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Home My Public Portal About9553 BLACKLEY ST_Sewer__ E-e . � S&E-dt�i81.99` APPLICATION FOR PERMIT S 8 'DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS sr. LEGAL OWNER DESCRIPTION LOT NO. 94 , ))) MAIL BLOCK 'TRACT ADDRESS C NO.OF BLDGS. CI'M1Y �+ TEL. NO. ' SIZE OF LOT NOW ON LOT USE OF DISTRICT NO. GROUP MAP BUILDINGS / BK PG CONTRACTOR 00.1 N DATA rz ADDRESS �- - s C7 AT10_, - 3 DEPTH a Cliza EL. NO.�' ; a MANHOLE REFERENCE r- UPPER ESTATE REGISTRATION NO. 1(f`_?.ZU ❑ COUNTY `� NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION _.L NGTH FROM PUBLIC SEWER @ $3.50 r �� Y. CURB P.L. M.L. TO P.L. SEPTIC TANK,SEEPAGE PIT OR - ITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD - P. C. N0, pp EXTN.,CESSPOOL,DRYWE LL,MAN HOLE Q $2 00 -e8--FMT�iO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N0. V I ��q QC�� PRIVATE DISPOSAL SYSTEM Q $1.00 - o / CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK'TO HOUSE SEWER Q $1 00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT g 1 00 AUTHORIZATION TOTAL FEE :5_6REIMBURSEMENT FEE I HAVE AT THIS DATE A'CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER -) SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK ' OWNERS AGENT SEPTIC TANK,SEEP,PITS) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL E3DRYWELL❑ - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 'ABANDON HOUSE SEWER CALIFORNIA OR THAT I dM THE L GAL OWNER 0 THE ABOVE DESCRIBED RESIDENTIA P OPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE S P PIT(S) CESSP00 ❑ OF PERMITTEE •' '�� rdmmmg�l JOHN A. LAMBIE. COU TY ENGINEER VALIDATIO ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. H. 0. C CASH i ACO p SEP 10 n 4.5 0 M G 5 E-663 11.33 ° APPLICATION FOR PERMIT 1 3 8 E-8 -DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS L ® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER MAIL .1 BLOCK TRAC ADDRESS a SIZE OF LOT NOW ON LOT NO. OF BLDGS. CIT Y'' TEL. NOV USE BUILD'NGS DISTRICT NO. GROUP MAP BK CONTRACTOR CONNECTION D ADDRESS _ _ f ' T ION � � �— DEPTH CI _ TEL. NO.AIFA �(rsa / MANHOLE REFER E 9 UPPER .a[ATE _ REGISTRATION NO. 1'� ❑ COUNTY - No. DESCRIPTION OF WORK FEE �� - HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L, SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0, EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 PERMIT NO. - ALTER,'REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL - - - CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT g no REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL I—] DRYWELL❑- AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT M THE EGAL OWNER THE ABOVE DESCRIBED RESIDENTI OPER BACKFILL SEPTIC TANKS❑ SIGNATURE EP.PIT(S) [I CESSPOOLS❑ OF PERMITTEE v JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR. CK. m. 0. CASH - - •• LAC0 4 6 3 1°° .SEP 10 1 1 A 2 5.0,Q o S IN E.6 9, i. � - APPLICATION FOR PERMIT 1 DIVaSION OF BUILDING AND SAFETY SEWER-S SWAGE'D I S POSA L y Department of County Engineer County of LOS Angeles BUILDING ADDRESS J C7.:573 JOHN A. LAMBIE, COUNTY ENGINEER ® CASSATT D. GRIFFIN, SUPT OF BUILDING - LOCALITY FOR APPLICANT TO FILL IN CROSS ST ' . LEGAL OWNER DESCRIPTION LOT NI, I MAIL BLOCK T •ADDRESS NO. OF BLCIT N0. SIZE OF LOT � NOW ON LOTT USE OF DISTRICT I G� I �MA� BUILDINGS P CONTRACTOR CONNECTION DATA ADDRESS STATION DEPTH CITY TEL. NO. MANHOLE REFERENCE UPPER ❑ STATE LOWER REGISTRATION NO. ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNE'C� ION - LENG FROM ' Y. CURB P.L. M.L 0 P.L. PUBLIC SEWER @ $3.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0, EXTN.,CESSPOOL,DRYWELL,MAN HOLE a $2.00 CO. IMP. NO. OB N0. ' HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM a $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHM T WORK TO HOUSE SEWER @ $1 00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE- SECT, OWNER'S PERMIT $ t 00 p� AUTHORIZATION TOTAL FEE REIMBURSEME .G 6 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE - INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS DAY OF I9 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK ' OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM IICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ OF PERM I SEEP. PIT(S) [I CESSPOOLS SIGNATURE TT /// ��,«<///!lINNN/ JOHN A. LAMBIE,1__OUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. N.O. CASH i - " ' LAC4589co , SEP 88 1 A 80.00A WORKERS"COMPEN§ATION DECLARATION firm that I have a certificate of consent to self i, certificate of Workers'Compensation Insurance, or 76A642D a cer top th_ZS— eca3800, Lab C. CE8081REV 1/831 APPLICATION FOR _PERMIT Polic l.++JJ ""'L�: Ca1401t� N a��o{�17 UCeltified copy is hereby furnished. SEWER - SEWAGE DISPOSAL Certified copy'is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department Dote �t/LAApplicant -RxA6eA'Z FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION*FROM WORKERS' BUILDING STATION DEPTH COMPENSATION INSURANCE ADDRESS 3 (This section need not be completed if the work Involved by the LOCALITY "` MANHOLE REFERENCE UPPER permit Is for one hundred dollars ($100)or less.) LOWER NEAREST TYPE OF CONNECTION LENGTH FROM I certify that In the performance of the work for which this CROSS ST C,LA 1F.c__ CURB P L ML TOPIL permit is Issued,•I shall not employ any person in any manner so as to become•sublect to the Workers'Compensation Laws. OWNER CAI"'\ Q CO IMP NO TOB NO MAIL �1 A CK�I TRUNK PERMIT NO ROAD PERMIT NO Date Applicant ADDRESS 1� 11 WAIVER EASEMENT RECORD INSTR NO DATE /� NOTICE TO APPLICANT: If, after making this Certificate of CITY C TEL NO p 56S sg9 Exemption, you should become subject to the Workers' LEGAL AFFIDAVIT 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 revoked BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION NO OF PERMIT NO LOT SIZE OF LOT 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 (� CONTRACTOR -��v U`� CONNECTION CHARGE FEE License Number a�a�.+l�o�q LIC Class b ADDRESS /V Dot REIMBURSEMENT FEE 0. Contractor 1�7�.+AvGv Date CITY "`��J% TEL NO 33-J-7 per,, DISTRICT NO GROUP MAP SSED BY OU BK PG ❑ 1 am exem t under Sec of the L.A.Co STATE uC P LICENSE NO CLASS L `T NO DESCRIPTION OF WORK FEE O Plumbing Code and/or Sec. of the FINAL y 11— 'HOUSE SEWER CONNECTING TO DATE VALIDATION W B & P. Code for the following reason PUBLIC SEWER SEPTIC TANK,SEEPAGE PIT OR FINA N Date PITS AND/OR DRAINFIELD BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM �I Signature 1 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, Bulsness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessions Code): SEWER OR DISPOSAL SYSTEM ❑ 1,as owner of the property,or my employees with-wages as A 4.0 9.8'A •their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business 01 #• 0 0 0 0 1 0 •'and Professions Code). OWNER'S Permit $ 0 ' ❑ 1,as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE 12-11 I o o 21.50 licensed-contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACITOBusiness and Professions Code CONNECT THE ABOVE,DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER 2.) •�.� � 21,5000NSTRUCTION•LENDING AGENCYI hereby affirm that there is a construction lending•agency SIGNED THIS DAY OF 224 8 for the performance of the work for which this permit Is OWNER OR issued (Sec. 3097, Civ C ). OWNERS AGENT 0 ADDRESS Lender's Name 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 Stbte laws regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter upon a above-m ntion d property for inspection purposes. Signature of PerrAittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE • II