-T 1< ✓ � COMPENSATION INSURANCE Ess WlIG' Q yrATl°n °EP,H (This section need not be completes! if the work involved by thet� WNHOLE REFERENCE UPPER permit is for one hundred dollars ($100) or less.) -ITY fid?'%& C � LOWER ST rp���� TYPE OF CONNEC i�ON LENGTH FROM I certify that in the performance of the work for which th s s'r e v Cu RB P( ML TOP L permit is issued, I sholl not employ any person in any manner GAL. so as to become subject to the Workers'Compensation laws. IPTION LOT NO CO c NO p{� O IMP NO ADB NO TRACT /V TRUNK PERMIT NO ROAD PERMIT NO Dare Applicant_ _ NOTICE TO APPLICANT: If, after making this Certificate O{ SOR AFFIDAVIT WArvEP EASEMEN7 R€CORD INSTP NO DATE g OOK PAGE PARCEL Exemption, you should become subject to theWorkers' y 2 �g No.OF 11 Compensation provisions of the Labor code, YOU must fOrthwoh F LOT 26I�(e'�`� NOW ON LOT HWY ORST WlhENING comply with such provisions or this permit sholl be deemed F 2 �revoked. INGS Fi !T6_�- ^l(.� STATE ENCROACHMENT I LICENSED CONTRACTORS DECLARATION 5 /y a _ PERMIT NO I hereby affirm that I am licensed under provisions of Chapter O`fdNERl,�.4°�i�t f " 1 f�/� 9 (commencing with Section 7000) of Division 3 of the Busi- MAIL 13 Iry 1j AV CHARGES Hess and Professions Code, and m� ADDRESS C license is in full force and y J' effect. CITY L /C/lJ7Jl�1 TEL N 9124,) 'L CONNECTION CHARGE FEE -License Number 38M2 2 btic-.Class '/7� CONTRACTOR /6'ljL-�f� ka1�" . REIMBUR5EM,F.NT FEE COntracior R"f�A 120 III, 11�V-1g� Y�` ,,R/ DISTRrC,T NO GROUP MAP PROCESSED BY ADDRESS `eJ BK PG ❑ I am exempt under Sec. _of the L.A C, t?. cm'W/trz' ?0% 7,TEL NO. .�f Plumbing Code and.,or Sec ---of the STATE p� � UCW NA, Com' LICENSE NO E^�� CLASS oA°E {r p ,.� �- a VALIDATION z B R.P. Code for the following rea5on___A_ .__ No. DESCRIPTION OF WORK FEE BF'� 1- 1' T— 0 ` HOUSE SEWER CONNECTING TO �5 ^y +-� {.NAL r Date 1 PUBLIC SEWER f 6rt Br O SEPTIC TANK SEEPAGE PIT OR (`-' LIJ Signature PITS AND OR DRAINPIELD HOUSE SEWER CONNECTING TO OWNERBUILDERDECLARATION D ► PRIVATE DISPOSAL SYSTEM I hereby affirm that I am exempt from the Contractor's License CONNECT ADDITIONAL BLDG OR Law for the following reason (Secton 7031 5, Buisness and Pro- WORK To HOUSE SEWER INFItLD f!�eesstsions Code): FX N CES"POOLGDRYWERAMANHOLE `1 j,as owner of the property,or my employees with wages as ALTER REPAIR OR ABANDONQM SEWER OR D,SPOSAL SYSTEM their sole compensation, wili do the work and the structure is not intended or offered for sole (Section 7044, Business ' p�d Professions Code). I. as owner of the property, am exclusively contracting with OWNER'S S licensed contractors to construct the project (Section 7044; P $ .-I(Q. yy Business and Professions Code) AUTHORIZATION T , ^ CONSTRUCTION LENDING AGENCY HAS AT Te.0 DA a, c:oNTVAC .Mt o^rtRAC'oRToI hereby affirm that there is a construction lending agency CONNECT THE ASOv DESCRIBEn EXPUBIC SE WE for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). SIGNED THIS DAY OF OWNFRS ArENT 19_, ' OWNER OR Lender's Name------- -- ------------- Lender's Address A- E5o_ I certify that i have read this opplitotion and state that the above information is correct. I agree to comply with all County ordinances and State jaws regulating Plumbing cnd Sewers, and hereby authorize representatives of this County to enter upon the above-mentioned property for Inspecti;,n purposes. Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARAiYON 1 hereby affirm ,that I have a certificate of consent to self 20'0051 DPW 689 ,)sure, cY a certificate of Workers' Compensation Insurance, or 75A642D P©hc?Nc,� p�jgh IsmPa� °eL � APPLICATION FOR PERMIT Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL [] Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date rly,' >Applicant` i� te,,A- FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' Bua.OING COMPENSATION INSURANCE ADDRESS / � "�G�{ ��I 74 , s ION DEPTH (This section need not be completed if the work involved by IETe "` "^ MANHOLE REFERENCE UPPER permit is for one hundred dollars ('1100) or less Z`2 C_ F-) LOCALITY LOWER I certifythat in the performance of the work for which 'Y`I5 NEAREST4es rr�J' TYPE OF CONNECTION LENGTH FROM CROSS ST. L � permit ,s issued. 1 shall not employ any person in any moaner cuaB P L M L ro P L so as to become subject to the Workers' Com ensation Lay.; -DESCRIPTIONLEGAL v C NO I P LOT NO CO IMP NO JOB NO Date__, Applicant_ BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO NOTICE TO APPLICANT' If, after Makin this Certificate of ASSESSOR AFFIDAVIT wAi VER EASEMENT RECORD INSTP NO DATE g MAP P,rX,'K PAGE PARCEL Exemption, you should become subject to the Workers' ryry��yy No o FL 'S Compensation provisions of the Labor code, you must forthwith SIZE OF LOT .2 OS 5- NOW GN LClr HWY OR 5i WIDENiNC> comply with such provisions or this permit shall be deemed _u 571E OR / y revoked BUILDINGS ! F � STATE ENC_RGACHMENT LICENSED CONTRACTORS DECLARATION r 1 �. PERMIT NO — I hereby affirm that I am licensed under provisions of Chapter O�`:NER 4e I f e104_9 C;111 O/ 9 (commencing with Section 7000) of Division 3 of the BUSI- MAIL � �� -- Y— ��,✓7�"' Hess and ProfesProfessions Code, and mJ ADDRESS 412,q? CHARGES license is in full farce and f 2��ry effect. ,�} CITY TEL N . R w'V -�.. _ CONNECTION CHARGE FEE L,c e n s e NUmbne-r3��y"��� _Lic.Class 4 � PL�.MBURSEMENT FEE ''JI�"! G f ,ry�y CONTRACTOR !a✓70 4(/4* �"l L.(>� Contractor ate �fu` � � �y DIST PICT NO GROUP MAP PROCESSED BY �- ADDRESS 3 BK PG I am exempt under Sec. of the L.A.Cc ( p � E . +U CITY 6'YE/'Yj l_N i:��t z:/ �'d ) 0. Plumbing Code and/or Sec. of the STATE „ Lc. `INA; U LICENSE NO. , 2 ClAS;i -� DATF '7 VALIDATION B. & P Code for the following reason N0. I?ESCRIPYtlpNOFWORK PEE r/"- f O_ HOUSE SEWER C014NECTING TC, FINAL Z " Date PUBLIC SEWER "�a} E'v U SEPTIC TANK SEEPAGE PIT OR - ��-.'P`' c a Signature PITS AND OR DRAINRELD -SOUSE SEWER CONNECTING TO OWNER-BUILDER DECLARATION PRIVATE OSPOSA,SVsTEM ► Z I hereby affirm that I am exempt from the Contractor's License CONNECT ADpmONAL BLDG OR Law for the following reason (Sectors 7031 S, Bulsness and Pro- wORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT DRAINFIE.LD fess ions Code): xTN CESSPOOL DRYWFU MANHOLE I, as owner Of the property, or my employees with wages as A.TER,RFPA-R OR ABANDON HOUSE SEV FR •G 'SPJSAL SYSTEM their sale compensation, will do the work and The structure is not intended or offered for sale (Section 7044, Business nd Professions Code). as owner of the property, am exclusively contracting with OWNER'S Permit $ Li _ licensed contractors to Construct the protect (Section 7044, Business and Professions Code) AUTHORIZATION TOTAL FEE _ CONSTRUCTION LENDING AGENCY I HAVE Ar THIS )ATE A CO ACI W TH THF HERE.N NAMtu n;rRA 'oR TO I hereby affirm that there is a construction lending agency CONNECT THE ABOVE DESCR BED FXIST!N3 DALING'0 THF Pu 6 I,-SFWEP for the performance of the work for which this permit is i - issued (Sec 3097, Civ. C 1 SIGNED TFiI$ DAY OF igT OWNER QR OiVNFRS AGENT -. ..,...... .„-_: Lender's Name --�-- •_ ,., _ Lender's Address,-_ ancRESs---__ — — 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 Sewers, and hereby outhorlZe representatives of this, County to enter upon the obove-mentioned roperty for Inspection purposes Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS" COMPENSATION DECLARAffON 1 hereby o4firin shot I hove a certificate of consent to sett 20-0051 DPW 618y insure, ()VCm y a certificate of Workers' opensation Insurance: or 76A6423 Ppirff? ` pv thereof (Sec3�00, `ab APPLICATION SJR PERMIT 06 ��� om an C Certified copy is hereby furnished. SEWER SEWAGE DISPOSAL Certified copy is filedwith the County building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY depot°men!. Date_11-1i, J-ApplicantFOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' PUILDING � t4jtp �e DEPTH COMPENSATION INSURANCE ADDRADDRESS, aN (This section need not be completed if the work involved by th- 1-'ANHOLE REFERENCE UPPER permit is for one hundred dollars ($100) or less.) L OCALII.Y :.OWER NEA,HEST TYPE OF CONNECTION LENGTH FROM Gerrity that in the performance of the wank for which ti-s .FOSS ST. /�f - CURB PL M is p L permit is issued, I shall not employ any person in any manner — LEGAL PC NO Sc) as t0�beCOm P. 3ubecY t0 the Workers' Corn penSah Or7 Laws. DESCRIPTION LOT NO, � .:7 LMR NO JOB NO Date Applicant_ BLOCK Pf TRACT { , 'RUNK PEUM;T No ROAD PERMIT NG A ,}"$ nR AFF ORD INSTR NO DATE NOTICE TO APPLICANT: If, after making this Certificate. of MAP BOOK PAGE RAFZCEL Exemption, you should become subject to the Wa Ke,°.' NO,?.r BLI'GS. Compensation provisions of the Labor code, you mast forth nth St7e of Lor � ��� NOoN LOT wv OR ST rn.oeNlraG comply with such provisions or this permit shall be deemed LISF revoked. BU!LDING'S Re'sPIM! C­ SIATE ENCROACHMENT LICENSED CONTRACTORS DECLARATI{Ng `=RMIT NO I hereby affirm that I am licensed under provisions of Chapter ovvNER 9 (commencing with Section 7000) of Division 3 of the Busi- MAIL l��� /1 't/� � �i�'GLV ;?Ii?.;y CHARGES Hess and Professions Code,. and my IlCe nse is in full force and ADDRESS µr, /6 effect. C, 7 _ CIiY O✓ �J 1EL.N t- •. � "[ .. 01,1NNECT ON CHARGE FEE License Number311187 f 52- bc.Class 6� g RE ME; RSEMt.NT FEE f, - /��Lf J CONTRACTOR e�W - �- (" Contrac?or!'�"{ 'a"� �e �°` a g /' f ;S'RTCT NO GROUP MAP PROCESSED BY _ —� ADDRLSs !' ! V J 8K RG �l I am exempt under Sec. of the L.A.Co. maw e �p�G„ a• p��, Y 1' � F°ir'f/r'�f 1' d�yd�,TcL NC). eG/ a/ ^- Q. Plumbing Code and/or Set. of the TAFF 73Rei ur. a AL f� L FNC•t NO LAEs LL I ti,f 5 VALIDATION B. & P Code for the following reason NO, DESCRIPTION OF WOPK PEE (� .� z HORSE SEWER CONNE;'ING TO � FINAL Date E PL BL c SEWFR SEPTIC TANK SEEPAGE PITT OR LU Signature PTS AND OR DRAINFIEID CL OWNER-BUILDER DECLARATION HOUSE SEWER CONNECTING TO �>RIVA'E DISPOSAL-SYS EM �. 1 hereby affirm that I am exempt from the.Crntractor's License CONNECT Acar ONAL B;.pG OR Law for the following reason (Secton 7031.5, Buisness and Pro- FORK TO HGusE SEWER OVERF,OW SEEPAGE PIT DRA[NFIEtD fessions Code): FXIN.CESSPOOL.DRYWELL.MANNL)LE 1.as owner of the property,or myemploye-es with wages as APER REPAIR OR ABANPON HOiuSE SEWER OR DISPOSAL SYSTEM their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code) 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, OWNER'S Permit $ Business and Professions Code), AUTHORIZATION TOTAL FEE j CONSTRUCTION LENDING AGENCY I HAV; A W,711 HE HERE N NAVE r NTRALTOu - 1 hereby offirrn that there is a construction lending agency C.)NNE_ HE AE BOVEDESCRiFc ExISTrN,>o.v,..ING ro THE PUB,C Sf 4 for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.1. SIGNED THIS OAY OF 19— OR '. Lender's Name _. CYAN P-AGENT__` A D DR P. - Lender's Address -- _ certify that I have read this application and state that the above information is correct.J agree to comply with all County a:,.rdlnances and State lowvs regulating Pfumbing and sewers, and hereby authorize representatives of this County to enter upon the above-menticineed property for inspect'<ncppurposes Signature of Permittee Dote SEE REVERSE FOR EXPLANATORY LANGUAGE v eORKERS' COMPENSATION-DECLARA-ION 20 0051 Dew 6189 U I heretry iffrm rho I have a certificate of consent to self LJ 1i sure, cv,f ceri,fical#of Workers'Ccmpenso:'Ion Insurance, or 76A642D a�_er?if „ ° (s �a�8�. L ,� APPLICATION FOR PERMIT Policy ,�' SEWER - SEWAGE DISPOSAL Cer?ifie?1 copy is hereby furnished. Cernfied`copy is "fled with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department > �.-� Dote tl� f ',,73 ApplicantFOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' Bu,LDING 7r /. r COMPENSATION INSURANCE. aeDRE�s ON DEPT Hl section need not be completed if the work involved by the �� 4 L �Nrro(E REE�RENCE uPaER permit is for one hundred dollars ($100)or !ess.) LOCAt]TY tC�WFR NEAREST TYPE r?E CONNECTION LENGTH FROM I certify that in the performance of the work for which th.s G13oss sT TUN4s CURB PL ML TOP L permit is issued, I shall riot employ any person in any monna LEGAL P<: NO 50 OS t0 become subject to the Workers' Compensation LAWS DcSCt"TiPTIOfJ LOT NO !.MP NO - )08 NO I Date Applicant BLOCK TRACT � RJNK.PERMIT P.O ROAD PERMIT NO _ NOTICE TO APPLICANT: If, after makln this Certificate Of .ASSESSOR AEEtOAVIT WAIVER EASEMENT RECORD (NSTR NO DATE g MAP BOOK PAGE PARCEL Exemption, you should become subject to the Workers' No OF BLOCS Compensation provisions of the Labor code, you must forthwith SIZE OF LOT �� NOW ON LOT 4F y,Av OR ST WIDENING comply with such provisions or this permit shall be deemed USE OF revoked. ,. BUILDINGS J'AtE ENCROACHMENT LICENSED CONTRACTORS DECLARATION ] f T —IRMiT NO I hereby affirm that I am licensed under provisions of Chapter 004NERG'i- '.�z � f 9 (commencing with Section 7000) of Division 3 of the Bus,- Mo��E.» � ` -Px? -1,�,�b` CHARGES ness and Professions Code, and my license is in full force and ect, / q�QST 2- License fNumbs�AI S � � S / CITY L' /11 r!/`-� TEL.NO S yNECTICN CHARGE FEE l" LIC.Class { ` /y �� {�/ `„ '�IJ.BURSEMEN7 FEE COniraC?Of !�-'A [ .R t CONTRACTOR /C !•l'L �(, ,� � `-STRICT NO C-ROUP MAP PROCESSED BY ADDRESS aUU� b-� BK F� .n [� I am exempt under Sec. of the L.A. Co. / r { / * . " "CITY :R eJ ! n Plumbing Code and/or Sec,_ of the STATE r � LIC C A U LICENSE NO. CLASS "Z_ _ 7 VALIDATION t B. & P. Code for the following reason NO. DESCRIPTION OF WORK FEE C7 HOUSE SEWER CONNECTING TC. ^^�� F'NAL I-•' Date PUBL':C SEWER V nr V SEPTIC TANK SEEPAGE P OR GR,^ W Signature �TS AND OR DRAINS ELC' _ HOUSE SEWER CO IN TCOWNER-BUILDER DECLARATION 'DISPSAL SYSTEM — I hereby affirm that I am exempt from the Contractor's License CONNECT ADDITIONAL BLDG OR Low for the following reason (Sec?on 703).5, Buisness and Pro- WORK To HOUSE SFW(R VERr OW SEEPAGE PIT DRAINFIELD fessions Code): rJExTN CESSPOOL DRYWEiL MANHOLE ; ❑ I, as owner of the property; or my employees with wages as ALTER REPAIR OR ABANDON HOUSE rw ER OR DISPOSAL SYSTEM their sole compensation, will do the work and the structure is not intended or offered for sole !Section 7044, Business end Professions Code). end owner of the properly, am exclusively contracting with OWNERS Permit $ (j sensed cantrac?ors to construct the project (section 7044, _ Business and Professions Code). AUTHORIZATION TOTAL FEE CONSTRUCTION LENDING AGENCY HAVE AT TH- SATE A CONTRACT W;TH THE HEREIN NAVED '.ON'RACiOR I hereby affirm that there is a construction lending agency CONNECT THE AB(-NE DES(R-BED EXISTING DwE:,vC,.TO THE PG5.._SEWER for the performance of the work for which this permit is - Issued (Sec. 3097, Civ. C.). SIGNED THIS _ DAY OF 19_ OWNER OR Lender's Name OWN F RS AGENT •` Lender's 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 Plurnbinq arid Sewers, and hereby authorize representatives of this County to enter .rpin c the above-mentioned property for wsp(ees fctlon purposes Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE