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Home My Public Portal About6132 AVON AVE_Sewer_4/1/2015_. t. L • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 0508 1504010004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: ISSUER / SEPTIC: SEWER I BUILDING ADDRESS: TR: 5903 IT; 47 ON: .002 IEXIST OCC GRP: [ 6132 AVON AV IBLOGS. NOW ON LOT: I SGAB CA 917752606 ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: I NEAREST CROSS STREET: GARIBALDI 5386-009-039 ORIGINATION: I THOMAS PAGE: 596 GRID: G2 LOCALITY: TEMPLE CITY ILEIGTH FII, TO PL: STATION: DEPTH: [ TENANT: IMANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY - 1 104/01/15 SR ICOUNTY IMPROVEMENT NUMBER: [ OWNER: TEL. NO: IPLAN CHECK NUMBER: IFINAL DAT FI Bj CODE: YOU, MICHAEL (626) 600-8809- JOB NUMBER: 556 S FAIR OAKS AVE [TRUNK PERMIT NUMBER: CR I RK PASADENA CA 91105 ROAD PERMIT NUMBER: [DES [AFFADAVIT: NO ICONNECT NEW SINGLE FAMILY DWELLING TO PUBLIC SEWER WAIVER: NO APPLICANT: TEL. NO: 1EASEMENT: NO WONG, KAM (626) 570-9969- [ 809 S ATLANTIC BLVD IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: MONTEREY PARK 91754 HIGHWAY/STREET WIDENING: 1 STATE ENCROACHMENT PERMIT NUMBER: CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE MCWONG HOLDING CO. (626) 570-9969- 809 S ATLANTIC BLVD, STE 201 LSC. NO [FEE DESCRIPTION: QUANTITY: DOM: AMO EW HOUSE SEWER (� MONTEREY PARK CA 91754 685220 1 101 PERMIT ISSUANCE FEE 27.BONNECT ADDITIONAL U 103 COHN TO PUBLIC SEWER 1.00 CON 47.00 IBUILDING OR WORK ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 74.80 [ LEE, PETER (626) 280-9000- 1 ISEPTIC TANK, SEEPAGE PIT 8748 E VALLEY BLVD SUITE L LIC. NO: [ [AND/OR DRAZN FIELD ROSEMEAD CA 91770 685220�p/�7+ ' IyDRYWELL r� / �l/.5 QQ'�ifj SEWER MAP BOOK: PAGE: �JJ �_^^�� ALTER, REPAIR, SEWER OR 1 1 SEWAGE DISPOSAL SYSTEM 1DISCONNECT PLUG AND 1 1ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS _ [SEEP. PIT _ CESSPOOL 1 GRAYWATER SYSTEM I I I [ [ I i 1 1* ADDITIONAL DATA ON FILE [ [REPORT ID: DPR266 ROUTE TO BS0508 [ 1 OWNER -BUILDER DECLARATION by affirm under penalty of perjury that I am exempt from mtractors' State License Law for the reason(s) indicated by the checkmark(s) I have placed next to the applicable (Section 7031.5, Business and Professions Code): Any county that requires a permit to construct, alter, improve, ish, or repair any structure, prior to its issuance, also es the applicant for the permit to file a signed statement e or she is licensed pursuant to the provisions of the actors' State License Law (Chapter 9 (commencing with n 7000) of Division 3 of the Business and Professions or that he or she is exempt from licensure and the basis alleged exemption. Any violation of Section 7031.5 by pplicant for a permit subjects the applicant to a civil V of not more than five hundred dollars ($500).): is owner of the property, or my employees with wages as ole compensation, will do (,r) all of or (_) portions of the and the structure is not intended or offered for sale m 7044, Business and Professions Code: The actors' State License Law does not apply to an owner of ty who, through employees' or personal effort, builds or 'es the property, provided that the improvements are not ed or offered for sale. If, however, the building or ,ement is sold within one year of completion, the Owner - r will have the burden of proving that it was not built or ,ed for the purpose of sale.). is owner of the property, am exclusively contracting with .d Contractors to construct the project (Section 7044, :ss and Professions Code: The Contractors' State License oes not apply to an owner of property who builds or yes thereon, and who contracts for the projects with a ►d Contrb�tor pursuant .to the Contractors' State License m exemdt from licensure under the Contractors' State ;e Law for the following reason: signature below I acknowledge that, except for my ial residence in which I must have resided for at least ?ar prion to completions of the improvements covered by rmit, Ic�Innot legally sell a structure that I have built as an builder if it has not been constructed in its entirety by :d contractors. I understand that a copy of the applicable ection 7044 of 'the Business and Professions Code, is ole upon request when this application is submitted or at owing Web site: htto://www.leoinfo.ca.aov/calaw.html. ure of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class R) License NoZ ZZV Date � � 1' Contractor Signature WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier aqdpolic u b r are: . Carrier ' Policy Rumber Exp' ti n Date Name of Agent Phone Number _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions (_,� .,U -,Q- <::�, 7--- ct lr l ig ure of Applicant Date ` l LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in Unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiar with the requirements of Los Angeles County Code Chapter 2.160 et seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself complied and will continue to comply therewith through the application process. Applicant (Print Name) Applicant Signature Company Name Date ,JOB ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amount specified on the hazardous materials information guide? Yes ❑ N o Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ N.o cffl� I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter 220' Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ANotification letter sent to AQMD and/or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this county to enter the above -identified property for inspection purposes. TS* tSi ature pf Prope Owner or Authorized Agent ( Date I