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Home My Public Portal About4834 BALDWIN AVE_Sewer__ (2) 2/70 76A6A 642D APPLICATION FOR PERMIT 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUP T OF BUILDING ` LOCALITY J FADDRESS R APPLICANT TO FILL IN NEAREST CROSS ST (PRINT OR TYPEONLY) L G TION LOT NO OWNER MAIL TRACTell ADDRESS O OF SLOGS �+ LOT NOW ON LOT CITY i' EL NO GS DISTRICT NO GROUP ('LASS MAP PROCESSEDJBIY , BK ` TOR \ �C� � j t) CONNECTION DAT/ (s//`� TEL NO 9,. ION DEPTH STAA �'NO ! GLASS MANHOLE REFERENCE c LOWER NO I DESCRIPTION OF WORK FEE T OF CONpit 'LENGT FROM HOUSE SEWER CONNECTING TO M L T P L f PUBLIC SEWER O C� (/ PC NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO PITS AND/OR DRAINFIELD f1000 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d PRIVATE DISPOSAL SYSTEM @ $300 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT WlIYIII IAIIYINI RECORD INSTR NO DATE U WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ SS 00 HWY OR ST WIDENING O ALTER REPAIR OR ABANDON HOUSE F- SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT U W PERMIT NO 0. INDUSTRIAL U) WASTE APPROVAL Z CHARGES OWNER S PERMIT s ' Oo AUTHORIZATION I TOTAL FEE r CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER r r OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE D CR ED ESIDE N71 L PROPERTY ABANDON HOUSE SEWER EE SIGNATURE BACKFILL SEPTIC TANKS Cl OF PERMITT SEEP PIT(S) ❑ CESSPOOLS ❑ ATION JACK R ALLEN CK o cgsH SUPERVISING MECHANICAL ENGINEER LAAO A _ ^ _- FEB 7 1 0 D 1 Go 0 N 1p e • a IF 6At_ 6 2/70 APPLICATION FOR PERM 76A 642D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7L0CALITYf'/- JOHN A LAMBIE COUNTY ENGINEER z LtJ IV COLEMAN W JENKINS SUP T OF BUILDING L C NT TO FILL IN(PRINT OR TYPE ONLY) LEGALDESCRIPTION LOT NO 1 C_C___l /< MAIL BLOCK TRACT 0 ADDRESS N OF BLDG5 �.. ,G SIZE OF LOT NOW ON LOT CITY I G EL NO USE OF BUILDINGS �� qq DISTR T NO GROUP ('LASS MAP .( PROCESSED BY CONTRACTOR a 0 B� .)D G ADDRESS �a�p.-�/ ,{jam D r1f 1) a CONNECTION DATA v _701- TEL NO TION ,A r v DEPTH STA E LIC MANHOLE REFERENCE C LICENSE NO CLASS G,� LOWER NO DESCRIPTION OF WORK FEE TYP F CON CTI LENGT FROM HOUSE SEWER CONNECTING TO Y M L P L PUBLIC SEWER $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ SIO 00 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM 0 $300 (L CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVII I IASIMI"T RECORD INSTR NO DATE O WORK TO HOUSE SEWER $300 U OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 0 HWY OR ST WIDENING O ALTER REPAIR OR ABANDON HOUSE SEWER R OISPOS L SY E $300 STATE ENCROACHMENT 1J PERMIT NO W fLJ a INDUSTRIAL (n WASTE APPROVAL Z CHARGES OWNERS PERMIT s CONNECTION CHARGE FEE AUTHOMATION1 TOTAL FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANKSEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICE NSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AN LRLESIDEIN THE A OVEDESC IBED R IDENTIA PROPERTY ABANDON HOUSE SEW ERRE BACKFILL SEPTIC TANKSRMITTEE SEEP PIT(s) ElCESSPOOLS ❑ PCK VA 1�TION JACK R ALLAN SUPERVISING MECHANICAL ENGINEER MCASHIALO a 3 C FEB 7 1 1 0 3000- 4 I p� 642D 2'7° 76A APPLICATION FOR PERMIT 78A 8 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUP T OF BUILDING OR PPLIC NT TO FILL IN(PRINT OR TYPE ONLY) /(.. LEGAL ` DESCRIPTION LOT NO OWNER DA AL,/ (r MAIL BLOCK TRACT Q ADDRESS 3 NO OF BLD G B SIZE OF LOT /I NOW ON LOT CITY TEL NO p ` v S USE OF BUILDINGS DISTRICT NO GROUP CLASS BK p MAP PRO ESSEO BY _ CONTRACTOR f -;5, ADDRESS G , �" -� CONNECTION DATA CITY )ojal_&�jald TEL NO 3' STATION DEPTH STATE �� j LIC AUPPER LICENSE N v CLASS` MANHOLE REFERENCE LOWER NO I DESCRIPTION CIF WORK FEE TYPE OF CO ECTION LENGT FROM HOUSE SEWER CONNECTING TO Y CUR PL M L O P L PUBLIC SEWER $5 00 C i �. PITS AND/OR DRAINFIELD f10 00 SEPTIC DANK SEEPAGE PIT OR CO IMP NO .108 NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO /ROAD PERMIT NO d PRIVATE DISPOSAL SYSTEM @ $300 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIY[[ [AS[M[XT R ORD INSTR NO DATE V WORK TO HOUSE SEWER @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 HWY OR ST WIDENING O ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ S300 STATE ENCROACH M T W PERMIT NO D_ INDUSTRIAL N WASTE APPR,94AL Z_ OWNERS PERMIT E 00 z CHARGES AUTHORIZATION TOTAL FEE 41 1 v CON CTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON EIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC Eby R APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THISX OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGEN �� CONNECT ADDITIONAL ADDRESS�� LDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DIS POSAL SYSTEM IFORNIA OR THAT M THE LEGAL OWNER OF AND INTEND TO ECT PLUG AND IDE IN THE A E T RIB E ONRESIDE TIAL ERTY DISCONNECT _ABANDOHOUSE SEWER TORE P ERM BACKFILL SEPTIC TANKS El SEEP PIT 15) ❑ CESSPOOLS ❑ VALIDATION JACK R ALLEN SUPERVISING MECHANICAL ENGINEER CK M O CASH LACO2 9140-- W120 1 0 D 600~ WORKERS COMPENSATION DECLARATION {� I hereby affirm that I have a certificate of consent to self 20 0051 DPW 6te9 U Insure or a certificate of Workers Compensation Insurance or 76A642D� a Policy le ��57¢�o 3O��lab � APPLICATION FOR PERMIT Policy d ❑ Certified copy Is hereby furnished SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the co building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department-;k Date "r�w/ /appllcan _ FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM ORKERS BUILDING COMPENSATION INSUR CE ADDRESS J STATION ��/ DEPTH (This section need not be completed If the work Involved by the n MANHOLE REFERENCE UPPER OWER PP permit is for one hundred dollars ($100) or less ) LOCALITY _ NEAREST TYPE OF CONNECTION LENGTH FROM I certify that In the performance of the work for which this CROSS ST F12 Zud/3 TQ_ Y CURB PL M L TO P L permit Is Issued I shall not employ any person In any manner LEGAL NO so as to become subject to the Workers Compensation Laws DESCRIPTION LOT NO co IMP No P P c C NO Date Applicant BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO NOTICE TO APPLICANT If after making this Certificate Of ASSESSOR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE g MAP BOOK PAGE PARCEL Exemption you should become subject to the Workers NO OF BLDGS Compensation provisions of the Labor code you must forthwith SIZE OF LOT NOW ON LOT HWV OR$T WIDENING comply with such provisions or this permit shall be deemed USE OF revoked BUILDINGS STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PERMIT NO I hereby affirm that I am licensed under provisions of Chapter OWNER _ jj:�4,9 9 (commencing with Section 7000) of Division 3 of the Busl MAIL' ness and Professions Code and my license Is In full force and ADDRESS CHARGES effect !, CITY �� i?� e,-17 TEL NO - ],�' CONNECTION CHARGE FEE License Number If 7�/ Llc Class C ` �+ CONTRACTOR n _f`(/l REIMBURSEMENT FEE Contractor�go/c g e�Date Z T-//1( f DISTRICT NO GROUP MAP PROCESSED BY ADDRESS J Gj�(J BK/ PG ❑ I am exempt under Sec of the L A CoCITY C/ A— / � NO Z p Plumbing Code and/or Sec of the r LIC~ FINAL U LISTATE CENSE NO �(J CLASS e"1'. C3 DATE VALIDATION z B & P Code for the following reason NO DESCRIPTION OF WORK FEE Q HOUSE SEWER CONNECTING TO FINAL ( (— Date PUBLIC SEWER BY I �O W SEPTIC TANK SEEPAGE PIT OR r 4 UJI Z Signature PITS AND OR DRAINFIELD ACC T.OWNER BUILDER DECLARATION HOUSE SEWER CONNECTING To PRIVATE DISPOSAL SYSTEM -��n I hereby affirm that I am exempt from the Contractor s License CONNECT ADDITIONAL BLDG OR ]7U� `7°�h Law for the following reason (Secton 7031 5 Buisness and Pro WORK TO HOUSE SEWER Q fessiOnS Code) OVERFLOW SEEPAGE PIT DRAINFIELD 1 ITEMS +-r ExTN CESSPOOL DRYWELL MANHOLE 1 L I as owner of the property or my employees with wages as TER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM �� TOTAL. 57 -20 their sole compensation will do the work and the structure is not Intended or offered for sale (Section 7044 Business CHECY 97°20 and Professions Code) ❑ I as owner of the property am exclusively contracting with OWNERS fj CHANGE °00 licensed contractors to construct the project (Section 7044 Permit $ Business and Professions Code) AUTHORIZATION I TOTAL FEE a CONSTRUCTION LENDING AGENCY I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO 0WO"0001 1129/96 1 hereby affirm that there IS O construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER ® �� .L + °�+� 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 OWNERS AGENT Lender s Address 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 jaws regulating Plumbing and Sewers and hereby authorize representatives of this County to enter 2� ov emention property for Inspectonp/urposesgnature of P rmlilee Date SEE REVERSE FOR EXPLANATORY LANGUAGE